FM...can I shed adults?

[matterandenergy]

Hey, SDN! I'm not sure much can be done about this, but here goes.

I'm a fairly fresh FM attending in private practice at a suburban clinic near a large city in the mid-west. I am a domestic grad, residency-trained and board-certified. Since early in residency, one clear trend has been present and steadily growing day after day: I love my kids more and hate my adults more every day.

I went into FM in the first place for a number of reasons. I had a fun MS3 rotation and a great preceptor. I also loved peds at the time, though I had a rough peds rotation at our academic center (various reasons) and I also wanted to keep adults (at the time...). So I ended up in FM, pleased with my choice.

But since actually practicing medicine starting as a PGY-1, I noticed a trend. My clinic days were strongly correlated by the % of the day that was scheduled with peds patients. I noticed myself energized by kids, drained by adults. Days with little peds got me down and in a funk; days with a lot of peds I would look forward to and exclaim to my fiancee when I got home, "tomorrow's gonna be a great end to the week, lotsa kids!"

The trend has continued beyond residency. I've grown an unexpectedly strong attachment to peds cases. No matter how crazy or annoying the kid is, I can handle it. Adults drive me up the wall, though, and all the endless things I could list about adult medicine that drives me mad. It's not that I see kids as a break from adults, or that I think peds patients are "easier" at all, no, no, absolutely not. I often feel more challenged with kids; they're fragile! I've been practicing long enough to realize what my personal style is, and this trend has been clear for years and is only increasing.

As an FM, it seems at face-value it might be simple enough to chop off your patient panel at 19+ since you are "allowed" to see kids. But I "have" to see everyone since I'm FM boarded. My employer would certainly have it as such. I believe the only way for me to see exclusively kids would be to to back and do a full 3-year peds residency in order to get boarded and certified properly. That's quite an opportunity cost. While I grow increasingly disillusioned with adult medicine, I still have this job right here, right now. It's quite a terrible dilemma. Plus, the guilt of leaving my adult patients would be absolutely crushing.

Perhaps I'm stuck. If anyone has any thoughts, anecdotes, advice, I'd be very grateful. But this is genuinely my situation and I can't keep quiet anymore. Thanks

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[oldbearprofessor]

This would be better placed in the FM forum. If you'd like me to move it, I'd be glad to. This topic has come up there before, so a search might find it.

 

[matterandenergy]

This would be better placed in the FM forum. If you'd like me to move it, I'd be glad to. This topic has come up there before, so a search might find it.

Sure!

 

[styphon]

Being family medicine, there is NO reason you can't see only pediatrics.

*BUT* your job may force you to see adults - and it would likely be in your contract. In my contract it is state that I will see patients "Aging from newborn to elderly" - other people have contracts which EXCLUDE pediatrics...

*GOOD NEWS*: If you leave your current job, there are chances to do what will make you happy. I have interviewed at some jobs which were peds only and wanted to hire FM. One of them was an inpatient Nursery, another was an Internal Medicine practice which wanted to start seeing kids, another wanted to replace their peds NP with an MD. You just have to look around, have clear objectives and get people to help you meet those objectives (recruiters can be helpful, as can hospital systems, clinic systems)

 

[matterandenergy]

I have interviewed at some jobs which were peds only and wanted to hire FM.

SIGN ME UP. Seriously, thanks so much for the reply. I figured logically that since I'm "qualified" to see 0-18 (as well as 19+), why should I have to go through additional training to simply cut the age range of patients I see down? Granted, yes, pediatrics residency gives you much more intense inpatient training and sub-specialty exposure. But I have a good buddy who works as a hospitalist right alongside IM docs, and my friend spent tons of time on kids during residency that he now never uses. So there is latitude out there. Certainly in FM.

Your advice has been illuminating, as I have never really looked up from my specific position and thought about things like that.

 

[simpler2]

I'll echo other replies that I have definitely heard of pediatric jobs that are taken by FM trained physicans. However, this is probably as rare as finding an open neurosurgery position. Especially in urban centers, there is typically an oversupply or pediatric clinics and residency trained pediatricians. If you want job opportunities similar to all you have avaiable now as a FP, then I would think going back to Peds residency is going to be necessary. If your passion is really peds then doing that residency has got to be better than continuing to drag yourself to work everyday at a FM clinic job you resent. I would highly recommend listening to the Freakanomics podcast on the upside of quitting: http://freakonomics.com/2011/09/30/new-freakonomics-radio-podcast-the-upside-of-quitting/
Very relavent to the decision you are faced with.

 

[RuralMedicine]

Hey, SDN! I'm not sure much can be done about this, but here goes.

I'm a fairly fresh FM attending in private practice at a suburban clinic near a large city in the mid-west. I am a domestic grad, residency-trained and board-certified. Since early in residency, one clear trend has been present and steadily growing day after day: I love my kids more and hate my adults more every day.

The trend has continued beyond residency. I've grown an unexpectedly strong attachment to peds cases. No matter how crazy or annoying the kid is, I can handle it. Adults drive me up the wall, though, and all the endless things I could list about adult medicine that drives me mad. It's not that I see kids as a break from adults, or that I think peds patients are "easier" at all, no, no, absolutely not. I often feel more challenged with kids; they're fragile! I've been practicing long enough to realize what my personal style is, and this trend has been clear for years and is only increasing.

As an FM, it seems at face-value it might be simple enough to chop off your patient panel at 19+ since you are "allowed" to see kids. But I "have" to see everyone since I'm FM boarded. My employer would certainly have it as such. I believe the only way for me to see exclusively kids would be to to back and do a full 3-year peds residency in order to get boarded and certified properly. That's quite an opportunity cost. While I grow increasingly disillusioned with adult medicine, I still have this job right here, right now. It's quite a terrible dilemma. Plus, the guilt of leaving my adult patients would be absolutely crushing.

Perhaps I'm stuck. If anyone has any thoughts, anecdotes, advice, I'd be very grateful. But this is genuinely my situation and I can't keep quiet anymore. Thanks

I'll start with the disclaimer that I am a double boarded IM/Peds attending. I think if what you really want to do is Pediatrics (and it sounds like you do) then your best bet is probably to truly train as a pediatrician. I don't know how many dedicated pediatrics months you got during your FM residency but if you opt to return to residency you should certainly ask about obtaining credit for those months towards your pediatrics time. You may be able to earn yourself six months of advanced standing for this. Good Luck!

 

[deleted87716]

I'll start with the disclaimer that I am a double boarded IM/Peds attending. I think if what you really want to do is Pediatrics (and it sounds like you do) then your best bet is probably to truly train as a pediatrician. I don't know how many dedicated pediatrics months you got during your FM residency but if you opt to return to residency you should certainly ask about obtaining credit for those months towards your pediatrics time. You may be able to earn yourself six months of advanced standing for this. Good Luck!

^ Concur.

Unless you open your own practice, you'll probably never find an employer who will allow you to see only children.

 

[Roguelyn]

It really depends on your position. If you didn't replace another doc and are building a new practice you should be able to advertise for more peds and instruct your front office staff mention that you see peds and to refer young families that call to you. I talked, personally, with our local midwife group and have gotten several referrals that way. I also did no-doc newborn inpatient for a year and picked up several patients. I definitely see far more adults than peds but it's possible to push your ratio towards peds.

So often patients don't realize that FM can see kids. Use every opportunity you can to change that opinion. If a patient brings their kid to a visit ask if they have a pediatrician, look up their vaccinations in your state registry, offer to give the vaccines and offer to see the kid next time he's sick.

You won't be able to eliminate adults but you can certainly change the makeup of your practice.