Obstetrics & Gynecology: A Rewarding & Unique Medical Specialty

Alexander Raths/123RF.com

Obstetrics and Gynecology (OBGYN) is the only specialty in which physicians are trained to do both medical and surgical care of patients. Women’s healthcare allows you to serve women throughout all phases of their lives, from teenager to older menopausal women. Following board certification, you are a primary care physician and surgeon for women. Annual exams with Pap testing (including treatment of those that are abnormal), hormonal management from contraception to hormone replacement therapy during menopause, preconception and obstetrical care, breast health, medical and surgical treatments for abnormal bleeding, fibroid tumors, ovarian cysts, and ectopic pregnancies are just the tip of the iceberg of General OBGYN. You are a radiologist to women requiring ultrasounds for both OB and GYN purposes. You will be trained in laparoscopic (minimally invasive), hysteroscopic, and open abdominal surgery. General OBGYNs screen for cancer risks (based on heredity) including breast, colon, ovarian and endometrial. More and more emphasis is being placed on the primary care of women from cholesterol screenings and blood pressure monitoring to counseling regarding weight and substance use/abuse. Recent information suggests that women make up greater than 75% of current OBGYN residents.

There are four fellowships available upon completion of a four-year residency. Those are: Reproductive Endocrinology and Infertility (REI), Maternal Fetal Medicine (MFM), Gynecologic Oncology (GynOnc), and Urogynecology/Reconstructive Pelvic Surgery (Urogyn).

Reproductive Endocrinology and Infertility (REI) manages endocrine disorders unique to women, issues related to infertility, and medical and surgical treatment of endometriosis. Infertility remains the most prominent of these. The diagnosis of infertility and its treatment may include hormonal management, laparoscopic surgery, egg retrieval, in vitro fertilization, preimplantation genetics, and embryology. REIs play a significant role in many women’s reproductive lives.

Maternal Fetal Medicine manages complicated cases involving the mother and/or the developing fetus. This includes disorders such as complicated diabetes, preexisting hypertension, cardiac defects, and infectious diseases among others. They are also involved in preconception counseling when heredity of fetal malformations, familial chromosomal abnormalities, blood dyscrasias, and fetal losses are encountered. Comprehensive fetal ultrasound and the use of color doppler studies are a crucial part of their services, as are chorionic villus sampling and amniocentesis. They also serve as consultants to general obstetricians.

Gynecologic Oncology, as named, involves the care of women with cancers of the ovaries, uterus, cervix, and Fallopian tubes. Complicated surgical procedures may include radical hysterectomy, oophorectomy, and debulking of advanced disease.  GynOncs also manage brachytherapy and the administration of chemotherapy as warranted by diagnosis and stage of disease. Their training includes management of bowel and ureteral involvement, as well as omentectomy and extensive lymphadenectomy.  They are consulted at times when other OBGYNs are faced with difficult cases of adhesions, significant bowel involvement of endometriosis, as well as obstetrical hysterectomy due to abnormal placentation into the myometrium or maternal instability due to life threatening postpartum maternal hemorrhage.

Urogynecology and Pelvic Reconstructive Surgery is the most recent board subspecialty. These gynecologists manage women with urinary and fecal incontinence, as well as pelvic organ prolapse. Care of urinary difficulties in women may be as simple as pelvic floor exercises, medication, or collagen injections at the bladder neck. There are also stimulators that may be surgically placed. More complicated cases may involve urodynamics for diagnostic purposes to various sling procedures for management of stress urinary incontinence.  Cystoscopic training is an integral part of this fellowship. Women with pelvic relaxation may respond to pelvic floor exercises or pessary placement; however, many will require complicated surgical reconstruction. This includes not only prolapse of the uterus or vaginal apex, but also replacement of the bladder and bladder neck to anatomic positions.  Management of small bowel hernias called enteroceles, surgical repair of rectal hernias, and repair of disruptions of the anal sphincter may also be needed.

Obstetricians, gynecologists, and sub-specialists enjoy the continuity of care that we have with our patients. Yes, we have high malpractice premiums and take call that often requires us to be in the hospital. Our reward is being able to not only diagnose but surgically repair problems as needed. Pay is commensurate with the knowledge and skills you provide. We infrequently request referrals, and are often the source of referrals from primary care physicians, physician assistants, nurse practitioners, and midwives. Obstetrics and gynecology is indeed a unique specialty.