Someone asked me about being an OB-GYN...
So I put some thought into it, and here goes:
Ahh, decisions, decisions.
Let's start with the easy stuff:
I currently work about 50 - 60 hr / week. Because I'm an MFM, my practice is a mixture of ultrasounds and clinic and consults, with the occasional labor and delivery built in. I take call for one week every 5 right now, and it's home call. It's a pretty cush life, actually.
My colleagues who have a "more normal" schedule and are generalist OB/GYNs take something like call q 4-6 with one of those being a weekend. Something like that. On the East Coast, everyone works all week. In the Midwest, more people work 4d/wk because they're on call once a week and their post-call day is off. Especially in smaller places, this is to one's advantage usually. My friend Laura has an operative 1/2 day per week. I think that other people have two 1/2 days per month, but I'm not entirely sure. There's a lot of office-based procedures that get done, depending where you go.
Laura's doing Essure (tubal ligations), hysteroscopy, laparoscopic assisted hysterectomy, and just got trained on using a robot for abdominal surgery. Other people do hysterectomies, vag hysts, hysteroscopy. Some people opt to do pregnancy terminations (and there's actually a fellowship in Family Planning as well that's only 1 year but you don't have to do it to do terminations.)
I was worried about liability too, but you don't really need to, especially as a resident. This is covered by your program. When you're all grown up and a provider, there's two different kinds of insurance (and I can never keep them straight) : a "tail" or "no-tail". One of them is incident-based and one is case-based. A lot of academic centers are self-insured, i.e., they have an off-shore insurance captive, keeping themselves insured and not getting routed by insurance premiums. Because of this, they don't generally carry a tail. "Tail" is what you have to cover (I'm not making this up!) as you leave a practice if they only agreed to cover cases that were brought up while you work there. As you know, cases have a long statute of limitations, and if you move your "tail" is what companies charge you to cover your ass if something comes up after you leave. I think this is "case-based". Anyway, I think "incident-based" is based upon whether or not you were working at the place at the time of the incident. For that, b/c you were working there and insured at that time, even if they sue you 10 years later, they have to cover you, end of story. This is much better for you and your pocketbook.
That's liability in a nutshell.
Residency is always a bitch. It doesn't matter if you're in psychiatry or pediatrics or OB. Work hours are regulated across the board, so that makes it physically possible but not fun and games. Chris' sister is in her Intern year, and she went in relatively prepared and is still swearing like a sailor and thinking she's dumb / bad person / etc. etc. It's the process, not the people in it. That being said, work hours are HALF of what I did the first two years, and they are doable. In fact, most of the residents try to break the rules by staying LONGER because of this surgery or that patient in labor. I'm always kicking them out. I would definitely ask around at interviews, no matter what speciality you choose, as to how they are managing their 80 hours. There's some BS where programs are making people see patients for 6h after they end a call night, and that's not the rules. That being said, at least on OB/GYN your problems arriving for admission at 2am are finite. There's only so much that can go wrong with a uterus, ovaries, and a set of tubes....
Chris developed hobbies like cooking, watering the plants, and paying the bills. He also would make beer with the other Residency widower. He won't have really a lot nice to say about residency. This is a factor of a) the program I was in, b) 120 hour work week, c) living in Minnesota, d) his job was kind of crap too. We both tried to talk his sister out of medical school, but hey -- she made an informed decision, and she really likes it. (Even though she's on call)
Surgery. I kind of liked surgery, but didn't love it. I think I did a good job and had good technique, but I decided to do essentially Medicine + OB = MFM so now all I do is C-sections and cerclages and the occasional vaginal laceration and hysterectomy. This is fine with me. There are other people (Laura) who love their office practice as a generalist, and are really good at surgery. BTW, there's a laparoscopic / minimally invasive fellowship as well! Generally, it's not that much of your time, and it pays really well, so it helps pay your keep. That being said, standing in the OR for 4 hours while a junior resident does a vaginal hysterectomy is nearly the death of anyone, and the med studs get stuck holding the retractors where they can't actually see anything because EVERYONE HATES THAT JOB. So, just keep it in mind. It's a lot more absorbing when you're wielding the knife.
The patients are fascinating. I just chose to limit who I see. If you do Medicine or
Familh you'll see everyone, but you have to deal with a lot of chronic illness and stuff that goes on and on and ON and that just drives me batty. I've got surgeon brain -- see a problem, identify it, and FIX IT RIGHT NOW.
I decided the ER was too much now! now! now! / death and dismemberment for me to handle for the next 20 years. Other people like to ponder things, go over all the possibilities, read papers on something and then make a decision. Take neurology, for example...8 hours rounding on 4 patients. I nearly died!! But some of my friends really like medicine, the subspecialties, and Family Medicine because of the breadth. One specialty that frequently gets overlooked is Anesthesia. Another is Physical Medicine and Rehab.
Oh, and if you're into general primary care, there's a lot more loan forgiveness programs out there.
So, in summary:
"What's wrong with q2 call?
You miss half the patients, sir!"
Ahh, decisions, decisions.
Let's start with the easy stuff:
I currently work about 50 - 60 hr / week. Because I'm an MFM, my practice is a mixture of ultrasounds and clinic and consults, with the occasional labor and delivery built in. I take call for one week every 5 right now, and it's home call. It's a pretty cush life, actually.
My colleagues who have a "more normal" schedule and are generalist OB/GYNs take something like call q 4-6 with one of those being a weekend. Something like that. On the East Coast, everyone works all week. In the Midwest, more people work 4d/wk because they're on call once a week and their post-call day is off. Especially in smaller places, this is to one's advantage usually. My friend Laura has an operative 1/2 day per week. I think that other people have two 1/2 days per month, but I'm not entirely sure. There's a lot of office-based procedures that get done, depending where you go.
Laura's doing Essure (tubal ligations), hysteroscopy, laparoscopic assisted hysterectomy, and just got trained on using a robot for abdominal surgery. Other people do hysterectomies, vag hysts, hysteroscopy. Some people opt to do pregnancy terminations (and there's actually a fellowship in Family Planning as well that's only 1 year but you don't have to do it to do terminations.)
I was worried about liability too, but you don't really need to, especially as a resident. This is covered by your program. When you're all grown up and a provider, there's two different kinds of insurance (and I can never keep them straight) : a "tail" or "no-tail". One of them is incident-based and one is case-based. A lot of academic centers are self-insured, i.e., they have an off-shore insurance captive, keeping themselves insured and not getting routed by insurance premiums. Because of this, they don't generally carry a tail. "Tail" is what you have to cover (I'm not making this up!) as you leave a practice if they only agreed to cover cases that were brought up while you work there. As you know, cases have a long statute of limitations, and if you move your "tail" is what companies charge you to cover your ass if something comes up after you leave. I think this is "case-based". Anyway, I think "incident-based" is based upon whether or not you were working at the place at the time of the incident. For that, b/c you were working there and insured at that time, even if they sue you 10 years later, they have to cover you, end of story. This is much better for you and your pocketbook.
That's liability in a nutshell.
Residency is always a bitch. It doesn't matter if you're in psychiatry or pediatrics or OB. Work hours are regulated across the board, so that makes it physically possible but not fun and games. Chris' sister is in her Intern year, and she went in relatively prepared and is still swearing like a sailor and thinking she's dumb / bad person / etc. etc. It's the process, not the people in it. That being said, work hours are HALF of what I did the first two years, and they are doable. In fact, most of the residents try to break the rules by staying LONGER because of this surgery or that patient in labor. I'm always kicking them out. I would definitely ask around at interviews, no matter what speciality you choose, as to how they are managing their 80 hours. There's some BS where programs are making people see patients for 6h after they end a call night, and that's not the rules. That being said, at least on OB/GYN your problems arriving for admission at 2am are finite. There's only so much that can go wrong with a uterus, ovaries, and a set of tubes....
Chris developed hobbies like cooking, watering the plants, and paying the bills. He also would make beer with the other Residency widower. He won't have really a lot nice to say about residency. This is a factor of a) the program I was in, b) 120 hour work week, c) living in Minnesota, d) his job was kind of crap too. We both tried to talk his sister out of medical school, but hey -- she made an informed decision, and she really likes it. (Even though she's on call)
Surgery. I kind of liked surgery, but didn't love it. I think I did a good job and had good technique, but I decided to do essentially Medicine + OB = MFM so now all I do is C-sections and cerclages and the occasional vaginal laceration and hysterectomy. This is fine with me. There are other people (Laura) who love their office practice as a generalist, and are really good at surgery. BTW, there's a laparoscopic / minimally invasive fellowship as well! Generally, it's not that much of your time, and it pays really well, so it helps pay your keep. That being said, standing in the OR for 4 hours while a junior resident does a vaginal hysterectomy is nearly the death of anyone, and the med studs get stuck holding the retractors where they can't actually see anything because EVERYONE HATES THAT JOB. So, just keep it in mind. It's a lot more absorbing when you're wielding the knife.
The patients are fascinating. I just chose to limit who I see. If you do Medicine or
Familh you'll see everyone, but you have to deal with a lot of chronic illness and stuff that goes on and on and ON and that just drives me batty. I've got surgeon brain -- see a problem, identify it, and FIX IT RIGHT NOW.
I decided the ER was too much now! now! now! / death and dismemberment for me to handle for the next 20 years. Other people like to ponder things, go over all the possibilities, read papers on something and then make a decision. Take neurology, for example...8 hours rounding on 4 patients. I nearly died!! But some of my friends really like medicine, the subspecialties, and Family Medicine because of the breadth. One specialty that frequently gets overlooked is Anesthesia. Another is Physical Medicine and Rehab.
Oh, and if you're into general primary care, there's a lot more loan forgiveness programs out there.
So, in summary:
"What's wrong with q2 call?
You miss half the patients, sir!"