DO attending AMA

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What is the appetite like for diet and lifestyle change where you are at? How much and how do you inspire, educate, and enable folks in your town?

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@SLC
Thank you for taking the time to do this AMA!

I am planning to go to SOMA and wanted to know your thoughts about the match list/board scores/residency prep. I saw that you initially wanted to go into oncology, but switched to FM which is awesome! I don't have a particular field I would like to go into at this moment, but I also don't want to be limited in my residency competitiveness. What were your experiences like going towards oncology/FM? Did you feel like the school prepared you well to be competitive in any field?

Thanks again for your insight.

so our match list was alright. People seemed to be able to go where they wanted to go. Board scores were average for DO schools, nothing special but definitely nothing to be concerned about. Residency prep, that’s not really a thing in DO school.

you will be somewhat limited for residency as a DO. If you fall in love with Integrated plastics, you might be able to match into it but the deck is stacked against you. It’s stacked against MD grads too, few actually are competitive enough to apply there either, but for the ones who are it’s easier. But understanding this going in can help you prep yourself to be as competitive as possible.
 
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What is the appetite like for diet and lifestyle change where you are at? How much and how do you inspire, educate, and enable folks in your town?

People love the idea of improving health with diet and lifestyle here. There are tons of folks with an almost pathological adversity to taking medicine. Getting them to actually follow through on diet advice is harder though.

But I have a fair few people doing great with lifestyle changes. I make a huge deal out of getting people off meds as I can when they lose weight and their BP and A1c’s allow it. Then I encourage them to go spread their success stories around town. That helps a lot because people around here know each other and they talk a lot.
 
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so our match list was alright. People seemed to be able to go where they wanted to go. Board scores were average for DO schools, nothing special but definitely nothing to be concerned about. Residency prep, that’s not really a thing in DO school.

you will be somewhat limited for residency as a DO. If you fall in love with Integrated plastics, you might be able to match into it but the deck is stacked against you. It’s stacked against MD grads too, few actually are competitive enough to apply there either, but for the ones who are it’s easier. But understanding this going in can help you prep yourself to be as competitive as possible.
Thanks for the response. I’m going to put in all I got and hit the ground running!
 
I seem to hear that FM programs can be very different when it comes to level of training you end up at by the end..What would you say is the best thing to look for in a program to feel confident and not end up just being a referral machine?
 
I seem to hear that FM programs can be very different when it comes to level of training you end up at by the end..What would you say is the best thing to look for in a program to feel confident and not end up just being a referral machine?

quality inpatient service, strong attendings who publish and prioritize teaching, busy continuity clinic that serves as a major outpatient center in the area (my program was the principle primary care office in a city of 80,000 people. We had a full 18-20 residents seeing patients at any one time.) Also, your inpatient service should fill largely with clinic patients so you can see people before the hospital, in the hospital, and for hospital follow-up.
 
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@SLC how did you go about finding a contract during residency? I’m stressed about matching into a place that doesn’t allow moonlighting and if I could sign to a place early in order to get a stipend or whatever then I’d totally be down for that.
 
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@SLC how did you go about finding a contract during bunny boot camp? I’m stressed about matching into a place that doesn’t allow moonlighting and if I could sign to a place early in order to get a stipend or whatever then I’d totally be down for that.

My wife found it in the job postings on the NEJM.

there is a lot of garbage out there, so be cautious if taking the early contract route.
 
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Who’s here after the April Fool’s joke because they were very confused by the title? :yawn:
 
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Your job is basically my dream.

Is there anything you would've done differently during med school if you knew you would be pursuing rural FM?

I'm also a nontrad with kids, starting OMS-I this July, and I'm 99.99% sure I want to do rural FM. My class's group chat keeps asking about research opportunities and things like that and I'm just like...nah. I'm curious how you would structure your time in med school (beyond passing classes and boards, obviously) if you knew rural FM was the end goal.
 
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Your job is basically my dream.

Is there anything you would've done differently during med school if you knew you would be pursuing rural FM?

I'm also a nontrad with kids, starting OMS-I this July, and I'm 99.99% sure I want to do rural FM. My class's group chat keeps asking about research opportunities and things like that and I'm just like...nah. I'm curious how you would structure your time in med school (beyond passing classes and boards, obviously) if you knew rural FM was the end goal.
I’d go get the most procedure heavy rotations my school had available. Places known for letting students get their hands dirty.
That and I’d 100% take all learning both pre-clinical and in rotations VERY seriously.
 
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How old were you when you entered med school? Did the stress of training rub off on your family? Do you feel more appreciated by the healthcare system as a whole being in a rural area? How old are your kids and did that missed time aspect relieve itself once you were out of residency?
 
I’d go get the most procedure heavy rotations my school had available. Places known for letting students get their hands dirty.
That and I’d 100% take all learning both pre-clinical and in rotations VERY seriously.
Thanks! My school has a free clinic and I’m hoping to devote a lot of time there.

If you had the choice, would you choose a rural site for clinical rotations, or does it really just depend on which sites let students be most hands-on? One of our clerkship sites has a rural FM residency and OB fellowship that I’m interested in, but I’m not sure if it would be better to do rotations in a different environment than I’m hoping to end up in for residency, or if that would give me the most valuable experience (I’m clearly obsessing about this stuff way too early, but my brain is unoccupied until classes start in July).
 
Thanks! My school has a free clinic and I’m hoping to devote a lot of time there.

If you had the choice, would you choose a rural site for clinical rotations, or does it really just depend on which sites let students be most hands-on? One of our clerkship sites has a rural FM residency and OB fellowship that I’m interested in, but I’m not sure if it would be better to do rotations in a different environment than I’m hoping to end up in for residency, or if that would give me the most valuable experience (I’m clearly obsessing about this stuff way too early, but my brain is unoccupied until classes start in July).
As general advice for any medical student you should try to get the most diversified experience during 3rd year and have an open mind.
 
Thanks! My school has a free clinic and I’m hoping to devote a lot of time there.

If you had the choice, would you choose a rural site for clinical rotations, or does it really just depend on which sites let students be most hands-on? One of our clerkship sites has a rural FM residency and OB fellowship that I’m interested in, but I’m not sure if it would be better to do rotations in a different environment than I’m hoping to end up in for residency, or if that would give me the most valuable experience (I’m clearly obsessing about this stuff way too early, but my brain is unoccupied until classes start in July).

You should try and go to anywhere with residents. So the FM would be good. Also, just keep your mind open to other things and prepare your application. Don’t pigeon hole yourself. You may fall in love with something else
 
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I live in a small town, less than 10k people, in the Intermountain west
I grew up in a small rural town of ~2k people, and often saw my FM doc out and about (ie at the grocery store, at my high school football games, etc). Talking to him now, he says that he is feeling major burnout ~6 years into practice because his patients approach him all the time outside of his clinic, and he is constantly doing "curbside" consults for people. Have you had similar experiences? Or is your town big enough that you can still be a stranger out in public lol?
 
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I grew up in a small rural town of ~2k people, and often saw my FM doc out and about (ie at the grocery store, at my high school football games, etc). Talking to him now, he says that he is feeling major burnout ~6 years into practice because his patients approach him all the time outside of his clinic, and he is constantly doing "curbside" consults for people. Have you had similar experiences? Or is your town big enough that you can still be a stranger out in public lol?

Town was small like that, but I made it known that I didn’t do work anywhere but in the clinic. It was never an issue.

I’ve since moved my practice for a somewhat related issue though. One of my kids went through a significant trauma, and the family of the kid that did it harassed us until we finally moved; being such a small town made escaping the harassment impossible. And being outsiders, anyone who was in a position to help wasn’t invested because the other people were town natives, and in law enforcement. It was to the point that as much as I loved my job and my patients, the pain that was being inflicted on the family wasn’t worth it anymore. It all culminated in this other family calling my corporate offices and feeding them lies about me, and making it so I had to face an HR investigation that was totally unfounded. My job, and potentially my entire career were put at risk. Once I helped my company see what was really going on, they helped me find a different job within the system, and paid to move us there. I’m now in the city (the suburbs really) where I am making more money and have a much better work-life balance, but my job is a little less interesting because of the presence of so many local specialists. Now my patients go to the ER with the fractures and lacerations, and to the Gynecologist for birth control; and they often come to me to ask what referral they need for the problem that brings them in. I’m having to teach them that we can do almost everything out of our office and that referral usually isn’t needed or appropriate.
 
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Town was small like that, but I made it known that I didn’t do work anywhere but in the clinic. It was never an issue.

I’ve since moved my practice for a somewhat related issue though. One of my kids went through a significant trauma, and the family of the kid that did it harassed us until we finally moved; being such a small town made escaping the harassment impossible. And being outsiders, anyone who was in a position to help wasn’t invested because the other people were town natives, and in law enforcement. It was to the point that as much as I loved my job and my patients, the pain that was being inflicted on the family wasn’t worth it anymore. It all culminated in this other family calling my corporate offices and feeding them lies about me, and making it so I had to face an HR investigation that was totally unfounded. My job, and potentially my entire career were put at risk. Once I helped my company see what was really going on, they helped me find a different job within the system, and paid to move us there. I’m now in the city (the suburbs really) where I am making more money and have a much better work-life balance, but my job is a little less interesting because of the presence of so many local specialists. Now my patients go to the ER with the fractures and lacerations, and to the Gynecologist for birth control; and they often come to me to ask what referral they need for the problem that brings them in. I’m having to teach them that we can do almost everything out of our office and that referral usually isn’t needed or appropriate.
I'm sorry to hear that. The mob mentality that comes with living in a small town can be extremely toxic, and was a huge reason I left home and came to the city to do my undergrad, rather than stay at the local CC.
 
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I’ve since moved my practice for a somewhat related issue though. One of my kids went through a significant trauma, and the family of the kid that did it harassed us until we finally moved; being such a small town made escaping the harassment impossible. And being outsiders, anyone who was in a position to help wasn’t invested because the other people were town natives, and in law enforcement. It was to the point that as much as I loved my job and my patients, the pain that was being inflicted on the family wasn’t worth it anymore. It all culminated in this other family calling my corporate offices and feeding them lies about me, and making it so I had to face an HR investigation that was totally unfounded. My job, and potentially my entire career were put at risk. Once I helped my company see what was really going on, they helped me find a different job within the system, and paid to move us there. I’m now in the city (the suburbs really) where I am making more money and have a much better work-life balance, but my job is a little less interesting because of the presence of so many local specialists. Now my patients go to the ER with the fractures and lacerations, and to the Gynecologist for birth control; and they often come to me to ask what referral they need for the problem that brings them in. I’m having to teach them that we can do almost everything out of our office and that referral usually isn’t needed or appropriate.

That is grounds for war. Since you were going to leave anyways, did you name and shame?

I would have told all my (your) 2,000+ patients that I enjoyed taking care of them and thanked them for being such wonderful patients (even if they weren't). Then I'd say had to leave the community due to harassment from a specific family. I would have named them specifically. If that family mistreated your kids, go into details about that. Invoke their sense of justice for the helpless. Small towns love to gossip and this would have traveled throughout the small community. That family will be known as the one who drove a physician out of the community by mistreating kids. And if patients have trouble getting timely care, they'll know who to blame. Use the environment to your advantage.

If you keep quiet, they only hear one side of the story, which is biased against you.

There is a reason why rural places treat their physicians extremely well and it's because they can't afford to have their physicians leaving.
 
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That is grounds for war. Since you were going to leave anyways, did you name and shame?

I would have told all my (your) 2,000+ patients that I enjoyed taking care of them and thanked them for being such wonderful patients (even if they weren't). Then I'd say had to leave the community due to harassment from a specific family. I would have named them specifically. If that family mistreated your kids, go into details about that. Invoke their sense of justice for the helpless. Small towns love to gossip and this would have traveled throughout the small community. That family will be known as the one who drove a physician out of the community by mistreating kids. And if patients have trouble getting timely care, they'll know who to blame. Use the environment to your advantage.

If you keep quiet, they only hear one side of the story, which is biased against you.

There is a reason why rural places treat their physicians extremely well and it's because they can't afford to have their physicians leaving.

I was tempted, and people did ask and I did dance around it. I didn’t name names though, but in a small town that’s probably not necessary.

But these people were so incredibly toxic, like serious personality disorder level toxic. I really just wanted to get out of there and leave it behind. Didn’t need drama following us up here. We were threatened with slander suits whenever their kid couldn’t keep his mouth shut about what he was accused of and took heat at school over it. I really didn’t want to get pulled into court.
 
I was tempted, and people did ask and I did dance around it. I didn’t name names though, but in a small town that’s probably not necessary.

But these people were so incredibly toxic, like serious personality disorder level toxic. I really just wanted to get out of there and leave it behind. Didn’t need drama following us up here. We were threatened with slander suits whenever their kid couldn’t keep his mouth shut about what he was accused of and took heat at school over it. I really didn’t want to get pulled into court.

Is it slander if it is the truth? And how can they prove slander? Just because there is gossip about that family doesn't meant it originated from you. They obviously feared ostracism and that would have been a good button to push. A lawsuit would have opened up a can of worms they would rather not open up. Because if it is found to be true in court, I would countersue for defense reimbursement and emotional pain and suffering and as law enforcement they should have assets to take.

A patient's wife threatened to sue me because I stopped some psychotropics to treat delirium. This was after he sexually assaulted female staff while delirious. I told her I documented the sexual assault and have a good reason I did what I did and they're free to bring on the lawsuit. They never did. I can't imagine digging into details about the sexual assault would make them very comfortable.

But I understand if you just want to put this all behind you. Some people want to avoid conflict while others thrive in it.
 
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Is it slander if it is the truth? And how can they prove slander? Just because there is gossip about that family doesn't meant it originated from you. They obviously feared ostracism and that would have been a good button to push. A lawsuit would have opened up a can of worms they would rather not open up. Because if it is found to be true in court, I would countersue for defense reimbursement and emotional pain and suffering and as law enforcement they should have assets to take.

A patient's wife threatened to sue me because I stopped some psychotropics to treat delirium. This was after he sexually assaulted female staff while delirious. I told her I documented the sexual assault and have a good reason I did what I did and they're free to bring on the lawsuit. They never did. I can't imagine digging into details about the sexual assault would make them very comfortable.

But I understand if you just want to put this all behind you. Some people want to avoid conflict while others thrive in it.

Apparently it’s potentially slander if the kid is not tried or convicted. And I agree, they’d have to prove it came from us. Still it’s not a fight we opted to take on. We went for the high road.

I’m the type that wants the fight, but my wife and kid don’t. So in the end they won out.
 
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