Everbody always says Family Medicine is more interesting than it seems, How so?

[EMDO2018]

Our school recruits heavily for their FM program, and they offer paid shadowing internships during the summer. Reps always say, "FM is more interesting than most people think." How so? I have been to FM doctors many times for simple things-sinus infections, strep throat, flu, etc. I have also shadowed a family physician. I assume family medicine doctors go from room to room treating comparable cases, maybe if they are in a rural area they may deliver a baby or two or maybe offer some therapeutic services, etc. Does that about cover it?

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[cabinbuilder]

I think they are trying to say that FP is very versatile: you can do FP clinic, urgent care, ER, hospitalist. Sports med fellowship, pain management fellowship, rural fellowship, OB fellowship, derm fellowship, do heavy peds or no peds, etc. You can be in the city or in a rural location. You don't need staff to practice. You don't need a hospital nearby. There is NO MOLD for what FP does or can do. You can mold your practice how you see fit.

 

[EMDO2018]

I think they are trying to say that FP is very versatile: you can do FP clinic, urgent care, ER, hospitalist. Sports med fellowship, pain management fellowship, rural fellowship, OB fellowship, derm fellowship, do heavy peds or no peds, etc. You can be in the city or in a rural location. You don't need staff to practice. You don't need a hospital nearby. There is NO MOLD for what FP does or can do. You can mold your practice how you see fit.

So a FM doing ER or Urgent Care, this is mostly for rural areas right? I always get this very polar view of FM. One where you get paid 150-180k and can't do much, the other where you are paid 200k-250k and can do some of everything. I have no family now, and I don't think I will ever have one really, so I am comfortable living anywhere in the US. Only think is, my student loans will be around 250k .

 

[VA Hopeful Dr]

So a FM doing ER or Urgent Care, this is mostly for rural areas right? I always get this very polar view of FM. One where you get paid 150-180k and can't do much, the other where you are paid 200k-250k and can do some of everything. I have no family now, and I don't think I will ever have one really, so I am comfortable living anywhere in the US. Only think is, my student loans will be around 250k .

I'm an FP doing Urgent Care in a decent sized city (150k).

I think the take home point is simple - you never know what will walk in your door. In my old practice, I'd go from diabetic check up to yearly pap to joint injection to sports physical to ingrown toenail removal to thyroid disease to "fatigue" work up to "hey I just found this guy's spinal mets from his colon cancer" to admission for COPD exacerbation.

Was that every day? Of course not, but I definitely had days not too far from that. Every branch of medicine is going to have its routine, we just have the broadest routine out there.

 

[cabinbuilder]

So a FM doing ER or Urgent Care, this is mostly for rural areas right? .

No, u r wrong

 

[Prncssbuttercup]

If by rural you mean 'major metropolitan area' then sure.
Here's a rundown of cases I've worked on in my two FM rotations:

Kaposi's sarcoma
HIV
Hep C
STDs
Wound closures
Fracture setting/splinting/casting
Ruptured brain aneurysm (yes, dude didn't want to go to the hospital so he came to our clinic, we had to call the ambulance for transport)
COPD
CHF
Imbedded foreign bodies
Depression
ADD/ADHD
Sinus infections
Colds
Ear infections
Arterial clot
DVTs
Ebola... just kidding... but we did have a lady ask if she had it.
Diabetes
Thyroids


There is TONS of stuff to do in FM. It is what you make of it... literally... if you want to see people in a certain group, then you start to see more and more of those patients... I loved it, it keeps my mind busy because everyday it's something different!

 

[SLC]

​

…Ebola... just kidding... but we did have a lady ask if she had it…

On my most recent rotation I though I might have had an Ebola patient. It was a kid being seen for fever and poor feeding, no apparent source. As I'm interviewing the parents I ask about recent travel and they inform me that they just moved from Liberia. My stomach dropped instantly. Turns out it was about 6 months ago though with no ill contacts since returning.

Glad the kid didn't have Ebola, but it would have been cool to pick that up as a medical student!

 

[NurWollen]

​

On my most recent rotation I though I might have had an Ebola patient. It was a kid being seen for fever and poor feeding, no apparent source. As I'm interviewing the parents I ask about recent travel and they inform me that they just moved from Liberia. My stomach dropped instantly. Turns out it was about 6 months ago though with no ill contacts since returning.

Glad the kid didn't have Ebola, but it would have been cool to pick that up as a medical student!

In more ways than one!

 

[SLC]

In more ways than one!

humor was not as subtle as I hoped eh?

 

[NurWollen]

humor was not as subtle as I hoped eh?

Haha maybe not. But just think... you could have taken a bike ride in front of reporters in obstinate defiance of government quarantine.

 

[Prncssbuttercup]

I caught the punny punness of it... and the normal meaning as well... I see what you did there

I want the damn Ebola vaccine, I'd be more than happy to be in the trial right now!

 

[BruceWilly]

I think they are trying to say that FP is very versatile: you can do FP clinic, urgent care, ER, hospitalist. Sports med fellowship, pain management fellowship, rural fellowship, OB fellowship, derm fellowship, do heavy peds or no peds, etc. You can be in the city or in a rural location. You don't need staff to practice. You don't need a hospital nearby. There is NO MOLD for what FP does or can do. You can mold your practice how you see fit.

Family med can do derm? Why is derm so competitive?

 

[cabinbuilder]

Family med can do derm? Why is derm so competitive?

I'm talking derm fellowship/classes to do laser hair removal, skin peels, botox, etc. Half of what I do in urgent care is derm cases, some rash or itch or infection, etc. Dermatology residency is a whole different entity and you should not confuse that with what FP does. There are not enough dermatologists to meet the demand of the derm cases seem and invariably FP gets the brunt of them. If you can "fix" someone's skin without having to send them a long distance or make them wait 6-12 months for a referral you will be the hero.

 

[MedicineMan99]

Family Medicine is medicine of the broadest scope. This makes it very interesting because you never, ever have to say, "Well, I don't deal with that or see that because I'm a Family Doctor." Many specialists spend their days saying, "I don't deal with that" or "You need to see your primary care doctor for that". In other words, we don't make excuses. In my experience, this makes for the most variety of any medical profession.

 

[Prncssbuttercup]

I honestly can't wait to go into FM. I like to know a lot about a lot of things, and I have a short attention span and like variety...

 

[Roguelyn]

I'll echo what's been said here; Family Medicine is what you make it. My practice IS very interesting. I do traditional cradle to grave outpatient medicine without OB. I am often the only stop for uninsured patients who need care and do my best to avoid referring to specialists. Last week I saw a 1wk old infant, a handful of of well children, a few sick children, lots of STI checks/complaints, new a. fib w/RPR, AIDS, a few new hepatitis C patients I plan to begin treating, several Paps, some pregnant patients for various things and of course, all the regular chronic illnesses: DM, COPD, depression, anxiety, HTN, thyroid, acne, back pain, CHF, migraines, obesity. I never know what I'll be asked to diagnose or treat next. It's challenging and forces me to stay on my game with regular CME.

Not that long ago I was still seeing patients in newborn nursery and in the hospital. That added yet another dimension to my practice.

I have friends who work in affluent areas, do not take uninsured, see only very few Medicaid, only adults, no OB, no procedures and they keep a very routine, mostly healthy practice. I don't find their style very interesting and would likely get bored. But they love that it's straightforward and simple.

So, like I said already, FM is what you make it.

 

[Dharma]

Big complaint I hear from FM docs (one of whom is a friend) is "too much damn paperwork." It's to the point where my buddy is using vacation time to catch up with it. Staying at the office until 6/7pm every night only to spend a bulk of the weekend doing paperwork doesn't exactly sound enticing. How do you guys get around this? There has to be a more efficient means of handling things.

 

[styphon]

Family medicine is different in that you have one of the widest scopes of practice which you can fashion to your needs/wants. I love OB and office based gyn, end of life care, and outpt ortho - so I focus on these.

I do urgent care in a major city (city area population >1million) as a family practice doctor, and I think I am pretty good at it. Besides the URI/sprains - I also remove foreign bodies from eyes/ears/noses/skin/vaginal. I do joint injections, dislocation reductions, displaced fracture reduction, suturing, I&D.

I also work in a clinic - I see peds, OB, and adults. There is a large burden of diabetes, but I also manage Bells Palsy, Lyme disease, miscarriages, abnormal paps (I do endometrial biopsies, colposcopies), pregnancy prevention (I do IUD and nexplanon placement), derm (I do shave, punch, excisional biopsies), and end of life care.

Family medicine is what you make of it. You can do only inpt or only outpt, or a combination. You can do no OB, or do OB + c/sections + outpt gyn procedures. You can do only hospice - or do none.

 

[Prncssbuttercup]

Big complaint I hear from FM docs (one of whom is a friend) is "too much damn paperwork." It's to the point where my buddy is using vacation time to catch up with it. Staying at the office until 6/7pm every night only to spend a bulk of the weekend doing paperwork doesn't exactly sound enticing. How do you guys get around this? There has to be a more efficient means of handling things.

ALL the docs I have worked with complain about the paperwork!

 

[NOsaintsfan]

I've never heard a surgeon or anesthesiologist complain about paperwork. Sure, there are plenty of other issues with both of those fields but paperwork isn't the problem.

Family med is awesome for all the reasons listed above but every field has its downsides, you just have to figure out which downsides bother you the least.

 

[surrender903]

I've never heard a surgeon or anesthesiologist complain about paperwork. Sure, there are plenty of other issues with both of those fields but paperwork isn't the problem.

Family med is awesome for all the reasons listed above but every field has its downsides, you just have to figure out which downsides bother you the least.

i think your sample size is too small then.

 

[Dharma]

ALL the docs I have worked with complain about the paperwork!

So far, it's the FM guys who have been complaining the most. And these are dudes who actually like FM- not the-grass-is-always-greener types.

 

[deleted87716]

Big complaint I hear from FM docs (one of whom is a friend) is "too much damn paperwork." It's to the point where my buddy is using vacation time to catch up with it. Staying at the office until 6/7pm every night only to spend a bulk of the weekend doing paperwork doesn't exactly sound enticing. How do you guys get around this? There has to be a more efficient means of handling things.

Yes, there has to be...and there is. Your buddy doesn't sound very organized.

How do I get around it? I get my notes done while I'm seeing patients. I take care of phone calls, faxes, forms, and whatnot as they come in throughout the day. I don't let them pile up. I refill prescriptions during regularly-scheduled office visits so I don't have to deal with refill requests in between appointments. I prescribe generics as much as possible, and try to adhere to insurance formularies as best I can. That cuts down on prior authorizations, and my staff is trained to handle the majority of the ones I do get. Patients get their labs done prior to follow-up visits for chronic diseases like diabetes, hyperlipidemia, etc. so I can make all of my management decisions during the visit rather than after the fact. I charge a form fee, which cuts down on stupid/unnecessary form/letter requests. I use our electronic patient portal as much as possible. I don't waste time at the office. When I'm there, I'm there to work.

My desk/in-box is usually clean by the time I leave the office, typically by 5:30pm.

I start my day by logging into our EHR from home while having my first cup of coffee, and take care of anything that came in during the night or over the weekend. This takes anywhere from 5 minutes on a weekday to maybe 20-30 minutes on a Monday. Sometimes I'll go online Sunday night instead, just so I'm not pressed for time on Monday morning. By taking care of things before I get to the office, I start every day with an empty in-box.

"We are what we repeatedly do. Excellence, then, is not an act, but a habit." - Aristotle

 

[Prncssbuttercup]

I would think FM docs would have more paperwork, they see far more patients in a day.

 

[deleted87716]

I would think FM docs would have more paperwork, they see far more patients in a day.

Not necessarily. The average number of patients seen in an 8-hour day in family medicine is around 20-25. Many specialists see far more than that, as they're typically only dealing with a single problem.

 

[KnuxNole]

Maybe it's just me as a resident talking, but it's impossible to finish notes while seeing the patient, and usually waits till some time after, or more commonly, after clinic is over. The ONLY way I can see this getting done is if my subjective contains a few words(i.e. not one complete sentence), and my plan has little to no details. Otherwise, there is SO much to document and not enough time

 

[deleted87716]

Maybe it's just me as a resident talking, but it's impossible to finish notes while seeing the patient, and usually waits till some time after, or more commonly, after clinic is over. The ONLY way I can see this getting done is if my subjective contains a few words(i.e. not one complete sentence), and my plan has little to no details. Otherwise, there is SO much to document and not enough time

I've been getting my notes done while seeing patients since I was a resident. It was actually a lot easier back then, as the patient volume was much lower. There was more wasted time in residency clinic, however, as a result of staff inefficiencies (which I had no control over) and the need to talk to a preceptor. Also, since I was still learning a lot, I spent more time looking things up and thinking about management issues. I don't have to do that quite as much these days.

 

[NOsaintsfan]

i think your sample size is too small then.

My sample size is limited to be sure but anesthesia notes are minimal at best and surgeons well they have it a little different (at least where I am).

Sure they document and write notes but often they have a PA/Nurse prectioner round on post op patients and do discharge summaries. The notes they do dictate/write are NOT like family med/internl med notes.

Again this may be just where I am and not the norm.

My big point was that paperwork can be less in other fields however that is with the trade off of other things that many will find undesirable. Every field has some sort of negative.

 

[cabinbuilder]

I almost never get my notes done while doing urgent care (unless I have dictation) as I see up to 50 patients in a 12 hour shift. Plus I do rural urgent care so it never is just that one issue: it's a CT, or an US, xray, splint, laceration, wart excision, setting up consultations, casting, OMT, lab workups, injections, getting someone admitted, calling the surgeon. Heck I tried to dig out a wire in an infected man's toe today without much success. I always seem to get crash and burn patient's that eat up my time. I never have the same staff everyday so most days I never know what they know how to do, etc. It's very inefficient and I gave up a long time ago trying to get the charting done. My saving grace is I cover at an outlying clinic on Fridays where I may see 5-10 patients as walk-in's and I finish up my charting then.

 

[Roguelyn]

@Blue Dog has it right. There's a lot of paperwork, but you can't let it pile up. My colleagues who do the most complaining are the ones who prescribe all the advertised meds their patients want, write for 30 days no refills, do referrals/make appts for patients when the pts are fully capable of calling a specialist themselves, show up late and leave early, let things sit. Those folks end up having to catch up eventually and it can be weekends or vacation time.

I can't charge a form fee (I wish!) but I make patients come in for an appt for paperwork which has cut back up some of the silly requests. I don't have home EHR access (I've been asking for it, though) so I go in 15-30min before the first appt and catch up any overnight/weekend stuff. I do my best to chart everything I can and usually complete charting during appts and never leave without having finished any open charts. My office is astonishly inefficient from a staffing and layout standpoint, but I'm working on convincing the higher ups to allow some reorganization. I finally have my own dedicated nurse so I'm training her to help me be as effective as possible. Thinking and acting on ways to improve efficiency is something more offices should try.

Even in busy urgent care settings you have to plan on getting dictation done quickly. There, though, you don't have nearly as much other stuff coming in. Much fewer refills, PAs, disability, referrals because it should be going back to the PCP. Now, we have a few places in town that do this cross between PCP and urgent care. They want to see 8-12 patients an hour but still manage all these chronic issues in some grand money making endeavor. They can't keep providers despite the ridiculous pay and I suspect it's the post-clinic time dealing with paper, among other things.

 

[Dharma]

Yes, there has to be...and there is. Your buddy doesn't sound very organized.

How do I get around it? I get my notes done while I'm seeing patients. I take care of phone calls, faxes, forms, and whatnot as they come in throughout the day. I don't let them pile up. I refill prescriptions during regularly-scheduled office visits so I don't have to deal with refill requests in between appointments. I prescribe generics as much as possible, and try to adhere to insurance formularies as best I can. That cuts down on prior authorizations, and my staff is trained to handle the majority of the ones I do get. Patients get their labs done prior to follow-up visits for chronic diseases like diabetes, hyperlipidemia, etc. so I can make all of my management decisions during the visit rather than after the fact. I charge a form fee, which cuts down on stupid/unnecessary form/letter requests. I use our electronic patient portal as much as possible. I don't waste time at the office. When I'm there, I'm there to work.

My desk/in-box is usually clean by the time I leave the office, typically by 5:30pm.

I start my day by logging into our EHR from home while having my first cup of coffee, and take care of anything that came in during the night or over the weekend. This takes anywhere from 5 minutes on a weekday to maybe 20-30 minutes on a Monday. Sometimes I'll go online Sunday night instead, just so I'm not pressed for time on Monday morning. By taking care of things before I get to the office, I start every day with an empty in-box.

"We are what we repeatedly do. Excellence, then, is not an act, but a habit." - Aristotle

Awesome write-up! Thanks for sharing. I like the flow you describe here. Are you in a group or riding solo?

I dig the quote.

Thanks to you other folks got describing your experiences as well. This is good stuff. Keep em coming!

 

[styphon]

For paperwork - we have secretaries/nurses fill out forms that we have past copies of (renewing disability/renewing home nursing) and I go thru it and change as necessary. I always try to keep busy, fill out forms while waiting for a patient to be roomed, or during lunch. I have not had to bring any paperwork home from work.

For referrals and tests requiring PA - we have 2 "referral clerks" who handle this for us.

 

[drcrispmd]

Big complaint I hear from FM docs (one of whom is a friend) is "too much damn paperwork." It's to the point where my buddy is using vacation time to catch up with it. Staying at the office until 6/7pm every night only to spend a bulk of the weekend doing paperwork doesn't exactly sound enticing. How do you guys get around this? There has to be a more efficient means of handling things.

My awesome nurses fill out as much as they can from the charts and have me sign it. It makes life a lot easier. I also do not do prior authorizations unless absolutely necessary. I walk out of my office shortly after 5pm with all notes done and PA charts co-signed that need it.

 

[cabinbuilder]

Even in busy urgent care settings you have to plan on getting dictation done quickly.
Now, this would be a dream for me. If I had dictation I would never be behind on charts. For me seeing 40 people a day there is no way I can type the chart note AND do the scripts AND the coding AND the diagnosis AND the after visit summary AND the xray/US/CT/referral orders AND procedures all day. Like today I am currently 70 charts behind from the last 3 days since I never had a chance to sit down the whole day. I have Fridays to catch up at the North clinic urgent care where I may see 5 patients and can type the rest of the day. It's just too much. I accept what it is and I'm here to see the patients, etc. The urgent care I"m currently in I never have the same staff everyday so no one knows what to do and I end up picking up the slack including answering the phone, doing my own labs, etc. Otherwise it just wouldn't get done and the patient's would sit there.

Not to worry, unlike the rest of you I get paid by the hour and for the time it takes me to finish all the charts. I would never do it if I was expected to do it on salary and in fact quit a job once due the charting time required each week.

 

[jl lin]

So far, it's the FM guys who have been complaining the most. And these are dudes who actually like FM- not the-grass-is-always-greener types.

This is something I have heard from more than one FP physician w the same mo (not grass is greener, etc). They seem fairly well organized; but in our state, there have been changes that have increased regs and paperwork.

 

[jl lin]

I understand that some patients want to chitchat a lot or go on and on about how they feel and their pain and illness. Still, I feel it is important to spend some time actually listening to the patient and honing in on the most important issues. If they have questions, they don't want them to be blown off of to be given answers that don't really help them. Balancing this, the paperwork, and being efficient is tough IMHO in FP--especially when there is a good amount of pediatric patients and parents with questions. Also, there are social needs that should be addressed w/a number of clients; but certainly most MAs or even a number of RNs w/o case mgt experience are not going to be as helpful w/ these patients. That means the doc is pulled into case mgt issues. The doc should address them on some level, but ideally a sound CM approach should be handed off to an RN that knows how to do this. This usually means a BSN, and more money than some practices are willing to pay. Insurance co CM's often are only going to do so much to help the client; but it depends.

 

[jl lin]

I understand that some patients want to chitchat a lot or go on and on about how they feel and their pain and illness. Still, I feel it is important to spend some time actually listening to the patient and honing in on the most important issues. If they have questions, they don't want them to be blown off of to be given answers that don't really help them. Balancing this, the paperwork, and being efficient is tough IMHO in FP--especially when there is a good amount of pediatric patients and parents with questions. Also, there are social needs that should be addressed w/a number of clients; but certainly most MAs or even a number of RNs w/o case mgt experience are not going to be as helpful w/ these patients. That means the doc is pulled into case mgt issues. The doc should address them on some level, but ideally a sound CM approach should be handed off to an RN that knows how to do this. This usually means a BSN, and more money than some practices are willing to pay. Insurance co CM's often are only going to do so much to help the client; but it depends.

BTW, I am only shared what I have heard and observed from FP physicians. I also understand the need to cut costs; but depending on the community in which you serve, more of a CM approach may be beneficial--and that means getting people that know how to do this. And no, you aren't going to get it from a MA or an RN with lesser education and experience, that is OK with a rate of $20/hr. And NPs generally don't want to do it either.

 

[styphon]

BTW, I am only shared what I have heard and observed from FP physicians. I also understand the need to cut costs; but depending on the community in which you serve, more of a CM approach may be beneficial--and that means getting people that know how to do this. And no, you aren't going to get it from a MA or an RN with lesser education and experience, that is OK with a rate of $20/hr. And NPs generally don't want to do it either.

In my clinic we have two "teams".

My team consists of me, a PA, a RN case manager for both of to use, 1 LPN and 1 MA (both who room our patients).

There is also a specific nurse not on my "team" who puts my OB pt's in, who usually is working with another doctor in addition.

We also have a nurse who deals with a peds NP who often fields calls for any peds (as I and the other doctor also see peds).

 

[jl lin]

In my clinic we have two "teams".

My team consists of me, a PA, a RN case manager for both of to use, 1 LPN and 1 MA (both who room our patients).

There is also a specific nurse not on my "team" who puts my OB pt's in, who usually is working with another doctor in addition.

We also have a nurse who deals with a peds NP who often fields calls for any peds (as I and the other doctor also see peds).

Nice, comprehensive coverage for patients.

 

[primadonna22274]

In my clinic we have two "teams".

My team consists of me, a PA, a RN case manager for both of to use, 1 LPN and 1 MA (both who room our patients).

There is also a specific nurse not on my "team" who puts my OB pt's in, who usually is working with another doctor in addition.

We also have a nurse who deals with a peds NP who often fields calls for any peds (as I and the other doctor also see peds).

Dreamy

 

[Morsetlis]

The thread of the day has a last post from 2014? I'm confused