FM in cities

[tirral]

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This is mainly a question for attendings: Do you feel that family medicine is too encroached-upon by specialists in urban areas?

I am interested in primary care mainly because I want a diverse practice, and I'd like to manage a variety of ambulatory complaints (not just refills on Lipitor).

The city where my med school is located is full of specialists, and many private patients self-refer to the derm/ortho/ENT when they have a problem related to those fields. Consequently, the family doctor's role often seems like it's mainly chronic disease management and sports physicals.

Are there cities where this model isn't the norm? My wife has professional interests which require a relatively sizable city (300k+). Can family medicine be fun in places like this, or does full-spectrum primary care really require one to live out in the sticks?

 

[deleted87716]

many private patients self-refer to the derm/ortho/ENT when they have a problem related to those fields

That's their problem, not yours. Most specialists don't want to see mundane crap that could be take care of in the primary care setting. For that reason, most don't accept self-referrals. If they do, they must not be very busy. Around here, most specialty visits are scheduled weeks out unless it's some sort of urgency/emergency. I'm pretty much the only doctor most patients can get in to see right away (aside from urgent care, which can involve longer waits, higher co-pays, overtesting, and treatment that frequently disappoints).

They key is availability. As long as you're accessible, you'll see everything you want to see. If they can get in to see somebody else faster or easier, many of them will.

 

[MonsterAddict]

I am just a lowly med student here but in my experience working with the underserved gives you the ability to manage tons of acute and complicated issues. The ability to handle these without referring to derm/ent/ortho is a huge asset and decreases healthcare costs.

 

[VA Hopeful Dr]

I am just a lowly med student here but in my experience working with the underserved gives you the ability to manage tons of acute and complicated issues. The ability to handle these without referring to derm/ent/ortho is a huge asset and decreases healthcare costs.

As a guy working in an underserved clinic, I can say that this is all true. However, the days can be pretty rough sometimes.