How to have a satisfying (non-private) practice in urban setting

[Spazz]

I hear all the time that family practice in urban settings limits your scope of practice, and for me that takes away from the satisfaction of doing FP. But in urban settings could I still see pediatric patients? I'm willing to give up Ob/Gyn, that's fine with me. I'd like to practice either in Los Angeles or my hometown in the Bay Area, and at a place like Kaiser, or even county system, how much I'd really be able to do besides just adult hypertension/DM/depression. (the other thing which makes it tougher I guess is that I don't want to do private practice -- too much to worry about). Thanks

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[skypilot]

How about an academic setting?

 

[ajce9]

You can see peds working in fm and it does not have to be in a private system.

Go to work for Kaiser in california. You can see all the peds you want.

If you speak spanish, you will get so many peds cases you won't know what to do with.

Once they know you are good and they like you, their whole family will come see you. That is how you build a practice.

I use spanish because of california which has a large latino population.

Oh, and you may not do OB, but you can do gyn. I can't see an FP not doing any gyn. I mean you may not do vag. exams and paps all day but there is more to gyn than that.

 

[deleted87716]

I hear all the time that family practice in urban settings limits your scope of practice, and for me that takes away from the satisfaction of doing FP.

Other than things that require credentialing (e.g., obstetrics, colonoscopy, inpatient, etc.), your practice location shouldn't limit your scope of practice in and of itself. It certainly won't stop you from seeing peds and gyn. If you go to work for somebody who dictates who you see and when you refer, well...you asked for it.

 

[Spazz]

You can see peds working in fm and it does not have to be in a private system.

Go to work for Kaiser in california. You can see all the peds you want.

If you speak spanish, you will get so many peds cases you won't know what to do with.

That's a great point, I definitely plan on using my Spanish, which I'm hoping will be fluent in the next few years.

With Kaiser, I heard actually that you don't see much of kids since they have their own Peds dept. Is this something that varies depending on location?

Other than things that require credentialing (e.g., obstetrics, colonoscopy, inpatient, etc.), your practice location shouldn't limit your scope of practice in and of itself. It certainly won't stop you from seeing peds and gyn. If you go to work for somebody who dictates who you see and when you refer, well...you asked for it.

I agree that private practice in an urban setting is the way to go if you want a wide scope of practice -- if that's what you're suggesting. However, since I don't want the administrative responsibilities, I'd rather join a group practice, county clinic, etc. That being said, do you think that closes off Peds, Gyn, maybe even OB?

This is what frustrates me about Family Med, because as rewarding as it could be, so many factors come into play in limiting scope of practice. I get satisfaction from knowing I'm taking care of parents and their kids.

 

[deleted87716]

I'd rather join a group practice, county clinic, etc. That being said, do you think that closes off Peds, Gyn, maybe even OB?

Not at all. You just need to find a group that practices the way you want to practice.

 

[SoCal Doc]

I am a Family Doc in Kaiser So Cal. I also am originally from the Bay (Fremont)
it is just too expensive to live up there.
Anyways regarding your question about Peds. I really do not have that many peds patients in my practice. I probably have 10-15 patients under the age of 10 on my panel of 2200. I do have quite a few teenagers. When there is a Peds dept readily available most parents will chose to have a pediatrician.

But your priorities change a lot when you graduate from residency. I have my hands full taking care of my adult patients. I see all sorts of various problems, definately not just DM, Hyptn, Depression. I do see a lot of children when I am working the Urgent Care, but I am not their primary doctor.

 

[beachbum]

thanks for your comments Southcaldoc. However, I have a question, what is the advantage of Doing FM over IM if your patient pool is for the most part adult. you said in your last post that you see few teenagers and not so much children. please, I am not trying to offend you or start a war of specialties, I want to see the advantages of the two so i could make a more informed decision for residency. thank you

 

[SoCal Doc]

I had already made up my mind in med school that I wanted to do primary care. I enjoy the relationship I have with my patients.
I knew I did not want to pursue a fellowship after my residency and Hospital Medicine was not a priority for me.

FM residents spend a lot more time in the clinic as opposed to IM, IM is a lot more hospital based, although we do our fair share of hospital rotations as well. I wanted to keep all my options open for what I wanted to do after I graduated. It just so happened that my practice ended being mostly adult medicine.

Although I did work in a high acuity urgent care (simillar to an ER except for the trauma) for 1 year after graduating and saw Peds, Adult and OB patients.
And felt adequately trained to handle everything that came through the door.
I still do Urgent Care shifts from time to time.
My IM collegues in the Urgent Care choose only see adult patients.

So to answer your question I just ended up seeing mostly adult patients because of the location I chose to work in. That my not be the case for you. A lot of my friends that graduated with me do see a large amount of peds in their practice and some still do deliveries as well. It all depends on how you want to set up your practice.

I sacrificed Peds because Kaiser allows me to have more of a 9-5 schedule with only 1 weekend day a month and pays quite competativley, so I was willing to give up that part of my practice.

I hope that answers your question.

 

[beachbum]

Thank you very much. FM here I come baby

 

[Museless]

One thing to think about, before giving up ob...

If you do ob, you will see more peds patients. The newborn will come to you, and the next baby too... it'll help keep your panel young.

And while I'm tossing in that two cents, here's two more...

deliveries pay pretty well.

OB's not for everyone; that's the beauty of FP, tailoring your practice to your own interests. But there are good reasons to keep it.

 

[Spazz]

I am a Family Doc in Kaiser So Cal. I also am originally from the Bay (Fremont)
it is just too expensive to live up there.
Anyways regarding your question about Peds. I really do not have that many peds patients in my practice. I probably have 10-15 patients under the age of 10 on my panel of 2200. I do have quite a few teenagers. When there is a Peds dept readily available most parents will chose to have a pediatrician.

>Sigh<, my dream life would be:

* to raise a family in the Bay Area, where I'm from
* and have a satisfying practice with a fair amount of peds
* and it be a nonprivate setting kinda like Kaiser

Unless my future spouse racks in $100K+ salary herself, I guess one of these things has gotta go?

 

[sophiejane]

Unless my future spouse racks in $100K+ salary herself, I guess one of these things has gotta go?

If there is a law school near you, I suggest you start hanging out in the library a lot, looking very single.

 

[ramonaquimby]

bump

 

[burlypie]

Re: peds in FM at Kaiser...in Santa Rosa CA peds had more kids than they know what to do with so the FM docs there get plenty of kids, no turf wars apparently.