how bad is FP lifestyle ?

[trilingdoc]

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AFTER residency, what FP lifestyle is like? I mean after a 9-5 day, do I need to go home and do a lot of reading , or I can go home and watch TV and take calls occasionally ?

 

[rpkall]

👍 Great post. I'd like to know the answer, too.

I wonder if you need to go in early, look at your schedule, and do research for an hour. Or, conversely, stay late, review your charts for an hour and a half, and then finally go home after an 11 hour day...

 

[espbeliever]

👍 Great post. I'd like to know the answer, too.

I wonder if you need to go in early, look at your schedule, and do research for an hour. Or, conversely, stay late, review your charts for an hour and a half, and then finally go home after an 11 hour day...

why dont you do what you want to do? fp i think is the most flexible specialty. work 15+ hr days or take 4 days+ a week off. what do you want to do??

 

[rpkall]

I want to be a good physician and a good father/husband at the same time. The reality is that there are some specialties where you can't do both--and there are also some specialties where you can only be home enough if you slack off at work, and that's not what I'm after. First and foremost, I'd like to be good to my patients, because their health is in my hands. In family practice, I'm just curious if that always means a few extra hours each day spent on literature searches and additional time on chart review.

 

[rpkall]

FP is definitely one of my favorite specialties because of it's flexibility; I'm also curious about hospice/palliative med, so FP it seems like a decent place to start. 😉

 

[AnnaMags]

I have found that it is very difficult to talk about average hours or average earnings for FM. This is because there is such a wide range. This is talked about on here all the time.

I'm trying to decide between going the IM or Peds route to Allergy/Immunology or doing Family Medicine. This is proving to be a very hard decision for me. I have talked to many people along the way and anyone in FM really stresses that you can make of it what you want. You can be a workaholic or you can set your job to suit your life. Now when you talk to those outside of FM, they seem to have the opinion that it is grueling that your patients own your life, the call is terrible, the hours terrible. I don't think this is true.

I do think FM docs most do some reading though. It is impossible to always be up on everything that may walk into your door without reading. As a family practice doc you aren't an expert in any one field, but that's where evidence based medicine comes in. The internet makes this so much easier.

The draw to family practice is that you are able to give a patient a place where their whole picture is looked at, even if they are seeing specialists...you can coordinate the care.

I always love hearing any and all thoughts on FM because they are so varied, so keep posting on this messageboard!!

 

[raidermedic]

As long as your reasonable in what you want fp is very flexible. You can probably find places where you can work 40 or less with no call. But the pay will be less and I'm not sure if that is a partnership track (if thats what you want).

 

[APACHE3]

So,,,the FM doc who works a 40 hr week job makes $140,000, while the FM doc who works 50hrs/wk makes $200,000? I don't know, anyone take a guess? 🙂

 

[dr_almondjoy_do]

http://fmignet.aafp.org/x30.xml
http://fmignet.aafp.org/x31.xml
http://fmignet.aafp.org/x32.xml


These are some pages from www.aafp.org that have information on lifestlye, income, and the different work settings you can tailor as an FP. The best and worst quality about FP is that you make it what you want it to be.

So, to answer the question, lifestyle is what you make it.

 

[APACHE3]

Thanks. those sites were interesting. I think my earlier post stands...the harder you work, the more income you will generate. 150k for anyone is a lot of money, but not so much when you have 150k in student loans that will eventually mature to about 300k by the time you can pay them all off! 😱

 

[trilingdoc]

thanks....
but my original question was not answered yet: After a busy day in office, do I need to go home and do a lot of reading , in order to keep up in the profession, or say, not being sued. If so, how much time I need to put in for this each day after FP residency ?
Anyone here a practicing family doctor? please please enlighten me.

 

[gungho]

thanks....
but my original question was not answered yet: After a busy day in office, do I need to go home and do a lot of reading , in order to keep up in the profession, or say, not being sued. If so, how much time I need to put in for this each day after FP residency ?
Anyone here a practicing family doctor? please please enlighten me.

Practiced for 19 years, started Path residency last summer, but not for lifestyle reasons. Have worked in private practice, for HMO, large group. Whatever everyone has said goes-you can do what you want. Specifically, do you need to go home and do a lot of reading? You could spend all day every day and nite reading if you wanted to. You have to decide what you need to do to balance the rest of your life-no one can tell you what that amount is. No amount of reading is going to keep you from being sued. You can "keep up" pretty easily by skimming journals and picking out articles you feel you need to review.

 

[trilingdoc]

Practiced for 19 years, started Path residency last summer, but not for lifestyle reasons. Have worked in private practice, for HMO, large group. Whatever everyone has said goes-you can do what you want. Specifically, do you need to go home and do a lot of reading? You could spend all day every day and nite reading if you wanted to. You have to decide what you need to do to balance the rest of your life-no one can tell you what that amount is. No amount of reading is going to keep you from being sued. You can "keep up" pretty easily by skimming journals and picking out articles you feel you need to review.

Thanks a whole lot!!! Now I am cleared on this big issue.

 

[island doc]

I am a practicing FP. I work 8-5 Monday through Friday, with no call, no hospital rounds. I have every weekend and most holidays off. I have plenty of paid vacation time available. And I work on a tropical island that is one of the most popular vacation destinations in the country with visitors coming from all over the world. That the my lifestyle in FP.

 

[island doc]

P.S. I go to the beach after work.

 

[texdrake]

P.S. I go to the beach after work.

Do you have a residency position available? I want your lifestyle. Are you in Hawaii? Are you Army?

 

[espbeliever]

Do you have a residency position available? I want your lifestyle. Are you in Hawaii? Are you Army?

lol you're lame. 🙄

 

[texdrake]

lol you're lame. 🙄

Wow...that was really nice. I was just curious, you were just rude.

 

[sophiejane]

Any doc who doesn't do some reading at night (even just a short journal article before bed) isn't in it for the right reasons. Of course you have to read. Don't you want to read? That's the whole reason I wanted to do this job--I love learning new stuff. You don't have to be obsessive about it but it's extremely easy to stay up to date...articles can be beamed to your PDA automatically, there's mdconsult, etc. etc...

 

[Newdoc2002]

Kind of a blanket statement there Sophie. It's more like any doc who doesn't read daily or regularly is setting themself up to fall behind the advancements in medicine.

 

[Mike59]

Any doc who doesn't do some reading at night (even just a short journal article before bed) isn't in it for the right reasons. Of course you have to read. Don't you want to read? ...

Actually, I don't want to read...Despite having a good background in EBM and well rounded training, I don't care to have to bury my nose in journals daily.

If you take a survey of articles from AFP or NEJM in the last 5 years, how many of them are actually "practice changing", revolutionary articles that make us fall like dominoes into a new way of working?

Between continuing education and the occasional giant article that trickles through every 2-3 years, family medicine is pretty consistent. I don't think one has to be reading all the time to be effective in the presence of re-cert requirements, monthly discussion rounds at the hospital etc.

 

[sophiejane]

Kind of a blanket statement there Sophie. It's more like any doc who doesn't read daily or regularly is setting themself up to fall behind the advancements in medicine.

true, good point.

 

[sophiejane]

Actually, I don't want to read...Despite having a good background in EBM and well rounded training, I don't care to have to bury my nose in journals daily.

If you take a survey of articles from AFP or NEJM in the last 5 years, how many of them are actually "practice changing", revolutionary articles that make us fall like dominoes into a new way of working?

Between continuing education and the occasional giant article that trickles through every 2-3 years, family medicine is pretty consistent. I don't think one has to be reading all the time to be effective in the presence of re-cert requirements, monthly discussion rounds at the hospital etc.

I guess I don't think of it as burying my nose in journals every day...but more like a little reading at night (I'm talking 30 minutes) or on the weekends can go a long way. True there may not be revolutionary studies more than every 3 years or so (like NCEP of JNC-7) but there are plenty of smaller studies that come out regularly that could help you deliver better care.

For example, there was the study not long ago from the Netherlands on OM in kids. It showed that most parents were content to "watch and wait" for a couple of days as long as they had good pain relief for the kiddo and could get some sleep. Then they'd call if they needed the prescription for abx if the kid wasn't better. Something like 80% of them never got the prescription because the OM resolved on its own, so that's 80% fewer unnecessary antibiotic courses in kids.

Took me about 5 minutes to get the gist of the article in JAMA and that is a "practice-changing" piece of information, in my opinion.

 

[cooldreams]

I guess I don't think of it as burying my nose in journals every day...but more like a little reading at night (I'm talking 30 minutes) or on the weekends can go a long way. True there may not be revolutionary studies more than every 3 years or so (like NCEP of JNC-7) but there are plenty of smaller studies that come out regularly that could help you deliver better care.

For example, there was the study not long ago from the Netherlands on OM in kids. It showed that most parents were content to "watch and wait" for a couple of days as long as they had good pain relief for the kiddo and could get some sleep. Then they'd call if they needed the prescription for abx if the kid wasn't better. Something like 80% of them never got the prescription because the OM resolved on its own, so that's 80% fewer unnecessary antibiotic courses in kids.

Took me about 5 minutes to get the gist of the article in JAMA and that is a "practice-changing" piece of information, in my opinion.

what about the other 20%?? how can you tell a difference?? how do you tell crying patients to just wait it out?? i dont see that as practice changing, but rather something interesting to lead more research to develop a change in practice.

 

[Mike59]

what about the other 20%?? how can you tell a difference?? how do you tell crying patients to just wait it out?? i dont see that as practice changing, but rather something interesting to lead more research to develop a change in practice.

Word.

IMHO, Practice changing = WHI, HOPE trial, COX-2-I media hype etc..

In a nutshell, I pay close attention to the reports that basically would force you into the courthouse if you continued doing what they did before the paper but the rest have very small impacts on day to day practice.....

 

[sophiejane]

what about the other 20%?? how can you tell a difference?? how do you tell crying patients to just wait it out?? i dont see that as practice changing, but rather something interesting to lead more research to develop a change in practice.

You don't let them cry. As I said, you give them adequate pain relief and that usually does the trick for a few days until it resolves on its own.

Obviously the other 20% will get the script and it won't be too late to treat if it turns out to be truly bacterial.

The fact that most OM is viral is well-documented already, so no further research is needed to convince me of that. The clincher for me was that the study showed that most parents in the study group were amenable to waiting and seeing if it truly needed an antibiotic. Showering a population of kids with shotgun antibiotics to cover the minority of cases that are not viral is irresponsible in my opinion.

 

[corpsmanUP]

I guess I don't think of it as burying my nose in journals every day...but more like a little reading at night (I'm talking 30 minutes) or on the weekends can go a long way. True there may not be revolutionary studies more than every 3 years or so (like NCEP of JNC-7) but there are plenty of smaller studies that come out regularly that could help you deliver better care.

For example, there was the study not long ago from the Netherlands on OM in kids. It showed that most parents were content to "watch and wait" for a couple of days as long as they had good pain relief for the kiddo and could get some sleep. Then they'd call if they needed the prescription for abx if the kid wasn't better. Something like 80% of them never got the prescription because the OM resolved on its own, so that's 80% fewer unnecessary antibiotic courses in kids.

Took me about 5 minutes to get the gist of the article in JAMA and that is a "practice-changing" piece of information, in my opinion.

I don't really think that is practice changing. Practice changes when some official organization like the AAP comes out and states that they have adopted a new standard of care for a particular disorder. OM is still one of those disorders that is treated with ABX because the 1 in 1000 that goes on to develop meningitis or mastoiditis will drain everyone's malpractice if we did it the way the Scandanavians or the Dutch did it. They routinely allow their OM patients to rupture, which is really painful. And there is no way to adequately treat OM for pain unless you use a narcotic truthfully.

See the funny thing about those studies that say to hold ABX is countered by the many studies that proove ABX reduce pain and sequelae even in viral cases. Now explain that 🙂 I just follow the standard of care "the crowd" and try not to be on the fringe of anything!

 

[Newdoc2002]

Netherlands does not equal USA. Call me after you have been in practice a while. Where are the reproduced studies in the US?

I think you ought to have a broader grasp on medicine before you let EBM be your sole decision maker in your practice.

 

[sophiejane]

Easy, there. I never said anything was going to be my "sole" decision maker in my practice. I would hope that my analytical and critical thinking skills are developed enough by the time I start a practice that I can use many different tools to make decisions. But one thing I know for sure is that evidence-based medicine is going to be one of them. It informs virtually everything we do--I can't think of any medications or therapies that are accepted standards of care that have not been upheld by EBM...can you?

By the way, withholding antibiotics for 48-72 hours for patients with acute non-severe OM symptoms (effusion without inflammation) is not some crack-pot idea by a bunch of clog-wearing Dutch doctors. It's part of the newly-released evidence-based practice guidelines for treatment of acute OM that was developed by the American Academy of Pediatrics and the American Academy of Family Physicians.

Anyone who wants to "go with the crowd" would hopefully want to practice the standards of care adopted by these two organzations...but maybe not. Maybe people are so afraid of being sued that they actually don't want do what is in the patient's best interest.

 

[sophiejane]

See the funny thing about those studies that say to hold ABX is countered by the many studies that proove ABX reduce pain and sequelae even in viral cases. Now explain that 🙂

placebo effect.

 

[p54]

i only want to work 4 days a week, 8-5, no weekends, no call, no hospital rounds...i wonder how much i can expect to make if even just 90,000 i would be happyi think
i want time to go to the gym everyday, catch my favorite tv shows, and go out and party on the weekend
i don't have any student loans so i don't have to worry so much about money especially right after residency so i guess i can afford not to work so hard initially until i want the really nice things

 

[RuralMedicine]

I don't really think that is practice changing. Practice changes when some official organization like the AAP comes out and states that they have adopted a new standard of care for a particular disorder. OM is still one of those disorders that is treated with ABX because the 1 in 1000 that goes on to develop meningitis or mastoiditis will drain everyone's malpractice if we did it the way the Scandanavians or the Dutch did it. They routinely allow their OM patients to rupture, which is really painful. And there is no way to adequately treat OM for pain unless you use a narcotic truthfully.

See the funny thing about those studies that say to hold ABX is countered by the many studies that proove ABX reduce pain and sequelae even in viral cases. Now explain that 🙂 I just follow the standard of care "the crowd" and try not to be on the fringe of anything!

Actually in children >2 years without significant comorbids AAP does not recommend antibiotics for Acute OM. As far as pain relief--antibiotics are not going to do anything towards pain reduction especially in the first 48-72 hours. In my own practice we've had good success with Auralgam & NSAIDS (but I don't use them in kids under 6months---of course per guidelines those kids get antibiotics which then brings up the question of do they also get an LP before you start those antibiotics if they are young enough?) Oh the joys of pediatrics 🙂

 

[MtnDoc]

Thanks. those sites were interesting. I think my earlier post stands...the harder you work, the more income you will generate. 150k for anyone is a lot of money, but not so much when you have 150k in student loans that will eventually mature to about 300k by the time you can pay them all off! 😱

You may owe 150 K in loans, but reality is that many companies, small cities and towns will pay it off for you... ESPECIALLY IN Fam Med. Also, we borrowed money at the LOWEST interest in the last 20 years. Think about it--- you can't borrow money for as cheap as you did. However, you'll probably have to borrow for a house. Wouldn't it be better to start paying off the house and other things (which will def be higher percentage rate) than worry about 3% interest??????? Credit cards, loans, etc... you will never get some "cheap" money in the future. In other words- I plan to pay that student loan off VERY SLOWLY... my potential to MAKE money is a higher percentage of interest than I owe... get it???? In fact... I'd rather get a community to GIVE me a huge BONUS of about 100K instead bc I can invest it at much more than 3%... duh... Well, I'm not great at explaining things... but the last thing to worry about is borrowing money at this low of an interest rate. I'd borrow a billion dollars at 3% interest simply bc you can INVEST at a higher rate (CD's... Roth IRA's... bonds... etc).

 

[razor]

i only want to work 4 days a week, 8-5, no weekends, no call, no hospital rounds...i wonder how much i can expect to make if even just 90,000 i would be happyi think
i want time to go to the gym everyday, catch my favorite tv shows, and go out and party on the weekend
i don't have any student loans so i don't have to worry so much about money especially right after residency so i guess i can afford not to work so hard initially until i want the really nice things

I want to travel the countryside in a horse-drawn buggy making house-calls where I receive fresh eggs and steer manure for fertilizer as payment.

 

[DCFamilyMed]

Really depends on job and situation. My first job out of residency was at 120 starting working 9-5 with call every 5 nights including hospital admissions. It was pretty bad. Currently I work 9-330 pm seeing 22-23 patients a day, on telephone call daily (though get much calls 1-2 per week), great lifestyle, and making 350. Funny I'm still having a hard time looking for someone to join me.


Sent from my iPad using Tapatalk HD

 

[deleted87716]

I want to travel the countryside in a horse-drawn buggy making house-calls where I receive fresh eggs and steer manure for fertilizer as payment.

Whoa. Zombie thread.

Don't worry, there's plenty of bull**** in medicine these days, no matter where you practice.

 

[vom]

Really depends on job and situation. ... Funny I'm still having a hard time looking for someone to join me.


Sent from my iPad using Tapatalk HD

That *is* funny. Inner city DC - I would've thought all the FM's would've been tripping over themselves to grab $120k.

 

[jl lin]

Actually in children >2 years without significant comorbids AAP does not recommend antibiotics for Acute OM. As far as pain relief--antibiotics are not going to do anything towards pain reduction especially in the first 48-72 hours. In my own practice we've had good success with Auralgam & NSAIDS (but I don't use them in kids under 6months---of course per guidelines those kids get antibiotics which then brings up the question of do they also get an LP before you start those antibiotics if they are young enough?) Oh the joys of pediatrics 🙂

Hmmm, I read the Cochrane Review on this. But here's the aspect of using judgment and experience, as opposed to sticking exclusively to EBP, that concerns me so much:

2 year old continues to scream and cry with OM--totally unable to console--in spite of tylenol or ibuprofen. He only stops periodically due to exhaustion. Should he get antibiotics? He's had symptoms for < 48 hours.

 

[deleted87716]

^ Just FYI...you're responding to a post that's over seven years old, written by somebody who hasn't been online in over four years. I hope you're not expecting a reply.

 

[cabinbuilder]

thanks....
but my original question was not answered yet: After a busy day in office, do I need to go home and do a lot of reading , in order to keep up in the profession, or say, not being sued. If so, how much time I need to put in for this each day after FP residency ?
Anyone here a practicing family doctor? please please enlighten me.

NO, you won't have the energy. I usually read up on cases as they walk through the door because FP is so broad. I rely heavily on uptodate as I can also get CME time too. You can't go through your work life thinking you are going to be sued. That's just miserable. A lot if is customer service and as long as the patient feel like they are getting your time and attention to figure out their issue you won't get sued. It all comes down to practice style. For me, I will not type a chart note or fuss with the computer in front of a patient, that way they get my attention in the room. I have a paper copy of what they told me and my thoughts during the visit and I dictate it later. My after clinic time consists of charting, not reading. The profession is so broad you can't possibly read everything that comes out.

Also depends on how much call you take, if you cover ER, if you are admitting your own patient's, the size of your practice, whether you have help or you are solo, etc. There are so many factors that affect your day. I do rural medicine so I cover everything. Some days I get home at 6pm, somedays I am doing a medevac and don't get home til really late like 10pm. Just depends on who walks through the door.

 

[jl lin]

^ Just FYI...you're responding to a post that's over seven years old, written by somebody who hasn't been online in over four years. I hope you're not expecting a reply.

😉

Clearly people were still responding to the thread; therefore, someone may weigh in on it. . .or not. Fine either way. 🙂

BTW. The forums on this end of SDN move rather slowly compared with those above. . .presumbably b/c docs are busy working and/or are tired or having a life, while students are busy moaning or are on SDN taking breaks from their studies.