One of our Reproductive Endocrinologists said something like, "I chose academics because I love to teach. I could have gone to Madison Avenue, in Manhattan, and made a million dollars a year with the rest of my friends, but instead, I wanted to stay here, for less than a third of that." If you can make 333,333.00 bucks in Columbia, Missouri, you could do much better elsewhere.
It can be a high paying job.
It is NOT the hardest post-Ob fellowship to get into, by the way. That would be Gyn Oncology. I asked my chief resident about competetiveness, and that's what she said.