Ob-Gyn stereotype - is there truth to it?

[FutureDoc734]

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I'd like to get some truthful advice about Ob-Gyn. I'm currently in my MS3 Ob-gyn rotation and have loved it - something that I never thought would happen - so I'm starting to seriously consider Ob for a career. I love the procedures, the excitement of deliveries, the possible continuity of care, the medical aspects of it. However, I am very concerned about the stereotype of Ob-Gyn - the awful lifestyle, the endless malpractice lawsuits, the outrageous malpractice insurance premiums, the "malignant" reputation. I feel like I get a different answer about these topics every time I ask an Ob-gyn resident or attending...I mean, is it really this bad? 😕 I don't want to go into a specialty and then regret my decision later down the road...

For those of you in Ob-Gyn: if you were to go back in time, would you choose Ob again, knowing what you know now and having gone through residency/fellowship/working?

Thanks for the advice. I really appreciate it 🙁

 

[bve388]

Well, it's hard to get a straight answer. It depends on my last call. Here is what I can tell you.

Pros:
-Compensation is not in a great deal of danger. Proposed legislation causes more financial harm to other specialties long before OBGYNs.
-Good mix of clinic/surgical time
-Relatively in demand



Cons:
-Malpractice threat is very, very real and very serious. Consider the fact that if you get a shoulder-dyst or a CP case, you are in a very serious problem. Also consider the fact that every career OB I have ever met has been sued several times and almost all have paid out. Settlements for the above are potentially bankrupting. Heavily dependent on location.

-Lifestyle. Will vary heavily by the group. If you are Q3 and a heavy OB practice your life will be terrible. My group is a heavy OB group (approx 25 deliveries per physician, 5) and are Q5. Last weekend (fri-sun) my partner delivered 19 babies, he was burnt. If you are in a heavy gyn group you will have a much better quality of life. Compensation follows OB. The best GYNs in the world can't get anywhere near the compensation of a decent OB.

-Burnout is real. From the above basically.



All over again, I would have gone into derm, hands down. Wouldn't make as much but would be working 3-3.5 days a week and no real call.

 

[Biology101]

Well, it's hard to get a straight answer. It depends on my last call. Here is what I can tell you.

Pros:
-Compensation is not in a great deal of danger. Proposed legislation causes more financial harm to other specialties long before OBGYNs.
-Good mix of clinic/surgical time
-Relatively in demand



Cons:
-Malpractice threat is very, very real and very serious. Consider the fact that if you get a shoulder-dyst or a CP case, you are in a very serious problem. Also consider the fact that every career OB I have ever met has been sued several times and almost all have paid out. Settlements for the above are potentially bankrupting. Heavily dependent on location.

-Lifestyle. Will vary heavily by the group. If you are Q3 and a heavy OB practice your life will be terrible. My group is a heavy OB group (approx 25 deliveries per physician, 5) and are Q5. Last weekend (fri-sun) my partner delivered 19 babies, he was burnt. If you are in a heavy gyn group you will have a much better quality of life. Compensation follows OB. The best GYNs in the world can't get anywhere near the compensation of a decent OB.

-Burnout is real. From the above basically.



All over again, I would have gone into derm, hands down. Wouldn't make as much but would be working 3-3.5 days a week and no real call.

wow...Is there any reason to go into OB? I am a male first year with an interest in OB, but the more I ponder it, the more I doubt it as being viable....

 

[gynogrl]

I haven't even started residency yet, so I'm not an expert by any means. That said, every surgical field has ridiculous malpractice. Yes, OB is more. But if you want to do a surgical field, you will be paying high malpractice. You will also probably be earning a higher salary. So you'll have to decide if the final balance is worth it.

As far as misery and malignancy - totally depends on your setting and practice (as PP said). Gyn groups have a pretty nice lifestyle. Many OB practices are going to a laborist model and often have midwife support, so the attending is frequently not even called in. If you work in academics, you will have shift work the same as a lot of other specialties. And obstetrics tends to be a happier field than a lot of other specialties, so it can be really rewarding.

From people I've talked to, your life after residency can be what you want it to be. You might have to sacrifice some earnings to have the lifestyle you want, but most of us didn't go into medicine expecting to work 40 hours a week and make crazy amount of money (you can have one or the other, definitely not both). OB/GYN offers the opportunity to be a primary care doc, a surgeon, an obstetrician, and a public health proponent. Just find something you like. I tried to like derm, but I found it so boring that I know I could never have done it for 40 years, no matter how much free time I had.

 

[FutureDoc734]

Thank you to everyone that has posted so far. As much as I've tried to make myself like dermatology, ENT, ophthalmology, and the like (you know the ones...), I really haven't been able to find them that interesting or exciting 🙁 I agree that I would also get bored..

It's disappointing to hear that so many Ob's get sued - and I almost wonder if it has to do with the type of patients you have (?). What about specific states? I'm in Texas and have heard that, since we have great Tort reform, malpractice insurance here is not ridiculous (again, ?).

And, what about Ob-Gyn subspecialties, do they also have bad malpractice/hours/lawsuits? I've heard that maternal fetal medicine is better because your patients know they have a high-risk pregnancy; what about REI, gyn-onc, and urogyn??

Again, thanks for all the input!

 

[bve388]

I haven't even started residency yet, so I'm not an expert by any means. That said, every surgical field has ridiculous malpractice. Yes, OB is more. But if you want to do a surgical field, you will be paying high malpractice. You will also probably be earning a higher salary. So you'll have to decide if the final balance is worth it.

You are a bit off base for a number of reasons. Unlike any other surgical specialty OBGYNs have a liability for 20 years by statute, generally, whereas it is otherwise 2 years. So enjoy the fact that you can get sued 2 decades after a delivery. Additionally, the two big issues showing up are both multi-million dollar suits each and every time. One of them with a payout is crippling to your MP premium.

Your theory that surgical fields are compensated by this with a higher income is also way off base. Look at the MGMA numbers for an OBGYN, then compare it to a Derm or Rad. They make more money, often by huge numbers, and have no real liability.

As far as misery and malignancy - totally depends on your setting and practice (as PP said). Gyn groups have a pretty nice lifestyle.

GYN groups also don't pay crap and are getting outdated by the day.

Many OB practices are going to a laborist model and often have midwife support, so the attending is frequently not even called in.

Really? This sounds like a student or a resident talking. Real world the laborist movement is dead, real dead. They had several laborist programs in Philadelphia, go look for them now. Midwives can be used, but it is also a liability/extender risk and doesn't really help all that much.

The only place where the laborist ideal is even a remote possibility is a major metro area. Now go and look at what OBGYNs get paid in major metro areas. It is the only profession where your income goes down as your cost of living goes up.

If you work in academics, you will have shift work the same as a lot of other specialties. And obstetrics tends to be a happier field than a lot of other specialties, so it can be really rewarding.

Tell that to every attending I had. Most of them tried to talk people out of the program before they joined. However, *IF* you can get a job at an academic institution, it is a better lifestyle, but it is a higher liability and also lower pay.

 

[bve388]

Thank you to everyone that has posted so far. As much as I've tried to make myself like dermatology, ENT, ophthalmology, and the like (you know the ones...), I really haven't been able to find them that interesting or exciting 🙁 I agree that I would also get bored..

It's disappointing to hear that so many Ob's get sued - and I almost wonder if it has to do with the type of patients you have (?). What about specific states? I'm in Texas and have heard that, since we have great Tort reform, malpractice insurance here is not ridiculous (again, ?).

And, what about Ob-Gyn subspecialties, do they also have bad malpractice/hours/lawsuits? I've heard that maternal fetal medicine is better because your patients know they have a high-risk pregnancy; what about REI, gyn-onc, and urogyn??

Again, thanks for all the input!

Hey, I hear you. I said the exact same thing ten years ago. Now I wish I had to do it all over again. It doesn't seem that bad from the start, but wait until you are taking horrendous call no matter what and struggling to make the same money you made the year before.

As to getting sued, the expression in the specialty has always been it is not a matter of if, it is a matter of when, and to what degree. It will happen, understand that. I have yet to be named, but every one of my partners has at least once. Every one of my attendings has, at least once. Most of those I trained with already have been as well.

Texas is good from a malpractice point of view so you have a good advantage there, and a huge portion of it has to do with your payor mix. Medicaid patients have been repeatedly shown to be a huge risk, same with the VBAC crowd or other high risk sort of stuff. I trimmed my practice so that I don't see medicaid, and never have or will, I don't do high risk OB, and I don't get involved with high risk/low RVU issues. It may sound money motivated, but I am not going to work 60-70 hours every week for nothing only to get sued for my trouble.

MFM is much lower liability, much more competitive though and the comp is under extreme pressure since they are almost always employed positions. Urogyn is terrible pay and messy work. ONC/REI I couldn't say, but REI is hugely economically sensitive. We do a lot of it in my group and it fell off a cliff two years ago.

 

[mamagir]

"As to getting sued, the expression in the specialty has always been it is not a matter of if, it is a matter of when, and to what degree"- WOW!!

So, what exactly is the cause of this high liability incurred by OBGYNs? This was actually an interview question by the way or more like why would I want to still pursue OBGYN in the face of the malpractice insurance crisis.

Do you guys see things ever changing for the better? Is there anything been done to "REALLY" address the issue? I was reading a comment on a blog where the person suggested that not having malpractice insurance is the way to go. If attorneys know a physician can't pay then most likely they won't come after them.

I agree. That's one of the reasons I haven't really hesitated about my choice of OB/GYN. Things can only deteriorate to a point before they're going to have to be fixed. I just hope that we don't have to wait too long.

I found this from 7years ago. I guess we can safely say this point has been reached.
Full thread http://forums.studentdoctor.net/showthread.php?t=137289

Finally are there any OBGYNs out there who wouldn't change a thing and will encourage people who want to go into the field? What would you say to futuredoc and biology101? is there really any reason to go into OBGYN?
What are some aspects of it that continue to motivate you, if any?

Thanks!!

 

[residencycoord]

BVE388 - You are new to the OBGYN forum and to be honest, I wish you would stop posting. You have such a negative view of everything that I am so glad that you are not part of our faculty. I would have you as far away from my residents as I could possibly get them. As far as the laborist practice in Philadelphia, you have no idea what you are talking about it. The laborist/hospitalist model is very much part of two large Philadelphia hospitals and there are no plans to get rid of it in the near future, there are only plans to have it grow larger.

 

[anonperson]

I'd like to get some truthful advice about Ob-Gyn. I'm currently in my MS3 Ob-gyn rotation and have loved it - something that I never thought would happen - so I'm starting to seriously consider Ob for a career. I love the procedures, the excitement of deliveries, the possible continuity of care, the medical aspects of it. However, I am very concerned about the stereotype of Ob-Gyn - the awful lifestyle, the endless malpractice lawsuits, the outrageous malpractice insurance premiums, the "malignant" reputation. I feel like I get a different answer about these topics every time I ask an Ob-gyn resident or attending...I mean, is it really this bad? 😕 I don't want to go into a specialty and then regret my decision later down the road...

For those of you in Ob-Gyn: if you were to go back in time, would you choose Ob again, knowing what you know now and having gone through residency/fellowship/working?

Thanks for the advice. I really appreciate it 🙁

I'm a resident and a guy so you can take what I say with a grain of salt as I haven't been out in the "real" world.

Pros:
-Generally dealing with healthier patients, which is nice in terms of management (you don't have to worry about renal failure, CHF etc about your patients most of the time)-
-Mix of surgery, clinic, and office procedures
-Reasonable compensation

Some salary surveys
http://www.alliedphysicians.com/salary-surveys/physicians/

http://www.merritthawkins.com/pdf/2005_Modern_Healthcare_Physician_Compensation_Review.pdf

http://cejka.force.com/PhysicianCompensation

http://www.merritthawkins.com/pdf/2010revenuesurvey.pdf

Cons:
-Malpractice is a big issue. I am doing residency in a state that is generally pretty bad for malpractice. The attendings I have worked with gripe about it from time to time but they manage it. Lawsuits in OB Gyn will happen on both the Obstetric side and Gyn side.

Best thing for this if you decide to go into the field is to be mentally prepared for it when it happens. Do what's best for the patient, keep reading and following practice guidelines, and realize that it's a part of the field of medicine in general.

Also practice in a state friendly to OB Gyns. This makes a decent difference from the attendings I have spoken with.

-Lifestyle will vary. You will generally take in house call and be fairly busy when on call. Just the nature of the beast. The practices in my area have midwives that are on with attendings. If they do have midwife coverage I never see them the entire night unless $hit hits the fan. Otherwise SVD are handled without them. You can find groups like this fairly often.

But remember, when you're on call, you're going to be working which can be physically demanding. But I feel that's going to be true with certain specialities regardless. The trauma guys can get beaten down dealing with ex laps on gunshot victims, the transplant guys have ridiculously long surgeries, etc. These things take a toll on the body.

----------------------------------------------------------------

It;s like any other speciality. Good and bad. But I wouldn't say the field is horrendous by any stretch. I've enjoyed residency greatly. I've worked heard but always have time to spend with my SO, read/study, and have a few dollars in my pocket. My loans are paid off so if I can pull around $200K a year in practice, I'm more than content, which I'm fairly confident I can pull off.

I think my main gripe with the speciality is being limited in the surgical aspect ie being able to handle certain complications such as bowel perf, uretral injury.

In terms of subspecialities:
MFM
-Very good compensation especially in PP.
-You are doing lots of diagnostic tests (U/S, CVS, Amnios) etc and these generate a fairly healthy income
-No deliveries unless you are at certain academic place where MFM does resident coverage
-Relatively normal hours and ability to take home call

Gyn Onc
-The highest earners out of the 4 fellowships (shown in some studies)
-Administering own chem etc generates big money
-Sick patients. Big surgeries. Very competitive fellowship
-More of your typical gen surg lifestyle
-Deal with death and significant morbidity on a fairly consistent basis

REI
-Can be very lucrative (In the Columbia medical system, the number 2 and 3 earners at over a million $$ a year were REI guys with busy IVF practices)
-Again this isn't the norm but shows you the potential
-IVF/infertility is generally a big business and pays fairly well.

-Generally low stress. Mainly clinic based. Microsurgery for tubal reanastomosis. Open myomectomies. Diagnostic laparoscopy and D+C are bulk of your procedures.

-Intellectually stimulating in terms of the endocrine aspect. REI know a ton of stuff

-No real call duties

Urogyn
-Relatively new field on the block
-Can tell you too much about compensation, but mainly GYN heavy.
-No real urogyn emergencies so call isn't a big issue.

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In response to certain things that BVE388 has said;

No field is immune to malpractice. Ob does get the brunt of it, but in my epxerience you will see a fair bit of this in many specialities (trauma, gen surg, peds, FP, and yes radiology-Who gets named if an image gets read incorrectly which does happen)

 

[2Sexy4MedSchool]

is there really any reason to go into OBGYN?
What are some aspects of it that continue to motivate you, if any?

Thanks!!

Of course there are reasons to go into OB-Gyn, like any field. What continues to motivate me is the (mostly) healthy patients, the (mostly) appreciative patients, and the (always) exciting deliveries. Vaginal or c-section, first time or multip, it's always this incredible magic trick: one person walks/rolls into the room, presto-chango, cut the umbilical cord, don't-blink-now-there's-two-people-there!

There are other great things about the job: you can do as much hospital work vs. clinic as you'd like, ditto surgery, ditto high-risk vs. primary care. It's very flexible in terms of how you'd like your day-to-day to be structured.

The best advice I ever got on my way through MS-IV and the whole residency application process was, "Don't do OB unless you really can't imagine doing anything else." I can't. The other specialties are all a bad fit for me. If OB is a good fit for you, too, then by all means, there's room for you in the profession. You will find a practice that fits your lifestyle when you're ready to go out on your own, because big city or small, roughly 50% of our population have vaginas +/- uteri and they're going to need someone to help them. 2S4MS

 

[FutureDoc734]

Of course there are reasons to go into OB-Gyn, like any field. What continues to motivate me is the (mostly) healthy patients, the (mostly) appreciative patients, and the (always) exciting deliveries. Vaginal or c-section, first time or multip, it's always this incredible magic trick: one person walks/rolls into the room, presto-chango, cut the umbilical cord, don't-blink-now-there's-two-people-there!

There are other great things about the job: you can do as much hospital work vs. clinic as you'd like, ditto surgery, ditto high-risk vs. primary care. It's very flexible in terms of how you'd like your day-to-day to be structured.

The best advice I ever got on my way through MS-IV and the whole residency application process was, "Don't do OB unless you really can't imagine doing anything else." I can't. The other specialties are all a bad fit for me. If OB is a good fit for you, too, then by all means, there's room for you in the profession. You will find a practice that fits your lifestyle when you're ready to go out on your own, because big city or small, roughly 50% of our population have vaginas +/- uteri and they're going to need someone to help them. 2S4MS

Thank you so much for this post - and I would like to see other perspectives as well, so please keep them coming. I have not decided yet on Ob-Gyn, but I have loved it so much that I wonder if I'm going to like internal medicine as much as I thought I would (have that at the end of the year). We will see.

anonperson, you mention that malpractice is very dependent on the state you are at; do you happen to know which states are better?

Thanks again.

 

[bve388]

So, what exactly is the cause of this high liability incurred by OBGYNs? This was actually an interview question by the way or more like why would I want to still pursue OBGYN in the face of the malpractice insurance crisis.

Well, generally a rise in litigation across the board doesn't help, combined with the incredibly long statute of limitations (ie: 20yrs vs 2), and the fact that people simply cannot accept that something wrong with the child is not the medical professionals fault.

The real problem is not the frequency to be honest, the problem is the severity. All it takes is a nice dystocia or CP case to annihilate your MP rates and possibly your personal financial assets. This is why you have to be very careful about how you title assets etc.

Do you guys see things ever changing for the better? Is there anything been done to "REALLY" address the issue? I was reading a comment on a blog where the person suggested that not having malpractice insurance is the way to go. If attorneys know a physician can't pay then most likely they won't come after them.

Most facilities will require you to carry MP and also dictate the limits, otherwise you won't get privelages, that simple. I have heard of some places doing this, namely south Florida. This only works if you are 100% certain your assets are shielded and the veil has not been pierced, a risky game.

BVE388 - You are new to the OBGYN forum and to be honest, I wish you would stop posting. You have such a negative view of everything that I am so glad that you are not part of our faculty.

That's fine, and I realize that you are in the business of blowing rainbows up your resident's back end, but this is the reality, plain and simple. You would do better to truthfully and honestly prepare your students for what is out there in the real world. Then again, being faculty, you don't really see too much of the real private practice world.

I would have you as far away from my residents as I could possibly get them. As far as the laborist practice in Philadelphia, you have no idea what you are talking about it. The laborist/hospitalist model is very much part of two large Philadelphia hospitals and there are no plans to get rid of it in the near future, there are only plans to have it grow larger.

Which hospitals? I know HUP and PENNSE are both shutting theirs down. I know Jeff shelved theirs before it took off. Those are generally the three biggest center city hospitals, this is also first hand from Laborists and department heads at all three facilities, so how many of your residents have recently taken laborists positions at these facilities? Or are you talking smaller, outlying facilities that generally run 3-5 years behind the curve anyway?

Lastly, as for the negativity, it is more about honesty. People need to understand where the pitfalls are in medicine, and particularly in OBGYN if they are to make guided decisions. Almost every aspect of medicine is under intense negative pressure right now, OBGYN is no exception and that is just life. As I have said before, academic medicine is different and that is where you come from. Having come from a major academic institution I can tell you there is a major difference in the two worlds. However you are a residency coordinator, do you really know what running a private practice entails? Do you understand the business and lifestyle side? Probably not, that is what I am trying to show, and I apologize if that impinges on your "ray of academic sunshine" point of view.

It may also be partly due to the fact that I do not have a vested interest in getting people to enter and stay in OBGYN programs, while you do. I would rather treat people as adults, lay out the pros and cons and let them decide.

 

[bve388]

anonperson, you mention that malpractice is very dependent on the state you are at; do you happen to know which states are better?

Thanks again.

Something to be clear on. MP is generally dependent not just on state but also regionally. A great example is PA. If you are in the middle of the state (aka:nowhere) your MP cost will be drastically different than if you were in Philadephia. The same is true for Florida.

So you need to be aware that it is driven by state, but also by locality. The worst states are the ones you would expect. FL, PA, NJ, and NY are the worst the last I saw, in that order. The best ones are those in the south and midwest, Texas generally has very favorable MP rules and the costs reflect it.

Now, let me be honest. If you are going into PP you don't need to worry about which are the best, you only need to worry about which are the worst. What I mean by that is that the monetary difference between the best and the median is not a ton of money. A TX MP policy for an OBGYN will probably run 25-30k a year (based off what I have seen) whereas a middle of the road state, such as TN my policy is exactly 37k a year, in a major metro area. The problem is when you got to the ten worst is shoots up like a rocket.

 

[davika0]

Hi - I'm an R3, just wanted to put my two cents in that I LOVE MY JOB and could not imagine doing anything else! My IM husband and we often play the, if you won the lottery tomorrow would you continue residency/practice, and I answer yes!! (he does not, but that's because he actually wants to be a chef/archeologist)

Some of the best advice I got as an R3 was, pick what you love to do and then find a way to do it your way... i.e. there's a large variety of residencies out there, find one with kinder hours/lack of malignancy... If you really don't want to deal with malpractice, stay in academics someplace with sovereign immunity. Whatever specialty you choose, you'll be doing it about 8 hours a day 5 days a week for the next 30+ years so you better like the patients, the problems, your co-workers, etc. I would be a miserable dermatologist or radiologist.

Good luck with your decision!

 

[FutureDoc734]

Thank you - this is all very encouraging. I have heard the advice of "don't go into Ob (or surgery, for that matter) unless you don't see yourself doing anything else" before - right now, I absolutely love my rotation, even after seeing crazy life-or-death situations. It is very scary at times, but it comes with the territory. I will have to decide soon!

 

[Chuck's Right Foot]

I'm a male 3rd year medical student who recently made my decision to go into OB/GYN. but since finishing surgery and ob/gyn clerkships I changed my mind. On every rotation people ask you what you're interested in and I always said internal medicine and got a positive reaction. Now that I'm definitively applying OB/GYN, I get a terrible reaction from everyone I tell no matter if they're medical or non-medical.
😕I know I have to do what I love, but any thoughts on how to manage the bad perception about OB/GYN?

Other people aren't you. Do your homework (which you've done) figure out your priorities, get a supportive mentor and look for me on the interview trail in a year!

 

[FutureDoc734]

Other people aren't you. Do your homework (which you've done) figure out your priorities, get a supportive mentor and look for me on the interview trail in a year!

I completely agree with the above statement - no matter what you go into, people are always going to find something to say or talk about or discourage you with. It's the same thing for a woman going into surgery - I cannot tell you how many times my decision to go into Ob-gyn has been frowned upon, mainly because it's a surgical, demanding specialty and, as a woman, I "should be doing pediatrics or family medicine." Silly stereotypes...

I think male Ob-gyns are more than welcome into the field! There are plenty of patients that don't care if you're a male Ob. Yes, maybe at first you'll have to work a little harder to build a clientele, but I think that, once you have your patients, people will flock to your practice. There are even women out there that prefer male Ob's because they feel that they're more caring (my family members being some of those women, which is totally ironic because I'm going into Ob-Gyn!).

 

[MeowMix]

bve, I appreciate your perspective and am glad you posted here

Then again, being faculty, you don't really see too much of the real private practice world.

I think the poster who objected to your perspective on laborists is a residency staff member and not faculty. I could be wrong.

Why do you think the laborist model is failing? It seems like such an attractive idea.

 

[DocBlueMtn]

I'm a male OBGYN - urogyn fellow. I had numbers to be competitive for any specialty coming out of med school and chose OB b/c I really loved it. My ortho/ophtho friends were a little confused by my decision, but nobody really cares what you do. Once you get out of your narrow world of med school, you'll realize that in the real world, people love and respect their OBGYNs. We are valued members of every community and most OBs that I know who are in the real world are very happy.

Also, to clarify on urogyn... Starting salaries range from high 200s to mid 300s. We've had graduating fellows start at over 350k. It's a pretty nice salary considering that you don't take any OB or GYN call.

I would have to agree with one poster who said it is messy work.... Squeamish folks need not apply. However, we make lovely elderly women happy by making their lives better. It truly is a wonderful specialty.

 

[msupaintballer]

Hey not too sure where you are getting this from or why. I am 4th year male medical student who discovered OB/GYN and had a total change of heart from to the field. Except for only a few rare cases, I almost always receive the most positive responses from people concerning the field and why it chose me. I honestly cannot be more passionate towards the field and cannot see myself doing anything else in medicine other than OB/GYN and when other realize this they almost always take it with a positive light.

 

[Diane L. Evans]

Tend to agree with residencycoordinator

Every specialty has its drawbacks sure litigation is a real possibility.

I would not change my specialty for any reason.

Do what you love and enjoy.

Diane L. Evans D.O., M.S.
F.A.C.O.G