Friday, December 16, 2011

OB/GYN: It was the Best of Times. It was the Worst of Times.

How is your specialty family friendly?

While OB/GYN has the reputation for being notoriously NOT family friendly, I have tried to shape my practice to make it at least ‘family manageable’. I know many of our contributors have found balance in academics, for me private practice has made more sense. I own my practice (with 4 other moms); so I can make my schedule somewhat flexible. I work 4 days a week and am on call ¼ of the time. I attempt to plan ahead to take off for my kids plays and special events. Having privileges at just one hospital prevents the added stress of laboring women at two different places. My office which is attached to my hospital is 10 minutes away { make that Seven minutes at 3 am when I am driving the Camero} from my home.

OB/GYN is a field where it is advantageous to be a woman. In general, women prefer to have female OB/GYNs, making it easier to build up your practice. Additionally as a fellow mom, you have an added layer of bonding to your patients. I’ve had morning sickness, stretch marks and sleepless nights with a fussy baby. I think this gives me a level of empathy that most patients appreciate.

Being family friendly goes both ways, though. I have a partner who is due this spring, so I will be working extra to help her while she is out, much as she helped me a couple years ago to take time off when we adopted our son.

The down side to private practice is that it makes it difficult to take an extended leave. We have 20 employees, rent, malpractice, insurance and a variety of other bills that must be paid monthly. So, taking a maternity leave of longer than 6 weeks is financially difficult. Going part time would not be a possibility for me. Also, being a small business owner adds a level of stress to your life: meetings with accountants, minimizing overhead, marketing. This are all concerns that must be added to the ‘to do’ list. We don’t have many business classes in medical school, so it’s mostly learn as you go.

I realize that are there are busy seasons and slower seasons. The fall is crazy. Everyone has babies {curse you snow storms from last winter!}. The surgeries that patients have been putting off all year that are suddenly emergencies now that they have met their deductibles. I know I will have to work more in the fall, but this fourth quarter revenue will help cover my overhead during the lean first quarter months. I plan extra days off with my family during January and February when things are already slower.

At times I miss being in an academic center and teaching medical students. I think that is part of the reason I blog/write is to help fill my desire to teach. At the end of the day I think the autonomy of private practice empowers me to help make my crazy job more family friendly.


What I didn’t realize about OB/GYN until I was in the thick of it:

Being up all night does not get any easier over the years. Yes, it’s part of the job. I accept that and try not to complain, but really it stinks. Leaving your cozy bed at 1 am to drive in the cold to the hospital, then work the entire next day, then come home to tend to the children…. Not easy.

Dealing with loss is emotionally draining. Miscarriage, stillbirth and infertility are truly heartbreaking issues. OB is thought of as a happy healthy specialty, but when things are bad they are often horrific. I recently had a patient that conceived spontaneously, after 10 years of infertility treatments, who then experienced a term stillbirth. There is perhaps, no worse place to be in the entire world, than a baby’s funeral. The emotional toll of this profession can be immense.

Being the bearer of bad news stinks. Probably at least once a week, I tell a nice married lady with a couple of kids that she has a STD. In doing this I am usually telling her that her husband has been unfaithful. This is often completely unexpected and extremely painful. Often I sit with a box of Kleenex, listening to her cry for as long as tears flow. I become more her therapist than gynecologist.

Is it worth it?

I’m in my seventh year of practice and I still absolutely love what I do. It’s never boring. I’ve delivered 8 babies in the last 3 days (that’s why I’m late getting this post done…. Sorry KC); I am bone tired. But even as I write this, I can’t help but smile at the joy that helping bring life into this world gives me. I truly feel like I am making a difference in people’s lives. You can be a workaholic in any field or any specialty and every specialty has its unique challenges. But if you love OB/GYN and are willing to count the costs, then there are ways to make it more manageable for your family.

9 comments:

  1. Thank you ofr your post on how you make it work for you and your family. I amclose to finishing residency and will imminently have 4 children, so thinking about thsi a lot. Your final comment resonated with me, and one of my colleagues (also a o&g mum) puts it this way- if its the right specialty for you you'll never be happy doing anything else.
    i also love my job. That moment when a newborn first starts to turn pink- its magic every single time.

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  2. Thank you ofr your post on how you make it work for you and your family. I amclose to finishing residency and will imminently have 4 children, so thinking about thsi a lot. Your final comment resonated with me, and one of my colleagues (also a o&g mum) puts it this way- if its the right specialty for you you'll never be happy doing anything else.
    i also love my job. That moment when a newborn first starts to turn pink- its magic every single time.

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  3. Beautifully written, RH+! I couldn't agree more. I feel like writing "ditto" every time you write a post. :) I hope you and your family have a Merry Christmas!

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  4. Thank you for your post. I am a third year medical student with a 15 month old. In 3-4 weeks I have to declare "what I want to be when I grow up." I always wanted to be an Ob/Gyn until I rotated through pediatrics, and now I cannot decide. I love the clinic side of Ob/Gyn, but I can't decide if I am a surgeon or not. I also know that Pediatrics has the reputation of being more family friendly, and I know I want at least one more child. I would love to know how much time you spend in the OR with your private practice setup. Thank you for continuing to inspire this momma/ future MD.

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  5. I'll echo Jane's post. I'm a MS3 with a 4yr old. I came to med school to be an Ob/gyn, but also loved family med. And like Jane said, it all comes down to figuring out if I'm a surgeon or not. Surgery is my next rotation, so hopefully that will seal the deal. The clock is ticking, we have to declare our specialty and start the planning process in January!

    Kristy

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  6. Thanks Dr. Whoo. I felt the same after reading your post!

    Jane & anonymous. I truly love surgery and spend a day a week in the OR. This is in addition to CDs.
    Surgery is a significant part of the specialty, unless you plan to subspecialize in MFM.
    Clinic is my least favorite part of OB/GYN.

    My advice is to only do OB if that is the only thing you can imagine yourself doing and being happy. If you have interests in more family friendly specialties I would definitely strongly consider those.

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    1. The catch here is you are the BOSS and also happens to be women more importantly you seems to be a nice person, However this is a very rare combination, my wife works with mostly male ob/gyns who also happens to be their boss and I know many of her friends are struggling in a similar situation where they are forced to start their on practice just to control their schedule however the downside is you are not trained to a run a business because that is what a private practice is and you have no time for that, I am sorry to say this but your profession is not a good balance for the family those who claims are just kidding

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  7. Thank you for your insight,

    I am a first year ob/gyn resident who wanted nothing more than to match to this specialty. Now that I am here, the uncertainty is seeping in, and I think about work-life balance (and the costs of my profession) on a daily basis. It sounds like you have found a way to make it manageable for you and your family, but how about your colleagues? Has anyone felt the need to quit clinical medicine or retrain in another field post residency due to family concerns?

    I personally want a family, and although I love ob, I could easily see myself enjoying family med or psychiatry as well. I worry that I am making the wrong choice . . . is sacrificing the specialty you love for something you like + more family time worth it?

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  8. One of my partners has stopped delivering babies and only does GYN. Her husband is also a doctor and they have 3 kids. She is much happier just doing GYN. I don't know anyone who has retrained, but several that have stopped delivering.

    I think that you should only do OB/GYN if you can't imagine doing anything else. If you think you could be equally satisfied with FP or psyche then strongly consider that.

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