Aversion to FP?

[MJB]

Or shall I say, general medicine?

What is the cause for very few people compared to the need going into this line of medicine over the last several years? Is it the money? Do they work insane hours that I don't know about? Not challenging enough? Too much call?

I'm just trying to understand the shortage that seems to be developing.

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[discover]

Or shall I say, general medicine?

What is the cause for very few people compared to the need going into this line of medicine over the last several years? Is it the money? Do they work insane hours that I don't know about? Not challenging enough? Too much call?

I'm just trying to understand the shortage that seems to be developing.

I'm actually wandering that myself...I mean why is it that generally FP is low on everyones list...Out of the Dr's that I have shadowed it seemed that FP was the most interesting, (I mean wide variety of medical issues and lots of patient contact and interaction...)

I suppose its all about the money, but that part doesnt make sense to me either...How come a Dermatalogist or Plastic surg make so much more that a ER physician who is saving lives on a daily basis....MAKEs no SENSE!!!!

 

[trudub]

I think you should just be aware that Derm and Plastics do some really good things too. Plastics do reconstructive surgery for burn victims, trauma victims, etc. Dermatologists deal with skin cancer and hemangiomas, it is not all just fluff. The thread is a good thread but I think people are quick to dog fields like plastics and derm when they do good things as well.

 

[brightblueeyes]

Or shall I say, general medicine?

What is the cause for very few people compared to the need going into this line of medicine over the last several years? Is it the money? Do they work insane hours that I don't know about? Not challenging enough? Too much call?

I'm just trying to understand the shortage that seems to be developing.

I think it's mostly due to how FP is valued.

I wonder how much of this is cultural. I think FP doctors are more highly valued in some other countries but this might just be because the difference in salary between FP and, say, surgical specialties is so much less.

And I don't think this is just about money--at least not directly. I sometimes get the feeling that a lot of med students see salaries as a measure of the worth of a given field. Therefore, it's not just a question of earning more, but also having achieved a worthy goal. And perhaps, in their eyes, Family Medicine no longer cuts it.

I know this might offend some of the more cynical among us, but I get the feeling that doctors in some other countries might not focus as much on salary in gauging the worth of a field. (Who knows, maybe this would change if their surgeons were paid as much as in the US...but I think there's more to it than that.)

I've also heard people claim they had to go into a given specialty because anything that paid less wouldn't have let them pay off their student loans. I find that very hard to believe but perhaps I don't know the whole story. (Their loans were pretty big.)

 

[MJB]

My intent is not to "dog" any specialty at all...I just want to understand why there seems to be so little interest in Family Practice.

I can understand going for money. I can understand not liking general practice.

What I'm wondering is why there is such little interest...are the specialties THAT interesting?

 

[DoctorFunk]

I wonder if the personality types of most medical students lend themselves to specializing. It seems that most of us are most comfortable knowing a subject in great detail (much like specialists), rather than having a broad knowledge of a variety of subjects (generalists).

For right or wrong, I believe the students that make the cut into medical school are not comfortable with feeling insufficiently informed about the subjects they work with, making specializing a very appealing option.

 

[MJB]

Could it also be that a FP doc has to be a master of many trades?

 

[rugirlie]

I think in general, the diversity of problems is not really looked favorably upon but some people may find that attractive.

I, personally, found FP boring as fock! Every day I shadowed was like either a cold or a child well check visit. I wanted to shoot myself by the end of the 3 months. ICK.... so basically, thats why I'm not interested. I don't know if this is why other people aren't going into it either though.

 

[nala]

I think in general, the diversity of problems is not really looked favorably upon but some people may find that attractive.

I, personally, found FP boring as fock! Every day I shadowed was like either a cold or a child well check visit. I wanted to shoot myself by the end of the 3 months. ICK.... so basically, thats why I'm not interested. I don't know if this is why other people aren't going into it either though.

I wouldn't rule anything out just yet. You haven't even started med school yet, so please try to keep an open mind. The best thing you can do is approach every rotation with the idea that this will be the field you'll go into..because if you don't, you'll never know what you might be missing.

Also - shadowing a doctor doesn't always give a good representation of what it is like to actually work in that field. Maybe it was coincidence that all you saw at the FP were colds and well child checks.

btw, don't think I'm just saying this because I'm going into FP..At this time I'm not planning on it but I'm still keeping my options open.

 

[rugirlie]

I wouldn't rule anything out just yet. You haven't even started med school yet, so please try to keep an open mind. The best thing you can do is approach every rotation with the idea that this will be the field you'll go into..because if you don't, you'll never know what you might be missing.

Also - shadowing a doctor doesn't always give a good representation of what it is like to actually work in that field. Maybe it was coincidence that all you saw at the FP were colds and well child checks.

btw, don't think I'm just saying this because I'm going into FP..At this time I'm not planning on it but I'm still keeping my options open.

Yeah, I mean I suppose you're right but I don't think its uncommon to have an idea of what would and wouldn't be right for you. I mean, don't get me wrong, you can't really get an idea until you've been through it, but I don't really see how shadowing for 3 months couldn't give me an accurate picture of how FP might be.

 

[Bo Hurley]

Like most things in life, it comes down to $$$ and prestige. Both of which are lacking in family med compared to other specialties.

 

[JakeHarley]

I think in general, the diversity of problems is not really looked favorably upon but some people may find that attractive.

I, personally, found FP boring as fock! Every day I shadowed was like either a cold or a child well check visit. I wanted to shoot myself by the end of the 3 months. ICK.... so basically, thats why I'm not interested. I don't know if this is why other people aren't going into it either though.

Out of curiosity, did you mention this opinion when interviewing last winter? It is my impression that a much larger number of folks say they are interested in FP before they start medical school than after, I assume partly because they know adcoms like to hear that.

I was just curious how forthcoming you were about your aversion to primary care, and if that was an issue for you at all.

Thanks!

 

[nala]

Yeah, I mean I suppose you're right but I don't think its uncommon to have an idea of what would and wouldn't be right for you. I mean, don't get me wrong, you can't really get an idea until you've been through it, but I don't really see how shadowing for 3 months couldn't give me an accurate picture of how FP might be.

True...I think a lot of people have an idea of what they want to do. Some end up in that field and some don't. The other thing is that shadowing gets a LOT more interesting once you actually understand the anatomy, physiology and pathology behind diseases.

 

[velo]

I think part of it may be that most medical schools are at large academic centers that are filled with specialists and sub-specialists. You see people that get the "hard stuff that stumped the PCP" which colors your perspective of specialists vs. generalists and you find mentors during the process who are, themselves, specialists. That might be part of it.

 

[OmahaMX80]

First... velocypedalist you ROCK (anyone who quotes Eddie Izzard is damn cool).

Second... I can't speak for why other people may not be attracted to FP; personally I think FP looks great. Bu then, most of the doctors I consider role models are FP's and as a field, I have tremendous respect for it. Most often I think FP's are out on the "front lines" as it were. Anyhoo, yeah we get a lot of indirect "jabs" at FP's with vignettes that say the FP missed the diagnosis.

However, I think it's important to point out that the specialists who ingeniously "find" what the FP missed have the BENEFIT of knowing the FP was wrong. I have to wonder how many specialists would actually get the diagnosis right without the FP having already ruled out the most obvious choice by being wrong. Btw, I've seen a number of vignettes in which the specialist basically goes through three or four different possible diagnoses before hitting the right one. I think it's really short-sighted and snobby to not give the FP's some credit. Are FP's wrong? Of course. But that doesn't mean their diagnosis, based on all the info at hand, was wrong in a clinical sense; specialists make wrong diagnoses too, let's not forget. I guess the main point I'm trying to make is that a lot of times specialists can be right because the FP was wrong.

Personally, I don't want to deliver babies and take care of kids which is why I'm leaning more towards Internal Medicine... plus, in IM, you can subspecialize and in some ways get the best of both worlds. FP is a bit more limited in terms of subspecialties, as I understand it.

 

[rugirlie]

Out of curiosity, did you mention this opinion when interviewing last winter? It is my impression that a much larger number of folks say they are interested in FP before they start medical school than after, I assume partly because they know adcoms like to hear that.

I was just curious how forthcoming you were about your aversion to primary care, and if that was an issue for you at all.

Thanks!

Actually, I was very forthcoming with this info when asked in interviews what I might wanna do. Of course, I didn't use the word "ick" but I let them know that it wasn't right for me and I didn't find it very interesting. I don't know if that hurt me or not but my interviewers didn't seem to react negatively to that statement.

 

[CambieMD]

Like most things in life, it comes down to $$$ and prestige. Both of which are lacking in family med compared to other specialties.

Prestige and money most likely do contribute to the negative perception of FP. The nature of FP and primary care is frustrating to many. You are responsible for coordinating all of a patients' care. This involves a lot of paper work and being dumped on. If I had a penny for each time a specialist told one of my patients "follow up with your pcp," I would be rich.

There are positive aspects to FP as well. The poster wanted to know why the impression of FP is negative. I would list the reasons as follows:

1. Poor pay( Having to seem increasing amounts of pts secondary to declining reimbursement
2. Huge paperwork
3. A lot of sociomas
4. Increased crap index
5. Uncertain future of specialty

I will probably be flamed but this is my view of things. I can also say that I saw things from the front lines. Med schools feed you crap because they have agendas. They want a certain number of this specialty and that specialty. They want to paint the prettiest picture for you. They do not know what is happening on the ground. It isn't their job to know what is going on that is your job. My view is obviously biased. (See my previous post).
However, there is a lot of truth in what Iam saying.

There should be a rule when it comes to flaming someone. If you really don't have any practical experience in a certain area you should limit your vernom and hostility. I have practiced as a primary care physician and read a lot of health policy.

CambieMD

 

[YouDontKnowJack]

how about those fp's who run their business model on cash payments?

We've all heard about those docs that take $50 cash per office visit. Much less paper work, no need to worry about reimbursements and getting focked by insurance companies.

As a patient, I would much rather pay cash for my doc visits. My insurance deductible is very high (like $5000 or something), so I have to pay everything out of pocket until I reach $5000 in total medical bills. My insurance plan is the cheapest there is since I am healthy, young, and don't see a need to throw so much free money at the insurance companies each year.

Usually, the doctor has 2 bill amounts: one that he bills the insurance companies, and one that he bills the patient if he elects to pay in cash. In my experience, the doc will bill the insurance company $100. But will accept $50 cash payment as an alternative, which is probably more than he will get from insurance companies anyway.

If I choose to have the insurance company pay for my doc visit, the insurance company will also try to screw ME over by saying this-n-this isn't covered, blah blah blah. I end up having to pay more than if I were to just pay the doctor directly with cash.

So the cash model seems to be a win-win situation for doctors and healthy young-to-middle-aged people who occasionally get sick. And this model may just be the key to ending the plague of declining reimbursement.

 

[pikachu]

Cash payments for professional fees makes sense but expenses really run up when you need lab tests. for example I was billed close to $200 for a Pap smear paid out of pocket.

I have also heard about practices that charge patients a yearly fee of a few thousand dollars, almost like a membership fee. Pt is then not charged for individual visits or other services (phone calls, Rx refills, etc.) from you once this fee is paid and it's my understanding that these practices are doing pretty well.

also, I love the "socioma" - haven't heard that one before but it's perfect!

 

[automaton]

nobody wants to be the clueless hick doctor that only knows how to prescribe coca-cola and a lollipop for every problem that comes through the door. that's what family practice is viewed as. hick doctors who are a half step up from clueless NP and EMT.

 

[zeloc]

I think in general, the diversity of problems is not really looked favorably upon but some people may find that attractive.

I, personally, found FP boring as fock! Every day I shadowed was like either a cold or a child well check visit. I wanted to shoot myself by the end of the 3 months. ICK.... so basically, thats why I'm not interested. I don't know if this is why other people aren't going into it either though.

The thing with shadowing is that you don't actually do anything, so naturally it's boring. If you had to go in there yourself, figure out what the patient had, do the physical exam, talk to the patient, etc, then you'd probably find it more interesting. I wouldn't necessarily take a negative view of family practice based on that experience.

 

[tigershark]

I think many people are turned off by family medicine and primary care in general because it is relatively "old-fashioned" when compared to the tremendous advancements being made in technology/molecular bio in the sexier fields.

I have lots of respect for FPs after doing my family medicine rotation but I found it personally boring and not stimulating at all. I think many med students who grew up during the tech/computer boom would agree. I would much rather be doing something technically complicated like MR or PET research as opposed to practicing old-school medicine in a small town somewhere.

 

[OmahaMX80]

nobody wants to be the clueless hick doctor that only knows how to prescribe coca-cola and a lollipop for every problem that comes through the door. that's what family practice is viewed as. hick doctors who are a half step up from clueless NP and EMT.

That's not very nice.

 

[MJB]

Some interesting responses...

After some research, it seems that money isn't that big of a deal as long as you don't wish to live in the bigger cities...but if 100K population is more your style, working at a Regional Health System, it seems you can live quite comfortably..making 6 figures with nice benefits..and sometime have your loans forgiven.

IM certainly does seem to have more opportunities...my PCP or "family doc" is an IM doc...and he's one of the best docs I've been around.

 

[discover]

Prestige and money most likely do contribute to the negative perception of FP. The nature of FP and primary care is frustrating to many. You are responsible for coordinating all of a patients' care. This involves a lot of paper work and being dumped on. If I had a penny for each time a specialist told one of my patients "follow up with your pcp," I would be rich.

There are positive aspects to FP as well. The poster wanted to know why the impression of FP is negative. I would list the reasons as follows:

1. Poor pay( Having to seem increasing amounts of pts secondary to declining reimbursement
2. Huge paperwork
3. A lot of sociomas
4. Increased crap index
5. Uncertain future of specialty

I will probably be flamed but this is my view of things. I can also say that I saw things from the front lines. Med schools feed you crap because they have agendas. They want a certain number of this specialty and that specialty. They want to paint the prettiest picture for you. They do not know what is happening on the ground. It isn't their job to know what is going on that is your job. My view is obviously biased. (See my previous post).
However, there is a lot of truth in what Iam saying.

There should be a rule when it comes to flaming someone. If you really don't have any practical experience in a certain area you should limit your vernom and hostility. I have practiced as a primary care physician and read a lot of health policy.

CambieMD

could you please explain what you mean by more paperwork vs other special..... I dont doubt you, Just wandering...thanks

 

[GoodMonkey]

nobody wants to be the clueless hick doctor that only knows how to prescribe coca-cola and a lollipop for every problem that comes through the door. that's what family practice is viewed as. hick doctors who are a half step up from clueless NP and EMT.

sorry, but bull****. this may be how other (either insecure or overly cocky) physicians with a chip on their shoulders looking down their noses view family practice doctors, but it's far from the norm in life. please. really f'n classy.

i'm sure you'll really appreciate the "clueless" EMT that comes to the assistance of you or a loved one needing emergent stabilization and transport to a hospital, or when they need to be pried out of a flaming wrecked car and safely taken for medical care, knowing what to do when you're in hypovolemic shock and need temporary stabilization until you can get to a hospital. i'm sure your future daughters will appreciate the "clueless" NP who knows the differences between the SEs of the BCPs he/she is providing to them, or the care with which he/she administers their first pelvic exam.

give me an FP residency over a radiology or opthy one anyday. especially if it's an FP residency followed by a sports med fellowship. you couldn't pay me enough to read radiographs (computerized or not) or do pathology or look at eyeballs for the rest of my life. i'd much rather be a "hick" doctor. you know, sometimes this website pisses me off - the main reason why i'm not here much - but i never expected this crap out of you.

and edit: my family practice doc/GP is fantastic. i've had nothing but good experiences there.

 

[Doctobee]

The thing with shadowing is that you don't actually do anything, so naturally it's boring. If you had to go in there yourself, figure out what the patient had, do the physical exam, talk to the patient, etc, then you'd probably find it more interesting. I wouldn't necessarily take a negative view of family practice based on that experience.

I agree with this. I actually shadowed an ER attending, as well as some med students who were "doing all the work", and I was really bored. So I attributed it all to the fact that I wasn't doing anything. And at that time (and it still might happen) I was really interested in residency in EM, just becuase I know that I won't have too much time to twiddle my thumbs. As for FP, I was really never interested in it just because of lack of "intensity" and speed that goes on in an ER.

 

[8744]

Every specialty has its "bread and butter" conditions which no doubt become incredibly boring over time. The radiologist dictating the results of all the duplex ultrasounds for DVTs I order does not sound very excited as she recites the litany of "good compressibilty" and "no evidence of deep venous throbosis."

Same with the cardiolgist who, for every Tetralogy of Fallot see hundreds of garden variety arrythmias which he can treat in his sleep.

Just because a specialty has good pay doesn't mean it is a laugh a minute. As you all know I tried to match into Emergency Medicine. I am disappointed that I didn't but I'm sure nobody who knows anything about it will accuse me of "sour grapes" if I tell you that most of the patients you see in the Emergency Department are people who should be seen by a Family Medicine or Internal Medicine physician. At the two EDs where I rotated, trauma and serious medical problems was about five percent, if that, of the patient load.

In fact, most Emergency Rooms are still staffed by Family Medicine and Internal Medicine Physicians and it will be a long time, if ever, before there are enough board certified Emergency Medicine physicians to fill them all.

The key to happiness in any field is to understand that while you may get bored with certain diseases, the patients themselves are always interesting. If you can't remain interested in the variety of human personality then maybe you need to be in pathology or radiology, tele-consulting from India.

By the way, Family Practice does pay pretty well in the more rural areas of the country. On the other hand, I don't consider a city of 50,000 to be "rural" so maybe I should say that the compensation is pretty good outside of the major metropolitan areas.

 

[8744]

nobody wants to be the clueless hick doctor that only knows how to prescribe coca-cola and a lollipop for every problem that comes through the door. that's what family practice is viewed as. hick doctors who are a half step up from clueless NP and EMT.

You are so going to eat those words when you discover that it is the FP (or IM) physician who is going to be sending you most of your patients (in whatever specialty you land) and you desperately kiss his ass so he will refer them to you.

Depend on it.

 

[ZephyrX]

I have also heard about practices that charge patients a yearly fee of a few thousand dollars, almost like a membership fee. Pt is then not charged for individual visits or other services (phone calls, Rx refills, etc.) from you once this fee is paid and it's my understanding that these practices are doing pretty well.

From what i understand it takes a doctor with an already establised patient base and incredible professional reputation to do that. Also they promise pretty hard stuff, such as same day appointments etc.

I may be wrong though so feel free to correct me.

 

[crys20]

I personally am so excited about MAYBE doing FP one day. You can tailor your practice anyway you want; it has gotta be one of the most versatile areas out there. Plus, (at the low end) 130,000 for 40 hrs/wk is NOT at all bad to me, but of course that is all relative to what you think. Plus I hear there are sweet loan repayment/sign on bonus options out there

 

[Blake]

It doesn't involve cool toys and surgery. I don't know, but it just doesn't seem exciting to me, and I don't like the feeling of not knowing everything. I don't really care about knowing some stuff about everything. I'm more of a ''I have to know everything about organ X'' guy. No, it doesn't mean that I won't care of the other diseases of my patients, but I'll mainly focus on my area of expertise.

 

[v-tach]

I personally am so excited about MAYBE doing FP one day. You can tailor your practice anyway you want; it has gotta be one of the most versatile areas out there. Plus, (at the low end) 130,000 for 40 hrs/wk is NOT at all bad to me, but of course that is all relative to what you think. Plus I hear there are sweet loan repayment/sign on bonus options out there

It definitely has those advantages, and from what I understand the scope of practice is pretty decent in rural underserved areas. And FP's can do OB--delivering babies would be cool! However, I'm not sure if I would do well with "knowing a little about everything" rather than being an expert in a more focused area. Especially considering FP covers both kids and adults too--how in depth can one's knowledge really be? I'll have to see how rotations go, I guess.

 

[skypilot]

It doesn't involve cool toys and surgery. I don't know, but it just doesn't seem exciting to me, and I don't like the feeling of not knowing everything. I don't really care about knowing some stuff about everything. I'm more of a ''I have to know everything about organ X'' guy. No, it doesn't mean that I won't care of the other diseases of my patients, but I'll mainly focus on my area of expertise.

Another way to look at it though is that by the time the patients get to you, the specialists, the disease will already be diagnosed by the generalist. The generalist gets to look at a lot of undifferentiated complaints and try to figure out what is going on. That could be pretty interesting. At least it seems as though it might be.

 

[crys20]

I need to ask the FP I'm shadowing right now this tommorrow...She has never seen a kid ONCE while I was shadowing. I think that in urban areas kids will go to peds docs, no? I need some backup on this from someone with more knowledge but I think if you're an FP in a city you are not going to see that many children.