The Role Of An Obstetrician & Gynaecologist
Torn between medicine and surgery? Fascinated by the intricacies of pregnancy and the female reproductive system?
If this sounds familiar, working within obstetrics and gynaecology may be what you are looking for. This article provides an insight into obstetrics and gynaecology and a guide to becoming a consultant in the specialty.
An obstetrics and gynaecology doctor provides care to pregnant women, their unborn child and manages diseases specific to women. More precisely, gynaecology revolves around the well-being of the female reproductive system and spans paediatric problems through to later years; it includes endocrinology, female urology and pelvic malignancy.
Obstetrics is primarily concerned with healthy and fit pregnant women, but also deals with acute or chronic conditions which may complicate their pregnancy. Most consultants work within both obstetrics and gynaecology (1).
Some common procedures and interventions performed by obstetricians and gynaecologists include:
Surgical interventions following miscarriage
Treating abnormal bleeding or polyps
Major surgery for gynaecological cancers
Minimal access surgery (e.g. in endometriosis)
Fertility treatment (assisted reproduction)
Obstetrics and gynaecology is an incredibly diverse specialty and balances intellectual stimulation and hands-on work. Your schedule is likely to mix ward rounds, seeing both inpatients and outpatients, performing scans, working in theatre, and attending specialist clinics.
Obstetricians and gynaecologists work within a diverse multidisciplinary team consisting of midwives, neonatologists, paediatricians, oncologists, urologists, and nurses to name a few; this is particularly important in the labour ward, which is a major component of this specialty.
In an average clinic, an obstetrician and gynaecologist may see 12 patients in one session, but this may vary depending on the complexity of cases. It is also possible to work in the community which offers a significant public health aspect to your work (1).
Apart from the necessary skills employed by all doctors, aspiring obstetricians and gynaecologists should demonstrate certain qualities and traits. Sensitivity, listening skills, as well as a sense of humour are of utmost importance as consultations often involve relating to patients and their families.
Excellent team-working skills and leadership ability are vital to effectively work in this specialty. The surgical component necessitates manual dexterity. As an acute specialty, obstetrics and gynaecology can be unpredictable and busy, requiring stamina and emotional resilience (1).
The specialty has evolved tremendously over the past few decades and continues to do so; it has also become female-dominated. A vast range of new cutting-edge technologies have emerged, and many initially incurable conditions have become curable, including gynaecological cancers.
Thus, obstetrics and gynaecology offers immense research opportunities, both at a clinical and molecular level (1).
A Typical Week
There is no such thing as a typical week or day for an obstetrician or gynaecologists due to the wealth of possible duties; your schedule highly depends on whether you are working as an obstetrician, gynaecologist, or both, and whether it includes a special interest related to a specific clinical skill e.g. ultrasounds, laparoscopy, prenatal screenings, or emergency gynaecology.
Consultant roles offer flexibility so you may develop new expertise and modify your clinical practice accordingly throughout your career (1,2).
Most trainees - and an increasing number of consultants - work on a shift pattern and start the day by attending wards, seeing inpatients and new admissions, and arranging any required investigations. Other direct clinical care duties include theatre sessions, antenatal clinics, labour wards, and a special interest (1,2).
Most consultants work during daytime and are regularly on-call out-of-hours on weekdays and weekends. Obstetrics and gynaecology has a substantial predictable on-call commitment, which mainly includes gynaecology ward and labour ward rounds, as well as telephone rounds.
Those on a gynaecology on-call rota must have a minimum of two day-time inpatient operating lists per month to maintain surgical skills for emergencies that may arise on-call.
The amount of unpredictable on-call commitment and emergency call-ins, eg attending the labour ward within 30 minutes, varies but is increasing. Some time must be allocated to teaching, audits, departmental meetings, and clinical governance.
The Route To Becoming An Obstetrician & Gynaecologist
Interested undergraduate medical students can join the medical society at their university and attend conferences for an opportunity to explore the specialty and network with potential future colleagues. Undertake student-selected modules and/or electives in obstetrics and gynaecology.
You may also want to consider registering with associated societies, institutes or professional bodies such as the Royal College of Obstetrics and Gynaecology (RCOG) and the British Medical Association (BMA) (1).
During your foundation years, aim to complete a rotation in obstetrics and gynaecology. If that is not possible, contact the obstetrics and gynaecology department at your hospital and ask how you can get involved. Furthermore, familiarise yourself with the person specification for specialty training and use this as a guide to develop your skills and abilities (1,3).
After completion of your foundation programme, you do not have to complete core medical training (CMT) or equivalent, but instead commence specialty training beginning at ST1 and running through to ST7; this means you do not need to go through an ST3 application once accepted for ST1 (1). In 2019, there were 2.02 applications per place for an ST1 post (4).
You need to demonstrate enthusiasm and commitment to the specialty for the recruitment process. To be eligible for specialty training, you will need to have acquired the Advanced Life Support Certificate from the Resuscitation Council UK. By the intended date of appointment, you will also need 18 months’ or less experience in obstetrics and gynaecology (not including foundation placements).
Additionally, academic and research achievements may aid in the selection process (1,3). Be ready to move to a different location as certain hospitals – such as the Southend University Hospital in Essex – are renowned for their excellence in this specialty and would prove beneficial to your career prospects (5).
By the end of ST2, you would normally complete Part One examinations of the RCOG, and Part Two at the end of ST5 and prior to ST6 to obtain full membership (MRCOG). A higher academic qualification, eg PhD (three-to-four years) or MD (two-to-three years), is desirable but not essential for a career in obstetrics and gynaecology. At the end of training, you will be awarded the certificate of completion of training (CCT) to go on to work as a consultant (1).
While many consultant obstetricians and gynaecologists develop special interests, only a small proportion work as subspecialists. These are obstetricians and gynaecologists who have undertaken additional training and are recognised to have subspecialty expertise in their field. There are four recognised subspecialties in obstetrics and gynaecology: gynaecological oncology, maternal and foetal medicine, reproductive medicine, and urogynaecology.
You can complete subspecialty training any time after passing the Part two MRCOG. Training comprises two years of clinical training and one year of research; if you already have a higher academic degree or produced a relevant publication, it may count towards the research component (3).
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Consultant obstetricians and gynaecologists may also wish to run private practices to supplement their salary; a purely private consultant is rare in the UK. On average, they can make a profit of an additional 49% of their NHS salary by working in the private sector (6).
In 2018, private obstetricians and gynaecologists made a profit of £74,000on average; this is higher than many specialties e.g. general surgery (£72,000) or Anaesthetics (£57,000), but lower than some others, such as urology (£92,000) or oncology (£102,000) (7).
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
If you are interested in deepening your knowledge in obstetrics and gynaecology, you may find it useful to consult relevant journals, such as the ones listed below:
BJOG: An International Journal of Obstetrics and Gynaecology
Best Practice and Research in Obstetrics and Gynaecology
Journal of Perinatology
BMC Pregnancy and Childbirth
The following societies and institutes offer a wealth of information on conferences, symposiums, careers days, awards/competitions, podcasts, and learning resources to help you stand out when applying for obstetrics and gynaecology:
Related Job Sources With BMJ Careers
Other Complete Guides By BMJ Careers
1. Obstetrics and Gynaecology [Internet]. Healthcareer | NHS. [cited 2020 Jun 5]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/obstetrics-and-gynaecology
2. Model Job Plans by Specialty [Internet]. British Medical Association. [cited 2020 Jun 5]. Available from: https://www.bma.org.uk/pay-and-contracts/job-planning/job-plans-by-specialty/model-job-plans-by-specialty
3. Careers Prospectus [Internet]. Royal College of Obstetricians and Gynaecologists. [cited 2020 Jun 5]. Available from: https://www.rcog.org.uk/en/careers-training/considering-a-career-in-og/careers-prospectus/
4. Specialty Recruitment Competition Ratios [Internet]. Specialty Training | NHS. 2019. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition Ratios 2019_1.pdf
5. Obstetrics and gynaecology training at Southend is top in the UK [Internet]. Southend University Hospital. 2018 [cited 2020 Jun 5]. Available from: http://www.southend.nhs.uk/about-us/media-centre/1week/obstetrics-and-gynaecology-training-at-southend-is-top-in-uk/
6. Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med [Internet]. 2008 Jul;101(7):372–80. Available from: http://journals.sagepub.com/doi/10.1258/jrsm.2008.080004
7. No Title [Internet]. Independent Practitioner Today. [cited 2020 Jun 5]. Available from: https://www.independent-practitioner-today.co.uk