Double Applying in FP and a surgical subpseciality: Axis II Diagnosis?

[Oh How Punny]

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Hey all-- Long-time lurker here.

I'm a new fourth year medical student who's spent much of the past couple of years buffing an application for a certain competitive surgical subspecialty.

However, I keep finding myself dreaming about being a truly full-spectrum family practitioner. I had an incredible FP rotation out in the wilderness, though they didn't do any surgery or surgically manage labor, and actually have secretly read this board on sdn and been struck by how nice everyone is and how much I'd like to have you as colleagues. I also have a lot of experience in international health and would like to keep that up.

Then I spend an evening with the residents in my chosen surgical sub and have to down a few bottles of bourbon to convince myself I'd be happy in that culture.

I definitely love surgery. I definitely want to be in the OR. But I love everything else as well-- hence my interest in full-spectrum FP.

Because it's fourth year already and I've set up a string of sub-is in the surgical field, I'm definitely applying in it. I do like it, really I do. But I want to apply in FP as well, and not just as a "back up." I just want to postpone the ultimate decision until February.

So with that being said, what do you all think of this? How would my application and story be received by family med programs? Would I have a chance at one of the competitive, full-spectrum programs like Contra Costa, Ventura or Tacoma if it didn't look like I was 100% committed to FM?

Also, could you help me out by naming other FP programs where surgery is an integral part of the training?

 

[smq123]

Then I spend an evening with the residents in my chosen surgical sub and have to down a few bottles of bourbon to convince myself I'd be happy in that culture.

I definitely love surgery. I definitely want to be in the OR. But I love everything else as well-- hence my interest in full-spectrum FP.

Because it's fourth year already and I've set up a string of sub-is in the surgical field, I'm definitely applying in it. I do like it, really I do. But I want to apply in FP as well, and not just as a "back up." I just want to postpone the ultimate decision until February.

- If you have to "down a few bottles of bourbon" to be happy in that surgical culture, how are you going to survive the 5+ years that it takes to finish a residency? Do you just dislike the culture of your program, or do you feel that you dislike the culture of that specialty?

- You're planning on applying to FP without having completed any FP sub-Is? How do you know that you'll like FP?

 

[Pontifex Maximus]

A lot of places dont have full on FP Sub-Is. Most people have some sort of exposure to it, though.

 

[deleted87716]

If you want to do surgery, don't apply to FM programs. You'd be basically leaving your career choice up to the Match.

That's a Really Bad Idea.

Surgery and family medicine are worlds apart. If you've already figured out that you prefer surgery, then do surgery.

If, at some point along the way, you realize you've made a horrible mistake (you wouldn't be the first), it'll be a lot easier for you to switch from a surgical residency into a FM residency than the other way around.

 

[Oh How Punny]

Thanks for the advice, all. I appreciate it.

I guess a lot of people at this stage go through commitment jitters. Although I do like the surgical subspecialty, I think a lot of me feels sad about giving up the rest of medicine. I remember my FP rotation fondly-- I would deliver a baby, resuscitate a road trauma, cover urgent care, admit adults & kids to the inpatient side, go over behavior modification techniques with an OCD patient, and get in a couple of well-woman exams all in a single day. Granted, this was a function of the extremely rural setting.

I know you're right, Blue Dog- it wouldn't be too hard to move into FP, at least as compared with the reverse.

And smq, to quote Baldrick-- it's a cunning plan, if not a particularly well-thought-out one. 🙂

 

[deleted87716]

I know you're right, Blue Dog- it wouldn't be too hard to move into FP, at least as compared with the reverse.

The issue isn't the difficulty of changing residencies, but rather Medicare funding. You'd be better able to switch if you were initially funded for the longer of the two residencies.

See: http://jama.ama-assn.org/cgi/reprint/282/24/2366.pdf

Excerpt:

Medicare defines an "initial residency period" as the number of years it takes for a resident to become board eligible in the first medical specialty the resident entered. The initial residency period is set when a physician enters residency, and it does not change. Hospitals with training programs will receive slightly less when a resident is beyond the initial residency period. Some hospitals are using this cut in funding to eliminate applicants to their programs.

Because of the way Medicare defines the initial residency period, residents who first enter specialties with longer initial residency periods may be better positioned to switch specialties than those whose initial residency periods are shorter. For example, a physician who first enters a general surgery program will be fully funded for 5 years of residency, whereas a physician who first enters an internal medicine program will be funded for 3 years. If a general surgery resident completes 2 years of training in general surgery and switches to a 3-year specialty, such as internal medicine or pediatrics, Medicare will fully fund that resident for both programs. If a resident first enters an internal medicine program, completes 1 year and then decides to switch to another specialty, Medicare will fully fund that resident for only 2 more years.