Famiy Medicine is a dying field

[cyborg88]

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I have been hearing a lot regarding this. Is Family medicine really a dying field? I have heard that nurse practitioners and physician assistant are going to take over the jobs of family physicians. Is that true?

 

[DIce3]

Hard to say but maybe. Family medicine, general pediatrics, general internal medicine, and general low risk ob/gyn will all sit in the same camp when the answer is revealed.

 

[primadonna22274]

Funny, FM faculty tell me the same thing about general IM. I've never heard that about Peds or Ob/GYN.
I'm less worried about being replaced/replaceable by a PA or NP because I've been a PA for 13 yr. I know very well what PAs and NPs do and don't know. I am very comfortable being the supervising physician having been a supervised PA and because I've taught PAs for a long time.
FM is one of the safest bets I think I'll make. I am not a bit worried about being pushed out of a job.

 

[cabinbuilder]

I have been hearing a lot regarding this. Is Family medicine really a dying field? I have heard that nurse practitioners and physician assistant are going to take over the jobs of family physicians. Is that true?

Not in rural medicine. And certainly not anytime soon. Just google on a locums website and see how many FM jobs are out there. I get at least 10 offers a day.

 

[deleted87716]

http://medicinesocialjustice.blogspot.com/2009/01/ten-biggest-myths-regarding-primary.html

Ten Biggest Myths Regarding Primary Care in the Future


Introduction: This article is by Robert Bowman, MD, of the AT Still College of Osteopathic Medicine in Mesa, AZ. Dr. Bowman is a long time scholar of primary care and rural health workforce issues. He identifies and comments upon 2 important workforce concepts. The first is “primary care forms” of training, which include 3 physician forms (family medicine, general internal medicine, and general pediatrics), and primary care nurse practitioners and physician’s assistants. The second is the Standard Primary Care (SPC) year, which allows us to look at the success of the different “forms” in terms of how many SPC years they provide per graduate. This takes into account the percentage of graduates who enter primary care, the portion of their practice that is primary care, at what rate they leave primary care for another area, the number of years they practice, and the percent time (part time/full time) they practice. Thus if a form of training has 100% of graduates entering primary care who practice full-time for an average of 35 years with 100% primary care practice, that form would produce 35 SPC years per graduate. If another form had only 50% of its graduates entering primary care, who averaged 50% primary care practice, practiced for an average of 20 years with an average of 75% FTE, that form would produce an average of only 3.75 SPC years per graduate (do the arithmetic: 20 years x 75% FTE x 50% of grads in primary care x 50% of practice is primary care). This is important in comparing projections – one can’t just say, for example “nurse practitioners will take care of our primary care needs” without doing such a calculation.

Myth Number 1: Primary Care has collapsed. Primary care internal medicine has collapsed with lowest production and lowest primary care retention levels. Those associated with internal medicine primary care perceive collapse. But primary care remains. Existing dedicated primary care practitioners continue to deliver primary care despite insufficient support. There are 5 training sources of primary care. Some are remaining steady and some are dropping. The ideal primary care provider would contribute 35 Standard Primary Care (SPC) years: a 35 years career, actively in practice 100% of those years, and 100% remaining in primary care and 100% or top volume of primary care. Among the 5 forms of primary care training, family medicine remains steady in primary care with over 25 Standard Primary Care (SPC) years per graduate. Pediatrics is also steady, but with only 16 SPC years per graduate. The other 3 forms have more graduates who are inactive or part-time, have fewer years in a career, retain a lower percent of graduates in primary care (retention), and have a lower volume of primary care. They thus make limited contributions with fewer SPC years per graduate. Internal medicine, nurse practitioner, and physician assistant forms have declined to less than 4 SPC years per program graduate. Collapse of primary care is found for forms that depart primary care during training, at graduation, and each year after graduation under the assault of poor primary care support. [1]

Myth Number 2: Nurse practitioners will take over more primary care duties. Nurse practitioners will continue to supply less than 12% of the primary care supplied by the five primary care training forms using past measures as well as future estimates.[1, 2] Increasing departures to hospital and specialty careers, lowest activity (inactive, part time), lowest volume of primary care, and greatest delays in entering primary care limit nurse practitioner primary care contributions.

Myth Number 3: Physician assistants will take over more primary care duties. Less than 30% of new physician assistants enter primary care and active physician assistants will dip below this level in the next 3 years.[3] Physician assistants will continue to supply less than 12% of the primary care supplied by the five training forms. Increasing departures to emergency medicine and subspecialty careers, lower activity (inactive, part time), and lower volume of primary care limit physician assistant primary care contributions.

Only if physician assistants or nurse practitioners were required to stay in the family practice mode of care would they be able to increase share of primary care, rural primary care, and underserved primary care duties.

Myth Number 4: Internal medicine graduates from international medical schools will make significant primary care contributions. Internal medicine residency program graduates from foreign origins and international medical schools will contribute the fewest years of primary care averaging 1.3 SPC years per graduate. The limitations are substantial with lowest primary care retention after graduation, loss of 8 years due to delayed entry into the United States workforce, and losses after graduation including 20% departing the United States for home nations, 8% chronic unemployment, and increasing fractions departing for other nations.[4, 5] Lowest primary care also means lowest rural primary care and underserved primary care. A family practice residency graduate contributes greater than 30 times the rural or underserved primary care per graduate. Changes in the J-1 Visa waiver program and increasing uses of international graduates by the military and teaching hospitals will further limit primary care, rural, and underserved contributions.

Myth Number 5: The United States is unable to produce enough primary care. Through policy, medical education efforts, and statewide efforts, the US has been consistently successful. The US was able to quadruple primary care graduates in the 1970s. The US increased primary care production 50% during the span of a few years in the 1990s. Historically Black, osteopathic, and many allopathic public schools have been successful for over 100 years. Primary care contributions are maximized when schools and states focus together on health access in birth to admission preparation, admission preferences, training curricula/faculty/locations, and health policy.[6]

To sum up: the only way that the United States can fail to produce primary care is to admit the most exclusive students (lowest probability primary care), train in locations with the least health access emphasis (lowest influence), fail to graduate enough family physicians (permanent form), and create a health policy that rewards the most exclusive careers and locations. This, of course, is exactly how US health care is structured.

Myth Number 6: Generic expansions of medical school, nurse practitioner, or physician assistant graduates can increase primary care. During the current time period with the worst health access policy in decades, fewer students are choosing primary care and those that can move away from primary care are leaving. Osteopathic (DO) graduates will more than double from 2004 to 2017 but, with the current steady declines in family practice percentages, the end result will be only a gain of 100 more family physicians or a 20% increase despite a 100% increase in graduates. With primary care retention rates dropping steadily at 1 or 2 percentage points each year in the large and growing nurse practitioner and physician assistant pools (over 230,000 combined), new graduates entering the workforce in primary care are not able to keep up with losses of active primary care plus departures from active practice. Only specific expansions of family practitioners that remain in the family practice mode (physicians, nurse practitioners, and physician assistants) can address primary care and health access needs. Retention in the family practice mode is much less likely for NPs and PAs since they can and do depart the family practice mode at any time.

Myth Number 7: Nurse practitioners make substantial rural primary care contributions. Rural primary care requires both rural location and primary care contributions. While 20-25% of nurse practitioners are rural, they do not have the primary care component. Nurse practitioners contribute 1 rural Standard Primary Care year per graduate (4 SPC years times 25% rural) in rural workforce whereas family physicians contribute 5 Standard Primary Care years per graduate (25 SPC years x 20%) in rural locations.

Myth Number 8: Primary care is not marketable to the American consumer.[2, 7, 8] It is very hard to understand how respected authorities in leadership positions could make such statements. Only a severe lack of awareness explains their comments. Workforce experts, trainers and educators in major medical centers and medical schools, leaders in the Council of Graduate Medical Education and the Association of American Medical Colleges all live in areas with the highest concentrations of people, physicians, and medical schools. These experts have spent their entire lives in locations that employ the fewest primary care physicians and support primary care at the lowest levels. They have tolerated the training of medical students and residents in dysfunctional primary care settings.[9] It is not surprising that primary care does not appear marketable to those clustered in the 3,300 US zip codes which make up 4% of the land area with 75% of physicians and 95% of medical schools. This limited perspective ignores the 38,000 zip codes in which 65% of the American population and 70% of the elderly are cared for by the remaining 23% of total physicians. In these locations, 30 – 100% of the total physicians are primary care physicians.

The total elimination of health care for millions is unconscionable and this is what is suggested by the statement that primary care is not marketable. The locations that depend upon primary care are also locations that offer better primary care salaries, better primary care support, better practice options to generate more revenue, lower costs of delivering health care, and lower costs of living. Those designing health care for an entire nation must place much more emphasis on care for the 65% of the population left out of the current health care design. All of medicine and medical education will pay dearly for the choices of a few leaders. Current leaders appear to have abandoned Butler’s call to a season of accountability and social responsibility for medical education.[10 ]

Myth Number 9: The nation needs more pediatric graduates to meet primary care needs. More pediatric graduates will not meet primary care needs. According to pediatric leadership, pediatric primary care is saturated in the locations where pediatricians choose to locate, at the same time that the United States has fewer children. Even though 15% of white female medical students remain committed to pediatric residency choices, they and other pediatric graduates will compete with all other primary care graduates already delivering pediatric primary care. This is likely to result in more practicing in part time, specialty, hospital, urgent, and emergent pediatric care settings.[11]

Myth Number 10: Care for Age 65 and Up Will Be Provided By Geriatric Specialists. Geriatricians are a small fraction of new physicians, they are less likely to be found in locations with concentrations of older Americans, they have limited support, they have lower volume of patients, and they have some of the most complex patients. Older patients move toward locations with lower costs of living and health care and they move away from concentrations of internal medicine physicians, geriatricians, geriatric training programs, stroke centers, and heart attack centers.[12] They move steadily toward locations served predominantly by family physicians.

National studies confirm patterns of care for the elderly and for all seeking ambulatory care in the United States in 2004. About 62.5% of age 65 and older patients saw a family physician compared to internists for 29%, and somewhat less than 19% seeing a nurse practitioner.[2] This is not what numbers of graduates predict since both internal medicine graduates and nurse practitioner graduates are about twice the number of family practice graduates. In 2004 family physicians led in all but one ambulatory category. In addition to seniors, family physicians were seen by 43.4% of adults seeking care, and 39% seeking women’s health care. The family physician share of 20% was second to pediatricians although family physician percentages increased for children over age 4 and for the 65% of the population beyond concentrations of pediatricians.[2] This is why increased family physicians can address pediatric care needs while more pediatricians cannot.

Myths persist unless they are compared to reality. Primary care must be measured according to a standard and the standard is set by forms of primary care training that produce providers who remain for 35 years of a career, who continue to provide primary care, who remain in the wide range of most needed locations, who continue to serve the populations most in need of care, and who continue to do so whether the current “policy era” is supportive or unsupportive of primary care. For physicians, nurse practitioners, and physician assistants, the standard is set by those that remain in the mode of care known as family practice.



1. Bowman RC. Measuring Primary Care: The Standard Primary Care Year. Rural Remote Health. Jul-Sep 2008;8(3).
2. Ferrer RL. Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status. Ann Fam Med. Nov-Dec 2007;5(6):492-502.
3. American Academy of Physician Assistants. Data and Statistics. http://www.aapa.org/research/index.html. Accessed October 26, 2006, 2006.
4. International Medical Graduate Section of the American Medical Association. Report on International Medical Graduates. Chicago 2007.
5. Quick Views. J-1 Waivers on the Decline. amednews.com. January 22, 2007.
6. Bruce TA, W.R. N. Improving Rural Health. Little Rock, Arkansas: Rose Publishing Company; 1984.
7. Philibert I. An interview with Carl Getto, MD. ACGME Bulletin. 2004;Spring:10-11.
8. Salsberg E. Physician Workforce Policy Guidelines for the U.S. for 2000–2020. Presented to the Council on Graduate Medical Education. Bethesda, MD. September 17–18, 2003.
9. Keirns CC, Bosk CL. Perspective: the unintended consequences of training residents in dysfunctional outpatient settings. Acad Med. May 2008;83(5):498-502.
10. Butler WT. Academic medicine's season of accountability and social responsibility. Acad Med. Feb 1992;67(2):68-73.
11. Committee on Pediatric Workforce. Pediatrician workforce statement. Pediatrics. Jul 2005;116(1):263-269.
12. Perrotta BL, Perrotta AL. Access to state-of-the-art healthcare: a missing dynamic in consumer selection of a retirement community. J Am Osteopath Assoc. Jun 2008;108(6):297-305.

 

[DIce3]

Appreciate the article. The SPC calculations are really interesting. The acceleration (velocity of the velocity) of midlevels may lead one to believe a future closer to present day anesthesia. I am not making a prediction but I don't feel confident about anything.

 

[DIce3]

(I am posting for my own interest and not making a specific point.)

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source: http://www.amednews.com/article/20120702/business/307029951/6/

"The nurse practitioner population will nearly double by 2025, according to an analysis published in the July Medical Care, the official journal of the medical care section of the American Public Health Assn.

"Nurse practitioners really are becoming a growing presence, particularly in primary care," said David I. Auerbach, PhD, the author and a health economist at RAND Corp.

Auerbach used modeling to project that the count of those trained as nurse practitioners would increase 94% from 128,000 in 2008 to 244,000 in 2025. The subgroup of those providing patient care as nurse practitioners, rather than filling administrative or other roles, will rise 130% from 86,000 in 2008 to 198,000 in 2025."

"According to the annual census by the American Academy of Physician Assistants, 40,469 physician assistants were practicing in 2000, and that number went up 106% to 83,466 in 2010."



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source: http://www.kevinmd.com/blog/2013/04/match-day-primary-care-aftermath-deans-lie-continues.html

"only about 20-25% of internal medicine residents remain in primary care (this is from the American College of Physicians, confirmed by a JAMA study 2012;308(21):2241-2247, down from over 50% in 1998). Internal medicine residencies should not be considered primary care residencies if an overwhelming majority do not practice primary care."

 

[primadonna22274]

I always enjoy reading Dr Bowman's projections. I have had an ongoing email correspondence with him since I first decided to apply to med school in 2008. He is well-published in rural medicine circles and he encouraged me to go ahead to med school and not worry about "wasting" my PA career. I think CB and Dr Bowman are onto something big here: the future is in RURAL MEDICINE. I know for myself there is nothing very enticing about urban or suburban medicine. I have much more fun practicing rurally and feel truly needed there. Now add in relocation and loan repayment and I am so there....

 

[MOHS_01]

Appreciate the article. The SPC calculations are really interesting. The acceleration (velocity of the velocity) of midlevels may lead one to believe a future closer to present day anesthesia. I am not making a prediction but I don't feel confident about anything.

Not to be a stickler, but acceleration is the change in velocity per unit time....

Other than that, the pricing for bread and butter office stuff -- for all specialties -- will be undercut by the proliferation of these half trainees. That's the simple, cold, hard reality of the mess we find ourselves in. Gresham's law does not apply merely to money -- it holds for anything of value.

 

[ActionFigure]

Not to be a stickler, but acceleration is the change in velocity per unit time....

I think what DICE is getting at is: acceleration is the derivative of velocity, which is the derivative of position in space. basically acceleration is how fast something changes speed (velocity of velocity) and velocity is how fast something is

 

[MedicineDoc]

I am not convinced that most if not all these dramatic threads where supposed students interested in FM are concerned that "FM is DYING!!!" are not really just trolling by dumb bored medical students who have no interest in pursuing general medicine. After all FM is a specialty that is probably the most in demand specialty there is right now based on recruiting. I don't see why these threads aren't just deleted by the moderator. They contribute nothing and are completely inane.

 

[deleted6669]

the future is in RURAL MEDICINE. I know for myself there is nothing very enticing about urban or suburban medicine. I have much more fun practicing rurally and feel truly needed there. Now add in relocation and loan repayment and I am so there....

agree- I regularly receive job announcements for rural positions. 2 of my current 3 jobs are at rural/critical access hospitals, the other is at a small inner city facility.
I'm tired of the big city, urban trauma ctr thing. it used to be fun but now it is just burnout inciting. much nicer to see 1-3 pts/hr of high acuity than 6+ low acuity folks who just don't want to see their pcp because then they have to pay for their visit.
10 yrs from now I hope to be doing 100% rural and/or overseas underserved .

 

[MedicineDoc]

I had a PA try to get me to admit a UTI with otherwise normal labs in an old woman who had previously been placed on levaquin in the ER and given a urine culture after the woman returned with the same complaint and the culture was resistant to levaquin but sensitive to multiple other by mouth antibiotics for "failure of outpatient therapy". . I had another patient who got admitted for a potassium of 7 after her NP put her on lisinopril, potassium supplements and spironolactone although she had no reason to be on spironolactone. Crappy medicine is our Job security

 

[cyborg88]

I am not convinced that most if not all these dramatic threads where supposed students interested in FM are concerned that "FM is DYING!!!" are not really just trolling by dumb bored medical students who have no interest in pursuing general medicine. After all FM is a specialty that is probably the most in demand specialty there is right now based on recruiting. I don't see why these threads aren't just deleted by the moderator. They contribute nothing and are completely inane.

I think you should confirm before making assumptions. I am a resident pathologist and will be starting my residency in July. I applied to internal medicine and pathology but i got matched to pathology. I like family medicine because of its diversity and outpatient medicine but i did not apply because i was told about its poor job prospects. If you did not like my thread you should just refrain from posting.

 

[primadonna22274]

I think you should confirm before making assumptions. I am a resident pathologist and will be starting my residency in July. I applied to internal medicine and pathology but i got matched to pathology. I like family medicine because of its diversity and outpatient medicine but i did not apply because i was told about its poor job prospects. If you did not like my thread you should just refrain from posting.

Here's a funny twist:

I love pathology but won't apply because I have read how dismal the job prospects are. Also I need more patient contact but pathology would serve me well as a medical educator down the line. I'm just trying to learn as much as I go 🙂
I wish you the very best in residency. Hope you find your niche and land a job somewhere that makes you happy.
As for the asinine comment about bad medicine = job security above (not yours!), I've been a PA for 13 years and grew up in lab medicine before that. MedicineDoc, you should use those situations as teachable moments--likely that PA didn't understand what "failed outpatient treatment" meant (or more likely her lazy supervising physician said "just admit her"...happened to me more times than I can count). We all get better with experience. As for the multiple K-sparing drugs and supplemental K, well, that's just bad pharmacology and a weak/defective knowledge base. You won't find that in most PAs because we have very standardized pharm education requirements. NPs do not.

 

[cyborg88]

Here's a funny twist:

I love pathology but won't apply because I have read how dismal the job prospects are. Also I need more patient contact but pathology would serve me well as a medical educator down the line. I'm just trying to learn as much as I go 🙂
I wish you the very best in residency. Hope you find your niche and land a job somewhere that makes you happy.
As for the asinine comment about bad medicine = job security above (not yours!), I've been a PA for 13 years and grew up in lab medicine before that. MedicineDoc, you should use those situations as teachable moments--likely that PA didn't understand what "failed outpatient treatment" meant (or more likely her lazy supervising physician said "just admit her"...happened to me more times than I can count). We all get better with experience. As for the multiple K-sparing drugs and supplemental K, well, that's just bad pharmacology and a weak/defective knowledge base. You won't find that in most PAs because we have very standardized pharm education requirements. NPs do not.

Yeah, I have also heard about poor job prospects of pathology but I did not know that beforehand otherwise I might have tried to avoid it . But I guess after doing 2-3 fellowships one is able to get some kind of job in pathology. Same goes for family medicine. I do not think that family medicine is going to die any time soon. They will continue to work in rural ares.

 

[xenotype]

Yeah, I have also heard about poor job prospects of pathology but I did not know that beforehand otherwise I might have tried to avoid it . But I guess after doing 2-3 fellowships one is able to get some kind of job in pathology. Same goes for family medicine. I do not think that family medicine is going to die any time soon. They will continue to work in rural ares.

Have you read the path forum for even 30 seconds? There is real data backing up the idea that a path residency is about the same as going to law school as far as employment goes. There is a serious oversupply, and there is little need for local pathologists now that samples can easily be shipped across the country on dry ice by UPS. There is a serious undersupply for FM, and it is literally impossible to outsource to another geographic area. Plus with the aggressive medicare cuts hitting path, the salaries will probably be identical in a another two or three years. There is little reason that path salaries won't just keep dropping too.

 

[Smokemont]

Yeah, I have also heard about poor job prospects of pathology but I did not know that beforehand otherwise I might have tried to avoid it . But I guess after doing 2-3 fellowships one is able to get some kind of job in pathology. Same goes for family medicine. I do not think that family medicine is going to die any time soon. They will continue to work in rural ares.

Even I know the outlook for path is abysmal. I don't understand how someone applying for residency could think there were no FM jobs compared to path. You apparently were given some terrible, terrible advice. Regardless, I wish you the best of luck.

 

[MedicineDoc]

Here's an idea. How about the path "because I love it" and family medicine "is dying!!!" posters as well as the PA and NP students/midlevels quit trolling the FM forum with bogus "ideas" threads and nonsense.

 

[primadonna22274]

Trolling? Puh-leeze. I have a right to be here. Even as "just a PA". Will be a DO a year from now. My perspective is different because I've been around the block a bit. And despite being told on a very regular basis I'm "too smart for family medicine", I will likely choose it because it's my first love and I'm damn good at it. And it offers the broadest range of career options to me.
Leave the path guy alone. It was an honest question.

 

[MedicineDoc]

But "it's DYING!!!!" Are you INSANE!!!!!

As I recall the FM NBME clerkship exam was the most comprehensive detailed and time consuming NBME clerkship exam to study for in medical school. Too smart for family medicine was not the general consensus of my medical school class after taking the NBME clerkship test.

 

[Bernie3144]

(I am posting for my own interest and not making a specific point.)

---------------------------------------------------------

source: http://www.amednews.com/article/20120702/business/307029951/6/

"The nurse practitioner population will nearly double by 2025, according to an analysis published in the July Medical Care, the official journal of the medical care section of the American Public Health Assn.

"Nurse practitioners really are becoming a growing presence, particularly in primary care," said David I. Auerbach, PhD, the author and a health economist at RAND Corp.

Auerbach used modeling to project that the count of those trained as nurse practitioners would increase 94% from 128,000 in 2008 to 244,000 in 2025. The subgroup of those providing patient care as nurse practitioners, rather than filling administrative or other roles, will rise 130% from 86,000 in 2008 to 198,000 in 2025."

"According to the annual census by the American Academy of Physician Assistants, 40,469 physician assistants were practicing in 2000, and that number went up 106% to 83,466 in 2010."



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source: http://www.kevinmd.com/blog/2013/04/match-day-primary-care-aftermath-deans-lie-continues.html

"only about 20-25% of internal medicine residents remain in primary care (this is from the American College of Physicians, confirmed by a JAMA study 2012;308(21):2241-2247, down from over 50% in 1998). Internal medicine residencies should not be considered primary care residencies if an overwhelming majority do not practice primary care."

Current evidence is mixed regarding actual primary care production for NPs and PAs. RWJ will make you believe their contribution towards the primary care workforce is exploding. So do deans at medical schools publishing "50+ percent of their graduating class entering primary care." It's all fluff. Other sources are showing that NPs are specializing at rates approaching medical student/resident sub-specialization rates.

Conclusion: who really knows. Those dominating the overall conversation and speaking out for independent practice obviously have stronger feelings and passion for their viewpoints. Poll the typical everyday, non-involved academy NP or PA member about how they feel and most would rather work together with physicians and support staff. It may just be easier to streamline those most passionate and advocating for independent practice into a modified, shorter in duration medical school and provide a standardized medical education for a medical degree followed by another standardized residency program (typically not internet or web-based).

Per the Robert Graham Center and AHRQ:

http://www.graham-center.org/online/graham/home/news-releases/2011/nov-10-ahrq-fact.html

"The rapidly declining proportion of NPs and PAs from primary care is concerning. It suggests that all three professions are leaving primary care and that we cannot avoid the hard work of fixing the problems that plague this important workforce and threaten access to effective health care," said Phillips.

At the same time, the data can help policy makers determine what health reforms can capitalize on the primary care workforce in a way that improves outcomes and helps constrain costs, according to Phillips. Among those reforms is the patient-centered medical home, in which teams of physicians, nurse practitioners, and others work together to meet patients' needs and coordinate care among team members.

"Studies of patient-centered medical homes have shown that team-based care comprising primary care physicians, nurse practitioners, and physician assistants result in better outcomes, greater patient satisfaction, and lower cost," said Phillips. "As this concept grows, we can turn to these data to determine how much we need to grow our primary care workforce."

Less than half of physician assistants (approximately 30,000) and slightly more than half of nurse practitioners (approximately 56,000) are practicing primary care in 2010.

Estimated number of nurse practitioners and physician assistants practicing primary care in the United States, 2010

Provider type Total Percent primary care Practicing primary care
Nurse practitioners 106,073 52.0% 55,625
Physician assistants 70,383 43.4% 30,402

http://www.ahrq.gov/research/findings/factsheets/primary/pcwork2/index.html

Per AAFP Workforce Reform Policy:

http://www.aafp.org/online/en/home/policy/policies/w/workforce.html

"While PAs and NPs remain important contributors to the primary care workforce and are an important part of the team-based approach within the Patient-Centered Medical Home model of care, their contribution will be affected by the decline in the number of graduates from NP programs as well as an increase in the percentage of PAs and NPs who practice in subspecialty disciplines rather than primary care will."

 

[primadonna22274]

But "it's DYING!!!!" Are you INSANE!!!!!

As I recall the FM NBME clerkship exam was the most comprehensive detailed and time consuming NBME clerkship exam to study for in medical school. Too smart for family medicine was not the general consensus of my medical school class after taking the NBME clerkship test.

I smoked that exam, after one year of med school, one easy FM rotation and 12 years of PA practice 🙂

 

[Dharma]

I think you should confirm before making assumptions. I am a resident pathologist and will be starting my residency in July. I applied to internal medicine and pathology but i got matched to pathology. I like family medicine because of its diversity and outpatient medicine but i did not apply because i was told about its poor job prospects. If you did not like my thread you should just refrain from posting.

you "got matched" huh? nice. stick to the path forums then.

as for the others with interest in any field... don't let fear be your guide.

 

[deleted87716]

I like family medicine because of its diversity and outpatient medicine but i did not apply because i was told about its poor job prospects.

You should choose your sources more carefully.

http://www.aafp.org/online/en/home/...ofessional-issues/20110817merritthawkins.html

The demand for family physicians continues to outstrip demand for other physician specialties and subspecialties, making family physicians the most sought-after physician group in terms of recruitment and retention.

http://www.merritthawkins.com/uploadedfiles/merritthawkins/pdf/mha2012survpreview.pdf

Primary care physicians remain at the top of the wish list for most hospitals, medical groups and other healthcare organizations. For the seventh consecutive year, two types of primary care physicians – family physicians and general internists – were Merritt Hawkins’ two most requested physician search assignments.

 

[deleted87716]

I do not think that family medicine is going to die any time soon. They will continue to work in rural ares.

80% of the US population lives in urban areas.

http://www.fhwa.dot.gov/planning/census_issues/archives/metropolitan_planning/cps2k.cfm

The chronic disease burden is increasing worldwide.

http://www.who.int/nutrition/topics/2_background/en/

See the post above this re: recruiting data. Family physicians will have job security for the forseeable future, regardless of location.

 

[cyborg88]

But "it's DYING!!!!" Are you INSANE!!!!!

As I recall the FM NBME clerkship exam was the most comprehensive detailed and time consuming NBME clerkship exam to study for in medical school. Too smart for family medicine was not the general consensus of my medical school class after taking the NBME clerkship test.

Man I asked a question .. I am sorry if my question offended you .. I am an IMG I did not take any nbme clerkship exams. But I must say that FM forum is optimistic about the future of FM. Pathology forum is so gloomy as if pathology is going to die soon. That is why I asked this question ... I might want to switch my residency. I am an IMG with good board scores but failed CS so I know it will be difficult to do that. Still I might want to try it.

 

[cyborg88]

you "got matched" huh? nice. stick to the path forums then.

as for the others with interest in any field... don't let fear be your guide.

Why stick to path forum only. I might want to switch to FM next year. Also family medicine forums are not your personal property. You sound like you own it.

 

[cyborg88]

80% of the US population lives in urban areas.

http://www.fhwa.dot.gov/planning/census_issues/archives/metropolitan_planning/cps2k.cfm

The chronic disease burden is increasing worldwide.

http://www.who.int/nutrition/topics/2_background/en/

See the post above this re: recruiting data. Family physicians will have job security for the forseeable future, regardless of location.

Yeah you are right I accept my mistake. I agree that family medicine docs will continue to work both in urban and rural settings.

 

[cyborg88]

You should choose your sources more carefully.

http://www.aafp.org/online/en/home/...ofessional-issues/20110817merritthawkins.html


http://www.merritthawkins.com/uploadedfiles/merritthawkins/pdf/mha2012survpreview.pdf

Man I am an IMG. I failed my CS. I thought I would never match. I applied to match without even passing CS. I like family medicine because of outpatient medicine and diversity. But I thought given my failed CS I would never get into it. I got 5 pathology interviews and 2 internal medicine interviews. Now I think I should have applied to family medicine too...I might have got a few interviews.

 

[xenotype]

Man I am an IMG. I failed my CS. I thought I would never match. I applied to match without even passing CS. I like family medicine because of outpatient medicine and diversity. But I thought given my failed CS I would never get into it. I got 5 pathology interviews and 2 internal medicine interviews. Now I think I should have applied to family medicine too...I might have got a few interviews.

Maybe you can switch into it? If its really more interesting don't settle for something less interesting to you unless you don't have a choice. Probably fewer barriers for you now that you matched too. Seems like you keep trying to get defensive and rationalize the choice you made with path.

 

[primadonna22274]

Ok, here's what I think: go ahead and start your path residency. A sure thing is preferable to nothing.
A solid pathology base would be a boon to a family physician. In fact the biggest reason I went back to med school after a decade as a PA was that I wasn't comfortable with everything I didn't know.
You definitely need to pass CS. If you need tutoring to do this, so be it. A family physician needs to be adept at physical diagnosis and interpersonal communication.
Once you begin your path residency, make friends with folks in family medicine. Go to their conferences if too can. Have lunch with them. Perhaps schedule a meeting with their residency director to discuss possibilities for switching residency tracks. By all means, do everything you can to be a great path resident and earn positive letters of recommendation.
Good luck to you.

 

[cyborg88]

Maybe you can switch into it? If its really more interesting don't settle for something less interesting to you unless you don't have a choice. Probably fewer barriers for you now that you matched too. Seems like you keep trying to get defensive and rationalize the choice you made with path.

Yeah I am getting defensive. I did not want to apply to match. I thought I would never pass CS let alone get residency. My family pushed me to apply for match. Not only that I passed my CS but also I got the residency at a university pathology program. But now I hear that pathology job market is really bad. I don't know if that is true but this is what SDN projects. But I guess even if I am not able to find a job in USA after residency and fellowship which I think is unlikely I can always go back to my home country and work there as a pathologist. I think I will be able to find a job there.

 

[xenotype]

Yeah I am getting defensive. I did not want to apply to match. I thought I would never pass CS let alone get residency. My family pushed me to apply for match. Not only that I passed my CS but also I got the residency at a university pathology program. But now I hear that pathology job market is really bad. I don't know if that is true but this is what SDN projects. But I guess even if I am not able to find a job in USA after residency and fellowship which I think is unlikely I can always go back to my home country and work there as a pathologist. I think I will be able to find a job there.

I don't think it is as bad as SDN says, but you will likely have to do a couple one year fellowships to get a job in path. The more important question is what do you WANT to do? If fam med is what you really desire and you want to work directly with patients, you won't have a fulfilling career in path.

 

[Kahreek]

in path you will get a solid amount of money for a very easy going schedule, you wont have to bear with many bs.
cons- it is pretty much like an office job. You either see parts of people or dead people.

 

[DIce3]

in path you will get a solid amount of money for a very easy going schedule, you wont have to bear with many bs.

Appreciate the post, but pathologists do not have very easy schedules but rather work in corporate sweat shops with huge amounts of BS from an army of corporate suits.

 

[bronx43]

in path you will get a solid amount of money for a very easy going schedule, you wont have to bear with many bs.
cons- it is pretty much like an office job. You either see parts of people or dead people.

Lol, strong unaware. I would avoid pathology like the bubonic plague. What you're describing was the stereotype for path about 15 years ago. Now, path is a dead-end field where jobs are harder to come by than an intelligent conversation at the Kardashian household. As a new path grad, you'll pretty much be the whipping boy for the old-school partners who will squeeze every ounce of work out of you while throwing you half a bone. I would pick FM over path every day of the week and thrice on Sunday.

For the OP, I would try what primadonna said. Worst comes to worst, you can reenter the match next year and focus on FM programs. Best of luck.

 

[cabinbuilder]

So I am out and about doing my locum thing in Nevada currently as the urgent care overflow/walk-in's provider. I tell you I get asked EVERY DAY if I would consider staying on permanent. I say "no" for personal reasons mostly and lack of close airport since my family doesn't want to move anymore.

Just got off the phone on an interview for the next locum job in Oregon. Was asked if I would consider staying on permanent before the converstation was even over.


Family Practice is HOT right now due to the versatility and huge need all over the country. I don't see it dying anytime soon. There is plenty of work out there. You can pay your bills no problem.😎

 

[surrender903]

So I am out and about doing my locum thing in Nevada currently as the urgent care overflow/walk-in's provider. I tell you I get asked EVERY DAY if I would consider staying on permanent. I say "no" for personal reasons mostly and lack of close airport since my family doesn't want to move anymore.

Just got off the phone on an interview for the next locum job in Oregon. Was asked if I would consider staying on permanent before the converstation was even over.


Family Practice is HOT right now due to the versatility and huge need all over the country. I don't see it dying anytime soon. There is plenty of work out there. You can pay your bills no problem.😎

where in Nevada?

 

[deleted87716]

Elko, they are desperate for a perm provider.

Wow...even hair stylists don't want to live there? 😉

 

[Silent Cool]

Elko, they are desperate for a perm provider.

Cabin,

For a locums FM doc like yourself, what is the reasonable upper limit income for a person willing to work 60 hrs per week?

thanx
😎

 

[Silent Cool]

Wow...even hair stylists don't want to live there? 😉

waka waka waka waka waka

 

[JustPlainBill]

Slightly off topic -- how are the FM prospects for those of us who have no desire to do any inpatient work?

I'm so-so at it but my exposure has been a large, county, safety-net hospital rather rather than a community hospital setting meaning I've often been told that I'll never see patents this sick again as an FM doc....

either way, I have no desire to do inpatient work.

What's it look like?

 

[VA Hopeful Dr]

Slightly off topic -- how are the FM prospects for those of us who have no desire to do any inpatient work?

I'm so-so at it but my exposure has been a large, county, safety-net hospital rather rather than a community hospital setting meaning I've often been told that I'll never see patents this sick again as an FM doc....

either way, I have no desire to do inpatient work.

What's it look like?

Still very good. In my class of 11, only 1 is doing any inpatient.

 

[cabinbuilder]

Cabin,

For a locums FM doc like yourself, what is the reasonable upper limit income for a person willing to work 60 hrs per week?

thanx
😎

Really depends on the contract.
Is that 60hrs just clinic, or clinic plus ER, do you take call? do you do inpatient? And how many months a year do you want to work?

If you do straight clinic at $80/hr x 60/wk = 4800/wk x52 wks= 249,000

I don't work that much, I generally work 7 months. Say you work 8 months = 153,600 and that's just doing straight clinic. When I do locums I work way more than 60, do ER, take call, and do inpatients. I avg 65-70 hr/s week when I do it all. I'm always over the 200K mark just because when I go to work I generally take the jobs where I can maximize my hours. I don't go to a site to sightsee.

Now my current job is clinic only with no call so I'm just doing 40 ish depending on the charting overflow.

 

[cabinbuilder]

Slightly off topic -- how are the FM prospects for those of us who have no desire to do any inpatient work?

I'm so-so at it but my exposure has been a large, county, safety-net hospital rather rather than a community hospital setting meaning I've often been told that I'll never see patents this sick again as an FM doc....

either way, I have no desire to do inpatient work.

What's it look like?

Most clinic jobs do not require inpatient. You just don't have time for that anymore, especially in a busy practice. Inpatient is generally smaller, more rural hospitals. No issue not doing inpatient.

 

[Kahreek]

i think inpatient work can be a good break from the usual stuff. but fm doctors are less and less required to do it. It is mostly clinic, urgent care, in fewer cases ER, and please someonelse enlight me what other stuff a fm doctor might do in residence.

 

[septoplasty]

Most clinic jobs do not require inpatient. You just don't have time for that anymore, especially in a busy practice. Inpatient is generally smaller, more rural hospitals. No issue not doing inpatient.

Does it not pay better? (Inpatient only vs. outpatient)

 

[cabinbuilder]

Does it not pay better? (Inpatient only vs. outpatient)

Inpatient only would make you a hospitalist. I'm talking about taking a clinic job and not getting hospital priviliges so you would not follow your patients in the hospital too.

 

[jl lin]

So I am out and about doing my locum thing in Nevada currently as the urgent care overflow/walk-in's provider. I tell you I get asked EVERY DAY if I would consider staying on permanent. I say "no" for personal reasons mostly and lack of close airport since my family doesn't want to move anymore.

Just got off the phone on an interview for the next locum job in Oregon. Was asked if I would consider staying on permanent before the converstation was even over.


Family Practice is HOT right now due to the versatility and huge need all over the country. I don't see it dying anytime soon. There is plenty of work out there. You can pay your bills no problem.😎

It's not that it isn't HOT, it is that the idea, especially with ACA, is to increase access to care. What does this mean? It means schooling and using more NPs and PAs. The current administration is all for this, b/c it is cheaper, and apparently a lot of physicians are too.

See my comment here: http://forums.studentdoctor.net/showthread.php?p=14191792#post14191792