Realistically, can I have a reasonable lifestyle?

[Metamorphosis.DO]

I am a medical student and OB/GYN has always been a big passion of mine. Being a husband and father has given me a unique perspective. I know that my family is my first priority and I actually see that as a strength professionally rather than a weakness. If my life at home is happy, ill be a better doctor.

Lately I’ve considered FM which I still think would make me happy. I plan on practicing in a relatively rural area of the country where FMs are still delivering. i wouldn’t rule out an OB fellowship either to acquire operative OB skills. Truly, though, surgery isn’t super important to me For the sake of being a surgeon. The reason I still consider OB is because I really want to be able to offer a fuller spectrum women’s health that I know I wouldn’t have in FM. Like infertility, not having to refer out for female surgeries, more complicated conditions, etc. so again, it’s not the “being a surgeon“ that makes me hang on to the possibility of OB, it’s more so the ability to offer more to my favorite patient demographic (women).

Now, what I’m wondering is if making these inevitable lifestyle sacrifices for OB would be worth it. Sure, my patients would have Access to more care if I have that training, but I don’t want my own girls (wife and two daughters) to disproportionally suffer.

Is it possible to have a reasonable lifestyle in OB? Does working in too big a group distort continuity of care and personalized healthcare? How small is too small in terms of a group of OBs to the point where my life would be overburdened?

2 year male med student.

Anyone have a current setup that they love and facilitates the realization of similar goals?

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[Campanella]

I currently work in a big group, and it does afford a lifestyle that's reasonable enough (what averages out to a 4 day work week and q 7 call schedule). But, I work in a large practice in a decent-sized city. If you want to practice Ob/Gyn in a rural setting, that definitely changes things. One of my good friends is a rural Ob/Gyn, and they essentially work 24/7 (although this is partially due to their older partner phasing out L&D call). Most rural practices tend to be smaller, which means you take L&D call more often, potentially even taking call every other night (q 2 call). While rural L&Ds are less busy, you still need to be readily available for whoever comes through your door.

I don't know how the work dynamic changes by being a family medicine physician in a rural setting, but I assume it wouldn't change much if you want to continue doing obstetrics. Family medicine is unique among specialties in that it's what you make it. You can work true bankers hours with no weekends, but continuing to practice obstetrics will definitely add a layer of unpredictability, especially if you're the only clinician practicing obstetrics in your area.

The biggest factor in your decision isn't necessarily family medicine with Ob vs Ob/Gyn, but whether you want to provide obstetric services in a rural location. How remote your location is also matters. Practicing in a town with 30,000 people is very different than working somewhere as remote as the Four Corners. You will have more resources and flexibility (i.e. more partners/clinicians to share the obstetrics load) in the former than the later.

 

[Metamorphosis.DO]

I currently work in a big group, and it does afford a lifestyle that's reasonable enough (what averages out to a 4 day work week and q 7 call schedule). But, I work in a large practice in a decent-sized city. If you want to practice Ob/Gyn in a rural setting, that definitely changes things. One of my good friends is a rural Ob/Gyn, and they essentially work 24/7 (although this is partially due to their older partner phasing out L&D call). Most rural practices tend to be smaller, which means you take L&D call more often, potentially even taking call every other night (q 2 call). While rural L&Ds are less busy, you still need to be readily available for whoever comes through your door.

I don't know how the work dynamic changes by being a family medicine physician in a rural setting, but I assume it wouldn't change much if you want to continue doing obstetrics. Family medicine is unique among specialties in that it's what you make it. You can work true bankers hours with no weekends, but continuing to practice obstetrics will definitely add a layer of unpredictability, especially if you're the only clinician practicing obstetrics in your area.

The biggest factor in your decision isn't necessarily family medicine with Ob vs Ob/Gyn, but whether you want to provide obstetric services in a rural location. How remote your location is also matters. Practicing in a town with 30,000 people is very different than working somewhere as remote as the Four Corners. You will have more resources and flexibility (i.e. more partners/clinicians to share the obstetrics load) in the former than the later.

This is very helpful. I appreciate the insight.
it also makes sense that more than anything, it’s WHERE I practice that will make the biggest impact on my lifestyle in the context of obstetrics. I did my undergrad in a town of 35,000 but would likely end up working in a town about 30 minutes from there which is 60,000. (So not really very rural but not suburban in that it’s no where near to a metropolis.) So I would like to believe that I could get into a big enough practice where I could hopefully shoot for something like what you have.

do you sense much disappointment from your OB patients since you don‘t (I assume) deliver most of their babies being that you are only on call q7?

I know you said it’s about a 4d work week average, how many hours dones that put you at?

I assume you operate 1/2 day a week?

And a side note, do most of your pregnant patients routinely see other physicians in your group for prenatal care? Is that common practice or is that just in some groups?

thanks for answering my multitude of questions.

 

[Campanella]

This is very helpful. I appreciate the insight.
it also makes sense that more than anything, it’s WHERE I practice that will make the biggest impact on my lifestyle in the context of obstetrics. I did my undergrad in a town of 35,000 but would likely end up working in a town about 30 minutes from there which is 60,000. (So not really very rural but not suburban in that it’s no where near to a metropolis.) So I would like to believe that I could get into a big enough practice where I could hopefully shoot for something like what you have.

do you sense much disappointment from your OB patients since you don‘t (I assume) deliver most of their babies being that you are only on call q7?

I know you said it’s about a 4d work week average, how many hours dones that put you at?

I assume you operate 1/2 day a week?

And a side note, do most of your pregnant patients routinely see other physicians in your group for prenatal care? Is that common practice or is that just in some groups?

thanks for answering my multitude of questions.

Even though I'm in a big group and we deliver each other's patients, I do sometimes come in to deliver my own patients. But I also explain to my patients early in prenatal care that if I'm not able to make it, one of my partners will definitely be there.

Half of my patients have seen me for their entire prenatal care (these are the ones I do try to deliver personally), and half see my partners for at least a part of their care. Based on what I saw from private groups in residency, I think this is fairly common.

About half of my partners will come in for their own deliveries during work hours, and even they rarely come in after hours. Granted, this is largely possible because all of our calls are in house (which means at least one of us will physically be in the hospital 24/7). But I've also seen this set up in private groups where the on-call physician takes home call.

On average, I work about 50 - 60 hours per week. Definitely much better than residency work hours. I also operate 1/2 day per week.

Keep the questions coming! This isn't stuff you're going to necessarily learn in academia (medical school and university residency programs for that matter).

 

[DocWinter]

Lately I’ve considered FM which I still think would make me happy. I plan on practicing in a relatively rural area of the country where FMs are still delivering. i wouldn’t rule out an OB fellowship either to acquire operative OB skills. Truly, though, surgery isn’t super important to me For the sake of being a surgeon. The reason I still consider OB is because I really want to be able to offer a fuller spectrum women’s health that I know I wouldn’t have in FM. Like infertility, not having to refer out for female surgeries, more complicated conditions, etc. so again, it’s not the “being a surgeon“ that makes me hang on to the possibility of OB, it’s more so the ability to offer more to my favorite patient demographic (women).

I’m not a very big fan of these OB fellowships for FM. Most end up only doing one year of OB which is insufficient to become a good obstetrician as well as as far as I know, no GYN surgeries.

At the end of the day you’re still not a surgeon and possibly a dangerous OB.

If you need to be in the OR, do OB. If you like better hours and don’t want the stress, do FM

 

[Metamorphosis.DO]

I’m not a very big fan of these OB fellowships for FM. Most end up only doing one year of OB which is insufficient to become a good obstetrician as well as as far as I know, no GYN surgeries.

At the end of the day you’re still not a surgeon and possibly a dangerous OB.

If you need to be in the OR, do OB. If you like better hours and don’t want the stress, do FM

I’m wondering if you are aware of any literature that may be consistent your analysis of OB fellowship being insufficient training for OB.
everthing I’ve seen shows that they are nearly equal interns of complication rates with few exceptions.

 

[DocWinter]

I’m wondering if you are aware of any literature that may be consistent your analysis of OB fellowship being insufficient training for OB.
everthing I’ve seen shows that they are nearly equal interns of complication rates with few exceptions.

Would like to see your sources. Curious if they comment on the difficulty of patients fellowship trained docs take on; hopefully they compare apples to apples rather than fellowship physicians largely taking “belly check” caliber patients and bypassing the train wrecks when they can. Also would be helpful if there other metrics than complication rates, or had an appropriate data size sample, as we all know most midwifes can deliver a NSVD without complications and a studies can easily be tailored to fit the desired outcome.

Regardless, my experience dealing with midwives and physicians who have not completed residency in OB are that they do very well and everything is fine, until it isn’t. Most of my most horrific experiences in residency were receiving a call from a FM doing OB or a midwife bringing a patient in for a ruptured uterus, uncontrolled hemorrhage and seizures. Dead kids. Massive transfusions. Comas. Otherwise young healthy ladies spending a week in SICU. Devastating outcomes happen, but they shouldn’t happen when they can be avoided.

All true stories, but I don’t think they made it into any of the literature

 

[Dr G Oogle]

I’m wondering if you are aware of any literature that may be consistent your analysis of OB fellowship being insufficient training for OB.
everthing I’ve seen shows that they are nearly equal interns of complication rates with few exceptions.

The outcomes are equal in straightforward uncomplicated deliveries because it requires less “OB” knowledge then anything remotely complicate (GDM, gHTN, prolonged labor, a repeat c section, etc). They are no more equivalent then a general obgyn is equivalent to a urogyn or gyn oncologist for treating pelvic floor stuff and cancer, respectively. Or for that matter an obgyn is to FM for treating anything beyond basic hypertension and high cholesterol or anything else that an FM handles routinely in their clinics.

 

[Campanella]

The outcomes are equal in straightforward uncomplicated deliveries because it requires less “OB” knowledge then anything remotely complicate (GDM, gHTN, prolonged labor, a repeat c section, etc). They are no more equivalent then a general obgyn is equivalent to a urogyn or gyn oncologist for treating pelvic floor stuff and cancer, respectively. Or for that matter an obgyn is to FM for treating anything beyond basic hypertension and high cholesterol or anything else that an FM handles routinely in their clinics.

This is the big caveat. I used to work in a place that had family medicine Ob fellowship and family medicine Ob staff. They were great at handling uncomplicated Ob and could even do primary c-sections fairly competently. We would get involved with anything beyond that though. The FM attendings trained in Ob would also either be in house, and it was clear that the Ob/Gyn had the ultimate say about laboring patients. So things never got out of hand to the point that DocWinter is describing.

 

[GEORG7]

I currently work in a big group, and it does afford a lifestyle that's reasonable enough (what averages out to a 4 day work week and q 7 call schedule). But, I work in a large practice in a decent-sized city. If you want to practice Ob/Gyn in a rural setting, that definitely changes things. One of my good friends is a rural Ob/Gyn, and they essentially work 24/7 (although this is partially due to their older partner phasing out L&D call). Most rural practices tend to be smaller, which means you take L&D call more often, potentially even taking call every other night (q 2 call). While rural L&Ds are less busy, you still need to be readily available for whoever comes through your door.

I don't know how the work dynamic changes by being a family medicine physician in a rural setting, but I assume it wouldn't change much if you want to continue doing obstetrics. Family medicine is unique among specialties in that it's what you make it. You can work true bankers hours with no weekends, but continuing to practice obstetrics will definitely add a layer of unpredictability, especially if you're the only clinician practicing obstetrics in your area.

The biggest factor in your decision isn't necessarily family medicine with Ob vs Ob/Gyn, but whether you want to provide obstetric services in a rural location. How remote your location is also matters. Practicing in a town with 30,000 people is very different than working somewhere as remote as the Four Corners. You will have more resources and flexibility (i.e. more partners/clinicians to share the obstetrics load) in the former than the later.

Even though I'm in a big group and we deliver each other's patients, I do sometimes come in to deliver my own patients. But I also explain to my patients early in prenatal care that if I'm not able to make it, one of my partners will definitely be there.

Half of my patients have seen me for their entire prenatal care (these are the ones I do try to deliver personally), and half see my partners for at least a part of their care. Based on what I saw from private groups in residency, I think this is fairly common.

About half of my partners will come in for their own deliveries during work hours, and even they rarely come in after hours. Granted, this is largely possible because all of our calls are in house (which means at least one of us will physically be in the hospital 24/7). But I've also seen this set up in private groups where the on-call physician takes home call.

On average, I work about 50 - 60 hours per week. Definitely much better than residency work hours. I also operate 1/2 day per week.

Keep the questions coming! This isn't stuff you're going to necessarily learn in academia (medical school and university residency programs for that matter).

On side note, if you don't mind sharing, how much is average annual income in your group and can you compare it to your friend is suburban or rural areas?

 

[gynObMD]

I’m not a very big fan of these OB fellowships for FM. Most end up only doing one year of OB which is insufficient to become a good obstetrician as well as as far as I know, no GYN surgeries.

At the end of the day you’re still not a surgeon and possibly a dangerous OB.

If you need to be in the OR, do OB. If you like better hours and don’t want the stress, do FM

I completely agree. I have seen bigger and more egregious problems (I do Chart review for several regional and state entities) with FM doing OB. It’s mostly with them getting in way over their head and not realizing it until it’s too late. I’m not saying that they are all bad, but when a difficult case becomes catastrophic, you really want the 4 years of OB training behind you. The two programs do not compare.