Customizing your FM practice

[studentdoctoraubs]

Hey everyone,

I'm not sure if there are already some threads about this, but I'm a 3rd year medical student starting to schedule my audition rotation for next year and I'm still undecided exactly what I want to be when I grow up. I LOVED my pediatrics clerkship, but I'm also really passionate about women's health and know that I'd find a practice that included adults fulfilling. Thinking of possibly pursuing FM to this end, but I'm wondering if it would be possible to tailor an FM practice toward higher numbers of peds/Obgyn patients? Or am I better off just choosing one if I really want a large portion of my practice to be one of these two groups?

Thanks!

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[Sardonix]

The great thing about FM is you can basically tailor your practice to do either of those things... but the downside is you will have to go out of your way to do it. You'll also likely be "competing" with pediatricians and OBGYNs because, well, obvious reasons. You also likely won't see peds in an inpatient setting outside of residency, as even pediatrics are requiring a peds hospitalist fellowship for that kind of practice. If you're really committed to OB, there are FM-OB fellowships after residency, but that would essentially require you to commit to seeing majority OBGYN patients and nothing else.

So again, the great thing about FM is you can do anything. But you have to decide what and it's on you to find/construct a practice that will help make it happen.

 

[AMEHigh]

A bit different perspective from above - lots of faculty and alumni from my FM program are OB-fellowship trained, and most do regular primary care in addition to a decent sized OB panel. I would certainly not describe them as "seeing majority OBGYN patients and nothing else," though obviously YMMV based on region, clinic/hospital system, personal preferences, etc. Doing OB is also a great way to keep your practice relatively young and peds-heavy, because you will pick up a lot of moms, their partners and kids, and the newborns to be their PCP and not just their OB care provider.

Also worth noting that even without the OB piece, you can still do a lot of women's health on the gyn end - even just doing LARC, colpos, etc. will set you apart from a lot of other PCPs (particularly IM trained PCPs) and attract child-bearing age women to your practice.

Yeah ditto this.
I work in a large urban city. Our clinics are full of peds and OB. We obviously get a lot of babies this way. I have no desire to do deliveries anymore, but I do prenatal care. The doctors here that do deliveries still have the full spectrum of other FM patients as well, they're not just doing OB all week.

We're also regularly expanding our reproductive health care services...EMB, colpo, LARC, miscarriage management with D&C, vasectomies, etc. So yes it's certainly possible to find places like this to work without opening up your own practice, the jobs are out there.

 

[Sardonix]

A bit different perspective from above - lots of faculty and alumni from my FM program are OB-fellowship trained, and most do regular primary care in addition to a decent sized OB panel. I would certainly not describe them as "seeing majority OBGYN patients and nothing else," though obviously YMMV based on region, clinic/hospital system, personal preferences, etc. Doing OB is also a great way to keep your practice relatively young and peds-heavy, because you will pick up a lot of moms, their partners and kids, and the newborns to be their PCP and not just their OB care provider.

Also worth noting that even without the OB piece, you can still do a lot of women's health on the gyn end - even just doing LARC, colpos, etc. will set you apart from a lot of other PCPs (particularly IM trained PCPs) and attract child-bearing age women to your practice.

Yeah ditto this.
I work in a large urban city. Our clinics are full of peds and OB. We obviously get a lot of babies this way. I have no desire to do deliveries anymore, but I do prenatal care. The doctors here that do deliveries still have the full spectrum of other FM patients as well, they're not just doing OB all week.

We're also regularly expanding our reproductive health care services...EMB, colpo, LARC, miscarriage management with D&C, vasectomies, etc. So yes it's certainly possible to find places like this to work without opening up your own practice, the jobs are out there.

And to be honest I would default to these opinions over mine, as my only perspective is from my friends and my own impression on the interview trail. It's great to hear that there is more variety than what I initially thought, coming from people actually working in the field.

 

[studentdoctoraubs]

Thank you all for your responses! They are very helpful- It's definitely encouraging to hear from those on the 'other side' of all of this training!

 

[simpler2]

If you want flexibility in location AND to focus on a specific population, I think you will have better luck with primary training specializing in treating that population. If you are flexible regarding location and are more interested in ability to treat many different populations, Family Medicine will serve you very well. You can try to build a more specialized practice in FM anywhere but this can be a gamble. If you hang your shingle in a community that doesn't match the supply you offer with commesurate demand, then you will either need to relocate or be forced to offer whatever services that community needs most.

 

[SLC]

Hey everyone,

I'm not sure if there are already some threads about this, but I'm a 3rd year medical student starting to schedule my audition rotation for next year and I'm still undecided exactly what I want to be when I grow up. I LOVED my pediatrics clerkship, but I'm also really passionate about women's health and know that I'd find a practice that included adults fulfilling. Thinking of possibly pursuing FM to this end, but I'm wondering if it would be possible to tailor an FM practice toward higher numbers of peds/Obgyn patients? Or am I better off just choosing one if I really want a large portion of my practice to be one of these two groups?

Thanks!

You sound a lot like me, I love peds, but I also like family planning and women’s health.

I think it’s really easy to customize a practice to this end. It takes planning and being selective about the job you take, but I’ve done it quite well.

I took a job in a small town, the entire county I’m in has less than 30k people. My town has about 7k.

There’s a college here, and there are tons of young families.

When I interviewed, they needed docs in 3 clinics in this county. I had my pick. I toured each clinic, and observed a few hours. The town just north of where I am seemed full of the stereotypical rural crowd. Lots of Skoal can rings, big trucks, and lots of meth.

The town just south of where I am had mostly geriatrics, tons of hyper-conservative 80’ish year olds with strange ideas about healthcare. You know the type, they come in with a folded up 8.5x11 paper with a list of items they’d like to discuss during their visit; then proceed to tell the doc they don’t like to take meds, and they think they have a salve at home for that. I wasn’t excited about that crowd either.

The town I’m in had the college, tons of young folks. The college also brings a different demographic to the town in terms of college professors etc. People took better care of themselves, people were a bit more open-minded, and so I came here.

I take inpatient call, we have no pediatricians In our hospital so I do almost all the newborn rounds. There are two FM’s doing OB here, but with the OBGyn nearby, most women see him for their pregnancies. More often than not, the mother and father have no established PCP, and have just seen the OBGyn. So when I see the baby, I invite them all into my practice. 99% of the time they gladly accept. I get a kid to care for, and a young couple. Which means I can talk about family planning at the peds follow-up visit with mom since our OBGyn isn’t very good about doing that, he also isn’t very interested in Gyn, seems to only want to do deliveries. Most women just come back to me with any Gyn complaints, even if they’ve seen him for Obstetrics.

I also frequently admit and manage peds on the inpatient floor when I’m covering the inpatient service because again, there aren’t any Pediatricians here. Some of our FM’s are afraid of these cases. But I got excellent peds training and it’s been fine.

I also have the college students, I have hundreds of young (18-23yo) females on my panel. This crowd really appreciates a frank discussion about sexual health and contraception. Usually it’s a UTI or an STD scare that gets the conversation started. I must’ve placed 100 Mirena’s already in the 18months I’ve been here. I keep a large jar of condoms and paper bags in all my exam rooms for patients to take too. Word spreads fast on campus, and now it’s not at all uncommon for a young woman to show up for her first visit requesting an IUD or nexplanon because her friend already got one and told her it was a good experience.

I don’t even do obstetrics, at all, and I’ve got just the practice I was looking for. My panel skews overwhelmingly toward the 40 and under crowd and is probably 65-70% female or pediatric.

So yes, FM can set you up for a practice you want. It’ll just take some “recruitment” on your part. I work pretty hard to find and recruit the patients I want. It doesn’t mean I don’t have some people outside the demographic I’m most interested in, but I definitely have stuff I’m Excited about doing almost every day.