Family Medicine Lifestyle

[Darkskies]

Hello,
I am a senior in college and am having an angst-filled time trying to decide whether pursuing medicine is the correct path for me. I've spent hours scouring the forums to glean as much information I can about the profession(s) and to be truthful many of the naysayers and unhappy/miserable individuals in medicine have given me quite a scare. I know that I should be particularly keen on primary care since if I can't find myself to be satisfied with one of those fields I shouldn't pursue medicine because I could be sorely disappointed since these are the areas most doctors will match into.

For this reason I have a couple of questions concerning family medicine. Although I am more than gung-ho about developing a rewarding practice and career where I give 100% for my patients, lifestyle is also important to my well-being. I have already read previous threads on the lifestyle in family medicine and know that it is an extremely diverse and flexible field but how common are 4-5 day a week outpatient clinics with little call/rounding on patients/teaching duties? Are the salaries in such settings still around the FP average?

What is the stress level for an average family practice physician in comparison to other specialties? How tolerable is residency? Are malpractice rates low? Is it true that primary care physicians are less satisfied than those in specialized fields? Why do so many residents/attendings state that they would steer clear of medicine(and especially the primary care fields) if they had the chance and forgiven loans to do so?

I was also under the impression that the incidence of patient death is significantly lower than in other specialties where the patients have more serious conditions. I know this last point seems a little strange but I guess I also have a fear of patients dying and coping with this situation both for myself internally and in having to explain such depressing news to patients' families.

Thank you so much for reading my post and any and all answers will be GREATLY appreciated!

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[deleted87716]

I have already read previous threads on the lifestyle in family medicine and know that it is an extremely diverse and flexible field but how common are 4-5 day a week outpatient clinics with little call/rounding on patients/teaching duties?

Extremely common.

Are the salaries in such settings still around the FP average?

Generally speaking, yes. All of the FPs in my group earn well above the national average working 4-5 days/week.

What is the stress level for an average family practice physician in comparison to other specialties?

Comparable.

How tolerable is residency?

I can't speak for everyone, but I had a great time during residency.

Are malpractice rates low?

Compared to many other fields, yes. This varies from state to state, of course.

Is it true that primary care physicians are less satisfied than those in specialized fields?

Not at all. Job satisfaction in medicine tends to be closely correlated with autonomy. Few fields afford as much flexibility as family medicine, assuming you don't take a crappy job somewhere.

Why do so many residents/attendings state that they would steer clear of medicine(and especially the primary care fields) if they had the chance and forgiven loans to do so?

Because people who are happy don't say as much.

I was also under the impression that the incidence of patient death is significantly lower than in other specialties where the patients have more serious conditions.

You're not usually there when they die (unless you're in the hospital), so you don't generally have to deliver the news of a death yourself, but you tend to know patients a lot better than most specialists. You frequently take care of their families as well, so you get to deal with the fallout. You diagnose a lot of cancer and other serious conditions (so there's lots of bad news delivery), and you deal with a lot of dying patients, hospice care, etc. There's no avoiding death in FM. That being said, it's difficult to appreciate it as a pre-med, but you do get used to it.

Family medicine is the ultimate lifestyle specialty.

 

[Darkskies]

Thanks a lot for responding blue dog. Would you say that the 7 years of medical school and residency were completely worth it? Do you feel that your compensation( all this talk of declining reimbursements) is not sufficient for the amount of hard work you do(a frequent complaint I've heard against primary care)? I've also never been one of those people who knew they were predestined to be a physician since before they were even born. Despite how much I've volunteered, the amount of reading I've done on these forums, and the doctors I've shadowed(only 2 to be fair) I do not have this innate sense of certainty that becoming a physician is my 'calling'. Would you say that treating the medical profession as a calling is somewhat exaggerated? At this point I feel as if I will never be sure until I'm a resident or an attending if this is truly the career for me. What were your reasons for entering medicine?

What are the principal sources of stress at your workplace? Would you say being a family medicine practitioner is a very stressful career? Does everyone learn how to adequately deliver bad news to patients in school/residency?

I keep hearing all this negativity surrounding paperwork. Is completing paperwork as a physician basically a similar task as to what a secretary at an office would do?

Do you feel that you gained your professional and leadership skills along the way? I am far from shy amongst friends and even most strangers but I have abysmal public speaking skills. Would this be a big hindrance? Thanks,
Darkskies

 

[deleted87716]

Would you say that the 7 years of medical school and residency were completely worth it?

I have no regrets.

Do you feel that your compensation( all this talk of declining reimbursements) is not sufficient for the amount of hard work you do(a frequent complaint I've heard against primary care)?

I think primary care is undercompensated, and it's getting harder to maintain our incomes (much less increase them to keep pace with inflation) as time goes on.

Would you say that treating the medical profession as a calling is somewhat exaggerated?

Generally speaking, yes. I have met people who feel that way, though.

What were your reasons for entering medicine?

I saw it as a good fit for me in terms of what I enjoyed doing (through our local volunteer rescue squad) and as something I would find continually challenging over the course of my career. I was, frankly, bored in my old job (worked for IBM), and knew I didn't want to be doing anything like that when I was 60.

What are the principal sources of stress at your workplace? Would you say being a family medicine practitioner is a very stressful career?

I find the stress manageable, and it's mainly limited to those times when we get behind, usually due to something serious or complicated coming in that was unanticipated. That, or when the computers are down (we're all electronic now). Doesn't happen much, fortunately.

The key to managing stress, IMO, is maintaining control over your environment. The less control you have, the more stress you're likely to feel. I don't think people always consider this when choosing a specialty or accepting a job.

Does everyone learn how to adequately deliver bad news to patients in school/residency?

Generally, yes. There are always going to be people who do a better job of this than others.

I keep hearing all this negativity surrounding paperwork. Is completing paperwork as a physician basically a similar task as to what a secretary at an office would do?

I don't personally feel that I'm "overwhelmed" with paperwork. Frankly, there are ways to avoid doing excessive amounts of uncompensated work outside of office visits simply by taking care of things during office visits. Unfortunately, many doctors ignore this, and simply let things happen. I also delegate a lot of it to my staff (prior auths, for example). Most of my paperwork is simply signing home health care plans, nursing home orders, and doing the occasional letter for somebody. I'll charge a form fee when it's applicable.

Do you feel that you gained your professional and leadership skills along the way?

Personally, yes. I'm on my group's board, I'm the chair of our I.T. committee, and am on the board of my state chapter of the AAFP. I'm also involved in teaching (med students and residents) as a community preceptor.

I have abysmal public speaking skills. Would this be a big hindrance?

Probably not, but I think you'd find something like the Dale Carnegie course tremendously helpful in overcoming that.

 

[deleted87716]

On the topic of physician satisfaction, here's an interesting article: http://www.google.com/url?q=http://...xQEwAA&usg=AFQjCNFeggBcbTR17TlSu1SjMDFIasFAMg

 

[notinkansas]

Your angst is well founded. There is a lot of crap that goes on in medicine that doesn't exist in other fields, or exists to a lesser degree.

I did 3 years of general surgery residency and then bailed out with 2 years left to go. I'm trying to figure out what field would be good to retrain in. I spent some time evaluating whether I could do something outside of medicine, but i don't have a skill set that would allow me to make six figures- a requirement if I am ever to get my student loan debt (upwards of $250K) paid off.

So some of my experience may be colored by having been in a primarily inpatient setting.

I did find the paperwork onerous. And it increased, pretty rapidly. Each year, another form or two needed to be filled out just to admit a patient. Most of these forms were to document stuff that I was doing already anyway. Example: a form to prove that I am properly ordering heparin, a blood thinning medication used to prevent blood clots. In the world of surgery, pretty much all of our patients are at risk, so it is unusual for us not to order this medication. But, so that the hospital can prove to the medicare police that we are ordering it, now most hospitals have a separate form, in triplicate, that must be filled out. It takes more time to fill out the form than it did to just write the order. Not to mention the fact that now there is another piece of paper that I have to run around looking for in the Emergency Department, since the stash frequently has run out at 2 am and the person who is responsible for restocking the file cabinet works from 8-5. This is just one example.

Something else that irritates the crap out of me is that medicare is starting to base payment on quality. On the surface that sounds good. But the measures of quality are flawed. It either revolves around following some drug protocol that may not be appropriate for all patients. If it isn't appropriate for your patient, then you have to fill out a form justifying why it isn't. Or medicare isn't paying hospitals for some bad things they have deemed "never events" Problem is, these events are not 100% preventable. For example: pressure sores (decubitus ulcers). These happen when a patient lays too long in one position. You might think "how can that happen?" It is not unusual for a patient to flat out refuse to get out of bed, at least after surgery. If you have the physical therapist come work with a patient like this, often they will refuse. And you can't just drag a patient out of bed- that violates their rights.

Finally, realize that, while technically a doctor provides a service and bills for it, you don't get to decide what you charge. You are paid what an insurance company decides they will pay you for that service. And increasingly, the public thinks they should not have to pay one red cent for medical care.

Think of it this way: Normally, if your water pipes break, and you call a plumber. He does the work and sends you a bill. If you think the bill is out of line, you may try to negotiate, but as long as the work was done and your pipes now work, you believe the plumber deserves to be paid.

Enter plumbing insurance. The insurance company decides the cost of plumbing is too high. So they look at all the services a plumber provides and decide how much they will pay for each. Each service is assigned a code, and the plumber must submit specific documentation to justify the code. The difference between one level of service and the next is often quite subtle. So when he submits the bill to the insurance company, they scrutinize it. If all the wording isn't exactly correct, for example, he writes "copper pipe" instead of "approved pipe, copper" the the claim will be denied or he will be paid at a lower level. Now the plumber has to hire an expert in coding for his office, to go over all his bills and make sure they meet the criteria. He also has to hire someone to call the insurance companies to discuss denied claims, track claims that are taking too long, and get pre-authorization. Meanwhile, the public decides it's not fair that some people have plumbing insurance and others don't, and demand the government step in and provide "free" plumbing for everyone. And in an effort to contain costs, the insurance companies reduce payments to plumbers, even as office overhead rises.

That said, few doctors are laid off in a recession. Plumbers have less work when fewer houses are being built. But people will always get sick. And there is a lot about medicine that is intellectually stimulating.

I think a lot of my dissatisfaction with medicine is that I have a very low tolerance for BS and stupid rules. These things don't seem to bother some people. I also think there is a good chance that the government will completely take over the health care system. I don't support that at all and do not relish the idea of being a government employee with every decision being controlled by regulations.

If you do decide to pursue medicine, I would strongly advise you to do everything possible to minimize your student loan burden (and your debt burden in general) One of the biggest reasons for my current discontent is that I need a certain level of income to make my loan payments, and that limits my options. The higher your debt, the more likely it is that you will get into a situation where you feel trapped an a job or career in order to pay debt. Less or no debt allows more choices for income which allows more freedom.

 

[deleted87716]

Sounds like you didn't have much control over your environment. See my earlier post (above).

Also worth pointing out that single-payer (should it ever come to that) doesn't mean that doctors will be "government employees."

Single-payer is what they have in Canada. The U.K.'s NHS workers are government employees. Very different setups.

 

[Darkskies]

Notinkansas, thanks for the advice. I'll definitely try to attend the cheapest school possible and I wish you luck in finding a new field.

To both of you, if reimbursements are declining at the same time that inflation is rising, doesn't that mean real income is steadily decreasing? To compensate for this do you feel the need to see more patients and work longer hours every year?

If controlling one's work environment is the key to managing stress and family practice is the field that offers the most flexibility and control over one's environment, why then do so few medical graduates choose it? In the same vein why is it often considered as a backup if one does not gain acceptance to a residency in a more 'desirable' field?

What task assignments in medical school and residency honed your skills in leadership/professionalism/communication/public speaking? How often did you have to give presentations on topics and teach in medical school and residency?

Is research an important component of medical training? I know it is required for admissions to certain specialties but is it generally considered as an extracurricular activity to boost one's application? How does one perform research and practice as a clinician without losing out in one or the other?

Thanks,
Darkskies

 

[deleted87716]

if reimbursements are declining at the same time that inflation is rising, doesn't that mean real income is steadily decreasing? To compensate for this do you feel the need to see more patients and work longer hours every year?

Not at this point.

If controlling one's work environment is the key to managing stress and family practice is the field that offers the most flexibility and control over one's environment, why then do so few medical graduates choose it?

Because most specialties pay better than primary care (at least, for now), and many folks are intimidated by specialties of breadth.

In the same vein why is it often considered as a backup if one does not gain acceptance to a residency in a more 'desirable' field?

The ready availability of residency spots (due to lack of interest) makes primary care fields less competitive.

 

[paiute]

general practice or family practice is the most challenging and most rewarding of all the types of medicine. you need to know everything, or, at least, try to know everything.

when i was an anesthesiologist, i read the 2 main US journals in the field. that's all i had to do to keep current. now, not only do i use journal watch (a journal summarizing service), but i have purchased, and try to read daily, a mountain of textbooks.

the rewards are that i discover new things in pts almost everyday. also, i have an increasing number of family, friends and co-workers asking me for advice, which rarely happened when i was an anesthesiologist.

as regards reimbursement, i think GP will stay about the same, but the specialties will suffer a big decline.

 

[DocYuki]

MS3 here, going into FM. I kind of arrived at this specialty by default (I mean this in a good way). During my rotations this year, I have found no other rotation that offered such versatility and breadth. And quite simply, that's the main reason I want this field; to go from managing a 80 y/o's hypertension to doing a dermatologic procedure to seeing someone who might be having a DVT. Lifestyle is a huge consideration for me, too. My older sister just matched into an FM program and has found her fellow residents to be the most understanding, genuine, and warmest people she has encountered in medicine.

The very fact that the specialty has an air of "take care of yourself as well as your work; live a balanced life" is a huge draw for me. I'm a hard worker, but also a hard player. EM was a close call for me, but I decided I wanted continuity and a little more of a regular schedule. The idea of working 4-5 days a week with little call/rounding is just perfect for me. The opportunity to be a doctor that people feel they can go to and ask any question, with the chance to have a real life and family, too. I just have to do my best in the next year to figure out how to be ready for the match

 

[notinkansas]

Blue Dog:

You are right, I didn't feel any control. (though I'm not sure that residents would have any control- is it possible for them to? ) It seems to me as though these rules are being imposed on hospitals because bureaucrats declare that it will save money without any evidence to support the claim. This is why I've developed a pretty strong interest in outcomes research.

In fact, one of the problems i have with more government intervention in health care is that I don't think they base their decisions on outcomes, and that they don't care what providers think.

That, plus lack of control of my lifestyle (and the fact that I discovered that I hate doing laparoscopic surgery) are what made me not finish GS residency. I've been working a moonlighting type job trying to pay down some debt and figure out what to change to. I have concluded that i would like to incorporate outcomes research- now to figure out the best path. And I've also developed a strong interest in international volunteerism, especially after returning from a trip to Tanzania.

At first I was most drawn to anesthesia, kind of a natural outcome of all the time in the OR. I'm finding myself exploring family medicine, and becoming more interested (which would draw gasps of horror from my surgical friends, but I don't care)


I guess it is important for anyone reading my posts to realize that I never finished a residency, so I never worked in a private practice environment. My experiences were all as a resident. That said, I have never had a high tolerance for BS and stupid rules. That's why I wouldn't make a good government employee!

 

[Darkskies]

Blue Dog(or anyone else), Would you mind answering the other questions in my last post as well? In addition I had something more to ask. Would you say that after residency training one is more than well equipped to handle just about any case in his/her field?
I apologize if I'm bombarding all of you with so many questions but I would really appreciate responses so I can have a better insight into what awaits me if I do choose to pursue medicine.

 

[lowbudget]

My older sister just matched into an FM program and has found her fellow residents to be the most understanding, genuine, and warmest people she has encountered in medicine.

This was my experience too as a medical student & resident. I'm glad to hear that this is the type of people our specialty draws and was to a large extent what made me want to be a part of it. It was something that was lacking in some coworkers in a past job I had and it really made me feel out of place. Awesome. Congrats.

 

[lowbudget]

Would you say that after residency training one is more than well equipped to handle just about any case in his/her field?

What's exciting is that I feel like I'm always learning. Biomedical science advances, many times, in warp speed. What you learn in medical school and residency is how to "approach" a problem, break it down, and analyze it. It's actually really cool. We take vague concerns, make a solid diagnosis. Once you know what you're up against, the management follows in line; but without a diagnosis, it's total chaos. It's nice being trained in a interdisciplinary fashion because you're capable of seeing the big picture, and, some times (a lot of times), are able to see angles that some specialists might miss out on. Family doctors can take care of 90% of all problems they face. Patients love it. If you like being a patient's "go to" person, family med is your specialty.

 

[lowbudget]

how common are 4-5 day a week outpatient clinics with little call/rounding on patients/teaching duties?

Very common. You would still take call on your patients but usually these are phone calls. Many FP's do inpatient medicine but many don't.

Are the salaries in such settings still around the FP average?

The way the current system works, the more patients you see and the more complex they are, the more you get paid. So, for example, seeing 5 patients for follow up for medication refills for their stable medical problems are different than seeing 5 new patients with complex problems, or 5 patients in the hospital or ICU. So, your take-home cash will vary depending on all of that. Since there are more and more outpatient only FP's, I think the average reported in salary surveys reflect the average outpatient FP.

What is the stress level for an average family practice physician in comparison to other specialties?

I think the stress level varies. My day-to-day stress is keeping clinic moving on-time. Patients take time out and make the effort to see me for their problems; so I try to respect their time. But, human beings don't work like machines, and sometimes it requires more than the time allotted to achieve your goals.

I think stress also depends on if you're in practice for yourself/partneship where you need to worry about the business side (like a small business owner) or if you are an employee (salaried by the year or paid by the hour). There're pros and cons and there's something for everyone.

How tolerable is residency?

Mine was tough, but tolerable. It wasn't the residency I was worried about. It was learning and trying to do the right thing for my patients that made me stay up late. You get out of residency what you put into it.

Are malpractice rates low?

Compared to surgical fields & emergency med, yes. For me though, I don't know. I'm an employee and my job pays for mine. So I don't stress over it.

Is it true that primary care physicians are less satisfied than those in specialized fields?

I don't think anyone really knows. If you read enough SDN, there seems to be dissatisfied people in every specialty. You'll find out that premeds, med students, and residents love to b!tch about something or another. It's all in your attitude, and how your life experiences mold your ability to cope and deal with stuff.

Why do so many residents/attendings state that they would steer clear of medicine(and especially the primary care fields) if they had the chance and forgiven loans to do so?

I think it's because they feel sorry for themselves and want someone to listen to them. There are other jobs out there, but throughout this entire financial/real estate crisis and joblessness, I've been pretty insulated and felt that I was fortunate to have such a stable job. I can't think of any other non-medical job that offers the type of pay, intellectual/emotional challenge & satisfaction, and stability that medicine gives.

Part of the nervousness, I think, comes from how distorted the health care market is in terms of economics. Our "prices" move based on politics and are subject to political risk and not necessary to market risk, like oil or corn or semiconductors. There's less visibility over just exactly what something "costs" and is "worth" and so people don't really have an economic appreciation for how much health care should be (for both the patient and for the doctor, and insurance company, and drug/device firms). If you're business is subject to political risk, it's exposed to pretty unpredictable forces. Maybe that's why... I dunno.

I was also under the impression that the incidence of patient death is significantly lower than in other specialties where the patients have more serious conditions. I know this last point seems a little strange but I guess I also have a fear of patients dying and coping with this situation both for myself internally and in having to explain such depressing news to patients' families.

You will see plenty of death and dying in medicine. No matter what specialty you're in. It's part of life. Medical school and residency will give you the opportunity to perfect your schpiel. I think if you're generally a genuine, good person, and capable of putting yourself in your patient's shoes, and understand how families would like to be treated, I think you would be ahead of the game. You'd be surprised too, a lot of times in good ways. Because of the chronicity of some of these medical problems, many family members are relieved that their love one is no longer suffering and will celebrate that relief that with you. It's a privilege to be a part of this and not very many people can say that.

 

[lowbudget]

Would you say that the 7 years of medical school and residency were completely worth it?

Definitely. Med school was the best time of my life. Residency was tough, but worth it definitely. It's 3 years. That's nothing.

Do you feel that your compensation( all this talk of declining reimbursements) is not sufficient for the amount of hard work you do(a frequent complaint I've heard against primary care)?

I wished I was paid more, hell, who doesn't? I try not to think too much about it, because it'll absolute kill you if you look at what other people have that you don't, no matter what job you go into, because you'll always compare yourself to someone with more stuff than you (and never to those who have less). That being said, I make plenty. Even if I could, I don't think I would've dropped out of college, start a software company in my garage, and take on the world like Bill Gates did. I think the way my life worked out was right for me.

Would you say that treating the medical profession as a calling is somewhat exaggerated?

I think those whom it is a calling have this higher purpose that makes them more resilient to adversity, whether it's difficult patients, the money, the politics. For me, I didn't start believing in what I did, until I started doing more and more of it and forming my own opinions about things. I guess, you can call it a calling, but it's only in retrospect.

At this point I feel as if I will never be sure until I'm a resident or an attending if this is truly the career for me. What were your reasons for entering medicine?

I was a number-cruncher in a prior life. And my job was to make as much filthy money for others (and by proxy, me) as humanly (and inhumanely) possible. I felt like I had lost my way in life, had become a different person than one that my parents raised me to become. I looked at the people who were my bosses, and at no point did I ever said to myself, "wow, one day, I want to be like him." All my coworkers kept saying, "I thought about premed" or "I considered going to med school"... so, the day I got my med school acceptance, I felt like I had broken away. I was no longer "them", accomplishing something that only people talk about. My boss asked me why I wanted to go into medicine, and after a long explanation, my conclusion really was "because I can." Medicine is a once in a lifetime opportunity. You either do it or you don't. Medical training fits right in this window of opportunity in your life when you can physically, emotionally, socially, financially do it. Very few people can pass up a chance to go to medical school, only to come back later to do it. It's turned out to be a very positive thing in my life. There are a lot of doctors I admire (and a few who I don't). But I feel like I've met more good people in medicine than I have elsewhere, in business or law. You just know it when you see it.

What are the principal sources of stress at your workplace?

Keeping patients happy on one hand, while doing the right thing on the other. In medicine, the customer isn't always right.

Would you say being a family medicine practitioner is a very stressful career?

I think it carries a different set of stresses depending on what you compare it to. You're responsible for people's families and their lives. That's pretty damn stressful being held to such a standard. That being said, this is why we train. Things that used to stress me out, don't anymore. There's definitely a psych component to handling one's stress.

Does everyone learn how to adequately deliver bad news to patients in school/residency?

Yes, although some people just aren't good at it. LMAO! It depends on what gifts and talents you bring with you into med school/residency. No matter those may be, you will grow as a person.

I keep hearing all this negativity surrounding paperwork. Is completing paperwork as a physician basically a similar task as to what a secretary at an office would do?

No different than any other job. It's better than being a lawyer or accountant. That's *all* they do. But, yes, compared to a summer camp counselor, I do more paperwork now.

Do you feel that you gained your professional and leadership skills along the way? I am far from shy amongst friends and even most strangers but I have abysmal public speaking skills. Would this be a big hindrance?

For me, I've learned a lot along those lines. Depending on what you do, public speaking skills may or may not come into play. For example, in academics, you will need public speaking skills. In certain private practices where you're growing your practice, you may go out and give talks. But, you don't have to. Many family docs don't do public speaking. You'll find ways to maximize your strengths and minimize your weaknesses. That being said, remember how I said that you'll grow as a person? No reason for you to not develop it in med school/resident as you build confidence in what you do and what you believe in. One caveat I will say is that family medicine is a people-business. You can't get around that...

 

[Darkskies]

lowbudget, Thanks for the responses. It's nice to have your perspective on this as well. How would you reply to my last few questions, namely the following:

"What task assignments in medical school and residency honed your skills in leadership/professionalism/communication/public speaking? How often did you have to give presentations on topics and teach in medical school and residency?

Is research an important component of medical training? I know it is required for admissions to certain specialties but is it generally considered as an extracurricular activity to boost one's application? How does one perform research and practice as a clinician without losing out in one or the other?"

 

[lowbudget]

Notinkansas, thanks for the advice. I'll definitely try to attend the cheapest school possible and I wish you luck in finding a new field.

+1... public school really should be your #1 goal economically; unless it's been a lifelong dream to go to Harvard/Yale/Stanford, etc. in which case, chase your dreams.

if reimbursements are declining at the same time that inflation is rising, doesn't that mean real income is steadily decreasing?

Absolutely.

To compensate for this do you feel the need to see more patients and work longer hours every year?

Not necessarily. You either figure out a way to come out from under declining reimbursements (like refusing to sign/renew contracts, be creative in what you do business-wise) or you find a way to beat inflation (like cutting or shifting costs). Interestingly, health care economists have studied target-income hypothesis for years and it doesn't hold up (at least in long run). Instead, it seems that physicians are more motivated by relative-incomes (which we saw during this health care debate).

Drop down to Physician Cost Shifting:
http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.472v1/DC1

If controlling one's work environment is the key to managing stress and family practice is the field that offers the most flexibility and control over one's environment, why then do so few medical graduates choose it?

Relative income.

It's also attitudinal. For me, I don't stress out over things I have no control over. So, for me either way, control or no control, life goes on.

In the same vein why is it often considered as a backup if one does not gain acceptance to a residency in a more 'desirable' field?

Like BD says, it's the number of unfilled spots out there and the perception people have that anyone can do family med. But as patients will tell you, not everyone is cut out for family med.

What task assignments in medical school and residency honed your skills in leadership/professionalism/communication/public speaking? How often did you have to give presentations on topics and teach in medical school and residency?

Frequently. This is a "skill" that you will learn, no matter what (white collar) job you pick. Don't worry, it'll come with time (and practice).

Is research an important component of medical training?

Yes and no. Few people end up doing research when they finish training. That being said, you need to understand research in order to understand the cutting edges of medicine.

I know it is required for admissions to certain specialties but is it generally considered as an extracurricular activity to boost one's application? How does one perform research and practice as a clinician without losing out in one or the other?

I don't know much about admissions anymore, since I'm so far out. But in principle, you want to be an "above average" candidate to assure yourself an acceptance. So if the "average" candidate does research, so should you; and you should either do it better than the "average candidate" or do something else (non-research) that the "average candidate" hasn't. You would hate to be compared against the "average" and be noted to have something "deficient". That's one admission strategy you can take. But, then again, med school admissions are so random.

Research & practice means different things to different people. In academia, it means doing studies, trials, and publishing, etc. etc. But in academia and in private practice, "research" can mean "quality improvement" where you go back and look at how you've been doing things, compare it against something, and figure out a way to do things better. And then, test to see if you succeeded in accomplishing that. This type of "research" done by the scientific method is something that will improve your practice.

 

[Rocher]

I love the optimism that I see in the FM forums sometimes. It's good to see every once and a while.

 

[Darkskies]

I love the optimism that I see in the FM forums sometimes. It's good to see every once and a while.

Would you say that on average this sort of optimism is rare for family practice physicians or do you mean that it is only rare on this forum?

lowbudget, I would like to thank you for all your thoughts. I wanted to make a minor correction: When i mentioned research, I wasn't referring to what is needed for acceptance to medical schools but instead research one conducts in medical school/residency. Is this sort of research done to have a better application for residencies and fellowships?

Also both you and blue dog cite the higher pay differential in specialties that make them more appealing than a career in primary care. Does this mean that the majority of medical students prefer higher pay over a relatively flexible/manageable lifestyle?

 

[lowbudget]

Would you say that on average this sort of optimism is rare for family practice physicians or do you mean that it is only rare on this forum?

Optimism is rare anywhere whenever the economy is down regardless of what specialty you're in. It's called the wealth-effect. And it trickles through the entire economy. Patients who don't have money or insurance aren't going to see the doctor unless they know they can pay those expenses. You can imagine how that affects all doctors. I don't think it has anything to do with family med in particular.

Is this sort of research done to have a better application for residencies and fellowships?

Yes & no. Many med schools require research or a form of scholarly activity some time during its 4 years. Residents are required to do research or some scholarly activity regardless of program (RRC requirement).

Obviously, if you're successful in completing your project, that's a positive thing.

Does this mean that the majority of medical students prefer higher pay over a relatively flexible/manageable lifestyle?

I can't speak of what's in the minds of majority of med students because I feel like many people go into medicine for different reasons and are motivated by different things, and those motivations change over time.

When people say they want to go into pediatric hem/onc because their brothers/sisters had cancer, how much do you think pay or lifestyle enters that equation? I don't know. It's not even a pertinent question for some people.

 

[smq123]

If controlling one's work environment is the key to managing stress and family practice is the field that offers the most flexibility and control over one's environment, why then do so few medical graduates choose it? In the same vein why is it often considered as a backup if one does not gain acceptance to a residency in a more 'desirable' field?

Because most medical students don't realize the appeal in a specialty that offers flexibility and control over one's environment. Either that, or they fool themselves into believing that they can achieve flexibility and control in ANY specialty.

As a med student, you experience only the exciting parts of any specialty. Attendings pull you into Whipples, pull you into ex laps for gun shot wound victims, pull you into cardiac bypass surgery. So you leave your rotation only having seen really cool, exciting cases. Plus, anything seems fun and exciting for a month....but do the same stuff over and over again for 8 months, and it becomes a different story. Your first trauma that rolls in at 3 AM is exhilarating; your 90th trauma that rolls in at 3 AM when you would rather be sleeping is significantly less fun.

At first I was most drawn to anesthesia, kind of a natural outcome of all the time in the OR. I'm finding myself exploring family medicine, and becoming more interested (which would draw gasps of horror from my surgical friends, but I don't care)

I actually found a lot of parallels between outpatient FM clinic and surgery. Both are very busy, so you have to manage your time efficiently....which means often being very problem oriented. I liked that about both - picking a problem, sticking with it, and leaving other issues for another time. I also felt that both FM and general surgeons were both very well-rounded, something very appealing to me.

 

[digitlnoize]

Does this mean that the majority of medical students prefer higher pay over a relatively flexible/manageable lifestyle?

If you look at the variations in competitiveness of various specialties over time, you will find that as salary rises, so does the amount of interest in a particular specialty.

About 2 decades ago, Anesthesia salaries were in the tank, and no one wanted to do it. Their match rates were pretty low. Now, salaries have risen and they're fairly competitive. Similar things have happened to radiology (and I'm sure many other fields) over the years.

Med students often pick things for the wrong reasons. It's certainly a mistake to pick a specialty due to it's current salary. That salary may not last, and even if it does, it might not be worth it, if you hate the work.

It's also common for people to pick a specialty because they had someone die of Disease X, because they HAVE Disease X, or because they had an amazing mentor.

It's important to separate these factors out and decide for yourself if you truly love the work.

Do what you love, and ignore everyone else.

Do what you love. Ignore everyone else.

 

[freakofnature]

I am pre-med myself and have been pondering some of the very same issues. As of now I am pretty set on FM. The idea of being able too develop real relationships with patients and too treat a wide range of problems/pts is very appealing, variety really is the spice of life. Almost all of the FM docs that I have been shadowing are very happy with their careers. Most have families and a great lifestyle. Residencies are what you make of them, if you want a residency with good hours family med can certainly provide. 1st year residents at the family med residency in my town work less than 60 hrs a week. awesome! As far as I know, less demanding family medicine residencies are not hard too find. I think that it is very good that you are looking into specialties now, too many people get caught up in the money issue. In my opinion these end up the bitter, jaded docs docs that try too scare you out of medicine.

 

[The Wild Wind]

Thank you for all these great advices and informations!

 

[digitlnoize]

1st year residents at the family med residency in my town work less than 60 hrs a week. awesome!

And where might this be? Just curious...

 

[freakofnature]

And where might this be? Just curious...

Idaho State University FM residency
https://freida.ama-assn.org/Freida/user/pgmWork.do

 

[Darkskies]

I'm back to update this thread with a new question that's been on my mind. What percentage of family practice physicians get sued at least once? Realistically shouldn't it be very unlikely that an attending would commit an error seeing as he/she would have had 4 years of medical school and at least 3 years of residency to have perfected his/her knowledge and skills? The idea of being sued or being directly responsible for the ill state of a patient( or god forbid his death) seems unbearable to me.

 

[DOtoCanada]

Idaho State University FM residency
https://freida.ama-assn.org/Freida/user/pgmWork.do

Please remember that these numbers are only averages. There will be MANY months in which you work the 80 hour max. Also keep in mind that these hours don't involve your reading time. These numbers can also be represented on paper as less than you actually put it. Your month of instant care clinic will probably not be 80 hrs, but I'll be damned if you can get less than 75-80 hours during a surgery or obstetrics rotation.

 

[deleted87716]

What percentage of family practice physicians get sued at least once? Realistically shouldn't it be very unlikely that an attending would commit an error seeing as he/she would have had 4 years of medical school and at least 3 years of residency to have perfected his/her knowledge and skills?

Ironically, some data suggests that the best doctors get sued more often.

http://findarticles.com/p/articles/mi_m0689/is_1_48/ai_53728225/?tag=content;col1

 

[Darkskies]

The findings in that study really are surprising. Does that mean that getting sued is a common occurrence in medicine? I know there are a number of factors involved in being issued with a lawsuit and it seems that in most cases the files are frivolous or baseless but how likely is it that a practicing physician, after completing residency would commit an error leading to serious complications for the patient?

Are lightning quick decisions on life or death matters really that common? How often are you unsure about what decision to make? After so many years of education, experience, and continual learning wouldn't one be very competent and comfortable in taking the most appropriate action for just about any situation?

 

[Darkskies]

Anyone?

 

[deleted87716]

You're presuming that you have to do something wrong to get sued. All you need is a bad outcome.

 

[Darkskies]

You're presuming that you have to do something wrong to get sued. All you need is a bad outcome.

If you are sued solely due to a bad outcome in a situation where you didn't do anything wrong, wouldn't this be a frivolous lawsuit which you're likely to win and not suffer much from? Personally, I don't think I would be upset or stress too much if I were sued in a situation where I had done everything correctly and to the best of my ability. What I'm actually worried about is how competent a family physician one becomes after residency and how common it is to make errors.

Is gross negligence and multiple deaths culminating in a license seizure specific to doctors who are being negligent purposely(for whatever reason) or can such grave errors be made by caring, conscientious physicians as well? In the latter case, shouldn't these physicians have conquered their weaknesses in residency and/or not have made it through residency?

I would really appreciate it also if the following questions were addressed:

Are lightning quick decisions on life or death matters really that common?

How often are you unsure about what decision to make?

After so many years of education, experience, and continual learning wouldn't one be very competent and comfortable in taking the most appropriate action for just about any situation?

 

[digitlnoize]

If you are sued solely due to a bad outcome in a situation where you didn't do anything wrong, wouldn't this be a frivolous lawsuit which you're likely to win and not suffer much from?

Not always...you'd be surprised what people can win with a good lawyer. Happens all the time. You just need to convince a jury that the doc did something wrong, or failed to do something he should have...

Are lightning quick decisions on life or death matters really that common?

I'll leave this to the real docs. In FM, it's not like you're in the ER and someone is bleeding out in front of you. But what happens if you miss that melanoma?

After so many years of education, experience, and continual learning wouldn't one be very competent and comfortable in taking the most appropriate action for just about any situation?

You'd think...but people still make mistakes...add to that the complication of medicine, and you've got a good chance for the occasional error.

 

[deleted87716]

If you are sued solely due to a bad outcome in a situation where you didn't do anything wrong, wouldn't this be a frivolous lawsuit which you're likely to win and not suffer much from?

You're kidding, right? There are many first-person accounts of what it's like to be sued available for your perusal on the Internet. Check them out.

Personally, I don't think I would be upset or stress too much if I were sued

Then you're super-human. Congratulations.

Most lawsuits drag on for years. Many are won or lost based on emotion or economics rather than the facts of the case. It's a truly sucky process that I hope I never have to deal with.

Are lightning quick decisions on life or death matters really that common?

In family medicine? No. Family physicians save lives every day...we just don't wait until the last minute.

Good article:

Seven Reasons Family Doctors Get Sued and How to Reduce Your Risk
http://www.aafp.org/fpm/2003/0300/p29.html

How often are you unsure about what decision to make?

Depends what you mean by "unsure." Uncertainty is a fact of life in most of medicine. You do your best with what you've got to work with.

 

[Darkskies]

Blue Dog,
I apologize for using a poor choice of words and giving the wrong impression. I did not mean to paint with a broad brush that getting sued for frivolous reasons should be no cause for concern but from reading some of the posts on these forums about malpractice I sensed that getting sued is very often inevitable in a medical career and I thought that if nothing differed from the standard of care the consequences should not be too grave. I guess I was wrong about that.

I've heard that belittlement and abuse is common during residency. Is there any way to avoid this?

Although I do well in classes and standardized exams, I feel that oftentimes I can be scatterbrained and make (sometimes egregious) practical mistakes. How well do residencies handle such an individual? I would be willing to work hard to improve on my absentmindedness.

One of the factors that seems to be an advantage in choosing the medical career track is that there is so much diversity in the different fields so that you're bound to find one that suits your liking and skills. Is this true or are there some individuals who never find a specialty that fits them?

 

[Darkskies]

Sorry to bump this up again but I'd appreciate some answers.
Thanks

 

[Chromatid]

Take a deep breath, take things in stride. If you are pre health, focus on getting into medical school instead of worrying about whether or not your going to get belittled in residency... that happens long before residency and the only way to avoid it is to know everything, which is not possible, or know everything and not come off as an ass.. which again, very hard to do....

 

[TheHowardRoark]

I was a number-cruncher in a prior life. And my job was to make as much filthy money for others (and by proxy, me) as humanly (and inhumanely) possible. I felt like I had lost my way in life, had become a different person than one that my parents raised me to become. I looked at the people who were my bosses, and at no point did I ever said to myself, "wow, one day, I want to be like him." All my coworkers kept saying, "I thought about premed" or "I considered going to med school"... so, the day I got my med school acceptance, I felt like I had broken away. I was no longer "them", accomplishing something that only people talk about. My boss asked me why I wanted to go into medicine, and after a long explanation, my conclusion really was "because I can." Medicine is a once in a lifetime opportunity. You either do it or you don't. Medical training fits right in this window of opportunity in your life when you can physically, emotionally, socially, financially do it. Very few people can pass up a chance to go to medical school, only to come back later to do it. It's turned out to be a very positive thing in my life. There are a lot of doctors I admire (and a few who I don't). But I feel like I've met more good people in medicine than I have elsewhere, in business or law. You just know it when you see it.

Amen to this entire paragraph. I can really relate to it. I recall sitting in my fancy office looking out the window on the 23rd floor of building downtown, and just not connecting at all with the person I had become... I walked away from that rather "cush" job a week later to pursue medicine, which at that point was most definitely a gamble. I went back to undergrad and 3 years later... I've been accepted and am looking forward to an awesome experience in medical school and beyond... Not sure where I will end up, but I really liked hearing some positive comments in this thread.

 

[EchosDad]

Hello,
I am a senior in college and am having an angst-filled time trying to decide whether pursuing medicine is the correct path for me. I've spent hours scouring the forums to glean as much information I can about the profession(s) and to be truthful many of the naysayers and unhappy/miserable individuals in medicine have given me quite a scare. I know that I should be particularly keen on primary care since if I can't find myself to be satisfied with one of those fields I shouldn't pursue medicine because I could be sorely disappointed since these are the areas most doctors will match into.

For this reason I have a couple of questions concerning family medicine. Although I am more than gung-ho about developing a rewarding practice and career where I give 100% for my patients, lifestyle is also important to my well-being. I have already read previous threads on the lifestyle in family medicine and know that it is an extremely diverse and flexible field but how common are 4-5 day a week outpatient clinics with little call/rounding on patients/teaching duties? Are the salaries in such settings still around the FP average?

What is the stress level for an average family practice physician in comparison to other specialties? How tolerable is residency? Are malpractice rates low? Is it true that primary care physicians are less satisfied than those in specialized fields? Why do so many residents/attendings state that they would steer clear of medicine(and especially the primary care fields) if they had the chance and forgiven loans to do so?

I was also under the impression that the incidence of patient death is significantly lower than in other specialties where the patients have more serious conditions. I know this last point seems a little strange but I guess I also have a fear of patients dying and coping with this situation both for myself internally and in having to explain such depressing news to patients' families.

Thank you so much for reading my post and any and all answers will be GREATLY appreciated!

Work situations with FP are very, very variable. Having said that, I read this online not too long ago:

http://www.careercast.com/jobs/content/JobsRated_StressfulJobs

 

[Darkskies]

Echosdad, are you a resident in family practice(or radiology?)? If in family practice, why did you choose the field and how is residency so far?

How would you(or anyone else) address the following questions I posted earlier:

"I've heard that belittlement and abuse is common during residency. Is there any way to avoid this?

Although I do well in classes and standardized exams, I feel that oftentimes I can be scatterbrained and make (sometimes egregious) practical mistakes. How well do residencies handle such an individual? I would be willing to work hard to improve on my absentmindedness.

One of the factors that seems to be an advantage in choosing the medical career track is that there is so much diversity in the different fields so that you're bound to find one that suits your liking and skills. Is this true or are there some individuals who never find a specialty that fits them?"

Thanks in advance,
Darkskies

 

[deleted87716]

I've heard that belittlement and abuse is common during residency. Is there any way to avoid this?

I never experienced what I would call "abuse" (not to be confused with working with a--holes, which is something you'll encounter pretty much anywhere, not just in medicine). Most FM programs are pretty non-malignant.

I feel that oftentimes I can be scatterbrained and make (sometimes egregious) practical mistakes. How well do residencies handle such an individual?

It's hard to generalize, but it's understood that residency is a learning period. That being said, blatant stupidity and/or utter cluelessness will not be looked at favorably.

 

[JackADeli]

...Family physicians save lives every day...we just don't wait until the last minute...

BD, us surgeons save lives and do it fast, we too do not wait until the last minute... we are usually just called at the last minute

 

[notinkansas]

BD, us surgeons save lives and do it fast, we too do not wait until the last minute... we are usually just called at the last minute

Amen to that. Other specialties who consult surgery frequently screw around getting unimportant data in the face of an obvious need for surgery before the surgical consult is called. I'm not sure they realize that surgeons don't always need to know exactly what the problem is- sometimes the degree of badness on abdominal exam is enough to buy the patient a trip to the OR for ex (as in exploratory) lap. I don't always need bloodwork, xray or CT- in some situations, the results of those tests won't affect the decision to take the pt to the OR and getting them just wastes time. (If pt has a truly rigid abdomen, I don't care what the lactate is, for example- we're going to the OR)

I'll never forget, early in my PGY 2 year, being called for surgical consult in the medical ICU. The patient was going downhill fast, with signs of sepsis/SIRS. She had large midline hernia, and the question was could that be the cause. I learned that she had CT done days ago that showed colon in the hernia, but for some reason, the radiology report read that the hernia was not incarcerated. But every subsequent day, the resident rounding on the pt documented, "non reducible hernia, not incarcerated per radiology report" Clearly more that one person hadn't been paying attention on their MS III surgery clerkship! I knew immediately what the operative findings would be... dead bowel. That consult stands out for two reasons: it was the first time that an attending told me to book the case based totally on what I told him on the phone, and it was the blackest, stinky-est bowel I recall encountering. Sadly, the SIRS process was far enough along that removing the offending bowel didn't help and the patient later died. It's not unusual in similar settings to remove the dying/dead bowel and see the patient improve immediately. But if the request for consult comes too late, outcomes aren't as good.

 

[JackADeli]

Amen to that. Other specialties who consult surgery frequently screw around getting ...

NIK... please note, this reply is not meant as an attack on you or anyone in particular. It is simply an observation/perspective/etc.... I appreciate the sentiments, but am going to refrain from turning this thread into a multispecialty/multidisciplinary combat zone...

Whatever the case, I will discuss a patient and/or their delay in surgical care with the referring parties in the hope of expanding multidisciplinary interactions and better care. I know good surgeons & bad surgeons. I know good FPs and bad FPs.... and all the specialists in between.....

I am getting somewhat exhausted at the "interdisciplinary jabs" as some refer to it.

...if the request for consult comes too late, outcomes aren't as good.

Absolutely agree. And, in the same train of thought, if you wait on hypertension/dyslipidemia/DM/obesity.... "outcomes aren't as good". Bypassing end-stage atherosclerosis is a suboptimal outcome as compared to preventing it.