Intended for healthcare professionals

Careers

Life as a physician in obstetrics and gynaecology

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m37 (Published 24 January 2020) Cite this as: BMJ 2020;368:m37
  1. Jacqui Wise
  1. London, UK

A career in obstetrics and gynaecology is flexible, exciting, and fulfilling. There is a great variety of work within the specialty, with most doctors working in both obstetrics and gynaecology.

Many consultants have an interest in a particular area, such as fertility care or high risk obstetrics, and some work solely in a specific area of practice. The specialty combines medical and surgical activity and involves close cooperation with other specialties such as colorectal surgery, oncology, and urology.

Most hospitals have a team of consultants who are responsible for providing obstetric or gynaecological care. Clinical activities are diverse, depending on your area of specialisation. Emergencies may arise at any time, so 24 hour cover is always necessary.

Obstetrics

In obstetrics, most women, although pregnant, are otherwise fit and healthy. However, some will have acute or chronic medical problems that may complicate their pregnancy. Most of the care of low risk patients and uncomplicated deliveries is performed by midwives.

Around a third of births are undertaken by an obstetrician—usually for more complex cases or if the baby becomes distressed during labour. Obstetricians may need to use instruments to assist delivery such as forceps or a ventouse suction cup. They will also perform caesarean sections, either as a planned or an emergency procedure.

In obstetrics, a unit’s workload is generally based on the delivery rate. The specialty is unique in that it involves taking care of two patients—mother and child. Advances in ultrasound have made care of the baby in the womb a central part of the specialty.

Obstetricians work closely with other specialties in maternity, such as midwifery, anaesthesiology, physiotherapy, and neonatology. They may also work with others elsewhere in the hospital, such as cardiology, renal, and diabetology, while providing care for high risk women during pregnancy.

Gynaecology

Gynaecology is concerned with the wellbeing and health of the female reproductive organs. It includes endocrinology, female urology, and pelvic malignancy. The specialty spans paediatric and adolescent gynaecological problems through to later years.

It can involve carrying out surgical interventions following miscarriage; treating abnormal bleeding and polyps; major surgery for gynaecological cancers; and keyhole surgery for problems such as endometriosis. Gynaecologists work closely with radiologists, surgeons, nurse specialists, and physiotherapists to provide holistic care to their patients.

Typical day

There is no typical day in obstetrics and gynaecology—which makes the job interesting. Most consultants work during the day and are on call out of hours on a regular basis. Most trainees work on a shift system. The EU Working Time Directive limits the working week to 48 hours. It is also possible to work part time once you are a consultant or to train on a less than full time basis.

The day will usually start by carrying out ward rounds, seeing inpatients and new admissions, and arranging any required investigations. The day might include an antenatal or gynaecology outpatient clinic, an operating theatre list or specialist clinic. In an average clinic, a doctor might see 10 to 12 patients in one session.

Trainees may have to attend to emergencies in the labour ward or they may work in gynaecology without other commitments during the day or night. The consultant often manages the labour ward. Consultants will also be involved in teaching and training medical students and trainees and may also undertake research. As with any specialty there will also be a fair amount of admin, paperwork, and meetings.

Skills needed

  • Good communication skills in order to relate well to patients and their families

  • Empathy and listening skills

  • Good problem solving and decision making skills

  • Adaptability

  • Manual dexterity

  • Stamina

  • Ability to work effectively as part of a multidisciplinary team

  • Leadership skills

  • A sense of humour

  • Ability to keep calm in a crisis

Rewards

  • Varied and challenging role

  • Helping to deliver a healthy baby is very rewarding

  • Broad range of medicine covered

  • Potential for development of strong doctor-patient relationships

  • Working in a multidisciplinary team

  • Opportunity for career development across all aspects of medicine and surgery

Challenges

  • Heavy on-call duties

  • Long and unpredictable hours

  • The job can be demanding and stressful at times

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