Guide me for M4 please..

[lovebes]

First my stats: US-IMG. Low step 1, and possibly low Step 2 as well..
I have a pretty multi-cultural upbringing, med school was multi-cultural, and generally like that nature in medicine. I like community work, and I somewhat like controlling every aspect of a patient in a life-long process.
I also like to tinker. One of reason to go into FM is to have me some time to prepare a ECG device to put through commercialization.

Situation: currently, I start M4 next week. Super-nervous.

Here are my questions.
1. If I'm interested in offering surgical/obstetrical care as well, do I decide to go into that training while in a FM program? Or are there specific FM programs, in which upon graduation, you're certified to offer the care? My goal is to offer comprehensive care in underserved populations, and I kinda like clinic-based surgeries. Obstetrics - well I'm trying to like that too
tl;dr version: how should I search for FM programs that'll get me competent to also offer surgical/Obstetrics care? Do
all FM programs give you that option?

2. I did not get into any Family electives. Closest one I am doing is a Palliative Care elective. All other ones are IM based. Sub-I IM will be in November, and I only have July and August - no September elective. How can I set up a September one fast, like within 2 months? Can you guys offer me up some leads? Or rather, would this greatly hinder my ERAS application?


Any advice would be awesome. Thanks!

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[aerodoc]

I can only answer question 1. The answer is that all FM residencies have OB and surgical rotations, so you will learn those skills no matter what residency you go to. On the other hand, some residencies are more well known for higher volume OB, or more intensive surgical experiences. To find out which ones, I'd recommend just visiting their websites and looking through the curriculum. If you haven't already, you should check out the AAFP residency directory here: https://nf.aafp.org/Directories/Residency/Search

Also you might get an arguably better surgical/OB experience at unopposed programs (ie where family medicine is the only residency on those services or at the hospital)

 

[primadonna22274]

Agree that unopposed FM programs are perhaps more likely to provide you good exposure to those fields.
Palliative med is tremendously valuable for FM and really any specialty that deals with chronic disease and longitudinal care.
FM was much more competitive last year. I think we are seeing a swing back to the 90s when FM was HOT.
So do very well this year and get good recs because low step scores are going to hurt you a bit.

 

[VenturaResident]

What sort of clinic-based surgeries are you interested in doing? Most FM folks do at least some office based procedures. Not everywhere will give you enough experience to do, say, colposcopies. There are a few where you may be able to learn enough to competently do EGDs/colonoscopies. Do you have a sense of what specifically you are interested in doing? Even in the fullest-scope FM, there are limit to how comprehensive the care you provide your patients will be - you can't be the neurosurgeon AND the radiation oncologist and and and and. You undoubtedly CAN offer broader care than what many people think of as typical FM, but since you can't do absolutely every thing, it's important to think about what you specifically want and be realistic about where you can get that training.

Other folks may feel differently, but without a FM rotation I think your chances of getting into a good FM program are low. Because if you haven't done it, how will they know that you like FM, rather than you are just looking for a back up plan for something else? I'd check with your med ed office and see about switching one of your rotations in the next couple of months to FM - definitely before your interview, preferred before your application goes in.

And this:

I somewhat like controlling every aspect of a patient in a life-long process.

sounds really strange. Residency anywhere will quickly disabuse you of the notion that you'll be controlling any aspect of a patient's life... Though maybe you meant something more like coordinating multiple aspects of their health care?

 

[drcrispmd]

You really need to do a FM rotation. There are many FM programs that offer good OB training. This could be changing since the ACGME have changed their OB requirements as of July 1 for FM.

What office based surgeries are you wanting to learn?

Typically skin lesions excision are the biggest thing we do. You can get training to do vasectomies and colonoscopies. We do colposcopy, endometrial biopsy, iud placement in my residency.

Look for unopposed. You will get more chance to learn more since you will not be competing with other residencies.

 

[lovebes]

Thanks everyone for the pearls of wisdom.
Yes VenturaResident, I by no means meant controlling as in forcing decisions onto patients, but what you thought - doing my best to coordinate.
As an FMG, there weren't much leeway of type and date of electives.
So far, I have 5 electives, and closest one to FM is Palliative Care. July is Surgical Oncology, Aug is Palliative, Sept is Cardiac Critical Care (also somewhat FM-related?), October is Cardiac/Arrhythmia, November is SubI in IM.

Assuming the "hotness" of FM is a trend, I might also not have much leeway in which type of FM residency I'd want - but that'll be known once the year unfolds.

My strategy is to filter and apply for low-income, low-population city programs / unopposed / high IMG% programs. Would that be a good starting ground?