Is it possible to build your practice to have an emphasis on surgery?

[SKaminski]

Hello all,

I am a third year medical student contemplating going into OBGYN. I really enjoy surgery, but have also really enjoyed the C-sections and vaginal deliveries I've been a part of while on my OBGYN rotation. Additionally, the connections you can build with patients is something I enjoy, and something I feel I might miss on surgery.

One thing i'm concerned about is how few procedures we do on my current OBGYN rotation. We have clinic every day from 9-5, and we've done about one C-section and a few vaginal deliveries a week.

Is this typical, or is this a bit on the lower side?

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[anonperson]

Not uncommon for large health systems to triage things out. In certain Kaisers or the Mayo Health System, they have specific physicians who can do hysterecomties and major cases, certain who just do labor and delivery, some who just do office/minor cases and procedures.

In a group/private practice setting, and if you have additional training you can get cases internally referred to you by partners but it depends.

Reality is that OB GYN is a clinic heavy specialty and operating 0.5 days to 1 day is generally the norm.

If you want to operate more, would recommend general surgery and the specialties associated with it.

 

[SKaminski]

Hmmm. What if you operate as a laborist/OB hospitalist?

 

[PikachuMD]

I know for a fact that there are several private practice Benign-Gyn surgeons who specialize in things like endometriosis and fibroids. I've worked with one of them a lot and he usually relies upon reputation and referrals from the community as a highly skilled minimally invasive surgeon. There are also several academic centers that have fibroid and/or endometriosis specialty clinics where a doctor could direct most of his/her practice towards gynecologic surgery. I think that is what I am ultimately looking for. I have been advised by one attending on an ObGyn residency interview as we were discussing a fellowship in minimally invasive surgery that becoming a MIS gynecologic surgeon can be a little tricky. She had recommended getting set up with a larger hospital system that could serve to funnel referrals to me rather than trying to find a small practice where I would potentially be seen as stealing cases from my future partners.

 

[anonperson]

Hmmm. What if you operate as a laborist/OB hospitalist?

You'll do a lot of OB including sections. If you cover the ED also maybe the occasional ectopic and ovarian torsion/cyst rupture.

 

[SKaminski]

You'll do a lot of OB including sections. If you cover the ED also maybe the occasional ectopic and ovarian torsion/cyst rupture.

That sounds like a lot of fun! Surgery, Shift Work, Emergency without the drug seekers!

 

[NWwildcat2013]

That sounds like a lot of fun! Surgery, Shift Work, Emergency without the drug seekers!

That is exactly what draws me to it.

 

[radtopedi]

I know for a fact that there are several private practice Benign-Gyn surgeons who specialize in things like endometriosis and fibroids. I've worked with one of them a lot and he usually relies upon reputation and referrals from the community as a highly skilled minimally invasive surgeon. There are also several academic centers that have fibroid and/or endometriosis specialty clinics where a doctor could direct most of his/her practice towards gynecologic surgery. I think that is what I am ultimately looking for. I have been advised by one attending on an ObGyn residency interview as we were discussing a fellowship in minimally invasive surgery that becoming a MIS gynecologic surgeon can be a little tricky. She had recommended getting set up with a larger hospital system that could serve to funnel referrals to me rather than trying to find a small practice where I would potentially be seen as stealing cases from my future partners.

Most complex surgeries are done by fellowship trained surgeons (urogyn,onc, mis, and to a lesser extent REI). More rural areas will have busier surgical practices but in general obgyn is moving away from the generalist model. In the 80s and 90s the average number of hysts performed was around 28, that number is <10 now. Most practices without a fellowship trained person usually assign 1 or 2 people to be the "surgeon" so it's not like you're stealing cases you are just the surgeon of that practice. Most people that will refer out for surgery will usually be referring to a fellowship trained surgeon. But realistically, in the future it will be hard to achieve a truly high volume surgical practice with a wide variety of cases in a non-rural area without having a done a fellowship.

http://journals.lww.com/greenjourna...gical_Volume_on_Route_of_Hysterectomy.17.aspx

Above is a link to a green journal article somewhat relevant to this.