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Is FM really that bad?

Discussion in 'Family Medicine' started by WnderWmn10, Dec 2, 2008.

  1. WnderWmn10

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    I keep on reading these articles on how 0.0002% of medical graduates say they want to go into FM and how even fewer attendings would go into the field if they could do it all over again and blah blah blah...

    I am a third year Medical Student and I have yet to begin my Family Medicine rotation. However, I am having trouble imagining what sucks so much about FM. Granted it's much lower reimbursement than some of the other specialties. But, I always thought it would be great to educate on preventative care, build long term relationships with patients, and have the opportunity to refer to specialists as need. Also, training is shorter, and you can start paying off debt sooner. And, there is always going to be a demand for good family docs, especially considering that it saves health care $$$ to focus on preventative care (and I have trouble believing the paranoia that NP's and PA's will eventually take over the primary care field).

    So I guess my question is...for those of you who are practicing primary care physicians, or residents. What are your thoughts on the field. Is it really that bad???

    I trying to be hopeful here.. so I appreciate your help. Maybe there is even a FP doc or two out there that even love what they do. Imagine that?
     
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  3. Blue Dog

    Blue Dog Fides et ratio.
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    I've been in practice since 2001. I love my job. I have a very reasonable schedule and made a good living. I have never discouraged anyone from going into medicine or becoming a family physician, although I'm quick to point out that it's not for everyone.

    Medicine isn't what it used to be. Hell, nothing is what it used to be. It's hard to appreciate what family medicine is all about unless you're doing it. Most medical students don't "get it" unless they have exceptional mentors. I try to be an exceptional mentor. I think many medical students start out wanting to do something like FM, but they get it beat out of them during their training.

    FM is a specialty of breadth. It's not glamorous. There aren't any TV shows about family physicians. Specialists sometimes dish the dirt about FM to protect their "turf" and their (usually unjustified) incomes. However, I can tell you without question that I'm probably happier than most other doctors I know. I certainly complain a lot less.

    Furthermore, things are looking better for FM more and more these days. We're finally getting some attention in Washington that's long overdue. The future's so bright, you gotta wear shades. ;)
     
  4. AFSmiley

    AFSmiley Member
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    Oh I beg to differ good sir. Who needs Uncle Jesse, Grey, and this moron when you've got Jane fricken' Seymour! Booyah.
     
  5. sophiejane

    sophiejane Exhausted
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    No, it's not "that bad." It's not bad at all. In fact, it's perfect for me. Is it perfect for you? You won't know that until you get a little further along.

    Keep an open mind, as you are doing. And what Kent said about the Turf Wars is very true. I think a lot of subspecialists (even pediatricians and internists) are critical of FM not because they think we can't do what they do, but because they know we can do a great deal of it, and they are more than a little threatened by that.

    Medical students are heavily swayed by their teachers, who are largely subspecialists. But show me anyone who has had a truly great experience on a 3rd year family medicine rotation, and I will show you a future FM intern. :)
     
  6. Blue Dog

    Blue Dog Fides et ratio.
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    I don't think Dr. Quinn was board certified. ;)

    As a tangent, didn't Sophiejane used to have Dr. Quinn as her avatar?
     
  7. sophiejane

    sophiejane Exhausted
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    I'm not sure which is more disturbing: the fact that you quoted that '80s song, or the fact that I know that you are quoting an '80s song, and one that I heard on the radio when it was just released at that.

    Sigh.

    ;)
     
  8. Blue Dog

    Blue Dog Fides et ratio.
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    Timbuk3, baby! :horns:

    [YOUTUBE]wvIAyxpjEuc[/YOUTUBE]
     
  9. sophiejane

    sophiejane Exhausted
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    No, but that's a great idea! I'm a little weary of Southpark Sophie, and she's a little weary of me, I think...:)


    Edit: wait, maybe I did...is my MEMORY going now??? Sheesh...
     
    #8 sophiejane, Dec 2, 2008
    Last edited: Dec 3, 2008
  10. iatrosB

    iatrosB trying not to kill anyone
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    :cool:
     
  11. Blue Dog

    Blue Dog Fides et ratio.
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    That's the one...I thought it was Audrey Hepburn in "My Fair Lady," remember? :laugh:
     
  12. andwhat

    andwhat Senior Member
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    dude, its lifestyle and flexibility. People do not understand that. Anesthesia, do you really want a Surgeon and OR staff dictating what you do for the rest of you're life (Plus the constant real threat of nurses taking over youre job in the near future)?
    Opthalmology do you really want insurance companies dictating how you get compensated for the rest of your life (granted this affects several other specialties also)
    FM is all about flexibility. True, not compensated as well as certain other fields (Traditional Outpatient FM starting out that is -- I know of FM docs making half a mil a year, doing tons of procedures), however it is really up to you -- and what you want to do for a living.
    I personally would loathe the idea of surviving hospital call, followed by a day full of clinic the very next day. This just isn't worth it anymore.
     
  13. sophiejane

    sophiejane Exhausted
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    You have a mind like a steel trap. I have a mind like a mouse trap, apparently. That was YEARS ago!

    :laugh:

    Well, it's time for old Jane to reassume her rightful place. Now I just need Depakote to give her a Santa hat...
     
  14. Consigliere

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    Wow! There is so much that is so fundamentally wrong with this post that I cannot even comment on it. Anyone interested in learning what anesthesiologists actually do, feel free to PM me.
     
  15. secretwave101

    secretwave101 Senior Member
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    I'm a family doc...and I got to be on T.V.! Flew me out to Hollywood, shot on the set of "Scrubs", no less (no sightings of Zach, unfortunately).

    http://tlc.discovery.com/tv/diagnosis-x/bios.html

    WHAT'S UP NOW?? Maybe we got a little glam, too, SPECIALISTS!

    I put my show up on YouTube, if you're interested. It's cheesy (actually, I was cheesy), but it was fun.

    [YOUTUBE]http://www.youtube.com/watch?v=k272WcbOWqU[/YOUTUBE]
     
  16. J-Rad

    Physician Moderator Emeritus 15+ Year Member

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    If you look through my posts, you'll note that I am pro-FM despite being a pediatrician (http://forums.studentdoctor.net/showthread.php?t=513052&highlight=family+practice+pediatrician post #40). I chose subspecialty medicine because that is where my heart lies, but I am also pro-primary care (FM, IM, and Peds; frankly, on occasion I even miss primary care peds) and think that the state of affairs right now is a shame for ALL the primary care folks.
    That being said, I respectfully submit that the above statement is crap. I've never met an internist or a pediatrician that was threatened by FM docs. Now, I have met some who did not TRUST FM docs (in a clinical sense) and I think this stems from something akin to fear of the unknown (even if exposed to FM during med school, the internist or pediatrician is still limited to that time of exposure for knowledge of the training/practice of FPs) and a sense of that which is different (from their own frame of reference) is not as good.
    As a pediatrician I admit that I am sometimes concerned about the exposure that some FM residencies give their residents to pediatric patients. I obviously trained to be an expert in inpatient and outpatient pediatrics (and my program was probably a little more inpatient focused) so it skews what I think someone's training in peds should include. The ACGME stipulates a need for 4 months of pediatric training during an FM residency (http://www.acgme.org/acWebsite/downloads/RRC_progReq/120pr07012007.pdf p23) and goes on to say that "the time must include experience in the following areas: neonates, infant care (both well-baby and ill), hospitalized children, ambulatory pediatrics, emergency care of children and adolescent medicine. This may include experience gained on the Family Medicine Inpatient Service, in the emergency department, in the pediatric hospital and clinic, and experience in nursery care associated with OB experience, provided that appropriate documentation of such experience is maintained for each resident." But the division of that time seems to be somewhat variable from residency to residency. Kent did a great job explaining the similarities in the pediatric scope and nature of practice between FPs and Pediatricians, but ALL primary care docs are faced with the need to determine "sick or not sick" at times and may need to acutely stabilize a patient (including a kid for the FPs and Peds). Frankly, I'm fine with it being an FP, but I'm much more comfortable if I know that they have had substantial experience in caring for both well and sick kids during their [FM] training (initial and CME). Others in the Peds (and I imagine the IM) world are less open minded and can't imagine that someone who didn't spend
    5 months in the NICU taking care of critically ill neonates, 2+ months in the PICU taking care of critically ill 0-24 year olds, 9+ months in the inpatient pediatric service taking care of mild to moderate to heading-down-to-the-PICU 0-24 year olds, and rotating through required outpatient pediatric rotations (developmental, adolescent, clinic) and electives could take care of kids as well as they do (understand my point in writing that last statement: it was not to point out the inadequacies of the FM trained, but rather to point out the differences that people see from their own frame of reference. I again reference Kent's sticky on pediatric practice of FPs and outpatient pediatricians for an explanation of why I think that this mindset is infrequently valid).
    As someone who is training to be a subspecialist, I feel even less threatened. You should very easily be able to distinguish a benign from pathological murmur in a child. But beyond that, what part of my job do you think I'm afraid of losing to you (and frankly, I really wish you and the other FPs and Pediatricians would make the "benign murmur" call in your office a little more often)? Other than colpos and suturing, what procedures that you share with some subspecialties are you going to steal from a pediatric subspecialist? Are FPs doing colonoscopies on 5 year olds often?
    (So after my long aside) back to the original statement: Sophie, this is akin to DOs saying that MDs are threatened by us because we can do everything they can do plus some. There are some DOs that believe this crap, but have you met many MDs that feel threatened at the thought of losing business to you because of your degree? Or, if you have met anyone who has thought lesser of your degree (though if you've had similar experiences to mine, the answer may blessedly be "no") was it for similar reasons to the above?
    So why did I spend so much time typing up what essentially amounts to an overly wordy aside? Because, folks, the "primary care" crisis does not apply only to FPs. The pediatricians and internists suffer from a screwed up system as well. I'd suggest that maybe pissing on your colleagues who are in the same boat as you might be self defeating. Unification of all primary care specialties toward a goal of more fair reimbursement may be a more seemly goal. Frankly all medical specialties have a vested interest in improving the screwed up areas of medicine (screwy reimbursement, abuse of EDs, defensive medicine which leads to inappropriate use of specialists...Oh, and before anyone jumps on a subspecialist for bringing up screwy reimbursement, just remember that the peds subs have the most reason to complain. You just can't tell me why when hearts like
    Heterotaxy.gif
    are stock in trade for my field, why I most likely make >$100,000 less than my adult counterparts?)
     
  17. Blue Dog

    Blue Dog Fides et ratio.
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    Most non-primary care specialties have a much more vested interest in preserving the status quo. Any increases in reimbursement for primary care will very likely come at the expense of procedural-based specialists. Don't think they don't realize this.

    None of that has anything to do with reimbursement. It has to do with the, um..."unique" malpractice climate in this country. That's another subject altogether.

    In a word? Medicaid.
     
  18. sophiejane

    sophiejane Exhausted
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    OMG!! Can I like, have your autograph?!!!

    Really, that was cool. Very fun.

    Who knows...you may not NEED to worry about how much real doctors make if the right people in Hollywood see this! ;)
     
  19. iatrosB

    iatrosB trying not to kill anyone
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    Honestly, FM IS that bad and no one should apply to it...especially this year, in the midwest :D
     
  20. Blue Dog

    Blue Dog Fides et ratio.
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    You're not afraid of a little competition, are you?

    I applied to FM in 1998, practically at the peak of interest in primary care.

    I had to walk uphill to my interviews, too...both ways. ;)

    (Check out them apples...)

    [​IMG]
     
  21. J-Rad

    Physician Moderator Emeritus 15+ Year Member

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    I acknowledge that I cannot speak to reimbursement issues as knowledgeably or as you do. I really enjoyed [most] of the "Are Subspecialists..." thread and your (and Mohs') contribution to it esp. when it came to discussions of reimbursement.
    My post was rather "stream of consciousness" so I should note that when referring to the "screwed up" areas of medicine I meant that very broadly to include things such as the malpractice environment in this country. While you may be correct that [adult] subspecialists may fight restructuring of the reimbursement system (I wonder if the peds subs would have a different opinion) I do believe that in a grand sense we can all unite for the greater good of medicine even though we may not agree on every point. I guess I was being a little naive and Kumbaya about it.
     
  22. DrJosephKim

    DrJosephKim Advisor
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    The BIG question is: how will family medicine change under this new administration?
     

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