Meet James

  • We'll begin with the fundamentals: Ob/Gyn is a medical specialty devoted to two aspects of women's health. First there is the care of women who are, or who would like to become, pregnant and second, there is the care of women who have diseases and problems of the reproductive system (e.g., the uterus, ovaries, etc.). Now that you know this, if you're still interested, read on. If not, James will not be upset if you surf on.
  • "Ask James" is a feature for those of you who are considering a career in Ob/Gyn and want more information to help you to make a decision. James, your answer guy, is an Obstetrician/Gynaecologist himself. He has slotted questions into three general categories:

 

Observerships

If you are a first or second year medical student at Schulich and are considering Ob/Gyn as a career choice, it may help you to set up an "observership" for a little while so you can see first-hand what we do. If you would like to learn more about this, contact Meagan Seale in the Ob/Gyn undergrad office.

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Q & A about the Nature of the Speciality

Q

What are the best things about being an Obstetrician?

A

For the most part, having a baby is a normal physiological event and your patients are young and positive about going through their pregnancies under your care.  It truly feels like you're in partnership with them.  Gone are the days when you can simply tell them how to take care of themselves while pregnant but you can listen to their concerns and offer rationales that will make sense to them in terms of diet, activity, work, sleep, etc. 

Managing a pregnancy is a trust-building process and when you gain that, then your patients will work with you and follow directions when "the chips are down" in the last trimester, during the labor and the immediate period after the birth.  There is always a feeling of being part of a miracle for even the most experienced Obstetrician.  It is a privilege to be with parents at this special of time for them.

Q How do you deal with the times when something goes wrong with the pregnancy or delivery?
A

There are never guarantees for a perfect outcome and it is important to build that thought into the relationship with your patient.  You do have the responsibility of being vigilant to signals of problems and making sometimes difficult decisions when you see trouble ahead for mother or baby.  It is important to be totally honest and fully inform the parents as soon as you are getting a sense that there will be complications with the birth.  There is no place in Obstetrics for promising to be a super hero for the mother when the outcome is clouded by some complication.  You can promise to do your best given the circumstances and that is where the promises must stop.  Then if the pregnancy outcome is not good, you are not left backtracking and defending yourself.  You need to acknowledge that your patient needs to mourn the loss of the perfect baby or perfect birth experience that they did not get and give support, and understanding through that.

 
Q What do you like about Gynaecology?
A

Women generally are extremely well informed about their health and keep Gynecologists on their toes to be well-informed also.  They ask probing questions and look for logic when it comes to management plans that you suggest.  They also are not shy about simply wanting your opinions rather than your intervention into their problem.  Don't feel that every time a patient consults you that you are obliged to solve her health problems.  They are refreshingly candid about their reactions to their Gyn problems and because many of their issues are not totally debilitating they are not so sick when they come to you that they cannot be pleasant people with whom to talk and to work.  Remember also that most Gyn problems are very "fixable" so you can come away from most patient encounters feeling that you have made a positive intervention.

 
Q If I train as an Ob/Gyn what options do I have for future practice?
A

First of all, you can choose to restrict your practice to what you like doing most.  If you want to do only Obstetrics that is your choice as is an exclusive Gynaecology practice.  It is also possible to sub-specialize in Maternal Fetal Medicine (2-3 years after residency) and have a practice restricted to high risk Obstetrics.  For that to work, you likely will need to be part of an Academic Health Centre's High Risk Unit since you will need to collaborate with like-minded individuals and have access to tertiary facilities and staff both on the Ob and on the Neonatal side of things.

For those who love the Gyn side of the specialty they too can restrict their practices or go the extra step of specializing in Gyn Oncology (which focuses on Cancers of the reproductive tract) or UroGynecology (which focuses on women's bladder problems).  Both require 2-3 years of extra training beyond your training to be an Ob/Gyn specialist. Practicing in such a so-called subspecialty also means you will need access to investigative and treatment resources that are usually only available in larger urban centres. This means you will usually have to practice in urban academic health centres, (cities where there are medical schools) although there are some exceptions.

Another area of subspecialty is Reproductive Endocrinology and Infertility where you can work with those couples having difficulty conceiving a baby.  Although you could do this along with mainstream Ob/Gyn, most REI practitioners (who also need 2-3 years extra training on top of a residency) do this type of work exclusively and are located in the larger cities where there are support services for all the lab work required.

Finally, you may wish to combine your practice with teaching medical students and residents. If so, you should think seriously about a sub-specialty and some research training to make yourself attractive to university medical schools. This can be a very rewarding life, but takes a long time to prepare for.

 
Q You mentioned about specialized Ob/Gyns such as "Gyn Oncologists" and "Uro-Gynaecologists."  Can you tell me what they do?  What is their approximate income?  Do they have to have their own staff (nurses, etc.) and do they work in their own private offices or in a hospital?
A

Uro-Gynaecologists are sub-specialists in female urology and pelvic floor problems.  Their training mainly deals with female urinary incontinence, pelvic organ prolapse (abnormal dropping of the pelvic organs from their usual position) and lower genitourinary problems.  It is primarily associated with advanced pelvic surgery in usually non-cancer patients.  Most academic Urogynecologists in Canada have a practice that is focused on their own subspecialty which often includes general Gynaecology too.  Often Urogynaecologists have advanced training in minimally invasive surgery techniques.  It is very much related to and overlaps with aspects of Urology and the training often includes spending time with Urologists.  The advantage of this subspecialty is that Urogynaecologists often are able to include Obstetrics in their practice, if they wish.  This is often the case for those who may choose to practice in a community setting and allows for some flexibility in structuring one's career/practice to individual goals, especially over time.

As a result, most Urogynecologists make an income that is comparable to general Ob/Gyns (see question on incomes above).  Obviously income is dependent on the circumstances and environment one practices in.  It is considered an area of Gynaecology that is very much surgically oriented so you need to like doing surgery if you are considering this area.

As with any practice, they require staff and nurses.  Urogynecologists, whether in the community or hospital, may need their own staff and nurses to help with investigation and treatment.  Sometimes, nurses can be affiliated with the hospital to help provide this service.  In general, clinic patients are seen in any average office setting, whether in a hospital ambulatory care unit or in a private office building.  However, the surgical treatments obviously require that the Urogynaecologists have hospital privileges and have a access to its facilities.  Dedicated nursing staff who are familiar with the problems and dealing with this population of patients is definitely an asset.

 
Q Is Ob/Gyn becoming a discipline for women only?
A

There is no doubt that the pendulum is swinging and that the preponderance of trainees in programs across the country are women.  Nevertheless, there is room for both men and women in the specialty and the current literature suggests that patients prefer having a choice for the gender of their Ob/Gyn.  Women bring special insights into the specialty which were not there a generation ago when men dominated the field.  However, as in most things in life, when men and women work collegially together in a profession, their unique perspectives trigger new ideas and changes that simply aren't possible when one gender holds sway. Whether you are a man or woman, come on in....the water's fine!

 
Q I hear the specialty is physically and emotionally grueling.  I don't know if I can handle it.
A

It's a unique specialty incorporating aspects of Medicine, Surgery, and Psychiatry. That wide scope makes it attractive but also a challenge since at times you feel that you have to be all things to all people.  Certainly it can be tiring since Obstetrical events have a nasty habit of occurring at night.  Nowadays, many Obstetricians work in groups and set up call coverage systems so that they can count on being off and have some predictable family life (and sleep!).  Working in groups helps ease the stress in other ways also.  It means you have others around you to consult with when difficult management judgments are called for. 

 
Q How do I know if I have the skills for a career as an Ob/Gyn, and how do I know if this is the career path I want to take?
A

This is not an easy question!  Your best bet is to ask several Ob/Gyns for their thoughts. You will get a variety of answers.  Here is mine.  You need to feel some passion about the rights of all women to have access to the best health care that is available, and to meet that end. you need to set high goals for your readiness to deliver that care. This means a life-long commitment to continuing medical education. 

In the last ten to fifteen years there has been an explosion in our understanding of how reproduction works.  It is no longer a matter of just having a working knowledge of the birds and the bees!  Ob/Gyn as a specialty truly represents the cutting edge of the medical biological sciences.  It is a full time job keeping up. You need to feel that with time and practice you could be comfortable talking to women (and their partners too) about very intimate aspects of their lives.  You may not be ready for that now, but if you seem to be a natural magnet for the stories of trials and tribulations of those around you, then chances are you have "the right stuff." 

Because Ob/Gyn involves both delivering babies and doing surgery, you should be reasonably adept with your hands.  This does not mean that you have to be Michelangelo, but you should have some evidence that you can develop good motor skills and good hand-to-eye coordination.  It is said that with the advent of laparoscopy (so-called "keyhole" surgery) that young people who have grown up with and developed skills playing video games have a distinct advantage in becoming adept at Gyn operative procedures.  They are used to looking at a video monitor and moving their hands independently of their eyes.  (Don't try this line on your mother; she would not likely understand.  It can just be between us.)  

You need to be able to stay cool in times of stress, since a team of doctors and nurses, to say nothing of the patient, may be relying on you to make rational and often quick decisions especially in problematic Obstetrical situations.  The last thing that is called for in these times is a doctor who "loses it" when things get tense. 

Perhaps the best trait that you bring to the specialty is a good sense of humor and an affable demeanor.  Your patients need to feel that you enjoy talking to them and that they can confide in you without "bothering" you.  This does not mean that you should take their problems lightly, but that you should represent a "safe harber" for problems that relate to reproduction and women's health in general.

 
Q Is it challenging balancing work and home life?
A

Yes, but that answer probably applies to all disciplines within Medicine.  Many wise Ob/Gyns schedule personal time into their week just as they would schedule their clinics and their surgeries.  This device helps to give back some family time that is otherwise eroded by time on call.  It is a real advantage for self-employed doctors in that they can give themselves a few hours off in the middle of the day, to take their kids to soccer practice or treat themselves to an afternoon in the country, or maybe just get a haircut or clean out the garage! 

Women with babies and young children can negotiate part time practices in order to be home more during the all important early years.

Remember that these suggestions are far more feasible if one is part of a group practice (see above).  The trick is to keep your priorities straight. Money isn't everything

 
Q How do you feel when you have to deliver a baby who you know is dead?
A

There is no doubt that this is an extremely difficult and sad time not only for parents but also for Obstetricians and, indeed, all the nursing staff in the Delivery Room.  We are all trained to do everything in our power to watch over and tend to the life of a baby as it is developing and awaiting birth.  Parents expect a healthy baby and we always try to make that expectation come true.  Sometimes catastrophic events happen for which we have no warning and we are shocked and grieving just like the parents.  Other times we may have known that the baby was in jeopardy (or "high risk" to use our term) but with careful monitoring we have been  trying to get the baby as far along as possible before delivering so that it won't have the extra problems of significant pre-maturity to deal with when it's born.  Balancing out the risks and benefits of premature birth in a "high risk" baby is one of the most difficult challenges for an Obstetrician and, despite all of our efforts and plans, sometimes the baby dies inside the uterus before we have decided to take the step of inducing labor. 

In either case, along with the sadness of managing the mother through labor when we know there will be no happy ending, the Obstetrician is often feeling upset that he/she had been unable to see it coming and prevent the death. Nevertheless, our prime job now is to comfort the parents and ensure a safe birth for the mother.  We also have to be mindful that our duty is not over when the baby is born.  We need to remain supportive for the bereaved family for days, weeks and even months after, as they struggle to come to grips with their loss. 

We too look for answers and learnings from each event like this so that we can avert such crises in the future. Although we have an obligation to strive to do the best that we can with our skills and knowledge, for our own mental health we also need to be mindful that we are not gods, just mere mortals and that sometimes the best we can do is not enough.

Most medical centres have special meetings to review these deaths, where doctors and nurses gather to go over the case carefully and look for clues that may have prevented the loss.  Afterward, taking care to protect the baby's identity, they share what they have found out as broadly as possible, across the province, and even the country sometimes, so that other doctors nurses and especially other expectant parents will benefit from the lessons learned. 

 
Q How much can I expect to earn?
A

This calls for a little background information. Most Ob/Gyns in Canada earn their income on a traditional fee-for-service basis. In Canada, Obstetricians are paid on the basis of the "units" of care that they render to patients.  At the end of each month, they add up the number of each kind of procedure that they do, the number of babies they deliver, the number of pap smears, etc., and they submit a bill to the provincial health system.  (In Ontario there is a branch of the Ministry of Health and Long Term Care (MOHLTC) that is exclusively devoted to this business of paying doctors. It is called OHIP or the Ontario Health Insurance Program.) 

There is a book published by OHIP called a fee schedule that lists how much the government is willing to pay for each unit of care delivered.  Although the payout per unit is similar across the country, it differs in each province since it is part of a contractual arrangement negotiated between the province's ministry of health and the provincial medical association.  In Ontario that contract is negotiated between the Ontario Medical Association (OMA) and the Ministry of  Health and Long Term Care (MOHLTC). Therefore, how much an individual Ob/Gyn earns depends on the amount of time he/she is willing to work, and the case mix of the type of procedures she/he does.  Someone who does a lot of major Gyn cancer surgery, for example,  may make more in a given month than someone who prefers to do primarily an office practice. 

On average, Ob/Gyns make about $260,000 per year.  However, this figure includes many people who are only working part time, and many full time Ob/Gyns can earn considerably more than this.  Remember that business expenses must be subtracted before you can take any money home.  In general, if you would like to be busy, you will be well compensated. 

The "bottom line" is that while you can make a lot of money in this specialty, the key to success and happiness is not the amount of money you make but keeping a balance between work and home life. 

You can see from all this why doctors need a specialized staff to tote up the billings, make the submissions for payment, then check the payments for accuracy once they come back, and generally keep all the accounts straight. You seldom see these people when you visit your doctor but they are a vital part of the staff.   This all adds to a doctor's overhead costs. 

 
Q Do Ob/Gyn doctors get extra stipends?
A

Some Ob/Gyns who are faculty members of medical schools get a stipend for the teaching that they do. Otherwise, in Canada, they are usually paid on a strictly fee for service basis, through their provincial ministries of health.

James once got a squash and two eggplants from a grateful patient but he doesn't think that counts as an extra stipend.

 
Q I'm just wondering how much gynecological oncologists make. I am told the majority are salaried and heard that they make around $120,000/year. Is that true? If so, it seems this is substantially less than general Ob/Gyns, especially since it's a highly surgical subspecialty.
A

The Gyn Oncologists in Ontario are on a contract with the Ministry of Health and Long Term Care (MOHLTC) and have been on salary since 2001. Prior to this, the fee schedule was such that they were in the top 10% for earnings among all Ob/Gyns and even that was not enough to retain and recruit Gyn oncologists for Ontario. There was a crisis.

The current contract is described as more beneficial than the old fee-for-service arrangement, and, as a result, has been conducive to getting and keeping more of these very well trained and vital people in the province. James will not give you dollar figures but if you look higher up in the list of questions you can see an average Ob/Gyn income and then assume that Oncologists in the specialty are getting at least that if not a bit more.

 
Q What is the "entry level" salary for an Ob/Gyn?
A

An understandable question but, unlike other professions, pay schemes for doctors are not dependent on the number of years of experience they have.  They get paid on the basis of the service performed and a doctor who opened his office yesterday, gets the same amount as the doctor who has been in practice for twenty years. 

 
Q How many patients do you get in one day?
A

The number of patients that an Ob/Gyn sees in one day is entirely up to him or her.  When running a practice, each doctor establishes "ground rules" that make for a comfortable patient flow.  Everyone has his or her own pace.  Some will allow twenty minutes or even half an hour for a new patient (a so-called consultation) since that involves taking a more thorough history and physical examination than a "repeat" visit would entail.  The latter might be allotted only ten minutes.  Of course nothing ever works out the way you plan, so sometimes doctors end up modifying the time that they spend with each patient "on the fly," subtracting some time from one patient in order to give "extra" time to another who seems to need more than was originally planned.  Antenatal patients, who come many times during a pregnancy and are often doing very well, can sometimes get only very short visits from the doctor although the nurse may spend considerably more time, talking to the patient, educating about diet, exercise and the like. Social workers and dieticians help to handle these things in large and busy clinics.

Some doctors put all the consultations together on a single day and all their antenatals together on another day, while others prefer to mix up their clinics with repeat visits and antenatals to ensure more variety and have some respite from some of the more difficult consultations.

In academic teaching practices, doctors must factor in a little extra time for teaching since they often have a medical student or a resident with them and trainees take a little longer to assess a patient than someone more experienced would.  Students also need some "teaching time" between patients for discussion, questions and answers etc.

Remember too that doctors must write or dictate notes on each patient as they go along. It is not enough to just see patients, you must make a record of what you saw and what your management was.  This is not only an aide memoire for the doctor, it is necessary for medical-legal purposes.   Moreover, it would be folly to wait until the end of the clinic to do this book-keeping since "the kindly old doctor" would most certainly get his/her patients' stories and findings mixed up.

When all is said and done it is not uncommon for an Ob/Gyn with a mixed practice to see twenty-five or thirty patients in a half day although that would make for a busy time and certainly no leisurely coffee breaks! 

 
Q Do I have to set up a private office if I want to be an Ob/Gyn?
A

Not necessarily.  When doctors form groups, they can reduce the costs of practice by sharing space in an office building.  They don't have to be in the same specialty, but it helps because then they can also share the cost of special equipment that they may need for their discipline.  For example, Ob/Gyns may need special examining tables, and may want to buy their own ultrasound equipment.  There are also firms that will provide so-called turn-key operations for doctors, configuring space, buying furniture and equipment, securing office supplies, even hiring staff, such as nurses and social workers and secretaries.  They do this for price, of course, but for many doctors it is worth it so that they can concentrate on taking care of their patients and not worry about the business of practice. 

 
Q Do you have to open a practice or can you just work at a hospital?
A

James will have to reframe this question a little. All Ob/Gyns have a practice, that is they work in a clinical space where they see patients who make an appointment to be seen for problems relating to Ob/Gyn. It is this base that provides the patients that the Ob/Gyn then takes care of in hospital. Ob/Gyns who are also faculty members (teachers) for medical schools have their clinic or "office" right in the hospital so that they are readily available to teach medical students and residents. These clinics are usually in a special wing of the hospital that houses only doctors' offices of the different teaching specialties.

 
Q What benefits come with this career (retirement, insurance, vacation time, etc.)?
A

In Canada, most physicians fall into two categories. There are those who are employed by institutions and those who are self-employed.

The institutions that might hire doctors on a salary are places like universities (the University of Western Ontario being a good example) hospitals, the military, government agencies (both provincial and federal), the pharmaceutical industry and insurance companies. If you work for an institution you get whatever benefits are negotiated for their employees. So, in the case of full time university-employed physicians who teach at Schulich, they get extended health benefits, group insurance, and a pension plan as part of their salary package. Vacations are usually limited to a maximum of about four weeks per year.

Physicians who are self-employed, (which includes most Canadian Obstetricians, even many who also teach at Medical schools) buy their own benefits packages from private insurers. It becomes part of the cost of doing business. These doctors can tailor-make the benefits to fit their needs. The number of weeks they take for holidays and the timing of those holidays is up to them. Just like any business, however, if you don't work, no money is coming in even though the bills still find their way to your mailbox! As doctors get older, they often take more holiday time, usually scattered throughout the year and in short stretches. Practising Medicine is stressful and most doctors, if they had the finances to do so, would opt to take short breaks frequently to keep themselves in good physical and mental shape. It is worth it to them and it ultimately benefits their patients as well.

 
Q Where are the most jobs found?
A

Ob/Gyns are needed everywhere in Canada. There is a great need at the present time for those who have academic qualifications as well as their Ob/Gyn training to return to the Medical Schools and teach and do research. In addition, as more and more family doctors give up doing Obstetrics in Canada, every region in the country seems to be advertising for specialists in this area, so you can almost call the shots. Be careful to link yourself to an area with a well equipped hospital that can sustain you in the type of practice that you have been trained for. Although Ob/Gyn is not as "high tech" as many specialties, you will require trained support staff and equipment to match.

 
Q In your opinion, would you think that job opportunities will still be highly available for an Ob/Gyn in 15 years time? In other words, would they still be "wanted?"
A

If you look at the big picture, all indicators suggest that Ob/Gyns will continue to be in high demand for a long time to come. There are several reasons for saying this. The population of Canada continues to grow so the absolute number of women of all ages is going to increase. That in itself is good news for the "enduring" need for specialists.

But there are other factors to consider also. In Canada, for the last two decades at least, family doctors have been easing out of the practice of delivering babies. They may still do antenatal and post natal care but they are increasingly turning over the care of their patients to Obstetricians during the perinatal period especially for delivery. So the case mix of many Obstetricians has become a combination of traditional complicated obstetrical patients and many "normal" obstetrical cases as well. The bottom line is that the numbers of Ob patients that they are carrying is increasing each year. While midwifery has helped to deal with some of the normal obstetric cases, the ranks of midwives and their style of practice do not offset that increasing caseload.

Secondly, as our knowledge of cancer, urodynamics and reproduction increases, the opportunity for our interventions increases and, in fact, robust new subspecialties are emerging within the broad domain of Ob/Gyn.

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Q Who are some successful Obstetricians and Gynaecologists?
A

This is a tough question because it depends on how you define "success."  There are many in our specialty who have achieved world wide recognition in the field of Ob/Gyn Research and they must certainly be deemed successful.  We have some in our own department.  There are others who have perfected new operative instruments, or ways of performing surgery that makes life easier for patients, and they must be cited for great and influential gifts to the specialty as well. Other Ob/Gyns are genuinely loved by their patients for seeing them through tough times and helping them back to health or to have babies.  Who can say that such day-to-day successes are not meaningful?  Therefore, James is going to take the easy way out and not give you any names.  The list of successful Ob/Gyns is very long and he would surely leave out some of the very best people.  Some day we should have an Ob/Gyn Hall of Fame where men and women could be voted in and then we would have a consensus. 

 
Q What career experience is necessary to obtain a position as an Ob/Gyn?
A

James assumes you are referring to the point when you are fully trained as an Ob/Gyn and want to start practising. In Canada, communities and hospitals looking for an Ob/Gyn advertise their needs in nationally circulated newspapers and commonly read medical journals. Doctors answer the ad, outlining their qualifications and then, if they meet what the community is looking for, they get called to meet with hospital and community leaders and see if there is a mutual degree of comfort with the doctor setting up there. Of course you can always just move into town and hang our your shingle, but it is better to know that you are really wanted than just to "parachute" into town.

Newly "minted" Ob/Gyns are just as desirable (sometimes moreso) than those who are getting a little "long in the tooth," so to answer your question, no practice experience is necessary as long as you can prove you are fully trained and certified in the specialty by the Royal College of Physicians and Surgeons. That credential guarantees that you have had enough experience to practis on your own.

 
Q If you were a Gynaecologist could you go back to being an Obstetrician if you wanted to?
A

In Canada and the U.S. Obstetrics and Gynaecology is one specialty so the training you get is in both areas. Now once you have completed your training you can choose to practice in only one of those areas if you wish. James is supposing that your question pertains to the situation where someone has decided to practice only Gynaecology but after a time wants to resume doing Obstetrics. You can do that without any trouble but remember once you stop working in an area, your skills and knowledge get a bit rusty so you would likely have to do some reading and bring your skills up to speed by working with another Obstetrician for a little while.

 
Q What exactly does the word malpractice mean in association with being an Ob/Gyn? I often come across it in an Ob/Gyn career page.
A

James can give you only a medical "take" on the word. It really belongs to the lawyers to define the term with precision. It is used to label management actions taken by a doctor which result in negative outcomes for the patient. This does not mean that everything that goes wrong when a doctor takes care of a patient is automatically malpractice,but if it can be shown that the unfortunate outcome was predictable and preventable if only the current local standards for precautions, judgements and system requirements had been observed, then it is likely that a court would rule that the physician was guilty of malpractice. As you can imagine there are many nuances and even disagreements as to what the doctor should have known before embarking on a course of action, and that is what judges and juries must grapple with to come up with fair decisions.

If an Ob/Gyn is deemed guilty of malpractice in relation to a delivery, the awards are often among the highest of all malpractice claims made in Canada. This is because the unfortunate outcome for the baby can affect its entire lifetime, and parents and caregivers are seeking funds to cover their costs for an extremely long period of time.

 
Q Ever get "turned on" during an exam?
A

James can only answer for himself and the answer is "no." As most medical students will tell you, the feelings that are aroused during a physical exam are usually related to fear, fear that they are going to miss something, hurt the patient, make a fool of themselves, etc. etc. The professional relationship with a patient dictates that you must be totally focused on the patient's needs and not your own. It puts your head into a very specific frame of reference which is anything but sexual. Sadly, this is not to say that doctors never slip into crossing boundaries with their patients. Every year there are some who lose their licences either temporarily or permanently because they neglected to pay attention to the codes enshrined by licensing authorities (and sworn to in the Hippocratic Oath) that set out what is appropriate in the doctor-patient relationship.

 
Q What type of work is done by Obstetricians?
A

As you might expect, Obstetricians take care of pregnant mothers by seeing them on a regular basis and checking to see that everything is going normally for mother and baby. This means taking a little history on each visit and examining the mother's abdomen to see that the baby is growing properly. It also means performing lab tests and arranging for ultrasound pictures to be done at the appropriate times. When the mother goes into labour, the Obstetrician manages the labour (sees the patient in labour, writes orders on her chart etc.) and does the delivery when the time comes. Sometimes this calls for surgery, that is, a caesarean section. He/she then takes care of the mother while in hospital and follows up after discharge at the six-week point.

Obstetricians also have a role to play when people want to get pregnant but cannot do so. The Obstetrician investigates for the causes of infertility and then prescribes or executes procedures that will try to correct the situation. In academic centres this function often falls to sub specialists in reproductive endocrinology and infertility but in smaller centres the Obstetrician is certainly the primary person in these cases.

One thing that the Obstetrician does not do is look after the baby after it is born. That job falls to the Family Doctor or the Pediatrician.

 
Q What skills are needed to become an Ob/Gyn?
A

The first questions in this series speak to those skills but "in a nutshell" you need to be not only sincerely interested in taking care of the the health of women but also to have respect and appreciation for the role of women in modern society. Medicine these days, and most especially Ob/Gyn, is all about meeting patients in their real-life context. Women are extremely well informed about the health issues that matter to them so you must keep up to date and avoid patronizing them.

Beyond that, you need to be good with your hands to handle the surgical aspects of the specialty and be the kind of person who communicates clearly and supportively for patients who may at times be very anxious. It helps to be a relatively calm individual who does not get flustered or angry when confronted with pressured situations. Delivery Rooms can be that way some times.

 
Q How many vacation days does an Ob/gyn get? Does an Ob/Gyn have to work on the weekends? How much does an Ob/Gyn get paid. How many hours does an Ob/Gyn have to work?
A

James's answer applies to Canada. Except for the very few Ob/Gyns who are salaried (for example, those who work for Universities) they are self-employed and so they decide how much vacation to give themselves, How much work they do on weekends is also up to them and depends on whether there is some else located in their community to share this responsibility with. The same goes for the number of hours in a day that they will work.

Since they earn money on a fee-for-service basis they get a monthly cheque based on the individual services they performed during the hours they worked. In other words, they don't get an hourly pay, but pay based on the work items they have completed during the month. The cheque comes each month from the government health insurance agency in the province where they are located; e.g., OHIP in Ontario.

 

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