Questions from a naive intern

[92brownmamba]

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Hello all, just an intern here with hopefully not too many questions regarding career outlook in our field. I have searched for answers from a variety of previous threads but I hope to get more updated answers.

1. Scope
- I've read from alot of different resources that family medicine is "what you make out of it", implying that you can pretty much do what you want with the field. My question is: is it possible to see a select group of patients, and how would this work? Say you join a practice, how can you dictate who you would want to see? From a financial perspective, it would be unwise to turn down patients who want to be seen, so how can you as a provider control who you see. Do you have the front desk turn away any patients that do not suit your interests?
-My primary areas of interest are in mental health and musculoskeletal medicine. I would love to focus on psychotherapy and also procedures (not limited to MSK), and eventually incorporate ultrasound.

2. Type of practice
- I've found that I enjoy more acute care issues than chronic disease management. I just feel that patient who are seen by multiple specialists, need more coordination on the PCP part than actual intervention, leaving me feeling like an organizer more than a physician. I've heard that urgent care is an option, but that it can lead to burnout, and I doubt i would be able to focus on mental health, and musculoskeletal areas specifically.

Hopefully this can help out others as clueless and naive as I am, and foster an informative discussion. Thank you all in advance.

 

[Freezeout]

You’d get a lot of MSK in urgent care, though MSK procedures might be fewer in opportunity.

 

[deleted87716]

I wouldn't recommend limiting your practice to that stuff. You'll starve. I'd publicize the things you're interested in and make sure you do a really good job with them. World will get around.

 

[5150man]

Depends on where you’re at. I’m in a town of about 40,000. 5 docs have retired since I came to town 9 years ago and I’m still the newest guy in town.

I hate to “close” my practice so I’m being selective now in that I won’t take on any new patients that are on controlled substances. Things have gotten so crazy after 1 partner left a couple weeks ago that I’m reviewing every new patient that comes in. I’m not real picky but try to weed out headaches as best I can. I did a sports fellowship and word has gotten around so I see probably 30-40% sports medicine.
It would be hard to predominately see urgent care in FP unless you’re in a large group with partners that don’t want to see or don’t have time to see their own urgent patients(the easy money) and you’re living off their overflow. I did this for the 1st couple years while I built my practice. Once you get your practice built up 1/4-1/3 of your day will be urgent care depending on time of year.

You will never have a shortage of mental health patients anywhere. They may be predominantly Medicaid patients so you may need to limit to survive financially.

Basically you can be pretty selective after you get built up which may take a few years or longer depending on location. You take whatever you can get the 1st few years and then try to weed out the problems after you get more full.

I’m in private practice and my staff has known from day 1 that I hate women’s health and like MSK medicine and urgent care. I have 4 partners, including an internist who does no urgent care so my staff steers women’s health away from me if they can and vice versa with MSK/fractures and stitches. Never outright refusing but kindly trying to steer people where they would best be served.