Primary Care and Ob/Gyn

[neilc]

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hello everyone! hopefully all of you kind souls out there can help me out again...

i have always been interested in primary care AND surgery. that is a huge reason for my choosing ob/gyn, as it is one of the few specialties that really combine these aspects. however, i am still interested in really increasing the scope of the primary care to increase my scope of practice opportunities when i finish up.

i have considered the family practice residency with an ob fellowship, but i really want to be able to do the gyn side of ob for lots of reasons, especially because of the fact that i enjoy surgery. also, the compensation for fp+ob is significantly less than that of ob/gyn for the same amount of training.

what i am interested in is something like a primary care fellowship after completing an ob/gyn residency. i would like to be qualified to work in a family practice type setting, if i ever had an opportunity to do that. the residency programs i am looking at are mostly emphasising the primary care, and they do have a significant amount of IM, peds and primary care rotations. but, i am thinking that a fellowship (even if just 6 mos more) would be great, make me more marketable, and give me a lot of flexibility in my carreer. especially because i am considering doing ob/gyn as a locum, and then working in planned parenthood type clinics and/or urgent cares when i am not travelling.

any input? is it possibe? do i even need to do a fellowship or look for extra training? am i insane? thanks in advance!

 

[ny skindoc]

hello everyone! hopefully all of you kind souls out there can help me out again...

i have always been interested in primary care AND surgery. that is a huge reason for my choosing ob/gyn, as it is one of the few specialties that really combine these aspects. however, i am still interested in really increasing the scope of the primary care to increase my scope of practice opportunities when i finish up.

i have considered the family practice residency with an ob fellowship, but i really want to be able to do the gyn side of ob for lots of reasons, especially because of the fact that i enjoy surgery. also, the compensation for fp+ob is significantly less than that of ob/gyn for the same amount of training.

what i am interested in is something like a primary care fellowship after completing an ob/gyn residency. i would like to be qualified to work in a family practice type setting, if i ever had an opportunity to do that. the residency programs i am looking at are mostly emphasising the primary care, and they do have a significant amount of IM, peds and primary care rotations. but, i am thinking that a fellowship (even if just 6 mos more) would be great, make me more marketable, and give me a lot of flexibility in my carreer. especially because i am considering doing ob/gyn as a locum, and then working in planned parenthood type clinics and/or urgent cares when i am not travelling.

any input? is it possibe? do i even need to do a fellowship or look for extra training? am i insane? thanks in advance!

I dont think you will have any problem learning primary care during an OBGYN residency,most OBGYNs who deliver primary care as part of their practice gain sufficient experience during a residency.However you might want to consider the economic viability of the arrangements you propose..The overhead costs of an OBGYN are high in any type of practice arrangement. Its not realistic to pay a GYN trained individual to do primary care. This can be done by FP or more frequently now by PAs especially in family planning clinics.GYNs need to do procedures that are well paid to cover their expenses. If you want to do mostly primary care then focus on that route through FP. If you did an OBGYN residency and focused on primary care your sugical skills would eventually atrophy.

 

[neilc]

I dont think you will have any problem learning primary care during an OBGYN residency,most OBGYNs who deliver primary care as part of their practice gain sufficient experience during a residency.However you might want to consider the economic viability of the arrangements you propose..The overhead costs of an OBGYN are high in any type of practice arrangement. Its not realistic to pay a GYN trained individual to do primary care. This can be done by FP or more frequently now by PAs especially in family planning clinics.GYNs need to do procedures that are well paid to cover their expenses. If you want to do mostly primary care then focus on that route through FP. If you did an OBGYN residency and focused on primary care your sugical skills would eventually atrophy.

i don't really want to "focus" on primary care and do gyn on the side...what i really want is more the opposite. i was thinking that it would be nice to have the flexibility to either "retire" into a primary care type setting, or to do mainly locum work for a large part of the year (say 8-9 months) and then have the option to fill holes in a schedule working in an urgent care.

i guess that i can do that without specific training, though. as you mentioned, there is lots of IM, primary and peds in an Ob/gyn residency, and i will be licensed.

 

[sjh]

look at it this way:

if you want to see ONLY WOMEN FOR THE REST OF YOUR CAREER, than Ob/Gyn is for you. this is the biggest difference btw family practice & ob/gyn.

if you want to deliver babies along with seeing the rest ofthe family, this is very do-able in family practice, depending A LOT on where you are (i.e. malpractice).

if you choose ob/gyn & want to do a lot of "clinic" work, paps, etc, than this is primary care & you can totally do this. you can then still do your occ TAH, myomectomy, & LEEPs. but you wont ever see kids or males.

if you love surgery then consider doing 1/2 time work doing surgeries & 1/2time at a free clinic or somthing. i know a lot of surgeons that do this & still get to see an interested cross-section of the population & then also follow patients over the course of a few years.

also consider a very rural area for family practice training. i worked with a family prac doctor in the middle of no wherein VA my 2nd yearof med school. he did endo biopsies, leeps, cryos, casting, splinting, deliveries-even a occ c/s!!!, removed moles, & other minor plastics, vascectomies,basically aside from open abd surgeries (or neuro of course!) he did it! the WHOLE town knew him & loved him & he saw everyone cradle to grave for their whole lives. the definiton of primary care!!

hope that helps!