Newly Interested in FP

[Murrow]

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So, I'm an (allopathic) M3 about three weeks into my FM clerkship and I've been very surprised with how much I like it. Up till now I'd been leaning towards IM or psych (or even both!), but I've been quite impressed with the scope of FM, particularly the opportunity to provide prenatal care (my favorite part of OB--couldn't stand the OR). And I've even found that I like pediatric visits... something I would never have guessed!

Having not considered FM before, I feel like I know far too little about it. In researching IM and psych programs, I've been very focused on university-based programs. As I'm learning, there are faaaaaaar more community-based programs in FM than there are university.

So, the most pressing concern I have is whether or not I should continue to strive for a university-based program. My ultimate goal is to be involved in academics, no matter what field I enter. I consider myself to be modestly competitive (step 1 235, gpa ~3.5). Are the experiences vastly different? Will I have a better shot at an academic career if I train at an academic center? And what about these "community based, university affiliated" programs, as listed by FREIDA?

Thanks in advance 🙂

 

[mataku527]

Congrats on choosing a great "specialty" =)

I think there are a few things you need to answer:
- What do you mean by academics? I like academics as well and have interest in research, but my main interest is working with medical students and residents, so working at a residency program that has some exposure to medical students would suffice.
- What kind of medicine do you want to practice? My interest is urban underserved (FQHC) and international. This question will help guide what programs to look at. Family medicine is very broad, some programs are very cush with good hours for people looking for lifestyle. Others can be very intense with being the primary surgeon on C-sections and other minor general surgery procedures, places that give you scoping experience, responders to level I trauma, etc...

P.S: I just took a look at the community based-university affiliated programs in the two states I applied to: Illinois and California and based on what I saw, that description is essentially meaningless.

 

[Murrow]

I would definitely like to be in a program with medical students. From my very limited experience at my school, which has a couple community programs affiliated with my university, there is some interaction between students and residents, but the bulk of the teaching is provided by attendings. I'd much rather be at a place where interns have more of a role in student learning. Is this something that can be found at university programs, or is this an uncommon feature of FM in general?

I would like to work in a mid-sized urban area, also with an underserved population. I wouldn't mind doing some rural work, but I'd prefer to be based in a city.

I've only done a little research into FM programs, but so far I've been impressed with UNC. Any word on what they're like?

 

[Murrow]

Bump

 

[JackADeli]

I believe it is now more appropriately titled Family Medicine (FM) as opposed to Family Practice (FP) and thus if newly interested, recommend you become aquainted with the newer/updated name/title.

If I am mistaken, please let me know. But, I read in another thread at some point something referencing that FP is actually an outdated title. Hence, this forum is Family Medicine? I will defer to BD...

 

[Murrow]

Fixed 🙂

My mom has been in family medicine for years, and she's always called it family practice. I guess that's where I picked it up!

 

[JackADeli]

Fixed 🙂

My mom has been in family medicine for years, and she's always called it family practice. I guess that's where I picked it up!

Hey, no problem from me. I am not in FM and am definately not an expert, thus on that I defer to BD. But, I try to be accurate and use the current and appropriate titles, name, etc... I have learned over a decade, a "newbie" trying to enter a field will serve themselves well to use the more appropriate/current titles/etc... That is why I posted to it.

Am correct in this, that is is the correct and more current naming FM?

 

[deleted87716]

Yes, the name changed in 2004.

 

[Lee]

The profession needed to prevent consumer confusion between family nurse practitioners and family physicians. Hence "Family Medicine."

If you want to teach in a major academic program look at some of the big name FM programs on the West Coast and Midwest. Also, get an MPH while you're still in med school. It's a valuable and interesting field to have under your belt. It's also a lot easier to do in school than later.

 

[deleted87716]

The profession needed to prevent consumer confusion between family nurse practitioners and family physicians. Hence "Family Medicine."

The term "family practice" is also used by a variety of other non-physicians, including chiropractors, psychologists, dentists, and even lawyers.

 

[JackADeli]

The term "family practice" is also used by a variety of other non-physicians, including chiropractors, psychologists, dentists, and even lawyers.

I actually think "FM" nomenclature was long over do. "Family Practice", as the examples demonstrate, seems more like a description of your particular practice model rather then accurate description of the specialty you are trained in... You can be fully trained in FM and then open a "Family Practice" or "Womans Health Practice" or "Adolescents Practice" or "Sports Medicine Practice" or etc, etc... But the training is to provide medical care to all members of the family.

 

[lowbudget]

So... anyways...

Yea, if you're interested in academic family medicine, realize that there's a couple of ways to go about doing it. There're generally 3 ways of getting involved in academics: 1) research track, 2) clinical teaching, 3) volunteer as an affiliate.

Research track is usually tenure track where your advancement is determined by your research productivity. The more successful your research, the more time is protected (i.e. no teaching, no patient care) for you to pursue your research and tell the world about it (publication, lectures).

Clinical teaching usually is a non-tenure track, where you hook up with a teaching institution and your advancement is determined by your patient care productivity with residents/med students learning along side you during your patient care hours.

Volunteering as an affiliate means that you don't belong to the teaching institution per se (i.e they don't employ you), but you donate time to student/residents to learn along side you, and in turn, they give you a title like adjunct, affiliate, or clinical faculty.

The advantage in doing residency in an academic medical center for FM if you are interested in academic FM is that you (presumably) already have a machine in place. There are research mentors, opportunities to hone your presentation/teaching skills, etc. The downside is that many university based residencies have to compete against other residencies for patients/procedures, although not always true, especially if you have your own hospital/clinic.

Some community based programs offer really good clinical opportunity and would train you nicely for practice should you decide later on that an academic career is not right for you, but many community programs don't have the infrastructure for research (i.e. experienced grant writers, mentors, statisticians, support staff or med students willing to do the grunt work).

I think if you want to academic family medicine at a university setting, you should go to a program with a long history of generating researchers. UNC is one of them, the other ones I know of are UCSD, Missouri, UCSF, and UWash. There are plenty more, I'm sure, but I just don't know them as well.

I will say, however, that primary care research is different from specialty care research, and if you're interested in research, you really should embrace community research because that's where most family doctors are and research in the community setting is what has the most relevance and impact. Primary care research starts with a patient you see (or a health care business/process that you encounter), and that generates questions that leads to a literature review and then a study. Remember, this is how primary care doctors first discovered AIDS: by describing, talking, and writing about what they were seeing in the community which snowballed into a discovery and race for a cure (read or watch: And the Band Played On). By training at a program that gives you a wealth of patient care experience, it makes it easier to generate the question and hypothesis. If you're limited in your patient care experience, you're limited in your questions.

Those are the pros and cons.

Teaching is teaching is teaching. If you're interested in teaching med students or residents, you'll thrive anywhere you train, whether it's in the medical center, the community, or in the bushes of some undeveloped country.

Remember, there are faculty development and research fellowships should you desire. Turns out UNC has one of the stronger ones. The fact that you can do an academic fellowship, to me makes clinical experience during residency a greater priority because if someone wanted to, they can always chase the academic fellowship later, but vice versa is not always true. You can't learn research during residency, and hope to learn how to take care of patients once you're out of training.

 

[BuckeyesFan]

I would definitely like to be in a program with medical students. From my very limited experience at my school, which has a couple community programs affiliated with my university, there is some interaction between students and residents, but the bulk of the teaching is provided by attendings. I'd much rather be at a place where interns have more of a role in student learning. Is this something that can be found at university programs, or is this an uncommon feature of FM in general?

I would like to work in a mid-sized urban area, also with an underserved population. I wouldn't mind doing some rural work, but I'd prefer to be based in a city.

I've only done a little research into FM programs, but so far I've been impressed with UNC. Any word on what they're like?

I've only done a little research into FM programs, but so far I've been impressed with UNC. Any word on what they're like?

If you mean University of North Carolina, they are awesome - one of the best programs in the country. I went to residency at a community program in Ohio and then stayed on as faculty there. They had me go to UNC to do a faculty development fellowship & the staff there is amazing - well known in their field but very personable. We didn't have much interaction with the residents but they seemed very good.