Direct Primary Care After Residency

[deleted480308]

Well, you could just randomly show up and ask for an availability and sit around until the spot opens up.

which is something that I've never had a problem finding a doctor willing to accept...I admitted I was a demanding patient

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[Doctor4Life1769]

which is something that I've never had a problem finding a doctor willing to accept...I admitted I was a demanding patient

This is true.
You definitely wouldn't have that problem in a DPC ran by NPs. Oh good lord if some greedy physician opened the door to mid levels into DPC I would gauge my eyes out.

 

[VA Hopeful Dr]

I don't know how you sell "enhanced care" to patients and then have them see an NP all the time. I'm a demanding patient, but I wouldn't buy that

Yeah that's the whole reason I don't plan to employ any midlevels. If I'm offering concierge-level care, most people expect that to be a doctor.

 

[VA Hopeful Dr]

This is true.
You definitely wouldn't have that problem in a DPC ran by NPs. Oh good lord if some greedy physician opened the door to mid levels into DPC I would gauge my eyes out.

In states where they don't have to be supervised, they're already doing it.

 

[Doctor4Life1769]

In states where they don't have to be supervised, they're already doing it.

Wonderful.

 

[surrender903]

Well, you could just randomly show up and ask for an availability and sit around until the spot opens up.

zing!

 

[Ericslv]

This is something I've been looking into for a while. Has anyone ever been to the DPC summit, or planning on going this year? It's in the beginning of July in Kansas City. I'm interested in this model, but utilizing PAs and NPs and outsourcings as much clinic work flow as possible. My vision is to have a clinic that I could see my patients in, and then have maybe a string of other clinics run by "mid levels" that are periodically supervised or function independently, but under the same idea of the low monthly subscription. Of course with the idea of taking a significant percentage of those clinics revenue. If thats possible it would be amazing to work when you want, but also be able to step away months at a time with a passive revenue stream.

So what you are saying is that those PA's and NP's have the same skill set as you. Why do we need you?

 

[Ericslv]

This is true.
You definitely wouldn't have that problem in a DPC ran by NPs. Oh good lord if some greedy physician opened the door to mid levels into DPC I would gauge my eyes out.

You better get ready to gouge your eyes out then. PA's and NP's are the future of primary care.

You still have time to do something else.

The most recent survey showed that 73% of Family physicians would go into medicine again but only 29% would choose Family medicine. 29%.

 

[deleted480308]

You better get ready to gouge your eyes out then. PA's and NP's are the future of primary care.

You still have time to do something else.

The most recent survey showed that 73% of Family physicians would go into medicine again but only 29% would choose Family medicine. 29%.

I think that's the case for the "pay per patient" medicaid/insurance crowd.....but those willing to cash pay for DPC will still expect a physician. I will definitely being shopping for one once I'm making resident money and I have good insurance.

 

[azhrei]

So what you are saying is that those PA's and NP's have the same skill set as you. Why do we need you?

If you're trying to deliver care to an underserved population, wouldn't it be okay to hire NPs and PAs to allow your clinic to serve more patients?

One could maintain their own patient panel, run the clinic, and provide supervision.

 

[Doctor4Life1769]

You better get ready to gouge your eyes out then. PA's and NP's are the future of primary care.

You still have time to do something else.

The most recent survey showed that 73% of Family physicians would go into medicine again but only 29% would choose Family medicine. 29%.

Eh.
They aren't the future of DPC/concierge.
They aren't the future anywhere in family medicine.

 

[Ericslv]

Eh.
They aren't the future of DPC/concierge.
They aren't the future anywhere in family medicine.

Just remember when it happens that it was me who said it would be. All specialist need is someone to do the paperwork and to refer patients to them. NP and PA are doing that now.

 

[Ericslv]

I think that's the case for the "pay per patient" medicaid/insurance crowd.....but those willing to cash pay for DPC will still expect a physician. I will definitely being shopping for one once I'm making resident money and I have good insurance.

There aren't that many who are willing to pay cash. The average dpc can take up to 5 years to ramp up. Plus the system is going to be universal health. Then there will be no need for dpc except for a small group of people who want to pay cash to get in quicker etc. There is not that many of those. The people who sign up for dpc are not the same people who sign up of high end concierge practice.

 

[Ericslv]

If you're trying to deliver care to an underserved population, wouldn't it be okay to hire NPs and PAs to allow your clinic to serve more patients?

One could maintain their own patient panel, run the clinic, and provide supervision.

Yes, it's already being done. That why after some time they will figure out that they don't need you much anymore. Family medicine has been reduced to a referral service.

 

[Aegis]

This is true.
You definitely wouldn't have that problem in a DPC ran by NPs. Oh good lord if some greedy physician opened the door to mid levels into DPC I would gauge my eyes out.

"The best way to predict your future is to create it"

― Abraham Lincoln

 

[VA Hopeful Dr]

There aren't that many who are willing to pay cash. The average dpc can take up to 5 years to ramp up. Plus the system is going to be universal health. Then there will be no need for dpc except for a small group of people who want to pay cash to get in quicker etc. There is not that many of those. The people who sign up for dpc are not the same people who sign up of high end concierge practice.

Really? Because I'm on month 10 and at 50% capacity.

As for universal health coverage, why not ask the Brits how their private insurance system is faring. Here's a hint: quite well. Or ask the Canadians who come to the US for procedures how much they like better access.

 

[VA Hopeful Dr]

Yes, it's already being done. That why after some time they will figure out that they don't need you much anymore. Family medicine has been reduced to a referral service.

Your experience is vastly different from mine, and I'm on my 3rd location since residency.

 

[AvrgPreMedKid]

I am the concierge coordinator/scribe for a well-known physician in a city with population of about 200k. Most people I have sold on our program want a doctor with great credentials/experience when they are looking for a concierge doctor. The doctor I work for didn't start doing concierge until he was about 10 years in, and his current model is actually a hybrid (has about 100 concierge patients and 3000 regular). He's the only hybrid around here I know of. I also plan on doing concierge if I do IM/FM, but I wasn't thinking about doing it straight out of residency. Very interesting to hear people thinking about doing this.

 

[VA Hopeful Dr]

I am the concierge coordinator/scribe for a well-known physician in a city with population of about 200k. Most people I have sold on our program want a doctor with great credentials/experience when they are looking for a concierge doctor. The doctor I work for didn't start doing concierge until he was about 10 years in, and his current model is actually a hybrid (has about 100 concierge patients and 3000 regular). He's the only hybrid around here I know of. I also plan on doing concierge if I do IM/FM, but I wasn't thinking about doing it straight out of residency. Very interesting to hear people thinking about doing this.

As Blue Dog has mentioned recently, this has the potential to be dangerous. If one of your regular patients has a bad outcome, it wouldn't even take all the bright of a lawyer to say "well if they had gotten the level of service of the concierge patients, this wouldn't have happend - Dr. So-and-so only cares about money" and so on.

 

[Ericslv]

Your experience is vastly different from mine, and I'm on my 3rd location since residency.

Didn't you start a DPC practice. I'm guessing you weren't very happy with the places you worked if you started a DPC.

 

[Ericslv]

As Blue Dog has mentioned recently, this has the potential to be dangerous. If one of your regular patients has a bad outcome, it wouldn't even take all the bright of a lawyer to say "well if they had gotten the level of service of the concierge patients, this wouldn't have happend - Dr. So-and-so only cares about money" and so on.

I agree on this. A hybrid model can create a rift. The lawyer can say why are you giving these patients priority. The only answer will be because they paid me more money. If I were him I would transition out of hybrid entirely.

 

[Ericslv]

Really? Because I'm on month 10 and at 50% capacity.

As for universal health coverage, why not ask the Brits how their private insurance system is faring. Here's a hint: quite well. Or ask the Canadians who come to the US for procedures how much they like better access.

The last time you wrote in here you said you were making about 8K net. If you had a regular job you would make about 220. So thats a loss of about 120 for at least 2 years. 240K. I'm not sure if thats worth it.

Regarding the socialized system in UK. It's not relevant. The US is moving in that direction. For good or Bad. So once it's done there won't really be a need for DPC except for those who want to pay more to get in faster etc. Most of your clients at 50 to 70 dollars per month won't really need it because they will be covered.

The concierge guys at 200/months may be able to stick around.

I know you like your DPC. I think it's great but I don't think it's the solution to the primary care healthcare issues in US and I strongly believe the NP and PA's will be the future with MD's just supervising.

As I said earlier, only 29% of the doctors who went into Family medicine would do it again. This last years match has an increase of about 45 more people choosing to go into FM.

And, I don't see anyone breaking the door down to go into DPC. The combined concierge and DPC practice in the US = 3 to 4%.

 

[AvrgPreMedKid]

As Blue Dog has mentioned recently, this has the potential to be dangerous. If one of your regular patients has a bad outcome, it wouldn't even take all the bright of a lawyer to say "well if they had gotten the level of service of the concierge patients, this wouldn't have happend - Dr. So-and-so only cares about money" and so on.

I agree on this. A hybrid model can create a rift. The lawyer can say why are you giving these patients priority. The only answer will be because they paid me more money. If I were him I would transition out of hybrid entirely.

Yeah, I can see that being a potential problem, but our practice is very discreet - it's not like, "Concierge patients over here, non-concierge wait outside." Also, he often ends up giving concierge service to patients who need it. For example, he will spend 30 minutes teaching a new diabetic how to use insulin whether or not they are concierge. Some might say that is proper medicine and how it should be, but when our day is booked full of 15-minute office visit slots, every minute counts. Today, a non-concierge patient had a stat CT which revealed two large masses on the sigmoid and pancreas. Doc added her on the schedule and ended up putting us 30 minutes behind, but it had to be done.

I'm sure he would love to transition to completely concierge. He has had numerous offers from concierge practices in the area, but he does not want to leave his patients who cannot afford it.

 

[Ericslv]

Yeah, I can see that being a potential problem, but our practice is very discreet - it's not like, "Concierge patients over here, non-concierge wait outside." The thing is, he often ends up giving concierge service to patients who need it. For example, he will spend 30 minutes teaching a new diabetic how to use insulin whether or not they are concierge. Some might say that is proper medicine and how it should be, but when our day is booked full of 15-minute office visit slots, every minute counts. Today, a non-concierge patient had a stat CT which revealed two large masses on the sigmoid and pancreas. Doc added her on the schedule and ended up putting us 30 minutes behind, but it had to be done.

I'm sure he would love to transition to completely concierge. He has had numerous offers from concierge practices in the area, but he does not want to leave his patients who cannot afford it.

Most doctors do what you just described. Your practice is not that discrete. And for sure not to an attorney. All he has to know is that it's a hybrid practice.

 

[VA Hopeful Dr]

Didn't you start a DPC practice. I'm guessing you weren't very happy with the places you worked if you started a DPC.

Had to move twice to follow my wife (liked both of those jobs). The third was because I was promised a job in a good FM practice but instead was shunted over to an Urgent Care that sucked the life out of me. After being repeatedly lied to by admin about that job, I swore that I would never be under anyone's thumb like that again. DPC was how I managed that since solo PP is very hard to pull off these days.

 

[AvrgPreMedKid]

Most doctors do what you just described. Your practice is not that discrete. And for sure not to an attorney. All he has to know is that it's a hybrid practice.

Well, I guess it's only a matter of time before we get sued! Good thing I'll be out of here soon.

Are you saying most concierge doctors do that? Hybrid docs? I'm saying that there is not a huge void in level of care between non-concierge and concierge in our practice. Concierge allows you 24/7 access, guaranteed sameday appt with the doc, longer appointments, and a few other perks.

Anyways, the point of my post was to point out that the concierge patients I know are not looking to sign up with a physician fresh out of residency.

 

[VA Hopeful Dr]

The last time you wrote in here you said you were making about 8K net. If you had a regular job you would make about 220. So thats a loss of about 120 for at least 2 years. 240K. I'm not sure if thats worth it.

Regarding the socialized system in UK. It's not relevant. The US is moving in that direction. For good or Bad. So once it's done there won't really be a need for DPC except for those who want to pay more to get in faster etc. Most of your clients at 50 to 70 dollars per month won't really need it because they will be covered.

The concierge guys at 200/months may be able to stick around.

I know you like your DPC. I think it's great but I don't think it's the solution to the primary care healthcare issues in US and I strongly believe the NP and PA's will be the future with MD's just supervising.

As I said earlier, only 29% of the doctors who went into Family medicine would do it again. This last years match has an increase of about 45 more people choosing to go into FM.

And, I don't see anyone breaking the door down to go into DPC. The combined concierge and DPC practice in the US = 3 to 4%.

You didn't mentioned income, you mentioned time to get running. Starting your own practice of any kind always entails an income hit at first, why would DPC be any different?

As an increasing percentage of my patients are already insured, I'm not worried about what universal healthcare will do to my practice. The first few months I got lots of uninsured, now I'm getting mostly insured who are sick of wait times, short visits, and never being able to get anyone on the phone.

As for DPC as a whole, its growing exceptionally rapidly. We went from around 50-ish docs doing it in 2008 to over 5000 in 2014. I don't expect it to completely replace everyone else, but I think it will be a sizable niche if nothing else.

 

[VA Hopeful Dr]

Well, I guess it's only a matter of time before we get sued! Good thing I'll be out of here soon.

Anyways, the point of my post was to point out that the concierge patients I know are not looking to sign up with a physician fresh out of residency.

See I have a large number of patients who come to me because I am young, they think I'm more up to date on the latest evidence (which truthfully, in this city isn't far off) and because they know I'll be able to be their doctor for at least another 30 years.

 

[AvrgPreMedKid]

See I have a large number of patients who come to me because I am young, they think I'm more up to date on the latest evidence (which truthfully, in this city isn't far off) and because they know I'll be able to be their doctor for at least another 30 years.

Mostly young and healthy patients? How much does your program cost?

 

[VA Hopeful Dr]

Mostly young and healthy patients? How much does your program cost?

$50/month, and I'd say about 50/50 healthy v. not healthy

 

[AvrgPreMedKid]

$50/month, and I'd say about 50/50 healthy v. not healthy

Wow, that is a good price. What does that $50/month include?

 

[VA Hopeful Dr]

Wow, that is a good price. What does that $50/month include?

Unlimited office visits, procedures, my personal cell phone/e-mail address, house calls, discounted lab work (CBC $4, lipid panel $7, PSA $11), wholesale prescriptions from the in-office dispensary (z-pack for $2, norvasc for $0.70, depakote for $8/month, lexapro for $3/month to name a few), have negotiated cash discounts with a local imaging center (x-rays including read $30, MRI $460, U/S between $90-120).

 

[AvrgPreMedKid]

Unlimited office visits, procedures, my personal cell phone/e-mail address, house calls, discounted lab work (CBC $4, lipid panel $7, PSA $11), wholesale prescriptions from the in-office dispensary (z-pack for $2, norvasc for $0.70, depakote for $8/month, lexapro for $3/month to name a few), have negotiated cash discounts with a local imaging center (x-rays including read $30, MRI $460, U/S between $90-120).

That's awesome. Are a lot of your patients uninsured? I feel like this kind of practice would dominate if the ACA didn't come along.
I heard that Anthem is working on making this kind of practice illegal, though.

 

[VA Hopeful Dr]

That's awesome. Are a lot of your patients uninsured? I feel like this kind of practice would dominate if the ACA didn't come along.
I heard that Anthem is working on making this kind of practice illegal, though.

About 50% uninsured at this point.

The ACA has actually helped. Lots of employers either stopped offering insurance or made it much more expensive. If you look at the insured numbers (and take away the Medicaid expansion), overall its not pretty. Plus, I have quite a few patients with high-deductible plans (much more common under the ACA than before).

 

[Ericslv]

Well, I guess it's only a matter of time before we get sued! Good thing I'll be out of here soon.

Are you saying most concierge doctors do that? Hybrid docs? I'm saying that there is not a huge void in level of care between non-concierge and concierge in our practice. Concierge allows you 24/7 access, guaranteed sameday appt with the doc, longer appointments, and a few other perks.

Anyways, the point of my post was to point out that the concierge patients I know are not looking to sign up with a physician fresh out of residency.

I agree they want someone with experience.

 

[Ericslv]

You didn't mentioned income, you mentioned time to get running. Starting your own practice of any kind always entails an income hit at first, why would DPC be any different?

As an increasing percentage of my patients are already insured, I'm not worried about what universal healthcare will do to my practice. The first few months I got lots of uninsured, now I'm getting mostly insured who are sick of wait times, short visits, and never being able to get anyone on the phone.

As for DPC as a whole, its growing exceptionally rapidly. We went from around 50-ish docs doing it in 2008 to over 5000 in 2014. I don't expect it to completely replace everyone else, but I think it will be a sizable niche if nothing else.

I think the patients that will get (or are now) sick of waiting etc. will continue to join DPC but those who couldn't afford insurance and can have universal will eventually just go with universal. So at some point in the future you may find yourself rebuilding your practice. Perhaps your attrition rate will simply replace some of the non-insured with insured ones that just want better, quicker care.

The other problem is regulatory issues. We don't know what a universal plan will look like. If it's like Canada you won't be able to charge cash from any patient for covered services. If it's like the UK then you can be private.

As far as income goes, yes it does take time to replace it and that's a hit you have to be comfortable with. Thats what I was trying to say.

But I can say with absolute confidence that it's coming and there is nothing we can do to stop it.

 

[VA Hopeful Dr]

I think the patients that will get (or are now) sick of waiting etc. will continue to join DPC but those who couldn't afford insurance and can have universal will eventually just go with universal. So at some point in the future you may find yourself rebuilding your practice. Perhaps your attrition rate will simply replace some of the non-insured with insured ones that just want better, quicker care.

The other problem is regulatory issues. We don't know what a universal plan will look like. If it's like Canada you won't be able to charge cash from any patient for covered services. If it's like the UK then you can be private.

As far as income goes, yes it does take time to replace it and that's a hit you have to be comfortable with. Thats what I was trying to say.

But I can say with absolute confidence that it's coming and there is nothing we can do to stop it.

As far as the uninsured crowd, I suspect you're right. But as we've seen with the VA (and every socialized medical system out there) quality decreases markedly while wait times skyrocket. I think DPC will do just fine.

I don't see us going the Canadian route, Americans are just too contrary. I also don't see socialized medicine happening anytime soon. Now that might mean 20 years instead of 5, but I'm pretty confident that if it happens most of us here will be close to if not actually retired.

 

[Ericslv]

As far as the uninsured crowd, I suspect you're right. But as we've seen with the VA (and every socialized medical system out there) quality decreases markedly while wait times skyrocket. I think DPC will do just fine.

I don't see us going the Canadian route, Americans are just too contrary. I also don't see socialized medicine happening anytime soon. Now that might mean 20 years instead of 5, but I'm pretty confident that if it happens most of us here will be close to if not actually retired.

I hope your right. I would do DPC but more in between like DPC and concierge. Somewhere in the middle. Charge a little more but not as much as concierge. Put my practice in a area that is relatively affluent but not the super rich or where there is a large enough density that it won't matter. When fishing for cash patients I would want to go where the money is.

 

[Doctor4Life1769]

Just remember when it happens that it was me who said it would be. All specialist need is someone to do the paperwork and to refer patients to them. NP and PA are doing that now.

Incorrect.
A good PCP can help consolidate things. They can go a step forward and possibly reduce that referral rate. They can also help tie together loose ends amongst specialists. I just don't see NPs being all that great at doing so. The value comes with low cost higher quality care, which is where NPs would probably run into issues. I'm not sure about PAs but I don't think they practice independently.

 

[Ericslv]

Incorrect.
A good PCP can help consolidate things. They can go a step forward and possibly reduce that referral rate. They can also help tie together loose ends amongst specialists. I just don't see NPs being all that great at doing so. The value comes with low cost higher quality care, which is where NPs would probably run into issues. I'm not sure about PAs but I don't think they practice independently.

I remember when I was a resident and though like that. But things change.

 

[Doctor4Life1769]

I remember when I was a resident and though like that. But things change.

Perhaps.
I'm unsure how things will go ultimately, but I have landed a job where the respect and the autonomy all goes to the physicians. The NPs/PAs are just that, mid levels. Perhaps I stick around, or perhaps I move in 2-3 years and go the DPC route but we'll see. I think as things continue to shift toward value-based care, physicians will gain the edge.

 

[Ericslv]

Perhaps.
I'm unsure how things will go ultimately, but I have landed a job where the respect and the autonomy all goes to the physicians. The NPs/PAs are just that, mid levels. Perhaps I stick around, or perhaps I move in 2-3 years and go the DPC route but we'll see. I think as things continue to shift toward value-based care, physicians will gain the edge.

I wish you the best in you future career and employments.

I've learned over the years that the words value and quality when coming from govt. or corporation simply translate into how can we save money and pay less.

And don't get me wrong I believe that Family medicine is a great specialty. I am one. But no one else seems to think so and according to the data only 29% are happy with their choice.

I can understand why. You know whats interesting? Foot soldiers are always getting praise for their bravery (and they are brave) but they also the ones that get ordered around the most, have the least power and die first.

 

[VA Hopeful Dr]

I hope your right. I would do DPC but more in between like DPC and concierge. Somewhere in the middle. Charge a little more but not as much as concierge. Put my practice in a area that is relatively affluent but not the super rich or where there is a large enough density that it won't matter. When fishing for cash patients I would want to go where the money is.

And you're likely in the bind that many practicing doctors are - you've gotten used to a certain lifestyle and going from making decent money to much less for a year or more is tough when you have a mortgage, kids, and all that.

 

[VA Hopeful Dr]

Incorrect.
A good PCP can help consolidate things. They can go a step forward and possibly reduce that referral rate. They can also help tie together loose ends amongst specialists. I just don't see NPs being all that great at doing so. The value comes with low cost higher quality care, which is where NPs would probably run into issues. I'm not sure about PAs but I don't think they practice independently.

They can't as they are under the state medical boards, and we are as hell aren't going to let them go independent on us.

 

[VA Hopeful Dr]

I remember when I was a resident and though like that. But things change.

If you don't mind me asking, where roughly are you located? I ask because I think FM's role in the overall health system varies markedly based on geography. I think its telling that the two attendings on this board that post the most and are pretty content (BD and myself) are both in the Southeast.

 

[VA Hopeful Dr]

I wish you the best in you future career and employments.

I've learned over the years that the words value and quality when coming from govt. or corporation simply translate into how can we save money and pay less.

And don't get me wrong I believe that Family medicine is a great specialty. I am one. But no one else seems to think so and according to the data only 29% are happy with their choice.

I can understand why. You know whats interesting? Foot soldiers are always getting praise for their bravery (and they are brave) but they also the ones that get ordered around the most, have the least power and die first.

I don't think the problem is with the specialty so much as with the increasing amount of nonsense associated with all of medicine (pick your favorite government mandated acronym). As the primary docs, we end up having to deal with that more than anyone else.

 

[Doctor4Life1769]

They can't as they are under the state medical boards, and we are as hell aren't going to let them go independent on us.

That's what I figured but didn't want to post something that was potentially outdated information, appreciate the confirmation.

 

[Doctor4Life1769]

I wish you the best in you future career and employments.

I've learned over the years that the words value and quality when coming from govt. or corporation simply translate into how can we save money and pay less.

And don't get me wrong I believe that Family medicine is a great specialty. I am one. But no one else seems to think so and according to the data only 29% are happy with their choice.

I can understand why. You know whats interesting? Foot soldiers are always getting praise for their bravery (and they are brave) but they also the ones that get ordered around the most, have the least power and die first.

I appreciate it.

I agree with VA Hopeful and also wonder where you are located. I'm also in the Southeast (must be a trend here?!) and I have not met a PCP that was not happy with what they were doing as FM physicians. However, the one knock on it is these new requirements (which upfront we'll all likely be compensated for it in a bonus) and the PCMH concept where specialists order procedures but rely on the PCP to attain authorization. That one puzzles me. Nonetheless, I picked a job where I won't be sitting in clinic all day every day seeing 30+ patients a day. I picked one where I can have variety, and I feel variety and volume are two huuuuuuge (I pulled a Bernie) variables involved in physician burn out. I am one of those that NEEDS variety or lower volume to help me not burn out. I'll get to spend a few days in the hospital, few days in facilities, a day in clinic, etc. and it keeps me fresh on everything, still be able to maintain relationships, and at some point if I want to do something else then I can. The times where I'm not in clinic, I don't have to run around between clinic and hospital. It's perfect. The volume I'd see is perhaps 20 facility patients, however many are in the hospital (avg is about 15 maybe 20 on a bad day), and in clinic probably 15-20. Everyone's hitting their bonuses easily. I've also been invited to join the CIN network (involves PCPs, specialists) and play in active role in terms of quality measures/core measures and eventual bonus structures because the group plays an active role in the community by bringing patients into their hospitals and we cut out the hospitalists from the equation.

I am leaning towards a DPC in the future. But, if for some reason I decide the current job I accepted is a great one and I continue to enjoy what I'd be doing - it's nice to know that I didn't just jump onto the first starter job available to me. You also have to pick a job where things aren't corporatized or where new physicians are being burned and churned. Physician respect shouldn't be a lip service, but something that is real. I think you have to truly dig deep and figure out what is best for you else you won't be happy. That's with any career. I had to find out sooner than expected when I switched specialties during residency.

 

[Ericslv]

I don't think the problem is with the specialty so much as with the increasing amount of nonsense associated with all of medicine (pick your favorite government mandated acronym). As the primary docs, we end up having to deal with that more than anyone else.

It's not the specialty. If they left us alone to do our job without interference and without all the excess BS and paid us more we would be fine.

My formula for a happy FP.

Less patients per day. (the only reason people like the NP is because they can spend more time with them and people equate with better care at times).

More money.

Less BS. Done.

 

[Ericslv]

If you don't mind me asking, where roughly are you located? I ask because I think FM's role in the overall health system varies markedly based on geography. I think its telling that the two attendings on this board that post the most and are pretty content (BD and myself) are both in the Southeast.

I'm out west.