"FAMILY PHYSICIANS CAN STILL MAKE IT!!!"

[Willamette]

Some of you may be familiar with my struggles to include FP as a potential career, but for those who aren?t, here?s a quick run-down:

I?m a non-traditional medical student (married, former military, several years in ?the real world? doing various things like building houses, working in the computer industry, and toiling away in a biotech lab) from a small town who harbors dreams of returning to small-town life back home as a family doc. I currently attend a private school where tuition and the cost of living are pretty steep, and I have worried almost incessantly that I wouldn?t be able to afford to pay my bills and live a comfortable life on a family physician?s income. Taking a look at ?the numbers? only increased my feelings of uneasiness and I was almost resigned to the idea that I would have to settle for a specialty that would pay me more, but wouldn?t really be what I wanted. However?

I delved deeper into the numbers and was more than pleasantly surprised at what I found. Without getting into specifics (I?ll be glad to post more if there is interest, and I?ll certainly answer PM?s on the subject) I found that FPs CAN STILL MAKE IT, EVEN WITH WHAT SEEMS LIKE SUFFOCATING DEBT!!! In my case the solution was simply to continue living like on a resident?s salary for five-years after completing residency, arriving on the other end DEBT FREE. For those of you who find that distasteful, consider the following:

If you plan to pursue a medical or surgical subspecialty, you will be living on a resident?s salary for roughly 5-6 years (that?s 5-6 years where your student loans are continuing to accrue interest). Afterward, you?ll have 2-3 years to become debt-free on the same timeline as an FP who pays his/her loans off in 5 years post-residency. Is this feasible? Yes, but you?ll have to live pretty much like a resident for those 2-3 years in order to make it happen. The net result is that no matter which specialty one chooses, to be debt-free 8 years after graduating from medical school, one will have to live like a resident for those 8 years.

So I say again ?FPs CAN STILL MAKE IT!!!?


Willamette

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[drlisa0318]

Though I haven't run the numbers, after 25 years in accounting, I can tell you that sounds like a workable plan.

 

[deleted6669]

I have a buddy in em who did it in 3........
now he lives like a king, takes 4-5 months off/yr to surf in top spots around the world.....

 

[PACtoDOC]

You can absolutely do very well in family medicine, and many times as well as most any specialist. FP has one of the widest spectrums of practice in terms of how you want to work. Whether you want to work 3.5 days a week, whether you want to do OB, whether you want to have midlevels or not, whether you want to work weekends and evenings...etc... And I am probably going to get flogged here, but lets not forget that probably half of the doctors that go into FM do it because of having very few other options. So might it not be a reasonable argument to think that the lower percentile docs who go into FP are also less capable of being good business people, and may simply just be less motivated. I have many many good friends who are FP's ranging from inner city to rural, and they all do very well. You can easily make into the high 200's, and even more if you want to work for yourself.

I hope you will follow your heart Willamette, as you will be happier overall long term if you do. Plant your garden with roses instead of weeds!!

 

[DocWagner]

When I was in medical school, I worked with a FP (in a group of 3) that made 300k...this was in St. Louis!
I really don't get the negative feed back CONSTANTLY on this forum! Don't you people become demoralized by the few that make negative comments that are untrue? Granted, many of the comments come from idiots that are barely out of diapers, but defending the art of FP "gots to be hard".

 

[gherelin]

fortunately FPs tend to have too much in the way of social skills and psychological insight to get involved in those kinds of silly interactions.

 

[MacGyver]

You can easily make into the high 200's, and even more if you want to work for yourself.

Oh thats a load of BS.

Yes, its POSSIBLE to make high 200s as FP

But thats not even close to the norm. The norm/average is about 140k, and many salary surveys have it much lower at 110-120k.

I'd venture to say that less than 5% of all FPs make 250k+

Your comment is like me saying that its easy for a new business owner to make millions.

 

[drlisa0318]

Your comment is like me saying that its easy for a new business owner to make millions.

Very true. When you look at practicing medicine as a business, it makes perfect sense. The IRS expects new businesses to show a loss for at least 3 years. Since there is a business side to practicing medicine why would a new practice (particularly one not long out of school) expect to be any different? This loss applies to both doctors who are starting a solo private practice and those who are joining an established group practice. For those entering an established practice, even though many costs associated with starting a practice (buying medical equipment, office equipment, hiring and training employees, etc.) have already been absorbed by the established group practice, there are other costs which relate to the individual doctor. These costs can vary widely depending on the legal setup of the practice (partnership, or corporation - where the doctors are employees, or other legal entity.) Did the doctor buy another's patient list? Or, until they establish their own patient list, do they get a small percentage of a second doctor's fees for seeing one of the second doctor's patients? Is the new doctor responsible for the wages of his nurse, etc? Even though the IRS does not consider a doctor's medical school loans a legitimate business expense, from a personal financial perspective, a new doctor should consider it such so that he takes it into account when determining his personal financial state. And since medicine is a business as well as an art and a calling, don't forget the old adage of the three most important things about a new business: 1) location, 2) location, 3) location!

And the moral of this story, children, is that there will be a wide range of earnings in any given specialty, and the extremes of these ranges cannot be considered the norm, which will be somewhere in the middle. Typically, those doctors at the higher end will tend to be more established, those at the lower end will tend to be less so. There will be many factors that play into this as well, including the business acumen of the doctor. Since doctors don't expect laypeople to know how to be a doctor, neither should a doctor expect to know how to be an accountant. The more financially successful a doctor, the more likely it is that he makes wise use of a reputable accountant and perhaps even a financial advisor.

 

[Willamette]

Oh thats a load of BS.

Yes, its POSSIBLE to make high 200s as FP

But thats not even close to the norm. The norm/average is about 140k, and many salary surveys have it much lower at 110-120k.

I'd venture to say that less than 5% of all FPs make 250k+

Your comment is like me saying that its easy for a new business owner to make millions.

The plan that I'm talking about considers that the FP makes $130K/year. This IS a feasible starting income, and the places where you might earn less are HIGHLY likely to be loan repayment sites. Thus, $130K is $130K even if it means $110K/year earnings and $20K/year loan repayment. While it IS possible to make GOOD money as a FP (like PAC2DOC pointed out), my 5 year plan only requires that you earn what a typical newly minted FP makes.


Oh yeah...the $140K number is (in my opinion) likely to be closest to the actual number because it jives with what the AAFP says it is. While I don't doubt that you've found a salary survey saying it's less, I have yet to see one that says FPs make less than $140K on average.

Willamette

 

[PACtoDOC]

Will,

In case you don't already know, Macgyver is one of the most educated members of our esteemed membership here at SDN. Unfortunately MacGyver has never given us any of the credentials he/she holds that makes he/she capable of engaging in a discussion that is worthy of consideration. I suggest you check their old posts and see how he/she likes to dive into a thread just to play devil's advocate. MacGyver is an expert on the PA profession, the NP profession, and the physician profession if you read his/her posts. I have had MacGyver on ignore for months now and should you find yourself becoming frustrated with his/her comments, you can always do the same. You have the right idea Will, and maybe I will be lucky enough to be in an FP residency with someone like you who actually appreciates the field.

 

[Willamette]

P2D,

I sure hope that we get to go through residency with folks who are dedicated to the profession! If I can pull you away from your California-Dreaming, maybe we'll both be at either:

#1) Cascades East, in Klamath Falls, OR
#2) The Rural Track at Boise/Caldwell, ID



Although, since I've discovered that the Idaho residency is unopposed (I'm only going to rank unopposed), it might actually slip into the number one slot because my wife's family lives in Boise (built in childcare you know?).


Willamette

 

[PACtoDOC]

I am actually considering one of the Idaho programs because they have several NHSC sites there for payback.

 

[cooldreams]

is over 150k really that unreasonable for a business savy doc who works 5-6 days?? i thought that number was for those who worked maybe 6-8 hrs a day and 4 days a week if that much. and the time they spend is a lot per patient?? seems like if you streamlined fp as much as say ortho, then 200k+ seems very possible.

any comments??

 

[PACtoDOC]

Trust someone who has been there guys. In my old practice, I routinely averaged about 30 patients a day, with some slow days and some fast days. I worked 5 full days per week usually, with the patients from 7:30-11:00, and 1:00-4:30. I generally billed about 110-120K per quarter, and collected about 75% of that, bringing my annual collections to nearly 400K. My medical assistant cost 25K per year, and my supplies probably another 15K. My billing person another 30K, and my portion of the overhead, office manager, and miscellaneous stuff left my profit at around 300K. And after I got paid, my boss got to keep the difference. Our other PA did not work nearly this hard nor collect nearly this much, but she collected about 250K per year. She had the same expenses as well. So my boss probably brought in another 80K off of her or so. Then, he only worked Monday/Wed/Frid AM's, and Tue/Thurs PM's...to a total of about 20 hours per week. He cleared over 300K when it was all said and done. Now had I actually had my own office and been an FP, I myself could have easily been clearing 200-250K annually based solely on the collections I was generating as a PA. So trust me, it can easily be done if you are efficient. There were weeks when I felt like I was working too hard, so even if I had scaled back to only 4 days a week, I still would have been able to clear 200K. And as an FP, you can really create a niche practice. There is a guy in my class who's Dad is an FP in Austin, Texas. He has a PA, 2 chiropractors, a pharmacist, a massage therapist, and a huge staff to boot and he literally makes over half a million a year.

 

[cooldreams]

what you are telling me seems to be the truth, but why is it then that so many say fps dont make much, or that the salary surveys say fps dont make much? are those just fps that dont want to make much? or are some ppl trying to keep ppl from being fps? just seems weird i guess.... oh well...

 

[calidoc2004]

Some questions:

Im interestd in going into Family practice.

1. Is where a website that has FM job listings so i can get an idea of what jobs are out there, locations, pay etc?
2. I read alot about FM being able to make more if they want to work harder. Is this alot based on location? Are there unlimited patients if you want to see 50+ per day? Or do you have to work in a big city to get higher numbers if you wanted them?

 

[Vukken99]

 

[Willamette]

look at my last thread on cloudy days in medicine

I did. Not impressed.

Willamette

 

[Willamette]

Some questions:

Im interestd in going into Family practice.

1. Is where a website that has FM job listings so i can get an idea of what jobs are out there, locations, pay etc?
2. I read alot about FM being able to make more if they want to work harder. Is this alot based on location? Are there unlimited patients if you want to see 50+ per day? Or do you have to work in a big city to get higher numbers if you wanted them?

Calidoc2004,

Check this link out:

http://newjobs.comphealth.com/jobse...ortal=physician&showJobSearch= &source=salary


Willamette

 

[Willamette]

BUMP

Willamette

 

[DOtobe]

So, are you still going to do FP?

Or have you switched to OB/Gyn (judging from your location)?

 

[Willamette]

So, are you still going to do FP?

Or have you switched to OB/Gyn (judging from your location)?

Hey DOtobe,

I'll probably end up going into FP or EM. Although I have really enjoyed my OB/GYN rotation thus far (I only have surgery to compare it to though) and I really like delivering babies, I know that I'd be happier caring for a more diverse patient population. I get to do FP next and I'm really looking forward to it. Best of luck with interviews!


Willamette

 

[PACtoDOC]

Hey DOtobe,

I'll probably end up going into FP or EM. Although I have really enjoyed my OB/GYN rotation thus far (I only have surgery to compare it to though) and I really like delivering babies, I know that I'd be happier caring for a more diverse patient population. I get to do FP next and I'm really looking forward to it. Best of luck with interviews!


Willamette

Wil and I seem to think alike!! I am seriously stuck between OBGYN and FP, but I really believe that my long term income potential and happiness would be better served in FP where I could work as much or as little as I wanted to in later years. I will probably end up doing FP at a top program known for killer OB experience. I would even consider the 4th year OB fellowship but my NHSC scholarship won't allow it. But to appease my curiousity I will still interview at a few hometown OBGYN programs just to see what I think of them. We'll just have to see!!

 

[erichaj]

Well I have read many of the posts. And, as an FP I know that it is not easy making it.

Here are some of the problems:

If you start you own practice, it takes about 18 months to two years for it to be able to be profitable. This is a long time if you are moonlighting to make ends.

The biggest problem comes in the form of capital to start up you practice.

This could be as much as 350000. Sometimes, it's easier to purchase a practice. If you do that, expect to lose about 40% of your pt. from that practice. You will be able to replace them with 40% more in the next 1 to 2 years.

Well, that's some of the basic doom and gloom.

Here is the upside:

With a good office manager and a good billing company (these two are golden) you will be able to get the max out of your practice.

By adding a couple of high paying procedures and advertising for those. You will be able to increase your bottom line. Remember that the procedures are gravy because you have met your expenses with the current base of pt.

Next, bring in a nurse practitioner or PA. this will increase your bottom line by about 50 to 60 k AFTER HIS/HER PRACTICE IS FILLED. At first you will lose money. Think of it as another investment for growth.

Location is very important. The golden rule of business is still "location, location, location".

How much can you expect to make per year. It depends on your procedures and on how many people you have working for you and producing for you.

Now with all that said, you can see that owning your own practice is not for everyone. It can and is very difficult. You have to have a business mind. It is a business of medicine.

So many doctors can't or are not willing to make it in the business of medicine. Therefore, they will work for someone and make around 140 to 175 per year. They will work about 40 to 60 hours per week to do this.

A few doctors, will take the risk.

Good Luck.

EH.

 

[OnMyWayThere]

I hope I can find smart people like some of you in about 7 years to open up a practice with... some of you REALLY seem to have it down cold! I feel so clueless but hopefully I'll learn about how PA's and PT's etc. contribute so much as 60k profit to your practice. I look forward to all of this as I am an ex-business owner turned medical student and probably future FP.

 

[RAM D.O.]

Hey Ethan, glad to see you are doing well. We graduated from UHS together in 2002. As for the original question, you can make an excellent living in FP but the real money comes when you work for yourself. I will be joining my family's practice and will make 275K my first year in practice. I have it a little easy as my family has done all the work to build the practice which includes a large family practice center and 4 surrounding urgent care centers. The practice employs 12 doctors all of which are making 200-350 depending on how much they are working. If you want to work for someone else as an employee (ie hospital owned) you can expect 130-180 depending on geographic location, # of hours, #of pts.....In the residency class that just graduated, one went into the ED and will make 260K, one went into practice and was given a 2 year salary guarantee of 160K/yr in addition to an 80K signing bonus while another is making a low 130K as a hospital employee working one of the urgent care centers. Needless to say the salary ranges vary considerably depending on a countless number of factors. If you want to make serious money in FP you need to take some risks and go into practice for yourself! Just my 2 cents! Good luck in which ever specialties you choose.

 

[erichaj]

275 K, well , if you have a practice that is already established and you are in an area that has a shortage that is possible as a pure FP. Now the other guys in your practice must be working very hard to be getting 200 to 300 per year.
EH.

 

[CambieMD]

Well I have read many of the posts. And, as an FP I know that it is not easy making it.

Here are some of the problems:

If you start you own practice, it takes about 18 months to two years for it to be able to be profitable. This is a long time if you are moonlighting to make ends.

The biggest problem comes in the form of capital to start up you practice.

This could be as much as 350000. Sometimes, it's easier to purchase a practice. If you do that, expect to lose about 40% of your pt. from that practice. You will be able to replace them with 40% more in the next 1 to 2 years.

Well, that's some of the basic doom and gloom.

Here is the upside:

With a good office manager and a good billing company (these two are golden) you will be able to get the max out of your practice.

By adding a couple of high paying procedures and advertising for those. You will be able to increase your bottom line. Remember that the procedures are gravy because you have met your expenses with the current base of pt.

Next, bring in a nurse practitioner or PA. this will increase your bottom line by about 50 to 60 k AFTER HIS/HER PRACTICE IS FILLED. At first you will lose money. Think of it as another investment for growth.

Location is very important. The golden rule of business is still "location, location, location".

How much can you expect to make per year. It depends on your procedures and on how many people you have working for you and producing for you.

Now with all that said, you can see that owning your own practice is not for everyone. It can and is very difficult. You have to have a business mind. It is a business of medicine.

So many doctors can't or are not willing to make it in the business of medicine. Therefore, they will work for someone and make around 140 to 175 per year. They will work about 40 to 60 hours per week to do this.

A few doctors, will take the risk.

Good Luck.

EH.

I always get in trouble when I post a reply on the fp forum . People get upset with me because my take on things is gloom and doom.

I have run my own practice for afew years and find many aspects of managing
my own practice unattractive. A few students will continue to go into fp because they believe propaganda put out by organizations like the AAFP. By the way in January they will become the AAFM.

Befor astudent goes into fp, they should really do their homework. Don't choose it because you think that the hours are good.

The very nature of primary care and fp make them unattractive to the astute observer.

CambieMD

 

[thanks]

I always get in trouble when I post a reply on the fp forum . People get upset with me because my take on things is gloom and doom.

I have run my own practice for afew years and find many aspects of managing
my own practice unattractive. A few students will continue to go into fp because they believe propaganda put out by organizations like the AAFP. By the way in January they will become the AAFM.

Befor astudent goes into fp, they should really do their homework. Don't choose it because you think that the hours are good.

The very nature of primary care and fp make them unattractive to the astute observer.

CambieMD

You sound a little bitter. Was FP not what you thought you were getting into? Did you not study it out before getting into residency? Not being confrontational, just curious. When you say propaganda, what facts are you suggesting are lies?

Thanks

 

[OnMyWayThere]

I always get in trouble when I post a reply on the fp forum . People get upset with me because my take on things is gloom and doom.

I have run my own practice for afew years and find many aspects of managing
my own practice unattractive. A few students will continue to go into fp because they believe propaganda put out by organizations like the AAFP. By the way in January they will become the AAFM.

Befor astudent goes into fp, they should really do their homework. Don't choose it because you think that the hours are good.

The very nature of primary care and fp make them unattractive to the astute observer.

CambieMD

Can you please elaborate?

 

[CambieMD]

Can you please elaborate?

I try not to sound bitter. I think that the constant close contact with the public can wear on you after a while. Taking care of the "whole" patient entails a lot. It is more responsibility than I want. The forms and the red tape are overwhelming. The pcp is forced to coordinate care. This causes on to spend huge amounts of time merely handling paper work.

I do not want to be dismissed as just being bitter. I may be presenting an opposing opinion. But please do not disregard what I am saying because I am an angry crack pot. Some attendings and others tried to steer me away from primary care but I dismissed them.

I think that we do more research when looking for a car than we do in searching for a specialty or spouse.

I have said before read the AMA News. Read journals related to the specialties that you are interested in.

Be honest with yourself. If you really like taking care of the whole person and getting into the social aspects of things fp may be for you.

I was a medical technology major with a minor in chemistry. I worked as a clinical microbiologist for four years following college. Maybe looking back I should have figured that a medical career that afforded me the opportunity to trouble shoot and work with machines and offered limited patient contact would have been better suited for me.

I am proud of much of what I have done for my patients but at times I see that I am merely the guy to write their referral or look at their sore throat.

The theory of a thing is often much different for the practice of it.

I am really not bitter but my impressions of fp and primary care mostly negative at this point. I have obtained a great deal of clinical experience that will serve me well in the future.

When I speak of propaganda I refer to things like the FFM project. Their report was such fluff. Read Family Practice Managemant.If you find what they are talking about compelling, you may have found your niche.

I want med students to make their career selection based on what will work for them not just during a three or four year residency but for the rest of their career.

The Hoover Institute published an article on fp that was interesting. I do not remember the authors name.

If it makes you feel better, you can call me bitter. FP was a great stepping stone for me. I have to admit that.The training was great.

Enjoy your Thanksgiving,

CambieMD

 

[lowbudget]

I'm assuming CambieMD is referring to this article. If you don't have suicidal ideations now, you will after reading this piece.

http://www.policyreview.org/apr04/alper.html

 

[PACtoDOC]

I'm assuming CambieMD is referring to this article. If you don't have suicidal ideations now, you will after reading this piece.

http://www.policyreview.org/apr04/alper.html

Cambie and the article both make good points. But if you come into FP with the right motivation, you will be just fine. For me it is to be the backwood's doctor who delivers babies, does minor surgeries, and takes care of newborns to geriatrics with every possible problem. The only thing that even gave FP a run for its money for me was OBGYN, but if you want to talk about some gloom and doom medicine, just go hang out on an OBGYN service for about 6 weeks. As motivated as I was, I could find very few people willing to step and tell me that I should do OBGYN.

Yes, it is true, the average FP in the city can probably be replaced by a midlevel without changing much of the patient's care. But you will never be able to get a midlevel up to par enough to be able to practice the all-encompassing medicine that FP's practice in rural and underserved areas. First of all, midlevels can't do OB. Second, midlevels cannot admit, treat, and discharge patients from the hospital without supervision, which is unlikely to occur in these areas. There will always be a niche for rural FP's. That may change in 2050 when New York is simply a suburb of LA. But until then, there will always be places that specialists refuse to go, and those places need FP's with serious balls!! Cambie never got to experience this kind of medicine, most likely due to attending one of the "regular" FP programs that turns out FP's who may as well be PA's or NP's. And there are only a handful of programs in this country that train FP's to be "Super FP's". 3 are in California, several are in the west and midwest, and a few are out east. There is one in Texas as well. Short of being a super FP though, I see no real reason why someone would want to do FP. If you don't learn to do many procedures and you simply refer patients to specialists across the street all day long, your role slowly becomes that of a gatekeeper and a URI/UTI guru.

Where is Willamette when I need him!!!?????

 

[BellKicker]

PACtoDOC, you're a great source of inspiration.

Can you tell me where in the midwest they hatch "super-FPs"? And, more importantly, do I get to wear a cape instead of a white coat?

I have a few more questions, if you don't mind. Questions for you or anyone. They're little things I picked up along the interview trail that I've been wondering about.

What do you think of the statement "you can get great training at any FP program; it just depends on how much work you put into it"? This makes me want to pick the best location over the best program.

Should one put importantce on actual OB volume numbers? Does 120 vs. 200 make a big difference? Isn't the teaching more important?

How do you make sure you get good procedure training? As you know, the "procedure rooms" are always an item on the clinic tour but it's hard to judge just how much these rooms are used.

The super 3 you talk about in Cali...... Is there a national rank list for FP? If a program says they are top 10 in the country, is it all talk?

Thanks.....

 

[Dr Sum Day]

Cambie and the article both make good points. But if you come into FP with the right motivation, you will be just fine. For me it is to be the backwood's doctor who delivers babies, does minor surgeries, and takes care of newborns to geriatrics with every possible problem. The only thing that even gave FP a run for its money for me was OBGYN, but if you want to talk about some gloom and doom medicine, just go hang out on an OBGYN service for about 6 weeks. As motivated as I was, I could find very few people willing to step and tell me that I should do OBGYN.

Yes, it is true, the average FP in the city can probably be replaced by a midlevel without changing much of the patient's care. But you will never be able to get a midlevel up to par enough to be able to practice the all-encompassing medicine that FP's practice in rural and underserved areas. First of all, midlevels can't do OB. Second, midlevels cannot admit, treat, and discharge patients from the hospital without supervision, which is unlikely to occur in these areas. There will always be a niche for rural FP's. That may change in 2050 when New York is simply a suburb of LA. But until then, there will always be places that specialists refuse to go, and those places need FP's with serious balls!! Cambie never got to experience this kind of medicine, most likely due to attending one of the "regular" FP programs that turns out FP's who may as well be PA's or NP's. And there are only a handful of programs in this country that train FP's to be "Super FP's". 3 are in California, several are in the west and midwest, and a few are out east. There is one in Texas as well. Short of being a super FP though, I see no real reason why someone would want to do FP. If you don't learn to do many procedures and you simply refer patients to specialists across the street all day long, your role slowly becomes that of a gatekeeper and a URI/UTI guru.

Where is Willamette when I need him!!!?????

I want to be a super FP. Which residencies are they?

 

[PACtoDOC]

I want to be a super FP. Which residencies are they?

I would not believe any program that says you can get great training anywhere. First of all, with the rare exception, I would never consider a program that is not the cornerstone of the hospital it serves. That is the first way to tell how grand a program is. The top programs know they are top programs but they do not advertise it. They usually stand out though if you look hard enough. They usually have all these characteristics:

1) unopposed, and in place as long as 25-30 years or more.
2) history of almost never having an unmatched slot, and rarely ever having FMG's
3) they pay average or better, and often a little better
4) they have residents from some of the best medical schools, but also some from small schools and DO schools....a great mix.
5) they have faculty who are happy and love to teach (find this out at the interview)
6) they will communicate with you early on in your medical school education
7) they will have near 1:1, or 1:2 faculty ratios for many rotations
8) they all emphasize training FP's to serve in rural and underserved areas
9) their OB numbers will emphasize that you can be primary surgeon on C-sections for a minimum of around 50 in 3 years
10) their ER is almost always top knotch
11) Here is the big kicker!!!! Most of the department chiefs of OB and EM, and sometimes even IM, are FP docs who have become so competent at those specialties that they run the department. This shows that the hospital is built around the residency and means that any specialist hired is hired by the FP docs, in order to get the best teachers. This is hard to find.
12) The best programs seem to have built-in moonlighting to keep their residents in their hospitals, meaning it is much easier to coordinate schedules and nearly double your income without having to travel all over the place to find outside work.

Contra Costa County in Martinez, Ca
Boise FP program
Swedish in Washington State
Natividad in Salinas, Ca
Ventura County California FP program
Greeley, Colorado FP program
John Peter Smith in Fort Worth, Texas
Kingsport, Tn FP program (minus the OB, east coast has bad OB experience)
An FP program in Missouri affiliated with Columbia
Possibly the Cheyenne, Wyoming program
Possibly the programs in Washington, Pa and Latrobe, Pa
I am still doing my research of programs and hope to find more.

 

[Dr Sum Day]

I would not believe any program that says you can get great training anywhere. First of all, with the rare exception, I would never consider a program that is not the cornerstone of the hospital it serves. That is the first way to tell how grand a program is. The top programs know they are top programs but they do not advertise it. They usually stand out though if you look hard enough. They usually have all these characteristics:

1) unopposed, and in place as long as 25-30 years or more.
2) history of almost never having an unmatched slot, and rarely ever having FMG's
3) they pay average or better, and often a little better
4) they have residents from some of the best medical schools, but also some from small schools and DO schools....a great mix.
5) they have faculty who are happy and love to teach (find this out at the interview)
6) they will communicate with you early on in your medical school education
7) they will have near 1:1, or 1:2 faculty ratios for many rotations
8) they all emphasize training FP's to serve in rural and underserved areas
9) their OB numbers will emphasize that you can be primary surgeon on C-sections for a minimum of around 50 in 3 years
10) their ER is almost always top knotch
11) Here is the big kicker!!!! Most of the department chiefs of OB and EM, and sometimes even IM, are FP docs who have become so competent at those specialties that they run the department. This shows that the hospital is built around the residency and means that any specialist hired is hired by the FP docs, in order to get the best teachers. This is hard to find.
12) The best programs seem to have built-in moonlighting to keep their residents in their hospitals, meaning it is much easier to coordinate schedules and nearly double your income without having to travel all over the place to find outside work.

Contra Costa County in Martinez, Ca
Boise FP program
Swedish in Washington State
Natividad in Salinas, Ca
Ventura County California FP program
Greeley, Colorado FP program
John Peter Smith in Fort Worth, Texas
Kingsport, Tn FP program (minus the OB, east coast has bad OB experience)
An FP program in Missouri affiliated with Columbia
Possibly the Cheyenne, Wyoming program
Possibly the programs in Washington, Pa and Latrobe, Pa
I am still doing my research of programs and hope to find more.

Thanks! That's very helpful info

 

[old blue]

KU/Via Christi in Wichita

 

[Chronotropic]

KU/Via Christi in Wichita

Shhhhhhhh Don't be giving out my hidden treasure

 

[dksamp]

You said in your analysis of what constitutes a good program...
"2) history of almost never having an unmatched slot, and rarely ever having FMG's"

Whats up with that?? As a US Citizen FMG, that offends me. You are implying that a progrm is bad if it has FMG's in it. Keep in mind, that in this diverse world of ours, FMG's add a certain flavor and perspective to the residency experience that makes the experience unique. Let me also remind you that approx 25% (that is 1 in 4) of the physicians in the US is trained outside of the US. This type of medical elitism has no place in a residency program, and DAMN SURE doesn't fly in private practice, where the REAL WORLD is made up of docs from EVERYWHERE on the planet.

getting off my soapbox now...back to our regularly scheduled programming




-Derek
(Residency trained in the midwest, but medical school trained in the Dominican Republic)

 

[lowbudget]

Legit or not, people do look at the number of unmatched slots and FMG residents when they evaluate programs. It could mean a variety of things ranging from an unpopular program to simply signifying that the program doesn't give a damn and is simply FMG friendly. FMG's in programs are helpful because some actually help to bridge the cultural/language divide with certain patient population. Other times, it's divisive because there may be a cultural gap between patient-resident or resident-resident. I've heard some people say they don't like FMG's because some FMG's are rich spoiled brats or were fortunate to be from a country where the government pays for all of their education and so it creates a difference in the sense of entitlement and work ethic within the resident group. But then again, FMGs know that in order to succeed they must bust their butts to overcome prejudices, and so they end up being very intelligent, very capable doctors. Or, they were the people who got rejected from med school 10 ways to Sunday and as a last resort went abroad. Or, they were attending physicians (good or bad) for the last 500 years, and just want to live in the US, but knows more medicine than your attending. I mean, there's really no way to make generalizations about FMGs unless you do an externship at the program and watch the residents work and interact from the inside. And even then, it's only specific to those jokers.

But you have to admit, fair or not, people look at where residents come from when they evaluate programs. PERIOD. Everyone does it, in every specialty, and every FMG knows it, especially the ones who sat down, thought out the issues, and made the deliberate decision to go abroad, knowing that they will one day come back to the US with many obstacles to overcome. Those are the facts and they are undeniable.

That's my response, and hopefully this FP thread won't degenerate into a US versus Rest of World debate.

[Break]
As far as evaluating strength of program is concerned... PACtoDOC has a good list started and it's good for you to think about. Many FP programs suffer on their Pedi experience, so that's something I look at personally to help evaluate. I think a program is totally BSing me when they want to train you to be a full-service doc, then turn around and say, "but if you have a sick kid, you're gonna refer them". Nuh-uh. You need to find out what the program transfers out because it'll affect the patients you see and follow.

The #11 is interesting to me because there may be various reasons why an FP heads a non-FP department. It may be because the community has a hard time recruiting specialists/sub and the FP is so entrenched politically that they run the department. It only speaks to the politics of the hospital (i.e, this hospital is FP friendly). It doesn't speak to the quality of education you'll get, because it's possible that the FP trained in Neurosurgery or Critical Care may be teaching you medicine based on tradition rather than on current evidence/standards because those FP's weren't trained in that discipline formally. I've heard one FP grandfathered in Crit Care say that the quality of the residents at this Super FP program was bad and that it was his job to simply stabilize the patient until someone else knows what to do with them. A definite departure from learning Crit Care from Pulm/CC fellowship trained attendings who believe that they are the End-All-and-Be-All of medicine. And it makes sense on a practical level and that's how it should be... but you need to question yourself *from whom* do you want to learn your medicine. That's why the choice between community vs. university isn't always a no-brainer.

Just a little bit of food for thought.

 

[CambieMD]

I would not believe any program that says you can get great training anywhere. First of all, with the rare exception, I would never consider a program that is not the cornerstone of the hospital it serves. That is the first way to tell how grand a program is. The top programs know they are top programs but they do not advertise it. They usually stand out though if you look hard enough. They usually have all these characteristics:

1) unopposed, and in place as long as 25-30 years or more.
2) history of almost never having an unmatched slot, and rarely ever having FMG's
3) they pay average or better, and often a little better
4) they have residents from some of the best medical schools, but also some from small schools and DO schools....a great mix.
5) they have faculty who are happy and love to teach (find this out at the interview)
6) they will communicate with you early on in your medical school education
7) they will have near 1:1, or 1:2 faculty ratios for many rotations
8) they all emphasize training FP's to serve in rural and underserved areas
9) their OB numbers will emphasize that you can be primary surgeon on C-sections for a minimum of around 50 in 3 years
10) their ER is almost always top knotch
11) Here is the big kicker!!!! Most of the department chiefs of OB and EM, and sometimes even IM, are FP docs who have become so competent at those specialties that they run the department. This shows that the hospital is built around the residency and means that any specialist hired is hired by the FP docs, in order to get the best teachers. This is hard to find.
12) The best programs seem to have built-in moonlighting to keep their residents in their hospitals, meaning it is much easier to coordinate schedules and nearly double your income without having to travel all over the place to find outside work.

Contra Costa County in Martinez, Ca
Boise FP program
Swedish in Washington State
Natividad in Salinas, Ca
Ventura County California FP program
Greeley, Colorado FP program
John Peter Smith in Fort Worth, Texas
Kingsport, Tn FP program (minus the OB, east coast has bad OB experience)
An FP program in Missouri affiliated with Columbia
Possibly the Cheyenne, Wyoming program
Possibly the programs in Washington, Pa and Latrobe, Pa
I am still doing my research of programs and hope to find more.

I knew that # 2 was going to get under someones skin. The argument regarding FMGs is an old one. I have to agree with dksamp. US facilities would not be staffed completely if it were not for FMGs. Many FMGs are better physicians than some USMGs. I have seen how FMGs have contributed to the well being of the inner city hospital that I am on staff.

So, to enjoy a rewarding career an FP must train and work in the boonies. Interesting.

CambieMD
p.s. My FP program was a nice cush program. It prepared its' graduates to practice in an urban setting.

 

[Dr Sum Day]

Shhhhhhhh Don't be giving out my hidden treasure

no way! I wanna know

 

[shemozart]

I enjoyed PACtoDOC's list of FP programs...I'm looking to go into rural FP as well, and am looking for that all-encompassing program that produces great all-around rural FPs as well. One to add to the list is Duluth (MN) family practice program...it is an unopposed residency in a town that had a formal internship since the 1930s, and turned that into an FP program when those came into vogue in the 70s - thus the FP residents run the hospital. Very impressive, especially with their OB. Intensive call schedule. Excellent reputation for turning out good rural FPs.

Hope interviews are going well!

 

[EvoDevo]

Trust someone who has been there guys. In my old practice, I routinely averaged about 30 patients a day, with some slow days and some fast days. I worked 5 full days per week usually, with the patients from 7:30-11:00, and 1:00-4:30. I generally billed about 110-120K per quarter, and collected about 75% of that, bringing my annual collections to nearly 400K. My medical assistant cost 25K per year, and my supplies probably another 15K. My billing person another 30K, and my portion of the overhead, office manager, and miscellaneous stuff left my profit at around 300K. And after I got paid, my boss got to keep the difference. Our other PA did not work nearly this hard nor collect nearly this much, but she collected about 250K per year. She had the same expenses as well. So my boss probably brought in another 80K off of her or so. Then, he only worked Monday/Wed/Frid AM's, and Tue/Thurs PM's...to a total of about 20 hours per week. He cleared over 300K when it was all said and done. Now had I actually had my own office and been an FP, I myself could have easily been clearing 200-250K annually based solely on the collections I was generating as a PA. So trust me, it can easily be done if you are efficient. There were weeks when I felt like I was working too hard, so even if I had scaled back to only 4 days a week, I still would have been able to clear 200K. And as an FP, you can really create a niche practice. There is a guy in my class who's Dad is an FP in Austin, Texas. He has a PA, 2 chiropractors, a pharmacist, a massage therapist, and a huge staff to boot and he literally makes over half a million a year.

That sounds like a totally cool practice setup.

*reconsiders FP*

 

[thanks]

Trust someone who has been there guys. In my old practice, I routinely averaged about 30 patients a day, with some slow days and some fast days. I worked 5 full days per week usually, with the patients from 7:30-11:00, and 1:00-4:30. I generally billed about 110-120K per quarter, and collected about 75% of that, bringing my annual collections to nearly 400K. My medical assistant cost 25K per year, and my supplies probably another 15K. My billing person another 30K, and my portion of the overhead, office manager, and miscellaneous stuff left my profit at around 300K. And after I got paid, my boss got to keep the difference. Our other PA did not work nearly this hard nor collect nearly this much, but she collected about 250K per year. She had the same expenses as well. So my boss probably brought in another 80K off of her or so. Then, he only worked Monday/Wed/Frid AM's, and Tue/Thurs PM's...to a total of about 20 hours per week. He cleared over 300K when it was all said and done. Now had I actually had my own office and been an FP, I myself could have easily been clearing 200-250K annually based solely on the collections I was generating as a PA. So trust me, it can easily be done if you are efficient. There were weeks when I felt like I was working too hard, so even if I had scaled back to only 4 days a week, I still would have been able to clear 200K. And as an FP, you can really create a niche practice. There is a guy in my class who's Dad is an FP in Austin, Texas. He has a PA, 2 chiropractors, a pharmacist, a massage therapist, and a huge staff to boot and he literally makes over half a million a year.

PACtoDOC,

what was the HMO percentage in this practice you worked in?

 

[BellKicker]

You said in your analysis of what constitutes a good program...
"2) history of almost never having an unmatched slot, and rarely ever having FMG's"

Whats up with that??

Generally, I would have to agree with PACtoDOC. Not because many IMGs aren't strong applicants because they are. But you must admit that there are MANY IMGs in FP out there who didn't want FP as a first choice. That's my concern with IMGs in FP. I do not want to train with people who would rather be in a different specialty.

I would have to say that the in the very best programs - who fill year after year - IMGs is no sign of weakness. These programs can get the best applicants, whether they are IMGs or not. There's also the "token" or diversity IMG, of course, which shows the world how openminded the program is.

I rotated at an FP program that never takes any IMGs. They have trouble filling every year and I believe the PD thinks it makes his program looks strong that they have no IMGs. But seriously, some of the residents there are people you wonder how they ever got into medical school. That's what they get from having to fish out of the limited AMG pool. If they opened up to IMGs, there's no doubt they would be a stronger program but because of the perceived weakness of having IMGs, they don't.