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

[GrignardsReagent]

How was residency vs medical school? Same hours? Same volume of information to be learned?

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[Dagrimsta1]

You the man bro for actually keeping up

1) When you do preform OMM, you bill for it without any issues? If you don't mind me asking but how's the reimbursement for it?
2) Since you work for a medical group, do you have any leverage or pull on the protocols that are implemented at least in your office?
3) Can you hire/fire or make suggestions towards the personal where you work?
4) You actually have time to play PS4?!?!
5) Strictly for personal reasons... You get drug tested? How often?

LOL thanks again for the answers.

 

[hsmooth]

Biggest difference between FM and primary care IM? Is there a particular reason you chose the former?

Differences?
In residency, IM would have had a lot more inpatient rotation months -- i.e. general medicine in the hospital, ICU, critical care, etc. You can only 'specialize' in areas such as cardiology, gastroenterology, pulmonolgy, etc..having done an IM residency. You can do a "fellowship" through family medicine in areas such as sports medicine, academics, geriatrics.

In practice: both FM and IM can become hospitalists. Outpatient FM vs outpatient IM - pretty much the same, except you don't see peds / adolescent <18 in IM nor do you have the ability to do OB.

The lines get blurred quite a bit...so much so that I will be working in an all- IM clinic soon as the sole FM physician.

I knew I hated hospital / inpatient medicine so the practical reason was I wanted more exposure to outpatient rotations as a resident.

 

[hsmooth]

Do you feel well compensated? Do you feel like your lifestyle is good?

I feel more than fairly compensated. Have mentioned it a few times in this thread, and at the risk of sounding like I'm #humblebragging...my work and financial situation allows for a lifestyle of making >$240k working 36 patient contact hours per week, call once every 10 days (straight phone triage call, often times get 0 calls), average 6 weeks vacation per year where I travel within the States and internationally, maximizing all retirement accounts and set to pay off all my loans within a few years and have net worth between my wife and I of about $1mil before the age 40. No worries making house payments, drive a decent (but not flashy or crazy expensive ) new car, have hobbies and ability to buy electronic toys like games, photography equipment, drone, etc. I really can't ask for more from a work/financial standpoint.

 

[hsmooth]

How was residency vs medical school? Same hours? Same volume of information to be learned?

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In Medical school - learning all the esoteric and detailed science and physiology of how the human body systems work. So you can probably do well on tests and exams, but you never really truly *understand* what everything means.

In residency, you get to apply the things you learn to real life situations. You learn and see what disease processes can do to real people. You learn what is "oh crap that's really bad" compared to "meh, they'll survive".

You get to learn the "art of medicine". You get to apply volumes of lab values, imaging tests, to what you see on physical examination to come up with the right diagnosis or management plan.

You learn that not everything is black and white, X or Y. Is it one thing, or another, or a mixture of both?

You learn how to lead family meetings. How to tell a family member that their loved one is going to die. You learn to give them the best information and guide patients in the end stages of their life. You learn how to give good news and bad news. You learn that sometimes it's ok to tell patients "you don't know" but that you'll do everything you can to get them the right information.

You learn that sometimes you can't fix a patient's problem with a medicine or injection or surgery, but sometimes the patient just wanted someone to vent to. So you learn to listen.

You learn how to be a team player in residency. That there's always going to be someone smarter, more experienced, and talented than you. You learn how to reach out for help when you need it. You learn to lean on your nurses to be the eyes and ears for your patients. You learn how to communicate effectively to get the information you need

You learn how to survive in residency. The hours are much longer and you learn just how dedicated you yourself can be, pushing the limits of your capability. Working on no sleep, when you haven't seen your significant other or child in 30 hours.

It may feel like you're learning a lot in medical school but I think the more important lessons will be learned in residency and in practice.

 

[JJRousseau]

I feel more than fairly compensated. Have mentioned it a few times in this thread, and at the risk of sounding like I'm #humblebragging...my work and financial situation allows for a lifestyle of making >$240k working 36 patient contact hours per week, call once every 10 days (straight phone triage call, often times get 0 calls), average 6 weeks vacation per year where I travel within the States and internationally, maximizing all retirement accounts and set to pay off all my loans within a few years and have net worth between my wife and I of about $1mil before the age 40. No worries making house payments, drive a decent (but not flashy or crazy expensive ) new car, have hobbies and ability to buy electronic toys like games, photography equipment, drone, etc. I really can't ask for more from a work/financial standpoint.

Wow, this seems to contradict all of the vitriol some physicians espouse toward their own careers. Especially, when family medicine is usually thrown under the bus as the folks that have it the worst. I like the optimism.


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[hsmooth]

You the man bro for actually keeping up

1) When you do preform OMM, you bill for it without any issues? If you don't mind me asking but how's the reimbursement for it?
2) Since you work for a medical group, do you have any leverage or pull on the protocols that are implemented at least in your office?
3) Can you hire/fire or make suggestions towards the personal where you work?
4) You actually have time to play PS4?!?!
5) Strictly for personal reasons... You get drug tested? How often?

LOL thanks again for the answers.

1) Never had an issue doing OMM and getting it paid for by insurances. Depending on how many body areas you treat with OMM, it can range anywhere from ~$25 for treating 1-2 body areas up to $50 for treating up to 5 areas. Generally speaking.
2) Yeah, sometimes I do, and sometimes I don't have leverage. Everything is within reason.
3) I can't do direct hiring or firing. But often times I can be involved in the recruitment / interview process, and I can give my opinion or feedback to the manager who does the hiring.
4) Yeah, played video games throughout med school, residency, and in real life. Of course I get to play a lot more PS4 now guilt free now that I have so much more free time compared to when in med school or residency.
6) Usually drug tested at the beginning of your employement....then I suppose each work place is different. In the last 3 years I haven't been drug tested at all. But I suppose if you're supposed to tell your patients to live a healthy, drug free lifestyle...as a physician you should probably try to lead by example too haha.

 

[hsmooth]

Your

Wow, this seems to contradict all of the vitriol some physicians espouse toward their own careers. Especially, when family medicine is usually thrown under the bus as the folks that have it the worst. I like the optimism.


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Your results may vary. If you live in a high demand, high cost of living area of the country, you probably won't make what I make. But from the job offers out there, even in major metropolitan areas aside from the coasts and deep south, pay has been steadily increasing for FM over the past few years.

You won't ever get to buy a Lambo or have your own private jet, but you should live more than comfortably, pay off your loans, and take care ofyour family and have a nice retired life if you do it right as a FM doc.

 

[JJRousseau]

Your

Your results may vary. If you live in a high demand, high cost of living area of the country, you probably won't make what I make. But from the job offers out there, even in major metropolitan areas aside from the coasts and deep south, pay has been steadily increasing for FM over the past few years.

You won't ever get to buy a Lambo or have your own private jet, but you should live more than comfortably, pay off your loans, and take care ofyour family and have a nice retired life if you do it right as a FM doc.

This makes a lot of sense. As a student my 450 square foot apartment rent is about to be 1.8x my brother's 2500 square foot house's mortgage payment. Northeast vs Midwest. I can see how even at much higher income levels this geographic disparity in housing costs can make a big difference.


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[hsmooth]

Take advantage of geographic arbitrage early on in your career to pay off your loans.

This article explains it all:
Geographic Arbitrage, or Why the Great Plains are Great - Physician on FIRE

 

[JJRousseau]

Take advantage of geographic arbitrage early on in your career to pay off your loans.

This article explains it all:
Geographic Arbitrage, or Why the Great Plains are Great - Physician on FIRE

Totally agree with this, unfortunately I'm interested in academic medicine which moves me back to toward the banker/lawyer position as the article describes despite loving living in rural areas. Definitely agree with and recommend this strategy though.

Edit: For the record, this is how many junior docs in the U.K eventually end up with great flats in London later in their career. It is truly an international strategy that works quite well.

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[Lawpy]

I feel more than fairly compensated. Have mentioned it a few times in this thread, and at the risk of sounding like I'm #humblebragging...my work and financial situation allows for a lifestyle of making >$240k working 36 patient contact hours per week, call once every 10 days (straight phone triage call, often times get 0 calls), average 6 weeks vacation per year where I travel within the States and internationally, maximizing all retirement accounts and set to pay off all my loans within a few years and have net worth between my wife and I of about $1mil before the age 40. No worries making house payments, drive a decent (but not flashy or crazy expensive ) new car, have hobbies and ability to buy electronic toys like games, photography equipment, drone, etc. I really can't ask for more from a work/financial standpoint.

Wow, this seems to contradict all of the vitriol some physicians espouse toward their own careers. Especially, when family medicine is usually thrown under the bus as the folks that have it the worst. I like the optimism.


Sent from my iPhone using SDN mobile

Your

Your results may vary. If you live in a high demand, high cost of living area of the country, you probably won't make what I make. But from the job offers out there, even in major metropolitan areas aside from the coasts and deep south, pay has been steadily increasing for FM over the past few years.

You won't ever get to buy a Lambo or have your own private jet, but you should live more than comfortably, pay off your loans, and take care ofyour family and have a nice retired life if you do it right as a FM doc.

This makes a lot of sense. As a student my 450 square foot apartment rent is about to be 1.8x my brother's 2500 square foot house's mortgage payment. Northeast vs Midwest. I can see how even at much higher income levels this geographic disparity in housing costs can make a big difference.


Sent from my iPhone using SDN mobile

Take advantage of geographic arbitrage early on in your career to pay off your loans.

This article explains it all:
Geographic Arbitrage, or Why the Great Plains are Great - Physician on FIRE

This fits well with basic economics. It's hard to get a secure, well-paying job in popular areas like cities in coastal regions. But it's definitely possible to enjoy an awesome lifestyle and make >$200k/year in more rural regions where physicians are less likely to work but demand for physician services is high.

 

[hsmooth]

This fits well with basic economics. It's hard to get a secure, well-paying job in popular areas like cities in coastal regions. But it's definitely possible to enjoy an awesome lifestyle and make >$200k/year in more rural regions where physicians are less likely to work but demand for physician services is high.

I'll tell ya, you don't even have to go "rural" to make >$200k. There are big cities that offer a salary over $200k.

 

[hsmooth]

Well I'm on a mini vacation now. Have the next 5 days off work to be lazy and visit family out of town...so I'd love to answer any questions y'all have!

 

[Shammyguy3]

Well I'm on a mini vacation now. Have the next 5 days off work to be lazy and visit family out of town...so I'd love to answer any questions y'all have!

So I have a couple questions here. I have worked and shadowed some specialists before and I can't see myself going into either of those specialties (ophthalmology and derm). But I've also shadowed a family practice physician for 100 hours over a year (and he's now my doctor). I really think I will want to go into family practice, unless something grabs my attention in school.

However, I love assisting the doctors I work for in procedures and I haven't seen the family doc do any procedures (just injections and OMM).

Because I would like to do some procedures in practice, I was thinking maybe internal medicine might be a better route? But I really want to be a PCP and work in a clinic as opposed to the hospital.

So the main question is do you get to do any procedures in clinic? Or is that generally left to specialists in clinic and hospitalists for admitted patients?

 

[DoctorCrush]

Hi Dr. Sorry if this has already been asked. But if one were to get sick of outpatient life as FM, how easily is it for one to transition into hospitalist gig? I ask because at the hospital I am at (northeast) we only have IM in those position...not sure if that's a geographical thing or not. Thanks

 

[Dr. Rafiki]

So I know you've answered this in regards to how many PAs work with you, but I was wondering if perhaps any of your colleagues / practices in your area complain of the mid level creep? I ask because I took my wife to an urgent care last week and got to chatting with the FM doc who was there moonlighting for extra hours. He pretty much told me avoid FM like the plague, and completely blamed it on NPs and DNPs who live to uproot doctors and confuse patients into thinking that they are the doctors of the future. Seemed a bit much to me, but this guy was certainly believing himself as he warned me away from FM. In fact, he said he's leaving medicine altogether and getting an MBA because of how bad NPs have become in terms of litigating the doctors role to basically nothing.

Your thoughts?

 

[hsmooth]

So I have a couple questions here. I have worked and shadowed some specialists before and I can't see myself going into either of those specialties (ophthalmology and derm). But I've also shadowed a family practice physician for 100 hours over a year (and he's now my doctor). I really think I will want to go into family practice, unless something grabs my attention in school.

However, I love assisting the doctors I work for in procedures and I haven't seen the family doc do any procedures (just injections and OMM).

Because I would like to do some procedures in practice, I was thinking maybe internal medicine might be a better route? But I really want to be a PCP and work in a clinic as opposed to the hospital.

So the main question is do you get to do any procedures in clinic? Or is that generally left to specialists in clinic and hospitalists for admitted patients?

The kinds of procedures you could do as FP include but not limited to: joint injections, casting, splinting, PRP, Tenex, OMM, IUDs, nexplanons, colposcopy, skin biopsies and excisions, wound repair, vasectomies, infant circumcisions, C sections, cosmetic dermatology, bedside ultrasound, cardiac stress testing, and more. How much of this stuff you want to do, or can do, would depend on the kind of training you get in residency and / possibly fellowship. It will also depend on the type of setting you practice in. Urban vs rural, etc. Urban settings -- you'll see procedures like C sections and colonoscopy go to the specialist.

So I'm not sure what kind of procedures you may be interested in. Hospital or OR based procedures will not be as commonly done if you're FP. Well unless you're a FP hospitalist, you should know how to do central lines and chest tubes and things like that...

 

[hsmooth]

Hi Dr. Sorry if this has already been asked. But if one were to get sick of outpatient life as FM, how easily is it for one to transition into hospitalist gig? I ask because at the hospital I am at (northeast) we only have IM in those position...not sure if that's a geographical thing or not. Thanks

Can be highly geographic dependent. I have many FP friends who are hospitalists and live in major cities in the Midwest and mountain West region. Less in the coastal areas. Another thing to consider is if you've practiced in outpatient clinics for several years you may very well end up forgetting or losing the inpatient skills you had coming out of residency. One of my colleagues works a few weekend hospital shifts every few months in hopes of retaining his inpatient skills so that may be an option.

 

[hsmooth]

So I know you've answered this in regards to how many PAs work with you, but I was wondering if perhaps any of your colleagues / practices in your area complain of the mid level creep? I ask because I took my wife to an urgent care last week and got to chatting with the FM doc who was there moonlighting for extra hours. He pretty much told me avoid FM like the plague, and completely blamed it on NPs and DNPs who live to uproot doctors and confuse patients into thinking that they are the doctors of the future. Seemed a bit much to me, but this guy was certainly believing himself as he warned me away from FM. In fact, he said he's leaving medicine altogether and getting an MBA because of how bad NPs have become in terms of litigating the doctors role to basically nothing.

Your thoughts?

One thing I learned is that there's always gonna be at least one of those people that complain about anything and everything... And that everything is horrible and all doom and gloom.

If you're a doc and you feel threatened by an NP or PA, then I say go take the time to learn some new skills to differentiate yourself and stand out.

Personally, if I were so disenfranchised with medicine and wanted to go into business I'd quit too but I certainly wouldn't go pursuing an MBA and going back into heavy student loans debt. If anyone asks I can tell you all about the time I started a startup business during my third year of medical school and grew it to six figures in sales within 18 months before I sold it off because I was starting residency.

 

[DexterMorganSK]

@hsmooth

This is one of the best threads on SDN. Although the title states it's about FM, in reality, this thread touches upon the aspect of the lives of a pre-med, med, and beyond. Thank you so much for your time!

 

[DoctorCrush]

Can be highly geographic dependent. I have many FP friends who are hospitalists and live in major cities in the Midwest and mountain West region. Less in the coastal areas. Another thing to consider is if you've practiced in outpatient clinics for several years you may very well end up forgetting or losing the inpatient skills you had coming out of residency. One of my colleagues works a few weekend hospital shifts every few months in hopes of retaining his inpatient skills so that may be an option.

Would it be just as hard the other way around too? Like going from inpatient to outpatient?

 

[hsmooth]

@hsmooth

This is one of the best threads on SDN. Although the title states it's about FM, in reality, this thread touches upon the aspect of the lives of a pre-med, med, and beyond. Thank you so much for your time!

I thought it was just gonna be a fun way to kill some time when I'm bored doing this thread but I'm glad it's actually helpful!! Haha.

 

[hsmooth]

Would it be just as hard the other way around too? Like going from inpatient to outpatient?

My own personal opinion... It may be easier to transition from inpatient to outpatient based on the mere fact that you have time to think things through. You're not dealing with super sick people all day long. You don't have to know all the answers and management plan right then and there. You can bring patients back for follow up in a week or two or three do that can buy you time to coordinate management, talk to some consultants, or look up some things in journals or up-to-date etc

 

[DoctorCrush]

My own personal opinion... It may be easier to transition from inpatient to outpatient based on the mere fact that you have time to think things through. You're not dealing with super sick people all day long. You don't have to know all the answers and management plan right then and there. You can bring patients back for follow up in a week or two or three do that can buy you time to coordinate management, talk to some consultants, or look up some things in journals or up-to-date etc

Thank you!

One more question please. What should be top priority when one picks an FM residency program. Besides the personal things, what should one watch out for and/or stay away from etc.?

 

[member212121]

If anyone asks I can tell you all about the time I started a startup business during my third year of medical school and grew it to six figures in sales within 18 months before I sold it off because I was starting residency.

I'd like to hear about the startup. I'm trying to come up with an idea for a side hustle to keep up with interest payments during med school.

 

[hsmooth]

I'd like to hear about the startup. I'm trying to come up with an idea for a side hustle to keep up with interest payments during med school.

I worked on 2 separate projects during med school and residency as part of my "side hustle".

First project was definitely more active and 'hands on'. I started a business in a traditional sense with one of my friends.

Second project was creating a blog and getting involved in affiliate marketing.

As a side hustle, I recommend doing something where you can passively generate income on an ongoing basis without expending a lot of energy and work to maintain, once you put in the time and effort at the beginning.

I learned a few lessons from both these projects which you could apply to any business idea, or even in your future medical practice:
- identify a problem that people experience. Then research and learn all about it, and come up with solutions to help people with these problems. From a business standpoint, this may help you identify a 'niche' product or area which would allow the highest probability of having financial success. For example, there's a million products or programs dealing with 'weight loss' in general. Good luck trying to launch a new product or business. But what if you find out a specialized 'niche area'? Let's say, you develop and sell a program marketed to 'weight loss for young professionals or med students'. Now you're talking something that hasn't been done over already.

This is how medispas made a fortune back in the day, back when botox and stuff like that was just coming out. It was a novel, niche area of dermatology (cosemetics) which some aspiring physician entrepreneurs really put together some good ideas and made some bank. Now, you see medispas all over the place. Not as lucrative. So work on finding your 'niche'.
- Don't sell your soul or ethics to hawk a product to make a quick buck. If you want to sell something, make sure it is something that actually works. because you're going to have to put your name behind this product. And that's the one thing you don't want to tarnish, is your reputation. Consumers are good at picking out 'sketchy' marketing or Too-Good-To-Be-True products. Be honest with people, how will your product help people? What are it's benefits? Are there any potential downsides or areas where it may not work? Be transparent.
- be interesting, socially likable, and communicate effectively. This is the image that your patients, clients, or other potential business partners see. If you communicate well, are trustworthy, and generally well liked, things are a lot easier to do. Maybe you'd be able to close a business deal, make a sale, or build rapport with your clients (or patients) so they trust you. Studies have shown that you are much less likely to face lawsuits even if you are in the wrong, if your patients like you and you communicate well with them. Growing up, I've always been more introverted and shy. Didn't do well in social situations. There's an old-school book called How To Win Friends and Influence People by Dale Carnegie. It's a bit hokey at times but it really helped me start learning and practicing effective communication skills

If you want specific details about my side hustle stuff, send me a PM and we'll continue our conversation there.

 

[Doctor_Strange]

During your rotations, what was it about EM that you crossed it off your list? Also, what specifically about inpatient medicine did you loathe? Charting? Rounding?

 

[ChiefsIntern]

@hsmooth Do you ever regret not becoming a surgeon? For you would it ever be worth it to work the 20-30 extra hours to have that level of intensity or is it really something you don't even question?

 

[hsmooth]

During your rotations, what was it about EM that you crossed it off your list? Also, what specifically about inpatient medicine did you loathe? Charting? Rounding?

I'm very much a laid back kind of guy. I like to be as stress free as possible. I like knowing routine and certainty. The ER stressed me out a bit too much, dealing with sick people and trauma and all that stuff. It's fun and exciting and pays well but takes a certain type of personality to do long term and to avoid burn out. Plus you end up working different shifts all the time so that can lead really easily to circadian rhythm disorder and messes up your sleep. I love my sleep and I want to spend as much time as I can with my wife and family.

Unfortunately, no matter what specialty you go in to, you're going to run in to charting. My experience with inpatient medicine was unfortunately heavily and negatively skewed by what inpatient medicine is like in an academic setting. A lot of deliberating, rounding and rounding upon rounding. Getting rude and mean consultants that never want to help you. All that is quite different than what inpatient medicine as a hospitalist may be like in a non-academic, community hospital setting. (Obviously, there's always exceptions). But hearing my hospitalist friends talk about their jobs, makes me feel like maybe I might have enjoyed that a bit more than what i did in medical school.

 

[hsmooth]

@hsmooth Do you ever regret not becoming a surgeon? For you would it ever be worth it to work the 20-30 extra hours to have that level of intensity or is it really something you don't even question?

See my reply above -- I really like to live as stress free as possible. Actually my goal in life is to work as little as possible so I have more time to spend with friends, family, my wife, possibly future children, and other non-medical hobbies. You'd have to pay me an extra $500k for me to even consider adding an extra 55% of my current weekly workload.

Surgery is cool and all, but not my cup of tea. I have surgeon friends that are on call every 4 days and often get called in the middle of the night to go do an emergent appendectomy or other surgery. I do like my 8 hours of sleep every night. It takes a certain type of personality and mentality to do surgical type specialties.

 

[hsmooth]

Hey what's up SDNers. Got any questions for me?

 

[hsmooth]

I'm really interested in family medicine and am starting with FM as my first clinical rotation next week! Any tips on how to do well and how to figure out if it's right for me? Thanks!

Awesome!!! good luck on your first rotation!
Don't be afraid to pick your attending's brain about what they like or dislike about family medicine. I don't think they'll expect a whole lot from you with it being your very first clinical rotation. Generally be present, on time, show interest, don't be a slob. Ask questions when appropriate, read up on 1 or 2 topics that you see from that day, like screening guidelines for diabetes, hypertension, etc. Those are bread and butter family medicine topics. Be courteous to ALL of the staff in the clinic. Should go without saying. Later in the rotation they may have you try to obtain a history from a patient on your own. Don't sweat it if you can't get all the right details. You'll get better with practice

 

[RootcanalT12]

Hey what's up SDNers. Got any questions for me?

Are you concerned about the future of medicine 10 years down the road?
I plan to apply to med school next year, but I have been reading about the saturation in the field and the NPs and PAs taking over the practice of medicine. Should I worry?
Since I will be the sole bread winner for my family, I am planning on taking loans to go to school again at age 40, therefore it is very important question for me.

Thank you for your detailed and very informative thread.

 

[Cali_NP_to_MD]

aking 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.

Sorry if this has been asked already, I didn't have time to read all 7 pages of replies - you get 8 weeks of vacation per year?!? Is that a normal amount for family medicine? Any input on vacation time in other specialties also?
I'm a FNP (hopefully future doc) and I get 2 weeks per year, and my boss (MD) takes 0-1 week per year off. I was shocked when I read 8 weeks, that seems like it would be incredible!

 

[hsmooth]

Are you concerned about the future of medicine 10 years down the road?
I plan to apply to med school next year, but I have been reading about the saturation in the field and the NPs and PAs taking over the practice of medicine. Should I worry?
Since I will be the sole bread winner for my family, I am planning on taking loans to go to school again at age 40, therefore it is very important question for me.

Thank you for your detailed and very informative thread.

Personally, I'm not going to stress about NPs and PAs. I think they're a valuable part of the medical team. I work with them and also supervise them. I think there's always going to be a role for a physician, though. You can adapt your practice, learn new skills, and market yourself in ways that NPs / PAs just aren't able to.

The bigger thing I'd be thinking about, is this new career change. I don't know anything about your current career, but there is going to be a tremendous opportunity cost to giving up your current job, taking up >$200k in debt, and not having a paycheck for at least 4 years. Especially if you're the sole source of income for your family. Think hard, and make sure you're going into medicine for the right reasons.

 

[hsmooth]

Sorry if this has been asked already, I didn't have time to read all 7 pages of replies - you get 8 weeks of vacation per year?!? Is that a normal amount for family medicine? Any input on vacation time in other specialties also?
I'm a FNP (hopefully future doc) and I get 2 weeks per year, and my boss (MD) takes 0-1 week per year off. I was shocked when I read 8 weeks, that seems like it would be incredible!

6 weeks time off for vacation plus 2 weeks off for CME. We'll usually go away to a medical conference for CME somewhere nice...think beaches, mountains, resort towns, the like. Mind you, I'm now on 'production' model for my salary...so the more time I take off for vacation, the less money I get paid. We are able to take a lot of time off because we live relatively frugally the rest of the time we're not traveling, we currently don't have children, and live in a lower cost of living area, paid off significant portions of our debt, etc.

Typically for Family medicine jobs i've seen 4-6 weeks of vacation plus 1-2 weeks of CME. This is for typical jobs within a larger medical group. I'd imagine it's harder for people in solo practices or smaller group practices to take more time off.

I really don't know much about vacation time off in other specialties.

 

[psychMDhopefully]

What kind of Contracts did your coresidents sign? 220k for 18 months is about 140k a year, seems low. Is the bait and switch salary as common in FM as people say? For example a resident signs a 4 year contract with guaranteed 240k for 2 years then they get paid based on " what they're worth" Which a lot of times is a lot less than the guaranteed salary of the first 2 years.

 

[hsmooth]

What kind of Contracts did your coresidents sign? 220k for 18 months is about 140k a year, seems low. Is the bait and switch salary as common in FM as people say? For example a resident signs a 4 year contract with guaranteed 240k for 2 years then they get paid based on " what they're worth" Which a lot of times is a lot less than the guaranteed salary of the first 2 years.

220k per year, for the first 18 months guaranteed. (in other words $330k total for 18 months). Salaries range. Sometimes they can be 12 month guarantee, sometimes 18 months, etc. After your guarantee period, you're often paid based on 'productivity' or a 'fee for service' type of model. Sometimes it can be less than your guarantee, sometimes it can be way more too. There are a lot of variables that go in to your pay once you're off your salary guarantee.

When you're negotiating your contracts it'd be in your best interests to find out on average what they're realistically expecting you to produce once you're off your guarantee, how difficult it would be to produce at that level, does the practice have enough patient volume to support you, etc.

 

[Lagmdoc]

Can you do a DO vs MD explanation? Not necessarily the philosophy, because I think everyone here understands that part, but apply post medical school. Like for example: Do you feel that being a DO FM physician is better than being an MD FM physician? I've heard that DO's are better b/c they are more wholistic and personable, but I've also heard an MD say that is a stereotype and MD's are just as good.


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[hsmooth]

Can you do a DO vs MD explanation? Not necessarily the philosophy, because I think everyone here understands that part, but apply post medical school. Like for example: Do you feel that being a DO FM physician is better than being an MD FM physician? I've heard that DO's are better b/c they are more wholistic and personable, but I've also heard an MD say that is a stereotype and MD's are just as good.


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I don't think one is better than the other just because the letters behind your name are different. It's what you do individually as a physician that defines your approach to practicing medicine. I know tons of MDs that approach medicine 'holistically' or 'personably', just as much as I know lots of DOs that don't. I don't think there was any particular class during DO med school that made me feel like I was better able to practice medicine holistically.

 

[kubyx]

Could you expand a little on the OMT you use in practice, how effective it is, etc.? Somewhat of a strong selling point to me for a DO education right now is that I do have a legitimate interest in doing primary care in more rural/underserved areas should I get into school, and given how insanely prevalent I have heard things like back pain are in primary care, it sounds like it could be a useful tool to provide to patients.

 

[hsmooth]

Could you expand a little on the OMT you use in practice, how effective it is, etc.? Somewhat of a strong selling point to me for a DO education right now is that I do have a legitimate interest in doing primary care in more rural/underserved areas should I get into school, and given how insanely prevalent I have heard things like back pain are in primary care, it sounds like it could be a useful tool to provide to patients.

The OMT that I use most are soft tissue (gentle manipulation of fascia, muscles, tendons, etc...kind of like 'massage'), muscle energy (using the force from resisted muscle contractions to allow those muscles to relax, stretch, and normalize joint mobility and function), and HVLA (High velocity, low amplitude -- spinal manipulation or sometimes 'popping' something back into alignment). I've learned that other professions such as massage therapists, athletic trainers, physical therapists, chiropractors seem employ somewhat similar therapies in their practice as well. You'll find that there is some research out there that shows it can be a very effective primary or adjunctive treatment.

There are other OMT techniques that I don't do, because either I didn't get comfortable enough doing during training or if I personally think has questionable efficacy.

I use OMT as just another one of those tools I keep in the tool box that could really help people. Sometimes it works great for my patients, and they happily return for OMT on a regular basis. Other times, we try it, and it doesn't really provide much relief of symptoms, and we move on to other options. Most commonly I'll use it in combination with formal physical rehab/therapy, exercise program, and medication management.

I've found that patients for the most part enjoy the 'hands on' aspect of the treatment. There seems to be some kind of therapeutic element of having your doctor spend an extra 20 minutes trying to work out some restricted or tight muscles to help with pain. Maybe it's placebo too, but they seem to like it!

 

[I'mJustCurious]

1. How hard is it to practice medicine with an expunged record?
2. Hardest part of med school for you and how do you handle it?
3. How much free time did you have every day in med school?
4. Any tips on the MCAT?

 

[hsmooth]

Bumping this thread, I realized I missed a post here. If anyone has any other questions, feel free to chime in!

1. I don't have any knowledge or insight into this, sorry.

2. Hardest part of the first 2 years of med school was staying organized enough to not fall behind on all the tests, assignments, and labs. I'm naturally a procrastinator and had to really make lists, keep a schedule and to-do list to stay on top of things.

The hardest part of the 3rd and 4th years of med school was all the long hours in your clinical rotations, and learning about what each preceptor expected out of you within that month.

3. I probably had 2-3 hours every day of totally 'free' time where I wasn't in class or studying. I spent this time exercising, hanging out with friends, cooking, and other hobbies or chores.

4. Understand what your own best personal learning style is. Some people do better in a classroom setting, some people do better doing active learning with repetition (do a bunch of practice exams!), some people are better self learners.

1. How hard is it to practice medicine with an expunged record?
2. Hardest part of med school for you and how do you handle it?
3. How much free time did you have every day in med school?
4. Any tips on the MCAT?

 

[MedicineZ0Z]

How doable is it to gain baseline competency in invasive EM procedures in a FM residency? (ex. chest tubes) Is it very doable at unopposed residencies? Not doable at all at hospitals with too many programs?

 

[hsmooth]

Highly variable on the residency program you go to. You'd have to do some juggling and really take a pro-active approach to seek these opportunities out (do extra elective rotations in ER, etc -- let the attendings know it's something you want to learn). Not impossible but many FM programs might not get you the numbers needed to be competent.

How doable is it to gain baseline competency in invasive EM procedures in a FM residency? (ex. chest tubes) Is it very doable at unopposed residencies? Not doable at all at hospitals with too many programs?

 

[MedicineZ0Z]

Highly variable on the residency program you go to. You'd have to do some juggling and really take a pro-active approach to seek these opportunities out (do extra elective rotations in ER, etc -- let the attendings know it's something you want to learn). Not impossible but many FM programs might not get you the numbers needed to be competent.

What's the exact reason for this? You could always do an anesthesia elective and push for volume right? Or is it more that they won't let you do that many ER electives or.. they won't let the fm resident do those procedures?

 

[Jedo]

PM’d you.

 

[hsmooth]

Yes, there are likely limitations on how many elective months you get during your 3 years. Let's say you get 5 or 6 elective rotations your whole residency...you may need to use many of those up to do ER etc

Not saying it can't be done, but will need some juggling and persistence.

What's the exact reason for this? You could always do an anesthesia elective and push for volume right? Or is it more that they won't let you do that many ER electives or.. they won't let the fm resident do those procedures?