Major Challenges Facing Family Medicine

[deleted496343]

Hey everyone,

I am medpeds but I feel many of the issues we face are similar to family medicine physicians in primary care. My friend and I (she is in family medicine), were discussing some of the challenges facing family medicine in the future, and we wanted to get your perspectives too. Curious what everyone's thoughts are? What are some of the challenges facing family medicine doctors and the specialty in the future and curious what we can do in the future to remedy them?

Thanks so much for your insight! We love talking about the future of our fields and what we can do in the future, since we are both in leadership positions. Thanks a bunch!

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[antispatula]

Same old same old: low reimbursments, etc.

On the bright side, everywhere is desperate for primary care docs, and FM salaries have gone up a little bit over the past year or two.

Dont worry. All primary care docs will have jobs throughout their lives, and will make MORE than enought to pay back student loans.

Life as a primary care doc is good according to all thr docs Ive talked to in primary care. The people on these forums that say otherwise are generally uptight 19 yr old premed students still in college.

 

[deleted496343]

Same old same old: low reimbursments, etc.

On the bright side, everywhere is desperate for primary care docs, and FM salaries have gone up a little bit over the past year or two.

Dont worry. All primary care docs will have jobs throughout their lives, and will make MORE than enought to pay back student loans.

Life as a primary care doc is good according to all thr docs Ive talked to in primary care. The people on these forums that say otherwise are generally uptight 19 yr old premed students still in college.

Thank you for your reply. I wasn't worried about future opportunity in terms of career, but my friend and I were wanting to know the challenges the specialty faces, for example, is there an aim to convert to a patient centered medical home model or other issues like the affordable care act.

 

[Wildcat73]

I'm a MS3 struggling to decided b/t FM and IM, definitely not a unique struggle. I've been leaning more towards IM or Med-Peds partly because it seems Family Med docs are going to have an increasingly difficult time defining themselves with more and more PAs/NPs stepping into the primary care role. Is this an issue I should continue to hold against FM in trying to decide? Or are my concerns misplaced?

 

[VA Hopeful Dr]

I'm a MS3 struggling to decided b/t FM and IM, definitely not a unique struggle. I've been leaning more towards IM or Med-Peds partly because it seems Family Med docs are going to have an increasingly difficult time defining themselves with more and more PAs/NPs stepping into the primary care role. Is this an issue I should continue to hold against FM in trying to decide? Or are my concerns misplaced?

Depends on who you ask. To paraphrase a poster here, if you can be replaced by a midlevel then you should be.

I have worked with NPs and PAs from time to time, more so in residency than now, and even then their knowledge base was significantly inferior to mine.

 

[deleted87716]

I'm a MS3 struggling to decided b/t FM and IM, definitely not a unique struggle. I've been leaning more towards IM or Med-Peds partly because it seems Family Med docs are going to have an increasingly difficult time defining themselves with more and more PAs/NPs stepping into the primary care role. Is this an issue I should continue to hold against FM in trying to decide? Or are my concerns misplaced?

And you don't think IM has had difficulty defining itself...?

As for the midlevel thing, most midlevels work in specialties, not primary care. Most midlevels working in primary care work for us (primary care docs), and we earn money by employing them. Sorry, but I don't see a problem.

 

[cabinbuilder]

I'm a MS3 struggling to decided b/t FM and IM, definitely not a unique struggle. I've been leaning more towards IM or Med-Peds partly because it seems Family Med docs are going to have an increasingly difficult time defining themselves with more and more PAs/NPs stepping into the primary care role. Is this an issue I should continue to hold against FM in trying to decide? Or are my concerns misplaced?

OH boy.......How so wrong you are. There are not enough primary care docs in this country right now. Huge shortage almost everywhere I go to work. At my current position in Southern Oregon there are 800 patients on a waitlist to be seen by both FP/IM and no patient can get a same day appt in any office. Patients flood into urgent care because they have no where else to go. Even podiatry is a 4 month wait to be seen. Rheumatology and Derm you are looking at a year. No matter what you decide to pursue you will always have a job, and never ever think that mid-levels will replace us. NP/PA are helping with the gap only but the amount of patients needing PCP's will remain high and I don't see the shortage ending anytime soon.

 

[JustPlainBill]

One month into a new position with an established practice -- I'm seeing overflow and already cranking 20-24 a day -- my own schedule is already booked at 9-10 per 4 hour block when it's just my patients --- No worries here -- had to choose between 2 equally good positions, getting hammer called by recruiters and if I was up for travel -- I could book my schedule months in advance.....

 

[Wildcat73]

Thanks for the replies, just trying to gain some perspective. Back to the OP, most of you being attendings now, what are you thoughts on the FleetFoxes question?

What are some of the challenges facing family medicine doctors and the specialty in the future and curious what we can do in the future to remedy them?

 

[deleted87716]

I've been an attending since 2001.

The OPs question, it seems, has been answered.

 

[cabinbuilder]

The challenge is that there are not enough PCP's to fill the need and everyone is over whelmed.

 

[FrustratedFamDoc]

Not unique to Family Medicine, but to med students choosing a speciality knowing that when they're graduate, they'll be stuck for $250k in student loans. Now certainly this is not everybody, but it's an ever growing number each year. 3 yrs of residency and come out making about $180k or do a surgical/procedure heavy speciality and come out a few years later making twice that...

 

[68PGunner]

Not unique to Family Medicine, but to med students choosing a speciality knowing that when they're graduate, they'll be stuck for $250k in student loans. Now certainly this is not everybody, but it's an ever growing number each year. 3 yrs of residency and come out making about $180k or do a surgical/procedure heavy speciality and come out a few years later making twice that...

And you work twice as hard in term of hours. It's not that simple. A difference of 100-150k a year isn't going to make you rich and happy given longer work hours and a higher tax bracket. You get rich by being a good businessman or investor.

 

[FrustratedFamDoc]

Holy tangent batman!

Not once did I ever imply that the difference in salary came with equal hours attached, nor did I bring up rich, happy or higher tax bracket stuff. This is my second career... I know what life is all about and the relationship money has with happiness. The original question had nothing to do with that in the first place. Rich has nothing to do with why I do what I do. This was supposed to be about barriers to the speciality.

 

[VA Hopeful Dr]

Not unique to Family Medicine, but to med students choosing a speciality knowing that when they're graduate, they'll be stuck for $250k in student loans. Now certainly this is not everybody, but it's an ever growing number each year. 3 yrs of residency and come out making about $180k or do a surgical/procedure heavy speciality and come out a few years later making twice that...

Or, you spend those extra few years working somewhere slightly less desirable and you end up with more like 200-220k and 100-150k in student loan repayment if you stay there for 3 years.

That doesn't even include moonlighting, which can be an easy 2000+ per weekend doing urgent care.

 

[FrustratedFamDoc]

Sigh...

As family docs, we all strive to fix things... But can we please stay on topic. Alls' (for the yankees among us) I was trying to do was answer the op's question. Trust me, I know the solution. Was just trying to ID a BARRIER as was asked. Like it or not, it just is.

 

[Ericslv]

There are several challenges in my opinion.

Low Pay
Low respect
Overwhelmed doctor. too many patients in one day, excessive paperwork etc.

No job shortages. But then in most fields when there is a shortage of qualified staff the pay goes up. But not much in FM.

Salaries haven't gone up much since the 90's.

FM docs have a vast knowledge but the specialist (especially in major university centers) don't seem to think that's true. This kind of thinking has eroded into the general population to some extent.

At the end of the day there are many many unhappy FM docs. There are many unhappy docs but I think more in FM.

That does not mean that you won't be happy in FM. You have to make an informed decision based on good research and understand that there are many issues in medicine that need attention and these are shared by every specialty. It's just that some specialties get paid much better and perhaps can tolerate these issue a little better for the trade off in pay.

 

[simpler2]

We suffer the consequences of the system we have built. Payment for care comes from 3rd parties that desire to control cost and are interested in their own profit margins. Providers now expect salaries that are untennable for the system we have built. As a consequence providers (not just in primary care) will continue to be asked to do more and see more people.

A big challenge that I see coming is the dealing with the shift in culture of chronic opiate analgesic therapy (COAT) for chronic pain. Primary care is and will continue to be asked to wean back on and stop COAT due to significant numbers of unintentional opiate morbidity/mortality and virtual lack of efficacy for this practice. If you haven't had to first hand deal with this yet, you will, and nothing makes your day more than having a conversation with a patient about decreasing or taking away their controlled substances. Unfortunately, this responsibility and task is being delegated to primary care much more than other specialties.

 

[Ericslv]

We suffer the consequences of the system we have built. Payment for care comes from 3rd parties that desire to control cost and are interested in their own profit margins. Providers now expect salaries that are untennable for the system we have built. As a consequence providers (not just in primary care) will continue to be asked to do more and see more people.

A big challenge that I see coming is the dealing with the shift in culture of chronic opiate analgesic therapy (COAT) for chronic pain. Primary care is and will continue to be asked to wean back on and stop COAT due to significant numbers of unintentional opiate morbidity/mortality and virtual lack of efficacy for this practice. If you haven't had to first hand deal with this yet, you will, and nothing makes your day more than having a conversation with a patient about decreasing or taking away their controlled substances. Unfortunately, this responsibility and task is being delegated to primary care much more than other specialties.

I agree. Many of those chronic pain patients end up buying it on the street and then move on to heroin.
Cannabis legalization may help but that remains to be seen.

 

[Bacchus]

We suffer the consequences of the system we have built. Payment for care comes from 3rd parties that desire to control cost and are interested in their own profit margins. Providers now expect salaries that are untennable for the system we have built. As a consequence providers (not just in primary care) will continue to be asked to do more and see more people.

A big challenge that I see coming is the dealing with the shift in culture of chronic opiate analgesic therapy (COAT) for chronic pain. Primary care is and will continue to be asked to wean back on and stop COAT due to significant numbers of unintentional opiate morbidity/mortality and virtual lack of efficacy for this practice. If you haven't had to first hand deal with this yet, you will, and nothing makes your day more than having a conversation with a patient about decreasing or taking away their controlled substances. Unfortunately, this responsibility and task is being delegated to primary care much more than other specialties.

I agree about COAT. Pain management doesn't really help me out though, either. Granted, they're tired of the opioid BS just as much as I am.