How hard is it to be pro-life in Ob/Gyn residency?

[HumbleMD]

Totally changing the subject, but to read about the debates about OCPs throughout history (for instance, that the Catholic was okay with them until they weren't), I highly recommend "the Fertility Doctor" by Wanda Ronner (near and dear doctor who inspired me to enter OB-GYN).

It focuses on the life of John Rock, one of the inventors of "the pill."

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[ranger9698]

For students looking for supportive residency programs, I have heard that Georgetown, SUNY at Buffalo, EVMS, and Methodist hospital in Houston are very supportive. Oh and the residents in these programs deliver upwards of 500 babies per year, not 10 as previously stated. Good luck!

 

[ranger9698]

Well, let me take a step to the side here. As I have been in private practice now for several years I can shed some light here...


First, be aware that most tier1 residency programs will not take a student who is already talking about what they will and will not do, particularly when it comes to contraception. That's just life. Quote the law if you want, you just won't get in. Now, since we are talking about Catholic hospitals that will not likely be an issue as they are generally smaller programs and less desirable.

Second, it will strain your relationship with other residents and fellows because of how it will cause workloads to shift. When you refuse to help a patient and it must then get bounced to another resident, they will not be happy.

Third, consider what happens after residency. Who will hire an OB/GYN who refuses to do all sorts of things? Sure, the abortion thing is not an issue there, not at all. However the tubals? That's annoying. The contraception? That's unemployment. A huge number of patients request contraceptives and if you refuse to offer them they will find another physician who will.

This is your big problem. If you are in a private practice they won't hire you because this will cost the practice money. If you are in your own practice this will cost you even more money. If you are an employed position it will last for a bit longer, but most of their models are also revenue driven and you are now alienating a huge portion of your patient population.

So, my conclusion is this.

You can do whatever you want, no one will legally force you to do anything. You will however kneecap your career before it starts. It will severely impair your ability to join a private practice, it will completely eliminate your ability to run your own practice, and it will impact your earnings as an employed physician.

So either way, if this is your viewpoint then my suggestion would be that you need to consider another specialty. You are walking into a business model like an academic. Physicians don't operate in a vacuum, you simply cannot throw away such a huge number of customers and expect to be employed or make any money.

This is completely incorrect. I know many women who will cross state lines to visit their NFP-only OB. I personally drive about 45 mins to visit my gynecologist (who is always crazy busy!) and I live in a major metropolitan area. Forgetting religion for a second, it is pretty interesting to me that while other specialties are eager to embrace differing modalities of treatment including natural or more conservative treatments, OBs are still so hostile to physicians who choose to adhere to their conscience - I do not want to provide harmful medications en masse to women who do not have a disease. and there are thousands of women who would want to be treated by such a doctor in my state. Unfortunately these women are underserved because, like you said, residency programs will frequently just refuse to accept medical students who have differing beliefs. However, there are still some excellent residencies that support their trainees while still providing solid education (visit AAPLOG.org for more info). And hopefully, as more of us enter the field, we can help to change this closed-mindedness. I think that we should afford the same respect to our colleagues that we afford to our patients in not forcing them to act against their conscience.

 

[HumbleMD]

This is completely incorrect. I know many women who will cross state lines to visit their NFP-only OB. I personally drive about 45 mins to visit my gynecologist (who is always crazy busy!) and I live in a major metropolitan area. Forgetting religion for a second, it is pretty interesting to me that while other specialties are eager to embrace differing modalities of treatment including natural or more conservative treatments, OBs are still so hostile to physicians who choose to adhere to their conscience - I do not want to provide harmful medications en masse to women who do not have a disease. and there are thousands of women who would want to be treated by such a doctor in my state. Unfortunately these women are underserved because, like you said, residency programs will frequently just refuse to accept medical students who have differing beliefs. However, there are still some excellent residencies that support their trainees while still providing solid education (visit AAPLOG.org for more info). And hopefully, as more of us enter the field, we can help to change this closed-mindedness. I think that we should afford the same respect to our colleagues that we afford to our patients in not forcing them to act against their conscience.

No.
I don't think you successfully put religion aside. Regardless, there a lot of problematic issues with your logic here. Your pseudo-victimization of women who will only see "NFP" practitioners cries awfully foul. I'd have just as little patience for a patient not wanting me to provide complete medical care to a different patient as I would for a racist patient asking that my practice only see whites. Would I serve a Catholic woman wanting to use the rhythm method? Of course. But I'd provide her with its high failure rate compared to other forms, and let her make her own decision.

And would ever afford the same respect to physicians they give to patients, nor should they. Would I call a patient a ******* to their face because they spend money on homeopathic remedies? Of course not. But I'd never work with a physician who believed in homeopathic remedies in the face of overwhelming evidence (and basic logic) that they are useless. Similarly, I'd work with a patient on heroine to risk reduce on methadone, but I wouldn't hire a physician who was using drugs. We are held to a higher standard for a very good reason.

And please don't purport that you are the only one acting with a conscience. Sigh.

 

[THP]

I understand that may be hard to do, but its a physicains job to transcend their beliefs and look after their patients wishes.

No its not. My patients are coming to me for advice and recommendations on their medical care. I have absolutely no obligation to look after their wishes. If there is a way we can find a solution that honors their wishes then that's fine and a good thing to do.

As a human it is my job to not transcend my beliefs despite misguided societal pressure.

 

[THP]

No.
I don't think you successfully put religion aside. Regardless, there a lot of problematic issues with your logic here. Your pseudo-victimization of women who will only see "NFP" practitioners cries awfully foul. I'd have just as little patience for a patient not wanting me to provide complete medical care to a different patient as I would for a racist patient asking that my practice only see whites. Would I serve a Catholic woman wanting to use the rhythm method? Of course. But I'd provide her with its high failure rate compared to other forms, and let her make her own decision.

And would ever afford the same respect to physicians they give to patients, nor should they. Would I call a patient a ******* to their face because they spend money on homeopathic remedies? Of course not. But I'd never work with a physician who believed in homeopathic remedies in the face of overwhelming evidence (and basic logic) that they are useless. Similarly, I'd work with a patient on heroine to risk reduce on methadone, but I wouldn't hire a physician who was using drugs. We are held to a higher standard for a very good reason.

And please don't purport that you are the only one acting with a conscience. Sigh.

Agree that a lack of NFP providers somehow violates a patient's conscience is nonsenese. If there is an underserved market it will quickly be filled. Besides offering NFP will likely increase your OB volume!

Don't sigh over the internet, its annoying.

 

[HumbleMD]

No its not. My patients are coming to me for advice and recommendations on their medical care. I have absolutely no obligation to look after their wishes. If there is a way we can find a solution that honors their wishes then that's fine and a good thing to do.

As a human it is my job to not transcend my beliefs despite misguided societal pressure.

Yikes. Did yo have any ethics courses in Medical School? So you don't respect patient autonomy at all? It's your way or the highway, and your belief system wins because you're the doctor? Switching to a less contentious subject, I don't think IVF is a good use of resources, but if a patient requests it I wouldn't dissuade them or refuse to help them find an REI clinic.

And I'm guessing no women come requesting an elective abortion from you in clinic because 1)you don't offer them all of their options and 2)you probably send off some anti-choice vibes or 3)you are at a Catholic hospital?

What program are you a resident at. I'll have to steer clear of it.

"Misguided societal pressure"... It sure beats magical thinking.

 

[THP]

Yikes. Did yo have any ethics courses in Medical School? So you don't respect patient autonomy at all? It's your way or the highway, and your belief system wins because you're the doctor? Switching to a less contentious subject, I don't think IVF is a good use of resources, but if a patient requests it I wouldn't dissuade them or refuse to help them find an REI clinic.

And I'm guessing no women come requesting an elective abortion from you in clinic because 1)you don't offer them all of their options and 2)you probably send off some anti-choice vibes or 3)you are at a Catholic hospital?

What program are you a resident at. I'll have to steer clear of it.

"Misguided societal pressure"... It sure beats magical thinking.

Of course I respect patient autonomy. I would never force a procedure or treatment on a patient they didn't want. That includes c/s for a baby dying in-utero. Patient autonomy doesn't mean you have to do whatever they want.

If you had a patient come in requesting female circumcision, would you do it? Would you refer her to someone who will? We had a patient whose perineum was torn to shreds after a vaginal delivery from her female circumcision, then requested we sew her back shut. Should we have done it?

You're right, women don't come in requesting abortion because our whole program doesn't offer it. The reality is, if patients find out you perform abortions they will not come to you when you are out practicing. There was an article in the Green Journal recently, I can't remember the exact number but only 15-20% of all OB/GYNs will offer abortions. In any given city the vast majority of abortions are performed by a few providers.

Of course, I am talking about elective abortions, issues where there is an anomaly incompatible with life or the mother's life is in danger, all bets are off.

IVF patients either pay out of pocket or with their private insurance. Most of those patients have a medical problem, ie infertility.

 

[HumbleMD]

Of course I respect patient autonomy. I would never force a procedure or treatment on a patient they didn't want. That includes c/s for a baby dying in-utero. Patient autonomy doesn't mean you have to do whatever they want.

If you had a patient come in requesting female circumcision, would you do it? Would you refer her to someone who will? We had a patient whose perineum was torn to shreds after a vaginal delivery from her female circumcision, then requested we sew her back shut. Should we have done it?

I'm not sure what you mean. Did she have an infibulation and was requesting you reperform it? No, in the States we wouldn't. But do you understand that she could just have easily called your team's call not to as succumbing to "misguided societal pressure."

You're right, women don't come in requesting abortion because our whole program doesn't offer it. The reality is, if patients find out you perform abortions they will not come to you when you are out practicing. There was an article in the Green Journal recently, I can't remember the exact number but only 15-20% of all OB/GYNs will offer abortions. In any given city the vast majority of abortions are performed by a few providers.

Which is why women seeking elective abortions are underserved, NOT women wanting NFP OBGYNs.

Of course, I am talking about elective abortions, issues where there is an anomaly incompatible with life or the mother's life is in danger, all bets are off.

Good to know your program isn't borderline committing malpractice. Tell me you would at least put rape and incest on the table as well?

IVF patients either pay out of pocket or with their private insurance. Most of those patients have a medical problem, ie infertility.

This logic is similar to Sean Hannity defending insurance supporting Viagra for ED (a "medical" condition) but not OCPs. Recall pregnancy is a "medically" morbid state. The point I'm trying to make is, according to my arbitrary personal beliefs, I don't believe IVF is a good use of resources, and would recommend adoption. Yet I recognize it as a gray area and it is my *duty* to not make all patients yield to my belief system, and provide them with information and a referral if needed.

We're running into the basic tenets of the pro-life v. pro-choice argument, which is usually a sign that we won't be accomplishing anything productive by continuing. Signing off.

 

[THP]

I'm not sure what you mean. Did she have an infibulation and was requesting you reperform it? No, in the States we wouldn't. But do you understand that she could just have easily called your team's call not to as succumbing to "misguided societal pressure."
.

I wasn't involved with that delivery but we talked about it at some point. I don't remember the details. So you wouldn't do it? Why would you violate the patient's autonomy? Didn't you take ethics in medical school?

By the way, I don't believe in moral relativism so no I don't understand how she could call it succumbing to misguided societal pressure from her perspective because it is objectively wrong.

I agree that the pro-life/pro-choice argument is a waste of time and not worth arguing, but don't insinuate that not doing an elective procedure is somehow malpractice.

 

[HumbleMD]

I wasn't involved with that delivery but we talked about it at some point. I don't remember the details. So you wouldn't do it? Why would you violate the patient's autonomy? Didn't you take ethics in medical school?

By the way, I don't believe in moral relativism so no I don't understand how she could call it succumbing to misguided societal pressure from her perspective because it is objectively wrong.

I agree that the pro-life/pro-choice argument is a waste of time and not worth arguing, but don't insinuate that not doing an elective procedure is somehow malpractice.

Using a case you don't know the details of is likely problematic. Regardless, infibulizing would violate the Hippocratic oath, and nonmaleficence trumps her wishes in this case (I currently help teach ethics in medical school). You may not understand how or why she would feel that way, but I'm sure that's the way she saw it. Understanding other's perspectives appears to be an area for improvement for you.

I am a cultural but not moral relativist. You should know the difference.

 

[TaraTMD]

I'm not trying to be controversial or stir up the pot here, but this is a topic I've been wondering about a lot lately and would appreciate any advice or first-hand experience anecdotes.

I'm a new 3rd year medical student (taking boards in a few weeks, eek!), father of 2, and a devout pro-life Catholic. I'm interesting in Ob/Gyn for a number of reasons, but am a bit scared by the dominant pro-choice mentality of the profession. ACOG has been particularly vociferous about it's pro-choice stance for instance. I know that once I'm done with residency I'll have the freedom to practice medicine in the manner I feel is most morally correct, but as a resident you are under the control of other physicians/offices/hospitals. Has anyone here had a problem with a superior dictating what you must do? And has anyone suffered because of their refusal?

I make a point of knowing the laws that protect my beliefs, but frankly they only do so much. The laws for protecting conscience rights don't have any teeth to them, and I'm acutely aware of how a bad word from the attendings or residents can sink your career goals.

I'm doing my clinicals, and plan on doing my Ob/Gyn residency, at a Catholic hospital. I've already informed the DME of my religious objections to certain procedures as is necessary by law to be protected. Beyond that there isn't much I can do right now.

For clarification, I won't prescribe contraceptives (for the purpose of contraception) or perform, recommend, or refer for abortions. I'm pretty sure the abortion thing won't be much of an issue, but I forsee the contraception thing being a stumbling block with many people.

Again, I'm not really trying to get into the whole pro-choice/pro-life argument here, but rather am looking for advice or anecdotes from people in this situation or who deal with this situation. Thanks in advance for your help!

I love it. You're a male, who wants to spend his life sticking his fingers in various female orifices, and yet you don't think they should have the right to choose. I'd say that makes you a complete scumbag. Lord, I'd love to see you in my residency program. We'd make your life a living hell. And let me say for the record that your categorical refusal to prescribe OCPs as an OBGYN would be malpractice.

 

[berger911]

I would love to be in your residency program so I could take a big turd on your face. I feel sorry for the male OBGYNs that likely dominate your residency program, your colleagues, and any patients you are responsible for. A lot of people go into OBGYN because of the unique mixture of surgery and medicine. It just so happens that the combination of both fields happens to deal with vaginas. Are you telling me the only reason you went into the field is to deal with women's health? It just do happens that many issues women deal with are medical and require either surgical or non surgical intervention. People who go into OBGYN enjoy managing patients medically and a lot of those issues are related to estrogen and female reproductive organs. What about basic medical problems, like hypertension and diabetes? Many woman see their OBGYN as their primary care provider. And Should family practice physicians not practice OB if they are males?

What is your deal anyway? Did you have a bad experience with a male physician? Yor hatred is way too subjective for my taste. I sense something personal...

 

[TaraTMD]

I would love to be in your residency program so I could take a big turd on your face. I feel sorry for the male OBGYNs that likely dominate your residency program, your colleagues, and any patients you are responsible for. A lot of people go into OBGYN because of the unique mixture of surgery and medicine. It just so happens that the combination of both fields happens to deal with vaginas. Are you telling me the only reason you went into the field is to deal with women's health? It just do happens that many issues women deal with are medical and require either surgical or non surgical intervention. People who go into OBGYN enjoy managing patients medically and a lot of those issues are related to estrogen and female reproductive organs. What about basic medical problems, like hypertension and diabetes? Many woman see their OBGYN as their primary care provider. And Should family practice physicians not practice OB if they are males?

What is your deal anyway? Did you have a bad experience with a male physician? Yor hatred is way too subjective for my taste. I sense something personal...

I’ve never seen a male OBGYN. But during medical school I overheard one of my attendings commenting to another how “attractive” his patient was. I knew then that that prick didn’t look at her simply as a patient, and I’d bet a million bucks that performing a pelvic exam on her was not purely a medical procedure in his mind. You may say in response that this is just one bad apple. Maybe he was just one of the dumber ones who didn’t have the sense to keep his mouth shut while other male OBs keep those kinds of thoughts to themselves. Still, where there’s smoke there’s fire. And not only that, there sure are a hell of a lot of heterosexual male OBGYNs, so there’s plenty of motive for that kind of crap to occur. Honestly, do you really believe that a male OBGYN never has a sexual thought pass through his head when examining an attractive patient?

 

[berger911]

I knew it had more to do with males not having a vagina...

Troll.

 

[TaraTMD]

I knew it had more to do with males not having a vagina...

Troll.

No. It has more to do with males wanting vagina.

 

[Ben Elyon]

I'm not trying to be controversial or stir up the pot here, but this is a topic I've been wondering about a lot lately and would appreciate any advice or first-hand experience anecdotes.

I'm a new 3rd year medical student (taking boards in a few weeks, eek!), father of 2, and a devout pro-life Catholic. I'm interesting in Ob/Gyn for a number of reasons, but am a bit scared by the dominant pro-choice mentality of the profession. ACOG has been particularly vociferous about it's pro-choice stance for instance. I know that once I'm done with residency I'll have the freedom to practice medicine in the manner I feel is most morally correct, but as a resident you are under the control of other physicians/offices/hospitals. Has anyone here had a problem with a superior dictating what you must do? And has anyone suffered because of their refusal?

I make a point of knowing the laws that protect my beliefs, but frankly they only do so much. The laws for protecting conscience rights don't have any teeth to them, and I'm acutely aware of how a bad word from the attendings or residents can sink your career goals.

I'm doing my clinicals, and plan on doing my Ob/Gyn residency, at a Catholic hospital. I've already informed the DME of my religious objections to certain procedures as is necessary by law to be protected. Beyond that there isn't much I can do right now.

For clarification, I won't prescribe contraceptives (for the purpose of contraception) or perform, recommend, or refer for abortions. I'm pretty sure the abortion thing won't be much of an issue, but I forsee the contraception thing being a stumbling block with many people.

Again, I'm not really trying to get into the whole pro-choice/pro-life argument here, but rather am looking for advice or anecdotes from people in this situation or who deal with this situation. Thanks in advance for your help!

Ok so now that it's been 6 years since you posted this - please give an update on what your "actual" experience has been.

I'm dying to know.

Thanks in advance!

 

[WGSgrad]

Indeed. @Ferrismonk is still around and should do an update for this thread for other people who find themselves with a similar question and seeking resources. It's six years later so, conservatively, even if they were an M1 at the time, they would be a second year resident at this point and have experience to add to their earlier perspective...

ETA: I did some snooping and based on their post from earlier this year, they are not an OB/GYN resident.

 

[BigTumor]

Indeed. @Ferrismonk is still around and should do an update for this thread for other people who find themselves with a similar question and seeking resources. It's six years later so, conservatively, even if they were an M1 at the time, they would be a second year resident at this point and have experience to add to their earlier perspective...

ETA: I did some snooping and based on their post from earlier this year, they are not an OB/GYN resident.

You can opt out of performing terminations at any program. You do need to know about the precedures and counseling for exams and to properly care for your patients. People opt-out at all kinds of programs and it does not ruin their careers. I am an OB/GYN resident and know people personally who have opted-out during residency and had no issues.

 

[WGSgrad]

You can opt out of performing terminations at any program. You do need to know about the precedures and counseling for exams and to properly care for your patients. People opt-out at all kinds of programs and it does not ruin their careers. I am an OB/GYN resident and know people personally who have opted-out during residency and had no issues.

Thank you for your perspective. I do not have the OPs concerns but since they are around I wanted to encourage them to update the thread. However, as I said above, it looks like the OP isn't a OB/GYN resident.

ETA: For the record, I am pro-choice and wouldn't opt-out but I can certainly appreciate the OPs desire to get information before moving into the field. It looks like they are happy in their chosen field and I am certainly happy for them.


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[anonperson]

Thank you for your perspective. I do not have the OPs concerns but since they are around I wanted to encourage them to update the thread. However, as I said above, it looks like the OP isn't a OB/GYN resident.

ETA: For the record, I am pro-choice and wouldn't opt-out but I can certainly appreciate the OPs desire to get information before moving into the field. It looks like they are happy in their chosen field and I am certainly happy for them.


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You can opt out.

Some programs are more elective termination heavy (ie UCSF, some random inner city New York programs, etc). Although hey can't force you to perform them, it may be frowned upon at some programs. Just my experience when I interviewed for residency.

Most are somewhere in between. A lot of hospitals won't even perform them because of the drama it causes so it is relegated to clinics with pseudo ORs etc.
You can easily find a program that offers a balance.

 

[finnasvaret]

If I have it on my resume/ERAS that I received a scholarship to attend a pro-life conference, would it count against me in the applications in any way (I'm average in grades/step scores)?

 

[anonperson]

If I have it on my resume/ERAS that I received a scholarship to attend a pro-life conference, would it count against me in the applications in any way (I'm average in grades/step scores)?

If it's a place with a Catholic affiliation, then sure, go for it.

Technically, it shouldn't ding you, but reality is something different. Each program is different in that regard. For some it will raise an eyebrow negatively, others it won't.

I would probably leave it out as it won't help you at any place and may hurt to be honest.

 

[BigTumor]

If it's a place with a Catholic affiliation, then sure, go for it.

Technically, it shouldn't ding you, but reality is something different. Each program is different in that regard. For some it will raise an eyebrow negatively, others it won't.

I would probably leave it out as it won't help you at any place and may hurt to be honest.

I would have to agree. Choice (pro-life or pro-choice) is just too much of a hot button issue to be on a job application unless you know your audience (like Catholic hospitals as mentioned).

Also i am glad someone is pointing out that plenty of programs w/o religious affiliation don't do elective terminations. This has been disappointing for a few of my friends who were interested in family planning but afraid to bring it up at interviews.

 

[BabyHero]

I have only been on a few interviews and made it very clear that I will take no part in any aspect of healthcare involved in abortions, including referring a patient to an abortion provider. I haven't had any push back from interviewers, but I can image a few places immediately placing my folder in file thirteen. I'd rather go unmatched than do something that violates my beliefs about protecting our most innocent lives.

 

[futuremd27!]

Very old at this point, but hoping some people are still out there or can ask friends for input! Compared to when this thread was originally made, majority of programs now have dedicated family planning rotations and seem to be very pro-abortion since the Dobbs decision, and worry about being an outcast with my decision to opt out of performing abortions. Do any of you know which programs (NOT catholic programs. and would love suggestions of the higher tier programs if possible) that would be ok with residents opting out of abortion training?

I'm totally fine with performing tubal and prescribing birth control etc. just don't want to perform abortions

 

[DocWinter]

When I was in residency, the family planning rotation was opt- out. Or you could still go, just not take part in the electives. I was at a standard, community based program, non-catholic.

I don't think it's a huge deal for most places. Just ask current residents of programs.

 

[Lost in Translation]

Very old at this point, but hoping some people are still out there or can ask friends for input! Compared to when this thread was originally made, majority of programs now have dedicated family planning rotations and seem to be very pro-abortion since the Dobbs decision, and worry about being an outcast with my decision to opt out of performing abortions. Do any of you know which programs (NOT catholic programs. and would love suggestions of the higher tier programs if possible) that would be ok with residents opting out of abortion training?

I'm totally fine with performing tubal and prescribing birth control etc. just don't want to perform abortions

Pretty sure it's an ACGME rule that programs allow residents to opt-out of performing abortions. However, this does not mean that those same residents don't need to learn about the different methods of elective termination and management of their complications because as an OB/GYN you may encounter a patient who had a uterine perforation from a D&C or someone who failed medical abortion and is now septic.