Specialty Advice & Clerkship Advice

[jstargirl17]

Hi,

I am currently a third-year medical student doing my clinical rotations. I apologize in advance for the long post

I have my OB/GYN rotation next month and I am in some ways excited and in some ways nervous. I am hoping that I enjoy OB/GYN since I really care about women’s health, healthcare disparities, and am very interesting in trying to combat maternal and fetal health mortality among black women and infants.

I’m currently on my Gen Surg rotation and while I haven’t hated the rotation, I do not love it. The hours have been very rough and I feel like I have not seen the sun in so long (I wake up at 4:15am, get to the hospital by 6:00am, and leave the hospital between 5:00pm and 6:00pm). Most of the surgeries I have seen are laparoscopic hernia repairs, gallbladder removals, sometimes some abscess and cyst removals. With these surgeries, I mainly just either hold the camera if it’s a laparoscopic procedure, retract, and then sometimes close/suture on small port site areas. Most of the surgery residents have been pretty nice but I understand that Gen surgery is a stressful specialty so at times they do not really explain what is happening during a surgery.. to prepare I just try to look up the anatomy beforehand and look up the surgery using resources such as SAGES YouTube channel, UptoDate, NIH stat pearls articles, and even jsut googling images of the anatomy

I do not hate the OR but at the same time I do not love the OR. I am not grossed out by blood or poop (even though poop smells) and I really don’t have any favorite place in the hospital. I feel like I can adapt/be comfortable in all areas of the hospital since at the end of the day it is still a work environment. However, I do know that I do not want to be in the OR the majority of the time like general surgery has been. Some days we have had 8 surgeries back to back in a row (mainly just laparoscopic or robotic assisted hernia repairs and laparoscopic gallbladder removals). There have been a couple of instances of open abdominal surgeries that have been neat to see (like seeing the entire small intestine and colon taken out).

Now this leads me to OB/GYN. I know GYN can have a lot of surgeries (like hysterectomies, Gyn Onc, tubal ligations, etc). This is a whole new area of the body that I have never seen before surgically so I am open to learning. I have never seen a C-section before and I have never seen a natural birth in person before (though I have seen some videos). As a naturally anxious person who overthinks, I sometimes have fear and anxiety about not liking OB/GYN after all or not being able to handle the stress and pressure of doing surgeries.. supportive friends have told me that a doctor is not born overnight and that as a third year med student I still have a long way to go before I’ll be allowed to practice medicine solo/independently/without supervision.. but for me I know being doctor, especially one that does procedures and/or surgeries is a serious thing and one that I do not take lightly.

I know the type of surgeries in General Surg is different from GYN... So still keeping an open mind like I have been doing for each rotation and learning as much as I can.. I have also been practicing doing a running subcuticular suture since I heard that suture is common for C-sections


Therefore, I just want some guidance on things I should be thinking about as a med student during my OB/GYN rotation when thinking about a specialty, resources to sue for studying, and how to prepare clinically for the first day of the rotation

________________________________________

The other two specialties I am considering are IM or FM. For IM, I do like the idea of being able to do a fellowship in a specialty area if desired (I’m interested in medical oncology or cardiology). However, I do not like that there is not as much women’s health.. For FM, I do like that there’s women’s health and an opportunity to do an OB fellowship. However, I heard from some FM residents that doing an OB fellowship still does not replace doing an OB/GYN residency and you still may need to consult an OB for help.. I also know family medicine is very broad and involves knowing a little bit about everything. While I do not think this is a bad thing, at the same time I feel like doing IM or specializing in on area could be beneficial instead of always having to rely on consulting patients to a specialist.. one of my mentors also told me (who is a FM attending) stated that FM physician burnout is real and that the amount of work that she and other FM docs do does not equate to the quality of care they can provide patients (which she said is frustrating since they want to spend more than 15 minutes with patients) or their compensation… she told me these are other things to consider with FM

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[anonperson]

Hi,

I am currently a third-year medical student doing my clinical rotations. I apologize in advance for the long post

I have my OB/GYN rotation next month and I am in some ways excited and in some ways nervous. I am hoping that I enjoy OB/GYN since I really care about women’s health, healthcare disparities, and am very interesting in trying to combat maternal and fetal health mortality among black women and infants.

I’m currently on my Gen Surg rotation and while I haven’t hated the rotation, I do not love it. The hours have been very rough and I feel like I have not seen the sun in so long (I wake up at 4:15am, get to the hospital by 6:00am, and leave the hospital between 5:00pm and 6:00pm). Most of the surgeries I have seen are laparoscopic hernia repairs, gallbladder removals, sometimes some abscess and cyst removals. With these surgeries, I mainly just either hold the camera if it’s a laparoscopic procedure, retract, and then sometimes close/suture on small port site areas. Most of the surgery residents have been pretty nice but I understand that Gen surgery is a stressful specialty so at times they do not really explain what is happening during a surgery.. to prepare I just try to look up the anatomy beforehand and look up the surgery using resources such as SAGES YouTube channel, UptoDate, NIH stat pearls articles, and even jsut googling images of the anatomy

I do not hate the OR but at the same time I do not love the OR. I am not grossed out by blood or poop (even though poop smells) and I really don’t have any favorite place in the hospital. I feel like I can adapt/be comfortable in all areas of the hospital since at the end of the day it is still a work environment. However, I do know that I do not want to be in the OR the majority of the time like general surgery has been. Some days we have had 8 surgeries back to back in a row (mainly just laparoscopic or robotic assisted hernia repairs and laparoscopic gallbladder removals). There have been a couple of instances of open abdominal surgeries that have been neat to see (like seeing the entire small intestine and colon taken out).

Now this leads me to OB/GYN. I know GYN can have a lot of surgeries (like hysterectomies, Gyn Onc, tubal ligations, etc). This is a whole new area of the body that I have never seen before surgically so I am open to learning. I have never seen a C-section before and I have never seen a natural birth in person before (though I have seen some videos). As a naturally anxious person who overthinks, I sometimes have fear and anxiety about not liking OB/GYN after all or not being able to handle the stress and pressure of doing surgeries.. supportive friends have told me that a doctor is not born overnight and that as a third year med student I still have a long way to go before I’ll be allowed to practice medicine solo/independently/without supervision.. but for me I know being doctor, especially one that does procedures and/or surgeries is a serious thing and one that I do not take lightly.

I know the type of surgeries in General Surg is different from GYN... So still keeping an open mind like I have been doing for each rotation and learning as much as I can.. I have also been practicing doing a running subcuticular suture since I heard that suture is common for C-sections


Therefore, I just want some guidance on things I should be thinking about as a med student during my OB/GYN rotation when thinking about a specialty, resources to sue for studying, and how to prepare clinically for the first day of the rotation

________________________________________

The other two specialties I am considering are IM or FM. For IM, I do like the idea of being able to do a fellowship in a specialty area if desired (I’m interested in medical oncology or cardiology). However, I do not like that there is not as much women’s health.. For FM, I do like that there’s women’s health and an opportunity to do an OB fellowship. However, I heard from some FM residents that doing an OB fellowship still does not replace doing an OB/GYN residency and you still may need to consult an OB for help.. I also know family medicine is very broad and involves knowing a little bit about everything. While I do not think this is a bad thing, at the same time I feel like doing IM or specializing in on area could be beneficial instead of always having to rely on consulting patients to a specialist.. one of my mentors also told me (who is a FM attending) stated that FM physician burnout is real and that the amount of work that she and other FM docs do does not equate to the quality of care they can provide patients (which she said is frustrating since they want to spend more than 15 minutes with patients) or their compensation… she told me these are other things to consider with FM

OBGYN is a flawed field.

I don't really recommend it to medical students for the following reasons:

1. Relatively poor reimbursement. Most practices are OB heavy because that generates the most revenue ( which still isn't great). Routine obstetric visits are easy and relatively mindless. Problem is, a significant number of patients are fat, diabetic, and hypertensive. This complicates things further.

For the amount of work, OBGYNs are not as well compensated compared to urology, ENT etc.

Running a GYN only practice is typically not financially viable.

2. If you do obstetrics, then there is the expectation of call. Typically that involves a 24 hour shift. Do you want to take overnight call when you're 50? It's physically demanding. Night shift work is an independent risk factor for heart attack, cancer, and stroke.

If you're in a private group, you may be on call for your own patients Mon through Friday and then split weekends with the group. Every set up is different.

If you're in a Kaiser type system, you will typically have a few 24 hour shifts a month. This will also involve covering the ER and every degenerate OB patient with no prenatal care. These are typically the worst of the worst patients. Usually active drug users.

The main takeaway is a decent number of patients will deliver between the hours of 11pm and 6am.

I had an unassigned patient actively abrupting due to meth use who was Hep C positive. Did an emergency c section. Baby eventually died in NICU. Patients friend snuck some drugs into maternity and patient ended taking them and stroked out. Eventually died. Thankfully no litigation from this.

3. Liability. Again typically related to obstetrics but GYN can come into play as well.

You know how I said most patients are fat nowadays? Now they have fat babies, I mean macrosomic. The spector of shoulder dystocia hovers over your head. God help you if you have a bad shoulder dystocia. If there's any injury, even if you did everything perfectly, you will get sued and it will be an unpleasant experience. Doesn't mean you'll lose but the process is a pain.

I've been sued twice. First one, I eventually got dropped. Hospital paid $10k, (bogus case) because it was cheaper than going to trial.

Second case is ongoing but I expect to get dropped at some point. Again, bogus case but bad outcome and in America, someone must pay.

And it doesn't help that more hospitals are tracking c section rates and trying to shame you if your rate is too high. I don't even care. I just want a good obstetric outcome.

4. I know you have noble intentions of improving obstetric outcomes in minorities but just know it's a losing battle. When your obstetric patient comes in at 5'2" , 200 lbs, you are in damage control mode. It is truly mind boggling how some of these patients get pregnant.

"Life finds a way" ... Unfortunately (my addition)
Ian Malcolm

And contrary to the media narrative, obstetric care in the United States is great. We just have incredibly high risk patients who didn't give a $&ck about anything.

Obesity
Diabetes
Hypertension
Drug use
Non compliance
Advanced maternal age

Normally, if you're a PCP or specialist and a patient doesn't want to listen, you just document and move on with your day. Maybe even fire them from your practice. Unfortunately, with obstetric patients there is an end point that you have to deal with and good luck trying to fire a patient. You are stuck with this patient until they deliver and it could be a huge disaster.

5. The burnout rate is high. The brightside is there are a ton of jobs out their because so many people either completely scale back or try to just do office etc. This will only get worse as the field gets more female dominated. If you want to work, there is money to be made, at the expense of your health though.

6. Malpractice coverage. If you join a private group, you will often have to cover your own tail insurance. This can easily run over $100,000 to be paid in full within a short time frame (think months). This can handcuff you to a bad job. Typically not an issue with academic and health system jobs.

7. Some people will tout being a laborist as a great job/alternative .It is true you can make a decent living working 8 to 10 shifts a month. But these are 24 hour shifts and if you go through one of these companies, you can get sent to some hospitals which are complete disasters.

Doing FM and then an OB fellowship is an option but again, why? Extra liability and worse hours. I have yet to be impressed by the obstetric skills of any FM attending. This isn't a knock on them but the training, even with a fellowship isn't adequate. Too much can go wrong.

-----------------------------------------------------------------

Other than that it's a great field.

I'm not trying to be overly negative but just wanted to point out real issues you will encounter if you become an OBGYN.
Maybe you'll love the field and decide to do it for the rest of your life.

 

[jstargirl17]

OBGYN is a flawed field.

I don't really recommend it to medical students for the following reasons:

1. Relatively poor reimbursement. Most practices are OB heavy because that generates the most revenue ( which still isn't great). Routine obstetric visits are easy and relatively mindless. Problem is, a significant number of patients are fat, diabetic, and hypertensive. This complicates things further.

For the amount of work, OBGYNs are not as well compensated compared to urology, ENT etc.

Running a GYN only practice is typically not financially viable.

2. If you do obstetrics, then there is the expectation of call. Typically that involves a 24 hour shift. Do you want to take overnight call when you're 50? It's physically demanding. Night shift work is an independent risk factor for heart attack, cancer, and stroke.

If you're in a private group, you may be on call for your own patients Mon through Friday and then split weekends with the group. Every set up is different.

If you're in a Kaiser type system, you will typically have a few 24 hour shifts a month. This will also involve covering the ER and every degenerate OB patient with no prenatal care. These are typically the worst of the worst patients. Usually active drug users.

The main takeaway is a decent number of patients will deliver between the hours of 11pm and 6am.

I had an unassigned patient actively abrupting due to meth use who was Hep C positive. Did an emergency c section. Baby eventually died in NICU. Patients friend snuck some drugs into maternity and patient ended taking them and stroked out. Eventually died. Thankfully no litigation from this.

3. Liability. Again typically related to obstetrics but GYN can come into play as well.

You know how I said most patients are fat nowadays? Now they have fat babies, I mean macrosomic. The spector of shoulder dystocia hovers over your head. God help you if you have a bad shoulder dystocia. If there's any injury, even if you did everything perfectly, you will get sued and it will be an unpleasant experience. Doesn't mean you'll lose but the process is a pain.

I've been sued twice. First one, I eventually got dropped. Hospital paid $10k, (bogus case) because it was cheaper than going to trial.

Second case is ongoing but I expect to get dropped at some point. Again, bogus case but bad outcome and in America, someone must pay.

And it doesn't help that more hospitals are tracking c section rates and trying to shame you if your rate is too high. I don't even care. I just want a good obstetric outcome.

4. I know you have noble intentions of improving obstetric outcomes in minorities but just know it's a losing battle. When your obstetric patient comes in at 5'2" , 200 lbs, you are in damage control mode. It is truly mind boggling how some of these patients get pregnant.

"Life finds a way" ... Unfortunately (my addition)
Ian Malcolm

And contrary to the media narrative, obstetric care in the United States is great. We just have incredibly high risk patients who didn't give a $&ck about anything.

Obesity
Diabetes
Hypertension
Drug use
Non compliance
Advanced maternal age

Normally, if you're a PCP or specialist and a patient doesn't want to listen, you just document and move on with your day. Maybe even fire them from your practice. Unfortunately, with obstetric patients there is an end point that you have to deal with and good luck trying to fire a patient. You are stuck with this patient until they deliver and it could be a huge disaster.

5. The burnout rate is high. The brightside is there are a ton of jobs out their because so many people either completely scale back or try to just do office etc. This will only get worse as the field gets more female dominated. If you want to work, there is money to be made, at the expense of your health though.

6. Malpractice coverage. If you join a private group, you will often have to cover your own tail insurance. This can easily run over $100,000 to be paid in full within a short time frame (think months). This can handcuff you to a bad job. Typically not an issue with academic and health system jobs.

7. Some people will tout being a laborist as a great job/alternative .It is true you can make a decent living working 8 to 10 shifts a month. But these are 24 hour shifts and if you go through one of these companies, you can get sent to some hospitals which are complete disasters.

Doing FM and then an OB fellowship is an option but again, why? Extra liability and worse hours. I have yet to be impressed by the obstetric skills of any FM attending. This isn't a knock on them but the training, even with a fellowship isn't adequate. Too much can go wrong.

-----------------------------------------------------------------

Other than that it's a great field.

I'm not trying to be overly negative but just wanted to point out real issues you will encounter if you become an OBGYN.
Maybe you'll love the field and decide to do it for the rest of your life.

Thank you for all of this information. I have heard that OB/GYN is a lot..

What things would you recommend med students do to prepare for their OB/GYN rotation? How can I be most helpful by day 1 of my OB/GYN rotation to help nurses, residents, and attendings?

 

[anonperson]

Thank you for all of this information. I have heard that OB/GYN is a lot..

What things would you recommend med students do to prepare for their OB/GYN rotation? How can I be most helpful by day 1 of my OB/GYN rotation to help nurses, residents, and attendings?

Your clerkship should have a guide on what is expected etc.

When I was in residency, some medical students were on GYN surgery while others covered labor and delivery. They then switched etc to give them full breadth.

Typically your residents should give their expectations regarding rounding, note writing, presenting etc.

OBGYN residents and attendings have a reputation for being miserable although I never really saw this as a medical student.

Book wise, it depends.. There isn't a lot out there to be honest. First Aid or Blueprints from what I am aware of. Choose one and just focus on it. Supplement with up-to-date as needed.

Show up on time. Do what is expected/asked. Seem interested.

 

[jstargirl17]

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Your clerkship should have a guide on what is expected etc.

When I was in residency, some medical students were on GYN surgery while others covered labor and delivery. They then switched etc to give them full breadth.

Typically your residents should give their expectations regarding rounding, note writing, presenting etc.

OBGYN residents and attendings have a reputation for being miserable although I never really saw this as a medical student.

Book wise, it depends.. There isn't a lot out there to be honest. First Aid or Blueprints from what I am aware of. Choose one and just focus on it. Supplement with up-to-date as needed.

Show up on time. Do what is expected/asked. Seem interested.

Thank you for the response

This is what makes me nervous about my OB/GYN rotation. Some people have been telling me that they didn’t like their rotation due to the atmosphere…


I’m hoping I have a good experience. I’ve never seen a childbirth in person before so I’m both a little excited and nervous. I’ve seen videos of childbirth online but never seen one in person. I’ve also never seen a C-section

I’m also nervous about GYN surg in the sense that I don’t know how it will compare to gen surg. I don’t hate the OR but at the same time I don’t love the OR either. But I’m not phased by blood, poop can smell/be nasty but I’ve survived lol
I’ve been working on suturing which is hard at times but I’ve told by numerous people that it takes lot of practice