How Can We Encourage Medical Students To Choose Primary Care?

[Prncssbuttercup]

I think that depends entirely on the 'urban' area in question. In Minneapolis, sure, Denver, not so much...

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[George85]

RPW - the "offers" you see will not be what you end up working. Even the offer you get at interview will sound reasonable. I have worked as a hospitalist - there's not many people I have seen who can tolerate the schedule that's needed to get to 300k - and you certainly wouldn't get 14 days off - and you would either be expected to take night call (smaller facility) or work a set of nights where you would take all the ER admissions on your own - believe me, that's no fun and you never get out on time either.

Of course, the specialist with much longer training. Would that be ortho or radiology at 5 years or anesthesia at 4 years or ob/gyn at 4 years or EM at 3 years ? A year or two extra training can translate into double the income and over your working lifetime that's huge. And yes, I know, ob/gyn is technically primary care and EM a specialty although in reality I would place them the other way around.

200K is clearly a good salary - but I would have to cut my shifts down from 12 to 6 a month to make that much.

Anyway, time will tell - see how you view the issue in say 5 years time when you've been in the real world for a while.

 

[Anne2009]

It seems like working 40 hours and making 200K doing something you enjoy is better than making more with something you don't enjoy. Life is multifactorial and it's tough to know what factors are more important to individuals than others. This profession is large enough to satisfy a variety interests and does attract a large variety. Why such an emphasis on putting someone down that is excited about the career he/she has chosen?

 

[George85]

Anne2009

>>working 40 hours and making 200K doing something you enjoy is better than making more with something you don't enjoy.
Very true


>>it's tough to know what factors are more important to individuals than others.
Correct again - and I'm not suggesting that money is the only factor and not even the most important - but if it is a factor to the individual then they need to have the full facts to make a decision - and my view is that many people enter primary care with high ideals and a false impression only to feel let down many years later. And I'm not saying that this only happens in primary care - it can happen across the board. Initially money was not important to me, but once in the real world I found I had student loans to pay, a mortgage, planning for the future, etc - all of these factors were obvious before I had to deal with them but I viewed my finances in a different light when they became reality - and that included the fact that I was working harder and taking more abuse than other docs and getting less for the privilege - so I went back and did EM. That was my solution but again, not for everyone.

>>This profession is large enough to satisfy a variety interests and does attract a large variety.
I need to check my medication - I try not to agree with others this much.

>>Why such an emphasis on putting someone down
That's not my intention and apologies if I come across like that.

>>that is excited about the career he/she has chosen?
I want people to be excited about what they choose - I actually want to see people going into primary care but with the full knowledge of what awaits - and this applies to all fields of medicine but I feel that it's especially important in primary care because of the challenges ahead.

 

[Prncssbuttercup]

There are challenges ahead in most fields. We have an incredibly unstable economy where jobs are being shipped overseas in droves, our government has no money and is inept, etc...

Every field is facing challenges, and every medical field will face challenges. I am not concerned about my choice to go into primary care, my friends who have chosen it are also not afraid or unwilling... we see potential where others see problems...

Life is 10% situation and 90% what you make of it...

 

[deleted19731]

Anyway, time will tell - see how you view the issue in say 5 years time when you've been in the real world for a while.

Yeah... In five years when I'm 33ish which if what i read on your profile is true you were still chipping away a med school round two at that time in your life... So will I also have to go to medical school twice and do two residencies to be as enlightened as you? Because that seems like a lot of poor foresight to me...

I like what I do. I knew what I was getting into and I've never had a family physician tell me I was making a mistake (well other than supposed family physicians on anonymous Internet forums).

 

[deleted87716]

I want people to be excited about what they choose - I actually want to see people going into primary care

I almost snorted beer out of my nose at that one!

I think it's a little too late to try to take the high road, George ol' boy.

 

[primadonna22274]

Back to the subject--my list:
1) loan repayment.
2) Shorter programs (mine is 3 yr so I save a year's tuition, although I still owe for PA school).
3) Affiliation with a medical school/residency program/teaching appointment with CME credit.
4) support for fellowship training if interested--for me, Hospice-Palliative Medicine, maybe an MPH.
5) opportunity to participate in research pertinent to the community.
6) to feel perceived value from the hospital and community at large for FM physicians.
7) reciprocal referrals from specialists who appreciate a skilled FM doc.
8) guaranteed employment for physician's spouse if desired--my husband is a high school history teacher who loves his work and is damn good at it.
9) A liveable schedule over which I have a significant amount of control, practice autonomy, a collegial and reliable call group, malpractice coverage and enough time off.
10) practice support appropriate to the setting (although I think I am more interested in half-time rural, half-time academic or possibly academic hospitalist/residency faculty) and a competitive wage. Not sure what competitive is just yet....

 

[MJB]

RPW - the "offers" you see will not be what you end up working. Even the offer you get at interview will sound reasonable. I have worked as a hospitalist - there's not many people I have seen who can tolerate the schedule that's needed to get to 300k - and you certainly wouldn't get 14 days off - and you would either be expected to take night call (smaller facility) or work a set of nights where you would take all the ER admissions on your own - believe me, that's no fun and you never get out on time either.

Of course, the specialist with much longer training. Would that be ortho or radiology at 5 years or anesthesia at 4 years or ob/gyn at 4 years or EM at 3 years ? A year or two extra training can translate into double the income and over your working lifetime that's huge. And yes, I know, ob/gyn is technically primary care and EM a specialty although in reality I would place them the other way around.

200K is clearly a good salary - but I would have to cut my shifts down from 12 to 6 a month to make that much.

Anyway, time will tell - see how you view the issue in say 5 years time when you've been in the real world for a while.

You're a shift worker, right?

If I wanted to work shifts and deal with the dregs of society, I would have just worked at McDonald's, or Sonic.

Not enough money in the world to make me do ED shift work. Or hospitalist shift work. Thank god there are people that enjoy dealing with the people that frequent ED's. Of course, I'm not sure why it pays so much...an NP or PA could easily determine "admit, or discharge" and order a ton of expensive tests to CYA.

 

[George85]

I had almost forgotten why I don't bother with these forums - people that are either unwilling or unable to accept that someone else might have more experience than they do about the topic in question.

MJB - you clearly have no idea what ER docs really do - otherwise you would understand why "it pays so much" - I'll tell you what - I'll try being nicer, if you'll try being smarter.

RPW - "I like what I do" - how do you know? - you're not doing it yet. And then as usual people hold their breath and stamp their feet and start making personal comments towards people who's posts they disagree with - but that's ok - I remember the first time I had a beer as well.

 

[deleted19731]

RPW - "I like what I do" - how do you know? - you're not doing it yet. And then as usual people hold their breath and stamp their feet and start making personal comments towards people who's posts they disagree with - but that's ok - I remember the first time I had a beer as well.

What am I not doing? I'm a licensed physician. I practice medicine. Did you really think I'd just watched a bunch of episodes of "Hart of Dixie" and decided to wax poetic on all the joys of family medicine?

I think I know where you're going with that comment though...But do you really believe that surgery residents know nothing about surgery or that radiology residents know nothing about radiology? But if you mean in the real world... Well you never know... My daddy might just have his own practice... I might know a lot.

And it wasn't really a personal attack on you... No more than the "you youngins don't know squat" line you're pulling on me is anyways. It was more of a "Please explain how you can give others advice about career planning when your own career planning appears to be questionable?"

And in response to your "I remember the first time I had a beer" comment I would just like to note that Zima is not considered beer...

 

[Substance]

Back to the subject--my list:
1) loan repayment.
2) Shorter programs (mine is 3 yr so I save a year's tuition, although I still owe for PA school).
3) Affiliation with a medical school/residency program/teaching appointment with CME credit.
4) support for fellowship training if interested--for me, Hospice-Palliative Medicine, maybe an MPH.
5) opportunity to participate in research pertinent to the community.
6) to feel perceived value from the hospital and community at large for FM physicians.
7) reciprocal referrals from specialists who appreciate a skilled FM doc.
8) guaranteed employment for physician's spouse if desired--my husband is a high school history teacher who loves his work and is damn good at it.
9) A liveable schedule over which I have a significant amount of control, practice autonomy, a collegial and reliable call group, malpractice coverage and enough time off.
10) practice support appropriate to the setting (although I think I am more interested in half-time rural, half-time academic or possibly academic hospitalist/residency faculty) and a competitive wage. Not sure what competitive is just yet....

Medical students are drawn to fields with money and prestige: derm, rads, ophtho, plastics etc.

Family medicine as a field has neither of these things. It pays crap, and the prestige is down there with the pathologists and psychiatrists.

The only way to attract good people is to pay them well and make them feel valued. The only way for "family medicine" to achieve this is to drastically reduce their spots so that they all fill with american graduates. Eventually demand will increase and the income will follow. When the income follows, the prestige goes with it.

The problem with my own suggestion is that "family medicine" by its very nature is primary care, and the primary care model is based on ease-of-access which runs counter to cutting the spots.

Maybe the specialty of "family medicine" could change to "rural medicine" and rural practitioners be paid exorbitant amounts for being both isolated and the community's physician (I'm talking combined the income of OB, ER, and FP into one huge 600k a year thing). Urban primary care could be taken care of by nurses and the occasional physician.

But since none of these things will come to pass, and family medicine(the specialty with the lamest name, by the way) will continue to be underpaid and undervalued, good students will continue to avoid it, and it will be the haven for the carib grads and FMGs as it is now.

There is no hope for family medicine.

 

[Prncssbuttercup]

Back to the subject--my list:
1) loan repayment.
2) Shorter programs (mine is 3 yr so I save a year's tuition, although I still owe for PA school).
3) Affiliation with a medical school/residency program/teaching appointment with CME credit.
4) support for fellowship training if interested--for me, Hospice-Palliative Medicine, maybe an MPH.
5) opportunity to participate in research pertinent to the community.
6) to feel perceived value from the hospital and community at large for FM physicians.
7) reciprocal referrals from specialists who appreciate a skilled FM doc.
8) guaranteed employment for physician's spouse if desired--my husband is a high school history teacher who loves his work and is damn good at it.
9) A liveable schedule over which I have a significant amount of control, practice autonomy, a collegial and reliable call group, malpractice coverage and enough time off.
10) practice support appropriate to the setting (although I think I am more interested in half-time rural, half-time academic or possibly academic hospitalist/residency faculty) and a competitive wage. Not sure what competitive is just yet....

No. I cannot imagine how less training for primary care will help anything. To me it sounds like an open door for even less money, more of the 'specialties are better' BS, etc...

 

[primadonna22274]

I did 2.5 yr of PA school and practiced 11 yr before going back to school last year. I will have MORE, not less training. In all my program is less than half a year shorter than the 4 yr as I have no vacation time and no summer off. Three years for me made it a teensy bit less painful to afford giving up a nice income and take on more debt for the personal satisfaction of finishing a lifelong goal to become an independent physician. It's not for everyone, sure, but for someone with lots of clinical experience it is an enticement to move up the ladder a few rungs.

QUOTE=SBB2016;12781198]No. I cannot imagine how less training for primary care will help anything. To me it sounds like an open door for even less money, more of the 'specialties are better' BS, etc...[/QUOTE]

 

[Prncssbuttercup]

You are doing the PA-DO pathway at LECOM. There is a reason your pathway is shorter. Doing this everywhere isn't a good idea imho. I never said YOU had less training. YOU are advocating that shorter primary care pathways will lead to more people doing it, maybe, except like I said, it could end up causing the problems I mentioned. I'll take my additional loan money out if it means I get treated the same. The condensed primary-care pathway at LECOM requires specific sites for rotations and residency because other programs don't believe the training is adequate. This is what I was told by LECOM staff, that isn't going to help get more people go into primary care...

 

[MJB]

MJB - you clearly have no idea what ER docs really do - otherwise you would understand why "it pays so much" - I'll tell you what - I'll try being nicer, if you'll try being smarter.

.

I can only go on my own experience, and let's just say what I've seen and worked with hasn't been overly impressive.

As for making wild generalizations, I figured it was fair game considering your rather uneducated posts full of generalizations and ill informed nonsense.

Now I'm guessing you need to go save the world one chest pain/vaginal bleed/abdominal pain at a time. Later. Don't forget to follow the protocol, or the narcs.



As for other snarky comments, there's a decent chance I've got you beat in life experience...but it doesn't really matter.

 

[Doctor4Life1769]

ED = Guaranteed CT angio r/o PE.

 

[ghost dog]

Medical students are drawn to fields with money and prestige: derm, rads, ophtho, plastics etc.

Family medicine as a field has neither of these things. It pays crap, and the prestige is down there with the pathologists and psychiatrists.

The only way to attract good people is to pay them well and make them feel valued. The only way for "family medicine" to achieve this is to drastically reduce their spots so that they all fill with american graduates. Eventually demand will increase and the income will follow. When the income follows, the prestige goes with it.

The problem with my own suggestion is that "family medicine" by its very nature is primary care, and the primary care model is based on ease-of-access which runs counter to cutting the spots.

Maybe the specialty of "family medicine" could change to "rural medicine" and rural practitioners be paid exorbitant amounts for being both isolated and the community's physician (I'm talking combined the income of OB, ER, and FP into one huge 600k a year thing). Urban primary care could be taken care of by nurses and the occasional physician.

But since none of these things will come to pass, and family medicine(the specialty with the lamest name, by the way) will continue to be underpaid and undervalued, good students will continue to avoid it, and it will be the haven for the carib grads and FMGs as it is now.

There is no hope for family medicine.

Trollin, Trollin, Trollin......

Substance appears to be a Canadian radiology resident. And an obnoxious one at that.

It has been my experience that the practice of family medicine is extremely varied, both in content of patients and financially. To wit, you can make a lot of money if you have the appropriate business plan. I have been able to do so, and currently work approximately 20 clinic hours per week.

In regards to job satisfaction, I believe that family medicine does quite well ( as a whole ) in this respect.

Staring at a screen all day ? Well, this would not suit me, and I would be hard pressed to see how someone would find this a satisfying endeavor.

 

[Substance]

Trollin, Trollin, Trollin......

Substance appears to be a Canadian radiology resident. And an obnoxious one at that.

It has been my experience that the practice of family medicine is extremely varied, both in content of patients and financially. To wit, you can make a lot of money if you have the appropriate business plan. I have been able to do so, and currently work approximately 20 clinic hours per week.

In regards to job satisfaction, I believe that family medicine does quite well ( as a whole ) in this respect.

Staring at a screen all day ? Well, this would not suit me, and I would be hard pressed to see how someone would find this a satisfying endeavor.

When people start making ad hominem attacks, I can be sure I've struck a nerve

Anyway, lets get back to business: I was referring to the American model of FM.

The Canadian model is better - it does allow you to branch out into other areas that aren't pure FM doing appointments. In fact, you're heavily involved in the very lucrative endeavor of pain medicine, are you not?

QED

 

[deleted87716]

The Canadian model is better - it does allow you to branch out into other areas that aren't pure FM doing appointments.

So does the "US Model."

If you really are a Canadian radiology resident, I'd be curious as to why you feel qualified to comment on a field with which you apparently have no "substantive" experience. You won't find me hanging out in Canadian radiology forums telling them that they're all going to be outsourced.

There is every indication that the US is finally recognizing that primary care is underpaid and undervalued, as discussed in this and other threads in this forum.
http://forums.studentdoctor.net/showthread.php?t=929989

 

[Substance]

So does the "US Model."

If you really are a Canadian radiology resident, I'd be curious as to why you feel qualified to comment on a field with which you apparently have no "substantive" experience. You won't find me hanging out in Canadian radiology forums telling them that they're all going to be outsourced.

There is every indication that the US is finally recognizing that primary care is underpaid and undervalued, as discussed in this and other threads in this forum.
http://forums.studentdoctor.net/showthread.php?t=929989

How often do you see American family docs make their primary income on non-family medicine things, like sleep or cosmo or emerg? My impression was that outside of the most rural areas, family docs can't really overstep their boundaries because their competition is specialists.

I am commenting on this from the perspective as someone who initially wanted to do primary care but was dissuaded by the impression I had gotten from it during medical school.

It seems that you and Ghost Dog etc. are happy with primary care. It also seems that there are a lot of avenues that aren't technically "family medicine" that one can pursue. The issue is that regular office family practice - you know, the stuff they show us all in medical school - is mundane on the best days and frustrating on the worst. Furthermore, the academic environment has family medicine at the bottom rung of the ladder, and the research coming out of family medicine is soft. Seeing frustrated academic family docs wallow in their ennui at not being recognized as real "specialists" is another thing. Maybe medical schools should be candid about the multiple non-classic options that are available with family medicine.

Also given the all or nothing game of medical residency applications, most students opt to specialize because family medicine is a safe fallback plan, whereas the opposite is almost never the case.

Family medicine has a lot of factors working against it, and I personally believe that it is very unlikely for all of them to alleviate simultaneously.

I find it interesting that the US is finding that primary care is underpaid and undervalued, but truthfully this has been known for a long time and has been met with nothing but lip service. In the Canadian province of Ontario, family medicine service fees are undergoing drastic cuts, even in the wake of a rural physician maldistribution.

 

[deleted87716]

How often do you see American family docs make their primary income on non-family medicine things, like sleep or cosmo or emerge?

Almost never. Most of us don't have any interest in that stuff.

My impression was that outside of the most rural areas, family docs can't really overstep their boundaries because their competition is specialists.

We don't have any "boundaries" other than our training and competency, and I've never known an FP who thinks he/she is "competing" against specialists. They do their thing, we do ours. Generally, neither wants to do what the other does, and everything works out best for the patients when we all work together.

http://blogs.aafp.org/cfr/leadervoices/entry/senate_committee_hears_importance_of?sf5082645=1

I am commenting on this from the perspective as someone who initially wanted to do primary care but was dissuaded by the impression I had gotten from it during medical school.

Medical school is probably the worst place to learn how primary care works in the real world.

regular office family practice - you know, the stuff they show us all in medical school - is mundane on the best days and frustrating on the worst.

Watching somebody else perform cognitive work is like watching paint dry. It's a completely different thing when it's you and your patients. I take a tremendous amount of satisfaction in the fact that my patients come to me first, and that I have the opportunity to not only figure out what's going on in most cases, but to take care of the vast majority of their issues without sending them to another doctor. I love the variety that I see in family medicine. Young, old, sick, well - you name it. No two days are the same. The breadth of family medicine is what makes it challenging and fun. In private practice, I manage my own practice, hire/fire (well, rarely fire) my own staff, set my own hours, see as few or as many patients as I want, take time off when I want, etc. And, sometimes, I even fire my patients (try doing that in the ER). I have time to be involved in the management of my group, and work on advocacy and legislative issues at the state level. I also have plenty of time for family and relaxation. Plus, I earn a good living. So, yeah...you could say I'm happy in family medicine.

Family medicine has a lot of factors working against it, and I personally believe that it is very unlikely for all of them to alleviate simultaneously.

Change doesn't happen overnight. A journey of a thousand miles starts with a single step.

I find it interesting that the US is finding that primary care is underpaid and undervalued, but truthfully this has been known for a long time and has been met with nothing but lip service.

That's changing, as has been mentioned already.

In the Canadian province of Ontario, family medicine service fees are undergoing drastic cuts, even in the wake of a rural physician maldistribution.

I'm sure the Canadian system has its own set of problems and challenges. I'm not really qualified to comment, since I don't live or work there.