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12 years 9 months ago #19366 by medstudent24
I am a 1st year med student and I know that I don't have to decide my specialty right now, but I would like to have some idea. I have always been interested in OBGYN, ER, and PEDS. OBGYN is my top choice but I am often warned about going into it. Whatever I do I want to be happy and have time for a family. I would like advice and opinions on hours/week, on-call time, pay and reimbursement, and any other pros or cons.

My husband and I are planning on having our first child during my 4th year and another one during residency. I do not want to take any time off, if at all possible. Any pros or cons with this too?

Thank you!

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12 years 9 months ago #19367 by JN819
thanks for you post!
I would also like to know the answers to your questions, as I am also looking into OBGYN, am married and we are thinking of having a baby in the 4th year.

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12 years 9 months ago #19368 by docE
Ok, this is a bit freaky...I'm also a 1st year med student, married, planning on having our 1st baby hopefully at the beginning of 4th year and strongly leaning towards OBGYN or possibly PEDS. Any OBGYNs with any info?

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12 years 9 months ago #19369 by DrEthiope
Hello,

I'm an OB/GYN who now only practices Gyn. The reason for that is because the doctor who owned the first practice I worked for lost his malpractice insurance 1 year and 10 months after I started, and the practice dissolved. Right after that is when I started doing GYN only. I'm not married and don't have any children, but the practice of gyn-only, I think, could be conducive to both.

Obstetrics is another story altogether. Obstetricians probably have among the craziest, most unpredictable and longest hours of any specialty. Of course, this is because babies have this pesky habit of being born at odd hours. Some doctors offset this by inducing most of their patients, but there is some controversy about this.

Most women with families I know either hire nannies or have family members that help care for their children or have husbands who stay home and do most of the childcare.

I know a couple who have gotten out of private practice and have more normal schedules. One works 9-5 3 days a week in an outpatient clinic doing prenatal care with no labor or delivery duties and no call (stopped working when she had severe complications with her first pregnancy partially precipitated by the stress of her job). The other is about to start in a OB hospitalist group which offer a good lifestyle. She will be doing 2-24 hour shifts per week and will make a very decent living doing it. There's no patient continuity (and no call) which could be seen as a very good thing or a bad thing depending on your perspective. These types of jobs are becoming more prevalent, and probably will become even more so in the future.

In private practice, when on call, even if you don't have any babies to deliver, the phone seems to ring incessantly with questions from worried mothers-to-be which could definitely interrupt family time. Most OBs share call either within their own group, or the ones that are in solo practice still set up a call group to rotate call. The more people in the group, the less call you have, but the busier any individual call could be.

Many of my friends who are still doing OB tell me about seeing 35-40 patients a day, which is crazy to me. Some of them still seem to think it's not too overwhelming, but admit that they don't know how they do it. I see about 15-20 a day which I'm financially able to do because I'm very selective about which insurances I accept. Still, my salary as a gyn-only is a lot less than my friends doing OB/GYN, but it's quite adequate for me (and still a lot more than most people make).

The malpractice pressures in OB are absolutely ridiculous with everyone wanting and expecting perfect children every time. If something's not absolutely perfect, most of the time they'll blame you, even if you had no control over the outcome and blame usually means being sued.

I have friends who had babies in residency, one of whom I was very close to, and I ran across her more than once crying because she felt like she was shortchanging everything she tried to do. Ob/Gyn residency without kids can be VERY time-consuming and difficult, as can raising kids without residency. Put the two together and it's a set-up for frustration and burnout - but still people manage to do it.

Bottom line, I'll tell you like I just told my niece who's thinking about going to medical school. If you absolutely love OB/GYN (and I'd do everything in my power to gain real experience with as many OBs as you can to find out if you love it - under the best of circumstances this is difficult since you never really understand the pressure of being a doctor until you are one) -but like I said, if you absolutely find you love OB/GYN and can't imagine doing anything else, then far be it from me to say you shouldn't do it. Just go into it with your eyes wide open. But, if you don't absolutely love it or aren't sure, I'd think twice, thrice and four times before doing it because the toll it can take on you can easily produce resentment and extreme frustration if not balanced by a true love of the field.

If you read some of my posts in the Women Physicians threads you'll see that I'm currently doing extensive research on alternative careers other than clinical medicine. Much of my decision is because of the problems of medicine (malpractice issues, managed care, call) but equal if not more of it is because of a personal mismatch between my personality and the speciality. So, the overriding most important thing is to know yourself and what motivates you and what you absolutely can't stand and need to be happy, and compare what you find with the realities of the specialty. If the two don't fit, look elsewhere.

And, by the way, if you want to do OB because of the babies, don't. You hold the baby for about 10 seconds if that and much of the time during labor is spent stressed and hoping that nothing will go wrong. I definitely know some people who say that there's nothing like delivering a baby. I, personally, can think of lots of things I'd rather do, but, like I said, my personality and this profession don't match - something I unfortunately didn't fully realize until after I entered it.

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12 years 9 months ago #19370 by lidiamd
i think dr. ethiope said it very well. i am an obgyn in my 7th year of practice and i am thinking very seriously of quitting medicine entirely. i always wanted to do obgyn from the time i started med school; i did electives outside of core curriculum in my 1st and 2nd years of med school. i had a good experience in my clerkship and was mentored by the head of the clerkship as well as the chair of the obgyn department. i believe i had about as good an experience in residency as you can get--very humane, no significant resident abuse, and night float systems in place. i left residency very well trained (medically) and eager for practice. that is when fantasy met reality. i had my child during my first year in practice. i joined a private group that looked great from the outside, but within 2 years it fell apart because of longstanding financial problems that finally came to the surface (luckily before i signed in as a partner and would have bourne financial hardship not of my making--keep that in mind before signing on with any practice). After several changes, i am currently in a ob and gyn practice that many would consider ideal. i work 3 days a week and share call with 3 partners. but i think i have about had it with the current practice of medicine. i am disenchanted with medicine in general and obgyn in particular. medicine is not what it used to be--the golden age is over. in private practice you have to wear too many hats--marketing, accounting, practice management, medical coder, etc, etc, etc. patients are now clients with high expectations, and unfortunately many (not all) have very little respect for your personal time. they expect to get services for free and get very indignant if they have to pay for your time (try that with your lawyer)--they think everything is/should be covered by their insurance (wrong-but you look like the bad guy). insurance companies and hospitals call the shots and determine how much you get paid (and if you get paid) for the services you provide. and obgyn--while i do like taking care of patients and love solving clinical problems and helping women, the specialty as it is usually practiced is crazy. most obgyns are on a constant treadmill to make more--doing surgery before office hours and during lunch, taking call and working the next day even if you didn't sleep. would any of us advise our patients to live that way?? but it is almost a badge of honor to keep going and going. i have practice predominately gyn with some ob--which i still don't hate; but the problem in many cases is malpractice insurance. most of us wouldn't mind doing a small # of deliveries, but you still have to pay the same insurance premiums as the people running a baby-mill practice. so with only a few deliveies per month ob becomes cost prohibitive.
so is this meant to be a total downer? no, but as was said before, go into it with your eyes open. be careful about getting into too much debt, evaluate practice options carfully. consider locum tenems or and employed position first to get a feel for how you like to practice and not box yourself in too fast. you may not realize how time, children, family issues rearrange your priorites; and what seemed absolutely desirable may become an obstacle to the life you really want. think outside the box. there are options in medicine that can give you more flexibility, but they usually are not the ones that give you $200k+ incomes boasted by the recruiters.
for obgyn--i really hope we can see the light like internal med/fp and go to a system of ob hospitalists. it is not perfect, but i think it is a better alternative than what is happening now. (don't let them fool you-the male physicians are burned out too, but because they are so often the primary/only wage earner in their families they have no other choice.)

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12 years 9 months ago #19371 by flashMD
Just wanted to chime in...we had 2 female residents in the OB/Gyn program pregnant this year. They both were absolutely miserable! The department did not seem to be very supportive, and both women were stressed out! In return for getting 4-6 weeks of maternity leave, they had to give up all 3 weeks of vacation for the entire year! In addition, the general feeling from the other residents was one of irritation! They would all have to be covering for the women when they were gone, making their rotations even harder as well!

Just one program and one experience, but keep it in mind!

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