In Calgary, obstetrician/gynecologists (OB/GYNs) are often referred to as “high-risk obstetricians” since they tend to manage the more complex pregnancies. In another article, I explored the role of low-risk family physician providers. This piece turns to the other side of that dynamic, now examining what makes OB/GYN unique and how the specialty differs from the other providers.
For this article, I had the privilege of speaking with three OB/GYNs in Calgary: Dr. Fiona Mattatall at Rockyview General Hospital, Dr. Kyle Lafreniere at South Health Campus, and Dr. Joel Steed at the Peter Lougheed Hospital.
To be called an OB/GYN, a physician must complete a five-year surgical residency. This differs from the two-year family medicine path taken towards low-risk obstetrics and differs from midwives, who complete a specialized education program focused on pregnancy, childbirth, postpartum care, and newborn health. As Dr. Mattatall shares, OB/GYNs “sort of have that split personality” built into the job, balancing both the obstetrical and gynecological parts of the specialty. For Dr. Steed, what drew him to OB/GYN was that “it was surgical,” he says. “I knew that the way to do surgery would be to go through the five-year program.”
While the surgical residency is the most obvious difference, the distinctions run deeper. OB/GYN residency trains physicians in advanced and acute obstetrical/gynecological presentations. This includes performing vacuum/forceps assisted deliveries and caesarean sections, but also more complexes cases such as multiple gestation, growth restriction, ectopic pregnancies, and more. As Dr. Lafreniere describes, OB/GYN entails “a combination of high-risk obstetrical patients and fetal conditions that differ from family medicine, which is generally focused around, more or less, routine obstetrical and prenatal care.”
However, OB/GYN training does come with trade-offs. Family medicine residents receive broad training that touches on a wide array of topics, including OB/GYN adjacent areas such as newborn and lactation care. “We don’t do newborn care at all,” Dr. Mattatall says, noting that the same goes for breast/chest health. “If I have a patient who has some lactation concerns, I will send them to the lactation specialist,” she says. “I cannot fill that piece.”
OB/GYNs also tend to have shorter relationships with their patients, though this exists on a spectrum. Dr. Steed finds satisfaction in more concentrated relationships, following patients through pregnancy and some postpartum. Dr. Mattatall acknowledges that her patient interactions are rarely cradle to grave like with family medicine, but she appreciates small bits of continuity. For example, seeing patients for menopause whom she once cared for during a pregnancy. “It is one of those little gems in medicine that can really fill your cup,” she remarks.
All three interviewees push back against the idea of a strict hierarchy amongst OB/GYNs, family physicians, and midwives. In fact, Dr. Lafreniere and Dr. Steed describe the culture of their units as collaborative. Dr. Steed shares that if a pregnancy becomes complex, the earlier the handoff, the better. “Our low-risk providers at our site are really good at collaboration,” he says, “and so they’ll sometimes even just give us a heads up.” Dr. Mattatall agrees and adds that a good working/professional relationship is key. In cases with grey areas, she describes checking in with her family colleagues’ comfortability and asking if they would prefer to hand over the case. During this decision process, everyone is always keeping “the patient at the centre of that decision.” Overall, the sentiment is that low risk providers are essential. Dr. Steed states that “the OBGYNs wouldn’t be able to handle it in Calgary without the low-risk providers.”
However, dynamics may need to change during emergencies. Dr. Steed says that when something acute is unfolding, someone needs to assume a leadership role, and that is typically the OB/GYN given their extensive training in emergent cases. Dr. Mattatall uses the analogy of a plane going down. Everyone on the team has a role, but someone must fly the plane. Interestingly, she points out that the pilot is not always the obstetrician. In some cases, such as severe maternal hemorrhage or cardiac arrest, it is the anesthesiologist who takes the lead.
For medical students wondering if OB/GYN is the right fit, Dr. Mattatall suggests asking yourself how it feels to be in an operating room, and how comfortable you are dealing with a high level of acuity and stress. OB/GYN can quickly turn acute and may require immediate surgical management. Dr. Steed agrees, noting that success in the field requires staying calm in stressful situations. “There’s often an adrenaline rush that you get in acute situations, and the more successful practitioners are those who can handle that.”
For students drawn to OB/GYN but still weighing their options, Dr. Lafreniere shares his own uncertainty as a medical student, having initially considered family medicine and low-risk obstetrics. It was not until he assisted in gynecologic surgery that he began considering OB/GYN. Therefore, seeking out shadowing opportunities is imperative, as it lets students see the breadth of the specialty and make more informed decisions for themselves.
These conversations demonstrate a system built on collaboration. Midwives, family physicians, and OB/GYNs each bring a distinct scope of training, and none of them can fully replace the others. What OB/GYNs offer is depth in surgical skills, advanced obstetrical training, and knowledge to handle emergent cases. In a city as busy as Calgary, the strength of the system lies in working together, and OB/GYNs bring a depth of training that complex deliveries demand.
