Women's Health

[auburnprin]

Does anyone know of any clinical opportunities in Women's Health for Internists to gain more experience and knowledge? I've seen fellowships for Women's Health that are open to Internists but those seem to be mainly focused on research.

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[VA Hopeful Dr]

What kind of clinical experience are you looking for?

 

[aafisahar]

if you're still in residency, you should be able to setup an elective rotating in the women's health clinic where you can get all your paps, OCPs, IUDs, etc.

 

[DrMetal]

Does anyone know of any clinical opportunities in Women's Health for Internists to gain more experience and knowledge? I've seen fellowships for Women's Health that are open to Internists but those seem to be mainly focused on research.

It's called a primary care residency (IM or FM). There should be no such thing as a 'Womens or Mens Health Fellowship'. If we're not providing this training in a regular IM/FM residency, then there's something really wrong with the way we train, and it should be corrected.

(and nobody gimme crap about doing procedures, colposcopy, delivering babies, etc . . .that's called a gyn residency).

 

[VA Hopeful Dr]

It's called a primary care residency (IM or FM). There should be no such thing as a 'Womens or Mens Health Fellowship'. If we're not providing this training in a regular IM/FM residency, then there's something really wrong with the way we train, and it should be corrected.

(and nobody gimme crap about doing procedures, colposcopy, delivering babies, etc . . .that's called a gyn residency).

Or an FM residency. The only reason I don't do colposcopy or IUD insertion is lack of volume in my individual practice. I do have a partner that does Nexplanon and apparently does several per month.

 

[DrMetal]

Or an FM residency. The only reason I don't do colposcopy or IUD insertion is lack of volume in my individual practice. I do have a partner that does Nexplanon and apparently does several per month.

Well there ya go, We are all doing 'Women's Health' . . . . No fellowship needed. Permission granted to just practice! [If anybody really wants an extra 'board certification', let me know, I've got a cool 3D printer that can make just about anything.]

 

[VA Hopeful Dr]

Well there ya go, We are all doing 'Women's Health' . . . . No fellowship needed. Permission granted to just practice! [If anybody really wants an extra 'board certification', let me know, I've got a cool 3D printer that can make just about anything.]

I'll take a "God Emperor VA Hopeful" certification

 

[auburnprin]

My residency's women's health experience was subpar. We were told straight by the OBGYN residents that we, the IM residents, were there just for PAPs. Despite my being proactive, the education and clinical experience didn't go any further than that. That is why I was wondering if there was anything like a fellowship or a mentorship or something of the equivalent to learn more to incorporate that knowledge into my practice. I am no longer in residency.

 

[VA Hopeful Dr]

My residency's women's health experience was subpar. We were told straight by the OBGYN residents that we, the IM residents, were there just for PAPs. Despite my being proactive, the education and clinical experience didn't go any further than that. That is why I was wondering if there was anything like a fellowship or a mentorship or something of the equivalent to learn more to incorporate that knowledge into my practice. I am no longer in residency.

National Procedures Institute | CME Programs & Products - Contraceptive and Women’s Health Procedures

www.npinstitute.com

 

[chessknt]

My residency's women's health experience was subpar. We were told straight by the OBGYN residents that we, the IM residents, were there just for PAPs. Despite my being proactive, the education and clinical experience didn't go any further than that. That is why I was wondering if there was anything like a fellowship or a mentorship or something of the equivalent to learn more to incorporate that knowledge into my practice. I am no longer in residency.

I am confused as to what you are hoping to incorporate exactly. Are you looking to put in IUDs/Nexplanon or are you trying to not refer for abdominal pain/vaginal bleeding with negative workup? More nuanced discussion of mammos? What do you think you are missing and could hold on to that doesnt rise to a specialist level?

My residency had a ton of Womens health emphasis (nexplanon/IUDs/way too many PAPs/agonizing over the mammogram recommendations etc) but I dont feel like any of this was that special that would warrant a fellowship.

 

[DrMetal]

My residency's women's health experience was subpar. We were told straight by the OBGYN residents that we, the IM residents, were there just for PAPs. Despite my being proactive, the education and clinical experience didn't go any further than that. That is why I was wondering if there was anything like a fellowship or a mentorship or something of the equivalent to learn more to incorporate that knowledge into my practice. I am no longer in residency.

What exactly are you looking to do? If it's a procedure you're interested in, you have to be taught it and appropriately credentialed to do it (for instance, IUD placement). Now there are some procedures (a DNC, a hysterectomy) that you just can't (and shouldn't do) unless you are a OB/GYN.

Not talking procedures? Then what, contraceptive management? screening? more aggressive HTN/HLD management in elderly females (often overlooked)? You're welcome to (and you should!) do all of this as a PCP.

 

[InternistDO]

I sympathize with OP, as my residency also has minimal gyn training--abnormal uterine bleeding, pap smears, LARC, etc all get sent straight to gyn by our attendings. I prescribe depo and OCPs but many residents don't feel comfortable discussing all the contraceptive options. It's hard to go from that to trying to work up a middle aged female with worsening heavy menstrual bleeding as an attending. Do you get imaging? Should you send for an endometrial biopsy? If you've never done it under supervision it becomes easy to refer out and barely do women's health at all.

Personally I'm doing outpatient gyn electives (and probably nexplannon/IUD courses) as I'll be doing primary care in the future but that's required me to be pretty proactive about it. I feel like spending a year doing a women's health fellowship is a waste of time for most people, but I don't think it's unreasonable to say that most IM residencies neglect women's health to some extent.

 

[auburnprin]

I sympathize with OP, as my residency also has minimal gyn training--abnormal uterine bleeding, pap smears, LARC, etc all get sent straight to gyn by our attendings. I prescribe depo and OCPs but many residents don't feel comfortable discussing all the contraceptive options. It's hard to go from that to trying to work up a middle aged female with worsening heavy menstrual bleeding as an attending. Do you get imaging? Should you send for an endometrial biopsy? If you've never done it under supervision it becomes easy to refer out and barely do women's health at all.

Personally I'm doing outpatient gyn electives (and probably nexplannon/IUD courses) as I'll be doing primary care in the future but that's required me to be pretty proactive about it. I feel like spending a year doing a women's health fellowship is a waste of time for most people, but I don't think it's unreasonable to say that most IM residencies neglect women's health to some extent.

Thank you. This is what I am referring to. Women's Health has been very neglected on my program's part and and all the attendings always referred to OBGYN whenever the topic of a vagina or uterus came up. I just dont have the experience. Screening, sure. Other work up and management, not so much. That's why I was inquiring about other resources.

 

[auburnprin]

National Procedures Institute | CME Programs & Products - Contraceptive and Women’s Health Procedures

www.npinstitute.com

Thank you. This is helpful.

 

[DrMetal]

Do you get imaging?

Always. I'm a hospitalist. My pelvic exam = CT Abd and Pelvis . . .with contrast.

whenever the topic of a vagina or uterus came up.

It's a scary part of the body...like the eyeball. I'm glad they have their own specialties.

 

[chessknt]

Always. I'm a hospitalist. My pelvic exam = CT Abd and Pelvis . . .with contrast.



It's a scary part of the body...like the eyeball. I'm glad they have their own specialties.

https://acsearch.acr.org/docs/69458/Narrative/

Might want to re-think that one. I dont do primary care but I have done plenty of EM/UC work and learned quickly that pelvic us is what you are looking for most of the time.

 

[chessknt]

I sympathize with OP, as my residency also has minimal gyn training--abnormal uterine bleeding, pap smears, LARC, etc all get sent straight to gyn by our attendings. I prescribe depo and OCPs but many residents don't feel comfortable discussing all the contraceptive options. It's hard to go from that to trying to work up a middle aged female with worsening heavy menstrual bleeding as an attending. Do you get imaging? Should you send for an endometrial biopsy? If you've never done it under supervision it becomes easy to refer out and barely do women's health at all.

Personally I'm doing outpatient gyn electives (and probably nexplannon/IUD courses) as I'll be doing primary care in the future but that's required me to be pretty proactive about it. I feel like spending a year doing a women's health fellowship is a waste of time for most people, but I don't think it's unreasonable to say that most IM residencies neglect women's health to some extent.

I guess the question is why do you feel you need to expand your knowledge in this area specifically? You could go down a rabbit hole for every organ and try to become a half-assed specialist in everything but if you have access to reasonable referral time frames (ie you don't live 100+ miles away from civilization) then why assume liability risk and delay patient care for something you don't have a good knowledge base in?

This exists even in subspecialties--if someone comes in to the hospital with a hemorrhagic stroke and there is a neuro ICU and medical ICU why would I send that person to MICU? A cystic fibrosis patient transitioning out of pediatric care should go to a pulmonologist with an emphasis (and preferably in an academic institution) in CF rather than a pulmonologist who has 0-2 other CF patients. Can the MICU doc and the general pulmonologist take care of these patients--yes but their care would be better if they didn't if there is another more qualified provider.

 

[fooli_doc]

I'll do an occasional pap, oral contraceptives, and post menopausal hormone replacement. Almost everything else gets referred out. It doesn't hurt my practice or my pride/ego at all, and they just flat out get better comprehensive women's health when they seen an OBGYN as well. Not to mention 90% of my female patients are already seeing one and don't expect this from me. I'm not in the most or least densely populated area but there is still great access to referrals.

Edit: I'll also add that I do a lot of complex managing of diseases without referral in my practice that other specialities such as OBGYN wouldn't touch. You simply cannot be the master of everything. Practice to your strengths. Sometimes I'll look back at the 10 diagnoses we addressed in a single visit and I will gladly let another doctor take on one in more detail.

 

[InternistDO]

I'm not suggesting anything outlandish--I certainly don't want to be working up a potential endometrial carcinoma any more than an OBGYN wants to manage heart failure. But I think for billing ourselves as a primary care specialty we should be at least have access to the training to do paps, STIs, contraceptives, etc, and some understanding of when to refer out beyond "problem with lady parts-->refer". I understand that part of the appeal of IM to many people (as opposed to FM) is the promise of never doing a pelvic exam again in your life, which is very reasonable for the hospitalists and cardiologists of the world. But for those in clinic it can be frustrating for patients to have to refer out constantly for what should be very simple care.

My residency is in a pretty underserved urban area and while access is theoretically easy, many of my patients will never make their specialty appointments so I like to at least know when I should be more concerned about certain gyn conditions.

 

[Splenda88]

It's called a primary care residency (IM or FM). There should be no such thing as a 'Womens or Mens Health Fellowship'. If we're not providing this training in a regular IM/FM residency, then there's something really wrong with the way we train, and it should be corrected.

(and nobody gimme crap about doing procedures, colposcopy, delivering babies, etc . . .that's called a gyn residency).

Why not? since we have peds hospitalist fellowship (the most ridiculous thing ever).

 

[Splenda88]

I sympathize with OP, as my residency also has minimal gyn training--abnormal uterine bleeding, pap smears, LARC, etc all get sent straight to gyn by our attendings. I prescribe depo and OCPs but many residents don't feel comfortable discussing all the contraceptive options. It's hard to go from that to trying to work up a middle aged female with worsening heavy menstrual bleeding as an attending. Do you get imaging? Should you send for an endometrial biopsy? If you've never done it under supervision it becomes easy to refer out and barely do women's health at all.

Personally I'm doing outpatient gyn electives (and probably nexplannon/IUD courses) as I'll be doing primary care in the future but that's required me to be pretty proactive about it. I feel like spending a year doing a women's health fellowship is a waste of time for most people, but I don't think it's unreasonable to say that most IM residencies neglect women's health to some extent.

The truth about IM residency is that they are good in teaching inpatient medicine. Yeah we can do outpatient but it will take most of us ~ 6 months to be comfortable like our FM colleagues.