GS to OB/gyn?

[Daisy_Buchanan]

Hey all, PGY-2 gen surg resident here, asking myself some heavy questions. I deliberated between GS and OB in med school, but ultimately picked the former, because the OR was my favorite part of OB. I loved deliveries almost as much, and clinic was fine, but not my favorite. I knew that my personality didn’t really match gen surg, and had seen my share of malignant personalities, but figured that dealing w/ some characters was just the price I’d have to pay. Fast forward to now: I still love to operate. But I never dreamed The treatment would be this horrible. I’m talking about attendings engaging in blatant sexual harassment, name calling, throwing objects, and even a couple of incidents of actual physical assault (which were “investigated” but promptly swept under the rug.) You are expected to start out on day 1 of intern year basically knowing how to function independently on the units, included no on specialty services like vascular. Questions or struggling with time management will get you a public lashing. Pgy-2’s on trauma run the entire trauma ER independently- the only input from attendings is when they b*tch you out in morning report for missing some minutia on a CT that not even radiology picked up. (Might have something to do w/ the 15-20 acutely ill traumas we get nightly. Just a thought.) They hold at least one person back per year as a scare tactic, and are notorious for doling out arbitrary and horrible evals. Several times intern year, I had to google attendings that had ripped me a new one on evals, because I had NEVER WORKED WITH THEM. (One of my seniors thinks this is a way of ensuring that people can’t switch to other programs, otherwise there would be a yearly mass-exodus.) Except for a precious few, the teaching is nonexistent and mostly consists of screaming/berating. I feel like my confidence in this specialty may have been permanently destroyed. I can’t be one of the guys, I can barely tolerate being in a room with these horrible people, and I just can’t “see” my future in this anymore. I have a great mentor and a few seniors/attendings that I trust, but they are the rare exception, and I get very little time working with them.

I have several friends in OB, as they rotate through ICU with us. They rave about their program and seem to be in the OR just as much, if not more, than I am. I am seriously considering trying to make this jump, but a)I’m worried that I may regret it because of less operative/procedural time, b) I realize that I am depressed and beaten down right now, maybe not the best tone to make huge decisions and c) most of the problem is my specific program. Unfortunately, switching to a different surgery program is even less practical for family/relocation reasons (plus the fact that my program would certainly find a way to stop it.)

I guess this was a long winded way of asking, how much are you in the OR? How happy are you with the surgical side of your training? If there are other OR junkies out there- is it enough?

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[BigTumor]

Hey all, PGY-2 gen surg resident here, asking myself some heavy questions. I deliberated between GS and OB in med school, but ultimately picked the former, because the OR was my favorite part of OB. I loved deliveries almost as much, and clinic was fine, but not my favorite. I knew that my personality didn’t really match gen surg, and had seen my share of malignant personalities, but figured that dealing w/ some characters was just the price I’d have to pay. Fast forward to now: I still love to operate. But I never dreamed The treatment would be this horrible. I’m talking about attendings engaging in blatant sexual harassment, name calling, throwing objects, and even a couple of incidents of actual physical assault (which were “investigated” but promptly swept under the rug.) You are expected to start out on day 1 of intern year basically knowing how to function independently on the units, included no on specialty services like vascular. Questions or struggling with time management will get you a public lashing. Pgy-2’s on trauma run the entire trauma ER independently- the only input from attendings is when they b*tch you out in morning report for missing some minutia on a CT that not even radiology picked up. (Might have something to do w/ the 15-20 acutely ill traumas we get nightly. Just a thought.) They hold at least one person back per year as a scare tactic, and are notorious for doling out arbitrary and horrible evals. Several times intern year, I had to google attendings that had ripped me a new one on evals, because I had NEVER WORKED WITH THEM. (One of my seniors thinks this is a way of ensuring that people can’t switch to other programs, otherwise there would be a yearly mass-exodus.) Except for a precious few, the teaching is nonexistent and mostly consists of screaming/berating. I feel like my confidence in this specialty may have been permanently destroyed. I can’t be one of the guys, I can barely tolerate being in a room with these horrible people, and I just can’t “see” my future in this anymore. I have a great mentor and a few seniors/attendings that I trust, but they are the rare exception, and I get very little time working with them.

I have several friends in OB, as they rotate through ICU with us. They rave about their program and seem to be in the OR just as much, if not more, than I am. I am seriously considering trying to make this jump, but a)I’m worried that I may regret it because of less operative/procedural time, b) I realize that I am depressed and beaten down right now, maybe not the best tone to make huge decisions and c) most of the problem is my specific program. Unfortunately, switching to a different surgery program is even less practical for family/relocation reasons (plus the fact that my program would certainly find a way to stop it.)

I guess this was a long winded way of asking, how much are you in the OR? How happy are you with the surgical side of your training? If there are other OR junkies out there- is it enough?

Less operating then general surgery for sure but we have a couple of gyn and onc blocks as interns and second years and 5-6 of 10 blocks that are gyn as seniors. You can subspecialize to operate more as well.

 

[Campanella]

Gynecology is definitely a surgical specialty, but some programs have a heavier slant towards obstetrics than others. Because Ob/Gyn residents shift between Labor and Delivery, clinic and surgeries in a four year period, I think our operative exposure is less than that of a general surgery resident. With that said, if you want to spend the rest of your career in the OR, there are surgical sub-specialties that you can pursue following residency, including Female Pelvic Medicine and Reconstructive Surgery, Minimally Invasive Gynecologic Surgery and Gynecology Oncology. These fellowships are not easy to get, however, and you would still have to go through the obstetric and outpatient clinic portions of an Ob/Gyn residency. I think your first step should be asking the Ob residents at your institution what their work mix is like. Another thing to consider is what type of surgeries you enjoy. Do you like big open cases, or do you like minimally invasive procedures. I believe this is also happening in general surgery, but CREOG (our residency governing body) has just initiated a campaign to shift the residency operative experience from open cases to minimally invasive cases. As a result, our gynecology surgical training is being shifted more towards straight stick and robotic laparoscopy (of course, Cesarean sections will always be open cases).

 

[Daisy_Buchanan]

Thanks, that’s helpful! In truth, I think post people have an overblown idea of how much time we spend in the OR anyway. The private practice guys who crank out 3-4 cases a day are the exception, at least where I am.

Which leads me to my next question: I already know that I love L&D. Is it possible to do a more surgical fellowship- say, gyn onc, but still pick up some OB call? (Sorry if I sound completely ignorant, just not sure what the usual setup is.) I seem to recall an REI doc from med school who did this, but I don’t really know the details.

 

[paradoxofchoice]

Which leads me to my next question: I already know that I love L&D. Is it possible to do a more surgical fellowship- say, gyn onc, but still pick up some OB call? (Sorry if I sound completely ignorant, just not sure what the usual setup is.) I seem to recall an REI doc from med school who did this, but I don’t really know the details.

The experience at your program truly sounds horrific. I was like you and couldn't really decide between GS and OG but eventually went into OG followed by a very angsty 9 months of intern year. By the end of the year, I was happier and decided to stay. But the environment at my program is very different from yours. I really don't have much advice for you, however, I believe that if you enjoy being in the OR (unfortunately, clinic is a reality for everyone even GS), you will enjoy OG. We are definitely a very procedure heavy field, but it is very unlikely that you will operate in private practice as much as you operate during residency in OG. We are also a very diverse field where you can choose to do a practice heavy with gyn or heavy in OB (more easily found). Of course, there are several fellowships noted above heavily rooted in surgery or medicine fields. From the residents who went into private practice as a generalist, they typically have gyn OR 1-1.5 days a week, mixture of scopes, minors, and 1-3 majors; of course, vaginal and cesarean deliveries/tubal ligagation happen throughout the week.

As for your latter questions, yes you can pick up OB call as you are a board certified OB/GYN as a gyn onc. However, OB is a field where many things change. I can recall several big things that have changed even during the course of my residency. It will be difficult, but not impossible if you are a gynonc in an academic practice, for you to stay up to date. Like any surgery/procedure, volume matters. You need to deal with a fair number of ob emergencies on a regular basis to stay up to task on those. It will be difficult if you only do a call here and there. Another option is that some academic programs have morbidly adherent placenta programs. You as a gynonc could find a niche there and be a member of that surgery team.

 

[anonperson]

Hey all, PGY-2 gen surg resident here, asking myself some heavy questions. I deliberated between GS and OB in med school, but ultimately picked the former, because the OR was my favorite part of OB. I loved deliveries almost as much, and clinic was fine, but not my favorite. I knew that my personality didn’t really match gen surg, and had seen my share of malignant personalities, but figured that dealing w/ some characters was just the price I’d have to pay. Fast forward to now: I still love to operate. But I never dreamed The treatment would be this horrible. I’m talking about attendings engaging in blatant sexual harassment, name calling, throwing objects, and even a couple of incidents of actual physical assault (which were “investigated” but promptly swept under the rug.) You are expected to start out on day 1 of intern year basically knowing how to function independently on the units, included no on specialty services like vascular. Questions or struggling with time management will get you a public lashing. Pgy-2’s on trauma run the entire trauma ER independently- the only input from attendings is when they b*tch you out in morning report for missing some minutia on a CT that not even radiology picked up. (Might have something to do w/ the 15-20 acutely ill traumas we get nightly. Just a thought.) They hold at least one person back per year as a scare tactic, and are notorious for doling out arbitrary and horrible evals. Several times intern year, I had to google attendings that had ripped me a new one on evals, because I had NEVER WORKED WITH THEM. (One of my seniors thinks this is a way of ensuring that people can’t switch to other programs, otherwise there would be a yearly mass-exodus.) Except for a precious few, the teaching is nonexistent and mostly consists of screaming/berating. I feel like my confidence in this specialty may have been permanently destroyed. I can’t be one of the guys, I can barely tolerate being in a room with these horrible people, and I just can’t “see” my future in this anymore. I have a great mentor and a few seniors/attendings that I trust, but they are the rare exception, and I get very little time working with them.

I have several friends in OB, as they rotate through ICU with us. They rave about their program and seem to be in the OR just as much, if not more, than I am. I am seriously considering trying to make this jump, but a)I’m worried that I may regret it because of less operative/procedural time, b) I realize that I am depressed and beaten down right now, maybe not the best tone to make huge decisions and c) most of the problem is my specific program. Unfortunately, switching to a different surgery program is even less practical for family/relocation reasons (plus the fact that my program would certainly find a way to stop it.)

I guess this was a long winded way of asking, how much are you in the OR? How happy are you with the surgical side of your training? If there are other OR junkies out there- is it enough?

I did a 4 year residency and 3 year fellowship in urogynecology. I'm now in practice for about a year doing a mix of OB/GYN/Urogyn. Ideally would drop the OB but I am geographically restricted so this is the job that I have.

A couple of things :
OB hours can be rough. You will do deliveries and C sections at 3am etc. Will you be happy doing this 15 years from now? It can be physically demanding. My personal record was doing 10 deliveries (c sections and vaginal) in a 24 hour call just last month . It was rough. I take 4 call a month that are in house. I am backup 2 to 3 nights a month for my partners so overall I have a reasonable work life balance.

In addition, GYN call can be a pain in the sense that operative cases have to be done urgently like ovarian torsion or a ruptured ectopic. You don't have the ability to sit on it unfortunately.

Surgically you will operate less than a typical general surgeon. I do half a day a week on average with a mix of majors(laparotomies, conventional laparoscopy, vaginal surgery and robotics) and minors(hysteroscopy, LEEPs, slings, etc).

In addition, I do 1 to 2 scheduled c sections a week.

Your office will consist of the following consults:
Pain
Bleeding
Cysts
Fibroids
Prolapse /Incontinence
Birth control

Office has its share of procedures:
Biopsies, Colposcopy, IUD and Nexplanon placement, cystometrics

It seems your surgery residency is exceptionally malignant. OB GYN can have that reputation as well but is very location dependent.

Overall I am happy with my surgical training. I have a very specific scope and feel my fellowship training augmented my skills significantly. I can handle myself in most situations but I definitely know my limits.

I don't have a lot of comfort with bowel issues (dealing with a bowel laceration/injury etc ) and would have a general surgeon come in if I ran into this. Luckily has not happened but I try to be overly cautious.

I am fine with bladder/ureteral issues and get called in to help repair them for colleagues from time to time.

Are you concerned about being fired from residency or anything?

My advice would be to switch into urology or ENT. I know this wasn't an option but wanted to throw that out there.

Honestly would just stick with general surgery and tailor your practice. Better pay and more ability to control your schedule .

Do you have research years or is it a straight 5 years? That makes a big difference mentally as well.

 

[Daisy_Buchanan]

Thank you all for your helpful replies. To be honest, yes, I am worried that I am in the chopping block. But even if that weren’t the case, I just don’t “see” myself in surgery like I can in OB/GYN anymore. Even 3 months into intern year, I was questioning this. But now it’s gone from threatening to switch to OB when I’m really fed up, to occasionally thinking about it even when things are looking up, to being totally sold on it.

I am not worried about getting solid letters, as I have several great faculty members who will back me up. Two of my mentors and several chiefs have all approached the PD on my behalf (without my asking!) because they’ve felt that I’ve been treated especially badly by some particularly malignant faculty. One in particular told me he thought I should try to find another surgery spot (furthering my suspicion that my position is in danger.) My PD actually surprised me by calling me into his office, telling me he “knew I’d been through a lot” and saying that if I did want to switch programs, he’d support me. I surprised him right back by thanking him, but asking how supportive he would be of me switching to OB/gyn. I caught him so off-guard that he didn’t even really answer me. It was more like, “OB? You know you have to deal with vaginas, right?” LOL. He actually seems like a good guy- alas, he’s an army of one, and I think even he is afraid of some senior faculty, as they were once HIS attendings.

So right now, I’m thinking I’ll re-enter this year’s match. It’s really scary, because I’m worried that doing so will give them the final straw to give away my position next year...and then what if I don’t match? I’m also quite geographically restricted due to my husband and child. So I would essentially be suicide matching to a small handful of programs- my home institution’s included. My OB friends tell me not to worry, as their PD realizes that our program is malignant, so much so that they pulled the OB residents out of SICU. They now fulfill their critical care requirement in MICU because of all the complaints about attendings’ behavior.

Thank you all for “listening” to a somewhat meandering rant. Any further tips on going forward would be much appreciated.