Is this generalization true about Carib schools? And if so, whats the problem?

[DrDre2001]

---

Members do not see this ad.

From what i've heard, if i go to a caribean school (instead of staying in school next yr and trying to make my application better for US schools) i will be "stuck" in a position when i apply for residency that will leave me with only the choice of Family Practice or Internal Med. These are the least competitive specialties and so this makes sense.

However, i don't really mind this. From what ive seen, Family physicians work around 50-55 hours a week and have so have a nice/not chaotic lifestyle. And according to FIELDA, residency for FP doesn't get too out of hand with the amount of hours that we will be expected to do in comparison to other specialties.

So i guess what im basically asking is, what is the big problem with going into FP or IM? Some say that going into FP is not very exciting and they feel somewhat undervalued because they will be doing things that PA's and nurses could do. But so what? If you like doing those things, then who cares who else can do it?

And obviously there is the money issue. I for one hardly even care about this though. 120 thousand/yr for when i start my practice and 150 thousand/yr once i am established looks good to me.

 

[RussianJoo]

no problem with that at all. if you want to be an IM or FP doc then there's nothing wrong with that.. lots of US grads go into IM and FP as well.

The problems is that if you want to be a Radiologist or Dermatologist or Orthopedic surgeon or ENT or anything that's competitive then your chances of doing that drop to a very small percent by going to the caribbean, and to be honest not everyone wants to be an IM or FP doc. But it will really suck to have to settle for a specialty that you hate or isn't your absolute top choice because you didn't wait for 1 year and get into a US school. Most don't know what they want to be until their 3rd year when they actually get to see what these docs do all day.

so if you're 100% sure that you'll be happy with being an IM doc then by all means go to the caribbean.

 

[JonathanMD]

From what i've heard, if i go to a caribean school (instead of staying in school next yr and trying to make my application better for US schools) i will be "stuck" in a position when i apply for residency that will leave me with only the choice of Family Practice or Internal Med. These are the least competitive specialties and so this makes sense.

St. George's University 2009 Residency Appointments:
https://baysgu35.sgu.edu/ERD/2009/ResidPost.nsf/BYPGY?OpenView&RestrictToCategory=PGY1&Count=-1

Ross University 2009 Residency Appointments:
http://www.rossu.edu/medical-school/files/2009ResidencyList.pdf

Majority are IM or FP, but plenty are not. Caribbean schools match lists differ a lot from school to school. People tend group all Caribbean schools together much too liberally. (The same people who enjoy linking to some rediculous chart that states US grads have 95% chance and 43% of Caribbean grads to successfully match.) You just can't bunch them all up together.

I'm going for ER myself.

 

[dragonfly99]

drdre
There are other specialties that tend to be easy to get, other than IM and fp. Psych, I think pathology, and to some extent peds, neuro and physical med/rehab also fall into that category.

A lot of people think they want to do primary care when they start med school, but then when they see that it can be more of a grind than many other specialties (to some extent physically, and also mentally, and in terms of the amount of BS paperwork and also some lack of respect from patients and colleagues) they change their minds.

It is true there are probably some cushier fp residencies and IM residencies, but compared with specialties that do little or no overnight call in residency (psych after the first few months, pathology, probably PM and R, etc.) the fp or IM residency can be demanding. We (IM) also tend to become the dumping ground for patients who are old, debilitated, poor with bad social circumstances, perhaps psych issues, but who have no easily identified medical problem that requires hospital admission. For example, we sometimes get patients that surgery or psych don't want to admit, for various reasons. I never minded that aspect too much, but it can make call harder when you have other patients who are actually acutely sick who need your attending, and it's just more paperwork (admissions notes, etc.) that has to be done that really doesn't add a lot to your learning. Sometimes those patients turn out to be interesting, though.

As far as the real world/out in practice, general IM and fp, if they still take hospital call/admit their own patients and don't turf everything to a hospitalist, pretty much commit to a lifetime of being on call. If you do a specialty like ER or dermatology, there is no such thing as being on call, essentially. Surgical subspecialists like urology and plastics would only have to see emergency consults in the ER, or postop complications, but not do a lot of hospital admissions in the middle of the night or after hours. Specialists in general don't have to deal with the volume of paperwork and BS from insurance companies and the gov't, either, though they deal with some. Basically, the primary care doc can become the final common dumping ground for all paperwork, patient complaints, etc. that nobody else wants to or is able to deal with. They are not financially compensated for a lot of the paperwork and care coordination they do, either. This is not to say that primary care has the worst lifestyle (would say general surg, trauma surg, etc. are definitely worse) or that it has no rewards (it's nice when some patients show appreciation and some get better). It's just not something I could personally do for years on end.

 

[relaxedMD]

A lot of people think they want to do primary care when they start med school, but then when they see that it can be more of a grind than many other specialties (to some extent physically, and also mentally, and in terms of the amount of BS paperwork and also some lack of respect from patients and colleagues) they change their minds.

...sometimes get patients that surgery or psych don't want to admit, for various reasons.... it's just more paperwork (admissions notes, etc.) that has to be done that really doesn't add a lot to your learning....

As far as the real world/out in practice, general IM and fp, if they still take hospital call/admit their own patients and don't turf everything to a hospitalist, pretty much commit to a lifetime of being on call.... Specialists in general don't have to deal with the volume of paperwork and BS from insurance companies and the gov't, either, though they deal with some. Basically, the primary care doc can become the final common dumping ground for all paperwork, patient complaints, etc. that nobody else wants to or is able to deal with. They are not financially compensated for a lot of the paperwork and care coordination they do, either. This is not to say that primary care has the worst lifestyle (would say general surg, trauma surg, etc. are definitely worse) or that it has no rewards (it's nice when some patients show appreciation and some get better). It's just not something I could personally do for years on end.

Oh My God! Dragonfly, you read my mind. My experiences in the hospitals drove me away from primary care.
OP, Get some good exposure in IM/FP, ask those docs about their residency experiences, before you jog off to medical school. Or else you may find yourself a bit confused when you get to 4th year of med school.

rlxdmd

 

[RustedFox]

Agree wholeheartedly with the above two posts.

I wish I'd have known more about A LOT of subspecialty fields (including primary care) before beginning medical school.... it would have made making up my mind a WHOLE lot easier (not to mention scheduling my fourth-year rotations).

I matched into EM from SGU. When I started, I felt SURE that I wanted to do FM/IM and nothing else. A few things changed my mind:

1. With FM, you're pretty largely tied to a practice/group, and there's a LOT of paperwork/running of a business involved. In my world, medicine is difficult enough without the paperwork and politics. That, and since I suffer from a terminal case of wanderlust, I wanted to remain very largely portable.

2. With IM, you can often spend more time with doctors talking about patients than you actually do with the patients themselves. While I found IM to be great for satisfying my intellectual curiosity, it can get VERY tedious and time-consuming. That, and the seemingly endless call schedule turned me off to it; I've got too many other interests outside of the hospital. "Internal Medicine" became "Eternal Medicine" to me. In the end, the benefits didn't justify the time requirements. This may sound selfish, but hey - I'm only one man.

3. The other drag is that if you want to do any IM subspecialty (Cardio, GI, Endo, etc.) - you're going to have to commit another year or two or three to a fellowship. After four years of undergrad, four years of medical school, and three years of residency, I am really sick of the "student mindset". I'm not getting any younger, and like I said - I've got side-projects that really need my attention.

This has just been my experience. I would be lying if I said to you that there aren't times when I say to myself - "Y'know, I really should've went into IM/FM instead...." because of the many good things about those fields. Just hit each specialty's forum and you'll find all the pros/cons from the people themselves.