Seatle Doc -Why the switch out of FP?

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chillin

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If I'm correct your an FP looking into anesthesia. Why the change? Both areas are appealling to me, but sometimes I wonder if the social complications with FP patients may get to me after awhile. Is this why you're changing?
Thanks,
Chillin
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reasons for leaving:

I'm not going to turn this into a "trash Family Practice" post but in no particular order.

I've found that the diversity of family practice is less diverse than one might think.

I've also found the volume of non-medical work detracts greatly from the actual medical work. (forms, requests for refills, phonecalls to specialist and patients, chatting on the scutwork forum...etc...)

I also think anyone that goes into FP needs to enjoy psychiatry, the social issues that patients bring in, and chatting with people about mundane things.

I've found that I'm bored with the lack of medical challenges. The field is very challenging in other ways, in fact I think many other physicians that aren't in primary care would be driven nuts after a couple weeks in an FP office. it's just not medically challenging for me.

I've found I have less and less tolerance for this and am getting out.
 
Seattle Doc,

Interesting points, I can see how that would be true for me as well. I also may find myself in the same situation if I don't get an anesthesiology residency. Is it possible to obtain another residency after having completing one? Will you be funded?
 
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yeah, after talking with a few program directors, I feel I should be able to get a position. My experience actually improves my standing to most programs.

As far as I can tell, I won't be funded, possible exceptions are new programs (none that I know of) and expanding programs may be able to get around the rule (not sure on that completely). It sounds like the bigger programs aren't as dependent on the funding, but it will definitely make things more difficult for me.
 
Originally posted by seattledoc
reasons for leaving:

I'm not going to turn this into a "trash Family Practice" post but in no particular order.

I've found that the diversity of family practice is less diverse than one might think.

I've also found the volume of non-medical work detracts greatly from the actual medical work. (forms, requests for refills, phonecalls to specialist and patients, chatting on the scutwork forum...etc...)

I also think anyone that goes into FP needs to enjoy psychiatry, the social issues that patients bring in, and chatting with people about mundane things.

I've found that I'm bored with the lack of medical challenges. The field is very challenging in other ways, in fact I think many other physicians that aren't in primary care would be driven nuts after a couple weeks in an FP office. it's just not medically challenging for me.

I've found I have less and less tolerance for this and am getting out.
Click to expand...

That sounds so cool to me! It makes me look forward to FP.
 
Seattledoc,

In your experience, which do you envision having a better lifestyle, an anesthesiologist or FP.
 
That depends,
In FP you can work 15,20,32 or 60 hours per week. You can do OB or not, You can do inpatient or not. So it's very maleable to suit how much you want to work and whether you want to have the burden of being on call to hospitalize patients.

In anesthesia, you'll work more afterhours because you need to be in the hospital when on call. You can still customize in many situations to work as much as you want to, only in anesthesia I think they tend to takes a week off at a time rather than working 2-3days per week (may not be a universal truth obviously). For example, in my current hospital, the anesthesia group is required (self imposed) to take 8 weeks of vacation minumum and 20 weeks maximum. Try doing that is an FP office and your patients will scatter and your colleagues will hate you because they'll pick up the burden when you're gone!

Sooooo, I think they both have good lifestyles for different reasons. I'm not really switching for lifestyle issues, I'm switching for professional issues as mentioned above.
 
I agree with seattledoc. The major problem with FP is the paper work and red tape that physicians have to deal with. Many patients have psychiatric problems. Some need case workers not docs.
The declining interest of medical students in FP is multifactoral.
Primary care is a failed experiment. The need for specialists will continue to increase the same time that less FPs are needed. Mid-level providers will perform most primary care in the near future.Technology is advancing at a pace that is amazing.To think that one physician can treat all of what ails a patient is absurd.

Instead of trying to promote FP the leaders in the field should push to reduce the number training positions available. A large percent of these spots are filled by IMGs. I doubt that anyone in leadership positions in FP wil be honest enough to propose such a thing.

I like seattledoc am contemplating leaving FP. I understand that barriers are set-up to make retraining difficult. Physicians continue to retrain after having completed residencies. The hardest thing about retraining is becoming a resident again.
 
Cambie,

So what would you go into?
 
Hello Folks:

I have observed that even though the people had the best of the intentions, this has unfortunately become a trash FP thread. I have been reading the posts on the "FP" forum for some time now, and I am sad to say that almost every post on this forum eventually becomes a trash FP post. This is truly sad.

In fact, most the problems with FP that you all have raised are true of all primary care specialties, including General IM, Peds, and even OB/GYN. But, the participants of the forums for these specialties don't voice the same concerns ad nauseum. In fact, the polls in the last 3-4 years show that Peds is the specialty with the lowest salaries. Not FP - FP salaries are somewhat higher than peds, at par with and at times, higher than General IM.

As one of the posters has already pointed out, FP is the most flexible of any of the specialties. An FP can decide his extent of work, hours of work, area of work etc. etc. Try doing that with any of the other specialties. Also, even today, the demand for FPs is high, much higher than other primary care specialties. On the other hand, I do acknowledge that FP does have limitations when it come to fellowships.

Let's all us FP folks realize that FP is a wonderful area of work. And, like all specialties, it has its own pros and cons. Let's not loose sight of that.

Cheers
 
I do not want to trash FP. There are areas of concern in FP that cannot be ignored. No one wants to trash any specialty. The areas of concern in FP and primary care in general shouldn't be ignored or glossed over.

As a practicing FP doc I understand the challenges faced in FP first hand. Med students should be aware of the issues out there and make an informed decision when they select a their field of concentration.

I have read predictions of physician supply and work force needs in the future and I have come to the conclusion that midlevel providers will be performing a large percent of the tasks now performed by FPs and other primary care physicians now. This trend will be hastened by the reluctance of third party payers to compensate physicians adequately for their work.

Technology and market forces have a strong impact on how medicine is practiced. Richard A. Cooper,MD of the Health Policy Institute at the Medical College of Wisconsin has some very interesting views. He has done extensive research in the area of physician demand and practice patterns.

I heard of an experiment where one monkey resceived a cucumber as a reward for performing a task. Monkey number two received a grape. To the surprise of the researchers, monkey number one would not work for what was deemed as a lesser reward. Grapes are more prized than cucumbers by monkies.
 
:)

That's ok. But, If the concern is about and I quote, "FP and other primary care specialties", as you are suggesting, then it should probably be presented in a different forum. Not in the FP forum.

I have never seen the participants on the IM and Peds forums vent adnauseum on their forums about predictions that we have read on primary care docs. BTW, I have read COGME predictions (even their latest reports still says the same thing) that they predict a Primary care physicians shortage. All these predictions are sponsored by some lobbying agencies, and they should all be taken with a pinch of salt. The outcome of each of these predictions studies can be presented in the manner that most suits the sponsors.

Lastly, when was the last time we saw someone write something good about FP specialty on this forum? I don't recall it at all.

My prior post was not meant towards any individual. We all value your opinions as well Cambie MD. And, by all means, you should stick by your opinions as you have experienced them. My only issue is that many other specialties, including radiology, might be facing problems in the upcoming years. Not just FP. But, despite that, the participants on other forums are truly excited about their chosen fields.

On the other hand, when was the last post on this forum which truly extolled the virtues of FP as a specialty? In fact, the FP forum on this website has become "The Enumeration of Reasons For Which You Should Not Choose FP As Your Specialty?" forum. And, that's truly sad.

Again, this post is not meant towards any particular individual. I have just outlined these observations based on the posts of all participants. May be, the moderator of this forum should put in his/her 2 cents on what I am suggesting.
 
I would have to say that every forum has its practice bashers. Anesthesia has the anesthetists, surgery has the lifestyle issue, ERs bashed by every specialty that takes admissions from them. But hey...if I'm going to be well informed about what specialty I purse in my 3rd and 4th year why not go to that forum. I'm seriously considering FP because I like the variety, the flexibility, and the preventative aspects, but the paperwork, and time consuming somatics that are out there worry me. When I see a post by someone who's leaving this profession, I would like to know why. Seattledoc's an FP and reply's on this forum often enough that I thought I'd ask the question here. Why ask it on the Anesthesiology forum???
 
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Hi Chillin, I do not want to put an overly negative spin on things.
I think that this forum is a good source for information. For a forum of this kind to be useful acurate information must be shared. You need to know the good, the bad and the ugly as you gather information. I aim only to do that. I want to make my comments as honestly as possible without offending sensibiltities. That said I do agree with you about the flexibility of FP.

CambieMD:cool:
 
I have been practicing FP for 18+ years as well as ER work. I agree with almost everything CambieMD has said. I, too, am making efforts to leave the specialty for another-in fact, I am in the interview process now. As with most things in life, there is a spectrum so while saying negative things about FP might be construed as "trashing FP", it is not neccessarily the case, just as saying postive things is not neccessarily "looking at things through rose-colored glasses". For me, I went to medical school for the interest in medical science and so much of FP is psychiatry, managing drug seekers, etc., at least in my practice. And that is the point-in my practice. A strong point about FP is the variety of things you can do, not neccessarily the variety of illnesses-whatever you do pretty much boils down to seeing the same things on a routine basis. The variety is in different emphases available-as I said, I have worked ER, have been a Medical Director of an HMO, there are many things you can do. But, for me, I want to return back to something more medical science oriented. I think that the demand for FP will go down in years to come as NP/PA can take over the more mundane problems for less cost and as specialties become more specialized, it is harder for the generalist to maintain competency across the board. Before everyone starts throwing tomatoes (or worse), this is just a generalization. An example is diabetes. When I finished residency, there were relatively few options for treatment. Now there is an explosion of new classes of medicines as well as new insulins and regimens plus insulin pumps and other technologies on the horizon. I still treat diabetics but my threshold for referral is a bit lower now. Anyway, just some thoughts from someone on the front lines.
 
I have been practicing FP for 18+ years as well as ER work. I agree with almost everything CambieMD has said. I, too, am making efforts to leave the specialty for another-in fact, I am in the interview process now. As with most things in life, there is a spectrum so while saying negative things about FP might be construed as "trashing FP", it is not neccessarily the case, just as saying postive things is not neccessarily "looking at things through rose-colored glasses". For me, I went to medical school for the interest in medical science and so much of FP is psychiatry, managing drug seekers, etc., at least in my practice. And that is the point-in my practice. A strong point about FP is the variety of things you can do, not neccessarily the variety of illnesses-whatever you do pretty much boils down to seeing the same things on a routine basis. The variety is in different emphases available-as I said, I have worked ER, have been a Medical Director of an HMO, there are many things you can do. But, for me, I want to return back to something more medical science oriented. I think that the demand for FP will go down in years to come as NP/PA can take over the more mundane problems for less cost and as specialties become more specialized, it is harder for the generalist to maintain competency across the board. Before everyone starts throwing tomatoes (or worse), this is just a generalization. An example is diabetes. When I finished residency, there were relatively few options for treatment. Now there is an explosion of new classes of medicines as well as new insulins and regimens plus insulin pumps and other technologies on the horizon. I still treat diabetics but my threshold for referral is a bit lower now. Anyway, just some thoughts from someone on the front lines.
 
There are some interesting views on FP on this forum. It has been stated that soon nurses/PAs may perform some of the mundane cases that FPs do currently, which would cause less demand for the FP.

I am interested in going FP in the future. Would you say that aspiring FPs may find themselves without a job within the next 40 years do to the change in the dynamics of medicine? I'd hate to enter into FP if it had an unstable future.
 
Appreciate your concern. No one can predict what will happen a year from now, much less 40 years. People make a lot of money trying to predict trends, etc. with no more accuracy on the long term than a bunch of monkeys throwing darts. I would suggest you do what you can to understand what the current practice of a specialty entails, do your own research regarding predictions if you're so inclined, then decide based on what you think you would enjoy. Even if the demand for FP physicians decreases, there will always be room for some-you just will have to position yourself to stand out. And, as I stated, FP offers much more flexibility in terms of what you actually do day in and day out than other specialties. No one faces a stable future. Wish you well.
 
I've talked to a couple of docs and PA's about the impact of midlevel providers on primary care jobs/compensation, and I have to admit, I'm not too impressed with the impact. From what I've been told, on the supply side, midlevels actually make docs life easier: they take first call, help with H&P's, work in satellite clinics where there are no full time docs. They allow docs to "see" more patients. They improve efficiency assuming that docs have ample volume. Also on the supply side, midlevel's KNOW that FP's not where the money is. Hot spots for midlevels right now are in surgical specialties anyways, especialy Ophtho. So I wouldn't worry too much.

On the demand side, no patient wants to see a PA or NP. Period. Every patient wants to see a real doctor. Just ask ANY 3rd year medical student and they will tell you that patients want to see their doctors and not some wannabe. So in this respect, doctors are "revenue generators" in that doctors can pull in patients to the practice simply by having their names listed in the telephone book. Midlevels don't have that advertising power with patients unless patients simply have no choice.

Well... I can see a threat to a doc if an existing practice or an HMO in a market where the practice has monopoly wants to hire a provider to lessen the burden on its staff physicians. Who do you hire? A doc or a midlevel? If I ran the business, I'd hire the midlevel, because they're cheaper. If that's the case, the doc can start a practice in the same market (with a group of other docs), compete directly with the monopoly, and serve a niche of patients. If that same practice was working in a market where it does not have monopoly, it would make sense to bring in a doctor, because doctors have greater advertising power than midlevels do (doctors can bring in new patients into the practice, midlevels can't, because no patient flips through the provider's directory and say "I will only see a physician's assistant for my primary care").

Bottom line: don't worry. market and labor economics won't allow NP/PA's from replacing FP's altogether.
 
LOW BUDGET-
a few things...
most pa's work in a practice with docs so the doc advertises and often the pt is seen by the pa, so advertising is not a big issue. some docs run a practice with several pa's and advertise as dr smith and associates. nowhere in that name can you infer the status of the other providers.
aside from medical students, most people don't know what a pa is and don't care as long as they get treated right. I probably see 100 patients a week and if you called them all at home the next day 95 of them would probably say" the er doctor was very nice" even though I have PA written all over me( ID, lab coat, scrubs) and do not represent myself as a doc in any way.even after telling them I am a pa they say" thanks doc" at the end of the visit.pa's are not trying to take over. we fill a specific need in specific markets where docs don't want to work or it is not economically feasible to pay for a doc(low census rural er or inner city/rural primary care for example). the bottom line is there is a huge provider shortage coming to america in the next 20 yrs and there will be enough patients for everyone to see and then some. peace.
 
I think lowbudget and emedpa both make some good points. Have worked in practices for last 13 years where PA/NP have worked and, anecdotally, most pts. don't make a distinction between MD and midlevel, though some do, and some even prefer a particular midlevel.
There may indeed be a shortage of FP in the future considering current debt levels of graduates and declining reimbursement and increasing hassle factor-again, roll your dice and play your chips.
 
Originally posted by jkoehler
There may indeed be a shortage of FP in the future considering current debt levels of graduates and declining reimbursement and increasing hassle factor-again, roll your dice and play your chips.
Click to expand...
That's what I figured. Most med students don't want to go into primary care because of rising debt. Even figures for graduates entering into FP residencies each year are going down.

Thus, I figured it was safe to assume that the demand would be high for FPs since most students want to specialize. I'd hate to get out of medical school and FP residency without a job. That's the whole point.
 
I believe that midlevel providers will perform much of what primary care physicians do now. Health care costs are driven by increasing technology and consumer demand. How many patients will refuse to see a PA/NP if the cost out of their pocket will be less. A financial incentive will "cure" any misgivings that the public may have.

CambiMD
 
Well stated jkoehler. Med students need to understand what is happening in the real world. Look at the OB posts. They are reflective of the problems facing Ob/Gyn.

How is the interviewing going. Is the rule regarding funding a second residency an issue with programs. I think that programs can do whatever they want to in terms of who they hire.
 
CambieMD,
I assume that was a question tossed my way re: interviewing. Actually applied to Rads last yr, had 2 interviews, didn't match. Had couple programs who stated they wouldn't interview me due to funding issues-was this an excuse or real reason? Don't know.
Applying to Path this year, which is really what I would rather do anyway-have 6 interviews, 2 rejections (no specific reasons given), and haven't heard from a bunch of programs as of yet.
So, we'll see what develops. Looking forward very much to starting Path.
 
Insurance companies are businesses. They will provide services at the cheapest cost possible. Give patients a financial incentive to see a NP/PA and they will. How many people will say pass up an opportunity to save 50% on their co-pays.
 
Originally posted by CambieMD
Insurance companies are businesses. They will provide services at the cheapest cost possible. Give patients a financial incentive to see a NP/PA and they will. How many people will say pass up an opportunity to save 50% on their co-pays.
Click to expand...
I don't think so. Patients will always want to see a doctor. I remember this one time when I was sick and a PA came in. My mom immediately told the guy we wanted a doctor. It was funny but kind of messed up.

People have health care insurance not just to see a PA or nurse. They know they don't have the training as a physician even if they have to pay $10 in copayment instead of $5.
 
yes, you can always request an md but then you have to wait until one is available, so if you have 2 hrs to burn, go ahead and request an md for your uri or ankle sprain. in my practice if someone wants to see a doc they go to the very back of the chart rack and are seen dead last after all of the docs appts are seen.....
 
emtp2pac- same deal in my E.D.
if you don't want to see the pa for a non-emergent problem you get seen by the docs after everyone else.
on the emergent cases the pa's almost always consult an md specialist anyway, so not that much of an issue there.
 
Jokoehler,

good luck in your search for a Pathology residency. You have received some interviews, that is encouraging. I always take my hat off to those who have put in the work of applying and interviewing with programs. A lot of us complain but never make an effort to actually switch specialties. I plan to apply to Anesthesiology and ER in2005. The only problem is everyone else is applying to anesthesiology also. Before I started really surfing the web, I did not realize how competitive some specialties had become. Back when I was in medical school some of the poorest students went into anesthesia. That has all changed. Specialties that don't require an office make a lot of sense in this day of high overhead.Medical students have become very savvy about the challenges of office practice. HIPAA hasn't improved the view that some aspects of practice have become overly cumbersome.

All of that said, I think that you should be able to find a position in Pathology.

All the best, CambieMD
 
Just an update,
I've completed the interview process, 6 interviews in 5 cities and landed a position outside the match in anesthesia. I'll be at Penn State in Hershey.
Now I need to figure out what exactly a Nittany Lion is and I'll be set! I can't wait to make the switch, and now I realize that my user name was a shortsighted choice...
 
Congrats to Seattledoc. I finish up my 6th and final interview tomorrow in Pathology. Not sure how things will end up but I'm hopeful. Can't wait to make the switch.
 
good luck with the match jkoehler, after six interviews I'm sure you are as tired as I was when they ask "so why the switch?"
 
Congrats to Seattledoc and Jkoehler for sticking with the application process. I know of other physicians who wanted to make a change but did not complete the application process.
Seattledoc, did the issue of funding come up often and did the fact that you are an experienced physician help your application.

Jkoehler, I commend you for pressing on. I am sure that you will match also.

All the best,

CambieMD
 
the funding issue did come up and probably hurt my situation at a couple of programs, but other programs seemed unconcerned.

My experience was viewed as a big asset and definitely set me apart from the average graduate. If you consider that over the few years of practice I've probably seen ~ 20,000 patients, that counts for something.
 
A 2002 fp Jama study demonstrated that in other countries where FP docs were the norm not the exception in medical care,
the quality of pt. care increased. In fact, we are ranked 23rd in the western world in quality of care.

We have all this technology, but we still can't even get all the people in this country to get a screening colonoscopy after 50.

We can't get DM pt. to get good control. And in rural areas in this country, we have very poor healthcare.


When people say we need to reduce the fp slots in this country and get specialists, I start to laugh. We are top heavy in specialist. and we are ranked 23rd in healthcare in the western modern world of medicine.

our system is NOT working.

Yes, technology is improving. but if you can't provide basic medicine to the pt, all the new gadgets in the world is not going to help.

As far as the doctor who could not get challenged enough in fp because it was not clinical enough for him, hmmm, lets take a look at anesthesiology. Most of them fall asleep during surgery, because they are so bored from sitting there doing nothing, every once in a while the beep goes off and they wake up to adjust the gases. Get real.

You want a clinical challenge? Try to use your mind, to dx and treat multiple medical problems in the elderly, manage their hospital inpatient needs. There is a challenge. Work in the ER. How is that for a challenge.

Buddy, your kidding yourself. If think you got tired of not making 300k a year and went over to the gas department. sweet dreams man.
 
While I agree with erichaj on some principles such as difficulty in getting patients to help themselves with aspects of their health care, pretty tough to draw cause and effect conclusions re: our status in the world, etc. and #'s of primary care vs. subspecialists, though intuitively, I think there is some validity there. Having said that, if I'm under the gas and all heck breaks loose, I don't care if the gas guy is whittling on a stick as long as he/she is ready to intervene. Much of medicine or any job is made up of the mundane.
As for me, having spent 18+ yrs. in primary care and practicing what amounts to behavioral medicine about 40% of the week, that's not why I went to medical school, it's not what I want out of medicine or my vocation, and it's not what I'm best at-hence my sojourn out of FP (hopefully).
 
in response to erichaj,

I'm sure I could have found an FP position that was more challenging clinically. It likely would have been in a fairly rural place which wasn't an option for my family or myself. In my current medical atmosphere, I do primarily psyc, reassurance that no intervention is needed, and diagnoses -> referral to specialist. And oftentimes I don't even get to diagnose, rather I detect a symptom -> referral to specialist.

So, at the beginning of this thread, I mentioned that I was not into FP bashing, I think it's one of the more difficult fields in that one has to be able to deal with all the personalities and psyciatric baggage the people bring with them to nearly every visit. One also has to be able to ferret out the truly ill from the many who believe they are but actually are more worried than ill (the worried well).

I guess my response to Erichaj is that each physician's career is their own, and you only get one lap around the track. My personal decision to switch to anesthesia in no way takes away from you or the field of Family Practice. Whether I'll be bored as an anesthesiologist is really dependent on my decisions of scope of practice after I complete my residency. Yes, I would be bored doing lap choles and hernias all day, so I will steer clear of those jobs.

And I have worked in a Level 2 ER, I liked it but it wasn't much different than my day to day job with the occasional trauma patient thrown in for interest. It wouldn't sustain me.

So I'm excited about my change of career and can't wait to get started. I'd like to hear more about what Erichaj's situation is and why this created such a response from him.
 
I'm sorry my original post sounded so harsh. But as I started to read the posts after your original post, I began to see the common trend of FP bashing. Not by you, but by other posts.

I had to put a stop to that.

I feel that fp doctors are the perfect doctors to enter fellowship programs like cardiology, ER, gI, rheumotology, or any other sub-specialty. There needs to be programs and lobby efforts by the aafp to promote this and make this the standard in US medicine.

Let me give an example. Lets say a urologist has a nurse practitioner working for him. This NP does no surgical work but does see most of the non-surgical pts and does procedures like cystoscopy and US of bladder in the office. This NP was trained by the urologist to do this over about a year or 18 months.
Consider if as an FP you could do a fellowship where he could learn how to manage most non-surgical urological problems in his office without referal to specialist or working with a urologist.
This would free up the urologist to do surgery. This would increase the bottom line for the surgeon and the FP. It would also
increase access of care for the pt.

This same model can be used in most subspecialties. FP can be trained to place stents in cardiology, they can and are doing colonoscopies and 20 years ago they did gallbladder and appendix and tonsils.

My point is that we need to take back primary care. The studies prove that we as primary care doctors can deliver better care than specialists. We should not allow specialist to dictate how the direction of medicine because primary care is the cornestone of medicine.

As im my own practice (opeining soon), I plan to do as many procedures as possible that interest me. This does not mean that every FP will be interested in doing procedures. But the avenue to do this needs to be open for them.

I find that the aafp has done little to promote this idea. This has led to fewer and fewer individuals going into fp and many such as yourself leaving fp.

There are many people that complain that we don't make enough money and many med-students that go into other specialties for money. Many of them like fp but don't feel they can be challenged enough or will be able to make a good living. I agree with some of what they feel. But I feel those that like fp should go into it and fight for primary care.

The future of american medicine is dependent on primary care. Specialist will not be able to do what we do. They don't want to do what we do. Only the most difficult cases should be sent to a specialist. If an FP is trained in a sub-specialty, he would be able to handle most of the cases in that sub-specialty and still maintain a balanced general practice. for example 50 to 60% subspecialty and 40 to 50 percent general medicine.

I hope this answered your question and shed some light on where I'm comming from.
 
A 2002 fp Jama study demonstrated that in other countries where FP docs were the norm not the exception in medical care,
the quality of pt. care increased. In fact, we are ranked 23rd in the western world in quality of care.


When people say we need to reduce the fp slots in this country and get specialists, I start to laugh. We are top heavy in specialist. and we are ranked 23rd in healthcare in the western modern world of medicine.



Which countries had the best quality of care?
I lived in Germany for part of my childhood (no, I'm not from a military family) and I at one point I had a very bad case of chicken pox. In the 2 weeks that I laid in bed, the German family physician came to my house 3 times to take care of me and make sure I was alright. I will never forget that, and it has impacted my goal in life of becoming a small town doc, who takes care of pts as best they can.
It really worries me as a second year medical student when I hear that FM positions may be dissappearing. I'm in the process of applying to the NHSC for a scholarship, and I find it hard to believe that they woul be getting rid of FP's if they are so desperate to hand out full tuition/fees to private school students just to get them to go into the primary care fields (mostly FP).
 
erichaj,
I agree with what you have stated about fighting for primary care . Do you think that we will have more power to do this if unversal care is implimented, and/or the answer of growing costs of medical malpractice and decreasing medicaid reimbersments etc are answered first. How are they related? Not just the 'financial cost but the approach to improved pt. outcome.
thanks,
Casey
 
Originally posted by CambieMD
I have read predictions of physician supply and work force needs in the future and I have come to the conclusion that midlevel providers will be performing a large percent of the tasks now performed by FPs and other primary care physicians now. This trend will be hastened by the reluctance of third party payers to compensate physicians adequately for their work.
Click to expand...

At least somebody gets it. Naturopaths already have full script rights in several states, and are pushing to expand it in all 50 states.
 
Originally posted by Slickness
There are some interesting views on FP on this forum. It has been stated that soon nurses/PAs may perform some of the mundane cases that FPs do currently, which would cause less demand for the FP.

I am interested in going FP in the future. Would you say that aspiring FPs may find themselves without a job within the next 40 years do to the change in the dynamics of medicine? I'd hate to enter into FP if it had an unstable future.
Click to expand...

Nuses and PAs wont cause docs to go unemployed. What they WILL do is drive down salaries. If you are happy making 50k per year as FP, then you can work anywhere you want to. But say goodbye to the days of FPs making 150k.
 
Originally posted by lowbudget
Bottom line: don't worry. market and labor economics won't allow NP/PA's from replacing FP's altogether.
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No, they wont force FPs to the unemployment line, but they WILL drive down salaries.
 
I think it's *highly* likely that FP salaries will trend upward, even if the number of FP declines. The American public won't accept health professionals that are unsupervised. The rise of PAs/NPs may lead to FPs taking more of the role of "team leader," in which they supervise a gaggle of mid-level practitioners and do less direct patient interaction on their own, but that will only lead to higher FP salaries as they take a cut of their employees' labor.

Personally, I see the NP/PA movement, if you will, as a very positive development for family practitioners. There's plenty of work to go around, and being able to hire someone who will work for a third of the cost of a doctor is going to make for very lucrative practices for those willing to go where there's a need. So though suburban FP-doc-employees may be in trouble, the classic private practice FP is already and will continue to turn the availability of NP/PAs to the advantage of his patients and his wallet.
 
Originally posted by lukealfredwhite
I think it's *highly* likely that FP salaries will trend upward, even if the number of FP declines. The American public won't accept health professionals that are unsupervised.
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What? People already accept that RIGHT NOW. There are many PA clinics where the doctor is NEVER in house.

The rise of PAs/NPs may lead to FPs taking more of the role of "team leader," in which they supervise a gaggle of mid-level practitioners and do less direct patient interaction on their own, but that will only lead to higher FP salaries as they take a cut of their employees' labor.

Personally, I see the NP/PA movement, if you will, as a very positive development for family practitioners. There's plenty of work to go around, and being able to hire someone who will work for a third of the cost of a doctor is going to make for very lucrative practices for those willing to go where there's a need. So though suburban FP-doc-employees may be in trouble, the classic private practice FP is already and will continue to turn the availability of NP/PAs to the advantage of his patients and his wallet.
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The problem with your logic is that you assume that PAs and NPs will always be content to work under doctors. Thats not the case. NPs are already pushing for full autonomy, and PAs are gradually getting more autonomous with time.

Eventually, they are going to go to the state legislatures and TAKE autonomy whehter the MDs like it or not.

Your model falls apart because you assume that MDs/DOs dictate all scope of practice and its under their control. Not true at all--scope of practice is under the state legislatures control--NOT doctors. If the state legislatures think the state can save money on health care by giving NPs/PAs/others autonomy then they will do that in a heartbeat and doctors wont have a say in the matter.
 
MacGyver, as I have said many times before, you are a complete idiot. I am a PA in medical school, and if what you said was so true I would have never needed to go back to school. You have yet to elaborate as to what gives you such knowledge to make such fantasy predictions. You are a troll at best, but more likely a deviant fetisheur who gets his rocks off fantasizing about having your own apartment one day away from Mommy and Daddy. Yesterday you tried to claim on another thread that ND's have this supposed full script rights in California, and I sent another reply to that thread showing just how stupid you really are. ND's have nothing near full script authority. And hey genious, it is not state legislatures that dictate scope of practice, but it is the state medical board that tells the legislature what to approve. Nothing gets through the legislature that the medical boards don't want passed. But I guess you enjoy being Chicken Little. Anyone else wonder why Macgyver never replies to my posts asking him to clarify his credentials? I agree, he most certainly has none!!
 
There's a reason why FP was ever created as a specialty... because people felt that being a GP (finishing an intern year, 1 year out of med school) was not enough training to keep up expanding scientific knowledge that's evidence based.

Please, as a first year med student, I had to explain to a seasoned PA how to read the diff on a CBC because he "has never ordered it with diff... what's an eosinophil?"... give me a break. Sorry kids, it's hard enough cramming ALL of medicine into an FP's resident's training and people ALREADY question the competence of FP's; what makes you think a shortened training will be better for the people?

I seriously doubt as medical science expands and advance that people/insurance companies will demand less scientifically educated clinicians to oversee their care.

The only reason why there are PA/NP's to begin with is because no FP wants to do the crap that PA/NP's do (like go out to bumblefu.ck to practice medicine, or take care of uninsured or do 100% Medicaid). It's FP numbers that drive PA/NP numbers, not the other way around.
 
Originally posted by PACtoDOC
And hey genious, it is not state legislatures that dictate scope of practice, but it is the state medical board that tells the legislature what to approve. Nothing gets through the legislature that the medical boards don't want passed.
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Oh really?

Please explain to me then how psychologists in NM were granted limited script rights for psychiatric drugs, when the NM medical associations were STRONGLY OPPOSED to it?

State legislatures hold the power here. Sure they can choose to listen to the docs medical associations, but you are incredibly naive if you think docs hold any real power in terms of dictating scope of practice.
 
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