I'm at the end of my M3 year and trying to decide between family medicine and internal medicine. I love the philosophy behind family medicine and have repeatedly been impressed by the faculty and residents I have met in the family medicine department at my med school. I'm currently in school in the mid-west, where family is widely accepted, but would like to move to NYC for residency both to be with my family and my boyfriend. I'll probably end up staying in the NY area for a long (if not indefinite) time.

My question is this: I've heard a lot about how much regional differences affect how family physicians practice and I'm concerned that NY might not be the ideal place to be a family doctor. Can anyone tell me about the pros and cons of practicing family in NYC?

Thanks!

I'm at the end of my M3 year and trying to decide between family medicine and internal medicine. I love the philosophy behind family medicine and have repeatedly been impressed by the faculty and residents I have met in the family medicine department at my med school. I'm currently in school in the mid-west, where family is widely accepted, but would like to move to NYC for residency both to be with my family and my boyfriend. I'll probably end up staying in the NY area for a long (if not indefinite) time.

My question is this: I've heard a lot about how much regional differences affect how family physicians practice and I'm concerned that NY might not be the ideal place to be a family doctor. Can anyone tell me about the pros and cons of practicing family in NYC?

Thanks!

I think FP in NYC is like out patient med-peds with women's health thrown in there. You learn many things for educational purposes (like OB) that will be difficult to do as an attending in NY unless you were in academic medicine. You learn to do many procedures that patients have to wait months for, like: derm, colonoscopy, and EEG interpretations. (just examples, people don't go crazy... lol)

I suggest you log onto www.aafp.org, go to the resident section, and look at the directory of residency programs. You can click by state and look at what every program has to offer. For the osteopaths, you can log onto www.acofp.org, and do the same.

Happy searching!

or how bout I do it for you...
allopathic:
http://www.aafp.org/residencies/
osteopathic:
http://www.acofp.org/ResPrgmGuideSearch/ResPgmSearch2.aspx

Unfortunately, family medicine seems to get a bad rep in NYC. I don't know if it's because of the quality of the residency programs or because of the saturation of subspecialists or just the culture of NYC or something else. Perhaps it's what Almondjoy alluded to above, learning lot of things for educational purposes, and thus no real motivation to master things for which there is another specialist readily available for.

Unfortunately, family medicine seems to get a bad rep in NYC. I don't know if it's because of the quality of the residency programs or because of the saturation of subspecialists or just the culture of NYC or something else. Perhaps it's what Almondjoy alluded to above, learning lot of things for educational purposes, and thus no real motivation to master things for which there is another specialist readily available for.

What other motivation do you need? Maybe you need to get a clue, and just spend 3 hours at a health clinic before you provide input on a medical specialty. There is not a specialist in the Northeastern USA that will readily treat the uninsured, or those with subpar insurance, and especially not medicaid patients. There are waiting lists 3 months long to see Derm, GI, or Optho in Queens for Medicaid patients. Right now as I type this. Trust me when I say that there is a need for family medicine in NYC, and there is alot to learn to treat patients, and no we are not learning alot of things for educational purposes with fp, just OB. There is a severe shortage of OB/GYNs for the amount of babies being born due to rising malpractice insurance and the legal liability of helping to bring life into this world. That's why there is an influx of midwives and NPs performing deliveries way more than an FP would be. And PAs performing vasectomies and vericose vein laser treatment, and medical assistants performing laser skin therapy out of derm offices.

The pure ignorance that eminates from this board about FP just disgusts me.

OK, well that is out of my system. Whew!

What other motivation do you need? Maybe you need to get a clue, and just spend 3 hours at a health clinic before you provide input on a medical specialty. There is not a specialist in the Northeastern USA that will readily treat the uninsured, or those with subpar insurance, and especially not medicaid patients. There are waiting lists 3 months long to see Derm, GI, or Optho in Queens for Medicaid patients. Right now as I type this. Trust me when I say that there is a need for family medicine in NYC, and there is alot to learn to treat patients, and no we are not learning alot of things for educational purposes with fp, just OB. There is a severe shortage of OB/GYNs for the amount of babies being born due to rising malpractice insurance and the legal liability of helping to bring life into this world. That's why there is an influx of midwives and NPs performing deliveries way more than an FP would be. And PAs performing vasectomies and vericose vein laser treatment, and medical assistants performing laser skin therapy out of derm offices.

The pure ignorance that eminates from this board about FP just disgusts me.

OK, well that is out of my system. Whew!

So, and I ask this with respect, can you make money in NYC treating the patient population you describe?

this question could be answered for regarding all specialties.

You can make money in NYC by treating the same patients that all other primary care physicians make. The income is comparable to IM. You can make even more money by becoming certified in procedures as a resident, and NYC residencies in FP afford residents ample patients to treat in an outpatient setting. That is what I was trying to relay when I mentioned the lack of specialty treatment for Medicaid patients. I didn't think I had to spell it all out, but I will.

Why doesn't anyone ever question IM salary in NYC? Its the same as FP. Maybe IM is a sexier field, but all that inpatient medicine depresses me....

A doctor that chooses to treat only federally insured patients will make less money than a doctor treating privately insured patients. This income can be supplemented by teaching, or going into private practice, or by doing research. This may not be the choice for all people, but it is an option for all specialties.

So, no you won't make as much money treating patients and relying only on the government to pay you. Many physician's spend only 2-3 half days in clinics while spending the rest of their time in private practices. But as a resident, this affords you the ability to perfect procedures that will equate to increased pay in your future practice.

aafp.org has some great articles on how procedures boost pay, since that is all everyone cares about.

aafp.org has some great articles on how procedures boost pay, since that is all everyone cares about.

True, and I find it really kind of puzzling. There are SO many fields where you can make so much more money, and work less, have less stress, fewer divorces, etc. than medicine.

The money argument is SO last week. It's been hashed and rehashed. I think we're all pretty much beyond it at this point, at least if we've chosen FP.

By the way, I did a rotation in the Bronx and worked with some amazing family docs there. They could totally hold their own against the medicine docs. In many ways, urban medicine is similar to rural medicine. Seems like you can do a lot more than you could in a well-heeled suburb, if you are willing to get your hands dirty and spend some time in the hood. :)

It saddens me. I am one of the few people that chose a field where I get to help people that are often ignored in society. Alot of you people that post have no idea that there is a whole subset of society that has no/or little access to basic care. That is what I chose to do for a living. I can do this and still make a six-figure salary while working 40hrs a week doing FP in NYC. I'll most likely work 60-80 hrs, and I am sure my pay will be adequate.

There are so many ways to make money. But I won't make it on the backs of poor, sick people. I'd rather invest in the market and real estate for that.

I just hate how an innocent question turns into some crass thread on the demise of primary care everytime it's answered in a genuine way.

Anyone that is looking into FP for the money is laughable, and clueless. Go into something else, please, and let us provide healthcare to the masses. If you are so unfortunate to scramble into FP, well then you deserve it. It may turn you into a real human being for once in your life.

I try to stay out of alot of these discussions for a reason, but I guess I was caught in the haze of matching, and wanted to pass on my experiences to the rising classes.

Go figure.

It saddens me. I am one of the few people that chose a field where I get to help people that are often ignored in society. Alot of you people that post have no idea that there is a whole subset of society that has no/or little access to basic care. That is what I chose to do for a living. I can do this and still make a six-figure salary while working 40hrs a week doing FP in NYC. I'll most likely work 60-80 hrs, and I am sure my pay will be adequate.

There are so many ways to make money. But I won't make it on the backs of poor, sick people. I'd rather invest in the market and real estate for that.



You go, AlmondJoy. You are not alone. There are plenty of people who still want to do this. It's so hard, because at every turn we are laughed at and scorned for retaining our idealism. But I can tell you I have seen docs out there doing what you and I want to do and they are HAPPY. They get to make a difference in the world and they make a fine living and at the end of the day they can look back and feel good about their day's work.

I don't understand the rush to criticize and put down primary care, especially by those who have chosen not to do it. Why should they care what the rest of us have chosen? Maybe there is some nagging guilt there about setting up shop in a well to do suburb that is already saturated with cardiologists, plastic surgeons, etc. while the masses keep crowding urban ERs for their basic care. Or maybe FP bashing is just a popular sport that makes you look cool.

Out of curiousity, what is the difference between family medicine and internal medicine? (I'm pretty early in my medical education so I don't know the difference!) Thanks!

Out of curiousity, what is the difference between family medicine and internal medicine? (I'm pretty early in my medical education so I don't know the difference!) Thanks!

FM sees kids, general IM does not. FM sees OB and Gyn patients, IM generally does not. IM is a route to medical specialty fellowships like cardiology, etc (basically any of the -ologies). FPs get more and better outpatient training. Those are the major differences.

Out of curiousity, what is the difference between family medicine and internal medicine? (I'm pretty early in my medical education so I don't know the difference!) Thanks!

That is one of the frequently asked questions. :)

http://forums.studentdoctor.net/showthread.php?t=158415

Basically FP is broader in scope than IM and includes minor surgery,
obstetrics and pediatrics. An FP can be the town doctor who does it all. IM is adult medicine only and doesn't include OB or Surgery. IM can subspecialize in many fields like cardio, pulm, or gastro.

I don't understand the rush to criticize and put down primary care, especially by those who have chosen not to do it. Why should they care what the rest of us have chosen? Maybe there is some nagging guilt there about setting up shop in a well to do suburb that is already saturated with cardiologists, plastic surgeons, etc. while the masses keep crowding urban ERs for their basic care. Or maybe FP bashing is just a popular sport that makes you look cool.

Specialists think of FP's as outpatient doctors ONLY. They are considered by many people to provide nothing more than society-wide triage. They take care of everything that isn't life-threatening and also anything that can actually be taken care of by any doctor, most nurses, any PA and even some well-educated lay people. Anything serious, anything actually life-threatening...leave it for specialists.

Aside from that, many FP's see themselves as capable of doing more than simple outpatient medicine, and still apply for privledges at hospitals for OB and inpatient work including ICU stuff. To many specialists, this is laughable. In their mind, no doc who works mostly out of an office is going to be able to manage the infusion rates and respirator settings of even a basic patient in need of critical care. Specialists have to work extremely hard just to keep up with the knowledge base in their tiny hamlet of the vast geography of medical knowledge. They read constantly, just to keep up. So when a doc comes in thinking he/she knows enough to also take care of patients in their field, most are pretty disdainful. It's hard not to be. Same is true for FP's when they interact with PA's or NP's who are attempting to fill the traditional role of an FP.

IMHO, it comes down to feeling threatened. OB's spend millions of hours doing OB, and then have to deal with unlicensed midwives who say they can take care of most patients having babies...and throw in the criticism that doctors are out of touch to boot. So the OB who just sacrificed his/her life on the altar of medicne, is getting beat out by someone who didn't sacrifice nearly as much and is doing the same work. It isn't fun to spend years of your life learning obscure facts about a field, only to find that what you know isn't all that practical, and that for all your knowledge, many people with lesser training can actually do it just about as well as you.

Specialists think of FP's as...

It never ceases to amaze me what they don't teach in medical school these days. :rolleyes:

In the Real World, the relationship between a good primary care physician and a good specialist is very synergistic. Neither does what the other does, nor would they want to. Their skills are complementary, not competitive, and neither could function optimally without the other.

Anyone who finds that this isn't the case needs to do some serious introspection to see if perhaps they're the reason.

Had an endocrinologist say something similar to what was in my post directly to me once when I told him I wanted to go into FM.

"There's no way you could stay current on all that you need to know..." blah, blah.

Of course, not ALL specialists think this way. But I think many do.

"There's no way you could stay current on all that you need to know..." blah, blah.

Let's face it, many people are intimidated by a specialty of breadth. Some people really have a hard time saying "I don't know," and trust me...that's not an admirable quality in any physician. There are many reasons why family medicine isn't for everyone, and that's just one of 'em.

Of course, anyone who actually does family medicine understands exactly what's entailed in keeping up, and it's no more formidable a task than that confronting any other specialist.

If being a doctor has taught me anything, it's that the more mankind learns about the human body, the more we realize how little anyone actually knows.

It isn't fun to spend years of your life learning obscure facts about a field, only to find that what you know isn't all that practical, and that for all your knowledge, many people with lesser training can actually do it just about as well as you.

Hee hee! That's the secret...that's what we know that they don't. Not true for every FP, but for the good ones, the ones trained in unopposed programs, with sick patients in big county hospitals, or even those in smaller, good community programs, we can handle those vent settings. We can handle the deliveries. We can run a code. Not to say we always know WHY we know what we know...that is for the "specialists".....suffice it to say we've got your back, Dr. OBGYN, Dr. GI, Dr. Endo, Dr. EM, in the most common 90% of disease you can throw our way. The other 10% we'll happily leave to the "specialists"....

Hee hee! That's the secret...that's what we know that they don't. Not true for every FP, but for the good ones, the ones trained in unopposed programs, with sick patients in big county hospitals, or even those in smaller, good community programs, we can handle those vent settings. We can handle the deliveries. We can run a code. Not to say we always know WHY we know what we know...that is for the "specialists".....suffice it to say we've got your back, Dr. OBGYN, Dr. GI, Dr. Endo, Dr. EM, in the most common 90% of disease you can throw our way. The other 10% we'll happily leave to the "specialists"....

Then after 10 years of practicing in the real world everything you learned is obsolete. Just playing Devil's Advocate ;) Just because you are trained to do something and can do something doesn't mean you should. As rural america slowly contracts I a can imagine the role of the rural family doc will change as well. People aren't all of sudden going to start suing less and insurance companies aren't going to decide they are done screwing physicians.
My family doc in undergrad thought the area he first practiced in was rural, ~460 people. He thought he would be doing deliveries and seeing his patients in the hospital for the rest of his career. Malpractice forced him to stop delivering and insurance companies plus the hospital made it next to impossible to see his patients in the hospital. He was all but forced to surrender his patients to the hospitalist group that just so happened to contract most the major carriers the hospital accepts. Hospitals love hospitalists. They make money. But they never did take away his admitting privilages. He just figured what's the point in keeping them. I asked him if he thought about moving. His reply was it is just a matter of time before it happened again.

Just because you are trained to do something and can do something doesn't mean you should.

If you're planning to be a proceduralist, that's good advice. ;)

My family doc in undergrad thought the area he first practiced in was rural, ~460 people. He thought he would be doing deliveries and seeing his patients in the hospital for the rest of his career. Malpractice forced him to stop delivering and insurance companies plus the hospital made it next to impossible to see his patients in the hospital. He was all but forced to surrender his patients to the hospitalist group that just so happened to contract most the major carriers the hospital accepts. Hospitals love hospitalists. They make money. But they never did take away his admitting privilages. He just figured what's the point in keeping them. I asked him if he thought about moving. His reply was it is just a matter of time before it happened again.

I'm sure that anecdotal example is true. And I'm sure there are others for whom that is true. I'm just going from what I am seeing in my region. I've actually spent a lot of time in small towns doing rotations over the past 3 years (our rural track program starts in 1st year). So, I do have some basis in reality for what I want to do in my area. Not that it won't change...everything changes. But to not go into the field that attracts me for fear it will change is just silly.

On the flip side, I've heard a number of anecdotes in the past year about FM grads with OB getting offers for $250,000 plus by rural hospital networks in my area who also pay their malpractice. They do OB, ER, inpatient, etc.

Medicine is regional, and it's a very big country.

IMHO, it comes down to feeling threatened. OB's spend millions of hours doing OB, and then have to deal with unlicensed midwives who say they can take care of most patients having babies...and throw in the criticism that doctors are out of touch to boot. So the OB who just sacrificed his/her life on the altar of medicne, is getting beat out by someone who didn't sacrifice nearly as much and is doing the same work. It isn't fun to spend years of your life learning obscure facts about a field, only to find that what you know isn't all that practical, and that for all your knowledge, many people with lesser training can actually do it just about as well as you.

Just a minor comment. In my experience CNMs (certified nurse midwives = RN plus midwifery) work side by side with the ObGyns handling all aspects of the uncomplicated deliveries. They have to cooperate because the midwives often have to hand off patients to the ObGyn if a C section is required.

I'm sure that anecdotal example is true. And I'm sure there are others for whom that is true. I'm just going from what I am seeing in my region. I've actually spent a lot of time in small towns doing rotations over the past 3 years (our rural track program starts in 1st year). So, I do have some basis in reality for what I want to do in my area. Not that it won't change...everything changes. But to not go into the field that attracts me for fear it will change is just silly.

On the flip side, I've heard a number of anecdotes in the past year about FM grads with OB getting offers for $250,000 plus by rural hospital networks in my area who also pay their malpractice. They do OB, ER, inpatient, etc.

Medicine is regional, and it's a very big country.

I was referring to the state of PA. The midwest is a different story. While my reference was anecdotal I would bet my first born he was not the first and won't be the last it will happen to. Lets just hope you get to practice the way you want for your entire career.

I was referring to the state of PA. The midwest is a different story. While my reference was anecdotal I would bet my first born he was not the first and won't be the last it will happen to. Lets just hope you get to practice the way you want for your entire career.

I'd be willing to bet MY firstborn that NOBODY has their practice just the way they want for their entire career. We get older, our priorities change, or we get bored. We go back and get different training. Our patient population changes, and we change with it, or we switch careers. That's life. All you can do is follow your heart right now.

This is career #2 for me so I have no delusions of finding perfection in anything. I loved music while I was in it. When I no longer loved it, I found something else to do. The great thing about family medicine is that it offers so many possibilities. There's always a way to do something new and different if you get bored.

Cruise ship doctor might be fun once things in rural medicine get boring...:)

Cruise ship doctor might be fun once things in rural medicine get boring.

I think those folks are required to know how to do emergency surgery (e.g., appendectomies, c-sections, etc.) I understand most of those jobs are filled by Europeans.

I think those folks are required to know how to do emergency surgery (e.g., appendectomies, c-sections, etc.) I understand most of those jobs are filled by Europeans.

Naaaah. They take all kinds. I knew two docs who did it and thought it was cool for awhile. One was a rheumatologist, one a FP.

They take all kinds.

Good to know, just in case. ;) Here's an article (http://www.touchbriefings.com/pdf/858/ACF7B2.pdf) I ran across online that seems to confirm that.

Cruise ship doctor might be fun once things in rural medicine get boring...:)

On that note, I just ran across this article on that subject from NYTimes.com:

April 11, 2006
The Doctor's World
Doctor of the Deep: The Challenges of Shipboard Medicine
By LAWRENCE K. ALTMAN, M.D.

ABOARD THE ZUIDERDAM, in the Caribbean — As a cruise ship physician, Dr. Gary Razon's most harrowing moments are when passengers and crew become injured or seriously ill hundreds of miles from shore.

Sudden life-threatening emergencies like internal bleeding, heart attacks, strokes and broken bones can leave little, if any, time to divert a ship to the nearest port. The challenge for a ship's doctor is to stabilize a patient until the ship reaches land.

Not long ago, untrained crew members aboard passenger-carrying freighters followed radioed instructions while doubling as ship doctors in responding to medical emergencies. Now, with the growth of the cruise ship industry, many ships have staff doctors and nurses aboard who work in well-equipped infirmaries.

Through the Internet, the doctors have access to telemedicine to send difficult-to-interpret electrocardiograms and X-rays, and they can consult specialists about problems that occur aboard the ships, which often carry more than 2,400 people. But the doctors do not perform surgery.

In extreme emergencies, helicopters transfer patients to hospitals on land. But with no helicopter pads on most cruise liners, such transfers "are quite hairy and downright dangerous," said Dr. Razon, who has conducted five such transfers in his three and a half years as a ship's doctor for Holland America.

A helicopter may have to hover over the bow of a vessel pitching in high seas and buffet stiff winds, while parajumpers lift a sick passenger into the craft, said Dr. Razon, who is certified in two specialties — pediatrics and emergency medicine — in the Philippines.

In the infirmary, Dr. Razon, 43, recalled some cases, amusing and serious.

One man nearly bled to death from a common bowel disorder, diverticulitis, on a run from San Diego to Hawaii last year. The man suddenly became anemic from a loss of red blood cells, his blood pressure fell and his heart rate quickened.

"We got very, very worried for him and we searched for blood donors" while his team injected saline intravenously to stabilize his circulatory system, Dr. Razon said.

From a data bank, he found that the man had an uncommon blood type, A negative, and that only the captain had the same one. Dr. Razon transfused a unit of the captain's blood, and the man's condition improved.

He went to a hospital after the ship docked at Hilo nearly two days later. (If the man had needed more blood aboard ship, Dr. Razon said he would have asked for donations from crew members with O-negative blood, which allows them to be universal donors.)

"That was one of the hairiest cases I ever had," Dr. Razon said.

Two weeks later, when the ship returned to San Diego, the captain happened to look down from the bridge and spot the former passenger claiming his luggage at the terminal. The captain went down to the pier where, according to Dr. Razon, the man said: "I am in the pink now. You saved my life."

While the ship was sailing in 35- to 40-foot seas off the Norwegian coast in 2004, a toolbox fell on an engine room worker's head, splitting his scalp. Dr. Razon was seasick, and each time he threaded a needle in the lurching ship, the suture fell out. It took him an hour and a half to do a 15-minute procedure.

Dr. Razon also checked the man's neurological functions every six hours until an M.R.I. scan could be performed ashore in Norway. It showed no brain damage.

Last year, a woman broke her hip in a storm between Hawaii and the mainland. "A really wide lady came down the steps trying to find a seat in the darkened show lounge when the ship lurched and she fell, landing between a railing and a wall," Dr. Razon said. Summoned to the scene, Dr. Razon found that "she was literally wedged in, screaming in pain."

The show stopped. In a test of the crew's agility and ingenuity, Dr. Razon supervised the eight stewards it took to dislodge the woman and carry her to the infirmary. Dr. Razon said he "was so scared because the ship was bouncing and feared she might be bleeding from the hip fracture."

Two days later, surgeons repaired her hip in a hospital after the ship arrived in Seattle.

During a Mexico run, an elderly man came to the infirmary, desperately seeking Viagra. "Buy some when the ship docks tomorrow," Dr. Razon said he told the man, who replied: "No, you don't understand. I can't wait. I need it now."

Dr. Razon responded: "Sorry, we don't have any."

Some incidents reveal how cruel some people can be, even to their own families.

On a Valentine's Day cruise in 2003, stewards called Dr. Razon in his cabin at 2:30 a.m., asking him to see a screaming woman who was stretched across the floor of a lounge.

"She looked at me through her demented eyes and said she had a rare neck disease and there is nothing bleep bleep you can do about it," Dr. Razon recalled.

Dr. Razon agreed and walked away. But, he said, "the woman got up and chased me, saying, "Wait, wait, you have to listen to me." He did, and she ranted about "a roommate from hell."

Then the crew put her in a vacant cabin to allow others to sleep. The next night, the woman put on a repeat performance.Meanwhile, he said, "We discovered that she had been discharged from an institution, lived alone in California and that her nephews flew her across the United States and left her on her own with us."

Dr. Razon could not reach the nephews. From other calls, he learned that the passenger's mother also was also demented. Her nurse provided the name of the woman's psychiatrist, who was skiing. Dr. Razon could not reach the covering physician and sent the woman to a hospital after the ship docked in Nassau.

On most embarkation days, many passengers come by to seek prescriptions for drugs they left at home and can describe only by their color and shape, not their names. Some passengers call their doctors to solve the problem; for others, the ship's medical staff has to play detective to determine the identity of the drugs.

"Our pharmacy is not a CVS, but does have a representation of every class of medication," he said. He tells passengers that "we can provide replacement for a few days and write a prescription so you can buy your medication at the next port of call."

The ship carries about 7,000 meclizine pills for seasickness. But the supply ran out on a recent charter where a vast majority of passengers were on their first cruise, and many became quite sick, Dr. Razon said. So he had to ask nearby ships for additional pills.

Outbreaks of norovirus, an infectious agent that can spread rapidly, have caused serious problems for cruise ships. On New Year's Eve, Dr. Razon said, he had to deal with 144 cases of illness from norovirus. He stopped it by following Holland America's manual on dealing with such outbreaks, which includes "shutting down many facilities and having a specifically trained team of stewards serve affected cabins."

He said he had never needed to exercise his authority to order the ship to turn back, make an unscheduled stop or overrule a ship's captain because of a medical emergency, though he has sought a captain's support to order a sick passenger to leave ship, when a passenger suffered a heart attack on a Mediterranean cruise, but repeatedly refused to go to a hospital in Athens, saying he preferred to die aboard rather than be treated in a Greek hospital.

"He's got to go," Dr. Razon said he told the captain, who gave the man that message.

The man went to the hospital.

While growing up in the Philippines, Dr. Razon said he was expected to follow his three older brothers into engineering but chose medicine in part because his math skills were not as good as theirs.

He became a ship's doctor after a colleague, who was one, whetted his appetite about the chance to see the world while practicing medicine. Dr. Razon said he had traveled to many areas but with less time ashore than he had expected. Still, Dr. Razon said, "Being a ship's doctor is an offer I cannot refuse."

He is divorced. He earns a salary but does not pay for food, rent, clothing or utilities. He usually works aboard ship for about five months and then has about three months off.

On returning to the Philippines, where he is now, Dr. Razon said, he visits his son, Calvin, 8, and wants to "forget work for a while because being on call 24/7 takes its toll."

But then he takes courses to keep up with new advances and covers other doctors' practices for brief periods to renew his skills in everyday land-based medicine and get ready for the next voyage.

You want cruise ship medicine? Join the Navy.

You want cruise ship medicine? Join the Navy.

Since when are MREs considered cruise ship fare? Hmm?

For so very many reasons that I won't dare go into here, someone would seriously have to hold a gun to my head to get me to join the military, especially as a physician.

That said, let's not hijack the thread, please.

Since when are MREs considered cruise ship fare? Hmm?

No MREs on Navy ships. The food is not that bad. At least on the ship I was on.

For so very many reasons that I won't dare go into here, someone would seriously have to hold a gun to my head to get me to join the military, especially as a physician.

Nice to know. I am sure all the women and men in uniform would appreciate that comment.

That said, let's not hijack the thread, please.

Since when do you dictate the discussions that go on here. The discussion transitioned to cruise ship medicine.