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

and give it to you straight.  This 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 components:  obstetrics and gynecology. Obstetrics is  

the medical and surgical management of pregnancy,  whereas gynecology is the medical and surgical  

management of the female reproductive tract.  OB/GYN is a form of primary care and includes  

a heavy longitudinal care element. After all,  you'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 trimester,  and 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. However,  you'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 from C  sections 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 sideways,  you have the baby's and mom's lives in your hands.  

Closure is also much faster and less precise,  but 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 is a  byproduct 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 competitiveness,  OB/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 ultrasound,  labor & 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 short,  is 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 surgery – nothing 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 cancer,  which is sometimes handled by general  

surgeons who have completed a breast fellowship.

Urogynecology is another 3 year fellowship,  and 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 fertilization,  egg 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 subspecialties,  this 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 fellowships,  each of which are 2 years in duration.  

These include minimally invasive surgery,  which 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 providing a  strong 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 population.  Particularly in OB, you'll be dealing  

with many young or middle adulthood patients,  giving 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 specialty,  it'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.