Family Medicine not good for family?

[mucus]

Hi everybody,

I am new to the site, but have a burning question. I am an MS4 who was totally set on ER until I started doing my ER rotation this month and realized I really like doing procedures, but I like managing and following patients over time, not just triaging. As such, ER is out and now I am trying to decide between Anesthesiology and Family Medicine.

A little background - I am a HUGE family man, with four kids and a wonderful wife. Suffice it to say that time for my family is by far the highest priority for me in choosing a specialty. At the same time I would like to enjoy what I do. I love working with people and feel I would really enjoy family medicine, but I am really worried about hours per week, being on-call, and being tied to your practice with limited ability to take vacation - especially since I would like to practice in a smaller town. I've seen lots of posts about the variability in practices, but I have to think that realistically it must be difficult to not take your share of call on weekends/nights, and very difficult to take vacation unless you are in a large group or HMO in which case it would be more difficult to have a flexible schedule and control over your own hours.

So even though I think I would enjoy family medicine a little more than Anesthesiology (don't get me wrong I think I will enjoy Anesthesiology - I would just miss Pt contact), given the overall package of family time, predictable schedule, and vacation hours, I am leaning toward Anesthesiology. Also, whenever I mention Family Practice, my wife cringes because she knows several FPs and their families suffer because they are so tied to their jobs and everything revolves around their schedule.

Please help with any insight regarding family life in family medicine.

P.S. Money is not really an issue for us as we both come from poor families and anything over $100K per year is way more than both of us are used to and would be plenty in paying off loans.

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[pockey]

In larger cities, the trend for FP's now is heading towards practicing in a large group, where admissions go to a hospitalist that is contracted with the IPA. So your call is basically home call, not very often, and consists only of telephone triages. Also, working 4 days a week is very common, thus giving you a 3 day weekend every single weekend. Not bad at all.

 

[dr_almondjoy_do]

http://fmignet.aafp.org/real.html#time

Hey check out this link. In it you will find alot of information on the real life of FP and how other FPs conduct a practice.

Hope it helps!

 

[VentdependenT]

You will rarely follow patients as an anesthesiologist (unless you specialize in CC). If long standing patient interaction is the crux of your interest in medicine then you may be disappointed. There is plenty of demand for gas doc's in smaller communities however and you may be suprised at the "quality of life" that these physicians have in that setting. Rotate rotate rotate.

Always keep your EM experience in the back of your noggin when rotating at other places. Compare and contrast constantly. Once match rolls around you'll be glad you did. Of course FP's cool if thats what you want.

Vent

By the way, although your patient contact is brief and focused in anesthesia it is often very intense and satisfying. Keep that in mind.

 

[Willamette]

Also, remember that YOU are ultimately in charge of your own schedule. This means that when you want to go on vacation, you don't have to schedule anyone for those 1-2-3 weeks. Most places that you might practice are fairly close to a hospital (at least a small one) and your patients can visit the ED in the event of an emergency. Finding someone to cover your OB call may take a little ingenuity, but it's certainly doable.


Willamette

 

[Apollyon]

Most places that you might practice are fairly close to a hospital (at least a small one) and your patients can visit the ED in the event of an emergency.

To rip off docB: I'm a very expensive and very bad primary care doc.

 

[Willamette]

To rip off docB: I'm a very expensive and very bad primary care doc.

But great in a pinch, no? An emergency qualifies as a pinch in my book. The point is, FP is largely ambulatory and the Family Doc is in control of how many patients s/he sees and when s/he sees them. Nowadays, FPs/GPs rarely find themselves as the SOLE provider of healthcare for an entire community. As such, it really shouldn't be that difficult to find someone to cover your inpatient/ob duties when you take a vacation (especially since they too will need someone to cover for them when they need a break). A full and satisfying family life should be a requisite part of any FP's life, and as we all know: one can always make time for the things one finds most important.


Willamette

 

[Carm]

That is a really good question Mucus. I am trying to make the exact same decision right now between the two specialties. From what I have heard from both camps is that you cannot go wrong either way. Like others have said "You can make it what you want." The fact that money does not play a huge role in your decision makes things simpler for you. This is a real simplification but these are the major factors of each for me.

Family Practice - A "real doctor". Probably what many of us thought of when we heard doctor before school. Plays an integral part in the lives of patients. Interacts with patients over the course of both your and their lives. If you plan on living in a small town, this can become even more personal. There are small town doctors who are delivering the babies of babies they delivered 23 years ago. I have heard of doctors being asked to officiated weddings of pts they have taken care of for years. You have the opportunity to become a part of your community in the role of physician. There are so many other positives with FP, but the relationship role seems to be the forefront for me. However, that same trait could be looked at as a D/A as well. If you become very involved and personal with your pts and community it makes taking vacation and not taking call harder. Having lived in a small community, I know what a role an FP plays and what a sense of responsibility they feel being one of few health care providers for the community. This since of responsibility often drives them to make personal sacrifices. This is going to be different from person to person, but I could see this being an issue for me personally.

Anesthesiology - Also a great field. There is not the continuity of care, nor the image of "traditional doctor." As far as family goes, it seems to be great as well. People get themselves boxed into a corner b/c they want (and understandably so) to max out their earning potential. If you are willing to to seek 65-75% of your potential you could pretty much structure your practice to fit any lifestyle you would want for your family. Even if you want to work 100% full time and max out your potential in anesthesia, it seems to be a nice lifestyle. You make more as a general rule in gas, so you could scale back your hours, days, etc to fit into your picture. It also seems easier to take time of in blocks (kids summer vacation time) b/c you do not have continuity of care with your pts. There are also lots of +'s to the field of gas, but I just wanted to share some of the "family issues" of both FP and gas since that was the thread.

There will be people who run down both fields. Explore them both, talk to doctors of each in an area you could see yourself living, and make an informed decision. As long as you keep family first, you cant go wrong

 

[spartanburg]

If you're wanting to practice in a small town with few physicians, you're going to have a problem with long hours whether you're an anesthesiologist or a family doc. It's a simple supply and demand problem. Too many patients, too few docs.

If you're interested in having a family life, you're gonna need to live in a mid-sized town or a small city. Remember that as a family doc, you can work in a walk-in-clinic with no call and 40 - 50 hour weeks. I know a resident who was offered such a job starting at $160k per year in Knoxville, TN for a forty hour week. If he worked 50 hrs a week he would make ~$200k per year. That's more than enough to keep food on the table and a roof over the heads of a wife and four kids.

If you do family practice, it's one year less of residency than anesthesiology. That one year is precious, because the number of years you have children in your house is limited, and residency does NOT let you have any control over your schedule.

Family Practice is versatile... if you wanna work in a walk-in-clinic you can, and then a few years later if you wanna do ER you can, then you could switch to a regular practice... e.t.c. You've got lots of options.

Whether you choose FM or Anesth., I would suggest living in a town of at least 50k people so that you won't be the only doc in town.

Hope that helps a little.

Family Practice PGY-I

 

[dr_almondjoy_do]

Also, don't forget that as an FP you can moonlight in alot of rural and even suburban (level 1 or 2) hospitals for extra hours. And there are always school physicals and sports clearances that can be done in the off time at a school district. You can do all this and still work on building a private practice.

I feel that as an FP you have more autonomy than an Anesthesiologist as far was what you would like to do. I'm currently doing my surgery clerkship, and to be honest, the aneth. looks bored at times, especially when there is a long procedure to sit through. I guess it depends on your personality. They do get paid more initially than the FP without having to be creative....

 

[ERMudPhud]

But great in a pinch, no? An emergency qualifies as a pinch in my book. The point is, FP is largely ambulatory and the Family Doc is in control of how many patients s/he sees and when s/he sees them. Nowadays, FPs/GPs rarely find themselves as the SOLE provider of healthcare for an entire community. As such, it really shouldn't be that difficult to find someone to cover your inpatient/ob duties when you take a vacation (especially since they too will need someone to cover for them when they need a break). A full and satisfying family life should be a requisite part of any FP's life, and as we all know: one can always make time for the things one finds most important.


Willamette

There isn't much that pisses us off more in the ED than a PCP who goes away and just leaves a message on his answering machine to go to the ED. We end up getting med refills, chronic complaints that just need their hand held , and no way to give you follow up on your patients. Plus, it just doesn't look very responsible to us or your patients. On the other hand if you are good about arranging coverage for you outpatients we and your patients will recognize you as a conscientious PCP and refer all sorts of paying customers your way.

 

[Willamette]

There isn't much that pisses us off more in the ED than a PCP who goes away and just leaves a message on his answering machine to go to the ED. We end up getting med refills, chronic complaints that just need their hand held , and no way to give you follow up on your patients. Plus, it just doesn't look very responsible to us or your patients. On the other hand if you are good about arranging coverage for you outpatients we and your patients will recognize you as a conscientious PCP and refer all sorts of paying customers your way.

So is every EM guy that chimes in going to miss my emphasis on "EMERGENCY?" I am in NO WAY advocating the use of the ED as a replacement for primary care. It's a crappy way to do things, and it's not your job. My post was not intended as the "end-all, be-all" for arranging one's practice to run smoothly while you're away. Rather, I was pointing out that the "full-spectrum" FP's would rest easier knowing that IN AN EMERGENCY there are competent folks who can provide EMERGENCY coverage for their patients. The ED does still do that right? <--meant to be "tongue-in-cheek"


Willamette

 

[Apollyon]

So is every EM guy that chimes in going to miss my emphasis on "EMERGENCY?"

Umm...yes? And then kinetic will say something, juddson will also chime in, and some tool with <50 posts will say something holier-than-thou.

That's normally how it goes.

The gulf comes between what we know as an emergency, and what patients consider same. If the only option is the ED, then everything is an emergency. It's like the cities that ONLY have 911, then complain about the lines being clogged. Give people an option for anything less urgent, and most people will use it appropriately.

 

[Willamette]

Umm...yes? And then kinetic will say something, juddson will also chime in, and some tool with <50 posts will say something holier-than-thou.

That's normally how it goes.

The gulf comes between what we know as an emergency, and what patients consider same. If the only option is the ED, then everything is an emergency. It's like the cities that ONLY have 911, then complain about the lines being clogged. Give people an option for anything less urgent, and most people will use it appropriately.

Agreed. On all counts.

I think it would make good sense to try to educate our patients about effective use of the health care "system" we have here in the states. This would include the conveyance of info as to just what constitutes an emergency, and what can really wait. Of course, even for physicians, this line can become somewhat blurred and a workup is in order to r/o urgent and emergent situations (that's just part of the game).

As far as refills and such go, it seems that the clever FP would have two good ways of dealing with them. First of all, if the FP has a partner (another FP, or a PA) it would make good sense to NOT be on vacation at the same time. This way, last-minute script writing doesn't become an undue disturbance because your partner can cover for you. Alternatively, the solo FP would do well to devise an email system of contact that s/he can visit once every day or so, and thus get that advair refilled in time for Billy to go to band camp. If this email system was integrated with a website, it would also be a great tool to help the newly christened parents of a bouncing-baby-girl figure out if that fever is something requiring medical attention, or if maybe they should just give tylenol and see how things progress first.

Anyway, enough blabbering for one post.


Willamette