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Vaginal
Birth After Cesarean (VBAC)
Yeast
Infections
Painful
periods
Genital
Warts
Uterine
fibroids
Pelvic
Inflammatory Disease
Laparoscopy:
What is it, when is it done and what can it do?
Becoming
an Ob/Gyn
Painful
Intercourse
Endometriosis
Cesarean
Section
Endometrial
polyps
Before
You Become Pregnant
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A number of people have expressed confusion about
the education and qualifications one must possess in order to become
an obstetrician/gynecologist. This brief summary is an effort to clarify
this issue and to provide insight into the training and lifestyle of
ob/gyns.
In college, students hoping for an acceptance into medical school must
take a large number of required science courses, such as biology, chemistry,
genetics, physics, and organic chemistry. Some medical schools also
require one or more writing or literature classes. Most "pre-med"
students major in biology, chemistry, or physics. Some schools have
a "pre-med" major while others do not. However, a number of
college students major in non-science disciplines or have dual majors,
for example in literature and biology. As long as a student takes the
required courses to gain acceptance into medical school the major is
not particularly important, and, to my knowledge, medical school admission
committees do not favor one major over another.
College is an extremely stressful time for many
pre-med students. *Nobody* is more grade-conscious than a pre-med student.
Science classes are generally more rigorous than non-science classes,
in part due to the huge volume of material, and also because of labs.
Labs usually occur in the afternoon after regular classes are over,
and I can recall many afternoons where I would look out the lab window
and watch other students
heading to the pool or beach! Pre-med students all know that excellent
grades, usually above 3.5 and often above 3.7 or 3.8, are necessary
to compete with other pre-med students around the country applying for
application to medical school. A "C" in a particular class
may mean an academic death sentence to a worried student, so dedicated
studying is the norm, often at the expense of athletics and social activities.
Most pre-med students are "weeded out" during the first year
of college, and it is not uncommon to have only 10-20 percent of the
freshman pre-med class actually graduate as pre-med students. Of course,
not all of these students will be accepted to med school. I usually
advise pre-med students to have a "second choice" career plan
in case they are not accepted to med school, or in case they are unable
to complete the rigorous course requirements.
Although academics are the most important requirement for medical school
admission, college students should not forget to take non-science classes,
nor should they neglect socialization. Nobody wants a "science
geek" as a doctor! Patients expect that their doctor be a good
listener and be able to relate to them as people, and a well-rounded
social environment is a must. Volunteerism is also important, although
not absolutely necessary, and most pre-med students attempt some type
of volunteer activity. Contrary to popular belief, is it not critical
that this volunteer activity take place in a hospital.
The last 2 years of college are spent getting ready
for the MCAT (Medical College Admission Test) and applying to various
medical schools. The MCAT is a grueling day-long test that covers physics,
chemistry, biology, and reading and writing comprehension and skills.
It is every pre-med student's nightmare, as a substandard score usually
nullifies any hope of medical school admission. An entire industry has
developed to "coach" students to take this test, which is
the first of many exams required during medical training, as discussed
later. By the second or third year of college, students should have
a pre-med advisor, who will be able to help that student decide on how
many schools to apply to and how to fill out the application form for
medical schools. Most (and perhaps all) U.S. medical schools now use
an electronic (computerized) form. The admission interview to med school
is yet another trial by fire, where students meet faculty from the medical
schools they have applied to, and answer all sorts of questions about
their career goals, background, and activities.
Medical school lasts 4 years. Most schools use the
first two years for classroom learning in subjects like biochemistry,
anatomy (including the complete dissection of a cadaver), microbiology,
and pathology. In addition, students are introduced to clinical medicine
by taking coursework in physical examination, use of a stethoscope and
other medical instruments, and by actually performing examinations under
the direction of a physician. Each med school sets it's own "hours."
During my first 2 years of med school, classes were held roughly 8-5
Monday through Friday. We would eat dinner then begin studying late
into the night. There was certainly time for some leisure activity,
but studying took up the bulk of one's day (outside of class). I do
not think it is unreasonable to state that my classmates and I went
to class and studied about 70-80 hours per week, although this
increased as tests approached. In my opinion the information presented
in med school is not unreasonably difficult; it's the unbelievable amount
of information that makes the first 2 years of med school so hard. This
can come as a huge shock to some students, who "sailed" through
high school and college but find themselves with their first C or lower
grades during med school. Of course, med school parties are legendary,
since students need to unwind after being tested on such things as the
location of every nerve in the body!
The third and fourth years of med school are spent
in the clinic or hospital. The 3rd year is one of the hardest but most
fulfilling times in a physician's training, as this is the first real
experience with direct patient care. Third- year students "rotate"
through such departments as surgery, internal medicine, psychiatry,
pediatrics, family medicine, ob/gyn, and perhaps anesthesia or radiology.
Students are expected to awake at the crack of
dawn (and sometimes earlier), go to the hospital, and "round"
on their patients before the resident physicians (doctors who are still
in training for their particular specialty) arrive. Rounding consists
of taking vital signs, asking the patient how he or she is doing, examining
the patient, then writing a progress note in the chart. Each of these
steps is reviewed and supervised by a resident and attending physician
(who is essentially the
doctor in charge of teaching the residents and students and who bears
ultimate responsibility for the patient's care). Third year can be grueling,
as most schools require that students take call, which usually means
spending the entire day and night (and often the entire next day) awake
and in the hospital to help care for sick patients. After rounds and
teaching, it's off to the clinic, operating room, labor and delivery
unit, or library. While students are allowed to do some procedures,
surgeries are conducted by residents with the attending physician supervising
and assisting. Call can be brutal. Some schools have gotten away from
36-hour call, but others have not. If you are really interested in how
third-year med students, many residents, and some doctors in busy practices
live, simply stay awake and work for 30-36 hours at a time, without
naps or a shower, about 5-10
times a month! Although much of the third year is hard, some rotations
during the third year are less demanding than others, with hours ranging
from 40-50 per week and only a few days of call per month.
The fourth year is spent in many elective rotations
and is much easier than the third year. There is almost always much
less call, less stress, and more time to concentrate on selecting a
specialty to practice. Plus, most attending physicians "lighten
up" on 4th-year students and ask them fewer questions than their
3rd-year colleagues. Some students actually spend a month or two at
another hospital or city. The months of December-February are spent
interviewing for a residency position at a number of hospitals, as it
can actually be harder to land a good residency spot than get in to
med
school! Residency is handled though a process called "the match"
where student's choices are matched with various residency programs
via a computer to select the optimal choice for each student. Top-notch
residencies in competitive specialties are extremely difficult to land.
Excellent programs can have over 1000 applicants for 5 or 6
positions! Less competitive programs may have only several dozen applicants.
To get in to a "star" residency program one must be a star
med student, with a class rank near the top 1/4 or perhaps 1/3. This
is not nearly as easy as in college or high school, as med schools usually
have only outstanding students, who are competitive and want to be ranked
as high as possible. In addition, excellent recommendation letters and
perhaps
published research is necessary for the better programs. Less competitive
programs are certainly easier to obtain and usually provide a high quality
education.
Medical school is expensive. Some schools "only"
cost $10,000-12,000 per year, while others can exceed $35,000 per year.
Scholarships are very limited, so most students take out student loans.
It is not at all unusual to find modern med students who owe over $50,000
for 4 years of med school, and I know of many young doctors who owe
over $120,000. The minimum student loan payments for a loan this size
can be $2000 per month for around 10 years! Physician incomes are slowly
decreasing in many areas due to managed care, and young doctors are
often hard hit when student loans come due. It is difficult to work
during med school due to the long hours, but some students manage to
get in a few work hours each week. Parents of young students who are
considering medical or other professional education should consult a
financial planner and a financial aid officer, who can advise which
investments or forms of aid are available to help pay
for medical school.
After medical school the med student is a physician,
but cannot legally practice medicine without supervision until licenced.
Medical students and resident physicians take a series of tests called
"boards" which must be passed prior to obtaining a license.
These are tough tests and a number of students fail, and must try again.
Once licenced some states allow young doctors to practice unsupervised,
while others desire that the doctor
complete a full residency program, which can last, depending on the
specialty, from 3-11 years.....after medical school! Put another way,
to become an ob/gyn one must have completed 12 years of education after
high school, which means one cannot begin working in one's career until
about age 30. We used to call doctors right out of med school "interns."
Many programs still use this terminology, although they are technically
a
"first-year resident." Ob/Gyn residencies are 4 years. Each
year the resident is allowed increasing responsibility and is allowed
to attempt more difficult procedures and surgeries. Becoming a skilled
surgeon takes practice, therefore residents often "come in early
and stay late" to learn surgery and care for extremely sick patients.
Patients in residency programs are usually the sickest patients in town.
My ob/gyn program had a night-call service which prevented 36 hour calls,
but I still recall working between 70-100
hours per week, every week of the year, for 4 years. Both general surgery
and ob/gyn are known as the hardest residencies in terms of workload,
due in part to the large number of patients, and also because of the
surgical cases. After all, one can't ask a patient with a ruptured tubal
pregnancy to "see me in the morning" since she will likely
be dead by then! Plus, babies often come at all hours of the night.
A young doctor who chooses a career in ob/gyn should have a passion
for the speciality, since the hours during
training (and in practice, since according to AMA information ob/gyn's
work as many or more hours per week on average than any other speciality)
are painfully long.
After residency the doctor becomes eligible to take
the specialty boards, and become "Board Certified." In ob/gyn
this involves a day-long written exam right after completion of residency,
then a grueling oral examination by 6 different professors 2 years later.
Every Board Certified ob/gyn can remember specific questions asked during
"the orals" even if they were taken decades ago! Women's magazines
and other media often make a
big deal out of board certification, but patients should realize that
doctors right out of residency (who are on many occasions the most up-to-date)
cannot become board certified until about 2 years after they begin practicing.
Many ob/gyns join a group practice once residency is over, while others
start their own practices or join an academic setting so they can teach
or do research. A smaller number go on to become subspecialists in cancer
gynecology (gynecologic oncology), high-risk pregnancies (maternal fetal
medicine), or infertility (reproductive endocrinology). The training
for
these subspecialties is called a "fellowship" and these fellows
must continue their formal education for 2-4 more years before they
can practice in their chosen field.
Ob/gyns in practice can expect to work irregular
and long hours, ranging from a low of 50 to a high of 90-100 per week.
Joining a group practice (as I have done) allows my partners and I to
split call, but as you will see it did not necessarily lead to fewer
hours. Using myself as an example, an average workweek would include
the following, although each week is a little different so hours will
vary:
- Monday-office all day (10 hours).
- Tuesday-on call for 24 hours in the hospital, teaching and supervising
residents and delivering our private practice babies (24 hours).
- Wednesday: Day off.
- Thursday: Office all day (9 hours).
- Friday: Operating room (8 hours).
- Saturday: on call (24 hours).
- Sunday: Day off.
Total: (75 hours).
The week I wrote this I worked 101 hours, as I was
on call 3 of the 7 days and had office and surgery on the other days!
Most ob/gyns will have a variation of the above schedule and may, for
example, work in the office every day except Thursday, when they are
in the operating room. Thus, that doctor's hours would average to about
50, including time spent making rounds and delivering babies. I suspect
60-70 hours per week is closer to a national average for full-time ob/gyns.
Although it may sound as if medical education is
punitive, I found it both very difficult and very rewarding. I have
spent countless hours memorizing the location of tiny nerves, caring
for sometimes hostile and violent patients, but have also held the hands
of dying patients, told tearful parents that their baby has no heart
beat, cured people of cancer,
and saved the lives of many babies and sometimes their mothers. Each
of these experiences is a part of me personally and professionally,
and while there were days along the way that I wondered if not going
outside the hospital for days at a time was worth it, there have been
countless times that I am grateful that I am able to practice medicine
and care for my wonderful patients. The path to becoming an ob/gyn is
long and
difficult, but if one is passionate about this speciality, the rewards
of helping to bring babies into the world, treating conditions like
endometriosis, infertility, abnormal Pap smears, painful intercourse,
and abnormal bleeding, and knowing your patients personally is worth
the many years of training and long hours in practice.
D. Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida
407-897-1668
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