What are FM programs looking for? What type of personality " fits" FM???

[psychMDhopefully]

I'm just asking because, there seems to be a certain type of personality that predominates each field. I know FM residencies aren't as focused on board scores or research, so what type of ECs do they like to see? Do they like ECs that are focused on service? I'm guessing you have to be a people person and likeable to do FM, I know you have to be socially competent in every field, is it especially important for FM or not really?

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[Natividad Resident]

The stereotypes are supposed to be funny. You'll laugh, hard, the first time you meet an ortho who is actually large, muscular, cavemannish and brospeaking. Because you'll only meet maybe one or two in your life. Most orthos can do a fine and funny imitation of that stereotype. What's the purpose of the heart? To get ancef into the bones.

As a freshly minted FM intern, I like to throw out "let's burn some sage" and "that'll be 5 duck eggs please" to make fun of the FM stereotype. Which gets a laugh from maybe 20% of my colleagues. The rest don't give a crap about the FM stereotype. In my residency we have conservatives, progressives, religious, crunchy, moms & dads, old farts, true intellectuals, biz people, systems people, sports people, extremely quiet people, extremely fashionable people, people actively changing the world for the better, people still playing as much xbox as they can, etc. And we just have 30 residents.

Huge country. 3000+ new FM interns every year. 500+ FM programs. The only bigger specialty is IM. Some FM residencies are at universities - and you bet they care about board scores and pubs. Some are at "community" hospitals that are so tightly integrated with a med school or research institution that they should be considered academic. Some are at free clinics, and you get shipped out to hospitals for your inpatient rotations. Some are in towns with populations under 30,000. Some are in Manhattan. Some are 100% Southern Baptist. Some include Ayurveda. Some are hugely popular and competitive because of location or what have you, and they're filled with AOA MDs from Ivy's with 260's. Some are 4 years long and/or have very well defined emphases.

Here's the thing. If you want to do well in the FM match, and you want your residency to challenge and energize your vocation, then be actually, legitimately interested in FM based on hard-won perspective from real-life experiences with families and illness and health. If you don't really want FM, you might as well do IM or Peds or Path. Don't just go FM if your scores are crap. Or if you just want to get out of residency in 3 years. Or you just want to be in a particular location. There are plenty of FM matches who don't actually legitimately want to practice primary care as a family med doc, maybe they picked it because they thought they wouldn't have to work too hard, or maybe they didn't match what they really wanted (Obgyn, EM, Ortho). Pretty much anybody who goes after FM will match, will graduate, will practice. Same with IM. Same with Peds. There are plenty of people who aren't defined by their specialty choice. Most people aren't. (I pretty much am. I pretty much don't ever stop thinking about disparity alleviation, process improvement, LARCs, yesterday's patients, am I gonna get some intubations, should I do a fellowship, etc. I pretty much give an actual crap.)

I can't tell if you have a real desire to practice family medicine, or if you can't see past the process of getting a residency. Maybe both?

Here are some activity clusters that could help legitimize (or kill) an FM aspiration, and/or help make FM interviews more fun, if you have a couple years to fill:
- anything involving a free clinic
- anything involving the underserved ie undocumented, incarcerated, the rez, homeless etc
- anything involving public health
- anything involving coaching, training, sports, PT, yoga
- almost nothing outside the US (because unless you have lived and worked in a developing country, you'll punk out the first time you get malaria)
- anything where a community goes nuts for its own health like Cyclobia or farmers markets or rails-to-trails 0r Blue Zones
- anything involving women & children & family planning & prenatal care
- anything involving prevention of disease or survivorship of disease
- anything involving the politics, economics or sociology of primary care
- anything involving low income access to healthcare such as ACA navigation, Medicaid signups, SSI, RAM clinics
- learn Spanish or Mandarin or Arabic
- anything involving chronic disease management, practice management, managed care
- conferences & SIGs for STFM, AAFP if you want to do academic med
- anything involving new primary care delivery models such as IORA, JenCare, DPC etc

Hope that helps. Good luck!

 

[Back 5]

The stereotypes are supposed to be funny. You'll laugh, hard, the first time you meet an ortho who is actually large, muscular, cavemannish and brospeaking. Because you'll only meet maybe one or two in your life. Most orthos can do a fine and funny imitation of that stereotype. What's the purpose of the heart? To get ancef into the bones.

As a freshly minted FM intern, I like to throw out "let's burn some sage" and "that'll be 5 duck eggs please" to make fun of the FM stereotype. Which gets a laugh from maybe 20% of my colleagues. The rest don't give a crap about the FM stereotype. In my residency we have conservatives, progressives, religious, crunchy, moms & dads, old farts, true intellectuals, biz people, systems people, sports people, extremely quiet people, extremely fashionable people, people actively changing the world for the better, people still playing as much xbox as they can, etc. And we just have 30 residents.

Huge country. 3000+ new FM interns every year. 500+ FM programs. The only bigger specialty is IM. Some FM residencies are at universities - and you bet they care about board scores and pubs. Some are at "community" hospitals that are so tightly integrated with a med school or research institution that they should be considered academic. Some are at free clinics, and you get shipped out to hospitals for your inpatient rotations. Some are in towns with populations under 30,000. Some are in Manhattan. Some are 100% Southern Baptist. Some include Ayurveda. Some are hugely popular and competitive because of location or what have you, and they're filled with AOA MDs from Ivy's with 260's. Some are 4 years long and/or have very well defined emphases.

Here's the thing. If you want to do well in the FM match, and you want your residency to challenge and energize your vocation, then be actually, legitimately interested in FM based on hard-won perspective from real-life experiences with families and illness and health. If you don't really want FM, you might as well do IM or Peds or Path. Don't just go FM if your scores are crap. Or if you just want to get out of residency in 3 years. Or you just want to be in a particular location. There are plenty of FM matches who don't actually legitimately want to practice primary care as a family med doc, maybe they picked it because they thought they wouldn't have to work too hard, or maybe they didn't match what they really wanted (Obgyn, EM, Ortho). Pretty much anybody who goes after FM will match, will graduate, will practice. Same with IM. Same with Peds. There are plenty of people who aren't defined by their specialty choice. Most people aren't. (I pretty much am. I pretty much don't ever stop thinking about disparity alleviation, process improvement, LARCs, yesterday's patients, am I gonna get some intubations, should I do a fellowship, etc. I pretty much give an actual crap.)

I can't tell if you have a real desire to practice family medicine, or if you can't see past the process of getting a residency. Maybe both?

Here are some activity clusters that could help legitimize (or kill) an FM aspiration, and/or help make FM interviews more fun, if you have a couple years to fill:
- anything involving a free clinic
- anything involving the underserved ie undocumented, incarcerated, the rez, homeless etc
- anything involving public health
- anything involving coaching, training, sports, PT, yoga
- almost nothing outside the US (because unless you have lived and worked in a developing country, you'll punk out the first time you get malaria)
- anything where a community goes nuts for its own health like Cyclobia or farmers markets or rails-to-trails 0r Blue Zones
- anything involving women & children & family planning & prenatal care
- anything involving prevention of disease or survivorship of disease
- anything involving the politics, economics or sociology of primary care
- anything involving low income access to healthcare such as ACA navigation, Medicaid signups, SSI, RAM clinics
- learn Spanish or Mandarin or Arabic
- anything involving chronic disease management, practice management, managed care
- conferences & SIGs for STFM, AAFP if you want to do academic med
- anything involving new primary care delivery models such as IORA, JenCare, DPC etc

Hope that helps. Good luck!

Great post

 

[atomheart]

Here's the thing. If you want to do well in the FM match, and you want your residency to challenge and energize your vocation, then be actually, legitimately interested in FM based on hard-won perspective from real-life experiences with families and illness and health. If you don't really want FM, you might as well do IM or Peds or Path. Don't just go FM if your scores are crap. Or if you just want to get out of residency in 3 years. Or you just want to be in a particular location. There are plenty of FM matches who don't actually legitimately want to practice primary care as a family med doc, maybe they picked it because they thought they wouldn't have to work too hard, or maybe they didn't match what they really wanted (Obgyn, EM, Ortho). Pretty much anybody who goes after FM will match, will graduate, will practice. Same with IM. Same with Peds. There are plenty of people who aren't defined by their specialty choice. Most people aren't.

Great post.

More recently I have noticed recommendations to "find your people" as a method of selecting specialty.

Would you more or less not advocate this as a method of choosing FM? It sounds like the breadth of the specialty pulls all types, but you also indicate that all types can be found in all specialties. Perhaps its not a stereotype that they're recommending people look for, but the mindset or approach of the specialty (ex: preventive and long term continuing general medical care in family medicine... But again you can do this in a bunch of different specialties but shift your population or procedures).

I think my frustration with trying to figure out whether I should pursue FM is figuring out exactly what that mindset is. Some have settled in as pediatric generalists, oc med specialists, procedural specialists, etc. Everytime one posts here I get a different feeling about FM. I see so many different types that I almost feel like the specialty as a whole does not know what it is about. I felt exactly the same after shadowing two FM docs: Completely different experiences. For the record, both docs pushed me away explaining that FM has become too broad...

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[Natividad Resident]

"Find your people" is a whole lot less granular than you're making it.

"Find your people" means you know you're home when you're in an OR for the first time...or you deliver a baby for the first time...etc...because those people are doing what you want to do. "Your people" aren't personality clones. They're alike in what they like to do.

A lot of med students never find their people. IMHO it's not actually the norm to be sure what you want to do after 3rd year.

A lot of med students (imho a majority) go IM because they have no idea what to pick, and they want to leave the door open for a high paying boarded subspecialty later. Somebody who at least likes kids can pick Peds for the same reason, or Med/Peds.

If you like every specialty you see in 3rd year, that tends to be a fair argument for pursuing FM. If you hate everything, or you're neutral after 3rd year, that's not a good argument for FM. If you aren't very, very sure what "primary care" means, it would be a HUGE mistake to do FM.

A fair number of med students take a prelim year (ie IM or surg or "transitional") because they need more time to choose. Or they go after a specialty that turns out to be just wrong, and they switch. My residency has 20% to 30% from those paths. Try hard to avoid that, but it's there.

It doesn't sound like you've had the experience yet of working with a happy FM doc. Which isn't surprising. A lot of primary care docs are unhappy. This is hard, but you should definitely find a primary care doc that loves and is dedicated to primary care, before choosing primary care as a specialty. If you haven't yet been inspired by at least one individual practicing primary care, then you definitely haven't "found your people" yet.

"the specialty as a whole does not know what it is about" makes me laugh. Sorry. I'm not laughing because "of course FM knows what it's about, harumph!" I'm laughing because you shadowed 2 FM docs, who apparently don't like their jobs, and you're making them represent the 2nd largest specialty in medicine in the 3rd most populous country on the planet which has no national health system and for better or worse allows the health industry to make up its own definitions for what "health care" means without bearing any responsibility for the effect on a population of such a definition. FM is generalist medicine. FM is primary care. That's responsibility for knowing what to do with every chief complaint. That's what the specialty as a whole is about.

So my suggestion is let go of "mindset" and figure out what you want to do. Do you want to be a generalist or a specialist? If you want to do everything, FM is the only way to do that. If you want to do everything except a couple of things, then FM might be good. If you honestly don't know, that's only a problem if you're an M4 right now, and if you're an M4 who doesn't know, then seriously consider a prelim/transitional year.

Hope that helps. Good luck!

 

[galactus]

For the record, both docs pushed me away explaining that FM has become too broad...

"Too broad" is the reason why I went into FM. Yesterday I did outpatient clinic. This morning I saw some college athletes before their football scrimmage, and went over spine boarding protocols on the field with the sports medicine fellows. Right after that I went to the hospital to do inpatient rounds with the residents. I enjoy being that versatile.

To the OP: I've seen many different personalities go into FM, the specialty is "too broad" to pinpoint a personality type

 

[hallowmann]

"Too broad" is the reason why I went into FM. Yesterday I did outpatient clinic. This morning I saw some college athletes before their football scrimmage, and went over spine boarding protocols on the field with the sports medicine fellows. Right after that I went to the hospital to do inpatient rounds with the residents. I enjoy being that versatile.

To the OP: I've seen many different personalities go into FM, the specialty is "too broad" to pinpoint a personality type

That's like the whole point. It didn't "become" too broad, it is broad, and like you pointed out its one of the reasons the people who want to do it are doing it in the first place.

The main complaint I've heard from FM docs across personality types is the ever increasing hoops and HM documentation that takes longer without increasing income or improving outcomes with their patients. We'll see what happens with those of us in the system now, but current docs remember an easier time, whereas the way it now is is pretty much all I'll know.

 

[kbeitz]

That's like the whole point. It didn't "become" too broad, it is broad, and like you pointed out its one of the reasons the people who want to do it are doing it in the first place.

They may have meant that it has become "too broad" for the surrounding business of medicine. Not that FM has changed, but the practice environment has.

I agree that the breadth of FM can be appealing, especially for those who have the desire to treat any CC that comes in the door.