Is there something wrong with this train of thought?

[han14tra]

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I'm trying to decide between a residency in family medicine vs. emergency medicine.

Here's the dilemma:
If I could go back to my hometown, which is an area that hasn't had a physician since the 1960s and is extremely rural, I would do family medicine in a heartbeat. I've always liked the idea of returning to the town where I was raised and fulfilling the need for doctors there.

However, if I can't practice family medicine in my hometown, then I'm not sure I want to do family medicine at all. I just wouldn't feel the same connection to the people. I would probably choose emergency medicine instead. I've always loved responding to emergencies as an EMT, and I've enjoyed my time in the ED. And, reading about emergency medicine is one of my favorite past times.

Main point: I really like emergency medicine, but the desire I have to return as a family doctor to the town that has given me everything but has nothing is huge.

I'm so confused and afraid of making the wrong choice. If I could be guaranteed a family practice office in my hometown, this decision would be easy. But, I'm just afraid it won't work out. Anyone have any advice?

 

[OneTyme]

I'm trying to decide between a residency in family medicine vs. emergency medicine.

Here's the dilemma:
If I could go back to my hometown, which is an area that hasn't had a physician since the 1960s and is extremely rural, I would do family medicine in a heartbeat. I've always liked the idea of returning to the town where I was raised and fulfilling the need for doctors there.

However, if I can't practice family medicine in my hometown, then I'm not sure I want to do family medicine at all. I just wouldn't feel the same connection to the people. I would probably choose emergency medicine instead. I've always loved responding to emergencies as an EMT, and I've enjoyed my time in the ED. And, reading about emergency medicine is one of my favorite past times.

Main point: I really like emergency medicine, but the desire I have to return as a family doctor to the town that has given me everything but has nothing is huge.

I'm so confused and afraid of making the wrong choice. If I could be guaranteed a family practice office in my hometown, this decision would be easy. But, I'm just afraid it won't work out. Anyone have any advice?

Well, if there hasn't been a doctor there since the 60's.... You are going to be the person who has to start a practice there. There will be no company to 'guarantee' that you have a job there. You will be self employed. You will be in charge of the business.

If starting, maintaining, and running business has no appeal to you.... Don't plan on going back there to practice.

 

[han14tra]

Well, if there hasn't been a doctor there since the 60's.... You are going to be the person who has to start a practice there. There will be no company to 'guarantee' that you have a job there. You will be self employed. You will be in charge of the business.

If starting, maintaining, and running business has no appeal to you.... Don't plan on going back there to practice.

The area hospital has spoken to me a little bit (weird I know, but they sort of sought me out and asked if I would come back). They are looking to expand their services and are interested in putting a practice in my hometown if I sign a contract stating that I will work there. However, they said they have to do feasibility studies first to see if the area is large enough to support a practice. They aren't planning on doing this until I'm in residency, but I really want to know now as it may influence my career choice. Should I just talk to the hospital about this? I sort of feel like a tool talking to the hospital about where my practice is going to be considering that I'm only a 3rd year med student.

 

[loveoforganic]

There's at least one dual FM/EM residency - http://www.christianacare.org/emergencymedicinefamilymedicine

and several IM/EM residencies -

http://www.abim.org/certification/policies/combinedim/comem.aspx#programs

both 5 years in duration if those would be a possibility. I would think EM training would actually be quite helpful in a very rural practice - potentially save a good number of hospital referrals

Don't take my word as gospel though, just a 1st year

 

[SpecterGT260]

what about your home down makes you want to do FM there?

Is it the patients you want to work with in the FM setting or is there not an EM openning and you want to be back home for personal reasons?

neither is necessarily good or bad, i am just curious about your motive.

I dont always think along the same lines as many people and tend to be pragmatic to a fault, but for me I feel like the hometown is subjective and intangible. or in other words, impermanent. The people will change with generations and normal flux of people in communities. The people you knew there will not always be there so eventually you are working the functional equivalent of someone ELSES home town. However if it is personal for you - i.e. you like the towns layout, you are comfortable with the surroundings, you see yourself living there when you are no longer working, then it makes more sense. I would just really assess whether my motivations are for the people who are likely to be fickle or for what the community gives YOU. and then when you get there figure out if what you have determined is worth it to you. personally I'd go with the specialty of choice over the region of choice because it will last longer

 

[armybound]

You can always start a family practice without having done a residency in FP. It's sort of general doctoring that most physicians should be able to do. You don't even have to complete a residency to be a GP.

 

[MT Headed]

One of the two physicians in my small town's Family Practice clinic is board certified only in EM. He just got tired of the ED scene and came back to his hometown to practice general family medicine. He could always leave and go back to practicing as an EP if he later decides he doesn't like the small hometown scene.

Seems like he has the best of both worlds.

 

[Rendar5]

You don't need a company to start your own practice.

 

[BigPizza]

Hmm.. can you start your own family practice with only ER board certification?

 

[K31]

Hmm.. can you start your own family practice with only ER board certification?

You probably couldn't advertise as a "family physician" without FM board certification, but you can start your own medical practice so long as you have a medical license. No board certification necessary (although the lack thereof may make credentialing and malpractice insurance more difficult).

 

[MT Headed]

Hmm.. can you start your own family practice with only ER board certification?

The clinic in my village is run by an allergist and an EM physician. They advertise themselves as "(town) Medical Clinic" and claim to have "expertise" in three three medical specialties, none of which is EM or allergies. The ad does mention "family care" though.

Another physician recently set up shop on the other side of the village. She calls her place "(county) Family Medicine" and she is board certified FM. So apparently you can practice whatever your insurance company allows you to, but you might have to watch your advertising carefully.

 

[ArcGurren]

If you are one of the central caregivers for primary care in your area, then it's a GREAT idea to practice medicine there. You're sorely needed and it sounds like it'll make you and the people you serve very happy. Plus, you will probably make bank in that area given that you'll be in high demand.

 

[Bacchus]

Are there any obligations besides a contract binding you there? Perks? Cons?

 

[Rendar5]

Hmm.. can you start your own family practice with only ER board certification?

If you're going to start a family practice, do family medicine. I promise you that as an EM-trained guy, I can take care of a lot of outpatient stuff, but you don't want me managing your chronic diseases, trust me.

 

[officedepot]

.

 

[Valadi]

Hmm.. can you start your own family practice with only ER board certification?

There are oral surgeons and obgyns calling themselves 'cosmetic surgeons' and running around doing rhinoplasties and breast augmentations.

Many states do not have laws requiring that you practice within your boarded specialty. Basically if you have an MD, you are licensed to do whatever you want in these states.

 

[SpecterGT260]

There are oral surgeons and obgyns calling themselves 'cosmetic surgeons' and running around doing rhinoplasties and breast augmentations.

Many states do not have laws requiring that you practice within your boarded specialty. Basically if you have an MD, you are licensed to do whatever you want in these states.

But the board will smack you pretty good for doing so...