Day in the Life of a Maternal Fetal Medicine Doctor
Maternal Fetal Medicine (MFM) is a subspecialty of Obstetrics and Gynecology (OBGYN).
To become an MFM doctor, you need to go through undergrad, medical school, OBGYN residency (4 years) and MFM fellowship (3 years).
When I was deciding to do fellowship, a pleasant side effect was the relatively predictable schedule of an MFM doctor when compared to a generalist OBGYN doctor. Because most of the practice is outpatient, we work Monday to Friday and our days end by 5 pm. We do have to cover the hospital inpatient antepartum service and occasionally take call.
Generally, my week is divided up into a bit of everything. But overall, the vast majority of my time is spent outpatient (in clinic and ultrasound) while a small portion is spent inpatient.
Clinic
MFM clinic is divided up into Consultations and Return visits:
1. Consultations: because high risk pregnancy can be so complex, consult visits are generally scheduled for 45-60 minutes. I am getting to know a patient and her complex history for the first time, so it’s important to take my time to ask the right questions and make a plan for the remainder of the pregnancy.
2. Return visits: when a patient is not new to the practice, and a plan is already made, seeing them back for return visits does not take as much time. These visits are usually scheduled for 30 minutes.
Some large practices further divide up their clinics into different conditions, like HIV clinic, Diabetes clinic, etc, by type of visit (return clinic or a consult clinic), or as Fetal or Maternal clinic.
Since there is so much overlap in high risk pregnancies (a mom with diabetes can later be found to have a fetal abnormality), most clinics are just high-risk clinics. Clinics typically run from 8 am to 5 pm with a lunch break.
Ultrasound
Ultrasounds are performed by a sonographer (aka ultrasound technician or technologist). As an MFM doctor, my role is to read ultrasounds performed by multiple sonographers at the same time. Most ultrasound scans are normal. However, as the person sitting in the reading room, I have to be readily available to make complex diagnoses and management plans in the case of an unsuspected fetal abnormality. Depending on the practice, the number of sonographers and the types of ultrasounds performed, an MFM can read anywhere from 20 to 50 ultrasounds per day.
At any given day, these are a few things I do in ultrasound clinic:
- Interpret ultrasound images
- Write up ultrasound reports
- Make a diagnosis of fetal or growth abnormalities
- Do procedures (chorionic villus sampling [CVS] or amniocentesis)
- Discuss findings with patients
- Discuss findings with referring providers
- Bill for the services provided
- Make follow up ultrasound recommendations
- Place follow up orders
Ultrasound clinic typically runs from Monday to Friday, 8 am to 5 pm.
Hospital service
Hospitals that have MFM doctors will require doctors to have an inpatient high-risk service to be able to support those patients through their pregnancies. A hospital shift typically includes attending morning report (sign-out), doing consultations for new high risk admissions, and rounding on patients in the antenatal ward. The service doctor is generally the on-call doctor, so you are also answering pages and phone calls from other providers regarding their high risk pregnancy questions or transfers. The days may also include performing surgeries, procedures and/or clinic. Hours are typically Monday to Friday, 7 am to 5 pm.
Call schedule
This varies between practices. Generally, the larger the practice, the larger the call pool, so the less call you take. As an MFM doctor, calls are taken from home (home call), and usually involve questions or potential transfers from outside hospitals. Uncommonly, a call would be for a very sick pregnant patient that requires the MFM to go into the hospital off-hours. Calls also include rounding on the inpatient service on days there are no MFMs inhouse (like weekends and holidays). Again, if you have 8 people in your practice, you will only cover 6 weekends and 0-1 holidays a year, and if you have 4 people in your practice, you will cover 12 weekends and 1-2 holidays a year.
Labor and Delivery
Traditionally, MFM doctors covered labor and delivery shifts. However, with the rise of OB hospitalists, and the demand for MFM’s to work within their expertise, the trend is going away from that. If you love labor and delivery, it is not impossible to find a job to support that right now. However, if this is your primary love, I would not recommend going into MFM because I definitely see a future without MFM’s on labor and delivery.
Vacation time
This is institution-dependent. Most practices will offer 4-5 weeks of vacation per year.
That’s the gist of it.
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