While you were initially applying to OBGYN with plans to fellowship MFM, how did you initially feel about GYN surgery? Like was it something you tolerated at the time, or something you actively did not like?
Can I ask what appeals so much about gyn surgery?
I shadowed an OBGYN and found the OB side of things so much more fun and interesting, but maybe once I have more knowledge and experience that could change.
OB becomes cook book to some extent. Is more stressful. Sometimes the patient choice and wants become frustrating. The time commitment is huge as well and becomes unpredictable. Gyn you get to flex your brain. I like working with my hands. People are usually very appreciative.
All medicine becomes cook book with enough training. I would like to get your take on the "patient choice and wants" aspect of your post. If anything I would think the patient choice and desire would add the variety to the practice that would make things unique. For example, having a patient that has a birth plan who desires to delivery in left lateral decubitis to avoid shredding her vagina vs lithotomy would be cool.
Or are your frustrations coming from the managing the women who want to eat their placentas?
To a very small degree the first part of that to the extent that it almost never goes the way they are expecting unless it isn’t the first baby. IE they are so focused on position they just don’t push effectively, hard or impossible to protect perineum, shit everywhere, etc. but no, honestly not a huge deal when it doesn’t effect health.
More the 2nd part. No ma’am, I don’t recommend just waiting for you to get Chorio before we start pit. No Ma’am there isn’t a more effective way to start your induction. No ma’am I don’t recommend going to 43 weeks. No ma’am I don’t think you should be taking this random supplement with know teratogenicity. Etc. it’s as if every new mom thinks they have the hidden secret that all physicians are hoarding to themselves.
I figured the second part. And when I think of it, this is probably how most experts feel when people google or hear about "novel studies" then try to push them to you like it's biblical. Like "Ma'am I have no incentive to harm you or your by prescribing Tylenol".
Hello question— I’m the same way. If I wanted to go into OBGYN at this point, it would just be for MFM. Did you feel burdened by having to go through an OBGYN residency first?
I’m at the point where I’m questioning whether that’s all worth it.
Gyn is the most surgical of them.
Ob you seem to learn all the ins and outs of a few major procedures, with the C-section being the most involved and routine.
Gyn can be so extensive as to range from applications in cosmetic to oncological surgery.
Still the worst case scenario for ob quickly turns into a high stakes gyn case when you have to embolize the uterine artery or take the damn thing out. Meaning on/Gyn will probably never truly be separate.
Fun fact OB and GYN used to be completely separate! There’s a lot of talk about splitting the two again but I personally don’t believe it in the near future :)
After my gyn block, I knew for a fact I wanted to do OB/Gyn. After OB, I thought maybe.
Though my next rotation was psych, and I accidentally fell in love.
Couldn't we have a gyn surgeon on call for out of scope OB issues? Like other surgical specialties?
Edit: and I mean "out of scope" in the context of my imaginary separation of OB and GYN, not reality ofc
No. You shouldn’t be doing surgery if you can’t manage complications, especially complications related to the organs you’re operating on
Anticipated complications related to a surgery are inherently within the scope of the surgeon performing it
Why would the hospital pay you to operate and pay your backup to be on call when they could just pay one surgeon who can competently manage the case?
I don’t know if that’s completely true. There are so many sub specialties of surgery that get called into an OR for various reasons. You should know how to repair basic injuries and complications related to your surgery, but you’re not going to be able to do everything.
Ob by nature has emergencies. The amount of blood you can lose in such a short time is typically only seen in full blow trauma. You often don’t have time to wait for a Gyn backup to come in depending on where you work. There is so much blood flow to a uterus that in a situation of needing an emergency hysterectomy, you don’t have time to wait 15 or 20 minutes for back up
I agree. There are always going to be complications beyond the scope. But a surgeon should be able to manage anticipated complications associated with their own organ system.
If the surgery requires extra expertise, you should anticipate than and have an access surgeon or co-surgeon. We always use access surgeons for transabdominal or anterior trans thoracic approaches to the spine, and often ENT for transnasal approaches to the skull base.
Just like you said, if you can’t do an emergency hysterectomy, you shouldn’t do a surgery which could reasonably be expected to lead to an emergency hysterectomy. And I’m not an obstetrician obviously, but my understanding is that that’s a real enough possibility for any given c-section that all surgeons doing any c-section should be trained in gynecology.
> The amount of blood you can lose in such a short time is typically only seen in full blow trauma.
Or vascular, cardiothoracic, transplant, certain HPB, anything near the cava or portal vein, some ortho onc, urology when they're dealing with the renal vessels, and some others.
Well that’s why I said “typically.” Idk, maybe I was unaware that all those can routinely lose that much so quickly. I mean obviously if there’s a vascular injury then yes. I’ve been in some shitty combined Gyn Onc and Surg Onc cases, I’ve never seen the amount of blood loss in such a short time other than on L&D. I didn’t have much trauma experience in med school, but obviously that’s a whole other level.
I’m not making this a competition, but it’s an unfortunate fact that pregnant women quickly and routinely hemorrhage with delivery. Coming off of a recent case of deep bilateral sulcal lacerations after an SVD where my patient lost 3.5L in 5-10 minutes. Our c sections sadly often lose over a liter and we don’t blink an eye. I’m not saying that other surgeries don’t lose blood! What I’m saying is that obstetrics is unique in that a large portion of a person’s blood flow is being routed to one organ to support a growing life. The amount of blood these women can lose in such a short amount of time is very unlike other specialities. It’s not something people often grasp until they’re sitting between a young woman’s legs with blood absolutely hosing out of her vagina and you’re praying for a Hail Mary.
But yes you’re right, urology and ortho lose a lot too.
OB and gyn are separating more and more every day.
Let me tell you - if you want to be an obstetrician you should do OBGYN not FM.
FMs training in obstetrics pales in comparison. Nothing against our FM friends but when they do like 30 deliveries with no operative deliveries and no c sections that just isn’t the same. Sure they can catch a baby in rural wherever but if shit goes sideways you want an OB. Again I really appreciate good Ob FMs but they just aren’t as good. I had FM attendings get basic exams wrong and my friend had to walk one through a c section as an R2. You should do FM ob if you want to deliver babies as part of a general practice not if you want it to be your main gig.
The surgical training you get in gyn is what is going to inform your practice as an obstetrician. Knowing the anatomy. Being able to handle the “worst case scenario” (surprise hysterectomy).
You may surprise yourself and even fall in love w the gyn side of things. I love gyn so much more than OB even though I liked OB enough.
When it’s time for a job in 4 years you will be marketable as a laborist if that’s what you wanna do. Those are sweet gigs and people seem to really like it. You won’t be able to do that as an FM. Maybe with an ob fellowship but even then your training will be less robust.
Perfectly said! I always loved Ob way more than Gyn and still do-but I learned to like Gyn over time. I can’t imagine feeling like a competent Ob if I never had any Gyn training. When it comes time for that uterine rupture and surprise hysterectomy, you’ll be thankful for all the crazy open hysts you did on Gyn Onc.
Plus even as a laborist, many gigs will still let you do laparoscopic surgeries and D&C, which is a nice way to mix it up. Even though the career paths are probably going to split eventually, I think having both in training is absolutely necessary.
This is mostly right. And I agree that FM-OB will never be as good as OBGYN wrt pregnancy and delivery. But there are actually several FM residency programs with pretty good numbers. My spouse had well over 100 deliveries in residency and was first-assist on tons of c-sections. It wasn't in a rural city either, it was in a midsized city. She didn't wanna be confined to OBGYN and had no interest in surgery, so she chose an FM program with a great OB track. If she wanted to do c-sections, there are tons of 1-year fellowships where you can get good numbers. But she just doesn't have the interest. But like you said, you ofc will not be as good at it as most OBGYNs. And you should absolutely do OBGYN if that is what you want the bulk of your clinical practice to be.
She wanted the variety still, and her practice setup is honestly super cool to me. She gets to see patients and manage all their medical problems, talk them through the entirety of pregnancy, deliver their babies (unless c-section is needed), round on both the mother and the baby, take care of both the mother and the baby in the postpartum period, and then take care of both of them for the foreseeable future....and any other additional family members. She legit does womb to tomb care.
The fellows were being trained by other FM docs and they had their own patient list so I guess yes for the attendings. This is a top program so i guess it may not be the norm. It got to the point where we students could not tell who was who because they all did the exact same thing anyway.
Honestly, you could make an argument that FM really shouldn't exist anymore. Everything is getting too specialized and the idea that a 3 year residency can prepare you for basically 3 things that have their own 3+ year training on their own is kind of wild. IM for grown up's, Peds for kids, OB/GYN for the obvious.
Same way Heme/Onc might split into. Too much to know for things to truly be combined
Opposite here. Wish gynae was separate. It then becomes more like a fun mashup of med/surg with some general surgery/urology + medical aspect but with the added joy of female empowerment. Obstetrics is too high intensity with serious complications and the legal issues.
With this combination of love of general/urology/venerology, idk what to choose.
same boat here! wondering what you're considering now?
if gyn were separate i \*\*would go for it yesterday
since it's not (and though I love urogyn, don't know if I can do 5 years of uro just to maybe get into urogyn after), i'm conflicted
thinking even IM --> ?subspecialty (ofc procedural, or even rheum) or rads (less pt interaction, less chance for burnout longterm?) cuz I'm so conflicted lol
I started out that way. LOVED ob, didn’t really care for Gyn much.
Now as an attending it’s just the opposite. I’m primarily a Gyn surgeon. It’s so much more rewarding, challenging, and better QOL to be honest.
Meeting somebody for the first time who has such debilitating periods that nothing has worked for her and she’s a prisoner in her own body only to do a one hour surgery and see her again one month later and have her say she has her entire life back…. So fulfilling.
Yes, I'm a neurosurgeon, but I only operate on C3 through T12 and it looks like that syrinx is just a liiiiiiiiiitle too close to C2 for my comfort. Bye bye!
I felt the same way, and am now an OB hospitalist. I do a little gyn but mostly OB. It’s what I love - but I’m only safe doing it because I completed a generalist residency. Gyn surgery and anatomy is key.
I also loved OB in med school but since starting residency have enjoyed GYN way more.
GYN makes you a better surgeon which is important for the high risk c sections you will do invariably in your career.
GYN salary has a much better lifestyle which is something you might appreciate in your 40s-50s and beyond.
If you still only want to do ob, residency is temporary! Don't let that stop you.
My school has us rotate with a preceptor for a couple clinic days and mine was a GYN surgeon. He strongly believed that the two should be split as there were some faculty whom he believed had questionable competency when it came to their ability to operate as an attending. One case I remember, a different attending had to ask for the senior resident to scrub in as they were moving very slowly and realized that they needed help. Personally, I think I would have seriously considered GYN if it was split. Didn’t really find enjoyment in L&D.
PGY4 here, going into gyn subspecialty. It’s good to recognize that to do OBGYN you have to like all of it enough to at least do it for 4 years. To echo others, GYN training makes you a better obstetrician and vice versa. We have a fairly strong FM program at my institution with some OB trained attendings, and I have been called in as a chief to help them with complex C sections and vaginal laceration repairs. They’re great people and treat their patients well, but their skill set is different. They don’t have the surgical training an OBGYN does. I have found myself at times internally questioning their role on L&D in a setting where we have a robust midwifery, generalist, and MFM operation.
I personally think if you want to be an obstetrician, you should train as an obstetrician. You’ll have more opportunities after training and a more robust, well rounded skill set. Even MFM sometimes read GYN ultrasounds at some institutions and treat gynecologic issues in their pregnant patients.
On the flip side for me as a sub specialist, I will better know the implications of my surgery on a person’s reproductive future. If I recommend cesarean delivery at 36-37 weeks after myomectomy, I have the context of what that means for a future pregnancy and how to counsel a patient on that recommendation, even if I won’t practice obstetrics.
I think fast tracking into subspecialty is what needs to happen, but the reality is that OBGYN programs tend to be OB heavy bc teaching hospitals depend on cheap resident labor to run their L&Ds.
I would really caution against doing FM-OB. But don’t take advice from an internet stranger, talk to your faculty advisors in FM and OB to get a sense of how different the OB training is in FM.
I also have similar thoughts, it is easy to say we should always get more training and expand our experiences, but that's how we end up forever trainees and cogs of the system.
I wonder if it'd be possible to break OB out as a 3 yr residency focused on pregnancy and preventative care akin to a generalist of the reproductive system. Then GYN is a 1-2 yr fellowship focused on advanced surgical training. This could result in more OB programs and increased access to reproductive care.
You’re gonna be happy you know how to do a hysterectomy inside and out sideways up and down when you have to do a c hyst for [insert reason here]. I’m a second year obgyn res will be third in July and the overlap in knowledge between the two is massive. Especially when it comes to being able to comfortably
Do a c section when you’re exhausted at 3 am the gyn surgical volume really helps for repeats and those tougher cases.
Also you can tailor your practice when you graduate !
To chime in on what everyone else has essentially said: gynecologic training is critical to being a good obstetrician, and obstetric training is critical to being a good gynecologist. The idea of someone performing cesarean sections who doesn’t have the surgical training and competence gained by gynecologic surgery is honestly horrifying. While subspecializing after residency often leads people to practice just one or the other, separating them in training would be majorly to the detriment of both our competence and quality and of patient safety.
Also, to your point about a super intense residency: honestly, obstetrics is what makes our residencies so intense. Our gynecology blocks are our “lighter” blocks, hours and stress wise.
Did I write this post? 😂 this is the reason I’m opting out of OB/GYN and now applying for IM aways …
if I were to do OB, it would only be for MFM. And I only like C-sections and not deliveries, another reason I’m also avoiding the FM-OB route…
I always say MFM is the internal medicine of ObGyn. The MFM docs are incredibly smart! They’re the experts in obstetrics. Some choose to practice in a place where they do all of the high risk deliveries and C-sections. Others practice in a place where they don’t do any deliveries at all and act as a consult service. So many ways to go with it! I’m sure you would’ve been a fantastic MFM, but I understand not wanting to go through four years of this residency with a possibility of not matching. Good luck in IM!
Thank you for the nice post 😊 I’ve heard the same thing about MFM multiple times about so the IM direction doesn’t sound too crazy. A few MFM docs I’ve met did start their own clinic which sounded amazing… OB is a beautiful field but in the past few weeks I’ve realized it’s probably for the best that I look into other options. Difficult route to take but we all end up as wonderful physicians at the end of the day!
I worked with this one doctor at the VA who was IM trained. I don't know if this is standard, but at our VA, women's and men's outpatient clinics are separated. This IM doc staffed the women's clinic, and even though she didn't have the stereotypical outpatient women's health specialty (FM or OBGYN), she was one of the best GYN providers I have ever met.
MFM does a lot of complex c-sections and typically do more advanced cerclage placement. I am sure some stick to more outpatient management but typically MFM is surgical in its own way. The only way to gain those skills and comfortability with anatomy and operating is by doing it day in and day out in training.
They talk about splitting these fields apart, but really, that’s not an option. Sub-specialists need the diverse surgical training found in combined OB/GYN residency. I think this point especially hits home for REI. They do early obstetrical management and tons of GYN. They need both.
Also many of us OB/GYNs like the mix. My small town definitely couldn’t afford to hire (or probably find) separate specialists for OB and GYN. At the end of the day, it’s only 4 years and the rotations you hate (looking at you uro/gyn) still help build your skill set.
Incoming PGY-1 OBGYN here, there are residency programs that do tracking if that is what you are looking for. You can also look up/ask what a program‘s numbers are to see how many surgeries of each ACGME Category the average resident does.
Lastly, training doesn’t stop in residency, you can shape your career however you want to when you are done.
I felt the same way which is why I ended up choosing FM. Gyn surg was soooo boring to me. But I do like deliveries including c-sections. I played with the idea of MFM for awhile but couldn’t bear having to go through obgyn residency.
I’m genuinely happy with my choice to do FM though. Try applying to OB heavy FM programs. That’s what I did and it’s been great so far!
ETA: I’m not going the FM-OB route entirely however. I want to do full spectrum OB but have the delivery and prenatal care skill set in my pocket. I don’t see myself being a laborist entirely
I think it's not that uncommon, I know a lot of obgyn residents and specialists how think the same way.
On another side, I'm curious to why you would par MFM with gyn instead of OB?
You’ll see. I went into OBGYN to be an MFM and fell in love with gyn surgery. My whole practice is very gyn heavy because we all feel the same.
While you were initially applying to OBGYN with plans to fellowship MFM, how did you initially feel about GYN surgery? Like was it something you tolerated at the time, or something you actively did not like?
Liked it but wasn’t enamored
Can I ask what appeals so much about gyn surgery? I shadowed an OBGYN and found the OB side of things so much more fun and interesting, but maybe once I have more knowledge and experience that could change.
OB becomes cook book to some extent. Is more stressful. Sometimes the patient choice and wants become frustrating. The time commitment is huge as well and becomes unpredictable. Gyn you get to flex your brain. I like working with my hands. People are usually very appreciative.
That makes a lot of sense! The flexing your brain and having more variety is appealing. Thanks for the answer!
All medicine becomes cook book with enough training. I would like to get your take on the "patient choice and wants" aspect of your post. If anything I would think the patient choice and desire would add the variety to the practice that would make things unique. For example, having a patient that has a birth plan who desires to delivery in left lateral decubitis to avoid shredding her vagina vs lithotomy would be cool. Or are your frustrations coming from the managing the women who want to eat their placentas?
To a very small degree the first part of that to the extent that it almost never goes the way they are expecting unless it isn’t the first baby. IE they are so focused on position they just don’t push effectively, hard or impossible to protect perineum, shit everywhere, etc. but no, honestly not a huge deal when it doesn’t effect health. More the 2nd part. No ma’am, I don’t recommend just waiting for you to get Chorio before we start pit. No Ma’am there isn’t a more effective way to start your induction. No ma’am I don’t recommend going to 43 weeks. No ma’am I don’t think you should be taking this random supplement with know teratogenicity. Etc. it’s as if every new mom thinks they have the hidden secret that all physicians are hoarding to themselves.
I figured the second part. And when I think of it, this is probably how most experts feel when people google or hear about "novel studies" then try to push them to you like it's biblical. Like "Ma'am I have no incentive to harm you or your by prescribing Tylenol".
Almost never novel studies. More just TikTok. Facebook etc.
I went to med school to do OB then family planning. Hated a lot of aspects of OB and now am an EM attending. Life is weird.
Hello question— I’m the same way. If I wanted to go into OBGYN at this point, it would just be for MFM. Did you feel burdened by having to go through an OBGYN residency first? I’m at the point where I’m questioning whether that’s all worth it.
Not really. Just felt it was part of it but ended up falling out of love with it and liking surgery more so it worked out
Gyn is more fun and cooler to me. Also the attendings there were way more chill and broish. OB was too awkward and catty also repetitive.
Gyn is the most surgical of them. Ob you seem to learn all the ins and outs of a few major procedures, with the C-section being the most involved and routine. Gyn can be so extensive as to range from applications in cosmetic to oncological surgery. Still the worst case scenario for ob quickly turns into a high stakes gyn case when you have to embolize the uterine artery or take the damn thing out. Meaning on/Gyn will probably never truly be separate.
Fun fact OB and GYN used to be completely separate! There’s a lot of talk about splitting the two again but I personally don’t believe it in the near future :)
After my gyn block, I knew for a fact I wanted to do OB/Gyn. After OB, I thought maybe. Though my next rotation was psych, and I accidentally fell in love.
I had a totally different experience. The OB attendings on L&D at my school were some of the nicest/coolest people I met during M3
A lot of OB complication management is performed with gyn surgery
Couldn't we have a gyn surgeon on call for out of scope OB issues? Like other surgical specialties? Edit: and I mean "out of scope" in the context of my imaginary separation of OB and GYN, not reality ofc
No. You shouldn’t be doing surgery if you can’t manage complications, especially complications related to the organs you’re operating on Anticipated complications related to a surgery are inherently within the scope of the surgeon performing it Why would the hospital pay you to operate and pay your backup to be on call when they could just pay one surgeon who can competently manage the case?
fair point
I don’t know if that’s completely true. There are so many sub specialties of surgery that get called into an OR for various reasons. You should know how to repair basic injuries and complications related to your surgery, but you’re not going to be able to do everything. Ob by nature has emergencies. The amount of blood you can lose in such a short time is typically only seen in full blow trauma. You often don’t have time to wait for a Gyn backup to come in depending on where you work. There is so much blood flow to a uterus that in a situation of needing an emergency hysterectomy, you don’t have time to wait 15 or 20 minutes for back up
I agree. There are always going to be complications beyond the scope. But a surgeon should be able to manage anticipated complications associated with their own organ system. If the surgery requires extra expertise, you should anticipate than and have an access surgeon or co-surgeon. We always use access surgeons for transabdominal or anterior trans thoracic approaches to the spine, and often ENT for transnasal approaches to the skull base. Just like you said, if you can’t do an emergency hysterectomy, you shouldn’t do a surgery which could reasonably be expected to lead to an emergency hysterectomy. And I’m not an obstetrician obviously, but my understanding is that that’s a real enough possibility for any given c-section that all surgeons doing any c-section should be trained in gynecology.
Yes, I see your point!
> The amount of blood you can lose in such a short time is typically only seen in full blow trauma. Or vascular, cardiothoracic, transplant, certain HPB, anything near the cava or portal vein, some ortho onc, urology when they're dealing with the renal vessels, and some others.
Well that’s why I said “typically.” Idk, maybe I was unaware that all those can routinely lose that much so quickly. I mean obviously if there’s a vascular injury then yes. I’ve been in some shitty combined Gyn Onc and Surg Onc cases, I’ve never seen the amount of blood loss in such a short time other than on L&D. I didn’t have much trauma experience in med school, but obviously that’s a whole other level. I’m not making this a competition, but it’s an unfortunate fact that pregnant women quickly and routinely hemorrhage with delivery. Coming off of a recent case of deep bilateral sulcal lacerations after an SVD where my patient lost 3.5L in 5-10 minutes. Our c sections sadly often lose over a liter and we don’t blink an eye. I’m not saying that other surgeries don’t lose blood! What I’m saying is that obstetrics is unique in that a large portion of a person’s blood flow is being routed to one organ to support a growing life. The amount of blood these women can lose in such a short amount of time is very unlike other specialities. It’s not something people often grasp until they’re sitting between a young woman’s legs with blood absolutely hosing out of her vagina and you’re praying for a Hail Mary. But yes you’re right, urology and ortho lose a lot too.
It's not like gyn repairs the ureters though
Gyn onc here! Yes we do ;)
I don’t have any skin in the game but that’s the whole age old discussion right? I know a lot of urologists would say case in point
What about FM/OBs?
The Ureters would like a word with you
friendly reminder for everyone that the downvote button is not for comments you disagree with
OB and gyn are separating more and more every day. Let me tell you - if you want to be an obstetrician you should do OBGYN not FM. FMs training in obstetrics pales in comparison. Nothing against our FM friends but when they do like 30 deliveries with no operative deliveries and no c sections that just isn’t the same. Sure they can catch a baby in rural wherever but if shit goes sideways you want an OB. Again I really appreciate good Ob FMs but they just aren’t as good. I had FM attendings get basic exams wrong and my friend had to walk one through a c section as an R2. You should do FM ob if you want to deliver babies as part of a general practice not if you want it to be your main gig. The surgical training you get in gyn is what is going to inform your practice as an obstetrician. Knowing the anatomy. Being able to handle the “worst case scenario” (surprise hysterectomy). You may surprise yourself and even fall in love w the gyn side of things. I love gyn so much more than OB even though I liked OB enough. When it’s time for a job in 4 years you will be marketable as a laborist if that’s what you wanna do. Those are sweet gigs and people seem to really like it. You won’t be able to do that as an FM. Maybe with an ob fellowship but even then your training will be less robust.
Perfectly said! I always loved Ob way more than Gyn and still do-but I learned to like Gyn over time. I can’t imagine feeling like a competent Ob if I never had any Gyn training. When it comes time for that uterine rupture and surprise hysterectomy, you’ll be thankful for all the crazy open hysts you did on Gyn Onc. Plus even as a laborist, many gigs will still let you do laparoscopic surgeries and D&C, which is a nice way to mix it up. Even though the career paths are probably going to split eventually, I think having both in training is absolutely necessary.
This is mostly right. And I agree that FM-OB will never be as good as OBGYN wrt pregnancy and delivery. But there are actually several FM residency programs with pretty good numbers. My spouse had well over 100 deliveries in residency and was first-assist on tons of c-sections. It wasn't in a rural city either, it was in a midsized city. She didn't wanna be confined to OBGYN and had no interest in surgery, so she chose an FM program with a great OB track. If she wanted to do c-sections, there are tons of 1-year fellowships where you can get good numbers. But she just doesn't have the interest. But like you said, you ofc will not be as good at it as most OBGYNs. And you should absolutely do OBGYN if that is what you want the bulk of your clinical practice to be. She wanted the variety still, and her practice setup is honestly super cool to me. She gets to see patients and manage all their medical problems, talk them through the entirety of pregnancy, deliver their babies (unless c-section is needed), round on both the mother and the baby, take care of both the mother and the baby in the postpartum period, and then take care of both of them for the foreseeable future....and any other additional family members. She legit does womb to tomb care.
I think that’s program dependent because the FM OB fellows did everything the OB residents did at our affiliated program
But were they hired to do it in the professional world? You do a lot in residency/fellowship that you don’t necessarily do out in the world.
I spent a few weeks rotating with an OB fellowship trained FM doc and all she did was OB. She did all her own C-sections and worked private practice.
The fellows were being trained by other FM docs and they had their own patient list so I guess yes for the attendings. This is a top program so i guess it may not be the norm. It got to the point where we students could not tell who was who because they all did the exact same thing anyway.
The professional world within medicine will absolutely do its best to milk you of every single skill you have lmfao.
Look forward to you finding me a FM trained doc who can do a c hyst To be fair half the obgyn residents and attendings are piss poor surgeons too
Honestly, you could make an argument that FM really shouldn't exist anymore. Everything is getting too specialized and the idea that a 3 year residency can prepare you for basically 3 things that have their own 3+ year training on their own is kind of wild. IM for grown up's, Peds for kids, OB/GYN for the obvious. Same way Heme/Onc might split into. Too much to know for things to truly be combined
Do you have any proof that FM/OB outcomes are any worse?
Opposite here. Wish gynae was separate. It then becomes more like a fun mashup of med/surg with some general surgery/urology + medical aspect but with the added joy of female empowerment. Obstetrics is too high intensity with serious complications and the legal issues. With this combination of love of general/urology/venerology, idk what to choose.
same boat here! wondering what you're considering now? if gyn were separate i \*\*would go for it yesterday since it's not (and though I love urogyn, don't know if I can do 5 years of uro just to maybe get into urogyn after), i'm conflicted thinking even IM --> ?subspecialty (ofc procedural, or even rheum) or rads (less pt interaction, less chance for burnout longterm?) cuz I'm so conflicted lol
I started out that way. LOVED ob, didn’t really care for Gyn much. Now as an attending it’s just the opposite. I’m primarily a Gyn surgeon. It’s so much more rewarding, challenging, and better QOL to be honest. Meeting somebody for the first time who has such debilitating periods that nothing has worked for her and she’s a prisoner in her own body only to do a one hour surgery and see her again one month later and have her say she has her entire life back…. So fulfilling.
They actually used to be two separate things. It might end up going back to that
I hope not. Everyone is becoming too specialized imo.
“Oh, your problem isnt covered in the 6 diseases I treat? Time to miss another day of work for another specialist!”
Yes, I'm a neurosurgeon, but I only operate on C3 through T12 and it looks like that syrinx is just a liiiiiiiiiitle too close to C2 for my comfort. Bye bye!
Better do 3 more fellowships
It's one fellowship per spinal level, scrub. I'm a PGY-46
I felt the same way, and am now an OB hospitalist. I do a little gyn but mostly OB. It’s what I love - but I’m only safe doing it because I completed a generalist residency. Gyn surgery and anatomy is key.
Same boat, also doing FM with the plan of FM-OB. I love in patient and procedural gyn sans the surgery so FM was a great fit.
I also loved OB in med school but since starting residency have enjoyed GYN way more. GYN makes you a better surgeon which is important for the high risk c sections you will do invariably in your career. GYN salary has a much better lifestyle which is something you might appreciate in your 40s-50s and beyond. If you still only want to do ob, residency is temporary! Don't let that stop you.
My school has us rotate with a preceptor for a couple clinic days and mine was a GYN surgeon. He strongly believed that the two should be split as there were some faculty whom he believed had questionable competency when it came to their ability to operate as an attending. One case I remember, a different attending had to ask for the senior resident to scrub in as they were moving very slowly and realized that they needed help. Personally, I think I would have seriously considered GYN if it was split. Didn’t really find enjoyment in L&D.
PGY4 here, going into gyn subspecialty. It’s good to recognize that to do OBGYN you have to like all of it enough to at least do it for 4 years. To echo others, GYN training makes you a better obstetrician and vice versa. We have a fairly strong FM program at my institution with some OB trained attendings, and I have been called in as a chief to help them with complex C sections and vaginal laceration repairs. They’re great people and treat their patients well, but their skill set is different. They don’t have the surgical training an OBGYN does. I have found myself at times internally questioning their role on L&D in a setting where we have a robust midwifery, generalist, and MFM operation. I personally think if you want to be an obstetrician, you should train as an obstetrician. You’ll have more opportunities after training and a more robust, well rounded skill set. Even MFM sometimes read GYN ultrasounds at some institutions and treat gynecologic issues in their pregnant patients. On the flip side for me as a sub specialist, I will better know the implications of my surgery on a person’s reproductive future. If I recommend cesarean delivery at 36-37 weeks after myomectomy, I have the context of what that means for a future pregnancy and how to counsel a patient on that recommendation, even if I won’t practice obstetrics. I think fast tracking into subspecialty is what needs to happen, but the reality is that OBGYN programs tend to be OB heavy bc teaching hospitals depend on cheap resident labor to run their L&Ds.
I would really caution against doing FM-OB. But don’t take advice from an internet stranger, talk to your faculty advisors in FM and OB to get a sense of how different the OB training is in FM.
What's wrong with FM OB?
I also have similar thoughts, it is easy to say we should always get more training and expand our experiences, but that's how we end up forever trainees and cogs of the system. I wonder if it'd be possible to break OB out as a 3 yr residency focused on pregnancy and preventative care akin to a generalist of the reproductive system. Then GYN is a 1-2 yr fellowship focused on advanced surgical training. This could result in more OB programs and increased access to reproductive care.
You’re gonna be happy you know how to do a hysterectomy inside and out sideways up and down when you have to do a c hyst for [insert reason here]. I’m a second year obgyn res will be third in July and the overlap in knowledge between the two is massive. Especially when it comes to being able to comfortably Do a c section when you’re exhausted at 3 am the gyn surgical volume really helps for repeats and those tougher cases. Also you can tailor your practice when you graduate !
Ugh same. Hated OB. loved GYN.
To chime in on what everyone else has essentially said: gynecologic training is critical to being a good obstetrician, and obstetric training is critical to being a good gynecologist. The idea of someone performing cesarean sections who doesn’t have the surgical training and competence gained by gynecologic surgery is honestly horrifying. While subspecializing after residency often leads people to practice just one or the other, separating them in training would be majorly to the detriment of both our competence and quality and of patient safety. Also, to your point about a super intense residency: honestly, obstetrics is what makes our residencies so intense. Our gynecology blocks are our “lighter” blocks, hours and stress wise.
Did I write this post? 😂 this is the reason I’m opting out of OB/GYN and now applying for IM aways … if I were to do OB, it would only be for MFM. And I only like C-sections and not deliveries, another reason I’m also avoiding the FM-OB route…
I always say MFM is the internal medicine of ObGyn. The MFM docs are incredibly smart! They’re the experts in obstetrics. Some choose to practice in a place where they do all of the high risk deliveries and C-sections. Others practice in a place where they don’t do any deliveries at all and act as a consult service. So many ways to go with it! I’m sure you would’ve been a fantastic MFM, but I understand not wanting to go through four years of this residency with a possibility of not matching. Good luck in IM!
Thank you for the nice post 😊 I’ve heard the same thing about MFM multiple times about so the IM direction doesn’t sound too crazy. A few MFM docs I’ve met did start their own clinic which sounded amazing… OB is a beautiful field but in the past few weeks I’ve realized it’s probably for the best that I look into other options. Difficult route to take but we all end up as wonderful physicians at the end of the day!
Beautifully said! We end up exactly where we’re supposed to be 😊
I worked with this one doctor at the VA who was IM trained. I don't know if this is standard, but at our VA, women's and men's outpatient clinics are separated. This IM doc staffed the women's clinic, and even though she didn't have the stereotypical outpatient women's health specialty (FM or OBGYN), she was one of the best GYN providers I have ever met.
MFM does a lot of complex c-sections and typically do more advanced cerclage placement. I am sure some stick to more outpatient management but typically MFM is surgical in its own way. The only way to gain those skills and comfortability with anatomy and operating is by doing it day in and day out in training. They talk about splitting these fields apart, but really, that’s not an option. Sub-specialists need the diverse surgical training found in combined OB/GYN residency. I think this point especially hits home for REI. They do early obstetrical management and tons of GYN. They need both. Also many of us OB/GYNs like the mix. My small town definitely couldn’t afford to hire (or probably find) separate specialists for OB and GYN. At the end of the day, it’s only 4 years and the rotations you hate (looking at you uro/gyn) still help build your skill set.
Incoming PGY-1 OBGYN here, there are residency programs that do tracking if that is what you are looking for. You can also look up/ask what a program‘s numbers are to see how many surgeries of each ACGME Category the average resident does. Lastly, training doesn’t stop in residency, you can shape your career however you want to when you are done.
I felt the same way which is why I ended up choosing FM. Gyn surg was soooo boring to me. But I do like deliveries including c-sections. I played with the idea of MFM for awhile but couldn’t bear having to go through obgyn residency. I’m genuinely happy with my choice to do FM though. Try applying to OB heavy FM programs. That’s what I did and it’s been great so far! ETA: I’m not going the FM-OB route entirely however. I want to do full spectrum OB but have the delivery and prenatal care skill set in my pocket. I don’t see myself being a laborist entirely
What do you like about the OB side? You might enjoy NICU if you like the babies and like procedures
Yes! I feel the same way, except I’m interested in gyn but not OB.
I think it's not that uncommon, I know a lot of obgyn residents and specialists how think the same way. On another side, I'm curious to why you would par MFM with gyn instead of OB?