Reciprocal licensing agreement with Australia

[lymphocyte]

I'm still dithering between psychiatry and FM, but one very attractive feature of FM is its international portability.

I'm an Australian med student and just found out that there's a reciprocity agreement between the Royal Australian College of GPs (RACGP) and American Board of Family Medicine (ABFM). This agreement allows any fellow of the RACGP to sit the ABFM board exams and become board-certified if they pass Steps 1-3 and are "actively involved in family medicine in the US" (with a fairly loose definition of "actively involved").

I emailed ABFM, and they said this agreement is quite stable and, for what it's worth, will likely continue long into the foreseeable future. They also confirmed that "actively involved" could include research, administration, fellowship, etc.

At this point, I'd like to do either psychiatry at a solid university programme in the US or outback FM in Australia.

My questions:

1. What kind of accredited or unaccredited fellowships are available to IMGs? How competitive do they tend to be? I'm especially interested in addiction medicine in a rural context (but I notice there are also some interesting academic fellowships available too).

2. Would a full-time American academic or administrative position be out of the question without FM board-certification?

3. As part of the reciprocity agreement, I'll need an unrestricted license to practice medicine in the US. Most states require 2 years of "postgraduate" training but don't specify if that's at the internship, residency or fellowship level. I've emailed a bunch of states to no avail, except for Wisconsin, which permits fellowship to count. Does anybody have any insight into this? I'd even consider doing a prelim year in medicine or surgery (though I don't think that would count for internship).

4. Could I get hired as a board-certified FM doctor without having completed a residency in the US? GP training in Australia is about 5 years long, and I'm planning on practicing rural/remote.

Finally, If any board-certified FM doctors (or interested resident/medical student) are interested in coming to Australia or New Zealand, please feel free to PM and I'd be happy to sort out contacts + information for you.

Sources:
https://www.theabfm.org/moc/reciprocityagreements.aspx
http://www.visalaw.com/wp-content/uploads/2014/10/physicianchart.pdf
https://nf.aafp.org/Directories/Fellowship/Search

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[lymphocyte]

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[NurWollen]

Wow, GP training is 5 years long in Australia? What do the learn that family physicians don't learn here in the states? How long are other specialty training programs?

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[lymphocyte]

Wow, GP training is 5 years long in Australia? What do the learn that family physicians don't learn here in the states? How long are other specialty training programs?

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Pardon, that should have been 4-6 years. Every medical graduate has to do a transitional year including medicine, surgery, and EM. After you finish PGY1, you gain general registration as a doctor and can apply to speciality colleges. If you don't gain admission, you do another transitional year and apply again. Psychiatry wannabes do some surgery; surgery wannabes do some anesthesia--and they all get evaluated together, so a strong-work ethic and collegiality are crucial.

GP speciality training is 3 years long with another year tacked on for procedural training if you want to go rural/remote.

Other specialities take much longer. Neurology, for example, is around 7-10 years, which probably includes a PhD or some substantial research if you want to train at a great programme.

This situation is mainly due to four factors: 1) minimal school debt, so nobody's clamouring to specialise, 2) fair remuneration during transitional years (overtime, 100K+ rural with 6 weeks vacation, absolutely free healthcare, and ~12% extra contributed to a pension plan), 3) a dearth of speciality training spots, and 4) the attitude toward work/life balance is strong. Want to have a baby? No worries. Come back when you're ready. Develop a passion for public health? We'll pay for your masters. Want to do a rotation in Papua New Guinea or Antarctica? Have six months and give it a go. Even as a medical student, the surgeons sent us home at 5p to go study. "Have you had lunch yet"? Etc. Dare I summon @Winged Scapula, but she did medical school in Australia too and has spoken about this aspect of training.

I don't think one is better than the other (at least not in ways that I'm willing to discuss publicly). It's just different. They both get you to the same place in the end.

 

[NurWollen]

Pardon, that should have been 4-6 years. Every medical graduate has to do a transitional year including medicine, surgery, and EM. After you finish PGY1, you gain general registration as a doctor and can apply to speciality colleges. If you don't gain admission, you do another transitional year and apply again. Psychiatry wannabes do some surgery; surgery wannabes do some anesthesia--and they all get evaluated together, so a strong-work ethic and collegiality are crucial.

GP speciality training is 3 years long with another year tacked on for procedural training if you want to go rural/remote.

Other specialities take much longer. Neurology, for example, is around 7-10 years, which probably includes a PhD or some substantial research if you want to train at a great programme.

This situation is mainly due to four factors: 1) minimal school debt, so nobody's clamouring to specialise, 2) fair remuneration during transitional years (overtime, 100K+ rural with 6 weeks vacation, absolutely free healthcare, and ~12% extra contributed to a pension plan), 3) a dearth of speciality training spots, and 4) the attitude toward work/life balance is strong. Want to have a baby? No worries. Come back when you're ready. Develop a passion for public health? We'll pay for your masters. Want to do a rotation in Papua New Guinea or Antarctica? Have six months and give it a go. Even as a medical student, the surgeons sent us home at 5p to go study. "Have you had lunch yet"? Etc. Dare I summon @Winged Scapula, but she did medical school in Australia too and has spoken about this aspect of training.

I don't think one is better than the other (at least not in ways that I'm willing to discuss publicly). It's just different. They both get you to the same place in the end.

Sounds like a system I could get used to for sure.

 

[Ericslv]

I'm still dithering between psychiatry and FM, but one very attractive feature of FM is its international portability.

I'm an Australian med student (dual-citizen) and just found out that there's a reciprocity agreement between the Royal Australian College of GPs (RACGP) and American Board of Family Medicine (ABFM). This agreement allows any fellow of the RACGP to sit the ABFM board exams and become board-certified if they pass Steps 1-3 and are "actively involved in family medicine in the US" (with a fairly loose definition of "actively involved").

I emailed ABFM, and they said this agreement is quite stable and, for what it's worth, will likely continue long into the foreseeable future. They also confirmed that "actively involved" could include research, administration, fellowship, etc.

At this point, I'd like to do either psychiatry at a solid university programme in the US or outback FM in Australia.

My questions:

1. What kind of accredited or unaccredited fellowships are available to IMGs? How competitive do they tend to be? I'm especially interested in addiction medicine in a rural context (but I notice there are also some interesting academic fellowships available too). My Step scores are 250+, and I plan on doing some research in this field.

2. Would a full-time American academic or administrative position be out of the question without FM board-certification?

3. As part of the reciprocity agreement, I'll need an unrestricted license to practice medicine in the US. Most states require 2 years of "postgraduate" training but don't specify if that's at the internship, residency or fellowship level. I've emailed a bunch of states to no avail, except for Wisconsin, which permits fellowship to count. Does anybody have any insight into this? I'd even consider doing a prelim year in medicine or surgery (though I don't think that would count for internship).

4. Could I get hired as a board-certified FM doctor without having completed a residency in the US? GP training in Australia is about 5 years long, and I'm planning on practicing rural/remote.

Finally, If any board-certified FM doctors (or interested resident/medical student) are interested in coming to Australia or New Zealand, please feel free to PM and I'd be happy to sort out contacts + information for you.

Sources:
https://www.theabfm.org/moc/reciprocityagreements.aspx
http://www.visalaw.com/wp-content/uploads/2014/10/physicianchart.pdf
https://nf.aafp.org/Directories/Fellowship/Search

So does that mean someone from the US who is board certified can practice in Australia without doing residency?

 

[lymphocyte]

So does that mean someone from the US who is board certified can practice in Australia without doing residency?

Yes, with some minor caveats, which I can look up this weekend.

 

[Vandalia]

Wow, GP training is 5 years long in Australia? What do the learn that family physicians don't learn here in the states? How long are other specialty training programs?

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You are comparing apples and oranges. Medical education (undergraduate+'medical school') is shorter in the countries in the British medical tradition. The "5 years" of GP training includes the last two years of what would be medical school in the US. When you add those in (or subtract those out) it is the same as in the US.

 

[lymphocyte]

You are comparing apples and oranges. Medical education (undergraduate+'medical school') is shorter in the countries in the British medical tradition. The "5 years" of GP training includes the last two years of what would be medical school in the US. When you add those in (or subtract those out) it is the same as in the US.

No, he or she is comparing apples to apples (perhaps Fujis to Pink Ladies)? Many medical schools in Australia and a whole heap in the UK have converted to the post-graduate 4 year model.

 

[lymphocyte]

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[Doctor4Life1769]

Yes, with some minor caveats, which I can look up this weekend.

Please be sure to post your research, I'd be interested in reading more on this.

 

[Ericslv]

Yes, with some minor caveats, which I can look up this weekend.

I understand that FM docs in Australia can practice in skin cancer clinics. Is that possible for FM docs coming from the US.

 

[lymphocyte]

I understand that FM docs in Australia can practice in skin cancer clinics. Is that possible for FM docs coming from the US.

Short answer: Yes.

Long answer: I don't understand this question.

After you gain your unrestricted medical license in the US or Australia, you can do whatever the hell you like. Wanna TAVR? Have at. Wanna do a Whipple while hanging upside down from the ceiling? Godspeed. The real questions are: 1) can you handle the liability, 2) can you get the appropriate hospital privileges, and 3) can you deliver safe and effective care at the level of a reasonable and appropriately qualified peer?

The answers to these questions matter just as much in Australia as they do in the US.

Rural Australian GPs see malignant or premalignant skin lesions Every. Single. Day. And all of them are qualified to use a dermoscope, apply the Menzies method (invented in Australia!), prescribe 5-FU or imiquimod, perform cryotherapy, do 4mm-margin excisions for small, superficial SCCs, etc. If you feel safe providing that level of care (and knowing when to refer), of course you can open a skin cancer clinic in Australia as a GP (even as one who qualified from overseas). And, in fact, there are heaps of Cancer Clinics with just that kind of set up. But I don't see why you couldn't do the same in the US.

And please trust me when I say: Sydney, Melbourne, Brisbane--theses cities are flooded with Cancer Clinics and dermatologists. Brother, you ain't never gonna be practicing on the North Shore. But if you head West, the need is tremendous and your expertise will be desperately valued.

Also, Australia has a huge emphasis on continuing education, from certificates to PhDs. Here are two of the more popular derm-related ones for Australian GPs:

http://www.londondermatology.org/faqs/index.html
http://www.racgp.org.au/education/courses/dermatology/

I believe you can get paid up to $20,000 to obtain the second one.

 

[lymphocyte]

So does that mean someone from the US who is board certified can practice in Australia without doing residency?

Please be sure to post your research, I'd be interested in reading more on this.

I understand that FM docs in Australia can practice in skin cancer clinics. Is that possible for FM docs coming from the US.

While I'm looking up all this information (which I'm happy to do), might anybody be able to give me some feedback on my questions?

 

[DrMidlife]

1. What kind of accredited or unaccredited fellowships are available to IMGs? How competitive do they tend to be? I'm especially interested in addiction medicine in a rural context (but I notice there are also some interesting academic fellowships available too). My Step scores are 250+, and I plan on doing some research in this field.

The IMG part is not a problem. It's the BC/BE part, and undoubtedly the hoop-jumping part. If you aren't bound to a location, that of course helps, but I hope you've spent time in rural US healthcare...

I assume you found the Multicare rural addiction program?

It's my understanding that addiction med isn't popular. I couldn't find one, but a listing of currently unfilled fellowships is pretty much what you need to get a read on popularity.

I think it might be reasonable to try to get contacts and start some conversations at the AAFP conference in late July, whichever year. This is aimed at graduating med students choosing residencies, but PDs and other faculty attend. I can't think of another opportunity to get in front of so many likely-relevant people at one time.

I suggest trolling the FM residency program websites looking for non-ABAM fellowships as well as looking for "current fellows" to see the variety of programs being offered.

BTW please please please get exposure to addiction med in the US before diving in. I assume you're on top of this, but if you've only seen tx in Australia you're in for a rough landing. The opioids are on top of chronic untreated other awfulness, by default.

2. Would a full-time American academic or administrative position be out of the question without FM board-certification?

You wouldn't get clinical responsibilities but you could teach. As in giving lectures. The LECOMs might hire you for PBL.

In other words an academic position wouldn't move the BC/BE ball down the field for you. It'd be the same for your licensing pursuit as wage work like urgent care. Unsupervised, not training.

3. As part of the reciprocity agreement, I'll need an unrestricted license to practice medicine in the US. Most states require 2 years of "postgraduate" training but don't specify if that's at the internship, residency or fellowship level. I've emailed a bunch of states to no avail, except for Wisconsin, which permits fellowship to count. Does anybody have any insight into this? I'd even consider doing a prelim year in medicine or surgery (though I don't think that would count for internship).

I wouldn't sweat this - if you get accepted to a fellowship with a PD, at a site that has a residency, then the spirit of the requirement is met and you have a completely reasonable case that you're training. That said, you can't drop the issue even after a horde of people tell you you're fine. Assume there will be paperwork hassles and you'll have the same conversation with hordes of administrative people who can't fathom what you're attempting.

There are always vacant PGY2 and PGY3 positions in FM programs, which could be nicely strategic. Get into the residency and use that leverage to get into the attached addiction program.

4. Could I get hired as a board-certified FM doctor without having completed a residency in the US? GP training in Australia is about 5 years long, and I'm planning on practicing rural/remote.

BC is BC. Rural America is desperate for you to get done with all this crap so they can pay you boatloads of money to get people on suboxone.

Definitely do rural FM electives if at all possible. You need contacts doing what you want to do. Cold emailing wouldn't be a bad idea. And by all means, find people practicing in the US who got there on Australian reciprocity.

I hope this is helpful, and I assume those who have more direct experience will correct me where I'm mistaken.

Best of luck to you.

 

[lymphocyte]

The IMG part is not a problem. It's the BC/BE part, and undoubtedly the hoop-jumping part. If you aren't bound to a location, that of course helps, but I hope you've spent time in rural US healthcare...

I assume you found the Multicare rural addiction program?

It's my understanding that addiction med isn't popular. I couldn't find one, but a listing of currently unfilled fellowships is pretty much what you need to get a read on popularity.

I think it might be reasonable to try to get contacts and start some conversations at the AAFP conference in late July, whichever year. This is aimed at graduating med students choosing residencies, but PDs and other faculty attend. I can't think of another opportunity to get in front of so many likely-relevant people at one time.

I suggest trolling the FM residency program websites looking for non-ABAM fellowships as well as looking for "current fellows" to see the variety of programs being offered.

BTW please please please get exposure to addiction med in the US before diving in. I assume you're on top of this, but if you've only seen tx in Australia you're in for a rough landing. The opioids are on top of chronic untreated other awfulness, by default.

You wouldn't get clinical responsibilities but you could teach. As in giving lectures. The LECOMs might hire you for PBL.

In other words an academic position wouldn't move the BC/BE ball down the field for you. It'd be the same for your licensing pursuit as wage work like urgent care. Unsupervised, not training.

I wouldn't sweat this - if you get accepted to a fellowship with a PD, at a site that has a residency, then the spirit of the requirement is met and you have a completely reasonable case that you're training. That said, you can't drop the issue even after a horde of people tell you you're fine. Assume there will be paperwork hassles and you'll have the same conversation with hordes of administrative people who can't fathom what you're attempting.

There are always vacant PGY2 and PGY3 positions in FM programs, which could be nicely strategic. Get into the residency and use that leverage to get into the attached addiction program.

BC is BC. Rural America is desperate for you to get done with all this crap so they can pay you boatloads of money to get people on suboxone.

Definitely do rural FM electives if at all possible. You need contacts doing what you want to do. Cold emailing wouldn't be a bad idea. And by all means, find people practicing in the US who got there on Australian reciprocity.

I hope this is helpful, and I assume those who have more direct experience will correct me where I'm mistaken.

Best of luck to you.

I bolded some of the key ideas for my own reference.

We're allowed to rotate overseas during our training. It seems the best way forward is to leverage that time to network and generate some contacts (as per above). A PGY2/PGY3 position (or even half of one) would be ideal and would count for unrestricted licensing purposes. Also, I can start attending conferences now (AAFP but also Global Addiction, NAADAC, ASAM, etc.) along with presenting research. Sounds like a plan in the making...

So much good stuff here... thank you!!!

 

[Ericslv]

Pardon, but while I'm looking up all this information (which I'm happy to do), might anybody be able to give me some feedback on my questions?

Thanks for you replies. I can answer a couple of your questions.
First addiction medicine fellowship is possible to get here. I don't think you can get an administrative position without being BC. Mostly because your colleagues will be BC.

You can contact the ABMS to get most of your questions answered. You can also contact some the licensing companies to get some insight. Also, sometimes the recruiter companies can assist you get through the process much faster.

One other thing. FP's in the US can't really open a skin cancer clinic even if they wanted to and had the skill. There would be too much backlash from the dermatologist. As you said the FP's in Australia have had training in this and it is normal for them to pursue this type of practice. In the US FP has been watered down and many sub-specialty positions are not available to them.

The reason I asked about the skin cancer clinics is because I understand that one can get training for it in Australia. Thanks for the links.

 

[lymphocyte]

Thanks for you replies. I can answer a couple of your questions.
First addiction medicine fellowship is possible to get here. I don't think you can get an administrative position without being BC. Mostly because your colleagues will be BC.

You can contact the ABMS to get most of your questions answered. You can also contact some the licensing companies to get some insight. Also, sometimes the recruiter companies can assist you get through the process much faster.

One other thing. FP's in the US can't really open a skin cancer clinic even if they wanted to and had the skill. There would be too much backlash from the dermatologist. As you said the FP's in Australia have had training in this and it is normal for them to pursue this type of practice. In the US FP has been watered down and many sub-specialty positions are not available to them.

The reason I asked about the skin cancer clinics is because I understand that one can get training for it in Australia. Thanks for the links.

That's unfortunate. Wide-scope general practice is alive and well in rural and remote Australia (and "rural" isn't that far from Sydney or Melbourne, as close as 50 miles for some districts). One of my rural GP mentors rounded at hospital in the morning, did outpatient for 4 hours, went home for an hour or two to diddle around with his farm, and then came back for some surgeries/procedural stuff in the afternoon (cholyes, colonoscopies, tonsillectomies, etc.). He did admin on Fridays and saw private patients on Saturday. He also did a handful of shifts in the ED every month (in a country where people can see GPs for free--so no bogus nothing). Made a few nursing home visits too. Pulled in north of $700,000/year and skied all around the world Dec-Jan (the hottest time of the year in Australia). What a life. A GP-anesthetist I know does something similar (because Australia, like Canada, allows GPs to anesthetise ASA 1-2 patients with just an added year of training).

It's not the dollar amount that makes it so attractive, but the autonomy, freedom, and the fact that their skills and abilities are appropriately valued.

Here's an example of a GP-run derm clinic (with non-derm bits as well).

http://www.keperrafamilypractice.com.au/about-us/doctors-and-staff

I don't want to comment too much on FM in the US... but it looks like a disaster from across the pond, with FPs getting trampled on by specialists, insurance panels, etc. Plus, the provision of care itself seems grossly immoral. I'm now going to keep my mouth shut on the matter... and I'm happy for any corrections, insights, or rebuttals.

I appreciate the tips, especially about the recruiters.

I'll get back to you later this week on the reciprocity agreement.

 

[Ericslv]

That's unfortunate. Wide-scope general practice is alive and well in rural and remote Australia (and "rural" isn't that far from Sydney or Melbourne, as close as 50 miles for some districts). One of my rural GP mentors rounded at hospital in the morning, did outpatient for 4 hours, went home for an hour or two to diddle around with his farm, and then came back for some surgeries/procedural stuff in the afternoon (cholyes, colonoscopies, tonsillectomies, etc.). He did admin on Fridays and saw private patients on Saturday. He also did a handful of shifts in the ED every month (in a country where people can see GPs for free--so no bogus nothing). Made a few nursing home visits too. Pulled in north of $700,000/year and skied all around the world Dec-Jan (the hottest time of the year in Australia). What a life. A GP-anesthetist I know does something similar (because Australia, like Canada, allows GPs to anesthetize ASA 1-2 patients with just an added year of training).

It's not the dollar amount that makes it so attractive, but the autonomy, freedom, and the fact that their skills and abilities are appropriately valued.

Here's an example of a GP-run derm clinic (with non-derm bits as well).

http://www.keperrafamilypractice.com.au/about-us/doctors-and-staff

I don't want to comment too much on FM in the US (as it would be coming from a position of relative ignorance)... but it looks like a disaster from across the pond, with FPs getting trampled on by mid-levels, specialists, insurance panels, etc. Plus, the provision of care itself seems grossly immoral. I'm now going to keep my mouth shut on the matter... and I'm happy for any corrections, insights, or rebuttals.

I appreciate the tips, especially about the recruiters.

I'll get back to you later this week on the reciprocity agreement.

First, thats fantastic that FM docs can do all of that there. That's exactly how it should be and we should be able to choose what area we want to focus on.

And, YES FM in US is so messed up. One of the lowest paid and least respected. That's why I'm thinking of going to Australia. But I wanted to do derm. and other procedures.

 

[deleted87716]

One other thing. FP's in the US can't really open a skin cancer clinic even if they wanted to and had the skill. There would be too much backlash from the dermatologist.

Not true at all. Most dermatologists are too busy to care. As long as you're trained and competent, you can do practically anything in your office that you want to do. Office-based dermatology procedures don't require credentialing, they're taught in residency and commonly performed by FPs all over the country. I treat skin cancer myself, just not boatloads of it. I have a dermatoscope, and I know how to use it. If you want to do that exclusively, however, the main thing to consider is your market. Regardless of marketing, a skin cancer clinic is going to be largely a referral-based practice, meaning you'll need support from the primary care physicians in your area in order to be successful. If you're in an area well-served by dermatologists, you'll probably face an uphill battle to get your colleagues to refer to you. If you're somewhere with lots of skin cancer and a dearth of dermatologists (sort of like the situation in Australia), you'd probably do well.

 

[Merely]

Not true at all. Most dermatologists are too busy to care. As long as you're trained and competent, you can do practically anything in your office that you want to do. Office-based dermatology procedures don't require credentialing, they're taught in residency and commonly performed by FPs all over the country. I treat skin cancer myself, just not boatloads of it. I have a dermatoscope, and I know how to use it. If you want to do that exclusively, however, the main thing to consider is your market. Regardless of marketing, a skin cancer clinic is going to be largely a referral-based practice, meaning you'll need support from the primary care physicians in your area in order to be successful. If you're in an area well-served by dermatologists, you'll probably face an uphill battle to get your colleagues to refer to you. If you're somewhere with lots of skin cancer and a dearth of dermatologists (sort of like the situation in Australia), you'd probably do well.

Very interesting

 

[lymphocyte]

.

 

[Ericslv]

Not true at all. Most dermatologists are too busy to care. As long as you're trained and competent, you can do practically anything in your office that you want to do. Office-based dermatology procedures don't require credentialing, they're taught in residency and commonly performed by FPs all over the country. I treat skin cancer myself, just not boatloads of it. I have a dermatoscope, and I know how to use it. If you want to do that exclusively, however, the main thing to consider is your market. Regardless of marketing, a skin cancer clinic is going to be largely a referral-based practice, meaning you'll need support from the primary care physicians in your area in order to be successful. If you're in an area well-served by dermatologists, you'll probably face an uphill battle to get your colleagues to refer to you. If you're somewhere with lots of skin cancer and a dearth of dermatologists (sort of like the situation in Australia), you'd probably do well.

Really. You can do mohs surgery? You can do appendectomies or anesthesia? Which family medicine residency has a fellowship for FMs to do anesthesia in the US or interventional pain procedures?

All the recent grads than feel 100% comfortable performing a colonoscopy by themselves and have done over 200 in residency please stand up. How about 100? Do I hear 50?

How many recent grads feel 100% comfortable performing an appendectomy today?

 

[lymphocyte]

Really. You can do mohs surgery? You can do appendectomies or anesthesia? Which family medicine residency has a fellowship for FMs to do anesthesia in the US or interventional pain procedures?

All the recent grads than feel 100% comfortable performing a colonoscopy by themselves and have done over 200 in residency please stand up. How about 100? Do I hear 50?

How many recent grads feel 100% comfortable performing an appendectomy today?

Then train longer. Or do procedural fellowships. I'm just not getting this.

Three points:

1. Yes, in fact, with an unrestricted licence in Australia or America, you can do whatever the hell you want. But will you get insurance, admitting privileges, good outcomes, referrals, or get strung up by the Medical Council?--those are what really matter and why people specialise in the first place. You will get away with wider scope in rural Australia, just like in rural America.

2. GP training is usually around 5 years. If you want to do surgery, anesthesia, or obstetrics, you'll need to do at least another year. And then also maintain the volume to keep your hospital and insurance company happy. Ain't no PGY3 GPs waltzing into surgical practice... (And correct me if I'm wrong, but you could do a surgical subspecialty if you trained for that long in the US).

3. The 700,000K guy? He retired. Nobody's replaced him and they've looked and looked and looked. There's a reason why. It's just as hard in Australia as it is in the US to practice rural and remote and few young practitioners feel up to the challenge. The need is real though, and they'll put up with some very crazy **** to meet that need: https://en.m.wikipedia.org/wiki/Jayant_Patel

4. Bonus point. Australia is awesome. Outback med is awesome. The support for wide-scope GPs is tremendous. The need is tremendous. I'll post more information later this week.

 

[deleted87716]

Really. You can do mohs surgery?

There are plenty of skin cancers out there that don't require Mohs. The majority, in fact.

 

[Ericslv]

Then train longer. Or do procedural fellowships. I'm just not getting this.

Three points:

1. Yes, in fact, with an unrestricted licence in Australia or America, you can do whatever the hell you want. But will you get insurance, admitting privileges, good outcomes, referrals, or get strung up by the Medical Council?--those are what really matter and why people specialise in the first place. You will get away with wider scope in rural Australia, just like in rural America.

2. GP training is usually around 5 years. If you want to do surgery, anesthesia, or obstetrics, you'll need to do at least another year. And then also maintain the volume to keep your hospital and insurance company happy. Ain't no PGY3 GPs waltzing into surgical practice... (And correct me if I'm wrong, but you could do a surgical subspecialty if you trained for that long in the US).

3. The 700,000K guy? He retired. Nobody's replaced him and they've looked and looked and looked. There's a reason why. It's just as hard in Australia as it is in the US to practice rural and remote and few young practitioners feel up to the challenge. The need is real though, and they'll put up with some very crazy **** to meet that need: https://en.m.wikipedia.org/wiki/Jayant_Patel

4. Bonus point. Australia is awesome. Outback med is awesome. The support for wide-scope GPs is tremendous. The need is tremendous. I promise I'll post more information later this week.

When you become an attending in the US you will get it. Until then I suggest you focus on becoming a attending.

 

[lymphocyte]

When you become an attending in the US you will get it. Until then I suggest you focus on becoming a attending.

Thank you for your suggestion. A suggestion in return: perhaps you should focus on better understanding the scope of your own speciality.

As your fellow attendings have commented, what you're after in Australia is probably available in the US. And either way you'd have to 1) get more training, 2) go "rural," and 3) have the guts to do it.

I just Googled "family medicine skin clinic -au" and popped up dozens of results: http://www.hillfamilyclinic.com/#!about-us/c9cl

I just Googled "family medicine dermatology fellowship -au" and this popped up: http://familymed.uthscsa.edu/residency08/facdev.asp

I just Googled "family medicine procedural training" and I read about Cayle Goertzen out in Kansas who performs operative OB, spinal and epidural anesthesia, open hysterectomies, lap-choles, and lap-appys. I also read that about 7% of American family practitioners perform colonoscopies, about 10% do C-sections, and about 45% round in the ICU. Relatively few are denied credentialing.

Here's an informative handout from AAFP on advanced procedural skills in Family Practice: http://www.aafp.org/dam/AAFP/documents/events/nc/handouts/nc15-procedures.pdf

Best of luck to you.

 

[Ericslv]

Thank you for your suggestion. A suggestion in return: perhaps you should focus on better understanding the scope of your own speciality.

As your fellow attendings have commented, what you're after in Australia is probably available in the US. And either way you'd have to 1) get more training, 2) go "rural," and 3) have the guts to do it.

I just Googled "family medicine skin clinic -au" and popped up dozens of results: http://www.hillfamilyclinic.com/#!about-us/c9cl

I just Googled "family medicine dermatology fellowship -au" and this popped up: http://familymed.uthscsa.edu/residency08/facdev.asp

I just Googled "family medicine procedural training" and I read about Cayle Goertzen out in Kansas who performs operative OB, spinal and epidural anesthesia, open hysterectomies, lap-choles, and lap-appys. I also read that about 7% of American family practitioners perform colonoscopies, about 10% do C-sections, and about 45% round in the ICU. Relatively few are denied credentialing.

Here's an informative handout from AAFP on advanced procedural skills in Family Practice: http://www.aafp.org/dam/AAFP/documents/events/nc/handouts/nc15-procedures.pdf

Best of luck to you.

Those are all very few and in between. Most FP's in the US talk alot about what they can do but do very little. Most do chronic care or urgent care. Same old, same old.

What's on paper is not what really happens.

In fact a recent survey of FP showed that most would do some other specialty if they could or could choose again.

Yes there are some rural FP's that do those things but most don't.

SDN has lots of idealistic people on here. The reality of FM in the US is that no one really wants to do it and most programs barely fill in their match. It is one the least sought after.

If things were so great here for FM it would be one of the most sought after. That whole supply and demand thing you know.

And regarding skin clinics. I wasn't talking about cosmetics and simple mole removal. I was talking about skin cancer and mohs surgery.

And yes FM docs in the US can treat some skin cancers but most don't because the lawyers are just outside their door waiting for them.

 

[lymphocyte]

Those are all very few and in between. Most FP's in the US talk alot about what they can do but do very little. Most do chronic care or urgent care. Same old, same old.

What's on paper is not what really happens.

In fact a recent survey of FP showed that most would do some other specialty if they could or could choose again.

Yes there are some rural FP's that do those things but most don't.

SDN has lots of idealistic people on here. The reality of FM in the US is that no one really wants to do it and most programs barely fill in their match. It is one the least sought after.

If things were so great here for FM it would be one of the most sought after. That whole supply and demand thing you know.

And regarding skin clinics. I wasn't talking about cosmetics and simple mole removal. I was talking about skin cancer and mohs surgery.

And yes FM docs in the US can treat some skin cancers but most don't because the lawyers are just outside their door waiting for them.

I get the sense that you might be burned out or in need of a mentor.

Point-by-point:

1. No, proceduralists are not far and few between. Please look at the data in AAFP handout. They represent a significant portion of practicing family physicians. 10% perform C-sections, 20% deliver, 7% perform major surgeries. How is that far and few between? I'm sorry your setup doesn't support a greater scope of practice. Perhaps you can upskill and move?

2. Most surveys of most doctors show that a majority would choose another speciality. That's true from general surgery to EM to IM to sub-specialities like CC or Rheum. Sure, derm, cards, uro and ortho are statistically significant exceptions, but the sheer passion it takes to break into those fields reflects on the speciality satisfaction.

3. I wasn't talking about cosmetics or simple mole removal. I don't think @Blue Dog was either. Did you even look at the website I posted? FPs should have no trouble dealing with most amelanocytic lesions.

4. Lawyers can hang outside your door all they want. If you deliver safe and effective care consistent with the expertise you developed in residency or beyond, then there's nothing to worry about. Especially if you move to states with doctor-friendly malpractice laws. By the way, Australia is the second most litigious country in the world for medical malpractice per capita. It's also not some cowboy backwater that will let you do surgery (especially Mohs, wtf?) or anesthetise patients with only 3 years of residency. Again, we train at least 6 years for advanced procedural skills.

Sorry I'm getting so emphatic. Mah jimmies have been rustled.

If you had said I want to be a GP in Australia for moral reasons (universal access to healthcare), less bureaucracy, better opportunities for my children, better funding for upskilling, etc. I would be more supportive. But your main concerns seem to be respect and remuneration. What can I say? Respect is earned and so is remuneration. There are plenty of poor idiot GPs in Australia too.

 

[Ericslv]

I get the sense that you might be burned out or in need of a mentor.

Point-by-point:

1. No, proceduralists are not far and few between. Please look at the data in AAFP handout. They represent a significant portion of practicing family physicians. 10% perform C-sections, 20% deliver, 7% perform major surgeries. How is that far and few between? I'm sorry your setup doesn't support a greater scope of practice. I suggest you upskill and move.

2. Most surveys of most doctors show that a majority would choose another speciality. That's true from general surgery to EM to IM to sub-specialities like CC or Rheum. Sure, derm, cards, uro and ortho are statistically significant exceptions, but the sheer passion it takes to break into those fields reflects on the speciality satisfaction.

3. I wasn't talking about cosmetics or simple mole removal. I don't think @Blue Dog was either. Did you even look at the website I posted? FPs should have no trouble dealing with most amelanocytic lesions.

4. Lawyers can hang outside your door all they want. If you deliver safe and effective care consistent with the expertise you developed in residency or beyond, then there's nothing to worry about. Especially if you move to states with doctor-friendly malpractice laws. By the way, Australia is the second most litigious country in the world for medical malpractice per capita. It's also not some cowboy backwater that will let you do surgery (especially Mohs, wtf?) or anesthetise patients with only 3 years of residency. Again, we train at least 6 years for advanced procedural skills.

Sorry I'm getting so emphatic. Mah jimmies have been rustled.

If you had said I want to be a GP in Australia for moral reasons (universal access to healthcare), less bureaucracy, better opportunities for my children, better funding for upskilling, etc. I would be more supportive. But your main concerns seem to be respect and remuneration. What can I say? Respect is earned and so is remuneration. There are plenty of poor idiot GPs in Australia too.

I love it when some med student thinks they know so much. The aafp is a self serving piece of garbage organization. Most surveys do not show FPs would go into FP again. Regarding number 4. Before you start talking learn to walk.

I get frustrated when people who have never worked in FP talk trash.

 

[VA Hopeful Dr]

Those are all very few and in between. Most FP's in the US talk alot about what they can do but do very little. Most do chronic care or urgent care. Same old, same old.

What's on paper is not what really happens.

In fact a recent survey of FP showed that most would do some other specialty if they could or could choose again.

Yes there are some rural FP's that do those things but most don't.

SDN has lots of idealistic people on here. The reality of FM in the US is that no one really wants to do it and most programs barely fill in their match. It is one the least sought after.

If things were so great here for FM it would be one of the most sought after. That whole supply and demand thing you know.

And regarding skin clinics. I wasn't talking about cosmetics and simple mole removal. I was talking about skin cancer and mohs surgery.

And yes FM docs in the US can treat some skin cancers but most don't because the lawyers are just outside their door waiting for them.

That's funny, in the 4 years I was involved my FM residency never had to scramble anyone (and in fact never even made it to the bottom 3rd of our rank list). We are not even all that special in terms of residency programs.

Very few dermatologists do mohs, so if that's your definition of "treating skin cancer" you're leaving out the majority of physicians that actually treat it.

I, like BD, treat skin cancer. Not daily like the derm guy down the hall, but unless I think its melanoma then I'm cutting it out myself. Oh wait, its not mohs so its not actually treating anything... my bad.

 

[Ericslv]

That's funny, in the 4 years I was involved my FM residency never had to scramble anyone (and in fact never even made it to the bottom 3rd of our rank list). We are not even all that special in terms of residency programs.

Very few dermatologists do mohs, so if that's your definition of "treating skin cancer" you're leaving out the majority of physicians that actually treat it.

I, like BD, treat skin cancer. Not daily like the derm guy down the hall, but unless I think its melanoma then I'm cutting it out myself. Oh wait, its not mohs so its not actually treating anything... my bad.

Your a funny guy VA. Everyone in the US knows that FP is one of the lowest ranked in the match. Even AAFP knows that. Where have you been? It's important be genuine. Last match the numbers went up by a little. Most debates are around the shortage of FM docs and why med students aren't entering FM. You can live in your idealistic fantasy land but the rest of us know better. In fact you had so much problems with corp med that you left and started a DPC.

As far as skin cancer your missing the point but I don't want to get into it. Your idealistic view of FM is far from the reality of it.

One other thing.
If your happy doing what your doing then great. Do it. But I think every med student should know the reality of FM before they are sold a bill of good by a bunch of academics.

Low pay. Tons of useless paperwork (you will be charting till hell freezes over and you won't get paid for it, in fact that 99213 that's worth 70 bucks will be worth about 25 after all the charting and chasing you have to do to get paid), Low autonomy, poor working conditions especially true for FM (many are just referral docs), Low respect in many situation and locations (not all).

In fact the reason many FM doctors are trying to go into DPC is because their work condition suck so bad. So if you are comfortable with all of that, then all the power to you.

 

[VA Hopeful Dr]

Your a funny guy VA. Everyone in the US knows that FP is one of the lowest ranked in the match. Even AAFP knows that. Where have you been? It's important be genuine. Last match the numbers went up by a little. Most debates are around the shortage of FM docs and why med students aren't entering FM. You can live in your idealistic fantasy land but the rest of us know better. In fact you had so much problems with corp med that you left and started a DPC.

As far as skin cancer your missing the point but I don't want to get into it. Your idealistic view of FM is far from the reality of it.

One other thing.
If your happy doing what your doing then great. Do it. But I think every med student should know the reality of FM before they are sold a bill of good by a bunch of academics.

Low pay. Tons of useless paperwork (you will be charting till hell freezes over and you won't get paid for it, in fact that 99213 that's worth 70 bucks will be worth about 25 after all the charting and chasing you have to do to get paid), Low autonomy, poor working conditions especially true for FM (many are just referral docs), Low respect in many situation and locations (not all).

In fact the reason many FM doctors are trying to go into DPC is because their work condition suck so bad. So if you are comfortable with all of that, then all the power to you.

No one is arguing that family medicine is super popular, but to say that, as you did "The reality of FM in the US is that no one really wants to do it and most programs barely fill in their match. It is one the least sought after." is untrue. There are plenty of us that could have done other things but chose this because we like being family doctors. Are there people who end up in FM because they have no other choice? Sure. But I don't think its even a full third of residents. I also suspect that the majority of programs fill just fine. Are there some that don't? Naturally, but I think more fill consistently than don't.

Med students aren't entering it for many reason, but the biggest is money. If you paid family docs 400k/year it would become quite the popular specialty even with the problems we have.

Its funny, most of the family doctors that I talk to are overall fairly content. We all have our complaints, but none actively talk about wishing they had done something different. I actually think this forum does a pretty good job of selling FM for what it is. Hell, @Blue Dog has been at this a while (and still in private practice mind you) and is quite open and honest about everything.

I actually think academics are worse for family medicine than anyone else. The large ivory tower places tend not to think too highly of FM and it shows in match rates from larger universities. When I was in med school, the family docs who worked for the university made FM look just awful. It wasn't until I did a community rotation that I realized that I actually really liked FM.

I went DPC because I hated my last job and couldn't move again. The previous 2 hospital-employed positions that I had were actually quite nice. My PCP is FM for the local hospital, sees ~18 patients/day, that 99213 you're bitching about pays him $40 each straight to his pocket, 4.5 days/week. He's quite happy with his choice as well.

Lastly, I'm still unsure what we're all "selling" that's untrue. The nice thing about family medicine is the variety. If you really want to essentially open a dermatology office, you can. You can't likely do it in NYC, but I bet you could in Iowa or Wyoming. If you want to do OB with c-sections, you can in the right place. If you want to be a quick-stop referral monkey, you can do that. If you want to do more and manage complicated patients, you can do that too.

 

[Ericslv]

No one is arguing that family medicine is super popular, but to say that, as you did "The reality of FM in the US is that no one really wants to do it and most programs barely fill in their match. It is one the least sought after." is untrue. There are plenty of us that could have done other things but chose this because we like being family doctors. Are there people who end up in FM because they have no other choice? Sure. But I don't think its even a full third of residents. I also suspect that the majority of programs fill just fine. Are there some that don't? Naturally, but I think more fill consistently than don't.

Med students aren't entering it for many reason, but the biggest is money. If you paid family docs 400k/year it would become quite the popular specialty even with the problems we have.

Its funny, most of the family doctors that I talk to are overall fairly content. We all have our complaints, but none actively talk about wishing they had done something different. I actually think this forum does a pretty good job of selling FM for what it is. Hell, @Blue Dog has been at this a while (and still in private practice mind you) and is quite open and honest about everything.

I actually think academics are worse for family medicine than anyone else. The large ivory tower places tend not to think too highly of FM and it shows in match rates from larger universities. When I was in med school, the family docs who worked for the university made FM look just awful. It wasn't until I did a community rotation that I realized that I actually really liked FM.

I went DPC because I hated my last job and couldn't move again. The previous 2 hospital-employed positions that I had were actually quite nice. My PCP is FM for the local hospital, sees ~18 patients/day, that 99213 you're bitching about pays him $40 each straight to his pocket, 4.5 days/week. He's quite happy with his choice as well.

Lastly, I'm still unsure what we're all "selling" that's untrue. The nice thing about family medicine is the variety. If you really want to essentially open a dermatology office, you can. You can't likely do it in NYC, but I bet you could in Iowa or Wyoming. If you want to do OB with c-sections, you can in the right place. If you want to be a quick-stop referral monkey, you can do that. If you want to do more and manage complicated patients, you can do that too.

Actually you kinda made my point for me. And it's not untrue that FM is popular. Sure some go into it because they want to but that my whole point of stating what I'm stating. They should be warned. Most of them have 250K debt for med-school and they won't be paying it off soon with FM wages unless they do some kind of loan repayment program etc which puts them in some place they may not want to be.

But like I said, if you enjoy it there is not problem. Go for it. Just know the facts.

 

[surrender903]

And it's not untrue that FM is popular.

double negatives make Strunk and White cry. 🙁

 

[DrMidlife]

I actually think academics are worse for family medicine than anyone else. The large ivory tower places tend not to think too highly of FM and it shows in match rates from larger universities. When I was in med school, the family docs who worked for the university made FM look just awful. It wasn't until I did a community rotation that I realized that I actually really liked FM.

Yup, same here. ObGyn & Peds were the same. Mostly miserable attendings stuck in jobs they hate, not interested in teaching, no active peer network, not all that interested in their patients, fairly delusional about their capabilities. I imagine a pretty yucky homelife too. One attending fancied himself a great marriage counselor but observing him made me want to call the cops. If I'd had to get a residency LOR from one of these faculty members I'd have been completely screwed. If I hadn't done community/rural rotations I wouldn't have gone after FM at all. I'm completely baffled by my classmates who went after academic FM, like they didn't notice?

It's my experience that the FM docs who didn't get what they want in a specialty or in a residency seem to also end up being hard to employ, maybe are fairly awful to work with/for, and maybe complain the most about how screwed up FM is. And then there are FM residents who were plenty unsure or reluctant going in, but end up happy and productive and fun during residency and are then great to work with/for later on. Same with every other industry - misery loves company. Success breeds success.

FM is huge. FM has huge regional variance. I suggest that there are absolutely FM residencies with a majority of FM-reluctant residents, one county over from FM residencies that can absolutely pick and choose the best FM-enthusiast candidates. And the most interesting and fun FM residents I met on the interview trail were in Alaska. No way you're going to Alaska for FM unless you're totally into it, competitive or not.

 

[Ericslv]

double negatives make Strunk and White cry. 🙁

LOL, I meant it's not true that FM is popular.

 

[VA Hopeful Dr]

Actually you kinda made my point for me. And it's not untrue that FM is popular. Sure some go into it because they want to but that my whole point of stating what I'm stating. They should be warned. Most of them have 250K debt for med-school and they won't be paying it off soon with FM wages unless they do some kind of loan repayment program etc which puts them in some place they may not want to be.

But like I said, if you enjoy it there is not problem. Go for it. Just know the facts.

I guess this is where I'm losing you but who is saying that everything about FM is sunshine and roses? Every field has its downsides. Ours is primarily money, although its not as bad as most think.

We sacrifice income for lifestyle. As a family doctor, its not that hard to break 200k working banker's hours 4-4.5 days/week with a solid 4 weeks of vacation per year. We don't have to set foot in the hospital, call is over the phone at worst, no weekends (meaning we get to spend time with families/friends/hobbies). I haven't had to do anything medical at 2am since residency. Patients generally love their family doctors (this translates into fewer lawsuits).

Am I ever going to clear the 500k/year that my hand surgeon cousin makes? No, very likely not. Am I going to miss every other soccer game, every 4th Christmas, or spend Thanksgiving in an OR somewhere like he does? No, not that either.

As for student loans - its not quite as bad as it looks. My wife finished school with ~200k in loans. We pay $2200/month for those. She's a hospitalist making the usual amount (just over 200k) and so that loan payment is only around 25% of her monthly take-home pay. Up that loan to 250k and we're talking maybe an extra $400/month so maybe 30% of take home? That's still not a bad life, and eventually the loan will be paid off.

 

[Ericslv]

I guess this is where I'm losing you but who is saying that everything about FM is sunshine and roses? Every field has its downsides. Ours is primarily money, although its not as bad as most think.

We sacrifice income for lifestyle. As a family doctor, its not that hard to break 200k working banker's hours 4-4.5 days/week with a solid 4 weeks of vacation per year. We don't have to set foot in the hospital, call is over the phone at worst, no weekends (meaning we get to spend time with families/friends/hobbies). I haven't had to do anything medical at 2am since residency. Patients generally love their family doctors (this translates into fewer lawsuits).

Am I ever going to clear the 500k/year that my hand surgeon cousin makes? No, very likely not. Am I going to miss every other soccer game, every 4th Christmas, or spend Thanksgiving in an OR somewhere like he does? No, not that either.

As for student loans - its not quite as bad as it looks. My wife finished school with ~200k in loans. We pay $2200/month for those. She's a hospitalist making the usual amount (just over 200k) and so that loan payment is only around 25% of her monthly take-home pay. Up that loan to 250k and we're talking maybe an extra $400/month so maybe 30% of take home? That's still not a bad life, and eventually the loan will be paid off.

That's great.

On a side note she could pay that off in 2 years if she lives like a resident.

 

[VA Hopeful Dr]

That's great.

On a side note she could pay that off in 2 years if she lives like a resident.

Yeah, but IVF is expensive.

But it speaks to my point - these big loans while a pain in the butt don't financially cripple people who aren't making ortho money.

 

[Ericslv]

Yeah, but IVF is expensive.

But it speaks to my point - these big loans while a pain in the butt don't financially cripple people who aren't making ortho money.

I feel they do. 2200 a month is huge. to many it's a house payment. To some it's 3 or 4 car payments. To others it's retirement stash.

So no it won't cripple you but sure does hinder your life.

And yeah IVF is expensive. Is it at least 2200 a month?

 

[lymphocyte]

I love it when some med student thinks they know so much.

Pardon, but you interjected yourself into this thread by asking for my advice. I then went on to cite data and give examples that have been corroborated by your colleagues.

I hear what you're saying. FP can suck. But what I'm saying is that it doesn't have to. If you're willing to move all the way to Australia to gain autonomy and less headaches, why not move a few hundred miles to a more rural location where you'll be more valued and more needed?

 

[Doctor4Life1769]

I don't see too many starving, poor FM physicians. Of course, if you can't manage your finances, being a celebrity or athlete won't save you from bankruptcy.

 

[Ericslv]

Pardon, but you interjected yourself into this thread by asking for my advice. I then went on to cite data and give examples that have been corroborated by your colleagues.

I hear what you're saying. FP can suck. But what I'm saying is that it doesn't have to. If you're willing to move all the way to Australia to gain autonomy and less headaches, why not move a few hundred miles to a more rural location where you'll be more valued and more needed?



This is why I respect the hell out of him or her.



Exactly. It's the same in Australia. But if you're willing to sacrifice location for lifestyle or take a gamble on trying something new, the reward can be tremendous.

I don't necessarily disagree with you. But since you have not done any of this yet, you should wait to say things like that until you have actually done them.

But you asked about the US system and I gave you a couple of answers and asked you about Australian system and appreciate the answer you gave me.

I wouldn't move to Australia just for autonomy. If I ever do it would be to enjoy the adventure, work part time and play more. For example, I dive so it would be a fantastic experience for me.

I wouldn't do it for money because the tax structure in the US puts any US citizen making over 90K at a disadvantage because they would have to pay taxes twice on anything over that.

People get so defensive when I point out the negative on FM. Its as if it was the first time they have lived or heard this. If I was a med-student I would want to know all of this before choosing a specialty so I can make an informed decision.

Anyway good luck with your career.

 

[VA Hopeful Dr]

I feel they do. 2200 a month is huge. to many it's a house payment. To some it's 3 or 4 car payments. To others it's retirement stash.

So no it won't cripple you but sure does hinder your life.

And yeah IVF is expensive. Is it at least 2200 a month?

How are you not getting this? $2200 is a decent chunk of change to be sure, but even for someone making FM money there is still plenty left over for house, nanny, vacations, eating out on occasion, and saving for retirement. I mean yeah, it would be nice to have that extra 2200/month but its not the difference between rationing out food and a 4th car.

 

[Ericslv]

I don't see too many starving, poor FM physicians. Of course, if you can't manage your finances, being a celebrity or athlete won't save you from bankruptcy.

I don't think it's a matter starving or not. That's kind of the bottom isn't it. I don't think anyone going to med-school would use that as a yard stick.

But when FM is near the bottom in salary and in many cases hours worked and lifestyle it's not so great. If you work 50hrs a week and the Derm guy does the same they make double what you made doing far less complicated cases most of the time. That's just an example but you get the drift.

If you use starving as the yard stick then someone can say well you don't starve at 100K either so let pay you that.

 

[Doctor4Life1769]

I don't think it's a matter starving or not. That's kind of the bottom isn't it. I don't think anyone going to med-school would use that as a yard stick.

But when FM is near the bottom in salary and in many cases hours worked and lifestyle it's not so great. If you work 50hrs a week and the Derm guy does the same they make double what you made doing far less complicated cases most of the time. That's just an example but you get the drift.

If you use starving as the yard stick then someone can say well you don't starve at 100K either so let pay you that.

Have you seen a typical derm schedule? They see high volume and have lots of MAs to ensure the engine is running. This is probably why 35% weren't satisfied and I believe reimbursement is gonna get cut there too. DNPs are looking derm my ex-gf who was a PA wants to do derm.

It's all relative. I came from anesthesia and this is like a breath of fresh air compared to anesthesia. I enjoy talking to people and I can relate to the general population. I lived a similar life to them, and I'm very flexible in my approach. I'm firm but reasonable. I have my nurses deal with stuff that I shouldn't have to. Is it always rainbows and unicorns? No, but it is compared to the way I was miserable in anesthesia. The pay isn't as good but honestly if you are multi-dimensional you will make a better than low-tier salary and still have the satisfaction. I like that I will be doing outpatient, inpt, facilities. I'm moonlighting in urgent care. After about 3 years, if I want to, I'll stay or I can bail and go DPC by joining or maybe doing my own. No speciality is as flexible as ours.

 

[lymphocyte]

I don't necessarily disagree with you. But since you have not done any of this yet, you should wait to say things like that until you have actually done them.

But you asked about the US system and I gave you a couple of answers and asked you about Australian system and appreciate the answer you gave me.

I wouldn't move to Australia just for autonomy. If I ever do it would be to enjoy the adventure, work part time and play more. For example, I dive so it would be a fantastic experience for me.

I wouldn't do it for money because the tax structure in the US puts any US citizen making over 90K at a disadvantage because they would have to pay taxes twice on anything over that.

People get so defensive when I point out the negative on FM. Its as if it was the first time they have lived or heard this. If I was a med-student I would want to know all of this before choosing a specialty so I can make an informed decision.

Anyway good luck with your career.

I get what you're saying, and I'll try to help however I can. I appreciate your candor.

The tax thing is not at all true. There's foreign income tax exclusion but also foreign income tax credit. I speak from personal experience.

 

[Ericslv]

How are you not getting this? $2200 is a decent chunk of change to be sure, but even for someone making FM money there is still plenty left over for house, nanny, vacations, eating out on occasion, and saving for retirement. I mean yeah, it would be nice to have that extra 2200/month but its not the difference between rationing out food and a 4th car.

Like I said. If your ok with it then great.

 

[Ericslv]

I get what you're saying, and I'll try to help however I can. I appreciate your candor.

The tax thing is not at all true. There's foreign income tax exclusion but also foreign income tax credit (and a housing credit too that might allow you to snag some tasty investment property). I speak from personal experience. I'll post that information tomorrow on the long-weekend (Queen's birthday!).

The tax thing I'd like to know more about because the last time I looked into it (about 2 years ago) I learned about the double taxation. Once in the US and once in the other country.