Primary care vs. specialization

[GBFKicks]

I was just wondering what people wanted to do after med school. Seems like most people want to specialize, but I wanted to see people's reasons to both specialize and not specialize. I mean, how many people out there are actually thinking about rural medicine?

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[Fumoffu]

Primary Care - Internal Medicine (not hospitalist)

 

[Gleevec]

Most people practicing academic medicine ARE specialists. In fact, academics tend to be the most specialized of specialists (oftentimes focusing on and mastering one particular disease within a field)

 

[GBFKicks]

Most people practicing academic medicine ARE specialists. In fact, academics tend to be the most specialized of specialists (oftentimes focusing on and mastering one particular disease within a field)

Yes, I understand that many in academic medicine are specialists, but what I meant by the academic medicine option of the poll is whether people plan to specialize or not, do they plan on pursuing a career in academic medicine. Maybe I should have phrased the question differently.

 

[skypilot]

In Family Practice... heh heh, ark ark.

 

[Alexander99]

I noticed over 70% of people plan to specialize while hardly any people want to do primary care. This will change once we know our board scores.

 

[pikachu]

There are a lot of different flavors of primary care docs. Internal Medicine, Peds, Family, and Ob-Gyn are all considered "Primary Care" but each of these fields (obviously) practice very different kinds of medicine.

Your decision will be made once you get into medical school -- specifically, when you actually experience each specialty and discover whether you like it or not. I think it will also be clear early on whether or not you want to do academics (do you like zebras? do you like research?) or private practice...Don't overthink things early on, lock yourself into a specialty, and confound your options.

 

[blazenfire]

There was actually a very interesting article about the declining number of primary care physicians nowadays in the New York Times Medical Magazine. Specialization all the way.

 

[GBFKicks]

I'm just surprised that as of now there are almost as many people interested in academic medicine as there are in primary care.

 

[SoulRFlare]

well, with medical school debt pushing $200,000 plus, not to mention the love affair our society seems to have with the judicial system, it's suprising that more people aren't planning to specialize.

 

[docjolly]

I noticed over 70% of people plan to specialize while hardly any people want to do primary care. This will change once we know our board scores.

Alexander99,

do you know why this is true? what's so bad about primary care? is it the salary? work hours? professional opportunities? i'm a little ignorant on this subject, but would greatly appreciate your (or anyone's ) answer..

 

[Fumoffu]

Alexander99,

do you know why this is true? what's so bad about primary care? is it the salary? work hours? professional opportunities? i'm a little ignorant on this subject, but would greatly appreciate your (or anyone's ) answer..

I'm guessing salary and prestige play a big role. Specialists get paid 2-3 times (if not more) than primary care.

Also for people who want to go into academia/research, you basically have to specialize.

I'm not entirely sure on hours AFTER you've been established in the fields as primary care doctors get called in at odd hours but I'm guessing surgeons have more scheduled hours (but long as well).

As for residency and fellowships, clearly specialization is longer.

 

[Alexander99]

Alexander99,

do you know why this is true? what's so bad about primary care? is it the salary? work hours? professional opportunities? i'm a little ignorant on this subject, but would greatly appreciate your (or anyone's ) answer..

Like someone said, salary may be a factor. I think primary care docs actually have reasonable hours compared to some specializations (but again, they get paid way less.)

I think many people can find something interesting to specialize in but a lot of the specializations can be competitive and require high board scores, good clinical grades, etc and in the end, you're kinda limited to a few specializations or primary care (not to knock primary care--we need those type of docs) if you don't have that stuff. Maybe what I'm saying is pure rubbish but it might explain why few people go into med school wanting to do primary care but quite a few actually enter the field.

 

[southbelle]

There are plenty of "specialties" that non-gunners with ordinary stats from any MD school can enter. Gas, Path, EM, Psych, neurology. Many of the IM fellowships that lead to academic spots aren't gunner favorites- Rheum, geriatrics, neph, CCmed.

 

[SailCrazy]

There was actually a very interesting article about the declining number of primary care physicians nowadays in the New York Times Medical Magazine. Specialization all the way.

Is there a link to that article around?

 

[Triple Threat]

Is there a link to that article around?

I think blazefire may have been referring to this article. Take a look. An excellent read for everyone.

http://www.nytimes.com/2004/04/18/magazine/18PRIMARY.html?ex=1083321199&ei=1&en=b4fe23abc41e3721

 

[Adapt]

Primary care all the way for me...and I'll float on ok.

 

[CalBeE]

I like specialization because I like to know really well about one area...it's just my personality, but I won't neccesarily go for super competitive specialties...right now I'm just thinking about Neurology.

 

[Jeffy]

I always thought that it would be hilarious to one day become a Pediatric Gynecologist, until the day that I realized that they actually exist

 

[GBFKicks]

Well, the government is paying people a lot of money (medical school tuition and etc...) through programs that get future physicians to go into primary care or under served populations. But, I imagine that only the people that were interested to go into primary care to begin with joing these programs and very few switch their decision from specializing to primary care. These programs don't work because most people that specialize have little trouble paying their bills. What do you guys think could be done instead of these programs?

 

[vtucci]

I plan on becoming an emergency department physician at an academic institution (so both specialization and academic medicine apply for me).

 

[Lion-O]

Does anyone have statistics on how many doctors are specialists vs. how many are in primary care? I'm thinking there are many more people who want to specialize than there are positions available. Most of the schools I've visited (admittedly not too competitive) have match lists with 50% going into primary care.

 

[Vandyfox]

I plan on returning to my hometown (very rural, Illinois) and possibly work a few surrounding towns in General Surgery. I'm also strongly considering taking over my father's family practice, but either way, I will be doing Rural medicine.

 

[TheFlash]

Going into IM still leaves a good amount of flexibility if you want to specialize in an IM focus through fellowship. Alternatively, you could be an IM generalist, so there's no need to specialize if you don't want to. Primary care isn't the "kiss of death" that a lot of people tend to think it is.

 

[jlee9531]

I always thought that it would be hilarious to one day become a Pediatric Gynecologist, until the day that I realized that they actually exist

whoa...i just learned this from you....damn....

 

[southbelle]

Does anyone have statistics on how many doctors are specialists vs. how many are in primary care? I'm thinking there are many more people who want to specialize than there are positions available. Most of the schools I've visited (admittedly not too competitive) have match lists with 50% going into primary care.

Virtually no allopathic schools, even ones with such a mission statement, have match lists that are > 50% primary care. You can only realistically count a certain% of IM matches as primary care. That's the catch. Even at state schools you'll see that a good portion of IM matches at university programs aren't on the Hopkins level but are still programs that send plenty of people into cards and GI.

I couldn't see myself doing primary care. Too many patients...one after the other after the other. Nor could I see myself going into a high powered specialty. Pretty much narrows it down to occ medicine, path, or pm&r

 

[jlee9531]

for the people concerned with salary...
if primary docs are on the decline...wouldnt that naturally mean that their salary will go up to attract people to go into that field?

the shift between primary care and specialties will slowly shift back and forth...

 

[skypilot]

I couldn't see myself doing primary care. Too many patients...one after the other after the other. Nor could I see myself going into a high powered specialty. Pretty much narrows it down to occ medicine, path, or pm&r

How about Psych or Gas?

 

[southbelle]

How about Psych or Gas?

Perhaps psych but I doubt it. I sorta wonder about the future of that specialty in 15 years. I know gas is supposed to be a lifestyle field, but it's still a little too much work for me relative to pm&r or occupational medicine.

 

[skypilot]

Perhaps psych but I doubt it. I sorta wonder about the future of that specialty in 15 years. I know gas is supposed to be a lifestyle field, but it's still a little too much work for me relative to pm&r or occupational medicine.

There is definitely some uncertainty in Psych over the next few years but damn there are a lot of potential patients out there!

 

[UCLAstudent]

I always thought that it would be hilarious to one day become a Pediatric Gynecologist, until the day that I realized that they actually exist

Yes, they do, and some of the things they deal with are unpleasant.

 

[Seaglass]

for the people concerned with salary...
if primary docs are on the decline...wouldnt that naturally mean that their salary will go up to attract people to go into that field?

The shift towards specialization has been going on since the first subspecialties were formed in the 50's. It has never swung back towards primary care over that time. Medicine does not follow normal economic rules well because there are a number of outside forces at work, for example physicians cannot decide what they are paid, it is determined by Medicare and insurers. Bottom line: don't count on normal market forces to fix anything in medicine.

C

 

[GBFKicks]

I plan on returning to my hometown (very rural, Illinois) and possibly work a few surrounding towns in General Surgery. I'm also strongly considering taking over my father's family practice, but either way, I will be doing Rural medicine.

Hey Vandyfox, where do you plan on going to med school? The Rockford track at UIC has a great rural medicine program. (I lived in Rockford for a while) Southern is also good for primary care.

 

[PNP2MD]

Primary care and acedemic medicine are not mutually exclusive. There are a number of primary care physicians in academic medicine. In academic medicine there are primary care physicians and specialists. Academic medicine meaning clincial practice, education, and research. Here at Mayo there are excellent examples of both.

 

[midlifecrisis]

I'm aiming toward rural med. Can't stand cities except for fast hits for arts and entertainment and some good food. Figuring emergency, IM, or FP offer me the best flexibility in terms of being able to live anywhere. Lots of rural/northern areas have pay incentives (for the "hardship" of rural living...bring on the rural hardship...) as well as the loan payback. And lots of rural places offer much more affordable living, though Alaska/Canada bush is super expensive. So making 100-150k looks alot better out here than in urban centers (I guess, it looks pretty good to me anywhere really).

So please keep your specialty focus/urban focus. Keeps more options open for us out here. 10 acres backed up to state land, with trail access out the door, recreational/ hunting/ fishing opportunities up the wazoo, and a community where you forget to lock your car most of the time, yup serious hardships here.