Overlapping Practices

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Here's my situation (a situation that I think a lot of us have been in at one time or another):

I like the idea of working in a family practice because of the variety of cases that I'll receive and the great, relaxed patient interaction in which I'll be able to engage. However, I feel that my true calling is one of surgery, where I can work with my hands, making small incisions here, fixing this there, correcting that there, and then sewing everything back up.

If it has to be one or the other, I'm going to specialize in some sort of surgery. But I wanted to ask if it's possible to half and half, or even 1/4 family practice and 3/4 surgery. Has anyone ever heard of anything like this?

 

[AmoryBlaine]

Here's my situation (a situation that I think a lot of us have been in at one time or another):

I like the idea of working in a family practice because of the variety of cases that I'll receive and the great, relaxed patient interaction in which I'll be able to engage. However, I feel that my true calling is one of surgery, where I can work with my hands, making small incisions here, fixing this there, correcting that there, and then sewing everything back up.

If it has to be one or the other, I'm going to specialize in some sort of surgery. But I wanted to ask if it's possible to half and half, or even 1/4 family practice and 3/4 surgery. Has anyone ever heard of anything like this?

Not doable. At minimum you would need 8 years post-graduate training. After that you woud need to maintain board certification in 2 widely distinct specialties. Then you would still have to find a job -- highly unlikely that anywhere is going hire you to do primary care and operative work.

 

[deleted77919]

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[HappyG0Lucky]

I shadowed a general/vascular surgeon in undergrad for about a semester. During his office hours he did see pre and post-surgical patients but he also saw a good amount of patients returning for wound care (often diabetics). So if part of what appeals to you about primary care is being able to see patients and manage their problems over time... there is a little bit of that done in surgery as well. Don't know if that's helpful to you or not but thought I"d throw it in there 🙂

Also if you have any interest in OB/GYN... it sort of encompasses both too, although might be more office work than what you are looking for. Good luck!

 

[Blesbok]

Ob/gyn sounds like the job for you.

Either that or you could be one of the many family practice doctors that do some minor procedures on the side.

 

[Sora]

Ob/gyn sounds like the job for you.

Either that or you could be one of the many family practice doctors that do some minor procedures on the side.

What kind of procedures are those?

 

[lilnoelle]

What kind of procedures are those?

Laceration repair, skin lesion biopsy, cryotherapy, casting, fine needle aspirations, etc

I've heard of Family practitioners doing appendectomies, and colonoscopies, and quite a few train to do c-sections in addition to uncomplicated labor and deliveries.

Obviously a Family practitioner can only do things that they have privaleges to do at the hospital, or that they can get insurance to cover, and also to the relative need and culture of the area that they practice in.

 

[1 Up]

I shadowed a general/vascular surgeon in undergrad for about a semester. During his office hours he did see pre and post-surgical patients but he also saw a good amount of patients returning for wound care (often diabetics). So if part of what appeals to you about primary care is being able to see patients and manage their problems over time... there is a little bit of that done in surgery as well. Don't know if that's helpful to you or not but thought I"d throw it in there 🙂

Also if you have any interest in OB/GYN... it sort of encompasses both too, although might be more office work than what you are looking for. Good luck!

Actually your comments sound pretty good. Thanks!

 

[DoctorPardi]

Laceration repair, skin lesion biopsy, cryotherapy, casting, fine needle aspirations, etc

I've heard of Family practitioners doing appendectomies, and colonoscopies, and quite a few train to do c-sections in addition to uncomplicated labor and deliveries.

Obviously a Family practitioner can only do things that they have privaleges to do at the hospital, or that they can get insurance to cover, and also to the relative need and culture of the area that they practice in.

A FP doing appendectomies? Not that I don't believe you, because I trust what you say, I just don't understand how that works. I've seen several general surgery residents come through the OR (where I worked before med school) and they would struggle with learning how to do it at least the first few times they actually performed it themselves. It isn't like putting in an IV or something, plus like any surgery it could have disastrous results.

My question is, where during a FP's training would he even encounter learning how to do appendectomies? (Sure in medical school like all of us, but like I've said, G-surg residents don't have that technique down following their medical school experience either) I guess if you know you are in a rural practice with no local hospitals equipped to do surgery with in an hour drive you could learn to do some simple stuff in some kind of training program possibly? Also though if you are doing something like an appendectomy wouldn't you have to have an anesthesiologist there as well?

Again I don't doubt it is true, I am just curious to know how it works 🙂 .

Edit: I guess if you did a categorial surgery 1 year and then did FP that might work, but I am not sure?

 

[deleted77919]

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[montessori2md]

FM being a good fit for someone who wants 75% procedures seems pretty unlikely to me. Now, if you flip that, I could see that being possible, and more so if you were willing to live in a rural/remote area (say a small less populous Hawaiian island : ) Or just "the hills". If you are one of a handful of MDs in a 100 mile radius, then C-sections and appys should probably be part of your game. Other, non-emergent surgery you might refer out, logically.

But I agree w/ above about surgery being interactive too. Being a surgeon doesn't mean you don't interact with patients, though you have more ability to not interact with patients if that's not your thing (hire a PA or get an intern to do your clinic visits). I imagine the sort of surgery you chose would influence the amount and quality of the interaction. A decent surgeon should spend a fair amount of time explaining what they think should be done and what the outcome and recovery time will be, and what the other choices are. Let's say you specialize in gyn-onc surgery. Before you go into the OR, you have to talk w/ the patient about what you might have to remove, where she draws the line for removal, and possible reconstruction. It's a little more complex than "Hi, I'm your surgeon, let's slice and dice".

 

[1 Up]

FM being a good fit for someone who wants 75% procedures seems pretty unlikely to me. Now, if you flip that, I could see that being possible, and more so if you were willing to live in a rural/remote area (say a small less populous Hawaiian island : ) Or just "the hills". If you are one of a handful of MDs in a 100 mile radius, then C-sections and appys should probably be part of your game. Other, non-emergent surgery you might refer out, logically.

But I agree w/ above about surgery being interactive too. Being a surgeon doesn't mean you don't interact with patients, though you have more ability to not interact with patients if that's not your thing (hire a PA or get an intern to do your clinic visits). I imagine the sort of surgery you chose would influence the amount and quality of the interaction. A decent surgeon should spend a fair amount of time explaining what they think should be done and what the outcome and recovery time will be, and what the other choices are. Let's say you specialize in gyn-onc surgery. Before you go into the OR, you have to talk w/ the patient about what you might have to remove, where she draws the line for removal, and possible reconstruction. It's a little more complex than "Hi, I'm your surgeon, let's slice and dice".

So how would you say that a surgeon could possibly squeeze out the most social interaction? I don't need a lot, but I'd like to know my options.

 

[SoCuteMD]

So how would you say that a surgeon could possibly squeeze out the most social interaction? I don't need a lot, but I'd like to know my options.

Surgeons are not without social interaction. My surgery preceptor was in the office 3d/week and in the OR 2d/week. He had LOTS of patients that he'd been seeing for 10-15 years.

 

[DrJosephKim]

You may enjoy working in an ER.

You can do this through Family Medicine, Emergency Medicine, or General Surgery if you want to work in smaller hospitals.

For larger hospitals/academia, you'll want to train in ER specifically.

 

[DoctorPardi]

Surgery rotations are part of FM training. Some question the value of this now that it is essentially impossible to get privileges and insurance, but it is taught. In terms of getting the number of procedures in such that you will feel comfortable doing them . . . well . . . only a handful of places offer this (and then you still have to get privileges and insurance after you finish residency). The FM forum can offer more help if you are interested.

Oh ok, see I had no idea surgery rotations existed as part of a FP residency. Interesting, thanks!

 

[LuckyBambooGirl]

A lot of the old FPs's had surgery as part of their training, and more of them actutally did appendectomies, etc. But most of the time even those old docs don't do them anymore, they just leave them to the surgeons. I can't imagine new grads from FP residencies actually doing these kind of surgeries any more.

 

[45408]

So how would you say that a surgeon could possibly squeeze out the most social interaction? I don't need a lot, but I'd like to know my options.

Some surgical subspecialties have substantial clinical components to them (also depending on how much you want it like that) - urology, OB/gyn, and ENT are the ones that come to mind. Many surgeons have patients that they follow over a long period of time.

You could also consider something like GI, which has procedures (EGDs, colonoscopies, G-tube placement, etc) along with non-interventional aspects.

 

[njbmd]

Laceration repair, skin lesion biopsy, cryotherapy, casting, fine needle aspirations, etc

I've heard of Family practitioners doing appendectomies, and colonoscopies, and quite a few train to do c-sections in addition to uncomplicated labor and deliveries.

Obviously a Family practitioner can only do things that they have privileges to do at the hospital, or that they can get insurance to cover, and also to the relative need and culture of the area that they practice in.

It isn't likely that any hospital in this country is going to give a Family Medicine physician permission to perform an appendectomy or colonoscopy. Even if there is no General Surgery or Gastroenterologist for miles, these procedures are well out of the scope of Family Medicine.

While they can perform minor biopsies and excise minor wounds, may Family Practicitioners elect not to do even these procedures as well as most do not wish to pay the extra malpractice rider to do deliveries.

If the OP is looking for a procedure-heavy speciality, Emergency Medicine or Anesthesia are better choices. If they are looking for long-term relationships with patients, OB-Gyn is a choice (female patients only). While surgery (and surgical subspecialties are procedure-laden, the practice of these specialties are definitely not laid back nor part time until you have acquired a fairly high degree of competence/experience not to mention cash.

 

[lilnoelle]

It isn't likely that any hospital in this country is going to give a Family Medicine physician permission to perform an appendectomy or colonoscopy. Even if there is no General Surgery or Gastroenterologist for miles, these procedures are well out of the scope of Family Medicine.

Yeah, I believe you.... I don't personally know anyone who does - but I have heard of FP's doing them (specifically one older physician in rural Kansas)

 

[DrBubbles]

It all depends on where you want to practice, and what kind of relationships you want to have with your patients.

There are surgeons who never know their patients beyond a pre-op visit and the procedure.
There are family practitioners who work in large groups or hospitals and refer everything out.
Then there are surgeons, such as those involved in oncology, who may follow a patient for follow-up resections.
And there are family practitioners in rural parts of the US and internationally who do C-sections, colonoscopies, excisions, stitches, and rotate as the ER doc, where they get to do all sorts of things, including some traumas.
And then there's Ob/Gyn, where you get to establish a relationship like in family medicine, and moms come back to you for all their children, but you're doing the C-sections and deliveries as well.

So I guess I would say,
1) Figure out how you feel after anatomy lab is over
2) Figure out if you want to practice in a city, a town, a hospital, a clinic, abroad, etc.
3) Figure out what kind of relationship you want to have with your patients
4) Figure out what you're willing put up with in residency

As a surgeon, a family medicine doc, and an ob/gyn, you can find ways to slice and stitch AND establish care relationships.

 

[1 Up]

You may enjoy working in an ER.

You can do this through Family Medicine, Emergency Medicine, or General Surgery if you want to work in smaller hospitals.

For larger hospitals/academia, you'll want to train in ER specifically.

Why is that? Are smaller hospitals normally short on ER specialists?

Why do people working in the ER have more patient interaction than people who don't?

 

[teddybear]

great, relaxed patient interaction in which I'll be able to engage.

If you count on this I think you're in for a rude awakening. My own FP runs nonstop from one patient to the other. From the time she gets to the clinic in the morning until the time she leaves at night. There's not a lot of relaxation there.

 

[PeepshowJohnny]

Some surgeons do quite a bit of medical management and follow up. Transplant, Bariatric, Urology, ENT, Vascular, etc. But they tend to focus on a single problem and not the complete healthcare of an individual.

I agree that you have somewhat of an idealized view of how the average FP works too.

 

[Mr Cookie Pants]

Going on what Peepshow Johnny said, it sounds like you're a bit idealistic. I think that Urology has the best combination of medicine + OR, so I'd recommend that, or OB/Gyn (so you better like genitalia!).

Or go practice in a 3rd world country where you can do everything as the town doc, but in todays superspecialized system, FP + surgery probably is unattainable.

 

[1 Up]

So I guess I would say,
1) Figure out how you feel after anatomy lab is over
2) Figure out if you want to practice in a city, a town, a hospital, a clinic, abroad, etc.
3) Figure out what kind of relationship you want to have with your patients
4) Figure out what you're willing put up with in residency

As a surgeon, a family medicine doc, and an ob/gyn, you can find ways to slice and stitch AND establish care relationships.

1. I loved Anatomy, and scored the highest grade in my entire class.
2. I'd like to practice in or near a city.
3. I don't need long term relationships, but enough to get that warm feeling from knowing that you've made someone's life better.
4. My guess is that 15 hours days is about what I'd be willing to put up with (give or take 5 hours, depending on the day), but it's hard to say because I've never done that.

 

[1 Up]

If you count on this I think you're in for a rude awakening. My own FP runs nonstop from one patient to the other. From the time she gets to the clinic in the morning until the time she leaves at night. There's not a lot of relaxation there.

I guess we have different ideas of what "relaxed" means.

Basically, I just don't want to come into a room and essentially say, "Your going to die unless I do surgery on you tonight. So are we a go? M'kay thanks!" and then leave. I know it's more drawn out than this, but I like to go a bit farther.

My FP has relaxed office visit, by my definition of the word "relaxed" so I don't see this an impossibility. And every visit that I've made to a sports doctor would also qualify as "relaxed."

 

[DrBubbles]

1. I loved Anatomy, and scored the highest grade in my entire class.
2. I'd like to practice in or near a city.
3. I don't need long term relationships, but enough to get that warm feeling from knowing that you've made someone's life better.
4. My guess is that 15 hours days is about what I'd be willing to put up with (give or take 5 hours, depending on the day), but it's hard to say because I've never done that.

Your profile says you're pre-health, so I'm a bit confused about whether or not you've had cadaver lab.

Based on your responses, though, if you loved cadaver lab, if you want to be in or near a city, if you don't need long-term patient-physician relationships, and if you're willing to work an average of 15 hours a day, my personal opinion, considering I know extremely little about you, is that surgery might be a better option. But this will be an ongoing exploration until the end of your third year of medical school.