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No it's not
M1 interested in FM - what's the catch?
- Thread starter lacrossegirl420
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I do love when people outside the field speak with authority on what its like within that field.
-You say dumping ground, I say a) do you really want ortho managing someone's diabetes or cardiology looking into someone's knee pain and b) I get paid for every patient I see why would I object to seeing patients?
-I love being a generalist. I'd hate to think of all the time/energy on 3rd year rotations that would be wasted otherwise.
-If it weren't for irresponsible patients, 90% of us would be unemployed. Trauma surgery would be first in line.
-If you can only address 2 chronic problems in a visit, you're a very inefficient physician. What about the cardiologists who manage CAD, CHF, and a fib all in the same patient? Ophthalmology that have cataracts, glaucoma, and diabetic retinopathy in a single patient. Most of us deal with multiple issues per patient, that's not unique to primary care.
I'm one of the most efficient in our group (6th out of 40, if it matters) and my appointments are 15 minutes. As @SLC pointed out, some visits can be 5 minutes which means I have more time for patients that need it.
All of those problems you mention are a big part of why primary care exists - to manage those problems. If you don't like it, don't choose FM. Lots of us do.
D
deleted87716
I virtually guarantee that anyone who goes into medicine for "prestige," regardless of the field they choose, will not be respected.
Family physicians save lives every day. We just don't wait until the last minute.
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Don’t be scammed. Do what you find interesting. There’s no prestige in working 80 hours a week for the rest of your life at the expense of being with your family or doing the things you love if that matters to you. Figure out your priorities and do what you want for you.
Live your life OP. People in medicine can be weird.
Live your life OP. People in medicine can be weird.
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I know a FP who works 2-3 days a week. She’s probably on the low end of the spectrum in terms of pay even within FP. She works for herself however, makes her own schedule and does not care at all what anyone says about her prestige because she is always travelling, and doing what she likes. She also has adult children. Doesn’t have med school loans so all her money is hers. She is not burnt out at all.
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The catch is you make no money? Your peers going into specialties will make boat loads of money, live in nicer neighborhoods, drive nicer cars, live a better life (at least that’s what they hope/think)
peds and FM and the lowest paid specialties. That’s the catch
peds and FM and the lowest paid specialties. That’s the catch
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OP, this is something you're going to have to figure out yourself tbh. I could rant about FM being a crap field. At the same time, I could also talk about all the positive experiences that comes with being a rural FM. See how some practice. If you see a practice you wanna model and it's something that can be feasibly done in this day and age, then by all means, go for it.
PrimaryCareDOToBe
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As my name implies, I am interested in being a PCP. I have been since before medical school, even before I really understood the gravity of the competitive disparity between specialties. I would always tell everyone that when they asked, and no one batted an eye. I think the fact that I'm at a DO school also, no one thought anything of it, since Family Medicine is really pushed in DO schools. I think most DO schools even slyly recommend not to take the USMLE, almost as a way to lock people into FM. I don't think that's right, there are different ways to go about getting people interested in FM. So many rotations are not great in FM, and that's on the school. They should be exposing us to great FM Physicians so we innately want to do it, not because "It's all we can do".
That being said, I always participated in class, was frequently the first one to get the answer right, and wasn't afraid to talk about scores in a very nonchalant way. I had nothing to hide, I did well in school, and regardless of how I did, no one looked down on my decision or thought I should do something more competitive just because I had good grades. That is of course, until I got into rotations and every doctor was like "Ohhh... really? You wanna do FM...? But there are so many great options...." - DO culture > Regular Healthcare culture.
Of course, you tell any patient you wanna do FM and they think it's incredibly honorable.
For me, it came down to the fact that I can do a "little of everything" and also Nationalistic Pride. I know it's something our country needs, and something our population desperately craves. I felt like I was doing a national duty by wanting to do Primary Care and have the fluidity to incorporate myself into whatever a community needs.
I hope it pays off. Don't care what other people say/think. Do what you're passionate about and because you're passionate about it, you'll succeed. But also recognize you're only in your first year of school and what you loved about Primary Care you may be able to find in another specialty as well. This is why I am still debating between IM and FM because IM could give me the opportunity to do something like Infectious Disease and go on to be an ID/PCP and have a panel of complex/interesting patients with infectious diseases who also need a primary care doc.
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I disagree regarding the practice style. It’s not too different from other specialties in that you ”serve” bread-and-butter cases often and treat them all the same, then a zebra or unicorn walk into clinic once a week/month. The challenge (and real question) is “how broad of a scope in what walks in are you comfortable with?” FM offers more variety in practice than oculoplastics or radiology, you decide to what degree. That’s what makes it challenging and fun for a driven doc…
…buuut also makes it an easy choice if you’re a slacker looking for a soft landing.
Source: PGY-3 Family Med
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Beechilds
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I've been prematched into Family Medicine. Only have to do three years of medical school too. At the end of the day, I wanted to be a Dr. Didn't care how. I get to fulfil my dream and everyone knows it. That's what matters to me. Oh, and working banking hours. I've been working in a Call Center doing tons of paperwork, general stuff, and seeing 30+ members for about 6 minutes on average for six years only making 40K. I've got a nice car, about to be new nice house, and I've been travelling my ass off with student loan debt I'm never going to pay off anyways. So I see these next 30ish years being a piece of cake making at minimum 150K. I'm used to it. 😂😂😂
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you prematched into FM as a pre-med student? is your flair outdated?
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This will happen. My interest starting becoming geared toward primary care after coming in with interest in surgery (I have a construction background, so it was natural haha), and people jumped to the conclusion that "haha yeah Step will do that to you" despite actually scoring in the ~99th percentile.
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There are 3-year MD programs where you pre-match before matriculation and upon completion you match into their residency program. I assume they're starting this Fall, and in 3 years will move on to their FM program.
I did a family practice residency and eventually switched to internal medicine, later to PCCM.
The reason I did not like FM is that you know a little about a lot and my preference was to know a lot but in a narrower field.
To me IM was more fulfilling because of a better knowledge base IMO of chronic diseases. I always loved little and obscure details of which IM is full of.
But is all about what you like and what you would be most comfortable with. Do not base your choice on other’s opinion.
The reason I did not like FM is that you know a little about a lot and my preference was to know a lot but in a narrower field.
To me IM was more fulfilling because of a better knowledge base IMO of chronic diseases. I always loved little and obscure details of which IM is full of.
But is all about what you like and what you would be most comfortable with. Do not base your choice on other’s opinion.
Loxley
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FM Resident here:
1. It is a difficult specialty if you actually give a damn. Instead of knowing a lot about nothing, you will know nothing about a lot. Not everyone's brain and ego are set up for that.
2. You'll have specialists $%@& on you every day and then tell you they couldn't do your job.
3. If you go to a community program, you will have to get used to every attending having imposter syndrome for the rest of your resident life. It's a very toxic environment.
4. Once you're out of residency and settled into your rural practice, you'll be happy as a clam.
1. It is a difficult specialty if you actually give a damn. Instead of knowing a lot about nothing, you will know nothing about a lot. Not everyone's brain and ego are set up for that.
2. You'll have specialists $%@& on you every day and then tell you they couldn't do your job.
3. If you go to a community program, you will have to get used to every attending having imposter syndrome for the rest of your resident life. It's a very toxic environment.
4. Once you're out of residency and settled into your rural practice, you'll be happy as a clam.
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Could you expand on that?
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Would you mind expanding a bit more on the amount of paperwork you do in a typical week? I am really interested in rural FM, and this thread is only making me more excited.
Sorry to derail the convo for a bit - can you expand more on why money may be an issue in academic peds?
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Im in rural FM. I practice in such a way as to make my paperwork burden essentially consist of skimming notes from specialists (DM retinopathy screens, Neuro or Cards office notes etc) for about 10-15mins a day. If a patient needs me to fill out papers, I have them make an appt and we fill them out together, then I can bill for the issue that created the paperwork.
Hey there, I'm an MS4 in the PNW applying to full spectrum FM. Good on you reaching out and asking this question. Let's start by recognizing the bias and breadth of opinion you're going to see here. We have people west coast, east coast, deep south, far north, maybe even international chiming in. There is a ton of regional difference. East coast FM is not west coast FM, is NOT global health FM. So let me put in my two cents.
people don't give it clout because:
1) Less money, usually. Depends on where you work. There are some settings that may comparable to EM salaries. True statement. But primary care doesn't pay.
2) Less prestige. You're not becoming a surgeon. You're often seen as the equivalent of a mid level provider doing busywork. I want to do full spectrum and people in big cities cannot wrap their minds around the idea that FM docs do anything besides primary care. I know an FM doc from my territory that did his own ex-lap in a remote one room OR and saved a pt with blunt abdominal trauma. True story.
3) A hard, hard job. I think this is an unspoken truth. FM docs doing ambulatory medicine end up with a huge pt panel and are constantly following up on labs and stuff. I know docs that spend two hours before work following up on stuff, then have a busy clinic day, and stay late spending hours following more labs and finishing notes. That's not the most glamorous but you've gotta respect it. I put a lot of the blame on our systems, ones that expect doctors to basically just produce as many highly billable charts and referrals per day as possible. That is a ****ty job. There are other settings to work in.
4) perceived lower acuity, and then a thought that they don't know how to manage high acuity and turf it.
So, FM is often seen as ambulatory medicine, and it can feel like it's being squeezed on both sides getting turfed out by mid-levels and specialists until your scope, which should be huge, is tiny.
The flip side is that it doesn't have to be that way. If you want to go rural you can do a ton. You can do surgeries, scopes, pull ER shifts, manage inpatient. Especially if you want to work underserved, and even more if you work internationally. I know FM docs that spend zero time doing primary care clinic. True statement.
Regarding the step scores. It's a misnomer that FM programs accept the lowest caliber applicants. Many do, statistically you need the lowest score. There are tons of programs full of lolligagging lazies that just want to manage diabetes (nothing wrong with managing DM but let's face it, it doesn't take 15 years of school to learn how to do that). Then there are other programs, DM me for a list, that are harder than surgical programs to get into. The ones that rep legit full spectrum are full of ballers that work their asses off, and after residency they can work anywhere. You do still need a job that lets you do full spectrum, but they're out there. And more importantly it's needed. There is a huge need for good generalists. Docs who can do an endoscopy in the bush so it'll actually get done, because that patient won't fly into the big city for it. Someone who can manage a trauma patient on their own, or c-section a mother who presents with abruption. In my opinion it's the most badass and terrifying job there is, and a lot of specialists are too scared to respect it.
Two cents, gotta talk some **** you know.
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They're just not super popular. Like half or less of spots get filled by US MDs. I think for pathology the market isnt too great, dunno why PM&R isnt competitive though.
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Very little: basically I sign things and that's about it. Prior auths? Nurses do them. FMLA? Nurses do them. I'll review them to make sure nothing is amiss, but that takes almost no time. Honestly my biggest pet peeves are the home health nursing orders that require a signature on every GD page of the 18 page order set.
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If literally all you care about is total income, then yes FM is much lower on the list.
But, as stated previously, money isn't everything. If you work 60+ hours/week to make twice what I do in 36 hours, is it worth it? Not to me. Is it worth it to be on call nights, weekends, and holidays at various times? Again, not to me. Is it worth it to have more years in training to make more money? You get the idea.
SDN has this weird fascination with income over all other factors. I finished residency before my 30th birthday. I haven't worked a night, weekend, or holiday since then. My job is low stress with plenty of time off. In exchange, I take a decent income hit compared to other specialties. For many people, this is a fine trade.
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This is why I don't understand these threads. Nothing in here is a secret and 100% of it is a pros/cons value judgement. Picking a specialty is all about tradeoffs. No one can make this decision for another person.
Lol why would you care about the opinion of someone who makes unfounded assumptions about people's scores? Two of our now-PGY1 AOA people are in family med - I would assume they didn't bomb Step. One of my classmates is a borderline savant and they have wanted family med from the start. I did decently well on Step and I'm considering FM myself
More generally, we're also assuming that more "technical" specialties have consistently rich intellectual stimulation that's absent in primary care. That's only true for radiology and maybe certain focuses within surgical specialties. Sure the training for specialists is far more extensive and the algorithms are more complex, but from talking to physicians, at the end of the day 70 to 80% of cases are fairly routine for someone fully trained
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Only in medicine would $250k-$300k a year be "no money."
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I think this might be changing. Rads is one of the top 5 specialties for income, but our local uni only matched 1 student in rads out of a class of over 100 students. I think the rads lifestyle is getting less appealing and FM more appealing. Fortunately, we are all different and find different aspects of each specialty more appealing. It's ALL just work in the end.
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Absolutely, and my goal is not to convince anyone to choose FM. But, I don't want someone who likes FM and chooses not to pursue it based on the usual assumptions about the field.
As someone who practices in the rural setting (Rural Hospitalist PA) rural medicine is not the same as practicing in a major metropolitan area. As a rural FM doctor, you could be doing EGDs, delivering babies, or covering patients in the hospital (including in the ICU). You could be doing surgeries such as Mohs or circumcisions. It's not consistent in all rural areas of the US, as every place has different resources, but if you are passionate about rural medicine (which is the number one criteria) you arguably have the opportunity to do more as a rural FM doctor than any other speciality.
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Really only on SDN.
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MedTwitter, too
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I don’t go to that cesspool.
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Could you expand a bit on this point? I'm curious.
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Likewise
It’s not seen as prestigious. Sometimes people care too much what others think or family/others in their life push them to do something more prestigious. Not only is it not seen as prestigious among medical students but even some people in general too. A couple I was making small talk with asked me what I do for a living. I said medical student. We got to talking about medicine and family med came up. One of them said well doctors only go into that since they couldn’t get into anything else. Lol! It’s a silly reason though. You should do what makes YOU happy in life not for the approval of others. Family medicine still makes you a top earner in the country.
Also it doesn’t pay as well. Some specialties can make double the salary. Let’s not kid ourselves. Even though there are many reasons to go into medicine money is something that a lot of us think about. If you are neck and neck deciding between family med and a specialty then money could be one of the factors that pushes a specialty over the top in your choice.
Also it doesn’t pay as well. Some specialties can make double the salary. Let’s not kid ourselves. Even though there are many reasons to go into medicine money is something that a lot of us think about. If you are neck and neck deciding between family med and a specialty then money could be one of the factors that pushes a specialty over the top in your choice.
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If you are M1 then it is way way too early to even figure out what you like/dislike. Until you start doing rotations and getting into the essence of what all the specialties do I think you are jumping the gun. FM actually has a lot of different aspects to it that you can fine tune what you line into your practice.
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Considering the loans you’re paying back, it’s closer to 100k of gross income (until you pay it off) and that could’ve been achieved in other fields not requiring sacrificing so many years and going through all the med school and residency bs. FM and peds are underpaid, really.
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Bro are you gonna be paying 100k/yr towards your loans??
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If you want to pay them off fast, yeah.
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There's a ton of folks for whom the only doctor they've ever interacted with is a family physician, I didn't realize there was more than one type of doctor until I was 20 lol
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Dang I was gonna refinance into 4% ish and put all my extra cash into the S&P
I guess you cant put a price on the satisfaction of being debt free ASAP though
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Yeah I mean I don’t have med school debt, but if I did, I’d live like a resident for 2-3 years and knock that **** out ASAP.
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How many years are you anticipating having the loan for? You're probably familiar with White Coat Investor but the general advice is to get rid of loans as quickly as possible and ideally within 5 years unless someone is going for PLSF.
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As you've probably discovered from reading this thread, the worst part about doing primary care is having to deal with residents and attendings who are not in FM trying to convince you that your life is miserable while you work 4.5 days a week and make $250k a year.
As much as I'd like to blame it all on SDN elitism, I think the biggest blame lies with academic hospitals and med schools who treat primary care clinic as an afterthought--putting students/residents in underfunded resident clinics without support staff and giving learners the idea that primary care is a paperwork infested hellhole as opposed to better funded specialty clinics or inpatient settings. If I thought primary care meant doing a dozen prior auths a week and rooming my own patients I wouldn't want to do it either.
As much as I'd like to blame it all on SDN elitism, I think the biggest blame lies with academic hospitals and med schools who treat primary care clinic as an afterthought--putting students/residents in underfunded resident clinics without support staff and giving learners the idea that primary care is a paperwork infested hellhole as opposed to better funded specialty clinics or inpatient settings. If I thought primary care meant doing a dozen prior auths a week and rooming my own patients I wouldn't want to do it either.
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I was gonna refinance anyway for the perk where you pay $100/mo in residency. A dollar now is worth a lot more to me than a dollar as an attending. And as long as the S&P is performing above 4% avg over the loan repay period, you're making money.
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Are you waiting for the 0% interest to end in October before privately refinancing?
