Family MD + 3R OB vs OBGYN

[Elaine I]

What are the differences in skills and knowledge of a family MD who takes a third year in OB versus an OBGYN specialist? Is the latter able to deal with just as complicated of deliveries, or do they still make referrals to OBs?

Further, is it possible to do one of these specialties and not perform abortions? I do not wish to get into a discussion about whether or not abortions should be allowed, but I do know that I don't want to perform them. Would that automatically rule me out from pursuing either family plus an OB year, or OBGYN?

Thanks for the information,
Elaine

[Ian Wong]

One of the OB/GYN-bound folks might give you better insight into this. The OB/GYN folks are going to handle the complicated cases, because they've got the fall-back option to handle most any complicated delivery, that being an emergent c-section. I haven't worked with any family doc's who've done the 3rd year in OB (seems like that's a rarity, particularly in an urban setting), but the family doc's who have worked with who also do obstetrics generally only handle the very straightforward cases. Anything requiring advanced skills usually goes to the OB/GYN, again because they've got the skills in instrumentation (forceps/vaccuum) and c-sections to handle the delivery if things get complicated.

As far as abortions go, wish I knew the answer to that. I'm certain that not every OB/GYN offers abortions as part of their patient care services, but I think you'll find that OB/GYN as a specialty is much more open to it than anyone else. As the reproductive specialists, it's something that will come up time and again throughout your practice; although I'm sure you can refer it out to a colleague, that doesn't mean that you still won't have to do the initial consultation for your own patients.

Ian

[aneliz]

The first thing to point out is that there is a lot more to OB/GYN than doing deliveries.... OB/GYN has a lot of surgery in it as well...from C-sections to hysterectomies to prolapse repairs to more radical surgery to remove pelvic tumours and dissect lymph nodes depending on if you are doing a subspecialty like gyne oncology or urogynecology, etc. There is a LOT more to the specialty than pregnant patients.

In contrast, family + 3rd year OB does not have a surgical component. It deals more with normal, uncomplicated pregnancy and delivery and counselling/medically treating essentially 'well' women.

If you are unsure of which you would be more interested in, consider your feelings about surgery. If you like surgery, like being in the OR than OB is a good choice. If you hate surgery, OB/GYN is going to be a bad choice.

The other thing to point out is that the 3rd year of 'womens health' after a family residency is not necessary to do your own deliveries...and is not that common...at least not in a teaching centre anyway. Many of the family docs doing deliveries haven't done a formal extra year. However, family docs doing deliveries are kind of like midwives doing deliveries...they do normal, uncomplicated deliveries...they refer to OB if things get difficult and they don't usually manage complicated pregnancies or difficult deliveries...they refer to an OB. Family docs also do not do C-sections...so if the patient needs a C-section...they get referred.

As for abortions...you don't have to do them as an OB/GYN...but you will have to counsel patients about them...and interestingly, many of the people that do 1st trimester abortions are family docs with extra skills... That said, you will find that there are both extremes with respect to the abortion issue within the OB/GYN community...while I would say most are pro-choice on some level, there are definitely some that are not. Not wanting to do abortions should not stop you from pursuing OB/GYN...but you should be aware that you are unlikely to be able to avoid the issue totally.

[gucio93]

Ian and Aneliz are right on the money ... the major differences between FM with Obs and Obs/Gyn are definitely surgical skills and complexity of the patient population. You may also want to consider the fact that more and more surgery (including gyne surgery) is being done using laparoscopic methods, so that laparoscopy is a big part of training. Also, once you are doing an obs/gyn residency, you have the choice to do a fellowship and tailor your practice to deal solely with specific issues (i.e. infertility, or only very high-risk pregnancies, or gyne oncology, or urogynecology - as Aneliz mentioned). It's also correct that not every obs/gyn performs abortions. Although personally I do believe that a woman has a right to make that choice and I do not have a problem presenting it to her as an option and explaining what is to be done, or exploring how she might feel about it, I am not willing to perform abortions myself ... I will always refer.

[Elaine I]

Thank you all for your explanations! You have helped to clarify the differences between the two options, especially regarding the surgical areas of OBGYN.

Thanks,
Elaine