obgyn vs. IM- (heart vs. the head) last minute decision

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That's quite the polar opposite in field choices, it's hard to say as both are quite different fields! The major issues are lifestyle and passion. If you're going to feel trapped and depressed in IM, then you'll be living a sorry life for the next few decades. If you're don't want the lifestyle or burnout that you're afraid of, you'll live your life like a candle in the wind!

There are a bunch of very kickgluteal women in IM, not just surg/ob!!
 
Splenda88 said:
Well, neither one is a lifestyle specialty, but IM is a little bit better than obgyn.
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Two of my hospitalists (married couple) have traveled to more countries in the last year than I have in my entire life. Most OB/GYNs can’t do big blocks of time off every month outside of doing locums. They also have to do both clinic and inpatient and then do OR as well. Most surgical specialties are very lifestyle unfriendly. General IM is actually pretty lifestyle friendly, especially if you are a hospitalist. When you subspecialize into a procedure based fellowship like cards or GI, the lifestyle perks go down while the money goes up.
 
Splenda88 said:
I guess I should wait until I become an attending then. IM residency sucks big time.
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Dude, with your protected hour-rules and etc y'all got it made! 30+hours was routine. 72hrs made me weep (nah, just drunk when I got home with beer and a panda express). But still nothing compared to the real olden days when people never left the hospital.

Lifestyle is what you make of it. A lot of us still work 13-14 hour days. A lot of us have more than one job. Etc.
 
IM is definitely a lifestyle specialty in my experience, residency included. Admittedly not in IM but am familiar with what a lifestyle specialty is not. Doesn't mean it isn't a great field—I think IM is really at the heart of what it means to be a doctor—I just wouldn't do it.
 
What do you mean it’s not a lifestyle specialty? You only work 26 weeks a year, and your time off is a week at a time versus other specialties where you have time off on random days. Plus there’s a lot of good fellowships to do from IM. OBGyn would only be lifestyle if you did REI, MFM, and a few other fellowships. Of course, they’re all super competitive.
 
MFM, Gyn-onc, REI, gyn only ( be the hysterectomy specialist in a group) are all viable specialties.
Even as a generalist, would you rather have 1,000 conversations with a teenager about birth control or 1,000 conversations with a patient who won't walk around the block, take their blood pressure medication or stop smoking?
There is no guarantee that you will get a fellowship in IM either, and you could end up a generalist with a less attractive patient population.
 
raiderette said:
MFM, Gyn-onc, REI, gyn only ( be the hysterectomy specialist in a group) are all viable specialties.
Even as a generalist, would you rather have 1,000 conversations with a teenager about birth control or 1,000 conversations with a patient who won't walk around the block, take their blood pressure medication or stop smoking?
There is no guarantee that you will get a fellowship in IM either, and you could end up a generalist with a less attractive patient population.
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It’s almost like all fields of medicine become redundant and annoying over time or something...
 
Splenda88 said:
I guess I should wait until I become an attending then. IM residency sucks big time.
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That''s because residency in general sucks. Your time is not your time. Once you're done you can find a job and/or tailor multiple jobs to fit whatever lifestyle you want which makes being an attending a million times better.
 
I was in a very similar situation. Loved OBGYN, but wasn’t sure I had the personality for it and everyone told me to do IM. I had my entire MS4 year setup for IM, then last minute switched to OBGYN. Loved the patient population and the subject matter.

I also thought I was destined for something GYN, but to my surprise I fell in love with OB in residency and now I’m in MFM fellowship. Still hoping for a decent lifestyle one day... and to have the option of maybe just being a consultant and giving up L&D call at some point later on...

But OBGYN residency is rough. While I can’t personally speak for IM residency of course, I had friends in IM that did not seem to have as bad of a residency as I had. This could certainly be program dependent.

Residency sucks for everyone and hours are long, but it’s temporary. Pick what you want to do beyond the training.

Fellowship is always competitive and keep in mind you may change your mind in residency.

I would consider doing a sub-I in OBGYN and one in IM at the very beginning of your MS4 year to help you test them both out one last time before ERAS.

Good luck!
 
IM based on what you said about hating to be a generalist. It is very likely that in this generation, unless you work somewhere rural, you will unlikely to be doing major surgery as a general obgyn and Gyn fellowships are very competitive for the reason you mentioned (many people hate or grow to hate OB). The year I matched into fpmrs the match rate was 72%, onc and MIGS are similar in match rates. While REI is nonOB most fellowships now do ivf and infertility and the surgical component is going by the wayside. The rei fellows where I did my fellowship had to do all their cases with MIGS because none of their attendings did majors.

With your scores competitive procedural specialties in IM are well within reach. Mostly because there are so many positions available of them. There are only 40 some spots for FPMRS, about the same number
makethemostofit said:
Hey all. So it is time to start turning in ERAS soon now and my heart is confusing the hell out of me. So, initially, I was most attracted to obgyn. I really admired the residents/attendings at my institution, liked the medicine + surgery. Liked the patient population. Only thing is that I really really really would hate being a generalist (i.e. not a super big fan of ob (as opposed to gyn), mostly because of terrible lifestyle, call, and on top of all of it, malpractice concerns). Despite loving my gyn onc subi, I crossed it off my list for this reason- that I couldn't imagine myself as a generalist. It would be a huge gamble to assume that I match into something gyn related and avoid ob, in other words, which is advice I had gotten from multiple residents.

So here I am applying to IM, mostly because I did like it to some degree and I know that my health would suffer less in the long them (both physically, due to less call, and psychologically, due to less malpractice concerns). THe only thing is that I suddenly realized that I will no longer be in the OR (which maybe I could get used to) and that I will never be around such a badass, inspiring group of women in my life again (they are really great here). I didn't want to do gen surg because the culture sucked here and none of the gen surgeons seemed happs (as opposed to the gyn oncs/general obgyns that I knew.) I also had no interest in other surgical subspecialties.

So: is my heart being stupid? I have read posts of early retired obgyns who burned out, but at one point were also following their hearts. It makes me wonder if the heart, as opposed to the head, should be trusted at all. Any thoughts at this point? Should I just make peace with IM?
Edit: I should add that my app is pretty T'd up for IM. I would still need some ob letters if I choose to switch. 250s/260s step 1/2
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IM based on what you said about hating to be a generalist. It is very likely that in this generation, unless you work somewhere rural, you will unlikely to be doing major surgery as a general obgyn and Gyn fellowships are very competitive for the reason you mentioned (many people hate or grow to hate OB). The year I matched into fpmrs the match rate was 72%, onc and MIGS are similar in match rates. While REI is nonOB most fellowships now do ivf and infertility and the surgical component is going by the wayside. The rei fellows where I did my fellowship had to do all their cases with MIGS because none of their attendings did majors.

With your scores competitive procedural specialties in IM are well within reach. Mostly because there are so many positions available of them. There are only 40 some spots for FPMRS, about the same number for Onc, fewer for MIGS, and not sure how many for REI but I’d wager it’s in the ballpark. So even with good scores and research (the latter which you’ll need both obgyn and IM competitive fellowships) the surgical fellowships rely much more on who you know than the IM fellowships, so much so that I’ve seen some very qualified applicants from not so great programs not match over questionable applicants from programs with very prominent people (at least in fpmrs).
for Onc, fewer for MIGS, and not sure how many for REI but I’d wager it’s in the ballpark. So even with good scores and research (the latter which you’ll need both obgyn and IM competitive fellowships) the surgical fellowships rely much more on who you know than the IM fellowships, so much so that I’ve seen some very qualified applicants from not so great programs not match over questionable applicants from programs with very prominent people (at least in fpmrs).
 
Dr G Oogle said:
IM based on what you said about hating to be a generalist. It is very likely that in this generation, unless you work somewhere rural, you will unlikely to be doing major surgery as a general obgyn and Gyn fellowships are very competitive for the reason you mentioned (many people hate or grow to hate OB). The year I matched into fpmrs the match rate was 72%, onc and MIGS are similar in match rates. While REI is nonOB most fellowships now do ivf and infertility and the surgical component is going by the wayside. The rei fellows where I did my fellowship had to do all their cases with MIGS because none of their attendings did majors.

With your scores competitive procedural specialties in IM are well within reach. Mostly because there are so many positions available of them. There are only 40 some spots for FPMRS, about the same number

IM based on what you said about hating to be a generalist. It is very likely that in this generation, unless you work somewhere rural, you will unlikely to be doing major surgery as a general obgyn and Gyn fellowships are very competitive for the reason you mentioned (many people hate or grow to hate OB). The year I matched into fpmrs the match rate was 72%, onc and MIGS are similar in match rates. While REI is nonOB most fellowships now do ivf and infertility and the surgical component is going by the wayside. The rei fellows where I did my fellowship had to do all their cases with MIGS because none of their attendings did majors.

With your scores competitive procedural specialties in IM are well within reach. Mostly because there are so many positions available of them. There are only 40 some spots for FPMRS, about the same number for Onc, fewer for MIGS, and not sure how many for REI but I’d wager it’s in the ballpark. So even with good scores and research (the latter which you’ll need both obgyn and IM competitive fellowships) the surgical fellowships rely much more on who you know than the IM fellowships, so much so that I’ve seen some very qualified applicants from not so great programs not match over questionable applicants from programs with very prominent people (at least in fpmrs).
for Onc, fewer for MIGS, and not sure how many for REI but I’d wager it’s in the ballpark. So even with good scores and research (the latter which you’ll need both obgyn and IM competitive fellowships) the surgical fellowships rely much more on who you know than the IM fellowships, so much so that I’ve seen some very qualified applicants from not so great programs not match over questionable applicants from programs with very prominent people (at least in fpmrs).
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Was just curious on the exact numbers so I looked them up and figured I'd post them here
MIGS 41 spots
Gyn Onc and FPMRS 64-68 spots
MFM 128 spots
REI 51
 
Not sure about others, but those fpmrs numbers seem a litte high (admittedly not as plugged into the exact number is I was during app season) not every program takes an applicant every year (U of Rochester), some programs take internal candidates (probably 4 or 5) and about 10-15 programs will take either a urologist or obgyn so there’s much stiffer competition at those (Case western, Med Star in DC and U of Alabama Birmingham are the ones that come to mind). In the future it is likely that most fpmrs fellowships will take either a urologist or obgyn. So that probably narrows it down to somewhere between 40-50 spots.

Thanks for looking it up, though I’m sure people will find info helpful. Surprised by MIGS number, used to be pretty low.
 
Tenk said:
Two of my hospitalists (married couple) have traveled to more countries in the last year than I have in my entire life. Most OB/GYNs can’t do big blocks of time off every month outside of doing locums. They also have to do both clinic and inpatient and then do OR as well. Most surgical specialties are very lifestyle unfriendly. General IM is actually pretty lifestyle friendly, especially if you are a hospitalist. When you subspecialize into a procedure based fellowship like cards or GI, the lifestyle perks go down while the money goes up.
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Besides getting a post-residency gig as a surgicalist (which I think you can be in multiple surg specialities?), are there any lifestyle friendly surgical specialties? I feel like most you wouldn't ever be able to take time off as you described. Unless maybe hospital-employed?
 
Gilakend said:
Besides getting a post-residency gig as a surgicalist (which I think you can be in multiple surg specialities?), are there any lifestyle friendly surgical specialties? I feel like most you wouldn't ever be able to take time off as you described. Unless maybe hospital-employed?
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In comparison to other specialties: not really. Maybe cosmetic cash only plastics.
 
Any field from FP to NSGY if you’re in private practice in an RVU only model will limit your ability to take time off as any time you take off will mean you’re not making money during that time. If you’re in a big practice or are employed somehow and have a guaranteed salary independent of RVUs it’s much easier to have a work life balance regardless of salary. Im a urogyn (kind of lifestyle friendly) at an academic practice and have 4 weeks guaranteed vacation and 4 guaranteed conferences (usually 3-5 days which are all expenses paid if I’m a presenting author on one or more papers and since I’m in charge of fellow and resident research it’s basically guaranteed) so essentially I have 2 months off a year whereas my friend works at a PP (just started, like me) and probably won’t let himself take Any vacay because he will miss getting patients, and surgeries which will be less money in his pocket. The difference in our salaries is roughly 2 months at 45-50 hours a week. Yeah he makes more but at a substantial cost to himself. So it’s all a give and take.

As far as a surgicalist, the only specialty I know that has that is general surgery; Obgyn has laborist a but they usually only staff L&D and don’t do any surgeries unless you count a csection a surgery.
 
Gilakend said:
Besides getting a post-residency gig as a surgicalist (which I think you can be in multiple surg specialities?), are there any lifestyle friendly surgical specialties? I feel like most you wouldn't ever be able to take time off as you described. Unless maybe hospital-employed?
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MOHS
Optho
ENT
 
Dr G Oogle said:
Any field from FP to NSGY if you’re in private practice in an RVU only model will limit your ability to take time off as any time you take off will mean you’re not making money during that time. If you’re in a big practice or are employed somehow and have a guaranteed salary independent of RVUs it’s much easier to have a work life balance regardless of salary. Im a urogyn (kind of lifestyle friendly) at an academic practice and have 4 weeks guaranteed vacation and 4 guaranteed conferences (usually 3-5 days which are all expenses paid if I’m a presenting author on one or more papers and since I’m in charge of fellow and resident research it’s basically guaranteed) so essentially I have 2 months off a year whereas my friend works at a PP (just started, like me) and probably won’t let himself take Any vacay because he will miss getting patients, and surgeries which will be less money in his pocket. The difference in our salaries is roughly 2 months at 45-50 hours a week. Yeah he makes more but at a substantial cost to himself. So it’s all a give and take.

As far as a surgicalist, the only specialty I know that has that is general surgery; Obgyn has laborist a but they usually only staff L&D and don’t do any surgeries unless you count a csection a surgery.
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That's all true...ish.

If a production-based surgeon is having to take zero vacation time to make the same as a academic surgeon than the former got screwed on his/her contract (or you are getting paid better than most academic physicians).

To illustrate: my attendings in residency (FP) when all is said and done are making roughly let's say 200k/year (it was less than that when I was a resident but that's been 7 years now).

For me, a production-based FP, to make that can be accomplished by seeing roughly 20 patients/day, 4 days/week, 46 weeks/year.

If I'm willing to work 4.5 days/week, I can work 42 weeks/year seeing 22 patients/day to accomplish the same.
 
Most academic urogyns make a reasonable salary (unless it’s straight salary academic like the Harvard system) the avg income after 5 years for straight RVUS is a little over 400 while in academics with mixed (base + incentive) it’s somewhere between 350-400. Starting will be lower in academics since most PP can get a guaranteed salary for 1-3 years. The reason is it’s this close is most academic places need a urogyn to do those cases and we generate a lot of downstream income, most patients get UDS, imaging etc and the surgeries we do (excluding hysterectomy) generate a lot of hospital revenue becauw they can be done at ASCs. In PP there are still generalists who do urogyn procedures but that’s the older generation, new grads aren’t trained to do any urologic procedures and prolapse repair or urodynamics so I suspect in the future pp urogyns will be in higher demand and thus better reimbursed since they will have less competition.
 
Pardon my ignorance, but is it really that difficult for an OB/GYN to do GYN only post residency? A lot of women use the GYN as their PCP, and do you need a fellowship to be competitive for positions where you're doing outpatient GYN + oopherectomies for radiologically benign looking cysts, myomectomies and hysterectomies for adenomyosis/fibroids?
 
Most general obgyns won’t be that busy if they are only doing gyn. High volume surgeons are considered those that do 12 hysts or more a year, that’s only the top 20% of obgyns and includes specialists like MIGS and urogyn. Most of the generalists that are doing more than 12 cases a year are older and don’t want to share those cases. Most young obgyns aren’t going to be surgically busy, and most procedures available to them or tubals, some adnexal surgery and D&Cs, it’s hard to build a viable practice out of that without doing OB.
 
There’s a lot of cool and smart and caring women in IM too 😎. You can find them and be one of them.

That said, you’re picking what will be your life for the next few decades. If you can’t be happy without the OR then I guess you’d better do something that lets you be there (can’t relate, I couldn’t be happy if I had to go In the OR).

My lifestyle as a general academic internist is high quality. No nights, no weekends (except the few weeks inpatient teaching service that I do sometimes because I want to), fine salary and benefits and leave, out of the office by 5, enjoy getting to know and taking care of my patients and working with the residents and students. You can always work more for more money in any field if you want.
 
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