Torn between peds and obgyn

[SpanishMusical]

Hi all -- I went into med school thinking I would do peds, but as third year ends, I was really taken by surprise both by how much I liked my time on OBGYN and by how I felt on peds. Breaking it down by field:
OBGYN
Pros
- I felt like I fit in best with the residents here, and really liked the culture. Residents seemed like actual friends, and the attendings were all great. I respond well to the "coach-pushing-you-to-be-better" types
- OBGYNs seem like badasses -- thought it was super cool when a delivery got a little complicated and the chief knew how to handle it with a cool head
- I love OB counseling, talking about the psych aspects (how the parents are feeling), and the focus on the family in OB clinic
- I enjoy working with the mostly young, (fairly) healthy population on OBGYN
Cons
- I'm not a natural in the OR. I was able to learn some, but knot-tying/suturing doesn't come naturally to me the way working with kids does
- We had a delivery of a congenital cards kid complicated by a perineal lac; I was much more interested in the resuscitation of the kid than the repair of the lac
- I don't particularly love the super long cases

Peds
Pros
- The weeks I smiled the most during clerkships was on outpatient peds. I love working with the kids and making the exam a game for them; it really makes me happy. The lack of acuity/complexity doesn't matter to me as much since the kids are so much fun
- I'm naturally good with kids -- have received this feedback a lot, and friends/family also comment on it
- I find pediatric pathology fascinating
- I really enjoy counseling/reassuring parents
- Some cool procedures on outpatient -- got to help with a few lac repairs and observe a circ, both which were very cool
Cons
- I didn't feel like I fit in. It's hard to describe, but my personality is a bit more laid back and direct than what I experienced when I was on peds, and I feel like I just didn't get close with the residents on peds the way I did on OBGYN
- On wards, there was much less interacting with the kids than I expected. This is what I would do peds for, and I felt a little let down. On OBGYN, I really felt like I was accompanying my patients on a journey, if that makes sense
- The peds residents seemed more burnt out and less happy than the OBGYN ones; there was less of that sense of comradery
- It seemed like the peds residents got less autonomy than the medicine/OBGYN ones, which I think would start to bug me as a resident
- Less of that "badass" feeling of being able to handle things
- Peds hospitalist fellowship seems insulting tbh

Thoughts? I admit my exposure to the more intense sides of peds (NICU/PICU) is limited, and it seems my qualms with peds may be more culture-dependent than with the field itself. I still have some time to take some electives and figure things out a bit more, but would still like to hear others' thoughts on this all. If I could find a peds program where the residents are close, get good autonomy, and maybe go into a peds field with some acuity and procedures, that could be it. The other thought I've had is FM w/ an OB fellowship, but then I'd have to deal with adult problems, which isn't quite my cup of tea...

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[HemeOncHopeful19]

You might actually be the first person in history to say “I’m too laid back for Peds, so I felt like I fit in best in OB/Gyn.”

I don’t have much to add other than don’t do FM -> OB fellowship if you actually wanna do OB.

 

[anonperson]

Hi all -- I went into med school thinking I would do peds, but as third year ends, I was really taken by surprise both by how much I liked my time on OBGYN and by how I felt on peds. Breaking it down by field:
OBGYN
Pros
- I felt like I fit in best with the residents here, and really liked the culture. Residents seemed like actual friends, and the attendings were all great. I respond well to the "coach-pushing-you-to-be-better" types
- OBGYNs seem like badasses -- thought it was super cool when a delivery got a little complicated and the chief knew how to handle it with a cool head
- I love OB counseling, talking about the psych aspects (how the parents are feeling), and the focus on the family in OB clinic
- I enjoy working with the mostly young, (fairly) healthy population on OBGYN
Cons
- I'm not a natural in the OR. I was able to learn some, but knot-tying/suturing doesn't come naturally to me the way working with kids does
- We had a delivery of a congenital cards kid complicated by a perineal lac; I was much more interested in the resuscitation of the kid than the repair of the lac
- I don't particularly love the super long cases

Peds
Pros
- The weeks I smiled the most during clerkships was on outpatient peds. I love working with the kids and making the exam a game for them; it really makes me happy. The lack of acuity/complexity doesn't matter to me as much since the kids are so much fun
- I'm naturally good with kids -- have received this feedback a lot, and friends/family also comment on it
- I find pediatric pathology fascinating
- I really enjoy counseling/reassuring parents
- Some cool procedures on outpatient -- got to help with a few lac repairs and observe a circ, both which were very cool
Cons
- I didn't feel like I fit in. It's hard to describe, but my personality is a bit more laid back and direct than what I experienced when I was on peds, and I feel like I just didn't get close with the residents on peds the way I did on OBGYN
- On wards, there was much less interacting with the kids than I expected. This is what I would do peds for, and I felt a little let down. On OBGYN, I really felt like I was accompanying my patients on a journey, if that makes sense
- The peds residents seemed more burnt out and less happy than the OBGYN ones; there was less of that sense of comradery
- It seemed like the peds residents got less autonomy than the medicine/OBGYN ones, which I think would start to bug me as a resident
- Less of that "badass" feeling of being able to handle things
- Peds hospitalist fellowship seems insulting tbh

Thoughts? I admit my exposure to the more intense sides of peds (NICU/PICU) is limited, and it seems my qualms with peds may be more culture-dependent than with the field itself. I still have some time to take some electives and figure things out a bit more, but would still like to hear others' thoughts on this all. If I could find a peds program where the residents are close, get good autonomy, and maybe go into a peds field with some acuity and procedures, that could be it. The other thought I've had is FM w/ an OB fellowship, but then I'd have to deal with adult problems, which isn't quite my cup of tea...

If you do OB GYN, the majority of jobs require some type of call which means waking up for 3am deliveries. If you are in a busy enough practice, that could mean in house call. You can find no call jobs but they are less common

Do you want to do in house call in your late forties and fifties? Some people are fine with that. Just be aware that working nights etc is an independent risk factor for developing certain cancers and MI.

Patient health status is variable. Majority of patients have diabetes, HTN, and obesity. It relatively common to have OB patients who are 300+ lbs. It is not fun to care for these patients. They are ticking time bombs.

 

[SurfingDoctor]

I thought they did episiotomies to prevent tears.

 

[DO2015CA]

I’m direct and not a Disney person. I’m in a subspecialty where there is complexity and consults for highly acute patients. You may be a peds sub person. I chuckled at you saying obgyn was chill. Throughout my limited obgyn exposure during medschool and residency, obgyns were some of the most high strung people compared to most specialties (especially peds).

 

[oldbearprofessor]

"We had a delivery of a congenital cards kid complicated by a perineal lac; I was much more interested in the resuscitation of the kid than the repair of the lac"

Your answer is here. Really the fields are extremely different. Do an outside month in each (MFM and pedi subspecialty for example) and you'll get a better sense.

 

[rollinghills123]

I have nothing to add except that I feel the exact same way!! OB residents definitely seemed more chill than the high strung peds residents to me, and I agree with all of your other points too... I think what I have decided to do peds and look more into procedural subspecialties- cards, gi, nicu, picu. We will see though.... good luck!

 

[Rumalum]

What residents are like / what residents do should have no bearing on the decision - residency is just a flash in the pan and that work does not represent the real world

 

[doodle_doc]

Just want to echo some of what's being said above - it's hard to judge the specialty by how you feel you get along with the residents because every program can have its own culture depending on who works there. Definitely try to think about the medicine - the big question is, of course, do you want to do surgery for the rest of your career? I think if you're not enthusiastic about being a surgeon then OB may be a difficult fit, as it is a very surgery heavy specialty pretty much no matter what (unless you go into a few of the OB subspecialties, maybe, but even then you're having to do a full residency before getting to that point). If you're very torn it may definitely be worth trying to look into some of the subspecialty options for each field just to get a better sense for how you like the full scope of the specialty.

I've worked with a lot of laid back people in peds and have gotten to have very close relationships with my classmates in both residency and fellowship, but that's true probably regardless of specialty - you try to find a program that you click with when applying to residency. Autonomy in a peds residency is a tricky thing just because of the way peds training is structured nowadays, but even then it's only 3 years before you're fully autonomous as an attending so most of us just suck it up and keep our heads down during the rotations when you have less autonomy. It all varies but at the end of the day residency is temporary.

 

[hmockingbird]

"We had a delivery of a congenital cards kid complicated by a perineal lac; I was much more interested in the resuscitation of the kid than the repair of the lac"

Your answer is here. Really the fields are extremely different. Do an outside month in each (MFM and pedi subspecialty for example) and you'll get a better sense.

Agree with this, plus you didn’t seem enthusiastic about surgery in general.

I could see you fitting well with procedural subspecialties!

I’m in Peds and was shocked by how much I loved my OB-Gyn rotation. Many happy memories. I also got along best with the surgeons out of any of my attendings in med school, just liked that they were no-nonsense and seemed to respond well to good effort. I did not like actually being in the OR though so any surgical specialty was out lol. I think Peds has a reputation for being a bit passive aggressive and for micromanaging which is somewhat deserved at times but I think if you get some subspecialty exposure you’ll see less of that, and it’s also program dependent.

 

[gyngyn]

If you can't decide, it's peds.

 

[mvenus929]

FWIW, during my third year rotation in peds, the intern was way stressed over caring for fewer patients than I was following. I didn't apply to that program. My program was better in terms of both strength of residents and comradery.

I'd recommend doing an away rotation in each specialty to see if you find the culture the same outside of your institution.

 

[smq123]

Pros
- I felt like I fit in best with the residents here, and really liked the culture. Residents seemed like actual friends, and the attendings were all great. I respond well to the "coach-pushing-you-to-be-better" types
- OBGYNs seem like badasses -- thought it was super cool when a delivery got a little complicated and the chief knew how to handle it with a cool head

Don't fall into the trap of basing your decision based on the culture of the particular residency you rotated through. As others have said, that is very transient and not something that will affect your day-to-day as an attending.

I had a great OB rotation as a med student. The attendings were great and really kind! The residents taught and seemed super smart and collegial! I loved it!

And then I had to rotate through OB again as a resident, at a different program. Holy ****, that was the most toxic environment that I have ever been in before, or since. The night float residents routinely rage-ate doughnuts during morning report. One intern told me that the only thing keeping her from jumping off the roof of the parking garage was Wellbutrin. The attendings routinely talked trash about all the residents (sometimes to their faces), the residents talked trash about all the attendings. The residents were so poorly trained that when one of the attendings told the PGY-4 to get the forceps ready to assist the delivery, the resident (a 4th year!) told her "I've never used them before." There were no "cool heads" whenever anything got complicated. The nurses were the only reasonably sane people around that floor. I couldn't run away from that rotation fast enough.

 

[BigRedBeta]

- We had a delivery of a congenital cards kid complicated by a perineal lac; I was much more interested in the resuscitation of the kid than the repair of the lac

Did you feel this way at all the deliveries? I also really enjoyed my OB/Gyn rotation as an M3 (more the Gyn side actually), but found myself craning my neck every time to see what the newborn team was doing while I was supposed to be massaging a uterus or watching something else with the mother. If you feel like the babies are more interesting (even when well!) then that's your answer. If it was *just* because this one was complex, then you need more exposure to sort this out.

At an absolute minimum, you have to separate the medicine from the people you were working with at the time. The pathology in a particular specialty remains the same, the people will change over time without a doubt (eg, the applicant who loves the program director they met while interviewing, and that person has left in between Match Day and intern orientation...but also just the influx of new interns/attendings each year into a program).