Rural, UC and EM

[elfmonkey]

Hello everyone,
I`m an IMG and I`m on the fence between Rural and UC/EM in FM .
I`ve been working in a private practice here in the "south" for almost two years and it`s never boring in FM .

Would Rural prepare more for both fields ?

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[cabinbuilder]

Hello everyone,
I`m an IMG and I`m on the fence between Rural and UC/EM in FM .
I`ve been working in a private practice here in the "south" for almost two years and it`s never boring in FM .

Would Rural prepare more for both fields ?

Not really sure of your question? What is UC? If you are FP and you want to work rural then go apply for a rural job. I am very confused. Please elaborate.

 

[elfmonkey]

I`m sorry, UC is urgent care I noticed some use that here .
I`m not an FP yet, I`m going to apply next match . I just got blessed with nice FP`s that let me work with them the past two year .
My question is would a Rural track be more comprehensive ?
Thanks

 

[cabinbuilder]

I`m sorry, UC is urgent care I noticed some use that here .
I`m not an FP yet, I`m going to apply next match . I just got blessed with nice FP`s that let me work with them the past two year .
My question is would a Rural track be more comprehensive ?
Thanks

I'm not sure what a rural track will offer to you unless you plan on doing OB but most rural places don't do OB anyway due to the risk and liability. Rural medicine is essentially flying by the seat of your pants and being able to imporvise and use what is available to you and not flip out when what is "standard" is not necessarily available to you. Being rural means being well rounded and can do clinic, inpatient, ER and/or urgent care. I do all of these or any combination of the 4 depending on the location.

You can learn everything you need in a regular FP residency as long as you have rural track in mind like I did. So I learned my medicine, how to splint, cast, suture, do lines, stress tests, read my own films/CT's/MRI's to at least see life threatening issues. EKG's, joint injections, OMT, nails, cysts, take of lesions anywhere including the face, know how to do conscious sedation, and intubate. Be able to make a decision and stick by it to save the patient however you can to get them to a higher level of care if need be. Be confident enough to know that you are competant in what you do as you may be the only one out there for many square miles.

 

[elfmonkey]

. Being rural means being well rounded and can do clinic, inpatient, ER and/or urgent care.

So I learned my medicine, how to splint, cast, suture, do lines, stress tests, read my own films/CT's/MRI's to at least see life threatening issues. EKG's, joint injections, OMT, nails, cysts, take of lesions anywhere including the face, know how to do conscious sedation, and intubate. Be able to make a decision and stick by it to save the patient however you can to get them to a higher level of care if need be. Be confident enough to know that you are competant in what you do as you may be the only one out there for many square miles.

That`s exactly what I want to do . Except that I`m not a big fan of OB, I need to learn it though .
So is there a specific part of the continental US where I should I head to ? I`m in the south east now and few FP`s do what you are talking about .
Thanks !!

 

[cabinbuilder]

trust me you don't have to do OB. I don't. Anywhere in the West will give you rural medicine. Texas, Montana, Colorado, Oregon, Nevada, Idaho, Wyoming, New Mexico, Arizona, Alaska, Oklahoma. The Dakotas, Minnesota, Kansas, Nebraska

 

[elfmonkey]

trust me you don't have to do OB. I don't. Anywhere in the West will give you rural medicine. Texas, Montana, Colorado, Oregon, Nevada, Idaho, Wyoming, New Mexico, Arizona, Alaska, Oklahoma. The Dakotas, Minnesota, Kansas, Nebraska

Cabinbuilder, thank you so much !

 

[Prncssbuttercup]

Read the country doctors casebook. It is about a rural doc in Northern MN, actually near my family's cabin... Very rural even today, many places up there are more than an hour from the nearest hospital...

 

[elfmonkey]

Read the country doctors casebook. It is about a rural doc in Northern MN, actually near my family's cabin... Very rural even today, many places up there are more than an hour from the nearest hospital...

Alright, I looked it up . Thanks !
I have two more questions for now :
1. Will I be able to take a month or so every year off to go overseas ?
2. Will I be my own boss ?
From my experience here in the U.S- which is a bit brief, I noticed that people really struggle with their employers, whether they were Surgeons, Researchers or Family Doctors- I only worked with those . They all advised me to be "My own boss" .

 

[cabinbuilder]

Alright, I looked it up . Thanks !
I have two more questions for now :
1. Will I be able to take a month or so every year off to go overseas ?
2. Will I be my own boss ?
From my experience here in the U.S- which is a bit brief, I noticed that people really struggle with their employers, whether they were Surgeons, Researchers or Family Doctors- I only worked with those . They all advised me to be "My own boss" .

Depends on the contract you have. If you work locums then you make your own availability/vacation time that suits you. Or if you can find a gig that is a few weeks on/a few week off - like hospitalist or ER type positions. Pretty hard to do if you are an employee of some larger entity that tells you how many days off a year you get to have.

Highly doubt you will be your own boss. Very difficult to start your own practice anymore due to high costs and student loan debt. Plus, if you have your own practice, difficult to take much time off there since you would have to have call coverage for your patient's for the length of time you are gone. I look at private practice like having a "third child", you are always bound to that entity until you close it.

 

[elfmonkey]

Depends on the contract you have. If you work locums then you make your own availability/vacation time that suits you. Or if you can find a gig that is a few weeks on/a few week off - like hospitalist or ER type positions. Pretty hard to do if you are an employee of some larger entity that tells you how many days off a year you get to have.

Highly doubt you will be your own boss. Very difficult to start your own practice anymore due to high costs and student loan debt. Plus, if you have your own practice, difficult to take much time off there since you would have to have call coverage for your patient's for the length of time you are gone. I look at private practice like having a "third child", you are always bound to that entity until you close it.

Hmm, I`ve seen one doctor setting up clinics in no time, not brand new equipment but in a good shape and really cheap . I think the problem is finding someone to help you, i.e., a nurse, a receptionist and someone for billing . He tried the cash only but it`s risky and needs a strong financial back up .
Something ectopic, would research affect my application to FM residency programs ? I`m doing basic science now in a top research center .
Many thanks Cabinbuilder, you are really helpful !

 

[cabinbuilder]

Hmm, I`ve seen one doctor setting up clinics in no time, not brand new equipment but in a good shape and really cheap . I think the problem is finding someone to help you, i.e., a nurse, a receptionist and someone for billing . He tried the cash only but it`s risky and needs a strong financial back up .
Something ectopic, would research affect my application to FM residency programs ? I`m doing basic science now in a top research center .
Many thanks Cabinbuilder, you are really helpful !

I cannot comment on research. I have never done it nor did I ever see it mentioned in residency when we were interviewing applicants. I cannot say what happens on the MD side of things. Research has never interested me in anyway.

Not to say you cannot open your own practce. A friend of mine did it but gone a 1 million dollar loan to do it. I personally could not live with that hanging over my head.

 

[VA Hopeful Dr]

That`s exactly what I want to do . Except that I`m not a big fan of OB, I need to learn it though .
So is there a specific part of the continental US where I should I head to ? I`m in the south east now and few FP`s do what you are talking about .
Thanks !!

I don't know exactly where in the SE you are, but take a look at these two rural tracks...

http://senecalakes.com/

http://georgiahealth.edu/resident/fm/ruralfmresidencyprgm.html


I know several folks in the Seneca program, they really like the program and are a bit ahead of same year people in my program with procedures. Something they do differently than many places, when you're working in the hospital you cover peds, medicine, and OB all on the same team. Family Medicine at its best, to my mind.

I don't know much about the Georgia one, I interviewed at MCG and this was briefly discussed but as I had no interest in rural medicine I didn't ask for any details.

 

[elfmonkey]

I live in NC .
I`ll take a look at the programs and probably e.mail them for details .
Wouldn`t it be better if I start somewhere in the West and stay there ? I have always been told that it`s better to do your residency - FM - where you want to practice .
Y`all are really nice, thanks !

 

[cabinbuilder]

Wouldn`t it be better if I start somewhere in the West and stay there ? I have always been told that it`s better to do your residency - FM - where you want to practice .
!

Who is telling you this?? Go to residency where you will learn your craft and be happy in your environment.No use making it more miserable than it has to be. Once you graduate then move to where you want to work.

 

[elfmonkey]

Who is telling you this?? Go to residency where you will learn your craft and be happy in your environment.No use making it more miserable than it has to be. Once you graduate then move to where you want to work.

So even if I went to, let`s say a city like NYC or LA ? I`m curious .

 

[cabinbuilder]

So even if I went to, let`s say a city like NYC or LA ? I`m curious .

So you are saying you want to learn rural medicine in LA or NYC? Or you want to work in LA or NYC and feel you have to do a residency in those places? I'm so confused.

 

[elfmonkey]

So you are saying you want to learn rural medicine in LA or NYC? Or you want to work in LA or NYC and feel you have to do a residency in those places? I'm so confused.

No, what if I did the training there, to start earlier, can I after that do Rural somewhere else ? Maybe through a fellowship ?

 

[cabinbuilder]

No, what if I did the training there, to start earlier, can I after that do Rural somewhere else ? Maybe through a fellowship ?

Why would you need a rural fellowship? If you train in a big city you are going to see everything anyway. Rural just means you are ready to deal with whatever comes through the door. Maybe you need to do a rural rotations to understand what it means? Rural just gives you freedom to do more than an FP in a big city who is limited to clinic practice.

 

[MedicineDoc]

Just go to an unopposed residency where they do icu work. That's what I did. You will then feel more comfortable doing ER, hospital icu, full spectrum medicine.

 

[cabinbuilder]

Just go to an unopposed residency where they do icu work. That's what I did. You will then feel more comfortable doing ER, hospital icu, full spectrum medicine.

I totally agree. We did everything in residency since our program was the only one.

 

[elfmonkey]

I`ll try then to match at an unopposed program which might be a bit more competitive .
If not, then interns from other residencies will have to"fight" me for cases !

 

[MedicineDoc]

I`ll try then to match at an unopposed program which might be a bit more competitive .
If not, then interns from other residencies will have to"fight" me for cases !

It's usually institutionalized. You will do what the residency program tells you to do and if it's a big place with alot of different residencies your director maybe doing what is instructed to him as well. It's not about competitive. It's about what is being taught. The average medical student graduating may not even get it until its too late. Some programs don't even let IM in the ICU except in rotations much less FM. Others like the one where I did my residency not so. We followed our patients and sent them where we thought they should go and wrote their orders including preliminary vent settings with pulmonology maybe seeing them the next day after consulted.

 

[AlmostJesus]

Look in a state where they have an emphasis on rural care such as the states listed above. I know the University of Nebraska has a 1 year rural medicine fellowship where you learn C-sections, scopes, lines, and do more rural specific rotations. If you are interested in working rural, you will have no problem finding a place rural, especially in the Midwest.
I currently work at a place that has two MDs and two PAs.The providers cover ER, follow inpatients, and do outpatient work. You have to be prepared to do everything. The good part about this is the doctors get a lot of respect and they have a lot of pull in regards to policies, etc. The con is the 1:4 call schedule and the demands of being one of the few doctors.
The other place I work has 10 FP, 2 Rads, and 2 surgeons. It is a little bit better of a place to practice as far as call schedule. The docs do inpatient, ER, OB, and outpatient work although some doctors do not do all of these. The call runs about 1:7, but it is a very busy practice.
If you are looking for openings, www.3rnet.org will give you an idea on where the openings are at. They will happily give you recruiting assistance.

 

[elfmonkey]

If you are looking for openings, www.3rnet.org will give you an idea on where the openings are at. They will happily give you recruiting assistance.[/QUOTE]

I didn`t know about this link . You should add it to the Family Medicine Links sticky thread .
Thank you !
So, what should one do if he/she is in a heavily opposed residency program ?
Family medicine is the broadest of all specialties . The more you see the more comfortable you get in your practice .

 

[elfmonkey]

I was reading about the Walsenburg, CO thread by Cabinbuilder, and I also stumbled upon this http://www.ruraldoctoring.com/2008/10/why-i-left-primary-care-part-2.html .
Yesterday a friend of mine, who is a much older Family doc, warned me and said that it might be a bit difficult in some areas, especially for an IMG .
It seems that some places are filled with hostility .
Is this the typical environment or just few locations of atypia ? I know it can get really tough in some places here in the south, really tough .

 

[cabinbuilder]

Yes, do yourself a favor and stay away from Walsenburg, CO. I would caution you to stay away from Southern Oregon, too. FMG's are hired in Oregon but usually for a lower rate of pay and I have yet to see any FMG stay after their 3 years of service is completed.

 

[AlmostJesus]

A couple residencies you could look at -
http://www.unmc.edu/familymed/residency.htm University of Nebraska has both a rural training track, and a specialized rural training track where you do a one year procedures fellowship to do c-sections, etc They have a huge rural emphasis which likely means they are open to getting their residents the most experience possible.
As a South Dakota resident, I have worked with residents through the USD residencies while working on the floors and in the resident clinic during my paramedic clinicals. The residents seemed pretty cool and they take IMGs. The bad part is you do compete with IM and transitional year students, but I did see FM residents in the ICU for lines, etc. When doing the ER rotations, the residents do a lot of procedures there as they arise too.
http://www.siouxfallsfpr.org/

http://www.regionalhealth.com/Commu...cation/Family-Medicine-Residency-Program.aspx
That may not be a bad residency to look for if you are looking unopposed. They take IMGs and are an unopposed residency, although I havnt worked with any of their residents.

Just some ideas for you, of course I am only speaking from the places I have experience with.

 

[elfmonkey]

Yes, do yourself a favor and stay away from Walsenburg, CO. I would caution you to stay away from Southern Oregon, too. FMG's are hired in Oregon but usually for a lower rate of pay and I have yet to see any FMG stay after their 3 years of service is completed.

This is kind of sad. I`ve been to so many places, that I realize it`s not worth it to be in a such an environment .

A couple residencies you could look at -
http://www.unmc.edu/familymed/residency.htm University of Nebraska has both a rural training track, and a specialized rural training track where you do a one year procedures fellowship to do c-sections, etc They have a huge rural emphasis which likely means they are open to getting their residents the most experience possible.
As a South Dakota resident, I have worked with residents through the USD residencies while working on the floors and in the resident clinic during my paramedic clinicals. The residents seemed pretty cool and they take IMGs. The bad part is you do compete with IM and transitional year students, but I did see FM residents in the ICU for lines, etc. When doing the ER rotations, the residents do a lot of procedures there as they arise too.
http://www.siouxfallsfpr.org/

http://www.regionalhealth.com/Commu...cation/Family-Medicine-Residency-Program.aspx
That may not be a bad residency to look for if you are looking unopposed. They take IMGs and are an unopposed residency, although I havnt worked with any of their residents.

Just some ideas for you, of course I am only speaking from the places I have experience with.

I love the Dakotas, they are just like a "fresher" version of the US. I bookmarked those residencies a while ago and planning on applying to them . Thanks for the confirmation !

 

[AlmostJesus]

This is kind of sad. I`ve been to so many places, that I realize it`s not worth it to be in a such an environment .


I love the Dakotas, they are just like a "fresher" version of the US. I bookmarked those residencies a while ago and planning on applying to them . Thanks for the confirmation !

If you go to one of these residencies, I can almost guarantee you a job right away. Many small towns are signing doctors while in residency to start upon completion.
http://www.keloland.com/NewsDetail6162.cfm?Id=129323
If you have any questions about the Dakotas, I would be more than happy to answer them for you, just PM me.

 

[elfmonkey]

If you go to one of these residencies, I can almost guarantee you a job right away. Many small towns are signing doctors while in residency to start upon completion.
http://www.keloland.com/NewsDetail6162.cfm?Id=129323
If you have any questions about the Dakotas, I would be more than happy to answer them for you, just PM me.

Wow, thank you .
Y`all have been really helpful . Another reason why I love Family medicine .

 

[AlmostJesus]

Wow, thank you .
Y`all have been really helpful . Another reason why I love Family medicine .

I think rural practice, especially in places like the Dakotas, Wyoming, etc has an unwarranted bad reputation, likely due to people simply not knowing what the realities are of living in these areas. Thus, when someone is interested in rural practice, you do not want them to get away.

Personally, being from a small town and also having the background as a paramedic, my aspirations are leaning more towards emergency medicine as my specialty. That being said, I would love to return to SD and use my training to improve emergency care in small towns in the area. Family practice is definitely in consideration though, I do like the idea of seeing patients in the clinic, following inpatients on the floor, and working in the ER all in the same day. It seems like the best of all worlds.

 

[elfmonkey]

I think rural practice, especially in places like the Dakotas, Wyoming, etc has an unwarranted bad reputation, likely due to people simply not knowing what the realities are of living in these areas. Thus, when someone is interested in rural practice, you do not want them to get away.

Personally, being from a small town and also having the background as a paramedic, my aspirations are leaning more towards emergency medicine as my specialty. That being said, I would love to return to SD and use my training to improve emergency care in small towns in the area. Family practice is definitely in consideration though, I do like the idea of seeing patients in the clinic, following inpatients on the floor, and working in the ER all in the same day. It seems like the best of all worlds.

Good luck with your dream .
There`s a french system, I think it`s parallel to their Emergency Medical Response, not sure though, called S.O.S. Médecins . I love it, and I think it can be run by FM in Rural areas. Well-trained operators can stratify and send cases to Emergency departments or to this house-call response. If you don`t have a Cath lab in the area and the closest ER is > 90 minutes, then such a service would save lives, save money and decrease ER visits.