Is primary care the only/best way to serve disadvantaged communities/minorities?

[and 99 others]

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A large part of my goals as a doctor are to help underserved communities. However, I want to specialize as well and am not interested in FM/IM. Is there a way to synthesize more specialized fields such as surgery or neurology to be able to effectively help these communities on both a local and larger scale given that the brunt of the problems they face is a lack of access to primary/preventative care?

 

[Tenk]

So long as you are a generalist ie general surgeon, general orthopod, general ob, ED doc, general neurology, etc, you will have no problem finding a job in a rural location. It’s when you sub specialize like a CT surgeon, ortho trauma, gyn onc, stroke neuro intervention etc that you will have trouble finding cases in more remote underserved areas.

 

[and 99 others]

So long as you are a generalist ie general surgeon, general orthopod, general ob, ED doc, general neurology, etc, you will have no problem finding a job in a rural location. It’s when you sub specialize like a CT surgeon, ortho trauma, gyn onc, stroke neuro intervention etc that you will have trouble finding cases in more remote underserved areas.

What about in densely populated urban areas that are underserved?

 

[IlDestriero]

You could work in a community hospital that caters to the underserved in nearly any specialty. That will likely have a significant financial impact, but if that’s your motivator and desired career path it shouldn’t be a problem.
I took a pay cut to practice pediatric anesthesia. Don’t cry for me though, I do fine and you can as well.

 

[OrthoTraumaMD]

So long as you are a generalist ie general surgeon, general orthopod, general ob, ED doc, general neurology, etc, you will have no problem finding a job in a rural location. It’s when you sub specialize like a CT surgeon, ortho trauma, gyn onc, stroke neuro intervention etc that you will have trouble finding cases in more remote underserved areas.

This isn’t entirely accurate, at least for ortho. Any community hospital is happy to take non-generalists if they have a need. It depends on how “remote” you’re talking about. Tiny villages in the middle of nowhere, okay I get that. But my hospital system has plenty of hospitals in suburban/rural areas and we have specialists.

 

[Tenk]

This isn’t entirely accurate, at least for ortho. Any community hospital is happy to take non-generalists if they have a need. It depends on how “remote” you’re talking about. Tiny villages in the middle of nowhere, okay I get that. But my hospital system has plenty of hospitals in suburban/rural areas and we have specialists.

Those specialists work a small fraction of their time helping the rural areas. They usually belong to big motherships in a system and get referred to by satellite. I’ve worked in multiple small EDs and have never seen an orthopod let alone a fellowship trained one step foot in those EDs. Do they help in follow up? Absolutely. But they don’t primarily serve rural America. The numbers just aren’t there.

 

[Tenk]

What about in densely populated urban areas that are underserved?

It’s basically a numbers game, so yes, that would be easier. Most of the underserved people in urban areas just wind up in the EDs though.

 

[deleted480308]

You can work free for anyone

 

[NickNaylor]

You could work in a community hospital that caters to the underserved in nearly any specialty. That will likely have a significant financial impact, but if that’s your motivator and desired career path it shouldn’t be a problem.
I took a pay cut to practice pediatric anesthesia. Don’t cry for me though, I do fine and you can as well.

Completely agree. There are many geographical areas that would love to have any kind of specialist in their area. The problem, of course, is that you will very likely take a pay cut, though you will still make a good amount of money. Just depends on your priorities.

 

[LizzyM]

A large part of my goals as a doctor are to help underserved communities. However, I want to specialize as well and am not interested in FM/IM. Is there a way to synthesize more specialized fields such as surgery or neurology to be able to effectively help these communities on both a local and larger scale given that the brunt of the problems they face is a lack of access to primary/preventative care?

Some underserved communities are in densely populated areas. Look at epidemiology and health disparities and you will come to the realization that kidney failure, diabetes, obesity, stroke, prostate cancer and many other cancers, etc are more common in the black community than in others. Poverty is more prevalent in inner-city minority communities than elsewhere. So, patients are likely to be on Medicaid or uninsured (particularly in undocumented persons). Connect the dots and you'll see that there is a demand for specialists and subspecialists who are willing to serve in areas that are less lucrative and more challenging than in tidy upper-middle class suburbs.

 

[OrthoTraumaMD]

Those specialists work a small fraction of their time helping the rural areas. They usually belong to big motherships in a system and get referred to by satellite. I’ve worked in multiple small EDs and have never seen an orthopod let alone a fellowship trained one step foot in those EDs. Do they help in follow up? Absolutely. But they don’t primarily serve rural America. The numbers just aren’t there.

I get what you’re saying, but I spend a good portion of my time in a relatively rural hospital. So a lot of it depends on whether the orthopedic surgeon is actually willing to come into the ER. The hospital had never seen any orthopedic surgeon, period, before I showed up. That was because nobody ever bothered before me.

 

[DrFortiusNatando]

EM - still the safety net everywhere, even in the most wealthy places in the country, you will find communities who are needy and come to the ED.
Lots of undocumented and underinsured folk in the Hamptons, Gold Coast/Greenwich CT, Martha's Vineyard, East Palo Alto.

 

[Tenk]

I get what you’re saying, but I spend a good portion of my time in a relatively rural hospital. So a lot of it depends on whether the orthopedic surgeon is actually willing to come into the ER. The hospital had never seen any orthopedic surgeon, period, before I showed up. That was because nobody ever bothered before me.

Well you are a beautiful unicorn then!

 

[babybrains]

Yeah, as people have said, underserved populations still need subspecialists. Even in child neurology, a fairly subspecialized field, there's a huge push by the community to increase the number of child neurologists in rural/underserved areas, since oftentimes adult neurologists are seeing these kids due to lack of providers. The vast majority of the programs I interviewed at had rotations at underserved hospitals to ensure that we were caring for those most in need as well.

With adult neurology, there'd be plenty of opportunities to care for underserved populations. I know of multiple areas where people have to travel multiple hours if they want to see a neurologist, which is why telemedicine has become popular for some visits.