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

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Dr. Rafiki said:
You. are. the. man.

Seriously though, thanks a lot for this - it has totally changed my perception of FM. My burning questions, which I'm sure you'd rather PM me the answers to some, are:

Again, thanks for taking the time to do this. I have always wanted to do primary care, but the general SDN "doom and gloom" has been pushing me to consider something like pm&r more, so your story is certainly reassuring.
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I'll answer some here and PM you the rest


which school did you attend?
which residency did you attend?

how many contiguous ranks did you list for FM? I'm not sure what you mean, but I applied to like 8 or 9 FM residency programs, interviewed at 5 of them, and ranked 5 if I remember correctly.

how many other specialties did you rank? I only applied to family medicine residencies.

how many interviews did you get invited to / go on? Invited to all the programs I applied to, but only went to 5 of them.

what kind of med student were you (I know you stated you were never great at exams, but performance in class / general grades)? I can't focus much during classic 'lectures' so I'd study on my own listening to the pre recorded lectures. Never failed any med school classes, and my average was probably in the low 80s, which was the bottom quartile in our med school.

what (general range is fine) were your actual COMLEX scores? I can't remember the actual score, but it was right around 50th percentile. I did fail step 2 once but re took it and scored in the 60th percentile.

what was the single hardest part of the preclinical years for you? Staying afloat with all the classes, exams, studying, labs, and other time commitments.

how did you overcome this hardest part? Buckling down and doing your work when you need to, staying in on weekends if some of your other friends are going out.

how did you know what kind of procedures you were interested in before you even started the clinical years (referencing your advice to ask attendings to perform procedures you are interested in learning during derm / ortho / whatever rotations)? I don't think I truly knew what I would like or dislike in family medicine, so as you go through rotations and get exposed to things you get a sense of things. Plus attendings will often ask you to do things like suturing and at least let you try an injection or two. Then once you learn what you like, in future rotations you can be more proactive in seeking out more opportunities to do those procedures.

where do you actually practice now (I have tried to piece the clues together and want to say smalltown, Indiana or somewhere like it)?

how many other docs work in your practice (I saw the 1 doc - 2 midlevels - handful others, but wondering if this is literal or ratio)? I work for one of the largest medical groups in the country, but at my current clinic I am the only doctor. 2 Midlevels, part time.

what is your post-tax income? we're a dual income, no children family, and my wife is a midlevel in family medicine too. I don't have my tax documents infront of me but we made around gross $320k combined, but maximized 2 x 401ks, 1 x 457b, 1 x HSA, and 2 x IRA accounts this year. We're in the 33% tax bracket filing as a couple.

what would you say was the most important preclinical class that helped you during residency? Hard to answer this. Pre clinical classes are good for getting you ready for the board exams. And that is helpful for getting you ready for your clinical rotations. Then your clinical rotations are most helpful for residency.
 
Dr. Rafiki said:
Oh yes, I also wanted to say that I once had a conversation (on SDN, no less) with a Canadian doc who said to me "I must admit, though, that in Canada we don't have your profession. So I can only speak about physicians and not osteopaths". 😕😕😕😕😕😕😕
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haha! The 'osteopathic school' in Canada / Quebec are not medical doctors. But if you go to a DO school in the states, you practice in Canada as a "medical doctor". There's an osteopathic association in Canada so there are definitely 'osteopathic medical physicians' practicing in Canada.
 
Are you worried about Nurse Practitioners? Or other mid level encroachment in Primary Care? Why or why not exactly?

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GrignardsReagent said:
Are you worried about Nurse Practitioners? Or other mid level encroachment in Primary Care? Why or why not exactly?

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To be honest, no I'm not worried, but moreso because I've decided to not really worry or stress about things that may be beyond my control. I personally think that there is always going to be some role for a family medicine physician. Our role may change and evolve several times over the next 20 years, and it'll be up to us to keep up with the changes in how healthcare is delivered.

If more mid levels start doing more of the day-to-day clinical medicine, I'm fine with that. They can take care of the URIs, and maybe physicians will take care of more of the complex chronic disease management. Or maybe we'll adapt our role into more of a supervisory one, overseeing a team of mid level practitioners. And so on and so forth.
 
hsmooth said:
To be honest, no I'm not worried, but moreso because I've decided to not really worry or stress about things that may be beyond my control. I personally think that there is always going to be some role for a family medicine physician. Our role may change and evolve several times over the next 20 years, and it'll be up to us to keep up with the changes in how healthcare is delivered.

If more mid levels start doing more of the day-to-day clinical medicine, I'm fine with that. They can take care of the URIs, and maybe physicians will take care of more of the complex chronic disease management. Or maybe we'll adapt our role into more of a supervisory one, overseeing a team of mid level practitioners. And so on and so forth.
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I appreciate the response! You have helped alleviate some fear on the family medicine side for me. Thanks you.

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Any insight/fellow colleagues in sports med? Having been a D1 athlete, the practice setup with some orthopedic docs has always sounded appealing on paper.
 
I've rarely used my vacation days in 20yrs of working and usually had the option of rolling them over every year and getting paid out when I leave for another gig. Have you found this to be negotiable in your job hunt? I'd rather have a larger salary and maybe 5 days vacation and 5 sick days.


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YoungDoc25 said:
Any insight/fellow colleagues in sports med? Having been a D1 athlete, the practice setup with some orthopedic docs has always sounded appealing on paper.
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I've seen most fellowship trained sports med family physicians practice in orthopedics groups as 'non surgical orthopedics', and will do strictly sports medicine and give up the other aspects of family medicine. If you plan on sports med academics or being a team physician for any level about D2 you're probably better off doing the fellowship.

That being said you can still learn a lot of sports medicine without doing the fellowship, it'd just be a bit harder to mold your practice into one that only does sports medicine
 
Gordon Gekko said:
I've rarely used my vacation days in 20yrs of working and usually had the option of rolling them over every year and getting paid out when I leave for another gig. Have you found this to be negotiable in your job hunt? I'd rather have a larger salary and maybe 5 days vacation and 5 sick days.


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The contracts I've seen are basically use it or lose it and don't roll over. Once you're on production, you get paid based on seeing patients. So basically taking time off for holiday means you lose out on anywhere from $1200 or more of gross pay per day depending on your specialty.
 
Gordon Gekko said:
I've rarely used my vacation days in 20yrs of working and usually had the option of rolling them over every year and getting paid out when I leave for another gig. Have you found this to be negotiable in your job hunt? I'd rather have a larger salary and maybe 5 days vacation and 5 sick days.


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If you only take 10 days off each year compared to someone who takes off 6 weeks, theoretically you'd make more money than them with all other factors being equal (ie specialty, reimbursement rates, your billing practices, patient volume).

However if the system you work in reimburses a lower conversion factor for each RVU you produce, or if you're slower and only see a fraction of the number of patients each day, or if you're not billing appropriately, there's a chance that the doctor who takes 6 weeks off can make more than you taking only 10 days off
 
hsmooth said:
You're welcome! I'm glad this thread has been a bit helpful.

At some point in your career, *hopefully* you learn that money isn't everything. In fact I will be turning down a job opportunity that will pay me 10% more salary and a six-figure signing bonus, so that I can take my dream job with less hours and some more time to work in policy and administration. With my extra free time I plan also to do some things outside of work, hopefully volunteer within the community. You have to figure out what your passion in life and in medicine is and work towards it. Finances and paying back your student loans are important, but shouldn't be the be-all-end-all. No matter what kind of job you take as a physician, whether you make $160k a year or $500k, if you're smart with your planning, you're going to be able to retire just fine.
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Are you planning on volunteering in a medical role? One of my favorite volunteer opportunities has been in my city's free clinic. For me it's mostly clerical but we do get a small chance to take vitals and ask a handful of questions when patients first come in. There seems to be a lack of actual physicians in the clinic as it is mostly medical students and NPs. It's something I think would be great to be a part of as a physician.
 
kamakazi5 said:
Are you planning on volunteering in a medical role? One of my favorite volunteer opportunities has been in my city's free clinic. For me it's mostly clerical but we do get a small chance to take vitals and ask a handful of questions when patients first come in. There seems to be a lack of actual physicians in the clinic as it is mostly medical students and NPs. It's something I think would be great to be a part of as a physician.
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Like you, one of my favorite experiences was volunteering at the free clinic during my residency years. It's been a bit harder to find a set up like that in practice but I've always thought I'd do some sort of medical mission trip at some point. I'm also around medicine so much that I think I'd like to do some non-medical volunteering. Like bring my dog to do social visits with elderly people with dementia or something. Or teach old people how to email and use the internet. Just something where I don't have to use my brain haha.
 
Your posts are very helpful to read, thank you! Do you have any advice for Canadians thinking about applying to DO schools?
I am from Canada as well and would like to apply broadly to both Canadian and US schools.

As a Canadian, how were you able to gain clinical shadowing experience? Would you recommend going to the US to shadow a DO and get a reference letter?

Did they ask you about the American healthcare system vs. Canadian health care system in your interviews? If so, how did you prepare to learn more about the American system?

I've been looking at tuition for schools, and it seems to be pretty steep with where the Canadian dollar sits at. Most schools are at least 50K USD for tuition alone coming out of country, where as it is a lot cheaper in Canada. Would you recommend applying multiple cycles in Canada or apply to DO as well first try? Are some DO schools significantly cheaper than others? My biggest concerns are getting big enough loans from banks in Canada to cover all expenses... and then paying that off.

Thanks!
 
caramilk222222 said:
Your posts are very helpful to read, thank you! Do you have any advice for Canadians thinking about applying to DO schools?
I am from Canada as well and would like to apply broadly to both Canadian and US schools.

As a Canadian, how were you able to gain clinical shadowing experience? Would you recommend going to the US to shadow a DO and get a reference letter?

Did they ask you about the American healthcare system vs. Canadian health care system in your interviews? If so, how did you prepare to learn more about the American system?

I've been looking at tuition for schools, and it seems to be pretty steep with where the Canadian dollar sits at. Most schools are at least 50K USD for tuition alone coming out of country, where as it is a lot cheaper in Canada. Would you recommend applying multiple cycles in Canada or apply to DO as well first try? Are some DO schools significantly cheaper than others? My biggest concerns are getting big enough loans from banks in Canada to cover all expenses... and then paying that off.

Thanks!
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Good question! You're going to have to figure out ultimately where you want to do residency, and where you want to practice after medical school
You should look in to the latest practice rights for DOs practicing in Canada. If you ultimately want to return to Canada for residency and to practice, be aware that there's going to be certain hoops you'll have to jump through.

I was able to find a DO to shadow in the Toronto area (this was years ago). You can contact the Canadian Osteopathic medical association and see if they have an updated contact list of DOs practicing in Canada. I also used to live close to the States so if I had to go across the border to shadow a DO, I probably could have. I know that some DO medical schools would require at least one letter of recommendation from a DO. So it would probably be in your best interest to find one. I'm pretty sure there's a thread in the Pre-DO forums that's specifically for Canadians looking to go the DO route. You'd probably find the most up to date info in there.

Staying for residency in the States has it's own set of challenges too, like getting visas to work in the States if you are a Canadian. Look in to H1B vs J1 visas. My own personal experience going through residency application is that there was quite a bit fewer programs that were willing to sponsor the H1B visa for me. A lot of the programs that sponsored H1B tended to be in more rural or 'less desirable' places. With the new political administration in power here in the States now, I've been seeing that they're looking to make adjustments and changes to the H1B visa program so I don't really know how that would affect medical residents.

Once you do your research and find out which DO schools would reasonably accept Canadians, you'll have to figure out if it would even be plausible with tuition. If there's absolutely no way you can obtain enough loans or funding, then don't even bother to apply. That being said, if there's any realistic chance you can make it work, I would apply to both DO and Canadian schools (or other MD american schools) at the same time. Just remember, every 'cycle' or 'year' that you don't get a medical school acceptance means you lose out on $200k+ of earning potential as a full time physician. Time is one thing you can never get back.
 
hsmooth said:
Good question! You're going to have to figure out ultimately where you want to do residency, and where you want to practice after medical school
You should look in to the latest practice rights for DOs practicing in Canada. If you ultimately want to return to Canada for residency and to practice, be aware that there's going to be certain hoops you'll have to jump through.

I was able to find a DO to shadow in the Toronto area (this was years ago). You can contact the Canadian Osteopathic medical association and see if they have an updated contact list of DOs practicing in Canada. I also used to live close to the States so if I had to go across the border to shadow a DO, I probably could have. I know that some DO medical schools would require at least one letter of recommendation from a DO. So it would probably be in your best interest to find one. I'm pretty sure there's a thread in the Pre-DO forums that's specifically for Canadians looking to go the DO route. You'd probably find the most up to date info in there.

Staying for residency in the States has it's own set of challenges too, like getting visas to work in the States if you are a Canadian. Look in to H1B vs J1 visas. My own personal experience going through residency application is that there was quite a bit fewer programs that were willing to sponsor the H1B visa for me. A lot of the programs that sponsored H1B tended to be in more rural or 'less desirable' places. With the new political administration in power here in the States now, I've been seeing that they're looking to make adjustments and changes to the H1B visa program so I don't really know how that would affect medical residents.

Once you do your research and find out which DO schools would reasonably accept Canadians, you'll have to figure out if it would even be plausible with tuition. If there's absolutely no way you can obtain enough loans or funding, then don't even bother to apply. That being said, if there's any realistic chance you can make it work, I would apply to both DO and Canadian schools (or other MD american schools) at the same time. Just remember, every 'cycle' or 'year' that you don't get a medical school acceptance means you lose out on $200k+ of earning potential as a full time physician. Time is one thing you can never get back.
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Amazing advice! Thank you. I will look more into these things before applying.
 
I have a few questions! I just finished reading this entire thread, so it was very helpful as someone who is interested in Family Medicine.

1) I want to practice in California, although I'm willing to live in the non-populated areas outside of the cities of SF, SD, LA, etc. Do you think it's still possible to make above 200k per year while working around 40-50 hours a week?

2) What advice do you have for medical students who are interested in Primary Care, outpatient? Should they volunteer in student run free clinics for more experience?

3) How do you deal with the mess of Health Insurance that keep blocking you from giving your patients the best care possible?

4) Why do you think Family Medicine is not popularly known to be a "lifestyle specialty" among the medical community?

5) How true is it that, as a Family Physician, you need to know a "little bit of everything"?

6) Do you have friends or relatives who ask you to do an "on the spot check up" for them or ask you to look at something when you're at a party or family gathering or any type of fun social event?

7) What types of cases were you worried about the most during your first year of practice, either because you felt inadequately prepared to handle those cases or because you didn't feel comfortable handling them?

Thank you so much for your time!
 
How do you think DOs are viewed by those outside of medicine? I'm particularly interested in working with public health and local policy makers on issues such as drug abuse and addiction and would love to pursue an MD or DO along with an MPH. Do people in policy know that there really isn't a difference, or is there still a stigma outside of the medical world?
 
1) I want to practice in California, although I'm willing to live in the non-populated areas outside of the cities of SF, SD, LA, etc. Do you think it's still possible to make above 200k per year while working around 40-50 hours a week?
- I've never looked for a job in California, and haven't talked finances with my FM friends that practice there, but I gather sure it can definitely be a possibility.
Let's do some math. Once you're on productivity you get paid based on RVU production. (every kind of office visit, or procedure, has an attached "value" called RVU, and you get paid a multiplier for this. For instance in areas in the Midwest, you can make $46 per RVU. I don't know what the average would be for California, but let's go conservative and say $40 per RVU
- don't forget most full time FM jobs are 36 patient contact hours per week, and about 4 to 4.5 days per week.
- Let's say you can see 2.5 patients per hour. 2.5 x 36 = 90 patients per week (or approx 20 pts per day)
- let's say you can average 1.5 RVUs per patient encounter (which isn't really all that difficult in a typical FM practice. You just have to know how to bill appropriately). 90 x 1.5 = 135 RVUs generated per week.
- let's say you want to work only 46 weeks a year, and take 6 weeks off for CME and vacation. 135 x 46 = 6210 RVUs. 6210 RVUs x $40 / RUV = $248,000. There's your > $200k without having to work 40-50 hours per week.

2) What advice do you have for medical students who are interested in Primary Care, outpatient? Should they volunteer in student run free clinics for more experience?
If you're seriously considering family medicine and you're a medical students, I recommend setting up a few different elective rotations in FM or urgent care. Ideally each rotation can be in a different part of town or practice style so you can get a good sense of the different practice styles and experiences you can have as a FM physician. It wouldn't hurt to work in the free clinics. You do get some good experience doing that.

3) How do you deal with the mess of Health Insurance that keep blocking you from giving your patients the best care possible?
A few curse words under my breath every time I get a denial or request for prior authorizations. Luckily I work in a group setting that has entire staff dedicated to dealing with prior authorizations and paper work. I also try to get the word out to people to take action by voting in political parties that will take action for health insurance reform.

4) Why do you think Family Medicine is not popularly known to be a "lifestyle specialty" among the medical community?
It's not a glamorous specialty, and perhaps people don't know just how 'lifestyle friendly' it can be if you want, and people probably don't know how much you can actually make if you're smart enough and hard working enough. If you don't have enormous loans to worry about, living on $200k+ a year can be very comfortable and dare I say luxurious.

5) How true is it that, as a Family Physician, you need to know a "little bit of everything"?
I think it is pretty true. You have to be prepared for basically anything that can step in through your door. I won't claim to know a lot about a lot of stuff, but I know enough of when to recognize certain things are more urgent or emergent, and get them to the right specialty or specialist in an timely manner. Or at least enough to start a work up myself. Or when to be concerned enough to pick up the phone and call to an on-call specialist for their opinion.

6) Do you have friends or relatives who ask you to do an "on the spot check up" for them or ask you to look at something when you're at a party or family gathering or any type of fun social event?
Not all that often, sometimes they may ask for an opinion on what to do. I rarely actually have to look at something. One time I pulled some ear plugs that got stuck in a family member's ear after work.

7) What types of cases were you worried about the most during your first year of practice, either because you felt inadequately prepared to handle those cases or because you didn't feel comfortable handling them?
- GYN / women's health issues.
- acute illness visits - I get stressed out determining if patient is safe enough to do outpatient labs, send to emergency room? How many tests to order, responsibly?
- I have a phobia of anything toes or nails related.

Aerus said:
I have a few questions! I just finished reading this entire thread, so it was very helpful as someone who is interested in Family Medicine.

1) I want to practice in California, although I'm willing to live in the non-populated areas outside of the cities of SF, SD, LA, etc. Do you think it's still possible to make above 200k per year while working around 40-50 hours a week?

2) What advice do you have for medical students who are interested in Primary Care, outpatient? Should they volunteer in student run free clinics for more experience?

3) How do you deal with the mess of Health Insurance that keep blocking you from giving your patients the best care possible?

4) Why do you think Family Medicine is not popularly known to be a "lifestyle specialty" among the medical community?

5) How true is it that, as a Family Physician, you need to know a "little bit of everything"?

6) Do you have friends or relatives who ask you to do an "on the spot check up" for them or ask you to look at something when you're at a party or family gathering or any type of fun social event?

7) What types of cases were you worried about the most during your first year of practice, either because you felt inadequately prepared to handle those cases or because you didn't feel comfortable handling them?

Thank you so much for your time!
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hsmooth said:
Good stuff
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You are amazing...thank you sooooo much! This was super helpful! You are literally the poster I needed all these years on SDN. I've been a long time lurker of the Family Medicine sub-forums for awhile, but it's hard to get the direct information that I need when threads appear there so infrequently! If I have anymore questions and you're still around that time, I'll come here again!
 
Toutie said:
Okay, I can see that. 😱 I was just thinking regular toe stuff...hang nails, ingrown toenail, etc.
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I mean, I think toe nails are just gross in general, but my first toe amputation for necrosis was really gross. It's probably the only thing in the OR that grossed me out in almost 10 years.
 
Aerus said:
You are amazing...thank you sooooo much! This was super helpful! You are literally the poster I needed all these years on SDN. I've been a long time lurker of the Family Medicine sub-forums for awhile, but it's hard to get the direct information that I need when threads appear there so infrequently! If I have anymore questions and you're still around that time, I'll come here again!
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You're welcome! Feel free to shoot me a PM or post on here if you have any other questions!
 
numbersloth said:
How do you think DOs are viewed by those outside of medicine? I'm particularly interested in working with public health and local policy makers on issues such as drug abuse and addiction and would love to pursue an MD or DO along with an MPH. Do people in policy know that there really isn't a difference, or is there still a stigma outside of the medical world?
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Practically speaking, and for the most part, I don't think anyone really cares much whether you're MD or DO.
 
Is it possible for a family medicine doctor specialize in adolescent medicine or focus more narrowly on adolescents?
How competitive are sports medicine fellowships and is FM the usual route to go into sports medicine?
Is it a bad sign if I think anatomy is super boring and I am thinking of FM as a specialty?
To what extent can FMs get involved in local/state public health initiates and health policy?
 
Thank you so much for this thread! I've always heard that if you like a broad skill set in medicine, then go into internal or family. What drew you away from internal and more towards family? Rotations? Residency options?
 
I am also confused on the exact relationship between internal medicine and family medicine. Also any suggestions on how to start clinically thinking? Anything from day 1 of medical school?

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Is it possible for a family medicine doctor specialize in adolescent medicine or focus more narrowly on adolescents?
There are several "fellowships" you can do after family medicine residency. They're called CAQs or certificates of additional qualifications. You can google AAFP CAQs and get information on all those fellowships. As of 2001 it looks like they do have an adolescent medicine fellowship. I personally don't know anyone that's gone through the adolescent fellowship so I can't comment too much about it.

I do know that you can cater and narrow your focus in a general family med practice even if you don't do a Fellowship. For example, you can build up a higher proportion peds / adolescent panel by volunteering for sports physicals and school events. You'll get your name out and the parents can establish them in your practice. You'll still probably have to see other adults or elderly patients too, however.

I haven't personally seen a family medicine practice job opportunity where you see exclusively adolescent patients -- I suppose that's why there's pediatricians.

How competitive are sports medicine fellowships and is FM the usual route to go into sports medicine?
I don't know the exact acceptance stats but out of all my friends that applied to sports fellowship after residency, got accepted.

Is it a bad sign if I think anatomy is super boring and I am thinking of FM as a specialty?
Nah, in anatomy class you learn everything down to the finest minute details -- what are all the branches of this nerve and what are all the 6 different functions of every muscle in the body?? OMG I remember my head exploding going through anatomy class and lab. If I were to estimate I probably forgot 90% of that stuff. The bread and butter basic anatomy will get you through a typical FM practice.

To what extent can FMs get involved in local/state public health initiates and health policy?
This is a good question that I may be interested in exploring further myself. The doctors that I know that are involved in policy are either in academic family medicine or administration. So I suppose that would be a good starting point. I know other FM doctors who aren't in academics or administration that take medical director positions for various community based programs, so that would be another avenue.
numbersloth said:
Is it possible for a family medicine doctor specialize in adolescent medicine or focus more narrowly on adolescents?
How competitive are sports medicine fellowships and is FM the usual route to go into sports medicine?
Is it a bad sign if I think anatomy is super boring and I am thinking of FM as a specialty?
To what extent can FMs get involved in local/state public health initiates and health policy?
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TeacherT said:
Thank you so much for this thread! I've always heard that if you like a broad skill set in medicine, then go into internal or family. What drew you away from internal and more towards family? Rotations? Residency options?
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You're welcome!
For me personally, internal medicine had a lot more inpatient based rotations during residency. I knew I wasn't going to do any inpatient work so I wanted to minimize my inpatient time as much as possible, and get as much outpatient based experience as possible. I also knew that I didn't want to pursue any specialities like cardiology, GI, etc. which you can do only through IM.
 
GrignardsReagent said:
I am also confused on the exact relationship between internal medicine and family medicine. Also any suggestions on how to start clinically thinking? Anything from day 1 of medical school?

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Internal medicine sees pts > 18 years old, and no OB.
FM you can see any age, with or without OB.
You can be a hospitalist as either IM or FM.
For my complicated adult aged people, say if they have a super large list of chronic conditions, and if it's difficult control their chronic conditions, I may refer them to IM to be their primary providers.

From day 1 of medical school? Just focus on your studies, get the best grades you can get, and learn your basic sciences.
 
hsmooth said:
For my complicated adult aged people, say if they have a super large list of chronic conditions, and if it's difficult control their chronic conditions, I may refer them to IM to be their primary providers.
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Just as a disclaimer, I don't mean to troll with this post or anything. I'm genuinely curious.

So do you have a threshold for when you refer to IM? Are you limiting yourself to uncomplicated patients? I feel like that's basically what a PA does--sees uncomplicated patients and refers out the more complex ones. Obviously your care for even uncomplicated patients will be better than a PA. Not implying you're the same as a PA.

If that is the case, do you feel that's a limitation of your training or is it just a personal preference (i.e., you have no desire to manage multiple comorbidities even though you're perfectly able)?
 
Matthew9Thirtyfive said:
Just as a disclaimer, I don't mean to troll with this post or anything. I'm genuinely curious.

So do you have a threshold for when you refer to IM? Are you limiting yourself to uncomplicated patients? I feel like that's basically what a PA does--sees uncomplicated patients and refers out the more complex ones. Obviously your care for even uncomplicated patients will be better than a PA. Not implying you're the same as a PA.

If that is the case, do you feel that's a limitation of your training or is it just a personal preference (i.e., you have no desire to manage multiple comorbidities even though you're perfectly able)?
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Good question, no offense taken.

The PA/NPs at my site do usually have complicated patients establish with me as their primary. I don't ever limit or restrict patients from the get go just by looking at their chart even if I see they have 30 problems on their problem list. I'll even see "difficult" patients at least once, you know the drug seekers that were discharged from multiple other practices. I always give patients at least one appointment to see if we can have a good therapeutic physician-patient relationship.

I've only ever referred to IM 2 times in the past 3 years. The one situation, I had been working with the patient for several months to try to get his multiple chroinic conditions under control. Tried different treatment options, different medications, nothing was working. Patient was getting very frustrated and I was getting the sense that they were losing confidence in me. So I happily offered them to meet and establish with IM basically as a way to see if a different set of eyes could or approach could get something to work for him. He was happy with this. Part of it may have been a difference in personality too. Either way I was seeing that the physician-patient relationship was deteriorating so it was a good time to see if someone else could get some better results.

The other time, the patient truly just wanted an IM physician because they had always had IM physicians and were reading on the internet that IM physicians specialized in managing multiple chronic conditions. So I happily referred them as well.
 
hsmooth said:
Good question, no offense taken.

The PA/NPs at my site do usually have complicated patients establish with me as their primary. I don't ever limit or restrict patients from the get go just by looking at their chart even if I see they have 30 problems on their problem list. I'll even see "difficult" patients at least once, you know the drug seekers that were discharged from multiple other practices. I always give patients at least one appointment to see if we can have a good therapeutic physician-patient relationship.

I've only ever referred to IM 2 times in the past 3 years. The one situation, I had been working with the patient for several months to try to get his multiple chroinic conditions under control. Tried different treatment options, different medications, nothing was working. Patient was getting very frustrated and I was getting the sense that they were losing confidence in me. So I happily offered them to meet and establish with IM basically as a way to see if a different set of eyes could or approach could get something to work for him. He was happy with this. Part of it may have been a difference in personality too. Either way I was seeing that the physician-patient relationship was deteriorating so it was a good time to see if someone else could get some better results.

The other time, the patient truly just wanted an IM physician because they had always had IM physicians and were reading on the internet that IM physicians specialized in managing multiple chronic conditions. So I happily referred them as well.
Click to expand...

Ah yeah that's totally different and what I was hoping you'd say. Thanks! I'm really interested in FM (Navy FM actually), but I want to make sure I can manage chronic, complicated patients if I have to. I also want to be comfortable with procedures and OB, but I know Navy FM residencies are pretty OB heavy because they expect FPs to take OB call.
 
Matthew9Thirtyfive said:
Ah yeah that's totally different and what I was hoping you'd say. Thanks! I'm really interested in FM (Navy FM actually), but I want to make sure I can manage chronic, complicated patients if I have to. I also want to be comfortable with procedures and OB, but I know Navy FM residencies are pretty OB heavy because they expect FPs to take OB call.
Click to expand...
Yeah! Be prepared to take care of anything. I've also heard that if you work on a military base there may be less chronic disease management given the nature and age ranges of service members living on base.
 
hsmooth said:
Yeah! Be prepared to take care of anything. I've also heard that if you work on a military base there may be less chronic disease management given the nature and age ranges of service members living on base.
Click to expand...

Yeah. Although from what I understand, you get retirees and families too.
 
hsmooth said:
I have a large gap in my schedule this morning...anyone got any questions?? ... falling asleep here! haha!
Click to expand...
Biggest difference between FM and primary care IM? Is there a particular reason you chose the former?
 
Do you feel well compensated? Do you feel like your lifestyle is good?
 
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