FP - the underclass of medicine?

[George85]

I am a resident member of one of the budget committees and I saw a document with the salaries of various staff members a few weeks ago. The FP faculty earn on average half what general surg and ortho earn and about 60% of what medicine specialists earn. So, for an extra 2 years of residency the 20 years earnings difference between surg and FP was $3 million. For cardiology it was $2 million for an extra 3 years of residency. I know it's not all about the money, but when the differential is so huge - enough to pay off all those loans, kids through college, and a comfortable retirement - then it makes FP even more unattractive. When your speciality is making 20 - 25% more than the CRNA's then that tells you all you need to know.

And if you think that FP is some sort of general physician then think again. To make a decent income you'll have to see pt's every 15 mins. You become a triage/Rx doctor - you can address their HTN and HLD, but then refer to ortho for the carpel tunnel because you don't have time to do the steroid injection yourself, and refer to GI for the chronic diarrhea because you just don't have time to work it up. Being an FP is simply not interesting. The ob training in most programs is so inadequate to be of any practical use. In fact most programs are very close to IM programs in their true practice - so go into IM and at least give yourself more options later down the line.

Then there's the applicant pool. Why would you want to be part of a "speciality" which never fills, is full of IMG's, and has zero competition for places - certainly for US grads who pass step 1 the first time. Why go through med school and post grad training just to be part of the underclass of medicine?

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[skypilot]

I am a resident member of one of the budget committees and I saw a document with the salaries of various staff members a few weeks ago. The FP faculty earn on average half what general surg and ortho earn and about 60% of what medicine specialists earn. So, for an extra 2 years of residency the 20 years earnings difference between surg and FP was $3 million. For cardiology it was $2 million for an extra 3 years of residency. I know it's not all about the money, but when the differential is so huge - enough to pay off all those loans, kids through college, and a comfortable retirement - then it makes FP even more unattractive. When your speciality is making 20 - 25% more than the CRNA's then that tells you all you need to know.

And if you think that FP is some sort of general physician then think again. To make a decent income you'll have to see pt's every 15 mins. You become a triage/Rx doctor - you can address their HTN and HLD, but then refer to ortho for the carpel tunnel because you don't have time to do the steroid injection yourself, and refer to GI for the chronic diarrhea because you just don't have time to work it up. Being an FP is simply not interesting. The ob training in most programs is so inadequate to be of any practical use. In fact most programs are very close to IM programs in their true practice - so go into IM and at least give yourself more options later down the line.

Then there's the applicant pool. Why would you want to be part of a "speciality" which never fills, is full of IMG's, and has zero competition for places - certainly for US grads who pass step 1 the first time. Why go through med school and post grad training just to be part of the underclass of medicine?

Everyone knows what FPs make; $130 to $160 on average. Which is not a bad income. It is a lot lower than Orthopodedic surgeons, but the lifestyle of an FP can be a lot better than that of a surgeon. And if you are in a more rural area, being a FP can provide a great income when compared to the cost of living, and a prestigious position in the community.

If you need a few extra dollars for the kids college education, you can always moonlight. You still might be working less hours than that Orthopedic surgeon. As far as retirement goes, savvy disciplined investing will take you a lot further than a big income.

In my rotation in FP, I did see the FPs doing the initial visits and then scheduling the procedures for the next visit. Some of the FPs were doing minor operations like vasectomies as well. And the FPs were running the rural hospital.

I think being an FP allows you to see the patients over and over again gaining a better understanding of their disease process and obtaining a better overall result for the patient through the opportunity for "trial and error" and balancing of the treatments for all their conditions than the specialist who is interested in only one area.

 

[lateness]

I am a resident member of one of the budget committees and I saw a document with the salaries of various staff members a few weeks ago. The FP faculty earn on average half what general surg and ortho earn and about 60% of what medicine specialists earn. So, for an extra 2 years of residency the 20 years earnings difference between surg and FP was $3 million. For cardiology it was $2 million for an extra 3 years of residency. I know it's not all about the money, but when the differential is so huge - enough to pay off all those loans, kids through college, and a comfortable retirement - then it makes FP even more unattractive. When your speciality is making 20 - 25% more than the CRNA's then that tells you all you need to know.

And if you think that FP is some sort of general physician then think again. To make a decent income you'll have to see pt's every 15 mins. You become a triage/Rx doctor - you can address their HTN and HLD, but then refer to ortho for the carpel tunnel because you don't have time to do the steroid injection yourself, and refer to GI for the chronic diarrhea because you just don't have time to work it up. Being an FP is simply not interesting. The ob training in most programs is so inadequate to be of any practical use. In fact most programs are very close to IM programs in their true practice - so go into IM and at least give yourself more options later down the line.

Then there's the applicant pool. Why would you want to be part of a "speciality" which never fills, is full of IMG's, and has zero competition for places - certainly for US grads who pass step 1 the first time. Why go through med school and post grad training just to be part of the underclass of medicine?

hellooo? for an extra 2 years of residency 20 yrs difference 3 million.?? I dont know where to begin with all of your statements, but I will just comment, that you are worried about a 20 yr difference in salary? surgy residency doesnt end with residency, they are always overworked and have a much higher malpractice. Plus I know many Fps making much more than that, if they want. It seems you are just trying to pick on some negative and not fully correct statements and attack people for wanting to do something they enjoy. You should try seeing some other FPs not just the ones in your hospital/school, in different areas before judging so quickly.

 

[George85]

Skypilot,
I totally agree with you. There are still opportunities out there and FP can be interesting. But, it's not the norm and such opportunities are diminishing. Medicine in general has not been aggressive enough in stopping mid-level providers from advancing their practice rights - this will affect FP more than anyone else.

 

[George85]

Bafootchi,
Yes, there are many more factors and variables than I have addressed. My 20 year extrapolation may be basic, crude, and not that accurate, but the point is clear. It was quite a shock to me to see the real salaries of various departments. The institution pays all insurance.

But what I'm doing is comparing hard work, and financial investment against return. FP's do long hours, especially when you add on the ancillary work load of running a business, pt phone calls, follow up, etc. To get paid $150k for all that when a CRNA can make $120k for just turning up 8 till 4, spending 80% of their time sat on their butt, no hassle of running a group or business - oh, and after just 2 years of post-grad education compared to 7 for the FP - helps put it into perspective.

I'm not saying surgery is a great option either. It seems to me that the more you specialize the better your lifestyle and the greater your earnings. I was shocked to see the salaries, but stunned to see what the hand surgeons made - and I have worked with them. All that ortho training, but they are like podiatrists, just the other end of the body. The message is clear - general medicine will become the domain of mid-level providers, NP's, PA's, and CRNA's, and physicians will have to become even more specialized. Personally, I'm planning on being a dextranephrologist.

 

[f_w]

Hi McGyver !

(don't mistake the little slice of reality at your academic medical center with the broader picture. plenty of FPs out there who make decent money with a diverse practice. your post is so full of misunderstandings and omissions that it is hard to even start to answer all of them. overall I get more of the impression that you are just trying to stir up the FPs on this board a bit, with remarkably little success)

 

[sophiejane]

do not feed the troll, please please please...

 

[George85]

Not trying to stir anything. Just looking for some "real" replies - i.e. peoples real experience & opinions that apply to the majority and the real world. The reason I don't usually look at these forums is that as soon as someone posts an unpopular view it usually incites childish responses.

 

[deleted87716]

Being an FP is simply not interesting.

Then please stop posting in the Family Medicine forum. I'm sure you can find a more interesting forum in which to spend your time.

Unless you're trolling, in which case you will be banned.

Thank you.

 

[f_w]

and I saw a document with the salaries of various staff members a few weeks ago.

Thereby only getting a very limited view of the income situation at one institution.

but when the differential is so huge - enough to pay off all those loans, kids through college, and a comfortable retirement -

You are talking about pre-tax income. All these things have to be paid out of post-tax income.

When your speciality is making 20 - 25% more than the CRNA's then that tells you all you need to know.

Who cares how much the CRNAs make.

And if you think that FP is some sort of general physician then think again.

Well, apparently you have only experienced a very limited scope of FM practice.

To make a decent income you'll have to see pt's every 15 mins.

And that would be different from lets says an orthopedic surgeon how ?

because you don't have time to do the steroid injection yourself,

Have the patient come back.

and refer to GI for the chronic diarrhea because you just don't have time to work it up.

Sure, if you want to limit your practice to this kind of idiot practice, you are free to do so.

Being an FP is simply not interesting.

That is your personal opinion.

The ob training in most programs is so inadequate to be of any practical use.

Your institution has a sub-par FM program it seems.

Why would you want to be part of a "speciality" which never fills,

How does the fact whether some community hospital in the hills of west virginia didn't fill affect your well-being ?

is full of IMG's,

Unless you don't like people who look different from you and might have a different background, why would that be a problem ?

and has zero competition for places -

All the better. Take your pick of the good FM programs which offer good OB and basic procedural education.

Why go through med school and post grad training just to be part of the underclass of medicine?

FM is certainly not the 'underclass' of medicine.

The underclass of medicine are:
- ignorant idiots
- sub par graduates who after doing 2 different prelims spend their life at a 'doc in the box' or non-hospital urgentcare.

 

[George85]

Then please stop posting in the Family Medicine forum. I'm sure you can find a more interesting forum in which to spend your time.

Unless you're trolling, in which case you will be banned.

Thank you.

Stop posting - why, because people don't like what I have to say, you don't like what I have to say, or both? My original post was an opportunity to examine what FP is becoming and where it is going - also, a personal view as to why anybody who chooses to enter FP should really be sure of their decision. Your approach to my comments reminds me of MD vs DO posts. If a poster dare suggests that people enter DO schools because they don't get into MD school - no-one seems to examine such a viewpoint, the poster simply gets slammed.

It might be that you have defined your practice and are happy with it - good for you. But reading through other postings, such as "FPs not doing gynecology?", it's clear that many people are having a far different experience than the picture that FP likes to paint for itself to others.

Ban me. Go ahead. God forbid that someone should hold and voice opinions that don't correspond with yours. Of course, you can simply remove a nusance poster like myself, bury your head in the sand, and you can all go on telling each other how grand FP is without examining the issues. I would refer people to one of Aesop's Fables, "The emperor's new clothes". Unless FP, as a collective, stands up to the rest of the medical comminity, including insurance companies, hospitals, and specialists, then the decline will continue. The irony is that primary care holds much of the power within medicine but has never managed to utilize it for the benifit of their members.

F_W read and noted. And thanks for the reply. And yes, I certainly feel my program is sub-par.

 

[deleted87716]

Unless FP, as a collective, stands up to the rest of the medical comminity, including insurance companies, hospitals, and specialists, then the decline will continue.

OK, George...explain how this thread, and your first post within it, accomplishes any of the above.

Go ahead.

I'm waiting...

 

[dulceleche]

Stop posting - why, because people don't like what I have to say, you don't like what I have to say, or both? My original post was an opportunity to examine what FP is becoming and where it is going - also, a personal view as to why anybody who chooses to enter FP should really be sure of their decision. Your approach to my comments reminds me of MD vs DO posts. If a poster dare suggests that people enter DO schools because they don't get into MD school - no-one seems to examine such a viewpoint, the poster simply gets slammed.

It might be that you have defined your practice and are happy with it - good for you. But reading through other postings, such as "FPs not doing gynecology?", it's clear that many people are having a far different experience than the picture that FP likes to paint for itself to others.

Ban me. Go ahead. God forbid that someone should hold and voice opinions that don't correspond with yours. Of course, you can simply remove a nusance poster like myself, bury your head in the sand, and you can all go on telling each other how grand FP is without examining the issues. I would refer people to one of Aesop's Fables, "The emperor's new clothes". Unless FP, as a collective, stands up to the rest of the medical comminity, including insurance companies, hospitals, and specialists, then the decline will continue. The irony is that primary care holds much of the power within medicine but has never managed to utilize it for the benifit of their members.

F_W read and noted. And thanks for the reply. And yes, I certainly feel my program is sub-par.

Geez!

What is your problem anyways? Do you know how to spell? "nusance" sounds like something to describe yourself. If you think you are so high and mighty why don't you tell us what specialty you are in, instead of coming on this forum to bash ours. So, FP is not for you. Who cares? Why are you so set upon being a "nusance" to others? If you think you are God's gift to medicine, that's just great. Just don't post anonymously and stir up trouble for no reason. I want to do missionary work and think FP is the most practical specialty to do so. If money is the only reason you want to do medicine. Please tell us who you are because I don't want to be one of your unnecessary procedures in order for you to buy that mansion. Remember, if you have an opinion about FP and if you are not in FP, please keep your opinions to yourself. I think most people on the FP forum are not interested in what you have to say anyways. I have noticed that people such as yourself don't do well anyways in medicine because your attitude permeates through your work and with others. Nobody wants to work with a stinker.

dulce

 

[iatrosB]

I know it's not all about the money,

Actually, you seem ignorant to this concept.

 

[Margaritaville]

Actually, you seem ignorant to this concept.

That's the least of the things that he seems ignorant about.

 

[George85]

dulce,

I really don't wish to descend to the personal critisism that others seem to relsih. But, you appear to typify the stereotypical view I have gained of many forum posters (again, not trying to offend the silent majority or vocal minority - depending on your view)

>>Do you know how to spell?
I leave a vowel out of a word and that's the best you can do. There are so many other comments you could make .... naiive, uninformed - at least make things more interesting than picking on my spelling.

>>tell us what specialty you are in
FP. So, I'm not bashing your speciality - I'm frustrated with our speciality.

>>FP is not for you
FP is for me. But, I want a varied and interesting career - not a stream of 10 to 15 min apts without peds and ob, where the pressure is on numbers just to make a living. I'm not greedy or even materialistic - but I think the pros and cons of FP salaries should be discussed openly so that those med students with 150-200k of debt can make informed decisions.

>>don't post anonymously
the reason I don't say where I am is that I don't want to cause trouble - for me or the others in my program.

>>stir up trouble for no reason.
the idea is to stir up debate.

>>I want to do missionary work and think FP is the most practical specialty >>to do so.
I rest my case. You hardly represent the majority of people in FP. Unfortunately, the rest of us have to live in the real world.

>>If money is the only reason you want to do medicine.
I never said or intimated that. But again, in the real world real people have student loans to repay, families to support, etc.

>>I think most people on the FP forum are not interested in what you have >>to say anyways.
Maybe.

>>I have noticed that people such as yourself don't do well anyways in >>medicine
A sweeping uninformed generalization that even I would have been proud of - oops, better be careful using sarcasm

>>Nobody wants to work with a stinker.
Mature response.

Kent_W - thanks for the opportunity - I will make a considered response when I get some time - right now catching up on those dictations from Friday's barrage of 15 min apts.

 

[iatrosB]

This last post seems reasonable and sincere. I don't think you're a troll, but a concerned/disgruntled resident. I wish you the best!

 

[deleted87716]

right now catching up on those dictations from Friday's barrage of 15 min apts.

I'm going to assume you're being facetious, since, as an intern, you're likely only seeing around 6 patients per half-day in clinic, and are not expected to see them in 15-minute slots (especially with precepting).

If you're still doing Friday's notes on Sunday, you have a time-management problem. But that's another topic.

 

[sophiejane]

Then there's the applicant pool. Why would you want to be part of a "speciality" which never fills, is full of IMG's, and has zero competition for places - certainly for US grads who pass step 1 the first time. Why go through med school and post grad training just to be part of the underclass of medicine?

Okay, I held off as long as I could.

George, hon. Do you honestly think that you can write something like this and then expect to have an "exchange of ideas?"

I'm sorry you feel like a second class citizen, are at a crappy program that you hate, and probably ended up in FP because you had to scramble. (This is just a guess, but how far off am I?)

I'm sorry you feel slighted because there are IMGs at your program and you don't get to do any procedures....but that's kind of what you get for overshooting your goals or whatever it is that you did that made you have to scramble. All the programs I'm applying to have great opportunities for procedures and excellent OB training.

Maybe you could make some lemonade out of your abundant lemons and try to LEARN SOMETHING from those IMGs, because I can guarantee you that as a whole they are a heck of a lot smarter than your average US grad, simply by virtue of the fact that most of them have already had careers as specialists or generalists in their home country. I have to say, everytime I've been on a rotation with IMGs I've been impressed with their knowledge and skill.

But then, I'm a DO student, so you should probably take that with a grain of salt, right? According to you, in another thread:

a 3 year program directed at those who already have poor MCAT and GPA scores - clearly shows that FP sits between a PA and a real doctor - another proud moment for osteopathic medicine.

It probably kills you that there are DOs at your program, too. I mean, they didn't study HALF as hard as you did for the MCAT, and now you have to WORK with them. As you said,

I just regret working so hard to get good MCAT and board scores when I could have kicked back, gone to an off-shore school, barely passed the boards, and still be where I am now.

That's just a shame, George. You must be hating life.

This forum is (happily) full of folks who are excited about FM. We are going to (or have graduated from) good, unopposed FM programs that will make or have made us into very good docs who enjoy what we do and are happy we have chosen this field. Otherwise, we wouldn't post, and try to help each other out, discuss things, etc.

Every now and then, someone like you or PandaBear comes along to rain on everyone's parade. Now, this is not to say we don't think there are problems in our field--I think most people are very realistic about it--but we like it enough to DO IT ANYWAY. And we have found a lot about the field that is satisfying and rewarding.

But the thing is, George, someone like you pissing and moaning about a field they ended up in by default is not going to spark very many productive discussions. So please crawl back under your rock and start working on your ERAS application so you can do whatever it is you wanted to do in the first place.

 

[hamlet423]

George,

I really think you need to look at what you've said so far and realize that while you make some good points, you omit a lot of info thats kind of important.

You compare FP salary to medicine SPECIALISTS and Orthopods. You didnt compare internal medicine docs that do primary care. Sounds like you have more of an issue with primary care in general perhaps?

You also fail to mention pediatrics in that realm...another glaring omission I would say.

I just finished my training in family medicine, and I am doing a fellowship in sports medicine. A FP doc CAN inject a wrist for carpal tunnel, a shoulder or a knee. They CAN work up chronic diarrhea, and then refer to a GI for further workup as needed, but ALOT will do the colonoscopy themselves. They can do well-child care, deliver children, and tons of office procedures. They not only do a lot of simple office procedures, skin biopsys, but other stuff like vasectomies and FleX sigs as well. And unlike some other residencies, I actually get TRAINING in how to do this before I finish residency. The few internal med people that do just outpatient will often take 6 months to another year in practice just to learn the bread and butter of outpatient procedures.

I have tons of FP faculty in my past program that do TONS of OB, including several that sit on the editorial board of major colleges and do cutting edge research in women's health care.

So to make sweeping generalizations thats all FPS only see a patient every 15 minutes and can't do anything else is just plain wrong.


Plenty of FPs dont make any money--plenty make ALOT! you can say that plenty of pediatricians/internal med for that matter (and peds has even LESS procedures they can do!).

so dont know fp--if you dont like it, do something else, but dont make an assumption that all FPS just see a patient every 15 minutes and hate their lives.

 

[sophiejane]

Not trying to stir anything. Just looking for some "real" replies - i.e. peoples real experience & opinions that apply to the majority and the real world. The reason I don't usually look at these forums is that as soon as someone posts an unpopular view it usually incites childish responses.

What is childish, George, is bashing IMGs, DOs, PAs and anyone else you can think of that you deem even LOWER on the totem pole than you, and then getting high and mighty when people are justifiably unsettled by your remarks.

 

[George85]

Sophiejane.

>>..write something like this ... expect to have an "exchange of ideas?"
If you look at my original post the title finished with "?" - it was a question, not a statement.

>>ended up in FP because you had to scramble
I never see the advantage in being personal, but .... pretty good scores, didn't scramble, got my 1st choice, interviewed at ob/gyn and FP progs, but only applied to FP.

>>because there are IMGs at your program
first IMGs ever this year and they both seem really good. My comments were aimed at programs that fill with IMGs or have more IMGs than US grads - that's ignoring the fact that FP is becoming even less attractive to US grads meaning more IMGs filling the slots. And no, I'm not xenophobic, it's just that such a situation serves to undermine our overall standing in the medical community, making FP even more vulnerable to mid-level providers being granted extended privileges.

Your view of IMGs being smarter than US grads - some might be - but you say "as a whole" - are we talking about the same group? are these the same individuals who figured that MyState U wasn't good enough, so enrolled in Ross, AUC, et al?

>>everytime I've been on a rotation with IMGs I've been impressed
>>with their knowledge and skill.
I'm sure you were.

>>take that with a grain of salt, right?
You could always put that grain of salt on that big chip that many DOs seem to have on their shoulder.

>>kills you that there are DOs at your program
Hardly. There are 1 or 2 DOs in each year of FP, and they do just fine. There are none in the other programs, and that's with an intake of about 50 residents across just about every specialty. And why doesn't anyone else have DOs - simple - they don't have to. I'm not trying to stir a topic that's already been covered ad infinitum. That's just how it is.

>>to rain on everyone's parade.
Just trying to get some people talking and thinking. Don't you ever think that Rep & Democrat conventions should swap speakers - what's to point of preaching to the converted. You should want to hear someone else's point of
view.

>>bashing IMGs, DOs, PAs
Not bashing anyone. We make choices in life. I chose to invest a lot of time, money, and effort in becoming a physician. So, yes it annoys me when I see CRNAs making close to primary care salaries, when I see PAs & NPs having extended privilages.

>>deem even LOWER on the totem pole than you
I can be accused of many things, but I never look down on others .... well, except the French

Kent - 2nd year just. 15 min apts, and these arn't "normal" people, they're all train wrecks.

 

[lowbudget]

Personally, I'm planning on being a dextranephrologist.

Why would you want to do that? Hmmph, the last thing this world needs is yet another underclass Right Kidney Doctor. Everybody knows the field is threatened by dialysis nurses.

 

[deleted87716]

Just trying to get some people talking and thinking...You should want to hear someone else's point of view.

That's not the issue. You need to work on your delivery. Big time. Furthermore, your comments regarding DOs and IMGs are inapproriate, and discussion of CRNAs is completely off-topic for this forum. The Anesthesia forum has enough trouble with people trolling about that; we don't need it here.

2nd year just. 15 min apts, and these arn't "normal" people, they're all train wrecks.

Where I trained, we called those patients "great learning cases."

Those "train wrecks" are also job security, my friend. You can't say, "Family docs don't do anything and midlevels are going to take over" and in the next breath complain about how complicated the patients are. Those patients are bread and butter family medicine, and there are more of 'em every day.

 

[f_w]

If you look at my original post the title finished with "?" - it was a question,

which was followed by a whole slew of unsubstantiated statements.

it's just that such a situation serves to undermine our overall standing in the medical community,

So, how is that. Do you think the rest of medicine is xenophobic and you aren't ?

 

[8744]

...Every now and then, someone like you or PandaBear comes along to rain on everyone's parade...

Hey. Leave me out of this. I don't believe I have posted here since I started my Emergency Medicine residency. I think the OP is a troll. On the other hand, if the shoe fits etc. No need to get all defensive if you really believe in your specialty.

 

[sophiejane]

I guess I'm confused by the fact that you got your first choice, which is a program that you describe as sub-par. Did you not know that before you started there?

As for the chip--I swear I'm not going to hijack this thread, but this really needs to be said. If you had people like yourself making statements like you made, that clearly are uninformed, well, you'd develop a chip. The funny thing is, my dumb little DO class had a higher pass rate on the USMLE Step I than a number of MD schools in my state, and since you are dragging undergrad in, higher GPA and MCAT average than at least two of the state MD schools. The other funny thing is that our grads are all over the map (unfortunately not at your program) so apparently, Johns Hopkins, Harvard, and Penn State (and that's just class of 2006) are a bit more enlightened. I guess anaesthesia at Penn, othopedic surgery at Emory and IM at Hopkins must have had almost NO apps this year, since apparently they HAD to let in a DO. From Texas, no less.

Now, back to family medicine....

 

[George85]

>>You need to work on your delivery.
Well, it's always good to have goals.

>>Where I trained, we called those patients "great learning cases."
The hospital has IMed and FP inpt services. IMed does not take those cases not considered good teaching cases such as overnight prep for colonoscopy following ER admit - they go to the hospitalist. Not so for FP - we get them all. All that does is distract from the cases which are good learning ones.

As for outpt clinic. The complicated pt's need more time - it's not just my inexperience, I see the attendings an hour behind by lunch time, they catch up over lunch and are an hour behind again by 4. Education costs keep going up at an unreasonable rate, insurance rates are going up, and reimbursement rate for primary care keep coming down. Something has to give.

Throw the ever increasing output of NPs and PAs into the mix and what I see happening in the future is mid-level providers addressing the HTN, HLD, etc, and refering everything else - something the specialists would be more than happy with.

 

[sophiejane]

Hey. Leave me out of this. I don't believe I have posted here since I started my Emergency Medicine residency.

Gosh, time has flown...it's been so peaceful...

Now back to the hookers and alcoholics with you.

 

[deleted87716]

No need to get all defensive if you really believe in your specialty.

There's a big difference between getting defensive and correcting flat-out nonsense. You've never struck me as a "turn the other cheek" kind of guy, so I'm a little surprised that you'd even say something like that.

 

[sophiejane]

The hospital has IMed and FP inpt services. IMed does not take those cases not considered good teaching cases such as overnight prep for colonoscopy following ER admit - they go to the hospitalist. Not so for FP - we get them all. All that does is distract from the cases which are good learning ones.

Are we supposed to have pity on you? You chose an opposed program at what sounds like a large academic medical center. If you had done your homework and really intended to be in FM (which I still don't believe), you would have understood that unopposed programs are superior for learning FM.

 

[deleted87716]

insurance rates are going up, and reimbursement rate for primary care keep coming down. Something has to give.

Of course it does. The AMA is lobbying heavily this year for CMS to increase the RVUs for ambulatory E&M codes. This will likely come at the expense of procedural reimbursements. Stay tuned.

Throw the ever increasing output of NPs and PAs into the mix and what I see happening in the future is mid-level providers addressing the HTN, HLD, etc, and refering everything else - something the specialists would be more than happy with.

No, they wouldn't. Specialists are already overburdened in many areas, and sending them stupid referrals isn't going to make things any better. There are a handful of primary care docs who practice this way in every city, and believe me...all of the specialists know who they are, and curse their name on a regular basis. Needless specialty referrals are also more costly to patients and to the healthcare system, both in terms of real dollars (higher copayments, office fees, etc.) and inconvenience for the patient. And, ask your friendly neighborhood specialist how comfortable they'd be sending that complicated patient back to a PA/NP for follow-up care instead of a physician.

Primary care physicians are the backbone of the healthcare system, not only in the U.S., but everywhere else as well. It's only the U.S. that has a problem compensating them fairly compared to specialists. That's going to change. Mark my words.

 

[George85]

Sophiejane,

>>sub-par. Did you not know that before you started there?
If I had then I wouldn't have put it 1st. And it's as much as a household name as Harvard, if not more so.

I remember reading the blog from Panda Bear a while ago and thinking "this is me".

I know what you're going to say .... how could you not know etc. I researched, asked all the right questions, etc. But still.....

And it's not that the people I spoke to tried to deceive - they simply had a different perspective. The only residents we were allowed to speak to were the happy ones .... I think that should read happy one. I also make incorrect assumptions. I figured that family medicine included peds - wrong - I also assumed it included ob - wrong. We go to the childrens hosp for peds rotations, so no continuity - same for ob - there are no preg women in the outpt clinic at all. How can the RRC allow this?

But my dissatisfaction goes deeper than where I'm at. I know plenty of people in other FP programs who are not happy with the direction they're going. I'm just very concerned that the primary care medicine I signed up for no longer exists. There is no room for it in the American health system.

And Sophiejane - no, I don't expect or want your pity. I don't need it as I'll be heading home after residency. It's yourself you should be concerned about - you'll be the one working in a system that's slowly going down the drain.

>>Primary care physicians are the backbone of the healthcare system,
>>not only in the U.S., but everywhere else as well.
Totally agree - that's why I see myself in primary care - just not here.

>>It's only the U.S. that has a problem compensating them fairly
>>compared to specialists.
Ditto.

 

[sophiejane]

I also make incorrect assumptions. I figured that family medicine included peds - wrong - I also assumed it included ob - wrong. We go to the childrens hosp for peds rotations, so no continuity - same for ob - there are no preg women in the outpt clinic at all. How can the RRC allow this?

OK, you got through 4th year and didn't know these things about the program you ranked #1?? Did you even visit the program before you ranked it? This is WHY people do audition rotations in family medicine. I have absolutely no sympathy for you.

The top 3 programs I am applying to have great OB, peds, and procedures. And this just in one small corner of my state. There are TONS of FM programs that offer a lot more that yours.

If you were book smart enough to graduate with an MD and not smart enough to seriously check out your #1 program, well, I think you deserve what you get.

Good Lord, it's PandaBear, Jr.

Just when we thought it was safe to go outside again...

Please don't judge the whole of family medicine in this (very large) nation with your own poor experience.

 

[deleted87716]

I'm just very concerned that the primary care medicine I signed up for no longer exists. There is no room for it in the American health system.

Sure, there is. In fact, the American health care system requires and demands it. Try to imagine healthcare in this country without primary care physicians. Go ahead, close your eyes and picture how it would work. Or, more accurately, how it wouldn't work. Primary care has taken a hit over the last few years, but everything in medicine is cyclical. The pendulum will soon be swinging back the other way.

Your mistake was in thinking you would get the best training at a big-name academic medical center. Unlike other fields, the big centers often provide the worst training experiences in family medicine.

 

[sophiejane]

And Sophiejane - no, I don't expect or want your pity. I don't need it as I'll be heading home after residency. It's yourself you should be concerned about - you'll be the one working in a system that's slowly going down the drain.

Ok, now I am confused. Home? As in not the US? So, you are an IMG? We have some serious communication issues here.

Well, it's been a nice diversion from studying, anyway, if a somewhat confusing one.

 

[deleted87716]

>>Primary care physicians are the backbone of the healthcare system,
>>not only in the U.S., but everywhere else as well.
Totally agree - that's why I see myself in primary care - just not here.

>>It's only the U.S. that has a problem compensating them fairly
>>compared to specialists.
Ditto.

You may have misunderstood. It's not that other countries pay their primary care docs more (generally, they don't), it's that they pay their specialists less. Therefore, the difference in compensation between primary care and specialists is a lot smaller than it is in the U.S., which takes away a lot of the attraction of specialization in the first place.

As things stand today, I think a lot more medical students would go into primary care if they were paid better (not even a lot better, just a little). That's coming. Fortunately, those who do go into primary care today are usually doing it for the right reasons.

 

[George85]

Sophinejane,

I don't know why you have to make this personal. I'm not an IMG. I'm a US grad. I'm a US citizen. I'm also a citizen of another country and will return there after residency. Not that confusing.

Also, my level of satisfaction with my program has nothing to do with the larger issues. It may cloud my judgement. And you should be concerened about my program. A suit of armour is only as strong as it's weakest link.

Also, there is something else you should keep in mind. Medicine is a dangerous place for someone who fails to recognize their own limitations. When KentW makes a post I read it, and consider what he has to say. I defer to his greater experience. I have my say, but I try to remain polite. He is a colleague, as are most of the people on these forums. Just because others are at the end of a phone line doesn't excuse you from interacting with them as you would do face to face.

 

[sophiejane]

Just because others are at the end of a phone line doesn't excuse you from interacting with them as you would do face to face.

I do take it personally when you make generalizations about me and my colleagues based on the letters behind my name, like my MCAT, board scores, GPA, etc. I take your comment about "another proud moment for osteopathic medicine" personally. Would you have said that to MY face, George? You can call it a chip, whatever, but I doubt you would say those things you said about DOs here on this forum to the DOs in your own program in person. If you do, I'd love to be a fly on that wall...

I'm not sure which limitations you refer to, but I'm well aware of my own.

It's funny, I usually stay out of these things because I LOVE where I chose to go to medical school and I'm really happy with what I have CHOSEN to do (like you, I have the board scores and GPA to choose a number of other fields). For some reason the sum total of your grossly uninformed comments made me respond.

But enough for now. Best of luck in whatever country you choose to practice in.

 

[George85]

Sophiejane,

I am the DO in my program.

 

[sophiejane]

Sophiejane,

I am the DO in my program.

Right. I'm sure you are.

Goodnight.

 

[George85]

MWU/CCOM class of 05 - 27th May to be exact - on the wall behind me - I remember it like it was last year, a sunny day in Downers Grove.

The diplomas had to re-issued because they left the word Chicago out - so the 2nd line said "College of Osteopathic Medicine" instead of "Chicago College of Osteopathic Medicine". Think about it - how many checks did those diplomas go through and no-one noticed. Not even on graduation day. The first I knew was when the school emailed everyone. By then it was framed and on my wall. Go figure.

 

[sophiejane]

Well, George, you have some bizarre communication skills, and I'm still not sure what you hoped to do with this thread, but I appreciate the challenge. I sometimes like defending my chosen field, and my chosen degree. Keeps me sharp.

However, I still think it's unfortunate that you choose to propogate the stereotypes, because--at least at TCOM--they are no longer true.

Sucks about the diploma.

 

[jeff2005]

You guys are being way too hard on George. He wants a discussion on issues that do affect us and that many of us think about. Don't be so defensive.

 

[George85]

>>Sucks about the diploma.

Not really - I have both of them. The one with "Chicago" on the wall here, and the one without on the wall at home. Does a DO squared = an MD?

Just because I'm a DO doesn't mean I can't recognise and accept that most people are there because they didn't get into MD school. Doesn't bother me. The guy at UIC doesn't beat himself up over not getting into Northwestern. The journey might take you along a different path, but the destination is still the same.

Anyway, the whole MD/DO thing has been done to death many times over. There is no difference between the two.

Also, FYI, the DO degree was recognised by the GMC of the UK last October. This will open up the rest of the english speaking world, such as Australia, S.Africa, New Zealand - places that DO's and DO students would probably like to go for rotations or to work. I now have full registration in the UK. That's why a 3 year DO degree aimed at the bottom of the bell curve worries me. We need to maintain standards, not allow them to drop.

 

[deleted87716]

You guys are being way too hard on George. He wants a discussion on issues that do affect us and that many of us think about. Don't be so defensive.

Here's your chance, George. I want you to list the issues that you intended your initial, inflammatory post to try to "bring up for discussion." Just list them as bullet points. You don't have to expand on them. I'll then move that post to the beginning of a new thread, and I will close this one so we can start over.

Go ahead.

 

[George85]

Here's your chance, George. I want you to list the issues that you intended your initial, inflammatory post to try to "bring up for discussion." Just list them as bullet points. You don't have to expand on them. I'll then move that post to the beginning of a new thread, and I will close this one so we can start over.

Go ahead.

Will do. Give me a day or two to formulate a considered post. Still working on those dictations -I'm just too easily distracted. Didn't set out to be inflammatory - guess I need to work on that delivery.

 

[deleted87716]

Will do. Give me a day or two to formulate a considered post. Still working on those dictations -I'm just too easily distracted. Didn't set out to be inflammatory - guess I need to work on that delivery.

Very well. Just start a new thread when you're ready. I'm closing this one because I don't think it's going anywhere but downhill from this point.