COMMENTARY

Opting for Ob/Gyn

Frederick C. Licciardi, MD

Disclosures

May 05, 2011

"Ob/gyn is great because it's some medicine and some surgery," many students say when they choose the field of obstetrics/gynecology. Certainly, this specialty is more than just medicine and surgery, and it is uniquely different from either one, but the statement is fairly accurate. Ob/gyn has a significant surgical component. The rate of cesarean sections for many ob/gyn practices is 30%, and this translates to a reasonable volume of laparotomies. Vaginal deliveries in many instances require cutting, control of blood loss, and tissue reapproximation. If you enjoy surgery and like putting your skills to the test, the obstetrics aspect alone should keep you mostly satisfied.

In addition, there are "operative deliveries," many of which include the use of forceps. Although fewer forceps deliveries are performed as the years go by, forceps are good tools to have when the need arises. In many cases, their use has been supplanted by either the vacuum device or good old-fashioned patience. Of course, there are also the more pure surgical procedures performed by ob/gyn specialists, including myomectomies, hysterectomies, and laparoscopies.

What about the medicine portion of obstetrics and gynecology? Treating classic medical problems such as hypertension and diabetes is a small but important part of obstetric practice. Although most general ob/gyns do not treat nonpregnant women for basic medical conditions, such specialists have become uniquely qualified to treat other types of significant medical issues. Contraception, for instance, can for some patients become a very challenging medical treatment process, and the treatment of menopausal symptoms is routinely an even more difficult endeavor.

Obstetrics/gynecology is a wonderful profession for those of you who like hands-on direct patient care. There is a large nursing component to ob/gyn, especially the ob part. Women in labor require constant care. They need physical care related to monitoring, checking the cervix for progression, and feeling for the stage of descent and position of the head. In addition to all the constant medical monitoring, women in labor need a lot of human comforting. It takes a special personality to take a woman through delivering her baby in a professional and caring fashion.

Practicing in the field of obstetrics/gynecology will also allow you to have long-term relationships with your patients and their families. A young woman may see you for contraceptive advice or a surgical problem such as an ovarian cyst. Years later, you may be the one to deliver her children or treat her for another cyst. On the same day you see her about her menopausal symptoms, you might, for example, perform an 18-week ultrasound on her expecting daughter. Additionally, the women in your practice may, depending on the availability of medical care in your area, ask you about unrelated medical problems, making you the point person for the overall care of their families.

The field of ob/gyn consists of 4 subspecialties: reproductive endocrinology, perinatology, gynecologic oncology, and pelvic surgery. The field of reproductive endocrinology encompasses diagnosing and treating women who have hormonal problems that affect the reproductive system. These days a very large percentage of reproductive endocrinologists solely treat women for infertility problems, using various methods including hormonal therapy, inseminations, surgery, and in vitro fertilization.

Gynecologic oncologists treat women for cancers of the uterus, tubes, ovaries, cervix, vagina, and vulva. Treatments may include surgery -- which can be extensive -- or chemotherapy. Perinatologists, also called maternal fetal medicine specialists, are the high-risk obstetricians. They are experts in dealing with complicated diabetes and hypertension, premature labor, complicated multiple gestations, and coexisting significant medical problems. Pelvic surgery specialists can be experts in vaginal reconstructive surgery, advanced laparoscopy, or both.

Increasingly, lifestyle choice directs students toward their choice of specialty. The life of a solo practitioner with a large practice can be grueling, and for some, this is the path that suits them best. Some trainees prefer to end up in large practices, whereas others prefer to work part time.

Medical malpractice is the dark cloud over obstetrics and gynecology. Although there is much talk about tort reform, we are far from a meaningful overhaul. Some states are "friendlier" to practice in than others, but historically states have changed their stance overnight. Adherence to guidelines and hospital protocols will help to reduce accidents and control premiums.

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