Monday, March 29, 2010

Answers for A

I recently received a comment on the blog posing the following questions. At first, I was going to just correspond via email, but I thought perhaps my readership could also jump in on answering these questions from "A," a 3rd year medical student considering Ob/Gyn. So, thank you in advance for your help!

Hi Dr. Whoo,

I have thoroughly enjoyed reading your blog and appreciate the time and effort you put into your posts to provide us readers with a glimpse of your life. I am currently an MS III with only 6 months left to decide on what to do with my medical career. My top 3 choices are OBGYN, Anesthesiology and Psychiatry. I loved my OB rotation and feel that the field is a perfect blend of medicine, surgery, procedures and primary care.

Hello, A! Thank you for the nice words about the blog, I am glad to be able to provide a glimpse of life in the world of Ob/Gyn. I agree that Ob/Gyn is a perfect blend of medicine, surgery, procedures, and primary care. It is a really great field, but it does have its limitations.

However, I am afraid to commit to the field for the following reasons:

-Work hours. I cannot get a straight answer from the academic faculty on what to expect after residency. Most of them have flat out discouraged me from choosing OB, telling me that I should just do one of my other 2 choices. Is it possible to find a job working 60-65 hours/week and still come out with a salary of $250-$300k in smaller cities in midwest or the south? I just want to be well-informed of what to expect before I take the plunge to ensure that I don't end up hating my career .

HAHAHAHAHAHAHA! Ahem, I mean, ah, not likely right off the bat, at any rate. I think you can get the salary you want with more work hours, or the work hours you want for a lower salary, but it would be rare to find the above combination just out of residency. My average work week (5 person group practice) is right about 60 hours with weekday call, 110 hours for weeks where I have weekend call. As an employed physician, I make less than $200,000. My pay will increase with each employed year until I am able to "buy-in" to the practice. After that, my income will increase (but a large portion of it will go back into buying into the practice). After about 5 years of "paying my dues," I will be able to set my ticket for income. It just takes some time.

At my previous job, I made over $250,000, worked in a rural, under served area with high Med.icaid, and only had 4 days off per month, so 168 hours the weeks that I worked weekends, 120 hour weeks the weeks when I had the weekend off. Trust me, it is far better to make less money and work less hours, especially now when looms on the horizon. (Plus, think of the taxes you will be paying on a higher salary, you may get to keep more of your money working for a lower income.) So, while I am sure you can find some places where low work hours and higher income combines, that would certainly not be the norm until you establish a practice.

-Liability. How stressful is this aspect of OB if I choose to move to a state with Tort Reform or low liability?

Liability, Tort Reform or not, is always stressful in OB. It will loom over your shoulder with every decision you make, especially with respect to managing labor and delivery. Even when you uphold the standard of care, you can still be sued for bad outcomes, and all it takes is one case to destroy you financially, personally, and professionally. Malpractice premiums are fairly exorbitant in the field, as well. You may not be able to cover your malpractice costs if you have a poor payer mix, meaning more volume, which leads to more chances of things going wrong. Vicious cycle. Most of the time, it is just like static noise in the background, other times you hear the alarm bells clanging. You get used to it, but it is always there.

-I am a male (a minority in the pool of OB applicants). I have been told that being a male would make it difficult for me to find a decent job because practices tend to prefer women OB's (hence males have to settle for worse locations, work hours and call schedules). How true is this?

Well, to be honest, I am not sure, since I am not a male. (Any male Ob/Gyns out there want to field this question?) I know that in many of the positions for which I interviewed, they were very interested in procuring a female physician. One field that you may consider, if you are so inclined, is the field of Urogynecology. I think it is a 3 year specialty after residency. It is a more surgery-heavy specialty, and, in my experience, still fairly male-dominated. You still get some procedures, good primary care and a lot of good surgeries, no babies, so less liability, and likely better hours and compensation overall. I hope that these answers helped somewhat, and I hope my readers are able to clarify further some points I am not able to elaborate upon. I truly wish you the best of luck with the rest of your training, and in whichever specialty you choose to pursue.


Anonymous said...

Here's my take...2 different private practice jobs over the years.

Work hours: now working 60-65 hours a week, making a lot less than $250K. When I worked 100+ hours a week, made more, but Dr. Whoo is so right. It is not worth giving up precious years of your life just to make more money.

If you want reasonable work hours with excellent compensation, do Anesthesiology.

Do ObGyn only if it is the ONLY field you can possibly imagine yourself doing. If you can be happy doing anything else, do it.

The liability issue is much worse than anyone who hasn't been sued can grasp. Dr. Whoo is correct, there need not be negligence, all that is required is a bad outcome. Negligence or some semblance of it can then be trumped up by John Edwards and his ilk. Mother Nature provides bad outcomes frequently. Being sued is a bitch no matter what specialty you choose, but the bad outcomes come more frequently and unpredictably in Ob.

Gender: some women want a female ObGyn, some don't care. However, remember that a huge part of your job will be chatting with women about their periods and their vaginal discharge and other fun female topics. Some men just get tired of all that.

Would I do it again? Only because I can't imagine doing anything else!

Good luck in your specialty choice. You're asking the right questions.

Captain and Crew said...

I would agree completely with the work hours/$ comment. I have been in private practice for almost two years now. I work about 60 hours a week two weeks a month, and 100 hours the other two weeks a month. I have 6 days off a month. For about 200K.

I realize that I feel the best and take the best care of myself when I work 35 hours a week. So, you can see that this is an impossible situation. I continue to wonder how I will ever lose that 5-10 lbs. I've been trying to lose.

Also, yes, it will be harder to get a job as a male. Don't kid yourself. I wouldn't go to a man.

Anonymous said...

Being sued is definitely a bitch. And it can happen in any specialty, including mine (family medicine. Just my two cents: being a male is necessarily a deterrent. I saw only women for years. Several years ago, thinking I was going to need surgery (correctly, as it turned out) I switched to a male because I wanted the best surgeon (and you better believe we generalists know who they are) and that person happened to be male. He's MUCH nicer than the last woman I saw, and even though it's pretty awkard to see the guy across the table in the doctor's lunchroom he's stuck with me till one of us retires. It's not the gender that's important as much as the person.

Anonymous said...

I have loved reading your blog, and I so look forward to seeing your new posts!

I am desperate for a new OB doc, but they are limited in my area.

Thank you for being so open and warm!

Anonymous said...

My OB & my PCP are both males and I have no issues at all. I'm not squeamish or uncomfortable about talking about weird body stuff though. I really only care that they are knowledgeable about what's going on and are able to communicate well with me, no matter what gender they are.

The OB practice I'm using has 7 male MD's, 2 female MD's, 6 females midwives, & 2 female NP's. There's a good balance and I likely won't see my regular OB when I deliver anyway, since it will all depend on who is on call that day. I trust that they are all competent professionals, and know that barring some complication, I'll be spending most of my labor with the nurses anyway.

Quasi Serendipita said...

"Do ObGyn only if it is the ONLY field you can possibly imagine yourself doing." This sums up how I feel about obstetrics: I simply can't imagine doing anything else!

Anonymous said...

I can't imagine ever going to a male OB. Of course, I also have an extensive history of sexual trauma, so I know that plays into it. I currently hate my female OB, but as choices are limited in my area, I will stick with her since all the other choices are male.

Anonymous said...

i love your blog, i'm a medical negligence lawyer and mum so find the issues interesting.

personally i prefer having a male ob - i'm a feminist but i'm strangely more comfortable with deferring to a father figure type old school dr. a female obs covers my male obs and i really like her and ask way more questions when i have her and feel more like her equal but strangely i prefer the way i don't second guess my male obs and just trust him implicitly even though intellectually i'm well aware that my trust is more some sort of paternalistic transference i have happening. i adore my obs and am moving soon and plan to find another male obs. i'm in australia where i could have a homebirth midwife, or midwifery led care at a birth centre and even though my views about birth align better with that i choose to have an obstetrician just so i can have a male care provider.

Anonymous said...

As an ob/gyn in practice, I too cannot imagine doing any other field than this. However, it can be hard to make a substantial salary, even if you're willing to put in the hours. Just depends on your practice setting. Do keep in mind though that when someone says they work 100 hrs/week, much of that time on call you will actually be at home just answering a page or two that comes your way.

Erin Hammond said...

Have to say I'm with the women who, all things being equal, prefer a female ob/gyn. But, I know plenty of women who are comfortable wtih having a male ob/gyn. And ultimately, the real goal is just finding the best match.

My own doc's practice group contains two male ob/gyns. They definitely are out there, and are employed.

As for liability, ob/gyn is a tough speciality liabilty-wise (I'm a med mal defense attorney, so I'm familiar from that perspective).

A recent CDC survey on this topic strongly suggests that the practice of this specialty is directly affected by liability concerns. See my blog post about the survery here:

Not enough reason not to practice this rewarding specialty. But at the same time, go in with your eyes wide open (and with lots of insurance).

Anonymous said...

Gee, you are only looking for a salary of $250 to $300k per year? Come back to earth and be grateful that you have such fantastic earning capacity at even $100k per year.

MJB said...

I'll be honest. I didn't get into Medicine for the money (that would have been incredibly stupid anyway considering the trends), but I will say that I hope to bring in at least 200K a year. I say this because I gave up a 60K a year job and a minimum of 7 years of my life to train for a career as a physician during some of the best years of my life.

I now have a newborn son that I'll be helping to raise during my last year of med school and then residency...and I'll never get the time back that I will miss spending with him while spending time on call, etc..

You add all the sacrifices to the 300K student loan bill I'm going to be graced with, and all of a sudden 200K doesn't sound like much, especially when compared to salaries other people make.

Dr's are in the business of helping can't say that about many professions. Most are in the business of making money.

I appreciate "A" prompting Dr. Whoo to post this. I'm a 3rd year Male medical student considering OB/GYN as well...and some of the other web blogs/sites have literally made me question why I'm even considering this as a specialty even though it's the only one that I've truly "ENJOYED".

Anonymous said...

Dear Dr. Whoo,

Thank you so much for generously taking the time out of your crazy schedule to answer my questions and posting them on your blog. I honestly wasn't sure that you would have the time to reply given how busy your schedule looks from your blog! I would also like to thank the other blog readers for taking the time to post a response.

To the poster that made the comment about coming back to earth and criticizing my question about salaries. I'm not sure that my question is so unreasonable given that the MGMA surveys rates OBGYN mean salary at $302,362 in 2008. Additionally, like the MJB had said, we take out $200k+ loans out, go through 4 hard years of medical school and potentially another 4 for residency to do this. If you factor in opportunity costs (I left a $100K, 50 hour job to go to medical school), I don't think it's unreasonable to expect a decent salary for working so hard.

For the anonymous poster that was clarifying what the "100 hour" week really entails, in your estimation, how many hours of that is actually patient contact time/hospital time/answering

Thanks again Dr. Whoo and everyone else that took the time to post your responses. It truly is nice to get the "real scoop" from real people in private practice vs the recruitment talk from the academia in medical school.


Nicholas Fogelson, MD said...

I'm a male OB/GYN and have always been happy with my choice. I work in academics and was able to get a substantial salary right out of residency, which increased after I brought in grant money. Not quite $300k, but close.

Getting a big salary means working hard. The money has to come from somewhere, and to make $300k you have a bill a lot of RVUs, or bring in the cash somewhere else.

As for the male/female preference, I've never had a problem with it. I treat my patients with respect and friendliness, and by in large they like me and want to come back to see me. In many cases I get new patients from the recommendations of present patients.

So are there patient who don't want to see males? Yes. But are there so many of those that a male has a hard time building a practice? Not really. At least I did not have that problem.

If big money is what you are going for, choose the thing that will get you there. Will all the specialties available to a medical student, it is a crime to not choose the specialty that will bring you what you desire. If you love OB/GYN and want a big salary, do a fellowship. If you like OB do MFM. If you like surgery do ONC. Either one in private practice makes $450k+, and in some cases lots more than than. REI can do very well also, but takes a lot longer to build up. REIs often end up owning infertility labs that can be very profitable in the long run, but also can cost millions of dollars to setup.

Anonymous said...

Tax attorney comment, please bear with me:

"Plus, think of the taxes you will be paying on a higher salary, you may get to keep more of your money working for a lower income."

That is never true in our current income tax scheme (including the proposed expiration of the Bush tax cuts that were, instead, extended for two more years). The tax is progressive. You will never have a lower net income at a higher salary, because only the amount earned above, say, $250,000 will be taxed at the higher rate. Instead of taking home 65% of the $30,000 you made above and beyond $250,000, you might take home 60% of it. 60% of $30,000 (i.e., $18,000) is still much more than $0.00 (what you would get if you don't make more than $250,000).

Under the present system, no matter how much your income increases, you will never have a higher net income when you earn less. Avoiding a higher tax bracket is meaningless; the higher bracket is only applied to the amount earned that falls into that bracket.

Anonymous said...

My wife is an Ob/Gyn (Generalist)... She makes about $220k/year. I can tell you with the hours she works and with the amount of RVUs she has each month (400-500), she is underpaid. She should be closer to $300k. We are in a major metro area.