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I want to see! Please
I'm a Family Medicine attending in my 2nd year of practice. Ask me anything
- Thread starter hsmooth
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Sent you a pm with the vid.
I want to see! Please
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Would love to see it as well! Sounds like you and your wife have a nice setup!
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sent you a PM as well!
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Damn that is low, but I'm glad you are back on track.
Those sound awesome! I wanna see, but if my mouth doesn't drop, then you owe me a trip. lol
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We're headed there for our honeymoon this year (I can say that now! happy new year!) I'm a photog as well, so i'm looking forward to it!
You paint a much better picture of FM than I typically hear about. It sounds great! I guess i'll throw in a question. I've always thought it silly that the typical doctors office is only 9-5. Mirroring the typical workday seems to be the reason ED's get overrun with hypertension, prescription management, URIs, and other non-emergent issues. Is there any push for FM physicians to move to extended hours? I'd be more drawn to FM if I could work 4 10's (3 12's would be even better!). I'd prefer to live in a rural area, closer to mountain sports, just not at the expense of working 7 days a week.
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D
deleted421268
Did you meet your S/O before med school? What was it like for you in terms of making time for her during your medical school studies, residency, and post residency?
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I can't seem to send you a message or pm. If you message me I'll give you the link
Hi @hsmooth ! Thank you for being so available to us. I have a question about loans. What is the amount of loans you accrued after med achool? Without the financial support of your wife, do you think you were able to live comfortably during residency and after ( while paying back loans)? About how much do you pay per month towards loans?Thanks!
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I'm interested in FM, but I've heard from many that it is "boring". Have you ever found this to be true?
Do you ever miss being involved in research? What made you decide not to work in a more academic setting?
What was your undergrad major? What was your favorite and least favorite part of the undergrad pre-med experience?
Do you ever miss being involved in research? What made you decide not to work in a more academic setting?
What was your undergrad major? What was your favorite and least favorite part of the undergrad pre-med experience?
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@EODguy Congratulations on your wedding! What month are you going for your honeymoon? Do you have your itinerary all planned out yet? You're going to have such an amazing time. If you have any questions about Iceland too -- feel free to PM me about that. What camera system do you shoot with?
Is there any push for FM physicians to move to extended hours?
If you work in a small private practice group, you could probably make your own extended hours. Outside of private practice, I'll hear of docs having slightly extended hours maybe once or twice a week, say start a bit earlier at 7am or stay later til 6 or 7 pm. And for the reasons you mention, those "after 9-5" appointment slots usually get booked up fast by people who want or need to see the doctor but don't necessarily need to take sick time off work.
Maybe throw in an occasional Saturday work day here and there. These are things that you could work out with the office manager or when you negotiate for your contract.
Is there any push for FM physicians to move to extended hours?
If you work in a small private practice group, you could probably make your own extended hours. Outside of private practice, I'll hear of docs having slightly extended hours maybe once or twice a week, say start a bit earlier at 7am or stay later til 6 or 7 pm. And for the reasons you mention, those "after 9-5" appointment slots usually get booked up fast by people who want or need to see the doctor but don't necessarily need to take sick time off work.
Maybe throw in an occasional Saturday work day here and there. These are things that you could work out with the office manager or when you negotiate for your contract.
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Did you meet your S/O before med school?
I met my wife the Sunday night before second semester of my first year of medical school. She was a PA student at that time.
What was it like for you in terms of making time for her during your medical school studies, residency, and post residency?
It worked out fairly well during medical school because we both would have to do a lot of studying...so we'd often "study" together. So at that time she understood how much time I needed to dedicate to school work.
During residency - we ended up moving in together during this time. She was then working in the ER so both our schedules were hectic. We just pre-planned having 'date days' or 'date nights' around both our schedules. Not going to lie, it was tough as there sometimes was days in between when we would actually see each other due to different work schedules -- even though we often would crawl into bed at some point while the other was already sleeping!
Post residency - now we are both working in family medicine. Life is good. Sometimes we share stories since we're in the same field so we can relate to each other. I like that. She works 4 days a week, I work 4.5 days a week. Neither of us work weekends or holidays. So we have all the time in the world to bug each other or hang out with each other haha.
I met my wife the Sunday night before second semester of my first year of medical school. She was a PA student at that time.
What was it like for you in terms of making time for her during your medical school studies, residency, and post residency?
It worked out fairly well during medical school because we both would have to do a lot of studying...so we'd often "study" together. So at that time she understood how much time I needed to dedicate to school work.
During residency - we ended up moving in together during this time. She was then working in the ER so both our schedules were hectic. We just pre-planned having 'date days' or 'date nights' around both our schedules. Not going to lie, it was tough as there sometimes was days in between when we would actually see each other due to different work schedules -- even though we often would crawl into bed at some point while the other was already sleeping!
Post residency - now we are both working in family medicine. Life is good. Sometimes we share stories since we're in the same field so we can relate to each other. I like that. She works 4 days a week, I work 4.5 days a week. Neither of us work weekends or holidays. So we have all the time in the world to bug each other or hang out with each other haha.
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What's one thing you wish you knew about being a doctor when you were still in undergrad
@holycrap That even with a nice lifestyle and regular schedule, being a doctor still adds a bunch of grey hairs to a 33 year old guy.
@holycrap That even with a nice lifestyle and regular schedule, being a doctor still adds a bunch of grey hairs to a 33 year old guy.
Happy new years
What's one thing you wish you knew about being a doctor when you were still in undergrad, also can I see the vid too
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Do you think you will ever open your own practice with just you and your wife and work together?
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What is the amount of loans you accrued after med school?
@eagle311 You're welcome!
I took out a $170,000 loan for medical school and also had a smaller but not insignificant amount of financial help from extended family.
My undergrad college loans were about $40,000.
I lucked out, my med school loan interest rate isn't bad at all - a paltry 2.5%.
Without the financial support of your wife, do you think you were able to live comfortably during residency and after ( while paying back loans)?
During residency my loans were in deferment so the only payment I was making was on the interest so it was only like $400 or so a month in interest. That was definitely doable on a resident's salary. Even when I was a resident from 2011-2014 we were relatively well compensated to the tune of $55k per year. That's more than the typical average American household income.
I wish I was smarter with money though during residency. I wish I learned more about investments and finance at that time. I would have started paying back towards the principal on my loan and not wasted money on frivolous things.
Although, I'll have to say that saving for my wife's engagement ring during residency was a great idea. I wouldn't call that frivolous
About how much do you pay per month towards loans?
I am paying back about $2,000 per month towards loans. We are living a very comfortable life at this time even with those loan payments. We took 6 vacations (8 weeks total) in 2016, bought a new car in cash, paid off about $80,000 in my wife's student loans (it was high interest), on top of maximizing all of our retirement contributions. We go out to eat at a restaurant every week. We have enough money for our hobbies, but we do save in other areas - we don't have cable, we don't spend a whole lot on clothes, etc.
@eagle311 You're welcome!
I took out a $170,000 loan for medical school and also had a smaller but not insignificant amount of financial help from extended family.
My undergrad college loans were about $40,000.
I lucked out, my med school loan interest rate isn't bad at all - a paltry 2.5%.
Without the financial support of your wife, do you think you were able to live comfortably during residency and after ( while paying back loans)?
During residency my loans were in deferment so the only payment I was making was on the interest so it was only like $400 or so a month in interest. That was definitely doable on a resident's salary. Even when I was a resident from 2011-2014 we were relatively well compensated to the tune of $55k per year. That's more than the typical average American household income.
I wish I was smarter with money though during residency. I wish I learned more about investments and finance at that time. I would have started paying back towards the principal on my loan and not wasted money on frivolous things.
Although, I'll have to say that saving for my wife's engagement ring during residency was a great idea. I wouldn't call that frivolous
About how much do you pay per month towards loans?
I am paying back about $2,000 per month towards loans. We are living a very comfortable life at this time even with those loan payments. We took 6 vacations (8 weeks total) in 2016, bought a new car in cash, paid off about $80,000 in my wife's student loans (it was high interest), on top of maximizing all of our retirement contributions. We go out to eat at a restaurant every week. We have enough money for our hobbies, but we do save in other areas - we don't have cable, we don't spend a whole lot on clothes, etc.
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When did you and your wife get married, and how were you able to finance all of that?
Where do you get the money to pay for things for eachother and yourself while you're still in medical school?
Thank you! I will be applying to medical schools this year and family medicine is what I am most interested in so far. Shadowed 3 DO's all in family medicine and it was such a great time. You guys are just so genuine and cool haha.
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Where do you get the money to pay for things for eachother and yourself while you're still in medical school?
Thank you! I will be applying to medical schools this year and family medicine is what I am most interested in so far. Shadowed 3 DO's all in family medicine and it was such a great time. You guys are just so genuine and cool haha.
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I'm interested in FM, but I've heard from many that it is "boring". Have you ever found this to be true?
@numbersloth True there are some days where you'll see a large portion of URI, sinusitis, bronchitis, rinse and repeat. But after a while you take those days as a "break" day from all the other more interesting and mentally challenging cases. You break up the monotony by making sure you continue to do the things you enjoy doing in family medicine. For me, I make sure I still stay active with my procedures. Injections, biopsies, cyst removals (Dr. Pimple Popper what what!!), and OMT.
You really don't know what will walk through your office in family medicine. To name a few mentally challenging cases in the past year of practice: helped diagnose cardiac sarcoidosis in a young guy when the ER kept telling him nothing was wrong - he ended up having a heart transplant. Young kid with 'just a sore throat' diagnosed in urgent care ended up being T cell lymphoma. A fellow doctor came in to see me for what he thought was acid reflux but I urged him to get a stress test and heart workup and he ended up having emergent heart surgery. Saved his life.
Do you ever miss being involved in research? What made you decide not to work in a more academic setting?
I never was interested in research even when I was in college. It made my decision easy to work in a community setting as a practicing physician and not in an academic setting. Although, I do enjoy teaching so i'll take premed job shadowers, medical students, residents, and NP students for rotations.
What was your undergrad major? What was your favorite and least favorite part of the undergrad pre-med experience?
Bachelor of Science. I miss not having any 'real' responsibilities in college other than making sure you get good grades. Miss the time hanging out with college friends, going out, and getting wild.
Least favorite part of pre med experience: constantly playing the premed game, trying to find a way to 'distinguish' myself as an applicant from others when in reality so many people are academically qualified to apply to medical school. Also don't miss comparing grades, volunteer experiences, and that inner feeling of seeing how I compare to other people.
@numbersloth True there are some days where you'll see a large portion of URI, sinusitis, bronchitis, rinse and repeat. But after a while you take those days as a "break" day from all the other more interesting and mentally challenging cases. You break up the monotony by making sure you continue to do the things you enjoy doing in family medicine. For me, I make sure I still stay active with my procedures. Injections, biopsies, cyst removals (Dr. Pimple Popper what what!!), and OMT.
You really don't know what will walk through your office in family medicine. To name a few mentally challenging cases in the past year of practice: helped diagnose cardiac sarcoidosis in a young guy when the ER kept telling him nothing was wrong - he ended up having a heart transplant. Young kid with 'just a sore throat' diagnosed in urgent care ended up being T cell lymphoma. A fellow doctor came in to see me for what he thought was acid reflux but I urged him to get a stress test and heart workup and he ended up having emergent heart surgery. Saved his life.
Do you ever miss being involved in research? What made you decide not to work in a more academic setting?
I never was interested in research even when I was in college. It made my decision easy to work in a community setting as a practicing physician and not in an academic setting. Although, I do enjoy teaching so i'll take premed job shadowers, medical students, residents, and NP students for rotations.
What was your undergrad major? What was your favorite and least favorite part of the undergrad pre-med experience?
Bachelor of Science. I miss not having any 'real' responsibilities in college other than making sure you get good grades. Miss the time hanging out with college friends, going out, and getting wild.
Least favorite part of pre med experience: constantly playing the premed game, trying to find a way to 'distinguish' myself as an applicant from others when in reality so many people are academically qualified to apply to medical school. Also don't miss comparing grades, volunteer experiences, and that inner feeling of seeing how I compare to other people.
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What's the most frustrating thing you deal with patientwise
To name a few:
- when patients come in for your recommendation on something but end up not taking the recommendation and instead will try their essential oils / herbal concoctions purchased from who knows where
- morbidly obese patients who swear they eat healthy but won't tell you what they eat, won't exercise, but want a weight loss medicine
- chronic pain sufferers who were unfortunately started down the pathway of long term usage of opiate or narcotic based pain medicines. Trying to help them while getting them off these medications is a challenge and frustrating.
what's the most frustrating thing on the business side?
Getting pressure from the higher ups to "see more patients" and to "be more productive".
On the flip side, I do my best to give all the time needed to my patients. They'll come in for their physical or preventative visit, but also want me to address their 6 other chronic medical conditions, new knee pain, and refill all their medications. I happily will get through these issues with them, but when I submit bills to their insurance for the services I provide, sometimes they'll complain that it wasn't all covered under one "physical" bill. No amount of explanation beforehand about how the insurance / billing system works will ever make them understand either. Ah well.
To name a few:
- when patients come in for your recommendation on something but end up not taking the recommendation and instead will try their essential oils / herbal concoctions purchased from who knows where
- morbidly obese patients who swear they eat healthy but won't tell you what they eat, won't exercise, but want a weight loss medicine
- chronic pain sufferers who were unfortunately started down the pathway of long term usage of opiate or narcotic based pain medicines. Trying to help them while getting them off these medications is a challenge and frustrating.
what's the most frustrating thing on the business side?
Getting pressure from the higher ups to "see more patients" and to "be more productive".
On the flip side, I do my best to give all the time needed to my patients. They'll come in for their physical or preventative visit, but also want me to address their 6 other chronic medical conditions, new knee pain, and refill all their medications. I happily will get through these issues with them, but when I submit bills to their insurance for the services I provide, sometimes they'll complain that it wasn't all covered under one "physical" bill. No amount of explanation beforehand about how the insurance / billing system works will ever make them understand either. Ah well.
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Do you think you will ever open your own practice with just you and your wife and work together?
Some couples would say they could never work with their significant other. I've talked about this with my wife before and we think we actually would be able to work together.
I don't think I'd ever start my own practice these days. There's too much to think about in terms of business expenses, paying for your own malpractice, and stuff like that. I'm perfectly happy with how I'm financially compensated working through a health system.
Some couples would say they could never work with their significant other. I've talked about this with my wife before and we think we actually would be able to work together.
I don't think I'd ever start my own practice these days. There's too much to think about in terms of business expenses, paying for your own malpractice, and stuff like that. I'm perfectly happy with how I'm financially compensated working through a health system.
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When did you and your wife get married, and how were you able to finance all of that?
We married in 2014. Thankfully, my wife had already been working full time for a few years and she had saved up enough for us to pay the wedding without having any help from either side's parents. She was definitely the bread winner.
Where do you get the money to pay for things for eachother and yourself while you're still in medical school?
My student loans also had a bit extra to help pay for living expenses. Some people even work super part time during medical school for some extra spending money.
Shadowed 3 DO's all in family medicine and it was such a great time. You guys are just so genuine and cool haha.
Right on! Good luck on your applications and let me know if you ever have any other questions. Make sure you apply to some DO schools -- us DOs really are an interesting lot and a DO Family med doc is even cooler!!!
We married in 2014. Thankfully, my wife had already been working full time for a few years and she had saved up enough for us to pay the wedding without having any help from either side's parents. She was definitely the bread winner.
Where do you get the money to pay for things for eachother and yourself while you're still in medical school?
My student loans also had a bit extra to help pay for living expenses. Some people even work super part time during medical school for some extra spending money.
Shadowed 3 DO's all in family medicine and it was such a great time. You guys are just so genuine and cool haha.
Right on! Good luck on your applications and let me know if you ever have any other questions. Make sure you apply to some DO schools -- us DOs really are an interesting lot and a DO Family med doc is even cooler!!!
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Do you use OMM at all?
Yeah, maybe once a week for patients. I do it more often at home though or for friends with aches and pains. I taught my wife also how to do some techniques so she can do it on me too haha.
Yeah, maybe once a week for patients. I do it more often at home though or for friends with aches and pains. I taught my wife also how to do some techniques so she can do it on me too haha.
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These questions are directed at Mrs. hsmooth.
What's her overall feeling about you being a FM doc? Is she comfortable with her lifestyle and relationship (as in, is she having enough time to spend with you)?
Also, and maybe this seems weird, but, does your job provide a circle of friends for your spouse?
What's her overall feeling about you being a FM doc? Is she comfortable with her lifestyle and relationship (as in, is she having enough time to spend with you)?
Also, and maybe this seems weird, but, does your job provide a circle of friends for your spouse?
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Was it difficult to find the opportunity to learn the extra procedures for your practice style? Did you do it in residency or was it post residency in exchange for patient referral? (i.e.- learn derm procedures from dermatologist and then send crazy derm cases you encounter to them)
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Do you only use certain aspects of it?
Also, I'm curious how strict you are with regards to EBM. We get people in sick call who want antibiotics for viral URIs, but we don't prescribe them and they can't argue because it's the military. I imagine civilians get pretty uppity if they have an idea of what they should get (antibiotics for viral pharyngitis) and you don't give them what they want. Do you cave or try patient education?
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What's her overall feeling about you being a FM doc? Is she comfortable with her lifestyle and relationship (as in, is she having enough time to spend with you)?
@Sanguis
I asked Mrs. Hsmooth (she got a kick out of that name!!haha). I'll paraphrase her response here:
I'm extremely happy that you're in family medicine. Especially now that you're done residency, I feel like we have everything we would ever really need. We live an extremely comfortable living, we don't ever really have to worry about money, we can afford some nice luxuries when we feel like splurging on ourselves.
I'm so glad you're not a surgeon or anything like that. It's like you have a regular office job, and when you're done at 5 during the week, you're done. When you're at home I feel like you're not distracted by work. You don't bring a lot of work home. When you're here, you're here mentally, physically, and emotionally.
Even when you're on call, you just take phone call. It's not like you have to get up in the middle of the night to go to the hospital to do an emergency surgery.
I think with your current work situation it allows us to have a very nice work-life balance and that makes me happy.
does your job provide a circle of friends for your spouse?
We have developed a small circle of friends that came out from my job. It would be a bit more different too if we had young children, but we don't. Many of my co-workers have young kids and I imagine we'd have play dates if we had kids too.
Nevertheless, my wife has become pretty good friends and actually works out with a girl who's good friends with one of our nurses.
The benefit of working for a medical system is that you also get to meet a lot of people at social events and work meetings. I've become pretty good friends with another young childless doc in our system and we'll get together for dinner dates with him and his gf.
@Sanguis
I asked Mrs. Hsmooth (she got a kick out of that name!!haha). I'll paraphrase her response here:
I'm extremely happy that you're in family medicine. Especially now that you're done residency, I feel like we have everything we would ever really need. We live an extremely comfortable living, we don't ever really have to worry about money, we can afford some nice luxuries when we feel like splurging on ourselves.
I'm so glad you're not a surgeon or anything like that. It's like you have a regular office job, and when you're done at 5 during the week, you're done. When you're at home I feel like you're not distracted by work. You don't bring a lot of work home. When you're here, you're here mentally, physically, and emotionally.
Even when you're on call, you just take phone call. It's not like you have to get up in the middle of the night to go to the hospital to do an emergency surgery.
I think with your current work situation it allows us to have a very nice work-life balance and that makes me happy.
does your job provide a circle of friends for your spouse?
We have developed a small circle of friends that came out from my job. It would be a bit more different too if we had young children, but we don't. Many of my co-workers have young kids and I imagine we'd have play dates if we had kids too.
Nevertheless, my wife has become pretty good friends and actually works out with a girl who's good friends with one of our nurses.
The benefit of working for a medical system is that you also get to meet a lot of people at social events and work meetings. I've become pretty good friends with another young childless doc in our system and we'll get together for dinner dates with him and his gf.
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Was it difficult to find the opportunity to learn the extra procedures for your practice style?
All the procedures I learned were from residency. That's why it's important to go to a residency that will help you develop the skills you need to thrive in your future practice. I knew I wanted to do certain procedures beforehand so it didn't make sense for me to try to match to a residency that didn't provide procedure training. Also I knew I didn't want to do inpatient medicine so I didn't try to match to a residency that was heavy in inpatient medicine.
For my elective rotations I chose rotations such as outpatient Ortho or sports medicine and dermatology. I'd be proactive and ask the attendings to allow me to do procedures, then I'd track how many procedures I did so I could get signed off as competent for the credentialing process.
There are other opportunities to learn procedures outside of residency, like at CME conferences. I don't think I'd ever ask a dermatologist now to let me follow them around to do procedures but I have no problems sending them pics of weird rashes or referring any pts who need biopsies if they're too complicated or if i just don't feel like doing it.
All the procedures I learned were from residency. That's why it's important to go to a residency that will help you develop the skills you need to thrive in your future practice. I knew I wanted to do certain procedures beforehand so it didn't make sense for me to try to match to a residency that didn't provide procedure training. Also I knew I didn't want to do inpatient medicine so I didn't try to match to a residency that was heavy in inpatient medicine.
For my elective rotations I chose rotations such as outpatient Ortho or sports medicine and dermatology. I'd be proactive and ask the attendings to allow me to do procedures, then I'd track how many procedures I did so I could get signed off as competent for the credentialing process.
There are other opportunities to learn procedures outside of residency, like at CME conferences. I don't think I'd ever ask a dermatologist now to let me follow them around to do procedures but I have no problems sending them pics of weird rashes or referring any pts who need biopsies if they're too complicated or if i just don't feel like doing it.
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Do you only use certain aspects of it?
I do mostly HVLA, soft tissue, and muscle energy techniques. I never figured out how to do cranial-sacral type techniques so I was never comfortable with it. Plus it seems a bit too woo-woo IMHO. I'll use OMT for neck pain, headaches, upper back pain, lower back pain. A natural progression of this is that I'll do trigger point injections as well, and refer patients to PT for dry-needling.
Do you cave or try patient education?
This is a great, great question you ask. It's a conundrum that many providers face on a near-daily basis. Without getting too political, the American health care system, and a proportion of the American public view health care as a business / commodity. Patients pay for their appointment with you, and a lot of times expect some sort exchange of goods or services (antibiotics, treatment, etc). As a physician, I could argue that I am providing them with the knowledge on how to help get over a URI (nasal spray, humidifier, over the counter products, rest, stay hydrated) but the patient may see this as a waste of their time and money to come see you.
This can also bring forth a potential conflict of interest. In many compensation plans, physicians' salaries to some extent are directly tied in to patient satisfaction scores. If a patient is extremely unhappy you're not going to provide them with an antibiotic for their URI, is that something you're going to risk your potential $3,000 quarterly patient satisfaction score bonus for?
Physician compensation is also directly related to complexity of care. If I prescribe an antibiotic and call your cough a bronchitis instead of URI, I may end up with an extra $40 in my bank account. Spread over the course of a year, that may end up equaling several extra thousands of dollars in a doctors bank account. You can see the ethical dilemmas that this situation would present.
So what do I personally do? This is also where the 'art of medicine' comes in. I'll try to get a sense of where the patient is. Some patients actually truly want to know the best treatment, and would avoid antibiotics like the plague and just need a little reassurance that they'll be ok. Perfect.
In the other extreme, I can also be tactful as well. If I get the sense that a patient is going to rage out of my exam room unless I give them something...I'll do a few thing: Explain to them that they likely have a cough URI, antibiotics aren't needed just yet, side effects of antibiotics, risk of resistance, etc. I can print them out a prescription for prescription cough syrup, magic mouthwash, or something they can tangibly have so they get "something" and ask them to call me in 1-2 weeks if their cough gets worse or more purulent and then I can call in a prescription over the phone for an antibiotic. Another thing I can also do is just print out a prescription for an antibiotic but post date it for a week or so later so they're forced to try the supportive cares before filling the antibiotic.
You end up learning little tricks of the trade to keep everyone happy, maintaining your ethical medical obligations, while not selling your soul to the business and almighty dollar.
@Matthew9Thirtyfive
I do mostly HVLA, soft tissue, and muscle energy techniques. I never figured out how to do cranial-sacral type techniques so I was never comfortable with it. Plus it seems a bit too woo-woo IMHO. I'll use OMT for neck pain, headaches, upper back pain, lower back pain. A natural progression of this is that I'll do trigger point injections as well, and refer patients to PT for dry-needling.
Do you cave or try patient education?
This is a great, great question you ask. It's a conundrum that many providers face on a near-daily basis. Without getting too political, the American health care system, and a proportion of the American public view health care as a business / commodity. Patients pay for their appointment with you, and a lot of times expect some sort exchange of goods or services (antibiotics, treatment, etc). As a physician, I could argue that I am providing them with the knowledge on how to help get over a URI (nasal spray, humidifier, over the counter products, rest, stay hydrated) but the patient may see this as a waste of their time and money to come see you.
This can also bring forth a potential conflict of interest. In many compensation plans, physicians' salaries to some extent are directly tied in to patient satisfaction scores. If a patient is extremely unhappy you're not going to provide them with an antibiotic for their URI, is that something you're going to risk your potential $3,000 quarterly patient satisfaction score bonus for?
Physician compensation is also directly related to complexity of care. If I prescribe an antibiotic and call your cough a bronchitis instead of URI, I may end up with an extra $40 in my bank account. Spread over the course of a year, that may end up equaling several extra thousands of dollars in a doctors bank account. You can see the ethical dilemmas that this situation would present.
So what do I personally do? This is also where the 'art of medicine' comes in. I'll try to get a sense of where the patient is. Some patients actually truly want to know the best treatment, and would avoid antibiotics like the plague and just need a little reassurance that they'll be ok. Perfect.
In the other extreme, I can also be tactful as well. If I get the sense that a patient is going to rage out of my exam room unless I give them something...I'll do a few thing: Explain to them that they likely have a cough URI, antibiotics aren't needed just yet, side effects of antibiotics, risk of resistance, etc. I can print them out a prescription for prescription cough syrup, magic mouthwash, or something they can tangibly have so they get "something" and ask them to call me in 1-2 weeks if their cough gets worse or more purulent and then I can call in a prescription over the phone for an antibiotic. Another thing I can also do is just print out a prescription for an antibiotic but post date it for a week or so later so they're forced to try the supportive cares before filling the antibiotic.
You end up learning little tricks of the trade to keep everyone happy, maintaining your ethical medical obligations, while not selling your soul to the business and almighty dollar.
@Matthew9Thirtyfive
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"don't go into family med because the debt to compensation ratio is so huge."
@georgia_boy1
You're welcome!
I mentioned the amount of debt I have, and my income earlier in this thread. I'm comfortable with where I'm at.
My advice to premeds would be to go to the cheapest (but still good) med school you can get in to. There's a huge difference coming out of med school with $200k in debt vs $500k in debt.
If you can suck it up and live a few years in a "less desirable" or "rural" location, pick up extra moonlighting shifts, etc..., you can make a huge dent in your debt with the larger salary and lower cost of living. Then when you're in your mid or late 30s you can move to your "dream location".
It's doable. Really doable. I recommend reading the following blogs:
White Coat Investor
Physician on Fire
Bogleheads - for investing.
Live like a resident even when you're an attending for the first few years. Don't buy your Tesla until you've paid off your loans. Go on a few trips but save your $20,000 African Safari until you're 37 or 38 and paid off your loans. Cut the cable out of your life and watch Netflix or better yet exercise and play board games with your spouse. etc.etc etc...
@georgia_boy1
You're welcome!
I mentioned the amount of debt I have, and my income earlier in this thread. I'm comfortable with where I'm at.
My advice to premeds would be to go to the cheapest (but still good) med school you can get in to. There's a huge difference coming out of med school with $200k in debt vs $500k in debt.
If you can suck it up and live a few years in a "less desirable" or "rural" location, pick up extra moonlighting shifts, etc..., you can make a huge dent in your debt with the larger salary and lower cost of living. Then when you're in your mid or late 30s you can move to your "dream location".
It's doable. Really doable. I recommend reading the following blogs:
White Coat Investor
Physician on Fire
Bogleheads - for investing.
Live like a resident even when you're an attending for the first few years. Don't buy your Tesla until you've paid off your loans. Go on a few trips but save your $20,000 African Safari until you're 37 or 38 and paid off your loans. Cut the cable out of your life and watch Netflix or better yet exercise and play board games with your spouse. etc.etc etc...
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Awesome answer. Thank you. It sometimes goes the other way too. I work with providers (there are 4 of us, but one is the supervising IDC so he only gets involved on the more complex or emergent cases usually), and the others will just throw drugs at things that don't need them just because it makes the patients happy, despite evidence that it either doesn't help or can actually be more harmful than helpful. When I ask them about it in private, their rationale is that patients want something, and even if it is just a placebo effect, it's still helping them. To me that's not good enough, because there are other things you can give that do work and aren't potentially harmful.
It's just frustrating sometimes from both sides. I'm hoping when I'm actually a doctor, that will be less common from the provider side. Mid-levels seem to be more experience/anecdote prone than EBM driven. I've even provided sample studies and the actual guidelines, but to them their experience trumps it.
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I know right
No weekends, 4 1/2 days a week make mid six fiures, 8 weeks vacation a year lol
That's awesome
Like crazy awesome
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D
deleted421268
When did you figure out exactly that you wanted to go into medicine and become a doctor? At any point did you ever have doubts that you may not get in or something?
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Glad we could help answer some of your questions!
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When you were applying, did you apply to both MD and DO? Why did you choose DO, personally?
I grew up in Canada and that's where I went to college / university too. If you take a look at the Canadian pre med sub forums on here you'll see that Canadian medical schools are historically very difficult to get an admission too. They basically have strict cut GPA and MCAT cutoffs. I only applied to Canadian schools after finishing undergrad. Obviously I didn't get in because I knew my stats and #s weren't going to cut it.
The next application cycle I decided to apply more broadly, to MD and DO schools in the States. I really didn't want to go to a Caribbean or European medical school. Actually I had never even heard of DO school until I read about it on these very forums... so I owe SDN my career basically.
By the time I had interviewed at a DO school and gained acceptance, I hadn't even heard back for interviews for the other MD schools I applied to. And honestly I didn't feel like playing the interview and stress game waiting for other schools. The DO school was a good fit for me, tuition wasn't bad, so I put down my deposit and never looked back.
@wahoowa2017
I grew up in Canada and that's where I went to college / university too. If you take a look at the Canadian pre med sub forums on here you'll see that Canadian medical schools are historically very difficult to get an admission too. They basically have strict cut GPA and MCAT cutoffs. I only applied to Canadian schools after finishing undergrad. Obviously I didn't get in because I knew my stats and #s weren't going to cut it.
The next application cycle I decided to apply more broadly, to MD and DO schools in the States. I really didn't want to go to a Caribbean or European medical school. Actually I had never even heard of DO school until I read about it on these very forums... so I owe SDN my career basically.
By the time I had interviewed at a DO school and gained acceptance, I hadn't even heard back for interviews for the other MD schools I applied to. And honestly I didn't feel like playing the interview and stress game waiting for other schools. The DO school was a good fit for me, tuition wasn't bad, so I put down my deposit and never looked back.
@wahoowa2017
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@greenturtle22 You're welcome!!! Glad some of my responses are informative and helpful to you.
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Family medicine physicans dont make 300k unless you work in the middle of nowhere. Surgeons barely make 300k.
Sent from my SM-G900V using SDN mobile
Sent from my SM-G900V using SDN mobile
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What was yours if you don't mind sharing?
Also what does it take to get into a Canadian school?
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He is in the midwest in a city of 80k(posted above)
Basically in an area not many want to live lol
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At any point did you ever have doubts that you may not get in or something?
Oh yeah, I'm the poster child for your premed and even medical student that was never super amazing at taking and acing tests. By multiple strokes of luck and persistence (some would say my persistence and dedication created the luck) I'm where I am now. There were so many steps along this journey where I really thought I was never going to make it. Sometimes I look back at it all, and feel so lucky that I was given the opportunity to prove myself even if at first I hadn't succeeded.
After graduating high school with an A / 3.9 average...here were just a few of the difficulties and obstacles I had to face:
@Fuarky
Oh yeah, I'm the poster child for your premed and even medical student that was never super amazing at taking and acing tests. By multiple strokes of luck and persistence (some would say my persistence and dedication created the luck) I'm where I am now. There were so many steps along this journey where I really thought I was never going to make it. Sometimes I look back at it all, and feel so lucky that I was given the opportunity to prove myself even if at first I hadn't succeeded.
After graduating high school with an A / 3.9 average...here were just a few of the difficulties and obstacles I had to face:
- Freshman year of college: was a bit of a challenge adapting to living and being on my own for the first time. Struggled and finished with a B- or 3.2-3.3 average for the year. Thought my chances for med school were shot. Buckled down really hard over the next few years to bring my undergrad up to a more respectable but not great 3.7.
- Disappointed that the months of hard prep work and studying for the MCAT resulted in only a score of 27P on the old MCAT system. I darn near cried when I got my score report.
- Got shut out the first time I applied to medical schools. Not even a secondary application request, let along interview offer.
- Struggled with the volume of classes the first year of medical school. Scored a solid 46% on a microbiology exam. Was quite a hole I had to dig out of to pass that class.
- In the middle of interviewing for residency programs, I found out I failed my Step 2 board exam. That was a bomb.
@Fuarky
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Smaller midwest town of 80,000 people. 20 minute drive to go see an NFL football game in person. Hour and a half to a larger city of 2 million in the greater area. 10-20 minutes to gorgeous lakes. Lots of trails to explore.
8 weeks of vacation means I could take a 7-10 days off every other month and go somewhere nice or exotic, and only take 30 seconds to get through TSA security at our airport hahah! ... And 2 of those 8 weeks would be covered under CME expenses. So my work basically pays me to go to the Bahamas, Cayman Islands, Canadian Rockies, Paris, Singapore..just to name a few places I'm considering doing a conference to 'learn' something.
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Hahah I'm a midwestern also and was just curious as to how far outside decent sized cities you have to work to earn that. Are we taking 20 minutes away from a team like the browns
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Hahah I'm a midwestern also and was just curious as to how far outside decent sized cities you have to work to earn that. Are we taking 20 minutes away from a team like the browns
LOL... I dunno, I don't think I'd want to watch a Browns game though...
