Family Medicine

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I am kind of torn between Family Medicine and Internal Medicine. I was wondering if anyone could help me with the pros/cons of each. I like the flexibility of Internal Medicine, however I am pretty sure I want to do primary care, in which case I feel Family medicine may afford me better training for procedures such as sigmoidoscopy, OB/Gyn procedures, vasectomies, etc.
Also, I was wondering if anyone knows of any websites that give some info regarding the Sports Medicine Fellowships and how that may be incorporated into our practice. I have a pretty substantial background in athletic training so it definately interests me, however, I wonder if it greatly impacts the earning power of the physician.

Thanks for your time.
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search on www.aafp.org for acgme family practice fellowship programs. If you search around enough, you will find info on it.

As far as FP vs. IM, well each has its pros and cons. Each have some similarities. So do rotations in both and decide what you really like more. Just be warned of one thing. If you tell IM docs you're thinking FP, they shut FP down, and if you tell FP you're thinking of going IM they shut IM down. Just do what you really like and what makes you happy! :)

FP's definitely do more OB and PEDS but don't disregard IM for procedures, they can do many many many things and if you get into a strong IM program, you will do many procedures that are valuable.

Also, IM programs are starting to integrate more womens health into their programs than they have in the past. I have noticed that many IM programs are requiring their residents to do more gyn/womens health months than in the past.

I really do think though that when it comes to being a primary care doc, the biggest difference between FP and IM is personality. I can't explain it, you just have to see it for yourself but the personalities of FP's and IM docs really are different. Also I have noticed, oddly enough that FP's are more into, well family, and promote a healthy home and family lifestyle of their residents and attendings. That is not to say that you can't have a family if you do IM but FP's do seem to be more into it.
 
I'll add some things as well. My decision came down between IM and FP as well and I don't think I would have been unhappy with either decision. One thing about FP right now (although I wouldn't bet my whole decision on it, but it was a factor) is that you will pretty much go wherever you rank first. I think 13/14 people going into FP got their first choice out of my class this year. I don't know it this is good or an indictment of FP but it is the way it goes right now.
Additionally, and this is completely anectdotal so take it for what it's worth, but on my last rotation on the CCU which is ran by the IM team, some of the residents were talking about moonlighting at an urgent care center, but were a little leary of if b/c they didn't feel comfortable working with children and OB. I don't want to be like that.
The bottom line is that if I was going to do IM I wanted to be an intensivist, not a general IM doc who runs a clinic. My personal feeling is that IM overtrains you if you want to do just clinical stuff in some fields (i.e. burn units) but undertrains you in other areas which are obvious.
Finally, you will take some flak more than likely if you decide to do FP, which is a shame but you will be in competition with pretty much every service you rotate on except maybe surgery.
 
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my biggest draw to FP really is the variety - i really never know what I am going to see on a given day, and I don't have to turn anyone away. It's not to say that other specialties don't have variety, they do, but it's typically variety by disease, whereas I have variety by disease and age.

Also, people have a lot of competing demands on their time, and it isn't always easy for people to take a day off work to go see their doc...even harder when there are a few kids involved. There is nothing like that look of relief on a parent's face when I let them know not only can I see them, but their 2 or 3 kids too...it's one stop shopping, instead of a few potential days of lost wages (yes days...appointment times aren't always convenient and then there's that whole waiting room thing). I don't do Ob, but I still do some prenatal work - again, great opportunity to provide teaching/counseling to soon-to-be parents, and get a new patient (the baby) in the process.

Kids...men...women....old..young... it's awesome. I'm at an academic program, so making money hasn't been a real big concern to me. The hours are good and lifestyle is great even though i'm not making nearly enough as i would in private practice.
 
I practice as an fp doc however given all of the uncertainty in fp now, I would say do im. Your practice options will be better once you get out of training. Some may argue with that point but it is true.

Medicine in general, is in flux but fp seems to have been hit hard. Look at the Future of Family Medicine Project at www.futurefamilymed.org.

This is just my two cents

CambieMD
 
I totally disagree with cambie md. The fact that the aafp and others initiated the family medicine project means that the specialty is a solid one and dedicated to react and mold to the ever changing world of medicine. do you see IM and others doing similar projects? In fact, the family medicine project does not only apply to FP, but all specialties in a way and mostly all primary care specialties! All specialties can learn a little about the family medicine project. ask yourself if you want to be in a specialty who is pretending nothing is wrong or avoiding the mess in medicine or one that launches a 2 yr project to investigate and respond to these changes?

You should go with your heart and do what makes you the happiest. i chose fp for the variety. i can see kids, adults, soon to be moms, grandmothers, etc. i think its very rewarding! i can see pts in the office one day, cover the local er the next, round on the service pts the day after that and finish up in the office on friday! and i can tailor my practice if i want. when i get older if i didnt want to see ob pts or kids then i can just do adult medicine. check out the aafp.org site and look under the student tab.

oh and dont forget that alot of people go into IM b/c they want to do a fellowship later. so there can be some very stiff competition and cut throat colleagues who want to shine over you. i did a medical sub-i and the residents were so damn uptight and each one of them seem to have an agenda. then i did an fp elective. wow!! what a difference...night and day. alot more out going, friendly, and more laid back. it all depends on personality too.

good luck its not an easy decision but go with your heart!
 
I know I'll get a lot of crap for this one but.....

I just don't get how FPs can TRULY feel competent to take care of adults, kids and ob patients. How can an FP be even close to as qualified as an internist, pediatrician and an OB? 3 years of training to learn what those three fields learn in 10 years????

Don't get me wrong - FPs are friendly happy souls. The FP residents are FAR happier than any medicine resident I ever met. But VERY few FP residents have impressed me with their knowledge in the same way internal medicine residents have. Truthfully I'd rather have an internist take care of my parents and a pediatrician take care of my child.

I would tell whoever is struggling to decide what field to go into to consider a few things....
1) Would you feel competent with only 3 years of training to care for kids, adults, and ob?
2) Could you be happy only taking care of one of these groups? For me, I decided I could live happily without taking care of adults so I chose peds.
3) If procedures are a big deal for you, have you considered a medicine specialty?
4) If you know you will never do OB outside of residency - go med/peds! You'll be far better trained to care for kids and older adults than an FP. And you have the option to specialize if you want to.

Those are some of the things I considered going through my 3rd year and part of my fourth till I figured out peds was for me.
 
Noelle,

I don't think you have a good working knowledge of FM esp. when you use residents to judge the specialty. FM poularity is at a LOW point with US seniors and that likely thins out many of the brightest in the field that are in residency at this time. You also have worked with FP's at how many programs? Maybe one or two if you are still a fourth year.

If I judged FP on the few residents at the school I graduated from, rather than my current residency, I too would be leary of the knowledge base FP's developed. But I have rotated and worked with residents in over 10 programs and attendings at multiple private offices.

I think its possible for FP's to gain a sufficient base of medicine to treat peds, adults and yes, even OB. The skill comes in when knowing what you don't know and referring or consulting a specialist. And you don't stop learning once you get out of residency.

You do not mention the FM as a central basis for coordinating patient care, initial diagnosis and treatment and an ability to treat the whole family which is certainly cheaper than sending everyone all over creation to get medical care. This especially holds true in smaller communities.

And while your opinions focus on primary care, we could take your argument to the next level and ask why don't we skip primary care altogether. Mom has stomach upset, send her to GI. Little Timmy has an ear infection, let's go over to ENT and Dad has a wart, better get him to Derm ASAP.

I whole heartedly agree that FM should attract the brighter students that can master the breadth and depth of knowledge. Facts are that it often doesn't and health care can't hold up under the current sepnding unless you want all of your primary care coming from a NP or PA (which is okay under limited circumstances and half the mid-levels are going into specialties anyway). Most specialists like for their patients to have competent primary care (they don't care whether it's IM, Peds or FM) because they love to say, "You better follow up with your PCP for that".

So if you take this post as a blast, so be it. I think my response was more insightful and less harsh that your post. Good luck in Peds. As for my family, I would rather a good doctor take care of my family than just picking based on specialty.
 
I don't think I saw Noelle's comments as a blast necessarily...I think I share some of the same concerns. I am currently doing a GP rotatioin in England and it's made me rethink if I FP can address the more complicated issues of treating various age groups. FP is an EXTREMELY big field to cover; it's intimidating because of its breath, not to mention its depth. I am currently debating whether I want to do rural FP or go into peds. I respect the FPs that can truly do it all; it's such a practical specialty that you can look at virtually anyone. I am trying to figure out if I can live uncertainty in looking at my patients. Would I rather be an expert, aka go-to-guy, for things. It's difficult. I am going to spend some time in the rural area and see if it really is what I am hoping it will be. I also worry that if I am in FP that I will eventually just be a geritrician which is exactly what I don't want to be; pregnant and little ones are where my real interest lies, but FP is the only place where the two meet in a single specialty (I guess MFM does some of that too). If I could meet some of the legend FPs that can do it all, I think I'd be sold on FP; I look forward to that time.
 
Noelle said:
I know I'll get a lot of crap for this one but.....

I just don't get how FPs can TRULY feel competent to take care of adults, kids and ob patients. How can an FP be even close to as qualified as an internist, pediatrician and an OB? 3 years of training to learn what those three fields learn in 10 years????

Don't get me wrong - FPs are friendly happy souls. The FP residents are FAR happier than any medicine resident I ever met. But VERY few FP residents have impressed me with their knowledge in the same way internal medicine residents have. Truthfully I'd rather have an internist take care of my parents and a pediatrician take care of my child.

I would tell whoever is struggling to decide what field to go into to consider a few things....
1) Would you feel competent with only 3 years of training to care for kids, adults, and ob?
2) Could you be happy only taking care of one of these groups? For me, I decided I could live happily without taking care of adults so I chose peds.
3) If procedures are a big deal for you, have you considered a medicine specialty?
4) If you know you will never do OB outside of residency - go med/peds! You'll be far better trained to care for kids and older adults than an FP. And you have the option to specialize if you want to.

Those are some of the things I considered going through my 3rd year and part of my fourth till I figured out peds was for me.
Click to expand...


I agree with some of Noelles' point. I have limited my practice to mostly the practice of general internal medicine. The theory of fp is great but it does not work out that way in pracitce. Ob is such a land mind right now that obs are reluctant to deliver babies in some parts of the country.

The practice of medicine is ever changing. Thirty years ago one doc could have done it all. That model no longer holds. I can handle whatever walks through my door in terms of adult medicine. That is not the case for little people so I do not see them. Others may feel like they can do everything but I do not. I am essentially an fp doing what an im doc would do.

I see that there is some redundancy in what fp docs do and im docs do. The question that must be answered in years to come is should fp be maintained as it stands now of should it be modified. These statements sound like blasphamy to some but we must look at how things are and not how they should be.

I think that the concept of med/peds is nice. The truth is that most of these docs practice either medicine or peds. This is the era specialization. Technology is lengthening lives and also improving the quality of those lives. A few years ago severely ill seniors in resp failure were routinely made comfort care. Now, these types of patients are getting better and going home. Technology cost money. Can the system support paying physicians to counsel patients and coordinate care. I do not think so. In the future more patient care will be directed by patients themselves. For example a guy on a statin may go to a lab and have blood drawn. The result is processed via a computer. A message instructing the patient is mailed to him. He may pay a monthly fee for this service.

This may sound crazy but this is where we are going. Primary care physicians will be needed but the shortage being predicted will not pan out.

All of that said, I still say that im is a better bet for med students getting out of med school now. This is not an emotional issue for me. I am looking at this from a strictly business point of view. This may be an emotional for some of you but for the powers that be $$$ rules the day. I can hear some of you guys now"I became a doctor to help people screw that CambieMD."

CambieMD
 
cambie md... you talk about $$ alot. how have you increased revenue in your practice? do you round on your pts? procedures? you must have a good amount of pts if your not doing peds anymore.
 
i agree with newdoc2002. i mean no fp pretends to be a pediatrician, an internist and an ob/gyn. but, it is certainly possible to be comfortable in these areas if your dedicated to the speciatly and really learn as much as you can in residency and after. learning doesnt stop in residency like newdoc said. the majority of peds is high yield infectious disease...Otitis, enteritis, etc. For the most part kids are healthy....no copd, chf, dm, etc. but, the ones that arent so healthy should be refered out and thats exactly what happens. Same thing for OB. FPs dont do high risk ob for that very reason. But, the basics...hey yeah we can handle that. If the midwives in england can why cant we. And the midwives there are awesome...ive worked with them. But, again they nor do we (fps) pretend to be ob/gyns. in the world of ultrasound and technology these high risk moms can be screened and appropriately refered out. And not to mention mom does all the work we just facilitate!

ANd the whole fp resident thing. Come on you cant base an entire global specialty on a couple of residents you worked with. And who said as residents we know everything. Isnt that why we are residents? Oh and Ive seen some IM residents who scare me. why dont you ask them the next time you see them about a peds or ob question. you cant compare the medicine knowledge of an IM to an FP. sure the resident who does nothing but IM will have an edge. no shocker! So there are bad residents everywhere...in every specialty. The chair of IM and the chair of FP gave a joint meeting on the differences of the two and how to make the choice to a group of medical students at my hosp. It was awesome to hear the chair of medicine say " i think the smart people should do fp b/c its such a broad specialty and so much to learn". He also talked about how him and his wife take their kids to their fp. i thought that was great. and newdoc is right...dont you want to take your kids and family to a good doctor? and if that doc happens to be an fp then great! i think in medicine we all get a little narcisistic, but come on a good doc is a good doc no matter what the specialty is.

and remember this...just because you dont think you would be confident doing adults, pediatrics and ob/gyn medicine doesnt mean thats the norm. i have gone to some awesome fp's growing up. there are some very competent and confident fps out there that know their capabilities and limits. im certain i will always practice my specialty to the fullest. why??? because i like what i do and am busting my a** to learn as much as i can and stay current with journals, courses, and cme. and i wont let the paranoia of litigation prevent me from doing this either.

all in all we are all colleagues and fellow physicians. good luck to everyone whatever they may choice to practice!
 
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There was an article not too long ago about Boca Raton, which has the highest per capita rate of doctor's visits anywhere in the country. Senior citizens have taken to visiting various specialists almost as a form of recreation. When compared to other areas without many specialist visits and comparable populations, though, the health outcomes were almost exactly the same (a little worse in Boca Raton, if I recall).

This is where I could maybe insert the big sweeping generalizations about how FP's bound to be resurgent when people catch on to the diminishing returns in specialization, but I don't really care too much about that.

What I DO care about, as one planning on going into FP, is providing competent care for a wide range of people. No offense to you, Noelle, but I'm far more convinced of FP's broad utility by studies like this than I am dissuaded by anecdotal opinions. Sure, it's the era of specialization, but the evidence is mounting that that's not necessarily a good thing.
 
My Lord, you would think some of you were under the impression that it takes an internist to see every elderly patient, an OB to do routine deliveries, and a pediatrician to see every runny nose kid. I probably saw an average of 30 patients a day for 4 years straight in FM prior to leaving the PA profession and going back to medical school several years ago. I can count on one hand the number of times I had needed a pedi or an IM doc to bail me out with a patient. Lets face it, 99% of pedi stuff doesn't even need to be in the office anyway and could stay at home. We treat the parents more than the kids, but when the kid happens to be truly ill, the diagnosis is not usually all that difficult. Lets see, OM, Sinusitis, Bronchiolitis, RSV, Rota, Cpox, Roseola, Strep, Scarlet fever, Scabies, Eczema, Conjunctivitis. Anything much more serious than that and a pediatrician will be calling for a pedi-subspecialist as well. And as for elderly IM, can anyone say HTN, AODM, Hyperlipidemia, CAD, COPD, BPH, Overactive Bladder, OA, Gout, and all the other common elderly ailments....nothing real difficult there. Truth is, anything much more difficult than that and the internist is calling the subspecialist as well. The vast number of all primary care doctors are way too liberal with their referrals anyway because of the litigious society we are in.

You guys forget that until about 30 years ago, your family doctor was simply a GP who had done an intern year in some hodunk hospital somewhere, and they seemed to do just fine as well. They probably delivered many of you. In the city, it was rare to see an internist who even did well woman exams, so many patients like FP's because FP's are like one-stop-shopping. From my experience, a good internist is invaluable. But what I have seen is that many internists, like many FP docs, are only there because they could not do anything else, and thus one is no better than the other. A top-knotch FP doc can easily compete tit-for-tat with a sharp IM doc, and so what if they IM doc knows a few more zebras at the bottom of the differential list? When was the last time someone saw a pancreatitis that was caused by a scorpion bite? If I hear another IM resident pimp a med student over that BS I am likely to throw a chair or something!!! :)

Rural FP is where it's at!! Truly needed, and truly appreciated by the patients.
 
couldnt have said it better myself. you know its crazy these days...this is what the medical students are thinking these days! why? because this is what they are being told and taught. the referal thing is insanity. i mean i dont know how many times i just want to scream when im off service on a specialty rotation and get a consult for some bs that the IM resident didnt even bother to work up and order the basic tests. or if they did they didnt even wait for them to come back and they wrote "cardiology consult, gi consult". its sad and embarrasing if you ask me.

and this cookbook medicine is killing me too. i mean at my hosp we have "pathways" we put pts on...anything from chf pathway to pneumonia pathway. its rediculous. you just check a series of boxes and sign the bottom. not much thought process there!
 
PREACH!!...REVEREND...PREACH!!!...Wellllllll...Can I get a witnesssss!!!
The good Rev done SPOKE!!!!
As a board certified FP out in the REAL WORLD in private practice (the only thing I don't do is OB), all I can say, is that ignorant people like Noelle have a LOT to learn about real world medicine. I see all age groups in my office and in the hopspital, in the BIG CITY, and I don't see what I do in the office as being any different than my peds or IM counterparts in my area. The only difference is that they see a larger volume of a LIMITED population (IM's do mostly geriatric w/ some young adults, and peds do Newborn-17). The fact is that ALL OF US (IM, peds, and FP alike), see BREAD AND BUTTER stuff in the office on a daily basis with MAYBE 1-5% being "zebras". If EITHER of us get into a situation we cannot handle, we get a specialist consult/referral. In this litigious environment, it would behoove you to check your ego at the door and get the consult when needed. IM and peds are no different. They see the bread and butter stuff on a daily basis, and refer out when warranted.
One mistake y'all have to avoid is PLEASE do NOT confuse the world of residency with the world of privatre practice, cause they are 2 different worlds.
Oh, and of course, cambiemd will have a negative view of FP, Cambie, in previous posts you have expressed your desire to leave FP and chamge specialties (anesthesia, right??). FP is not what you thought it would be and has made you unhappy. And thats ok, cause you HAVE to do what makes you happy. So people when gauging opinions, consider the sources of these opinions. FP has problems...PLENTY OF PROBLEMS, so does all of medicine. EVERYBODY is taking a hit, and the liability issue affects everyone. So don't fool yourself thinking there is a medical utopia out there, cause it DOESN'T EXIST. I personally could never be a specialist, cause that would bore the crap out of me. I LOVE my variety and wouldn;t give it up for anything. PEACE!

-Derek

PACtoDOC said:
My Lord, you would think some of you were under the impression that it takes an internist to see every elderly patient, an OB to do routine deliveries, and a pediatrician to see every runny nose kid. I probably saw an average of 30 patients a day for 4 years straight in FM prior to leaving the PA profession and going back to medical school several years ago. I can count on one hand the number of times I had needed a pedi or an IM doc to bail me out with a patient. Lets face it, 99% of pedi stuff doesn't even need to be in the office anyway and could stay at home. We treat the parents more than the kids, but when the kid happens to be truly ill, the diagnosis is not usually all that difficult. Lets see, OM, Sinusitis, Bronchiolitis, RSV, Rota, Cpox, Roseola, Strep, Scarlet fever, Scabies, Eczema, Conjunctivitis. Anything much more serious than that and a pediatrician will be calling for a pedi-subspecialist as well. And as for elderly IM, can anyone say HTN, AODM, Hyperlipidemia, CAD, COPD, BPH, Overactive Bladder, OA, Gout, and all the other common elderly ailments....nothing real difficult there. Truth is, anything much more difficult than that and the internist is calling the subspecialist as well. The vast number of all primary care doctors are way too liberal with their referrals anyway because of the litigious society we are in.

You guys forget that until about 30 years ago, your family doctor was simply a GP who had done an intern year in some hodunk hospital somewhere, and they seemed to do just fine as well. They probably delivered many of you. In the city, it was rare to see an internist who even did well woman exams, so many patients like FP's because FP's are like one-stop-shopping. From my experience, a good internist is invaluable. But what I have seen is that many internists, like many FP docs, are only there because they could not do anything else, and thus one is no better than the other. A top-knotch FP doc can easily compete tit-for-tat with a sharp IM doc, and so what if they IM doc knows a few more zebras at the bottom of the differential list? When was the last time someone saw a pancreatitis that was caused by a scorpion bite? If I hear another IM resident pimp a med student over that BS I am likely to throw a chair or something!!! :)

Rural FP is where it's at!! Truly needed, and truly appreciated by the patients.
Click to expand...
 
Good Lord. Can we all say SENSITIVE? I am not confusing FP residents from FPs in the real world. I am at a school that practically shoves FP down your throat. I have not had good experiences with FPs personally and also with patients I've seen in various hospitals and clinics throughout my rotations. I can literally think of ONE good FP that I had to do my FP rotation with. My parent's current FP is the nicest guy in the world but blows off legitimate medical concerns and doesn't seem to be able to follow basic hypertensive guidelines. It seems to me that the teaching that I received (whether from attending or residents) while on my FP rotation was always so BASIC whereas IM teaching was included so much more THOUGHT. I'm currently rotating with a developmental pediatrician and she has cited multiple times that FPs have neglected to do basic developmental screens and have lead to years of delay in receiving critical services to kids. You are absolutely right - kids are pretty much healthy but I've seen and heard SO many stories of kids getting delayed care for conditions when being treated by an FP. The training for adult medicine is most likely adequate but 3 months of specific peds training??? Not for my kid.
 
Hey Noelle,

Any office can chart growth. Its not that hard. I'll man up enough to say that I feel an infant is best treated by a pediatrician, but after 2 years, there is really no need. All I can say Noelle is enjoy your many months in a peds office with your future kids. There is no place worse to hang out as a patient than a peds office. Everyone is screaming...everyone has a URI that needs no treatment but will soon leave with an antibiotic, and those who are well will undoubtedly have that URI in about a week!! There are cleaner urinals than some peds waiting rooms. At least if you go to an FP office there are only a few kids screaming, and only a few to spread the dreaded cold!!!

Take this from someone with 2 kids and who used to take them to a Pedi until I got sick of them literally pushing antibiotics even at well child exams where my kids only had allergy symptoms!!
 
Well I can tell you the FP I used to take my son to pushed the antibiotics worse than any other doc we ever had. And if you feel that plotting growth on a chart is all that is required to make sure a child is developing properly you have just proven my point.
 
Respectful as possible.........Noelle, your opinion would be better accepted if you were in a position to really understand the real world of medicine. You might be the smartest student ever but you are not "schooled" yet in this area. Tell us how you feel in about 4-5 years.
 
Noelle said:
The training for adult medicine is most likely adequate but 3 months of specific peds training??? Not for my kid.
Click to expand...

First of all, FP is not a 3 month block of peds. A FP resident FROM THE MOMENT HE/SHE ENTERS HER PROGRAM takes care of kids from newborn on up in a LONGITUDINAL manner. Yes, there are specific rotations, however, training in kids is a year round phenomenon due to continuity clinics, and the kids you follow regularly as part of your patient panel...capice??

And I will reiterate one more time, an FP in the PRIVATE PRACTICE world who sees kids functions no differently than a peds in private practice. You will see the SAME BREAD & Butter stuff on a daily basis. Anything funky GETS REFERRED OUT (for practical, financial, as well as MEDICO-LEGAL reasons). Don't think for one minute that a general pediatrician is doing anything special/exotic in the office (not in this capitated managed care world of ours), hell, most of the peds here in town don't even admit to the local hospital and turn their patients over to the hospitalist, so let us not fool ourselves. PEACE!!!

-Derek
 
It is amazing to me how bent out of shape people get when you diagree with what almost everyone else. The fact that I have expressed an interest in doing something other than fp several months ago does not invalidate my views.

Like I said before before, our profession is in trouble period. When I say our profession I mean the system of health care in the US. To be fair I suppose I cannot say that there isn't someone out there who can do it all. I said that I do not feel comfortable doing everything that I was trained to do. I stated that I limit the patient population that I see.

Also , on a previous post I mentioned that malpractice concerns has changed how medicine is practiced. Some fps have given up ob as response to rising insurance premiums. Yes, some fps perform deliveries but students should know that they may not be able to perform deliveries when they get out. Call coverage often pops up as an issue. Ob is a land mine. Simple deliveries can quickly turn into complicated problems.

Regarding peds, I prefer to see adults with "real pathology" I don't like runny noses that shouldn't even come to the office. I see a lot of htn,dm,asthma,cad and other asorted medical problems. This is what I prefer to see so I have geared my practice to this. It has worked for me.

I am not a guy who says certain things to get others upset. I have done a lot of reading in the area of medical economics I know what I am saying is correct. I have past trends to follow. Health care spending in this country is out of control. Cost containment was the main reason for the big push towards primary care.

The FFMP was created by several groups within fp to explore was to increase interest and insure the viability of fp.

It is easy to criticize someone for breaking ranks and dissenting.

Those who really love fp must find ways to increse interest among US med students and retain the physicians now in fp.

It is interesting that the first person fired by Trump was a physician. He was unable to adapt to changing circumstances.

I have come with all sorts of models that can be used to practice primary care. I do not know if they will work. Computer s and technology will reduce the need for some services and increase the need for others. In some ways the future can be exciting. The problem is a lot of folks continue to force round pegs in square holes. Instead of trying to keep things the way they are now the FFMP should investigate ways of providing primary care with less providers more efficiently.

User fees will probably be charged for certain services. I could go on and ....
My point is simply that we are trying to make a model that no longer is relevant work.

CambieMD
 
Cambie,

Great post! I'm a bit skeptical of your conclusions, but I really appreciate the experience and thought that led to them. Great discussion on both sides, and very helpful to those of us looking to go into FP.
 
The first guy got fired by Trump on the Apprentice because he was an idiot who assaulted people on the streets of New York harbor and tried to conjure them into buying lemonade. He was a freaking idiot!! :laugh:
 
Noelle said:
... I have not had good experiences with FPs personally and also with patients I've seen in various hospitals and clinics throughout my rotations. I can literally think of ONE good FP that I had to do my FP rotation with. My parent's current FP is the nicest guy in the world but blows off legitimate medical concerns and doesn't seem to be able to follow basic hypertensive guidelines. It seems to me that the teaching that I received (whether from attending or residents) while on my FP rotation was always so BASIC whereas IM teaching was included so much more THOUGHT. I'm currently rotating with a developmental pediatrician and she has cited multiple times that FPs have neglected to do basic developmental screens and have lead to years of delay in receiving critical services to kids. You are absolutely right - kids are pretty much healthy but I've seen and heard SO many stories of kids getting delayed care for conditions when being treated by an FP. The training for adult medicine is most likely adequate but 3 months of specific peds training??? Not for my kid.
Click to expand...

As another fourth year, it doesn't seem fair to judge an entire speciatly, and the practitioners within it based upon the poor facutly teaching at your school and second hand stories you heard from your community based rotations.

I hated my month of general surgery because of the jerk I worked with. But, I still recognize that there are nice surgons out there that preform a usefull role in patient care or consultations with other practitioners.

My FP expereince - teaching ran the gamut from spectacular to below average. People were usually very nice etc. No horror stories from other practitioners in the community about FPs.

I would suggest to you that perhaphs your FP expereince was skewed in an unflattering manner.
 
gamut and skewed
 
YOu know, I think that we can summarize this all with one statement:

An FP has to know his/her limitations!!! THat simple!!

There are aspects of OB and PEDS that are simple enough that yes, you can have a 3 year FP resident learn these things. But what makes a good FP is one that sees an OB or PEDS case that is more complex than what they were trained and appropriately refers the case to the specialist.
 
in the rapidly evolving world of technological medicine...ALL specialties have to know their limits!!
 
margaritaboy said:
My FP expereince - teaching ran the gamut from spectacular to below average. People were usually very nice etc. No horror stories from other practitioners in the community about FPs.

I would suggest to you that perhaphs your FP expereince was skewed in an unflattering manner.
Click to expand...
I absolutely loved my FP rotation, it was exactly the kind of practice I want to have. The docs saw everything, including OB. With the technology today it's so fast and easy to quickly double check something you're not 100% sure of or don't see very often. It's also easy to keep up with the latest treatment recs, etc. As many have said, it's very important to know when you should refer, but with so much information so readily available, there's no reason why FP shouldn't be viable.
 
I wonder how the responses would be on this topic if everyone was certain that every specialty would be assured of being around and important for the next 100 years making everyone rich.

As it stands, it's scary to think that FP is going to fade away because it is irrelevant and not useful, so people now invested in it aren't going to respond comfortably to accusations of this ilk. On the other hand, no Peds or IM doc is happy to hear that maybe they are too full of themselves to accept that the colds and heart disease they primarily treat is in fact well within the purview of FP's. Maybe THEY are the irrelevant ones.

The reality on the ground today is that there's waaay more snotty-nosed kids and chest pain and labor pangs to go around, and different types of docs are handling those things with competence. Maybe Cambie's economical models of doom will come to pass, and maybe the anti-christ will swoop down and REALLY shake things up. The bottom line is that medicine was a good field 50 years ago, 20 years ago, and for all the whining and moaning, it's STILL a good field. Things will probably change in the next 20 years - and in general I think docs will be happy about it. They're too well-placed with the decision makers of the US to end up destitute and driving cabs in their off-hours.

Personally, I'm attracted to the broad training of an FP because even if I primarily practice in a big city (not likely, but you never know...things are changing dramatically I'm told), I also plan on doing as much underserved and overseas work as I am able to do. From my experience in the 3rd world, it doesn't matter if you're a specialist of the left leg medial-collateral ligament pacticing in Vail at 8billion $$ a year. If you happen to end up in Addis Ababa for a stint with World Vision, you'll be delivering the babies, repairing the hernias and diagnosing the choleras. ANY training is better than none. It doesn't matter if you're "the best", it just matters that you know something. For me, I'd like to know a little more than something for those times, and I'll figure out a way to enjoy my practice while in the US as well. I'm generally certain that this can be done.
 
Hello to everyone,

I am sitting in a call room reading all of the comments generated. I like good dicussions that present several differing viewpoints. It is unfortunate that some posters have been attacked for their views.

Healthcare is a very dynamic sector. Things are constantly changing. I did not say that fp would completely go away. My point was that it will change in the coming years. Change is a necessary part of life. A driver must turn the steering wheel of a car for it to stay on the road. Likewise, physicians must adapt.

The turf wars will always be faught in medicine. The point is that we must know what we know and what we do not know as physicians. The three A 's
will determine who does best.

I practice mostly general internal medicine because that is what I seem to enjoy more. I see patients in my office and in the hospital. I get a lot of referrals from ob/gyns and surgeons. They do not know what my specialty is,im or fp. All they know is their patients are happy with my workand I communicate with them.

Someone mentioned the Anti-Christ earlier. He is here already. I heard that he works for an HMO.

I talk about cash not because I want a lot of it . The theft that I witness in medicine is sickening. I have never heard of a lawyer or a plumber for that matter filing a claim . You better have the cash ready before services are rendered. Have you heard of a retainer. The guy takes your money then he tell you are screwed and you don't have a case. Oh no! I'm rambling now.

Have a good weekend,

CambieMD

p.s. #1

Where do you hide money from a lawyer. Stick it in the truth.
 
Pepe said:
One thing about FP right now (although I wouldn't bet my whole decision on it, but it was a factor) is that you will pretty much go wherever you rank first.
Click to expand...

How true is this? Even for programs like UCSF, Duke, Brown etc?
 
Noelle,

You really out to use a concept of "Scientific Method" when coming to such broad conclusions. It's the same thing they use in "EBM". You know, that pesky little thing taught at your medical school.

You are admonished for using a few personal experiences to develop conclusions that apply to a entire specialty and then you keep on doing it. I'm done responding to your dribble because I don't think you are here for an honest discussion, just insults to make yourself feel better for choosing to see snot and OM all day for the next 30 years. (That was sarcasm, I really do respect peds.)

Cheers,
 
Blue Dog said:
You bumped a 16-year-old thread?
Click to expand...

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