Make an informed decision when considering family medicine

[George85]

Can't remember when I last posted here. I'm usually prompted to do so when I come across something that reminds me why I should not have done FP. The bottom line is that it's a poor choice with limited options. For example, fellowships - FP must be the only area where extra fellowship training enables you to earn less, such as hospice. No doubt there will be lots of cries of "sports medicine" - like I want to work as an ortho MLP.

Anyway, 7 years out of residency and I am interested in moving into another area, such as critical care. This 2014 study comments of the fact that FP can't apply to critical care programs; "This group that can potentially be trained in critical care and help solve the crisis has been prevented from doing so."

Also noted; "American Board of Emergency Medicine, in conjunction with The American Board of Internal Medicine, opened the pathway for emergency physicians to enter a critical care fellowship."

http://www.ncbi.nlm.nih.gov/pubmed/25204608

So, while other specialities create additional opportunities for themselves FP is simply left as the poor relation. I'm usually accused of trolling which I'm not - just want people who are considering FP to reconsider and encourage them to make an informed decision.

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[VA Hopeful Dr]

I'm probably going to regret even entering into this thread, but I'm going to take a stab at it.

First, there is a reason FPs can't do critical care fellowships while EPs can. Most FP residencies will either have a single month of ICU time or have an open ICU, the latter of which is good training but doesn't usually get quite the same volume or acuity as a closed ICU. EM residents in my city, by contrast, do 3 months in the ICU, 2 months in the PICU, and 2 months in the surgical ICU.

Second, I don't know what sports medicine docs you know but my experience has been vastly different. The sports fellow a year above me in residency started his own sports med practice. The local FPs and orthos send him patients for U/S guided injections. The one from my class is the team physician for the local Division 1 university football team. The one below my class does work for an ortho group, but he spends 90% of his time doing U/S guided injections and the other 10% treating non-operative fractures. If you like sports med, all of those seem pretty nice.

Third, you're the only person I've seen who sees "lack of fellowship" and reads that as "limited options". In my residency (from the 3 years I was there) alone we have a hospitalist, a traditional practice guy (both inpatient and outpatient), someone doing direct primary care, another doing rural practice including obstetrics with c-sections, one doing ED work, and another working full time in a state psych hospital. We have a nursing home director, a rural guy doing scopes, a missionary to China, and a hospice director. But yeah, you're right - very limited opportunities.

This may surprise you, but many of us are/were quite informed about what family medicine entails and are still happy doing it.

 

[Chicago2012]

 

[Bacchus]

I have to agree with VA Hopeful, above. It sounds to me as if you didn't make a very informed decision, or may have been pushed into FM one way or another. I think most FM trained physicians are not going to be upset by the inability to do ICU level care. My past 2.5 years of residency would not have been FM if that was my career goal. Having 2 months of ICU rotations, I'd never trust someone like me to manage the ICU. That said, we do have a current faculty member who was doing open ICU care out on the rural west coast, so it is possible. But, you better be well versed in it because its a whole different world.

 

[mabinante]

I'm kind of surprised that you are surprised about the state of FM and fellowships? Seems to me that if you wanted to do any fellowships, it is pretty widely known that you should do IM instead.

Loved the post, VA.

In addition, not everyone does fellowships to make more money. I would hope most people do a fellowship to get specialty training in something they love to do.

 

[cabinbuilder]

Hmm.... FP has been very versatile for me: Rural critical care access hospital, ER, urgent care, nurging home, hosptialist, famiy practice clinic. Can get a job anywhere since the demand exceeds the supply. OP must be doing it wrong.

 

[George85]

Appreciate the replies. I agree that's it's easy to find work and that there are varied roles available. But the groups that are meant to represent the interests of FM do a poor job - such as AAFP and ABFM. And in my personal experience of residency the difference between FM and IM was minimal - which is probably while FM has no trouble finding jobs as hospitalists - and makes me wonder why there are no pathways into any of the medicine fellowships.

 

[deleted87716]

 

[drake19]

Can't remember when I last posted here. I'm usually prompted to do so when I come across something that reminds me why I should not have done FP. The bottom line is that it's a poor choice with limited options. For example, fellowships - FP must be the only area where extra fellowship training enables you to earn less, such as hospice. No doubt there will be lots of cries of "sports medicine" - like I want to work as an ortho MLP.

Anyway, 7 years out of residency and I am interested in moving into another area, such as critical care. This 2014 study comments of the fact that FP can't apply to critical care programs; "This group that can potentially be trained in critical care and help solve the crisis has been prevented from doing so."

Also noted; "American Board of Emergency Medicine, in conjunction with The American Board of Internal Medicine, opened the pathway for emergency physicians to enter a critical care fellowship."

http://www.ncbi.nlm.nih.gov/pubmed/25204608

So, while other specialities create additional opportunities for themselves FP is simply left as the poor relation. I'm usually accused of trolling which I'm not - just want people who are considering FP to reconsider and encourage them to make an informed decision.

good to know

 

[septoplasty]

I think the OP may have had a rougher time than some of the attendings in this subsection. Objectively, that's very possible.

I do agree with the op when he/she writes "But the groups that are meant to represent the interests of FM do a poor job - such as AAFP and ABFM." There's really no push for the next step. Sure they publish tons of stuff IN THEIR OWN MAGAZINE, but haven't heard of them being referenced anywhere else. Mean while ABIM is readily referenced, even though both are primary care.

The other point that I was going to disagree with the OP was when he/she went on to call sports FM as MLP. VA Hopeful Dr already provided good examples of what we can do. There's a growing push from the ortho groups to get FM Trained Sports to do minor surgical stuff as well. The group that I was shadowing recently has their fm-trained sports fellow trained for arthros. They don't want to "waste" their time doing "minor" surgical stuff, or injections when they could be replacing hips & knee's left and right. That's where the differentiation comes. I would love to do those "minor" non-emergent, "lower" risk procedures, be team docs etc. while the ortho guys make the bigger moolah. Which is what they want to do anyways. No enroachment either way. A little bit more hands on stuff for us procedure guys, win win.

FM is what you make it to be. If you're going to be a debbie-downer about it, than its going to chew you up.

Coming out of residency, working 36 "relatively stress free" hr weeks, having weekends off without any call AND getting paid above the 90%tile of US income = gravy. Also known as FM .

 

[galactus]

The other point that I was going to disagree with the OP was when he/she went on to call sports FM as MLP. VA Hopeful Dr already provided good examples of what we can do. There's a growing push from the ortho groups to get FM Trained Sports to do minor surgical stuff as well. The group that I was shadowing recently has their fm-trained sports fellow trained for arthros. They don't want to "waste" their time doing "minor" surgical stuff, or injections when they could be replacing hips & knee's left and right. That's where the differentiation comes. I would love to do those "minor" non-emergent, "lower" risk procedures, be team docs etc. while the ortho guys make the bigger moolah. Which is what they want to do anyways. No enroachment either way. A little bit more hands on stuff for us procedure guys, win win.

sports FM as MLP's? Come on now. I don't "check out" to my ortho colleagues like hired MLP's do. I see my own patients and refer if I feel like they need surgical intervention. I do my own minor procedures. Ortho's refer to me for any medical management/concussion for their patient/athletes. In terms of sports medicine coverage, me and my ortho colleague share equal time for training room clinic, and I see MSK issues as well. If a player is injured and I need to evaluate a player during the game, I'll do it on the sidelines, while my ortho colleague monitors the game and vice versa.

Previous poster is right though. Ortho's love the OR, I like my clinic. It is a win win!

 

[Ericslv]

Can't remember when I last posted here. I'm usually prompted to do so when I come across something that reminds me why I should not have done FP. The bottom line is that it's a poor choice with limited options. For example, fellowships - FP must be the only area where extra fellowship training enables you to earn less, such as hospice. No doubt there will be lots of cries of "sports medicine" - like I want to work as an ortho MLP.

Anyway, 7 years out of residency and I am interested in moving into another area, such as critical care. This 2014 study comments of the fact that FP can't apply to critical care programs; "This group that can potentially be trained in critical care and help solve the crisis has been prevented from doing so."

Also noted; "American Board of Emergency Medicine, in conjunction with The American Board of Internal Medicine, opened the pathway for emergency physicians to enter a critical care fellowship."

http://www.ncbi.nlm.nih.gov/pubmed/25204608

So, while other specialities create additional opportunities for themselves FP is simply left as the poor relation. I'm usually accused of trolling which I'm not - just want people who are considering FP to reconsider and encourage them to make an informed decision.

I don't think there are limited options. There are different options. You are upset because you didn't make the money you want from FP. I get that. So you do what most doctors do. You start to look at further training like going into ICU or getting further residency training etc.

The problem there is that all of those things are prone to the income and legal issues in the current medical system.

Your solution is not to try to find another specialty (although some specialties will make much more money they will also require significant time commitments to get there).

Your solution is to become a better businessman. That means risk and possibly lots of it. But you are in the field of medicine. That means insurance pays for things and there things you can do as an FP that people will pay cash to receive.

If your looking for specialty salaries (400---500K range) you have to become good at the business of medicine.

DPC, utilizing PA's and NP's, opening more offices, offering more services, advertising heavily to get those services etc. If you take these risks and give it time (lots of it) you can do well and it is reasonable to see your income rise to the 300 to 500 range.

Every FP that I know that does this well is in business for themselves and has people working for him. Many take cash only patients.

So it is true that there are few fellowship opportunities in FP that will do what an IM fellowship in cardiology or GI will do. But then an IM fellowship in endo. won't get you much more in money either.

I believe you may have either chose the wrong specialty or could not do others and now are upset.

You have 3 choices:

1. Apply for another residency. Now that you are seasoned you may get the one you want.
2. Become a good businessman and expand.
3. Get out of medicine and get a non-clinical job that make good money.