Hi everyone!
I'm an incoming M1 at a T5 school, and am very interested in FM (rural in particular). I've shadowed a lot of FM's (and other specialties), and had really great experiences growing up with my FM docs. Would be really interested in sports medicine but would be happy doing FM in general too.
The thing is, it seems like literally no other peers seem to think FM is a good idea, especially at top schools. Is there something I'm hugely missing out/being naive about on why FM is generally considered "bottom of the barrel" in terms of specialty consideration? Why are so many bright students staying away from this field?
My scores were good in undergrad (>3.9, >520), so it's not like I'm worried about my test-taking abilities or anything for more competitive specialties. Med school loans are not a problem since I was fortunate to receive full tuition.
Thanks!
Several main reasons, some which have been mentioned:
-Less money on average than some specialists at the moment, but the pay difference is much narrower nowadays that perceived once you factor in the additional 2-3 years of training time for most specialists and potential changes in insurance reimbursements. Insurance reimbursements (which are a big driver for compensation) will change over time and ever since Obamacare was implemented there's been a bigger push from CMS to reimburse more for primary care services.
-Less prestige, but this is subjective and probably not the sole driving factor.
-Less intellectual work with doing primary care since you're not an expert in anything, while in primary care there's more "scutwork" and half of your job is not far off from being the glorified social worker for your patient.
-Less opportunities to specialize with limited fellowship options. One could just go IM and have nearly all the opportunities of FM including doing primary care and hospitalist, and IM isn't hard to get into either for U.S. grads. And with IM, you have much more opportunities for fellowships that aren't available to FM grads in case your career plans change. For example, there are occasional FM grads that become interested in a specialty like cardiology or GI but they just can't do those fellowships unless they do another full 3-year IM residency.
-The idea that you're likely to end in working a rural/underserved area, which most people wouldn't want.
However there are few upsides to FM (but not unique to FM, as you can get them with other specialties)
-FM has a relatively short 3 year residency so there's less delayed gratification (this is the case with IM and EM as well)
-There's been a bigger focus from the government on expanding primary and preventative care which may lead to higher reimbursements for primary care services in the future. After all, more preventative care reduces downstream medical complications that become much more expensive for the system to treat (and it's the downstream complications that specialists usually make the bigger bucks from)
-FM does offer peds exposure that IM doesn't, but peds patients tend to be a smaller fraction of the patient population so most don't find that they're missing out much by going peds.
-possibility for more predictable 9-5 PM schedule (though you can get such a schedule with derm as well and make more money)
-less competitive to match so for residency you will have a higher chance of matching your #1. Geography seems to be an especially important factor especially for non-trad med students with families who may not be able to relocated anywhere in the country for residency.
At the end of the day, if PCPs can on average make the same per hour as the higher paying specialists like cardiology, derm, radiology etc... (perhaps by significant increases in insurance reimbursements for primary care services) a lot more med students would pursue FM or IM with the plan of doing primary care with the allure of making a typical specialist salary with less training time. Of course the other factors like preceived lack of prestige and the nature of the work will still deter many but it wouldn't have as bad of rep as now.
