Truly can’t decide between OBGYN & FM - help

[Rogue42]

Hey guys,

I’m truly suffering between trying to pick between the two to the point that I’m afraid I won’t even get an application in on time from how much I’ve procrastinated on my decision.

OBGYN
Pros:
- I love the surgeries.
- I love that I can do surgery without being responsible for super sick patients as opposed to gen surg
- I like that clinic is *usually* quick visits with happy, healthy women
- Minimal management of chronic disease
- Bringing life into the world is pretty cool
- There for big, life changing family moments
- Income -> not that money is everything but I know I’ll get to pay my loans back
- Enjoy both clinic and surgery/hospital environment
- In-office procedures
- Immediate gratification for a lot of things

Cons:
- Probably very hard to own my own clinic
- Call hours can be rough
- Difficult work-life balance
- Lawsuits can be rough
- High stress level in comparison

Other thoughts:
I enjoy the quick visits and surgical aspects more than the delivery part. If I could do all benign gyn / surgery, I would. But I do enjoy the whole specialty - just some parts more than others. Very unknown in terms of what my life would really be like (see below for explanation).

Family Medicine
Pros:
- Can own my own clinic
- Make my own hours
- Build my clinic and schedule the way I see fit
- Can coach HS football
- Be at all of my future kids events and support them
- Build solid relationships with continuity of care
- Low stress specialty in comparison
- Minimal lawsuits and low malpractice insurance
- I know what my life can really be like

Cons:
- Can never set foot in an OR again
- Lower income -> stress about paying back loans
- Management of chronic disease
- Many complex, unhappy, unhealthy patients
- A lot of clerical work
- No immediate gratification

Other thoughts:
I like family medicine for what it offers me outside of medicine. Before medical school, I was a scribe that worked at a family medicine clinic / urgent care, and I LOVED it. I also have an MBA, and my plan was to always go FM and then open a similar clinic to the one I came from so that I could do and get both clinic and business aspects. I don’t really want to do FM w/ OB because it’s not the OB part of OBGYN that I’m in love with. If I could do FM with hysterectomies, I’d pick this specialty 11 times out of 10.

I like both specialties for far different reasons; I’d probably be more fulfilled in my career as an OBGYN, but there’s something pretty nice about knowing what my life would be like (clinic wise and family wise) as an FM and be more fulfilled in my life outside of medicine. I like surgery, but will I still like it at 50, who knows???

Any advice, wisdom, thoughts, comments, or opinions from a different perspective / eyes is greatly appreciated.

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[Angus Avagadro]

There is a FM track with additional qualifications in OB and there us a Board for this. I believe they can be certified to do C sections, but not100% certain. Something to check out. Good luck and best wishes!

 

[SLC]

I’d ask yourself if you want to be restricted to solely womens health or not. If you want surgery in FM, there are ways; but it’s not common. I for one, get bored without a wide variety, and I can’t stand the hospital these days so FM was perfect.

But I have FM partners who’ve done Gyn surgery, general surgery procedures etc. usually with a bit of extra time or extra focus/used up free time during residency training, and usually only in rural/critical access settings. Also the things they do are limited (hysters, Appy’s, Chole’s, scopes) but it happens at times.

I do plenty of office Gyn in my practice, including IUD, some bartholin drainage, endometrial biopsy etc, even trained to do colpos but current office isn’t set up for it and plenty of Gyns around so I’m not at the moment.

But I don’t use the OR.

 

[Rogue42]

I’d ask yourself if you want to be restricted to solely womens health or not. If you want surgery in FM, there are ways; but it’s not common. I for one, get bored without a wide variety, and I can’t stand the hospital these days so FM was perfect.

But I have FM partners who’ve done Gyn surgery, general surgery procedures etc. usually with a bit of extra time or extra focus/used up free time during residency training, and usually only in rural/critical access settings. Also the things they do are limited (hysters, Appy’s, Chole’s, scopes) but it happens at times.

I do plenty of office Gyn in my practice, including IUD, some bartholin drainage, endometrial biopsy etc, even trained to do colpos but current office isn’t set up for it and plenty of Gyns around so I’m not at the moment.

But I don’t use the OR.

Yeah, I am totally open to seeing just women in my practice.

If I could family medicine, and do a hyst, or a GB, every now and again, I would not even question the decision. Unfortunately, I do not want to live in a super rural place. I would love to be somewhere between 5,000-50,000 in population with like a regional hospital or something, which means the surgical aspect of family medicine is probably out

 

[SLC]

Yeah, I am totally open to seeing just women in my practice.

If I could family medicine, and do a hyst, or a GB, every now and again, I would not even question the decision. Unfortunately, I do not want to live in a super rural place. I would love to be somewhere between 5,000-50,000 in population with like a regional hospital or something, which means the surgical aspect of family medicine is probably out

Sounds like an easy decision then…

 

[VA Hopeful Dr]

There is a FM track with additional qualifications in OB and there us a Board for this. I believe they can be certified to do C sections, but not100% certain. Something to check out. Good luck and best wishes!

It's not ABMS recognized though.

 

[Angus Avagadro]

It's not ABMS recognized though.

Thanks for clarifying. I knew it existed, but that was all. Just like the Amaerican Board of Pain Medicine isn't recognized by ABMS, but by some states. FL I believe is one.

 

[gyngyn]

If I could family medicine, and do a hyst, or a GB, every now and again, I would not even question the decision.

We don't remove gallbladders in OBG...

 

[Rogue42]

I know 😂 I was just making a general point about FM and surgical procedures that they can do.

I prefer gyn surgery much more.

 

[DOVinciRobot]

I know 😂 I was just making a general point about FM and surgical procedures that they can do.

I prefer gyn surgery much more.

FMs should not be taking out gallbladders and even in a state with a lot of rural areas and critical access hospitals I have never heard of it happening. In the old days the occasional rural cowboy would take out an appendix. But an appendix is not millimeters away from disaster and this is a relic of the past. Sorry, but no FM should be doing a surgery of any kind. If you want to do surgeries then you should do actual surgery training.

 

[VA Hopeful Dr]

Thanks for clarifying. I knew it existed, but that was all. Just like the Amaerican Board of Pain Medicine isn't recognized by ABMS, but by some states. FL I believe is one.

Fellowships are weird. The boards that certify you in your initial specialty generally are the ones to recognize that you are fellowship trained in whatever. On single specialty boards (cardiology, allergy, gyn onc, Ortho sports med, and so on) that board handles board certification for those subspecialties. In multi-specialty boards, each primary specialty recognizes your certification but usually one specialty is responsible for administering the test with input from the other specialties on designing the thing. Anesthesia is the leader on pain, IM on sleep, FM on sports med to name a few.

 

[DocWinter]

I am an OB/GYN attending.

Obviously I chose this field and I am very happy with it

I think you have a good grasp on the situation.

As you get further in Medicine, making a decent paycheck and having a life tend to rise to the top. What are you actually do to earn that as in taking out uteruses versus gallbladders versus not doing any of that in FM may be overrated. At the end of the day we want to be around our family and have good job security in a good working environment.

OB/GYN residency can be brutal. Family medicine residency is definitely not as difficult. All the family medicine colleagues are rotated with us I thought that the six weeks with us was the worst of their three-year residency. their quality of life after residency is markedly better as well. It’s to be considered.

You make a good point that is easier to be self-employed as FM, not as much as OB. That’s the sad tragedy in the way Medicine is going but it does have as many pros as it has cons.

 

[SLC]

FMs should not be taking out gallbladders and even in a state with a lot of rural areas and critical access hospitals I have never heard of it happening. In the old days the occasional rural cowboy would take out an appendix. But an appendix is not millimeters away from disaster and this is a relic of the past. Sorry, but no FM should be doing a surgery of any kind. If you want to do surgeries then you should do actual surgery training.

While I don’t disagree, in principle; in the absolute center of the map of the middle of nowhere, where no general surgeon exists or is willing to go, sometimes things have to happen. And who am I to judge if an FM has done a lot of a particular GenSurg procedure who has a track record of good outcomes, lack of bad outcomes, is credentialed by his hospital and has malpractice coverage, and who knows when to operate and when to ship someone out, operates to fill a desperate need.

I get your sense of the need for protecting your turf, but it’s not as though this is happening just because some FM doc wants to do it; everyone I know who’s done it sought out hundreds of hours of focused training, usually at the expense of vacation time in residency, spending all their electives on it, and taking call for free. All to be ready to answer the call in places like Dutch harbor AK in the middle of a prolonged no travel weather events etc. I have friends who practice there, I have friends practicing off the road system in AK. I have friends in the middle of nowhere west Texas or extremely remote southern Utah who’ve stepped in and handled things when it was necessary. There are times where moving a patient to a higher level of care becomes impossible, there are no surgeons available, and things have to happen.

 

[DOVinciRobot]

While I don’t disagree, in principle; in the absolute center of the map of the middle of nowhere, where no general surgeon exists or is willing to go, sometimes things have to happen. And who am I to judge if an FM has done a lot of a particular GenSurg procedure who has a track record of good outcomes, lack of bad outcomes, is credentialed by his hospital and has malpractice coverage, and who knows when to operate and when to ship someone out, operates to fill a desperate need.

I get your sense of the need for protecting your turf, but it’s not as though this is happening just because some FM doc wants to do it; everyone I know who’s done it sought out hundreds of hours of focused training, usually at the expense of vacation time in residency, spending all their electives on it, and taking call for free. All to be ready to answer the call in places like Dutch harbor AK in the middle of a prolonged no travel weather events etc. I have friends who practice there, I have friends practicing off the road system in AK. I have friends in the middle of nowhere west Texas or extremely remote southern Utah who’ve stepped in and handled things when it was necessary. There are times where moving a patient to a higher level of care becomes impossible, there are no surgeons available, and things have to happen.

Outside of trauma stabilization, not sure I can think of a scenario where it would be acceptable for the FM doc to touch a patient surgically, regardless of how rural it is. The gallbladders that need to come out emergently are not chip shot cases a non-surgeon should be doing. Pt would be significantly better off getting loaded with broad spectrum abx

There is quite literally nowhere in southern Utah or west Texas where this should ever be acceptable.

Lack of bad outcomes doesn’t mean they don’t exist, it means they just went somewhere else for management of the bad outcome….

 

[SLC]

Outside of trauma stabilization, not sure I can think of a scenario where it would be acceptable for the FM doc to touch a patient surgically, regardless of how rural it is. The gallbladders that need to come out emergently are not chip shot cases a non-surgeon should be doing. Pt would be significantly better off getting loaded with broad spectrum abx

There is quite literally nowhere in southern Utah or west Texas where this should ever be acceptable.

Lack of bad outcomes doesn’t mean they don’t exist, it means they just went somewhere else for management of the bad outcome….

Well I suppose one day when you’re the guy who gets to control all of this stuff, you’ll have a chance to determine what other people are and aren’t going to do.

 

[AlbinoHawk DO]

It's stupid to make your life harder if you'd be equally happy with the easier road

 

[Drrrrrr. Celty]

It's stupid to make your life harder if you'd be equally happy with the easier road

Vague but somehow direct. I like it.

Choose what's going to not make you miserable waking up in the morning in 10 years. I think this is probably the easiest way to determine what will actually make you happy as it's grounded in reality. And also keep in mind that your happiness is going to be significantly influenced by what kind of people you're around and the environment it's set in.