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  • So you want to be an obstetrician and  gynecologist, or OB/GYN. You like the  

  • idea of babies, mommies, and taking care of lady  parts. Let's debunk the public perception myths,  

  • and give it to you straightThis is the reality of OB/GYN.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our next installment in So You Want  to Be. In this series, we highlight a specific  

  • specialty within medicine, such as OB/GYN, and  help you decide if it's a good fit for you.  

  • You can find the other specialties on our  So You Want to Be playlist. If you want  

  • to vote in upcoming polls to decide what future  specialties we cover, make sure you're subscribed.

  • If you'd like to see what being an OB/GYN  looks like, check out my second channel,  

  • Kevin Jubbal, M.D., where we'll be covering  a day in the life of an OB/GYN in the future.

  • OB/GYN is comprised of two componentsobstetrics and gynecology. Obstetrics is  

  • the medical and surgical management of pregnancywhereas gynecology is the medical and surgical  

  • management of the female reproductive tractOB/GYN is a form of primary care and includes  

  • a heavy longitudinal care element. After allyou'll be seeing your patients during puberty,  

  • through adult life, during pregnancy, and  then continued through menopause and later.

  • As my OB/GYN colleague says, it's "The  perfect combination of primary care and  

  • surgery. The only thing you give up is the  prostate and male reproductive organs."

  • In obstetrics, the bread and butter includes  delivering babies in the form of vaginal delivery  

  • or cesarean delivery, also known as a  C-section. When caring for pregnant women,  

  • you'll see them approximately once  per month in the first trimester,  

  • every 2-4 weeks in the second trimesterand every 1-2 weeks in the third trimester.  

  • You'll be making sure the mom and fetus are doing  well, looking out for problems and symptoms.  

  • The interesting thing about this stage is that  women are highly engaged with their medical care.  

  • Many people are usually less willing  to see their primary care physician,  

  • but once they're pregnant, they often  reprioritize their own and their baby's health.

  • In gynecology, you'll be doing the annual  well woman exam in clinic, in addition to  

  • treating pelvic pain, infections like vaginitis  or STI's, and providing contraception options.  

  • If you're on call, you'll rush to the ED to  treat ectopic pregnancy, ovarian torsion,  

  • and vaginal bleeding of various etiologies. And  if you're in the operating room, the most common  

  • surgery is the hysterectomy, or removal of the  uterus. This can be emergent if there is bleeding,  

  • as the patient can exsanguinate, meaning  experience a severe loss of blood.  

  • And for those who want to remove the  possibility of future pregnancies,  

  • you can do a tubal ligation. Think of this  as the female equivalent of a vasectomy.

  • There are a few ways to categorize the specialty.

  • First, you can divide the specialty  as having an OB-focus, Gyn-focus,  

  • or being a generalist and dealing with both.

  • Immediately out of training, you'll be  a generalist, able to handle both the  

  • obstetrics and gynecology side of things. Some  continue down this path and don't want to give  

  • up either part of the practice, while others  choose one to focus on. Being a generalist  

  • is the most common and dominant form of OB/GYN  practice in the United States. You'll be on call  

  • for both labor & delivery as well as on gynecology  emergency department call, often at the same time.

  • Those that want to focus on pregnancy and  delivering babies will focus their practice  

  • on just OB. Obstetrics is divided into office and  labor & delivery. Office visits will be primarily  

  • around regular checkups with pregnant women  across all three trimesters of pregnancy. Labor  

  • and delivery is when the woman is in the hospital  and you help deliver the baby. As an obstetrician,  

  • you can be a solo-practitioner, although this  is increasingly uncommon in modern times,  

  • or work in a group practice. Babies don't  care about your 9 to 5 working schedule and  

  • are delivered at all hours of the day, which  means a more demanding schedule and lifestyle.  

  • Compared to being a generalist or pure  gynecologist, obstetrics has the lowest  

  • compensation. The reason being that pregnancy  is reimbursed as a single bundled payment from  

  • insurance companies and Medicare, including  all office visits and labor and delivery.

  • Those that want to focus on women's reproductive  health will adopt a gynecology-only practice. This  

  • is more common as practitioners advance in their  careers, as there's a lower risk of being called  

  • in the middle of the night. When you're 50 years  old, you probably won't be as eager to run to the  

  • hospital in the middle of the night. Compared  to being a generalist or pure obstetrician,  

  • this is the more lucrative path, as there are more  procedures. Think of the lifestyle as similar to a  

  • urologist, where you can be in the operating room  more or less, depending on your desired balance,  

  • and can transition to a heavier clinic  focused practice in later years.

  • OB/GYN can also be divided by  practice setting - namely academic,  

  • community, and private practice types.

  • In academia, you'll of course be  teaching medical students and residents,  

  • in addition to conducting research on top of your  clinical duties. Compared to other practice types,  

  • this generally has lower compensation. Howeveryou'll be more likely to see more complicated and  

  • often interesting cases in academia, as these  are tertiary care centers with state of the  

  • art equipment, copious resources, and experts  in other specialties for consults if needed.  

  • Severely preterm deliveries are also  best handled by academic centers,  

  • which can handle premies or babies  with congenital issues in the NICU.  

  • Community institutions and private practice  groups are generally not as well equipped.  

  • Remember, delivering babies isn't just about  making sure the mom is safe, but also the baby.

  • In a community based practice, you'll be working  at a medical group not affiliated with a teaching  

  • hospital. This is the most common practice  type and serves the majority of the population.  

  • They're able to handle the bread and butter  straightforward cases and presentations,  

  • such as hysterectomies and other  basic gynecologic surgeries.  

  • In terms of labor and delivery, they can  again handle straightforward deliveries,  

  • but will often transfer out moms or babies  requiring more advanced levels of care.

  • Private practice groups can have an affiliation  with an academic center or community hospital.  

  • Private practice physicians own part of their  practice, and the more work they put in,  

  • the more money they earn. While private practice  OB/GYNs make more money than either academic or  

  • community based ones, they have more pressure  to see more patients, schedule more cases,  

  • take more call, and work harder overall. The  smaller your practice, the more frequently you'll  

  • have to take call, but the fewer people you'll  have to split the profits with. Whereas academic  

  • institutions take all patients, including those  without insurance, private practice groups may  

  • only accept patients with insurance and who are  less complicated in terms of medical presentation.

  • There's a lot of misinformation floating  around about obstetrics and gynecology.  

  • Let's set the record straight.

  • First, no, they don't all wear pink  scrubs (like in Grey's Anatomy),  

  • although you're free to should  you decide to become an OB/GYN.

  • Second, many surgeons from the traditional  surgical subspecialties look down on OB/GYN  

  • as not being real surgery. This comes fromsections being less refined than other types.  

  • There's wiggle room involved in a cesarean  section and multiple steps will be done with blunt  

  • dissection, meaning with your hands, rather than  a surgical dissection using scissors and pickups,  

  • which is much slower and more precise. Still, this  requires knowledge of the anatomic planes between  

  • the bladder and uterus and other anatomical  structures to be wary of. The stakes are high too  

  • things often go well, but if things go sidewaysyou have the baby's and mom's lives in your hands.  

  • Closure is also much faster and less precisebut this view oversimplifies the complexity  

  • and intensity of the procedure, even though it  may appear straightforward from the surface.

  • This "not real surgery" mindset also overlooks the  

  • surgeries that gynecologists do  on the female reproductive tract,  

  • such as hysterectomies. Gynecologists are  surgeons just as much as urologists. The  

  • main difference being the former operates on  females and the latter primarily on males.

  • The third misconception is that residencies are  malignant and it's full of unsavory personality  

  • types. My OB/GYN colleague states "this isbyproduct of any residency filled with women  

  • who are very tired and overworked. Let's  acknowledge our potential gender biases!"

  • After medical school, OB/GYN  residency is 4 years in duration.  

  • You can go either down the categorical  or advanced paths. With categorical,  

  • you attend all 4 years at one institution. With  advanced programs, you'll first complete your  

  • intern year at one institution. This can be in the  form of a preliminary year or transitional year,  

  • after which you'll complete your three years  of OB/GYN residency at a separate program.

  • In your first year of residency, or PGY1, known  as your intern year, you'll rotate on emergency  

  • medicine, ICU, medicine, and sometimes a NICU  rotation, with other rotations depending on  

  • the program. During PGY2 through PGY4, you'll  rotate on labor and delivery spit between days  

  • and nights. You'll also have benign gynecology  rotations and gynecologic oncology rotations.  

  • In your later years, you'll get  subspecialty exposure opportunities,  

  • such as family planning, high risk  obstetrics, urogynecology, and infertility.

  • According to my OB/GYN attending colleague,  

  • there are two primary types of medical  students who apply into the specialty:  

  • shiny pretty women with perfect manicures  or women who eat granola for breakfast and  

  • perform at the vagina monologues. Regardless of  the stereotyping, these are medical students who  

  • can handle the gamut of pap smears to emergency  c-sections. In the early 2000's the field was  

  • more evenly split between men and women, but  now close to 90% of OB/GYN residents are female.

  • In terms of competitivenessOB/GYN is middle of the pack,  

  • between internal medicine and pathology. The  average match rate is 89%, average Step 1 is 229,  

  • Step 2CK is 245, and average number of  publications hovers around 4 and a half.

  • After completing OB/GYN residency, you can opt  to further subspecialize with a fellowship.

  • Maternal fetal medicine, or MFM, is the only  obstetrics-specific fellowship and is 3 years  

  • in duration. There's a high degree of ultrasoundlabor & delivery, and it may include some neonatal  

  • surgery. You'll primarily be dealing with  more complicated diseases of pregnancy,  

  • like cardiovascular issues, diabetes in  pregnancy, or a patient with mechanical  

  • heart valves requiring fine tuning  of the patient's anticoagulants.  

  • You'll also help coordinate care for fetuses  that are ill or have rare conditions.

  • This is the fellowship for the  OB/GYN nerds who want to sit down  

  • and review 3 papers to make  one decision, hours later.

  • Gynecologic oncology, or gyn-onc for shortis also 3 years in duration. There's generally  

  • 1 year of research and 2 years of surgical  training. These are the cowboys and cowgirls  

  • of surgerynothing scares them. If something  goes down with the female reproductive tract  

  • in the hospital, you can count on gyn-onc to  help save the day, even if it isn't cancer.

  • Gyn-onc surgeons are unique in that they handle  their own chemo, meaning they handle both  

  • the medical and surgical aspects of  oncology. In most other parts of medicine,  

  • you'll have separate medical  and surgical oncologists.

  • The most common types of cancers they  deal with include uterine, ovarian,  

  • cervical, and sometimes breast cancerwhich is sometimes handled by general  

  • surgeons who have completed a breast fellowship.

  • Urogynecology is another 3 year fellowshipand it has some overlap with urology.  

  • For example, both do plenty of cystoscopy and  bladder procedures. As a urogynecologist, you'll  

  • primarily be dealing with incontinence, meaning  the lack of voluntary control over urination,  

  • and prolapse, or the bulging or falling of certain  body parts into others. There are various sling  

  • and mesh procedures to address continence, and  various procedures to affix a prolapsing bladder,  

  • uterus, or rectum. This is for those who are  comfortable with lots of urine and older patients.

  • Reproductive Endocrinology and  Infertility, or REI for short,  

  • is a 3 year fellowship focusing  on primarily infertility.  

  • That means dealing with in vitro fertilizationegg transfers, polycystic ovarian syndrome,  

  • and hormonal issues like precocious puberty, also  known as early puberty. You'll be harvesting eggs,  

  • freezing them, defrosting them, injecting  sperm, and making dreams come true.

  • Of all the subspecialtiesthis has the best lifestyle.  

  • These are the OB/GYNs with super fancy  clothes and who are making serious bank.

  • There are a few non-ACGME accredited fellowshipseach of which are 2 years in duration.  

  • These include minimally invasive surgerywhich deals with lots of laparoscopy.  

  • Family planning fellowship focuses on  complex abortion and contraception.  

  • And reproductive infectious  disease is rather self explanatory.

  • There's a lot to love about OB/GYN. There's the  continuity of care. The specialty is truly womb  

  • to grave, taking care of patients for their entire  lives, including their best and worst days. If you  

  • enjoy building longitudinal relationships  with patients, this has a strong draw.

  • For those who enjoy excitement and  adrenaline, there's an emergency element to  

  • get your fix. There are enough gynecologic and  obstetric emergencies to keep you on your toes.  

  • Plus, since you have two  patients, the mom and the baby,  

  • there's an added degree of  uncertainty to add to the excitement.

  • OB/GYN is also unique in providingstrong primary care and advocacy element.  

  • There's a strong public health focus that's  emphasized, particularly women's health advocacy,  

  • and while that's common amongst primary  care specialties, it's harder to find in  

  • other surgical subspecialties. If you care  about infertility, abortion, contraception,  

  • and being a part of social and political change  in women's health, OB/GYN is where you want to be.

  • And finally, the patient populationParticularly in OB, you'll be dealing  

  • with many young or middle adulthood patientsgiving you the opportunity for meaningful and  

  • highly impactful intervention as they  present for pregnancy care. On average,  

  • your patients will be younger compared  to many other non-pediatric specialties.

  • While OB/GYN is a great specialtyit's certainly not for everyone.

  • The lifestyle is more challenging than most,  

  • as you'll often be on call for  various OB or gynecologic emergencies.

  • In terms of compensation, you'll be slightly below  middle of the pack, averaging $308,000 per year.

  • Some patients may truly challenge you  – for example, the IV drug abusers who  

  • are pregnant. Patients do things you  may not agree with but you still must  

  • provide them with care and do your  best to help them and their baby.

  • While delivering babies is exciting and  rewarding, it can be profoundly sad when  

  • your patients experience a pregnancy loss or  cancer. It's not all happy babies and flowers.

  • And last, it's often a messy specialtyIt's a high blood loss specialty,  

  • which is often combined with other  bodily fluids and solids during labor,  

  • if you know what I mean. Let's just say  there's lots of fluids and smells on the job.

  • Who should go into the field of  OB/GYN? If you're high energy it helps,  

  • as you'll be running between  the office, labor & delivery,  

  • and emergency department. It's a very active  specialty and you'll be on your feet frequently.  

  • If you're not running around, you'll  be standing in the operating room.  

  • There's often a lot happening at once, and it's  an often unpredictable field. You should be  

  • ok with uncertainty and controlled chaos, and  maybe even the occasional uncontrolled chaos.

  • This is not the place for the stereotypical  emotionally cold surgeon, meaning you'll need  

  • to be more empathetic and willing to emotionally  connect. In other specialties, anesthesia will  

  • put the patient under, but in OB/GYN, the patients  are often awake. It's best if you're nice, warm,  

  • and tactful. After all, it can be incredibly  awkward as you're having a conversation with  

  • your patient while you have your hands in their  intimate parts. Patients don't want to go to the  

  • gynecologist - it's on you to make it a positive  experience, or at least as painless as possible.

  • Special thanks to Dr. Grace Fergusonattending OB/GYN in Pittsburgh,  

  • and the Insiders at Med School Insiders for  helping me in the creation of this video.

  • Are you hoping to become an OB/GYN? To get into  medical school and match into OB/GYN residency,  

  • you'll need to not only crush your MCAT and  USMLE, but also shine on your personal statement,  

  • secondaries, interviews, and other  soft components of your application.  

  • We've had over 3,000 customers so far and have  an industry leading 99% customer satisfaction  

  • rating. That's not an accidentwe've obsessed  and invested heavily over the past few years  

  • in creating our proprietary systems  that allow us to consistently provide  

  • excellent service and deliver stellar resultsThat's the Med School Insiders difference.  

  • Learn more about why our customers  love us at MedSchoolInsiders.com.

  • Thank you all so much for watchingIf you enjoyed this video,  

  • check out our So You Want to Be a Urologist video,  

  • or another specialty on our So You Want to Be  playlist. Much love, and I'll see you guys there.

So you want to be an obstetrician and  gynecologist, or OB/GYN. You like the  

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So You Want to Be an OB/GYN [Ep. 22]

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    Summer posted on 2021/03/27
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