Family Medicine: is it anything other than referrals?

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Hello! As an undergrad I'm interested in a career as an MD. Family medicine is one of the fields that has gotten my attention.

One of my concerns as a family practitioner is that I would simply be a "middle man" between patients and specialists. I would want a medical career where I get the opportunity to treat my patients and help them through the healing process myself, not simply diagnose a problem and send them down the pike to a specialist of some sort.

Are my fears unfounded? How often do you find yourselves sending patients to specialists vs. being able to treat the patient yourself? Do you work closely with specialists that you send your patients to? Of course, I understand that I will be referring patients, I just don't want to make a career out of writing referrals.

I would love to hear comments from FP's from both rural and urban settings. I have a feeling that rural doc's are more all-encompassing.

Thanks

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Someone once said to me that good family medicine was knowing how to treat 90% of what you see and knowing when to refer the other 10%. (If this is a well known quotation I apologize to whomever originally said it, but I don't know.)

Just food for thought.
 
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You're going to have to convince me that you're not trolling.

This is basically like going into the EM forum and asking them if all they do is triage.

If you're serious, read the forum FAQ, check out the links in the stickied threads, and come back with some better questions than that.

Since you're a pre-med, shadowing some good FPs wouldn't hurt, either.
 
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Hello! As an undergrad I'm interested in a career as an MD. Family medicine is one of the fields that has gotten my attention.

One of my concerns as a family practitioner is that I would simply be a "middle man" between patients and specialists. I would want a medical career where I get the opportunity to treat my patients and help them through the healing process myself, not simply diagnose a problem and send them down the pike to a specialist of some sort.

Are my fears unfounded? How often do you find yourselves sending patients to specialists vs. being able to treat the patient yourself? Do you work closely with specialists that you send your patients to? Of course, I understand that I will be referring patients, I just don't want to make a career out of writing referrals.

I would love to hear comments from FP's from both rural and urban settings. I have a feeling that rural doc's are more all-encompassing.

Thanks

Oh no he didn't! :corny:

FM is far more than writing referrals. Follow Blue's advice and go shadow some.
 
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:confused:

I meant no offense and I did not mean for the original post to undermine FP. As I said, I am interested in family practice and have great respect for the general practitioner.

I do plan to shadow FP. Right now I am shadowing at the VA Hospital's rad onc department (another field of medicine I am interested in).

Blue Dog, I have been reading your comments for about 6 months now. I appreciate what you have to say. I did not mean to insult anyone's area of practice, however your strong rebuttal shows that I obviously have a narrow view of what FP is truly all about.
 
...As an undergrad ...Family medicine is one of the fields that has gotten my attention.

One of my concerns as a family practitioner is that I would simply be a "middle man" between patients and specialists. I would want a medical career where I get the opportunity to treat my patients and help them through the healing process myself, not simply diagnose a problem and send them down the pike to a specialist of some sort...
If you are not a "troll" and rather really are an undergrad, I have a few suggestions. First, the quote below should be your answer:
...good family medicine was knowing how to treat 90% of what you see and knowing when to refer the other 10%...
Second, follow BD's advice and take it upon yourself to investigate things. It doesn't matter if it is medicine or a law degree. You need to take some responsibility and not take the shortcut of seeking gossip on forums.

If you are not a "troll", I can understand how a naive individual (a little lazy) that has not done any real research can make such a dumb perspective. It probably goes back to the whole "gate keeper" thing. It is poorly explained and in its most simplistic description (albeit in error), one may see the gatekeeper as simply a referral agent. That being said, go do some real research cause giving you even the slightest benefit of the doubt requires a presumption that you suffer serious stupidity.
 
If you are not a "troll" and rather really are an undergrad, I have a few suggestions. First, the quote below should be your answer:Second, follow BD's advice and take it upon yourself to investigate things. It doesn't matter if it is medicine or a law degree. You need to take some responsibility and not take the shortcut of seeking gossip on forums.

If you are not a "troll", I can understand how a naive individual (a little lazy) that has not done any real research can make such a dumb perspective. It probably goes back to the whole "gate keeper" thing. It is poorly explained and in its most simplistic description (albeit in error), one may see the gatekeeper as simply a referral agent. That being said, go do some real research cause giving you even the slightest benefit of the doubt requires a presumption that you suffer serious stupidity.


I am not seeking gossip on this forum. The reason I come to this forum is to learn more about the medical field in general. I trust that the greatest amount of information one can garner from SDN is from reliable practitioners who are knowledgeable about the topics they choose to discuss.

I agree that I should do real research. My participating in SDN is a part of that.

Saying that I suffer serious stupidity is simply an attempt at a personal insult. I didn't mean mean to cause any feelings that would provoke one to feel the need to do that. Jack, I know that you can be pretty aggressive with your responses towards other posters. Please, stop with the attacks. I have already apologized for inadvertently insulting the family practitioners who participate in this forum. That includes you and I stand by that.

I agree that I have been naive in my view of family practice physicians. I had suspected this. My intent was to gain insight on the family practitioners scope of practice and their relationship with specialists. I hope it is possible to get back to the subject of the post.
 
Saying that I suffer serious stupidity is simply an attempt at a personal insult. I didn't mean mean to cause any feelings that would provoke one to feel the need to do that.

You have to understand that physicians, whether they be surgeons (JackADeli) or FPs (Blue Dog), do not suffer fools lightly. And you could say that going into a forum and being so tactless as to imply that a whole specialty of medicine is mindless and mentally unchallenging, is something of a foolish move.

FM is far more than writing referrals.

There are some days when I *wish* that FM was just about writing referrals. It's usually after days like the one we had at our clinic earlier this week - one of my patients came in tearful and actively suicidal, the patient in the room next door had a seizure and hit the ground writhing and we all had to run and help stabilize him, and I ended the day with one of those rare 14 year olds who, instead of being pretty healthy without a medical history, actually had 3-4 serious problems (including recurrent Bell's Palsy that wasn't improving despite steroids). Ughhhh....
 
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Just for giggles, I went back and reviewed this weeks' schedule.

I've done exactly five (5) referrals this week.

Two to ophtho for diabetic dilated eye exams.
One to GI for a routine screening colonoscopy.
Two to ortho for an MRI-proven meniscal tear (diagnosed on exam), and an MRI-proven rotator cuff tear (diagnosed on exam).

Seriously. That's it. Out of 80-something patients.
 
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...Jack, I know that you can be pretty aggressive with your responses towards other posters. Please, stop with the attacks...
I think you should just let it go.
...you could say that going into a forum and being so tactless as to imply that a whole specialty of medicine is mindless and mentally unchallenging, is something of a foolish move...
If one is an undergrad... other then Houser, you are likely an adult.... so, do the adult thing. That is, follow the sound advise you have been provided in several different manners and tones by several different individuals.
I feel all warm and cuddly now:smuggrin:
 
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You have to understand that physicians, whether they be surgeons (JackADeli) or FPs (Blue Dog), do not suffer fools lightly. And you could say that going into a forum and being so tactless as to imply that a whole specialty of medicine is mindless and mentally unchallenging, is something of a foolish move.

Agreed. I am very sorry for the way I put it. Jack and Blue, you have my apologies and my respect.

Blue, that's not many referrals at all!! This is exactly what I wanted to hear. I love the idea of the FP being able to handle so many cases effectively and that, to me, is the most appealing thing. I have heard it said, (by you, I think) that FP is a specialty of breadth. That is encouraging. :thumbup:
 
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If one is an undergrad... other then Houser, you are likely an adult.... so, do the adult thing. That is, follow the sound advise you have been provided in several different manners and tones by several different individuals.
I feel all warm and cuddly now:smuggrin:


Will do. Thanks for your input.
 
Agreed. I am very sorry for the way I put it. Jack and Blue, you have my apologies and my respect.

Blue, that's not many referrals at all!! This is exactly what I wanted to hear. I love the idea of the FP being able to handle so many cases effectively and that, to me, is the most appealing thing. I have heard it said, (by you, I think) that FP is a specialty of breadth. That is encouraging. :thumbup:

god, shut up. quit kissing bluedogs ass
 
...Blue, that's not many referrals at all!! ...I love the idea of the FP being able to handle so many cases effectively and that, to me, is the most appealing thing. I have heard it said, (by you, I think) that FP is a specialty of breadth...
Hhhhhmmmm I find this enlightening. I hear the sucking sound of lips placed upon a rump. I must return to BD's original assessment:
You're going to have to convince me that you're not trolling.

...If you're serious, read the forum FAQ, check out the links in the stickied threads...
Clearly, one that has been reading the literary works of BD and aware of the "breadth" would not ask the original question so inartfully. For, such an individual would already know this answer. It is the clumsy work of a troll to enter a forum, drop a flaming question with a veil of sincere need for guidance to then return and cite the literary works of others. "Oh, woe to me, I have been so meanly struck by Jack. I am but a lowly undergrad seeking knowledge and guidance....thank you for your comment, I think I read it that FP delivers babies too...":troll:
 
They're the real deal no question.

I doubt that this kid is representative of the lay persons impression of FM but the term "troll" gets thrown around too easily on these forums. It's obvious that he's new and doesn't know the dynamics of SDN.

OP i suggest you check out the pre-med forum (http://forums.studentdoctor.net/forumdisplay.php?f=10) you can ask as many questions as you want and you'll have thousands upon thousands of pre-med and med students that have never received a modicum of respect in their lives.
 
Proverbs 15:1 "A gentle answer turns away wrath, but a harsh word stirs up anger."

\pre-med and med students that have never received a modicum of respect in their lives.

Guess I better get used to it. :)
 
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Proverbs 15:1 "A gentle answer turns away wrath, but a harsh word stirs up anger."



Guess I better get used to it. :)

My Shadowing and Med School experience correlates roughly with e numbers Blue posted. Referrals do happen, but it's far from the norm. They happen when they NEED to happen.

I'd also reccommend looking the careers in medicine specialty page on the aamc website, as well as the various specialties' organizations websites.
 
Totally unrelated to this silly thread, but what the heck...

Family Medicine is the best job in the world.

I have an employment contract in hand...and I think I'm going to sign it in the next couple of weeks!

OK, carry on.

(yes, I've been drinking to celebrate)
 
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Digital, thanks for the heads up.

Shinken, congratulations!
 
For what it's worth:

My residency trained me to treat patients from the ED to the ICU. I have drilled intracranial bolts, intubated numerous pts, ran trauma codes, removed appendices, performed >40 c-sections, delivered >200 babies, resuscitated kids/adults, repaired countless complicated lacerations, reduced numerous fractures/dislocations, done LP's on neonate's and geriatric pt's, achieved competency in colposcopy/vasectomy/circumcision/thoracentisis/paracentisis, and ran the ICU ALONE as a 2nd year resident.

As a resident, I rarely consulted cardiology/ophtho/ID/rheumatology, never consulted pulmonology/dermatology/endocrinology, but routinely consulted GI, and surgery for scopes/interventions and oncology for management of NEW diagnoses that I made. Cardiology was consulted when a pt had MI or an unstable refractory rhythm. Otherwise, we did it all.

I had a personal experience where a family member was admitted to a private hospital and had >5 consultants actively working on his case. At the end of the day, I wished he had been admitted to our poor county hospital where a well-trained senior resident managed most of those conditions without piece-meal care and actually practiced the ancient art of coordination of care and patient advocacy.

A good family medicine residency will train you to treat >90% of conditions without needing the assistance of specialists.
 
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good to know. I am learning that a good FP can handle much more than I originally thought. thanks for checking in. :thumbup:
 
When the stewardess in the back of the plane lets out a shriek and yells "Is there a doctor on the plane?!, who is going to stand up, the orthopedic hip and knee specialist?, No, is it FP doc, who jumps up, ready for literally anything and says, "I am!"
 
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...No, is it FP doc, who jumps up, ready for literally anything and says, "I am!"
Or maybe the IM or pedes or IM/Pedes or GSurgeon or anesthesia, etc.... and yes, even the ortho doctors. Fairly limited number of events that cry out for a physician on a plane. They usually have significant acuity but are not particularly esoteric. Granted, the pathologist and radiologist are least likely to want to take that call.
 
When the stewardess in the back of the plane lets out a shriek and yells "Is there a doctor on the plane?!, who is going to stand up, the orthopedic hip and knee specialist?, No, is it FP doc, who jumps up, ready for literally anything and says, "I am!"
After fielding clinic calls this evening and doing cardiology rotation this morning, I have to say this comment made me grin. :laugh:
 
The breadth of practice coupled with the financial incentives (i.e., tuition reimbursement) make this seem like a pretty attractive specialty.

I believe the last poster was a D.O. Any takes on the difference between allopathic and osteopathic modalities of treatment?
 
The breadth of practice coupled with the financial incentives (i.e., tuition reimbursement) make this seem like a pretty attractive specialty.

I believe the last poster was a D.O. Any takes on the difference between allopathic and osteopathic modalities of treatment?

I don't know, but could you change your avatar so I could maybe take you more seriously?

thanks

mx
 
I don't know, but could you change your avatar so I could maybe take you more seriously?

thanks

mx

:laugh:really?! this coming from someone with a cheeseburger as their avatar?:laugh:
 
:laugh:really?! this coming from someone with a cheeseburger as their avatar?:laugh:

Too bad the Hamburgler isn't the avatar
hamburglar.gif
 
Totally unrelated to this silly thread, but what the heck...

Family Medicine is the best job in the world.

I have an employment contract in hand...and I think I'm going to sign it in the next couple of weeks!

OK, carry on.

(yes, I've been drinking to celebrate)

me too!!! (minus the drinking...I have children to take care of)!
 
When the stewardess in the back of the plane lets out a shriek and yells "Is there a doctor on the plane?!, who is going to stand up, the orthopedic hip and knee specialist?, No, is it FP doc, who jumps up, ready for literally anything and says, "I am!"

That's actually happened to me twice BTW. And there WAS an ortho doc on the plane who was super happy to step the side when I walked up. ;)
 
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For what it's worth:

My residency trained me to treat patients from the ED to the ICU. I have drilled intracranial bolts, intubated numerous pts, ran trauma codes, removed appendices, performed >40 c-sections, delivered >200 babies, resuscitated kids/adults, repaired countless complicated lacerations, reduced numerous fractures/dislocations, done LP's on neonate's and geriatric pt's, achieved competency in colposcopy/vasectomy/circumcision/thoracentisis/paracentisis, and ran the ICU ALONE as a 2nd year resident.

As a resident, I rarely consulted cardiology/ophtho/ID/rheumatology, never consulted pulmonology/dermatology/endocrinology, but routinely consulted GI, and surgery for scopes/interventions and oncology for management of NEW diagnoses that I made. Cardiology was consulted when a pt had MI or an unstable refractory rhythm. Otherwise, we did it all.

I had a personal experience where a family member was admitted to a private hospital and had >5 consultants actively working on his case. At the end of the day, I wished he had been admitted to our poor county hospital where a well-trained senior resident managed most of those conditions without piece-meal care and actually practiced the ancient art of coordination of care and patient advocacy.

A good family medicine residency will train you to treat >90% of conditions without needing the assistance of specialists.

bunnymd where did you do your residency that sounds like the perfect mix of everything!? I keep bouncing back and forth between FM and meds/peds because I want to be both broad and deep in my knowledge/skills, and I feel like I sacrifice one or the other by choosing FM (deep) or med/peds (breath) . Your program sounds like you got a great balance of both.
 
For what it's worth:

My residency trained me to treat patients from the ED to the ICU. I have drilled intracranial bolts, intubated numerous pts, ran trauma codes, removed appendices, performed >40 c-sections, delivered >200 babies, resuscitated kids/adults, repaired countless complicated lacerations, reduced numerous fractures/dislocations, done LP's on neonate's and geriatric pt's, achieved competency in colposcopy/vasectomy/circumcision/thoracentisis/paracentisis, and ran the ICU ALONE as a 2nd year resident.

As a resident, I rarely consulted cardiology/ophtho/ID/rheumatology, never consulted pulmonology/dermatology/endocrinology, but routinely consulted GI, and surgery for scopes/interventions and oncology for management of NEW diagnoses that I made. Cardiology was consulted when a pt had MI or an unstable refractory rhythm. Otherwise, we did it all.

I had a personal experience where a family member was admitted to a private hospital and had >5 consultants actively working on his case. At the end of the day, I wished he had been admitted to our poor county hospital where a well-trained senior resident managed most of those conditions without piece-meal care and actually practiced the ancient art of coordination of care and patient advocacy.

A good family medicine residency will train you to treat >90% of conditions without needing the assistance of specialists.

As an outpt doctor:
I consult cardiology quite a bit: usually abnormal stress tests, but occasionally severe CHF requiring pacemaker, severe valve pathology. I will manage HTN, CHF, mild-moderate valve problems without consult.
I consult rheumatology frequently as I am not comfortable with "biologics". (this is after i confirm SLE/RA). I will manage stable autoimmune disease, I also do the workup that leads them to the diagnosis.
I use ID as all of our wound care clinics use ID as the medical directors. (for chronic wounds that will not respond to normal treatment). I will do initial wound care and wound checks.
I use ortho after MRI/PT (for surgery + synvisc injections). I do joint/fracture reductions, joint injections..
I use ENT for surgical consults only
I would never use endo for Diabetes. But I would refer for pituitary adenomas, thyroid nodules that need biopsy (one of our endos biopsies)..

But I would say majority of problems I do not consult for. I do not consult for DM as I have extensive experience and have my own educator/nutritionist. I would not consult for CP until after the workup, same with joint pain. I also see kids/newborns/OB/GYN patients.
 
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A lot of patients I have cannot afford to see a specialist, and it must be on me to somehow manage and provide outlets for resources. Thus, I can't always refer and it keeps me challenged and on my toes. I like it for that reason.
 
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Referrals are a big part of outpatient practice unless if you live in a rural area.
 
Patient population drives a lot of my referral base. I happen to live in one of the most obese counties with one of the highest incidence of tobacco use in my state. If I tried to manage all of the pathology that walked in my door, I wouldn't be able to see 15 patients a day and do a good job. GI gets most of my business for routine colon screening followed by cards for CAD management, suspected false neg stress tests and some CHF management. I manage most of my diabetes but I will share the love in the patients that continue to routinely run a double digit A1C despite my best management and advice. I do almost all psych myself except for unstable peds. Been burned by that one once and that's enough for me. Ortho also gets quite a bit of love as well. I do all the routine injections but if your BMI is > 40, no NSAID has been helpful and not willing to try weight loss or PT, there really isn't much I can do to help.
 
Just FYI, this is an eight-year-old zombie thread. The OP is probably long gone.
 
You made him rethink his career choice BD. Nice going.
 
I referred 2x this week out of over 50 encounters. One was to derm for a biopsy of a suspicious modular lesion on an eyelid (I’d shave it, but not on an eyelid personally); the other was to Urology, for a teenager with depression and a “guy problem” stemming from that depression. I told him it was because of the depression it would get better with treatment of the depression, but his therapist has him convinced he needs to see a urologist, so I obliged.

That was it.
 
lol, popcorn emoji

Seriously OP--you are what you want to be. If you're FM and bust your @$$ to learn and know how to treat most stuff--you can handle most of it. Most things you'll be able to handle if you're well trained and driven to stay current.

I'm sure there are doctors who refer a ton out of lack of comfort with a diagnosis/diagnoses. But you are what you want to be.
 
Hello! As an undergrad I'm interested in a career as an MD. Family medicine is one of the fields that has gotten my attention.

One of my concerns as a family practitioner is that I would simply be a "middle man" between patients and specialists. I would want a medical career where I get the opportunity to treat my patients and help them through the healing process myself, not simply diagnose a problem and send them down the pike to a specialist of some sort.

Are my fears unfounded? How often do you find yourselves sending patients to specialists vs. being able to treat the patient yourself? Do you work closely with specialists that you send your patients to? Of course, I understand that I will be referring patients, I just don't want to make a career out of writing referrals.

I would love to hear comments from FP's from both rural and urban settings. I have a feeling that rural doc's are more all-encompassing.

Thanks
I will tell you that FP is HARD. You have to know so much information, diagnose and treat across all disciplines: Cardiology, Ortho, Derm, IM, ID, Nephro. Surg, Psych, OB/Gyn, You have to know when someone needs to be admitted, when they could die if you don't send to the ER, etc.

I work urgent care where labs are minimal and I have xray. I have to decide on a daily basis who is sick and who is not. Most patients I treat and street. Some I refer for ortho/surgical f/u. I have to be able to determine if they are having an emergent cardiac problem or an acute abdomen or whether they can wait for f/u care with the PCP.

You are getting blowback because the breadth of knowledge needed to do FP well is extensive. Specialists only care about they they do. We have to care about everything and how all decisions impact patient's outcomes. Do your homework.
 
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Wow. I can't believe how this poor undergrad was treated for expressing a commonly held perception. Talk about tactless.

OP--yes, its a common misconception. I had the same fears you did. I can tell you with 100% certainty, that family medicine is far more than referrals. Yes, we do a lot of referrals. We are the gateway to the medical system. And with that, comes the inevitable problem that sometimes, you are going to refer a patient somewhere, and some specialist will figure out what's really going on with a patient, and you may never hear about it.

But on a daily basis, the bulk of what I do, I'm the only one trained to do this. And by "this" I mean, putting it all together, looking at the big picture."

"The cancer doctor says I need to take this injection for my bone mass, do I really need it?"
"The urologist says I should have chemo and radiation, but I'm in my 80's, do I really need it."
"The cardiologist says I need to be on 80mg of atorvastatin, is that true?"

It goes on and on. As a family doc, your patients will, bizarrely enough, trust you more than anyone else in the world. Your patients inhabit a medical system that encourages insane medical spending, tons of prescription drugs, procedures, etc. And many times my job is to reign it in. Making sure your patient gets precisely the treatments they need, no more no less.

As a family doctor, you will be challenged every single day to make difficult diagnoses, do a variety of procedures, counsel people on lifestyle changes, and generally, make a really big impact in people's lives.

There has not been a single day in my career, that I've gone home and said, "Gosh, that was kind of boring, all I did was make referrals all day."
 
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Wow. I can't believe how this poor undergrad was treated for expressing a commonly held perception. Talk about tactless...There has not been a single day in my career, that I've gone home and said, "Gosh, that was kind of boring, all I did was make referrals all day."

So, you agree.

Meanwhile, the OP hasn't been on SDN since 2011, and hasn't seen any of this.
 
I'm not a doctor, nor in med school -- I took the Epidemiology route. However, the thing that almost tipped me over to pursue a medical degree was shadowing a friend, who does family practice. Holy cow, it was fascinating! I had literally no idea. She knows many of these patients more thoroughly than I know my own kids. I saw a person in their 30's with Borderline Personality Disorder who had been having micro-strokes for weeks before coming in... two other doctors had missed the signs, so my friend had ordered an MRI and referred her to a neurologist; she showed me the images while I was there, so that was cool. There was a new patient with genital warts that needed freezing off. There was an elder with emphysema, who refused to give up smoking because it was "too late", and a patient with vertigo from stuck otoliths - my friend ran her through an exercise in the office, and she walked out feeling fine. An old guy who didn't speak any English came in with his wife serving as translator; they were so sweet. The depth with which she knew her patients, and the amazing breadth of health issues she dealt with, really seduced me. I almost decided to apply to med school, and five years ago I probably would have done it, but I don't think I have the energy anymore. Grad school is exhausting enough. The coolest part is that my friend says she is constantly researching symptoms and reading about new stuff, which sounds so great to me!

So no, most of FM, from what I've seen, is not referrals, and even when it is, that's just one component of the patient visit. It looks fun. REALLY fun, and interesting, and a great way to connect with people you're helping if you're a people person.
 
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