Family Med

[BestDoctorEver]

There are medical schools that offer fast track 3 yrs program for family medicine.

How about the 2-year residency that he suggested for PCP?

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[MerickManual]

Ill let them speak for themselves. I can see how my original statement was offensive, however.

In regards to IM, I think outpatient IM is pretty similar, as you mentioned, to outpatient family medicine. Inpatient IM/FM, however, in my opinion, can be challenging and requires more education. I had a patient the other day status post a multiple organ abdominal transplant (pancreas, liver, a portion of small bowel) with an acute rejection, a possible CMV infection, and some other stuff. I didn't really know where to begin expect to keep him breathing. I've never been completely dumbfounded like that in an outpatient setting.

I hope you don't think you were "blasted," I think everyone's been somewhat civil with expressing their thoughts. You have a different experience with outpatient medicine which has your opinions slightly skewed, and I can see how you think a certain way about outpatient FM. I have been in clinics with "easy" patient population, everyone' well off, very straightforward check-ups and coughs/colds. On the other hand, I have been to clinics where it is a complete 180: patients with cancer/complex pain issues, debilitating psych cases, child psyh/developmental problems, with a wide variety of interesting and not-so-straightforward cases. The same with inpatient medicine. One day you can have a list full of "COPD exacerbation" or "ileus" the next day you have the cases like you mention above. The reason people on this forum are being defensive and persistent is because they don't think the oversimplification of their specially is doing justice and deserves more respect.

 

[costales]

There are medical schools that offer fast track 3 yrs program for family medicine.

I think only Texas Tech and Mercer have been approved for that curriculum.

 

[MerickManual]

How about the 2-year residency that he suggested for PCP?

I'll be starting a FM residency in six-seven months, and I think three years is too short There are so many electives I want to do to learn!

 

[deleted382095]

I think only Texas Tech and Mercer have been approved for that curriculum.

lake erie college of osteopathic medicine offers it too

 

[Postictal Raiden]

How about the 2-year residency that he suggested for PCP?

I don't think this is doable. There have been propositions to increase the training to make it 4 years instead of 3. In fact, in many other industrialized nations, FM training is at least 4 years long.

 

[Member102918]

I don't think this is doable. There have been propositions to increase the training to make it 4 years instead of 3. In fact, in many other industrialized nations, FM training is at least 4 years long.

In Canada, whose medical education system is more similar to the United States' than any other nation, a Family Medicine residency is 2 years long.

 

[BestDoctorEver]

In Canada, whose medical education system is more similar to the United States' than any other nation, a Family Medicine residency is 2 years long.

Interesting...

 

[deleted382095]

In Canada, whose medical education system is more similar to the United States' than any other nation, a Family Medicine residency is 2 years long.

Interesting...

Interesting...

 

[MerickManual]

In Canada, whose medical education system is more similar to the United States' than any other nation, a Family Medicine residency is 2 years long.

It appears they have more fellowships for "PGY3" to do addiction, obstetrics, geriatric, emergency, hospitalist, etc. Some of which include areas that when finishing a 3 year American FM residency doesn't require additional training (ie: hospital medicine, emergency, etc).

http://www.dfcm.utoronto.ca/prospectivelearners/prosres/pgy3.htm

 

[JGimpel]

A PCP can start anywhere from 160K to 200K with their first contract and make much more when the current/next hiring party sees a record of efficiency/proficiency that allows them to bill for 25-40 patients per day, depending on inpatient/outpatient settings and any med mal filings. If you read the Resident forums on a regular basis, you'll also see that having a lawyer read and negotiate your contracts will usually yield major dividends in these departments too.

Getting past 250K is tough in many fields if you don't have 20%+ of your billings involving a procedure of some kind. DOs are all trained for this but rarely incorporate this into their billing structure which is costly and unfortunate. Being able to get paid an additional $400-500/day on a regular basis will make a significant increase in your income.

If you work with a doctor that drives his basic daily driver to work during the week, then his supercar in to dictate charts for a few hours on the weekend, figure out the most tactful way to ask how he does it and be guided by his real world experience.

Being able to step outside the algorithm when you're going deeper into the HPI while your asking it, then accounting for the many other social, economical and medical issues the patient also presents with is where you need to be a really good doctor that gets the initial "next step in management" right that leads to getting over 90% good outcomes that you need to have.

No medical student or new NP/PA can do even close to any of the above, so saying they could is absurd. With 5 years of progressive experience, some could. There's a much better chance of this if they were closely monitored and held to a very high standard that has many standardized exams along the way that keeps the pressure on them to operate at such a high standard is the best way to do this. This is why doctors will always be able to handle the widest range of patient populations with complex issues; they ALL go through this type of training for a very long time.

 

[hallowmann]

One doctor's opinion doesn't mean he's right.... There was one school who is/was(?) shortening the curriculum one year if you decide to do primary care, but I have reservations how that will pan out.

Its being done. A few schools have programs for it, and some more are looking to start programs for it. LECOM has a 3 year PCP program (PCSP) and a 3 year program for former-PAs going into primary care (APAP).

There are stipulations however. The PCSP students have to maintain a high GPA through the first year, they get no real vacations, due to the accelerated nature of the degree, they begin their rotations early and do fewer of them than a regular student (I believe they lose all their electives and selectives, and come out with ~1-1.5 years of clinical rotations), and they can only match into AOA PCP residencies (and they may even be only at LECOMT affiliates, not sure of that part). Technically, you can complete the program and apply wherever you want, but you'd have to pay an extra $30k (essentially the 4th year's tuition).

I don't know any graduates of that program, but I imagine they are doing just fine.

How about the 2-year residency that he suggested for PCP?

I doubt that's happening any time soon. PCP programs have increased in length over time (granted slowly), not decreased.

 

[KnuxNole]

Maybe not run an office, but, yes, I think a 4th year medical student could easily see 30 patients a day if they had to. Im sure somewhere they do. They will undoubtedly miss some stuff, but I think the overall care would be adequate. You'll be surprised how quickly you become efficient when you have to. We, the interns, have to cover the surgical icu alone on the weekends. My first weekend alone I had 15 patients. Prior to that weekend, I never covered more than 3 icu patients. That first weekend sucked, but each following weekend has become easier and easier, and now it's actually fun instead of being terrifying. And similiarly, in pain clinic, I have to see 40-60 patients a day. The visits are way shorter and more focused than a primary care visit, but I still have to take a history, do a physical exam and dictate a note. The first week I was terrible and I had to stay up all night dictating, but I quickly got the hang of it. I'm sure the same thing would happen in the scenario we're discussing. Sure, the med student would be terrible at first, but after a few days they'd probably be fine.

I'm not saying anything negative about family doctors.

Those 4th years will be slow as ****. I can't name one 4th year who could see 30 patients in a 9-5 setting whatsoever...

They could see 8-14 like you mentioned, and after a few months, can be reasonable. However, tons of med students will be crushed seeing 8-14 patients especially in a month of FM(which is why they usually get less to see), so you are a rockstar amongst your peers!

 

[KnuxNole]

No, I don't think a 4th year med student could do the billing, hire staff members, or handle other business related aspects of running a practice. I do, however, think a decent 4th year student could make the correct assessment and plan way more often than 50% of time. You obviously disagree, and maybe I am wrong. I basing my assessment on 4 months of outpatient family medicine in a punt friendly environment.

Maybe it was just a bad environment?

I never understood when people in general say FM is just mainly HTN and DM. 6 months into residency, and that's not the case by far. Lots of outpatient diversity, and not a lot of punting.