FM and its fellowships -- deciding on FM

[DD214_DOC]

I have been stuck in the internal debate between FM and IM for a long time and don't seem to be making much headway. I really want to do surgery, but I don't want the lifestyle. I really like procedures.

Currently, I am leaning more towards FM. I really, really like the experience I have had rotating in a FM residency program; they do a lot of stuff and seem more like "real" doctors, working in the hospital and what-not. However, I did do a month at an office and the doc really didn't do anything that a NP/PA couldn't do; we just refilled lortab all day for pts with LBP.

I am hoping doing one of the fellowships could spare me a life of office-based monotony. However, I don't know much about either the OB fellowship or the EM fellowship; anyone care to enlighten me?

FM attracts me due to its variety and the opportunity to do lots of procedures, even C/S with the OB fellowship. The flexibility to also work in the ED at a rural hospital or as a hospitalist is also wondeful. However, a doc I recently worked with made the argument that in 10-15 years FMs won't be doing ED, OB, IM type work at all and will basically be equivelant to DNPs -- slaves of the outpatient clinic, seeing nothing high acuity. This concerns me and makes me want to do IM.

In considering of IM, keep in mind that I do not plan to subspecialize. If I decide to ever go back for 2+ years to do anything, it will be another residency, not a subspecialty IM fellowship.

I guess I'm really just looking for advice on anything above.

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[mrnight]

i thought u were looking at psyc as well. what happened to psyc

 

[iatrosB]

Honestly, if the thought of clinic scares you that bad, FM is probably not for you. Especially in the military, it's gonna be all clinic all day. I suggest you look elsewhere...you like OB that much...do OB.

 

[lowbudget]

I think the reason why you're refilling lortab all day is because you refill lortab all day. I'm a little surprise that your preceptor struggles with LBP management, seeing that your sig suggests you're a DO and probably are rotating with a DO... Must have lost a lot of their MSK osteopathy skills...

I think it's really up to you whether or not you subject yourself to the office-monotony. From rotating with subspecialists, it seems to me that the more you "specialize", the more monotonous things get with people who all have the same problems. Everyone in the endocrinologist's clinic had fatigue and weight gain. Everyone in the ID clinic had fever. Everyone in pulm clinic was SOB and/or coughing. And if they didn't have a primary physician who would've worked them up properly and if patients were mis-referred, get ready for some chaos because Cards say, it's a Pulm problem. Pulm says it's a Renal problem. Renal says it's a Cards problem. And the patient gets confused, and now wants a 2nd opinion from a 2nd cardiologist, who says something totally different.

I mean, it's crazy. You as a general doctor (FM/IM) can make a big impact and really help this patient, if you care to.

If you train broadly and keep your skills well-rounded and know your limits, I don't think there's anything you'd have to worry about, in terms of the DNPs. Year-for-year, their skills just don't compare. Seriously. And FP's aren't the only ones with turf issues. Every specialty has their own turf issues.

But, it's a lifestyle decision. Don't want to deliver? Work ED shifts? Do hospital work? Fine. Don't want to write narcs? OK. Tired of seeing only old people? That's fine too. Don't want to deal with politics & overhead? Be employed. Can stand following someone's rules? Create your own destiny and start a practice. Want to slow down and enjoy your near-retirement? Make it happen.

The question here is what are you willing to sacrifice to get what you want. Money? Time? Job satisfaction? Autonomy? Security? Prestige?

What's nice about being a general doc is that you can reinvent yourself how ever way you want. If your community changes, if technology changes, if politics changes, it'll be ok.

 

[thethom]

Your LBP experience was not representative of day to day Family medicine. It truly is "real medicine", and as for office monotony, don't forget you can also work as a hospitalist, work in the ED (IM trained physicians are not as effective in an ED setting because they are not trained to see children).

You only mentioned 2 fellowships, lets not forget the sports medicine fellowship, geriatrics fellowship, international medicine fellowship, etc etc...

Everything you have done in your IM, peds, OB, and ED rotations, you can/will do in FM...

-T

 

[DD214_DOC]

and as for office monotony, don't forget you can also work as a hospitalist, work in the ED (IM trained physicians are not as effective in an ED setting because they are not trained to see children).

This is the point I was trying to make in my original post, unless I forgot to mention it? Most ED/IM docs I have worked with think that, by the time I'm out of the military, FPs generally won't be working as hospitalists or rural ED docs. EDs already prefer board-certified EM docs and with enrollment increasing I suspect they may get their wish in displacing the FPs in the ED.

Also, a general search for hospitalist jobs very rarely returns any that accept either IM or FM -- most specifically ask for IM.

 

[deleted87716]

^ True, BUT...those jobs are out there. You just need to be willing to go where they are.

If you want to be a hospitalist, PM me. We're hiring, IM or FM (most of the existing folks are FM).

 

[thethom]

This is the point I was trying to make in my original post, unless I forgot to mention it? Most ED/IM docs I have worked with think that, by the time I'm out of the military, FPs generally won't be working as hospitalists or rural ED docs. EDs already prefer board-certified EM docs and with enrollment increasing I suspect they may get their wish in displacing the FPs in the ED.

Also, a general search for hospitalist jobs very rarely returns any that accept either IM or FM -- most specifically ask for IM.

Just curious if you were one of the people that feels that everything outside of the limits of a city >750k population just doesn't exist (not tryin to be an a**, just curious)

I interviewed at nearly every FM program in NC (rural, urban, and university), and all the graduating residents at every program had multiple hospitalist job offers 6+ months before finishing in NC, surrounding states, some in cities, some further out in the community. The truth is, with ~3 hospitalist jobs per prospective hospitalist, no reasonable increase in enrollment will produce enough IM docs to fill all the positions. MOST programs don't specify IM/FM from what I've seen. Its currently about 50/50, FM/IM. I'm not sure where you're getting the info that most hospitalist positions specify IM only.

As for EDs, University medical centers and large urban medical centers will prefer EM boarded docs, but there are many many more hospitals across the state that need IM and FM docs to staff their EDs...

-T

 

[DD214_DOC]

Just curious if you were one of the people that feels that everything outside of the limits of a city >750k population just doesn't exist (not tryin to be an a**, just curious)
-T

Nope, not me. I actually prefer smaller community-type hospitals. I think they're more fun to work at and I have seen just as much interesting pathology as I have any larger university-based hospital.

I intend to practice in a smaller community.

 

[lowbudget]

This is the point I was trying to make in my original post, unless I forgot to mention it? Most ED/IM docs I have worked with think that, by the time I'm out of the military, FPs generally won't be working as hospitalists or rural ED docs. EDs already prefer board-certified EM docs and with enrollment increasing I suspect they may get their wish in displacing the FPs in the ED.

Also, a general search for hospitalist jobs very rarely returns any that accept either IM or FM -- most specifically ask for IM.

Interesting. I don't know; it's hard to say. EM docs burn out and move on. I haven't worked with one who was old, had a stable family life, and/or was psychologically stable. Most say the plan is to accumulate as much wealth as possible early so that they can do something else in their lives.

With the turnover, amount of shift coverage, and geographical coverage, there's room for you.

Same goes for hospitalists. High burn out, many shifts to cover, hospitals all over the place, there's room for you. Although I will admit, there ain't no jobs, IM or FM, for hospitalists in Maryland where there's a bajillion doctors.

All of my FM friends found hospitalist jobs they wanted though, so it's no big deal.

One (unsolicited) advice: don't let the "general search" of want ads be your only view of the world out there. Many jobs, the good ones, are filled by people who are referred by people. Many jobs never make it to the want ads or recruiter stage.

So... get out there, do good work, let the quality of your work speak for you, and the job you seek will somehow find you.

 

[Station51]

Interesting. I don't know; it's hard to say. EM docs burn out and move on. I haven't worked with one who was old, had a stable family life, and/or was psychologically stable. Most say the plan is to accumulate as much wealth as possible early so that they can do something else in their lives.

Just like to add that the above is the complete opposite of my experience. For your leisure:
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Also worth noting that EM is a relatively new specialty that started in the mid-70's. Most of the EM residencies didn't start until the 80's and many starting in the 90's through today. You're not going to find very many "old" EM-trained physicians.

 

[DrJosephKim]

ERs used to be run by surgeons.

 

[deleted87716]

EM is a relatively new specialty that started in the mid-70's. Most of the EM residencies didn't start until the 80's and many starting in the 90's through today. You're not going to find very many "old" EM-trained physicians.

EM became officially recognized as a specialty by the ABMS in 1979.

 

[andwhat]

^ True, BUT...those jobs are out there. You just need to be willing to go where they are.

If you want to be a hospitalist, PM me. We're hiring, IM or FM (most of the existing folks are FM).

FM Hospitalist amazing

 

[andwhat]

Interesting. I don't know; it's hard to say. EM docs burn out and move on. I haven't worked with one who was old, had a stable family life, and/or was psychologically stable. Most say the plan is to accumulate as much wealth as possible early so that they can do something else in their lives.

With the turnover, amount of shift coverage, and geographical coverage, there's room for you.

Same goes for hospitalists. High burn out, many shifts to cover, hospitals all over the place, there's room for you. Although I will admit, there ain't no jobs, IM or FM, for hospitalists in Maryland where there's a bajillion doctors.

All of my FM friends found hospitalist jobs they wanted though, so it's no big deal.

One (unsolicited) advice: don't let the "general search" of want ads be your only view of the world out there. Many jobs, the good ones, are filled by people who are referred by people. Many jobs never make it to the want ads or recruiter stage.

So... get out there, do good work, let the quality of your work speak for you, and the job you seek will somehow find you.

dude??? Maryland, that is like the Mecca of Hospitalism.... that is ironic, my friends state that there are tons of jobs there..
You know I won't deny what you are saying about Hospitalist 'burnout' because there are some programs that will work you hard...
but if you are in the right gig, you can go far.. and have a great lifestyle overall...
I wouldn't say high burnout -- I would say read youre contract carefully, and choose youre Hospitalist program wisely.
Many shifts to cover? Not necessarily. Then again obviously it depends on where you are practicing. Geography is everything at times.
Its tough, but you can become wiser, and better with time management, and social contacts within youre system -- for example good ER docs, and Nurse Managers.

 

[Bleurberry]

There's a few out there I just recently discovered:




Originally Posted by DrMidlife
Here's Seattle's famous/infamous patron saint of the ER: http://blogs.seattleweekly.com/daily...epping_dow.php

He graduated med school in 1964, so I'm guessing that makes him 70. He's still working, just not 80 hours a week.

Just like to add that the above is the complete opposite of my experience. For your leisure:
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Also worth noting that EM is a relatively new specialty that started in the mid-70's. Most of the EM residencies didn't start until the 80's and many starting in the 90's through today. You're not going to find very many "old" EM-trained physicians.