My future options , plz help

[scharnhorst]

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Hello everybody

32 yo IMG I graduated from a FP program and completed 1yr of geriatric fellowship
I primarily did the latter to get more inpatient experience and because of some visa issues.I have started now my J-1 waiver in midwest, where its a 8-5 outpatient adults only job, its great pay is okay hours not too long.


But having serious doubts about my future, although this job is great for now and will likely complete my waiver in 3yrs but then what ?

Is there really any future for outpt only family med for adults only ?

I dont like kids and would only see them in a urgent care like setting dont want to deal with parents and their annoying trivial problems

OB is out of question I barely passed my OB months in residency

Geriatrics is not bad actually but in america, geriatricians work mostly as glorified social workers ( sorry but that was my experience in my program) and in outpt they get put on production and then they cant for sure meet the objectives set by the administration ( our fellowship clinic which had several very seasoned clinicians was always in loss)


To top it all my FP program did not provide good emergency medicine and urgent care training, I dont feel comfortable doing that by myself right now.Opportunities for procedures were scarce and the hospital had too many consultants

so what are my options ? I could think of 4
1-stick with outpt FM and get bored and possibly replaced by NPs
2-Hospitalist fellowship :what are my chances with these fellowships? could get more ICU experience to get good at inpatient procedures
3-Urgent care /ER fellowships :Is it easy to get into ?
Work in the ER on weekends and continue regular outpt adult practice
4- Geriatric faculty ? what do I need to do to get into such a place ? awfully boring if they just deal with dementia and social issues

My goal is not a lot of money but 150-200 range I am happy ! but interesting work not a lot of repitition and job security
I have ADHD and I dont do well with constantly changing my practice, I can handle updates but cant switch from OB to peads to geriatrics !

plz advise

 

[thethom]

Is there really any future for outpt only family med for adults only ?

You seem like you are in a tough place not being happy with what you have. As for the future for outpatient FM, I think this forms the backbone of medicine as a whole in the US. You will not be replaced by midlevels, they still need MD supervision and if you work with them, they can only increase your productivity.

As for being bored, gosh you are in family medicine, the most broad based specialty there is though it seems you have converted yourself to essentially internal medicine by not doing procedures and avoiding pediatrics. I would say get whatever training you need to see peds again and add that to your practice.

Do you see work-ins? Increasing the number of these that you see could be a good segway into doing more urgent care type duties. UC is a particular interest of mine.

Of course there's always the sports medicine fellowships that offer training in MSK medicine far beyond what you learn in residency, MSK US, more complicated fracture mgt (incl salter harris types), injections into virtually every joint including the tougher glenohumeral, SI, femoroacetablar, spinal nerve root, etc. Oh yeah, and the personalities of these patients are almost exclusively enjoyable.

Just a PGY2 right now but this is my 2c.

 

[lowbudget]

But having serious doubts about my future, although this job is great for now and will likely complete my waiver in 3yrs but then what ?

Is there really any future for outpt only family med for adults only ?

What? Seriously? What do you mean "then what"?

What you do now is work. And, you start living your life. And, you start by appreciating what you have in front of you: your health, your family, your friends, and the people you work with. There are so many more things that are interesting, meaningful, and rewarding right in front of you just waiting for you to see it.

Why are you so concerned about the "future of family medicine"? Who cares? You're finished with training. These are questions that MS1's and MS3's ask because they have a 5-7 year time horizon where they have absolutely no flexibility or mobility, but for you, you're done. You can do whatever the hell you want, job wise, but no matter which of those options you pick, you're not going to be happy or interested because finding the right job is not where the answer is at.

I have ADHD and I dont do well with constantly changing my practice, I can handle updates but cant switch from OB to peads to geriatrics !

That's the answer and the problem. You have ADHD, and your OP is classic for how ADHD people derail their own careers and sabotage their own relationships with people. So, let me get this straight... you want to pursue fellowship training in the things you're not good at? Why? Fellowship is an optional opportunity to pursue advanced training, in something that you are good at... not remediation. You're all over the place and none of it makes any sense.

I don't know you and I'm not your doctor, or whatever, so take it with a grain of salt. But, if it were me, I would spend more of my time/money/effort trying to get my ADHD under control than to chase the next gig and do it in a half-ass kind of way. My personal opinion, FWIW, is that you'll lose more than you will gain by bouncing around. Channel your energies towards what you're good at. Find something else that will bring you happiness in your own personal life. At this point you have nothing to complain about.

 

[JackADeli]

...32 yo ...graduated from a FP program and completed 1yr of geriatric fellowship

...I have started now ...in midwest, where its a 8-5 outpatient adults only job, its great pay is okay hours not too long.


But having serious doubts about my future, although this job is great for now ...in 3yrs but then what?

Is there really any future for outpt only family med for adults only ?

...My goal is not a lot of money but 150-200 range I am happy ! ...I have ADHD and I dont do well with constantly changing my practice...

I am not a FM physician. However, your post does not require an FM physician. As noted by others, it makes no sense and rather then garden variety ADHD, it borders on paranoia.

1. You have completed residency and advanced fellowship training
2. You say you prefer outpatient adult primary care.
3. You say you have a great pay, outpt only practice now
4. You are not seeking excessive compensation
5. Then you ask about the future of outpt adult primary care employment...say what?!?

That is the one area I believe all specialties, the public, politicians, and special interest groups agree there is a current shortage that is only getting worse. So, there is no information or reasonable data to spur your anxiety of lack of future adult primary care opportunities.

Then, despite your preference for adult outpatient primary care you run on about more training in just about everything but what you enjoy doing and have and can reasonably presume you have a future career to keep doing.

Not intended to be insulting, obviously do not know you, but, based on your self described baseline psychiatric disorder and everything else you have posed, IMHO preservation of a longterm career is more dependent on you seeking appropriate psychiatric diagnosis, counseling, and treatment and NOT attempting further fellowship training in the areas you have proposed.

What? Seriously? What do you mean "then what"?

What you do now is work. And, you start living your life...

...you want to pursue fellowship training in the things you're not good at? Why? ...You're all over the place and none of it makes any sense.

I don't know you and I'm not your doctor, or whatever, so take it with a grain of salt. But, if it were me, I would spend more of my time/money/effort trying to get my ADHD under control than to chase the next gig and do it in a half-ass kind of way...

 

[scharnhorst]

Thanks for replying everyone, it did help a lot.

You say you prefer outpatient adult primary care.

For now, since our inpatient rotations were not too great.I mean I literally begged my attendings to give me complicated patients and our hospital was crawling with all kinds of consultants and requests for inpatient electives got denied quite often since the focus was on "holistic approach to primary care"

Thats why I was thinking of ER or inpatient hospitalist fellowship experience to further improve my skills in procedures

 

[scharnhorst]

What you do now is work. And, you start living your life. And, you start by appreciating what you have in front of you: your health, your family, your friends, and the people you work with. There are so many more things that are interesting, meaningful, and rewarding right in front of you just waiting for you to see it.

I appreicate your advice and believe me I keep a good work leisure balance.But sometimes I lack the professional satisfaction from what I do, that bother me a lot.

 

[JackADeli]

...serious doubts about my future, although this job is great for now ...in 3yrs but then what?

Is there really any future for outpt only family med for adults only ?...

I wish you the best of luck. Your original opening was confusing. The short answer to the question that seemed grounded in paranoia, is, YES. Yes, there is most definately a future in outpt medicine.

...our inpatient rotations were not too great...
Thats why I was thinking of ER or inpatient hospitalist fellowship experience to further improve my skills in procedures

...But sometimes I lack the professional satisfaction from what I do, that bother me a lot.

But, honestly, you are very difficult to follow and somewhat incoherent. You ask about a future in outpt medicine. You are going back to concerns that your inpatient residency completed training was inadequate, but you did a geriatric fellowship. You are happy doing what you are doing. Your training is complete. It really isn't clear what you are really asking... Unless, you are in some way trying to ask an internet forum chat room if you will be happy practicing primary care in three years? Again, that is a ludicrous question to ask anyone other then "the man in the mirror".

...What you do now is work. And, you start living your life. And, you start by appreciating what you have in front of you: your health, your family, your friends, and the people you work with. There are so many more things that are interesting, meaningful, and rewarding right in front of you just waiting for you to see it...

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