Podcast Summary: The OB/GYN Resident Survival Guide

Episode #22: OB/GYN Career Paths - Part 2: Generalist, Hospitalist, Locums & Per Diem Roles Explained

Host: Dr. KC Miller
Release Date: March 9, 2026

Episode Overview

In Part 2 of her deep dive on OB/GYN career paths, Dr. KC Miller explores the different ways physicians can practice within the four main employment models of OB/GYN careers previously discussed. This episode focuses on three primary roles: Generalist, Hospitalist, and Contractor (Locums & Per Diem). Dr. Miller offers an honest, practical look at the pros, cons, lifestyle implications, and unique considerations of each work model to help residents and new attendings make informed career decisions.

Key Discussion Points & Insights

1. Review of Employment Structures

Timestamp: 00:39

• Four main structures: Private practice, academic practice, hospital-owned practice, county/city-owned practice (see Part 1 for details).
• Today's focus: Practice roles within those structures.

2. Generalist Roles

Timestamp: 01:24

• Definition:
  • The “traditional” OB/GYN, practicing both obstetrics and gynecology in both inpatient and outpatient settings; includes clinic, surgeries, deliveries, and hospital call.
• Pros:
  • Maximum procedural variety.
  • Get to practice the full spectrum of skills learned in residency.
  • High potential for long-term patient relationships.

    “You may start seeing a patient when they are very young as an adolescent. Then you may go on to deliver one or more of their babies. And if you're there for a really long time, you might even end up managing their transition to menopause.” (Dr. Miller, 02:17)

  • Potentially the highest long-term income, especially in private/hospital-owned practices.
  • Greater control over departmental management/decisions compared to hospitalist or contractor roles.
• Cons and Pain Points:
  • Burnout:
    • Frequent 24-hour calls on top of full clinic and OR days can be exhausting.
  • Unpredictable Schedules:
    • Clinic and call days shift week to week.

      “One week you might be in clinic Monday, Tuesday, Wednesday, operating Thursday and on call Friday to Saturday... then the next week be operating on Monday, Tuesday and clinic Wednesday, Thursday, Friday with call Sunday to Monday next.” (Dr. Miller, 04:15)

  • Primary Care Responsibilities:
    • Significant portion of practice spent doing primary care due to patients lacking dedicated PCPs.
    • Not everyone wants this aspect:

      “A lot of people that go into specialties such as OB GYN go into it because they don't actually enjoy the primary care component.” (Dr. Miller, 05:20)

  • Inbox and Test Result Management:
    • Heavy administrative load—must follow up on all labs and imaging ordered.
    • Administrative work often spills into unpaid personal time.

      "All of that adds up very quickly... when abnormal test results come into your in basket, you do need to contact the patient to inform them of the results and/or send them medications and/or ask them to book a follow up visit so that you can discuss things further.” (Dr. Miller, 06:34)

    • Paid admin time is rare and should be negotiated.
• Tips for Job Seekers:
  • Ask about admin time and support staff during job interviews.
  • Clarify daily patient volume and division of responsibilities.

3. Hospitalist Roles

Timestamp: 10:15

• Definition:
  • OB/GYN working exclusively inpatient—no clinic and no scheduled outpatient surgeries.
  • Divided into “laborist” (OB only) and broader hospitalist (OB + inpatient GYN).
  • Usually employed by third-party companies.
• Pros:
  • Work Stays at Work:
    • Little or no after-hours administrative burden.

      “When your shift ends, it ends. Work doesn't follow you home into your personal time.” (Dr. Miller, 11:25)

  • Flexible and Predictable Time Off:
    • Typical schedule is 6-8 24-hour shifts per month.
    • More days off and better predictability (can plan well in advance).

      “When you're not on call those days, you can guarantee to be off and have to yourself.” (Dr. Miller, 12:00)

  • Increasingly Competitive Benefits:
    • Some roles offer benefits comparable to generalist jobs.
• Cons:
  • Limited Schedule Control:
    • Schedules may be fixed by employer, with little say over assigned shifts.
    • Some groups forbid trading shifts, even if no conflict exists.

      “They might be hiring specifically for certain weekdays or weekends that they don't already have coverage for.” (Dr. Miller, 12:45)

  • Variable Compensation:
    • Some hospitalist roles pay less than generalists, despite high productivity or acuity.
  • No Productivity Incentives:
    • Flat-rate pay regardless of workload; no bonuses.
  • “Rusty” Skills:
    • Pure hospitalist work may erode outpatient and surgical skills over time.

      “If you are going into a hospitalist role right out of residency... you’ll become pretty rusty with your gynecologic surgical skills and even your medical knowledge.” (Dr. Miller, 15:41)

  • Lack of Continuity:
    • No long-term patient relationships; must build trust rapidly with unfamiliar patients.

4. Contractor Roles: Locums & Per Diem

Timestamp: 17:47

• Definition:
  • Temporary/fill-in positions, often called “locums” (require travel, 1099) or “per diem” (local, W2).
  • Designed to fill staffing gaps, e.g., for parental leave, hiring lags.
• Pros:
  • Ultimate Flexibility:
    • Choose contracts based on personal interests, schedule, location.
    • Ideal if personal circumstances (e.g., partner’s job search) make long-term commitments difficult.

      “These roles provide opportunities to supplement your other income.” (Dr. Miller, 19:33)

  • Higher Hourly Pay:
    • Generally higher pay per shift (but lower annual income).
    • Excellent way to supplement income for hose wanting extra cash.

      “If you're just picking up shifts as a per diem to make some extra cash, the work that you're actually doing on your shifts is probably getting you a little farther financially.” (Dr. Miller, 19:10)

  • Professional Variety:
    • Some contracts can be clinic-only, others full-scope generalist.
  • Logistical Support:
    • With locums, agencies may cover malpractice insurance, travel, housing, credentialing.
• Cons:
  • No Benefits:
    • Lacks health insurance, retirement, paid leave.

      “Because you're considered a temporary employee and not working full time equivalent hours, it's too high of a cost to the employer to include this within your compensation.” (Dr. Miller, 21:15)

  • Lack of Stability:
    • Reliant on contracts for income—less predictability.
  • Travel and Adaptation Issues:
    • Frequent travel is difficult with family/roots.
    • Constantly adapting to new teams and EMRs can be tiring.
  • Limited Continuity:
    • No ongoing patient relationships or department influence.

Notable Quotes & Memorable Moments

• On work-life boundaries as a hospitalist:

  “When your shift ends, it ends. Work doesn't follow you home into your personal time.” (Dr. Miller, 11:25)

• On the reality of inbox management for generalists:

  "All of that adds up very quickly... when abnormal test results come into your in basket, you do need to contact the patient to inform them of the results..." (Dr. Miller, 06:34)

• On career flexibility:

  “Overall, working as a contractor is really the only way to get complete control over your life and your work schedule.” (Dr. Miller, 20:57)

Key Takeaways & Final Recap

Timestamp: 23:39

• Four main employment structures: private practice, academic, hospital-owned, and county/city-owned models.
• Within any structure, you can work as a generalist, hospitalist, or as a contractor (locums/per diem).
• Each role comes with unique trade-offs involving scheduling, compensation, continuity, administrative burden, and personal/professional fulfillment.
• Dr. Miller underscores the importance of reflecting on personal priorities and negotiating thoughtfully during interviews.

  “Pros and cons really depend on what your priorities are... I hope this episode provided you with some basic information and inspires you to really consider what you think will be the most important to you when it comes to your lifestyle and your work situation after residency.” (Dr. Miller, 25:30)

Action Points & Resources

• Review episode Part 1 for context on employment structures.
• Assess job contracts for support staff, administrative time, and scheduling flexibility.
• Email Dr. Miller with further questions: info@drkcmiller.com
• For more guides: www.drkcmiller.com
• Follow Dr. Miller on Instagram, TikTok, and YouTube for ongoing tips and resources.

This clear, practical discussion equips OB/GYN residents and new attendings to navigate the many career options available—and empowers them to seek situations best suited to their values and lifestyle goals.