I'm a Family Medicine attending in my 2nd year of practice. Ask me anything

[AnatomyGrey12]

But give me hundreds and hundreds of acres and I will be happy

Nice to find someone who shares my love of the country. No matter what specialty I end up in for my location give me some fresh air and trees, lots and lots of trees. Preferably with plenty of wildlife.

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[Dr.Sticks]

Nice to find someone who shares my love of the country. No matter what specialty I end up in for my location give me some fresh air and trees, lots and lots of trees. Preferably with plenty of wildlife.

Yessss

Honestly if I didn't want to be a doctor I think I would go be a cattle rancher lol

 

[hsmooth]

Nice to find someone who shares my love of the country. No matter what specialty I end up in for my location give me some fresh air and trees, lots and lots of trees. Preferably with plenty of wildlife.

Come live by me @AnatomyGrey12
My back yard overlooks a wooded forest, yet I'm still in the 'city'. I have deer, coyotes, cranes, and owls visit me in the backyard.

 

[Dr.Sticks]

J

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.

dude
Canadian Rockies???
Soooooo jelly
Lol

 

[zurc2014]

What is your pre tax annual income?
I finished residency 2 years ago and signed on to my job with an 18 month salary guarantee of $220k pretax. I live in a low cost of living area in the midwest, in a slightly smaller town of about 80,000. This salary was about $35k more than if I stayed in the city where I did residency which was a medium to larger city of population 600,000 / 2 million in the greater city region. After my 18 month salary guarantee, my income is mostly based on production / RVUs and to some small degree patient satisfaction scores and quality metrics.

Taking about 8 weeks of vacation this year I figure to earn about $245k. Next year, if I take only 4-6 weeks of vacation I hope to make $300k. I definitely feel this is fair compensation. As a med student, I never really thought I could make this much as a family med doc.

I know some family med docs in my group that make >$300k.

Any things you are thinking about in the future to increase your compensation?
Have multiple streams of income, maybe not necessarily medicine related. Maximize my investments. Decrease extraneous purchases. Rental property? Online blogger? Develop some product?

Practice good medicine, be personable and likeable by your patients, show them you care, and you'll have as busy of a practice as you want. I might try to convince the manager to hire a scribe for me.

I love you. Lol. Most people on sdn will shoot you down asap if you dare whisper anything about money and pile on comments about doing I banking or something else. You got straight to the point, no BS, no questions asked. I respect that sir (ma'am?) Thanks for your help.

 

[hsmooth]

I love you. Lol. Most people on sdn will shoot you down asap if you dare whisper anything about money and pile on comments about doing I banking or something else. You got straight to the point, no BS, no questions asked. I respect that sir (ma'am?) Thanks for your help.

You're welcome! I hope this thread has been helpful to you.
SDN was really helpful to me way back in 2005 when I was a premed -- just trying to give back now that I've been through it all. I wish people did these 'Ask me anything' style threads back in 2005 as I would have asked sooo many "taboo" questions haha.

 

[AnatomyGrey12]

Come live by me @AnatomyGrey12
My back yard overlooks a wooded forest, yet I'm still in the 'city'. I have deer, coyotes, cranes, and owls visit me in the backyard.

You can PM me if you want to tell me your location, I'm always looking for new places to add to my list of potential future places to live. My wife thinks I would be really good at rural medicine so it is definitely something I am considering, and this thread has been extremely beneficial.

 

[hsmooth]

Sent you a pm!

You can PM me if you want to tell me your location, I'm always looking for new places to add to my list of potential future places to live. My wife thinks I would be really good at rural medicine so it is definitely something I am considering, and this thread has been extremely beneficial.

 

[hsmooth]

Family medicine physicans dont make 300k unless you work in the middle of nowhere. Surgeons barely make 300k.

The financial situation is easier if you work out of the city or coasts.

There is a wide range of income potential too with many factors. How hard are you going to work? How much time do you take off? Do you moonlight or do locums aside from your regular job?

Here's an interesting thread that's worth a read:
How much do family doctors actually earn? Right after residency?

 

[hsmooth]

What was yours if you don't mind sharing?
Also what does it take to get into a Canadian school?

3.7 / 27P
You can read all about some of the obstacles I faced getting into and through med school / residency here
I have no idea what the Canadian med school requirements are these days, but back when I was applying unless you scored at least a 30 on your MCAT don't even bother to apply.

 

[AnatomyGrey12]

Sent you a pm!

Thank you! It's on the list

 

[SansaStarkMD]

How realistic is it for a family doctor to do three days a week of clinic and one or two ER shifts?

How does this affect benefits, call coverage, partners, etc? Can mid levels help?

 

[hsmooth]

How realistic is it for a family doctor to do three days a week of clinic and one or two ER shifts?

How does this affect benefits, call coverage, partners, etc? Can mid levels help?

I can only speculate because obviously I'm not working in a situation like this and I don't know anyone personally who is doing this...
..but you could theoretically get a part time outpatient family medicine job and then do locums work to cover ER shifts as well.
Your benefits would then probably only be 'part time' however.

 

[HopefulSlav]

Do you plan on opening up businesses outside of medicine (hotels, restaurants, etc.)?

 

[Dr.Sticks]

3.7 / 27P
You can read all about some of the obstacles I faced getting into and through med school / residency here
I have no idea what the Canadian med school requirements are these days, but back when I was applying unless you scored at least a 30 on your MCAT don't even bother to apply.

Your tale is very interesting; It is kind of like How Dr.Carson said he was going to fail one of his classes in college.. But uh, he said he got the answers form God during the test so he passed..
I don't know about you though..

 

[hsmooth]

Do you plan on opening up businesses outside of medicine (hotels, restaurants, etc.)?

Do you plan on opening up businesses outside of medicine (hotels, restaurants, etc.)?

At this stage of my life I don't think I have any interest in doing that. Although, between the 3rd and 4th year of medical school I did start a wedding cinematography business with my non-med school friends and we turned it into a 6-figure a year business. It was a lottttt of work though.

One of my dreams would be to open a small gym or small fitness studio however and not really care too much how much money it makes.

 

[hsmooth]

Your tale is very interesting; It is kind of like How Dr.Carson said he was going to fail one of his classes in college.. But uh, he said he got the answers form God during the test so he passed..
I don't know about you though..

wait so would that constitute as cheating if you get the answers from someone else during your test??

 

[Dr.Sticks]

wait so would that constitute as cheating if you get the answers from someone else during your test??

According to him the test wasn't open book but nothing said it wasn't "open to the lord" so it doesn't count
Yep... 0_0

 

[Nesrizona]

Hi Hsmooth!

I'm also a Canadian (born and raised in Canada) and learned about DO via SDN, haha. You mentioned that you are in the MidWest currently, are you ever planning to return to Canada to practice Medicine?

 

[hsmooth]

Hi Hsmooth!

I'm also a Canadian (born and raised in Canada) and learned about DO via SDN, haha. You mentioned that you are in the MidWest currently, are you ever planning to return to Canada to practice Medicine?

Hi! Good to hear from you. Where in Canada are you from?
I am leaving the door open for a return to Canada in the future. No immediate plans, but I made sure I did an ACGME residency so returning back to Canada would be a bit easier. What are your future plans, practice in the States or Canada?

 

[shouldibeadoc]

Are you and your wife both happy with the respective paths you took (PA and DO)? Do either of you ever wish you'd gone the other way? If you don't mind, what is your wife's salary? I'm interested in the difference between the two and you two seem like you'd be a good comparison because you're in the same location in the same specialty.

 

[Nesrizona]

Hi! Good to hear from you. Where in Canada are you from?
I am leaving the door open for a return to Canada in the future. No immediate plans, but I made sure I did an ACGME residency so returning back to Canada would be a bit easier. What are your future plans, practice in the States or Canada?

Western Canada and yes I would like to come back to Canada to practice eventually .

 

[hsmooth]

Are you and your wife both happy with the respective paths you took (PA and DO)? Do either of you ever wish you'd gone the other way? If you don't mind, what is your wife's salary? I'm interested in the difference between the two and you two seem like you'd be a good comparison because you're in the same location in the same specialty.

Are you and your wife both happy with the respective paths you took (PA and DO)? Do either of you ever wish you'd gone the other way?
Yes, we both are. Although if she were to go back and choose a non-medical career path I think she really wants to be a zookeeper and work with animals. And I am happy and satisfied with my career choice as well.

If you don't mind, what is your wife's salary?
She makes $85-$90k working 4 days a week (32 hours a week).

 

[Dracula5000]

Thank you for your open honest replies. You truly did mean "ask me anything"! I wish you and your wife all the best in life!

 

[WedgeDawg]

Just wanted to say thanks for doing this. Members like you are what makes SDN special.

 

[hsmooth]

Thank you for your open honest replies. You truly did mean "ask me anything"! I wish you and your wife all the best in life!

Just wanted to say thanks for doing this. Members like you are what makes SDN special.

You're welcome! I said it before, but SDN was really helpful to me wayyyyyyyyyyyyy back in 2005 when I was a premed. Just trying to do my part to help the next gen of health care providers!

 

[Neuroplasticity]

Thank you for answering questions. I am interested in your opinions on preventative care. How can we maximize its potential? Do you feel like you are able to effectively discuss preventative care with patients?

 

[hsmooth]

I am interested in your opinions on preventative care. How we can maximize its potential? Do you feel like you are able to effectively discuss preventative care with patients?

I won't pretend like I know the answers as these are questions that even the country's forefront medical gurus, advisers, and politicians struggle to come to grasps with. A look at the data shows the US spending tons and tons of money on healthcare with marginal, at best, health outcomes compared to other 1st world countries. So we do have a lot of work to do in the realm of preventative care and health care in general.

Please not that the following is my own personal opinion and you may agree or disagree with some or all of it.

I think there are institutional, societal, and individual / personal 'norms' and factors at play that all can be improved upon.

Starting at the top, institutionally speaking, our healthcare system as you know is fractured. It also is very much so a 'reactive' rather than 'proactive' system. With its roots in a fee-for-service system, there isn't a whole lot of incentive to physicians to spend the extra time needed to really do a good job in teaching preventative health care. Whether my physicals are 20 minutes, 40 minutes, or 1 hour, the pay is the same. When the corporate health system is breathing down your neck to 'see more patients' and 'make more money' the temptation can be real to just do the bare minimum in your 20 minute physical and spend the rest of that hour seeing other 15 minute appointment patients, prescribing some antibiotics here and starting some blood pressure medications there, and coming out ahead financially that way.

Other frustrating aspects include restricted access to ancillary specialists such as nutritionists, dieticians, etc. I've tried to get obese and "metabolic syndrome" patients in to learn about healthy eating and lifestyle changes but their insurance won't pay for it unless they have a diagnosis of diabetes.... That makes a lot of sense right?

So, I'm intrigued by a either a direct primary care model -- which bears some similarities to systems such as the Canadian 'capitation' system - you take care of a 'roster' of patients and you get paid a set fee per year regardless if you see each patient 10 times or none.

Or, you do healthcare reform to give back the practice of medicine to actual physicians instead of having the insurance companies dictate and determine your treatment plans, medications, etc. But I digress, that kind of conversation could quickly escalate into a bloody mess here on the internet haha. And I realize I've been somewhat babbling over the past couple of paragraphs so I'll just end here -- if you want to continue this conversation with me please send me a PM!

Thank you for answering questions. I am interested in your opinions on preventative care. How we can maximize its potential? Do you feel like you are able to effectively discuss preventative care with patients?

 

[doc2be245]

I'm a 2nd year medical student preparing for boards with an interest in Family Med, internal Med. And possible emergency medicine (maybe). I'm required to go to 50% of my class lectures otherwise I'll loose 10% of my final grade. I learn best on my own and can ace the exams but I will end up with a B no matter what if I don't go to class. Do you think that if I skipped class and took the B that it would hurt me when applying for residency? I would much rather put those extra 8-10 hours a week into prepping for step 1.


Sent from my iPhone using SDN mobile

 

[hsmooth]

I'm a 2nd year medical student preparing for boards with an interest in Family Med, internal Med. And possible emergency medicine (maybe). I'm required to go to 50% of my class lectures otherwise I'll loose 10% of my final grade. I learn best on my own and can ace the exams but I will end up with a B no matter what if I don't go to class. Do you think that if I skipped class and took the B that it would hurt me when applying for residency? I would much rather put those extra 8-10 hours a week into prepping for step 1.


Sent from my iPhone using SDN mobile

Not sure how your classrooms are set up, but you could literally sit in class to be physically present but be studying on your laptop or tablet for the Step or other classes.

I know some of the students in the 'back row' during my med school years would be making money playing online poker instead...haha!

 

[doc2be245]

Its more of a focus thing, but I see your point. Also getting called out by the professor kinda sucks.


Sent from my iPhone using SDN mobile

 

[Shammyguy3]

What was something you thought you understood about Family Medicine heading into it that turned out to be wrong when you started practicing?

 

[The Buff OP]

@hsmooth
I gotta say, this is one of the best AMA threads I have ever read on here. Down to earth guy, speaks the truth, and gives good advice.

What is your opinion on some doctors endorsing dietary supplements? I'll send you a PM on what I'm talking about.

 

[jaymaster7]

Massive respect for you doc. Loved your responses truly an inspiration and couldn't stop reading even though I'm predent

 

[hard08]

How hard was it to get a residency for you considering your were Canadian? Did you have your green card (assuming your wife is American)?

 

[LoveBeingHuman:)]

Do you feel it's worth it to take the USMLE step 1 as a DO student? Some do this to increase proportionate-MD dominated residencies.

 

[hsmooth]

What was something you thought you understood about Family Medicine heading into it that turned out to be wrong when you started practicing?
I always felt like I was a strong communicator and thought I could read people well enough to know the best way to motivate them to make a positive change in their lives. Being out in practice now you learn that some people, no matter how hard you try, or even if you try different communication or motivational techniques, you just can't get through to them. Those are the cases that sometimes leave me thinking "what else can I do to help this person?" when in reality, there isn't much more you an do, until they make the conscious decision or effort to help themselves. And sometimes it is sad because they never get to that point themselves and end up sick or dead.

What was something you thought you understood about Family Medicine heading into it that turned out to be wrong when you started practicing?

 

[hsmooth]

What is your opinion on some doctors endorsing dietary supplements?

Thanks @The Buff OP for your kind comments!! I dunno about the 'good advice' part lol. I'm just trying to be as honest as I can be with the experiences I've had. It may work for others or it may not

Well if a doctor is openly promoting a product that hasn't been thoroughly tested or approved treatment / therapy, I feel they've sold their souls to the highest bidder to make a quick buck. I hope they can sleep at night knowing this. Now on the other hand, if they still market these products but openly put up their own disclaimer that the products haven't been tested and that results are purely anecdotal, maybe I might have some small amount of respect for that. I dunno.

Someone asked me earlier if I would ever do side businesses like restaurants or franchises, which I wouldn't, but I've dabbled in online affiliate marketing as a side hustle. I didn't really stress the fact that I'm a doctor and the product is going to miraculously help them, but it was for a product that I believe in myself from personal experience.

@hsmooth
I gotta say, this is one of the best AMA threads I have ever read on here. Down to earth guy, speaks the truth, and gives good advice.

What is your opinion on some doctors endorsing dietary supplements? I'll send you a PM on what I'm talking about.

 

[Aicrag]

"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...

It's only reasonable that you push for the cheaper route, but if you had the decision to go to a top med school (400k) vs. a med school in your state (150k) which would you go to?

 

[hsmooth]

Massive respect for you doc. Loved your responses truly an inspiration and couldn't stop reading even though I'm predent

thanks @jaymaster7 for your comments. Good luck to you in your dental career.

 

[hsmooth]

How hard was it to get a residency for you considering your were Canadian? Did you have your green card (assuming your wife is American)?
It did add a different element as I could only apply to residencies that would sponsor me with the visa I wanted to get (H1B). I was lucky in that I found a great program with a good reputation that sponsored me. I didn't have my green card yet at that time. So I had to switch over from student visa to OPT and then to H1B.

There were hoops to jump through as on two instances my H1B wasn't approved in time so I had to delay reseidency. I graduated a few months later than the rest of my classmates.

Now that my wife and I had been married for a while, I now have my green card. Had to pass a super tough interview though to prove to them I didn't just marry her for status hahah.

How hard was it to get a residency for you considering your were Canadian? Did you have your green card (assuming your wife is American)?

 

[hsmooth]

Do you feel it's worth it to take the USMLE step 1 as a DO student? Some do this to increase proportionate-MD dominated residencies.
I haven't really been following what it will all mean with the DO/ MD merger in a few years. At this point, if your goals are to match in primary care type residencies, you don't need to do the USMLE. I never did, and just did the COMLEX.

Now if you want to do some super specialized sub-specialty, you should do your research and consider doing the USMLE.

Do you feel it's worth it to take the USMLE step 1 as a DO student? Some do this to increase proportionate-MD dominated residencies.

 

[hard08]

How hard was it to get a residency for you considering your were Canadian? Did you have your green card (assuming your wife is American)?
It did add a different element as I could only apply to residencies that would sponsor me with the visa I wanted to get (H1B). I was lucky in that I found a great program with a good reputation that sponsored me. I didn't have my green card yet at that time. So I had to switch over from student visa to OPT and then to H1B.

There were hoops to jump through as on two instances my H1B wasn't approved in time so I had to delay reseidency. I graduated a few months later than the rest of my classmates.

Now that my wife and I had been married for a while, I now have my green card. Had to pass a super tough interview though to prove to them I didn't just marry her for status hahah.

Thanks for the response. Was the delay your fault, the school's fault or someone else's fault? Just curious.

How long did it take you to get a green card? Like how long is the process typically?

 

[hsmooth]

It's only reasonable that you push for the cheaper route, but if you had the decision to go to a top med school (400k) vs. a med school in your state (150k) which would you go to?
Depends on what your career aspirations are. If you want to hold down prestigious teaching or research positions at Ivy level schools, or work for the Health Department as a top level adviser, become the next Dr. Oz, etc etc etc... I suppose I would have went to a top med school for $400k.

I knew I wanted to be a regular ol' family med doc that checks in at 8am, leaves at 5pm, spends time with family, friends, and my wife, and take my 6-8 weeks vacation off every year and if I never published a research article that'd be fine by me. So I chose the cheaper route.

It's only reasonable that you push for the cheaper route, but if you had the decision to go to a top med school (400k) vs. a med school in your state (150k) which would you go to?

 

[hsmooth]

Thanks for the response. Was the delay your fault, the school's fault or someone else's fault? Just curious.

How long did it take you to get a green card? Like how long is the process typically?

USCIS immigration department. They were back logged. I paid the extra $1200 expedited processing fee too and they still didn't get it turned around in time.

I think you can start applying for the green card right after you get married. Although I waited a year. From the time I started the green card application to the time I got it, it was like 4-5 months.

 

[Fluffy123]

Hey thanks so much for this thread! its amazing! My question is I was told family med residencies are charting a lot more and it kind of makes family med docs wish they did something else. any thoughts?

 

[hsmooth]

My question is I was told family med residencies are charting a lot more and it kind of makes family med docs wish they did something else. any thoughts?
You're welcome @Fluffy123 !

Are you referring to documentation and charting of office visits? You're going to have EMR and documentation struggles in every specialty. Just hope your workplace has a somewhat decent EMR in place and that'll make things a bit more bearable. A good EMR will allow you to make templates which can streamline "routine" visits.

I say this as I have 26 office visits I need to chart on. Do I wish I did something else? Ya, I'd rather be playing video games instead of charting. Now that you mention it, I think I'll fire up the Playstation 4. Charts can wait.

Hey thanks so much for this thread! its amazing! My question is I was told family med residencies are charting a lot more and it kind of makes family med docs wish they did something else. any thoughts?

 

[kamakazi5]

Best AMA I have read on this site by far. Very honest and chill. Thanks again.

What hotel did you stay at in Iceland? My wife and I want to go if I get accepted, before matriculation.

What drone do you have? I bought a cheapish one to practice on and I'm loving it. I really think I found a new hobby.

 

[hsmooth]

Best AMA I have read on this site by far. Very honest and chill. Thanks again.

What hotel did you stay at in Iceland? My wife and I want to go if I get accepted, before matriculation.

What drone do you have? I bought a cheapish one to practice on and I'm loving it. I really think I found a new hobby.

Thank you @kamakazi5 !

We did the ring road in 10 days so we were at a new hotel each day. You need to book well in advance. We used airbnb, booking.com and TripAdvisor.

I have a DJI phantom 4. The nicer drones are actually way easier to fly than the entry level ones. Message me if you have any other questions about drones / iceland

 

[Funny_Current]

@hsmooth Thanks for taking the time to answer these questions. I am curisous about how your relationships are with other physicians. For example, being a family medicine doc, I imagine you communicate frequently with your patients other doctors (cardiologists, radiologists, etc). Do you ever find that it's difficult to keep an open line of communication with the "team" of providers caring for a patient, especailly the ones who are chronically ill? Both of my parents were extremely sick and unless I was persistant about their doctors communicating with each other there was often miscommunication. Do you feel more obligated being a FM doc to make sure your patients other caregivers are on the same page? Is that even how it works?

Also, I am interested in diagnostic radiology. I read various blogs here and elsewhere that are in conflict with each other about the future of radiology. I know you are a FM doc, but I'm sure you utilize radiologists often. What do you think about the future of DR? Thanks in advance!