OB/GYN or FM w/ GYN Fellowship ?

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Metamorphosis.DO

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I’m a medical student and our program has us take several tests to narrow down specialties. I’ve always been interested in OB/GYN because I love the physiology of female reproductive system and I also think the OB side would be rewarding. I am more interested in women health I feel but I don’t know if I’m just really repelled by the lifestyle many OBGYNS have. I shadowed a lot in premed and hope to spend some elective clerkships there as well. All my tests I’ve taken show OB/GYN as my number one with FM as a second option.
anyway, I have a wife and kid and this has given me some perspective. My family is most important to me. I am not interested in people telling Me to make work a bigger priority. It’s obviously a priority or else I wouldn’t be here. i also feel that if work becomes So overbearing then I won’t enjoy my family life,, even if I love my job. If my family life suffers, it doesn’t matter that I like my job. At the end of the day, im Husband and father first. I‘ve stood in too many ORs full of divorced and, truthfully, unhappy surgeons. this includes many obgyns.
how awful is residency? I’d do it.. I just want the candid truth. if I decide to just go more gyn and little OB if any.. should I just go into FM and focus on womens health? What options would I have that direction? I say this becuase its Not the baby catching that really Calls me to thspecialty, it’s womens health. I see OB More as an added bonus.

looking for guidance.. ideas.. thoughts.

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I’m a medical student and our program has us take several tests to narrow down specialties. I’ve always been interested in OB/GYN because I love the physiology of female reproductive system and I also think the OB side would be rewarding. I am more interested in women health I feel but I don’t know if I’m just really repelled by the lifestyle many OBGYNS have. I shadowed a lot in premed and hope to spend some elective clerkships there as well. All my tests I’ve taken show OB/GYN as my number one with FM as a second option.
anyway, I have a wife and kid and this has given me some perspective. My family is most important to me. I am not interested in people telling Me to make work a bigger priority. It’s obviously a priority or else I wouldn’t be here. i also feel that if work becomes So overbearing then I won’t enjoy my family life,, even if I love my job. If my family life suffers, it doesn’t matter that I like my job. At the end of the day, im Husband and father first. I‘ve stood in too many ORs full of divorced and, truthfully, unhappy surgeons. this includes many obgyns.
how awful is residency? I’d do it.. I just want the candid truth. if I decide to just go more gyn and little OB if any.. should I just go into FM and focus on womens health? What options would I have that direction? I say this becuase its Not the baby catching that really Calls me to thspecialty, it’s womens health. I see OB More as an added bonus.

looking for guidance.. ideas.. thoughts.

Residency is challenging but has an end point.

The main challenge is if you are a generalist, typically obstetrics call is apart of the picture.

Patients can and will deliver at inopportune times. Depending on your set up, you could be taking call from home or in house. You could be on call anywhere from 4 to 8 times a month.

Can you find no call jobs? Yes but it will take some searching.

Alternatively, you can take a job as a laborist and work 5 to 8 defined shifts a month
No office or OR. These typically are 24 hour shifts.

If you want a more GYN heavy practice, you will typically need to subspecialize and even then there may be some challenges depending on geography etc.

In your situation, I would probably lean toward primary care.

For the amount of work required in OBGYN compensation is typically lower compared to specialties like ENT and urology.
 
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Yes you have options if you do FM & want to focus on reproductive health. You can do ob/prenatal care, miscarriage care, abortion care, all contraceptives (including "difficult" IUD removals), endometrial biopsies, vulvar biopsies, colposcopy, etc. I also have colleagues that do vasectomies if that interests you. I work 4 days a week and pick up other per diem & consult work as I want if I want to make more money and I never have to be on call or work nights and I love it.

If you want to be a surgeon then you obviously need to complete an obgyn residency, which yes does typically mean longer hours and more things like call that can affect "work-life balance." But for many people thats obviously worth it!
 
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Yes you have options if you do FM & want to focus on reproductive health. You can do ob/prenatal care, miscarriage care, abortion care, all contraceptives (including "difficult" IUD removals), endometrial biopsies, vulvar biopsies, colposcopy, etc. I also have colleagues that do vasectomies if that interests you. I work 4 days a week and pick up other per diem & consult work as I want if I want to make more money and I never have to be on call or work nights and I love it.

If you want to be a surgeon then you obviously need to complete an obgyn residency, which yes does typically mean longer hours and more things like call that can affect "work-life balance." But for many people thats obviously worth it!
This is very helpful. Thanks for responding. I take it you are a PCP?

I think I would enjoy providing the types of services you mentioned. Is a fellowship post-FM residency recommended? As mentioned, I wouldn’t want to do an OB fellowship if I did one, I’d rather be better trained in GYN. If I don’t do a fellowship, would this be remarkably limiting in my scope of care? I’m not worried about not being able to offer surgical treatment. If I could do several procedures in office I’d be happy with that.

Is ferti something I could do in that capacity or would that be beyond my training?

Also, I know a FM doc who does vasectomies in office on a weekly basis. It’s a pretty rural area though. Is it realistic to think I could do this in a bigger city without butting heads with uro?

Thanks again.
 
Residency is challenging but has an end point.

The main challenge is if you are a generalist, typically obstetrics call is apart of the picture.

Patients can and will deliver at inopportune times. Depending on your set up, you could be taking call from home or in house. You could be on call anywhere from 4 to 8 times a month.

Can you find no call jobs? Yes but it will take some searching.

Alternatively, you can take a job as a laborist and work 5 to 8 defined shifts a month
No office or OR. These typically are 24 hour shifts.

If you want a more GYN heavy practice, you will typically need to subspecialize and even then there may be some challenges depending on geography etc.

In your situation, I would probably lean toward primary care.

For the amount of work required in OBGYN compensation is typically lower compared to specialties like ENT and urology.
Given the necessity of a fellowship post a grueling residency to eventually NOT do OB as much.. it sounds like your assessment is right. I think FM would be best for me.

I wonder if doing more GYN procedures in-office may significantly increase compensation? Thoughts?
 
The lifestyle of an OB can be manageable in bigger groups where you take call rather than are on call for your own patients. Makes schedule more predictable. Some practices employ a laborist model that allows other members to see patients in office, do procedures or be off without worrying of getting called in.

I believe there’s a women’s health fellowship after fm but not sure if you need it if you get a lot of it in residency. In general office gyn procedures have OK reimbursement and procedures tend to reimburse better than say a follow up office visit, but if reimbursement is a big criteria for you, skin biopsies pay a pretty penny. Also rural FM reimburses quite well and though I am a surgical subspecialist I think about what could have been if I went into rural FM at least once a week. It’s more flexible and lets you live in smaller towns with lots of nature around you.
 
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