Deceptive Training??

[secretwave101]

Now that I'm about to enter residency, I'm questioning the FP programs that offer the super-procedural type of training. Actually, I'm questioning whether or not FP is the best choice for anyone who is attracted to the procedural-oriented FP residencies.

During my 3rd and especially my 4th year, I was totally focused on this type of residency. I'm big into procedures, so I've always thought the procedure-oriented FM programs were the way to go for me. Now as I approach the actual choice, I'm wondering WHY learn all this stuff? The funnest stuff I did in med school was intubating, suturing, central lines and codes. You get to do all this stuff in FM residencies...but then you get out and - IN REALITY - you never do it again. Where in the U.S. do FP's run codes and place central lines...then run off and do a C-section before seeing some clinic patients? Yeah, you might go somewhere faaaar away and hope a surgeon, OB, pediatrician or other specialist never bothers to notice your neck of the world. But in general, why learn all this stuff in residency?

After years of certainty, I'm wondering if FM is the right choice for me. It may be that surgery is the better place for me, assuming I can deal with fiiiiive freaking years and assuming somewhere will take me (both big assumptions).

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[lateness]

Now that I'm about to enter residency, I'm questioning the FP programs that offer the super-procedural type of training. Actually, I'm questioning whether or not FP is the best choice for anyone who is attracted to the procedural-oriented FP residencies.

During my 3rd and especially my 4th year, I was totally focused on this type of residency. I'm big into procedures, so I've always thought the procedure-oriented FM programs were the way to go for me. Now as I approach the actual choice, I'm wondering WHY learn all this stuff? The funnest stuff I did in med school was intubating, suturing, central lines and codes. You get to do all this stuff in FM residencies...but then you get out and - IN REALITY - you never do it again. Where in the U.S. do FP's run codes and place central lines...then run off and do a C-section before seeing some clinic patients? Yeah, you might go somewhere faaaar away and hope a surgeon, OB, pediatrician or other specialist never bothers to notice your neck of the world. But in general, why learn all this stuff in residency?

After years of certainty, I'm wondering if FM is the right choice for me. It may be that surgery is the better place for me, assuming I can deal with fiiiiive freaking years and assuming somewhere will take me (both big assumptions).

I was and am having the same the type of thoughts as you. Deciding between surgery b/c i love procedures, and FM b/c i lovde the variety. You have to look at everything. Surgery, 5 years, and all the procedures. But pretty much thats all you do is procedures. no real clinic work, and alot of the surgoens i saw and worked with did repetitive procedures and only rarely did any unusual ones. And they had no contact with the patients, they were in and out and never really had a strong connection at all. most patients didnt even know the surgeons existed. The other thing is when you are done with residency, after years of working I think life is alot different than residency. I think doing FM is a good choice, but try to practice in an area or setting where you are a hospitalist, so you get to more consistently do procedures. I am not sure, though. someone who is already there will have better input.

 

[secretwave101]

I can elaborate to say that the training of the hands-on FP residencies sounds totally fun. I do like some clinic time, and continuity of care is really attractive element of family practice. Just not exclusively.

I'm just worried that this type of experience only lasts 3 years. Then it's outpatient forever...unless you live outside a city, and even then I suspect that what FP docs do is pretty constrained compared to what they were doing in residency.

Anyone know if this perception is true?

 

[tridoc13]

I can elaborate to say that the training of the hands-on FP residencies sounds totally fun. I do like some clinic time, and continuity of care is really attractive element of family practice. Just not exclusively.

I'm just worried that this type of experience only lasts 3 years. Then it's outpatient forever...unless you live outside a city, and even then I suspect that what FP docs do is pretty constrained compared to what they were doing in residency.

Anyone know if this perception is true?

I am going into FP next year and had the same Surgery vs. FP struggle for months before I finally chose FP. From the FP docs I've worked with I hear that it totally depends on where you practice and how comfortable you are doing procedures. I can't tell you how many people I've gotten to cut and sew this past month while working with my rural FP doc. Depending on how you structure your practice, you can also do a lot of inpatient work and/or ER work (again, depends on what part of the country you're in). Everyone I've spoken with says it's pretty much up to me and what I want to do with my practice. I'm sure I'll continue to do a lot of office procedures, but I'll be doing international work as well so I'm planning to be trained in doing some additional surgeries (appys, etc.) so that I can do them if I have to. As for intubating, placing lines, etc. all of the residencies that I applied to do a good job of teaching you these things. I don't know how much I'll use them in the future, but I also don't know how much inpatient or ER work I want to do yet. It's good to know I'll be trained to do them and can use these skills down the road if I need or want to. Hope this helps.

 

[gungho]

I am going into FP next year and had the same Surgery vs. FP struggle for months before I finally chose FP. From the FP docs I've worked with I hear that it totally depends on where you practice and how comfortable you are doing procedures. I can't tell you how many people I've gotten to cut and sew this past month while working with my rural FP doc. Depending on how you structure your practice, you can also do a lot of inpatient work and/or ER work (again, depends on what part of the country you're in). Everyone I've spoken with says it's pretty much up to me and what I want to do with my practice. I'm sure I'll continue to do a lot of office procedures, but I'll be doing international work as well so I'm planning to be trained in doing some additional surgeries (appys, etc.) so that I can do them if I have to. As for intubating, placing lines, etc. all of the residencies that I applied to do a good job of teaching you these things. I don't know how much I'll use them in the future, but I also don't know how much inpatient or ER work I want to do yet. It's good to know I'll be trained to do them and can use these skills down the road if I need or want to. Hope this helps.

Having practiced in rural, urban, and suburban areas for 19 years, I would endorse Tridoc13's comments. If you know where you want to live and the FP's in that area have the freedom to do what you want to do, go for it.

 

[sophiejane]

I also think it's very important to talk personally with docs in the area where you want to practice,and compare urban vs suburban vs rural practices in those areas. I've experienced all three through my school's curriculum and I'm pretty sure that the only way for me to get the kind of variety I want (procedures, clinic, ER, OB, inpatient) is to do rural practice. But rural life really appeals to me, as well. I think you might not be happy even if you have an interesting practice if you hate where you live.

But this is also an entirely regional phenomenon. I know of inner-city family docs who have very "rural-type" practices in other parts of the country.

As for "deceptive" training, I don't think programs are out to deceive anyone. If you want to do procedures in your practice you have to practice them in residency, and if your program doesn't offer that, you have no choice but to do strictly ambulatory clinic work.

 

[deleted87716]

I'm wondering WHY learn all this stuff? The funnest stuff I did in med school was intubating, suturing, central lines and codes. You get to do all this stuff in FM residencies...but then you get out and - IN REALITY - you never do it again.

Not necessarily. It depends on where you end up practicing, and how you wish to structure your practice. If you're in the hospital, you may do some of these things a lot. If you're strictly outpatient, probably not as much. It sounds like the residency you're describing provides pretty in-depth training, which will make its graduates better all-around doctors, even if they never float another Swan again after residency. Nothing wrong with that. Some of the things you mentioned (suturing, for example) you are likely to do no matter where you practice, while other things (like ACLS) you hope you'll never need, but should the situation present itself, you (and the patient) will be very glad you know how to do it. ;-)

 

[secretwave101]

I don't mean to say that the programs are deceptive...but that the training itself is. I've been attracted to programs that allow me to learn all kinds of procedures. But now I'm realizing that learning this stuff will maybe satisfy some sort of curiosity for me, but won't be very useful in the real world of practice.

Yes, I've been told that things are different in more rural areas. Although true today (but significantly less true than 10 years ago), I'm starting to believe that the trend toward specialization is moving so rapidly and extensively, it won't be long until the only place FP docs practice anything other than outpatient medicine is in some REALLY remote areas. Like, antarctica.

Here in Portland, OR, I've been told that many FP's forego doing any sort of inpatient medicine even though they probably could get privledges for some services. But, they make more money just cranking as many patients through their clinics as possible. Stopping to call in orders or do rounds in the hospital is a major income depressant. Same for 1st assisting on surgeries. Same for OB d/t HUGE insurance overhead.

So, now that I have something like 12 days before I certify my rank list, I'm feeling pretty disillusioned with this specialty I thought would really fit my interests and personality.

I would like to have a practice that looks almost exactly like residency. I'd also like that practice to merely pay off my loans, and provide a cool house for my family, a modest amount of disposable income and reasonable retirement for my wife and I. There was a day when what I'm seeking was entirely possible. Today, I think something in that equation has to be given up...

 

[tridoc13]

Are you at all interested in academia? It might allow you to have a nice combination of inpatient/outpatient while keeping up with the skills you learned during residency (teaching them, actually). It's something I think I want to do down the road a ways. Anyway, just a thought! Good luck with your residency plans.

 

[sophiejane]

So, now that I have something like 12 days before I certify my rank list, I'm feeling pretty disillusioned with this specialty I thought would really fit my interests and personality.

At this late hour you can't really switch, can you? I guess you could try to scramble into EM,IM, or OB, maybe gas--is that what you are thinking about?

The thing with Family is that you can do a fellowship--there are some great ones out west--and gear your practice in many different directions. You could do an ER fellowship (TN and OK both have them, might be others too) or OB or geri or whatever and make yourself a nice little niche with plenty of hospital work and procedures if you want them.

I really do think it's regional, too. The kind of practice you are looking for still exists all over TX and probably all over the midwest, but I'm not surprised that things are different on the west coast.

If you are willing to relocate, I'm pretty sure you can have the kind of practice you want and the life you want as well. The other thing to keep in mind is that cost of living is much higher on the coasts. In the midwest and south you can work less, or do more lower-paying things like hospital work (last I heard being 1st assist on surgeries could pay $500-800, maybe more--that's not bad for a couple of hours' work), and still have a nice life, house, etc.

I'm sure that's not what you want to hear--Oregon is gorgeous and I'd live there in a second if I could. I guess there is a price to pay for everything.

Best of luck to you--I think it will all work out the way it should in the end for you.

 

[deleted87716]

I've been attracted to programs that allow me to learn all kinds of procedures. But now I'm realizing that learning this stuff will maybe satisfy some sort of curiosity for me, but won't be very useful in the real world of practice.

Again, that depends on the type of practice you want.

I'm starting to believe that the trend toward specialization is moving so rapidly and extensively, it won't be long until the only place FP docs practice anything other than outpatient medicine is in some REALLY remote areas.

I have absolutely no idea where you're getting that idea. It's hard for me to say much beyond "hogwash."

Here in Portland, OR, I've been told that many FP's forego doing any sort of inpatient medicine even though they probably could get privledges for some services. But, they make more money just cranking as many patients through their clinics as possible.

So what? That doesn't mean you have to practice like that.

I would like to have a practice that looks almost exactly like residency.

Sounds to me like you should look into academics.

 

[lateness]

I don't mean to say that the programs are deceptive...but that the training itself is. I've been attracted to programs that allow me to learn all kinds of procedures. But now I'm realizing that learning this stuff will maybe satisfy some sort of curiosity for me, but won't be very useful in the real world of practice.

Yes, I've been told that things are different in more rural areas. Although true today (but significantly less true than 10 years ago), I'm starting to believe that the trend toward specialization is moving so rapidly and extensively, it won't be long until the only place FP docs practice anything other than outpatient medicine is in some REALLY remote areas. Like, antarctica.

Here in Portland, OR, I've been told that many FP's forego doing any sort of inpatient medicine even though they probably could get privledges for some services. But, they make more money just cranking as many patients through their clinics as possible. Stopping to call in orders or do rounds in the hospital is a major income depressant. Same for 1st assisting on surgeries. Same for OB d/t HUGE insurance overhead.

So, now that I have something like 12 days before I certify my rank list, I'm feeling pretty disillusioned with this specialty I thought would really fit my interests and personality.

I would like to have a practice that looks almost exactly like residency. I'd also like that practice to merely pay off my loans, and provide a cool house for my family, a modest amount of disposable income and reasonable retirement for my wife and I. There was a day when what I'm seeking was entirely possible. Today, I think something in that equation has to be given up...

I had some of the same worries as you, thinki8ng that i wont be doing what i do during residency in practice, then i thought and realized, that alot of residencies, like IM, do things in residency that they dont do in practice; b/c in practice people are trying to survive and it becomes more of understanding the business aspect. But thats a generalization. I also know of people who do all sorts of procedures and things they did in residency. But it depends on where and in what type of setting you practice. FM is regional as was stated before. You can do alot of things if you seek them out. I also dont believe in the future of FM being obsolete or lost out to specialties. I just dont. there are alot of things that fm does that no other specialty does period. And all the specialties are going to rely for years to come on FM for referrals and the broad base of their training. I think the demand for FM will increase.
I am just bothered by those new types of places in WALMART and etc, that offer , and often mislead, services to people to come in for checkups and whatever. But the demand for a good trained FP, exists and will exist in my opinion for a while to come.

 

[lateness]

also, if you want choose a more unopposed type of residency, where you get to do more by nature during residency. I am chosing that, and I am happy with that decision. Any type will be good. But i have found that the FM residencies with less residents in the hospital from other specialties, have more responsiblity and learn more management skills, without the added competition from other specialities

 

[deleted87716]

I am just bothered by those new types of places in WALMART and etc, that offer , and often mislead, services to people to come in for checkups and whatever.

You're talking about things like MinuteClinic. We're straying from the original subject a bit, but I just wanted to point out that I have yet to meet an FP who feels threatened by these clinics. They're likely to carve out a niche, but it's really the same market that urgent care centers have been addressing for as long as I can remember. The real issue here isn't quality of care, it's availability and convenience. If physicians focus on being more available to their patients (offering same-day appointments, extending office hours, etc.), and being more patient-friendly, most patients will prefer to get their care from somebody who knows them. These clinics aren't necessarily cheap, either. Convenience comes with a price. Remember the old adage: "Cheap, fast, good...pick any two."

 

[lateness]

You're talking about things like MinuteClinic. We're straying from the original subject a bit, but I just wanted to point out that I have yet to meet an FP who feels threatened by these clinics. They're likely to carve out a niche, but it's really the same market that urgent care centers have been addressing for as long as I can remember. The real issue here isn't quality of care, it's availability and convenience. If physicians focus on being more available to their patients (offering same-day appointments, extending office hours, etc.), and being more patient-friendly, most patients will prefer to get their care from somebody who knows them. These clinics aren't necessarily cheap, either. Convenience comes with a price. Remember the old adage: "Cheap, fast, good...pick any two."

Well I am glad you informed me. I was misled as to what those things are.
Well I am sure your right, being in practice already, especially. i am glad to hear that FPs arent really being affected or worried about it.. I just remembered seeing an article about it, on AAFPs website, and addressing it, as being a bit misleading, if anything, if i remember correctly. But I do agree with you that patients are for the most part going to go to someone who knows them and is familiar with them and their history. But it still seems like they are tryikng to market it like fast food, or some product, more than a service. But we are straying off the original subject..
thanks for the info