Interest in fammed

[snurpy]

---

Members don't see this ad.

Hi, so I'm set to attend a DO school in August, and kinda jumped the gun looking into different residencies and what interests me. I found that I really like family medicine, despite all the crap people say about FM not making money. I have a few questions about the field though, so I'm posting in here to hopefully get some more light on it.

1. What are the residency hours like for FM? It can't be as painful as surgery residents? Or is this a hospital by hospital sort of thing?

2. I'm reading a lot of articles about how PCPs are starting to expand their practice by offering laser / botox / cosmetic procedures. How does one get certified in this? Any stories about this to share?

3. Regarding the previous question, I think it's a load of bull that some derms/ plastic surgeons are trying to corner the market on cosmetic / aesthetics. Nevertheless, likelihood of them persuading enough lawmakers to prevent PCPs from doing these procedures in the future?

I realize I already sound like an ass asking about hours and ways to increase revenue, and I'll probably get a lot of comments telling me to stay away from the altruistic path of FM, but I don't see what's wrong with charging rich people to pump em full of collagen if that means I can stay in business to help the sick poor people who really need any medical care they can get.

 

[deleted87716]

Yes, FM residency is generally less malignant than a surgical residency. However, all residencies must adhere to the 80-hour workweek (at least, officially), so it's not nearly as big a discrepancy as it used to be. Intern year tends to be the most intense. After that, it progressively gets better.

As for cosmetic procedures, I think many people overestimate the earning potential there. Everybody and their cousin is into this crap nowadays, so prices (and profit margins) are plummeting. It's all about marketing. It has nothing to do with medicine. Unless you focus exclusively on the cosmetic stuff, you'll likely never make any real money doing it. Did you really go through four years of med school and three years of residency so you could zap pubic hairs with a laser?

 

[andwhat]

Yes, FM residency is generally less malignant the a surgical residency. However, all residencies must adhere to the 80-hour workweek (at least, officially), so it's not nearly as big a discrepancy as it used to be. Intern year tends to be the most intense. After that, it progressively gets better.

As for cosmetic procedures, I think many people overestimate the earning potential there. Everybody and their cousin is into this crap nowadays, so prices (and profit margins) are plummeting. It's all about marketing. It has nothing to do with medicine. Unless you focus exclusively on the cosmetic stuff, you'll likely never make any real money doing it. Did you really go through four years of med school and three years of residency so you could zap pubic hairs with a laser?

not so interesting thing about it is, that you as a Primary Care doc get compensated less than a Specialist for the same procedure. Not Rocket Science obviously. Nonetheless, this makes the procedure actually more of a waste of time, with the paperwork and the lack of appropriate compensation.
There are several other ways to make money, botox injections and vasectomies, etc are not the way to do it.
FM is significantly better lifestyle wise, than a Surgery residency. I will not be modest there.

 

[thethom]

Lets not forget that these laser hair removal/laser facelift machines cost a couple hundred thousand dollars... Yeah, during my plastics rotation, I asked my preceptor (a plastic surgeon, not fammed), and he expressed complete regret in buying it...

Maybe they will become more profitable when the economy improves, and people start spending more on luxuries, but currently his machine collects dust and is nowhere near having payed for itself..

 

[midwesterner]

Can some of you give more details on what FP residency is like? I feel like once I'm practicing I can control my own hours to some degree and am less worried about that. I want to know as much as I can about residency though before I even start medical school, since that sounds like the hardest part, so I know exactly what I'm getting into and whether the sacrifices will be worth it.

As the OP was asking about with hours- I don't hear FP residents complaining much. Is it because the hours and workload are not that bad or you just don't complain as vocally (or maybe I just don't hear it)? Is it possible to find a residency with almost no overnight call?

I've also been wondering if everything you learn in residency really necessary for being a good primary care physician. It sounds like a lot of time is spent managing really sick hospital patients, which a typical practicing family doctor would not do, especially if he or she doesn't admit patients in the hospital.

 

[andwhat]

Can some of you give more details on what FP residency is like? I feel like once I'm practicing I can control my own hours to some degree and am less worried about that. I want to know as much as I can about residency though before I even start medical school, since that sounds like the hardest part, so I know exactly what I'm getting into and whether the sacrifices will be worth it.

As the OP was asking about with hours- I don't hear FP residents complaining much. Is it because the hours and workload are not that bad or you just don't complain as vocally (or maybe I just don't hear it)? Is it possible to find a residency with almost no overnight call?

I've also been wondering if everything you learn in residency really necessary for being a good primary care physician. It sounds like a lot of time is spent managing really sick hospital patients, which a typical practicing family doctor would not do, especially if he or she doesn't admit patients in the hospital.

Intern year is busy, second and third year are pretty sweet. Third year the hours are long, but the work is mostly a supervisatory role, and if youre first year residents are good --- then youre life is set honestly. Cruise control.
You should get used to the fact that you will be working at night, unless you want to do Hospitalist or Urgent Care. I still chose to do a few nights as a Hospitalist here and there once in a while. Nights are usually not that bad.
Traditional FM nights are not that bad either. You have an assortment of admissions, including Pediatrics, which usually are not that bad at all. I do say usually, because sometimes you can get rapidly spreading cellulitis of a newborn, yikes! 😱
You can absolutely control youre own hours, and even defer all of the hospitalist work to the Hospitalists. Expect to work hard during residency training -- but remember that once you are done, you can control whatever you want to do.
I would prefer to do either one or the other; Traditional FM using a Hospitalist system (all docs love this idea honestly, even the ones who were reluctantly hesitant to admit it at first), or Hospitalist, or even Urgent Care. All three are very very nice lifestyle - wise in my opinion.
Traditional Family Medicine whilst seeing youre own patients in the Hospital is rewarding also, albeit you will work harder. Most FM docs work 4.5 days per week. This is nice -- and very chill usually
Everything you learn doesn't necessarily apply -- if you choose to do a fellowship, or work in FM without admitting and use Hospitalists, or you become a Hospitalist.
FM residency is to a great degree Outpatient, and research oriented Preventive Medicine training.

 

[EdibleEgg]

I don't love the idea. I won't use hospitalists. It works for some people, but it's not for me. I spent too much time learning to take care of sick people to just give away part of my practice.

 

[andwhat]

I don't love the idea. I won't use hospitalists. It works for some people, but it's not for me. I spent too much time learning to take care of sick people to just give away part of my practice.

if I had a practice, I would totally be with that idea. I think that longevity wise, the patient wants to see their own doctor. However imagine the evolution of the Emergency Room Physician, it started exactly like this.
Yes it is fragmented, no it does not necessarily mean better outcomes, but patients, and specialists, nurses and Hospital administrators overall -- believe it or not are more satisfied -- that is the consensus that I have come across.
Me personally? I would probably want my own physician seeing me.

 

[deleted87716]

not so interesting thing about it is, that you as a Primary Care doc get compensated less than a Specialist for the same procedure.

With some private insurers, perhaps. Not so with Medicare. Doesn't matter, anyway. If you're quick, and can add on a procedure (cryosurgery, biopsy, joint injection, etc.) using Modifier 25 during a regular office visit (typically a 99214), it's well worth the effort. If you bring people back for a second visit just for the procedure, it's less efficient and less lucrative. Sometimes, however, it's the right thing to do.

However, since we were talking about cosmetic procedures, which are typically non-covered services, it's a moot point. You'll get paid whatever you charge.

 

[thethom]

I've also been wondering if everything you learn in residency really necessary for being a good primary care physician. It sounds like a lot of time is spent managing really sick hospital patients, which a typical practicing family doctor would not do, especially if he or she doesn't admit patients in the hospital.

Couple of comments on this, for one you need to go to a few websites of FM residency programs and check out their curriculum. Most of intern year is usually inpatient with call, 2nd and 3rd years are progressively outpatient years with less call. You NEED experience taking care of really sick patients in the inpatient and even ICU setting.

As for fam docs not admitting, what happens when you as a family doc have one of your own patents get sick enough to need admission...you admit them, fam docs admit patients, why do people think they dont..?!

 

[deleted87716]

As for fam docs not admitting, what happens when you as a family doc have one of your own patents get sick enough to need admission...you admit them, fam docs admit patients, why do people think they dont..?!

Because a lot of them don't nowadays. In most cases, this is by choice. In the mid-atlantic region, where I work, 80% of FPs surveyed have hospital admission privileges (source: http://www.aafp.org/online/en/home/aboutus/specialty/facts/31.html ) - which I think is an overestimate. Those who don't admit are increasingly referring their patients to hospitalists, either by simply sending the patient to the ED, or arranging to have them directly admitted to the hospitalist service.

 

[DD214_DOC]

I'm leaning much more towards FM these days, simply because I want to do a bit of everything and can't pick a single specialty. To answer your questions


1. What are the residency hours like for FM? It can't be as painful as surgery residents? Or is this a hospital by hospital sort of thing?

I've rotated through an FM residency for several services. The hours are not bad RELATIVELY speaking. We start pre-rounds at 7AM. Attending rounds are usually around 9AM followed by a short 15-30 minute lecture. You're on day call until noon conference. Usually, I wrap up the day (while still on day call) in the clinic from 1PM-5PM. Call depends on which service you're on. Here, they combine OB with Peds and OB/Peds call is q4. I don't know what the call schedule is for medicine.

The hours aren't bad when compared to other internships, such as a surgery. I think most FM programs allow one to have a reasonable life outside of residency; it's called "family" medicine for a reason.

You're allowed to also moonlight in the ED or work on the hospitalist service after your intern year. Pay is about $60/hr.

2. I'm reading a lot of articles about how PCPs are starting to expand their practice by offering laser / botox / cosmetic procedures. How does one get certified in this? Any stories about this to share?

I think this is a stupid idea. The only people who are going to pay for crap like this are people who would prefer to go to/already have a relationship with a plastic surgeon. Everyone else is doing it already anyway. A better option would be to research what is lacking in your area and tailor your practice to fill that need.

3. Regarding the previous question, I think it's a load of bull that some derms/ plastic surgeons are trying to corner the market on cosmetic / aesthetics. Nevertheless, likelihood of them persuading enough lawmakers to prevent PCPs from doing these procedures in the future?

They can't force them to stop anything. When you graduate, you have a license to practice medicine and surgery. If you're willing to accept liability (and get privileges) you can do whatever you want. I know of a board-certified EM doc who does cosmetic surgery. Huge liability, but luckily he's pretty good at it. FMs can do surgery, too, if they can find the training, particularly in the midwest where they're still trained to do some of the less complex general surgeries. In GA there's a family doc who did his hospital rounds in the AM, had clinic until 5pm, then would go back to the hospital to do his tubals, hysterectomies, etc.