So you want to be a reproductive endocrinologist.
You love babies and want to help make your patients’ dreams of parenthood come true.
Let’s debunk the public perception myths of what it means to be a reproductive endocrinologist
and give it to you straight.
This is the reality of reproductive endocrinology.
Dr. Jubbal, MedSchoolInsiders.com.
Welcome to our next installment in So You Want to Be.
In this series, we highlight a specific specialty within medicine, such as reproductive endocrinology,
and help you decide if it’s a good fit for you.
You can find other specialties on our So You Want to Be playlist.
If you have a specific specialty you want to be covered on our next So You Want to Be,
make sure you’re subscribed to vote in upcoming polls.
Also, consider becoming a YouTube channel member to receive additional perks and priority
in helping us decide on future specialties.
Click the JOIN button underneath this video for more information.
If you’d like to see what being a reproductive endocrinologist looks like, be sure to check
out my Day in the Life of a Reproductive Endocrinologist video with Dr. Carrie Bedient on my second
channel, Kevin Jubbal, M.D., and subscribe for more Day in the Life videos covering other
specialties in the future.
Reproductive endocrinology and infertility, or REI for short, is the field of medicine
concerned with helping people get pregnant who are unable to do so on their own.
REI physicians are experts in all things related to conception and reproduction and are adept
at managing any issues that may be preventing patients from becoming pregnant.
REI doctors are often best known for fertility treatments such as intrauterine insemination,
or IUI, and in vitro fertilization, or IVF; however, their actual scope is much broader.
REI physicians handle the full spectrum of issues that cause infertility from hormone
imbalances to polycystic ovarian syndrome, or PCOS, to even some forms of cancer.
In addition, REI physicians also help patients preserve their ability to have children in
the future through procedures such as egg and sperm cryopreservation.
There are a few ways to categorize reproductive endocrinology.
Let’s start with infertility versus reproductive endocrinology.
In general, infertility comprises the bulk of what an REI physician does day-to-day.
It encompasses all of the evaluations and treatments for patients who want to become
pregnant but have difficulty doing so on their own.
The bread and butter of infertility is focused on the evaluation of the uterus, fallopian
tubes, ovaries, and sperm, as well as the patient’s general health and genetics, to
determine why the patient or couple is having difficulty conceiving.
The infertility aspect of REI also includes various procedures to help patients become
pregnant, most notable of which are ovulation induction and intrauterine insemination, sometimes
called artificial insemination, and in vitro fertilization.
With ovulation induction and IUI, patients are given a series of medications followed
by a trigger shot to help their bodies release an egg.
Once the egg has been released, sperm is introduced into the uterus in an attempt to fertilize
the egg.
In contrast, in vitro fertilization requires the extraction of eggs from the patient after
which they are combined with sperm in a laboratory.
The embryo will then be allowed to grow within the lab for a few weeks after which it will
be transferred into the uterus to, hopefully, result in pregnancy.
In contrast, the reproductive endocrinology aspect of REI is similar to medical endocrinology;
however, it focuses solely on the hormones related to reproduction – namely estrogen,
progesterone, and testosterone.
The bread and butter of reproductive endocrinology involves working with conditions such as menopause,
premature ovarian insufficiency, and PCOS.
Another method of differentiating an REI practice is academic vs private.
REI physicians working in the academic setting will split their time between clinic, teaching,
and research.
Depending on the arrangement, academic REI doctors may spend as much as 80% of their
time teaching and researching and as little as 20% of their time in clinic seeing patients.
It should be noted, however, that this varies significantly depending on the specific arrangement.
The majority of REIs work in private practice.
This means that they are either running their own clinic or working for a private group.
In private practice, the focus tends to be on clinical medicine and less on research
or teaching as evaluating and treating patients is often what drives revenue.
That being said, hybrid practices splitting one’s time between clinic, research, and
teaching do exist.
In terms of compensation, physicians working for private practices will generally make
more than their colleagues in academia.
That being said, there is a great deal of variation in terms of compensation within
private practice.
Let’s clear up some of the misconceptions about REI.
To start, many people believe that fertility treatment is only available for male and female
couples.
This is not true.
There are many single women, LGBTQ+ couples, and even the occasional single male who seek
fertility treatment.
REI physicians see the full spectrum of patients with regard to race, sexual orientation, and
socioeconomic status.
Another misconception is that REI physicians can help you get pregnant regardless of the
situation.
People see celebrities in their 50s getting pregnant and believe that it’s possible
for everyone.
The reality is that REI doctors can help enhance your ability to get pregnant, but only if
it’s possible in the first place.
Female patients who have children later in life generally either froze their eggs when
they were younger or used an egg donor.
If there are no eggs left in the ovaries or no sperm being created in the testicles, REI
doctors can’t change that.
They can, however, provide a donor.
Lastly, many people incorrectly believe that it is an easy specialty.
REIs have to be incredibly detail-oriented as seemingly small mistakes can be the difference
between your patient becoming pregnant or not.
In addition, miscarriages, ectopic pregnancies, and negative pregnancy tests are common occurrences
and those conversations are never easy – even for the most seasoned physicians.
To become an REI physician, you must first complete four years of OB/GYN residency followed
by 3 years of REI fellowship.
Occasionally there are urology residents who will cross over to REI; however, the vast
majority are OB/GYN trained.
This makes sense as REI physicians still use many of their OB/GYN skills in their daily
practice.
For instance, when patients become pregnant, the reproductive endocrinologist will typically
follow the patient through the first trimester of pregnancy.
Additionally, REIs still have to deal with the many complications that can occur during
pregnancy such as miscarriages and ectopic pregnancies.
REI fellowship is generally divided evenly between research and clinical work.
Due to the heavy emphasis on research, REI fellows are required to present a thesis,
or original piece of research, as a part of their fellowship curriculum and as part of
their oral board exams.
The majority of time during the second half of fellowship will be spent in the REI clinic;
however, they are also required to complete rotations in medical endocrinology, pediatric
endocrinology, urology, and genetics.
In terms of competitiveness, OB/GYN is considered tier 4 or “less competitive.”
The average match rate is 89%, average Step 1 is 229, Step 2CK is 245, and the average
number of publications hovers around four and a half.
To learn more about the different tiers of specialty competitiveness, check out Why Every
Specialty Seems Competitive over on the Kevin Jubbal, M.D.
channel - link in the description.
That being said, REI is known for being one of the most competitive OBGYN subspecialties.
In 2021, there were 70 applicants that applied out of which 49 were offered positions.
That’s a match rate of 70%.
Medical students best suited for reproductive endocrinology and infertility tend to be detail-oriented,
patient, and are adept at working in a slower-paced yet still high-stress environment.
There’s a lot to love about REI.
To start, being an REI doctor is immensely gratifying.
The feeling of satisfaction you get when you see a baby’s first heartbeat on an ultrasound
after you’ve spent months, or even years, helping a patient conceive is difficult to
put into words.
As an REI physician, you also get to spend a lot of time with your patients.
This gives you the opportunity to build very close relationships which you don’t necessarily
get in many other specialties.
REI physicians also tend to have higher compensation.
According to the 2020 MGMA Physician Compensation Report, the median salary is $457,000 with
a mean compensation of $461,000.
It should be noted that compensation can vary significantly, with some making $250,000 at
the low end and others making more than $500,000 at the high end.
It should be noted, however, that those at the higher end of the salary range will generally
own their own practice, which comes with all of the additional work that goes into owning
a business.
REI also offers flexibility within the specialty.
If you want to focus on procedures, you can do that.
Or if you’re more interested in the medical aspects of REI, that’s fine too.
And if you’re interested in teaching, the heavy emphasis on the basic sciences during
your training also opens up many opportunities to teach.
Lastly, the lifestyle is generally pretty good.
The hours spent in the clinic are fairly predictable and night-call or night emergencies are very
rare.
That being said, due to the time-sensitive nature of fertility treatments, you do have
to remain fairly accessible to your patients.
While reproductive endocrinology and infertility is an awesome specialty, it’s not for everyone.
To start, the training is longer than most specialties as you must complete 4 years of
OB/GYN residency followed by 3 years of REI fellowship.
In addition, if you’re interested in opening your own practice, there is a great deal of
overhead that you don’t necessarily have with other specialties.
Even if you’re opening a small practice with only one physician, operating an REI
practice requires a large team.
You’ll often need at least a lab, a surgery center, an office, and the associated staff.
This includes front staff, medical assistants, an embryologist, an anesthesiologist, and
other staff to help coordinate the care.
As such, it can often be incredibly difficult to start your own REI practice.
Fertility treatments also don’t work 100% percent of the time and it can be incredibly
frustrating for both the patient and physician when things don’t go as expected.
In some instances, patients burn out, become angry, or don’t have the financial resources
to continue pursuing fertility treatment and, as an REI physician, you’re often the one
that has to bear the brunt of those frustrations.
As such, REI can be stressful.
You have to be confident in yourself and your abilities and be able to acknowledge that
if someone doesn’t get pregnant, it isn’t necessarily your fault.
No treatment is 100% effective.
That being said, it can often be difficult not to internalize these feelings as there
are very clear lines regarding whether treatment was successful.
Either the pregnancy test was positive and the baby was born, or it wasn’t – and
that’s a heavy burden to bear, both for the patient and the physician.
How can you decide if REI is right for you?
You should enjoy both the procedural and non-procedural aspects of medicine and be willing to dedicate
extra years in training for the satisfaction of knowing you’re helping bring new life
into the world.
You should also be patient and persistent – willing to endure the rollercoaster of
emotions that comes with unsuccessful pregnancies if it means ultimately getting your patient
to that one successful pregnancy.
Lastly, you should enjoy research and basic sciences, at least to some degree, as they
are a major component of the training to become an REI physician.
Huge shout out to Reproductive Endocrinologist Dr. Carrie Bedient for helping me with this
video.
See a day in her life on my other channel, Kevin Jubbal, M.D.
- link in the description.
And check her out on her social media platforms - links in the description.
Are you hoping to become a reproductive endocrinologist?
To get into medical school and match into a top OB/GYN residency, you’ll need to score
well on your exams and have a killer application.
As you look for experts to work with, seek out those who are actual MD physicians who
crushed their MCAT and USMLE, gained multiple top medical school acceptances, matched into
competitive residencies, and even had medical schools fighting over them by throwing merit-based
scholarships to sway their decision.
Only the top performers can best show you how to most effectively improve your own performance.
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Thank you all so much for watching!
If you enjoyed this video, be sure to check out Day in the Life of an REI or So You Want
to Be an OBGYN.
Much love and I’ll see you guys there.