Specialty Crisis

[jstargirl17]

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Sounds like you should do FM (possibly with a women’s health fellowship). This is the one specialty that would let you check the boxes above to one extent or another.

There are some IM women’s health tracks that seem to offer great training and still the option to sub specialize if I want (IM has both inpatient training and outpatient)

If I did FM I want to have good women’s health training and exposure….

 

[gutonc]

There are some IM women’s health tracks that seem to offer great training and still the option to sub specialize if I want (IM has both inpatient training and outpatient)

IM+Women's Health doesn't set you up for OB care like FM+OB would. But you are correct that IM would allow you a broader slate of fellowship options if you decided that the WH track wasn't what you wanted.

If I did FM I want to have good women’s health training and exposure….

You definitely would.

 

[smq123]

Hi all!

I have reached out to a few of the program directors for IM residency programs with either women's health tracks or primary care tracks. I will be meeting with Ohio State's IM residency primary care program director about women's health training next week.

I have also been talking to OB/GYN attendings that I have worked with.

My gut is saying to do OB/GYN but my logical side/brain is saying do I really want to do GYN surg?

My dream job is to have a women's health clinic that does OB care, GYN care, primary care, and mental health. I have truly enjoyed the patient population I have worked with

I am still exploring all of my options (OB/GYN, IM, even FM)?

I have heard of OB anesthesia since people have told me that anesthesia has great money and a great lifestyle and something I should look more into.

Trying to have faith that everything will work out and be okay

Aside from OB (which you could easily add in most of the US), you’ve described 80% of a typical FM practice.

 

[smq123]

There are some IM women’s health tracks that seem to offer great training and still the option to sub specialize if I want (IM has both inpatient training and outpatient)

If I did FM I want to have good women’s health training and exposure….

Have you ever done an FM rotation? You don’t sound like you have….

 

[LucidSplash]

Have you ever done an FM rotation? You don’t sound like you have….

OP’s reservations about FM, despite all the reasons that it probably is the best fit for them, seem to be primarily financial.

 

[jstargirl17]

I have not had my FM rotation yet... I have it in May

I also want to be able to have options for fellowship... I like that with IM it is the most broad (can do inpatient med, outpatient med, or fellowships down the road).

 

[smq123]

OP’s reservations about FM, despite all the reasons that it probably is the best fit for them, seem to be primarily financial.

Fair enough. Although IM with a focus on womens health and FM with a focus on womens health get paid roughly the same. Outpatient primary care is outpatient primary care. That said, we're not starving or asking for food stamps, unless you do something financially REALLY stupid (like this guy: https://www.courts.wa.gov/content/petitions/90043-4 COA Respondents Brief.pdf). (That PDF will never not be fascinating to read.)

I have not had my FM rotation yet... I have it in May

I also want to be able to have options for fellowship... I like that with IM it is the most broad (can do inpatient med, outpatient med, or fellowships down the road).

That's fair. But if you are truly interested in womens health, but don't want to do GYN surgery (and many people don't) then FM-OB is a viable option.

 

[jstargirl17]

I have done more research on FM-OB... it will be hard to do C-sections compared to trained OB/GYNs... also you may need backup for complications by an OB/GYN... also it will be harder to find a job in urban and suburban areas (which is where I'm interested in practicing) vs OB/GYN doctors. I'm not interested in working rural or semi-rural...

so it looks like I have some big decisions to make- if I want to have full spectrum ability for women's health, then OB/GYN is the way to go.. I will need to ask myself tough questions of it I can handle GYN surg training in residency... -> as my mom has said to me, "**** or get off the pot"

if I decide not to do OB/GYN, then it is IM. IM is broad, good exposure to both inpatient and outpatient medicine, and there are fellowship opportunities.

I just do not like how FM is not paid for the amount of work and hours they do....

I know that it should not be all about the money, but residency and attending life is hard. I feel that I should be able to make the $300K threshold in a specialty that I like/am interested in, feel connected with patients, and also have a healthy work-life balance

 

[HemeOncHopeful19]

I have done more research on FM-OB... it will be hard to do C-sections compared to trained OB/GYNs... also you may need backup for complications by an OB/GYN... also it will be harder to find a job in urban and suburban areas (which is where I'm interested in practicing) vs OB/GYN doctors. I'm not interested in working rural or semi-rural...

so it looks like I have some big decisions to make- if I want to have full spectrum ability for women's health, then OB/GYN is the way to go.. I will need to ask myself tough questions of it I can handle GYN surg training in residency... -> as my mom has said to me, "**** or get off the pot"

if I decide not to do OB/GYN, then it is IM. IM is broad, good exposure to both inpatient and outpatient medicine, and there are fellowship opportunities.

I just do not like how FM is not paid for the amount of work and hours they do....

I know that it should not be all about the money, but residency and attending life is hard. I feel that I should be able to make the $300K threshold in a specialty that I like/am interested in, feel connected with patients, and also have a healthy work-life balance

I would be REALLY careful about assuming OBGyn is paid any more $/hour than an FM doc...

 

[RangerBob]

I have done more research on FM-OB... it will be hard to do C-sections compared to trained OB/GYNs... also you may need backup for complications by an OB/GYN... also it will be harder to find a job in urban and suburban areas (which is where I'm interested in practicing) vs OB/GYN doctors. I'm not interested in working rural or semi-rural...

so it looks like I have some big decisions to make- if I want to have full spectrum ability for women's health, then OB/GYN is the way to go.. I will need to ask myself tough questions of it I can handle GYN surg training in residency... -> as my mom has said to me, "**** or get off the pot"

if I decide not to do OB/GYN, then it is IM. IM is broad, good exposure to both inpatient and outpatient medicine, and there are fellowship opportunities.

I just do not like how FM is not paid for the amount of work and hours they do....

I know that it should not be all about the money, but residency and attending life is hard. I feel that I should be able to make the $300K threshold in a specialty that I like/am interested in, feel connected with patients, and also have a healthy work-life balance

Plenty of FMs are making $300k or more with a very good work-life balance

Per hour worked, it wouldn’t surprise me if they’re often paid more than OB

 

[dozitgetchahi]

I would be REALLY careful about assuming OBGyn is paid any more $/hour than an FM doc...

Yeah. As I understand it, the money for OB/GYN is not nearly as good as it once was. And the lifestyle is way worse vs FM.

OP, another thing you should realize is that if you want to do true *primary care* outpatient clinic with some amount of women’s health, then FM or IM are really your only options. OB/GYN doesn’t really train you to do primary care (yes, I’ve seen a few OBs try to claim they’re “PCPs”, but they’re not very good at it. I’ve seen these “PCP OBs” try to manage primary hypertension and heart failure etc…it’s not pretty).

 

[gutonc]

Yeah. As I understand it, the money for OB/GYN is not nearly as good as it once was. And the lifestyle is way worse vs FM.

OP, another thing you should realize is that if you want to do true *primary care* outpatient clinic with some amount of women’s health, then FM or IM are really your only options. OB/GYN doesn’t really train you to do primary care (yes, I’ve seen a few OBs try to claim they’re “PCPs”, but they’re not very good at it. I’ve seen these “PCP OBs” try to manage primary hypertension and heart failure etc…it’s not pretty).

This part can't be overstated. Recognize that "Women's Health" isn't just "lady parts management". It's managing DM, HTN, HLP, COPD, etc as well.

 

[dozitgetchahi]

I have done more research on FM-OB... it will be hard to do C-sections compared to trained OB/GYNs... also you may need backup for complications by an OB/GYN... also it will be harder to find a job in urban and suburban areas (which is where I'm interested in practicing) vs OB/GYN doctors. I'm not interested in working rural or semi-rural...

so it looks like I have some big decisions to make- if I want to have full spectrum ability for women's health, then OB/GYN is the way to go.. I will need to ask myself tough questions of it I can handle GYN surg training in residency... -> as my mom has said to me, "**** or get off the pot"

if I decide not to do OB/GYN, then it is IM. IM is broad, good exposure to both inpatient and outpatient medicine, and there are fellowship opportunities.

I just do not like how FM is not paid for the amount of work and hours they do....

I know that it should not be all about the money, but residency and attending life is hard. I feel that I should be able to make the $300K threshold in a specialty that I like/am interested in, feel connected with patients, and also have a healthy work-life balance

Looking at this, I think you need to sort out some priorities here - you need to figure out what you care about the most with patient care, what’s next in importance to you, etc.
Some points:

- You can definitely make $300k in primary care (I’ve encountered PCPs doing much better than that, even). You talk about the “hours worked vs pay” issue in primary care, but quite honestly I think that ratio is better in primary care than OB.

- With regards to FM vs IM: you need to figure out whether women’s health means more to you than access to IM fellowships. If you really want to focus on women’s health in the context of primary care, then FM is the obvious choice - you get a lot more OB training in FM residency vs IM (read: zero). FM has dedicated OB rotations and much more training in gyn associated issues in clinic, whereas IM residencies have basically…nothing (the only thing I ever did in that direction as an IM resident was Pap smears). Not saying that there’s not some amount of women’s health training you can cobble together in an IM program - maybe OB electives or something - but it’s not going to be a focus of the program.

- re: fellowships: In FM, you have access to women’s health fellowships - note that you *don’t* have access to those fellowships in IM. (Obviously, you have a bunch of medical subspecialty options in IM that you don’t have in FM). So you need to know if, say, matching cardiology matters more to you someday than doing women’s health. Because if you go IM and match a subspecialty, you’re almost certainly not going to be doing much women’s health aside from helping to manage some pregnant patients who happen to have issues associated with your specialty.

 

[jstargirl17]

Xx

 

[jstargirl17]

I don’t know why I’m not able to reply to post from my phone without the emojis/it looking a mess with all of the different characters… I’ve never deleted the app from my phone and re-downloaded and it’s still acting funny

So I will try to post from my computer instead..

 

[Lost in Translation]

Yeah. As I understand it, the money for OB/GYN is not nearly as good as it once was. And the lifestyle is way worse vs FM.

OP, another thing you should realize is that if you want to do true *primary care* outpatient clinic with some amount of women’s health, then FM or IM are really your only options. OB/GYN doesn’t really train you to do primary care (yes, I’ve seen a few OBs try to claim they’re “PCPs”, but they’re not very good at it. I’ve seen these “PCP OBs” try to manage primary hypertension and heart failure etc…it’s not pretty).

Non sequitur but I F**KING HATE that ACOG is pushing the field towards “OBs are primary care providers”. I didn’t get into OBGYN to manage diabetes and blood pressure with bullsh*t meds like Novolog and labetalol and hydralazine or do wart removals just because it’s on the labia majora. Yes, OBs typically get saddled with doing nonsense like that because many docs in other fields better-educated to treat such conditions won’t touch a woman with a ten foot pole, but the solution is not to bend over and accept it; the solution is to tell these other doctors to do their jobs and not be afraid of the p*ssy, or be comfortable referring to Primary Care who does basic HTN, DM, and hypothyroid on the daily.