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Thinking of doing a second residency in OB - am I crazy?

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  • Thinking of doing a second residency in OB - am I crazy?

    Sorry in advance for the long post...

    I am a family physician in New York, 3.5 years out of residency. I started doing a hybrid of private practice and academics, but moved to 100% academic after my first year because I enjoyed it so much more.  Since medical school, I really considered doing an OB residency but was scared off for many reasons. I'm now thinking of going back and applying for one, which seems crazy on so many levels.  Here are my hesitations:

    1. Opportunity cost from loss of income. I realize this is essentially a $500k decision because of how much income I will be giving up.  We are fortunate to live very frugally in a LCOL area. In my short time since graduating, we have eliminated all debt (except a $240k mortgage) and have saved up $600k in retirement assets (including a fully paid rental property that nets $1k/month of cash flow), so I feel as if we are doing very well from that perspective.

    2. Work/life balance of OB. This was a big reason why I didn't do OB in the first place; now in academics, I frequently work 70 hour weeks including overnights for deliveries, and I enjoy it more than churning out 40 hours per week in the office, which I found brutal.

    3. Loss of schedule autonomy.  It's really nice to be able to get a day or week off whenever it's needed without too much hassle.

    4. Family.  My wife actually suggested that I go back to residency, because she could see how much I enjoy OB. I think she would be fine with it. However, we are 32/30 years old, and are thinking that we may want to start a family soon. I don't want to leave everything on her.

    5. Geographic requirements. I would be limited in applying to the 3-4 programs located near me so that we would not have to move. My wife loves her job, which is very unique and difficult to replicate, and I don't think it would be fair to ask her to move.  I graduated at the top of my class with excellent board scores, so I think I would be competitive at these programs, but would be quite a non-traditional applicant.

     

    All that being said, I really enjoy doing obstetrics so much more than any other aspect of my job. Working in New York has felt like an uphill battle to be perceived as an acceptable OB provider despite the fact that I know I provide excellent care to my patients.  I also really miss the OR; I wanted to be a surgeon when I started medical school and I have missed it ever since residency.

    So am I totally crazy to think about doing a second residency at this point?  Especially one that is known for high burnout? Any thoughts or other things I should consider would be appreciated.

  • #2
    You are killing it financially, esp for an academic primary care doc.

    It's tough to support the idea of retraining in a field that is traditionally thought of as being one of the most prone to burn out. You could end up 6 years from now having taken hundreds of overnight calls and missed $500k+ in compensation only to find out that there are a bunch of things about OB you dislike just as much.

    As you get older, I think it's harder to wind down/cut back in OB. From what I can tell you either have to become a laborist or drop OB altogether in favor of a gyne practice. I'm not an OB though so take with a grain of salt.

    Have you considered an OB fellowship? I know these are out there for FP docs although I don't know anything about the quality or future practice options.

    Another thing is that if you are interested in women's health there are plenty of primary care docs who do that and mold their practices towards that. Academics might even be more amenable to that.

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    • #3
      Interested to hear what @hatton1 would say to this

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      • #4




        Interested to hear what @hatton1 would say to this
        Click to expand...


        me too

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        • #5
          Thanks for the replies thus far. I'm also hoping that @hatton1 chimes in, as well as @LizOB to get the early-career perspective.

          Regarding the OB fellowship, I've considered it but it will not really help me. In rural America, FM can get OR privileges, but not in NY state. So the additional skills would not actually get me anywhere, as I already have full L&D privileges except for OR.

          I know that burnout is a risk, but I work with some academic OB's who have a better work/life balance than I do right now. I also think that our financial situation will allow me to be a lot more flexible in the future. Plus I have an MBA and interest in leadership, so a hybrid position 10-15 years down the road could also help provide balance.

          I guess it's just hard when I know I want to do it because it's where my passion lies, but also know that it doesn't make any "sense."

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          • #6
            Yes. You are crazy.
            Doesn’t mean you shouldn’t do it. But it depends on how long you want to work.
            It sounds like you are not moving no matter what. Are you sure you can have the ob job you want in the area you want? Not a job, the job. The wrong job in the right specialty can still be miserable.
            What age do you want to retire at? Does working ten years really mean that much to you? If however you are not interested in early retirement, then this concern would not apply.
            Good luck

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            • #7
              The opportunity cost is a bit more complicated than that.  You are going to be losing money you'd be saving into the market and watching it compound. Have a post coming out in May on opportunity cost for fellowship, but could apply it to your situation, too.

              You'll additionally have to figure out how to pay for the four years of residency as you have already used three years of payment from the ACGME.  This makes getting paid during residency harder.  Some hospitals are willing to do this as they already have more residents than ACGME spots and are footing the bill.  Other hospitals and residency programs would not be willing to do this.  I would look heavily into this before I considered doing much else.  You said there are only 3-4 programs that you would consider.  I would check into those hospitals and whether they allow people to do this sort of thing.  If not, you've answered your question

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              • #8
                Honestly I think you should move to a State where you could have OR priviledges and continue to practice FM with an emphasis on OB. Unless you feel the need to be board certified you can get joy out of OB during this portion of your career and fall back to FM when you burn out.



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                • #9




                  The opportunity cost is a bit more complicated than that.  You are going to be losing money you’d be saving into the market and watching it compound. Have a post coming out in May on opportunity cost for fellowship, but could apply it to your situation, too.

                  You’ll additionally have to figure out how to pay for the four years of residency as you have already used three years of payment from the ACGME.  This makes getting paid during residency harder.  Some hospitals are willing to do this as they already have more residents than ACGME spots and are footing the bill.  Other hospitals and residency programs would not be willing to do this.  I would look heavily into this before I considered doing much else.  You said there are only 3-4 programs that you would consider.  I would check into those hospitals and whether they allow people to do this sort of thing.  If not, you’ve answered your question
                  Click to expand...


                  This is important. I switched during residency to another specialty with longer training and had already "used up" 2 years of funding. Had several programs tell me that they wouldn't even interview me bc of the funding issue. This may be a deal breaker for you.

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                  • #10
                    Hey! Here I am to give you some comments.  I have to go to the dentist in a few minutes but I will leave a better post when I get back.  What do you mean that you have full L&D privileges but no OR?  Can you do a c-section or do you have to have backup for that?  When I was a resident at Vanderbilt there were people who did internal medicine and switched to OB without repeating the internship.  I don't know if that is still possible. The hospital I in work in has an OB fellowship for FPs.  I better run but will complete the post this afternoon.

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                    • #11




                      Hey! Here I am to give you some comments.  I have to go to the dentist in a few minutes but I will leave a better post when I get back.  What do you mean that you have full L&D privileges but no OR?  Can you do a c-section or do you have to have backup for that?  When I was a resident at Vanderbilt there were people who did internal medicine and switched to OB without repeating the internship.  I don’t know if that is still possible. The hospital I in work in has an OB fellowship for FPs.  I better run but will complete the post this afternoon.
                      Click to expand...


                      Correct, I have full privileges except that I need backup for C-section.  I wish my hospital had an OB fellowship!  I will be very interested to hear the rest of your thoughts.

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                      • #12
                        Hard choices - workplace happiness is key to longevity -- but so is work life balance and money/family counts too.

                        Being in academics -- how about cutting back time, expanding teaching or administrative roles?   Find balance that route or any of 'side jobs/rackets/hobbies'. $500k is a lot and finding an alternate balance besides different work can be a solution to this too.   Remember to factor in the future family and your own thoughts of parenting time demands on this.

                        My point is --- explore options beyond the work as clinical physician/type work.  Being in lower cost upstate NY, I'm hopeful you'll have options available to explore beyond the traditional work and Face-2-face visits and one that matches a little better than your current grind.   Not often we hear OB is the desirable side of the work equation.

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                        • #13
                          OK.  I am back the dentist has new software that is sending out appointment reminders 2 weeks ahead of time so lots of people including myself are arriving one week early.  I wondered why the appointment was not on my phone.

                          I currently work in a hospital with a family medicine teaching program.  OB/GYN is a much harder residency.  You would be starting at 33 or 35 which is still doable physically.  I was in residency with a female who was early to mid- thirties after doing something else prior to med school.  She did fine.

                          One point not discussed so far is I think you are male.  That would not be a problem in residency but it might make finding a job harder.  You would have to work harder to get a new practice going also.  I am just being honest.  This has really changed in my career.  A lot of stuff was harder for me because of gender at first but now it is harder for males.  If you stay in a rural underserved area probably less of an issue.

                          I dont know about the issues that Physician Philosopher and Decapolis bring up about funding.

                          The lifestyle after residency if you do private practice can be brutal.  I am assuming you know this.  Right now you are in a sweet spot for obstetrics you are doing the low risk vaginal deliveries. If something is going bad you call the OB.  If you do an OB/GYN residency then you have to do the C Section on the 450 lb hypertensive diabetic.  I know you know this too.  You may not like OB as much if you have to do it all.

                          OB is not always happy either.  Plenty of patients walk in with dead babies and it is your job to tell them and then deliver it.  I assume you know this too.

                          One very negative aspect of OB is being used.  If I was FP I would not do OB because of this.  You will be sued if you change to OB and probably more than once.  You will likely not lose money because of this but it is terrible psychologically.  I think you know this too.

                          All this being said you are not too old to do it.  Plenty of OB residents start families in residency.  Over a career you would likely make more money if you changed.  Beware because burnout is very high.  Most OBs actively involved in a lawsuit are clinically depressed IMHO.  I would rather see you do an OB residency than a FP OB fellowship.

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                          • #14
                            I'm not sure if anyone already mentioned this, but you might want to rethink if you're planning to have kid(s) soon.  If you have someone to help your wife at home in the future, then it shouldn't be an issue for you to start a new residency.  I feel like once my daughter arrived in this world, every decision my wife and I made revolve around her.  Good luck.

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                            • #15
                              I am a psychiatrist.  Anytime someone asks me "am I crazy" the answer is usually yes, but I don't always tell them.   In this case, yes you are crazy.  Really crazy unless you are profoundly unhappy in your current specialty.  Is there really nothing in your current practice you enjoy?  Why did you become a FP if you loved OB so much?  Also the obvious answer is to move out of NY and into the boonies.  Lots of FP doing OB down here.

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