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A day in the life of a Family Medicine doctor

Discussion in 'hSDN' started by smq123, 11.26.12.

  1. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Some people on hSDN had expressed an interest in finding out what a typical day in different specialties are. I'm a Family Med doctor, which is a field that most people have personal experience with, but gets a bad rap on SDN. So I figured I'd talk a little bit about what I do on a daily basis.

    As a family doctor, we're trained to see people of all ages, from pregnant women, to newborns, to adults, to the very elderly. We're also trained to work in either a hospital or in an outpatient office, although many (not all) will choose one or the other. Some will also work in urgent care centers or nursing homes.

    Family Medicine is one of the shorter paths in medicine - 4 years of undergraduate work, 4 years of medical school, and then 3 years of residency. Some people will do a 1 year fellowship in sports medicine, geriatrics, palliative care, or additional training in obstetrics.

    Personally, I see mostly adults, and only see patients in an office. My hours are, pretty consistently, from 8AM to 5PM, 5 days a week. I have my weekends off and do not have to see patients in the ER in the middle of the night. I work in a Federally Qualified Health Center in Florida. The patients we see are quite poor - most are on some kind of federal or state insurance (Medicaid, Medicare), while the rest have no insurance at all.

    7 AM - I typically try to leave the house at 7AM, so I can get to the office at 7:30. I'm a morning person, and I like having that empty half hour to review lab results and go over phone messages. I'm the only person in the office who does this, though.

    8 AM until 5 PM - I see patients, every 15 minutes, starting at 8. Some patients need more than 15 minutes, and some will need less, so it mostly balances out. I'm generally finished seeing patients by 11:15, so I have time to finish paperwork before lunch. The same goes for the afternoon - I generally finish patients at 4:30, so I can finish charts before 5.

    I see a wide variety of patients, and never know what is going to walk through the door. Some of it is routine (physicals, pap smears, blood pressure, diabetes, arthritis), and some of it is fairly exotic (MS, chronic pancreatitis, lupus, epilepsy). There is a lot of uncertainty, because patients come in with vague symptoms that could represent any number of things. Part of the challenge of medicine, particularly general medicine, is learning how to live with that uncertainty.

    Where I work, I get little help from specialists. Because most of our patients are uninsured or have terrible insurance, they cannot afford to see specialists for their care, and need to have their Family doctor manage it instead. And while that is intellectually rewarding, it is also somewhat stressful to be pulled out of your comfort zone constantly, numerous times over the course of a day. As you become more experienced, your comfort zone gets bigger, but it's a process.

    5:30 PM - I'm almost always on my way home. I rarely need to be in the office later than this.

    When I get home, I try to read, go to the gym, cook dinner, etc. But work is done until the next morning.

    10 PM - I go to bed early, because if I don't get a good 8 hours, I don't feel sharp seeing patients. And when you see 20 patients a day, being sleep deprived is a recipe for disaster.

    That's pretty much my day in a nutshell. If you have any questions, feel free to post them here!
     
    Aerus and Ramo711 like this.
  2. FCMike11

    FCMike11

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    Hey very informative post....was curious how does the lack of insurance effect your reimbursements?
    Or is the clinic you mentioned you work in provide you a predetermined salary?

    Sent from my SAMSUNG-SGH-I747 using Tapatalk 2
     
  3. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    All the doctors here get paid a pre-set salary.
     
  4. I'm No Superman

    I'm No Superman MS-Paint

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    Thanks for doing this.

    I have two questions:

    1) what would you say is your favorite aspect of your career?

    2) How much work, if any, do you do on the weekends (paperwork etc.)?
     
  5. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    None. I finish up my charts before I leave on Friday.

    Our clinic is open on Saturdays, so I see patients on Saturday once every 6 weeks. If that happens, I get the following Friday off, as a "compensation day."

    I like medicine - I think it's an interesting subject, and patients are generally pretty interesting. It's an intellectual challenge, and I like that.

    I like that, where I am now, I can do small procedures like skin biopsies, wart removals, etc. I like doing procedures like that.

    When you really get to help someone, even if you didn't cure them, that feels good. Making a real connection with a patient can be enormously gratifying. And it sounds cheesy, but to have a patient walk in and say, "I want to see MY doctor....Dr. SMQ," that's a good feeling, too.

    I like the variety. Each day is different, and you can never be sure exactly what will walk through the door.

    Family Medicine is in huge demand. I have had friends from residency who went wherever they wanted. New England? No problem. West Coast? Sure. Staying in metropolitan Philadelphia/NY/DC? Absolutely. If you want to go somewhere more exotic, like Hawaii or Alaska, people will fall over themselves to recruit you. This is definitely not the case in some other specialties.

    I'd be lying if I didn't say that I'm eternally grateful to be in a job where I make a pretty comfortable living. I don't have any loans (did one of the federal primary care scholarships....a HUGE plus to being in primary care), so whatever income I make is mine, not the government's (or the bank's). I can pay all my bills, throw a lot of it into savings, and give my parents a good chunk every month to augment their retirement income. Family Medicine doesn't pay as much as some other fields, but if you consider the hours (no weekends, 40 hours a week, regular daytime hours), the relatively quick duration of training, and the lack of loans, it isn't a bad deal. I may never own a house in the Hamptons or anything, but that's fine with me.
     
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  6. I'm No Superman

    I'm No Superman MS-Paint

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    Thanks a ton for this SMQ. I hope someday I can contribute things like this to the forum.
     
  7. RuralPhysician8

    RuralPhysician8

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    First off thanks for taking the time to post this thread, even if you only work around five days a week I am sure you have other things to do. As you might guess from my username, I am very interested in pursuing a career as a primary care physician practicing within rural populations that are in need and I was wondering if you would mind weighing on a few questions...
    1. I would like to participate in a few medical aid based mission trips to rural regions of Latin America. In regards to gaining experience, actually helping people, and looking good when it comes time to apply to medical school, what would be an adequate amount of time to spend in the service?

    2. Do you recomended a particular book on the practice of family medicine? I am putting my Christmas list together.:)

    Thanks again.
     
  8. Shinobiz11

    Shinobiz11 Living the dream

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    Thanks for the post. I originally wanted to go into FM, but I found about podiatry. They are very similar regarding schedule and patients, but I just enjoy the surgery aspect that comes with the specialty along with the biomechanics; I still wouldn't mind being an FM though. It's true they get a bad rap, people just think about money and "prestige"....sigh.
    Quick question! Do you refer all of your foot problems to a pod? Or do you take care of some of the simpler ones yourself? One of my pod mentors told me they obviously get a lot of referrals from the GP's or FM's from local clinics, I just wanted to know how much an FM would actually attempt to handle themselves.

    I would also love to do something like this in the future. You ever think about doing of the 20 Questions Articles for this site?
     
  9. Arijos0222

    Arijos0222 "The Opportune Moment"

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    Thank you for the informative post. Very intriguing!

    Would you say that the majority of FP Physicians have the same hours as you?
     
  10. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    1) In terms of gaining experience, a month is probably plenty. In terms of helping people? You'll probably feel like you need a lifetime. ;)

    2) I don't use a textbook. If you're interested in family medicine, I highly recommend the journal published twice a month by the American Academy of Family Practice. (http://www.aafp.org/online/en/home/publications/journals/afp/subscriptions/afp-subscribe.html) This journal is what we all use.

    I take care of the simple ones that don't require surgical intervention - mostly skin infections or warts. In residency we would remove our own toenails; we don't have a toenail elevator here, though, although we're working on buying one. Anything else gets referred out.

    I can't say for sure. FP physicians who are in a similar practice environment (all outpatient) do. The FP physicians who do nursing home or ER or hospital rounds or OB have significantly worse hours (but make much more).
     
  11. nburnett3

    nburnett3 MS-4

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    Why do you say FP gets a bad rap on SDN? I haven't actually been on here in a while but is it just because FP is less competitive than other specialties?
     
  12. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    In some of the other forums, a lot of people say that it's not very intellectually challenging, not very difficult, and easy enough that a NP or a PA should do it, not a physician. And other people say that FP is only about figuring out which specialist to refer the patient to, not actually taking care of anything yourself.

    If you wanted to do it poorly, then yes, it's easy. But that's true of pretty much any specialty. I wish it were only about referring patients; my day and my charts would be so super easy. I wouldn't have to keep reading to keep up on the latest treatments or diagnostic methods. It'd be awesome (if a little boring). But that's not the reality for most of the FP physicians that I know.
     
  13. Fuarky

    Fuarky

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    I have questions about someone choosing to go Family medicine and sports medicine fellowship route? What are hours like for that?? What kind of work do they do?? How would you say it is for someone who is a sports enthusiastic??
     
  14. RuralPhysician8

    RuralPhysician8

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    Thanks for answering my questions. I will definitely look into that journal. Also, I am trying to find a physician to shadow. I have contacted one private group practice that told me that because they only had one M.D. and a Nurse Practitioner, they did not really have room to move around with a shadower. I have also tried a nearby hospital, but I believe they told me that it would be a patient privacy violation. So any advice on how to find a physician to shadow? Should I contact private practices or entire hospitals?
     
  15. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Sports Medicine is basically non-surgical ortho. They do joint injections, order braces/orthotics, make casts and splints in the office, etc. They will evaluate athletes after concussions. They will also do ultrasounds of joints if needed. They also do a lot of physicals.

    The hours can be worse, in that some Sports Medicine doctors have to cover evening games, if they help take care of a local sports team.

    Some Sports Medicine doctors do ONLY sports medicine, others do a combination of general medicine and sports.

    I think it's a good field for people who are interested and sports, and seems to draw people who would otherwise do ortho, but don't have an interest in operating. Keep in mind, you can do sports medicine from Family Medicine or PM&R.

    You might be better off looking through the pre-allo forum; it's been some years since I have had to find someone to shadow. :oops: I actually didn't even shadow when I was a pre-med.
     
  16. I'm No Superman

    I'm No Superman MS-Paint

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    Rural, have you tried asking the FM doc that your family goes to if you can shadow him?
     
  17. RuralPhysician8

    RuralPhysician8

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    Actually, my primary care is just out of a residency so I do not want to put any extra work on him since he also already has one or two medical students observing him. My parent's primary care physician's office is too far from my home to do frequent shadowing. Thanks for the advice, I will post the question in the pre-allopathic forum.
     
  18. RuralPhysician8

    RuralPhysician8

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    Thanks, I found some older posts that answered my questions.
     
  19. Nascent

    Nascent

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    Are you satisfied with this life? If you could go back what would you change?
     
  20. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Yeah, I would say that I am.

    If I could change things....I would change how long it takes to become a doctor, and how I approached it. I think was too super-focused during college and med school, and didn't really enjoy life during those times. I didn't travel as much as I would have liked, and didn't pursue the hobbies that I liked. I come from an Asian family with a lot of anxiety about "success" and "job security," so there was a lot of external pressure to succeed, and that took away from a lot of the enjoyment.

    Everyone says, "Oh, you can go back and do those things later," but really, you can't. You can't re-live life, and once you've gone so long without doing things that YOU enjoy, it's hard to remember how to, you know, just relax and have fun.

    There's a lot of delayed gratification in medicine. Maybe too much. I'd change that, if I could.
     
  21. acslater99

    acslater99

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    What would you do on a typical day as a undergrad that would force you to not have fun?

    Constant studying?
     
  22. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    I studied a lot. I was a history/"pre-med" major, which was time consuming. Not all med schools accept AP credit, and I was discouraged from repeating coursework that I'd already done, so I was doing things like Quantum Physics and Calculus for Engineers to fulfill my pre-requisites. :rolleyes:

    I lived with my sister to save money for med school. She was a resident at the time, working 120 hours a week, so I did all the cleaning and grocery shopping. (They changed the work-hour rules right as she finished residency.)

    I volunteered, because, everyone says that you need volunteer experience to get into med school.

    I did research (which was also my part time job), so that ate up a good chunk of time each week as well. The consensus at the time was that you "needed" research to get into med school. I don't know if people still say that. I don't use a single thing I learned in my research job in my daily life now. I also, for the record, don't use any of my organic chemistry or biochemistry knowledge, either.
     
  23. duckflyer

    duckflyer

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    smq123 > Thank you so much for your post. I've been trying to learn more about different types of physicians. I'm curious, do you use medical resources during the day? Anything like Up-to-Date, Wikipedia or others to help you figure out a patient case before you decide on the treatment plan or to refer them? If so, which ones do you use the most and, if possible, what situations trigger these and which don't?

    Thanks again for taking the time to be so thorough in your explanation.
     
  24. styphon

    styphon Senior Member

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    I feel like I could contribute something to this as my lifestyle is slightly different from the OP's.

    Monday-Friday I am employed by a Native American tribe, at an Indian Health Services facility, and I can only see native Americans (no exceptions). I am family medicine trained, but I only work at a clinic from M-F. I see Peds, OB, and adults. We have a large diabetic burden, but I also deal with coronary disease, HTN, asthma, auto-immune disease, sport injuries, mental illness, substance abuse. I do minor procedures, such as lesion removal, injections, and in office GYN procedures (IUD, colposcopy, nexplanon).

    My typical day: I get into office at 8 am. I start doing paperwork and computer tasks(refills, reviewing labs, etc) while waiting for my patients to be put in. I try to see a pt every 15-30 minutes.

    I stop for "lunch" when I am done my morning patients, usually 12 to 12:30, I then eat at my desk and do more paperwork/computer tasks. I start seeing patients again at 1:00pm usually stop around 4 to 4:30. I then spend about 30 minutes finishing up paperwork.

    On the weekend, I do an urgent care shift at a private "urgent care center". I start at 9am - and we do walk ins only, no appointments - and our doors close at 9pm and I usually get out 9-10pm. There is very little paperwork as when I am there I do not deal with chronic problems (which are the cause of lots of the paperwork). There is also very little labs to review as most we order are done on site.

    At this location my population is mostly adult whites, but around 10-20% of the patients will be pediatrics. The majority are either injury (fracture, sprains, dislocations, lacerations) or versions of minor infection(colds, mild pneumonia, bronchitis, sinusitis). But I will occasionally get new onset strokes/heart attacks/cardiac arrest/drug OD, seizures, amputations. I do minor procedures here also, but do a lot more laceration repair, abscess I&D, and joint reductions as opposed to the GYN procedures I do during the week.

    I am salaried at both positions (and therefore do not get paid for # of patients or procedures).
     
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  25. as90

    as90

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    Do you mind if I ask what type of salary one could expect working in this setting? Are you in Nevada?
     
  26. styphon

    styphon Senior Member

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    I work in NY. There is an IHS site (usually in multiple locations) in almost every state.

    Salary depends on if you work for IHS (a federal program) or for the local tribe (who are likely to pay more). Although I work for the local tribe, we are an IHS facility.
     

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