Preventive Medicine

[canadian1234]

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Is there a forum or sub-forum on preventive medicine residency programs?

If not, I am wondering which preventive medicine programs are progressive and/or open minded to alt medicine?

 

[Winged Scapula]

Is there a forum or sub-forum on preventive medicine residency programs?

If not, I am wondering which preventive medicine programs are progressive and/or open minded to alt medicine?

There is not a forum for Preventive Medicine.

I don't know the answer to your second question; as usual, you would be well advised to contact programs yourself for this information.

 

[gutonc]

If not, I am wondering which preventive medicine programs are progressive and/or open minded to alt medicine?

Here's the deal. If you want to train and/or practice in the US, for better or worse, you have to play the game when it comes to residencies. Don't expect much (if anything) in the way of alt med training in any allopathic (or, let's be honest, osteopathic) training programs in the US. If you're lucky, you'll land in a place that will give you a minimal amt of exposure to integrative/alternative treatment options, maybe a few hours of accupuncture training or a few afternoons (over the course of your training) w/ a naturopath or an herbalist or a chiropractor or a ....

My program, which is one of the most open minded IM programs you're likely to find, has a very few opportunities to get exposure to alt med training but there is absolutely no way to fulfill the requirements of a US residency training program, AND to get comfortable/certified in any of the numerous alternative treatment options available.

My advice, FWIW, is to find a place you like, train there, do what's expected of you and then, when you're done, licensed and on your own, get whatever additional training/education you need to do whatever it is that you really want to do.

Alternatively, if you have another $150K plus living expenses for the next 5 years just sitting around, go to naturopathic college and practice essentially free of limitations on scope of practice and malpractice liability in the few states that recognize NDs.

If you want to be an MD, be an MD. If you want to be something else, have at it and be something else.

 

[Winged Scapula]

FYI:

the OP is already an MD, having graduated from a Canadian school many years ago. He has not practiced conventional Western medicine for a number of years, and is apparently well established in the field of alternative medicine. His primary training was a single year of GP in Canada.

He wishes to come to the states to practice, so was inquiring about residency programs as we've told him that he would be unlikely to get licensed without one (given other circumstances regarding his Canadian license).

 

[lowbudget]

FYI:

the OP is already an MD, having graduated from a Canadian school many years ago. He has not practiced conventional Western medicine for a number of years, and is apparently well established in the field of alternative medicine. His primary training was a single year of GP in Canada.

He wishes to come to the states to practice, so was inquiring about residency programs as we've told him that he would be unlikely to get licensed without one (given other circumstances regarding his Canadian license).

Hmm... interesting. I just finished reading the OPs old posts and if I'm reading them correctly: Older Canadian GP trained by way of psych/medicine internship practicing Alt Med s/p license revocation for practicing Alt Med now with restricted educational license seeking US FMG position in either FM, Psych, or PM hopes of practicing Alt Med in US? Very interesting background.

Sounds like the issue with your Canadian license is a separate debate all to itself. I'm not even going to touch that one because it sounds like you may need professional advice on that one.

I don't know the answer to the OP's question, but I would imagine one such way of find out would be to look up which institutions have both PM residency *and* either a fellowship in Integrative Med or a research center for Integrative Med.

So places like UTMB, UCSF, Harvard, U Maryland would fit that bill with U Arizona being the mother of them all.

I understand your predicament. In my state, an FMG needs 3 years of residency training in order to get a license (vs. 1 year for US grads). I can see why you'd want to go for a 3 year PM residency because it's the least clinical of all the residencies (only requires 1 year of clinical training + 2 years of paperwork training). Integrative Med is not widely accepted but is practiced by a lot of specialties but the specialty that exposes residents to it is FM (which is 3 years of clinical training). But do you really want to go through 3 years of FM training after having spent so many years away from mainstream medicine just so you can go back to Alt Med? Psych, I think would be better, but do you want to do 4 more years?

PM's not a bad choice in your case. With your years of experience, it's not like you need "further training" in Integrative Med since you've been practicing it. So just do a residency and practice it.

Come to think of it, who cares & why bother? Is alternative medicine even regulated? I mean, do you have to be licensed to practice alternative medicine? Why not just set up shop and practice alternative medicine without a medical license? Why do you have to be licensed as a physician to be an alternative practitioner?

 

[gutonc]

FYI:

the OP is already an MD, having graduated from a Canadian school many years ago. He has not practiced conventional Western medicine for a number of years, and is apparently well established in the field of alternative medicine. His primary training was a single year of GP in Canada.

He wishes to come to the states to practice, so was inquiring about residency programs as we've told him that he would be unlikely to get licensed without one (given other circumstances regarding his Canadian license).

I am aware of all that. I was just pointing out that he is unlikely to find a residency program that will allow him to practice any of the alt med treatments that he is already familiar with while he is in training, with a few minimal exceptions.

The recommendation for ND school was mostly tongue-in-cheek but also meant to point out the minimal oversight and surprising breadth of scope-of-practice that NDs have in those few states that recognize them and that, if he chose to go this route, he could essentially do whatever he wanted to do practice-wise

 

[Winged Scapula]

Thanks for the clarification; I wasn't aware if you knew the backstory. But you are right, for the most part, as I've said in other posts, alternative medicine is still fringy and not taught to any meaningful extent in MD/DO residencies in the US.

 

[canadian1234]

I appreciate all of your input. As the OP of this thread, I would like to clarify that I am looking to do a residency in the USA or Canada in order to enter clinical practice again in Canada or the USA. I am not looking to practice alternative medicine in the residency but trying to find a program that has an open mind to my "advancing" age, long time out of medical school, past involvement in alt med which lead to my battle with the College of Physicians etc.

You might be interested to know that a group of us, by working with a variety of individuals and organizations, recently was able to convince the government to abolish the College's largest committee. The College lost millions of dollars and a large amount of its power because they had been conducting unfair physician audits which caused many to restrict or close their practices and some to commit suicide.

 

[Blade28]

Which College of Physicians is this? The Royal College of Physicians and Surgeons of Canada?

Which committee was abolished?

Why would physicians be committing suicide after an audit?

 

[canadian1234]

Which College of Physicians is this? The Royal College of Physicians and Surgeons of Canada?

Which committee was abolished?


Why would physicians be committing suicide after an audit?

Each Canadian province has a College of Physicians and Surgeons which is similar to the USA State Medical Boards.

You might want to read Professor R. Hamowy's "Canadian Medicine, A Study in Restricted Entry".

The government abolished the Medical Review Committee and replaced it with a new audit system.

A pediatrician who was overworked in an underserviced area committed suicide subsequent to being told by the Medical Review Committee to repay over $100,000 because his clinical notes were inadequate.

Doctors have a higher than average suicide rate. It is a definite risk. Do medical schools today talk of the various risks of being a doctor?

Judge Peter Cory, an internationally respected judge, found the College was running an audit system that was devastating, debilitating, unfair, unreasonable and had a negative effect on the delivery of health care.

 

[oldbearprofessor]

A pediatrician who was overworked in an underserviced area committed suicide subsequent to being told to repay over $100,000 because his clinical notes were inadequate.

Do you have a link to a description of this story so we may form our own opinion of what happened?

 

[billydoc]

Try this www.ACAM.org first. Many well-respected physicians who incorporate integrative medicine are members of the ACAM. I'd also sugguest to get out to their conference for both your professionl delopement and may be to shake a few hands. Personal contact with ppl who matter will almost always make or break you.

Best of Luck.

Is there a forum or sub-forum on preventive medicine residency programs?

If not, I am wondering which preventive medicine programs are progressive and/or open minded to alt medicine?

 

[canadian1234]

Do you have a link to a description of this story so we may form our own opinion of what happened?

Certainly. There is a lot on this. I appreciate your interest. A good brief article in the lay media (Ottawa Citizen) is:

http://www.cofp.com/media/DworkinArticleHsu.asp

Part of the problem was a lack of sensitivity to cultural differences. Some cultures (Chinese, Muslim) put a high value on honour...above life and limb. Dr. Hsu felt dishonored and treated like a criminal since he was accused of overbilling the system.

We have small Yahoo group of doctors and citizens with over 8000 posts over 5 years that played a major role in eliminating the unfair audit system...mostly by work on the Internet.

 

[NotAProgDirector]

Do you have a link to a description of this story so we may form our own opinion of what happened?

Google is a wonderful thing. I had never heard of this.

Here's a summary dated 2005

The details here are just amazing. Sound like:

1. The gov't decides that they think you are billing fraudulently, based on whatever criteria they want.
2. They audit you. You pay for the audit.
3. Depending on what they find, they take back money. Sounds like they can take lots.
4. If you contest it, they take the money anyway by refusing to pay any new billings.

My favorite quote is: "I feel bad those small numbers of people feel so upset by having their records checked. But I would like to point out that 20 per cent of those investigated don't pay anything back." If their audit process finds that 80% of people are billing fraudulently, then they either have a tremendous fraud problem or the audit system is crap.

All of this is old. Has this been dismantled?

EDIT: Ooops. Better post above while I was writing this one. Ignore me. As usual.

 

[canadian1234]

Try this www.ACAM.org first. Many well-respected physicians who incorporate integrative medicine are members of the ACAM. I'd also sugguest to get out to their conference for both your professionl delopement and may be to shake a few hands. Personal contact with ppl who matter will almost always make or break you.

Best of Luck.

Thanks. I have attended some of the conferences. I get the impression they are mainly for docs in practice and so much for residents?

 

[canadian1234]

Google is a wonderful thing. I had never heard of this.

Here's a summary dated 2005

The details here are just amazing. Sound like:

1. The gov't decides that they think you are billing fraudulently, based on whatever criteria they want.
2. They audit you. You pay for the audit.
3. Depending on what they find, they take back money. Sounds like they can take lots.
4. If you contest it, they take the money anyway by refusing to pay any new billings.

My favorite quote is: "I feel bad those small numbers of people feel so upset by having their records checked. But I would like to point out that 20 per cent of those investigated don't pay anything back." If their audit process finds that 80% of people are billing fraudulently, then they either have a tremendous fraud problem or the audit system is crap.

All of this is old. Has this been dismantled?

EDIT: Ooops. Better post above while I was writing this one. Ignore me. As usual.

Thanks for Googling it. That is a great quote. Another from the President of the College: "If doctors fail to make good notes, they deserve whatever they get".

It was the Conservative government that set up the draconian audits in an attempt to fund an ill-fated tax rebate system. We were successful in convincing the current Liberal government to dismantle the old system and replace it: see Schedule G of the Health System Improvements Act 2007.

We had a large debate as to whether to use legal, lobbying or media coverage to accomplish this. It was our lobbying efforts that did the job. Some called it 'unprecedented' since it meant the College lost millions of dollars and a large amount of its power.

We are still working on this issue to ensure the new system is good. We are thinking of pressing for compensation/restitution for the victims.

As President of the organization, Ontario Doctors For Fair Audits, I encourage everyone here to join (free) and post to our group. (You have to join this Yahoo Group in order to read the posts.) We appreciate the help of additional intelligent, thoughtful and active people.

Go to: http://www.groups.yahoo.com/group/ontariomedicalaudits

 

[billydoc]

Thanks. I have attended some of the conferences. I get the impression they are mainly for docs in practice and so much for residents?

Sure it is. And I think it's a good thing. You have a high cocentration of pracicing, somewhat like-minded physicians. If you establish some contacts there, I'm almost certain that some of them are either PDs or know someone who is, or at least know of someone who is. But it can't get any closer to what you seemingly want to do. I'd go there in April. I think Orlando, FL during the Easter/Passover time beats Canada wheather-wise hands down 😉😀

Best of Luck to you, friend

 

[TRAMD]

Just wanted to put in a plug for a preventive med forum.

 

[canadian1234]

Hey Billy,

Thanks for this. I live in Toronto and Vancouver. I prefer the left coasts. I have many friends in Los Angeles and will probably apply mostly to wet coast programs. Might you recommend any CAM conferences out west?

Sure it is. And I think it's a good thing. You have a high cocentration of pracicing, somewhat like-minded physicians. If you establish some contacts there, I'm almost certain that some of them are either PDs or know someone who is, or at least know of someone who is. But it can't get any closer to what you seemingly want to do. I'd go there in April. I think Orlando, FL during the Easter/Passover time beats Canada wheather-wise hands down 😉😀

Best of Luck to you, friend

 

[billydoc]

Hey Billy,

Thanks for this. I live in Toronto and Vancouver. I prefer the left coasts. I have many friends in Los Angeles and will probably apply mostly to wet coast programs. Might you recommend any CAM conferences out west?

I'd check ACAM's website often. I know that they meet in Las Vegas, NV, and in S.F Cali but don't know their dates right now. Also check out their physician list in States you are interested in. You may not even have to go anywhere if you don't want to. If you show some interest I think these folks will go uot of their way to help you, or at least give some pointers 😀

Good Luck

 

[USMELL]

Just wanted to put in a plug for a preventive med forum.

Are you considering a Preventive Medicine Residency also? How exactly those that work. Like I know you do a prelim year, then apply as a PGY-2, but are schools favoring those with completed residencies. Also can one later choose to practice clinical medicine, or would one have to go back to residency, anyone with info please post.

thanks
confused CC3

 

[TRAMD]

Are you considering a Preventive Medicine Residency also? How exactly those that work. Like I know you do a prelim year, then apply as a PGY-2, but are schools favoring those with completed residencies. Also can one later choose to practice clinical medicine, or would one have to go back to residency, anyone with info please post.

thanks
confused CC3

Yes, I plan to complete an occ med residency after PM&R. I don't know if there is a preference for those that have already completed a residency but if there is it certainly isn't prohibitive. I know people that went the direct route from a prelim year. There can be clinical medicine in preventive medicine specialties. Your limitations are the same as they are with any other specialty. Technically once you are licensed as a doc in a state you can do anything that a doc can do (an FP could do breast implants) but you are most likely (far more likely) to be successful and competent practicing what you are trained in.

 

[Blade28]

Yes, I plan to complete an occ med residency after PM&R.

You're going to do two residencies?! 😕

 

[fantasty]

You're going to do two residencies?! 😕

Prev med residencies are not quite the same. As mentioned, PGY1 year is clinical (and would be fulfilled by the poster's PMR residency). Year 2 is academic (getting your MPH) and year 3 is basically a practicum year. And, many in prev or occ med are dual boarded (in IM, peds, family, PMR, etc).

 

[TRAMD]

You're going to do two residencies?! 😕

Think of it more as a fellowship. Total will be 5 years. Here is my (hopeful) plan:

1 year family medicine prelim
3 years PM&R and getting my MPH simultaneously
1 year clinical occupational medicine

 

[USMELL]

Think of it more as a fellowship. Total will be 5 years. Here is my (hopeful) plan:

1 year family medicine prelim
3 years PM&R and getting my MPH simultaneously
1 year clinical occupational medicine

Thanks for posting, I have a question though, I thought Prelim year has to be internal medicine, surgery, or peds. never heard of a family medicine prelim before, and would Preventive Med residency, even accept it?

To do the MPH and residency at the same time, is that even possible?

thanks

 

[Blade28]

Think of it more as a fellowship. Total will be 5 years. Here is my (hopeful) plan:

1 year family medicine prelim
3 years PM&R and getting my MPH simultaneously
1 year clinical occupational medicine

Ah, gotcha.

Nice! 👍

 

[TRAMD]

Thanks for posting, I have a question though, I thought Prelim year has to be internal medicine, surgery, or peds. never heard of a family medicine prelim before, and would Preventive Med residency, even accept it?

To do the MPH and residency at the same time, is that even possible?

thanks

Most programs are fine with any prelim year. I can't speak for ALL but most are ok with it. Plus, you can do preventive med as a fellowship from just about any specialty. Most of the programs are very non-competitive.

As for your second question, I am not sure. Some programs will only accept certain MPH degrees and some will only accept their own MPH program. I am still in the process of figuring this out. I will likely not do it if it will take me two extra years.

 

[USMELL]

Most programs are fine with any prelim year. I can't speak for ALL but most are ok with it. Plus, you can do preventive med as a fellowship from just about any specialty. Most of the programs are very non-competitive.

As for your second question, I am not sure. Some programs will only accept certain MPH degrees and some will only accept their own MPH program. I am still in the process of figuring this out. I will likely not do it if it will take me two extra years.

thanks for replying, nice to see someone else considering PM&R. I actually just started thinking of Pm&R, Preventive medicine, and some of the other less known residencies like medical genetics, management etc, but I'm also scared because I am worried are these financially stable residencies, is there long term job security for like 20 years, vs the other well known routes, like family med, internal med etc. basically, this long post is just to ask you, why PM&R, why preventive medicine, and what do you see yourself doing with them. thanks. If you don't want to post that's fine, or you can just PM me also. thanks 🙂

 

[TRAMD]

thanks for replying, nice to see someone else considering PM&R. I actually just started thinking of Pm&R, Preventive medicine, and some of the other less known residencies like medical genetics, management etc, but I'm also scared because I am worried are these financially stable residencies, is there long term job security for like 20 years, vs the other well known routes, like family med, internal med etc. basically, this long post is just to ask you, why PM&R, why preventive medicine, and what do you see yourself doing with them. thanks. If you don't want to post that's fine, or you can just PM me also. thanks 🙂

My father has an occupational medicine clinic (he is double-boarded in occ med and family med). He is as busy as he wants to be, doesn't take call and brings in a good salary. I chose PM&R because so much of occupational medicine is musculoskeletal medicine and I can do EMGs, injections and inpatient work on top of that. I plan to work with him for a few years until he retires and then buy his practice after that. His practice consists mainly of worker's compensation patients, work physicals and being an MRO for drug testing. He also does wellness screenings for companies and performs walk-throughs to make suggestions relating to safety and ergonomics. I find all of it rather fascinating and there is a strong legal aspect to it that I also find interesting. He has testified as an expert witness multiple times.

As far as job security, I think pretty much all medical specialties are strong in this area (you will find "beware the ides of march" types that will disagree with this, however). There are some that I feel are stronger than others. Job security in medicine seems to be determined by two things. The first is a continued need for the specialty. Hips will keep going bad and bones will continue to be broken so something like orthopedics is very strong in this area. The second factor seems to be whether or not secondary providers are encroaching into the territory. This has been a worry in the past with CNPs, CRNAs and PAs but I have not seen any evidence of this really hurting physicians. On the contrary, it seems to have helped many so I think this is arguable either way. The biggest safeguard here seems to be more procedures as most secondary providers are not trained in them. Again, orthopedics would be very strong here.

In occupational medicine there will continue to be workers that are injured on the job and employers will continue to want to do their best to hire healthy people and keep them healthy so I feel the demand will keep up. There are PAs, CNPs and even family and IM docs that do some of what an occ med doc does but there is plenty of specialized stuff and the population of occ med docs is pretty sparse.

I feel that the future of PM&R is changing to a degree but is very strong indeed. The population is getting older and as mortality at younger ages goes down we are left with more survivors with more morbidity. The need for rehab (both secondary to trauma and CVAs) and pain management will continue to increase.

It is true that some occ med residencies are struggling to stay afloat financially but there are still many very good programs out there that are just fine. I guess I can make another point here that I believe there is little danger of residencies training too many docs in any one specialty. If there is enough "business" out there to keep X number of residencies open then there is enough to keep Y number of physicians in that specialty busy. The whole deal is controlled by market forces and if demand for a specialty goes down so will the number of residencies and that just means fewer people are invited to the party but they all still get a good-sized piece of cake.

 

[USMELL]

My father has an occupational medicine clinic (he is double-boarded in occ med and family med). He is as busy as he wants to be, doesn't take call and brings in a good salary. I chose PM&R because so much of occupational medicine is musculoskeletal medicine and I can do EMGs, injections and inpatient work on top of that. I plan to work with him for a few years until he retires and then buy his practice after that. His practice consists mainly of worker's compensation patients, work physicals and being an MRO for drug testing. He also does wellness screenings for companies and performs walk-throughs to make suggestions relating to safety and ergonomics. I find all of it rather fascinating and there is a strong legal aspect to it that I also find interesting. He has testified as an expert witness multiple times.

As far as job security, I think pretty much all medical specialties are strong in this area (you will find "beware the ides of march" types that will disagree with this, however). There are some that I feel are stronger than others. Job security in medicine seems to be determined by two things. The first is a continued need for the specialty. Hips will keep going bad and bones will continue to be broken so something like orthopedics is very strong in this area. The second factor seems to be whether or not secondary providers are encroaching into the territory. This has been a worry in the past with CNPs, CRNAs and PAs but I have not seen any evidence of this really hurting physicians. On the contrary, it seems to have helped many so I think this is arguable either way. The biggest safeguard here seems to be more procedures as most secondary providers are not trained in them. Again, orthopedics would be very strong here.

In occupational medicine there will continue to be workers that are injured on the job and employers will continue to want to do their best to hire healthy people and keep them healthy so I feel the demand will keep up. There are PAs, CNPs and even family and IM docs that do some of what an occ med doc does but there is plenty of specialized stuff and the population of occ med docs is pretty sparse.

I feel that the future of PM&R is changing to a degree but is very strong indeed. The population is getting older and as mortality at younger ages goes down we are left with more survivors with more morbidity. The need for rehab (both secondary to trauma and CVAs) and pain management will continue to increase.

It is true that some occ med residencies are struggling to stay afloat financially but there are still many very good programs out there that are just fine. I guess I can make another point here that I believe there is little danger of residencies training too many docs in any one specialty. If there is enough "business" out there to keep X number of residencies open then there is enough to keep Y number of physicians in that specialty busy. The whole deal is controlled by market forces and if demand for a specialty goes down so will the number of residencies and that just means fewer people are invited to the party but they all still get a good-sized piece of cake.

Thanks for such an awesome post. 🙂

 

[USMELL]

My father has an occupational medicine clinic (he is double-boarded in occ med and family med). He is as busy as he wants to be, doesn't take call and brings in a good salary. I chose PM&R because so much of occupational medicine is musculoskeletal medicine and I can do EMGs, injections and inpatient work on top of that. I plan to work with him for a few years until he retires and then buy his practice after that. His practice consists mainly of worker's compensation patients, work physicals and being an MRO for drug testing. He also does wellness screenings for companies and performs walk-throughs to make suggestions relating to safety and ergonomics. I find all of it rather fascinating and there is a strong legal aspect to it that I also find interesting. He has testified as an expert witness multiple times.

As far as job security, I think pretty much all medical specialties are strong in this area (you will find "beware the ides of march" types that will disagree with this, however). There are some that I feel are stronger than others. Job security in medicine seems to be determined by two things. The first is a continued need for the specialty. Hips will keep going bad and bones will continue to be broken so something like orthopedics is very strong in this area. The second factor seems to be whether or not secondary providers are encroaching into the territory. This has been a worry in the past with CNPs, CRNAs and PAs but I have not seen any evidence of this really hurting physicians. On the contrary, it seems to have helped many so I think this is arguable either way. The biggest safeguard here seems to be more procedures as most secondary providers are not trained in them. Again, orthopedics would be very strong here.

In occupational medicine there will continue to be workers that are injured on the job and employers will continue to want to do their best to hire healthy people and keep them healthy so I feel the demand will keep up. There are PAs, CNPs and even family and IM docs that do some of what an occ med doc does but there is plenty of specialized stuff and the population of occ med docs is pretty sparse.

I feel that the future of PM&R is changing to a degree but is very strong indeed. The population is getting older and as mortality at younger ages goes down we are left with more survivors with more morbidity. The need for rehab (both secondary to trauma and CVAs) and pain management will continue to increase.

It is true that some occ med residencies are struggling to stay afloat financially but there are still many very good programs out there that are just fine. I guess I can make another point here that I believe there is little danger of residencies training too many docs in any one specialty. If there is enough "business" out there to keep X number of residencies open then there is enough to keep Y number of physicians in that specialty busy. The whole deal is controlled by market forces and if demand for a specialty goes down so will the number of residencies and that just means fewer people are invited to the party but they all still get a good-sized piece of cake.

Thanks for such an awesome post. 🙂

 

[Blade28]

My father has an occupational medicine clinic (he is double-boarded in occ med and family med).

Is the plan for you to take over his practice?

 

[TRAMD]

Is the plan for you to take over his practice?

Yes. This admittedly makes my outlook for occ med especially favorable.

 

[Blade28]

Yes. This admittedly makes my outlook for occ med especially favorable.

Ah. Gotcha!

 

[TRAMD]

Ah. Gotcha!

What about you? What are your long-term goals for practice?

 

[path15]

What do most general preventive physicians end up doing? I know an occupational medicine physician who does full-time research, but I'm wondering if this is the norm for general preventive medicine too?
Also, I know this is an annoying question to ask, but how much money to they make? I've heard (again, all rumors from questionable sources) that they only make around 80,000 a year, which isn't that much if someone has extensive med school loans to repay.
Any info would be much appreciated.

 

[Blade28]

What about you? What are your long-term goals for practice?

Answered in your new thread!

 

[TRAMD]

What do most general preventive physicians end up doing? I know an occupational medicine physician who does full-time research, but I'm wondering if this is the norm for general preventive medicine too?
Also, I know this is an annoying question to ask, but how much money to they make? I've heard (again, all rumors from questionable sources) that they only make around 80,000 a year, which isn't that much if someone has extensive med school loans to repay.
Any info would be much appreciated.

I don't know about full-time research but practicing preventive med docs make $140k-$200k on average. My dad makes about twice that.

 

[zer0el]

I don't know about full-time research but practicing preventive med docs make $140k-$200k on average. My dad makes about twice that.

What does your dad do? I'm considering applying for a combined IM/PM residency that will also give me an MPH, but am not exactly sure what I can do with that kind of training. Thanks.

 

[fantasty]

Check about 10 posts up on the page 😉

 

[GumbyGoGo]

Check about 10 posts up on the page 😉

Fantasy,

Are you in preventive medicine? Can you PM me?

 

[fantasty]

There is not a forum for Preventive Medicine.

I don't know the answer to your second question; as usual, you would be well advised to contact programs yourself for this information.

Maybe there should be 🙂 (Although I know that's come up before)

Fantasy,

Are you in preventive medicine? Can you PM me?

Sorry about the delay - check your inbox. Thanks!

 

[sanktank7]

IM resident here also with questions about PM. Specifically, I am interested in how important the pedigree of MPH is in getting a future position as a city/county health officer?

Also, I want to be able to practice as a primary care doctor or geriatrician if my public health aspirations don't pan out. Would I be able to get these jobs just as easily with PM boarding alone or do I need to be IM boarded as well?

Finally, can I do a fellowship in hospice and palliative care after just PM boarding or do I need to be also be IM boarded to be able to apply for palliative care fellowship?

 

[fantasty]

IM resident here also with questions about PM. Specifically, I am interested in how important the pedigree of MPH is in getting a future position as a city/county health officer?

Also, I want to be able to practice as a primary care doctor or geriatrician if my public health aspirations don't pan out. Would I be able to get these jobs just as easily with PM boarding alone or do I need to be IM boarded as well?

Finally, can I do a fellowship in hospice and palliative care after just PM boarding or do I need to be also be IM boarded to be able to apply for palliative care fellowship?

I would definitely recommend finishing IM and being dual-boarded if you still want to practice as an internist (whether that's as a generalist, geriatrician, or in palliative care). There is significantly more job security and opportunities being dual-boarded.

As for the MPH, my opinion is that the preventive medicine residency itself will have a much bigger impact on your career options (and connections). Most of the PM programs are associated with "top-tier" or at least "well-respected" MPH programs, anyhow. If you were pursuing an MPH independently (without the benefit of preventive medicine training), then the pedigree of the degree would probably matter more.

If you're interested in learning about city/county health officer careers, a good starting place is the National Association of County and City Health Officials http://naccho.org/ I assume that most (if not all) PM residencies will have some rotations in that setting, though.

 

[fantasty]

I was going to PM but I guess there's no reason not to post here....

It's interesting that you also have a palliative care interest. I, and several colleagues, have been discussing our interests in palliative / end-of-life care, even though we're more in tune with preventive medicine. As "preventive" medicine generally is much for focused on keeping people from getting sick to begin with, there aren't a lot of folks in PM that think about palliative care. (And we've been shot down a few times in planning conference sessions and things). But, philosophically, I think there's a lot of overlap. Preventive medicine should also consider "the prevention" of suffering and symptoms. And, the "prevention" of overuse of medically futile procedures and medical decisions that impact the quality of care. (And of course - patient safety and quality improvement).

I have inquired about palliative care fellowships, but the answers I've gotten so far have all specified that they'll only consider you if you completed specialties like IM, peds, and FP.

 

[sanktank7]

Thanks for your reply. I am consistently getting the same feedback regarding finishing IM before doing PM. I am just looking for ways to save time and minimize the opportunity cost of my training since I know my career will not be financially lucrative.

One career trajectory I have considered is IM->PM->hospice. I believe PM trained physicians are perfectly positioned to be leaders in driving healthcare sustainability. My goal is to use the epi/health systems training to quantify the inherent value of better utilization/end of life decisions. I also want to use the PM training to get better experience in safety net settings and hopefully demonstrate that leveraging inpatient savings for outpatient preventive care can create further sustainability. Even administrators acknowledge that this is the future of medicine if you follow publications from the advisory board or similar organizations.

Not sure if I can find a job that will entertain what I have in mind, hence the need for a reliable fall back...

Are you a PM doc Fantasty? I was hoping to message you about some specifics of my situation but found that your profile was limited. Could you message me?

 

[fantasty]

We'll have to clarify which PM is private message, which is preventive, and which is palliative 🙂 But, I'll go with preventive for now unless otherwise specified... Your post reminds me that my post from 2008 is not really correct anymore:

Prev med residencies are not quite the same. As mentioned, PGY1 year is clinical (and would be fulfilled by the poster's PMR residency). Year 2 is academic (getting your MPH) and year 3 is basically a practicum year. And, many in prev or occ med are dual boarded (in IM, peds, family, PMR, etc).

This was correct when I was a medical student applying to IM residencies. Several years ago (I can't remember when, but probably 2010 or so, based on my timeline), ACGME changed the "rules" for PM residency to make our training more consistent with other clinical specialties. Specifically, most places now require that you have some of your "clinical" training consistently through the 2 years of training (still PGY2 & PGY3). So, the old idea of just doing your MPH in one year then one year of practica / rotations is no longer accurate. Most programs I know of switched to doing both your coursework and your rotations at the same time. But, as our rotations are a mixture of public health and clinical (and tend to be longer commitment than 2-4 weeks like IM rotations). The main reason I wanted to point that out here is that, under the "old" way, one way to streamline your length of training was to have your MPH before hand. If that was the case, then PM training only required that 1 year of rotations. But, now... I'm pretty sure... you won't get out in less than 2 years. There may be nuances I don't know, though (for example, I know that Mayo's training program is technically a "fellowship", but I don't know if that affects your standing for being boarded - I presume not, but we could check). Also, there are some combined programs, but very few. I *don't* know about the ease or availability of transferring in to a combined program. But, the Griffin program may be one to look at (and I can point you to the right person at ACPM who keeps track).

My long-term mentor was an IM/PM doc, and his advice at the time for my career goals was invariably that I should do IM first (if I wanted to be a clinician). He also voiced concerns about the flexibility and status of PM as a field. As you can tell - we don't have a forum on here. I later learned through ACPM that many people never even know that PM is a career option because their dean's offices don't know about it. We don't participate in the match (for the most part), and you have to at least one year of clinical training before you apply, so relatively few graduating medicine students even have that on their radar. And, PM residencies are not funded by the same mechanism as everyone else (CMS), so it can be a real challenge. But, we are a boarded specialty and have been for decades. Occ Med & Aerospace are our "sister specialties", and PM docs can sometimes go the OM route (and get boarded as such). There are many opportunities for dual-boarded folks. And, there are definitely great career opportunities being only PM-boarded. But, not having the "primary care" specialty under your belt simply does limit you.

My anecdotal take on job searching now... There are 10 X as many OM job posting as strictly PM positions. And, probably 10 X as many IM positions as OM. And, like I said, I don't think most IM/FP fellowships will take you just being PM trained. We have recognized fellowships, of course (toxicology and informatics being the most obvious). And, you can certainly have a clinical career being PM-boarded only. But, there are also a number of "less" clinical options (I'm not going to say "non-clinical" but less clinical than I was hoping for), so I don't want to paint the job market as unfavorable.

But, being dual-boarded really makes you a rockstar when it comes to options. And, like you said, having two years of intensive, essential "on-the-job" training in PM gives you an excellent skill set for epidemiology, health systems / administration, community / public health, and clinical prevention, which I think is worth it. And, lastly - PM & OM docs tend to have some of the highest reported career satisfaction, for what it's worth 🙂

 

[fantasty]

A recent blog entry from a colleague. There's one thing I would fact check, but otherwise a snapshot of Prev Med

Preventive Medicine FAQs