Pediatrician opposed to circumcision--career suicide?

[univlad]

Is it possible to become a pediatrician and never perform a circumcision if one was ethically opposed to it? Would one be able to satisfy residency requirements without doing them? If one decided after residency not to perform them, would it be difficult to find a job? If in a large group practice would others gripe at having to pick up the extra work?

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[oompaloompa]

Is it possible to become a pediatrician and never perform a circumcision if one was ethically opposed to it? Would one be able to satisfy residency requirements without doing them? If one decided after residency not to perform them, would it be difficult to find a job? If in a large group practice would others gripe at having to pick up the extra work?

I guess I'm always surprised at how strongly people feel about this either way. I just tell people that there is a slight medical advantage to circumcision but that it's so statistically insignificant that the main reasons for doing it would be religious or cosmetic if you have those inclinations. Otherwise, as long as you are capable of basic hygeine, whatever.

But in response to your question, a lot of programs, like my medical school program, have OB-GYN deal with that issue. So if this is such a major issue to you, you could include it in decision process for residency. One insight you may or may not realize is that medicaid does not pay for circumcision. In my experience, even the most adamant medicaid parent has forgone the procedure once they found out they would have to pay for it.

So in my rambling way, I'm saying it is ENTIRELY possible never to perform a circumcision and suffer no stigma for it. Good luck.

 

[univlad]

I guess I'm always surprised at how strongly people feel about this either way. I just tell people that there is a slight medical advantage to circumcision but that it's so statistically insignificant that the main reasons for doing it would be religious or cosmetic if you have those inclinations. Otherwise, as long as you are capable of basic hygeine, whatever.

But in response to your question, a lot of programs, like my medical school program, have OB-GYN deal with that issue. So if this is such a major issue to you, you could include it in decision process for residency. One insight you may or may not realize is that medicaid does not pay for circumcision. In my experience, even the most adamant medicaid parent has forgone the procedure once they found out they would have to pay for it.

So in my rambling way, I'm saying it is ENTIRELY possible never to perform a circumcision and suffer no stigma for it. Good luck.

I'm not actually a med student but a resident in another field (pathology). It will never become an issue for me, but I wondered about it after our pediatrician asked my wife and I if we wanted our son circumcised.

 

[Doc-Hollywood]

Is it possible to become a pediatrician and never perform a circumcision if one was ethically opposed to it? Would one be able to satisfy residency requirements without doing them? If one decided after residency not to perform them, would it be difficult to find a job? If in a large group practice would others gripe at having to pick up the extra work?

univlad, I have never done one. Don't care to.

I'll give you my take on circs, but if you haven't already done so, read this http://aappolicy.aappublications.org/cgi/reprint/pediatrics;103/3/686 and then try to read some of the many published comments for and against this policy.

As a pediatrician/neonatologist/ OB etc, it isn't your decision whether a newborn gets cir'd or not. It's up to the parents.

However, don't worry, most circs are still done by OB's so you likely will never have to do one if you do peds

Families may ask your advice, and you can give your opinion, but really your responsibility is to become familiar with the literature and to educate the family on the literature ( try to keep it peer reviewed ) so they can make an informed choice.

I am in a group of 5 neonatologists. One of my partners is militant anti-circ. To me , he comes off sounding like a nut. The rest of us don't really care what the family does. 99% of the time nobody asks us our opinion. People already have their minds made up on yes or no. Most males in the USA are circ'd
I personally am indifferent to the procedure. I do suggest to families that they demand adequate anesthesia and discuss this with the OB and to demand it for the procedure ( if I don't know their OB. Most of the guys do use some form of anesthesia so I usually don't have to mention it to the family. If asked I give a synopsis of the data based on the policy statement of the AAP task force, and I let the family make their own decision.

If I ever have a son, I'm getting him circ'd by the way but it has much more to do with social and cosmetic reasons than real medical indications, and I am totally comfortable with that decision

 

[kristing]

univlad, I have never done one. Don't care to.

However, don't worry, most circs are still done by OB's so you likely will never have to do one if you do peds

I don't think this is the case everywhere. Where I am training (Kalamazoo, MI), the pediatricians do them. In AZ, where I went to med school, the pediatricians did them. I know in other parts of Michigan, the OB's do them.

I am opposed, and I won't do them. I was also worried about this issue when I started residency. The ACGME website states that a resident does not have to do teh procedure to graduate, but a program has to offer it to the residents.

When it came up on my newborn month, I said "I don't do circumcisions, I am opposed", honestly, and it was ok with my attendings. I was that blunt about it, because I didn't want to get any grief. I didn't want to seem wishy washy, because I wasn't going to be talked into it.

I do believe, though, that if I stay in the midwest, this position of mine may hinder my job prospects, strictly because of the vast majority of boys getting them done. WE'll see.

 

[univlad]

I don't think this is the case everywhere. Where I am training (Kalamazoo, MI), the pediatricians do them. In AZ, where I went to med school, the pediatricians did them. I know in other parts of Michigan, the OB's do them.

I am opposed, and I won't do them. I was also worried about this issue when I started residency. The ACGME website states that a resident does not have to do teh procedure to graduate, but a program has to offer it to the residents.

When it came up on my newborn month, I said "I don't do circumcisions, I am opposed", honestly, and it was ok with my attendings. I was that blunt about it, because I didn't want to get any grief. I didn't want to seem wishy washy, because I wasn't going to be talked into it.

I do believe, though, that if I stay in the midwest, this position of mine may hinder my job prospects, strictly because of the vast majority of boys getting them done. WE'll see.

I noticed this abstract/article the other day and wondered if it is becoming a trend with more OB/GYN services pushing circumcisions off on other services? It makes sense.

http://www.greenjournal.org/cgi/content/abstract/109/3/750

Does anyone work in a hospital where there is no one who is willing to perform circumcisions on normal newborns or has anyone heard of such a hospital? What do the parents do or how do they react?

 

[exgatr]

I One insight you may or may not realize is that medicaid does not pay for circumcision. In my experience, even the most adamant medicaid parent has forgone the procedure once they found out they would have to pay for it.

Where I've trained, even the most ghetto-licious parents scrounge up the 400 bucks pretty quick when it comes to circs

 

[medmom]

Where I've trained, even the most ghetto-licious parents scrounge up the 400 bucks pretty quick when it comes to circs

I am from Colorado, and had my son while on medicaid. In Colorado, medicaid DOES cover a circ. Just an FYI.