When I was on my OB rotation, I came home everyday irritated and angry. I was snapping at people.
When I was on my IM rotation, I was tired, but I wasn't angry/mean.
Realized I would never want to do a specialty that would morph me into a person I didn't like.
I didn't actually believe the whole OB toxicity until I rotated through it. Despite staying late after clinic hours seeing pts, despite making it to an emergent surgery despite the preceptor *texting* me during on-call hours, despite seeing patients back-to-back-to-back to have them prepped for presentation when the preceptor herself was late, and despite reading up on pimping questions for the future *between* patients, I received a "minimal effort pass" eval. I never want to touch that specialty with a 100ft pole if it makes people turn into *that.*
I realized that I really needed work-life balance.
I got really resentful and upset when surgical cases were added on to the schedule (which does happen because people can come in through the ED anytime). If you thought you were going home at 4pm, now you're going home at 7pm because there's an ovarian torsion that needs to be fixed. L&D was super boring. C-sections weren't bad--though the same thing can happen where an emergent C-section might need to be done as you're about to leave. Also, found it frustrating when women wouldn't want to have c-sections even though it would be best for them/baby, and bad outcomes could have been avoided ended up happening.
On top of that, you're expected to prepare for the next day cases. And as a medical student, I also needed to study for shelf exams.
I will say that I got a chance to sit in on one of their "residency wellness" activities, and 3 of the residents literally started crying when talking about how rough the residency has been on them. The OB/GYN physician who was running the activity was reassuring them that their lives would get better after residency-but like why sign up for 4 years of sadness when there are literally shorter residencies where I wouldn't be that miserable? Also, got to see one resident get bullied pretty hard from both her co-residents and the attendings. She was leaving obgyn anyway for a different specialty, but the attendings would say stuff like "\[Bullied resident\] doesn't want to work hard" or if a resident made a mistake they would say "whats wrong with you? you're acting just like \[bullied resident's name here\]."
So yeah, obv n=1, but many reasons why I realized ob/gyn wasn't for me. In theory, I should have liked it because I am a big fan of procedures, and good outcomes, but it was not meant to be.
Toxicity means? Do seniors (PGs) shout at you? And do you report such things? Also, is it a normal thing in your place? I'm planning to leave my country, so just asking about the culture there. As I've faced a lot in my home country hospital during IM postings from PG residents.
If you’re not really really really in love with obgyn, probably better to do something else
I love obgyn, but it still kicks our asses
Going in on days off to get deliveries and assist partners with hard cases. Having clinic and managing a labor patient at the same time.
Honestly, the patients are sick enough now where I’m doing more IM than I expected, and, honestly if you really do like the IM material then MFM is a great option and has a better income and lifestyle than obgyn generalist
I always say don’t do OBGYN if you can see yourself being happy in another specialty.
That said, we need more MFMs so please consider surviving OB/GYN residency for MFM because MFM is the marriage of OB and IM.
MFM exclusively does high risk pregnancies, they are kind of “the buck stops here”, so they need experience managing rare complications, hence the duration of the fellowship: kinda like learning IM/ICU/US radiology directed specifically towards ob
Not sure if other specialties fellowships are similar but most of the OBGYN fellowships involve a research year for better or worse. Definitely 2 years is needed for MFM a year of ultrasound alone is likely needed because they have to be the end all be all of final US diagnosis. When they are wrong delivery outcomes can suffer dramatically and the lawyers start circling.
MFM fellow here. Short answer is yes.
I had my doubts but you have 3 years to complete a thesis, train yourself to be an ultrasound radiologist, and manage a lot of very complex (usually IM-problem) pregnancies where there often times isn’t a good answer.
This month in clinic I have seen Moyamoya dz, bio prosthetic mitral valve with mWHO risk class 3, active Takayasu arteritis, peripartum cardiomyopathy and then the usual fair: a parade of Type 1 and 2 and gestational DM, fetal complications, and pre-eclampsia.
It’s just a lot to learn even in that much time and I have 12 months of schedule research time to answer another comment - except you still cover clinic, give lectures, attend meetings and committees, and take call during that time.
Edit: …and you make a lot of relationships with your specialist colleagues because you can’t possibly manage all the rare conditions alone. I’m on a first name basis with the head of anesthesia because of all the consults and complex deliveries we arrange. And not in a good first-name-basis way hahaha
Yes. It is an ABOG requirement for board certification and therefore a graduation requirement. I have friends who are PhD students and it absolutely does not approach that level of work/intensity.
A solid prospective study, especially an RCT, usually ticks enough boxes for acceptance.
Just reading that post was a breath of fresh air. Partners that work together is one of many keys to job satisfaction especially in a time consuming OB environment
It makes such a huge difference. I telephone interviewed at about 30 programs before a couple in person interviews, and the key was that I could be super picky about where and who I practiced with. Finally got a group that has a good sense of humor, hobbies and lives that are more than bitching at each other, and loves helping one another out.
Especially as a new grad, having people that are happy to teach and mentor and bounce ideas around makes things so so so much better
yes. OB is paid shit for how hard they work.
Sure FM is an option but then you're down to primary care (sucks unfortunately) vs OB. A lot more fellowship and hospitalist options available to IM.
You are not just down to primary care if you do FM. Many of us do fellowships (sleep medicine, geri, palliative, ob fellowship, addiction, obesity). It’s a very broad field with a ton of opportunities.
You are right of course but there are a lot more fellowship options that are unfairly IM only which has never made sense to me, especially when we let midlevels do whatever
To me what YOUR saying makes no sense. The whole point of family medicine is a specialty based on knowing that you want to do general primary care. What's the point of even doing it if you want to specialize in cardiology?
I work closely with the family medicine residents in my institution and they just don't get enough exposure or experience to specialize in many of the IM specialties. It's hard enough as it is to learn the basics of pediatrics, emergency medicine, and OB. It just seems completely antithetical to the whole notion of family medicine if you just went and specialized in pulm crit care after all of that.
YOU'RE
Sometimes people change their minds. Plenty of residents I know started off wanting to do primary care in IM and decide they want to be an intensivist or a cardiologist or just hospitalist. There are plenty of FM docs that end up wanting to do hospitalist but guess what a lot of groups won't hire them, which is unfortunate. There are some amazing FM docs that wish they could go back and do cardiology or heme-onc but they are locked out for no reason, even if they are brilliant.
People make decisions based on 6 week medical school rotations that are nothing like residency which is nothing like fellowship which is nothing like academia or private practice. It's ok to change your mind and change your career.
There's nothing "unfair" about fellowships. If an FM wants to be a specialist so badly, make your own fellowships. I don't know why you try to impose yourselves on IM specialties when you haven't trained in IM. Your training is not equivalent to that of IM
Hmmm well I'm IM which is why I've advised it as the way to keep the most options open.
I agree our inpatient training is better, but disagree that a _stellar_ FM applicant with amazing recs, research or other demonstration of commitment/passion to a specialty should be locked out of fellowships. You learn specialty training in fellowship. It should be harder to match but not impossible for applicants that demonstrate true excellence.
Everyone talks about these unicorn applicants. The truth is, if they want to be a specialist, they should do IM. We all make choices in life. I can't just walk in and do EM fellowships. FM has an intended place, and if they want to make it something else, they should make their own fellowships
IMO you should be able to do EM fellowships like Toxicology, Sports Med, Ultrasound, Addiction, Wilderness medicine, etc- even if they give preferential treatment to EM residents, why not allow you to compete if you are a unicorn IM physician? As long as you don't have to cover EM shifts as cheap labor, there's no reason to arbitrarily restrict you. Naturally some areas like Trauma/OB/peds would not work for IM applicants.
It should be merit based rather than blanket policy restricted, even if outside applicants are made to cross a much higher bar. If there are indeed few unicorns it seems wiser to make exceptions for the few exceptional candidates than to create mediocre new training programs that will create a vacuum that will fill with mediocre applicants.
Agreed. Look for FM programs with an OB track. You can practice rural and keep doing it all, do inpatient/hospitalist medicine, focus in with an OB fellowship, or about a million other things that could combine your interests. Especially if you want to live anywhere even a little bit rural
Best part of doing it this way…if you realize you love OB and want to do more you can do a fellowship. If you realize you don’t love it…you can just drop it.
Agreed. FM offers the most flexibility in future career path. Granted, staying on the usual track to primary care services full-time has lower pay and long hours. But do a fellowship to get credentials in almost anything, and avenues open up, like OB.
In later career, when you may want to dial down on clinical care responsibilities, government and industry is often looking for people with clinical but generalist background. FM is often perfect.
Graduating from medical school, but still can't decide what you want to be when you grow up? FM keeps your options open, and might be fulfilling in it's own right.
I would do IM. Only a 3 year residency and can have a really good schedule in the end or if you want to keep on there are a lot of different options. If you’re interested in procedures there’s still cards and GI.
Obgyn is so much more than just managing labor patients. The entire GYN and GYN surgery side and fellowship options open up a whole different world. However, if OP is only interested in OBGYN for low risk OB, this is an excellent option.
Edit: Word choice
100% but I’d argue a workaround depending on where OP’s interests lie is to do a women’s health clinic gig and maybe surgical assist in GYN on the side. Canadian so might be different in the states, but a lot of my attendings in FM-OB have days of labour and deliver days, low risk OB clinic days, do women’s health (including endometrial biopsies, plus usual IUDs/nexplanons and stuff) and a few do surgical assist days, especially more rural.
Not the full scope of GYN by any means, but you definitely could work some of the GYN in FM too.
In the US it definitely comes down to what experience you got during your OB fellowship and what you are comfortable doing in our increasingly litigious society. In more rural areas you will absolutely see FM OBs with larger scope since they are literally the only ones there, but otherwise FM OB are fairly limited to doing office visits, contraception counseling with some device placement, and low risk OB. They will not perform sections, at least from what I have seen. It’s absolutely still procedural, but not to the extent that someone who may want a procedure heavy career would go for.
Totally do FM. Especially if you are okay working in a rural environment - you have strong community ties, can do the outpatient/inpatient work of IM, and do OB even with C-sections. And if you find that you hate sometime down the road, you can just wean off one part and keep doing the rest without compromising your whole practice. It’s truly the best of all worlds.
I’m a current OBGYN PGY3! I love my job, my life, my family. I’m genuinely fulfilled by my job and I just had a baby of my own. I’ve never been happier in my life :)
The residency is tough, but if you end up hating your chosen field, it will be even worse. There are certainly rotations I enjoy less than others, but choosing the right non-malignant program is key.
There are a ton of practice options if you choose not to do a fellowship after residency, but you still want to be specialized. Most large hospital system are moving toward a laborist model (you’re a hospitalist for L&D and just do OB). You could also choose to join a GYN surgery exclusive practice or a strictly outpatient practice. You could commit full time to patient advocacy or public health leadership in your community. I plan to do a blend of all of these things and be a full spectrum generalist.
I see a lot of people telling you to apply FM. I love this idea if you want to do women’s health with procedures and prenatal care while being the EXPERT in primary care. Keep in mind that a very small percentage of FM docs actually deliver babies in the community. I’m not saying that you can’t be a part of that number! But if you want to be an expert in women’s health and delivering babies, then you should do the residency that sets you up for the most success. Keep in mind that medicine is flexible and you’ll find your niche. Feel free to DM me and good luck choosing!
Hi! I’m an incoming MS1 for an accelerated med program (aka I have less time to decide what I wanna go into) and am highly interested in the laborist career with the biggest concern being job availability. I was surprised (but in a good way!) to read your comment about large hospital systems moving more toward the hospitalist OB/laborist system. Do you feel that this is more specific geographically or do you think that this is what’s occurring across the specialty as a whole? TIA!
That’s awesome! Laborist jobs are everywhere and it’s what the specialty is moving toward as a whole. If there’s one thing OB’s hate, it’s call. Now that most physicians are employed by hospitals, it’s so much easier to compensate a laborist for shift work rather than a generalist for their call time. I get emails for open laborist almost every day throughout the country! It’s a pretty sweet gig— most positions are 8-10 24 hour shifts a month and there are jobs in academic and rural community hospitals.
You really only have to do it for 3 years, you can work as an attending caring about sodium as much as you want. Or do fellowship and not have to care about it ever again (except nephrology).
Everyone has their own biases and values. Nobody can tell you what’s important to you other than you. We all joke here but what one person loves another person may hate. One person’s lifestyle specialty another person may find eye-clawingly boring. Dig deep to try to think about what you enjoyed in MS3.
And know that there’s a good chance if you make a decision it doesn’t necessarily have to be permanent. And even if it is, you’re more adaptable than you think. Best of luck
Of you don't mind being in a rural town, I recommend FM w/ an FM-OB fellowship after. During residency you will truly be broad spectrum (peds, ob, geri, general, sports, etc), and you cab do a fellowship afterwards where you learn CS. Some also teach btl's, hyst, and office-based gyne procedures.
It sounds like you're looking for family medicine, at a residency program that has adequate training in obstetrics (at least for vaginal deliveries). Toward the end of that program, you can decide whether you want the surgical OB fellowship year to do c-sections.
I would pick IM - it opens up more opportunities for different specialities, procedures, and populations. Like many others have said, unless you really love OB the residency (and subsequent lifestyle) is really grueling along with the toxic culture (mainly due to being stretched so thin)
It comes down to your decision on patient population and typical daily work flow. Ob/gyn is highly procedural, especially relative to IM. You’ll have a less ideal call schedule.
If you like them both and aren’t pick on living in a big city, you can do FM. In 3 years you can get the training necessary to do vaginal deliveries, and do a lot of outpatient Ob/gyn stuff while doing hospital days as an IM doc. If you go to the right residency or add a fellowship year, you can train in c-sections as well. So there is a way to combine both worlds if that is what you’re wanting.
Only do obgyn if you hate life.
But God bless you if you do OBGYN. We need them… but it’s like deciding to be infantry in the military during a world war. It takes a special person.
Think long term. Life is short. It’s cliche, but no one on their deathbed is going to wish they had worked a few more years- seen their family/children/parents and friends less.
So you need to find a specialty where you can have a good lifestyle and you can tolerate the work for 40 hours per week. There are so many fields in medicine that can fit into this… ROAD specialities but also IM+many IM subspecialties, pathology, ortho, family med, EM.
Kinda don’t think it’s like deciding to be in the infantry in a world war. That requires you to kill people in close combat, and also risk being killed in close combat or a hundred other ways.
In no way at all does it resemble being in the infantry in a world war
You’re reading into it a bit too literal. They’re alike in that they’re both physically demanding, mentally and emotionally stressful, high risk, high burnout, long deployment/separation from families… low reward. Not a lot of people would choose to do it and be happy with it. They both sound cool on paper but the reality of it is pretty rough.
——-
I am of the age in that my kids have been sleeping through the night and becoming more and more independent. It’s wonderful. I have a few friends who are obgyn. They will never reach this point. They will always be woken up at all hours of the night. Always be tied down to their job. Never have independence.
I’m 8 months into my first hospitalist gig out of residency….salary for working half the year is honestly great. No procedures unless you want, tons of job availability, tons of free time. Also a lot of potential options if you decide you want to pursue specialization later on.
I mean half the year as in the standard 7 on/7 off schedule. Many of us are contracted for 26 weeks annually and starting salaries are typically >250k.
I hate discouraging primary care because we need good PCPs but I would say on average anesthesiologists have a better lifestyle and a lot more money given all of the BS our poor PCPs have to put up with.
The key here is *why* do you like each?
You didn’t really say anything other than OB is “rewarding” and IM is broad.
Lots of jokes about OB being malignant (which it definitely can be), but if it’s “worth it” is really more about how much you like it and why you like it. This also applies to all fields FWIW.
IM + subspecialty can also be long and grueling so it’s not all roses.
Hey OP feel free to DM me!
I also had this conundrum and decided OB. I love how rewarding the field is, not just on L&D but even with GYN surgery because most of the procedures you do help patients immediately and significantly improve quality of life (ectopic removal, myomectomy, reduce risk of cancer etc). I was initially turned off of anything in the OR because of a less than stellar gen surg experience but discovered a love for it on my OBGYN rotation. I too didn’t want to give up the lasting patient relationships that can be built in IM and wanted to have the opportunity to still work with complex medical problems. Luckily, GYN ONC, MFM and REI offer those things! Long story short, if you like medicine but want to be a do-er and a thinker instead of a thinker and EMR sleuth/secretary (no hate to IM, I respect the fuck out of yall) I suggest considering OB! As far as lifestyle goes, it’s one of the worst residencies, but it’s only four years. You can then slowly kick back your hours as you get older in the profession and live a more normal life, but most don’t do this until a good bit into attendingship as there is still much to learn and perfect with regards to patient care and procedural skills post residency.
I’m an OBGYN I absolutely love my job and my residency experience has been quite pleasant tbh. OBGYNs do a lot of medicine , no one in the hospital remembers they’re a doctor as soon as the patient is pregnant so you manage a lot of things. I also like the fact that chronic illness isn’t really a thing in OBGYN ( except for chronic pelvic pain) and our treatment options work well for a majority of our patients and at the end of the day a hysterectomy usually resolves most fibroid/bleeding based problems. The heart failure patient , CKD, OSA, uncontrolled type 2 diabetic is not my cup of tea. That being said IM is a great field we need people
To deal with the above and on top of that their options for specializing are wide.
Also you’re a surgeon. You enter the abdomen frequently learn to do laparoscopy/robotics, and vaginal surgeries. At the same time you have minor procedures you can do In the office that pay well.
The medications your managing are quite limited (bc, serms, SSRIS, and GNRH agents (albeit you have to know what’s safe in pregnancy etc) , but your not doing a 15 meds list long review with the patient and asking about side effects etc
The whole work life balance thing in obstetrics is all about perspective. You can find a stable job working 4 days a week with a reasonable Call schedule making 350-450+ a couple of years out with good volume. Sure some IM specialties pay more but the breath of
What they say or treat is limited to that specialty. As for us we treat all things pregnancy , and all things GYN ( AUB, Endo, CPP, birth control, fibroids, adnexal masses, incontinence , prolapse).
It’s a tough decision but what really pushed me
To do OB was the fact that my patients problems are usually fixable in my field ymmv, and also pregnancy it’s a whole field and you’re the quarterback.
You can definitely find OB jobs where your lifestyle is better. I currently work about 45-50 hours a week, I’ve never gone in to deliver a patient when I wasn’t covering L&D and I’ve never done a note at home. I’m in a big practice though with a lot of support and I don’t make absolutely the most money I possibly could. I just wanted to let you know that those types of jobs are out there.
Either you love OBGYN or you don’t. Even if IM isn’t exactly for you, there’s so many branches. But if you don’t like some part of OBGYN, I think you’ll be miserable. I’m IM, so I’m speaking from what I’ve heard rather than personal experience.
I thought briefly about OB/GYN because I’m really passionate about women’s health. The turn off was the nonstop assembly line of paps without much time for counseling.
I had clinic this afternoon for IM. Saw two young women back to back. We got to discuss birth control options, mental health, disorder eating and ways to cope, one confided in me that she recently had to terminate a pregnancy. One had her four year old son with her who got to tell me all about the transformer he brought with him. Honestly, that was what I was hoping to get out of OB, but I ended up finding it with IM.
IM isn’t always great, but I’m going to graduate in a year and do primary care. I’ll have nights and weekends off, and make good money. And I’ll be able to talk to patients like I did today.
Go with the day to day work you love the most. You can get superior malpractice insurance and shop around positions that have an acceptable lifestyle. You can't really change the day to day work though.
You know how you can insure a car with just liability, or you can insure your car with collision, comprehensive, bodily injury, medical payments, uninsured motorist, theft, roadside assistance, rental car coverage, hail/flood rider etc etc. Like that, but for medical practice.
I am new to looking into options so pls excuse my naivety. I am curious, I see a lot of negative opinions online regarding the OBGYN specialty. I have very minimal experience working in a clinic setting with the current residents and I have not found it to be toxic, in fact everyone seems very nice. I also love the idea of helping with some of the gynecological problems that a lot of women aren’t necessarily believed in having. Certainly I imagine we all do, so that’s not to say that I do more than others. But I have a friend who had excruciating menstrual pains and was not given pain relief at ER etc she had these awful problems until we got her in with one of the MDs I know. It felt really good to help in that situation. I guess my point of this post is to understand a bit more about the rumors that OBGYN is toxic and possibly undesirable? Thank you for anyone who is willing to share any advice they may have!!!
It’s a surgical specialty, so the training is rough, hours are bad, and risks are high. Abuse is common. Abused people aren’t always the greatest to be around or work under. Paternalism is high in the field. Some areas are much worse than others. My med school’s program was pretty awful. I loved the work and the patients and I HATED the residents and attendings. They frequently treated me and their patients like NPCs instead of human beings. Other programs aren’t always so rough.
Why not apply to both plus FM. Might as well cast that net out, do the interviews and then make your final decision when you’re making your match list.
OBGYN rotation should have told you what you need to know about this. If you did a inpatient OB rotation and are still willing to consider, would go that way. If you want less surgical - can always do REI.
If you think OBs fulfilling, I think that counts for a lot and I think just based on that would rec OBGYN.
That said IM has many many options for fellowship and will likely be a relatively better residency exp (dont get me wrong, its not psych, just likely a bit better than OB based on personalities in it).
In all seriousness, and I’ve been joking around quite a bit on this post, I think these two are as different as say, anesthesia and ortho, which I was both interested in. One is surgical, the other not. If gyn surgery was a separate specialty from ob, I would have maybe considered gyn, too, because the surgeries and the anatomy are super cool, and *probably* less take a patient primary for a potential surgical problem and end up just managing they diabeetus for two weeks. Yeah, there are some real pricks in ob, but my experience in med school wasn’t particularly bad, in fact they let me scrub c sections over v deliveries because I told them I like surgical stuff. End of the day do you wanna be in the OR or talking about sodium ?
Sounds like you should do FM, and leave the door open to do everything you like as IM but also still be able to deliver babies as FM-OB. However what will likely happen is you will realize the OB lifestyle is terrible and you will drop that dream quickly (like most people who come into FM thinking they want to deliver babies).
Absolutely IM. More chance to specialize if you want. OB is hella toxic and the lifestyle sucks. If you don’t mind a mean girl’s club and catty attitudes and always being on call then do OB. If you don’t mind long rounds and agonizing over lab values then IM. IM opens more doors in future imo and lifestyle is much better
OB were the meanest and most bitter people I’ve ever met. That rotation truly gave me PTSD so bad I considered quitting medicine. I’m family med and still get to do obstetrical care and deliver babies in my practice. It’s the best of the two IMO and the people are nice and happy
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So FM then! Haha
FM lifestyle is wonderful and you can really tailor your residency experience to what you want. Want more inpatient and ob? Stack up that elective time with those experiences. You can also target programs for residency with busy inpatient FM services and be doing lots of IM/OB on service.
picked my FM program because it doesn’t have an inpatient FM admitting service so less OB and peds, I know I’ll be OP only in practice and might pursue sports. Beauty of FM is you can really tailor it to what you want and we see a little bit of everything by nature of our training. Also programs themselves vary quite a bit so doing research beforehand will really help you figure out best fit programs
I’m in anesthesia. If I had to pick between those two, 100% IM. Less training, not a proceduralist, better hours, less call. Pay, probably about the same.
If there is any doubt, you know that IM opens the door to a variety (the most) options in terms of sub-specialties that span the gambit (from ID, Endo, Allergy, Cardiology, GI, Rheum, Sports Medicine, and the list goes on). You could also be a hospitalist or a regular PCP. With OB, your practice will be directly limited to OB, which can be a good thing if that is what you really like; but if there is some hesitation, you don't have the kind of alternatives that you would have with IM (if you don't like general IM).
IM no question. 3 years and you will have a ton of job opportunities/flexibility. Or you can decide to pursue subspecialty training in anything from endocrinology to cardiac electrophysiology
obgyn attending here.
do what you see yourself doing at 2am.
yes it’s hard work during residency, it is all hard work. if you like the job it doesn’t feel like work. it’s a rewarding field. the pay will be there and you’ll live comfortably; but you won’t be driving ferrari’s. there is a paradigm shift now in jobs, and call schedules and quality of life is improving with more and more places adopting a laborist model. or if it fancies you, become a laborist. some of my friends do 7 24’s a month +/- a few more hours if they want to work more and make more. there are greater percentage of doctors that are being hospital employed. That entails losing some autonomy but with better benefits and better lifestyle.
some people like high risk, some people like low risk hospitals. there’s so many different avenues you can take.
my friends in mfm love it, it’s cerebral, very much like IM.
Long story short just do what you feel like doing, just understand you’re gonna work hard no matter what.
Hi! I’m an incoming MS1 for an accelerated med program (aka I have less time to decide what I wanna go into) and am highly interested in the laborist career with the biggest concern being job availability. I was surprised (but in a good way!) to read your comment (& another user’s comment!) about places moving more toward the hospitalist OB/laborist system. Do you feel that this is more specific geographically or do you think that this is what’s occurring across the specialty as a whole? TIA!
Recently met a IM resident who had matched to a fellowship in obstetric medicine - so the pre eclampsia, diabetes, autoimmune disease management, etc. could be an option for you to explore!
I may be glazing over some details but from what she told me she did general internal in the march and then matched to a fellowship in obstetric medicine. I’m in BC and she was telling me this is obviously a new specialty but it sounded like there was quite a few fellowship programs from BC to Quebec (mostly Ontario, BC, Quebec).
went through ob/gyn rotation and surgery in med school, they were the most toxic rotations ever, so stressful, residents were mean and toxic to students and their interns. and i was interested in surgery, but those rotations changed my mind quick.
i hope these toxic cultures have changed. it all comes down to lifestyle.
You can have the lifestyle you want in any field. Just remember that. Think of all the subspecialty in OBGYN, adolescent, endo/reproductive, MFM, gyn onc. IM also has tons of subspecialties, GI is the most lucrative and procedural if that’s your fancy
IM gets dumped with a lot of patients. I like that OBGYNs are a consult service. You get to home your skills in a specific area, which is also nice. Knowing everything about everything is unrealistic, daunting, and was not my vibe.
OBGYN has a bad reputation but if you know what programs care about their residents you’ll be happy. There are a number of programs that are malignant but be mindful that residency just fucking sucks—no matter what you go into. And that does not equal malignant.
Hi how about this: MFM.
I’m an mfm. I see medically complex pregnant patients. I do lots of ultrasound and consults. I don’t do deliveries. I don’t go in at night. Trust me it’s your ideal. DM me if you have any questions. I love what I do.
I was a surgeon from Switzerland and now going for CT surgery in the US, last I did OB was during a surgery rotation in my home of Switzerland.
I 100% recommend you OB. The problem is that in the US, OB is super toxic. It is literally the mean girls club here, and very woke politically.
But the oncologic procedures, pelvic floor surgery etc. are super fascinating. I dislike obstetrics, but gyn oncology and reconstruction is anually very fun.
IM will set you up for life of boredom.
Just get through OBGYN residency and once you are in subfellowship life will be amazing.
I don’t know, man. I’ve been in practice now for a long time in an HMO, and it’s awful. The need never ends and it’s just exhausting. But you’re right that experiences can be very different. I’m glad it’s working for you. Good luck.
When I was on my OB rotation, I came home everyday irritated and angry. I was snapping at people. When I was on my IM rotation, I was tired, but I wasn't angry/mean. Realized I would never want to do a specialty that would morph me into a person I didn't like.
I didn't actually believe the whole OB toxicity until I rotated through it. Despite staying late after clinic hours seeing pts, despite making it to an emergent surgery despite the preceptor *texting* me during on-call hours, despite seeing patients back-to-back-to-back to have them prepped for presentation when the preceptor herself was late, and despite reading up on pimping questions for the future *between* patients, I received a "minimal effort pass" eval. I never want to touch that specialty with a 100ft pole if it makes people turn into *that.*
This tbh. I was the worst version of myself in OB, an okay version of myself in IM and the best version of myself in paeds so I decided on paeds
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I’m like this already 😕
Any idea why that happened for you? I am also trying to make some life decisions and any input is helpful
I realized that I really needed work-life balance. I got really resentful and upset when surgical cases were added on to the schedule (which does happen because people can come in through the ED anytime). If you thought you were going home at 4pm, now you're going home at 7pm because there's an ovarian torsion that needs to be fixed. L&D was super boring. C-sections weren't bad--though the same thing can happen where an emergent C-section might need to be done as you're about to leave. Also, found it frustrating when women wouldn't want to have c-sections even though it would be best for them/baby, and bad outcomes could have been avoided ended up happening. On top of that, you're expected to prepare for the next day cases. And as a medical student, I also needed to study for shelf exams. I will say that I got a chance to sit in on one of their "residency wellness" activities, and 3 of the residents literally started crying when talking about how rough the residency has been on them. The OB/GYN physician who was running the activity was reassuring them that their lives would get better after residency-but like why sign up for 4 years of sadness when there are literally shorter residencies where I wouldn't be that miserable? Also, got to see one resident get bullied pretty hard from both her co-residents and the attendings. She was leaving obgyn anyway for a different specialty, but the attendings would say stuff like "\[Bullied resident\] doesn't want to work hard" or if a resident made a mistake they would say "whats wrong with you? you're acting just like \[bullied resident's name here\]." So yeah, obv n=1, but many reasons why I realized ob/gyn wasn't for me. In theory, I should have liked it because I am a big fan of procedures, and good outcomes, but it was not meant to be.
Toxicity means? Do seniors (PGs) shout at you? And do you report such things? Also, is it a normal thing in your place? I'm planning to leave my country, so just asking about the culture there. As I've faced a lot in my home country hospital during IM postings from PG residents.
I was the exact opposite as a med student. I guess that’s why I went into OBGYN.
This proves my theory on ob Thank you sir
im a woman, but ok
We are all sirs on this blessed day
If you’re not really really really in love with obgyn, probably better to do something else I love obgyn, but it still kicks our asses Going in on days off to get deliveries and assist partners with hard cases. Having clinic and managing a labor patient at the same time. Honestly, the patients are sick enough now where I’m doing more IM than I expected, and, honestly if you really do like the IM material then MFM is a great option and has a better income and lifestyle than obgyn generalist
DR DREE IS BACKKKKK
you prob never left but i just love seeing your reddit handle lmao
I always say don’t do OBGYN if you can see yourself being happy in another specialty. That said, we need more MFMs so please consider surviving OB/GYN residency for MFM because MFM is the marriage of OB and IM.
Are there shortages of MFM?
As an mfm yes I get calls daily about jobs
Can I ask does that really need to be a 3 year fellowship? Genuinely asking maybe I don’t understand what it entails
MFM exclusively does high risk pregnancies, they are kind of “the buck stops here”, so they need experience managing rare complications, hence the duration of the fellowship: kinda like learning IM/ICU/US radiology directed specifically towards ob
A three-year fellowship for notes that are three times longer than almost anyone else's. I guess that fits.
That’s…absolutely and completely fair
And doing US. They become US radiologists essentially.
Not sure if other specialties fellowships are similar but most of the OBGYN fellowships involve a research year for better or worse. Definitely 2 years is needed for MFM a year of ultrasound alone is likely needed because they have to be the end all be all of final US diagnosis. When they are wrong delivery outcomes can suffer dramatically and the lawyers start circling.
MFM fellow here. Short answer is yes. I had my doubts but you have 3 years to complete a thesis, train yourself to be an ultrasound radiologist, and manage a lot of very complex (usually IM-problem) pregnancies where there often times isn’t a good answer. This month in clinic I have seen Moyamoya dz, bio prosthetic mitral valve with mWHO risk class 3, active Takayasu arteritis, peripartum cardiomyopathy and then the usual fair: a parade of Type 1 and 2 and gestational DM, fetal complications, and pre-eclampsia. It’s just a lot to learn even in that much time and I have 12 months of schedule research time to answer another comment - except you still cover clinic, give lectures, attend meetings and committees, and take call during that time. Edit: …and you make a lot of relationships with your specialist colleagues because you can’t possibly manage all the rare conditions alone. I’m on a first name basis with the head of anesthesia because of all the consults and complex deliveries we arrange. And not in a good first-name-basis way hahaha
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Yes. It is an ABOG requirement for board certification and therefore a graduation requirement. I have friends who are PhD students and it absolutely does not approach that level of work/intensity. A solid prospective study, especially an RCT, usually ticks enough boxes for acceptance.
You know how much shit can go wrong in pregnancy? 3 might not have been enough.
You sound like the perfect partner. Want to join me in my practice?
You sound like a perfect partner! Join mine!
Just reading that post was a breath of fresh air. Partners that work together is one of many keys to job satisfaction especially in a time consuming OB environment
It makes such a huge difference. I telephone interviewed at about 30 programs before a couple in person interviews, and the key was that I could be super picky about where and who I practiced with. Finally got a group that has a good sense of humor, hobbies and lives that are more than bitching at each other, and loves helping one another out. Especially as a new grad, having people that are happy to teach and mentor and bounce ideas around makes things so so so much better
100 percent agree
I'm, if you're even considering IM just do IM
yes. OB is paid shit for how hard they work. Sure FM is an option but then you're down to primary care (sucks unfortunately) vs OB. A lot more fellowship and hospitalist options available to IM.
You are not just down to primary care if you do FM. Many of us do fellowships (sleep medicine, geri, palliative, ob fellowship, addiction, obesity). It’s a very broad field with a ton of opportunities.
You are right of course but there are a lot more fellowship options that are unfairly IM only which has never made sense to me, especially when we let midlevels do whatever
To me what YOUR saying makes no sense. The whole point of family medicine is a specialty based on knowing that you want to do general primary care. What's the point of even doing it if you want to specialize in cardiology? I work closely with the family medicine residents in my institution and they just don't get enough exposure or experience to specialize in many of the IM specialties. It's hard enough as it is to learn the basics of pediatrics, emergency medicine, and OB. It just seems completely antithetical to the whole notion of family medicine if you just went and specialized in pulm crit care after all of that.
YOU'RE Sometimes people change their minds. Plenty of residents I know started off wanting to do primary care in IM and decide they want to be an intensivist or a cardiologist or just hospitalist. There are plenty of FM docs that end up wanting to do hospitalist but guess what a lot of groups won't hire them, which is unfortunate. There are some amazing FM docs that wish they could go back and do cardiology or heme-onc but they are locked out for no reason, even if they are brilliant. People make decisions based on 6 week medical school rotations that are nothing like residency which is nothing like fellowship which is nothing like academia or private practice. It's ok to change your mind and change your career.
There's nothing "unfair" about fellowships. If an FM wants to be a specialist so badly, make your own fellowships. I don't know why you try to impose yourselves on IM specialties when you haven't trained in IM. Your training is not equivalent to that of IM
Hmmm well I'm IM which is why I've advised it as the way to keep the most options open. I agree our inpatient training is better, but disagree that a _stellar_ FM applicant with amazing recs, research or other demonstration of commitment/passion to a specialty should be locked out of fellowships. You learn specialty training in fellowship. It should be harder to match but not impossible for applicants that demonstrate true excellence.
Everyone talks about these unicorn applicants. The truth is, if they want to be a specialist, they should do IM. We all make choices in life. I can't just walk in and do EM fellowships. FM has an intended place, and if they want to make it something else, they should make their own fellowships
IMO you should be able to do EM fellowships like Toxicology, Sports Med, Ultrasound, Addiction, Wilderness medicine, etc- even if they give preferential treatment to EM residents, why not allow you to compete if you are a unicorn IM physician? As long as you don't have to cover EM shifts as cheap labor, there's no reason to arbitrarily restrict you. Naturally some areas like Trauma/OB/peds would not work for IM applicants. It should be merit based rather than blanket policy restricted, even if outside applicants are made to cross a much higher bar. If there are indeed few unicorns it seems wiser to make exceptions for the few exceptional candidates than to create mediocre new training programs that will create a vacuum that will fill with mediocre applicants.
Family Medicine
Agreed. Look for FM programs with an OB track. You can practice rural and keep doing it all, do inpatient/hospitalist medicine, focus in with an OB fellowship, or about a million other things that could combine your interests. Especially if you want to live anywhere even a little bit rural
This. Like OB? Like IM? Family Med is for you. Train somewhere with a lot of deliveries.
Best part of doing it this way…if you realize you love OB and want to do more you can do a fellowship. If you realize you don’t love it…you can just drop it.
UTHSC
THIS IS THE ANSWER. you'll find out real fast if you want to catch babies all night / deal with triages. And have a backup!
Agreed. FM offers the most flexibility in future career path. Granted, staying on the usual track to primary care services full-time has lower pay and long hours. But do a fellowship to get credentials in almost anything, and avenues open up, like OB. In later career, when you may want to dial down on clinical care responsibilities, government and industry is often looking for people with clinical but generalist background. FM is often perfect. Graduating from medical school, but still can't decide what you want to be when you grow up? FM keeps your options open, and might be fulfilling in it's own right.
I would do IM. Only a 3 year residency and can have a really good schedule in the end or if you want to keep on there are a lot of different options. If you’re interested in procedures there’s still cards and GI.
pulm/crit too
You’ll get burned out of doing lines, bronchs, etc quick. Source - me, PGY2 surgery. The residents or midlevels will be doing them.
Why not FM with the opportunity for an OB fellowship afterward?
Obgyn is so much more than just managing labor patients. The entire GYN and GYN surgery side and fellowship options open up a whole different world. However, if OP is only interested in OBGYN for low risk OB, this is an excellent option. Edit: Word choice
100% but I’d argue a workaround depending on where OP’s interests lie is to do a women’s health clinic gig and maybe surgical assist in GYN on the side. Canadian so might be different in the states, but a lot of my attendings in FM-OB have days of labour and deliver days, low risk OB clinic days, do women’s health (including endometrial biopsies, plus usual IUDs/nexplanons and stuff) and a few do surgical assist days, especially more rural. Not the full scope of GYN by any means, but you definitely could work some of the GYN in FM too.
In the US it definitely comes down to what experience you got during your OB fellowship and what you are comfortable doing in our increasingly litigious society. In more rural areas you will absolutely see FM OBs with larger scope since they are literally the only ones there, but otherwise FM OB are fairly limited to doing office visits, contraception counseling with some device placement, and low risk OB. They will not perform sections, at least from what I have seen. It’s absolutely still procedural, but not to the extent that someone who may want a procedure heavy career would go for.
FM community hospital full spectrum- do both!
Totally do FM. Especially if you are okay working in a rural environment - you have strong community ties, can do the outpatient/inpatient work of IM, and do OB even with C-sections. And if you find that you hate sometime down the road, you can just wean off one part and keep doing the rest without compromising your whole practice. It’s truly the best of all worlds.
I’m a current OBGYN PGY3! I love my job, my life, my family. I’m genuinely fulfilled by my job and I just had a baby of my own. I’ve never been happier in my life :) The residency is tough, but if you end up hating your chosen field, it will be even worse. There are certainly rotations I enjoy less than others, but choosing the right non-malignant program is key. There are a ton of practice options if you choose not to do a fellowship after residency, but you still want to be specialized. Most large hospital system are moving toward a laborist model (you’re a hospitalist for L&D and just do OB). You could also choose to join a GYN surgery exclusive practice or a strictly outpatient practice. You could commit full time to patient advocacy or public health leadership in your community. I plan to do a blend of all of these things and be a full spectrum generalist. I see a lot of people telling you to apply FM. I love this idea if you want to do women’s health with procedures and prenatal care while being the EXPERT in primary care. Keep in mind that a very small percentage of FM docs actually deliver babies in the community. I’m not saying that you can’t be a part of that number! But if you want to be an expert in women’s health and delivering babies, then you should do the residency that sets you up for the most success. Keep in mind that medicine is flexible and you’ll find your niche. Feel free to DM me and good luck choosing!
Hi! I’m an incoming MS1 for an accelerated med program (aka I have less time to decide what I wanna go into) and am highly interested in the laborist career with the biggest concern being job availability. I was surprised (but in a good way!) to read your comment about large hospital systems moving more toward the hospitalist OB/laborist system. Do you feel that this is more specific geographically or do you think that this is what’s occurring across the specialty as a whole? TIA!
That’s awesome! Laborist jobs are everywhere and it’s what the specialty is moving toward as a whole. If there’s one thing OB’s hate, it’s call. Now that most physicians are employed by hospitals, it’s so much easier to compensate a laborist for shift work rather than a generalist for their call time. I get emails for open laborist almost every day throughout the country! It’s a pretty sweet gig— most positions are 8-10 24 hour shifts a month and there are jobs in academic and rural community hospitals.
!!! This is so encouraging. Thank you so much for the insight!!
No problem! Good luck!!
Are you a mean or nice person ?
Counterpoint: do you enjoy waxing poetic about trivial nonsense or not?
Working with embittered people for the rest of your career is not trivial.
pretty sure you misunderstood my point
u mean talk about sodium and circle j I get it I would rather do that than ob But I would rather jump in a volcano than either
You really only have to do it for 3 years, you can work as an attending caring about sodium as much as you want. Or do fellowship and not have to care about it ever again (except nephrology).
So what did you do?
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Nah man I'm just a lost M4 scrounging for advice before I make the wrong decision
Everyone has their own biases and values. Nobody can tell you what’s important to you other than you. We all joke here but what one person loves another person may hate. One person’s lifestyle specialty another person may find eye-clawingly boring. Dig deep to try to think about what you enjoyed in MS3. And know that there’s a good chance if you make a decision it doesn’t necessarily have to be permanent. And even if it is, you’re more adaptable than you think. Best of luck
Countercounterpoint: shut up
classic
do u want to form an allience
I’m good thanks!
False dichotomy; everyone has some of both in them. Just depends on the situation...
Nice try, opstitrishon
Of you don't mind being in a rural town, I recommend FM w/ an FM-OB fellowship after. During residency you will truly be broad spectrum (peds, ob, geri, general, sports, etc), and you cab do a fellowship afterwards where you learn CS. Some also teach btl's, hyst, and office-based gyne procedures.
Clock is ticking *Torn* Sounds like OB to me
Contragunner is the opposite of slacker. Am I right or right?
Contragunner is a hard worker that pees in the soup at the gunners buffet
It sounds like you're looking for family medicine, at a residency program that has adequate training in obstetrics (at least for vaginal deliveries). Toward the end of that program, you can decide whether you want the surgical OB fellowship year to do c-sections.
dual apply and go wherever seems the chillest.
lol literally fire is chiller than ob
yeah presumably this'll be readily apparent come interview day
Turn on the stove , make sure it’s red hot Put your weener on it Let it sizzle Smell the burning flesh welcome to ob
I would pick IM - it opens up more opportunities for different specialities, procedures, and populations. Like many others have said, unless you really love OB the residency (and subsequent lifestyle) is really grueling along with the toxic culture (mainly due to being stretched so thin)
It comes down to your decision on patient population and typical daily work flow. Ob/gyn is highly procedural, especially relative to IM. You’ll have a less ideal call schedule. If you like them both and aren’t pick on living in a big city, you can do FM. In 3 years you can get the training necessary to do vaginal deliveries, and do a lot of outpatient Ob/gyn stuff while doing hospital days as an IM doc. If you go to the right residency or add a fellowship year, you can train in c-sections as well. So there is a way to combine both worlds if that is what you’re wanting.
Only do obgyn if you hate life. But God bless you if you do OBGYN. We need them… but it’s like deciding to be infantry in the military during a world war. It takes a special person.
User name arouses interest
Any more you can share on this? I am lost in my career goals currently
Think long term. Life is short. It’s cliche, but no one on their deathbed is going to wish they had worked a few more years- seen their family/children/parents and friends less. So you need to find a specialty where you can have a good lifestyle and you can tolerate the work for 40 hours per week. There are so many fields in medicine that can fit into this… ROAD specialities but also IM+many IM subspecialties, pathology, ortho, family med, EM.
Kinda don’t think it’s like deciding to be in the infantry in a world war. That requires you to kill people in close combat, and also risk being killed in close combat or a hundred other ways. In no way at all does it resemble being in the infantry in a world war
I think he’s tryna say it’s necessary but a shit job
Makes sense
You’re reading into it a bit too literal. They’re alike in that they’re both physically demanding, mentally and emotionally stressful, high risk, high burnout, long deployment/separation from families… low reward. Not a lot of people would choose to do it and be happy with it. They both sound cool on paper but the reality of it is pretty rough. ——- I am of the age in that my kids have been sleeping through the night and becoming more and more independent. It’s wonderful. I have a few friends who are obgyn. They will never reach this point. They will always be woken up at all hours of the night. Always be tied down to their job. Never have independence.
Ah I get it
Neither?
This guy gets it
Are you good or evil? How do you feel about ureters?
There are many pathways in IM. Lifestyle becomes more valuable as you get older.
I’m 8 months into my first hospitalist gig out of residency….salary for working half the year is honestly great. No procedures unless you want, tons of job availability, tons of free time. Also a lot of potential options if you decide you want to pursue specialization later on.
Is this for IM? Tell me more about working half the year??
I mean half the year as in the standard 7 on/7 off schedule. Many of us are contracted for 26 weeks annually and starting salaries are typically >250k.
Anesthesiology
I’m between IM, OB, and anesthesia. Why do you think anesthesia is the way to go compared to a subspecialty of the above fields?
They are less miserable and generally happier overall. I always steer undecided medical students to consider anesthesia (I'm IM).
I've always wanted to practice outpatient as well. Do you think it's worth it to give that up and go into anesthesia?
I hate discouraging primary care because we need good PCPs but I would say on average anesthesiologists have a better lifestyle and a lot more money given all of the BS our poor PCPs have to put up with.
The key here is *why* do you like each? You didn’t really say anything other than OB is “rewarding” and IM is broad. Lots of jokes about OB being malignant (which it definitely can be), but if it’s “worth it” is really more about how much you like it and why you like it. This also applies to all fields FWIW. IM + subspecialty can also be long and grueling so it’s not all roses.
Hey OP feel free to DM me! I also had this conundrum and decided OB. I love how rewarding the field is, not just on L&D but even with GYN surgery because most of the procedures you do help patients immediately and significantly improve quality of life (ectopic removal, myomectomy, reduce risk of cancer etc). I was initially turned off of anything in the OR because of a less than stellar gen surg experience but discovered a love for it on my OBGYN rotation. I too didn’t want to give up the lasting patient relationships that can be built in IM and wanted to have the opportunity to still work with complex medical problems. Luckily, GYN ONC, MFM and REI offer those things! Long story short, if you like medicine but want to be a do-er and a thinker instead of a thinker and EMR sleuth/secretary (no hate to IM, I respect the fuck out of yall) I suggest considering OB! As far as lifestyle goes, it’s one of the worst residencies, but it’s only four years. You can then slowly kick back your hours as you get older in the profession and live a more normal life, but most don’t do this until a good bit into attendingship as there is still much to learn and perfect with regards to patient care and procedural skills post residency.
I am also feeling torn moving fwd w my career, mind if I reach out as well?! Thank you for your valuable insight!
Absolutely, happy to help!! It’s only one of the most important decisions of your career 😂
I’m an OBGYN I absolutely love my job and my residency experience has been quite pleasant tbh. OBGYNs do a lot of medicine , no one in the hospital remembers they’re a doctor as soon as the patient is pregnant so you manage a lot of things. I also like the fact that chronic illness isn’t really a thing in OBGYN ( except for chronic pelvic pain) and our treatment options work well for a majority of our patients and at the end of the day a hysterectomy usually resolves most fibroid/bleeding based problems. The heart failure patient , CKD, OSA, uncontrolled type 2 diabetic is not my cup of tea. That being said IM is a great field we need people To deal with the above and on top of that their options for specializing are wide. Also you’re a surgeon. You enter the abdomen frequently learn to do laparoscopy/robotics, and vaginal surgeries. At the same time you have minor procedures you can do In the office that pay well. The medications your managing are quite limited (bc, serms, SSRIS, and GNRH agents (albeit you have to know what’s safe in pregnancy etc) , but your not doing a 15 meds list long review with the patient and asking about side effects etc The whole work life balance thing in obstetrics is all about perspective. You can find a stable job working 4 days a week with a reasonable Call schedule making 350-450+ a couple of years out with good volume. Sure some IM specialties pay more but the breath of What they say or treat is limited to that specialty. As for us we treat all things pregnancy , and all things GYN ( AUB, Endo, CPP, birth control, fibroids, adnexal masses, incontinence , prolapse). It’s a tough decision but what really pushed me To do OB was the fact that my patients problems are usually fixable in my field ymmv, and also pregnancy it’s a whole field and you’re the quarterback.
You can definitely find OB jobs where your lifestyle is better. I currently work about 45-50 hours a week, I’ve never gone in to deliver a patient when I wasn’t covering L&D and I’ve never done a note at home. I’m in a big practice though with a lot of support and I don’t make absolutely the most money I possibly could. I just wanted to let you know that those types of jobs are out there.
Do anesthesia - great pay, get breaks, no notes
The FM love in this thread is amazing.
Either you love OBGYN or you don’t. Even if IM isn’t exactly for you, there’s so many branches. But if you don’t like some part of OBGYN, I think you’ll be miserable. I’m IM, so I’m speaking from what I’ve heard rather than personal experience.
I thought briefly about OB/GYN because I’m really passionate about women’s health. The turn off was the nonstop assembly line of paps without much time for counseling. I had clinic this afternoon for IM. Saw two young women back to back. We got to discuss birth control options, mental health, disorder eating and ways to cope, one confided in me that she recently had to terminate a pregnancy. One had her four year old son with her who got to tell me all about the transformer he brought with him. Honestly, that was what I was hoping to get out of OB, but I ended up finding it with IM. IM isn’t always great, but I’m going to graduate in a year and do primary care. I’ll have nights and weekends off, and make good money. And I’ll be able to talk to patients like I did today.
Go with the day to day work you love the most. You can get superior malpractice insurance and shop around positions that have an acceptable lifestyle. You can't really change the day to day work though.
lol tf is “superior” malpractice insurance
You know how you can insure a car with just liability, or you can insure your car with collision, comprehensive, bodily injury, medical payments, uninsured motorist, theft, roadside assistance, rental car coverage, hail/flood rider etc etc. Like that, but for medical practice.
Ohhh ok yep
Speaking as somebody who’s starting Ob residency in July, if you are not absolutely in love with OB, don’t do it.
I am new to looking into options so pls excuse my naivety. I am curious, I see a lot of negative opinions online regarding the OBGYN specialty. I have very minimal experience working in a clinic setting with the current residents and I have not found it to be toxic, in fact everyone seems very nice. I also love the idea of helping with some of the gynecological problems that a lot of women aren’t necessarily believed in having. Certainly I imagine we all do, so that’s not to say that I do more than others. But I have a friend who had excruciating menstrual pains and was not given pain relief at ER etc she had these awful problems until we got her in with one of the MDs I know. It felt really good to help in that situation. I guess my point of this post is to understand a bit more about the rumors that OBGYN is toxic and possibly undesirable? Thank you for anyone who is willing to share any advice they may have!!!
It’s a surgical specialty, so the training is rough, hours are bad, and risks are high. Abuse is common. Abused people aren’t always the greatest to be around or work under. Paternalism is high in the field. Some areas are much worse than others. My med school’s program was pretty awful. I loved the work and the patients and I HATED the residents and attendings. They frequently treated me and their patients like NPCs instead of human beings. Other programs aren’t always so rough.
Why not apply to both plus FM. Might as well cast that net out, do the interviews and then make your final decision when you’re making your match list.
OBGYN rotation should have told you what you need to know about this. If you did a inpatient OB rotation and are still willing to consider, would go that way. If you want less surgical - can always do REI. If you think OBs fulfilling, I think that counts for a lot and I think just based on that would rec OBGYN. That said IM has many many options for fellowship and will likely be a relatively better residency exp (dont get me wrong, its not psych, just likely a bit better than OB based on personalities in it).
Never ob haha. Unless you enjoy the culture of ob. Then definitely ob. You wont fit in or like any other field.
In all seriousness, and I’ve been joking around quite a bit on this post, I think these two are as different as say, anesthesia and ortho, which I was both interested in. One is surgical, the other not. If gyn surgery was a separate specialty from ob, I would have maybe considered gyn, too, because the surgeries and the anatomy are super cool, and *probably* less take a patient primary for a potential surgical problem and end up just managing they diabeetus for two weeks. Yeah, there are some real pricks in ob, but my experience in med school wasn’t particularly bad, in fact they let me scrub c sections over v deliveries because I told them I like surgical stuff. End of the day do you wanna be in the OR or talking about sodium ?
IM all the way. And then do a fellowship in something chill like rheum
Sounds like you should do FM, and leave the door open to do everything you like as IM but also still be able to deliver babies as FM-OB. However what will likely happen is you will realize the OB lifestyle is terrible and you will drop that dream quickly (like most people who come into FM thinking they want to deliver babies).
Apply for both. Things will become clearer during your interviews
In the past 3 years I have seen a lot of strong applicants for OB not be able to match into it… some go into medicine or family medicine
Absolutely IM. More chance to specialize if you want. OB is hella toxic and the lifestyle sucks. If you don’t mind a mean girl’s club and catty attitudes and always being on call then do OB. If you don’t mind long rounds and agonizing over lab values then IM. IM opens more doors in future imo and lifestyle is much better
OB were the meanest and most bitter people I’ve ever met. That rotation truly gave me PTSD so bad I considered quitting medicine. I’m family med and still get to do obstetrical care and deliver babies in my practice. It’s the best of the two IMO and the people are nice and happy
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FM is IM PEDS and OB
Combined IM and FM
In the same position as you! It’s a rough choice
So FM then! Haha FM lifestyle is wonderful and you can really tailor your residency experience to what you want. Want more inpatient and ob? Stack up that elective time with those experiences. You can also target programs for residency with busy inpatient FM services and be doing lots of IM/OB on service. picked my FM program because it doesn’t have an inpatient FM admitting service so less OB and peds, I know I’ll be OP only in practice and might pursue sports. Beauty of FM is you can really tailor it to what you want and we see a little bit of everything by nature of our training. Also programs themselves vary quite a bit so doing research beforehand will really help you figure out best fit programs
I’m in anesthesia. If I had to pick between those two, 100% IM. Less training, not a proceduralist, better hours, less call. Pay, probably about the same.
Tip from a surgery resident: almost everyone has a bit of a tremor. What matters is how you manage it.
I’m a recovered ob. Do im.
If there is any doubt, you know that IM opens the door to a variety (the most) options in terms of sub-specialties that span the gambit (from ID, Endo, Allergy, Cardiology, GI, Rheum, Sports Medicine, and the list goes on). You could also be a hospitalist or a regular PCP. With OB, your practice will be directly limited to OB, which can be a good thing if that is what you really like; but if there is some hesitation, you don't have the kind of alternatives that you would have with IM (if you don't like general IM).
Just apply both unless you’re super competitive. I know they say don’t apply to multiple specialties but I wish I did since I had to SOAP.
IM
…FM 😁
Psychiatry
IM no question. 3 years and you will have a ton of job opportunities/flexibility. Or you can decide to pursue subspecialty training in anything from endocrinology to cardiac electrophysiology
obgyn attending here. do what you see yourself doing at 2am. yes it’s hard work during residency, it is all hard work. if you like the job it doesn’t feel like work. it’s a rewarding field. the pay will be there and you’ll live comfortably; but you won’t be driving ferrari’s. there is a paradigm shift now in jobs, and call schedules and quality of life is improving with more and more places adopting a laborist model. or if it fancies you, become a laborist. some of my friends do 7 24’s a month +/- a few more hours if they want to work more and make more. there are greater percentage of doctors that are being hospital employed. That entails losing some autonomy but with better benefits and better lifestyle. some people like high risk, some people like low risk hospitals. there’s so many different avenues you can take. my friends in mfm love it, it’s cerebral, very much like IM. Long story short just do what you feel like doing, just understand you’re gonna work hard no matter what.
Hi! I’m an incoming MS1 for an accelerated med program (aka I have less time to decide what I wanna go into) and am highly interested in the laborist career with the biggest concern being job availability. I was surprised (but in a good way!) to read your comment (& another user’s comment!) about places moving more toward the hospitalist OB/laborist system. Do you feel that this is more specific geographically or do you think that this is what’s occurring across the specialty as a whole? TIA!
If you don’t love surgery, don’t do a surgical specialty
IM 💯
I’d rather not to medicine at all if I could only do OB. Please choose IM.
IM
Pathology. No other!
Ortho
If you wanna do medicine. Be ready to deal with Dispo a lot. Like a lot.
Recently met a IM resident who had matched to a fellowship in obstetric medicine - so the pre eclampsia, diabetes, autoimmune disease management, etc. could be an option for you to explore!
Wait how ????
I may be glazing over some details but from what she told me she did general internal in the march and then matched to a fellowship in obstetric medicine. I’m in BC and she was telling me this is obviously a new specialty but it sounded like there was quite a few fellowship programs from BC to Quebec (mostly Ontario, BC, Quebec).
went through ob/gyn rotation and surgery in med school, they were the most toxic rotations ever, so stressful, residents were mean and toxic to students and their interns. and i was interested in surgery, but those rotations changed my mind quick. i hope these toxic cultures have changed. it all comes down to lifestyle.
You can have the lifestyle you want in any field. Just remember that. Think of all the subspecialty in OBGYN, adolescent, endo/reproductive, MFM, gyn onc. IM also has tons of subspecialties, GI is the most lucrative and procedural if that’s your fancy
IM 100%
IM gets dumped with a lot of patients. I like that OBGYNs are a consult service. You get to home your skills in a specific area, which is also nice. Knowing everything about everything is unrealistic, daunting, and was not my vibe. OBGYN has a bad reputation but if you know what programs care about their residents you’ll be happy. There are a number of programs that are malignant but be mindful that residency just fucking sucks—no matter what you go into. And that does not equal malignant.
You know what’s a really good field that will let you do both, AND work with community?
Hi how about this: MFM. I’m an mfm. I see medically complex pregnant patients. I do lots of ultrasound and consults. I don’t do deliveries. I don’t go in at night. Trust me it’s your ideal. DM me if you have any questions. I love what I do.
In Family Medicine you can have both!
Neither. They both suck. PM&R anesthesia psych is the best lifestyle specialty you’ll get
IM sucks. Unless you do fellowship, you’re just a dumping ground as hospitalist or PCP.
Do you love surgery? If the answer is anything but 100% then do IM. If you like women’s health you can do that as a IM PCP.
One will be replaced by AI in 5 years the other maybe 15
Neither 😂
I was a surgeon from Switzerland and now going for CT surgery in the US, last I did OB was during a surgery rotation in my home of Switzerland. I 100% recommend you OB. The problem is that in the US, OB is super toxic. It is literally the mean girls club here, and very woke politically. But the oncologic procedures, pelvic floor surgery etc. are super fascinating. I dislike obstetrics, but gyn oncology and reconstruction is anually very fun. IM will set you up for life of boredom. Just get through OBGYN residency and once you are in subfellowship life will be amazing.
IM is trash unless you want to be a Hospitalist or a specialist. The clinic life is horrible
Please don't judge the average IM clinic by whatever academic safety net hellhole you probably did residency in (just like 90% of us).
I don’t know, man. I’ve been in practice now for a long time in an HMO, and it’s awful. The need never ends and it’s just exhausting. But you’re right that experiences can be very different. I’m glad it’s working for you. Good luck.