IM resident seeking help- stay vs. switch

[MickyMyki]

I wanted to do ob/gyn originally. Somehow got talked out of it due to the "if you can imagine anything else, then do that" and "high malpractice" trap which led to me to IM. Not nearly as passionate about it as I was about ob/gyn.

I wrestled with thoughts of switching but the nightmare of changing gears my intern year, without board certification, and the thought of having no job at all, esp during a pandemic, terrified me so I stuck through. So far GI was the only thing that really kinda drew me- it has a nice mix of clinic, inpatient, and procedures (similar to ob/gyn) which I like. Still, passion-wise, no where near ob/gyn.

I saw a young female Crohn's pt the other day, and it took me back to ob/gyn and made me miss that pt population...

I am at a cross-roads. On one hand, I have been tee-ing an application for GI with research, rotations, etc. GI ranks among the highest satisfied specialists on national surveys, among females too, while ob/gyn ranks near the bottom. I would have good job security and I also gel with the people with GI.

On the other hand, I was hoping my feelings for ob/gyn would have subsided by now and I dont want to regret this in middle age. Things that scare me from switching are: 1) not matching ob/gyn and having to be a general IM doc 2) programs not having enough $$ to fund me 3) matching to a crappy ob/gyn program without all accredited fellowships 4) realizing maybe I don't like surgery as much as I think 5) ob/gyn seems to be crazy competitive now so I wonder if applying would be a total crapshoot. Luckily, I can take the financial hit of extra training. I am a bit of a workaholic and don't mind the extra hours either.

For me, it was ultimately the pt population of ob/gyn I was drawn to. It was the only time I truly felt PRIVILEGED to be working for these pts.

Is the grass just greener on the other side? Anything I'm missing? Does it all really become a job in the end? Maybe I'm too naive?

***please be nice about ob/gyn (yes I know most people's experience was negative, yada, yada). Would especially like opinions from those in IM, GI, surgery, or ob/gyn

---

Members don't see this ad.

 

[BorntobeDO?]

In IM, going for fellowship. There are several components to unpack here. First, I think it goes without saying that if your halfway thru IM, you should just finish. Your funding is already shot, i doubt having 1 year of funding vs none left for residency makes any difference at this point. I think the benefit of finishing your last year of IM and becoming board eligable far outweighs the likely nominal benefit having that year of funding gives. Plus I think it makes you more attractive as a candidate who will complete things. If I was a PD, I would rather have someone who finished a residency than a canidate who did 2 years of a 3 year residency and quit, but that is speculation on my part. So I think you finish IM even if you want to go back for OB.


I also think if you get a GI fellowship you will never regret it. Way too much going for that fellowship/subspecialty overall to feel a real let down. It beats general OB in my opinion in nearly every way: lifestyle, money, lawsuit risk, practice flexibilify, job market, outcomes. The only thing I could see being better about OB is the actual deliveries of babies when it goes well on an emotional level. But OB also has the horrific situation when it doesnt go well also, which is a big downside. On the surgery front, I feel like you probably know by now if surgery is something you really want to do day in and day out. Particularly the surgical call and culture. IMO OB lifestyle doesnt get better unless you cut big parts of your practice out (like delivering babies/OB part of Gyn). I will give credit that you can do that so thats cool to have the option. Also REI is a cool subspecialty, but if you really wanted that why not just do Endocrine and come at it from the medicine side.

If it was me and the question was GI vs OBGYN, especially if OBGYN required extra years, I am picking GI every time. 10 years from now, I dont see how I would regret that decision either.

 

[Crayola227]

Also not clear to me your draw to obgyn besides the population. People always think of it as delivering babies, but there's tons of gynecology that isn't that.

Do you have an idea what specifically you want to do/focus on as an ob/gyn? My understanding from my rotations is that they don't "do it all" and frequently focus and so they can have practices that are drastically different from one another.

 

[MickyMyki]

Also not clear to me your draw to obgyn besides the population. People always think of it as delivering babies, but there's tons of gynecology that isn't that.

Do you have an idea what specifically you want to do/focus on as an ob/gyn? My understanding from my rotations is that they don't "do it all" and frequently focus and so they can have practices that are drastically different from one another.

I would say in general gynecology, urogyn, and gynonc appeal to me.

 

[rokshana]

so there are a number of things to consider.

what year are you? if you are working on a fellowship application, the you are pgy 2 or 3..not a lot of time left and you should at least just complete the IM residency...that way you can apply for a GI fellowship and if you don't match to an ob/gyn residency, then you have a fall back for work. you can then focus on say, women's health and work with the patient population that you like.

are you competitive enough for a GI fellowship? it is after all the most competitive of the IM fellowships and there is no guarantee that you will get that 3-4 yr fellowship. And if you are willing to spend the 3-4 years in fellowship, its the same amount of time that yo would spend doing an ob/gyn fellowship.

are/were you competitive for ob/gyn? are you an AMG? IMG? FMG? if the first, then you prolly can apply and get something, if the other 2...meh...though having completed an IM residency may help.

 

[BorntobeDO?]

I would say in general gynecology, urogyn, and gynonc appeal to me.

So your really interested in a subspecialty of OBGYN and not the OB part at all. If you want to be in an OR most of the time doing surgery then I think its fine to reapply after finishing IM. I assume its competative for the OBGYN subspecialties as well, but you can decide that part.

I still dont think you would regret GI if you can get it, but it makes sense to me to want surgery instead of medicine and I think that story sells alot better on an app then just straight 'I like womens health' when you were already in primary care.

I would try to do what you can to get an OBGYN elective and make sure its everything your hyping it to be in your mind. You are allowed 3 off service rotations per IM ACGME guidance, and I dont think people would raise eyebrows at requesting OBGYN if you say your interested in womens health.

 

[MickyMyki]

so there are a number of things to consider.

what year are you? if you are working on a fellowship application, the you are pgy 2 or 3..not a lot of time left and you should at least just complete the IM residency...that way you can apply for a GI fellowship and if you don't match to an ob/gyn residency, then you have a fall back for work. you can then focus on say, women's health and work with the patient population that you like.

are you competitive enough for a GI fellowship? it is after all the most competitive of the IM fellowships and there is no guarantee that you will get that 3-4 yr fellowship. And if you are willing to spend the 3-4 years in fellowship, its the same amount of time that yo would spend doing an ob/gyn fellowship.

are/were you competitive for ob/gyn? are you an AMG? IMG? FMG? if the first, then you prolly can apply and get something, if the other 2...meh...though having completed an IM residency may help.

pgy-2. 250/260 steps, only couple 'honors' in med school AMG. does that change anything? i think i should be pretty good for applying GI

 

[Crayola227]

pgy-2. 250/260 steps, only couple 'honors' in med school AMG. does that change anything? i think i should be pretty good for applying GI

You haven't really said what you've done in residency for GI. That really matters for getting a GI fellowship, not just your med school performance.

I'm not an expert on ob/gyn, but finish your residency certainly, do what ob/gyn rotations you can and get some glowing LORs from ob/gyns, and you might be appealing for ob/gyn. You clearly can complete a residency, and have commitment to the field of ob/gyn if you're willing to do a second residency to make the switch. So the main question will be, can you be good at on/gyn and rotations and letters can address that.

There might be more to it but I know the above is part of it

 

[NotAProgDirector]

If you're competitive for GI (which assuming research it appears you are), then you're also competitive for getting an OB/GYN spot. It's possible that by completing your IM residency you'd get some sort of advanced credit in OB/GYN.

At this point, it's too late to apply to this year's match -- except at your current institution. If they have an OB program, they might consider a late application from an internal candidate.

It's fine for people to list the things about GI or OB that make them better/worse, but in the end it really depends all upon what you want to do. Which is all on you.

So:

You can almost certainly get an OB/GYN spot if you're an AMG (yep) with good scores (yep) at a quality IM program (probably).

This year, your only option is your home program. It's not too late if you want them to consider you, you can ask. Tell your PD first.

If not, then next year you'll need to decide whether to apply to GI or OB. You can't apply to both, since matching in GI would make you inelegible for the main match. If you apply to OB and you don't get a spot (which seems unlikely to me), then you can apply to GI after a gap year.

 

[rokshana]

pgy-2. 250/260 steps, only couple 'honors' in med school AMG. does that change anything? i think i should be pretty good for applying GI

notAPD has said it better than i can...if you have research, you should be fairly competitive.

that being said, you have a year and a half left of your IM residency...would complete it and have that under your belt to be able to have as plan B. You would be applying in 2022 for 2023, so you can finish IM and then go into Ob/gyn without any gap.

 

[anonperson]

I wanted to do ob/gyn originally. Somehow got talked out of it due to the "if you can imagine anything else, then do that" and "high malpractice" trap which led to me to IM. Not nearly as passionate about it as I was about ob/gyn.

I wrestled with thoughts of switching but the nightmare of changing gears my intern year, without board certification, and the thought of having no job at all, esp during a pandemic, terrified me so I stuck through. So far GI was the only thing that really kinda drew me- it has a nice mix of clinic, inpatient, and procedures (similar to ob/gyn) which I like. Still, passion-wise, no where near ob/gyn.

I saw a young female Crohn's pt the other day, and it took me back to ob/gyn and made me miss that pt population...

I am at a cross-roads. On one hand, I have been tee-ing an application for GI with research, rotations, etc. GI ranks among the highest satisfied specialists on national surveys, among females too, while ob/gyn ranks near the bottom. I would have good job security and I also gel with the people with GI.

On the other hand, I was hoping my feelings for ob/gyn would have subsided by now and I dont want to regret this in middle age. Things that scare me from switching are: 1) not matching ob/gyn and having to be a general IM doc 2) programs not having enough $$ to fund me 3) matching to a crappy ob/gyn program without all accredited fellowships 4) realizing maybe I don't like surgery as much as I think 5) ob/gyn seems to be crazy competitive now so I wonder if applying would be a total crapshoot. Luckily, I can take the financial hit of extra training. I am a bit of a workaholic and don't mind the extra hours either.

For me, it was ultimately the pt population of ob/gyn I was drawn to. It was the only time I truly felt PRIVILEGED to be working for these pts.

Is the grass just greener on the other side? Anything I'm missing? Does it all really become a job in the end? Maybe I'm too naive?

***please be nice about ob/gyn (yes I know most people's experience was negative, yada, yada). Would especially like opinions from those in IM, GI, surgery, or ob/gyn

I'm in OBGYN and do urogynecology as well (fellowship trained).

My job is a mix of urogyn/ general gyn/OB. I used to take call but don't anymore.

Stay with GI. Don't do OBGYN.

I am fine with my job but is it the best specialty? Not really.

You will have better compensation, lifestyle and job opportunities with GI.

General OB call is physically demanding. Sure, you are a workaholic now, but will you feel that way in 10 years? Not really.

Most jobs want you/need call coverage so that will likely be the package with most jobs.

The patient population is fine but can be weird.

Had an OB patient who was GBS positive refuse antibiotics because she did her research and didn't think it was needed. Just delivered and now the baby has GBS sepsis in an otherwise normal term baby.

Real rewarding...

Have I done some rewarding stuff, sure. Fixed some fistulas, fixed some other docs complications etc. Patients are typically grateful but you will see that in any specialty.

The subspecialties can be fine but they are very niche and if you have any geographic limitations that will make the job search much harder.

 

[collegestud2013]

I wanted to do ob/gyn originally. Somehow got talked out of it due to the "if you can imagine anything else, then do that" and "high malpractice" trap which led to me to IM. Not nearly as passionate about it as I was about ob/gyn.

I wrestled with thoughts of switching but the nightmare of changing gears my intern year, without board certification, and the thought of having no job at all, esp during a pandemic, terrified me so I stuck through. So far GI was the only thing that really kinda drew me- it has a nice mix of clinic, inpatient, and procedures (similar to ob/gyn) which I like. Still, passion-wise, no where near ob/gyn.

I saw a young female Crohn's pt the other day, and it took me back to ob/gyn and made me miss that pt population...

I am at a cross-roads. On one hand, I have been tee-ing an application for GI with research, rotations, etc. GI ranks among the highest satisfied specialists on national surveys, among females too, while ob/gyn ranks near the bottom. I would have good job security and I also gel with the people with GI.

On the other hand, I was hoping my feelings for ob/gyn would have subsided by now and I dont want to regret this in middle age. Things that scare me from switching are: 1) not matching ob/gyn and having to be a general IM doc 2) programs not having enough $$ to fund me 3) matching to a crappy ob/gyn program without all accredited fellowships 4) realizing maybe I don't like surgery as much as I think 5) ob/gyn seems to be crazy competitive now so I wonder if applying would be a total crapshoot. Luckily, I can take the financial hit of extra training. I am a bit of a workaholic and don't mind the extra hours either.

For me, it was ultimately the pt population of ob/gyn I was drawn to. It was the only time I truly felt PRIVILEGED to be working for these pts.

Is the grass just greener on the other side? Anything I'm missing? Does it all really become a job in the end? Maybe I'm too naive?

***please be nice about ob/gyn (yes I know most people's experience was negative, yada, yada). Would especially like opinions from those in IM, GI, surgery, or ob/gyn

I probably wouldn't switch at this point. You will have funding issues at most Ob/gyn residencies (you started IM so you have 3 years of funding if you start another residency, but Ob/gyn is 4 years). You by repeating residencies you will also be starting as an attending much later which translates to lost income (which is especially problematic for those with high medical school debt). Ob/gyn for the most part isn't a lifestyle specialty either: residency is brutal and usually busier than most IM programs, with OB/GYn residents frequently average of working 70-80 hs per week similar to Surgery residents. Make sure you can put up with that. And even as an attending, there's a large amount of call unless you're practicing soley in some of the niche subspecialities like reproductive endocrinology.

The high malpractice liability with OB is real, and it's a major practice expense for OB/Gyn physicians. In PP, you often have to pay it yourself, and in high risk areas (eg South Florida, NYC) it can cost over $200k per year. You may be able to limit it by practicing in an area with more tort reform, but it's one of the main reasons why compensation isn't higher for Ob/gyn once you consider the long hours they typically work.

GI is a decent field at the moment with better pay and better lifestyle at the moment, but don't count on it for long-term money and job stability. It only takes a single large paycut decision from CMS for EGDs and colonoscopies (which is what a lot of the GI revenues come from) to drive down the pay. You have good shot of being able to get into GI fellowship based on what you're telling us, but there's no guarantee since it's the most competitive IM subspecialty.

 

[Gastrapathy]

Women’s health in GI is a pretty important aspect of the field. Women will often prefer female GIs given the personal nature of their complaints. IBD in reproductive age women is certainly complex. People like Dr Mahadaven speak at every single meeting on these topics ( Uma Mahadevan). I like my job. My partners (men and women) like their jobs. If OBGYN is your calling, then switch I guess, but most people would be better off down your current path IMO.