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Family Practice Today - What is it like??

Discussion in 'Family Medicine' started by OnMyWayThere, Oct 12, 2004.

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  1. OnMyWayThere

    OnMyWayThere OMS-III

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    My father who has practiced in the states for over 25 years has seen the good and bad of family practice. Although he specialized in internal medicine, he is a family doc. Well, I watched him raking in over 100k a month and now he barely makes 10k. It's pretty friggun crazy.

    I spoke to him today about whether I should enter his field. Let's face it, we're going to medical school and all the crazy residency stories so I want to be compensated.

    He says he is not making much money nowadays because he is old and doesn't want to work so hard. I also hear that his colleagues that are family docs are doing very, very well. With 3 clinics in spanish areas of Los Angeles, they are doing very well.

    At my interviews, when I told my interviewers that I wanted to be a family doc, 2 / 4 expressed their concern to me that I won't make as much I used to as a business owner (20k/mo.). Something in line with " Are you sure you want to go into family practice and make significantly less when you left such a successful company". Well, I am not in this for the money, but I don't want to be punished for going through all the schooling either...

    So, if you open up a couple clinics, have some fresh docs work for you and put a little business into it, can you live a lifestyle that I feel we all deserve? Or is it still a battle with HMOs and all the b.s. that exists today?

    Thank you for all of your input. It's greatly appreciated.

    Edit: Fresh docs = right out of school and in debt
  2. BellKicker

    BellKicker Twisted Miler

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    Hmm, I'm just trying to wrap around your father's past income. So he made more than a million dollars a year? At a time when a house cost like $10K? :confused:

    I can just imagine life at your house: "What's that, OnMyWayThere, you want a new car? Sure, Daddy will just work 3 extra hours this week". ;)

    It just seems a little unbelievable.

    At medicaleconomics.com you can find the average incomes per specialty. FP is beaten by everyone except pediatricians and GPs (which is a dying breed anyway). I have always theorized that the income distribution for FPs has a larger SD than other specialties because of the broad practice scope, though, but I don't know if that's true.

    Interesting topic, btw.
  3. OnMyWayThere

    OnMyWayThere OMS-III

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    He did make more than a million dollars a year... I guess you are unaware of the 80's.

    Not even close. It was more like " drive this Toyota til you're 18 and old enough to work and buy your own car"

    I was actually asking if it's possible to still make a good living if one ties in the business aspect of the world to his/her practice. I guess it is possible though, just takes some strategies that were unnecessary in the past.
  4. BellKicker

    BellKicker Twisted Miler

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    I still find it hard to believe. The average income now for an FP is around 130K. With inflation, are you saying doctors have taken a 90+% salary cut since the 80s? :wow:
  5. OnMyWayThere

    OnMyWayThere OMS-III

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    You have not helped answer my question one bit, but to answer you question, go back to my original post and read it over... focus on the part that said

    .

    That should answer the question you have just stated. Back to the topic please.
  6. bmickelsen

    bmickelsen Junior Member

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    OnMyWayThere

    One of the great parts about family practice is there are so many options. If you read some of the previous threads you will see people talk at length about this issue, one option is to acquire the training for many different procedures. If a family physician does lots of procedures and has other doctors working under him he has the potential to make a very adequate income, probably not what your father was making. But it's not unreasonable for a family physician doing procedures to make 150,000-250,000. Then if he has 2 doctors working under him, he would probably pocket 30,000-60,000 dollars from each doctor.
    Just my thoughts, as a 3rd year medical student, take it for what it's worth
  7. OnMyWayThere

    OnMyWayThere OMS-III

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    That's good enough. I don't plan on becoming a millionaire pursuing medicine, but I just don't want to fight to make some extra money for all the hard work ahead. Thanks for your response. I just wanted some outside opinions. :thumbup:
  8. BellKicker

    BellKicker Twisted Miler

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    Whoa whoa, calm down buddy, I'm no expert at this. I don't know exactly what it is you want to know. I can just repeat myself and tell you that FPs make little money compared to some other specialties. The average annual income is now around 130K. Whether it was once 10 times more, I really don't know; I'm just saying I strongly doubt it. Maybe your dad just did some lucrative procedures or had lots of people under him; I suspect he was the exception to the rule.

    Like bmickelsen suggested, there is a wide span of incomes out there for FPs but if you're looking to make a million dollars a year, FP is not the smartest choice. (Actually, med school probably isn't the smartest choice......) :)

    OTOH, many FPs live in a rural areas where the money stretches further. These days, that's a huge factor in what sort of standard of living you'll have. In some areas, on 130K, you'll be the richest guy in town. I guess everything is relative that way. And to sound really lame, wealth isn't just about money.
  9. dr_almondjoy_do

    dr_almondjoy_do So Very Happy to Be Here!

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    OnMyWayThere,

    I can truly understand where you are going with this, since as I've said in many postings, there is a whole wealth of income that the FP doc is not tapping into.

    We can't practice today's medicine with yesterday's approach. Nowadays, a pt would feel cheated if they didn't get a vascular study, endoscopic procedure, pulmonary function test, immunotherapy panel, full blood work up, and whatever else they feel we need to diagnose their illness. All of these procedures we can provide as FP docs.

    This is medicine, and, b/c of HMOs and insurance, it is also a consumer driven market. We provide a service now that is not so inaccessible to the public. If a pt. doesn't like you, they can go elsewhere, and pay the same copay. So to them, nothing is lost. We have to find a way around that for our own personal survival. This is so easy to do within the scope of our practice, no "get rich quick schemes" here!

    So now with the advance of medicine, we are now able to get certification and hire ancillary staff to help us perform the very procedures that are driving up the cost of medicine. In addition to that, we can hire staff (PAs, new docs, NP, RN, CNA, LPN, etc.) to staff our practices to help improve productivity. Add in the "Bedside Manner" we try to perfect, and you have happy people. Happy pts, happy staff, and happy doctor that has a grip on it.

    This is family medicine today, and I just love when people interested in other specialties try to compare. Specialists don't have the capability to cater to their customer like Primary care docs can. An orthopedic surgeon can make alot of money just by providing their service. An opthamologist can make money by just treating eyes. But the two specialties don't have the flexibility that FP can afford.

    An FP can make the same money as the two by just using business sense, and at the same time, do what they love, see a variety of illness, and enjoy the schedule they like. An FP practice can't be run by just blind medicine and faith in insurance reimbursements.

    Ok, don't know where all that came from, but I stand behind it! lol
  10. OnMyWayThere

    OnMyWayThere OMS-III

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    Thanks BelKicker for giving your insight... that's more what I was asking. :thumbup:
    Hey dr_almondjoy_do, that was a great post. I appreciate your effort in clearing that up. I just kept hearing all this negative stuff from interviewers to docs about how I will be struggling as a FP. I was really thinking I must go into a specialty and that was not my original plan. I was hoping I would hear everything you just said. Thanks!
    I guess before it was almost as easy as opening up shop and being in good shape. That's simply not the case now and that's just fine with me. But the scope of practice for a FP is indeed very attractive. It seems as though if one doesn't want to have business involved and still wants to make some money, it is best to specialize. Thanks for the input guys. :horns:
  11. captbadass

    captbadass Senior Member

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    OnMyWayThere,

    I know exactly where you are coming from. The 80s were very good to doctors and I have no doubt your dad was pullin in some major cash, even as a family medicine doctor. It's all about business sense. Making money may have been easier for our fathers, but with ingenuity, hard work, and a solid business plan I think we can match their revenue. Don't let people dissuade you with the averages they looked up. In my community I know of a family med physician that has several offices, associates, ancillary staff, and a lab. I would not be surprised if he makes well over a million. If you have great business skills and can capitalize on opportunity, then the sky is the limit. I have heard the same BS while on interviews about family med not making money. However, I think the people who make these statements are ignoring the possibilities that exist for people like us who are willing to take chances and act on our entrepreneurial spirit. So, to answer your question, yes you can still make similar money as your dad once did. You just have to adapt to the market. On the other hand, if you simply set up shop someplace without much organization and vision for the future, then plan on being average.

    capt
  12. dr_almondjoy_do

    dr_almondjoy_do So Very Happy to Be Here!

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    OnMyWayThere,

    You said it best when you said that doctors that just want to open shop and make money should specialize. They will get paid for making widgets all day, and they'll be very happy.

    When you look at your fellow classmates, I know you will find a good number that would be eaten alive in the real world. These people specialize. No need to think about anything else except for the work at hand, and the end of the day. I'm sure it's reassuring to know that you just do your job and go home and bank, but that gets so tired after a while, especially having to work 80-100 hrs a week, and having to spend so many years as fellows and residents. No money there until they're completely done!

    I wonder why people even compare. FPs have such a wide range of hours worked, and compared to surgeons and other specialists that work 100 + weekly, how can you compare their pay to a Family doc that works 50 hrs, no call always, and a flexible schedule?

    We need to find a source that shows payment per hour.
  13. BellKicker

    BellKicker Twisted Miler

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  14. OnMyWayThere

    OnMyWayThere OMS-III

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    Right on. :thumbup: It makes sense.
  15. dksamp

    dksamp Member

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    Hello,
    I think that a Sticky/FAQ on family practice is WAYYYY overdue. Although I have been swamped lately, I will try to work on one. Having been in private practice for over a year, I got quite a few things to say...

    PEACE!

    -Derek
  16. OnMyWayThere

    OnMyWayThere OMS-III

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    Please do share whenever you get a chance. I'm sure lots of people would like to hear. Thank you for your insight :thumbup:
  17. dr_almondjoy_do

    dr_almondjoy_do So Very Happy to Be Here!

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    please don't post a sticky letting people know how sweet FP really is, b/c then we'll have board score posts and "Do you think I can get in with a 99%, top person in my class, saved the free world, and cured cancer? I'm worried because I didn't get a LOR from the surgeon general..."

    No really, I do feel it's long overdue.....Thanks!
  18. awdc

    awdc Senior Member

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    Okay, I'm going to play the other card on this one. There are plenty of specialties where one can make more with seeing fewer patients, less call, and with fewer or comparable hours to a FP. Rads, rad onc, derm, anes, ophtho, GI, EM, ENT, rheumatology, nuc med, etc. just to name some. Another plus to specializing is that you can focus on medicine instead of dealing with as much paper work and all the other managed care hassles. And with some specialties, you won't even have to worry about running a practice/business which would free up your time to pursue other interests. And since when did FP's have no call? Flexible schedule? They always seem tied to their pagers.
  19. oldandtired

    oldandtired Senior Member

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    252 Step I, 243 Step II, 3 publications in American Family Physician, AOA senior year. Can I get a spot in a competitive FP program?

    :) Sorry, could not resist.
  20. Fermata

    Fermata kekeke

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    :rolleyes: :D
  21. iatrosB

    iatrosB trying not to kill anyone

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    highly unlikely. I would try a less competitive specialty like ortho or derm. Good luck.
  22. erichaj

    erichaj Removed

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    It's not just your board scores or publications. FP is about people and how you deal with them. Most FP doctors are down to earth and laid back. If you are that person, then you should shine.

    you scores get you an interview, who you are get you a job.

    Best wishes,

    EH.
  23. dr_almondjoy_do

    dr_almondjoy_do So Very Happy to Be Here!

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    That is very true, but you can always have a back up, like gyn/onc or cardiothoracic surgery....lol
  24. dr_almondjoy_do

    dr_almondjoy_do So Very Happy to Be Here!

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    Yeah, but you failed to remember how long it takes for these students to become doctors. Some of these specialties, besides EM, derm, rads, will have you as a resident/fellow until you're 40 if you started early enough. FP is a two year residency, and one year traditional/rotating internship. Three years top, and you are on the way! Plenty of time to scut at group practice and get real life knowledge in a real practice before running your own.

    You are right when you say that these people make money, and they do, but they don't have the freedom of variety like fp does. FP is truly for creative people to make money and like it. But you have to be that kind of person.

    I would love to manage my practice and know what is coming in and out. I hear alot of rich, bored specialists at my hospital now complaining still about protocols, policies, hours, call schedules, alloted time in the OR, hospital priviledges, etc, etc, etc..... bottom line, they are making good money, but they are not their own boss. I think its important to like what you do where and how you do it. These people work so hard and went to school for so long.

    And FP docs do not have to take call if they have an agreement with a hospital for inpatient care by a hospitalist, and they can do outpatient only. Then they use the inpatient care in collaboration with their office care. An inpatient doc does have to do call. I don't mind it, but its not mandatory.

    Sorry, but I had to do it! The thread is about the status of FP today, not "how can I make the most $$$$ and work the least, but spend more time as a medical student?" lol
  25. erichaj

    erichaj Removed

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    That's funny. Your going to use cardiothorasic surgery as you back up. hehe.

    Good luck man.

    Usually it's the other way around.

    They are not even in the same catagory. One is primary care and the other is ultra-subspecialty.

    During the interview the guy is going to ask you why you want to get into cardio surgery and your gonna say hmmmmmmmmmmmmmm well I could not get into FP. lol.

    He is going to say. GET REAL.

    EH.
  26. cooldreams

    cooldreams American Mensa Member :)

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    dood?? itz a joke...
  27. PACtoDOC

    PACtoDOC 1K Member

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    I was an FP PA with 1 other PA and 3 total docs. We did no special procedures although I personally did toenails, biopsies, excisions, and other small things. We worked in a suburb of a major city, each saw about 25 patients a day, and in the end we were truly nothing more than a med refill office liberal in our referrals. Even such, the PA's made 100K, and the docs each made about 180K, 250K, and 350K respectively...ballpark area. We had one satellite clinic with another doc, and we just all had good bedside manners where patients came to see us because they liked us. My guess is that if we had done more procedures, and branched out and worked harder to see more patients, we could have done even better. The myth that FP's make 120K is based on the idiots who came into FP and have no people skills, and don't want to work more than 36 hours per week. And rural FP is even higher potential for pay.
  28. banner

    banner Senior Member

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    You know, I think that your father is giving you really good advice. It also seems that you have quite the entrepreneurial spirit. I'd hate to see that dampened by medical school and then by finally killed by going into family practice. To go give up your successful business and go to medical school and do a residency would be economic suicide.
  29. OnMyWayThere

    OnMyWayThere OMS-III

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    I guess it boils down to if you are business oriented and a people person or not. The latter must specialize if he/she wants a good income.
    Banner... My father didn't really give me advice on what to get into it, other than what I will enjoy. I was an entreupeneur and a successful one. I don't see why I can't use those skills once I am done with medical school and residency? I love medicine. I love people. And I like business. You mentioned that going to medical school and family practice would be an economic suicide but from the above posters, it seems like it's not for a person like myself. I am not trying to become a millionaire from medicine, I just don't want to make 10k before taxes, student loans, malpractice, etc. Can you elaborate on how it would be an economic suicide for a person like me though?
  30. thanks

    thanks Member

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    I've heard a few docs mention, as you have, "if an FP chooses to be aggressive with procedures, he/she could make much more." I know FP's are doing biopsies, cryotherapy and such but when you say "more procedures," Exactly what procedures are you speaking of? How aggressive do you have to be to do them?

    And how many hours were you guys working? Any call? Weekends.

    Finally, if anyone cares to chime in, I'd love to hear about the economics of contracting with hospices and nursing facilities in terms of time invested and income generated from them.

    Thanks
  31. BellKicker

    BellKicker Twisted Miler

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    I just wanted to say this is turning into one helluva thread. :thumbup:
  32. iatrosB

    iatrosB trying not to kill anyone

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    Its about time the family medicine forum represented. :thumbup:
  33. cooldreams

    cooldreams American Mensa Member :)

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    dewd.... :cool:

    DOOD!! :mad:

    dude?? :confused:

    hehe... dwed.....

    hey so you are gonna goto kcumb for shure then?? kewl... :thumbup:
  34. Willamette

    Willamette Good with a bo-staff

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    FP's do the following (not an exhaustive list):

    PAPs
    Colposcopies
    Biopsies (of all sorts)
    LEEPs
    C-Sections
    Vasectomies
    Endoscopies
    Sigmoidoscopies
    Colonoscopies
    Circumcisionss
    Joint injections
    Central lines
    Venous Cut-downs
    Incision & Drainages (I&Ds)
    Casting
    Suturing of Lacs


    The list is actually pretty long and includes plenty of things that I probably left out. Feel free to add to the list...


    Willamette
  35. dr.smurf

    dr.smurf Senior Member

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    treadmill stress tests
    cryotherapy (skin lesions, cervical dysplasias, etc.)
    spinal taps
  36. emedpa

    emedpa GlobalDoc2B2015

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    Thoracentesis
    Paracentesis
    Minor Cosmetic Procedures With Appropriate Training(botox, Etc)
  37. iatrosB

    iatrosB trying not to kill anyone

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    Yep, it's KCUMB for sure!! :D
  38. PACtoDOC

    PACtoDOC 1K Member

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    Emed,

    Thoracentesis? What are you smoking dude? :)
  39. emedpa

    emedpa GlobalDoc2B2015

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    if an fp pa can do it then an fp doc can too.....I'm talking rural here of course.....I know of primary care rural pa's who have tapped large malignant pleural effusions to ease work of breathing in fairly sick folks at a distance from a tertiary care facility.
  40. oldandtired

    oldandtired Senior Member

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    FP's do the following (not an exhaustive list):

    PAPs
    Colposcopies
    Biopsies (of all sorts)
    LEEPs
    C-Sections
    Vasectomies
    Endoscopies
    Sigmoidoscopies
    Colonoscopies
    Circumcisionss
    Joint injections
    Central lines
    Venous Cut-downs
    Incision & Drainages (I&Ds)
    Casting
    Suturing of Lacs


    Outside of bumbleding, WY. An FP will not get priveleges to do many of these procedures in hospitals. Most FPs will not take on the added liablility due to soaring malpractice.
  41. PACtoDOC

    PACtoDOC 1K Member

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    2/3 of these procedures are in office procedures anyway. And you don't have to be in BFE to get C-section priviledges, you simply need to be in a place where OB's are in short supply, and have the training to do them. Most hospitals require around 40-50 of them to get credentialed. There are FP's doing sections within 30 miles of my city of 600,000 where I am now. Leeps, circumcisions, vasectomies and colpos are bread and butter procedures that pay well and have virtually no chance of a bad outcome. They are see-one-do-one-teach-one type procedures.

    I plan to do them all if I do FP, along with OB where I can deliver 1-2 per week on average. You have to do 50 a year to pay the insurance.
  42. dksamp

    dksamp Member

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    I am almost about 75% done with the sticky...As soon as I get it done, it will be posted....


    -Derek
  43. dr.smurf

    dr.smurf Senior Member

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    how exactly does malpractice insurance work when you are an fp attending who wants to do these things? does the amount you pay to the ins co depend on what type of practice you plan to do (hospital, outpt, both, er, etc.)??
  44. Gr42

    Gr42 Member

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    I'd like to know if a FP who is EMcertified gets paid and treated the same as a physician who has completed a residency in Emergency Medicine???
  45. iatrosB

    iatrosB trying not to kill anyone

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    Do a search in the EM forum about family practice or FP. They talk about it in there quite extensively.
  46. OnMyWayThere

    OnMyWayThere OMS-III

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    Eagerly waiting ot read it. :thumbup:
  47. erichaj

    erichaj Removed

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    The list of procedures that I saw in this page is correct, EXCEPT:

    What you have to realize is that you don't do all of these on a regular basis. And not all insurance pays for all of the above procedures.


    What you need to do is advertise for a specific procedure that the other guys are not doing. Everybody does paps.

    The ones that make money are the injections. (just as an example)

    Advertise for joint pain, discomfort. Do hylan injections.

    EH.
  48. dksamp

    dksamp Member

    Joined:
    Oct 26, 2001
    Messages:
    76
    Location:
    Southeastern US
    SDN 10+ Year Member
    WOOHOO!!!

    It is done and will be posted shortly...By the way, whoever moderates this group, can you pelase hook a brotha up with a moderator position on this board??? please?? :D

    -Derek
  49. OnMyWayThere

    OnMyWayThere OMS-III

    Joined:
    Apr 2, 2003
    Messages:
    2,024
    Location:
    The best coast (west coast)
    SDN 7+ Year Member
    If one chooses to go into cosmetic as a family doc... is lip augmentation (via collagen injection or implant) out of the family doc's scope of practice? If so, are there problems associated with doing it as a family doc (malpractice coverage / liability)? Thanks :thumbup:
  50. PACtoDOC

    PACtoDOC 1K Member

    Joined:
    Aug 2, 2002
    Messages:
    1,057
    SDN 7+ Year Member
    The only thing that is not within your scope is whatever you do not feel comfortable doing, other than the obvious invasive surgeries. But some FP's routinely even do hernias and appy's. But anything that a dermatologist can do, an FP can do if they learn it correctly and feel comfortable with it. A lot of FP's don't remove BCC's, especially on the face. But I have seen on my derm rotations that this is no more difficult than any other body location. You just need the right tools, and the right training. You can do whatever you want my friend. You can't literally do it all as an FP because it would take away from your practice. But my focus is going to be OB for the first 5 years or so, along with lots of derm stuff since that is my other favorite entity. Quite frankly you could do 95% of all your derm other than melanom's and Moh's right in your office and make as uch as a derm doc would make on those cases for the most part. I plan to train my patients from the get-go that skin care is of the utmost importance, and then biopsy anything suspicious and routinely treat pre-cancerous lesions all myself. Add on acne treatment, become an expert at hyphecator treatments for warts, throw is a little Botox if you are so inclined, and attend CME's that teach newer derm treatments annually. Then you have created your own niche per-se. Refer all the stuff you are uncomfortable with to your nearest Derm doc to stay on good terms with them, and you have yourself a cash cow. I do not plan to do colonoscopies, but I do plan to also do colpo's, IUD's, endometrial biopsies, and other unique things. Pick your passion and run with it.

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