Just committed to family med!

[Back34]

Yep, took the big step today. I was wavering there for a while, but our Dean of Students set my mind at ease a few hours ago. After having a great family med rotation, my heart was with the field but I seriously doubted its practicality, mostly based on what others were telling me and the standard SDN fare; you know: "it'll be obsolete in 10 years, the NP's are taking over, you'll be lucky to crack 50 g's without working like a fiend, etc." After expressing my concerns, he point blank told me it was "bull$hit," propagated mostly by students trying to justify their interest in plastics and derm, and disgruntled FP's clearing "only" 150 grand a year.

I wasn't aware of this, but he told me family med was intensely competitive in the early nineties and when he was doing his residency in the 80's. He also noted that its popularity cycles and will probably be one of the most sought after residencies in five years time. Thus, it's a great time to get into the field while we still have our relative pick of residencies. Plus, given the 80 hour/week rule, there's a mass exodus to surgery, making the field even more wide open.

Anyway, just wanted to say "hi" to any future colleagues and am highly anticipating working in a great field.

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[espbeliever]

does your voice sound wispy like?

didnt you get the chance to talk to any fp's in the "real world" to help make that decision?? however i do want to go into fp, i think you should be careful here..

 

[doc05]

I hope you didn't base your career decision on a talk with your dean of students! those guys don't live in the real world, and many haven't seen patients in years. be sure to talk to private practice fp's to get a sense of what it's really like.

 

[PACtoDOC]

Don't worry about what all these people are saying to you Back. I have been in the real world of family medicine and I know personally that if you surround yourself with good, honest people, work hard, and care about your patients, that you can and will make great money and be very satisfied and respected. Take it from me that your Dean actually sounds like someone who has been in the real world. FP will be competitive in the future when incentives will increase to bump up the numbers. Now is the time to go into it, especially if you love the lifestyle. I have excellent board scores and stats, and yet I am going into FP wholeheartedly. Trust me, you will not regret it.

 

[Back34]

Don't worry about what all these people are saying to you Back. I have been in the real world of family medicine and I know personally that if you surround yourself with good, honest people, work hard, and care about your patients, that you can and will make great money and be very satisfied and respected. Take it from me that your Dean actually sounds like someone who has been in the real world. FP will be competitive in the future when incentives will increase to bump up the numbers. Now is the time to go into it, especially if you love the lifestyle. I have excellent board scores and stats, and yet I am going into FP wholeheartedly. Trust me, you will not regret it.

Thanks for the vote of confidence and the encouraging post. It's nice to see something positive said about family med.

 

[EP to FP]

Thanks for the vote of confidence and the encouraging post. It's nice to see something positive said about family med.

I think you made a great choice going into family medicine. I was previously an emergency medicine resident and I too had good board scores etc., and gave up emergency medicine to transfer into family medicine. I don't regret my choice one bit. Family medicine is just as challenging as any of the subspecialties and as you'll see, patients truly do appreciate us. Don't let anyone tell you different about your choice of specialty. You'll hear a lot of negative talk regarding family medicine in terms of money and lifestyle. Honestly, the money is not that bad and the lifestyle is what you make of it. If you want to work 80 hours a week, you can... and if you want to work 32 hours a week, you can. There's so much flexibility in family medicine that I don't think you get in some of the other specialties. Anyways be proud that you picked a specialty because it is really what you want to do and not because of money or prestige.

 

[JudoKing01]

My dean told me that he had a student just match into family practice that could've gotten into a neurosurgery residency with not too much trouble. Sounds like you love the field and have a dedication to it. You'll be a great FP.

 

[Back34]

Many thanks for the positive replies and not a moment too soon either. I've been catching flak from some relatives about going into FP: one is an ortho and the other a radiologist. They rolled their eyes at me as if to say "FP is the best you can do, aim a little higher."

 

[PACtoDOC]

Many thanks for the positive replies and not a moment too soon either. I've been catching flak from some relatives about going into FP: one is an ortho and the other a radiologist. They rolled their eyes at me as if to say "FP is the best you can do, aim a little higher."

It just depends on how much you get off to measuring your accomplishments against your colleagues, versus getting what you want out of life. My dream is to be Doc Hollywood in rural nowhere so I can have my office across from the ER, see patients in the hospital at lunch, and work my butt off doing just this until I collapse dead!! All I want is a decent house on some land, a 4 wheeler, a fishing pond, a nice Texas sized truck, an easy chair with a cup holder, my own fitness equipment in the basement, and satellite dish. I want my kids to be known as docs kids, and I want to wear jeans (Levis, not Wranglers), boots, and play classic rock on the sound system in my office. On Christmas day I want to go to the hospital and see my patients, and come home to the pies and turkey the other patients brought my wife. I want to know about my patients lives and I want to become part of their lives. I want to go to the high school football games not only to watch but to work, ans I want to be on the chamber of commerce. I want to join the Veteran's of Foreign Wars and drink beer on Wednesday nights while we talk about "the war". I want to go to church on Sunday with my family.

As you can see, insert basically any profession into this story and this lifestyle is conceivable. Insert a physician's salary and you can live this life and have savings to send your kids to any college in the country. And in the end, you can still retire and die fat and happy. I guarantee I will be more satisfied than any ortho or radiologist. They might win the race in terms of salary, but I am not planning on leaving millions for others anyway when I die!!

 

[JudoKing01]

Wow PAC....that was very inspiring. Almost makes me feel guilty for wanting to be a surgeon, lol.

 

[iatrosB]

It just depends on how much you get off to measuring your accomplishments against your colleagues, versus getting what you want out of life. My dream is to be Doc Hollywood in rural nowhere so I can have my office across from the ER, see patients in the hospital at lunch, and work my butt off doing just this until I collapse dead!! All I want is a decent house on some land, a 4 wheeler, a fishing pond, a nice Texas sized truck, an easy chair with a cup holder, my own fitness equipment in the basement, and satellite dish. I want my kids to be known as docs kids, and I want to wear jeans (Levis, not Wranglers), boots, and play classic rock on the sound system in my office. On Christmas day I want to go to the hospital and see my patients, and come home to the pies and turkey the other patients brought my wife. I want to know about my patients lives and I want to become part of their lives. I want to go to the high school football games not only to watch but to work, ans I want to be on the chamber of commerce. I want to join the Veteran's of Foreign Wars and drink beer on Wednesday nights while we talk about "the war". I want to go to church on Sunday with my family.

As you can see, insert basically any profession into this story and this lifestyle is conceivable. Insert a physician's salary and you can live this life and have savings to send your kids to any college in the country. And in the end, you can still retire and die fat and happy. I guarantee I will be more satisfied than any ortho or radiologist. They might win the race in terms of salary, but I am not planning on leaving millions for others anyway when I die!!

Sounds like a good life to me!

 

[JudoKing01]

You know, it sucks, because I really love the idea of family practice, but I just can't give up the OR. I love to scrub and I love doing surgery. If there was a way to be a FP and do surgery in the OR I'd be able to die happy.

 

[PACtoDOC]

You know, it sucks, because I really love the idea of family practice, but I just can't give up the OR. I love to scrub and I love doing surgery. If there was a way to be a FP and do surgery in the OR I'd be able to die happy.

Exactly how much surgery are first years getting these days?

 

[pbmax]

I always find it interesting to read these boards and posters' views on family medicine.

The top guy in my graduating class went into family medicine (from an a very good MD school no less). He always explained it to me as - to be a good family physician is a challenge in itself. Every specialty has its monotony, but at least in family medicine there is variety. The pay may be lower than other specialties and the prestige (at least on this board) may not be as great, but you are your patient's doctor. I grew up with parents who didn't clear $30,000 a year so the pay for a family physician sure seems pretty good to me.

And on a related note: A recent study showed that an increased density of specialists in a community do not lower morbidity or mortality, but available primary care does.

Congratulations on your choice of family medicine. I wish you the best.

 

[sparky5]

Exactly how much surgery are first years getting these days?

I think pre-first year would be a better description of a class of 2009er.

 

[JudoKing01]

I've been a scrub nurse for a while. I'm in the OR everyday. I also follow the patients onto the floor once they leave the OR for certain doctors.

Edit: Actually, I just finished a Lap Chole/Roux-En-Y, but the RNFA that helped out sees patients in that surgeon's office, so I'm not going to do anything else on this patient. There are other surgeons that I work with however where I'll help them with their follow-ups, dressing changes, etc.

Also, it used to say MS1 - 4 mo, but that was awkward looking.

 

[PACtoDOC]

I've been a scrub nurse for a while. I'm in the OR everyday. I also follow the patients onto the floor once they leave the OR for certain doctors.

Edit: Actually, I just finished a Lap Chole/Roux-En-Y, but the RNFA that helped out sees patients in that surgeon's office, so I'm not going to do anything else on this patient. There are other surgeons that I work with however where I'll help them with their follow-ups, dressing changes, etc.

Also, it used to say MS1 - 4 mo, but that was awkward looking.

Excellent!! I just got home from 2 carotids, damn back is killing me. I had never been in on one before and found vascular to be pretty cool. Its pretty amazing how those patches don't leak much even with big bites. Well you will be worlds ahead in the OR!

Good luck!

 

[JudoKing01]

Oh don't get me started on vascular. I love it. Did they do it with EEG monitoring or did they do it the old school way with the clicker and/or squeeze my hand, wiggle your toes, talk to me?

I think the coolest vascular cases are the AV fistulas, both creation of and revision of. I just love seeing the "road map" of the venous system.

As much as I love the or, I am already getting bored with it...I've been doing this for a little while and the newness has already worn off, and I don't think that I would like to be a surgeon (Plus, doing laparoscopic cases makes me dizzy when I drive the camera, lol). I think, although I'm sure I'll change my mind as I go through school, that I'm probably heading towards a family medicine route, maybe with obstetrics.

 

[PACtoDOC]

Oh don't get me started on vascular. I love it. Did they do it with EEG monitoring or did they do it the old school way with the clicker and/or squeeze my hand, wiggle your toes, talk to me?

I think the coolest vascular cases are the AV fistulas, both creation of and revision of. I just love seeing the "road map" of the venous system.

As much as I love the or, I am already getting bored with it...I've been doing this for a little while and the newness has already worn off, and I don't think that I would like to be a surgeon (Plus, doing laparoscopic cases makes me dizzy when I drive the camera, lol). I think, although I'm sure I'll change my mind as I go through school, that I'm probably heading towards a family medicine route, maybe with obstetrics.

Are we talking about the same procedure? Carotid endarterectomy is not done to my knowledge with the patient conscious. Both ours today were tubed. Maybe I am confused!!

 

[JudoKing01]

In the old days they used to put them under, and then when they clamped the carotid, they'd wake them up and have them squeeze either a clicker or wiggle their arm and foot to make sure sufficient blood flow was still getting to the brain.

Edit: Then they'd put them back under again. Lots of people use the EEG monitoring now, but I know quite a few surgeons who still do it the old way. I also know surgeons who do not use a patch, they just close the vessel. Everyone does it a little differently.

 

[PACtoDOC]

In the old days they used to put them under, and then when they clamped the carotid, they'd wake them up and have them squeeze either a clicker or wiggle their arm and foot to make sure sufficient blood flow was still getting to the brain.

Edit: Then they'd put them back under again. Lots of people use the EEG monitoring now, but I know quite a few surgeons who still do it the old way. I also know surgeons who do not use a patch, they just close the vessel. Everyone does it a little differently.

I gotcha!! You really know your stuff. The way we did them today, we used a small shunt that looked like a coffee stir straw, and then tied with silk to stop any leaks while we were working on the patch.

 

[JudoKing01]

Yeah a lot of people shunt the carotid...but you have to be real careful that they don't stroke out. To me it just seems safer to clamp.

BTW, not to single you out, but your post really made me rethink family medicine, and even though I know I have a while before I have to choose, I realized I could easily give up the OR for family medicine. What I really want out of my career is a strong connection to my patients and community, from peds to geris. Yes, I want to do procedures, but there are procedures and hospital time in FP. Also, if I did obstetrics, which I love and most likely will (assuming I stick with FP), I'd get to scrub anyway, which is really the part I'd miss about the OR: the thrill of scrubbing into a procedure.

Anywho, I'd just like to say thanks for helping me rethink a specialty I definately overlooked.

 

[dr_almondjoy_do]

Yeah a lot of people shunt the carotid...but you have to be real careful that they don't stroke out. To me it just seems safer to clamp.

BTW, not to single you out, but your post really made me rethink family medicine, and even though I know I have a while before I have to choose, I realized I could easily give up the OR for family medicine. What I really want out of my career is a strong connection to my patients and community, from peds to geris. Yes, I want to do procedures, but there are procedures and hospital time in FP. Also, if I did obstetrics, which I love and most likely will (assuming I stick with FP), I'd get to scrub anyway, which is really the part I'd miss about the OR: the thrill of scrubbing into a procedure.

Anywho, I'd just like to say thanks for helping me rethink a specialty I definately overlooked.

Although FP is a very rewarding field that I plan to enter, you can get the same closeness with Surgery that you get with FP. Your patient relationship depends on the way you interact with them, not the field you enter into. I know plenty of great general surgeons out here on suburban long island that are loved by the community.

But you could change your mind 10000 times over before 2009...

 

[JudoKing01]

haha, I know, and I probably will. In 2009, watch me post that I matched into a pathology program.

...at least I'd be close to my patients.

 

[PACtoDOC]

Although FP is a very rewarding field that I plan to enter, you can get the same closeness with Surgery that you get with FP. Your patient relationship depends on the way you interact with them, not the field you enter into. I know plenty of great general surgeons out here on suburban long island that are loved by the community.

But you could change your mind 10000 times over before 2009...

I agree to some degree. A surgeon generally does not keep a patient for very long, and thus the real patient-doctor relationship is not as unique as it is to FP. Figure that a surgeon sees probably more than 75% new patients on each clinic day, while an FP may see a few new patients a week. But I completely agree that if you take the time to sit down with your patients and get to know them, you will enrich them as they will enrich you.

That said, FP's can even find other ways to scrub on cases especially in rural areas. If you do enough appy's and lap chole's in your residency for instance, you can get credentialled to do them in smaller places. I personally would like to do them but I would like a general surgeon on staff to do them if possible. I would like to just be credentialled to do the emergency cases that the surgeon can't make for whatever reason. I also plan to do c-sections. And there are literally tons of derm and minor surgeries you can take to the OR simply for better/safer sedation than in the office, but the procedures are still simple and allow OR use. Like I don't like to do lipomas in the office because you really need a Bovie.

FP rocks, and its even better knowing that most people pass it up right now! That leaves the competition slim and the pickings rich! But unfortunately you have to be careful or you can end up in a program where residents are unhappy and would rather be doing something else.

 

[JudoKing01]

See, I didn't think of that. You can always just take them to the or because you want safer facilities. Also, some obstetrics fellowships prepare you to do D&Cs, vacuum deliveries, all that jazz...like Florida's program (forget which hospital) does.

I think that a surgeon definately can have a great patient-doctor relationship...I've seen it first hand. But I think it is different than the relationship between a patient and his/her family doctor. You are that patient's doctor. They may need a surgeon for a complicated procedure, but they will still come to you when they don't feel right. That's what I was getting at.

Btw, PAC...I didn't know FPs could get credentialled to do lap choles and appys in more rural areas. Is that true?

 

[raptor5]

Are we talking Wichita Falls,TX rural or Aspermont,TX rural.

 

[espbeliever]

Are we talking Wichita Falls,TX rural or Aspermont,TX rural.

uhmmm .... uh.... yes.

 

[dr_almondjoy_do]

ESP.... no pun intended..
What is the future of FP? I figured you'd know better than anyone...


JudoKing01
I have seen surgeons get really close with a certain population. Especially repeat surgury cases, like smokers with ESRD.....they make vascular surgery happen! Not to mention all the general surgery this population needs.

I'm pretty sure they have a primary care doc as well, but I was only thinking of your backgroud and how much you seem to like it. You will get plenty of procedures in FP, and you can even set up a small OR (skeleton OR) in your office. Dermatologists and Plastic Surgeons do it all the time, and they have full ORs set up....

 

[espbeliever]

ESP.... no pun intended..
What is the future of FP? I figured you'd know better than anyone...


JudoKing01
I have seen surgeons get really close with a certain population. Especially repeat surgury cases, like smokers with ESRD.....they make vascular surgery happen! Not to mention all the general surgery this population needs.

I'm pretty sure they have a primary care doc as well, but I was only thinking of your backgroud and how much you seem to like it. You will get plenty of procedures in FP, and you can even set up a small OR (skeleton OR) in your office. Dermatologists and Plastic Surgeons do it all the time, and they have full ORs set up....

i dunno... i would surmize that with an increasingly unstable global environment, potential of imminent war, uhhmm.... i dunno...

 

[JudoKing01]

That's a pretty nifty idea. This is why I love this forum. People think of the stuff that I miss because I'm so focused on the little picture.

 

[Back34]

What was it about emergency medicine that made you change your mind?

I think you made a great choice going into family medicine. I was previously an emergency medicine resident and I too had good board scores etc., and gave up emergency medicine to transfer into family medicine. I don't regret my choice one bit. Family medicine is just as challenging as any of the subspecialties and as you'll see, patients truly do appreciate us. Don't let anyone tell you different about your choice of specialty. You'll hear a lot of negative talk regarding family medicine in terms of money and lifestyle. Honestly, the money is not that bad and the lifestyle is what you make of it. If you want to work 80 hours a week, you can... and if you want to work 32 hours a week, you can. There's so much flexibility in family medicine that I don't think you get in some of the other specialties. Anyways be proud that you picked a specialty because it is really what you want to do and not because of money or prestige.