OB actually is a lot of fun, despite how un-fun OB residents want to make it for you. Don't let that be a distraction. There's a lot of skill involved but, hey, that's why we go through training and learn lifelong. It's just like anything else in medicine.
Rural communities usually have a real hard time recruiting (and retaining) doctors. But if you look at want ads, there's so much demand for FP's in rural communities. I don't know what it's like for Med-Peds.
And, if you decide some time in the future that you don't want to live in a rural community, it's way easier to move back into a super crowded city as a rural doc. And, if you do OB, holy cow, there're so many jobs, good paying jobs, looking for FP-OB's it's ridiculous. And, if you're a rural doctor who does FP-OB looking to move back into the city, it'll be EASY to land an academic job where you can continue to do OB. If... you're interested in OB.
If you are willing to do 4 years of residency anyways, you should consider doing a fellowship. There are Rural Medicine fellowships as well as OB fellowships and hospitalist fellowships (
www.aafp.org/fellowships). I don't think any of these would increase your income significantly, but I do think they would make you a better doctor.
A good FM program should offer you good inpatient medicine training comparable to a internal medicine residency. The difference may be that your ventilator management skills, scope skills, and possibly critical care skills may not be as good as the medicine folks. But a good FM program will allow you to obtain this.
Even a good FM program, however, may not get you a pediatric training equivalent to a pediatric residency. It'll get you really good outpatient and general inpatient skills, but a lot of FM programs don't train at super-high-tech tertiary or quaternary children's referral hospital. That being said, most rural communities and a lot of suburban communities don't have capabilities like that anyways, so you can make the argument that training in such facilities may not be pertinent to your future practice.
I don't know. I can see the argument both ways. When I made my decision to go FM, I made a conscience decision to sacrifice the care of Siamese twins, transplant babies, incubator babies, and genetic defect babies to pediatricians. Hmmm... yea, I'm ok with that. I still see plenty of kids and adolescents in the scope I'm comfortable with.
Lastly, remember, to be a true Med-Peds, you have to take 2 boards and keep up your certifications in 2 specialties. That means you study for the boards twice, buy 2 sets of review books, go to 2 board review courses, and do twice the amount of CME. In rural communities, sometimes, it's really hard to get access to these courses/CME's because of distance. And, if you could go, it may be hard to find someone to cover for you to take time out to go. That being said, the Internet has been great to rural communities. But if you're going to be inconvenienced, I'd rather do it one time than have to do it twice.
But that's just me.
