Pgy3 obstetrics training for family med residents

[tinker]

Hi all,

 

I was wondering if anyone has any experience with the pgy3 training programs in obstetrics offered as extensions of the family medicine residency at UofT and Mac? I am starting medical school at UofT but because of my age and personal goals, a five year OBGYN residency just doesn't fit with my life plan:)

That being said, a career in obstetrics is something that I think I would really like and that fits with my research expertise in stem cells and development.

 

I was wondering if any current or past trainees of these programs could comment on what they thought of the training, how easy it was to build a practice centered primarily around obstetrics and what they did to prepare for applying to these programs. I saw that McMaster is running a family medicine obstetrics clinic (http://www.maternitycentre.ca) and I was thinking of trying to set up some electives so if anyone has specific insight into this type of clinic I would be really interested to hear it.

 

Thanks!

[BoyInTheBubble]

Family med obstetrics is mostly limited to low risk obstetrics. Ability to do C-sections is a big deal, either they do it or they need back up (obgyn or gen surg) coverage. If they do it, it changes the dynamic in terms of who is responsible for what, etc.

 

They mostly operate in rural areas with less ob coverage. You linked to a clinic in hamilton, so it's not that it doesn't happen in urban areas, but less common as the obgyn's dislike rural areas as much as everyone else. Family med-obstetrics is kind of a dying breed. I'd love for some keeners to prove me wrong that they are excited to go out into the community and deliver babies as a family doc but the numbers don't lie. It's way down.

 

 

I have not done family med plus obstetrics training, but I am very sure if you are interested in stem cell research that obgyn is the way to go. Family docs get to do a lot, but I don't think that is covered in the 2 (or 3) years...

[Jochi1543]

Hmm, I don't actually think that obs-gyne is what you should be doing is stem cell research is your thing. Pathology or lab medicine seems like a better option. Stem cell research seems fairly detached from clinical practice. As in, of course your research results may be applicable to pediatrics or obstetrics practice, but is your research going to be greatly enhanced by your ability to do hysteroscopies? Or vacuum-assisted C-section deliveries? Obs-gyne practice is pretty far detached from stem cell and other bench research, IMHO.

 

The 2+1 obs program is highly practical, I suspect. 2+1s in ER, obs, gen surg, anesthesia mostly exist to supply docs with moderately advanced skills for rural/isolated areas, not to produce research scientists or experts in the field. As a 2+1 in obs, I bet you'll just be on the delivery floor and doing C-sections all day for 6-12 months.

 

If you are serious about incorporating a lot of research into your practice, I would get some career counselling earlier rather than later.

[tinker]

sorry but neither of these replies addressed my actual questions. i am really looking for input from people who have gone through these programs. i am not looking for career counselling or research advice.

 

also, for the record, stem cell biology is based almost entirely on developmental biology and is highly relevant to embryonic development. embryonic stem cells do come from embryos after all. there are entire research centres at UCSF, yale and stanford devoted to interdisciplinary science in reproductive medicine with a huge focus on stem cells including ES cells, adult stem cells and cord blood. you can do a lot more with a stem cell besides transplantation.

 

http://stemcell.ucsf.edu/research/reproductive

[spontaneouscombustion]

Most hospitals are pretty open to FM's delivering babies, and there's nothing really stopping you from starting up a maternity clinic. The issue is being successful. You might have trouble getting a consistent stream of referrals - most GPs would probably refer to an OB, and I imagine most patients would want the same.

 

The FM+1 GPs I know mostly do FM and just deliver their own patients, with the occasional referral from other GPs within their practice.

[bloh]

sorry but neither of these replies addressed my actual questions. i am really looking for input from people who have gone through these programs. i am not looking for career counselling or research advice.

 

also, for the record, stem cell biology is based almost entirely on developmental biology and is highly relevant to embryonic development. embryonic stem cells do come from embryos after all. there are entire research centres at UCSF, yale and stanford devoted to interdisciplinary science in reproductive medicine with a huge focus on stem cells including ES cells, adult stem cells and cord blood. you can do a lot more with a stem cell besides transplantation.

 

http://stemcell.ucsf.edu/research/reproductive

 

None of which you can do as a family physician.

[holiday1001]

research-based heme oncology or heme-path seems more suitable given your descriptions

[NLengr]

Most hospitals are pretty open to FM's delivering babies, and there's nothing really stopping you from starting up a maternity clinic. The issue is being successful. You might have trouble getting a consistent stream of referrals - most GPs would probably refer to an OB, and I imagine most patients would want the same.

 

The FM+1 GPs I know mostly do FM and just deliver their own patients, with the occasional referral from other GPs within their practice.

 

That's the way the family doc I go to works. They offer all the pregnant ladies the option of the GP-Obs (and keep going to the same office), or a referral to OB-GYN.

[Jochi1543]

None of which you can do as a family physician.

LOL, true. OP, your experience in stem cell research, etc will be irrelevant. I suggested you go see a career counselor at your med school if you wanted to incorporate stem cell research into your future career, because family medicine (no matter how much extra training you do) is NOT the way to go. They may also provide you with the contacts of people who've attended these programs. I guarantee you no FM+obs have time to log onto this forum.

 

Regarding maternity, you DON'T need to do 2+1 to deliver babies, even if you want ob to be the focus of your practice. There are GP-run low-risk obstetrics groups in every decent-sized city. There was one where I trained at U of A and there is one near where I'm doing my residency at UBC. Usually, GPs who wanna do obstetrics just do an extra elective or two during residency. You get enough exposure to obs in medical school and FM residency (14 weeks) to have a decent grasp of how to manage deliveries. An extra elective at a high-volume centre allows you to encounter enough risky situations (post-partum hemorrhage, shoulder dystocia) to be comfortable managing them and to get hands-on practice doing things like repairing complex tears, but you don't even NEED that to do low-risk obstetrics as a GP.

 

The 2+1 is basically training in operative deliveries (forceps, vacuums, C-sections and operative management of post-partum hemorrhages, etc). It's meant for rural doctors with limited resources, where an obstetrician is not available. Even some smaller centers will not allow a GP-OB to operate if there's an obstetrician available. At my centre, there's a 2+1 person who is not allowed to do C-sections because we have an obstetrician. He pushed quite hard for it, but they wouldn't allow him to do it because they felt that since the option of a specialist is available, the patient deserves specialist care.

[BoyInTheBubble]

LOL, true. OP, your experience in stem cell research, etc will be irrelevant. I suggested you go see a career counselor at your med school if you wanted to incorporate stem cell research into your future career, because family medicine (no matter how much extra training you do) is NOT the way to go. They may also provide you with the contacts of people who've attended these programs. I guarantee you no FM+obs have time to log onto this forum.

 

Regarding maternity, you DON'T need to do 2+1 to deliver babies, even if you want ob to be the focus of your practice. There are GP-run low-risk obstetrics groups in every decent-sized city. There was one where I trained at U of A and there is one near where I'm doing my residency at UBC. Usually, GPs who wanna do obstetrics just do an extra elective or two during residency. You get enough exposure to obs in medical school and FM residency (14 weeks) to have a decent grasp of how to manage deliveries. An extra elective at a high-volume centre allows you to encounter enough risky situations (post-partum hemorrhage, shoulder dystocia) to be comfortable managing them and to get hands-on practice doing things like repairing complex tears, but you don't even NEED that to do low-risk obstetrics as a GP.

 

The 2+1 is basically training in operative deliveries (forceps, vacuums, C-sections and operative management of post-partum hemorrhages, etc). It's meant for rural doctors with limited resources, where an obstetrician is not available. Even some smaller centers will not allow a GP-OB to operate if there's an obstetrician available. At my centre, there's a 2+1 person who is not allowed to do C-sections because we have an obstetrician. He pushed quite hard for it, but they wouldn't allow him to do it because they felt that since the option of a specialist is available, the patient deserves specialist care.

 

Some programs don't even train you in C-sections! Besides C-section privileges is hard to get at hospitals - even rural hospitals - due to perceived liability and lack of 'proper' training. (Even though, its pretty basic from a surgical perspective. Slice, rip and then yank out baby. Sew up later.)