Is FM a dying field?

[DO2015CA]

its reassuring to see the comments on this forum by FP MD/DO about the "threat " from APN

However it seems like many practices are cutting down the number of MDs they have had in the past

both of my past practices have cut down MDs by like 75% and filled the remaining slots by APNs
ofcourse we can argue these were not great "quality" practices [ they were FQHCs] that is debatable however
the fact is there is SOME ground that is being lost to midlevels as the administration for the most part does not see much difference except that APNs are cheaper

Like the trend in the 70s and 80s when FAC started replacing most destroyers /frigates as the former can carry the same long range antiship missiles thus the same ASUW capability.To the laymen it does not matter that FAC were bad sea boats, had poor ASUW or AAW capabilities and were ill suited to peace time or blue/green water missions.

newer physicians just need to refuse to oversee these midlevels. The hope is lost swaying older ones to stop. Their proliferation of schools without a bottle neck is already starting to see a pinch on job opportunities. The recruiter at my old hospital would get 150 applications for 1 spot. I can tel you the ones winning out are the ones that had extensive clinical careers prior to schooling. The least amount of clinical experience required ones are having a hard time

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[DO2015CA]

I think they should change the name of Family Medicine to General Medicine.
American Board of General Medicine.
Or General Practice
American Board of General Practice

Why?

 

[VA Hopeful Dr]

I think they should change the name of Family Medicine to General Medicine.
American Board of General Medicine.
Or General Practice
American Board of General Practice

No, because General Practitioners already exist and are distinct from Family Physicians.

 

[PieOHmy]

Why?

Because it describes what they do.. Family sounds stupid

 

[DO2015CA]

Because it describes what they do.. Family sounds stupid

That’s rude. No it does not. It depicts their role. Cradle to the grave medicine. General medicine is used sometimes in the hospital to refer to the IM team on the general medicine floor

 

[PieOHmy]

That’s rude. No it does not. It depicts their role. Cradle to the grave medicine. General medicine is used sometimes in the hospital to refer to the IM team on the general medicine floor

How about General Practice? As in General PRactitioner.

 

[DO2015CA]

How about General Practice? As in General PRactitioner.

General practitioners still exist to a much smaller number. For the people that didn’t finish a BE residency. They just finish intern year. The majority of them work for the jail system I’ve noticed

 

[VA Hopeful Dr]

General practitioners still exist to a much smaller number. For the people that didn’t finish a BE residency. They just finish intern year. The majority of them work for the jail system I’ve noticed

Exactly. Family medicine became a specialty precisely to distinguish ourselves from GPs.

 

[DO2015CA]

Exactly. Family medicine became a specialty precisely to distinguish ourselves from GPs.

And the extra training is well served for the specialty. They are the masters of outpatient medicine. You really can not become competent in outpatient medicine in the 1 intern year. Outpatient medicine is hard and learning for all age ranges even harder. Family medicine really is a specialty not just GP. I’ve seen nuanced peds be missed due to the relatively small exposure compared to adult exposure in residency but really they are great outpatient clinicians.

 

[scharnhorst]

I second general practice or primary care provider
But that's just my preference and that's how I introduce myself.
Others prefer family medicine I DO NOT see whole families so in my case inaccurate description

 

[scharnhorst]

General practitioners still exist to a much smaller number. For the people that didn’t finish a BE residency. They just finish intern year. The majority of them work for the jail system I’ve noticed

Didn't know u can practice without finishing residency

 

[VA Hopeful Dr]

Didn't know u can practice without finishing residency

State dependent, but a majority allow it.

 

[KeikoTanaka]

State dependent, but a majority allow it.

Although if I recall correctly, CA was the most recent state to disallow 1 year-internship directly into independent practice. I imagine it will spread and become the norm.

 

[PieOHmy]

Although if I recall correctly, CA was the most recent state to disallow 1 year-internship directly into independent practice. I imagine it will spread and become the norm.

They let Nurse Practitioners do it in an 18month online course why should they let physicians do it

 

[hallowmann]

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.

I seriously get multiple emails a week with new FM job offers, and I swear, I only signed up for 1 recruiter because I was curious. I can't imagine what it would be like if I was actually looking.

Everyone on here who is super against midlevels in any capacity, super against school expansion, and super against Carribean and some foreign grads. Where the hell do you think all the doctors will come from? At some point, there are purely too many patients. If the docs on my IM subspecialty service were completely on their own, we literally would never see all the patients, finish notes, and be able to have any sort of a life. Personally I enjoy my free time outside the damn hospital.

I'm not saying midlevels should gain any more power, but utilized correctly they do serve a role. If there ever gets to be some standardization of schools and role on the team (like how PAs are), then were getting somewhere.

Cue the vicious posts calling me out for 'midlevel sympathy', but the logic on here astounds me

The reason that the specialty service is struggling, is because the hospital doesn't want to pay for more attendings or sponsor more residency spots. Too much money going to administrators or the billing department to sort out the American insurance system.

That said, I don't think it's the end of the world if midlevels work in their appropriate capacity under physicians. I won't be hiring or training them more because of their rhetoric than anything else, but I think they have a place in healthcare.

Although if I recall correctly, CA was the most recent state to disallow 1 year-internship directly into independent practice. I imagine it will spread and become the norm.

This isn't a new thing. The majority of states still license GPs. CA is just the most recent of the 18 or so that don't. I don't see GPs going away 100% during my practice lifetime.

And in all honesty, any state that has unlimited practice rights for NPs/PAs should be licensing GPs too.

 

[DO2015CA]

I seriously get multiple emails a week with new FM job offers, and I swear, I only signed up for 1 recruiter because I was curious. I can't imagine what it would be like if I was actually looking.



The reason that the specialty service is struggling, is because the hospital doesn't want to pay for more attendings or sponsor more residency spots. Too much money going to administrators or the billing department to sort out the American insurance system.

That said, I don't think it's the end of the world if midlevels work in their appropriate capacity under physicians. I won't be hiring or training them more because of their rhetoric than anything else, but I think they have a place in healthcare.



This isn't a new thing. The majority of states still license GPs. CA is just the most recent of the 18 or so that don't. I don't see GPs going away 100% during my practice lifetime.

And in all honesty, any state that has unlimited practice rights for NPs/PAs should be licensing GPs too.

agreed. GP>>>>>>>>>>>>mid level solo practice rights. You did at least an internship so you know how to not kill someone

 

[sunshinefl]

How about General Practice? As in General PRactitioner.

They’re not a general practitioner though. They have trained and specialized in Family Medicine. Please stop insisting on devaluing that.

 

[MedicineZ0Z]

And the extra training is well served for the specialty. They are the masters of outpatient medicine. You really can not become competent in outpatient medicine in the 1 intern year. Outpatient medicine is hard and learning for all age ranges even harder. Family medicine really is a specialty not just GP. I’ve seen nuanced peds be missed due to the relatively small exposure compared to adult exposure in residency but really they are great outpatient clinicians.

And many do inpatient medicine too. You don't just do outpatient necessarily..

 

[DO2015CA]

And many do inpatient medicine too. You don't just do outpatient necessarily..

Sure. But they are not as equipped as IM for that. There are the masters of outpatient but not inpatient. Just like IM can and do outpatient but they get vastly less experience in outpatient compared to FM and vice versa for inpatient

 

[MedicineZ0Z]

Sure. But they are not as equipped as IM for that. There are the masters of outpatient but not inpatient. Just like IM can and do outpatient but they get vastly less experience in outpatient compared to FM and vice versa for inpatient

You mean on average or vast majority of cases? I'd fully agree with the average and strongly disagree with vast majority. The subset of FM who pursues an inpatient dominant career will be on par with the average IM. The reason is that there are truckloads of community IM residencies which do not provide the same patient complexity of training that the strong FM residencies do.
# of months on inpatient is just one statistic to look at. Patient complexity/acuity and census volume are extremely important as well.

 

[Ole_Toe]

My Dean told me at our white coat ceremony that a psych fellowship for FP has been approved. They did not elaborate on what sites or accreditation. I expect to see them advertised soon.

Can anyone confirm if this is real? I know there are a few psychiatry/FM combined residencies, but psychiatry fellowships would be a huge win for FM docs. I've searched around and can't seem to find many details about what this entails, or what the scope of practice for fellowship trained FM docs would be.

 

[Splenda88]

I think we should definitely have a 2-yr psych fellowship for FM docs... maybe IM as well.

 

[DameJulie]

If you are a FM doc trained by a primary care pathway, how would your daily practice/salary/hours different than a midlevel?

If one is pursuing FM, should they pursue fellowship too to avoid future midlevel problems?

 

[VA Hopeful Dr]

If you are a FM doc trained by a primary care pathway, how would your daily practice/salary/hours different than a midlevel?

If one is pursuing FM, should they pursue fellowship too to avoid future midlevel problems?

At my job, our base salary is ~2.5X the NPs. We actually make way more than that as most physicians are much busier than NPs and we're mostly production based.

Hours are pretty much the same - we all have to do a minimum of 36h/week to be considered full time.

Day to day work is also pretty much the same, except for the physicians who supervise the midlevels who have extra work for that part.

That's not a great reason to do any of the fellowships FM has access to. When it comes to FM, midlevels aren't a huge impediment to finding work.

 

[Ole_Toe]

That's not a great reason to do any of the fellowships FM has access to. When it comes to FM, midlevels aren't a huge impediment to finding work.

Have you heard anything else about these supposed psychiatry/mental health fellowships that were previously discussed? It's certainly an interesting idea, but I can't seem to find anything confirming that they are real, or that they would equip FM docs to open a psych-focused outpatient clinic. As someone currently on the fence between psychiatry and family medicine, this option would be very appealing.

 

[NITRAS]

Have you heard anything else about these supposed psychiatry/mental health fellowships that were previously discussed? It's certainly an interesting idea, but I can't seem to find anything confirming that they are real, or that they would equip FM docs to open a psych-focused outpatient clinic. As someone currently on the fence between psychiatry and family medicine, this option would be very appealing.

You are missing it. When you get your medical license, it is an unrestricted license. The same license they give to IM docs and surgeons. I could open my own psychiatry practice if I wanted to. I couldn’t say that I was board certified or sit for board certification Unless I fulfilled the requirements (which would be go to a psychiatry residency Unless they have an alternate pathway I’m not familiar with). I’m not the person to tell you how that would effect your insurance payments.

You can practice medicine quite broadly. FM (and IM) are ultimately generalist specialities. It doesn’t mean you can’t focus on the parts you like.

 

[VA Hopeful Dr]

Have you heard anything else about these supposed psychiatry/mental health fellowships that were previously discussed? It's certainly an interesting idea, but I can't seem to find anything confirming that they are real, or that they would equip FM docs to open a psych-focused outpatient clinic. As someone currently on the fence between psychiatry and family medicine, this option would be very appealing.

There are non-accredited Behavior Health fellowships that already exist. I haven't heard anything about fellowships in psychiatry beyond that.

 

[Ole_Toe]

You are missing it. When you get your medical license, it is an unrestricted license. The same license they give to IM docs and surgeons. I could open my own psychiatry practice if I wanted to. I couldn’t say that I was board certified or sit for board certification Unless I fulfilled the requirements (which would be go to a psychiatry residency Unless they have an alternate pathway I’m not familiar with). I’m not the person to tell you how that would effect your insurance payments.

You can practice medicine quite broadly. FM (and IM) are ultimately generalist specialities. It doesn’t mean you can’t focus on the parts you like.

To be honest, I never knew this! I didn't realize that a psychiatrist, if so inclined, could open up a direct primary care/integrated behavioral health clinic, and there would be no legal repercussions. I understand the ethical and financial reasons against it, but thank you for clarifying this point.

 

[TwistedTea]

If you are a FM doc trained by a primary care pathway, how would your daily practice/salary/hours different than a midlevel?

If one is pursuing FM, should they pursue fellowship too to avoid future midlevel problems?

Does your circle of med school friends compare FM to midlevels while all the surgical subs are compared to gods? lmao