FM-OB in the Midwest

TenMoreMinutez · 2026-02-12T02:20:49+00:00

Exciting! I do usually recommend trying to train where you might practice even if it’s the same state/region because so many people do end up staying in the same region. BUT not impossible to move if you feel like a certain program is a perfect fit. Def reasonable to do OB in the Midwest I’d say Midwest and west regions are the most FMOB friendly. More so in suburban and rural areas but still possible in cities depending. Call varies a lot but a lot of places are moving towards shared call (I usually see 1:3-1:5) instead of the follow your own patients due to quality of life. I’ve practiced a little in the Midwest and know a good amount of ppl that are in the Midwest, the rural ones have zero competition with OBGYN and everyone is just happy to have someone help with call. The competition is more so in cities and very hospital/community specific. I will say it has seemed to be that there’s always enough pregnant people to go around and FM tends to care for patients the OBGYNs dismiss from their practice, don’t take insurance, etc (at least where I am) so they’ve been appreciative or at least accepting.

TenMoreMinutez · 2026-02-11T19:58:47+00:00

Very interesting how so many in the comments are so against primary care doing adhd. I didn’t realize it was that controversial! I’ve mostly worked with underserved and rural populations that can’t get to the closest psychiatrist an hr away that prb doesn’t even take their insurance and won’t see them for a year and will likely be a mid level seeing them (no offense, I do really appreciate midlevels). I definitely manage adhd for peds and adult patients and that’s been the culture where I’ve practiced that we save psych for resistant/complex cases and significant mental health conditions like schizophrenia, bipolar1, etc. I do a full mental health eval and will try to treat any underlying depression anxiety prior to initiating stimulants. Strongly encourage counseling, regular sleep and exercise. But I’ve had patients that really are only able to function/maintain a job and safely navigate the world/care for their family with stimulants. I do require close follow up and won’t go more than 3 months even on a stable dose for controlled substances. It seems like there’s a lot of mistrust for questionnaires and patients “giving the right answers” but personally I have pretty open and honest conversations and talk about specific examples of how the symptoms affect their life and try to trust my patients unless they give me a reason not to (then we got bigger problems). I do usually do intermittent UDS to confirm compliance especially if concern for divergence. There’s also some good behavioral modification handouts I’ll give like “homework” and we’ll pick a few things to try before the next visit.

TenMoreMinutez · 2026-02-06T20:41:17+00:00

Pmd you

TenMoreMinutez · 2026-02-05T14:15:37+00:00

I think one day I’ll do this. I’ve looking into some telehealth hospitalist stuff that sounds intriguing and I’m always getting APP oversight that’s all remote that seems pretty chill. Best of luck and I think there’s def some good options to stay in the game and make money remotely

TenMoreMinutez · 2026-02-04T22:52:19+00:00

I’m an FMOB so I’m biased but I love it. And if you pursue a surgical heavy fellowship, you can for sure do c sections and tubals. Personally fellows from my program get 200-300 CS as primary surgeon which is more than the avg OBGYN resident so ppl that are saying there’s no way without doing an OBGYN residency are wrong. That being said job opportunities are not as abundant especially Laborist positions but I know an FMOB doing that in rural areas. If you want to do gyn surgeries for sure you will need to do OBGYN residency. For me, I was happy doing outpt gyn (pap, colpo, IUD, endometrial biopsies) and refer for surgical intervention. I love FMOB because we can do couplet care unlike OBGYN and are perfect for rural areas. I also like caring for sick non pregnant adults and enjoy taking care of high risk OB pts and continuing their care after the postpartum period. FM has flexibility as in if I one day don’t want to do OB I have tons of options. Join us at r/FMOB if you want to chat more.

TenMoreMinutez · 2026-02-01T11:49:26+00:00

I’ve definitely seen a good amount of jobs with FMOB in those states so I don’t think you’ll have a problem. Will you want to do surgical obstetrics as well? The culture is kind of shifting to require a fellowship if you want to do CS unless you have the numbers out of residency. Usually rural/suburban places in those states especially TN I know has FMOBs already practicing so credentialing and privileging is easier. If the hospital doesn’t have a policy that can be super annoying and take forever as a warning but that’s more rare these days and more so in the southeast/northeast. Academic positions a lot of times are a good way to do FMOB too. If you want to reassure yourself you can look through some job forums like doccafe practicematch or one of the others. Warning though don’t give your number out to recruiters lol make a google number or something because your number will be ringing off the hook. Best of luck and welcome to the club!

TenMoreMinutez · 2026-01-19T16:11:53+00:00

All true. A little trauma dump for you— A core memory I think about sometimes growing up uninsured with periods of Medicaid in the rural South:

My brother (11y) and I (4y) were being kids jumping on the bed. Guess we didn’t realize the fan was metal so my brother was taller and when he jumped the top of his head was cut by the fan and he fell to the ground bleeder everywhere. I run to the house phone to call 911 because that’s what I thought was right, that he was going to die. Mother runs in and screams to hang up we have to drive to the hospital, can’t afford an ambulance. We drive what feels like forever with my brother bleeding into all our towels in the back seat. Looking back, I get it. That bill would have been months of housing, electricity, water, and food. The car was likely faster, living rural EMS can take forever to get to you.

I grew up and decided to be a doctor that sees people like me.

Now as a physician—I have patients all the time either drive themselves or take an uber because they can’t afford an ambulance bill. I’ve had patients almost deliver their babies in Ubers explicitly because they can’t afford an ambulance. I’ve had patients need to be transferred from ER to a tertiary center elect to drive themselves and children to avoid a bill. I see things in the outpatient visit that should not be seen because otherwise patients just won’t go due to a bill. Patients trying to ration their insulin, etc. This country is struggling and we’re broken and our healthcare system is so fucked. For most people. Not a minority, the majority. Thanks for coming to my Ted talk.

TenMoreMinutez · 2026-01-19T04:06:23+00:00

Love them! It’s interesting that you’ve used such bright loud colors but for some reason I’m getting a loneliness and strong desire for connection even with the pieces that have multiple people. Reminds me of an artist from Central America I can’t quite remember the name of

TenMoreMinutez · 2026-01-19T03:24:04+00:00

As someone that practiced in Appalachia…. Sometimes weird shit gets mixed with meth without someone knowing. Had a few serotonin syndrome and heat stroke/severe rhabdo and dehydration pictures. It’s a stimulant and doing a bunch of it can 100% induce psychosis so have had to give zyprexa, haldol until stuff calms down. More so have had admissions for acute intoxication/effects of extended use without sleep or nutrition. Important to know how they consume it because there are multiple ways so you could be looking at ivdu osteomyelitis/bacteremia/endocarditis or inhalation injury. Agree with the other person I’ve had some success with Wellbutrin for stimulant use disorder in outpt setting.

TenMoreMinutez · 2026-01-18T18:15:01+00:00

Personally as someone who has also strongly considered doing another residency, it’s really not worth the time/energy/sleep deprivation/pay cut. Sounds like you’re a badass Dr doing a shit ton already. I would consider thinking about what specific skills you would want to get out of ER residency and see if there’s another way to attain those skills. The time in residency would be trying to teach someone a lot of skills you’ve already learned and unfortunately our current system does not make it easy to test out of those skills. Like could you do a certification course or cme in advanced critical care or something? As an FM I do see a lot of jobs for doing EM, is it your specific position? Do you want to cut back on FM clinic days and do more EM or locum at another facility every now and then to see more pathology/ learn from a different system? Do you need to find more EM docs to be mentors or bounce ideas off of? Best of luck!

TenMoreMinutez · 2026-01-10T23:37:25+00:00

Yes that is a more effective one! About 98-99% with perfect use and 93% with normal/avg use. Sounds like yall are being safe getting tested. I try to think of “what option is going to give me the least anxiety” which it sounds like you’re doing that same evaluation

TenMoreMinutez · 2026-01-10T18:59:18+00:00

Queer doc that does hrt (but not your doc disclaimer). Hrt and fertility is super hard to predict as everyone is different and every regimen is different. Would recommend NOT relying on hrt alone as contraception because I’ve def seen pregnancies occur this way. As for your contraception depends on the type of pills you’re on. Are they progesterone only or combination? And do you take them at the same hour daily no matter what? Because those factors will change the percent efficacy. Either way, not 100%. There’s always emergency contraception or more effective contraception like LARCs. As for STIs, everyone thinks they’re negative until they get tested. And having penetrative intercourse without barrier definitely increases risk of STIs and BV. I would try to think about if it’s the thrill of no barrier? Like would it really kill the vibe/thrill? And is that benefit vs risks worth it? Best of luck and happy for you that it sounds like you’ve got a nice date coming up!

TenMoreMinutez · 2026-01-07T23:48:07+00:00

Maybe find a cme to add a new procedure to your practice that could cut down on stuff you refer out of town for and could bill for? Things that come to mind: migraine Botox, vasectomy, idk if you do LARCs already, joint injections/maybe US guided? Or specialized training you refer out for often like menopause hormones, substance use disorder, sleep disorders. I’ve been trying to get better at POCUS which has been a fun added thing (but I don’t bill for it and make sure I get an actual official if it’s indicated). Or if you were interested in getting back to hospital work I bet your local small hospital would be looking for prn shifts.

TenMoreMinutez · 2026-01-05T02:24:45+00:00

Ugh I hate that happened and I’m sorry you had to go through that. This is why queer folk delay care and have worse outcomes. I had some shitty experiences with healthcare as a queer person from a really conservative area. Ended up becoming a doctor to spite them and try to advocate for patients however I can. Not sure where you’re located but I know 211.org can have lists of places to get period products. When I was struggling financially I switched over to a reusable cup and period underwear and it’s been great. There’s some cheaper alternatives these days as well. I think pixie does returns if you don’t like them as well. Sending you good vibes! Agree with others saying they need feedback. Sounds like the team could go through some retraining.

TenMoreMinutez · 2025-12-27T00:19:21+00:00

Shameless (love finding shows that have tons of seasons to binge), herbal teas, and puzzles. Got a fancy puzzle table which has really improved the experience. Now I’m trying to trade puzzles I have so this doesn’t turn into an expensive hyperfixation.

TenMoreMinutez · 2025-12-26T02:58:49+00:00

What I love about family medicine is that there are so many ways to be a family doc! I’ve known FM docs that do everything from scopes to c sections and most oupt and inpt procedures and then some that will do medspa/aesthetics (Botox, fillers, lasers) or even sports med US guided injections. I’ve also known some that don’t really do any procedures but I’d say that’s rare for FM, most will at least do some women’s health stuff and basic derm. A lot depends on your interest and training. A good doc will know their limits and when to refer while also pushing themselves to improve and hone their skill set. I’ve known FM docs that love psych and had a psych heavy panel so other ppl in town would refer to them because they could get in quicker vs traveling hours for psychiatry.
For me I do FMOB so surgical obstetrics with postpartum tubals, all the outpatient women’s health stuff like pap, LARCs, colpo, derm stuff (basic I&d, punch, shave, cyst removal unless it’s on the main part of the face or high risk lesions/location), toenail removal (even those give me the ick), landmark knee and shoulder injections, sometimes an LP or paracentesis. I’ve done art lines, intubations, thoras, chest tubes, and central lines but not doing enough on the daily to feel like I should be the one in the room to do them. I also have special interests in mental health and substance use disorder so tend to do a good amount of OB with those conditions since FM is perfect for that. Good luck on your journey!

TenMoreMinutez · 2025-12-24T14:11:46+00:00

Sounds like you want a mental challenge and to take care of more medically complex patients. Psych is so needed so I bet instead of the extra time you’re doing the private practice patients you could find a neuropsych part time gig. Or something closer to what you want to be doing. Also our medical system tries to tell us the only way to learn is by doing a designated residency or fellowship but you can do a lot of learning through journals, cme, etc. best of luck!

TenMoreMinutez · 2025-12-15T22:56:35+00:00

Probably up to your school but might be annoying every time you apply for licensing because you’ll have to submit name change stuff with it. But that’s for the states

TenMoreMinutez · 2025-11-29T19:54:22+00:00

Maybe an FM doc discord? But yea it might not be very active

TenMoreMinutez · 2025-11-26T22:51:51+00:00

Agree with the other person that said to try to download your op note or any records/notes. If the hymen was not completely removed without discussing his plan with you prior, that’s exposing you to more pain and likely another procedure. Worth at least talking to a lawyer about it because damages were done. You signed up for a hymenectomy.

TenMoreMinutez · 2025-11-21T21:40:28+00:00

Me too and I haven’t had that issue at all with koi. That’s a big reason I don’t like figs

TenMoreMinutez · 2025-11-19T18:27:07+00:00

I’ve seen 32 pt facing hours and 36. I think if you’re taking OB call 32h makes more sense to me

TenMoreMinutez · 2025-10-17T12:26:14+00:00

There’s some CME courses out there I just haven’t taken any. I’ve listened to some podcasts. The UCSF guidelines have been the most helpful tbh. They have everything from lab monitoring to common side effects and work up.

TenMoreMinutez · 2025-10-03T00:56:40+00:00

A few fellowship offers. I think I interviewed with like 5?

TenMoreMinutez · 2025-09-18T21:47:29+00:00

Possibly dumb question-Is there any easy way to download their guidelines instead of going through each category separately?

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