Family Medicine and Its Possibilities

[angeloss2766]

HI, Im a 3rd year DO medical student that is highly considering Family Medicine because of all the possibilities with the training. I am finishing my last rotation before board studying and it happens to be ER, which I also really like. All of the ED docs and internists have been telling me not to do FM because of how NP are taking over primary care and they are more marketable than a FM based on cost. My problem I am having is that I like and want to do everything. So initially I was thinking that I could do FM and maybe work in the ED for a few years, then work in an outpatient setting later on. My father who is an ED doc said that FM docs in the future while be squeezed out of the ED with maybe the exception with a few rural towns. The IM docs were telling me that all the NP will take the outpatient jobs. So where does that leave me in FM? Where is it going in the future with FM? I'm just worried because I like FM and I am attracted to all the possible routes, but also nervous to go into FM if they are being squeezed out. Also, would it be possible to work in the ED near bigger cities like Pittsburgh or Columbus if you FM? Is it realistic to think that I could work in a ED for 10 years then do outpatient?

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[VA Hopeful Dr]

Outpatient is going to be fine. Most places are hiring more docs and less midlevels (my current employer likes a ratio of 4 docs to 1 NP per office). In fact, we have the best job market in all of medicine. I can quite literally find a job anywhere in America.

The ED part is somewhat true - as more and more board certified EM docs come out there will be fewer EM opportunities for FM. That said, that isn't going to happen overnight. Just go to the ED forum and see the ridiculous money they make doing locums. When that stops being possible, then FM won't be in EDs much. That said, most FM is relegated to smaller, more rural EDs at the moment. If that doesn't bother you, you'll be able to find ED work.

You can always find FM jobs in big cities. They pay won't be as good as in smaller ones, but it won't be terrible either.

 

[cabinbuilder]

If you have your heart set on working the ED for that long then do an EM residency. It would be too hard to go back into outpatient IMO. Too hard to keep up on all the medication changes in psych meds and bp meds, etc. What the new insulins are and other diabetes meds. I have been out of outpatient care for 6 years and know that I am not up on all the new regulations and recommendations, etc. since switching to urgent care exclusively but that's what I like.

 

[SLC]

There is one program in Delaware, DO friendly, that is a joint FM/EM training situation. You could get double boarded.

Met a doc from there in an urban ER, and he absolutely loved his training. He works outpatient FM during the weekdays and picks up ED shifts on some nights and weekends. Keeps him from getting the ED burnout.

The program is Christiana Care, and I think there are a few others out there too.

I’ll be working in a rural area in 2 months. Outpatient clinic, hospital medicine, ED, and possibly some OB (still deciding). These jobs still exist.

 

[AFMD]

Mid-levels, in my experience, aren't very interested in primary care. They make more, and arguably have more utility, in specialty settings. I know less about the ED, but there are plenty of outpatient and hospitalist jobs for family trained physicians everywhere I'm looking in the West.

 

[angeloss2766]

Thanks everyone for you responses. This really helps. I have been torn between FM and ER. One of the things that has made it hard with FM is that, here in southern Ohio, mid levels have control of primary care. Most of the docs here think primary care is being taken over by NP because that is all that is here, which in there minds is making Family doc less marketable. Mainly because NP are cheaper. Hearing what you guys have to say about this makes me feel a lot better. So thanks again.

 

[TableMD]

Thanks everyone for you responses. This really helps. I have been torn between FM and ER. One of the things that has made it hard with FM is that, here in southern Ohio, mid levels have control of primary care. Most of the docs here think primary care is being taken over by NP because that is all that is here, which in there minds is making Family doc less marketable. Mainly because NP are cheaper. Hearing what you guys have to say about this makes me feel a lot better. So thanks again.

My mother is an NP. When I spoke to her about quitting my job and the long road to med school, she was on of the biggests advocates of med school and going that way, as opposed to the shorter route to becoming an NP. The knowledge needed to function as a physician is daunting.


The reason there are NPs in Ohio is an inability to recruit primary care physicians. Its the same thing that allows family docs to work in EDs. The fact that EDs have FPs doesnt mean we are taking over the ED, it means they cant staff it with a board certified EP. If you like family med, then do jt with the knowledge that you can work in any city you want, with the understanding that an uber diserable place will likely have a higher cost of living and a pay cut. Raw numbers - ill be in a nice metro, great amenities, near family 220 w/ 100k loan repayment plus production bonus. NYC id be looking at 180 (no thanks), higher if urgent care (not for me).

ED pays more but you earn the difference in my opinion (hours, acuity, circadian rhythm, etc). ED also has excellent job opportubities all over US, from what I can tell perusing the ED board and my buddies who finished EM residency.

Take job availibilty oput of the equationand ask, do you like continuity, prevention, chiseling away at problems over time, or do you like the adrenaline of stabilizing a sick, crashing person. To me, the multitasking and triaging and management of multiple complicated sick patients simultaneously is a recipe for an unhappy professionally life, but my friends who do it live for it. Apples and oranges. Good luck. Remember that the specialist who dumps on primary care probably exists in an ivory tower and doesnt interact with us.

My mom would be the first person to tell you that as an NP, its more desireable to have a deeper knowledge in a narrower scope (ie cardiology)

 

[Ericslv]

If you have your heart set on working the ED for that long then do an EM residency. It would be too hard to go back into outpatient IMO. Too hard to keep up on all the medication changes in psych meds and bp meds, etc. What the new insulins are and other diabetes meds. I have been out of outpatient care for 6 years and know that I am not up on all the new regulations and recommendations, etc. since switching to urgent care exclusively but that's what I like.

Wouldn't just a review course fix all of that?

 

[cabinbuilder]

Wouldn't just a review course fix all of that?

I guess, if one was motivated????. Not for me.

 

[deleted87716]

Wouldn't just a review course fix all of that?

Most review courses are for Board review, not to bring somebody who hasn't been practicing for years back up to speed. I took a Board review course this year, and it was like drinking from a fire hose. It would've been useless to somebody who was trying to re-enter the primary care workforce.

My recommendation would be some sort of supervised practice for a while, along with a helluva lot of studying.

 

[cabinbuilder]

Most review courses are for Board review, not to bring somebody who hasn't been practicing for years back up to speed. I took a Board review course this year, and it was like drinking from a fire hose. It would've been useless to somebody who was trying to re-enter the primary care workforce.

My recommendation would be some sort of supervised practice for a while, along with a helluva lot of studying.

Thanks for this. It's what I wanted to say but refrained.

 

[betamale]

HI, Im a 3rd year DO medical student that is highly considering Family Medicine because of all the possibilities with the training. I am finishing my last rotation before board studying and it happens to be ER, which I also really like. All of the ED docs and internists have been telling me not to do FM because of how NP are taking over primary care and they are more marketable than a FM based on cost. My problem I am having is that I like and want to do everything. So initially I was thinking that I could do FM and maybe work in the ED for a few years, then work in an outpatient setting later on. My father who is an ED doc said that FM docs in the future while be squeezed out of the ED with maybe the exception with a few rural towns. The IM docs were telling me that all the NP will take the outpatient jobs. So where does that leave me in FM? Where is it going in the future with FM? I'm just worried because I like FM and I am attracted to all the possible routes, but also nervous to go into FM if they are being squeezed out. Also, would it be possible to work in the ED near bigger cities like Pittsburgh or Columbus if you FM? Is it realistic to think that I could work in a ED for 10 years then do outpatient?

Yes, I get offers for ER in Pittsburgh, Columbus, Cleveland, Indianapolis, Toledo... I am FM-trained. There are ER fellowships for FM docs in Ohio, Pennsylvania, Indiana, West Virginia if that's a place you wanna go.

 

[Ericslv]

Most review courses are for Board review, not to bring somebody who hasn't been practicing for years back up to speed. I took a Board review course this year, and it was like drinking from a fire hose. It would've been useless to somebody who was trying to re-enter the primary care workforce.

My recommendation would be some sort of supervised practice for a while, along with a helluva lot of studying.

I think if someone has kept up with the reading on the core concepts they will be able to re-enter but if they have not and have been doing administrative medicine then it will be much harder.