Dr. Rodney:
In a painstaking search of strong family practice programs that offer good quality and quantity obstetrics (which is what I'm interested in), I've come across your name and resources. I'm specifically looking in California, and I've come up with UC Davis FP/OB program, Ventura, Contra Costa, possibly Santa Rosa, and Salinas. I'm also looking for programs in/near NYC (family in both locations). Do you have any suggestions for out there?
Thank you for any leads.
MS4
WMR Writes:
The success of this search depends on the ability of the physician to articulate their training goals in the context of their professional destination. The political and economic forces of the US health care system are not aligned to encourage family medicine obstetrics. Most academic environments are not forthright in their approach to students who bring this question.
Start here.
What will your dream job look like ten years from now? Go beyond the rhetoric of the obvious. Training environments are so artificial, that the learning obstetrics is difficult until you have graduated from residency. This Catch-22 has created a market for fourth year fellowships in Surgical Family Medicine Obstetrics.
Programs are easy to understand. Watch what they do, not what they say. To this day I still encounter training where the FP is required to sit with the pit drip for every induction. This is unnecessarily punitive in USA hospitals. Meharry used this policy to literally eradicate any and all FP interest in deliveries 1985-2002.
The Defining Dozen
There are no more than a dozen defining issues but the first and foremost will be Cesarean section. Find a Chair or Director who has ever done even one Cesarean or trained even one FP OB.
If you cannot do your Cesareans, then the second most important thing will be how you fit into a community of physicans who back you up. If Cesareans are not rapidly available, you will not be allowed to do deliveries. See Kirkville, Mo., Nashville, Tn., Anchorage, Al.
The third defining issue is the right to use OB-Gyn ultrasound in your own office. Will it be permitted and will you be allowed to bill for it? See #4
Four--Will you be a corporate employee or an FQHC staff member? There is a lot of bait and switch in these job offers. They want you in the office, and obstetrics by others will be encouraged. This also applies to office surgery of all kinds. There are exceptions.
Lawrence Mass would be worth looking at, but the Cesarean training is done at the fellowship level. Seeking a family medicine group with established obstetrical activity and privileges is the safest choice.
Will your future include hospital work?. You would be amazed at how few physicians ask to see the hospital bylaws . They move their families only to find that there is no department of family medicine and that family medicine doctors cannot obtain hospital privileges[including OB].
5. Do you want to see children? Without OB, your pediatrics may be sparse.
There is more, but this is a start. Skills, Faith, and career planning transcend training location IF the physician is inoculated against the misinformation given by faculty who have hidden agenda to keep OB out. You have to leapfrog the residency to articulate the conditions under which you hope to establish your professional career.
Specific Programs
The programs you have listed on the West coast are good choices compared to most programs in the Northeast. There are others in Seattle, Phoenix, Reno, Portland, Chicago, Indianapolis, etc. But everything is in flux. Shop carefully. Lawrence Ma,Boston U, and Brown. FP's have Cesarean privileges at those institutions. One of my fellows moved to Hunterdon NJ specifically for the FP-OB. You should talk to him. Others on the listserv might suggest other programs in the NYC area..
I had a fellowship graduate who went to Lutheran General in Brooklyn and they gave her OB privileges to teach in that residency. Many programs need help, and this is a good entry point for acquisition of privileges in a city. Once you have those privileges somewhere, your next application will be easier.
The continuing need for FP OB faculty is one reason that fellowships in Surgical Family Medicine Obstetrics continue to prosper. Maybe you are destined to be faculty. But, careful investigation separates out the survivors from the many who are demoralized along the way..
This is the key.
IF your aspiration includes OB, do family medicine faculty have Cesarean privileges at the institution? Do they do a substantial amount of the teaching in the residency? One of the Va. programs has a token FP OB, but the other faculty are basically opposed to the entire idea of FP OB. If the Chair and Residency Director are opposed to FP OB, it is a bad sign.
With best wishes for your professional success,
Wm. MacMillan Rodney MD, FAAFP, FACEP
Clinical Professor and Chair
Medicos para la Familia
Procedural Skills and Office Technology
www.psot.com
www.medicosmundial.com
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