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

[hsmooth]

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?
It is a bit difficult at times, especially if your consultants or specialists are on a different EMR system. It makes it a lot easier to communicate if everyone's on the same system - you can send messages directly in the EMR, and I can easily see their consult notes.

It's intimidating and confusing for a patient to navigate the healthcare system and I'll often have to provide 'non medical- medical' advice ....basically pointing patients in the right direction, how to deal with insurance stipulations, etc. Sometimes I'll need to re-explain things that were talked about at their consultation with the specialist. Sometimes patients will ask me for my opinion on X, Y, or Z procedure that was offered by the surgeon.

For complicated cases, I'll talk directly with the consultant by phone. I've found that community medicine is much more open and "friendly" than those in academic type settings. Consultants appreciate referrals to them. I appreciate when they'll call me and update me on our mutual patients. I text a handful of specialists whenever I have a certain question and don't feel embarrassed to ask even if it might be something "simple" to them.

There's unwritten "etiquette" rules out in practice. If I have a complicated patient I'm sending to a specialist, I'll send them a message as a heads up so they're not blindsided. ER docs will call me if there's some important follow up needed..etc ..etc.

I really enjoy the professional relationships I have with other providers now that I'm out in practice. Gone are the days of dreading calling a doc in an academic setting and they just give you a bunch of push back or 'wtf why are you calling me' attitude that you'll sometimes see.

@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!

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[Nietzsche's Barber]

Could you send me that Iceland video? The wife and I want to go up there...summer or winter?

 

[hsmooth]

Could you send me that Iceland video? The wife and I want to go up there...summer or winter?

sent you a pm @Nietzsche's Barber
I went in the summer but yet it was still only 50F.
Northern lights and ice caves can only be seen in the winter.
It'll be beautiful whichever season you go. Maybe go in the summer first and if you love it, make it a point to go back again sometime in the winter to see the lights and caves.

 

[Nietzsche's Barber]

sent you a pm @Nietzsche's Barber
I went in the summer but yet it was still only 50F.
Northern lights and ice caves can only be seen in the winter.
It'll be beautiful whichever season you go. Maybe go in the summer first and if you love it, make it a point to go back again sometime in the winter to see the lights and caves.

Hey! Thank you so much!!! Can't wait to watch.

 

[mo-97]

Hey fellow SDN'ers ! I always liked reading these AMA threads, and a search here shows it's been about 3-4 years since a family medicine attending opened up one of these threads. I figure I'd jump in to the ring and answer your questions. Maybe I can help answer any of your burning questions about medicine, school, life in general ?.. haha!

A bit about myself:
I'm in my 2nd year of practice so I like to think I'm still young and can relate to life as a pre-med, med student, or resident
Some things I enjoy doing: traveling, photography, videography, techie toys, eating copious amounts of food, reading the internet, sports, basketball, working out, and being as lazy as I can possibly be.

On average, how many hours do work per week?

 

[hsmooth]

On average, how many hours do work per week?

36 clinic patient contact hours plus maybe 2-3 hours of work at home doing charts

 

[YoungDoc25]

Did your fellow residents land similar jobs (pay, hours, etc)? Or is this a kind of job that was hard to come by?

 

[hsmooth]

Did your fellow residents land similar jobs (pay, hours, etc)? Or is this a kind of job that was hard to come by?
3 other residents from my program moved up to this smaller town and have relatively similar hours and salary.

Other residents that stayed in the larger midwest city of 600,000 have similar hours but pay I estimate is about $30,000 less per year on the starting salary guarantee.

If you're open to smaller towns, you can basically take your pick of jobs.

Edit: When I was applying to my job, they showed me 3-4 clinics within a 20 mile area here and I basically could have taken any one of those jobs

Did your fellow residents land similar jobs (pay, hours, etc)? Or is this a kind of job that was hard to come by?

 

[I'mJustCurious]

How hard is it to get into residency for family medicine? Also, I want to be a sport medicine doctor after doing family medicine residency, any advice and opinions?

 

[ac62994]

Do you plan on having kids? Are you located in a good school district?

 

[hsmooth]

How hard is it to get into residency for family medicine?
Not as hard as some other specialties like ENT, ortho, surgery, derm, etc. However you can't be a total unlikable arrogant tool either as you'll get weeded out in the application process fast. For perspective's sake, I failed my Step 2 once but with some planning I played the interview game alright and matched to a pretty good residency program still (that was also my #1 choice). I think I remember seeing some data from a few years ago that about ~85% of students matched into one of their top 4 choices for residency? But don't quote me on that.

Also, I want to be a sport medicine doctor after doing family medicine residency, any advice and opinions?
What kind of sports medicine are you thinking of? Like team physician for a high profile college or athletic team? Or work in an orthopedics clinic as a non-surgical sports / orthopedist? There are a select few primary care fellowships you can do after Family Med residency, such as sports medicine. You'd get more training that would make you more attractive to working in an orthopedic type setting. Having said that, you can still do a ton of ortho-based procedures without doing the fellowship...it's just not as likely you'll work in an exclusive "sports" setting. You can always mold your practice to how you like. I personally do joint injections, synvisc injections, manipulation, trigger point injections, etc.

How hard is it to get into residency for family medicine? Also, I want to be a sport medicine doctor after doing family medicine residency, any advice and opinions?

 

[numbersloth]

What are your opinions on new urgent care centers popping up?

 

[hsmooth]

Do you plan on having kids? Are you located in a good school district?
My wife and I are in the anti-child phase of our lives right now. To us babies are loud, sleep depriving, and not all that cute. Having said that, yeah we'd probably try to have one sometime in a few years

One of the bonuses of living outside of a big city is that the public school system is really good. It's not imperative to send your child to a private high school or anything like that. Makes it easier and faster to become financially independent, while they still get a great education.

Do you plan on having kids? Are you located in a good school district?

 

[hsmooth]

What are your opinions on new urgent care centers popping up?

You got me on this one. I don't really have too much of an opinion on it ?

 

[math123]

Thank you so much for doing this. I was wondering if it is easy to work the kind of hours you are working or less in internal medicine outpatient practice. In other words, is it easy to find a job where I can work like 30-35 hours a week and no weekends in internal medicine. In addition, is it easy for family medicine specialists to find jobs as hospitalists anywhere they wanted or do majority hospitalists positions, except rural ones, only take internal medicine docs. Thank you for your time.

 

[hsmooth]

Thank you so much for doing this. I was wondering if it is easy to work the kind of hours you are working or less in internal medicine outpatient practice. In other words, is it easy to find a job where I can work like 30-35 hours a week and no weekends in internal medicine. In addition, is it easy for family medicine specialists to find jobs as hospitalists anywhere they wanted or do majority hospitalists positions, except rural ones, only take internal medicine docs. Thank you for your time.

You're welcome @math123 !

I was wondering if it is easy to work the kind of hours you are working or less in internal medicine outpatient practice.
I do know of IM docs that only work outpatient clinics. There's a wide range of how much or little they work. Remember that once you get past your first year or two of salary guarantee, most jobs pay based on 'productivity' or 'RVUs'. Meaning, sure, you can work 2 days a week if you want but your health/retirement benefits may also reflect that, and you would only make as much money as someone who would work 2 days a week.

is it easy for family medicine specialists to find jobs as hospitalists anywhere they wanted or do majority hospitalists positions, except rural ones, only take internal medicine docs.
This is probably going to be very location dependent. Hospitals in less demand areas would probably be more apt to hire a FM doc as a hospitalist. Having said that one of my friends works in Minneapolis (no small city) as an FM trained hospitalist and she loves her gig. 7 days on, 7 days off. It's like having a vacation every other week. Although part of that is spent recovering and doing normal human things like cook, laundry, grocery shopping, etc.

 

[Shammyguy3]

I would LOVE a 7 on, 7 off day schedule. I'm pre-med, don't really have any interest outside of FP/IM

 

[SansaStarkMD]

Do you know any family docs that do OB with c sections? What is their lifestyle like? How often do they take call?

 

[hsmooth]

Do you know any family docs that do OB with c sections? What is their lifestyle like? How often do they take call?

Only the teaching attendings at my old residency program. They had call like any other OB doctor. I didn't know much about their lifestyles.

Most would call my current town 'rural' even though it's population 70,000 with most 'city' conveniences - and here all the OBs are OB trained, not FM.

 

[hard08]

How is the lifestyle like in residency for FMs?

 

[YoungDoc25]

Did your fellow residents land similar jobs (pay, hours, etc)? Or is this a kind of job that was hard to come by?
3 other residents from my program moved up to this smaller town and have relatively similar hours and salary.

Other residents that stayed in the larger midwest city of 600,000 have similar hours but pay I estimate is about $30,000 less per year on the starting salary guarantee.

If you're open to smaller towns, you can basically take your pick of jobs.

Edit: When I was applying to my job, they showed me 3-4 clinics within a 20 mile area here and I basically could have taken any one of those jobs

Were you all flooded with job offers from recruiters? If so, what factors did you use to narrow down your choices? Were you able to get a guarenteed job for your wife included? My fiancée is an RN and will be going wherever I end up too!

 

[hsmooth]

How is the lifestyle like in residency for FMs?
Highly dependent on the residency you go to.
Theoretically a smaller residency program with fewer co-residents means you'll be on call more, and the teaching hospital may depend on the residents more, and you'd have much more time committed to tough inpatient service months. You may end up working closer to the 80 hour per week limit.

Some residencies are more OB focused, so maybe you'd have more OB patients and be on call for them more often.

Theoretically larger residency programs may have more co-resident and you'd be on call less, and maybe you'd have more outpatient based rotations, and you would work only 60 hours per week.

There's a wide range of 'lifestyles' you could potentially experience in FM residency.

How is the lifestyle like in residency for FMs?

 

[hsmooth]

Were you all flooded with job offers from recruiters? If so, what factors did you use to narrow down your choices? Were you able to get a guarenteed job for your wife included? My fiancée is an RN and will be going wherever I end up too!
I don't know how the recruiters knew, but they just seemed to know when residents are in their 3rd year / beginning of 4th year and they call you on your cell phone for jobs. It was weird.

Our residency had a nice lecture series that prepared us for 'Life after Residency' and it went through all the factors you should consider in narrowing down your job.
Some factors I would consider off the top of my head include:
- how you fit in to the actual clinic itself, quality of ancillary / work staff, efficiency
- are you stepping into an established practice or will you have to build your own?
- location
- size of call group
- how the health system's core values and goals correlate with your own
- salary, benefits, sign on bonus, retirement benefits

I thought I'd be able to have more clout in getting my wife a job, but they couldn't provide it for her (she's a midlevel and the system didn't have any active openings at that time). They did keep in touch with her over the course but ultimately she found a job at a competing health system on her own.

So good to hear! I live in a town of ~2,500 but grew up in a city of ~90,000 and would love to practice in either of these two kinds of areas. The rural area probably right after residency and a more suburban area like yours when I have kids for the educational opportunities like you talked about.

Were you all flooded with job offers from recruiters? If so, what factors did you use to narrow down your choices? Were you able to get a guarenteed job for your wife included? My fiancée is an RN and will be going wherever I end up too!

 

[IgEdoc]

"Now that you mention it, I think I'll fire up the Playstation 4. Charts can wait."
A colleague to my liking. Stack of medical journals make a good foot rest while I fire up my gaming laptop for PC gaming...putting CME on pause

 

[hsmooth]

"Now that you mention it, I think I'll fire up the Playstation 4. Charts can wait."
A colleague to my liking. Stack of medical journals make a good foot rest while I fire up my gaming laptop for PC gaming...putting CME on pause

I'm a few months behind on my journals ...oops! What PC games do you play?

 

[IgEdoc]

"What PC games do you play?"
Currently focused on Fallout 4 and SWTOR. Finished Witcher 3 but would have loved more playable material. Occasionally will hit Doom just to use an Xbox elite controller on the PC. Expensive hobby when you tie in the hardware cost. Got myself a few months ago the MSI G83Titan SLI lappy and what a machine with those twin Nvidia 1080s in there

 

[hsmooth]

"What PC games do you play?"
Currently focused on Fallout 4 and SWTOR. Finished Witcher 3 but would have loved more playable material. Occasionally will hit Doom just to use an Xbox elite controller on the PC. Expensive hobby when you tie in the hardware cost. Got myself a few months ago the MSI G83Titan SLI lappy and what a machine with those twin Nvidia 1080s in there

Hah! Yeah the hardware upgrades were always a big chunk out of your wallet. That's why I eventually just went back to console gaming for a while.

 

[Dr.Sticks]

When do you plan to retire?

 

[hsmooth]

When do you plan to retire?

I'm aiming for complete financial independence in 15 years when I'm around 48 or so. But realistically maybe I'll just go down to super part time work at around age 50-53

 

[MedicineZ0Z]

Hey fellow SDN'ers ! I always liked reading these AMA threads, and a search here shows it's been about 3-4 years since a family medicine attending opened up one of these threads. I figure I'd jump in to the ring and answer your questions. Maybe I can help answer any of your burning questions about medicine, school, life in general ?.. haha!

A bit about myself:
I'm in my 2nd year of practice so I like to think I'm still young and can relate to life as a pre-med, med student, or resident
Some things I enjoy doing: traveling, photography, videography, techie toys, eating copious amounts of food, reading the internet, sports, basketball, working out, and being as lazy as I can possibly be.

Thoughts on concierge med? I've read there is significant demand for it. Is it doable to get away with charging 200-300$/month per patient?

Thoughts on family docs doing low invasive cosmetics? The market is saturated which needs a ton of marketing but how far do you think family docs should go?

 

[Full metal alchemist]

Hey fellow SDN'ers ! I always liked reading these AMA threads, and a search here shows it's been about 3-4 years since a family medicine attending opened up one of these threads. I figure I'd jump in to the ring and answer your questions. Maybe I can help answer any of your burning questions about medicine, school, life in general ?.. haha!

A bit about myself:
I'm in my 2nd year of practice so I like to think I'm still young and can relate to life as a pre-med, med student, or resident
Some things I enjoy doing: traveling, photography, videography, techie toys, eating copious amounts of food, reading the internet, sports, basketball, working out, and being as lazy as I can possibly be.

1) What's your favorite thing about what you do?
2) What do you wish you did differently in undergrad?
3) Would you consider work/life balance an important factor in deciding your career?

Cheers!

 

[LoveBeingHuman:)]

What's the difference between Family Medicine and Internal Medicine?

 

[holycrap]

"What PC games do you play?"
Currently focused on Fallout 4 and SWTOR. Finished Witcher 3 but would have loved more playable material. Occasionally will hit Doom just to use an Xbox elite controller on the PC. Expensive hobby when you tie in the hardware cost. Got myself a few months ago the MSI G83Titan SLI lappy and what a machine with those twin Nvidia 1080s in there

Witcher 3 is still really long and great, get the DLC if you haven't.

 

[hsmooth]

Thoughts on concierge med? I've read there is significant demand for it. Is it doable to get away with charging 200-300$/month per patient?
I think this would be highly market-driven. Some locales may be more receptive to this or have the financial means to have concierge medicine. Also some areas you may have success in DPC but not concierge medicine. So, there are subtle differences even between those two subsystems. DPC =/= Concierge medicine even if they have similarities. I've read about just as many DPC and concierge clinics failing as they have succeeded.

Thoughts on family docs doing low invasive cosmetics? The market is saturated which needs a ton of marketing but how far do you think family docs should go?
In my opinion, the time to get wildly rich off medispas and botox and stuff was like 15 years ago. You're right, the market is saturated. If you do your groundwork and run a tight business, you probably could still be successful in it today.

Thoughts on concierge med? I've read there is significant demand for it. Is it doable to get away with charging 200-300$/month per patient?

Thoughts on family docs doing low invasive cosmetics? The market is saturated which needs a ton of marketing but how far do you think family docs should go?

 

[MedicineZ0Z]

Thoughts on concierge med? I've read there is significant demand for it. Is it doable to get away with charging 200-300$/month per patient?
I think this would be highly market-driven. Some locales may be more receptive to this or have the financial means to have concierge medicine. Also some areas you may have success in DPC but not concierge medicine. So, there are subtle differences even between those two subsystems. DPC =/= Concierge medicine even if they have similarities. I've read about just as many DPC and concierge clinics failing as they have succeeded.

Thoughts on family docs doing low invasive cosmetics? The market is saturated which needs a ton of marketing but how far do you think family docs should go?
In my opinion, the time to get wildly rich off medispas and botox and stuff was like 15 years ago. You're right, the market is saturated. If you do your groundwork and run a tight business, you probably could still be successful in it today.

Yea thats what I figured.

Is cosmetics something "extra" you can offer to your patient base as an "add-on" or do you need major commitment?

 

[hsmooth]

I think you'll find that patients don't really want someone who does something 'on the side' when it comes to injecting things into their face, so you'll probably have to be pretty proficient and do enough volume to gain the trust of your patients.

Yea thats what I figured.

Is cosmetics something "extra" you can offer to your patient base as an "add-on" or do you need major commitment?

 

[MedicineZ0Z]

Did becoming a physician put a strain on dating/relatonships/marriage?

 

[FeinMS]

Do you feel like your ob training in FM residency has been of less use due to the fact that you have lots of ob specialists near your practice? Do you feel like doing a residency in Med/Ped would have been better for you?

 

[hsmooth]

1) What's your favorite thing about what you do?
The privilege and honor to be a part of your patient's most emotional and intimate moments of their lives. You get to see them at their times of triumph and tribulation. You get to help patients when they're in their darkest moments of need, you can hold your dying patient's hand to reassure them they won't die alone, and you can give the warmest celebratory hug when they just lost 70 lbs over the past 5 months with the help of your guidance.

2) What do you wish you did differently in undergrad?
Realize that the opposite sex doesn't care how many drinks or shots you buy them on your credit card that you're going to have to pay off with your student loans... learning how to converse and have interesting things to say will get their phone numbers much easier.

Also I wish I used my electives to take more interesting classes outside of the typical ones in Science -- like in the arts, humanities, etc.

3) Would you consider work/life balance an important factor in deciding your career?
This was very important to me. Which is why I stayed away from surgical specialties, I knew I wanted an outpatient 8 or 9 - 5 career.

1) What's your favorite thing about what you do?
2) What do you wish you did differently in undergrad?
3) Would you consider work/life balance an important factor in deciding your career?

Cheers!

 

[deleted600623]

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.

This is literally my aspiration.

 

[hsmooth]

What's the difference between Family Medicine and Internal Medicine?
In a practical real world setting, I'd estimate that what I do on a day to day basis is probably about 80% similar to what an outpatient general Internal medicine doctor does.
I do a lot of chronic disease management for adults, physials, medicare annual wellness visits.
I have adults with hypertension, hyperlipidemia, history of stroke, CAD, depression, T2DM, and you manage all those.
I'll see peds patients however, internal medicine is usually > 18 years old. So I'll see newborns, well child exams yearly, and take care of acute issues for children.
If I wanted to, I could probably still see some OB patients up to a certain gestational age...but I have no interest in that.

If I have really super complicated patients with 30 chronic disease and many of them uncontrolled, I might refer them to Internal medicine so they can be their primary doctors.

In some locations or cities, it may be easier for you to get a job as a hospitalist compared to being in family medicine.

During residency, I had I think a total of 3 months dedicated to OB and 3 months in Peds related rotations. Those months would have been spent in other rotations in internal medicine such as cardiology, GI, heme/onc, ICU, etc etc. So they would have had a bit more exposure to that than I did.

Out of internal medicine, you can do fellowships to speciliaze and become a cardiologist, pulmonologist, gastroenterologist, etc....those fellowships are not available to a family medicine residency trained physician.

What's the difference between Family Medicine and Internal Medicine?

 

[hsmooth]

Did becoming a physician put a strain on dating/relatonships/marriage?
It did help tremendously that my wife is also in the medical field and we did school at the same time. It did present some unique challenges though - for our clinical rotations, we were basically long distance for about 4 years. She'd have rotations in North Carolina, Florida, Iowa, and my rotations took me to places like Michigan, Pennsylvania, and the east coast. It was difficult during those times and required a high level of hard work and commitment towards our relationship. There were many tough days for sure. There were some times when I even wasn't sure if we'd make it, relationship wise. Regardless though, communication is an important aspect of a relationship and whether you're a physician or not, that is one thing that can save or kill a relationship.

Did becoming a physician put a strain on dating/relatonships/marriage?

 

[hsmooth]

Do you feel like your ob training in FM residency has been of less use due to the fact that you have lots of ob specialists near your practice? Do you feel like doing a residency in Med/Ped would have been better for you?
Yeah, since I basically do no OB now, however I still will do some "partial" managing of OB patients. Like if a pregnant patient or recently pregnant or breast feeding patient comes in for an acute issue, it is still helpful to know of which medicines to use and avoid in those situations, and also be aware of pregnancy or post partum related complications or diseases.

For me personally, the Family Med route was just fine. I know med/peds programs can be heavy into inpatient peds too, so that would also have not been used much in an typical outpatient practice.

Do you feel like your ob training in FM residency has been of less use due to the fact that you have lots of ob specialists near your practice? Do you feel like doing a residency in Med/Ped would have been better for you?

 

[hsmooth]

This is literally my aspiration.

...To be the next Dr. Oz or to work 9-5 everyday and have a nice work / life balance? lol

 

[partypantss]

Thanks for doing this!
So based on your responses it sounds like the only thing you had to do in order to get a job that pays more than average for FM and has you working fewer hours per week than average was choose a more "rural" location, is that correct? Is this generally true of all specialties as far as you know? Would you say that was really all you needed to do in order to get such a nice job or was it partially luck or a competitive residency position or something else? As a naive M0 I'm currently more interested in specializing since to me it just seems like it would be more "interesting" and also everyone always says that primary care docs work a lot more and get paid less, but your an example of a FM doc that has a great lifestyle so I'm just trying to understand what it is that determines where you end up..

I want to do something that I love and interests me but I don't think I can see myself being happy having to work 60 hours or more per week indefinitely. What's your advice for someone who wants a good work schedule and nice income? I see all of the national averages for physicians being crazy #s of hours per week and then I see all of these AMAs on SDN describing these great work schedules that are way better than what are the apparent averages, I just don't understand how this happens?

 

[canihazMDplease?]

This is a truly great thread. Thank you for being so honest and informative!

 

[SansaStarkMD]

Do you know any family doctors doing c sections who don't do academics or rural medicine? Wondering how realistic FM/OB in the suburbs is after an OB fellowship and a few years out in rural practice to get c section numbers up above 400.

 

[hsmooth]

it sounds like the only thing you had to do in order to get a job that pays more than average for FM and has you working fewer hours per week than average was choose a more "rural" location, is that correct?

If you want to make very broad general assumptions, yes finding a more "rural" location did result in having an initial higher salary. Of course, once you get past the initial salary guarantee, a lot of it also depends on how busy you are. You can have a very busy practice even in a "suburban" or "city" location and still make great money. If I'm not busy enough here in my "rural" location, I won't make good money, either.

If you work for a hospital or health care system owned clinic, sometimes they may pay different rates for each unit of RVU you produce too. For instance, some systems might pay you $46.06 per unit while others might only pay $41...so there's even variation there.

Is this generally true of all specialties as far as you know?
I know of a classmate who is a CT surgeon who took a position in a location even more "rural" than where I'm at, and her starting salary and sign on bonus is definitely much larger than comparable "city" jobs. But as always, there are more variables to this than mere location.

was it partially luck or a competitive residency position or something else?
As in all things in life, having good business acumen, interview and social skills, and well rounded CV all help in landing you "better" jobs. I did go to a highly-regarded residency program that trained me well, so I suppose that made me look better "on paper". I was also able to negotiate better terms on my first contract with the help of a contract lawyer. The laywer probably helped me negotiate an extra $15,000 worth of incentives. Whereas I know of a classmate who took a similar job in town and their finance package was worth much less -- they didn't do any negotiating at all.

everyone always says that primary care docs work a lot more and get paid less
I can't speak for any other locations or parts of the country, but I don't think I know of any primary care docs in the region where I live that works more than 45-50 hours including time spent catching up on work at home or after typical office hours.

What's your advice for someone who wants a good work schedule and nice income?
Weight the pros and cons of each specialty you're considering as you rotate through them as a student. If you develop a good rapport with the attendings, feel free to ask them 'tough' questions. What's their work-life balance like? Why did they go into their specialty? If they had to re-do it, would they go back into their specialty?

In any specialty, at some point you can always try to negotiate to cut back your hours. I know docs in all specialties that semi retire or work part time when they're nowhere near the classic retirement age of 65. They've usually just reached a point in their lives where having extra time with family is more important, they've paid off their debts, etc.

If having a good work - home balance is VERY important to you , maybe you'd have to think really really hard about going into some ultra time-consuming specialty that might demand you to work 70+ hours for the first 10 years of your residency/fellowship/practice until you can finally cut back.

Thanks for doing this!
So based on your responses it sounds like the only thing you had to do in order to get a job that pays more than average for FM and has you working fewer hours per week than average was choose a more "rural" location, is that correct? Is this generally true of all specialties as far as you know? Would you say that was really all you needed to do in order to get such a nice job or was it partially luck or a competitive residency position or something else? As a naive M0 I'm currently more interested in specializing since to me it just seems like it would be more "interesting" and also everyone always says that primary care docs work a lot more and get paid less, but your an example of a FM doc that has a great lifestyle so I'm just trying to understand what it is that determines where you end up..

I want to do something that I love and interests me but I don't think I can see myself being happy having to work 60 hours or more per week indefinitely. What's your advice for someone who wants a good work schedule and nice income? I see all of the national averages for physicians being crazy #s of hours per week and then I see all of these AMAs on SDN describing these great work schedules that are way better than what are the apparent averages, I just don't understand how this happens?

 

[hsmooth]

Do you know any family doctors doing c sections who don't do academics or rural medicine? Wondering how realistic FM/OB in the suburbs is after an OB fellowship and a few years out in rural practice to get c section numbers up above 400.

Sorry, I don't know any doctors that do that personally. They're all either in academics or rural. Doesn't mean they don't exist, though I don't know how common it is to do that.

 

[RTC19]

Thanks so much for doing this thread. I have really enjoyed reading it.