Tuesday, 2 May 2017

Re-evaluating My Options

Five facts that are causing me some stress:
1. I love obstetrics and gynaecology. A lot.
2. I have concerns about the physical toll of an OB/Gyn residency on me and the stress it will place on my family.
3. I will likely not be able to return home for a long time if I do OB/Gyn.
4. I do not greatly enjoy the full scope of family med nearly as much as I like OB/Gyn, but do enjoy some parts that are not part of the OB/Gyn scope (well-baby care, breastfeeding concerns)
5. We all really want to go home.

So I'm looking into the possibility of being a women's health-focused family physician who does low-risk obstetrics including deliveries. As far as I'm aware, there's really only one family doctor on the Island who does deliveries routinely, but I know in Ontario there are multiple family doctor groups that do low-risk obstetrics and women's health.

There is at least one physician on the Island whose practice is primarily women's health, and there's another I'm aware of who receives referrals from other family physicians because she does things like IUD insertions and pessary management. They're also establishing a women's health centre out of one of the hospitals, and last I heard they've been looking for someone who will work there.

I think I'd be satisfied with not having gynae surgery as a part of my practice if I were still able to do obstetrics and women's health as the majority of my practice.

In Ontario, I know it's entirely possible to do that.

I don't know about how achievable that is back home, but if it can happen, I want to make it happen.

It would be the best of both worlds if I could manage pregnant patients through pregnancy, parturition, and postpartum, see their babies for well-baby checks at the same time as postpartum checks, see them for breastfeeding concerns, do contraceptive counselling and IUD insertions, STI screening and management, do initial nonsurgical management of gynae issues like endometriosis, prolapse, and PCOS. Do low-risk OB, primary care gynae, some paeds.

None of that is outside the scope of a family doctor. Most family doctors don't do deliveries nowadays, but it's more a practical consideration - you basically always have to be on call to manage your own patients' deliveries - but that's manageable if it's done as a call group, and I know for a fact that there are family doctors who do that.

I figure, if a family doctor can do primarily emerg, or hospitalist, or geriatrics, or palliative, why can't I do women's and infants health?

If I could go into a family medicine residency being sure that I could make that sort of thing into my future, I would do it in a heartbeat and I don't think I'd regret the fact that I wouldn't be doing surgery.

I love OB/Gyn, but if I could be something between a family doctor and an OB/Gyn, I'll dive in with both feet.

I think I'm going to call the offices of the doctors back home who I know do more women's health-oriented practice and see if I can speak with them, and I think I might try to change my family med elective this summer to be with a women's health focused family doc.

Thinking on this, it's actually feeling like this might be a workable solution, and might be a good way to shape my career the way I want it to be, combine all areas I enjoy, and provide a desperately needed service to my home province.

It would also mean we could go home, potentially as early as next year if I match to that family med program. That is incredibly tempting.

I'd have to leave for a year (possibly) to do a women's health fellowship, but there's also the possibility I could do that in the maritimes, so I could potentially just be gone during the week.

This seems workable, but I need more information so that's my next steps.


  1. That sounds like a great plan to me. Our family medicine docs (in Ontario) at the clinic where I work do basically what you described: pre- and post-natal, well-baby, sexual health, paps, IUD insertions, contraceptive counselling and family planning, and low-risk deliveries (high risk referred to an OB). My family doc manages my endometriosis, except when I've needed surgery or when the pain has gotten bad enough to want the input of a Gyn. If only 12 year old me had had family doc who listened to me, it might not have been 13 years before I had a diagnosis of endometriosis, and all those years I might have had better pain control and QoL. Family docs are SO important in women's health and care.

  2. There is a woman's health focussed family med elective at Mcgill if you're interested!