Making imp decision in 4 days, need FP advice

[hckyplyr]

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Hello Doctors,
I'll make a long story as short as possible. I'm a PA student (age 30), graduating tomorrow. This past year, I interviewed at Lecom for the PA-->DO bridge. The bridge essentially cuts off the 4th year of med school. The bridge has 12 openings for PAs. 6 spots are designated for the primary care field (peds, geriatrics, IM, FP, ob-gyn) and 6 spots are undeclared (can pick any specialty). Also, these bridge students must complete a DO residency. As of today, these are my options: The 4-yr pathway is not available to me (long story), but I can be accepted to the primary care spots, but there are NO undeclared spots left. This means I can do the bridge, be done in med school in 3 years, but I must choose either FP, IM, ob-gyn, peds, or geriatrics.

1. Initially when I wanted to return to school, it was for surgery only. However, if I went back for surgery, I would now have to wait a year + apply to another school, 4 yrs med + 4-6 residency = 11 years. I would be 41 years old before I was a surgical attending. However, during my 3 months on a primary care rotation, my preceptor did MANY surgical procedures (I&D, Cysts removals, injections everywhere, derm, scopes, etc) that I didn't know you could really do in FP, mostly because on my other FP rotations, the doc would refer out for any procedure. I loved how he incorporated so much surgery into the practice.

I'm concerned about debt, like everyone is. I've read many posts on the board, and seemingly, as a primary care doc, I would be able to get my loans paid off. I will be going into med school with $90,000 debt. The bridge program is 3 years, at approx. $31,000/yr. So I'm looking at probably $183,000, not including interests, fees, other expenses, so it will be well over $200k. Assuming my salary as a doc would be around $180-$200k, plus the tuition reimbursement, I "think" I should no problem paying off loans, and living a very comfortable life.

I find I'm most interested in surgery and surgical procedures, but I still like managing chronic disease, so I feel FP is "probably" the best route. Here are my questions:
1. As a FP with a FM residency, I can still practice in urgent care, ER, and IM correct? That's what's so intriguing about FP, I "think" I will have the opportunity to practice in many different settings, correct? What other areas can I practice for extra money?

2. I'm not particularly interested in peds and ob-gyn, do you think I'm entering the wrong field because I'll see a lot of this demographic?

I strongly prefer the OP setting opposed to IP. I just feel painted into a corner because yes, I will be accepted to medical school and will achieve my dream of becoming a doctor, but I have to pick my field now, and also I have to complete a DO residency, and cannot do any fellowships/additional training (bc it would be considered breach of contract). I'm not sure if I should just apply broadly to more schools next year, which will allow me to apply to any residency I want (in case I change my mind in the future), but I feel like I'm getting too old to continue delaying my future. All comments welcome. Thank you for reading.

 

[primadonna22274]

I've told you what I think.
But it is true that you can do a LOT of procedures in FM.
Having said that, look long and hard for an AOA FM residency that will provide what you are looking for--I'm sure they exist but I just have to say I have not been at all impressed with the training offered at many AOA FM residencies (very little inpatient, almost no surgery, YUCK!!)
I have a bias obviously. I'm not restricted to osteopathic residencies and don't think I would have chosen the 3-yr path if I was (also I'm undeclared).
I hate to see you do this and be unhappy. I have a former PA student who I talked out of it for the same reasons. She is thriving as an EM PA now and loving it. She may still go back but it won't be under duress and she will know what she's leaving behind. I really don't like to see PAs go directly into med school without practicing first because you may find that a) you are perfectly happy as a PA b) you enjoy making a nice living c) the opportunity costs of med school are too much.
I'm almost done but I'm not sure I would do it again. The financial burden has been tremendous. I'm so grateful to be almost done though!!
Good luck with your decision. I know how agonizing it is.

 

[cabinbuilder]

Yes, FP is full of procedures. If you go to LECOM you will learn OMT too which is considered a procedure as well. I do rural/frontier FP as locums and I do procedures all day every day because I chose to learn how to do everything in residency and I knew that where I would be referring wouldn't practical. I don't do any OB and I don't do peds mgmt - only urgent care peds.

As FP you can do IP, hospitalist, ER, Urgent care, and OP chronic managment. As far as extra $$ you can do locums, you can supplement your visits with OMT, you can pick up urgent care shifts, ER shifts, and maximize the procedures you do.

There is NOTHING wrong with a DO residency. Contratry to primadonna, I did my residency in South Texas that was IP/ER/IM/ procedure heavy. minimal peds and OB. I learned how to do everything there, IR, read MRI's, ortho injections, surgical procedures, etc. You can cater your rotations to do what you want to learn. Not sure why you are saying you can't do a fellowship? Once you are done with residency it's up to you to do a fellowship. Not getting that statement. Whose contract are you breaching??

 

[hckyplyr]

primadonna-I really appreciate your advice. You've been so helpful during this process for me, since I've been going through this for awhile now.

Cabinfever-I pm'd you

I have no problem with a DO residency, but since there are many more MD residencies, I would like to have the opportunity to apply to any of them, like any other 4yr DO student would do. If I take the primary care spot, a breach of contract would be considered going into a MD residency, doing a specialty residency, or fellowship, etc. The contract says I have to practice for 5 years in (for ex.) primary care only. If I were to do a fellowship (and breach contract), I would have to pay for the 4th year of med school (that was essentially waived, because of the bridge) Like I mentioned to cabinfever, it seems like one barrier after another. I'm sitting next to the 4yr students for 2 years in the same classes, yet they can apply to both MD/DO residencies (gives them a better chance of matching their specialty), and they are not restricted in any way, yet I am. I admire Dr. K for all of his hard work with starting this program, and it definitely has its benefits, but he is also limited by the school administration, things that he has no control over. In my situation, as much as I hate to say it, may benefit me more to apply next year to both MD and DO schools, where I won't be restricted at all. However, if I'm deadset on primary care, which I'm not at this time, the bridge would make the most sense.

As I stated above, I really like primary care, and would probably have a practice that was very procedural based, but if I decide to change my mind regarding specialty while in med school or on rotations, I will never be able to apply to it because of the programs limitations. Back to loans though, and just to reinforce it in my brain, if I have $200-$250k in loans as a primary care provider, I should have no problems finding a job around $200k/yr and student loan payoff, correct? (Given the shortage and demand for FP)

 

[brats800]

1) In my mind, the question (that only you can answer) is if you WANT to do primary care. Yes, you will be fairly locked in if you go the bridge route. But if you want to do primary care I think you would be silly to not take this shorter (and cheaper, right?) route. If you don't want to do primary, then you should apply for regular med school next year.

2) You would not be significantly at a disadvantage applying to only DO programs. There are many good DO programs - I trained in Chicago and my residency was a dual (MD and DO) program.

3) I didn't see in your posts - do you have geographic requirements for where you match? If you said, for instance, that you only wanted to match in NY, then you might want to have all MD and DO programs open to you. If you are more flexible, then you should have plenty of good programs to apply to as a DO only.

4) Similarly, if you do not have a specific location / big city that you want to work in after graduating residency, you should be able to get a well paying job and be able to pay off your loans fine as long as you live within a budget. It will also just relate to how fast you want to pay the loans off (5 yrs vs 25 yrs gives a very different monthly payment).

5) Lastly, you asked about opportunities open to a Family Practice doc. I know FM docs working in mostly clinic (like me), as hospitalists, in ED / UC settings, etc. You could try to tailor your clinic to be more procedural (skin, MSK, etc) and/or even do a fellowship after your 5 years of "general" primary care.

And don't forget that everything we talk about is based on the uncertainty of future payments / job markets. We anticipate that primary care reimbursement will not go down (or, if it does, not as much as the specialist reimbursement) and I am still seeing my salary go up.

 

[Kahreek]

Go ob/gyn if you want surgeries.

 

[simpler2]

Go ob/gyn if you want surgeries.

I agree, or hold out for surgery if that is what you really want to do. Family Physicians are not surgeons. Sure you can do procedures, but most of your time will be spent providing primary (mostly medical) care. If you are training for longer in something you love to do, it wont really feel like training.

 

[styphon]

I would also agree. Most(if not all) of the procedures are minor, like you mentioned, ex: I&Ds, shave/punch biopsies, joint injections...Very few FM do scopes, some FM do c-sections/BTL..But the surgeries where you are actually in an OR are rare, and if that is what you are looking for - do another residency.