Family Practice

[Claymore]

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Interested in everyone's opinion on the pros/cons of family practice, also, how difficult it is to get a sports med. fellowship. I have heard from a couple of FP docs that they would recommend NOT going into this specialty now, because managed care is attempting to replace the docs with cheaper alternatives in primary care; ie, nurses, PAs, etc. Any truth to this? Thanks.

 

[UHS2002]

Next thing you know managed care will attempt to replace vascular surgeons with plumbers 🙄

The issue of being replaceable is analogous to the forever debate between anestesiologist and CRNAs. It is not going to happen, period.

Although some PAs and NPs would like to think they have the same training as FPs, they don't, period, end of question. As such they cannot replace FPs, no matter how much managed care would want it to happen. The question should be: because we have a fair number of NPs and PAs working under the supervision of physicians now, will be there a decrease in the number of FPs needed in the future? The answer is: perhaps. A lot of your office time is spent with no brainer visits, be it in FP, peds, IM or even OB/gyn. Even in the ER, most of the visits are no brainers. Lab checks, med follow ups, uncomplicated UTIs/URIs/gastroenteritis. You don't need to have gone through a residency program to handle this stuff. Heck, any 4th year med student can handle all of the routine stuff in his sleep. Some things that appear routine, are far from that though and other things are evidently not your run of the mill self resolving problem. THat is where the physician is needed vs the physician extenders.

There are PAs and NPs working in many specialties. We should then extend your fears to these many areas. ER, peds, cardiology, even ortho all have PAs or NPs. PAs and NPs are good at what they are trained for: physician extenders NOT physician equivalents.

 

[e2k]

Truth is, FPs are not paid much more than PAs.

FP salary 100-140K starting
PA salary 60-90K starting

As for replacing FPs, that's true and not true. Yes, if you hire more PAs, you don't have to hire as many FP/IM/Peds/etc. However, a PA must work for an Dr., so there has to be a Dr. around somewhere.

My wife goes to a NP for her primary care, and she really likes her NP. However, if she had a serious medical problem, she'd go to a specialist. This is the way it's changing.

BTW, it's totally different in rural areas, South, Midwest, etc. They don't accept PA/NPs as much, they want their doctors, and they pay pretty well.
Some FPs make serious bucks and do lots of interesting things from Dermatology to Surgery when there aren't a lot of specialists around.

From the little I understand, I would only do FP if I planned to live outside of the city, or if I was totally committed to family medicine.

They have 'primary care' IM tracks now, which are a little bit FP but also allow you to do the hardcore specialities of IM if you want. Also IM/Peds is only 4 years.

Luck,
ERIC

 

[LR6SO4]

That's so true about rural FP's! I grew up in a remote area. The FP's that I shadowed back there did a lot! One guy was practically a cardiologist, did his own stress tests and everything and made a ton of money on it. He also did a lot of derm-type work and removed a whole lot of skin stuff. It wasn't that he was money hungry, but he took a lot of continuing ed courses to provide a better level of care to his patients. The nearest derm was 3 hours away and booked 6-9 months, same thing for cardio. By the way, this guy was in the $300,000 range, and as it is one of those shortage areas loans are all helped to be paid off as well.

 

[Freeeedom!]

There are also other points...

The PA is a self-made problem of physicians, we created the profession to help us make more money, and now the creature has begun to have a mind of its own! That certainly IS troubling, and before it gets too out of hand, the AMA and the specialist groups will most likely address the problems. The answer may be found in collective bargaining type of physician unionization. That is what unions are for! If some lesser qualified group begins to do similar work, of lesser quality, higher risk and lesser pay forcing out the physicians...unions fight for the right of the worker(physician) to the payer (insurance).
The PA may find similar problems that PTA's did in the recent past (PTA being physical therapists assistant). PTA's had a HUGE surge in popularity and then HMO's began to limit reimbursement and forcing their paychecks ever lower. And now many PTA's work as personal trainers in gyms as apposed to working in PT clinics.
OR the PA/NP issue may be handled by lawsuits. At somepoint (God forbid), someone will get hurt by a monumental error, leading to lawsuits of phsysician and NP/PA's...probably forcing malpractice rates higher and risk higher...then lowering the advantage of having a PA/NP in the first place.
Likely it will be a combination of the three.

The FP doc will and should never be replaced...why settle for anything less trained? Would you want your children only taught by the teachers assistant? Would we want our car fixed by the mechanics assistant?

I am sure, someone, will get all up-in-arms about my comments and say some hateful things. But I respect an love my future profession and I hate to see it cheapened. I repect my friends entering into FP and would always fight for their practice rights.


Regarding sports med fellowships...yeah, it's competative to get and there aren't that many spots available. Good luck.

 

[LR6SO4]

Freedom,
How can you say that a PA or NP can't diagnose and treat?! They aren't qualified after 6 years of school, and most of them have a lot of clinical experience before that...in fact a lot are MORE experienced than a FP MD right out of residency...

That's what someone is gonna post here in a minute, just thought I would do it myself. In all seriousness though you make some excellent points! PA/NP are gaining practice rights at an alarming rate. Even when they practice with physicians in my own experience they aren't even "assisting", they are practicing medicine without a license. I go to a PA (NOT by choice). He prescribed me a med that I had a pretty bad reaction to, I went back in, he gave me some Prednisone and I wanted to talk to the doc about it. In all honestly I only thought that PA's could prescribe antibiotics. The PA got all huffy about it, though I did end up talking to the doc before taking the steroid.

In this sue-happy society someone, somewhere will be misdiagnosed by a PA/NP. They will either become seriously ill or die. Sorry, but they are trained to treat symptoms. They are not taught the pathological mechanisms of disease like we are. For example, how much time in PA/NP school is dedicated to treating routine kidney diseases? Probably enough to Dx a UTI and when to look for ARF. Are they trained in the minutae of immunologically mediated glomerular disease? Is that a simple UTI or an IgA nephropathy or Goodpasture's?

 

[Freeeedom!]

Thanx...

I just wanted to add one thing (again)...
This may sound cliche, but part of being an Osteopathic Physician, especially in primary care is to be able to look at the most "simple" or "ordinary" problems through different eye glasses. When looking at Otitis Media, we as DO's, are to also look for Somatic Dysfunction in addition to a tympanic membrane, don't we have special training to see the body working as a unit? That is why we are unique, that is what we are taught! If the person has frequent Asthma attacks, are we not taught to look for rib dysfunctions?? If the PA or NP sees all of the "simple" or "ordinary" complaints...what does a visit to the DO family physician offer?? What will then make us special? How do you teach a PA, who isn't even a physician, to also look for things they aren't even trained to do???? What will the DO have to offer then? A way to treat sore necks? No.
The DO primary care giver, must continue to use the unique skills we have learned to treat even the "ordinary" problems, and continue to offer the BEST care possible.

OK done.