Family with Obstetrics vs. Obs/Gyn

[HappyAndHopeful]

Hi everyone!

I’ve always been drawn to obstetrics, and my backup plan if I didn’t get into medical school was to be a midwife. I’m also finding myself drawn to Family Medicine, because of the continuity of care, the diversity in patient needs, and the flexibility/ability to have control over your schedule. 

Obs/Gyn also really appeals to me because of the combination between obstetrics and women’s health. The only thing is that the OB/GYN lifestyle makes me nervous; I worked with an OB/GYN in my undergrad, and he’d frequently be awake for 48 hours and at the hospital or clinic well into the night. Having a family is VERY important to me, so I would like, ideally of course, for my career to allow me to have a healthy balance between work and family life.

I think if I did Family medicine, I would want to offer obstetric services as well. I know there would still be call involved, and that family doctors who do obstetrics can be part of a call group or deliver their own patients (which I’ve heard can be tricky if one patient goes into labour while you’re in clinic). 

So, would anyone be able to comment on the lifestyle differences between an OB/GYN versus a Family doctor who does obstetrics? I have some electives planned for later in the semester, but I’d love to hear your experiences/insight.

[JohnGrisham]

As a Family doc who does obstetrics, you can choose more or less at any time to dial down your obstetrics coverage etc, and modulate as your life demands change..and do the rest of your scope of FM practice. As an Ob/gyn...you don't have that flexibility, not nearly as much. As it is the core part of your job requirement.

[Wachaa]

Although it's true that OB-Gyn residency trains you to do deliveries, the field is a surgical subspecialty and that's what the majority of time and training is for.

You would need to decide if you just want to do deliveries, or if you're interested in surgery.

You don't even need to be a family doctor to do deliveries. Like you said, a midwife is well equipped to do normal, uncomplicated deliveries.

If you go through 2 years of FM training with extra electives in maternity care/ obstetrics, you should be pretty well-trained to practice FM-maternity care when you graduate. Joining a call group is fine. You can be on-call as often or as little as you like, usually on-call 1-4 shifts a month, depending on the size of your group and your practice set-up. Eg. out of a 5 day work week, you can be at your family med clinic/ walk in/ locum for several days, and your FM-maternity clinic for X days a week. The challenge is if your call day is not busy, you don't make any money. That's generally the case with OB-Gyne too. But OB-Gyne call is generally much busier because you're not just doing deliveries. You have ER gyne assessments, urgent C-section, vaginal bleeding, patients from your office, etc. That's quite hectic and for most people it's not compatible with having the family life you imagined.

[HappyAndHopeful]

On 2018-01-20 at 2:31 PM, JohnGrisham said:

As a Family doc who does obstetrics, you can choose more or less at any time to dial down your obstetrics coverage etc, and modulate as your life demands change..and do the rest of your scope of FM practice. As an Ob/gyn...you don't have that flexibility, not nearly as much. As it is the core part of your job requirement.

 

23 hours ago, Wachaa said:

Although it's true that OB-Gyn residency trains you to do deliveries, the field is a surgical subspecialty and that's what the majority of time and training is for.

You would need to decide if you just want to do deliveries, or if you're interested in surgery.

You don't even need to be a family doctor to do deliveries. Like you said, a midwife is well equipped to do normal, uncomplicated deliveries.

If you go through 2 years of FM training with extra electives in maternity care/ obstetrics, you should be pretty well-trained to practice FM-maternity care when you graduate. Joining a call group is fine. You can be on-call as often or as little as you like, usually on-call 1-4 shifts a month, depending on the size of your group and your practice set-up. Eg. out of a 5 day work week, you can be at your family med clinic/ walk in/ locum for several days, and your FM-maternity clinic for X days a week. The challenge is if your call day is not busy, you don't make any money. That's generally the case with OB-Gyne too. But OB-Gyne call is generally much busier because you're not just doing deliveries. You have ER gyne assessments, urgent C-section, vaginal bleeding, patients from your office, etc. That's quite hectic and for most people it's not compatible with having the family life you imagined.

Thank you both!  

[bearded frog]

paging @Birdy

[Birdy]

2 hours ago, bearded frog said:

paging @Birdy

Thanks. 

 

 

 

So, OP, this was my dilemma for a long time and I agonized over it for months and months and probably drove my friends and husband up the wall with my indecision on whether to do OB or FM. 

I talked with a lot of OBs and residents and family docs who do deliveries. The general consensus was do OB/Gyn if you want to be a surgeon. Do FM with obstetrics if you want to deliver babies and do women’s health/reproductive health (trying to get away from using the “women’s health” terminology since it excludes trans men who need gynae services too.) Family docs can be trained in IUD insertions, c-sections, D&Cs.

 

As my OB preceptor put it, a family doctor with an interest can do 85% if OB/Gyn. You can’t (usually) do high risk obstetrics, gynae onc, or independently do gynae surgery (you can first assist though.) But you can do more. Bonus, the baby is still your patient after the cord is cut and you get to see them when they eventually get cute too. 

 

For me personally, I just don’t have a five year surgical residency in me. I have three kids, the oldest of whom will be a teenager soon, and I really need to be here for them. If they were all very young, I might consider a surgical residency, but honestly when they need me as much as they do during these really rocky years, I decided I can’t do that to them. I applied to family medicine only, and plan to do obstetrics and other “enhanced” reproductive health. Plus some emerg, because I found out I like that too, and FM gives me the flexibility to do lots of that and change it over time as my needs change. 

 

Feel free to PM me if you have any questions. I’ve spent a LOT of time talking to people about this very issue. 

[Mithril]

I've never had the urge to do obs in my practice, but speaking with my colleagues who have done obs or are still doing obs as a family physician, it's exhausting work. Along with keeping up clinic hours and depending on the size of your call group you may be on call often, the pay is usually not compensated well for the amount of work you do, and it's very draining work. I know many of my colleagues who did it for a few years, and then stopped because they couldn't juggle the workload anymore. In terms of billing purposes there are a certain number of deliveries you must do quarterly in order to qualify for delivery bonuses.

I can't speak for the obs/gyn lifestyle but from what exposure I had in med school it seemed pretty brutal on the residents and staff.

[lasix_and_normal_saline]

As with anything in FM, bear in mind that location has a huge impact on your scope of practice. In a big centre served by many FRCP OBs, you may have a very hard time (especially at the start of your career) getting the amount of OB "business" that you want, and that you need to keep your OB skills sharp. This is a common complaint among many new grads with strong OB interest in my city (I'm a FM resident in a large urban centre). A couple have given up on doing low-risk OB altogether because they just can't get enough deliveries in a year to remain comfortable, and the hit to your income doesn't help when you're saddled with debt.

Some older docs in large urban centres have vibrant FM OB practices, but bear in mind they have had years (decades even) to develop strong local reputations with other (often older) GPs who will refer them maternity care patients, as they started practice at a time when FM OB care was a lot more common.

Not a reason not to do FM OB of course, but just another way in which FM OB is a very different entity from FRCP OB -- it isn't just FRCP OB with no surgery.

[HappyAndHopeful]

Thank you for the responses!  That is all useful and helpful insight, so I appreciate it.  @Birdy, thanks so much for the offer! I may take you up on that in the future!

[End Poverty]

Sorry to revive an old thread, but does anyone know how many on call shifts does the average Obs/Gyn resident does per year? Is there any chart that compares the number of on call days that the residents in the different speciality have to do per year?

[LittleDaisy]

On 1/21/2018 at 4:35 PM, Wachaa said:

Although it's true that OB-Gyn residency trains you to do deliveries, the field is a surgical subspecialty and that's what the majority of time and training is for.

You would need to decide if you just want to do deliveries, or if you're interested in surgery.

You don't even need to be a family doctor to do deliveries. Like you said, a midwife is well equipped to do normal, uncomplicated deliveries.

If you go through 2 years of FM training with extra electives in maternity care/ obstetrics, you should be pretty well-trained to practice FM-maternity care when you graduate. Joining a call group is fine. You can be on-call as often or as little as you like, usually on-call 1-4 shifts a month, depending on the size of your group and your practice set-up. Eg. out of a 5 day work week, you can be at your family med clinic/ walk in/ locum for several days, and your FM-maternity clinic for X days a week. The challenge is if your call day is not busy, you don't make any money. That's generally the case with OB-Gyne too. But OB-Gyne call is generally much busier because you're not just doing deliveries. You have ER gyne assessments, urgent C-section, vaginal bleeding, patients from your office, etc. That's quite hectic and for most people it's not compatible with having the family life you imagined.

I agree with wachaa. If you want to do FM obstetrics later on and wants it to be a significant part of your practice, you need to go rural to get more exposure. 

In large urban centers, a lot of patients have the option of being followed by OBS-GYN, FM-OBS (referred by their GPs), midwifes, the vast majority (uncomplicated healthy patients) decide to be followed by OBS-GYN. Well, if you have the luxury of choosing, and if you were pregnant, I think that it is common sense to pick the physician with the most experience, and who is prepared to deal with the worst post-partum complications or proceed to C-section if necessary.

A lot of FM obs staff in urban centers still book regular FM clinic when they are on FM obs call, which gets really tricky, because you will be running behind for your clinic's patients or might have to end up cancelling. The reason of double-booking is that the calls are quite light-volume, and you don't want to waste a day sitting around at home. 

So if you want to have a good exposure, it makes more sense to set up a FM obs in the community or rural setting. 

[HappyAndHopeful]

On 7/7/2018 at 8:36 PM, End Poverty said:

Sorry to revive an old thread, but does anyone know how many on call shifts does the average Obs/Gyn resident does per year? Is there any chart that compares the number of on call days that the residents in the different speciality have to do per year?

Was just reading through this thread again and noticed your question! I was talking to an OB/GYN resident a few weeks ago who said they usually have about 7 call shifts per month. As you get to be a more senior resident, that number drops down to 4-5/month. I’m not sure how that compares to other specialties... hopefully someone else can chime in.

[cats5ever]

On 7/7/2018 at 8:36 PM, End Poverty said:

Sorry to revive an old thread, but does anyone know how many on call shifts does the average Obs/Gyn resident does per year? Is there any chart that compares the number of on call days that the residents in the different speciality have to do per year?

Most schools have a residency guidelines pdf posted, mcmaster's (from 2009 but still applicable afaik) is (per month):

PGY-5 (April, May): 2 nights, no weekends

PGY-5 (June): 6 nights (may include weekends)

PGY-5: 4 nights, no weekends

PGY-4 Chiefs (April, May, June): 5 nights (may include weekends)

PGY-4: 6 nights (2 weekend nights)

PGY-3: 7 nights

PGY-2: 7 nights

[JohnGrisham]

20 hours ago, cats5ever said:

Most schools have a residency guidelines pdf posted, mcmaster's (from 2009 but still applicable afaik) is (per month):

PGY-5 (April, May): 2 nights, no weekends

PGY-5 (June): 6 nights (may include weekends)

PGY-5: 4 nights, no weekends

PGY-4 Chiefs (April, May, June): 5 nights (may include weekends)

PGY-4: 6 nights (2 weekend nights)

PGY-3: 7 nights

PGY-2: 7 nights

Strongly depends. Its 8-9 per month for the pgy1 obs on service at the hospital where I did my rotation at.

[cats5ever]

5 hours ago, JohnGrisham said:

Strongly depends. Its 8-9 per month for the pgy1 obs on service at the hospital where I did my rotation at.

Sorry do you mean it depends within sites at McMaster or between schools? 

[JohnGrisham]

4 minutes ago, cats5ever said:

Sorry do you mean it depends within sites at McMaster or between schools? 

Not McMaster specific.   Even within a given residency program, if you rotate between hospitals you will notice big differences. Theres overarching guidelines of course, but nothing is gauranteed