Primary Care

[Trogghunter]

Has anyone chosen to pursue a D.O. degree to be a PCP? I dont want to specialize, unless you consider EM a specialty, so I think that an osteopathic school would be just as good if not better for me anyway.

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[Superman DO]

I am wanting to become a Family Physician, and I want to do a fellowship in Obstetrics so I can really become a complete Family Practitioner. I didn't really decide on this until after I decided to pursue a DO degree, but I think it works out great because I think that I am going to get a very good primary care foundation.

 

[TopQuark]

Has anyone chosen to pursue a D.O. degree to be a PCP? I dont want to specialize, unless you consider EM a specialty, so I think that an osteopathic school would be just as good if not better for me anyway.

I think you're on the right path. It's rather refreshing to see a thread like this not asking if DO's can match neurosurg, integrated PRS, etc.

 

[Black Adder]

EM is a specialty. Actually, so is FP I believe...

 

[Superman DO]

EM is a specialty. Actually, so is FP I believe...

Every medical field is a specialty, but FP, general IM, EM and Ob/Gyn are encompassed by the realm of primary care.

Well, EM can be debatable, but I consider it primary care.

 

[Mzeep]

Has anyone chosen to pursue a D.O. degree to be a PCP? I dont want to specialize, unless you consider EM a specialty, so I think that an osteopathic school would be just as good if not better for me anyway.

 

[Flushot]

Every medical field is a specialty, but FP, general IM, EM and Ob/Gyn are encompassed by the realm of primary care.

Well, EM can be debatable, but I consider it primary care.

I always thought of PC this way: if you're healthy and are able to see a physician for any medically viable reason such as a check up, screening test or a pregnancy, it's PC. You can see your FP, IM and Ob doc while healthy and it can make sense.

I guess if you could count stories where people show up to the ER just for check ups, but I'm thinking you should avoid going to the ER whenever you can. In other words, there is no viable medical reason to go if you're healthy.

 

[dudechiefboss]

I wish to pursue IM, with further certification in geriatric care.

My thinking is to go where you will be needed the most.

 

[Biology101]

I wish to pursue IM, with further certification in geriatric care.

My thinking is to go where you will be needed the most.

OB/GYN or peds for me

 

[Tekar]

So much funniness in this thread.

"I want to do Internal Medicine because you have to go where the jobs are."

lmao.. that's so true with all baby boomers entering into medicare.. not to mention getting a hospitalist position just about requires an address to send your paycheck and a license they are so short... not to mention the really decent compensation they get for the hours they work.

"I don't really consider ER primary care"

lol, you should because it's about 2/3 of what they do. I can't even count the number of times I've seen ER docs give the news that you're pregnant. Then of course there is the "since I was here for a cough, could you check my 2 week old baby doctor?" What doctor isn't going to pick up a brand new baby and ensure everything is ok.

I have to agree with the response that said they are glad to see a post like this about FP instead of the can I possibly specialize posts. I don't care what all the non-confrontational folks say that there is not a difference between a DO and an MD. It takes 2 minutes on the other board to see the difference lies in the kinds of people that attend each. Ask an MD neurologist to manage the entire patient's admission for a stroke when they have cardiac/vascular issues and their response will be "What's the number for cardiology?"

I am really intrigued by the whole patient approach of Osteopathy and I too and intrigued by FP, IM, and EM. All of them have their merits and all of them are primary care.

 

[Tekar]

Has anyone chosen to pursue a D.O. degree to be a PCP? I dont want to specialize, unless you consider EM a specialty, so I think that an osteopathic school would be just as good if not better for me anyway.

Me and I couldn't agree more with your perception of why to attend an osteopathic school

 

[voitokas]

FP for me, probably rural

 

[spicedmanna]

"I don't really consider ER primary care"

lol, you should because it's about 2/3 of what they do. I can't even count the number of times I've seen ER docs give the news that you're pregnant. Then of course there is the "since I was here for a cough, could you check my 2 week old baby doctor?" What doctor isn't going to pick up a brand new baby and ensure everything is ok.

I do not agree with you entirely. EM isn't supposed to be primary care, but unfortunately, because of the problems with our current health care system, it frequently does serve a similar (but not identical) role for some patients, particularly those without adequate health insurance, or those who are unable to secure appointments with their PCP. Most EM (not ER, by the way) physicians, by my observation, don't really like to play this role, but do it anyway because it has to be done.

I'm glad that these patients are getting seen for their primary care needs, in addition to their emergent ones, but it ultimately hurts both the system and the patient. First of all, it places an undue stress on EMS and potentially jams up the system for those who actually need emergent care. Secondly, the patients seen in the ED for their primary care needs aren't getting adequate follow-up and preventive care which is exactly what good primary care is supposed to be. The idea of primary care is that the PCP is the nexus for the patient's care. He follows the patient, keeps track of things through time, all of the patient's consults, and has a coherent, complete picture of the patient's health. This is not the same as an EM physician doing point of service care and then never seeing that patient again. That patient isn't getting adequate primary care; he is getting his immediate needs met, but nobody is tracking his progress and holds the entire picture.

 

[Ibn Rushd]

I'm pretty interested in internal medicine. I can see myself being a hospitalist. I especially like that idea because there are many opportunities to subspecialize thereafter, which I would consider.

 

[Tekar]

I do not agree with you entirely. EM isn't supposed to be primary care, but unfortunately, because of the problems with our current health care system, it frequently does serve a similar (but not identical) role for some patients, particularly those without adequate health insurance, or those who are unable to secure appointments with their PCP. Most EM (not ER, by the way) physicians, by my observation, don't really like to play this role, but do it anyway because it has to be done.

I'm glad that these patients are getting seen for their primary care needs, in addition to their emergent ones, but it ultimately hurts both the system and the patient. First of all, it places an undue stress on EMS and potentially jams up the system for those who actually need emergent care. Secondly, the patients seen in the ED for their primary care needs aren't getting adequate follow-up and preventive care which is exactly what good primary care is supposed to be. The idea of primary care is that the PCP is the nexus for the patient's care. He follows the patient, keeps track of things through time, all of the patient's consults, and has a coherent, complete picture of the patient's health. This is not the same as an EM physician doing point of service care and then never seeing that patient again. That patient isn't getting adequate primary care; he is getting his immediate needs met, but nobody is tracking his progress and holds the entire picture.

Yep, which is why I can't say not to family practice. It seems hypocritical to me to rail against the specialization machine only to grab a cardiology fellowship. We need family docs and I've been told I'd make a good one. Perhaps they see something in me they might trust themselves and their families to. Besides, 9-5 plus call residency or 36 hours on 12 off residency?

 

[Cybii]

I am wanting to become a Family Physician, and I want to do a fellowship in Obstetrics so I can really become a complete Family Practitioner. I didn't really decide on this until after I decided to pursue a DO degree, but I think it works out great because I think that I am going to get a very good primary care foundation.

Exactly my plans!

A quick question: when you say "complete family practitioner" is that a term commonly used when a family physician did a fellowship in Obstetrics?

 

[Poliscidoc]

Has anyone chosen to pursue a D.O. degree to be a PCP? I dont want to specialize, unless you consider EM a specialty, so I think that an osteopathic school would be just as good if not better for me anyway.

I have the same plan

 

[JanikeyDoc]

Has anyone chosen to pursue a D.O. degree to be a PCP? I dont want to specialize, unless you consider EM a specialty, so I think that an osteopathic school would be just as good if not better for me anyway.

Many MDs become PCPs as well. I remember when I was an undergrad in the early 1990s, the vast majority of DOs became primary care physicians. These days an increasingly larger number of DOs are specializing, nationally I believe 60 percent of DOs enter primary care while 40 percent specialize, at some schools, a greater percentage specialize, but this is for many reasons.

 

[Superman DO]

Exactly my plans!

A quick question: when you say "complete family practitioner" is that a term commonly used when a family physician did a fellowship in Obstetrics?

No, that is just something I said. A family physician is a family physician whether you have completed a fellowship or not. I say "complete" because many family medicine residencies do not adequately prepare you to deliver babies, so many family physicians choose not to handle pregnancies (along with the fact that malpractice insurance is higher if you decide to incorporate obstetrics into your practice); however, having a fellowship in obstetrics really prepares a FP to care for both mother and child, from pre to post-pregnancy. Therefore, I think that you are a more complete and competent family physician if you are able to do this.

 

[Biology101]

No, that is just something I said. A family physician is a family physician whether you have completed a fellowship or not. I say "complete" because many family medicine residencies do not adequately prepare you to deliver babies, so many family physicians choose not to handle pregnancies (along with the fact that malpractice insurance is higher if you decide to incorporate obstetrics into your practice); however, having a fellowship in obstetrics really prepares a FP to care for both mother and child, from pre to post-pregnancy. Therefore, I think that you are a more complete and competent family physician if you are able to do this.

Do you know about any of these programs? I am kinda interested in that.

Thanks

 

[Superman DO]

Do you know about any of these programs? I am kinda interested in that.

Thanks

Do I know about any of these obstetrics fellowship programs?

 

[Biology101]

Do I know about any of these obstetrics fellowship programs?

Yea just asking

 

[Laryngophed]

I'm pretty interested in internal medicine. I can see myself being a hospitalist. I especially like that idea because there are many opportunities to subspecialize thereafter, which I would consider.

x2.

I think the same thing about Peds, in addition to IM.

 

[Superman DO]

Sorry biology101, I was just trying to understand your question. . .I hope i did not come off as snappy! =) I do not know a lot about which programs offer the obstetrics fellowship. I was really going to worry about it when it came time for me to rank my residencies because I would like to do my residency and fellowship at the same place. From what research I have done so far, I know the Spartanburg Family Medicine residency offers the fellowship in Obstetrics, and they are dually accredited. Not to mention it is only 1.5 hours from my hometown, sooo this sounds very lucrative too me!

Most fellowships are a year, and they are completed after your 3 year residency in Family Medicine. Mostly, you are just logging the hours in performing high-risk pregnancies and C-Sections so that you can be certified to do such procedures. The AAFP has a list of current fellowship sites: http://www.aafp.org/fellowships/obstet.html

Right now, I'm just browsing google and getting a cursory understanding of everything. I'm hoping to really learn a lot more once I actually start med school. Hopefully this little bit helps though! =)

 

[Biology101]

Sorry biology101, I was just trying to understand your question. . .I hope i did not come off as snappy! =) I do not know a lot about which programs offer the obstetrics fellowship. I was really going to worry about it when it came time for me to rank my residencies because I would like to do my residency and fellowship at the same place. From what research I have done so far, I know the Spartanburg Family Medicine residency offers the fellowship in Obstetrics, and they are dually accredited. Not to mention it is only 1.5 hours from my hometown, sooo this sounds very lucrative too me!

Most fellowships are a year, and they are completed after your 3 year residency in Family Medicine. Mostly, you are just logging the hours in performing high-risk pregnancies and C-Sections so that you can be certified to do such procedures. The AAFP has a list of current fellowship sites: http://www.aafp.org/fellowships/obstet.html

Right now, I'm just browsing google and getting a cursory understanding of everything. I'm hoping to really learn a lot more once I actually start med school. Hopefully this little bit helps though! =)

May I ask why not become an OB/GYN if you are so interested in obstetrics?

p.s. I didnt take you as being snappy

 

[Superman DO]

May I ask why not become an OB/GYN if you are so interested in obstetrics?

I am interested in practicing medicine for the entire scope of humanity and the family, both men and women, young and old, rich and poor, ect. I do not want to limit myself to just the female body; however, I do want a strong foundation in maternity care and obstetrics so I can treat both low and high risk pregnancies, and be capable of looking after the fetus and newborn as well as the entire family for many years.

 

[Biology101]

I am interested in practicing medicine for the entire scope of humanity and the family, both men and women, young and old, rich and poor, ect. I do not want to limit myself to just the female body; however, I do want a strong foundation in maternity care and obstetrics so I can treat both low and high risk pregnancies, and be capable of looking after the fetus and newborn as well as the entire family for many years.

....sigh...FB with OB or OB/GYN....I am lost...

 

[spicedmanna]

Many MDs become PCPs as well. I remember when I was an undergrad in the early 1990s, the vast majority of DOs became primary care physicians. These days an increasingly larger number of DOs are specializing, nationally I believe 60 percent of DOs enter primary care while 40 percent specialize, at some schools, a greater percentage specialize, but this is for many reasons.

Exactly. The trend is toward specialization in non primary care fields.

Anyway, I think either degree will prepare you well for any of the medical fields, including primary care. Unless you have a particular interest in OMT, I'd just pick the best school, MD or DO, with respect to your personal criteria. If you want to be a PCP, either path will get you there. Your approach to care is more defined by your personality than where you went to school, or what degree you have.

 

[jp104]

May I ask why not become an OB/GYN if you are so interested in obstetrics?

p.s. I didnt take you as being snappy

FP with OB fellowship is focused on deliveries. OB/GYN is a field with a heavy surgical component so you will be doing stuff like hysterectomies, oopherectomies, etc in addition to deliveries. Some people like the delivery part but not the surgical part

 

[Tekar]

FP with OB fellowship is focused on deliveries. OB/GYN is a field with a heavy surgical component so you will be doing stuff like hysterectomies, oopherectomies, etc in addition to deliveries. Some people like the delivery part but not the surgical part

See, I don't really care for the surgical side of this, nor do I particularly care for the 24 hour labors and the endless call. I'd prefer to be the family practice doctor the patient can go to for all the pre-natal care and the one they bring the baby back for the pediatric care, but turn the birthing over to people who do that every day, all day (not me). Once labor is occurring, the damage has already been done. Preventing unhealthy children from being born by providing the pre-natal care seems more up my ally. It also allows women in their first pregnancy to come back after you took care of them as kids and receive that same pre-natal care. I also think that I'd like to be more of the collaborator and coordinator of the plan of care for a woman getting ready to decide how and what parts to remove. That's a huge decision and I think it's important to have a perspective other than a surgeon as the only option... or at least a devil's advocate that forces the surgeon to stop and think.

 

[Cybii]

No, that is just something I said. A family physician is a family physician whether you have completed a fellowship or not. I say "complete" because many family medicine residencies do not adequately prepare you to deliver babies, so many family physicians choose not to handle pregnancies (along with the fact that malpractice insurance is higher if you decide to incorporate obstetrics into your practice); however, having a fellowship in obstetrics really prepares a FP to care for both mother and child, from pre to post-pregnancy. Therefore, I think that you are a more complete and competent family physician if you are able to do this.

Thanks! Yea, I share you're ideas... but I was wondering if there was such a thing as doing a fellowship in pediatrics? Or could you do both? Or would that just be too much?

Or would it make more sense to complete a residency in obstetrics and then a fellowship in peds? Hmmm.... Heheh, so many questions/hypothetical situations, I know...

 

[Superman DO]

Thanks! Yea, I share you're ideas... but I was wondering if there was such a thing as doing a fellowship in pediatrics? Or could you do both? Or would that just be too much?

Or would it make more sense to complete a residency in obstetrics and then a fellowship in peds? Hmmm.... Heheh, so many questions/hypothetical situations, I know...

I do not think that there is a fellowship in Peds for Family Medicine. I would expect that you get enough of Peds during residency. If you wanted more, you should just end up doing a residency in Peds!

This is a nice little website that tells you all the current fellowships for Family Physicians and the states they are located in: http://www.aafp.org/fellowships/

But yes, there are so many things that you can do! Even I sometimes have doubts about going into FM and doing EM. We will found out what we really love come rotation time! =)

 

[beckhunter116]

Just to let you know, I believe there are some FP residencies that are OB heavy if you wanted to look into those instead of adding a fellowship. I can totally understand wanting to do the fellowship though as I am sure you get more experience especially with higher risk pregnancies and more opportunities to deliver.

 

[beckhunter116]

Also, I believe that psych is often considered a primary care. At least with a lot of the government loan repayment options. For awhile I was really interested in a psych/FP residency because I felt like then I could work for both a patient's physical and mental health--truly care for the 'whole person'; however, I have seen (through SDN) that the majority of people who complete a dual boarded residency typically only practice in one area or the other.

I'm keeping my options open, because I know that I will love learning something about each specialty and who knows what I may be passionate about most when the time comes around to choose.

 

[Cybii]

I do not think that there is a fellowship in Peds for Family Medicine. I would expect that you get enough of Peds during residency. If you wanted more, you should just end up doing a residency in Peds!

This is a nice little website that tells you all the current fellowships for Family Physicians and the states they are located in: http://www.aafp.org/fellowships/

But yes, there are so many things that you can do! Even I sometimes have doubts about going into FM and doing EM. We will found out what we really love come rotation time! =)

Wow, thanks for the website, it is very helpful! Thanks for all your help. There seems to be only a few spots open for each fellowship... is it highly competitive or just not a lot of physicians pursuing a fellowship? (I am very naive to this stuff, so I'm just getting a rough idea for the future- not like I'm planning everything out to the dot right now )

I am really hoping that in the beginning of med school we get a packet that lists the steps for everything- like when we will take the USMLE or COMLEX and everything. I'd rather focus on school and not worry about missing any information/deadlines.

 

[lokiperson]

Oh how I wish the NHSC Scholarship would consider EM as primary care...

 

[Superman DO]

Wow, thanks for the website, it is very helpful! Thanks for all your help. There seems to be only a few spots open for each fellowship... is it highly competitive or just not a lot of physicians pursuing a fellowship? (I am very naive to this stuff, so I'm just getting a rough idea for the future- not like I'm planning everything out to the dot right now )

I am really hoping that in the beginning of med school we get a packet that lists the steps for everything- like when we will take the USMLE or COMLEX and everything. I'd rather focus on school and not worry about missing any information/deadlines.

Yeah, there are not a lot of spots. . .I don't know whether it is a lack of interest or the willingness of programs to offer many spots. And I do not know at all about the competitiveness. . .I am hoping they will tell me everything I need to know in school and residency , which I am quite sure they will

 

[Superman DO]

Oh how I wish the NHSC Scholarship would consider EM as primary care...

Oh so are you trying to get this scholarship too?? Gosh, it would be so awesome if I could get me one of these! =)

 

[TheFamilyDoc]

If you like the philosophy of osteopathic medicine then I think DO would be an excellent choice for Family Medicine

 

[simpler2]

To be a primary care field you have to follow-up on your pt's problems. You are the Primary Provider responsible for whatever might be going on with that person for the duration of your patient/provider relationship. In the ED you may deal with a typical outpt issue but doing so does not a PCP make.

 

[JaggerPlate]

To be a primary care field you have to follow-up on your pt's problems. You are the Primary Provider responsible for whatever might be going on with that person for the duration of your patient/provider relationship. In the ED you may deal with a typical outpt issue but doing so does not a PCP make.

I think in rural areas, EM is quite PC-ish.

The classification system is weird in my opinion. For me, FM, IM, OB/GYN, and Peds are PC fields. However, I've heard other lists where G-surg and Psyche are considered PC ??

 

[beckhunter116]

Well for the NHSC they include psych for the scholarship. And I see how some could think of EM as PC because in some areas of the country that may be the only care that a person receives. Is that the proper care for them? Of course not becuase often times people don't come back until the problem has escalated again and then not only is their health compromised, but the problem is much more expensive at both at a later stage development and in an emergency facility.

 

[JaggerPlate]

Well for the NHSC they include psych for the scholarship. And I see how some could think of EM as PC because in some areas of the country that may be the only care that a person receives. Is that the proper care for them? Of course not becuase often times people don't come back until the problem has escalated again and then not only is their health compromised, but the problem is much more expensive at both at a later stage development and in an emergency facility.

Yeah.

 

[Superman DO]

Oh so are you trying to get this scholarship too?? Gosh, it would be so awesome if I could get me one of these! =)

ok, sooo after reading through this again, I am going to retract my statement! I thought it would be awesome, but after some consideration, I do not think the NHSC scholarship is good for me anymore. While I still want to pursue family medicine, I want to still leave my options open just in case. The loan repayment deal seems like a much better option too since you are given a little more options in where to practice. Sigh, if only the price of my dream was not so dang expensive....

 

[MLT2MT2DO]

ok, sooo after reading through this again, I am going to retract my statement! I thought it would be awesome, but after some consideration, I do not think the NHSC scholarship is good for me anymore. While I still want to pursue family medicine, I want to still leave my options open just in case. The loan repayment deal seems like a much better option too since you are given a little more options in where to practice. Sigh, if only the price of my dream was not so dang expensive....

I would love to nab me one of those scholarships, sure beats the military IMO.

 

[JaggerPlate]

ok, sooo after reading through this again, I am going to retract my statement! I thought it would be awesome, but after some consideration, I do not think the NHSC scholarship is good for me anymore. While I still want to pursue family medicine, I want to still leave my options open just in case. The loan repayment deal seems like a much better option too since you are given a little more options in where to practice. Sigh, if only the price of my dream was not so dang expensive....

The loan repayment seems like a really solid option.

 

[Siggy]

EM is a specialty. Actually, so is FP I believe...

There are very few true GPs left. Most primary care physicians have either specialized in either FP or IM.

 

[FutureCTDoc]

Osteopathic medicine is a great choice if you want to go PCP. Look at schools that are well rounded because you never know when you might fall in love with G Surg (which there is an acute shortage of). If you are interested in rural FP http://www.amec.uwa.edu/ is a good site to check out. Consider schools with good PC scholarships i.e. DMU's RMEP http://www.dmu.edu/com/do/strengths/rmep/ and NSU has a strong rural program. However, I would recommend considering schools that are less well known for producing PCPs as well. There is no telling which field of medicine and surgery, you will fall in love with.

 

[beckhunter116]

The loan repayment seems like a really solid option.

Ehhh...there is a forum or thread about the scholarship and some people really complained about the jobs that they received post residency. It seems that it is better to try to find your own clinic and get it to qualify for their loan repayment vs taking the scholarship. This was just the opinion in that thread so more research is probably warrented.

 

[MLT2MT2DO]

Ehhh...there is a forum or thread about the scholarship and some people really complained about the jobs that they received post residency. It seems that it is better to try to find your own clinic and get it to qualify for their loan repayment vs taking the scholarship. This was just the opinion in that thread so more research is probably warrented.

Negativity on SDN?!?!