Is Obstetrics and Gynecology the Specialty for You?

by Edward Hannigan, M.D.

Residency Director, Obstetrics and Gynecology

1) How did the specialty of Obstetrics and Gynecology arise?

The necessity to decrease the hazards of childbirth demanded that physicians give attention to Obstetrics. Gynecology arose from the need to treat the injuries associated with childbearing. These needs led to the establishment of the specialist in disorders of the female reproductive tract, i.e., the Obstetrician and Gynecologist. Formal training in Obstetrics and Gynecology was offered in the early part of this century and the field has steadily expanded to include many areas of new technology. Obstetricians and Gynecologists are today challenged to be not only specialists in female disorders, but they also serve nearly 60% of the women in this country as their primary care physicians.

2) How much surgical expertise is required in Obstetrics and Gynecology?

Obstetrics and Gynecology is a broad field. Expertise in surgery of the female reproductive tract is required of all physicians completing residency training. The sub-specialty of oncology provides exceptional surgical challenges in an area where surgical cure is possible. Reproductive Endocrinology and infertility involves some of the most sophisticated surgical techniques. Operative obstetrics requires surgical skill combined with precise clinical judgment.

In addition to the traditional surgical approach to Gynecologic surgery, minimally invasive surgical techniques have been pioneered by our specialty. Many procedures performed are of a non-emergency nature and consequently generally have a good outcome. It is possible for the Gynecologic surgeon to truly master the procedures that are performed within the female pelvis with a demonstration of distinct benefit to the patient. Gynecologic surgery can be emergent, exciting, and extremely demanding.

3) How has the field of Obstetrics changed in the past few decades?

Obstetrics has become much more than just "catching babies". The obstetrician has at least two patients throughout each pregnancy and the influence of obstetric care has proven beneficial in the remarkable reduction of maternal and fetal morbidity and mortality. The obstetrician must be knowledgeable in all areas of medicine since pregnancy is influenced by diseases of every system of the body.

With ultrasonography providing the ability to look into the uterus with accurate diagnostic studies, advances in prenatal diagnosis and treatment dramatically change the outcome of pregnancy for both mother and baby. The end product of obstetrics is like none other in medicine, namely, assisting in the "miracle of birth". There is nothing that compares.

4) What training is necessary to become an Obstetrician and Gynecologist?

The training of the general Obstetrician/Gynecologist requires four years. Fellowship training is additional and is currently available in; Maternal-Fetal Medicine, Gynecologic Oncology, Reproductive Endocrinology and Infertility, and soon to come in pelvic surgery and urogynecology. During the four years of residency, the physician will be heavily exposed to the ambulatory care setting as well as in-hospital care. The resident in obstetrics and gynecology is expected to master the art and science of obstetrics, and to become an accomplished Gynecologic surgeon. Because the variety is great, the training process is always interesting. Upon completion of residency training, most Ob/Gyn's elect to remain in general obstetrics and gynecology, but a significant percentage will go on to fellowship training.

5) Is the field of Ob/Gyn too narrow a specialty for the current emphasis on Primary care?

Obstetrics and Gynecology has the widest practice scope of any specialty. The Ob/Gyn physician is not only a mixture of a surgeon and obstetrician, but also serves as a sort of "intrauterine pediatrician", a reproductive medical specialist, and a primary care physician. The generalist has the opportunity to emphasize any of these areas in practice according to personal strengths and desires.

6) Are the demands of an Obstetrical and Gynecological Practice as heavy as they seem?

The influx of female physicians into the specialty has had a very positive effect, both for the patient's benefit and the mode in which the specialty is practiced. The image of the sleepy, overworked obstetrician just trying to make it through another delivery has changed. Call schedules are compatible with family schedules. Groups practice has overshadowed the "solo" and can provide a lifestyle that is busy but not overwhelming. The rewards of obstetrics and gynecology are not just of scientific fulfillment, but are of the heartfelt knowledge of unique benefit to the female patient.