Needing some FM love...

[sophiejane]

So most of you know, I'm a pretty gung-ho family medicine kinda girl...but lately I've had 3 attendings tell me they think I should do medicine instead. One was an assistant PD at a program where I just finished a medicine sub-I, and two others were attendings on my current rotation....

I always thought I wanted to do family because I couldn't imagine not seeing the kiddos...

But now so many people are casting doubt on my conviction that family doctors really can be competent at adult and pediatric medicine.

Is that really possible, or is it what I have convinced myself of since I so want it to be true?

There is this prevailing notion in the non-FM world that it's impossible to be good at more than one thing. It's been such a loud chorus in my ears lately that I am starting to doubt.

It's not my abilities I doubt--I am an extremely hard worker and LOVE to learn, read, study, and get really good at stuff. But I wonder if even the best FM residency can give me what I need to really do this well.

I'm just thinking out loud, and having a mini-crisis right before I have to submit my ERAS. When I close my eyes, I can see myself being a really good family doc, but I wonder if it's enough to be a really good family doc, and if medicine has become such a specialty-driven entity that being a jill-of-all-trades is becoming obsolete...?

Help!!

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[deleted87716]

Naysayers are just something you have to deal with as a medical student interested in family medicine. Get used to it. Once you're in practice, it's a nonissue. There is a growing need for good family physicians. Don't let anyone try to convince you otherwise.

 

[RuralMedicine]

Not to throw a fly into your ointment Sophie but you may wish to consider Med-Peds (I've seen your posts in the past about how it is inefficient/useless so perhaps not--but it is something to think about.) I had all intentions of doing FP (and rural medicine) when I started medical school. My committment to rural practice grew throughout my undergraduate medical years and it became clear to me that the best way to prepare for family medicine was not to do a FP residency. Obviously we're all different but since I spent some time fighting Med-Peds myself (and trying to convince myself that FP was the path to take) I can identify with some of your struggles. Feel free to PM me if you have additional questions. Regardless of your decision best of luck with your interviews.

 

[deleted87716]

IMO, the only reason to do med-peds is if you want to leave the door open for specialization in one field or the other, which basically negates half your training anyway. For most med-peds folks, it's merely a longer, more expensive road to primary care without much gyn experience, with the added burden of maintaining certification in two different specialties for the rest of your life.

 

[Marigold]

IMO, the only reason to do med-peds is if you want to leave the door open for specialization in one field or the other, which basically negates half your training anyway. For most med-peds folks, it's merely a longer, more expensive road to primary care without much gyn experience.

Not to discount RuralMedicine's well-meaning advice or choice of specialty....but I agree. Yes, you're dual boarded, but are you really gonna use both of them at the same time? Probably not, unless you do a general practice. And if you want to have a general practice anyway, then I think Family is your best option, since it's shorter, cheaper, with a more well-rounded experience (better gyn and OB if you want it).

If it's the education you're concerned about, remember that your experience is what you make of it. You can be as good a family medicine doc as you want to be...just because there are lots of folks who see FM as an inferior specialty doesn't mean that you can't be an EXCELLENT physician and an FM physician at the same time. Go to a great program and commit yourself to being the best you can be. I don't think doing IM or Med Peds would make you a better doctor in the long run...you'll be a better doctor if you're HAPPY and personally fulfilled in what you're doing!!

That brings up my last, most important point. What makes you happy? What is it that you see yourself doing, that gets you excited when you think about your future? What YOU WANT to do?? This is what matters most. These naysayers don't know you or what's best for you; they only know what was best for them. Choosing a specialty is a very personal choice, and because of that, the decision should come from within.

The best way to be the best doctor you can be is to make sure you love what you do. If you think you might love something else more than family, by all means, head that direction. But if that little voice inside you is saying, "But FM makes me happier than anything else..." then I think your answer is right there. That would seal the deal for me.

 

[deleted87716]

Not to discount RuralMedicine's well-meaning advice or choice of specialty....but I agree.

I'm sure RuralMedicine made the decision he thought was best for him. However, this is the family medicine forum.

As I've said before, IM and peds residency programs are generally more academic than FM or EM, which are more practical. As in EM, we can learn to do a lot in three years by cutting out the fluff.

 

[sophiejane]

Not to throw a fly into your ointment Sophie but you may wish to consider Med-Peds (I've seen your posts in the past about how it is inefficient/useless so perhaps not--but it is something to think about.)

Wow--I said Meds/Peds was inefficient/useless? I don't recall ever even thinking that, much less saying it...I'm not sure I even know enough about meds/peds to make a statement like that--but if I did, I apologize, because I don't believe that's true, at least not now. I just don't know if Meds/Peds is for me.

 

[Marigold]

I'm just thinking out loud, and having a mini-crisis right before I have to submit my ERAS. When I close my eyes, I can see myself being a really good family doc, but I wonder if it's enough to be a really good family doc, and if medicine has become such a specialty-driven entity that being a jill-of-all-trades is becoming obsolete...?

Help!!

About generalists in primary care becoming obsolete....

I like to believe that one of the reasons our healthcare system is so disjointed and difficult these days is because of all this specialization. I predict (and hope) that one day, hopefully in our careers, this will come to the realization of the greater population, and more attention will be turned to going back to basics...back to the importance (and necessity) of good primary care for the population. I don't see primary care becoming obsolete at all...on the contrary, I think it will see brighter days in the future as our society explores ways to solve the healthcare crisis in our country.

AND, not only is being a really good family doc enough;....it's admirable! One thing our healthcare system sorely needs is excellent, professional, committed family physicians. Be one!!!

disclaimer: I'm clearly biased, but FM love is what you asked for, so you got it.

 

[sophiejane]

As I've said before, IM and peds residency programs are generally more academic than FM or EM, which are more practical. As in EM, we can learn to do a lot in three years by cutting out the fluff.

That's an interesting take. What's the fluff, though? Is the fluff academics? Because I actually really like thinking about problems, considering differentials. I don't really love to round for 4 hours, but I don't think that is the life of a general internist, either.

I do love procedures, though....and I love women's health...and cardiology....and ID...and....and.....

sigh.

 

[Marigold]

As I've said before, IM and peds residency programs are generally more academic than FM or EM, which are more practical. As in EM, we can learn to do a lot in three years by cutting out the fluff.

I am ALL ABOUT cutting out the fluff.

This is another consideration for SophieJ....do you like the fluff? Or not? Do you want to end up in academics?

 

[sophiejane]

Naysayers are just something you have to deal with as a medical student interested in family medicine. Get used to it. Once you're in practice, it's a nonissue. There is a growing need for good family physicians. Don't let anyone try to convince you otherwise.

I know this...and up until now I've shouldered all the negativity pretty well. But when three (actually 4 now that I think of it) docs tell you within a span of 4 days that you'd be better off doing medicine, it gives you pause.

The thing is, I don't WANT to have to choose. I love the whole package--how all the systems work together, the social issues, psych, old, young....I think I really am a whole-picture kind of person.

I just don't want to sacrifice quality. I don't want my patients to suffer because I chose to try to learn too much.

 

[deleted87716]

What's the fluff, though?

For the most part, the fluff is simply repetition ad nauseum. Does anyone really need to spend eight months doing wards at the V.A.? I'll take quality over quantity any day.

But when three (actually 4 now that I think of it) docs tell you within a span of 4 days that you'd be better off doing medicine, it gives you pause.

I dunno, I got the same thing when I was in med school, and I graduated from a primary care-oriented school in 1998, at the height of interest in family medicine! That's just the way things are in med school...it's specialty-driven, and everyone's got their own agenda. The only agenda you need to worry about is your own.

 

[Marigold]

Actually, it's not really whether or not you like the fluff, it's how you want your practice to be. Because you can be an FM doc and still respect the fluff...spend your time thinking, considering differentials, discussing possibilities, etc. You don't have to de-fluff yourself to do FM. It's just less fluffy in general than IM or MedPeds, because it's less academic...but that said, you CAN still stay in Academics and help sell FM to the future generations!! heh.

 

[sophiejane]

I am ALL ABOUT cutting out the fluff.

This is another consideration for SophieJ....do you like the fluff? Or not? Do you want to end up in academics?

I do love to teach--was a teacher in my previous life. Do I want all the administrative BS that goes along with academic medicine? Not really. But I'd love to be able to teach medical students and residents someday. But I do know I can do that in family, too--IM doesn't corner the market on academics, after all.

 

[Marigold]

I love the whole package--how all the systems work together, the social issues, psych, old, young....I think I really am a whole-picture kind of person.

I just don't want to sacrifice quality. I don't want my patients to suffer because I chose to try to learn too much.

You don't have to sacrifice quality. Your experience will be what you make of it. And remember, a quality doctor is a happy doctor. Whole-picture kind of people are great in family medicine.

 

[Marigold]

I do love to teach--was a teacher in my previous life. Do I want all the administrative BS that goes along with academic medicine? Not really. But I'd love to be able to teach medical students and residents someday. But I do know I can do that in family, too--IM doesn't corner the market on academics, after all.

yeah, it's the administrative BS that I dislike too.

 

[sophiejane]

For the most part, the fluff is simply repetition ad nauseum. Does anyone really need to spend eight months doing wards at the V.A.? I'll take quality over quantity any day.

OK, I get it. You have a point.

IM: 0
FM: 1

Give me one more like that and I'm back on track!

(I knew I could count on you guys!)

 

[deleted87716]

I'd love to be able to teach medical students and residents someday. But I do know I can do that in family, too--IM doesn't corner the market on academics, after all.

Not at all. I'm an active teacher of medical students and residents myself. It's something I really enjoy, and it helps keep me on my toes.

 

[deleted87716]

Give me one more like that and I'm back on track!

Peds clinic...easily as painful as wards at the V.A. Sheer pandemonium.

Seriously...well child checks are a nice way to break up my day, but one after the other, after the other, after the other? All? Freakin? Day?

 

[Marigold]

OK, I get it. You have a point.

IM: 0
FM: 1

Give me one more like that and I'm back on track!

(I knew I could count on you guys!)

Remember, you just said that you love the young, the old, cardiology, ID, social issues, psych, and that you're a whole-picture kinda gal...there's no better place for all that than FM.

 

[Marigold]

Peds clinic...easily as painful as wards at the V.A. Sheer pandemonium.

 

[sophiejane]

Peds clinic...easily as painful as wards at the V.A. Sheer pandemonium.

Seriously...well child checks are a nice way to break up my day, but one after the other, after the other, after the other? All? Freakin? Day?

This is so true.

I think I have a somewhat rosy idea of peds, but even I know I couldn't do it all. freakin.day.



Thanks Marigold and Kent. You said all the things I know I believe deep down...but needed to "hear"...even if it's with electronic ears.



Now, back to ERAS...

 

[Marigold]

 

[iatrosB]

This is so true.

I think I have a somewhat rosy idea of peds, but even I know I couldn't do it all. freakin.day.



Thanks Marigold and Kent. You said all the things I know I believe deep down...but needed to "hear"...even if it's with electronic ears.



Now, back to ERAS...

I think it's just cold feet for you. If you want to practice outpatient medicine, there is no better training than FM. If you are leaning toward hospital medicine IM/Peds may be the way to go. As I recall, though, you are interested in outpatient whole family care. There is no better training than FM for that! Good luck! We need FM doc who care and are passionate!

 

[skb21]

This is an interesting discussion. The only time I've heard doctors talking against family medicine is when I talk to the surgeons I worked with as an OR Tech before I went to medical school. Of course, to them, surgery is the only thing anyone should do. One is an orthopaedic surgeon that is trying to convince me to do ortho so I can come back to town and be his partner. It's a great offer that has made me think, but I'm not sure that's what I want to do.

The only specialty that I've been told to absolutely not go into is OB/GYN.

 

[deleted87716]

The only specialty that I've been told to absolutely not go into is OB/GYN.

That reminded me of...

http://theunderweardrawer.homestead.com/obgyn1.html

 

[Marigold]

Teehee, those Scutmonkey comics are sooo funny! I especially like the one about Surgery, since that's the rotation I'm finishing right now. Soooo funny because it's sooooo true...

http://theunderweardrawer.homestead.com/surgery1.html

 

[dr.smurf]

Sophie...

this is a very nerve racking time in your life...i know us residents went through it not so long ago. i too was in a very similar situation. i had IM attendings, residents, GI guys all telling me that i belonged in IM. i thought long and hard and it made my already made up decision to do family not so already made up. and i thought hmmm.. now this doesnt make sense to me. if im so good then why wont i be "good enough" for a specialty where you have to know everything! well of course noone can know everything but you get my drift. so it took me a while but i figured out that they had a problem with being comfortable knowing a huge wide range breath of knowledge in all the specialties. i loved every rotation as a student and what better specialty than family medicine where you can focus and tailor your angle to fit your desires of the specialty.

oh and by the way most IM residents arent doing IM to do IM they are after fellowships so of course they are going to pull their snotty narcasistic attitude. dont get me wrong about IM...I have several friends in medicine and i respect them a great deal, but they can be that way. i can think of many instances when my more general training has made me stand out over medicine residents on off service rotations. for example:

icu pt (train wreck) alt mental status and weird rash - intensivist and im residents baffled so want to consult derm- derm in icu..lol.. so derm calls and wants the resident (im) to describe rash. well a nurse could have done better. so derm is like bx it.. who does the im resident come to for help? yep ME. the intensivist is so nervous about it he consults surgery to do the punch. surgery resident (friend) pulls me to the side and says..are u for real man? we laughed.

post partum pt in icu febrile, low bp, thinking sepsis right? wrong! medicine res on call is thinking PE, PP cardiomyop, etc. on rounds after i was assigned pt i reported that i thought it was endometritis with sepsis due to fever tender supra pub, and foul vag d/c (all of which were present the night before pt admitted) and that i cultured her vagina and covered her with amp/gent/flagyl. they looked at me like i was some kind of genious and i wasnt being a bit over zelous about it! sure enough thats what it was of course after gyn was stat consulted b/c intensivist didnt want to touch her.

so...am i slamming IM? absolutely not. am i hyping myself up or family medicine? well not myself but definitely family medicine. all im saying is that being well rounded and having a wide knowledge base is a great asset and dont let anybody tell you differently. looking back arent you just a little bit glad you took those liberal arts courses in undergrad? did it not make you a more rounded individual. trust me i hated those courses but hey call me more mature or something, but im glad i took them.

regarding med/peds i agree with most of the above posts. its not necessary if you arent going to specialize unless you really truly love medicine and peds and hate the ob/gyn part. i know two people who went that route. one guy changed to straight IM one yr in and the other dropped the peds as an attending and did general peds. i think unless you are going to a rural area where you will be admitting lots of kids sick or not so sick its not necessary. i think they got into it not realizing how hard it would be to practice and stay boarded in both when they could have done FM. not really sure what the exact reason was, but there you go.

hope this helped. sit down and ask yourself where you see yourself the most comfortable and go for it and kick a**. take the remarks you get from those IM guys as compliments with big grains of salt, but remember its their insecurities and lack of comfort level with what we do and nothing to do with your ability as a family medicine doc.

 

[sophiejane]

dr. smurf, you are an angel. Thank you from the bottom of my heart (which actually knows best, unlike my head sometimes).

The best part of your post was the examples...you are so dead-on about that! I am realizing that I think very globally about patients. I love putting together the big picture, and actually, it comes very naturally to me.

You guys rock (brushing a tear from her eyes) ....thanks again!

 

[deleted87716]

Want another example? Here's one from the real-life world of private practice, just last week.

I sent one of my patients to a urologist for a vasectomy. The urologist calls me up afterward...seems the guy has come in for follow-up, and has this weird numb sensation over his anterolateral thigh. No pain or weakness, just diminished sensation and sensitivity to touch. Classic distribution. Urologist wants to know if he should refer the guy to neuro. No, I tell him...it's meralgia paresthetica, probably from positioning during the vas, and it should improve in a few days/weeks. So he tells the patient. Turns out, the guy has also developed bilateral sperm granulomas, but he was so unimpressed with the urologist's inability to explain his numbness, that he comes back to me for an opinion about the granulomas, too! Sure enough, that's what they were, and I offered reassurance...and by then, his meralgia paresthetica was improving, as expected.

Edit: You know one of the best parts of family medicine? The shocked looks on peoples' faces when you tell them you can do something for them that they didn't know you could do. "You can do that?!?"

"You're overdue for a Pap smear...why don't you go ahead and schedule an appointment with me next week?" "You can do that?!?"

"Looks like your daughter there has some pretty nasty allergic rhinitis. You know, we see kids, too...why don't you make her an appointment on your way out?" "You can do that?!?"

"You've got bursitis in your shoulder, Mr. Smith. Let's try a cortisone injection, if that's alright with you." "You can do that?!?"

"I'm concerned about this mole, Mrs. Jones...I'd like to biopsy it in order to rule out a type of skin cancer called melanoma. We can take care of that for you today, if you have a few minutes." "You can do that?!?"

Yes, indeedy...I am the "doctor for all of you." But, not necessarily all in one visit.

 

[secretwave101]

You don't have to de-fluff yourself to do FM.

In fact, a stronger academic contribution by FM is exactly what the specialty needs. If you're interested in academics and FM, it doesn't mean the specialty isn't for you...it could mean that you are for the specialty. Additionally, there's TONS of academic work in IM and Peds, but relatively little work in primary care (read: much of the cutthroat academic politics in medicine is still absent in the relatively pristine climes of academic FP, and you have a better chance of distinguishing yourself from that angle).

Now in FM residency, it does bug me to see how much stuff is shipped out to specialists. The other day someone was giving a talk and described how a pregnant lady they were caring for developed GDM and eventually required an insulin regimen, "so, of course at that point we sent her to a OB/Gyn."

WHAT? Are you serious? I asked my program director later if I would be shipping out every pregnancy case who needed an insulin regimen when I was in practice. He said absolutely not. I would just need the initiative to learn about GDM during residency. "Very few of us," he said "would have sent her out, but this particular doc did."

As stated: Make it what you will.

 

[sophiejane]

This reminds me of the saying,

"To a man whose only tool is a hammer, all the world's a nail."

 

[skb21]

Want another example? Here's one from the real-life world of private practice, just last week.

I sent one of my patients to a urologist for a vasectomy. The urologist calls me up afterward...seems the guy has come in for follow-up, and has this weird numb sensation over his anterolateral thigh. No pain or weakness, just diminished sensation and sensitivity to touch. Classic distribution. Urologist wants to know if he should refer the guy to neuro. No, I tell him...it's meralgia paresthetica, probably from positioning during the vas, and it should improve in a few days/weeks. So he tells the patient. Turns out, the guy has also developed bilateral sperm granulomas, but he was so unimpressed with the urologist's inability to explain his numbness, that he comes back to me for an opinion about the granulomas, too! Sure enough, that's what they were, and I offered reassurance...and by then, his meralgia paresthetica was improving, as expected.

Hmm. So this urologist leaves the testicular end of the vas open as well, huh? I'm on my family medicine rotation, and we performed a vas in the office a week ago last Friday. The doc I'm with does a no incision vas. He told me that he leaves the testicular end of the vas open to prevent testicular engorgement, but that sometimes you can get a spermatic granuloma at the end of that section, which can be easily treated with abx.

 

[deleted87716]

Hmm. So this urologist leaves the testicular end of the vas open as well, huh?

Since they were bilateral, I'm assuming so. I'll have to ask him about his technique, just out of curiosity. I didn't put the guy on any antibiotics or anything, since he was asymptomatic except for the palpable granulomas. Hopefully, they'll resorb in time.

 

[RuralMedicine]

It sounds like you've reaffirmed your decision to pursue FP and if that's what you want to do then I truly wish you the best with that. We definitely need more rural practitioners regardless of what route they take to get there. One thing I would encourage in general is to consider the source of your information when determining it's credibility and value. FPs/FP residents may not be the best source to learn about what Med-Peds is like in residency and beyond.

As a Med-Peds resident I did only a single month of VA wards (and yes that was enough--although even among my categorical colleagues I think 3 or 4 over the residency was the higher end of the norm). I also never experienced the "dreaded chaotic" peds clinic as we had a Med-Peds continuity clinic although I'm sure that there were days then (as now) that I had a few back to back spots of Peds and somehow I didn't spontaneously combust as Kent implies he would --but then recognizing our differences and limitations is part of life.

Part of life is also recognizing our strengths---perhaps you are going to be able to get all you need to have a great handle on OB/GYN, adult medicine, pediatrics, and surgery over a three year residency. I think the key is knowing where your limits are and staying within them. If you do that you'll be great. For years I've seen FPs who didn't have a good handle on that and did more harm than good. Yes I realize this problem is not limited to FPs but I've seen it more in this group--although perhaps that's because in both residency and now in practice IM/Peds/IM-Peds were the damage control/ mess cleaner uppers for FPs. You can argue that general surgeons, (or really any specialty has this same potential) and I'll concede that up front. I offer my experiences not to be negative or derogatory but because I think they may be helpful to you.

 

[deleted87716]

consider the source of your information when determining it's credibility and value. FPs/FP residents may not be the best source to learn about what Med-Peds is like in residency and beyond.

Then what are we to make of your opinions regarding FP? Can't have it both ways.

 

[sophiejane]

I offer my experiences not to be negative or derogatory but because I think they may be helpful to you.

RM,

I appreciate your perspectives--I really do. If it wasn't for my interest in women's health, and geographical constraints (there are 2 IM/Peds programs in my state, and neither of which are in areas where my husband is likely to find work--plus we need to be close to home for his 8 year old daughter) I would more seriously consider IM/Peds.

I am not blind to the fact that there are plenty of people who enter FM because it's all they could match into, or because they want to coast. Those people would be bad docs in any specialty. I think there's this stereotype out there, and every time someone has a bad experience with FP, it's reinforced.

What you don't hear about are all the great FPs who are busy managing their sick patients and keeping them out of specialists' offices and the hospital. They don't come to anyone's attention because they are doing a good job. I believe those docs are in the majority, not the minority.

As for being prepared for rural medicine, I've done a lot of research on programs in my area. One I am applying to has 36 required weeks of inpatient adult medicine, which is only 4 weeks less than some of the IM programs in my area. Another has 24 weeks of peds, 16 of which are inpatient. Both have 20-24 weeks of OBGYN. These are unopposed programs where the FM residents do it all.

For me, part of being a good rural doc is being able to offer comprehensive health care to my patients who may not have an OBGYN or pediatrician they can get to. If I can keep people out of the hospital who may not otherwise see a doc, that's enough to help me sleep well at night. I would rather know that I can manage that vaginal bleeder or see that kid before they get really sick than know that those patients didn't go to a doc because there wasn't a specialist available.

I think it's interesting that people like to talk about FPs needing to "know their limits"...isn't this true in any specialty? You wouldn't feel comfortable doing EMBs, and a cardiologist wouldn't remove a mole. But if an FP has had enough training to feel comfortable doing both, what's the problem with that? I agree there are some who feel they are better prepared than they are, but I would argue there are those people in every specialty.

All of us operate from our own subjective experience, and yours has been unfortunately negative re: FM. Mine has not. I think in the end we'll both end up as fine rural docs, and do good work for people who really need it.

 

[Marigold]

Nice stories, Dr. Smurf and Kent. I've only recently decided that family med is for me, and your posts just cemented it even further.

SophieJane, glad you see you're back on track!

 

[RuralMedicine]

I think it's interesting that people like to talk about FPs needing to "know their limits"...isn't this true in any specialty? You wouldn't feel comfortable doing EMBs, and a cardiologist wouldn't remove a mole. But if an FP has had enough training to feel comfortable doing both, what's the problem with that? I agree there are some who feel they are better prepared than they are, but I would argue there are those people in every specialty.

If you read my post I'm not sure how you conclude that FPs are the only physicians with limitations obviously they are not and that is not my perception or my intention. In my experiences (in 4 different states in medical school, residency, and now practice) the breadth but lack of depth has made an accurate assessment of limitations difficult for FPs more than for physicians in other disciplines I have interacted with. It is completely possible that all of my experiences are "outlier" type experiences of course and I was willing to convince myself of that as a student, blame it on the poor quality of the FM program at the place I trained, and perhaps its because our community being rural can only attract poor quality FPs as well. (Although at this point its becoming a recurrent theme so I think there is some potential that there is something there.) I think this is particularly evident with FPs delving too deeply into pediatrics. I realize that 16 weeks sounds more impressive to say than 4 months but that was one of my big concerns with FP actually and in retrospect that was one concern that was definitely born out by my residency experience. That said I do think that FPs can do well child care quite well in fact if they try. Some might argue that their anticipatory guidance can be more focused than a pediatricians if they are seeing the whole family, and I think I'd agree with that as I definitely see a difference in my approach/rapport with kids/parents where I see the whole family. This has been a big plus of doing Med-Peds for me and really doing true "cradle to grave" family medicine. Additionally Med-Peds gives me the continuity of being able to carry that over into the inpatient arena and I really love that too.

I'm curious as to what an EMB is. laugh: I always make it a point to avoid procedures I don't even know what are.) The only thing I can think of is endometrial biopsy (although I've never heard it called that or seen it documented that way) and I do do those in my office. (Largely because none of my FP colleagues will.)

 

[RuralMedicine]

Then what are we to make of your opinions regarding FP? Can't have it both ways.

I think I missed my posts where I commented on the content of FP programs or what it's like to practice day to day as an FP,as you did with commenting on what Med-Peds entailed at the residency level.

I'm truly sorry that my suggestion that there are other ways to prepare for family medicine than the route you took is ego-dystonic for you. I'm sure you're a great physician and your patients are very fortunate to have you.

 

[deleted87716]

there are other ways to prepare for family medicine

No, there are other ways to prepare for primary care.

Even the National MedPeds Resident's Association web site agrees:

Note that while this is a form of comprehensive primary care, it differs both structurally and philosphically from Family Practice.

Here's a good article from Medical Economics that helps explain some of the differences: Where Do Med-Peds Fit?

Also helpful is this excerpt from the MedPeds Guide at MedPeds.org:

Since its scope is broader, Family Medicine offers advantages for those who anticipate practicing in settings where physicians are expected to handle a greater range of problems without the availability of specialists.

 

[sophiejane]

I think this is particularly evident with FPs delving too deeply into pediatrics. I realize that 16 weeks sounds more impressive to say than 4 months but that was one of my big concerns with FP actually and in retrospect that was one concern that was definitely born out by my residency experience. That said I do think that FPs can do well child care quite well in fact if they try. Some might argue that their anticipatory guidance can be more focused than a pediatricians if they are seeing the whole family, and I think I'd agree with that as I definitely see a difference in my approach/rapport with kids/parents where I see the whole family. This has been a big plus of doing Med-Peds for me and really doing true "cradle to grave" family medicine. Additionally Med-Peds gives me the continuity of being able to carry that over into the inpatient arena and I really love that too.

I'm curious as to what an EMB is. laugh: I always make it a point to avoid procedures I don't even know what are.) The only thing I can think of is endometrial biopsy (although I've never heard it called that or seen it documented that way) and I do do those in my office. (Largely because none of my FP colleagues will.)

I wasn't trying to sound "impressive" with 16 weeks rather than 4 months. I was just trying to make the point that it's more than the 8 weeks some have cited as their peds experience.

EMB was the shorthand for endometrial biopsy used at the hospital where I did my OBGYN rotation in 3rd year. I'm glad you are able to offer that to your patients. The FP residents at that hospital did a lot of endometrial biopsies and I would have no issues doing them in my practice if I trained there and got a similar number of opportunities to practice.

It's all about the training. Apparently the FPs in your area didn't get a lot of exposure to that particular procedure in their training. If so, good for them that they delegate to you.

There are very few people who choose meds/peds, as it is still a new field. I will be interested to see how it develops over the years. I know that one of the meds/peds programs in my area (at a large, well-known hospital) recently closed--I don't know if that is indicative of a trend or just a blip on the radar.

I sense a tone that is a bit less than congenial here, and I'd rather this not degenerate into another IM vs FP thread. We all find our niche. Glad you've found yours. I seriously doubt my patients will suffer because I'm not doing Meds/Peds, but you of course are entitled to your opinion.

 

[mamadoc]

Sophie,
I'm glad you're back in the fold! I have had those sorts of experiences, too - including as an intern in my opposed program, where not a day went by on my peds rotations without the attendings telling me, "You really belong here." I'm afraid we FP types sometimes are a little sensitive (you know, match statistics and all that) and so even if it isn't said, we hear, "You belong here.... because you're too smart for FP."

As a third-year resident, I still find it interesting that FP is so different from IM even though much of what we do is the same. I would rather poke my eyeballs out with a sharp stick than spend another month on an inpatient medicine team... and yet during my own hospital weeks I'll have the same GOMERs and nursing home casualties and such that I had during my student days on IM. But there's still something different about it, or maybe it's because I'll see a new baby in the office later in the day, or do a skin biopsy, I dunno.

There is just something common-sensical about FP, and it's not that other practitioners are lacking in common sense but the zebras do seem to have more room to roam. I like to think that I certainly know and can recognize the zebras, but I am quite happy spending my time with the horses for the most part.

Sophie, we need you!!!! I am sure you'll do the right thing on September 1st.

 

[sophiejane]

That's awesome, mamadoc...thank you...

I just finished my personal statement and I have to say this thread really helped me put some things in words that were just notions before.

Thanks you guys. I'm proud to be your future colleague!

 

[raptor5]

I know that one of the meds/peds programs in my area (at a large, well-known hospital) recently closed

Are you talking about S&W? I love that area. Was just down there in December.

 

[sophiejane]

Are you talking about S&W? I love that area. Was just down there in December.

Yep. I think they actually stopped taking new residents a few years ago. They might just have a few left in their last year.