Saturday, January 6, 2018

To OB or not to OB...that is the question

Career advice wanted

I’m having a mid-residency crisis. I’m halfway into my three year family medicine residency, which means in a year and half there will be much more independence but also much less of a safety net below me.   I want to practice in primary care - so I know that it won’t be hard to find a job, however will be much more difficult to find the right one. I’d like to continue doing underserved medicine of some variety - but not sure if that means staying in the city as I am now or moving to a rural area, possibly closer to family now that Baby is here. I’m currently ruminating on whether I’d like to continue practicing OB or not.

It was a surprise to me how much I liked practicing OB as a resident. I liked it as a med student enough (although I will forever hate ORs - I’m too clumsy with too little body spatial awareness) but doing deliveries of my own clinic patients has been so rewarding and energizing. When I find that precious time to devote to independent learning, I find myself reading OB literature (and staying awake through it) more than any other kind.

Today was the first call for a delivery I’ve had since our own Baby was born. As timing goes, it was perfect for me. I was called at 6 am, ran to the hospital, and was back after a beautiful delivery by 9 am. It was great for me - but maybe not so much for Husband. When I left at 6, Baby was just starting to wake up and Husband had stayed up late working the night before, was already awake and was very much looking forward to a morning nap. He didn’t say anything negative, but his expression was less than pleased.

...and this is a best case scenario when I got called in. Our residents are continuously on call for our own patients with lots of back up as with residency schedule we may be working nights or a hospital shift elsewhere that we may not be able to leave. My husband didn’t realize it was a possibility that I would be going in today, but the reality is it’s pretty much always a possibility as I’m usually within 2 weeks of a patient’s due date and babies don’t always come on schedule. And I think as an attending, I’ll likely be much more responsible for my own patients’ deliveries - although having adequate back up is something I am definitely evaluating as part of my future job.

So my question is... can we do this? Or more accurately, will it be worth the effort to do this? We don’t have family close. We don’t really have an emergency contact nearby who can watch Baby if plans change quick. I think I can handle the lack of sleep and unpredictable hours, but is it fair to ask my family to do the same? What about when we want to leave town and spend time with our family? Husband and I have had several conversations and will continue to do so over the next 6 months as my patients continue to deliver and we’ll see how it goes.

 I just really wanted the advice of some moms who have been practicing outside of residency for awhile. Spoiler alert: this likely won’t be my last post asking for career advice. Are you doing what you want in your careers despite a somewhat demanding call schedule? Or did you find that giving up a bit of call was worth it for a little more overall family stability?


  1. All I know about the OB part is what my family doc told me. Not rural here, and most leave it to the OB/GYN. We specifically talked about pap smears - he said he gave those up a few years ago because he couldn't keep up with the changing guidelines - the ones I had to ridiculously memorize when I did my 10 year re-cert recently. I prefer to go to my OB for that anyway, since we've had a long relationship.

    As for the less call more sanity I say yes. Started it as a single mom and still selling what I can off. I'm the only one in my group that feels this way, so it works out well - I get rid of about half of my call weekends now and I like it much better, they get extra $$.

  2. I think as an fp provider in the U.S. doing ob will restrict where you can practice Bc in most places ob/gyns or midwives provide obstetric care. Also, not being able to do c sections will limit your practice, and birth might not continue to be as exciting for you after you’ve seen 1,000 of them. That said, if you can’t imagine being happy without it, you probably shouldn’t give it up! Tough choices!

  3. I graduated FP residency with a 6 month old and had similar questions (though full disclosure had some PTSD from my own traumatic delivery, so there’s that!). I found a practice where I do prenatal care but am not part of the call group to do deliveries. It has worked for me so far. I know I can do deliveries again in the future, though getting privileged will be a challenge the further I am from residency, but right now I need to be there for my baby (soon to be babies) in the middle of the night. I’m not advising this answer, just sharing one perspective! It has been helpful to me to think of this as a particular season of life, while I have a young family, where I have a particular focus on home— knowing that future seasons may be a complete shift; we shall see. Best of luck!

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  5. I am full FP with OB in a rural area so I also do C-sections. I love it and wouldn't change it for anything! My husband is usually flexible with my schedule, but when not I have backup plans in place (ie if I'm on OB call and he's gone, I have a neighbor on standby to watch my kids if I have to go in.) After being in practice for 5 and a half years I still love obstetrics; it's probably my favorite thing that I do. Every delivery is a miracle. I say go for it if you want it! The lifestyle really isn't bad. My volume of deliveries isn't as high as if I were OB so it's manageable - lately about 4/month. As for the comment above about pap smears, that is absolutely bread and butter for family medicine. If you don't do OB there will be plenty of women's health care including paps, IUD's etc and women will be lining up the door to see you since you are a woman.

  6. I am also a FP-OB in rural practice and I echo the previous commenter. I love my job and I love doing OB! I do csections, but my partner does not (he just does vaginal deliveries). We are on call one week on, one week off. If one of my partners patients needs a section, and I’m in town and available, I do it. However if I’m not, it’s no big deal, our general surgeon can do it for him. I love the continuity of OB. I love that my practice is full of babies and kids! I love that I truly care for the whole family, through the full spectrum of medicine! In addition, I have two little boys and I’m currently pregnant. My husband is amazing supportive and we are a total team with the kids. It’s worked out great for us and I love the balance I’ve achieved. Our practice delivers on average one baby a week, nowhere near as many as a busy obgyn practice, so it’s allowed us to manage the lifestyle quite well.

  7. Thanks as always for your thoughtful comments. Gizabeth - sounds like no fun to memorize all those Pap guidelines - I have them printed out and handy with me at all times in clinic. OMDG I am lucky to live in a region with a strong FP+OB and don’t plan on moving too far so that at least works in my favor a bit. Everyone else thanks for your comments, it’s always good to hear from those who have been in similar situations. I agree that having a focus on women’s health and prenatal care is a good way to ensure lots of moms and babies in your practice, so at minimum I’d like to do lots of prenatal care in clinic. And it’s great to hear from people doing it and loving it! I discussed it with husband - who fortunately generally works a 9-5 M-F job with the option to work from home at times - and he thought we could do it too (I had just told him I didn’t have any deliveries for the near future...but forgot to tell him I had recently picked this patient up in clinic...oops!). The next 6 months should be really informative as I have to continue taking OB call and try to deliver my continuity patients regardless so I will keep you all posted how it goes!

  8. I'm in Canada, but I am a family doctor who also does deliveries. We have a hard call schedule where I'm in a group of 7-8 and do every other Thursday, plus a full F-Sa-Su weekend every other month. It's ideal and I wouldn't do it any other way. I have childcare all sorted out for my call days (3 kids) and when I'm off, I'm off. My husband is also a GP with his own call schedule so this is the only way I could still deliver babies. Highly recommend this setup!!


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