Is FM a dying field?

[bigfootisreal]

Somewhat conflicted on my current interests. I really like the career flexibility, job flexibility, and diversity that comes with general fields like FM. However, I sometimes worry about its projection moving forward and I’m also unsure on the compensation having heard very great things and some not so great things. Looking for an open discussion here! Thanks!

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[Dr. Doctor MD]

Somewhat conflicted on my current interests. I really like the career flexibility, job flexibility, and diversity that comes with general fields like FM. However, I sometimes worry about its projection moving forward and I’m also unsure on the compensation having heard very great things and some not so great things. Looking for an open discussion here! Thanks!

At the moment there is nothing to worry about, and tbh the future also looks incredibly bright, especially in comparison to other fields

Good lifestyle, short training, non-brutal residency, decent pay 225-250k (or more), incredible job market, very high demand, options for concierge or direct primary care. If you like the actual day to day practice of FM, there's no reason not to do it.

 

[Cardboard101]

Curious as well. Was interested in FM but the older attendings I've worked with tell me that FM is a dying field due to decreasing reimbursements, midlevel encroachment and increasing amounts of paperwork/legalwork required for a private practice. They went as far as to warn me away from the field.

 

[ace_inhibitor111]

I don’t know about “dying field” but it is getting oversaturated like many areas of medicine, maybe to an even greater degree than IM or EM. The amount of FM residencies has been increasing by 10% a year, which is insane. It also sucks knowing that midlevels can for the most part do 95% of what you do. Yes MDs have training that PA/NPs don’t, but when 100,000 midlevels are graduating every year, there will be some talented clinicians that you’ll have to compete against, for cheaper pay too. So yeah it doesn’t look good unless we as a profession stand up for ourselves.

 

[AMEHigh]

No it's not.
I know I'm biased since I'm FM though.
But I love love love the variety. I live in a very large city and my colleagues and I are doing peds, prenatal care, OB, gyn (colposcopy, endometrial biopsies, miscarriage management with MVA, etc), msk injections, derm procedures, etc. Many of us work in a variety of settings including outpatient, inpatient, urgent care, fast track of EDs, women's health clinics, nursing homes and jails. Most of us have 1 "speciality" area that we focus on and enjoy the most, but having the variety is so great. Sure there are a lot of PAs and NPs, but they certainly can't do the same jobs with such a wide variety that MD/DOs are doing. Sure you're likely not going to be making 500k right after residency, but residency is only 3 years and diversifying your career with a lot of options can also increase your pay significantly.

 

[InternistDO]

Curious as well. Was interested in FM but the older attendings I've worked with tell me that FM is a dying field due to decreasing reimbursements, midlevel encroachment and increasing amounts of paperwork/legalwork required for a private practice. They went as far as to warn me away from the field.

Every attending in every specialty says this

 

[Rekt]

I'd 100% be worried about the constant exponentially increasing influx of mid-levels. Everyone is trying to play doctor these days without any of the effort.

 

[aldol16]

I mean, I'm not sure it's going to die any time in the near future. I know that mid-levels are encroaching and can do many of the same things. But there is a demand for family practitioners and I don't think that midlevels will saturate that demand.

But the pay may not be the best. Although you do a lot of procedures in family medicine, the RVUs just aren't the same as the RVUs for the more competitive specialties. Until we start paying more for prevention instead of treating disease that has already occurred, that isn't going to change.

 

[ace_inhibitor111]

Every attending in every specialty says this

Ortho, ENT, Derm, IR would like to say hi. There’s a reason competitive specialties are competitive.

 

[Ho0v-man]

FM residents where I’m at are getting job offers as interns.

The pay is lower than most other fields, but they also train less and have pretty great hours.

Mid levels aren’t really much threat to FM. They’re after big pay just like most docs. But they don’t have to deal with that pesky rigorous training so they all apply ortho, derm, cards, EM, etc. The scope in FM is really too broad for them anyway. They’re honestly better suited for doing specific things everyday for specialists and that pays them more too. I saw something a few years ago showing DOs go into PC more often than NPs.

 

[aafisahar]

FM is too broad for its own good. Unless you absolutely need OB and peds, ditch FM for IM. Better adult training and leaves the door open to fellowships.

 

[ciestar]

FM residents where I’m at are getting job offers as interns.

The pay is lower than most other fields, but they also train less and have pretty great hours.

Mid levels aren’t really much threat to FM. They’re after big pay just like most docs. But they don’t have to deal with that pesky rigorous training so they all apply ortho, derm, cards, EM, etc. The scope in FM is really too broad for them anyway. They’re honestly better suited for doing specific things everyday for specialists and that pays them more too. I saw something a few years ago showing DOs go into PC more often than NPs.

Most of the applicants ive interviewed with thus far have been DOs

 

[ciestar]

FM is too broad for its own good. Unless you absolutely need OB and peds, ditch FM for IM. Better adult training and leaves the door open to fellowships.

I like OB and peds.
I hate hospital medicine and IM has sooo much of it, which is in part why I didnt pursue it.

 

[allantois]

There isn't a 100,000 midlevels graduating every year, nor do all of them want to do FM

 

[bigfootisreal]

This is interesting to me because there’s almost exactly 2 opposite threads going on here. The group that thinks FM has a bright future and based off the repeated shortage numbers may suggest this. As well as the group that states FM is largely threatened by mid levels. This is in part why I asked this question because it seems so often that this field gets split. I feel like if our medical system were to change in the slightest that FM could see the same spike that psych has seen recently but until then it gets either overlooked or avoided.

 

[BorderlineQueen]

There isn't a 100,000 midlevels graduating every year, nor do all of them want to do FM

Number of NPs/PAs in Specialty Care Rises 22% Over a Decade
Exactly most of them want Derm,Anesthesia or other surgical specialties. The top five specialties that hire NP/Pa are Derm,Cards,Gastro,Ob/gyn and ortho.

Number of NPs/PAs in Specialty Care Rises 22% Over a Decade

Multispecialty practices were the most likely to employ nurse practitioners and physician assistants, and surgical specialties were least likely to employ them.

www.medscape.com

 

[BorderlineQueen]

This is interesting to me because there’s almost exactly 2 opposite threads going on here. The group that thinks FM has a bright future and based off the repeated shortage numbers may suggest this. As well as the group that states FM is largely threatened by mid levels. This is in part why I asked this question because it seems so often that this field gets split. I feel like if our medical system were to change in the slightest that FM could see the same spike that psych has seen recently but until then it gets either overlooked or avoided.

Dude mid-levels are invading every field. Psych,Derm,Anesthesia and surgical specialties. The only thing safe for now is surgical specialties as NP/PA don't operate on their own but that might change.

 

[bigfootisreal]

Dude mid-levels are invading every field. Psych,Derm,Anesthesia and surgical specialties. The only thing save for now is surgical specialties as NP/PA don't operate on their own but that might change.

Totally agree. I personally really value the primary care specialties so I’m extremely hopeful that they begin to get the emphasis they deserve for our nation’s healthcare sake and for the sake of those seeking to go into primary care.

 

[studentxx8800]

I have not met one single FM resident that worries about job prospect and as a matter of fact, most of them are drowning in job offers all over the country. Some signed contract during their intern year and have been receiving stipend of 2k+ per month in residency. Can’t predict the future but if anything FM will become more prevalent as the cost saving benefit of preventive medicine is becoming more and more apparent to Uncle Sam and FM is the leader in the field of preventive medicine

 

[operaman]

My sense from friends who did it is that at least for now the outlook is still very good. The key point mentioned above is that you should make sure you actually enjoy the day to day work of FM, not just the variety. And I mean all the click boxes and paperwork that come with it - make sure on rotations that you get some exposure to this side of it too.

By and large my friends who did it have taken Hospitalist jobs after graduating residency. A few have done outpatient FM - some with insanely lucrative offers starting over 300k in underserved areas - but most have chosen to start out inpatient. This does raise the question whether IM would have been a better choice for them, so something to consider.

 

[AMEHigh]

I have not met one single FM resident that worries about job prospect and as a matter of fact, most of them are drowning in job offers all over the country. Some signed contract during their intern year and have been receiving stipend of 2k+ per month in residency. Can’t predict the future but if anything FM will become more prevalent as the cost saving benefit of preventive medicine is becoming more and more apparent to Uncle Sam and FM is the leader in the field of preventive medicine

Exactly.

I have a friend who’s about to finish fellowship in their super competitive "cool" field and there are literally 4 jobs in the country for them to apply to for their niche area. It’s cool to do what you love and train for a billion years to have 4 job options that all include moving yet again, but no thanks that’s not for me. If your FM you can literally find a job just about anywhere and you can tailor it to your interests.

 

[InternistDO]

Ortho, ENT, Derm, IR would like to say hi. There’s a reason competitive specialties are competitive.

I've heard attendings in all these fields complain about hours, midlevels, paperwork, and decreasing reimbursement. Crusty attendings complain about medicine, it's what they do. It has absolutely nothing to do with whether or not their field is competitive or lucrative.

 

[deleted957830]

I'd 100% be worried about the constant exponentially increasing influx of mid-levels. Everyone is trying to play doctor these days without any of the effort.

Third year med student and at our clinic, a pharmacy, PA, and nursing student all go in the room with me. I get lots of “oh wow I didn’t think to ask that” and interruptions during my presentations. Then when the attending comes in, they start writing notes furiously. I feel like I’m training my replacements so that when their lobbies successfully pull off the “heart of a PA/pharmacist/nurse, brain of a doctor” campaign, they will be ready. Also, I notice we are the only ones who seemingly have to have respect for other professions. These students regularly insult my training and treat me poorly.

 

[slowthai]

Ortho, ENT, Derm, IR would like to say hi. There’s a reason competitive specialties are competitive.

Reimbursements are decreasing and paperwork is increasing in like all fields. These competitive specialties are competitive for other reasons that I'm sure everyone's aware of: relative number of spots, pay, prestige, +/- lifestyle.

Midlevels have a significant presence in each field you listed. Midlevels prefer specialties, on average. Derm is also dealing with private equity and increased residency expansion.

 

[ace_inhibitor111]

There isn't a 100,000 midlevels graduating every year, nor do all of them want to do FM

There are 28,700 nurse practitioners and nearly 10,000 PAs graduating every year. Happy now? The point is a large proportion of these midlevels do end up in FM and many of them are actually clinically talented.

Reimbursements are decreasing and paperwork is increasing in like all fields. These competitive specialties are competitive for other reasons that I'm sure everyone's aware of: relative number of spots, pay, prestige, +/- lifestyle.

Midlevels have a significant presence in each field you listed. Midlevels prefer specialties, on average. Derm is also dealing with private equity and increased residency expansion.

I've never heard an ortho, ENT, derm, or IR doc complain, which is my point. Even if paperwork increases (how?) that's what they hire the midlevels for, to do the easy follow-ups and paperwork while they do the high-paying procedures that no midlevel will ever be able to touch. They're not directly competing against midlevels as opposed to specialties like FM or general peds.

 

[slowthai]

There are 28,700 nurse practitioners and nearly 10,000 PAs graduating every year. Happy now? The point is a large proportion of these midlevels do end up in FM and many of them are actually clinically talented.



I've never heard an ortho, ENT, derm, or IR doc complain, which is my point. Even if paperwork increases (how?) that's what they hire the midlevels for, to do the easy follow-ups and paperwork while they do the high-paying procedures that no midlevel will ever be able to touch. They're not directly competing against midlevels as opposed to specialties like FM or general peds.

I hear that, and I agree with your point that most of those fields are more or less untouchable from a midlevel competition standpoint. My point was that they are present in those fields, and they are used extensively. I will say that I have heard complaints from derm about midlevel competition, though.

But I have heard physicians in those fields (except for IR) complain about increasing paperwork/documentation burdens. They have to deal with the paperwork directly, not midlevels.

 

[Dr. Doctor MD]

There are 28,700 nurse practitioners and nearly 10,000 PAs graduating every year. Happy now? The point is a large proportion of these midlevels do end up in FM and many of them are actually clinically talented.



I've never heard an ortho, ENT, derm, or IR doc complain, which is my point. Even if paperwork increases (how?) that's what they hire the midlevels for, to do the easy follow-ups and paperwork while they do the high-paying procedures that no midlevel will ever be able to touch. They're not directly competing against midlevels as opposed to specialties like FM or general peds.

You can't group dermatology into that list. ENT/Ortho/IR have never been and will never be threatened by midlevels.

Dermatology (and most importantly patients) are suffering greatly from the rapid expansion of midlevels in the field. It its one of the top field for midlevels to invade and things are only getting worse.

Midlevels were originally made for primary care and have been around forever, and things are fine. There won't be many drastic changes. However fields like dermatology that were nearly devoid of midlevels 20 years ago are rapidly changing, largely because of PE and unethical doctors hiring and utilizing midlevels with no knowledge or supervision.

 

[frog301]

Thoughts on independent mid-level practice for primary care? One of the states I worked in has laws allowing mid levels to practice independently at urgent care centers. They only need to have a "physician on call" but I have seen only 1 out of maybe 300+ cases use this option to ask a question regarding treatment regimen. In reality, these are simple cases like flu/uri/uti stuff but the fact remains that they are still practicing with almost complete autonomy...

 

[bogle8]

Third year med student and at our clinic, a pharmacy, PA, and nursing student all go in the room with me. I get lots of “oh wow I didn’t think to ask that” and interruptions during my presentations. Then when the attending comes in, they start writing notes furiously. I feel like I’m training my replacements so that when their lobbies successfully pull off the “heart of a PA/pharmacist/nurse, brain of a doctor” campaign, they will be ready. Also, I notice we are the only ones who seemingly have to have respect for other professions. These students regularly insult my training and treat me poorly.

My experience exactly

 

[fldoctorgirl]

Dermatology (and most importantly patients) are suffering greatly from the rapid expansion of midlevels in the field. It its one of the top field for midlevels to invade and things are only getting worse.

I personally know several online degree NPs who graduated and opened up an "aesthetic" clinic injecting botox 2 days later. What a joke.

 

[Sleepingdoc]

Do what you like... If you like ortho.. do ortho...if you like family med... do family med...
If a med student decides to go to ortho because of step scores and pay while being uninterested in surgery... just imagine what could go wrong.

 

[Link0358]

The salary of FM docs have only climbed the past few years. The docs who I rotated with during my 3rd year were making close to 300K near a major US city. With Monday-Friday 8-5 hours, it’s certainly a nice gig.

Not sure how accurate this report is, but it’s encouraging for PCPs:

https://s3.amazonaws.com/s3.doximity.com/press/doximity_third_annual_physician_compensation_report_round3.pdf

With that said, no one really knows what the future of medicine will be. Maybe we become like Denmark where PCPs make more than specialists but we all make less.

All you can control right now is choosing a field that you will enjoy for the rest of your career.

 

[fldoctorgirl]

The salary of FM docs have only climbed the past few years. The docs who I rotated with during my 3rd year were making close to 300K near a major US city. With Monday-Friday 8-5 hours, it’s certainly a nice gig.

I think this is an important point. Outside of derm and maybe psych, all of the specialities making significantly more than PC also work wayyyy more hours and have significantly longer/more brutal residencies.

 

[bigfootisreal]

I think this is an important point. Outside of derm and maybe psych, all of the specialities making significantly more than PC also work wayyyy more hours and have significantly longer/more brutal residencies.

Besides the quality of work you do, this is one of the reasons I find it enticing. Not to mention the wide array of job types one get get into upon finishing residency.

 

[DoctwoB]

This thread is crazy. FM (and pcps in general) are insanely in demand. Like pick your location and receive good job offers. That is not the case in many fields.

Yes the pay is lower then most specialties and primary care deals with a lot of BS, but that is partly why it is so hard to fine and recruit good pcps

 

[VA Hopeful Dr]

So there are lots of parts to this to unravel.

Job opportunities: Great. Simply put there is no where in America that I could go and not get a job within a few weeks. And that doesn't include that FM is one of a handful of specialties where I couldn't just open my own practice from scratch and likely do well.

Money: Pretty good. I don't know anyone making under 200k and in our group almost everyone who works full time and has been here more than 18 months is pushing 300k. That said, this is highly variable. Go rural and you'll make more, go big city and you could make less. If you are salaried your potential is less than if you're paid on production. That said, we do make less than most other specialties and its very very rare to break 400k.

Lifestyle: Easily one of the best. 8-5, no nights/holidays/weekends. That also helps for money: plenty of time for moonlighting if you want.

Midlevels: Meh. My group has open positions for 8 family doctors. Zero for midlevels. Patients as a general rule prefer doctors. This has gotten more true with the increasing deductibles. If you're paying $10 to see the doctor you might accept a midlevel. If you're paying $100, you're going to be more picky.

Paperwork: Outside of charting if you're doing much paperwork you haven't trained your staff properly. Other than signing prior auths/PT forms/whatever I don't do any paperwork outside of charting.



Long story short: if you like FM, do it and you'll be fine. Now I can't predict what the field will be like in 30 years, but FM has been a solid choice for the last 30 and I don't see that radically changing barring a massive change to the whole American medical system in which case every field will be affected in major ways that are hard to predict.

 

[Angus Avagadro]

At the moment there is nothing to worry about, and tbh the future also looks incredibly bright, especially in comparison to other fields

Good lifestyle, short training, non-brutal residency, decent pay 225-250k (or more), incredible job market, very high demand, options for concierge or direct primary care. If you like the actual day to day practice of FM, there's no reason not to do it.

Not all FM residencies are Non Brutal, many programs have no other residents in the hospital so the FM residents have increased inpatient responsibilities, and even some OB. Makes for a good generalist IMO.

 

[AMEHigh]

Not all FM residencies are Non Brutal, many programs have no other residents in the hospital so the FM residents have increased inpatient responsibilities, and even some OB. Makes for a good generalist IMO.

Non-brutal is on a spectrum. I think what that poster was saying is that FM residency is only 3 years and the insanity isn't the same as neurosurgery for example. In addition, I'm going to stereotype here, but in general FM doctors are "nice" and the culture is different. So if you really are struggling with working for 24 hours then I think it's more acceptable to speak out, have faculty listen and get help/support you need. Whereas in some specialties you really are expected to work come hell and high water. I think those aspects of specialities are definitely something to consider as residency sucks no matter what, but it can suck less based on your specialty and your specific program.

 

[InvestingDoc]

Nah, not dying at all. I started my own primary care practice and netted just over 45k last month (after expenses). I've been open full time 11 months.

Be greedy when others are fearful and fearful when others are greedy.

No one is going into primary care anymore (it seems) and with all the high deductible plans, patients want to see a doctor rather than NP if they have to pay full price.

 

[bigfootisreal]

Nah, not dying at all. I started my own primary care practice and netted just over 45k last month (after expenses). I've been open full time 11 months.

Be greedy when others are fearful and fearful when others are greedy.

No one is going into primary care anymore (it seems) and with all the high deductible plans, patients want to see a doctor rather than NP if they have to pay full price.

Do you do DPC or traditional model?

 

[Kardio]

I started my own primary care practice

Is this something a new physician, one with ~300k debt, can pull off without family connections or business experience?

 

[nimbus]

I have not met one single FM resident that worries about job prospect and as a matter of fact, most of them are drowning in job offers all over the country. Some signed contract during their intern year and have been receiving stipend of 2k+ per month in residency. Can’t predict the future but if anything FM will become more prevalent as the cost saving benefit of preventive medicine is becoming more and more apparent to Uncle Sam and FM is the leader in the field of preventive medicine

Is there a cost saving benefit to preventive care? Or is it just kicking the can down the road? Everybody eventually becomes critically ill, then dies. More frequent primary care visits and preventive medicine may actually increase costs over a lifetime. People who live longer use more resources of every type including healthcare. The least expensive patients to our health care system are the ones who don’t see any doctors for 60 years, don’t take any prescription medications, then gets hit by a bus and dies at the scene.

 

[AMEHigh]

Is there a cost saving benefit to preventive care? Or is it just kicking the can down the road? Everybody eventually becomes critically ill, then dies. More frequent primary care visits and preventive medicine may actually increase costs over a lifetime. People who live longer use more resources of every type including healthcare. The least expensive patients to our health care system are the ones who don’t see any doctors for 60 years, don’t take any prescription medications, then gets hit by a bus and dies at the scene.

Yes there is mixed data in regards to whether or not preventive care saves money in the long run. However, I’m not sure the data looks at primary vs secondary vs tertiary prevention which is a good distinction to make. I would bet that secondary prevention so that a diabetic doesn’t end up having a heart attack, with an amputation and on dialysis is going to be an overall cost savings. But yes of course you’re correct, if no one ever went to the doctor then of course it wouldn’t cost anything, but productivity and quality of life would likely be drastically reduced as well.

 

[AMEHigh]

Is this something a new physician, one with ~300k debt, can pull off without family connections or business experience?

Yes if one is motivated enough then opening your own practice is definitely still possible. While not having a boss sounds great in theory I personally have no desire to have to think about the business side of medicine and I don’t want the responsibility of having to work everyday, especially in the beginning when you’re establishing things. I enjoy my vacation and "work-life balance" too much!

 

[Kardio]

Yes if one is motivated enough then opening your own practice is definitely still possible. While not having a boss sounds great in theory I personally have no desire to have to think about the business side of medicine and I don’t want the responsibility of having to work everyday, especially in the beginning when you’re establishing things. I enjoy my vacation and "work-life balance" too much!

I’m sure some of the rose tints will peel off my glasses as that day gets closer!

 

[InvestingDoc]

Do you do DPC or traditional model?

Traditional model. I take insurance

 

[Epilepsy365]

I used to care about the threat of midlevels as a premed and then as a MSI - MSIII.

Now, no way in hell. Loosen that anal sphincter and chill out kids.

 

[InvestingDoc]

Yes if one is motivated enough then opening your own practice is definitely still possible. While not having a boss sounds great in theory I personally have no desire to have to think about the business side of medicine and I don’t want the responsibility of having to work everyday, especially in the beginning when you’re establishing things. I enjoy my vacation and "work-life balance" too much!

absolutely. 100%, owning your own practice is not for everyone. There are lots of business and administrative decisions to be made. The trade-off for the freedom is that your salary decreases since you're paying someone to fill in that role.

I've seen approximately 3500 new patients in the last eleven months and I get about one call on average a week after hours.

Work life balance can be what you make of it.

Some of my friends share the same mentality though that they have no desire to do the administrative tasks and as a result I've just offering to add them to my tax ID, credentialing call my billing team and they can just open up shop. Working on finalizing plans to expand to a couple of more areas this way.

 

[InvestingDoc]

Is this something a new physician, one with ~300k debt, can pull off without family connections or business experience?

Yeah you can. I would suggest not going out, getting a business loan. If you're going to go solo, do locums, save some cash call around to find an independent surgeon or podiatrist or other specialist that you can just basically rent space from. Open up shop, get rolling and then once you're busy enough, go sign a five-year lease somewhere else.

I started up my practice for about $15,000.

 

[Epilepsy365]

absolutely. 100%, owning your own practice is not for everyone. There are lots of business and administrative decisions to be made. The trade-off for the freedom is that your salary decreases since you're paying someone to fill in that role.

I've seen approximately 3500 new patients in the last eleven months and I get about one call on average a week after hours.

Work life balance can be what you make of it.

Some of my friends share the same mentality though that they have no desire to do the administrative tasks and as a result I've just offering to add them to my tax ID, credentialing call my billing team and they can just open up shop. Working on finalizing plans to expand to a couple of more areas this way.

On the business side of things, give me the extra hours that you spend outside of clinical hours during your first two years Monday to Friday, and then Saturday/Sunday. I have a very strong business background before medical school, and am wondering about this aspect of medicine. Thank you for taking the time to answer our questions.