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Primary Care pros and cons

Discussion in 'General Residency Issues' started by devilwearsprada, Apr 9, 2007.

  1. devilwearsprada

    devilwearsprada 2+ Year Member

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    Apr 8, 2007
    Chicago
    I am interested in primary care medicine but I keep getting negative feedback about it from PCPs themselves.
    First is of course the reimbursement and lack of procedures but thats not really what bothers me.
    Second is the feeling of 'jack of all trades and master of none' and this bothers me.What are your takes on this field ?
     
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  3. McDoctor

    McDoctor Over One Billion Cured 5+ Year Member

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    Feb 13, 2006
    McHospital
    The money thing is always going to fluctuate, so I wouldn't let that influence you a whole lot.

    The "jack of all trades and master of none" is a legitimate drawback to the field. You will have a more superficial knowledge of each body system than a corresponding specialist in the field. A gastroenterologist will know more about the GI tract than a primary care doc. A cardiologist will know more about the heart...etc...

    To me, there is no shame in this. As a family doc, your input is just as important and at times you will have valid reasons to override the treatment recommendations of a specialist. Some examples:

    Ophthalmologists generally want all of their patients on high doses of vitamins A, C, E, Zn, Copper to prevent macular degeneration. Its up to the family doctor to know when that's appropriate, because for many patients it isn't.

    Nephrologists seem to approach hypertension as though the body is a life support system for a pair of kidneys. As primary care, you have to recognize which patients need to be on beta blockers (as opposed to the all time favorite of nephrologists: the calcium channel blocker) or otherwise to improve all patient outcomes, not just reduction in proteinuria.

    Actually, there are far too many examples too list where your knowledge in primary care will override the recommendations of a specialist. You just can't be a sheep. The bottom line: there is nothing inferior about your knowledge base in primary care if you do your job right. While your knowledge is not as deep, the broad scope of practice often puts you in a better situation to help your patients make the right decisions. If you work hard and back up your decisions with good medical evidence, then your specialist peers will be forced to respect you. So, to me, the broad scope and lack of depth in some areas, it is not a big deal.

    The biggest drawback I see in family medicine is that you often don't have the reward of seeing your patients get measurably better. They come to the office, you give them prescriptions, and then they leave. If they had an acute problem, and they got measurably better, you'll never know it. You'll have your chronic patients, and you'll get them through crisis to crisis, but the chronic illnesses will remain. Most patients don't get measurably better. This is a stark contrast to a surgeon or a hospitalist whose patients, generally, get markedly better as a result of their interventions.

    I did IM for 18 months before switching to FM. I do kind of miss the times when I had a patients acutely dyspneic from pulmonary edema, I gave them lasix, and their respiratory statuts markedly improved in front of my eyes as their foley bag filled with clear urine. You rarely see these kind of results from anything you do in Family Medicine, or primary care in general, outside of the hospital. To me, that's the biggest drawback in primary care.
     
  4. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

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    Jan 21, 2006
    Not at all...we do things every day that result in gratifying, short-term improvement for patients. Just off the top of my head: asthma/COPD exacerbations, gout flares, infections of all types, abscesses, acute pain, etc.

    To be honest, I don't think I watched anybody fill up their Foley bag even when I worked in the hospital. ;)

    To the OP, feel free to visit the FM forum for more information about primary care. If you use the Search feature, I think you'll find that many of your questions have been asked and answered already. If not, that'd be a good place to inquire.
     
  5. McDoctor

    McDoctor Over One Billion Cured 5+ Year Member

    656
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    Feb 13, 2006
    McHospital
    :laugh: call it a weird fetish.

    I'm just saying that in general the acuity of care is lower. This translates to less stress, but also, IMO, less reward. I still stand firm that FM is the far better choice than IM, for a number of reasons that the OP can find in the FM forum.
     
  6. Museless

    Museless Senior Member 7+ Year Member

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    Apr 17, 2003
    Your patients are "yours". Some will be with you many years. This is a very different feeling than being a specialist managing a limited scope of issues on someone else's patient.

    Your practice is limited only by your preferences and your ambitions. Want to sort-of-specialize? Fine. Do a fellowship in sports med, or geriatrics, or, heck, even sleep medicine, since the ABPN recently opened the SM certificate to FM residency grads. Like acute issues? No problem. Do a hospitalist fellowship - or not, depending on the hospital system - and see nothing but inpatients. Hate hospital rounds? Okay. Do straight outpatient FM - even skip out on ob if you really want to never set foot in the hospital again. Dislike continuity of care? Work in an ED or urgent care. Like community involvement? Work with schools, churches, nursing homes, gyms, or spas.

    It's true that you will never know as much about a given organ system as the corresponding specialist. But your "fund of knowledge", if that could be weighed, would weigh the same as any specialist, it would just be made up of a variety of different things. 90% of patients have 10% of possible problems. Rather than know everything there is to know about the heart or brain or kidneys or lungs or skin, you will know the common problems of each. That's what primary care really is, IMO: the specialty of the common. Nothing wrong with that; it will make you more popular than you'd like to be at cocktail parties as you look at rashes and hear other tales of woe. ;)

    A lot of docs in a lot of fields are unhappy right now. That's a situation that's likely to get worse before it gets better. Don't make your decision based on who complains, because I think just about everybody does. I've heard a dermatologist whine they should've gone into anesthesia, and an anesthesiologist whine they should've gone into derm. Most folks in most fields don't leap out of bed before the alarm on Monday morning, beyond thrilled to go to work. But many are content with their careers and their lives. Call me naive, I'm just a resident myself. But I still believe you can find something fulfilling and work on balancing it with the rest of your life and be happy, and only you can decide what you'll find fulfilling long-term.
     
  7. gungho

    gungho gungho Physician 10+ Year Member

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    Jun 24, 2002
    behind glass
    Would agree with KentW and McDoctor. I think you have to know yourself well and what you're looking for. FP can be great because it is broad and gives you so many options. You can also focus on a particular area and become somewhat of an "expert" though you won't be recognized to the same degree as the boarded/fellowship-trained specialist. Personally, I spent a lot of years practicing Family Medicine and switched to Pathology. I love it, but I also recognize that the field has its own set of problems and potential future concerns. After I get out of residency and start practicing, it will develop its own routine and degree of boredom. If you can find an area that provides satisfaction 70-80% of the time, I'd say you're in good shape, probably better than the majority of the workforce.
     

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