13 Things I Wish I Knew Before I Became an Ob-Gyn
1. The schedule can be erratic, especially if you're delivering babies. Babies do not watch the clock or the calendar, so you need to be available all the time, at a moment's notice. The commitment I make to my pregnant patients is that if I'm in town, I'll be there for the delivery. In the eight years that I've been in private practice, I've only missed seven deliveries: two were the week of my wedding, two were when I was on maternity leave; one time, I had the flu and was literally too sick to enter the hospital.
2. There are trade-offs between working in private practice and working for a medical group. If you're an employee for a bigger company, you have a lot less control over your hours, who's on your staff, how many patients you see in an hour, and how many pregnant patients you'll need to deliver in a given year. If you're in private practice, you can make all those decisions on your own - but if you want to take time off, that's lost income. I decided to go into private practice eight years ago because I wanted to have control over how much time I spent with patients, but it's made taking time off really difficult. There are benefits and drawbacks either way.
3. You'll be shocked by how much time and energy med school and residency take out of you. First, you have to do four years of undergrad, then four years of medical school, and then go through a residency, which is special training in a particular field of medicine. To be an ob-gyn, the residency is four years following med school. There are several sub-specialties within ob-gyn: high-risk obstetrics, infertility, oncology, urogynecology, and so on. You can also do fellowships, which are an additional three years after the four years of residency. It's a big time commitment, you're working really long hours, you're constantly stressed out, and you won't have much of a personal life. There were days when I really wasn't sure if it would be worth it. It's a major financial commitment too; I'll be paying off student loans for a while.
4. You won't get paid the big bucks. While some doctors get paid six-figure salaries out of the gate to offset the cost of medical school, it can be difficult for ob-gyns to get reimbursed from insurance companies (unlike hospitals and big practices, my staff doesn't have the time, resources, or experience to follow up and adjudicate every claim that gets denied by insurance companies). Plus, if you're in private practice like I am, you have to pay for things like malpractice insurance and overhead costs, which means you won't be making tons of money.
5. Even though you're helping women have babies, the job isn't all that conducive to having your own. If you decide to have children early, there's a sacrifice, because you're missing out on some of the early moments with them while you're in school. If you decide to postpone having kids until you're done with school, you risk having more trouble getting pregnant because you'll be in your 30s or older by the time you finish school. It's an additional sacrifice women physicians make. And although I help other women get pregnant all the time, I couldn't take six weeks off for my own maternity leave, because that would be six weeks of lost income. I definitely felt pressure when I had my daughter to come back to work after just three weeks because I needed the income and my patients who were pregnant didn't want me to miss their delivery - and actually, I even cheated on my maternity leave by performing a patient's delivery when I was 15 days postpartum! I don't know that I would have felt the same pressure had I been an employee who had maternity benefits.
6. Vaginas are completely amazing. Yes, I stare into vaginas all day, and yes, the vagina is awesome. It changes over the course of somebody's life, and it'll put up with a lot. There's this saying that if you want to be tough, you should "grow some balls," but balls are weak! If you want to be tough, you grow a vagina. Those things can really take a beating and come out OK.
7. Pelvic exams are uncomfortable, so you've got to have a good bedside manner. There's nobody who isn't nervous during their first (or second, or third) pelvic exam. Aside from quite a bit of modesty that we have in our culture, it's an awkward exam, and there's not a whole lot of getting around that. My goal is to try to make my patients as comfortable as I can: I explain everything, I show them all the instruments, I explain why they're being used, and I tell them everything I'm doing as I'm doing it. For patients who are particularly anxious or have a history of abuse - and there are more than you'd expect - this can be very traumatizing. The rates of sexual abuse and assault are surprisingly high and so very sad: Nearly 1 in 5 women in the United States has been raped, and 80 percent of those women were raped before the age of 25. Emotional response to these experiences often comes up during a gynecologic visit - whether it's a discussion of STDs, pain during intercourse with their current partner, or just difficulty tolerating the exam. My goal is to make every patient feel as comfortable and in control of the visit as I can, so I let them know that if anything I do is painful, all they have to do is say the word, and I will stop immediately.
8. The problems you're solving are (mostly) treatable, though not always easily. I love problems that I can fix, and as an ob-gyn, there are lots of those. The field involves way more surgery than you might expect: I get to remove cysts on ovaries, remove uterine polyps, and help women with fertility problems get pregnant. I love operating, but it's definitely not for the squeamish.
9. Patients will confuse their Google search with your medical degree. The Internet has made it very easy - and tempting - for patients to diagnose themselves. I've had patients who come in with a stack of articles that they've printed out from online and they're sure that they have a diagnosis. But man, Dr. Google is a very bad doctor! People think they are getting accurate information, but usually they're not, and it can be awkward to explain the difference between self-diagnosis on WebMD and getting a doctor's professional opinion. The one exception might be STDs. The CDC has a great website, and so does Planned Parenthood.
10. Yelp can ruin your career. Anybody can post anything on Yelp, but I'm bound by HIPPA to protect my patients' information, so if somebody posts something that's wrong or blatantly lying, I have no resources. I can't even acknowledge if a person is a patient of mine, let alone comment on their accusations. A lot of new patients find me from a Google search, so having positive Yelp reviews is important, and it can be awful for doctors who don't have any opportunity to combat a bad review. If I owned a laundromat and somebody posted something unfair, I could go online and say, "This is not true. This person came in with a stain that you could never remove," and you can reply to the accusation as a business. But as physicians, you can't.
11. The job is super messy, physically and mentally. Birth is beautiful and incredible and elegant and messy. I get all kinds of things splashed on me at various points during the day; I don't bring my work shoes into the house because of what they're covered in. But it's also messy in terms of the emotional aspects. There are so many highs and lows: I've had a day where I diagnosed a miscarriage in the morning, had to do an emergency surgery for a patient who had a ruptured ectopic pregnancy in the afternoon, and that evening, I did a vaginal delivery of twins on a woman from an IVF pregnancy. By the end of the day, I was totally drained.
12. You have to make time for yourself. When I got married, I had the ceremony on a cruise ship - with no cell service - because I knew that if one of the nurses called me the morning of my wedding and told me one of my patients was going into labor, I would've felt guilty about having to miss it. This year, I scheduled my vacation a year in advance, before any of my current patients announced they were pregnant, so I wouldn't take on anyone who was due during my vacation. I knew that if there was a chance I'd miss someone's delivery, I would consider not taking that trip. But I do actually need a vacation every once in a while!
13. It's incredibly rewarding to be there for your patients' big life moments. I get to participate in a full range of my patients' life experiences. Sometimes, I get to follow somebody over the course of their life: I've had patients who were teenagers when they first came to see me, who are now getting married or having their first child. I take care of post-menopausal patients. And, of course, I'm there when my patients give birth, which is an unbelievable experience. When I get Christmas cards this time of year and I see the babies I delivered growing up - or those babies in their Halloween costumes, or pictures of them starting preschool - I feel this incredible love for families that I got to participate in.
Dr. Layne Kumetz is a Board-Certifiedobstetrician gynecologist and an attending physician at Cedars Sinai MedicalCenter in Los Angeles. She proudly delivers over 95 percent of her patients' babies.
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