Little help with OB & MFM...

[Lests55]

Hello,

I am just applying to medical school now, but I already think OB is for me; however, I am not that comfortable with the GYN side (I am a male, and just not comfortable with the situation). But, after shadowing in the delivery unit, I absolutely LOVED the whole setup. I liked the medicine, surgery, delivery, everything! So my question is...are there residencies that are strictly OB, or is a MFM fellowship the way to approach this? Is MFM really difficult to obtain? I think I would be miserable doing only GYN.

Many thanks!

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[anamarylee]

If you want to do strictly OB, the only way I can think of is going for nurse-midwife. I don't think there are any residencies that do just OB. You don't have to do MFM to practice OB. Just like some OB/GYN do only gyn, some of them do only OB.

From what I understand MFM is just as hard to get into as any other fellowships in OB/GYN. At least that's the impression I've gotten from my attendings.

 

[ceg]

Midwives do gyne-only care too, so that wouldn't solve your problem.

 

[UCLAMAN]

If you want to do strictly OB, the only way I can think of is going for nurse-midwife. I don't think there are any residencies that do just OB. You don't have to do MFM to practice OB. Just like some OB/GYN do only gyn, some of them do only OB.

From what I understand MFM is just as hard to get into as any other fellowships in OB/GYN. At least that's the impression I've gotten from my attendings.

well...not true from what i have heard(although what i have heard could certainly be wrong)...per the program director at my institution(who also happens to be my advisor as I go thru the app process this year)...

REI > gyne onc > urogyne > MFM

...for order of difficulty to obtain a fellowship in. how much more difficult is one over the next i have no clue. however, if i am not mistaken, mfm has the most spots compared to the others.

 

[UCLAMAN]

Hello,

I am just applying to medical school now, but I already think OB is for me; however, I am not that comfortable with the GYN side (I am a male, and just not comfortable with the situation). But, after shadowing in the delivery unit, I absolutely LOVED the whole setup. I liked the medicine, surgery, delivery, everything! So my question is...are there residencies that are strictly OB, or is a MFM fellowship the way to approach this? Is MFM really difficult to obtain? I think I would be miserable doing only GYN.

Many thanks!

whats wrong with gyne? have you shadowed docs for gyne appointments? have you done gyne procedures in the operating room? if not, i would suggest that you do before you pass judgment. if you have, perhaps you just need time to get over the "uncomfortable" feeling you have. i mean...its like the 5th grade when we had sex education...the teacher had to say "sex," "penis," and "vagina." for like 5 min straight before the class would finally be serious about it.

furthermore...everything in medicine involves unnatural conversations about bodily function...whether you do peds, psych, internal medicine, or gyne. you will be talking about child abuse, children masturbating, to someone's bowel habits, flatus, to suicide and depression to someone's sexual partners and cottage cheese vaginal discharge. and don't think you only have such conversations on gyne...you will have these convos on your medicine rotation and surgery rotations as well. difficult convos generally become less difficult the more you are exposed to them. the point being...medicine is all about difficult convos...not all the time...but its a facet you must learn to deal with.

and gees...i would argue that labor and delivery is a lot messier than gyne surgery.

i am curious to know your reasons for your apprehensions. kinda feels premature if not immature. not rippin on ya...just trying to get another fellow guy into the field!

 

[juddson]

I've been told by several attendings and one fellow that MFM is by far the easiest to get into. In fact it was explained to me that the OB/GYN fellowships were "competitive with the exception of MFM".

Judd

 

[anamarylee]

Thanks to everyone who clarified the difficulty of getting the various fellowships. It's kind of hard to gauge since they don't have any on the island, so all my information on the subject is from 3rd parties.

 

[Doula-2-OB]

Midwives do gyne-only care too, so that wouldn't solve your problem.

They don't *have* to, but CNMs have the luxury of working in a variety of settings, as opposed to lay midwives who only work at home/birth centers.

I think if he went the CNM route he could certainly elect to work in OB only.

 

[UCLAMAN]

They don't *have* to, but CNMs have the luxury of working in a variety of settings, as opposed to lay midwives who only work at home/birth centers.

I think if he went the CNM route he could certainly elect to work in OB only.

while i know the studies for OB/gyns goes something like 25% of pateints prefer male ob/gyns, 25% prefer women ob/gyns, and 50% just dont care so long as their care is good...i wonder how well a male CNM would do.

 

[UCLAMAN]

Thanks to everyone who clarified the difficulty of getting the various fellowships. It's kind of hard to gauge since they don't have any on the island, so all my information on the subject is from 3rd parties.

my advisor says that if i want to do REI or gyne onc, i'd most certainly have to match at an academic residency program...but for MFM...even respectable community programs routinely send people into MFM fellowships.

 

[Doula-2-OB]

while i know the studies for OB/gyns goes something like 25% of pateints prefer male ob/gyns, 25% prefer women ob/gyns, and 50% just dont care so long as their care is good...i wonder how well a male CNM would do.

Well I know that the concept of male midwives comes up in the birthing circles, and anecdotally (in doula/midwife circles anyway), there's support for it. There is a male midwife who practices in TJ, Mexico with the 'riverbed' women who are sometimes as young as 11 years old. He lives in CA and just goes down there for the births. He has a website, I'll see if I can find it.

It can be done! I think if he went that way and he connected with the 'right' (subjectively) people, he could have a whole lot of support. Getting patients would require some patience but once there was a reputation, I think there's plenty of room. That's JMO.

I'd see a male midwife if he respected my views about birth. That's all I'm really looking for.

 

[UCLAMAN]

Well I know that the concept of male midwives comes up in the birthing circles, and anecdotally (in doula/midwife circles anyway), there's support for it. There is a male midwife who practices in TJ, Mexico with the 'riverbed' women who are sometimes as young as 11 years old. He lives in CA and just goes down there for the births. He has a website, I'll see if I can find it.

It can be done! I think if he went that way and he connected with the 'right' (subjectively) people, he could have a whole lot of support. Getting patients would require some patience but once there was a reputation, I think there's plenty of room. That's JMO.

I'd see a male midwife if he respected my views about birth. That's all I'm really looking for.

hmm...yeah...not a fan of anecdotal evidence. especially if it is one male midwife who practices in TJ. if you can find me several male cnm's who practice on the magnificent mile in chicago then i might have a little more faith in the anecdotal evidence.

i also don't like the idea of "it can be done" here on SDN. yeah...anything can be done...i can win the lottery tomorrow...i can drive a lamborghini tomorrow...these things are all certainly within the realm of possibility...but how likely are they are to occur? similarly, how likely is it that a male cnm will thrive? definitely possible...as most things are always possible. haha...sorry. one of my many pet peeves on sdn. i'll shut up now.

 

[Wednesday]

If you want to do surgery, the nurse route won't be for you. I imagine that you will get over your gyn phobia. The thing I've realized is that although the atmosphere on L&D is a lot different than in a gyn OR (can't think of a good equivalent, but you know what I mean), you are taking care of the same patients and the same body parts and the same problems, just at different points in the patients' lives. If you like that stuff, you'll probably find that you don't mind gyn. The one thing people don't like about gyn is the surgery part. This doesn't seem to be your problem. Of course you have so long to decide that this is all just an intellectual conversation at this point. Keep getting exposure to many different fields so you have a lot of information when decision time finally comes. Good luck with everything!

 

[Lests55]

Thanks for all the replies. For the person curious about my emotions on the issue....I was volunteering in the ER one day and one of the residents asked be to witness (don't know if this is a req. for the exam) a pelvic exam and I this is where I experienced the lack of comfort. The resident mentioned jokingly afterwords that it really didn't look I wanted to be there. However in L&D I absolutely loved the whole experience without any apprehension...

 

[tiredmom]

I think people also get fooled into thinking that gyn is like the Gyn ER. The gyn ER concept (while helpful in getting patients out of ER and residents from having to go down to main ER to see pts) also causes a misrepresentation to med students that all gyn is vaginal bleeding after vaginal bleeding after vaginal bleeding.

 

[ceg]

They don't *have* to, but CNMs have the luxury of working in a variety of settings, as opposed to lay midwives who only work at home/birth centers.

I think if he went the CNM route he could certainly elect to work in OB only.

I'm actually a (doula and) midwifery student myself and providing care across the lifespan is an important concept to me. I for one, love my midwife and look forward to going in for appointments. I don't loooove pelvic exams but it's a trade off, right I can only have so many babies.

Lay midwives also provide well-woman care including pap smears. This of course depends on the state laws where they practice, but generally speaking they are able to. In some states they have hospital priveliges.

There are some hospitalist midwives in my city who work in L & D. There are a few male midwives in the ACNM. I think around 8 in the US. So there's an option, although I am in the group who prefers a female provider.

It's good to see you here, Doula. I met a doctor last year who thought doulas and midwives were the same thing- and equated them both with witches, LOL.