How to Become a Obstetricians and Gynecologist

Where Obstetricians and Gynecologists have the most money left over after rent

Median pay minus estimated federal + state + FICA taxes, minus 12 months of rent at HUD's 2-bedroom Fair Market Rent. Darker green means more money left over each year. Hover any state for the breakdown.

Education and training

OB/GYN is four years of residency after four years of medical school, total 12 years post-high school. Fellowship adds two to three years depending on the subspecialty. The match is moderately competitive and has been trending more competitive as the specialty shrinks in some geographic areas while demand grows.

Undergrad pre-med requirements are standard. Clinical exposure in obstetrics specifically is helpful before committing to the specialty because the work, including managing laboring patients and performing deliveries, is physically and emotionally distinctive from outpatient gynecology or elective surgery. Some students discover in a clinical rotation that delivering babies through the night is not what they envisioned. Better to find out early.

Medical school: four years. Step 1 above 235 is competitive; many matched applicants have higher scores. Your OB/GYN sub-internship is important for both learning the specialty and making the connections that result in letters. Research in reproductive medicine, obstetrics, or gynecologic oncology helps for competitive fellowship-focused programs.

OB/GYN residency is four years. It covers antepartum care, intrapartum management, postpartum care, gynecologic surgery (laparoscopic, hysteroscopic, and open), urogynecology, gynecologic oncology, reproductive endocrinology and infertility basics, and family planning. The surgical volume in OB/GYN residency is substantial: cesarean sections, hysterectomies, laparoscopic procedures, and obstetric emergency surgery.

Fellowship subspecialties: maternal-fetal medicine (MFM, three years, covers high-risk obstetrics), gynecologic oncology (three to four years, surgically intensive cancer subspecialty), reproductive endocrinology and infertility (REI, three years, IVF and fertility management), and urogynecology/reconstructive pelvic surgery (FPMRS, three years). Each of these is a genuinely different practice from general OB/GYN.

Licensing and certification

State medical licensing after USMLE. OB/GYN physicians must be licensed in the state where they practice. Given the political and legal environment around reproductive healthcare in different states since the Dobbs decision, licensure geography has taken on additional significance; what you can legally offer patients varies by state.

ABOG certification (American Board of Obstetrics and Gynecology) requires passing a written qualifying examination after residency, followed by an oral examination approximately two years after completing residency. The oral exam involves case presentations from your own practice log. Pass rates for the written exam are around 80-85% for first-time takers; the oral exam is meaningfully more variable.

Subspecialty certification in MFM, gynecologic oncology, REI, or urogynecology requires completing the relevant fellowship and passing a separate subspecialty examination.

Hospital credentialing for OB/GYN requires documentation of surgical privileges for every procedure you want to perform. The credentialing process at hospitals with active labor and delivery units involves additional verification of obstetric management skills. Credentialing at multiple hospitals (for OBs covering multiple delivery sites) multiplies this burden.

Malpractice in obstetrics drives state licensing decisions for some physicians. States with insurance markets where obstetric malpractice coverage is extremely expensive or difficult to obtain have seen OB workforce shortages as some physicians drop obstetrics from their practice. This is a structural problem, not an individual physician failure.

What the day-to-day looks like

The OB/GYN day is split between outpatient clinic and the labor and delivery unit, with the balance depending on how your practice is structured. A general OB/GYN seeing prenatal patients, well-woman visits, and gynecologic problems in clinic while also delivering their own patients is managing two demanding environments simultaneously.

Labor and delivery is the variable that makes OB/GYN unpredictable. Patients don't start labor on a schedule. Your elective surgical slate on Thursday afternoon gets interrupted by the patient who's laboring rapidly or the 34-weeker with preterm preeclampsia. Call in OB/GYN is substantive: you're available for your admitted labor patients, C-sections, and obstetric emergencies at any hour. The middle-of-the-night cesarean section is not occasional; it's part of the job description.

Gynecologic surgeons who drop obstetrics have a fundamentally different practice: clinic, elective surgery, non-emergency call. This is a real option for OB/GYN trained physicians and many make that transition after years of combined practice. The lifestyle of gyn-only is significantly better than OB/GYN combined.

MFM specialists (perinatologists) work in a high-risk obstetric environment, consulting on complicated pregnancies, managing hypertensive disorders, preterm labor, fetal anomalies, and co-managing medically complex pregnant patients with internists and other specialists. Their call is serious because their patients are the ones most likely to deliver emergently.

Gynecologic oncologists have a mixed practice of complex surgery (radical hysterectomies, staging lymphadenectomy, debulking procedures) and medical oncology management (chemotherapy). The surgical days are long and the patient population is dealing with cancer, which has its own emotional weight.

Career progression

General OB/GYN starting salaries are $280,000-$400,000 for employed positions. Group practice or hospital employment is the dominant model. Solo OB/GYN practice has largely disappeared because the call burden of a solo OB is unsustainable: you'd be available essentially every night and weekend for your patients' deliveries.

Established general OB/GYNs in productive group practices earn $350,000-$500,000. Physicians who limit to gynecology (no obstetrics) earn toward the lower end because they lose the delivery fee revenue. Gynecologic surgeons doing high-volume minimally invasive cases have good income potential.

MFM specialists earn $350,000-$500,000, with academic MFM at major perinatal centers on the lower end of that range and productive community practice MFM at the upper end.

Gynecologic oncologists earn more: $400,000-$650,000 in academic and community settings. The surgical complexity and the cancer management component drive higher RVU production and compensation.

REI specialists who can build or access an IVF program are in a unique financial position. IVF is largely cash-pay because insurance coverage is limited. A high-volume IVF program generates revenue streams that employed REI physicians may not access but practice-owning REI physicians do. REI practice owners with successful IVF programs in fertility-aware markets can earn well above $500,000.

Malpractice costs are a real component of OB/GYN economics. Premium costs for combined OB/GYN physicians can be $100,000-$200,000 per year in high-risk states like New York or Florida. This eats significantly into earnings and explains why hospital employment with employer-paid malpractice is appealing to OBs.

Salary progression

Highest paying states

Where the jobs are

Salary negotiation

OB/GYN contracts have several unique elements compared to other specialties. Call coverage is the most important lifestyle issue and must be spelled out explicitly: how many nights of call per week, how many weekends, whether call includes both your own patients and coverage for other physicians, and what the compensation structure is for call.

Call stipends for OB/GYN are meaningful and negotiable. Labor and delivery call in an OB/GYN group has real value to the hospital (because OBs staffing labor and delivery keeps the service running) and real burden to the physician. In markets where OB recruitment is difficult, hospitals pay significant stipends for guaranteed coverage. Stipends of $2,000-$5,000 per weekend of OB call are not uncommon in undersupplied markets.

Malpractice coverage by the employer is a major benefit in this specialty. Given the premium costs, having the employer pay your coverage saves $50,000-$150,000 per year in states with high obstetric malpractice rates. Understand whether coverage is occurrence or claims-made, and understand who pays tail coverage if you leave.

For gyn surgeons building a minimally invasive surgical practice: access to the OR time and scheduling priority matters more than you might initially think. Negotiate for defined OR block time. A gynecologic surgeon without reliable OR access can't build a productive surgical practice regardless of their skills.

REI physicians joining or building a practice should understand the IVF program economics completely before accepting any compensation structure. If the practice's IVF revenue is substantial, your participation in that revenue through ownership or a percentage structure is a major financial issue.

What the data doesn't tell you

OB/GYN is one of the most rewarding and most exhausting specialties in medicine simultaneously. You participate in births, which are among the most significant events in your patients' lives. You also manage obstetric emergencies where bad outcomes happen despite doing everything right: shoulder dystocia, placental abruption, eclamptic seizures. The emotional weight of maternal and fetal outcomes is real, and the malpractice system's response to bad outcomes regardless of physician performance creates a legal shadow over obstetrics that affects physician wellbeing and career longevity.

The specialty's relationship with reproductive rights policy has become clinically and professionally complicated since 2022. Physicians in states with restrictive abortion laws face situations where they cannot legally provide care that medical training and patient needs indicate is appropriate. This is not a small issue and has already driven some OB/GYN physicians to relocate from certain states. If you're a medical student now, the state where you match for residency and build your career has legal and professional implications that did not exist for the generation before you.

The workforce in OB/GYN is under strain in rural areas. Hospitals are closing labor and delivery units because they can't staff them with OBs willing to cover rural call indefinitely. Rural OB is a genuine service for communities that have no other option, and the physicians who do it provide care that's hard to quantify in RVU terms.

The surgical skill set in OB/GYN is genuinely broad. Trained OB/GYNs are competent in both obstetric emergency surgery and laparoscopic gynecologic surgery, which is a wider procedural range than most surgical specialties achieve. Gynecologic oncologists who do complex debulking and regional lymphadenectomy are among the most technically accomplished abdominal surgeons in any hospital. This is an underappreciated aspect of a specialty that sometimes gets dismissed as less surgically complex than it actually is.

Frequently asked questions