Is OB/GYN now the worst specialty?

[omn]

Is there a listing somewhere that ranks job dissatisfaction, patient dissatisfaction, and practice dysfunction somewhere? Is it agreed that the sums for these factors would possibly make OB/GYN one of the worst?

The issue being, I liked it (but it was at a European hospital). Will other medical systems inevitably inherit all of the dysfunction that exists in this specialty?

Why have a read about such nightmares.. I am scared now.. and I think it would be worse if I am male...!

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[Naijaba]

Funny you should ask. May I present the 2017 MedScape Physician Compensation Report: Medscape Physician Compensation Report 2017

It just came out yesterday. For Ob/Gyn:
Annual Compensation: $284K (+3% from last year)
Do they feel fairly compensated? 48% said yes
Will they participate in MACRA? 41% said yes
Would they choose medicine again? 72% said yes (second-lowest); only neurology is lower at 71%
Would they choose the same speciality? 76% said yes (sixth-lowest)

It's definitely one of the worst according to that survey.

 

[northernpsy]

Are you asking because you're trying to decide whether or not to go into OB yourself?

I really actually enjoyed my time on OB as a student and I think aspects of it are even cooler now that I have had my own child. However, to me, it seems like a specialty where you have to truly find the work extremely meaningful and feel a calling to do it or you'll probably be miserable.
It doesn't seem like an easy life:
-The malpractice liability of course.
-Long, unpredictable hours
-Having to juggle both primary care issues and surgical issues seems like a lot to have on your plate
-Having to witness heartbreaking tragedies on a regular basis (I think the death of a child and watching parents grieve would, for many people, be haunting and traumatic in ways that are harder to reconcile than when an 80 year old dies as a natural conclusion to a full life)
-Disrespect from laypeople who think that lay midwives know more about birth and that OBs force people into unnecessary csections so they can go play golf. And, of course, male gynecologists are pervs to many people.

I have a lot of respect for those who can handle this kind of stuff with grace and find joy in delivering babies or helping women. To me, it isn't all that surprising that many people say they felt abused on their OB rotations. It seems like an environment where many people will easily burn out or become bitter.

That being said, I am in psych, which is considered a relatively low burn out, high satisfaction specialty and I still think burn out is a problem among us psych people. I think it's just a little easier to cope with burn out when you can attend to aspects of life outside of work - and that's easier to do in psych than a surgical specialty.

 

[anonperson]

Malpractice is an issue. That goes without saying but isn't actually the worst. This paper in the NEJM sheds some light : http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

The hours can be terrible. Physicians aren't always on call as this is usually shared unless in solo practice. But if on call, you will be called into the hospital . That is grueling.

Haven't really run into disrespect from people regarding the mid wife thing. Some people have a preference. God bless them. More than enough patients to go around and I have had collegial relationships with them in general.

Heartbreaking tragedies are seen in every specialty in general.

The specialty itself is not bad. It is interesting stuff and there is a fair amount of variety.

There is good job security. No other specialty deals with OB and GYN other than superficially. Not a huge amount of turf wars to be honest. FP has left the domain of OB in general and mid wives only really serve a very specfic function. Most docs don't have much knowledge of gynecologic issues which makes the training valuable. The amount of women with pelvic floor disorders/ gynecologic issues is astounding at times.

Can get a job as a generalist in any major metro area pretty easily.

The main issues with the job are as follows:
Compensation is piss poor when compared to the hours worked and type of work.

Obstetrics can be stressful but rewarding. Unfortunately it is not reimbursed fairly but that is more of a function of the modern day safety of Obstetrics and the general lack of respect given to women's health.

I tell prospective med students the pros and cons. If they enjoy obstetrics, then do OB GYN. If looking for a procedural specialty with a mix of office and OR, would recommend urology or ENT. Much better lifestyle and pay for the work done.

 

[omn]

Malpractice is an issue. That goes without saying but isn't actually the worst. This paper in the NEJM sheds some light : http://www.nejm.org/doi/full/10.1056/NEJMsa1012370
\
I tell prospective med students the pros and cons. If they enjoy obstetrics, then do OB GYN. If looking for a procedural specialty with a mix of office and OR, would recommend urology or ENT. Much better lifestyle and pay for the work done.

I think I like how the specialty is based in primary care ...? (if that makes sense) your suggestion is, of course, much easier said than done.. but I understand (or don't) the sentiment..

where can I find a nice OB/Gyn residency filled with caring, intellligent, concerned professionals who love to teach and care for others... is there a place in Orlando

 

[northernpsy]

Haven't really run into disrespect from people regarding the mid wife thing. Some people have a preference. God bless them. More than enough patients to go around and I have had collegial relationships with them in general.

I appreciate your input since obviously you know what the deal is better than I do. I do find this kind of turf war stuff interesting/concerning just from the perspective of wanting to see physicians in general protected from encroachment by mid levels.
I am glad that the loose cannon doulas/midwives/etc. haven't been a problem for you. I was thinking of people like this certified nurse midwife who solemnly explains on her page how gynecologists are being abusive by doing routine pelvic exams (she herself sees women online by Skype to give them advice on pregnancy). Just from being in parenting groups as a mom myself I have seen some really ignorant attitudes about OB/gyns by people who really don't understand what you guys go through and how stupid it would be for someone who just cares about making tee time to do an OB residency. However if these patients are just screening themselves out before they get to you, then maybe that's for the best.

 

[anonperson]

I think I like how the specialty is based in primary care ...? (if that makes sense) your suggestion is, of course, much easier said than done.. but I understand (or don't) the sentiment..

where can I find a nice OB/Gyn residency filled with caring, intellligent, concerned professionals who love to teach and care for others... is there a place in Orlando

They're out there.

My residency was pretty benign overall. Where I trained for fellowship, the residents have a pretty benign experience. No one is yelling, screaming etc. Stay out of inner city New York etc and you should find a reasonable program.

Residency is like any other job with the same personality issues you see in the white collar world compounded with the stress of sick patients. Generally people are fine but there are certain dysfunctional personalities.

 

[anonperson]

I appreciate your input since obviously you know what the deal is better than I do. I do find this kind of turf war stuff interesting/concerning just from the perspective of wanting to see physicians in general protected from encroachment by mid levels.
I am glad that the loose cannon doulas/midwives/etc. haven't been a problem for you. I was thinking of people like this certified nurse midwife who solemnly explains on her page how gynecologists are being abusive by doing routine pelvic exams (she herself sees women online by Skype to give them advice on pregnancy). Just from being in parenting groups as a mom myself I have seen some really ignorant attitudes about OB/gyns by people who really don't understand what you guys go through and how stupid it would be for someone who just cares about making tee time to do an OB residency. However if these patients are just screening themselves out before they get to you, then maybe that's for the best.

Some people just hate the medical community. It is what it is. I'm sure you see plenty being a psychiatrist. The number of "renegade" mid wives is pretty low and most understand and appreciate the limits of their care ability regarding high risk obstetrics etc.

Had a patient in residency who was seeing a lay midwife in the community. Had third trimester pruritus. Fairly classic for intrahepatic cholestasis of pregnancy. Midwife blew it off for awhile. Patient got nervous and saw us. Of course she had intrahepatic cholestasis which carries increased risk of fetal demise. She switched her care to the resident service after that. Anecdotal of course but you see these things from time to time.