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Mumpu is actually pretty intelligent and judging from other posts, he knows quite a bit of medical science. I'll bet he is MS3 or 4
Mumpu said:Lowbudget, I agree with you on psych. They rag on every other specialty for "not addressing psych issues" and then refuse to see psychotic patients until they are "medically cleared." All your other points are playing on stereotypes. It's very easy to insult ANY medical specialty -- my experience has been that there are excellent people and sucky people in all of them.
PAC, I'm an MS3. Don't get into poo-throwing contests, you will lose. Instead of throwing out childish insults, why don't you try making intelligent arguments? What exactly did you dislike about that quote (is there some PA vs NP rivalry that I'm sensing?). I expressed my opinion on FP TRAINING (not FP as a profession) and I freely admitted to my bias (I'm interested in hospitalist IM). All you've done is troll and make personal attacks.
Mumpu said:I think the average PCP does an excellent job, but some people are referring machines and others sit on patients for too long.
Mumpu said:Kimberli, I think the intelligent discussion on this thread may be DOA (thanks a bunch PAC!).
Hypersting, I agree with your comment but it opens a whole 'nuther can of worms. Namely, where do you draw the line between a PCP and a specialist? Should hypertension be treated by PCPs or cardiologists? Diabetes by PCPs or endocrinologists? Are 10-15 minute appointments enough to get a grasp of these medical issues? (specialists tend to have longer appointments). There is no good evidence for difference in outcomes (except maybe in cardiology) and no guidelines for when referrals should be made. I think the average PCP does an excellent job, but some people are referring machines and others sit on patients for too long.
I take my hat off to FP docs.........I could never do it!Harrie said:Exactly! It never really made sense to me...
Medicine residency = 3 years
Pediatrics residency = 3 years
OB-Gyn residency = 4 years
FP residency = 3 years? Althought FPs claim to be medicine/peds/ob/gyn all in one, shouldn't that require 10 years of training??? (minus a few for overlap I guess) Not that I think that there is no place for FPs, but I don't know how they are supposed to be the all around doctor yet still have only a three year residency.
Melanie said:I wonder how many practicing physicians (>10yrs.)would tell you that they reach back to their residency every day? I have a good feeling that many of them look more to their years of experience than their residency programs.
Melanie said:Medicine is an amount of knoledge that can be obtained in many ways. Perhaps in 100 years our system of medical education/residency training, etc. will be completely obsolete? (This is NOT a theory)
Mumpu said:Kimberli, I think the intelligent discussion on this thread may be DOA (thanks a bunch PAC!).
Hypersting, I agree with your comment but it opens a whole 'nuther can of worms. Namely, where do you draw the line between a PCP and a specialist? Should hypertension be treated by PCPs or cardiologists? Diabetes by PCPs or endocrinologists? Are 10-15 minute appointments enough to get a grasp of these medical issues? (specialists tend to have longer appointments). There is no good evidence for difference in outcomes (except maybe in cardiology) and no guidelines for when referrals should be made. I think the average PCP does an excellent job, but some people are referring machines and others sit on patients for too long.
There is no good evidence for difference in outcomes (except maybe in cardiology) and no guidelines for when referrals should be made.
doccomet said:I was referred to this site by my students, and I'm an FM clerkship director and asst residency director, obviously biased to FM. The differences as I see them for IM/Peds vs FM are twofold, and of course you are entitled to your opinion.
1. Even in IM/Peds practices 90% of their time on average is spent in the oputpatient setting, and 10% inpatient, yet their training is largely the inverse, and the subtle differences in management of inpatient problems(DM for example) are markedly different than the issues seen in the outpatient setting. I want a physician trained where they provide care.
2. The care of the family in its entirety, ie knowing the interactions of the family and other illnesses/roles/problems inherent in a family is truly valued by FM physicians and we are trained to provide care in this context to a much larger degree than othger specialties. I know that argument doesn't flywith many docs, but it does for me and for my patients. Its often seen as the "fluff" part of medicine, but I view it as an integral part of patient care.
I want someone who can manage the common things uncommonly well, and can recognize and coordinate my care for the rare things in the context of my family and my life outside of my disease, and for me that's where the strength of FM training lies
carrigallen said:It seems to me that med-peds is better compensation than peds. All three may have a fellowship afterwards. What use is med-peds without a fellowship?
As a wise man once said... If you think a NP or PA can take your place then they probably should. The training for these two areas is lacking in many critical features, most importantly the basics of medical science we are all taught in medical school. They know "if a then b", but not why which is critical to recognizing outliers and deviations from patterns. As far as managing inpatients, my experience (and thus not science) in my institution is that our family docs are consistently better in terms of mortality and LOS for similar patients diagnoses, and similar complexities based on scores. Be careful of generalizations.jdaasbo said:FP has a bad rap and I really feel that as an FP to be succesful you need to know how to limit your scope of practice safely, or you need to be very very smart . I have met FP's that are wonderful in outpatient settings who are just not comfortable managing inpatients settings. Many of my friends from med school who now are in FP programs don't feel that they are learning inpatient medicine to the same degree as their IM counterparts and don't feel comfortable taking care of sick people in the hospital. Several of them have stated that they dont want to do ANY inpatient medicine when they are done with their training. At my institution, there is no FP residency and the few FP attendings on staff cannot admit to certain parts of the hospital (like the CCU) without having an IM doctor accept the patient as the primary physician.
I have met a handful of amazing FP's who were 100% up to speed with the latest literature and felt confident managing sick patients in the hospital. They all were amazingly intelligent.
I do feel that the culture of FP and IM is totally different. medical students interested in non pediatrics primary care always discuss whether FP or IM is "right for them." As I look at the students in this situation at my present institution, it is pretty clear from the get go which will choose FP and IM. I agree with the previous posting, that FP involves the non-medical l family milleu aspects of patient care more than other specialties. I see this being more meaningful in rural "marcus welby" settings. I think that this model of family medicine is hard to do in larger cities or busy populated suburban areas.
I am also fearful that FP, as more docs choose to limit their practice to outpatient care, may fall victim to NPs and PAs (who work for less, are liked by patients, and in many areas have high levels of autonomy). I am not sure what he role of FP will be in 15 years.
Mike59 said:First, FPs don't "claim to be medicine/peds/ob/gyn all in one". The bread and butter of FP is common outpatient complaints and management. This easily explains why a 3 year residency is suficient. It's not about mastering everything in all fields of medicine, it's about having enough of a background to address patient needs for non-emergent/non-complex diseases and if necessary, recognize serious disease patterns and refer patients to the right source for such ailments. 90% of an FP's day is spent managing diabetes/back pn/URIs/well child visits etc. To argue that they require 10 years of training to do this is nothing short of absurd. OBGyns and Peds train for 4+ years because of they are required to master the subtleties of managing the zebras that FPs are only required to recognize warning signs of.
Find a new doc, but don't generalize to a specialty! Good luck.Doc Ivy said:So this is why my FP hasn't hasn't bothered to test me for sickle cell trait after I had a costal osteomyelitis from Salmonella surgically debrided (which he totally missed by the way--- he thought I had reflux)... and I'm of African descent!?! Please, that's just negligence, I can see that and I'm just a M2!