So I finished my pro-c0n list a while ago, and I’ve decided on family medicine.  Whoo!  But because I am a bit OCD and for completeness, I’ve posted the final pro-con list below.   Most of you’ve already read this anyway, so ignore this post- I’m not even going to read it because it’s application time and filling out forms is stressful enough without going through pro-con list and potentially re-<3-ing OBGYN!  Wah!  Hate forms.

OBGYN:

Pros:

–         Prenatal care: I ❤ prenatal care!  I love that there’s a schedule to baby development (I love schedules in general…), and that you run specific tests during their corresponding weeks into pregnancy.  Is so organized and process of elimination-y and systematic!

–         It’s fun to hunt down fetal heart tones with a Doppler.  And I like testing for rupture of membranes and watching the ferning under the microscope… (amniotic fluid makes a fern pattern when it dries.  Isn’t that cool?!)…and really all the other procedures that are the bread and butter of general OBGYN.

–         OBGYN patients are the only patients who are happy to go to the doctor (them and people with Munchausen’s…), and most of my patients would be healthy and young.

–         Contraceptive counseling: I get really excited about contraceptive medicines / methods.  I like to talk about the drug side effects and the different forms and the different ways they can be dispensed.  And besides that they have fun commercials and ridiculous names and dancing people.

–         Hospital life is run like surgery- short, focused rounds, short, focused notes, none of this 5-6 hour rounds crap.

–         I would get to wear scrubs and wouldn’t have to worry as much about professional-wear except for in clinic.

–         Surgery- I generally don’t have any grounds to make claims about being good at medicine things, but I am good with my hands, and I am good at surgery and procedures.  I like to cut things open and sew them back up, and I like knot tying.

–         The actual material related to obgyn stuff: Repro was my most favorite block during Med 1 and 2.  I like learning about ovaries and uteruses and how things work regarding female reproductive system.  Everything is organized so systematically, and things make so much sense because they follow the pattern.  I won’t even go into the smiling uteruses and antlers, but we all know how I feel about these particular organs.

–         I was actually excited to pay attention during the lectures related to obgyn stuff.   I still fell asleep like I always do, but I fell asleep a fewer number of times than usual.  And as doctors, we will have to attend lectures/seminars for the rest of our lives, which is a horrible thought, but I’m less annoyed by it when I think about OB stuff.

–         I like the idea of becoming super good at one focused area in medicine and not having to worry about the other stuff.  And since obgyn stuff is so focused, there aren’t a bajillion other interactions I have to worry about.  Or if there are, we put in a consult and let less reproductively minded doctors take care of that junk.

Cons:

–         **super high malpractice insurance

–         **potential lifestyle suckiness

–         **not doing the same stuff/the stuff I really like throughout my whole career

  • **a bit more explanation regarding these three items** So, I’ve talked to OBGYN residents, old old obgyns, and also a couple who are currently practicing, and this is sort of the picture I put together from talking to them.  OBGYN malpractice insurance is astronomically high, especially if you are in private practice (number I got from young, currently practicing doctor was 120,000 a year). Ways to get around that- if you work in an academic setting where they are self insured so you don’t have to worry about it (not sure how that works), or in some academic settings where you pay less (still 60,000 a year).  If you can’t find a set-up where you pay less, ways to get around it are: work many many hours with lots of deliveries and procedures, or have a spouse who’s an orthopedic surgeon.  Also, from what I understand, most general obgyns start off doing lots of deliveries and surgeries and things because they a) need the money b) have the energy to handle the crazy schedules and surprise calls c) have less home-life responsibilities at that point in their life (pre-children/marriage).  Eventually as they get older and weaker and more burdened with life outside of medicine, most obgyns give up on the surgery/deliveries and end up mostly doing gyn stuff = lots of pap smears and colposcopies, benign gyn surgeries, in addition to contraceptive counseling and stuff related to benign gynecological issues.  So, from what I’m gathering- you can do obgyn and have the lifestyle you want- a lot of people work 3-4 days a week- but you have to find some way to get around the malpractice, and for most people by the time they hit a certain time in their lives, they drop most of the ob stuff.
  • I would imagine that at some point I would want to give up the OB part of my career- not that everyone has to give it up, but I do know that I want other things in life (I’m not ok with going through the trouble of getting fat for 9 months and pushing a baby out the door that’s too small and then only seeing the little sucker once or twice a week).  With that though, I don’t know if I like gyn stuff enough to only do that for most of my older years.  OB I <3, gyn is… wah-wah, ok.

–         Pap smears.  I guess I don’t mind terribly.  But there’s definitely a smell.  And of all the OBGYN procedures, it’s probably the one I like the least and then one I’d be doing the most.

–         In clinic today the patient asked my doctor what his recommendation was regarding fosamax for osteoporosis, and he didn’t know how, and told her to go ask her PCP.  It hit me a little bit, and I realized that I’m not sure I’m ok with that.  As much as I really like obgyn stuff, I’d want to be able to take care of people’s general stuff as well.  I don’t know if I want the majority of what makes me a doctor to be related just to the babymaker and nothing else.

–         I really like a schedule, and you all know about my crazy lists and how I like to know when things are going to happen.  Babies trying to be born are fairly insensitive to other people’s schedules.  And I think I could deal with it for a while (years of training with functioning on little sleep and weird hours..), but I would imagine that it would become wearisome pretty early in the game.

–         Working with female colleagues all the time.  Forget about logistics of meeting future partner in crime forever, but can you imagine that much estrogen in your vicinity every day?  My resident said it’s like being in a sorority/all girl’s dorm…shoot me in the face.

FAMILY MEDICINE

Pros:

–         Lifestyle flexibility- I can be super busy with giant clinic or doing service work or whatever I want, or I can work a couple days a week and still make enough to not die in giant money hole (after loans are paid off of course…), AND I can switch between the two depending on where I am in life.

–         I could live almost wherever I wanted, because they need FP doctors everywhere.

–         Jack of all trades phenomenon: I do want to know a lot about lots of different things.  That’s what I always imagined a doctor to be, and I want to be able to handle most of the general issues so I can be useful to a greater population of patients.

–         I can still do contraceptive counseling and basic gynecological care.

–         Patient population would also include men, old people, adolescents, and even newborns and kids if I wanted.  I actually really like working with adolescents, and it’d be nice to be able to take care of teens who aren’t seeing me because they’re 3 months pregnant because they thought saran wrap = condom.

–         I like outpatient clinic settings and actually interacting with patients.  The reason I’m not considering internal medicine is because I really dislike inpatient care, with the seeing your patients for a couple minutes at a time and then rounding and putting in orders the rest of the day.  If I’m not going to be spending most of my day actually talking to patients, I’d better be cutting something open.

–         I really really really believe in preventative care.  Most of the patient’s I’ve seen during my third year would’ve been just fine if they had better primary care, and so many medical problems + ridiculously high cost of medical care could be fixed if people would just do a good job to begin with.  I really like the idea of trying to clean up the mess from where it starts rather than fixing people up just enough so they can go back and botch it up again.

–         It fits my personality- I feel like it’s my tendency to want to fix up people to help them become better/faster/stronger/healthier at their baselines, not just with acute issues.  I like taking care of my crew, and the people around me, and family medicine would be sort of like me extending my inherent tendencies with a medical license.   Future Asian mafia leader + MD!  I like the idea of bullying people into doing a good job with their cholesterol and their blood pressure.  I also like counseling people on making good choices and improving social/emotional circumstances.  Not that you wouldn’t do this with OBGYN as well, but I could do so much more of this with the long-term relationships of family med patients.

–         I would have flexibility + knowhow to go away to other countries and be super useful. It isn’t something I’ve explored at all during med school, but I think it’s something I’d like to look into in my future.  Have to learn a little more first- about international issues…where the countries are located on a map… that sort of thing.  But would be exciting, no?

–         As long as I keep up with my certifications, there are still lots of in-house procedures I could do, so I could still be working with my hands a lot (though of course not as much as with surgeries..)

Cons:

–         I couldn’t do prenatal care or deliveries unless I do the OBGYN fellowship. (From what I understand, as soon as a patient is pregnant you turf them to the gyno girls because so many issues could affect a pregnancy.)

–         If I did the fellowship, it would be really difficult to maintain a high enough income to cover my malpractice insurance, and I’d have to work somewhere where there isn’t a better qualified OBGYN in the vicinity to take care of the pregnant patients.

–         Medicine rounds during residency or if I work with a hospital. Also, medicine-length notes.  I bet there’s some sort of system to make note-taking and dictations and stuff easier and faster, but it’s no comparison to obgyn/surgery notes: “Alive?  Breathing?  Eating, drinking, peeing, pooping?  Good.  Done.”

–         It’s intimidating to think about having to know a lot about many things, but not being an expert at anything.  What if I botch something up because I don’t see it very often?  And you’d have to not only know a lot, but also keep up with everything.  We had a patient come into neuro because he had massive rhabdomyolysis and proximal muscle weakness that was getting worse because his family medicine doc had started him on a statin and he was already on HIV meds.  I really don’t want something like that to happen to one of my patients, but I feel like there are soooo many different interactions I’d have to be aware of, and it just seems highly likely that something is going to slip through the cracks somewhere sometime, no matter how hard I try.

–         No surgeries!!!  WAAAAAH.  Goodbye surgeries…and knot tying… and ‘scalpel!’ I know I don’t want to be a surgeon.  But I do ❤ surgeries a lot, and I will be a little bit sad about it.

–         On the one hand, you see lots of different things- on the other hand, you rarely see –exciting- things.  If at some point I discover that patient interaction and bullying you into healthy lifestyle things isn’t enough to keep me going, I could see some potential for family medicine getting really boring after a while.

–         Sort of similar to the one above, but- I really really like seeing horribly disgusting things and then telling all you guys about it.  You all know how much I enjoy that.  I imagine that there’ll be a lot less of that in family.  (which might just be sad for me, not so much for my friends…sorry Kim!)

–         Regardless of how enthusiastically I encourage people to be healthier, there are lots of people in this world who are not going to take my recommendations, who are going to continuously do the things that make them worse, and who will also keep demanding that I help them find some shortcut out of it despite their noncompliance.  I am going to have to figure out some way to deal with this business, because I am prone to becoming judgmental and frustrated and grumpy when the threshold of my patience has been exceeded.  Exploding molten lava crazy in the office or bringing it back home is not healthy.  Nor professional.

–         I’d have to wear grown-up clothes every day.  Or at least until I’ve been at an office long enough that people won’t care that I come in wearing jeans and sneakers.

So!  Those are my pros and cons.  I have been writing this on and off for the last week, and during the writing of it I think I’ve come up with my potential plan. Let me know what you guys think:

Family medicine + OBGYN fellowship.  I was originally going to scrap this route completely, because it seemed so difficult and impractical, and I’m sure it still is.  But as I was writing the lists, it occurred to me that if I’m willing to entertain going into straight OBGYN and dealing with the stressful schedule and financial difficulties and all that other crap, why not put that effort into doing family with OB.  It might be hard to make it work, but I imagine that it would be just as difficult to become an OBGYN who only wants to do OB stuff who also wants to have a life.  And besides, everyone who argues for me doing OB says it’s doable, there are always around it, you can make it work, etc.  That’s also sort of what I’ve been hearing regarding every difficult specialty- that if you try really hard, you can make your doctoring into whatever you want it to be. Well, I see no reason why I can’t apply that to becoming a family doctor who delivers babies.  AND if I manage to do it, it would be a double win- I would get to the prenatal ob stuff I really like (depending on where I work, I could still do c-sections… yay surgery!), in addition to being able to take care of lots and lots of other people, and when I want to be done with baby delivering, I won’t be stuck with only doing pap smears and colposcopies and LEEPs forever.  AND if I decide to go world traveling, I would be that much more useful if I could not only take care of most general medical issues but also be proficient in women’s health care.

The one big issue with this is what if I’m not able to do the OBGYN part of it- would I still pick family if that part wasn’t an option.  I think… I would, because with this route I could potentially land the awesome combo deal, but in the event it sucked horribly and I realize I don’t want to do family at all, I can always (as painful as it might be) go back and do straight OBGYN, and then I would be the super OBGYN who knows everything.  Whereas if I did OBGYN and decided it wasn’t everything I wanted it to be, I would be going through the same amount of work to switch back into family without having had the chance to try the awesome combo deal first.  Also I think it’d be easier to go from family to ob, rather than switching from ob to family, because I’d lose so much general medical knowledge if I started off a specialty.

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