Rei

[stonewall22]

Do reproductive endocrinologists see children and males for endocrinology problems? Is there much surgery in REI or is the main focus on IVF with little else? Thanks all!

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[smq123]

Do reproductive endocrinologists see children and males for endocrinology problems? Is there much surgery in REI or is the main focus on IVF with little else? Thanks all!

- Reproductive endocrinologists only see women of child-bearing age for endocrinology problems.

Children would go see a pediatric endocrinologist. Men see regular endocrinologists.

- There is as much surgery in REI as you feel comfortable doing. If you're not comfortable with doing surgery (or don't want to), you can focus on IVF. If you enjoy surgery, you can remove fibroids, remove ovarian cysts, reverse tubal ligations (i.e. re-connecting tubes that were previously "tied"), do hysterectomies, etc.

 

[VFTW]

- Reproductive endocrinologists only see women of child-bearing age for endocrinology problems.

Children would go see a pediatric endocrinologist. Men see regular endocrinologists.

Actually, most peds gynecologists are REI trained. So there are REIs who see children for congenital anomalies of the reproductive tract as well as general adolescent-related health issues that are pertinent to the practice of gynecology.

 

[smq123]

Actually, most peds gynecologists are REI trained. So there are REIs who see children for congenital anomalies of the reproductive tract as well as general adolescent-related health issues that are pertinent to the practice of gynecology.

But pediatric gynecologists often do not go through an entire REI fellowship, and are not board certified in REI.

Most REIs do not see children. A few may operate on children, although I think that those would be more likely to be referred to peds surg or peds gyn.

 

[VFTW]

But pediatric gynecologists often do not go through an entire REI fellowship, and are not board certified in REI.

Most REIs do not see children. A few may operate on children, although I think that those would be more likely to be referred to peds surg or peds gyn.

Again, I disagree. There are only 3-4 peds gyne fellowships in the country. Most practicing peds gynes are actually REI board certified. There is a way to integrate peds into a general infertility practice, esp given that most peds gyn surgeries are for congenital anomalies that one might also see later in life as a cause of infertility (didelphys comes to mind.) Adolescent gyn/pelvic pain issues are also in the realm of REI.

 

[smq123]

Again, I beg to differ. There are only 3-4 peds gyne fellowships in the country. Most practicing peds gynes are actually REI board certified, including the current president of the national peds gyn organization and most of its active board members. There is a way to integrate peds into a general infertility practice, esp given that most peds gyn surgeries are for congenital anomalies that one might also see later in life as a cause of infertility (didelphys comes to mind.) Adolescent gyn/pelvic pain issues are also in the realm of REI.

Fair enough.

That being said, when it comes to the OP's original question: children with endocrine disorders do not usually get referred to an REI. Things like Graves disease, diabetes, growth hormone disorders, etc., are better seen by a peds endocrinologist, not by an REI.

 

[VFTW]

Fair enough.

That being said, when it comes to the OP's original question: children with endocrine disorders do not usually get referred to an REI. Things like Graves disease, diabetes, growth hormone disorders, etc., are better seen by a peds endocrinologist, not by an REI.

While it is true that REIs do not manage peds medical endo disorders, they can and do see children for reproductive-related disorders, and operate on children.

 

[OBGXYN]

Do reproductive endocrinologists see children and males?

And just to add fuel to the fire . . . From what I understand, it's not actually all that uncommon for REIs to be involved in the initial evaluation of infertility in men, either. H&P, semen analysis, relevant lab work, etc. Most IVF labs have an andrology division, and some providers also perform basic procedures for male-factor infertility (PESA/TESE, for example).

But to think that REIs are managing hypothyroidism or pituitary adenomas (outside of their impact on reproduction) seems somewhat misinformed. Both men and women would see a 'regular' endocrinologist for this.

To address the OP, though, REI is a nice combination of surgery and procedural clinic. IVF is where the money is, so many clinics unfortunately limit their practice.

 

[DeaconMD04]

Finally a post that doesn't make me cringe because of awkwardness. Med students are sooooo touchy. I'm sure plenty of pediatric gynecologists dable in REI stuff, as do many general ob/gyn's. That doesn't mean that they are double boarded. The current president of North American Society for Pediatric and Adolescent Gynecology? Dr. Diane Merritt? Yeah, only boarded in OB/GYN. President elect? Pediatrics. Fellowship in adolescent medicine. I'm just saying...

FYI: I do agree that REs seen children, primarily for congenital anomalies, as well as males. But in my experience adolscent pelvic pain isues are not in the realm of REI. I also agree that they do not treat general endo disorders.

But please don't freak out on me, just my two cents!

 

[simone]

Does anyone know much about the lifestyles of a pediatric/adolescent gynecologist or what types of procedures they perform. Im really interested in finding out more about what the day to day lives of ped gynecologists are like. Also, anyone know what the salary range is? Is the life of an REI doc better than that of a general ob/gyn. I am perfectly happy working like crazy during residency but I want to know that if i go into either of these fields that my life will get better after residency. any thoughts on this?

 

[wvshootr]

FYI:

-Do reproductive endocrinologists see children and males for endocrinology problems?

There are few specialized Adolescent Gyns in the country, and most of those practicing are usually generalist Gyns or REIs that have shifted their focus to pediatric/adolescent Gyn. But with the lack of availability, many REIs end up doing pediatric and adolescent gyn/REI. Some peds endos handle the growth problems, but outside of that don't touch peds gyn. With the growing obesity, childhood metabolic syndrome, and PCOS are ever increasing problems. Most congenital anomaly surgery is done by REIs as they have the most experience, though some older gynecologists do them. There just isn't a large enough base of well trained pediatric/adolescent gyns available to refer to in most parts of the country.
As far as males, we do often initiate the male evaluation. General male infertility is included in most REI training, as in mine. However, this field is often has gray areas that are controversial in the method of treatment, thus it's better to refer to a urologist that preferably has male infertility training or a special interest in it. Most general urologist cringe at infertility and do a poor job of it. In our large city, there are about 40 urologists and only one that anyone would trust with male fertility


- Reproductive endocrinologists only see women of child-bearing age for endocrinology problems.

Not true, pediatric and adolescent issues are an important basis of REI problems. Non-reproductive endocrine issues are handled by peds endo, but all of endo is included in the training of REIs, as we have to cross train with adult endocrinologists, pediatric endocrinologists, and urologists for the male side.


-But pediatric gynecologists often do not go through an entire REI fellowship, and are not board certified in REI
This is true. Most pediatric gynecologists out there are a mix of older gyns that focus on pediatrics, or REIs. The Adolescent Gyn fellowships are a newer thing of sorts, with a limited number of graduates out there. This is not a boarded fellowship, thus they are usually just boarded in general Ob/Gyn.

--A few may operate on children, although I think that those would be more likely to be referred to peds surg or peds gyn.

This is just really dependent on whether there are pediatric gyns in that part of the country or not. Most pediatric surgeons don't have the background to do these cases or the interest. Granted, some REIs don't have the interest either. Most cases being done in the pediatric age group are simple and small. Most of the bigger cases are done in adolescence, thus they are practically adults, which is why REIs usually do the cases.

----And just to add fuel to the fire . . . From what I understand, it's not actually all that uncommon for REIs to be involved in the initial evaluation of infertility in men, either. H&P, semen analysis, relevant lab work, etc. Most IVF labs have an andrology division, and some providers also perform basic procedures for male-factor infertility (PESA/TESE, for example).

Somewhat true, labs can be done sure, but the male evaluation is highly dependent on the exam, in which we are not usually trained. Thus these patients go to a urologist with a training or interest in fertility. Yes, IVF labs have an "andrology" division, but this usually amounts to running semen analyses and dealing with the IVF. Male procedures are not performed in IVF labs by REIs. When these are done, they are done by urologists with a cooperative relationship with the IVF group.

---But to think that REIs are managing hypothyroidism or pituitary adenomas (outside of their impact on reproduction) seems somewhat misinformed. Both men and women would see a 'regular' endocrinologist for this.

Very wrong. General endo problems which relate to fertility (pituitary adenomas, hypothyroidism, hypothalamic problems) are our 'bread and butter'. As most endos don't focus on the reproductive consequences of these issues, they often do not treat them as they should be to maximize fertility. For most REIs, we wouldn't think of referring adenomas or thyroid issues.


---Is there much surgery in REI or is the main focus on IVF with little else?

This is dependent on the practice and somewhat on the area of the country. Many practices do focus only on IVF, but those are the people who usually aren't as surgery oriented. Many REIs have a broad based practice with a fair amount of endocrinology, surgery, and general gynecology in addition to IVF.

---Does anyone know much about the lifestyles of a pediatric/adolescent gynecologist or what types of procedures they perform. Im really interested in finding out more about what the day to day lives of ped gynecologists are like. Also, anyone know what the salary range is?

Like any field, they have their basics (like hypertension is to IM) such as contraception, vaginal discharge/irritation. They often do a lot of irrregular bleeding, PCOS, pelvic pain, endometriosis, benign ovarian masses. To a lesser extent (Just due to the rarity), they do mullerian anomalies, (tons of hymenectomies), and growth disorders. Salary is based on how hard they work of course, and is probably not as good as most general ob/gyns. This is due to the fact that insurance pays horribly for these problems, and it's hard to generate enough surgeries even in a big practice. General Obs make most of their money through OB, and not Gyn.

--Is the life of an REI doc better than that of a general ob/gyn.

Oh, just a thousand times better or so. Yes, it's tons better. Never a night in the hospital, often after hours phone calls, but rarely ever having to go into the hospital. The extra three years of training pays huge dividends in both income and lifestyle.





I'd be happy to entertain any other REI based questions, as I've been there/am there and doing it.




Travis McCoy, MD FACOG
2nd year REI Fellow

 

[stonewall22]

FYI:

-Do reproductive endocrinologists see children and males for endocrinology problems?

There are few specialized Adolescent Gyns in the country, and most of those practicing are usually generalist Gyns or REIs that have shifted their focus to pediatric/adolescent Gyn. But with the lack of availability, many REIs end up doing pediatric and adolescent gyn/REI. Some peds endos handle the growth problems, but outside of that don't touch peds gyn. With the growing obesity, childhood metabolic syndrome, and PCOS are ever increasing problems. Most congenital anomaly surgery is done by REIs as they have the most experience, though some older gynecologists do them. There just isn't a large enough base of well trained pediatric/adolescent gyns available to refer to in most parts of the country.
As far as males, we do often initiate the male evaluation. General male infertility is included in most REI training, as in mine. However, this field is often has gray areas that are controversial in the method of treatment, thus it's better to refer to a urologist that preferably has male infertility training or a special interest in it. Most general urologist cringe at infertility and do a poor job of it. In our large city, there are about 40 urologists and only one that anyone would trust with male fertility


- Reproductive endocrinologists only see women of child-bearing age for endocrinology problems.

Not true, pediatric and adolescent issues are an important basis of REI problems. Non-reproductive endocrine issues are handled by peds endo, but all of endo is included in the training of REIs, as we have to cross train with adult endocrinologists, pediatric endocrinologists, and urologists for the male side.


-But pediatric gynecologists often do not go through an entire REI fellowship, and are not board certified in REI
This is true. Most pediatric gynecologists out there are a mix of older gyns that focus on pediatrics, or REIs. The Adolescent Gyn fellowships are a newer thing of sorts, with a limited number of graduates out there. This is not a boarded fellowship, thus they are usually just boarded in general Ob/Gyn.

--A few may operate on children, although I think that those would be more likely to be referred to peds surg or peds gyn.

This is just really dependent on whether there are pediatric gyns in that part of the country or not. Most pediatric surgeons don't have the background to do these cases or the interest. Granted, some REIs don't have the interest either. Most cases being done in the pediatric age group are simple and small. Most of the bigger cases are done in adolescence, thus they are practically adults, which is why REIs usually do the cases.

----And just to add fuel to the fire . . . From what I understand, it's not actually all that uncommon for REIs to be involved in the initial evaluation of infertility in men, either. H&P, semen analysis, relevant lab work, etc. Most IVF labs have an andrology division, and some providers also perform basic procedures for male-factor infertility (PESA/TESE, for example).

Somewhat true, labs can be done sure, but the male evaluation is highly dependent on the exam, in which we are not usually trained. Thus these patients go to a urologist with a training or interest in fertility. Yes, IVF labs have an "andrology" division, but this usually amounts to running semen analyses and dealing with the IVF. Male procedures are not performed in IVF labs by REIs. When these are done, they are done by urologists with a cooperative relationship with the IVF group.

---But to think that REIs are managing hypothyroidism or pituitary adenomas (outside of their impact on reproduction) seems somewhat misinformed. Both men and women would see a 'regular' endocrinologist for this.

Very wrong. General endo problems which relate to fertility (pituitary adenomas, hypothyroidism, hypothalamic problems) are our 'bread and butter'. As most endos don't focus on the reproductive consequences of these issues, they often do not treat them as they should be to maximize fertility. For most REIs, we wouldn't think of referring adenomas or thyroid issues.


---Is there much surgery in REI or is the main focus on IVF with little else?

This is dependent on the practice and somewhat on the area of the country. Many practices do focus only on IVF, but those are the people who usually aren't as surgery oriented. Many REIs have a broad based practice with a fair amount of endocrinology, surgery, and general gynecology in addition to IVF.

---Does anyone know much about the lifestyles of a pediatric/adolescent gynecologist or what types of procedures they perform. Im really interested in finding out more about what the day to day lives of ped gynecologists are like. Also, anyone know what the salary range is?

Like any field, they have their basics (like hypertension is to IM) such as contraception, vaginal discharge/irritation. They often do a lot of irrregular bleeding, PCOS, pelvic pain, endometriosis, benign ovarian masses. To a lesser extent (Just due to the rarity), they do mullerian anomalies, (tons of hymenectomies), and growth disorders. Salary is based on how hard they work of course, and is probably not as good as most general ob/gyns. This is due to the fact that insurance pays horribly for these problems, and it's hard to generate enough surgeries even in a big practice. General Obs make most of their money through OB, and not Gyn.

--Is the life of an REI doc better than that of a general ob/gyn.

Oh, just a thousand times better or so. Yes, it's tons better. Never a night in the hospital, often after hours phone calls, but rarely ever having to go into the hospital. The extra three years of training pays huge dividends in both income and lifestyle.





I'd be happy to entertain any other REI based questions, as I've been there/am there and doing it.




Travis McCoy, MD FACOG
2nd year REI Fellow

I'm sure you're very busy. Thank you very much for taking the time to write this.

 

[travelbug73]

Questions:

Is an REI fellowship only available after an Ob-Gyn residency or are there other paths to it?

I'm assuming there is a lot of scope to pursue research, am I correct?

Thank you.

 

[achiever]

Yes, that's correct. REI can only be done after you finish OBG.

There is research available for any specialty in any field.

 

[American Desi]

What is the future for RG? How can you steer your career after RG fellowship?
Private? Academic? Are there many jobs in metro area? Pay range? Life style?
Competition?
Any information will be appreciated. Thank You.

 

[fsamsam]

I am kindly asking any one who has experience with getting in to REI fellowship. I am an IMG and did dual residency, both here and overseas. I always had great scores in CREOGs, in the whole program and each year, but due to being new to American hospital and some other politics and cultures, I had some difficulties in my first year, internship. I overcame that successfully. Due to not having great research experience in REI , I couldnt get any interviews. Of note that I was not also supported by my program to get in to REI, that stem from my first year experience. I recently passed my OBGYN boards with good score and as I stated I had always the best score in the program . My senior research project has been published in a Journal. I also have another study that have been selected for poster presentation in SMFM. I also have some research back ground overseas. There is also a paper published in REI in local journal in my country of origin. my program was not strong in REI, and they tried to discourage me of applying. Now, I really feel like that I can not convince myself not to do REI and I really want to pursue that. I need a sincere advise from expert, preferably attendings if there are any in this discussion board, that how is possible to get in that fellowship and what should be done to improve my chance. Obviously, I am older than the other residents and fellows due to my dual training that was mandated my US Medical education law. I appreciate if some one could enlighten me and give a good advise. I will be gald to hear about other's experience who could or could not get in to this fellowship.
Thanks for your patience.