Just how necessary is primary care experience?

[Wilted]

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I've seen some posts on here critiquing certain people's shadowing/clinical work/volunteering experiences because they are only in highly competitive fields (IR, Ophthalmology, Ortho, Cardiology, etc.), saying that it is necessary to spend some time among primary care specialties also. In my case all of my experiences so far have involved competitive fields because this is what I took an interest to early on. I get the reasoning of wanting to be sure you will still enjoy being a physician if you can't be a specialized surgeon or go into a competitive fellowship, but how off-putting would it be to adcoms if they read an app with no primary care experience at all?

 

[eigen]

This is less about how adcoms consider it, and more about my advice to applicants, but how do you know you'd be happy being a primary care physician if you have no experience in primary care?

On how it looks to adcoms, do you feel like you'd be able to convince them that you've seen and experience a broad swath of what it means to be a doctor?

 

[ecobio]

Not strictly required, but a nice addition to have. In general showing broad experiences is helpful—gives you more perspective when entering the field. Its okay to not be interested in FM or primary care, but I think its important to understand what happens in those settings, which you can only do if you actually seek out those experiences.

With that said, if everything else in your app is good, i highly doubt adcom would scrutinize your shadowing experiences specifically. Hours are hours.

 

[LunaOri]

At my school, we like to see some clinical experience or shadowing that involves primary care or a primary care adjacent field. That would include family med, IM, peds, geriatrics, EM, ObGyn. If you have a parent or sibling who practices in primary care, I wouldn’t consider additional exposure necessary. If your only medical exposure is limited to a specialized field, I would worry that you don’t really know what you are getting into.

 

[Hollow Knight]

I think it’s pretty necessary.

The thing is, if you know you’d hate IM or general surgery, I’d argue you shouldn’t even go to med school now. The step 1 fail rate is over 10%. There’s a very real chance that you’ll not do super hot in med school and be “stuck” in a non competitive specialty.

Don’t go to med school counting on being a dermatologist, orthopedist, etc. There are more perfect med students than spots in those specialties

 

[Goro]

I've seen some posts on here critiquing certain people's shadowing/clinical work/volunteering experiences because they are only in highly competitive fields (IR, Ophthalmology, Ortho, Cardiology, etc.), saying that it is necessary to spend some time among primary care specialties also. In my case all of my experiences so far have involved competitive fields because this is what I took an interest to early on. I get the reasoning of wanting to be sure you will still enjoy being a physician if you can't be a specialized surgeon or go into a competitive fellowship, but how off-putting would it be to adcoms if they read an app with no primary care experience at all?

I'm less concerned about it, unless the vibe that comes across is, say, "Ortho or bust".

 

[Wilted]

This is less about how adcoms consider it, and more about my advice to applicants, but how do you know you'd be happy being a primary care physician if you have no experience in primary care?

On how it looks to adcoms, do you feel like you'd be able to convince them that you've seen and experience a broad swath of what it means to be a doctor?

That makes sense. I've certainly tried to gain some shadowing or work with IM and peds but I have either been told shadowing isn't allowed for undergrads or been ghosted by the jobs. The employment and shadowing with more competitive specialties have just presented themselves to me first. I've spent time around many different specialties and I can pinpoint a lot differences that make them unique and interesting but none of them have been around primary care.

 

[Mr.Smile12]

I'm thinking larger workforce issues (if you believe the projections), and the compelling interest that states have to ensure that medical schools train enough future doctors to address these issues. There's a reason why we are seeing a growth burst of new medical, dental, and veterinary schools now. Having more specialists vs. primary care docs is not how our (anyone's) health care system is structured.

New AAMC Report Shows Continuing Projected Physician Shortage

The AAMC released the 2024 physician workforce projections report.

www.aamc.org

ADDED
Besides, if you're on an airplane flight, and the staff asks "is there a doctor on the plane?" even a radiologist should be able to handle simple emergencies. At least unless someone tells me legally that's not allowed.

 

[Wilted]

I'm less concerned about it, unless the vibe that comes across is, say, "Ortho or bust".

I definitely know how competitive these fields are and I'll have to work as hard as I can if I want a chance to be in them, but the vibe is not "surgical subspecialty or bust." I feel I'd be happy no matter what type of chance I get but I'll have to find some primary care experience to be sure.

 

[polymerization]

I worked ED -> Derm/Mohs -> Ortho/Hand -> Neurogenetics/Complex Disorders -> Interventional Cards/Nuclear -> Family before applying to medical school.

I can tell you, categorically, that the FM environment is significantly different from any of the ultra-high specificity specialties I'd worked. I would think it's important because I noticed that in FM, you spend an extraordinary amount of time with the patient; like 45-minute visits. That's insane. In Derm or Hand, we could see up to 70 patients a day by overbooking 15-minute slots. The kind of interaction you have to have in order to fill that time in FM is significant, and I think the physician actually works harder because there is economic and administrative pressure to make the time you have in the room with the patient be productive.

It is also alarmingly versatile: where in Cards, for example, you're coming to execute a stress test and nothing else, in FM, you could have 5 totally different pathologies across different body systems you're expecting to resolve in one visit. It's a lot of documentation, variety, and communication with the patient that often results in long, diverse treatment plans that require professional coordination and sometimes upwards of 5 different referrals. Then there's medications and other treatments; patient education; and the unspoken but universal expectation that the physician be a vigilant monitor of all of these... they really deserve to be paid more, but that's for another time.

Logically, the specialty hierarchy is a pyramid, from high-scope specialties like primary care, up to the most niche sub-specialties. While all specialties are technically practicing medicine, it would make sense from the medical school's perspective to expect that applicants have experiences with the full breadth of medical practice...which is only available through engaging with the most generalist specialty available, often FM/IM in a primary/preventive care setting. It's the specialty everyone thinks about when you say "I need to go to the doctor."

 

[AJS59]

Others have mostly covered it, but would reiterate that it's a nice thing to have to show to adcoms but more importantly it's nice to know what you're getting yourself into. Statistically, the top 3 specialties by number of residency positions are IM, FM, and Peds (EM and Gen Surg are close behind). So for the undifferentiated applicant, if you couldn't see yourself being happy in one of those areas (even if its an IM -> Subspecialty fellowship), you may want to rethink your purpose as a physician a bit.