Family Medicine is NOT a backup!

[jackieMD2007]

I am starting to get really irritated about this. I understand that this is part of the deal with FM and some docs look down on it and make nasty comments but I am really over the rudeness.

When I was first asked by some advisors what I was going into and I told them I was going to go into family medicine they started the "why don't you do med-peds" song and dance. Like I hadn't looked into it, talked to residents, etc. I had already decided on family medicine--I wasn't ASKING them, I was TELLING them. There are a few other instances where I was told that I am "wasting my life" and once I got to the department of FM at my University life was better.

Ugh! Whatever.
/end rant

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[rachmoninov3]

Amen sister!

Let's see...family medicine give me continuity, variety, inpatient and outpatient and OR, as well as getting me out of this damn city!

I get to find the reason for patient A's acute renal failure while at the same time managing a labor or two up stairs, and talking to the parents of the kid who we're bolus-ing in the ED b/c of a viral gastritis...all in at least two different languages!

So why is it that the person who knows everything to know about the eyeball gets paid mad $$$ and is considered smarter? How boring. You couldn't pay me enough to do optho (or some similar specialty).

 

[deleted87716]

I love threads like this.

 

[jackieMD2007]

Hey Rach:

I know, right? Being a family doctor IS the kind of doctor I had always thought I'd be and when I went through third year and liked medicine, pediatrics, ob/gyn---I didn't know what to do--and then I found FM!

I think it takes a lot of personal discipline to be a good FM doctor with all of the things we are going to need to stay current on, but I am up to the challenge. All of the variety, the chance to impact whole families, being there for people who traditionally have no health care at all--yes, please. Every group in medicine has their patients that are difficult and their bad days. But people refer to their family doc as "my doctor."

Other specialities may minimize family medicine and think we are "not important" but I don't need other (non FM) doctors to validate my intellectual ability or my worth as a clinician. What matters is my patient. What my patient thinks about me. And the quality of care I am able to provide.

Here's another gem during our CV review:
Dr. X: "Wow, this is a lot of research experience."
Me: "Uh-huh."
Dr. X: "Have you thought of Derm or Rads?"
Me (boiling, furious): "Excuse me, I have to go to the bathroom"

I am not going to get RUDE with these people!!

 

[Shaman11]

Great thread.

I should update my status, as Im a 2nd year med student. Rarely post since trying to survive and focus on the task at hand. I had an amazing experience over the summer doing an externship with a family doc. It fired me up and helped me realize why I am enduring all the difficulty of medical school.

 

[rachmoninov3]

Great thread.

I should update my status, as Im a 2nd year med student. Rarely post since trying to survive and focus on the task at hand. I had an amazing experience over the summer doing an externship with a family doc. It fired me up and helped me realize why I am enduring all the difficulty of medical school.

This externship wouldn't be called PIE would it? At my school we do an externship the summer between MSI and MSII. I'm so glad that you are interested in family medicine. Next year will be a challenge for you considering all the specialties you'll get to see. I hope you'll still feel the same about FM.

Luckilly (unluckilly for this thread) my school is very FM friendly and something like 20% of my class is going into FM. So I haven't seen the same amount of anti-FM sentiment that you have had to put up with Jackie.

Where are you looking to match? I'm going the unopposed route, which in theory would have less of the "FM is a back-up" mentality. Of course, I'm sure that is everywhere.

 

[jackieMD2007]

Hey Rach,

Pretend to be interested in internal medicine (aka "Capital M medicine" ) to get other docs' real thoughts on family medicine docs.

A key question to ask people is: How are the FM residents treated on non-FM rotations?

Get ready because there are a lot of crappy opinions from other docs re: Family Medicine. I wish it wasn't this way. I have talked to a lot of other students about the negativity and we all just have to get over it.

Part of the problem is that there aren't enough super-qualified US grads picking family medicine, so it becomes a "backup" for people. The other thing is that there are a lot of DO's that choose Family Medicine (and thank god) and there are a lot of people with the still-really-ignorant attitude that DO's are less somehow than MD's. If you haven't already thrown up in your mouth a few times, the next thing pointed out is the number of FMGS/IMGS in family medicine.

You would think then, that people would be totally PUMPED that qualified US MEDICAL GRADS are picking Family medicine. And to their credit, a lot of people are. But there are a lot of "have you thought of med-peds" and "what about internal medicine?" and "you're wasting your life!" sayers.

 

[senseiturtle]

Last year, 3 of my school AOA's went into family medicine.

The only person who stayed for medicine scrambled into the position after failing to match in surgery.

This year, 13 / 110 are doing FM. Many staying for the home program, but qualify for whatever they would choose.

To imply that its dead just proves the short sighted idiocy of many internists.

 

[hippiedoc13]

Hey Rach:

I know, right? Being a family doctor IS the kind of doctor I had always thought I'd be and when I went through third year and liked medicine, pediatrics, ob/gyn---I didn't know what to do--and then I found FM!

I think it takes a lot of personal discipline to be a good FM doctor with all of the things we are going to need to stay current on, but I am up to the challenge. All of the variety, the chance to impact whole families, being there for people who traditionally have no health care at all--yes, please. Every group in medicine has their patients that are difficult and their bad days. But people refer to their family doc as "my doctor."

Other specialities may minimize family medicine and think we are "not important" but I don't need other (non FM) doctors to validate my intellectual ability or my worth as a clinician. What matters is my patient. What my patient thinks about me. And the quality of care I am able to provide.

Hang on to this attitude through residency. These are the same reasons I chose FM, and the same things that keep it interesting and gratifying every day. I'm glad to know that people like you are choosing our field.

 

[EdibleEgg]

Last weekend I was working in the ED and I had a couple of great cases. When there was a calm moment, I thought," Wow, this is great, I really should've done an EM residency. Later that week I extubated a really sick CHF/pneumonia patient and thought, I should have done critical care. Today I did sixteen polypectomies on a 53 year old that was very resistant to having a colonoscopy, and doing a GI fellowship seemed really appealing.

On second thought... I'm pretty happy with family medicine.

 

[rachmoninov3]

Hey Rach,

Pretend to be interested in internal medicine (aka "Capital M medicine" ) to get other docs' real thoughts on family medicine docs.

A key question to ask people is: How are the FM residents treated on non-FM rotations?

Get ready because there are a lot of crappy opinions from other docs re: Family Medicine. I wish it wasn't this way. I have talked to a lot of other students about the negativity and we all just have to get over it.

Part of the problem is that there aren't enough super-qualified US grads picking family medicine, so it becomes a "backup" for people. The other thing is that there are a lot of DO's that choose Family Medicine (and thank god) and there are a lot of people with the still-really-ignorant attitude that DO's are less somehow than MD's. If you haven't already thrown up in your mouth a few times, the next thing pointed out is the number of FMGS/IMGS in family medicine.

You would think then, that people would be totally PUMPED that qualified US MEDICAL GRADS are picking Family medicine. And to their credit, a lot of people are. But there are a lot of "have you thought of med-peds" and "what about internal medicine?" and "you're wasting your life!" sayers.

I really like your "key question" and will be good to ask during the upcoming interview.

hope to see you on the interview trail!

 

[indynshrty]

Even though I'm doing peds..I thought about family medicine.

I think it's great that you guys are interested in it I just don't like internal medicine enough to want to do it.

And let's face it...there's good and bad doctors in EVERY specialty

Cheers and yay for Family Medicine

 

[jackieMD2007]

I really like your "key question" and will be good to ask during the upcoming interview.

hope to see you on the interview trail!

Absolutely! PM me if your schedule puts you in the Middle West!

 

[tootsweet]

Last weekend I was working in the ED and I had a couple of great cases. When there was a calm moment, I thought," Wow, this is great, I really should've done an EM residency. Later that week I extubated a really sick CHF/pneumonia patient and thought, I should have done critical care. Today I did sixteen polypectomies on a 53 year old that was very resistant to having a colonoscopy, and doing a GI fellowship seemed really appealing.

On second thought... I'm pretty happy with family medicine.

Story of my life as I go through my residency rotations....I'm SO glad I chose family medicine!

 

[DaveinDallas]

Interesting conversation with some attendings today.....on a pedi rotation this month and I'm the one off-service intern.....

After two of the attendings found out I was 'The Family Intern', they both commented that they can't understand why we don't get paid more since we have a whole lot more that we're responsible for in terms of spectrum and information......

 

[VLAStudent]

GREAT thread! I am glad to read that there are other students like me feeling conflicted because they love family med but hear so many negative things about their choice. I don't visit studentdoctor.net very often, but signed on today looking for more info as I prepare for residency interviews. Excited to find this- I'll have to sign on more often!

 

[scharnhorst]

if anyone who is familiar with military aviation its like this

while we have unlimited defence budgets we can afford to have "specialized" aircraft for strike/recon/air superority and ground attack

but when military budgets turn dry we have to rely on multi-role combat planes to do all these tasks, even though the specialized aircraft may be better at doing any individual task.

unfortunately in health care we always want the "best possible care for our loved ones" a doctor who focuses on prostate all his life will be able to provide that better than a doctor who deals with all other organ systems.Thats why people want to bypass the family doc to get to the specialist right away.Its like calling a A-10 to take out a toyoto pickup.Or a su-27 flanker to intercept a pipercub

 

[deleted87716]

in health care we always want the "best possible care for our loved ones" a doctor who focuses on prostate all his life will be able to provide that better than a doctor who deals with all other organ systems.Thats why people want to bypass the family doc to get to the specialist right away.

And yet, who is more likely to spend the time talking to the patient about the pros and cons of PSA testing, instead of just reflexively ordering it?

Me, not the f'in urologist.

"Best care." Bah...in a pig's eye.

 

[EdibleEgg]

if anyone who is familiar with military aviation its like this

while we have unlimited defence budgets we can afford to have "specialized" aircraft for strike/recon/air superority and ground attack

but when military budgets turn dry we have to rely on multi-role combat planes to do all these tasks, even though the specialized aircraft may be better at doing any individual task.

unfortunately in health care we always want the "best possible care for our loved ones" a doctor who focuses on prostate all his life will be able to provide that better than a doctor who deals with all other organ systems.Thats why people want to bypass the family doc to get to the specialist right away.Its like calling a A-10 to take out a toyoto pickup.Or a su-27 flanker to intercept a pipercub

I don't know much about military aviation, but this isn't a very good analogy.

 

[GoodmanBrown]

unfortunately in health care we always want the "best possible care for our loved ones" a doctor who focuses on prostate all his life will be able to provide that better than a doctor who deals with all other organ systems.Thats why people want to bypass the family doc to get to the specialist right away.

I agree that some people think like this, but isn't there substantial evidence showing that one doctor who sees all aspects of the body has significant advantages? Thereby avoiding the cardiologist ordering one thing for the heart, the nephrologist ordering something for the kidneys, the pulmonologist ordering one thing for the lungs, etc. and having all the medications and interventions interact in bad ways.

 

[rachmoninov3]

while this looks like a problem that can only be solved on an attending to attending level, let me add this:

Every specialty sees things through their own eyes. In the words of my beloved grandmother, known as nurse hellcat in her day:

"A specialist only sees things from his point of view. A generalist tends to see everything, including the patient's point of view."

 

[lowbudget]

if anyone who is familiar with military aviation its like this

while we have unlimited defence budgets we can afford to have "specialized" aircraft for strike/recon/air superority and ground attack

but when military budgets turn dry we have to rely on multi-role combat planes to do all these tasks, even though the specialized aircraft may be better at doing any individual task.

unfortunately in health care we always want the "best possible care for our loved ones" a doctor who focuses on prostate all his life will be able to provide that better than a doctor who deals with all other organ systems.Thats why people want to bypass the family doc to get to the specialist right away.Its like calling a A-10 to take out a toyoto pickup.Or a su-27 flanker to intercept a pipercub

No clue what was just said.

But, the next time patients, insurance companies, specialists asks me why I'm referring the patient, I'm busting out this analogy.

 

[scharnhorst]

I don't know much about military aviation, but this isn't a very good analogy.

why ?
thats why doctors are squares

 

[scharnhorst]

No clue what was just said.

But, the next time patients, insurance companies, specialists asks me why I'm referring the patient, I'm busting out this analogy.

thanks I have used something like this in real life with a patient who wanted a "specialist" for everything, he was a USAF veteran he burst out laughing !

 

[danielmd06]

What a nifty thread! It's refreshing. And it cheered me up after a tough afternoon clinic.

I'm extremely happy with my own residency and fellowship selections, and I guess that's part of the reason I enjoyed reading these posts. Happy people tend to enjoy seeing others be happy.

Life is too short to do something you don't want to do, and I think too many medical students behave like lemmings...they just blindly follow where others are leading. Props to you guys for being true to yourselves and not playing follow-the-leader!

 

[deleted87716]

The problem is that when the FP orders the PSA they are not always using evidence based standards to follow up with the result. In my interactions, many have no consistent point at which they refer patient's for biopsy or evaluation.

I do.

My biggest problems have been patient's who follow up with their FP's following a radical prostatectomy. Often the patient's PSA continues to rise and when it gets to 1 the FP says go see the urologist

Any FP who is following PSAs on patients with a history of prostate CA when there are urologists available is an idiot. That's way too high risk.

Screening and CA surveillance are two completely different things.

 

[jackieMD2007]

"A specialist only sees things from his point of view. A generalist tends to see everything, including the patient's point of view."

Love it Rach!

As for the urology argument that somehow involves the USAF here on my thread about Family Medicine as a specialty, I am staying out of this sidebar as it is not really what the thread is about. Go piss on Family Medicine somewhere else.

I'm glad this thread is cheering people up.

 

[osteohopeful09]

this thread has cemented my desire to go into FM, if it means anything to you guys. I just hope there are residency spots when I'm done in 3 years :-/......from the talk around other parts of these boards, the res. spots are gonna be terrible.....

 

[VA Hopeful Dr]

this thread has cemented my desire to go into FM, if it means anything to you guys. I just hope there are residency spots when I'm done in 3 years :-/......from the talk around other parts of these boards, the res. spots are gonna be terrible.....

You shouldn't let what other specialties say influence your thinking. Just because I say something like "OB/GYN residencies are soon going to be entire female" doesn't mean that its true.

There are plenty of strong residency programs that'll still be doing well in 3 years.

 

[MossPoh]

You shouldn't let what other specialties say influence your thinking. Just because I say something like "OB/GYN residencies are soon going to be entire female" doesn't mean that its true.

There are plenty of strong residency programs that'll still be doing well in 3 years.

I don't have anything to contribute really, but just thought I'd say that Dr. Who is awesome.

I guess I could contribute something, every speciality seems to put down other ones. It is what they do best. In the 60s, when my dad decided to enter radiology he was told it was a "waste of [his] talents" and he should've stuck with internal medicine or surgery. I've heard more than my fair share of family docs talk trash about specialists as well. It isn't exactly a one-way road. If you are truly confident in your decision and following what you love, those smug little comments should have no weight with anything you do. Who cares if they don't think it is tough or a backup? They aren't the ones doing so they don't have the faintest idea. If they are truly obnoxious about it, then you simply won't refer patients to them.

 

[Fredsgotslacks]

this thread has cemented my desire to go into FM, if it means anything to you guys. I just hope there are residency spots when I'm done in 3 years :-/......from the talk around other parts of these boards, the res. spots are gonna be terrible.....

What specifically is being said? In the Southeast it seems like family residencies are going strong unless there is something that I have not heard about.

 

[VA Hopeful Dr]

I don't have anything to contribute really, but just thought I'd say that Dr. Who is awesome.

I guess I could contribute something, every speciality seems to put down other ones. It is what they do best. In the 60s, when my dad decided to enter radiology he was told it was a "waste of [his] talents" and he should've stuck with internal medicine or surgery. I've heard more than my fair share of family docs talk trash about specialists as well. It isn't exactly a one-way road. If you are truly confident in your decision and following what you love, those smug little comments should have no weight with anything you do. Who cares if they don't think it is tough or a backup? They aren't the ones doing so they don't have the faintest idea. If they are truly obnoxious about it, then you simply won't refer patients to them.

This is definitely true. In fact, I didn't rank a program I interviewed with because, during my interview with the PD, he said some really nasty things about other specialties. Everyone has a role to play and we all think differently. A surgeon doesn't understand the way an internist thinks just like a radiologist doesn't think the same way that one of us does. Its OK and certainly not worthy of scorn.

 

[surag]

Question: how much money does fam practice make? And are you guys satisfied with the potential?

Also, I understand many of you are in residency-but wont the cases and everything change once you hit the "real world" and deal with paperwork etc? Why is there such a high dissatisfaction rate amongst fam practitioners? Is it solely salary or other factors involved? (paperwork, need to see x patients to cover etc?)

Also, if you guys got a Step score of 240+ and were AOA would you pick fam practice? ( i saw thread above about AOA but what about steps)

I just got accepted to DO school and I'm really interested in fam practice but want to understand all the pros and cons (cons right now ) of it. My cousin-retina ophthalmologist- is trying to dissuade me from it.

 

[thethom]

Also, if you guys got a Step score of 240+ and were AOA would you pick fam practice? ( i saw thread above about AOA but what about steps)

I did.

To practice QUALITY family medicine you should have at least a firm grasp on nearly everything. Takes a sharp person I think. Be careful of the "follow the leader" attitude mentioned above, rather than relying on someone else's scale of satisfaction, you need to determine if YOU will be satisfied in FM. You will learn whether or not FM is for you in rotations (its really just a combination of IM, peds, Ob/gyn). Could you see yourself treating ONLY adults, or ONLY kids, or ONLY women for the rest of your life?

Would you really be satisfied treating just the eye for the rest of your life? Would you be happy as a surgeon, in the hospital at 3am managing your post-op complications, when you're 55 years old and should be in bed with your spouse (I see it every time I'm on call (I'm still a resident), old surgeons, complaining about being in the hospital late at night and working so much at their age). Is it really worth making a little over 100k more? Who has to stay in or near the hospital for emergent caths and scopes in the middle of the night, Cards and GI...

If you like these things, then the aforementioned specialties are for you (extrapolate to other specialties as well).

Avg FM incomes (center for medicare and medicaid srvc website): https://www.cms.gov/AcuteInpatientPPS/Downloads/AMGA_08_template_to_09.pdf

Just think about it for yourself, not what someone else tells you you should be doing.

As for paperwork, you do the same paperwork as the attending in residency (or at least we do). FMLAs, prior auths, refills, referral letters, office notes, etc etc...Every specialty has to do this paperwork and see X number of patients to cover overhead.

As for dissatisfaction...I absolutely LOVE my job, love clinic (both FM and Sports clinic), and am bored and not intellectually stimulated on cards, gyn, derm, etc rotations.

There's a place for everyone.

 

[MLT2MT2DO]

Question: how much money does fam practice make? And are you guys satisfied with the potential?

Also, I understand many of you are in residency-but wont the cases and everything change once you hit the "real world" and deal with paperwork etc? Why is there such a high dissatisfaction rate amongst fam practitioners? Is it solely salary or other factors involved? (paperwork, need to see x patients to cover etc?)

Given I only have a pre-med, with 10 years+ of hospital experience, opinion but I've actually noticed the opposite. Family Medicine seems to have a higher job satisfaction than other specialties. This is of course anecdotal and from a small pool of doctors I interact with (n=<20).

 

[lowbudget]

Given I only have a pre-med, with 10 years+ of hospital experience, opinion but I've actually noticed the opposite. Family Medicine seems to have a higher job satisfaction than other specialties. This is of course anecdotal and from a small pool of doctors I interact with (n=<20).

I'm more dissatisfied that people are telling me that I'm dissatisfied, when in fact I'm not.

 

[crossled]

I am starting to get really irritated about this. I understand that this is part of the deal with FM and some docs look down on it and make nasty comments but I am really over the rudeness.

When I was first asked by some advisors what I was going into and I told them I was going to go into family medicine they started the "why don't you do med-peds" song and dance. Like I hadn't looked into it, talked to residents, etc. I had already decided on family medicine--I wasn't ASKING them, I was TELLING them. There are a few other instances where I was told that I am "wasting my life" and once I got to the department of FM at my University life was better.

Ugh! Whatever.
/end rant

What are your thoughts now?

 

[deleted87716]

What are your thoughts now?

10 years later…? FWIW, the OP hasn't posted on SDN since 2014.

 

[Postictal Raiden]

Most fields are potentially backup. A classmate of mine "settled" for ortho because he couldn't do integrated plastic. True story.

 

[slowthai]

Most fields are potentially backup. A classmate of mine "settled" for ortho because he couldn't do integrated plastic. True story.

What?? He should've just gone the GS route if he really wanted plastics, unless ortho was a close second and he wasn't willing to trudge through 5 years of gen surg.

 

[Postictal Raiden]

What?? He should've just gone the GS route if he really wanted plastics, unless ortho was a close second and he wasn't willing to trudge through 5 years of gen surg.

Yeah, the latter + no guarantees of matching plastics afterwards

 

[hallowmann]

Most fields are potentially backup. A classmate of mine "settled" for ortho because he couldn't do integrated plastic. True story.

I think the point is that there are genuinely people who want FM. This is the case for a couple fields, but the general mentality of a lot of people is that the ONLY reason you'd do FM is if you were forced to because it was your backup or you had no other choice. There are plenty of people who go into FM because (surprise surprise) it was their first choice.

 

[KeikoTanaka]

if anyone who is familiar with military aviation its like this

while we have unlimited defence budgets we can afford to have "specialized" aircraft for strike/recon/air superority and ground attack

but when military budgets turn dry we have to rely on multi-role combat planes to do all these tasks, even though the specialized aircraft may be better at doing any individual task.

unfortunately in health care we always want the "best possible care for our loved ones" a doctor who focuses on prostate all his life will be able to provide that better than a doctor who deals with all other organ systems.Thats why people want to bypass the family doc to get to the specialist right away.Its like calling a A-10 to take out a toyoto pickup.Or a su-27 flanker to intercept a pipercub

Except they thought it was their prostate and turned out to be colon cancer and they just wasted a specialist's time and money and spent more time waiting for a urologist appointment and now needs to wait 2 more months to get in to see a GI because they wanted to "bypass their PCP" - How'd they know they had a prostate problem in the first place? Oh wait, they spent 2,000$ on an ED visit to get pumped with radiation rather than 25$ and a blood test with a finger up their butt and a mere swab of the poo to get them to the right doctor sooner for 1975$ less and reduced risk of further GI cancer. Great medicine. Call in the nuclear bombs, we have people attacking us with rafts.

 

[scharnhorst]

I don't know much about military aviation, but this isn't a very good analogy.

precisely as you do not understand the analogy