Family Medicine VS OB/GYN?

So, you’ve done a few rotations and discovered you love family medicine, but you also love OB/GYN.  Considering pursuit of a career in family medicine, but still want to do pre-natal care and deliveries?  Questioning whether you can get cesarean section experience?  Wondering if there’s still a place in the US for the family doc who provides a broad spectrum of OB/GYN care?  In a great ACOFP webinar with Dr. Tabitha Danley I learned the answer to the latter is YES.  She lives the family med full-spectrum of care life – delivering babies and seeing the whole family grow up in her practice.  Instead of having to choose between pediatrics or OB she chose to do both while maintaining a family-friendly work/life balance.  Her talk covers a lot of the questions about how to achieve FM-OB, from the advantages of a CAQ versus an FM-OB fellowship and the steps involved to attain board certification in FM-OB.  Dr. Danley also discusses practical issues of malpractice, hospital privileges, residency considerations and competition.

Where Can I Practice FM-OB?

If you can only enjoy life in a metropolis like LA or NY, your odds of an OB-heavy family medicine practice are poor. But if you’re willing to live in a suburban community your opportunities for practice expand, and those eager to try “rural” life will have no shortage in scope of practice. To get an idea I did a quick PracticeLink search (Family medicine OB) which easily proves you can definitely find jobs doing this work!

Ok, But How to Find the Right Residency?

Some residencies have a strong OB experience for all students, especially those emphasizing rural family medicine. Others offer tailored “tracks” or custom curricula in “women’s health” or “maternity care,” and you’ll find a wealth of information for both types on their program websites. There have been lists on forums like SDN, and websites that get sporadic updates about strong OB programs (ie: “The List” (Advanced OB Training for Family Medicine)). While you’re researching, it helps to start to decide what opportunities matter to you, so the following is not what’s required, or close to exhaustive, but a list of possible questions to help you determine what is important for your education.

  1. What are the min/max vaginal delivery statistics (per resident, as well as total deliveries per year for the hospital)
  2. Is OB continuity experience offered?
  3. Are there “extra” or elective rotations in OB/L&D for interested residents?
  4. Is cesarean section training offered? Do residents leave capable of performing c-sections on their own, or is additional training necessary?
  5. What type of OB experience will you get? Are deliveries Low vs High Risk?
  6. Is there maternal-fetal medicine experience?
  7. Is GYN procedure training offered? (ie: colposcopy, IUD insertion, endometrial biopsy, D&C)
  8. Do they provide training for laceration and episiotomy repair?
  9. Is ultrasound training offered?
  10. Is OB training provided by OB, FM or both types of doctors?
  11. Are you competing with OB residents for deliveries?
  12. Is training provided “in-house” at residency hospital, or elsewhere?
  13. Are graduates of the residency providing full-spectrum OB care now?

Still have more questions? While I can’t answer them, there’s a good chance my reference list can. I hope you enjoyed this article, let us know in the comments if you’re interested in FP-OB or if there’s a great program out there we should highlight in the future!

By Pixie

 

 

 

References

  1. ACOFP’s Webinar: Obstetrics within the scope of Family Medicine
  2. WordPress Blog (Advanced Family Medicine) “The List” (Advanced OB Training for Family Medicine)
  3. American Family Physician “Family Physicians Make a Substantial Contribution to Maternity Care: The Case of the State of Maine
  4. AAFP’s Cesarean Delivery in Family Medicine (Position Paper)
  5. PracticeLink Search: “Family medicine OB