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We need an informational stickied thread about what family medicine is all about

Discussion in 'Family Medicine' started by Sense, Jul 17, 2004.

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  1. Sense

    Sense Sensible User

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    I am a soon to be first year medical student that is interested in family medicine. I have noticed in the forums of other specialities moderators and other people have stickied threads that have a FAQ section and such about their perspective specialty.

    I was thinking maybe someone could start up an informational thread such as the ones in the other specialty forums. One that includes how life is like as a family physician, what kinds of qualities make up a family physician, work hours, typical days and so forth.

    I am really curious to learn more about the field of family medicine and believe a thread like this would be helpful. Any takers? :thumbup:
  2. PACtoDOC

    PACtoDOC 1K Member

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    I think that is a great idea. I will work on it and submit it to Lee and the moderator and see if they will approve what I write as a sticky. Lee being an FP himself can change it around or ammend it as he sees fit, but at least it is a start. Hopefully it will be done next week. Thanks for the idea.
  3. Sense

    Sense Sensible User

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    Thanks for taking the initiative. I look forward to reading it. :D
  4. Sense

    Sense Sensible User

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    Pactodoc, so what's the deal with the sticky?
  5. PACtoDOC

    PACtoDOC 1K Member

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    The more I think about it the more I realize I am not qualified to do it. Maybe one of the residents could put something together for the sticky.
  6. Sense

    Sense Sensible User

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    That's ok. Any other takers?
  7. cooldreams

    cooldreams American Mensa Member :)

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    i would like to read it hehe :)

    i am having trouble deciding between ortho and fp... i think i like them both a lot but i am really leaning towards fp.... hmmm
  8. dj_smooth

    dj_smooth Member

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    I am also conflicted...thinking hard on rural FP or doing peds. I'd really like to be competent in treating unwell children and am a bit leary if FPs are able to handle sick kids. I am heading to Minot, ND with the hope that I'll get a better feel for what FP is all about as I have only done a GP rotation in the UK and was a bit frustrated how they handle things...lots o' referrals which really bugs me. I really like FP because Ob can be part of your practice, and after seeing our 6th kid born last week, it really reinforced how much I like deliveries...sigh. WHY IS CHOOSING A SPECIALTY SO DIFFICULT?? Sorry. Didn't mean to yell.
  9. hidradenitis

    hidradenitis Senior Member

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    This is my perspective of "what family medicine is all about" from the standpoint of an FP resident. What follows is mostly true, thickly embellished with personal experience and authoritative anecdote. It comes in the form of questions asked by an inquisitive first-year med student, eager as a beaver for career guidance, followed by responses from an overworked and harried resident; it is arranged in no particular order (read: flight of ideas).

    What is family medicine?
    Family medicine is the heir to the GPs of yore, and is about as general a field as you can get. Of all the specialties, it is the most diverse in terms of scope of practice. It was known as family practice until recently, when it became politically incorrect to do so (out of fear of being confused with nurse pracs).

    What do FPs do?
    They do a lot, although the reality is that their scope of practice is largely defined by region, locale, and interest. The rural FPs I worked with did their own C-sections, were first assist for their patient's appy's and whatnot, saw their own at the ED, and took care of their own peds and adult inpatients. Others I've known have a more limited practice consisting of mainly ambulatory medicine.

    Isn't family like a watered-down hybrid of medicine and peds?
    In a way, yes, as well as of surgery and OB. And that's not necessarily a bad thing. Although folks assume family is a poor version of medicine and/or peds, they do receive sufficient training for the more common diseases of both, as well as some additional things that the other two don't get much of, like time in the OR or delivering babies. Even for those FPs that don't do much of that in the real world, it's good experience and provide them with a unique perspective that even some of the other primary care specialties may not get. Essentially, FPs treat the most common diseases; just because they aren't cardiologists or peds id specialists doesn't mean that they aren't qualified to do routine workups of common things like MIs or childhood sepsis. And although these may not be sexy topics and even though they're common as all get out, they're still pretty darn important.

    Will I be respected as an FP? What about fame? Fortune?
    In truth, it depends. Let's start with respect. Short answer: at an academic center, NO, NO, and HECK NO; in the real world, yes, if the specialists want your business; by your patients, yes, if you're good. Long answer: do you need a long answer? I think it's pretty self-explanatory.

    One funny thing is that although it's inherently uncool to want to go into family when you're at Tertiary Care U, it can become eerily nice to have in your back pocket later on in life. Take Howard Dean, for instance. During the recent (2004) Democratic primaries, he proudly trumpeted the fact that he was a "family doctor" (he's an internist). Now, I don't begrudge the man that he called himself a family doctor (after all, I wouldn't want to have to explain what an internist is to the lay public), but here's my point: a) people know what a family doc is and b) it's a good thing to be known as one (at least Dean thought so).

    Now about the money thing: you won't become filthy rich. Oh, you'll do all right, but you'll never approach the levels of your invasive cards buds. If you dig lots of money, then do something else. The average (off the top of my frenzied mind) is like 120-140. It ain't pocket change, but it ain't the Taj Mahal, either. And you'll always be towards the bottom of the barrel (although not at the bottom); primary care is always reimbursed at a lower rate. (I'm actually okay with that; I don't begrudge my specialist buddies; after all, they trained longer and are being paid to be 'the final word'.)

    But isn't family for the med students that took the 'slow bus'?
    It is true that FP is the least competitive of all specialties and that it's dropping like a rock. (Let's face facts, after all.) And it has more total slots than any other specialty, which makes the job of filling them that much harder. As a result, the qualifications of landing an FP slot are: pulse > 40 bpm and ICU euboxemia (ie, air goes in and out, blood goes round and round, glucose is good.) And as a result (please don't take this the wrong way) there are lots of IMG's in the field. Now, the IMGs at my program are no dumber/smarter than the US grads (some are dumb and some are smart but no more or less so than the rest of us.) But, fair or not, FPs lose 'status points' for not filling their slots in the US match. On a related note, FP often is a backup for those who 'didn't match derm (or OB, or EM, or _____)'. Also not cool. ("So, going into family, huh?" [Couldn't make it in the real world, eh?])

    One thing that came as sort of an epiphany for me was the realization that ambulatory medicine (which I had always relegated to the status of 'easy medicine') is actually pretty darn hard, that is, hard to do right. You need to know a heck of a lot and to be able to apply it right now. Unless you've done a lot of it, you don't know how hard it is: it ain't all runny noses and stubbed toes.

    What is the residency like?
    FP is a three-year residency; there are ACGME fellowships in Sports Med and Geriatrics, as well as a multitude of non-ACGME fellowships, including Rural Med, OB, Adolescent Med, Women's Health, etc, etc, etc. The residencies tend to be front-loaded with the intern year being hard and the other two somewhat lighter. A common misperception is that FP is an easy residency (and profession, for that matter.) Although the hours aren't as bad as a lot of specialties (like gen surgery, for instance), it ain't a walk in the park, either. I've gone over 100 hours a couple of times thus far as an intern.

    So who wants to go into family, anyways?
    Given the breadth of the field, it's not surprising the variety of personalities it attracts. A typical family program will have one 'cowboy' do-it-all, do-it-yourselfer, full scope of practice, practice in Armpit, Alaska; one tree-hugging granola type who is planning on an MPH after residency and before working for either Doctors without Borders or the local inner-city clinic; and a good-sized handful of suburbanites heading back to suburbia. And, yes, there are the "couldn't get into EM/OB", per above.

    What personality type do you need for FP?
    See descriptions above. FP docs place a high premium on practicality but lack the ADHD needed for EM (and substitute it with passive-aggression.) They are medicine/surgery hybrids who enjoy ruminating over the weird but subacute offings of human pathology that frequent their offices, but at the end of the day would rather be sewing lacs, taking off lumps and bumps, or injecting a joint.

    That pretty much sums it up for now; I'd be happy share my blatant opinions, unadulterated with knowledge or foresight, with anyone who might have any questions.

    And that's all I have to say about that. :D
  10. dr.smurf

    dr.smurf Senior Member

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    Hidradenitis that was way cool of you to post that info for those students seeking more info about the specialty in family medicine. Im sure those eager students appreciate the good info. It was a really good post.

    I have to reinterate the variety and diversity of fp. For example, Im a first yr resident and I was shocked yesterday when I went to clinic to find that my first pt for the day was a 35 y.o. male with osteogenesis imperfecta. I was like wow..you are never suppose to see that just read about it in med school and never hear about it again. But, it was very interesting to say the least. My M.A. came out and said wow doc your not going to believe this one. I was like yeah yeah whats up and she was like you have a pt with OI. I was like " uhh osteogenesis imperfecta " and she was like yep. I seriously thought she was kidding but far from it. So before I walk in the room my mind is racing as to what I can remember from genetics and path regarding OI. I remembered blue sclera and brittle bone disease and that was about it. Then I recalled there are 4 types. Long story short this guy had gross noted deformity with short stature and multiple rods and pins from previous fx's. He was very functional to my surprise. Used a tiny wheelchair but very mobile.

    Anyway, this is family practice. You can see something as rare as this or as common as HTN and URI's. Thats what I love about this specialty. You can do pretty much whatever you want from ER and urgent care to ambulatory practice with hospital admission priviledges to purely ambulatory medicine or even something as diverse as a team physician or cruise ship doc.

    The only advice I can give to students is whatever you choose to go into..do it for the right reasons, not the money, prestige, etc.

    Best of luck to all of you out there going through ERAS and NRMP now. I do recommend this site for more info regarding FP.
    http://fmignet.aafp.org/
  11. erichaj

    erichaj Removed

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    Wow, what a twisted explanation.

    I'm a board certified FP, I'm not passive aggressive, I did not do it because I could not get into another specialty.

    FP is about doing general medicine and building personal relationships with your pts. You can choose certain areas of interest and go with that. You can choose to work urgent care or ER. I know many that do. FP give you a choice. Many people don't like to do the same thing over and over again. Or be in a high stress burn out situtation (ER) all the time. FP allows some of each. Or none of it. You can choose to work part time and pursue other interests. Medicine is not all there is in the world.

    Now if your the type of person that needs to be the authority in pulmonary medicine or cardiology or something like that. Then FP is not for you. If you are someone who want to take care of pt's and be laid back doctor. Then FP is for you.

    As far as the money goes. The avg. is aroung 145,000. The low is around 90000, the high is around 250000.

    Good luck.

    EH.
  12. erichaj

    erichaj Removed

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    Wow, what a twisted explanation.

    I'm a board certified FP, I'm not passive aggressive, I did not do it because I could not get into another specialty.

    FP is about doing general medicine and building personal relationships with your pts. You can choose certain areas of interest and go with that. You can choose to work urgent care or ER. I know many that do. FP give you a choice. Many people don't like to do the same thing over and over again. Or be in a high stress burn out situtation (ER) all the time. FP allows some of each. Or none of it. You can choose to work part time and pursue other interests. Medicine is not all there is in the world.

    Now if your the type of person that needs to be the authority in pulmonary medicine or cardiology or something like that. Then FP is not for you. If you are someone who want to take care of pt's and be laid back doctor. Then FP is for you.

    As far as the money goes. The avg. is around 145,000. The low is around 90000, the high is around 250000.

    Good luck.

    EH.
  13. hidradenitis

    hidradenitis Senior Member

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    A couple of comments:

    1. That passive-aggressive thing is a joke. It's HUMOR, people! Just like the ADHD thing. And, okay, maybe it's not that funny. So sue me.

    2. If you took from my post that folks who go into FP do it only because they can't get into other things, then you didn't read it. What I did do was acknowledge the fact that many folks do indeed end up in FP as an alternative. I'm not suggesting that this is true for the majority. I guessing most folks do it because they want to be family docs. For example, I was (almost) always going into FP because I thought it was an interesting field and wanted to practice 'hands-on' medicine with patients I knew better than any other doc they might have. I was a competitive residency applicant, was in the top quartile of my class, scored in the high 230s on step 1 and 2, and am a delightful and engaging dinner guest. I wasn't 'forced into' family by any means. But it just isn't a competitive specialty. 'Nuff said.

    3. Twisted? What, me twisted? Okay, okay;you're right that the explanation is all over the place. That I freely admit. Hey, I wrote it at 2 am, fer cryin' out loud! But I think it's a pretty good summary of what most first and second years are worried about.

    4. Speaking of summaries, erichaj's is great (and succinct, to boot!) Like dr. smurf points out, family's all about variety; you can do what you want. As long as you can live with not being the expert, you can pick and choose what you want. Another epiphany I had as a med student was that the subspecialists see a VERY narrow spectrum of disease. For example, a neurologist with a fellowship in movement disorders will spend (I'm guessing here, but it's probably pretty close) a majority of his/her time on parkinson's. If you dig parkinson's, great; but wouldn't that get old after a while?

    Anyways, I'm post call and need some z's. To quote dksamp, PEACE!!
    :D :D :D :D

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