Applying to schools with "Primary Care" focus..

[FiremedicMike]

The school that I'm most interested in, due to location and affiliations, has a "primary care focus" that extends into their personal statement, where you are supposed to discuss why you are interested in primary care. The other focus of this particular school is that they want to train doctors to stay in the general area, but again as a primary care doc.

So I realize I'm still a few years off from applying, but I'm in the home stretch and starting to mentally prepare for this process. While I do understand that my mindset could change between now and application and then again during medical school, I truly don't think I'll ever have a desire to be a primary care physician (unless a rural general surgeon counts, but I doubt it). With that said, I have every intention of staying in this area and even a desire to work at a rural hospital in the area. So I definitely check the second half of their boxes, just not the first half.

So how does one handle the application and interview process at such schools. Would I be immediately rejected for admitting that primary care is not likely my field of choice? Should I approach with a broad/vauge "I am approaching medical school with an open mind and am certainly planning on giving primary care a fair shake"? Should I 'play the game' and tell them what they want to hear, which is that I'd love nothing more than to be a family practice doc?

Again, I realize I'm way ahead of myself here, but as stated, I like to mentally prepare for these things in advance so that I'm not caught off guard. Any input/advice is greatly appreciated.

Thanks!

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[popopopop]

I interviewed at a school with a similar mission statement recently. I wouldn't tell them you want to go into surgery, but that you want to keep an open mind about it especially since you'll be rotating through 3rd and 4th year. No school's match list will have 100% primary care. Actually, they didn't even asked me "why primary care, " but I had brought it up because that's what my application looks like and that's where I'd probably end up working. One of the interviewers actually told me outright to NOT say that I want to be a general practitioner. This guy didn't have access to my profile and I did not tell him about my motivation to go to primary care. He understands the school's statement is primary care based, but wishes the student specializes and are more motivated to raise their board scores.

 

[FiremedicMike]

I interviewed at a school with a similar mission statement recently. I wouldn't tell them you want to go into surgery, but that you want to keep an open mind about it especially since you'll be rotating through 3rd and 4th year. No school's match list will have 100% primary care. Actually, they didn't even asked me "why primary care, " but I had brought it up because that's what my application looks like and that's where I'd probably end up working. One of the interviewers actually told me outright to NOT say that I want to be a general practitioner. This guy didn't have access to my profile and I did not tell him about my motivation to go to primary care. He understands the school's statement is primary care based, but wishes the student specializes and are more motivated to raise their board scores.

Surgery is just one of the pathways that I have an interest in, but they all revolve around being in the hospital.

That's good to hear, so in my circumstance, how should I address a direct question about my desires to go into primary care?

 

[Matthew9Thirtyfive]

Surgery is just one of the pathways that I have an interest in, but they all revolve around being in the hospital.

That's good to hear, so in my circumstance, how should I address a direct question about my desires to go into primary care?

I would say that you have an interest in practicing locally (if that's true) and practicing rural medicine, and that you are keeping an open mind about which specialty you will ultimately go into, to include primary care specialties.

 

[popopopop]

Surgery is just one of the pathways that I have an interest in, but they all revolve around being in the hospital.

That's good to hear, so in my circumstance, how should I address a direct question about my desires to go into primary care?

I would tell them you'd keep an open mind about everything, especially since you know you'd be rotating in 3rd and 4th year. Be aware that they might press you with more questions if your application doesn't reflect it and you have all surgery related activities or something.

 

[FiremedicMike]

Awesome, thanks!

 

[Nasrudin]

It's an interesting question. Because it punctures a certain hypocrisy in institutional dogma. And also it begs the question of to what degree the person opposite you in an interview represents that stated mission/dogma.

If an institution places importance on locally practicing graduates that's an easier play. Just find out about what you like about the area and talk about it. Leave out what you don't. Or admit the downsides in a calculated manner to more accurately portray a realistic thought process that resembles practical intent to live there.

Just one ridiculous aspect about the primary care thing is that if they need GP's in their area they sure as **** need specialists in that area even more.

I think if you look at the clockwork of primary care focus it's more likely a back calculation of it's match list. Or just the silly notions of socialism that populate those peripherally involved in medicine or from those capable of withstanding the cognitive dissonance of multi-hundred thousand dollar student debt load inducement. In other words socialists who've never paid the balance of the checks their insisting the younger generation should write...on some vague moral grounds.

 

[Nasrudin]

go with the advice above. indicate you're keeping an open mind on specialty choice. which is the only prudent answer for anyone in the applicant position. except for oddly born surgeons or what have you. i'll admit that some people are cut from very specific molds. It's just ridiculous to expect that from applicants.

 

[DrMidlife]

Nas & I disagree on underlying causes/effects, and we would have completely different answers to this question, but I totally agree that primary care emphasis as presented to premeds is asinine.

The faculty physicians reading essays and doing interviews might or might not be religious about primary care, community, diversity etc. Yeah they do expect premeds to have cookie cutter answers in response to required questions. This being nontrad, you should try to do better than that.

Answer with some numbers on gen surg shortages in rural areas, in general, and in your community of interest. Gen surg shortages are a real thing. And this is actually a pertinent response to the question, vs. the usual everybody-knows-you're-lying response.

Also answer with a bit of data on the health care infrastructure for your community of interest. Number of hospitals, number of insurers, % medicare/medicaid, uninsured, undocumented etc. Who owns the hospital where you want to work? What are the (usually BS but sometimes interesting) quality numbers on that entity? What is the economic ground game in the OR where you hope to find yourself? Who employs surgeons there?

Start with googles on like "community health data" and go from there. You have to read as if you care, not as if you're looking for "the" answer, or don't bother.

Of note, your essays/answers need to NOT be about this data. And they need to NOT be about gen surg. Just HINT at a relatively mature understanding of the business of local medicine, and your current interest, and let them ask you about it in interviews.

Be aware that to get into a decent surgical residency you need good clinical experiences and the support of a surgery department chair. So, does this med school have a surgery department? When I was in your shoes I was looking at 4th year experiences, but residency apps go out 2.5 months into 4th year so what really matters is what you get in 3rd year.

Best of luck to you.

 

[FiremedicMike]

For what it's worth, gen surg is one of many different interests I have right now, which include anesthesia, critical care, impatient IM, ortho surgery, and sometimes even EM. Kind of all over the place, I know, which is why I look forward to 3rd and 4th year so I can be more exposed and make a better decision. I will reiterate, however, that at this point in my life I don't feel any desire to work in a primary care family practice role (and I find it unlikely that this position will change much)..

All of your input is still valuable and pertinent, I just didn't want the focus to turn to general surgery..

 

[Matthew9Thirtyfive]

For what it's worth, gen surg is one of many different interests I have right now, which include anesthesia, critical care, impatient IM, ortho surgery, and sometimes even EM. Kind of all over the place, I know, which is why I look forward to 3rd and 4th year so I can be more exposed and make a better decision. I will reiterate, however, that at this point in my life I don't feel any desire to work in a primary care family practice role (and I find it unlikely that this position will change much)..

All of your input is still valuable and pertinent, I just didn't want the focus to turn to general surgery..

Keep in mind that when schools say primary care, they usually mean IM and peds as well (and OB/GYN in some cases). So saying you have an interest in IM would fall under primary care.

 

[FiremedicMike]

Keep in mind that when schools say primary care, they usually mean IM and peds as well (and OB/GYN in some cases). So saying you have an interest in IM would fall under primary care.

But my interest is only in inpatient and/or critical care IM. Does this count as primary care, or should I just leave off the part about inpatient and stick to the interest in IM?

 

[Matthew9Thirtyfive]

But my interest is only in inpatient and/or critical care IM. Does this count as primary care, or should I just leave off the part about inpatient and stick to the interest in IM?

I would just be vague. I'd say you have a strong interest in rural medicine, but your specialty interests are varied and you're keeping an open mind as you enter med school and clinicals.

 

[Nasrudin]

Nas & I disagree on underlying causes/effects, and we would have completely different answers to this question, but I totally agree that primary care emphasis as presented to premeds is asinine.

The faculty physicians reading essays and doing interviews might or might not be religious about primary care, community, diversity etc. Yeah they do expect premeds to have cookie cutter answers in response to required questions. This being nontrad, you should try to do better than that.

Answer with some numbers on gen surg shortages in rural areas, in general, and in your community of interest. Gen surg shortages are a real thing. And this is actually a pertinent response to the question, vs. the usual everybody-knows-you're-lying response.

Also answer with a bit of data on the health care infrastructure for your community of interest. Number of hospitals, number of insurers, % medicare/medicaid, uninsured, undocumented etc. Who owns the hospital where you want to work? What are the (usually BS but sometimes interesting) quality numbers on that entity? What is the economic ground game in the OR where you hope to find yourself? Who employs surgeons there?

Start with googles on like "community health data" and go from there. You have to read as if you care, not as if you're looking for "the" answer, or don't bother.

Of note, your essays/answers need to NOT be about this data. And they need to NOT be about gen surg. Just HINT at a relatively mature understanding of the business of local medicine, and your current interest, and let them ask you about it in interviews.

Be aware that to get into a decent surgical residency you need good clinical experiences and the support of a surgery department chair. So, does this med school have a surgery department? When I was in your shoes I was looking at 4th year experiences, but residency apps go out 2.5 months into 4th year so what really matters is what you get in 3rd year.

Best of luck to you.

Great advice. But I disagree that we disagree. Conan, you, and I are on the same page here--we do what the F we wanna do.

 

[sullen-burger]

So how does one handle the application and interview process at such schools. Would I be immediately rejected for admitting that primary care is not likely my field of choice? Should I approach with a broad/vauge "I am approaching medical school with an open mind and am certainly planning on giving primary care a fair shake"? Should I 'play the game' and tell them what they want to hear, which is that I'd love nothing more than to be a family practice doc?

Again, I realize I'm way ahead of myself here, but as stated, I like to mentally prepare for these things in advance so that I'm not caught off guard. Any input/advice is greatly appreciated.

Thanks!

You're presenting yourself in a story. I started here at B and did C and then D led to me realizing I was interested in IM. I think you definitely have the right idea. You need to present yourself as having thought through this process and having a plan, like DrMidlife said. I would also agree with Nasrudin that you should convey (in an essay or interview or wherever) that you are keeping an open mind about medicine because, obviously, most people have not experienced enough that they know one particular field is 100% the only thing for them.

I'm sure there are those weirdos who knew they wanted to do neurosurgery from the start, but hey...don't argue in absolutes, am i right?

But my interest is only in inpatient and/or critical care IM. Does this count as primary care, or should I just leave off the part about inpatient and stick to the interest in IM?

Have you thought about emergency medicine? For what it's worth, there are physicians and med school faculty would describe EM as primary care. Don't quote me on this, because I think the AAFP has a different definition. I simply say this to say that is how I framed my interest in a program during an interview at a primary care focused school. This actually led to a great discussion about discovering fields and finding out what you want to do.

The interviewer at the end later told me they thought I would be straight up naive if I said I wanted to only do xyz. So yea. Conveying that you have an open mind seems important. Good luck to you!

 

[FiremedicMike]

Have you thought about emergency medicine? For what it's worth, there are physicians and med school faculty would describe EM as primary care. Don't quote me on this, because I think the AAFP has a different definition. I simply say this to say that is how I framed my interest in a program during an interview at a primary care focused school. This actually led to a great discussion about discovering fields and finding out what you want to do.

The interviewer at the end later told me they thought I would be straight up naive if I said I wanted to only do xyz. So yea. Conveying that you have an open mind seems important. Good luck to you!

I have thought about EM, but it's honestly pretty low on my list. I could maybe get into rural EM, but honestly when I think about EM I think about all the garbage that we transport into the ER and how happy I am to have only dealt with some of those folks for 15-20 minutes.. Plus.. rotating shifts....

The advantage to EM is the ability to act as an EMS medical director on the side..

 

[Goro]

If you look at the match lists of schools like these (and mine is one of them), you'll find that a significant number of grads go into specialties. It's > 40% at my school. At Mercer, U WV, and SIU they're all > 50%.

So quit fussing about Primary Care (which is NOT the 7th Circle of Hell the way most pre-meds make it out to be) and just keep an open mind.

And first get into med school, then worry about your specialty. Don't assume you're getting a 260 on USMLE.

The school that I'm most interested in, due to location and affiliations, has a "primary care focus" that extends into their personal statement, where you are supposed to discuss why you are interested in primary care. The other focus of this particular school is that they want to train doctors to stay in the general area, but again as a primary care doc.

So I realize I'm still a few years off from applying, but I'm in the home stretch and starting to mentally prepare for this process. While I do understand that my mindset could change between now and application and then again during medical school, I truly don't think I'll ever have a desire to be a primary care physician (unless a rural general surgeon counts, but I doubt it). With that said, I have every intention of staying in this area and even a desire to work at a rural hospital in the area. So I definitely check the second half of their boxes, just not the first half.

So how does one handle the application and interview process at such schools. Would I be immediately rejected for admitting that primary care is not likely my field of choice? Should I approach with a broad/vauge "I am approaching medical school with an open mind and am certainly planning on giving primary care a fair shake"? Should I 'play the game' and tell them what they want to hear, which is that I'd love nothing more than to be a family practice doc?

Again, I realize I'm way ahead of myself here, but as stated, I like to mentally prepare for these things in advance so that I'm not caught off guard. Any input/advice is greatly appreciated.

Thanks!

 

[Matthew9Thirtyfive]

If you look at the match lists of schools like these (and mine is one of them), you'll find that a significant number of grads go into specialties. It's > 40% at my school. At Mercer, U WV, and SIU they're all > 50%.

So quit fussing about Primary Care (which is NOT the 7th Circle of Hell the way most pre-meds make it out to be) and just keep an open mind.

And first get into med school, then worry about your specialty. Don't assume you're getting a 260 on USMLE.

To be fair, I think he's concerned with admissions. The school seems to have a primary care mission, and he wants to be able to answer the question of how he will add to that without shooting himself in the foot.

I do agree that you shouldn't assume you will score high on the USMLE or even do spectacular in med school, and that primary care certainly isn't horrible. I thought I was dead set on surgery after my 8 years of OR experience, but being involved with the primary care at my command and shadowing a couple primary care docs, my mind is basically open to anything.

 

[FiremedicMike]

If you look at the match lists of schools like these (and mine is one of them), you'll find that a significant number of grads go into specialties. It's > 40% at my school. At Mercer, U WV, and SIU they're all > 50%.

So quit fussing about Primary Care (which is NOT the 7th Circle of Hell the way most pre-meds make it out to be) and just keep an open mind.

And first get into med school, then worry about your specialty. Don't assume you're getting a 260 on USMLE.

I'm only worried about admissions at this point. The school I'm interested in wants you to write about your interests in primary care, of which I currently have none. I don't want to lie and I'm looking for suggestions as to how to handle this from the admissions standpoint.

 

[Goro]

So why go to that school???????

Just keep an open mind. And don't forget that IM is Primary Care.

I'm only worried about admissions at this point. The school I'm interested in wants you to write about your interests in primary care, of which I currently have none. I don't want to lie and I'm looking for suggestions as to how to handle this from the admissions standpoint.

 

[DrMidlife]

IM match does not equal primary care.

With IM, peds, gen surg & obgyn there are very straightforward paths to specialization. not so with FM.

so how to count? i used to have time to look up the data & run the numbers & post tables. now left as an exercise for the reader.

^^ just another among many reasons not to drink too much of the "we're a primary care school" koolaid.

 

[FiremedicMike]

So why go to that school???????

Just keep an open mind. And don't forget that IM is Primary Care.

It's 10 minutes from my home and where I got my undergrad from.. Yes I know that med school is an adventure and you should be prepared to move, but I have a life here, I love my location, their location, their hospital linkages.. It's just the ideal school for me, so long as they aren't completely set on the primary care ethos..

 

[FiremedicMike]

And for what it's worth, I'm willing to move if it becomes absolutely necessary.. it's why I'm waiting until my kids graduate before I apply, but if I can stack the deck in my favor into a situation where I don't need to move, I'm going to try to do that..

 

[Goro]

If you have MSAR, you can look up how many people went into Specialties vs Primary Care. I assume that we're talking about an MD school? But even if DO, the odds are at least 1/3 that you can specialize. The school should have a match list published... just google "XSOM match list 2016"



To my learned colleague DrMidlife:

http://www.aafp.org/about/policies/all/primary-care.html
"A primary care physician is a specialist in Family Medicine, Internal Medicine or Pediatrics"

I agree that being in IM doesn't 100% mean Primary Care. It's often a portal to subspecialties. Also, sometime Ob/Gyn is lumped into Primary Care.

It's 10 minutes from my home and where I got my undergrad from.. Yes I know that med school is an adventure and you should be prepared to move, but I have a life here, I love my location, their location, their hospital linkages.. It's just the ideal school for me, so long as they aren't completely set on the primary care ethos..

 

[Nasrudin]

is it a rural place?

 

[libertyyne]

If you look at the match lists of schools like these (and mine is one of them), you'll find that a significant number of grads go into specialties. It's > 40% at my school. At Mercer, U WV, and SIU they're all > 50%.

So quit fussing about Primary Care (which is NOT the 7th Circle of Hell the way most pre-meds make it out to be) and just keep an open mind.

And first get into med school, then worry about your specialty. Don't assume you're getting a 260 on USMLE.

Every night before I go to bed I say to myself three times.
USMLE scores have a high degree of correlation with MCAT scores.
And I feel better about life.

But OP why not Just OBGYN- classified as primary care and you get to cut stuff.
Also OP keep an open mind, you may not even get into that school, or some other school may offer you a deal you cant refuse. I have a pretty vague response to the specialty question during interviews which includes: healthcare is changing so rapidly it is difficult to see where I may be able to make the greatest impact.
The second point is that if the school is geared towards primary care their rotations may lack the specialties or sub-specialty electives you may want to do, and would make it more difficult to gain exposure to those during your clinical years. So might not be the best match for you. Also dont minimize the impact of the cool-aid. If you end up attending said school you may find yourself developing an interest in primary care.

 

[Esquire]

This shouldn't even be a question. Medicine is literally and figuratively about checking the right boxes. Check the damn box.

 

[sazerac]

IM counting as primary care only further exposes the bogosity of the primary care mission- the school can claim it had a huge number of graduates who went into "primary care," and then school is just shocked, SHOCKED I tell you, that so many decided to specialize three short years later.

 

[Marrowist]

I interviewed at a school that emphasized primary care, and on the map they displayed with the match list it included IM, OBGYN, Surgery, EM, FM, Peds and Traditional Rotations as Primary Care.