Any FM docs practicing in the Northwest?

[HipsterLorax]

Hey folks,

Appreciate any replies in advance.

I'm looking for advice on practicing family medicine in the Pacific Northwest. I love rural and underserved medicine and I'm hoping to have a broad-spectrum practice (low-risk OB, peds, nursery, inpatient, etc.). But I was wondering what the likelihood of finding a good job is with that type of scope and how rural I'd have to go. I definitely see myself living in a smaller community, but probably not smaller than 50K. Wouldn't mind a bit of a commute either if it meant I could find the right practice. I know academics is also an option to have that sort of variety while still living in a bigger city.

So my questions are:
-What are the jobs like in the Northwest?
-How possible is it to practice in a broad scope while living in a city >50K?
-Which residency programs have good reputations among physicians in the region?
-Any advice or stories on searching for jobs in the region?

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[nraesmith]

This is just one person's experience, but when I was looking for full-scope jobs in the PNW, there were very few in towns >50k population. 1 I saw, if you were fellowship trained you could do OB w/ C/S in a 90k town. Now, smaller towns, sure. Lots available. But you gotta be willing to be pretty rural like <30k.

 

[cabinbuilder]

In Oregon I worked as locums in: Roseburg, Hermiston, Cornelius, Grants Pass, Manzanita, Tillamook, and Newport. Oregon has a HUGE HUGE HUGE need for FP docs. I left Oregon because I hate the rain and I was tired of paying 20,000 in state income tax every year.

I also worked in Southeast Alaska for 9 months as locums. Always looking for doctors in Alaska too.

I worked in Elko and Tonopah, Nevada.

You don't have to do residency in the PNW in order to get a job there. I did my residency in south Texas. You can do full scope if you want but most don't anymore due to being overwhelmed and not having enough time to get it all done anymore.

 

[HipsterLorax]

Thanks for the replies.

@nraesmith good to know. How long ago was this? Did you end up in the PNW?

@cabinbuilder Full scope will most definitely not be sustainable for all of my career, but I think right out of residency (while I'm relatively youngish) it's something I'll want. That subject to change, of course.

 

[Blessthefall]

Oh thank god, I found a likeminded individual @HipsterLorax! It's my dream to practice FM in rural OR.

The questions I have to anyone informed and willing to answer:
1. What's a fair estimate of the annual salary of a FM doc in rural OR? In the city such as Portland/Eugene/Salem?
2. Any visible presence of direct primary care?
3. Are single provider practices common or are a majority of the practitioners employees of a hospital agency?

Will be following this thread BIG TIME! Thanks!

 

[cabinbuilder]

Oh thank god, I found a likeminded individual @HipsterLorax! It's my dream to practice FM in rural OR.

The questions I have to anyone informed and willing to answer:
1. What's a fair estimate of the annual salary of a FM doc in rural OR? In the city such as Portland/Eugene/Salem?
2. Any visible presence of direct primary care?
3. Are single provider practices common or are a majority of the practitioners employees of a hospital agency?

Will be following this thread BIG TIME! Thanks!

In Rural Orgeon people DO NOT HAVE MONEY. I don't see DPC ever taking off there. Oregon Medicaid is overwhelmed and loses money faster than the budget can compensate.
I just left Oregon after 5 years of living there. I honestly never saw any private practice there, every one I worked with was employed by a larger entity.
It is not unreasonable to have a starting salary of 200K that is without OB. It will be lower in Portland.

I moved to Oregon originally to take a permanent job there - I took over a practice that was incorporated into a larger entity. Was forced out by staff who made it miserable. Uncovered a huge amount of malpractice cases and was paid to leave and keep my mouth shut. Just FYI- be very careful about working in Oregon especially if you are not from there. Very suspicious group. I'm very glad to be gone. Plus the marijuana mills leave something to be desired. Everyone smells like dope anymore.

 

[Blessthefall]

In Rural Orgeon people DO NOT HAVE MONEY. I don't see DPC ever taking off there. Oregon Medicaid is overwhelmed and loses money faster than the budget can compensate.
I just left Oregon after 5 years of living there. I honestly never saw any private practice there, every one I worked with was employed by a larger entity.
It is not unreasonable to have a starting salary of 200K that is without OB. It will be lower in Portland.

I moved to Oregon originally to take a permanent job there - I took over a practice that was incorporated into a larger entity. Was forced out by staff who made it miserable. Uncovered a hug amount of malpractice cases and was paid to leave and keep my mouth shut. Just FYI- be very careful about working in Oregon especially if you are not from there. Very suspicious group. I'm very glad to be gone. Plus the marijuana mills leave something to be desired. Everyone smells like dope anymore.

Yikes! That's quite the nightmare... I absolutely appreciate the brutal honesty though! That's something that is also of concern to me: how OR views outsiders within the medical profession.

 

[cabinbuilder]

Yikes! That's quite the nightmare... I absolutely appreciate the brutal honesty though! That's something that is also of concern to me: how OR views outsiders within the medical profession.

The other thing is you need to be aware of the state income tax. I was paying 20-25K income tax to the state on top of the 50K to the IRS. If you do work there, make sure they adjust your total income to include that chunk that you will never see. Yes, I am much happier in Texas.

 

[ggidgetzz]

OP, this was within the last year (2016). I did not end up in PNW, I am ending up in the northern midwest due to a unique job opportunity that suited my family and lifestyle.

Edit: oops just realized I am under a different account (nraesmith)

 

[brianmartin]

You'll have a tough time finding true full spectrum in towns >50k. Coverage of ER, urgent care, hospice, nursing homes, is becoming more rare. It's directly related to clinics being bought up by large organizations, many hospital owned. And with the poor payer mix in most rural areas, these organizations are looking at the bottom line, unfortunately. They need you to see clinic patients because that's how they get paid. They can pay NP/PAs less than they'd have to pay you to cover urgent care/ED shifts. Most places will have EM docs covering small EDs, and this is indeed the case in many critical access hospitals. There are some private groups out there still doing well, who encourage or sometimes even require providers to do urgent care/ED work--this might be worth looking into. But these are usually desirable jobs and you can't simply walk into one of these positions.
Doing low risk OB sounds nice on paper, but there's malpractice insurance to pay for, and to make it worth it you have to do a certain number of deliveries. Many private FM groups that are still doing OB are transitioning to a rotating call schedule where you deliver everyone else's patients on your designated day--not because its the right thing to do, but as a concession to the reality that it's extremely difficult to have a full clinic and also deliver your own patients. There are many very real reasons (economic, political, personal) that explain why only 10-15% of family docs end up doing OB. Most FM residents, even ones that enjoy the OB part of the training, do not end up doing OB.

Don't take this the wrong way--FM is great and we all want to use our skills. I would venture a guess that most FM docs are initially like you--they'd "like" to practice full spectrum medicine. But once you go through residency and then a job search and realize what's going on in the real world, a lot of the things you thought you'd "like" to do, well, let's just say every person revises their expectations a bit.

If you think you truly want to go the full spectrum route, you should pick a community family medicine program in a rural or semi-rural area with high OB volume and high ER acuity. There are several programs like that in the pacific northwest, but not as many as you might think. The program I'm about to graduate from, Central Washington Family Medicine in Yakima, WA, is probably one of the best if those are your criteria.
I'd also look at:
Cascades East in Klamath Falls, OR
Family Medicine of Spokane, WA
Kootenai Clinic in Coeur D'Alene, ID

If you want to be closer to a city, look at the programs in the Tacoma, Olympia, and Puyallup area (washington), or Providence Milwaukie in Portland but I don't think any of these programs would be as good as the more rural ones I mentioned first, based on what your interests are.