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Women's Health-Focused Fm?


Birdy

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I'm caught between FM and OB/Gyn. Being realistic about it, pursuing an OB/Gyn residency would not be ideal for me, but women's health is definitely my favourite area of medicine which is why I'm very much leaning in that direction. 

 

I know there are family doctors who focus on women's health as well as FM call groups that do low risk deliveries. If I go the route of FM, this is what I'd like to do for sure. 

 

Question is - how likely is it that I'd be able to pursue women's health and OB as a family doc? Are these PGY3 programs particularly competitive? It looks like there's standalone 3-6 month low-risk obstetrics only while some schools offer a combined 12 month women's health and low risk obstetrics enhanced skills program.

 

Anyone here who has gone this route or can direct me to a resident or recent family med grad who is familiar with this pathway?

 

I appreciate it.  

 

 

 

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Full disclosure - I did not do an OB fellowship or womens health fellowship - however I did recently finish my family medicine training. I can tell you at least in Toronto all the people who wanted OB (and showed interest in it through electives, research or simply a focus of OB/womens health in their FM practices etc.) seemed to get it as far as I can remember.

 

I remember looking into the 12 month womens health fellowship (very briefly! so please feel free to learn more about it from better sources than I!) but I recall it being a lot of theoretical courses at U of T and not much added value (from my personal viewpoint - then again I have very little interest in counseling and the psych aspect of women's health), plus you have to apply for the 3 month OB fellowship separately (which can be completed during the same 12 month womens health fellowship). In the end I decided to do a different fellowship (ED) but while I was considering doing a women's health focused practice my plan was to do the 3 months OB fellowship and to spend my FM elective time and free time getting more hands on time with various gyne/sexual health procedures.

 

http://www.dfcm.utoronto.ca/enhanced-skills-program is a good place to start when looking into the various enhanced skills programs. I also believe there are contacts for you in each program if you wanted to ask more questions.

 

Best of luck!

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You dont need the +1 to do OB, especially if you got a decent amount of exposure in a hands on FM residency. Many FM docs dont want to touch OB, so if you have an interest you can get the extra training you need. One of the local call groups here is very supportive and helps train etc.

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I will echo JohnGrisham's statement.

 

I'm a second year graduating FM resident, with similar interest in low risk obstetrics and women's health. I had 8 weeks of core OB/Gyn in my program and also did an additional 4 weeks of electives in low risk OB/Gyn spread out in second year. My residency site has high volume OB so I was able to get lots of experience, enough that I will be doing low-risk OB once I'm finished. Regarding women's health, I get a fair amount of STI and pap screening, contraception including some IUD insertion, and menopausal care in my primary care office. I know of a few other elective opportunities I could have taken if I wanted to get more experience.

 

FM residency will allow you to explore specific areas of interest through electives, and maybe even some programs would match you with a primary preceptor with a practice scope that includes your area of interest. I know my program accepted requests from us when I first matched. Perhaps something for you to look for as you start considering various FM programs.

 

When I start I will be balancing my practice between general office based FM (which, as a female MD, naturally presents lots of opportunity for women's health) and low risk OB locums for one of the maternity groups in the area. For now it would satisfy my passion for preventive and longitudinal care + women's health. In the future I might consider narrowing down to just low risk OB as part of a call group... the beauty of FM :)

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Not an MD, but an allied health team member. Three of our family medicine MDs at the clinic where I work do low risk deliveries (out of four MDs) and only one has the +1 in women's health. All of our MDs do sexual health and prenatal appointments (as do our NPs). Women who are pregnant do tend to get funnelled towards one of the MDs who does low risk deliveries once they are past their first trimester, as the doctors do like to get to know the patients - after all, they will be the ones delivering their baby in all likelihood! Some patients don't like that (i.e. If they have a really good relationship with their NP) but most understand why we do it this way! For well baby checks, we alternate between one of the NPs and one of the MDs. So if they see an MD for the first well baby check, they'll see an NP for the next one, and so on.

 

The three MDs who do deliveries are rather tired at times, but they do enjoy the work! Of course, they also enjoy the rest of primary care, particularly with our rather challenging patient population, which is certainly a necessity. One of our MDs has had quite the varied career as a family doctor, doing lots and lots of different things.

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This is a topic i thought a lot about. Ultimately I ended up matching to OB/GYN for various reasons (ended up becoming very drawn to the surgical aspects), but really seriously considered family medicine +1 women's health and know I could have been very happy in that as well. 

 

My understanding from talking to a few women's health (full year) fellows and the director of a women's health year at an Ontario school, is that the full +1 year is more so focused on gaining additional knowledge / skills in the "theory" of women's health and gender and health, whereas 3 months of extra OB/GYN or whatnot is centred on procedural skills in labour and delivery and for things like IUD insertions, endometrial biopsy.

 

Over the course of my electives, I talked to / met a few residents doing an extra three months in OB, and they were essentially spending almost every day on labour and delivery. You don't necessarily NEED to do that to deliver babies safely and competently as a family physician, though they were gaining additional skills in things like vacuum delivery, more complicated repairs, first-assist C/S, managing some slightly more complicated inductions, intrapartum patients, etc. 

 

Those I met who went the women's health route usually did the 3 months of OB, but also had the opportunity to kind of define their own year in terms of interest (adolescent health and sexuality, psychotherapy for survivors of abuse and domestic violence, outreach work in women's shelters, additional time in the NICU, increased competency with LBGTQ patients and prescribing hormones for those who are transitioning, etc.). Again to gain extra skills in any one of those things you wouldn't necessarily need to do an extra year after family medicine but I think the core goal of the full year in women's health is to produce a provider who almost a bit of an academic expert on the relationship between female gender/sex and health from a full biopsychosocial perspective.

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