all things gyn/onc

[confuzzled2019]

Hello,

I am a 4th year medical student who recently decided to take a year off to do some research. I am still pretty confuzzled (as you can see by my username) about what I want to do. I have always wanted to go into OB/GYN but the discouragement throughout medical school from various parties got me thinking and veering away from it. I know everyone says "you shouldn't care what people think", but the reality is, sometimes its hard to shut out all of the opinions. Recently I have gotten some clarity however and think that gyn onc might be a good fit for me. However, I have very limited experience with the field as we only had 1 measly week of it during my OB rotation. So I'm here asking and gyn/onc attendings or fellows about the field.

1) what does your typical week look like?
2) are you managing your patients chemotherapy or are medical oncologists taking that over?
3) what are the surgeries you are performing most often?/what are the bread and butter cases of this subspecialty?
4) what is your lifestyle like? do you feel that you have balance with work and your personal life? (this is post ob/gyn residency)? do you work on weekends?
5) this is sort of a vague question but, considering the aggressive nature of many of the gynecologic malignancies, how do you deal, emotionally, with the prospect of not being able to cure patients of their cancer? and if I am completely mistaken about this...are you finding that many of your patients are having good outcomes? essentially, how sad is the field and are you able to stay emotionally resilient while dealing with some very heavy end of life care situations
6) do you take call?
7) would you choose this field again, why or why not?
8) what do you see the future of this field becoming and why do you think that is the case?
9) are the majority of cases done robotically or are many still done using the open approach?
10) what is the average compensation and how does it vary depending on your practice?
11) anything else about the field that you think a medical student trying to decide on their future should know?

As you can tell, I am very new to the field, don't know much, and have had a tough time finding good information online. Thank you in advance for answering my questions!

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[Dr G Oogle]

I’m not a onc, so can’t comment on specifics, but am a urogyn (Same idea, surgical fellowship), the advice I got (which I chose to ignore) is that you shouldn’t go onto a field specifically only to do a fellowship, you should like the base field as well as in will you be happy being a generalist if you don’t match. All fellowships out of obgyn are exceedingly competitive with match rates between 65-78% even family planning which is an unaccredited fellowship with generally a 1:1 position to applicant ratio has people not match and I’ve seen many qualified residents become very unhappy after not matching into a fellowship which was their whole reasoning for going into obgyn. That being said I completely ignored that advice knowing full well Id hate being a generalist, fortunately it worked out, but if it didn’t I don’t know what I’d be doing

 

[confuzzled2019]

I’m not a onc, so can’t comment on specifics, but am a urogyn (Same idea, surgical fellowship), the advice I got (which I chose to ignore) is that you shouldn’t go onto a field specifically only to do a fellowship, you should like the base field as well as in will you be happy being a generalist if you don’t match. All fellowships out of obgyn are exceedingly competitive with match rates between 65-78% even family planning which is an unaccredited fellowship with generally a 1:1 position to applicant ratio has people not match and I’ve seen many qualified residents become very unhappy after not matching into a fellowship which was their whole reasoning for going into obgyn. That being said I completely ignored that advice knowing full well Id hate being a generalist, fortunately it worked out, but if it didn’t I don’t know what I’d be doing

Thanks so much for this. I see where you're coming from, not to focus on the fellowship but make sure you enjoy general OB first. I think in this case I would be okay doing general OB but would hope for a fellowship.

 

[makethemostofit]

I am not a gyn onc but I did do a rotation in it and performed extensive research on the field and talked with a lot of people in the field:

1) what does your typical week look like?

Generally speaking , in academics: 2 days of clinic 8-6pm, 2 days of operating, 1 day off for teaching/administration/research. I never got a good idea of total hours but at least 50-60 hours/week. Probably more on top of that because there are a lot of teaching and research obligations.

The Society of Gynecologic Oncology wrote a recent report stating that 60% of gyn oncs work >60 hours/week. In private practice, 1 person I spoke with works 50-60 hours a week. Again, 2 days of clinic and 2 days of OR time. OR days typically go 7-5 pm if there are quick cases, but otherwise can last until 8pm or so (primarily for extensive debulking surgeries).

2) are you managing your patients chemotherapy or are medical oncologists taking that over?
-typically they manage both chemo and surgery (the only specialty that can do this)

3) what are the surgeries you are performing most often?/what are the bread and butter cases of this subspecialty?
-cold knife cones, ex laps, diagnostic laps, debulkings, hysterectomies, BSOs

4) what is your lifestyle like? do you feel that you have balance with work and your personal life? (this is post ob/gyn residency)? do you work on weekends?

All gyn oncs I spoke with said they have difficulty with work life balance- both in fellowship (especially grueling) and as an attending. You are working with a very sick population and their problems are on the docs' minds nearly ALL the time. For example, even if you have said time off after a busy day, gyn oncs are still often thinking about preparing for their next case, or else they are wondering and hoping that that questionable anastomosis isn't leaking. It requires a tough mind to deal with death, dying, tough surgeries,and complications day in and day out.

5) this is sort of a vague question but, considering the aggressive nature of many of the gynecologic malignancies, how do you deal, emotionally, with the prospect of not being able to cure patients of their cancer? and if I am completely mistaken about this...are you finding that many of your patients are having good outcomes? essentially, how sad is the field and are you able to stay emotionally resilient while dealing with some very heavy end of life care situations

It can be very hard. Even docs 8-9 years out still have difficulty handling death. With things like advanced ovarian cancer, you're just trying to buy the patients some time, but it ultimately, and often, comes back. A strong support system is required. Some docs take to counseling

6) do you take call?
Yes. In academics, depends on the number of partners.So if there are 4 people, you take call q4 day and you rounds with the residents/fellows on weekends every 4 weeks. Call is better than that of general ob/gyn. i.e. rarely called in and most issues can be handled by phone or by residents/fellows.

7) would you choose this field again, why or why not?
Most I've talked to say yes as it is very rewarding.

8) what do you see the future of this field becoming and why do you think that is the case?
Pretty bright. No threat from midlevels. Good job security.

9) are the majority of cases done robotically or are many still done using the open approach?
Depends on the institution and their capabilities. Small institutions might have to just do open procedures; however larger facilities may have robots to facilitate that approach. Generally speaking robotic procedures have a lower risk of post surgical complications and are the preferred route.

10) what is the average compensation and how does it vary depending on your practice?
Starting in academics is around 300k with improvement to around >400k as you move up. Private starts at 400k or so with a "eat what you kill" mentality.