Is family medicine residency just like medical school?

[medgrlsox21]

So I've been going back and forth between family, peds and pathology (ya i know). I really want to do family I think. I really love patients and talking to them and helping them is the only thing I enjoy about medicine. Everything else I kind of hate. Which is why I'm concerned. 3rd year of medical school has been the worst experience of my life. I have not enjoyed it one bit and it seems like family medicine residency is just repeating it. Medicine, Peds, Surgery, ObyGYN. I hated feeling like an outsider, constantly changing rotations and feeling like I made no real difference to the team. Please someone tell me family medicine residency is NOT the same as 3rd year medical school. I want to work outpatient, see entire groups of families and most likely serve rural populations.

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[discodoctor]

Sounds like you are just a little burnt out. I started my clinical years in surgery at a pretty lets say "aggressive" program. I saw myself longing for path because of the quiet and time off. I was just burnt out. I look back liking certain aspects of each rotation. This is why I chose family medicine. I used to laugh under my breath when attendings would say family med "jack of all trades master of none". I wanted to say and you can only master one? I loved peds, psych, EM, OB, IM, and FM.

Take some vacation time. Deep breath. Remember why you started this in the first place. You are a 3rd year, use your electives in 4th year to see what is out there.
You will do fine .

 

[DocYuki]

Well, I'm MS4 just matched into FM yesterday, but from talking to a lot of FM residents, as well as my older sister who is one, I can offer 2 cents.

For one, my older sister is at a very opposed FM program in a large city. There are many, many other residents in her hospital system (surgery, OB/GYN, fellows) and yet she has loved residency from day one. If she can find autonomy and independence in that system, anyone elsewhere can. Granted, this is her particular experience, n=1 as they say, but I think the point is that you are a resident now, no longer an MS.

For me, I felt exactly the same way you did during MS3. I hated my MS3 year. I went into it with an open mind and got beat down every time feeling like I was in the way and getting !@#$ dumped on me from above. Some rotations were better than others, yes, but it was hard to overcome the feeling of being a fly on the wall. I think part of that was the sheer size and often malignant nature of the academic institution I was at. My motivation was to get through the rotation. Have notes done, make the resident happy, report to the attending, attend the case, and so on. It might be wrong, but I found my motivation to be very extrinsic, from the outside.

But I think in residency you're in the field you want to be in, and my motivation will be intrinsic. Every moment you spend as a resident is towards you being a good attending when you graduate. The programs I looked at, for instance, were unopposed and very geared towards the FM resident having to get training that would do him/her good once out of training. So on surgery at my program, for instance, you don't come in at 5:00am and get brutalized all day like I was in medical school. You do what you need to in order to be prepared to see surgical patients as an FM attending. You scrub in on some cases that are helpful to see (appy, lap chole) but for the most part you manage surgical patients on the floor and see them in the office. How will you handle hernias and post-op patients in your clinic? The intent isn't to torment you but to allow you to see what you need to. Different approach.

I feel like the ultimate ideal for residency is to feel like a resident. From what I gather, the unanimous agreement is that being a resident (as opposed to MS) and in a decent program will put you in a place to want to make your own decisions, seek out your own training, and make a difference. I chose an unopposed program in a community setting because I believe FM is best practiced and learned in this setting (as opposed to downtown metropolis flooded with sub-specialists). Can you get a great FM education downtown? Sure! It's all a matter of what suits you best.

Interview broad when you do and talk to the residents. They should be honest. Find out what fits you and I think you'll find it to be vastly different from medical school. After all, we have an important and solemn duty to accomplish during residency ... to bridge between MS4 and attending. That, my friend, is scary!

 

[senseiturtle]

The solution is simple... Match into an unopposed program. No residents from other specialties to compete with. That's precisely what I did.


When I'm on a service, I want to be the pediatrician, the surgeon, the OB, whatever. That's why I'm there. I won't accept being the "+1" when I'm there to learn.

 

[deleted87716]

Please someone tell me family medicine residency is NOT the same as 3rd year medical school.

Family medicine residency is nothing like the third year of medical school.

 

[markglt]

pretty deep blue dog.

 

[Shinken]

Well, that's what the OP was asking for...Blue Dog just beat me to the punch.

 

[J-Rad]

Can I point out that every field rotates through different specialties in every residency? As a pediatric resident I rotated through the NICU, PICU, wards, outpatient, developmental, cardiology, adolescent, EM, etc. Each built upon different, though often related, skill-sets and often required nuances of cognitive assessment. I was always a learner. But just like you will be in FM residency, I was an integral member of the "team" when taking care of patients. Yes, as a medical student it is easy to feel marginal, but residency is the time to learn your skill-set as a clinician and decision maker. You may have more hand-holding early on than later, but you will note the fundamental difference in your position and responsibility when you hit residency. It is often noted that this can be a difficult thing for some people in transitioning from MS to intern. But it will most assuredly differentiate you from a MS. Despite the challenge, it should be something that you enjoy and take pride in. Challenge yourself to become an outstanding family medicine (insert any other specialty here) clinician and educator (of patients, students, and-if you are good-your peers) and you will be happy with your decision. And remember how it felt to be marginalized when you are responsible for teaching others, so you may avoid the same mistake and you give your learners meaningful and appropriate roles.

 

[markglt]

well said fellow...
you take notes attending?
and the former..kma, quasi gunner

 

[rachmoninov3]

to the OP: 4th year gets a lot better!!!

Also, it is natural to be indecisive about your future at this point, but do some sub-internships early and you'll figure things out. Also, having only just matched (ok, so the 'resident' tag may be a bit premature) I'm going to an unopposed rural program and I chose it precisely to get the most exposure without being the "FM on ___ service" (insert peds, surg, ob, etc).

 

[medgrlsox21]

Thanks for your responses, that's really what I was hoping for. I was unaware how many unopposed programs there are and now I feel like I can pick what will really be best for me. Thanks again!

 

[simpler2]

I think there are residencies out there where residents are essentially 3rd year med students. You can spot them when you are a student and playing the exact same role as the resident.
The exception is continuity clinic...this really can't be fudged (as OB numbers often are) and like it or not you are the doctor taking care of persons in this setting. Since a little less than half your time on average is spent in your clinic you always feel like there is some degree of autonomy in your life, even when you are on a crappy rotation.
Also, I think its safe to say that there are a few "shadow" experience rotations at any residency program. Honestly, once you start residency, you are happy that these exist every once in a while--they give you a few weeks to take a breath or offer excellent time to take your vacation days =).

 

[msbbc833]

I think there are residencies out there where residents are essentially 3rd year med students. You can spot them when you are a student and playing the exact same role as the resident.
The exception is continuity clinic...this really can't be fudged (as OB numbers often are) and like it or not you are the doctor taking care of persons in this setting. Since a little less than half your time on average is spent in your clinic you always feel like there is some degree of autonomy in your life, even when you are on a crappy rotation.
Also, I think its safe to say that there are a few "shadow" experience rotations at any residency program. Honestly, once you start residency, you are happy that these exist every once in a while--they give you a few weeks to take a breath or offer excellent time to take your vacation days =).

Hate to bump an old thread, but it seems that by third year of FM residency most individuals spend 4 or so half days in their continuity clinic. If you are going into FM with the intention of working in the outpatient/UC setting, then I imagine the continuity clinic time is the most valuable. Is this true? I mean I know you learn a lot on inpatient/surgery rotations, but cont. clinic is where to apply it and the setting will be similar to the rest of your career.

 

[VA Hopeful Dr]

Hate to bump an old thread, but it seems that by third year of FM residency most individuals spend 4 or so half days in their continuity clinic. If you are going into FM with the intention of working in the outpatient/UC setting, then I imagine the continuity clinic time is the most valuable. Is this true? I mean I know you learn a lot on inpatient/surgery rotations, but cont. clinic is where to apply it and the setting will be similar to the rest of your career.

Somewhat. Inpatient teaches you what truly sick patients look like (ie. who needs to be admitted/sent to ED right then). You also get a better handle on disease process since you see these people every day while they're getting better. From inpatient, I learned how to tell when COPD patients were getting better and how long it took for them to notice a difference. Helps me counsel when they present initially and made me better at the follow up vists.

Rotating with the other specialties is good for learning more specific diagnosis and treatment in their fields (like what urologists do with an elevated PSA that's referred to them, for example, or maybe some more experience with ortho exams/injections while with them).

 

[VenusinFurs]

Go to an unopposed program. A lot of the specialists like to teach and like to give FM residents a chance to do more.

 

[JustPlainBill]

Family medicine residency is nothing like the third year of medical school.

As BD said -- Medical school is nothing like residency and residency is nothing like being an attending -- In med school if you screw up, no one dies or has a bad outcome because you can't write orders, yeah, you get a bad review, may fail a rotation, feel like the world is coming to an end but by the time you're in your clinical years, it's really hard to flunk out -- you have to majorly hose up to get booted.

In residency -- you're responsible -- you can make a decision to give whatever meds you want and push the edge of the envelope if you're a cowboy and by extension, you can really injure some people and potentially have a fatal outcome-- you can get booted, and you have to answer to your attending, PD and potentially the state medical board for your screw ups -- and you'll find that most people don't want your help, they want what they want and will do what they do, so (and this is totally based on my experience at a LARGE county hospital) -- get the idealism out of your soul now, recognize that for every 100 patients you see, 1 or 2 may be grateful for what you do, the vast majority indifferent and a few will game on you to get what they want -- expect to get yelled at a lot in your intern year, not so much in your 2nd year and 3rd year is hit or miss because by then, the attendings either like you, are ignoring you or are actively trying to make you quit....

Being an attending is more political, plus responsibility -- unless you open your own practice (unlikely these days), you will deal with the patient and office politics and try to do what's right while navigating those waters.....

Medical school is truly the easiest part of all of this, especially the first 2 years -- enjoy your time as a 3rd year -- it's really low stress and 4th year is even better.....or you could always opt out while your debt is still low and manageable --

 

[DocBlin]

Great answer 'JustPlainBill'....

 

[HooliganSnail]

As BD said -- Medical school is nothing like residency and residency is nothing like being an attending -- In med school if you screw up, no one dies or has a bad outcome because you can't write orders, yeah, you get a bad review, may fail a rotation, feel like the world is coming to an end but by the time you're in your clinical years, it's really hard to flunk out -- you have to majorly hose up to get booted.

In residency -- you're responsible -- you can make a decision to give whatever meds you want and push the edge of the envelope if you're a cowboy and by extension, you can really injure some people and potentially have a fatal outcome-- you can get booted, and you have to answer to your attending, PD and potentially the state medical board for your screw ups -- and you'll find that most people don't want your help, they want what they want and will do what they do, so (and this is totally based on my experience at a LARGE county hospital) -- get the idealism out of your soul now, recognize that for every 100 patients you see, 1 or 2 may be grateful for what you do, the vast majority indifferent and a few will game on you to get what they want -- expect to get yelled at a lot in your intern year, not so much in your 2nd year and 3rd year is hit or miss because by then, the attendings either like you, are ignoring you or are actively trying to make you quit....

Being an attending is more political, plus responsibility -- unless you open your own practice (unlikely these days), you will deal with the patient and office politics and try to do what's right while navigating those waters.....

Medical school is truly the easiest part of all of this, especially the first 2 years -- enjoy your time as a 3rd year -- it's really low stress and 4th year is even better.....or you could always opt out while your debt is still low and manageable --

Sorry but medical school is a soul sucking hell which we all crawl through to become a doctor. It is far from "really low stress". Also, from the way you describe your residency, it seems you trained at a very malignant program. Mine is nothing like that.

 

[brianmartin]

It depends on who you are and where you want to go. I hated med school and felt exactly the same way as you. Like an outsider, not really connected to anything. I decided to go to a community unopposed FM program and I don't regret it at all. Yea it looks similar on paper, with all the different rotations. But in reality its far better. I would say go to a smaller community program, I guarantee you'll be far happier in that environment, based on what you've said.

Oh, and regardless of where you end up, as long as it isn't a malignant program (of which there are very few in FM), it will be better than 3rd year. 3rd year of medical school is literally one of the worst things a person could possibly go through. Do everything you can to pass step2 and match in FM, and trust me, you will NEVER have to do anything that bad again. You may not realize this yet, but there is just something about having a bit of knowledge and some responsibility that really makes you perk up and say, hey, this isn't so bad. In FM at least, it's the knowledge that these are my patients and what I do matters. Don't worry, 3rd year is something you do once and then file away under "that sucked..." and then you move on to better things. Just work on getting a solid knowledge base and you'll be fine

Just as an example, in my 3rd year med school surgery rotation, I rounded every morning at 0530 and then followed around a team of crazy surgeons until night time 6 days a week and did 24 hour shifts, had to do presentations and projects, and by the end of it I hated everyone and everything. Surgery rotation during FM residency starts at 7am, no pre rounding, choose clinic or OR according to what you want to do, surgeons all very nice, you learn suturing really well, see some hospital patients, no projects or presentations, no shelf exam after, lots of time to do independent learning, weekends off.

Now, when I go on inpatient medicine, it's the real deal. I manage my patients fairly independently and I do work a lot harder than I ever did in med school. But it just feels more, worth it. Like the work I do is actually important. Therefore when I go home, I'm not in a bad mood. And remember, the rotations are 4 weeks and you can always say, "in a few weeks I'm going to get a golden weekend and I'm going to go have fun."

It's really not that bad. Do it!

 

[VenturaResident]

It depends on who you are and where you want to go. ... I decided to go to a community unopposed FM program and I don't regret it at all. ...

Just as an example, in my 3rd year med school surgery rotation, I rounded every morning at 0530 and then followed around a team of crazy surgeons until night time 6 days a week and did 24 hour shifts, had to do presentations and projects, and by the end of it I hated everyone and everything. Surgery rotation during FM residency starts at 7am, no pre rounding, choose clinic or OR according to what you want to do, surgeons all very nice, you learn suturing really well, see some hospital patients, no projects or presentations, no shelf exam after, lots of time to do independent learning, weekends off.

Now, when I go on inpatient medicine, it's the real deal. I manage my patients fairly independently and I do work a lot harder than I ever did in med school. But it just feels more, worth it. Like the work I do is actually important. Therefore when I go home, I'm not in a bad mood. And remember, the rotations are 4 weeks and you can always say, "in a few weeks I'm going to get a golden weekend and I'm going to go have fun."

It's really not that bad. Do it!

I'm with you on the community unopposed thing, and the fact that working hard can be ok because you are doing actual important work. And, like you say, it really depends on where you go. At our community unopposed program, our surgery rotations starts at 5:30-6am, we pre-round, work around 6 days per week, do 24 hour shifts (as 2nd and 3rd years), are assigned to clinic or OR or on call depending on where we are needed needed rather than where we'd like to be, are first assist on all general surgery and most trauma cases, run trauma codes, learn suturing as well as some open stuff (including all the c sections) really well, don't have weekends off, don't have lots of time to do independent learning, do manage patients fairly independently, and do work a lot harder than medical school. But the no projects or presentations and no shelf exam makes a big difference. It's not necessarily an easy rotation, but it's a really good rotation. And the work feels meaningful. But bottom line is that the experience is different depending on where you are (but not all FM surgery is just mellow!)

 

[brianmartin]

^^^
I'm sorry Joking, kind of. That sounds like a good rotation if you like surgery and/or want to do c-sections. Now I like doing things with my hands and learning procedure skills. However I'm never going to be a surgeon or do surgeries, and I'd be mad if I had to play surgical resident for a rotation. But yes, the rotations will vary place to place and it is wise to ask these kinds of questions at interview.

 

[DermViser]

As BD said -- Medical school is nothing like residency and residency is nothing like being an attending -- In med school if you screw up, no one dies or has a bad outcome because you can't write orders, yeah, you get a bad review, may fail a rotation, feel like the world is coming to an end but by the time you're in your clinical years, it's really hard to flunk out -- you have to majorly hose up to get booted.

In residency -- you're responsible -- you can make a decision to give whatever meds you want and push the edge of the envelope if you're a cowboy and by extension, you can really injure some people and potentially have a fatal outcome-- you can get booted, and you have to answer to your attending, PD and potentially the state medical board for your screw ups -- and you'll find that most people don't want your help, they want what they want and will do what they do, so (and this is totally based on my experience at a LARGE county hospital) -- get the idealism out of your soul now, recognize that for every 100 patients you see, 1 or 2 may be grateful for what you do, the vast majority indifferent and a few will game on you to get what they want -- expect to get yelled at a lot in your intern year, not so much in your 2nd year and 3rd year is hit or miss because by then, the attendings either like you, are ignoring you or are actively trying to make you quit....

Being an attending is more political, plus responsibility -- unless you open your own practice (unlikely these days), you will deal with the patient and office politics and try to do what's right while navigating those waters.....

Medical school is truly the easiest part of all of this, especially the first 2 years -- enjoy your time as a 3rd year -- it's really low stress and 4th year is even better.....or you could always opt out while your debt is still low and manageable --

Awesome answer JustPlainBill. Funny how the opposite is said on Allo and Pre-Allo.