OB/GYN vs. Gen Surg

[wanderingorion]

Currently in a bit of a dilemma. Did my OB/GYN rotation first during M3, fell in love with it. Enjoyed obstetrics, really interested in Gyn/Onc given my research interests. Started a project with a Gyn-oncologist, got LOR from the clerkship director, and planned an early Sub-I towards the end of 3rd year.
Jump to now, on the 2nd half of my GS rotation, and thinking about shifting gears. Really enjoy the variety of GS, various pathophysiology, being able to manage medical+surgical issues in sick patients, surg onc (along with other cool fellowships), more operative focus outside of residency if I don't pursue a fellowship.

At this point, I know I belong in the OR, but trying to figure out which path to take. Additionally, I'm concerned about the work/life balance with my SO and toddler (with another on the way).

Has anyone else experienced this dilemma? What pushed you one way or the other? What are the best/worst things about both?

---

Members don't see this ad.

 

[odyssey2]

You’re not going to have much free time in either for residency so I wouldn’t let that be a deciding factor with kids at home. If you love operating more than anything you’re going to get a lot more training in it as a GS than a gyn.

 

[Gurby]

Let the self-hatred flow through you... surgery...

 

[OnePunchBiopsy]

Work/life balance is an issue in any residency. As an attending, both Ob/Gyn and GS have a lot of work hours. Either way, you’ll likely have to find ways to balance your family and career.

If you want an Ob/Gyn career where you start out solely operating and not delivering babies or doing other things not in the OR, you’ll definitely need a fellowship afterward. With that, there is still no guarantee.

Any way you go in GS you’ll be operating. For more advanced skills like Surg Onc you’ll need a fellowship.

Unless you really like the obstetric side of things, I would do GS if I were in your shoes. I also loved operating. Ob/Gyn was my second favorite rotation.

 

[ACSurgeon]

Currently in a bit of a dilemma. Did my OB/GYN rotation first during M3, fell in love with it. Enjoyed obstetrics, really interested in Gyn/Onc given my research interests. Started a project with a Gyn-oncologist, got LOR from the clerkship director, and planned an early Sub-I towards the end of 3rd year.
Jump to now, on the 2nd half of my GS rotation, and thinking about shifting gears. Really enjoy the variety of GS, various pathophysiology, being able to manage medical+surgical issues in sick patients, surg onc (along with other cool fellowships), more operative focus outside of residency if I don't pursue a fellowship.

At this point, I know I belong in the OR, but trying to figure out which path to take. Additionally, I'm concerned about the work/life balance with my SO and toddler (with another on the way).

Has anyone else experienced this dilemma? What pushed you one way or the other? What are the best/worst things about both?

rule of thumb: pick the residency that you’ll be happy with if you can’t get your fellowship of choice.
So you rather be a general OB/GYNor general surgeon?

gyn/onc is a hard fellowship to get from what I know.

lifestyle is terrible for both in residency with a million options when you’re done. ie you can sacrifice money for lifestyle in either specialty.

 

[Dr G Oogle]

Hysterectomy in Residency Training: The New Numbers Game? : Obstetrics & Gynecology

An abstract is unavailable.

journals.lww.com

I posted above link in OB/Gyn forum. Basically it says that surgical numbers are low in obgyn residency. If the thing you love about OBGyn is obstetrics then go for it, if you love gynecologic surgery the reality is that the only way you can do a meaningful amount of surgery is be somewhere rural or do a fellowship. And as the poster above stated the surgical fellowships are quite competitive with match rates between 60-75%. Though last year forms had a match rate of 90% because many people got siphoned off by MIS fellowships. Obgyn is going through a big growth change which will take decades with a shift in training and practice realities the outcome will likely be something like what happened in DR/IR. So if your dream career is to be a surgeon obgyn is far from a guarantee for that. In my practice even older experienced generalists are referring relatively simple surgery to me like adnexal cysts because they don’t do enough surgery in their practices. GS on the other hand will guarantee you doing surgery even if you don’t match into a fellowship. I did obgyn and was fortunate to match into urogyn and I love my job but honestly would have hated being a generalist and either would have kept reapplying or would have applied to GS residency if I couldn’t match a fellowship.

As far as differences in residency work load, they are basically the same; while obgyn is 4 years and GS is 5 (or 7 if you go the research route) Gyn surgery fellowships are 3 years (2 for MIS, but MIS only jobs are hard to find and you’ll still be doing lots of OB) while GS fellowships are 1-2 years so if time wise it’s a wash. There are also excellent community GS programs that give you a good option for fellowships and have reasonable workloads whereas you’re at a significant disadvantage in OBGyn if you go to a community program and want to apply for a surgical fellowship, can say the latter with certainty because at my program we only interview people from university programs unless there is some sort of personal connection or otherwise remarkable characteristic like having a bunch of first author pubs.

 

[wanderingorion]

Hysterectomy in Residency Training: The New Numbers Game? : Obstetrics & Gynecology

An abstract is unavailable.

journals.lww.com

I posted above link in OB/Gyn forum. Basically it says that surgical numbers are low in obgyn residency. If the thing you love about OBGyn is obstetrics then go for it, if you love gynecologic surgery the reality is that the only way you can do a meaningful amount of surgery is be somewhere rural or do a fellowship. And as the poster above stated the surgical fellowships are quite competitive with match rates between 60-75%. Though last year forms had a match rate of 90% because many people got siphoned off by MIS fellowships. Obgyn is going through a big growth change which will take decades with a shift in training and practice realities the outcome will likely be something like what happened in DR/IR. So if your dream career is to be a surgeon obgyn is far from a guarantee for that. In my practice even older experienced generalists are referring relatively simple surgery to me like adnexal cysts because they don’t do enough surgery in their practices. GS on the other hand will guarantee you doing surgery even if you don’t match into a fellowship. I did obgyn and was fortunate to match into urogyn and I love my job but honestly would have hated being a generalist and either would have kept reapplying or would have applied to GS residency if I couldn’t match a fellowship.

As far as differences in residency work load, they are basically the same; while obgyn is 4 years and GS is 5 (or 7 if you go the research route) Gyn surgery fellowships are 3 years (2 for MIS, but MIS only jobs are hard to find and you’ll still be doing lots of OB) while GS fellowships are 1-2 years so if time wise it’s a wash. There are also excellent community GS programs that give you a good option for fellowships and have reasonable workloads whereas you’re at a significant disadvantage in OBGyn if you go to a community program and want to apply for a surgical fellowship, can say the latter with certainty because at my program we only interview people from university programs unless there is some sort of personal connection or otherwise remarkable characteristic like having a bunch of first author pubs.

Honestly, one of the most difficult things to let go of is the obstetrics aspect, but the rest of it (apart from gynonc) is so-so. The initial pull to OB/Gyn was the variety (clinic + OR), and if I were a generalist (given the wild gynonc match rates), I don't think I'd be happy to operate so infrequently. My thought has been, "Why go into a specialty where you'll sub-specialize into a surgeon, when you can just be one from the get go."

 

[wanderingorion]

Let the self-hatred flow through you... surgery...

You know me too well, Gurbs

 

[Dr G Oogle]

Hysterectomy in Residency Training: The New Numbers Game? : Obstetrics & Gynecology

An abstract is unavailable.

journals.lww.com

I posted above link in OB/Gyn forum. Basically it says that surgical numbers are low in obgyn residency. If the thing you love about OBGyn is obstetrics then go for it, if you love gynecologic surgery the reality is that the only way you can do a meaningful amount of surgery is be somewhere rural or do a fellowship. And as the poster above stated the surgical fellowships are quite competitive with match rates between 60-75%. Though last year forms had a match rate of 90% because many people got siphoned off by MIS fellowships. Obgyn is going through a big growth change which will take decades with a shift in training and practice realities the outcome will likely be something like what happened in DR/IR. So if you’re dream career is to be a surgeon obgyn is far from a guarantee for that. GS on the other hand will guarantee you doing surgery even if you don’t match into a fellowship. I did obgyn and was fortunate to match into urogyn and I love my job but honestly would have hated being a generalist and either would have kept reapplying or would have applied to GS residency if I couldn’t match a fellowship.

As far as differences in residency work load, they are basically the same; while obgyn is 4 years and GS is 5 (or 7 if you go the research route) Gyn surgery fellowships are 3 years (2 for MIS, but MIS only jobs are hard to find and you’ll still be doing lots of OB) while GS fellowships are 1-2 years so if time wise it’s a wash. There are also excellent community GS programs that give you a good option for fellowships and have reasonable workloads whereas you’re at a significant disadvantage in OBGyn if you go to a community program and want to apply for a surgical fellowship, can say the latter with certainty because at my program we only interview people from university programs unless there is some sort of personal connection or otherwise remarkable characteristic like having a bunch of first author pubs.

Honestly, one of the most difficult things to let go of is the obstetrics aspect, but the rest of it (apart from gynonc) is so-so. The initial pull to OB/Gyn was the variety (clinic + OR), and if I were a generalist (given the wild gynonc match rates), I don't think I'd be happy to operate so infrequently. My thought has been, "Why go into a specialty where you'll sub-specialize into a surgeon, when you can just be one from the get go."

I mean you’ll still be in OR as a generalist you’ll just be doing c-sections, OB can be very interesting and obviously rewarding, and in large practices the schedule is quite manageable in fact the laborist model is becoming very popular. I just hear a lot of Students saying they imagine doing a lot of surgery like hysts, urogyn, adnexal surgeries as a generalist but the reality is it’s mostly csections and Tubals and the occasional hysteroscopy, remainder is done by fellowship trained people. If you understand that and are happy with it than general obgyn is a very rewarding career, the ones who are disappointed are those who don’t realize that or stop doing cases when a subspecialist shows up. Gen surgery is much the same way in terms of limits of what you can do without a fellowship but you’re definitely spending a lot more time doing “real surgery” as a general surgeon than a general obgyn.

 

[theonlytycrane]

Let the self-hatred flow through you... surgery...

I'm trying to convince myself not to do surgery and this is exactly how I feel!

 

[libertyyne]

Will you be content with a large majority of your surgeries just being C-sections?
I personally felt like there was way more variety in terms of surgery on gen surg.
I also felt that the ob-gyns at least at my hospitals had rougher/more frequent call compared to gen surgeons.
This is my opinion, but in my limited experience, the Gen surgeons seemed like they were better technically compared to the obgyns.
It really boils down to do you want to spend more time in the OR doing surgery, or do you want to spend more time waiting for something to happen so you can do surgery.

 

[sab3156]

You can do Urogynecology (AKA Female Pelvic Medicine & Reconstructive Surgery) as a fellowship after Ob/Gyn if you really love surgery.

 

[Frogger27]

Or you can do Urology and get that Urogyn/Onc patient population that the fellowship trained OB/Gyn tend to see, get superior surgical training, and only 5 years (compared to 7 with OBgyn+fellowship)

 

[Dr G Oogle]

Or you can do Urology and get that Urogyn/Onc patient population that the fellowship trained OB/Gyn tend to see, get superior surgical training, and only 5 years (compared to 7 with OBgyn+fellowship)

Seconded. You can still do high end surgery as a genreal Uro but not so much as a genral obgyn

 

[OrganRepo]

if you go surgery at least when its all over you will have begun to learn to operate

 

[WinslowPringle]

What about patient populations? What types of patients do you enjoy working with?

What about inpatient management? The length of stay and type of management tends to be pretty different for gen surg v. ob-gyn. Affects your residency experience, although obviously as an attending it's tailored to your practice desires.

What types of complications do you hate? What types of patients/complications/badness do you never want to see again?

What type of work environment do you like?

 

[penguins15]

i thought the same in med school,... loved surgery (esp transplant) and i loved gyn onc (not so much obstetrics). I would say find your people- who do you mesh with better? And where do you find yourself more curious or interested? For me, i loved the long-term relationships w/patients, how surgery was a big part of the job, the research, and the ability to manage chemo in gyn onc (I would argue gyn onc does way more medicine than surgery).

I am heading into gyn onc fellowship... and it took a lot of dedication, research, and $$ to apply. It was worth it because even from interviews and meeting people along the fellowship interview trail... I knew it was my specialty.
And yes... you do unfortunately have to live through obstetrics as a resident (although, far more tolerable as a resident than as a med student).

And if gynonc doesnt work out for you... gyn only practices are increasingly popular now....

 

[Dr G Oogle]

i thought the same in med school,... loved surgery (esp transplant) and i loved gyn onc (not so much obstetrics). I would say find your people- who do you mesh with better? And where do you find yourself more curious or interested? For me, i loved the long-term relationships w/patients, how surgery was a big part of the job, the research, and the ability to manage chemo in gyn onc (I would argue gyn onc does way more medicine than surgery).

I am heading into gyn onc fellowship... and it took a lot of dedication, research, and $$ to apply. It was worth it because even from interviews and meeting people along the fellowship interview trail... I knew it was my specialty.
And yes... you do unfortunately have to live through obstetrics as a resident (although, far more tolerable as a resident than as a med student).

And if gynonc doesnt work out for you... gyn only practices are increasingly popular now....

Gyn only practices are probably only in the purvey of MIGS and maybe urogyn if they want to deal with endo And AUB. The vast majority of general obgyn grads who don’t go to fellowship are unlikely to find a job like that unless they are in a solo practice in less urbanized areas. And more importantly contemporary residency training does not prepare people for anything but the most straightforward of hysterectomies