Salary

[jdgmu33]

So what? Did those others who "live on mere dollars a week" put in the sweat and tears that I have? Do they deal with the stress I deal with on a daily basis? No, they don't - they deserve the minimum wage they get. Simple Darwinian concepts, my friend: the excellent excel and the mediocre exist in mediocrity. That's life.......

Stress that you deal with? Stress is living in a shack with wife and kids not knowing where your next meal is going to come from. Worrying about getting sued because you busted someone's tooth intubating isn't exactly grace under fire. It's interesting how people underestimate the value of luck... you should check out MATCH POINT (Woody Allen's latest, great flick)

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[The_Sensei]

i suppose in the same sense that you used darwinism to explain why some people are born into poverty and bill gates is a billionaire through all of his sweat and tears.... where is the biology, mr gas man?

or perhaps in the same sense that you complain about only making 350k for having to work so many hours and yet get on here at midnight and toss around nonsense with doctor wannabes in a pathetic attempt to obviously boost your own ego....

cheers.

Dude,

You are an idiot - I guess Mensa has lowered their standards; that is if you are indeed a member. I am done discussing this with you.

 

[The_Sensei]

Stress that you deal with? Stress is living in a shack with wife and kids not knowing where your next meal is going to come from. Worrying about getting sued because you busted someone's tooth intubating isn't exactly grace under fire. It's interesting how people underestimate the value of luck... you should check out MATCH POINT (Woody Allen's latest, great flick)

Yep...And I'm talking about the stress of taking an ASA 5 patient to the OR while some hack surgeon does an exploratory laparotomy on them at 3 a.m. For the record, nothing I do is luck - it is all skill.

Peace out

 

[deleted87716]

I'd like to remind everyone to please discuss the topic, not each other. Thank you.

 

[halodoctor]

I think it's safe to assume that if your peers think you're a whiner, the homeless in Thailand and India would probably concur.

While I would agree that one of the most precious characteristics to inherit as a physician is the ability to empathize, I highly doubt that anyone would be able to place himself in a position to comment about the homeless of Thailand or India.

What if they will never face the pressures that we place on our citizens?

What if we will never know the suffering of being homeless in those countries?

The middle ground is probably safest in this argument as swaying too far to any side seems to be the doomed path. Who likes whiners? Who can deny the stress of medical education?

If you never ran into a medical student whiner, then you were seriously sheltered, which is also true if you did not feel serious pressure from your life as a medical student.

 

[halodoctor]

So what? Did those others who "live on mere dollars a week" put in the sweat and tears that I have? Do they deal with the stress I deal with on a daily basis? No, they don't - they deserve the minimum wage they get. Simple Darwinian concepts, my friend: the excellent excel and the mediocre exist in mediocrity. That's life.......

negative on that one... i was rotating through a hospital in connecticut where we had a chance to drive to newport, ri (for those not in the know, newport, ri is an amazing little place to vacation with tons of cool mansions to check out and other neat things to do) and we couldn't help but notice all the amazing houses along the water with yachts docked...

now, taking that into consideration, all anyone has to do in that part of the country to become successful is be born...

take that to the other extreme and take a snapshot of the southside of chicago, where you have about 5-10 GSWs coming into the er daily from a 10 mile radius and all someone has to do to fail there is be born...

yeah you worked hard, but don't say that others don't. affirmative action all the way! (to qualify this, i always put white in my applications)

 

[cooldreams]

Dude,

You are an idiot - I guess Mensa has lowered their standards; that is if you are indeed a member. I am done discussing this with you.

yes please, attack me personally. ignore the fact that you are wrong, and attempt to say that my argument is wrong by proxy of me being an "idiot". i would say it takes one to know one, hehe, but you dont know me at all.

 

[cooldreams]

and yes, i am infact in mensa, i qualified by having a superior level even for mensa entrance. i scored in the top .99% IQ range, mensa only requires top 2%.

 

[deleted87716]

i would say it takes one to know one, hehe, but you dont know me at all.

C'mon, guys...enough already. Pissing contests have no place in this forum, and I've already warned you once. Stick to the subject, not each other.

 

[Miami_med]

negative on that one... i was rotating through a hospital in connecticut where we had a chance to drive to newport, ri (for those not in the know, newport, ri is an amazing little place to vacation with tons of cool mansions to check out and other neat things to do) and we couldn't help but notice all the amazing houses along the water with yachts docked...

now, taking that into consideration, all anyone has to do in that part of the country to become successful is be born...

take that to the other extreme and take a snapshot of the southside of chicago, where you have about 5-10 GSWs coming into the er daily from a 10 mile radius and all someone has to do to fail there is be born...

yeah you worked hard, but don't say that others don't. affirmative action all the way! (to qualify this, i always put white in my applications)

I actually knew a guy personally whose father had done quite well for himself being born in that very area. Plus, anyone watch the Bernie Mac Show ?

 

[Miami_med]

and yes, i am infact in mensa, i qualified by having a superior level even for mensa entrance. i scored in the top .99% IQ range, mensa only requires top 2%.

I'm not sure I'd make the IQ range for mensa, though they did once threaten to induct me on the sheer size of my head. Something like, he seems like an idiot, but with a head that size, he must harbor some sort of hidden brilliance.

 

[Jack Daniel]

While I would agree that one of the most precious characteristics to inherit as a physician is the ability to empathize, I highly doubt that anyone would be able to place himself in a position to comment about the homeless of Thailand or India.

What if they will never face the pressures that we place on our citizens?

What if we will never know the suffering of being homeless in those countries?

The middle ground is probably safest in this argument as swaying too far to any side seems to be the doomed path. Who likes whiners? Who can deny the stress of medical education?

If you never ran into a medical student whiner, then you were seriously sheltered, which is also true if you did not feel serious pressure from your life as a medical student.

This is a post I can agree with. I think your apparent ability to see both sides and make a tactful post will serve you well.

 

[halodoctor]

I have to agree with iatros here. I'm sure all 3 of these important factors are impacting this doc's income. Remember that coding a 99213 vs a 99214 is a huge difference in pay.

Example: I live in NYC, my FP works 55-60 hrs/week and earns about $200k/yr. Go figure.

i'm sure many of us have come accross the salary information provided on the following website:

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

this states that fp's coming out make like 160, then after 3 years it's like 195, and the max reported was like 240. i have the following two questions regarding this list.

1) did docs with their own business participate in this survey or is it limited to those with salaried position?

2) one of the doctors i worked with during my family rotation used a 30K electronic medical record to keep track of all her patients. it was especially convenient because it allowed her to code at higher levels by marking in the appropriate fields. how much could this help in raising earnings?

for those following, i'm having the toughest time choosing my future and part of it is the financial burden i have incurred in school combined with the 4 kids i want to raise in one of the most expensive parts of california.

thanks for helping in advance.

 

[deleted87716]

did docs with their own business participate in this survey or is it limited to those with salaried position?

That information isn't provided on the site, as far as I can tell.

one of the doctors i worked with during my family rotation used a 30K electronic medical record to keep track of all her patients. it was especially convenient because it allowed her to code at higher levels by marking in the appropriate fields. how much could this help in raising earnings?

That depends on how poorly she was coding before she implemented an electronic medical record. The majority of physicians are not coding properly, so an EMR would likely help them out. Those of us who have already learned how to code correctly probably wouldn't benefit as much, however.

 

[deleted87716]

Typically, an EMR just helps with E&M code selection. The program counts "bullets" in your documentation according to the E&M guidelines, and suggests an appropriate code based on the level of service that you've documented. In order to maximize reimbursement, you'll still need to understand how to use modifiers, Medicare-specific codes, time-based coding, etc.

 

[mfd]

$160,000 is likely high for an FP coming out of residency. Residents from my graduating class (2004) started with salaries in the 125-130 range, significantly lower if they started at a public/community health clinic. My program was in the south but residents took jobs in several place around the country and the salary range seemed fairly constant. It goes up after a couple of years in private practice, but not necessarily much if you hire on in a salaried position.
I think the big issue once you're out in practice is that as an FP you make quite a bit less than the specialties and it can be bothersome. I thought $100,000 was more money than I'd ever need when I was a med student, but now that I have a house, kids, and an outstanding med school loan balance it is really not that much money.
Especially in comparison to specialties like anesthesia and emergency med, who work fewer hours and get paid significantly more, the pay in family med can be depressing. If I had it to do over I would not have done family med, although the money is only one component of why I say that. Family med is losing ground on a number of fronts I think, and really needs an overhaul if it is going to survive, although that discussion is probably better off in a different thread.

 

[iatrosB]

$160,000 is likely high for an FP coming out of residency. Residents from my graduating class (2004) started with salaries in the 125-130 range, significantly lower if they started at a public/community health clinic. My program was in the south but residents took jobs in several place around the country and the salary range seemed fairly constant. It goes up after a couple of years in private practice, but not necessarily much if you hire on in a salaried position.
I think the big issue once you're out in practice is that as an FP you make quite a bit less than the specialties and it can be bothersome. I thought $100,000 was more money than I'd ever need when I was a med student, but now that I have a house, kids, and an outstanding med school loan balance it is really not that much money.
Especially in comparison to specialties like anesthesia and emergency med, who work fewer hours and get paid significantly more, the pay in family med can be depressing. If I had it to do over I would not have done family med, although the money is only one component of why I say that. Family med is losing ground on a number of fronts I think, and really needs an overhaul if it is going to survive, although that discussion is probably better off in a different thread.

 

[deleted87716]

It goes up after a couple of years in private practice, but not necessarily much if you hire on in a salaried position.

That's typically the nature of a salaried job. Generally speaking, salaries are for people who are risk-averse, and don't want to work very hard. If you're in private practice, you assume greater risk. With risks, come rewards. One of those rewards is much higher income potential. Nobody should expect to have a big bag of money dropped in their lap. You're going to have to earn it.

I think the big issue once you're out in practice is that as an FP you make quite a bit less than the specialties and it can be bothersome.

It doesn't bother me one bit. I have lots of friends who are specialists, and they all work a lot harder than I do, take way more call, and generally do things that I wouldn't want to do. Plus, it's a lot cheaper to go fishing on your friend's boat than to pay the upkeep on your own.

 

[Frijolero]

$160,000 is likely high for an FP coming out of residency. Residents from my graduating class (2004) started with salaries in the 125-130 range, significantly lower if they started at a public/community health clinic. My program was in the south but residents took jobs in several place around the country and the salary range seemed fairly constant. It goes up after a couple of years in private practice, but not necessarily much if you hire on in a salaried position.
I think the big issue once you're out in practice is that as an FP you make quite a bit less than the specialties and it can be bothersome. I thought $100,000 was more money than I'd ever need when I was a med student, but now that I have a house, kids, and an outstanding med school loan balance it is really not that much money.
Especially in comparison to specialties like anesthesia and emergency med, who work fewer hours and get paid significantly more, the pay in family med can be depressing. If I had it to do over I would not have done family med, although the money is only one component of why I say that. Family med is losing ground on a number of fronts I think, and really needs an overhaul if it is going to survive, although that discussion is probably better off in a different thread.

Care to elaborate on the last few sentences? I'm thinking family is a good fit but am concerned about the future of the specialty and encroachment by NPs. I know the concern about mid-levels is not FM specific but I'm interested to hear your take.

 

[sophiejane]

Plus, it's a lot cheaper to go fishing on your friend's boat than to pay the upkeep on your own.

This is so true. Now I understand kids cost money, and houses, etc...but I also think people get themselves into the hole because they feel if they are a doctor, they somehow deserve the pool and the boat and the vacation home.
While those things are great, if you can afford them, chances are, you are paying more for them than the hours of enjoyment you get out of them. Does that make sense? It goes back to the old axiom that you can have time or you can have money, but you can rarely have both. Unless you win the lotto.

I guess to each his own. I'd rather live a bit more simply and take really great vacations than pay taxes and upkeep on a lake house that I can only get to a handful of times a year.

I also think if you find yourselves envious of specialists' salaries and if the grass really does look greener in other fields, you probably didn't make a wise choice with family medicine. I know more happy FPs than unhappy ones. Though I'm sure the unhappy ones are out there...

 

[McDoctor]

That's typically the nature of a salaried job. Generally speaking, salaries are for people who are risk-averse, and don't want to work very hard.

That's a bit harsh. Some people just don't want to be businessmen. They want to take care of the person in front of them, without the distraction of considering whether or not their insurance plan is capitated or fee for service factoring in to determining whether or not they need a follow up appointment.

I'd say salaried positions are for people who don't want to deal with the business aspects of medicine, or perhaps correctly recognize they are poorly equipped to run a business fresh out of residency. It says nothing about ones work ethic, however.

 

[Static Line]

That's a bit harsh. Some people just don't want to be businessmen. They want to take care of the person in front of them, without the distraction of considering whether or not their insurance plan is capitated or fee for service factoring in to determining whether or not they need a follow up appointment.

I'd say salaried positions are for people who don't want to deal with the business aspects of medicine, or perhaps correctly recognize they are poorly equipped to run a business fresh out of residency. It says nothing about ones work ethic, however.

But it is the Truth. The business world is not a nice place for a weak minded business person. All he is saying is that with risk comes reward or for some, punishment. Private practice is not only a medical clinic but a business. In private business, if you're any good, then the more you work the more you make. In a salaried position the more you work the more the owner makes. In a salaried position you work the hours they tell you to work for no more pay if you work 50 hours or 80 hours. That's the price you pay for security. As for me and my house--I'll be a risk taker.

 

[McDoctor]

But it is the Truth. The business world is not a nice place for a weak minded business person. All he is saying is that with risk comes reward or for some, punishment. Private practice is not only a medical clinic but a business. In private business, if you're any good, then the more you work the more you make. In a salaried position the more you work the more the owner makes. In a salaried position you work the hours they tell you to work for no more pay if you work 50 hours or 80 hours. That's the price you pay for security. As for me and my house--I'll be a risk taker.

What is "the truth"? That people in salaried positions are there because they don't want to work very hard? There are alot of physicians in academia who would take issue with that assertion.

There is also a difference between being risk averse and recognizing that it is more prudent to learn the in's and out's of running a practice with the safety net of a guaranteed salary underneath you. I've also never heard of any salaried position that didn't have some productivity bonuses in the agreement.

Kent said people who take salary jobs are risk adverse or don't want to work hard. I suggested instead that they are perhaps just more pensive about entering the business world and perhaps more interested in academia than business. Probably, I was just being critical for the sake of being critical on a slow day on the SDN forums. But nothing you said backs up his assertion.

I realize healthcare is a business. That's why we're not just doctors, We are all McDoctors. Personally, I'm content to work the register and man the fries for a while before I want the headaches of management. There are alot of reasons for this, but none have much to do with my work ethic or risk aversion. (Maybe a little bit with the latter, but having a baby due in August radically changes the risk equation.)

 

[deleted87716]

Kent said people who take salary jobs are risk adverse or don't want to work hard.

Actually, I said "and"...but "or" is more along the lines of what I was thinking.

 

[George85]

Here's the real world. I have been talking directly to several practices as I am now starting to look for a job. This morning's conversation, which is quite typical so far - $140 starting, 4 weeks vacation, 25-30 patients a day. As for those that feel that expecting over $160 a year represents greed - I don't think I'm unreasonable for expecting to earn more than a CRNA who has 2 years post-grad against my 7 years post-grad. And, I don't expect to earn half of what a new anesthesia grad makes after just an extra year's residency.

Compared against the pay for other grads, the pay for FP's is insulting - believe me, they're making much more, and getting better terms, such as more time off. As for seeing 25-30 patients a day - how can that translate into quality care?

So, if you think that the primary care "shortage" translates into better pay and conditions - think again. In fact, if you're considering primary care - think again.

 

[deleted87716]

I am now starting to look for a job. This morning's conversation, which is quite typical so far - $140 starting...As for those that feel that expecting over $160 a year represents greed - I don't think I'm unreasonable for expecting to earn more than a CRNA who has 2 years post-grad against my 7 years post-grad.

So, keep looking. Only you know how much you're worth. It helps to be realistic, of course.

As an aside, I don't understand why you insist on continually comparing yourself to CRNAs. I can't think of many jobs in medicine that are further removed from primary care than anesthesia. If it's just a money thing, get over it. Lots of people make more money than primary care physicians. Surely, this isn't news.

Speaking of anesthesia, this is what one of the anesthesia forum regulars had to say about his chosen specialty in a recent thread entitled, "Unhappiness in Anesthesia." Keep in mind that this was intended as a positive statement about the field:

giving anesthesia is tiring. yes, it's tiring. it takes a special person to sit there for hours... you know the saying, hours of boredom - moments of terror. most people not in the field do not realize that. when i have rotators with me (med students and residents from other fields), they are inevitably yawning by early afternoon and/or asking if they can be excused. i see it all the time.

a common analogy about giving anesthesia is that it's like flying a plane. i actually think it's more like driving an 18-wheeler on a long haul. when's the last time you went on a long drive? (i mean a several hour car trip.) once you pack the car, gas up, and navigate to the highway, you are then sitting there for hours. but, you have to pay attention. you can't let your eyes of the road, even if you're on cruise control. you never know when someone's going to swerve in front of you, or whether or not a big thunderstorm is going to kick up.

now, imagine doing that every day of the week for 8+ hours.

my acid test for future wanna-be anesthesiologists is just that: imagine going on a long car ride every day. if you can't stand sitting in a car for long stretches, this isn't the field for you. think about that before you choose anesthesia. that's what this profession is like.

So, yeah...they might earn more money than we do. But, you know what? You couldn't pay me enough to do their job. To each his/her own. It's highly unlikely that anyone who is well-suited for primary care would be happy in anesthesia, or vice versa. If you're happy in your job, the money matters a lot less than if you're not.

 

[Static Line]

So, keep looking. Only you know how much you're worth. It helps to be realistic, of course.

As an aside, I don't understand why you insist on continually comparing yourself to CRNAs. I can't think of many jobs in medicine that are further removed from primary care than anesthesia. If it's just a money thing, get over it. Lots of people make more money than primary care physicians. Surely, this isn't news.

Speaking of anesthesia, this is what one of the anesthesia forum regulars had to say about his chosen specialty in a recent thread entitled, "Unhappiness in Anesthesia." Keep in mind that this was intended as a positive statement about the field:


So, yeah...they might earn more money than we do. But, you know what? You couldn't pay me enough to do their job. To each his/her own. It's highly unlikely that anyone who is well-suited for primary care would be happy in anesthesia, or vice versa. If you're happy in your job, the money matters a lot less than if you're not.

I know I would be happiest in FM. I am not worried about what specialists make versus FM rather I am worried about the 250k at the end of the process that I need to repay and if FM salary down the road is.... I know--same old song and dance.

 

[sophiejane]

For those of you worried about paying back your loans, just remember that you don't have to pay them off in 5 years, or even 10 years. Of course, that's the ideal, but there is no reason why you couldn't comfortably make the loan payments on $150-200K debt with a salary of $140-160K. I just set up my repayment program, and although I will likely pay more to get it out of the way sooner, here's what I'm looking at:

For $148K debt:

$330/month for first 240 months, $660/month for last 120 months. This is a graduated repayment plan for 30 years. Again, I can afford to pay quite a bit more than this even with my resident's salary, because my husband also contributes to our earnings.

If you can't handle that with a salary of $140K, you either have 6 kids in private school, or need financial counseling.

Most people will have one or two kids by the time they finish medical school or residency, but most people will also have a working spouse. If you aren't married, no problem. If you are and have kids and your spouse chooses not to work, well, that's a decision that has a price.

Just trying to shed some light on this--I think a lot of people freak out unneccessarily about medical school debt. So...do what you love. The money will follow.

 

[deleted87716]

I know I would be happiest in FM. I am not worried about what specialists make versus FM rather I am worried about the 250k at the end of the process that I need to repay and if FM salary down the road is.... I know--same old song and dance.

Nearly half of the folks going into FM have more than $175,000 in educational debt ( http://www.aafp.org/online/en/home/aboutus/specialty/facts/26.html ). I've never met anyone who had trouble paying off their loans.

 

[iatrosB]

Thanks for the light at the end of the tunnel guys (and gal). It really does make a difference. People enter medical school with the idea of FM, then they see loans and interest accumulate like mad and reimbursements decline and rethink it. It's nice to be re-assured that it is not a big of an issue as it seems (certainly something to be mindful of however).

 

[sophiejane]

My other wee bit of advice: Don't always take the maximum amount they offer you unless you absolutely need it. It sucks to live the bohemian life now, but later, you'll be glad you did.

 

[Static Line]

Nearly half of the folks going into FM have more than $175,000 in educational debt ( http://www.aafp.org/online/en/home/aboutus/specialty/facts/26.html ). I've never met anyone who had trouble paying off their loans.

I certainly appreciate th bright voices out there. With so much doom-and-gloom talk about primary care salary it is easy to get caught up in it. The fear of the unknown is a strong voice.

 

[Faebinder]

Well taking a contract for a year or 2 is not a bad idea till you get a better offer. You can always supplement it with urgent care hours I guess.

 

[racerx]

I don't know much, but I feel that I could pay student loans, still have a comfortable day-to-day life, and save for retirement with salaries such as:

XXXXXXX, Illinois - XXXXXXX Clinic is a multi-specialty group of 90 physicians that is recruiting for 3 family physician's, one in XXXXXXXX and the others in nearby communities. Call: 1/8. No OB. Very busy practices. The clinic is looking for highly motivated family physician's who want to work hard and be rewarded for it. Starting salary could be $170K, with lucrative bonus potential. Earnings well above national and regional averages. Metro population of 150,000. Home of the University of XX, with comfortable college town lifestyle and many cultural amenities. 2½ hours south of Chicago.


Or,

Starting salary of $180,000 Start/Stay bonus and/or 100% Student Loan Repayment of up to $150,000 A new, fully staffed and equipped clinic in friendly, scenic community In-patients average 2 per day and 15 to 20 outpatients per day Anticipated number of deliveries for a new physician would be 15-20 per year General call is every 6th night and can be done from home Weekend ER coverage is 1:5 or 1:6 Coverage is in addition to salary and paid directly to the provider by the hospital.


and then,​

Call is: 1:13 for General and 1:6 for Obstetrics (OB optional).
No emergency room call.
4 day work week.
2 year guaranteed salary of $165,000 plus production incentives and benefits!
Highly respected, physician led medical center with 40 multi-specialty physician clinic: w/ visiting specialists and medflights from Mayo Clinic!


Just a representative slice of ads found on a quick search. Of course the small print isn't presented in the ads. Also, the pay seems to be very regional.

 

[mfd]

To me the 'do what you love and forget the rest' aspect of some of these posts seems a bit idealistic. If you can maintain that, that's wonderful. But the pressures in primary care are pretty significant at the moment in my opinion. Money is just one, but for example: $130,000 translates to about a take home of $6000/month after taxes in my experience. If you live in a moderately expensive area (major cities, the west coast, etc) housing prices are often quite steep. In my area median home prices are about $420,000 (our home was just about that) and coming out of residency we had no money to put down so our monthly payments are in the $3800 range, add $500/month loan debt, child care, etc and the money goes pretty fast. It really isn't a matter of paying for a villa in the south France, just living a comfortable life. I don't know that this is excessive greed at work here.
As for the 'lifestyle' trade off in FM--there is a huge variation in types of practice, but most I know work quite hard and have long hours. Seeing 30 complex patients a day, plus doing all the follow-up, phone calls etc translates to long hours. And if you cover a hospital, the call is another layer of work that can be pretty taxing. If this isn't the experience of most people posting here that's great, but I don't know that it's reflective of the specialty as a whole.
And this next comment I think I will try to post on another forum, but FM is really in the midst of an identity crisis. I don't think this is just me talking, it's all over the AAFP newsletters and a driving force behind "the future of FM" that they have been doing. It's very difficult now in a lot of areas to get privileges for procedures that FPs used to do a lot (colonoscopies, c/s, assisted vaginal deliveries, even if you're fellowship trained).

 

[Faebinder]

To me the 'do what you love and forget the rest' aspect of some of these posts seems a bit idealistic. If you can maintain that, that's wonderful. But the pressures in primary care are pretty significant at the moment in my opinion. Money is just one, but for example: $130,000 translates to about a take home of $6000/month after taxes in my experience. If you live in a moderately expensive area (major cities, the west coast, etc) housing prices are often quite steep. In my area median home prices are about $420,000 (our home was just about that) and coming out of residency we had no money to put down so our monthly payments are in the $3800 range, add $500/month loan debt, child care, etc and the money goes pretty fast. It really isn't a matter of paying for a villa in the south France, just living a comfortable life. I don't know that this is excessive greed at work here.
As for the 'lifestyle' trade off in FM--there is a huge variation in types of practice, but most I know work quite hard and have long hours. Seeing 30 complex patients a day, plus doing all the follow-up, phone calls etc translates to long hours. And if you cover a hospital, the call is another layer of work that can be pretty taxing. If this isn't the experience of most people posting here that's great, but I don't know that it's reflective of the specialty as a whole.
And this next comment I think I will try to post on another forum, but FM is really in the midst of an identity crisis. I don't think this is just me talking, it's all over the AAFP newsletters and a driving force behind "the future of FM" that they have been doing. It's very difficult now in a lot of areas to get privileges for procedures that FPs used to do a lot (colonoscopies, c/s, assisted vaginal deliveries, even if you're fellowship trained).

With the risk of getting off topic, the solution is rather simple but AAFP just doesn't see it. You need to prove that your effectiveness is as good as the other specialties when it comes to doing these procedures. That's the only way to slap them it in their face.

So how do you do that? CLINICAL RESEARCH! You know, studies that actually see differences in outcome of PROCEDURES and THERAPIES.

Yet you see FM laugh at research. I did a Fisher's exact test on publication effect on getting accepted into FM and the answer was you are less likely to be accepted with publications!? Kinda messed up no?? This is causing us to lose the science in family medicine. On the other hand I keep hoping they are slowly correcting this problem because I see more research requirements now in FM.

 

[deleted87716]

FM is really in the midst of an identity crisis. I don't think this is just me talking, it's all over the AAFP newsletters and a driving force behind "the future of FM" that they have been doing.

It's not really an "identity crisis." It's just change. I'm always a bit bewildered when people act like any kind of change is a bad thing. Change is good! If you don't continuously examine what you're doing and consider ways to improve, you're stagnating. It's always better to take a proactive approach to change (which the FFM project does) than a reactive one. Nothing stays the same in medicine for long.

This book really should be required reading in med school: Who Moved My Cheese.

 

[sophiejane]

Seeing 30 complex patients a day, plus doing all the follow-up, phone calls etc translates to long hours. And if you cover a hospital, the call is another layer of work that can be pretty taxing. If this isn't the experience of most people posting here that's great, but I don't know that it's reflective of the specialty as a whole.

You see 30 complex patients a day? Every day?

Now, I can understand a few complex patients mixed in with the usual med refills (which I realize can often be more complicated than they seem), well child, well-woman, sports physicals, back pain, and URIs.

Maybe that's just been my admittedly limited experience, but I've spent time in a number of FM clinics on rotations over the past few years, and I've never seen a clinic yet where the docs see 30 complex patients every day.

I guess it depends on how you define "complex". Yes, the guy with back pain also has hypertension (which is well controlled) and just started Lipitor, or whatever. I guess I don't really call that complex though. Complex to me would be something like DM, on dialysis, with HTN, hyperlipidemia, depression, and migraines. 30 of those a day would make you a little bitter about the pay, I'll give you that.

 

[deleted87716]

I think it's important to remember that there's no news like bad news. The fact that people tend to talk about the negative aspects of family medicine more than they do the positive aspects should in no way be considered as representative of the field as a whole. That's true of any specialty. SDN in particular seems to be a magnet for naysayers and doomsday prognosticators, so you need to consider that, as well.

Most of us are doing just fine.

 

[George85]

Imagine you're an airline pilot. You have spend much time and money getting your FAA license. Then you find that the stewards that work in business class have the legal authority to fly as well - what's more they only spent a fraction of the time and money getting their license. They don't get their authority through the FAA, but various states have granted the Business Class Stewards Association the abilty to fly under the loose supervision of an FAA pilot. In fact, several states even allow then to fly alone. To add insult to injury these Steward Pilots can make as much as you and have smaller loans to service. But of course, you smile and say "good luck to them". Like hell you would.

My often quoted comparison to CRNA's actually has more to do with attitude than money. We can see mid-level providers practicing medicine without a medical degree, and that's a threat to us all and society in general. That's because it demonstrates an underlying principle of increasing rights and autonomy to mid-level providers. This while the RRC requires less of FM grads - no need for flex sig, now they're removing the ICU requirement. So, as their rights and autonomy increases, our's decreases. Eventually, we will meet in the middle - and guess who will win out on pure cost.

It also shows the difference between a true and a perceived shortage. We hear about shortages of nurses and FP's. This isn't reflected in salaries because there are various ways for hospitals and insurance companies to get round the issue - such as LPN's, PCT's and of course mid-level providers. But, in anesthesia there is a true shortage and the only way around it is to use CRNA's. So, we see their salaries are often higher than FP's.

And, perhaps the most important issue is the overall attitude of medicine as a whole to primary care. We are being forced into a high volume triage system, dealing with only the most basic of complaints. Primary care will become a mid-level provider service in the US. There is no way to stop this happening because American medicine is not primary care driven as it is in most other countries. Most people in primary care already recognise this. In fact, most med school grads already know this - that's why only about 80% of residency slots are filled each year. And, if it wasn't for IMG's then it would be about 50%.

And I'm sorry if this is doom and gloom, but before you can fix something you need to recognise it's broke.

 

[mfd]

I would agree that a site like this one is ripe for someone surfing the internet in the middle of the night, annoyed with their job and looking for free therapy. I am definitely in that category, so my apologies.
However, I also logged on because I feel like I have experience to contribute to this conversation (negative though it is). I really didn't have much guidance as a med student (no family or older friends in medicine) so was perhaps not as aware of the realities. I did my FM rotation at an Indian Health Services site on a reservation, which was something of a FM nivana and much different from my current pratice. FM certainly does have a lot of potential to be a rich and rewarding profession, but it is pretty embattled at the moment. There was a good comment in this week's Lancet about primary care in the US, basically saying major structural changes need to occur for the system to continue. The huge salary discrepancies between primary care and the specialities is an important issue and will continue to make medicine in america a largely specialty-driven machine unless something changes

 

[deleted87716]

And, perhaps the most important issue is the overall attitude of medicine as a whole to primary care. We are being forced into a high volume triage system, dealing with only the most basic of complaints.

I take it you're speaking from your own experience with your own practice.

That certainly doesn't describe mine.

 

[mfd]

I would agree that a site like this one is ripe for someone surfing the internet in the middle of the night, annoyed with their job and looking for free therapy. I am definitely in that category, so my apologies.
However, I also logged on because I feel like I have experience to contribute to this conversation (negative though it is). I really didn't have much guidance as a med student (no family or older friends in medicine) so was perhaps not as aware of the realities. I did my FM rotation at an Indian Health Services site on a reservation, which was something of a FM nivana and much different from my current pratice. FM certainly does have a lot of potential to be a rich and rewarding profession, but it is pretty embattled at the moment. There was a good comment in this week's Lancet about primary care in the US, basically saying major structural changes need to occur for the system to continue. The huge salary discrepancies between primary care and the specialities is an important issue and will continue to make medicine in america a largely specialty-driven machine unless something changes

 

[deleted87716]

IFM certainly does have a lot of potential to be a rich and rewarding profession, but it is pretty embattled at the moment.

I'm not really sure what you mean by "embattled." If you're talking about reimbursement, specialists have a lot more to lose than we do.

There was a good comment in this week's Lancet about primary care in the US, basically saying major structural changes need to occur for the system to continue.

It might surprise you, but this has very little effect on the day-to-day life of a primary care physician.

The huge salary discrepancies between primary care and the specialities is an important issue and will continue to make medicine in america a largely specialty-driven machine unless something changes

I think you can pretty much count on the income gap narrowing, but it's more likely to be the result of cuts in specialty reimbursement than increases for primary care.

 

[cooldreams]

Example: I live in NYC, my FP works 55-60 hrs/week and earns about $200k/yr. Go figure.

thats tough man. even more so since that is a high cost of living area. man, if i were working 60 hrs a week, i would be seeing about 170k plus some decent bonus figures and im just an engineer but i get paid per hour.

i did a salaried job when i just got out of college and worked those kinds of hours. all the while, i thought to myself, never again will i accept a salaried position...

 

[bkpa2med]

thats tough man. even more so since that is a high cost of living area. man, if i were working 60 hrs a week, i would be seeing about 170k plus some decent bonus figures and im just an engineer but i get paid per hour.

i did a salaried job when i just got out of college and worked those kinds of hours. all the while, i thought to myself, never again will i accept a salaried position...

I totally agree with you, salary sucks. But she works for herself. Thing is, she is quite happy with her choice in FP and her hours and patients. Go Figure! I've been around her practice alot and can say that I wouldn't mind a practice like hers. She doesn't do inpatient, has an IM partner, great office with a waterfall and all! lol

 

[ajce9]

This site does have some negative posts. but there are some good points as well.

I know some people will go to their grave defending family medicine. You know like the saying "win or die trying".

But if we look at things from an objective point of view and take emotion out of it we can get a better idea of the future of FM.

The future of FM project was a scramble to get something out there to help find a way for future doctors and renew interest in FM. It is like a last draw effort to save this specialty.

FM is a great specialty, and it is in real trouble but not as much as people feel.

specialty salaries are going down and General medicine (I know we don't like to be called that but that is how insurance companies view us as) is stabalizing or even going up a little. (but not much)

But when you are the lowest paid physician that does not mean much.

if you make 160 a year, after taxes you are left with anywhere from 8600 to 9300 per month.

If you live where the average home is 400K and had to take out some big loans to go to school you will have a hard time.

3000 K home
1500 student loan
400 car
1500 general
Kids
retirement savings. (remember on average doctors have less time to save and therefore the money does not compound as much, we hoped that the higher salary would compensate for that but it does not in FM).

So, now you have someone who works 50 hrs per week as a doctor and his quality of life (home, cars, travel, retirement) is not much better than someone who went makes 100K or 90 K and is not in debt for student loans and did not have to go to school for as long.

This brings up the question: What is the point then?

I know we don't go to medical school just for money but it is an important factor. We are giving up a major portion of our youth in pursuit of medicine.

So far doctors, even fms have a good job security. Most likely more than any other career.

As much as someone may love to do FM. If they have a huge debt and live in an area where this could pose a problem, they may have to reconsider their specialty choice.

One other thing, there are lots of FMs that say their practice is not very complicated and they are doing great. that may be true now, but as medicine changes I believe you will find that your practice will become more complicated and due to need you will be forced to see more complicated patients in a day. This will decrease your quality of life and at the same time you will either get paid less per patient or due to the nature of the patient will not be able to see as many and make less. This is already taking place.

It may not be at your front door yet, but it will be. You may say, I can choose the kind of practice I want, but I don't buy that. The reality of it is that the market will choose you and your choices will decrease.

In business you have to adjust to the market or create new markets. In medicine there are not many new markets.

 

[deleted87716]

As much as someone may love to do FM. If they have a huge debt and live in an area where this could pose a problem, they may have to reconsider their specialty choice.

As I've said many times, I make it a point never to try to tell somebody else how much money it should take to make them happy. That would be incredibly presumptuous.

One other thing, there are lots of FMs that say their practice is not very complicated and they are doing great. that may be true now, but as medicine changes I believe you will find that your practice will become more complicated and due to need you will be forced to see more complicated patients in a day.

I see complicated patients all day long. They're my bread and butter, and I consider the challenges that they pose to be the "fun" part of my job. If I had to do nothing but sore throats and physicals all day long, I think I'd shoot myself.

You may say, I can choose the kind of practice I want, but I don't buy that. The reality of it is that the market will choose you and your choices will decrease.

I don't believe that. Family medicine offers more flexibility in choosing how, where, and when you work than practically any other field. If people don't choose to take advantage of that, and instead "settle" for something less than what they want, that's their problem. If anyone feels trapped, it's because they've built the cage themselves.

In business you have to adjust to the market or create new markets. In medicine there are not many new markets.

Don't be too sure of that, either. I'm heavily involved in the business aspects of my group, and we're exploring new revenue opportunities on a regular basis. If you're entrenched in "the old ways," or naive to the opportunities presented by changes in healthcare, I can certainly imagine that it could be frustrating. It doesn't have to be that way, however.

 

[McDoctor]

Imagine you're an airline pilot. You have spend much time and money getting your FAA license. Then you find that the stewards that work in business class have the legal authority to fly as well - what's more they only spent a fraction of the time and money getting their license. They don't get their authority through the FAA, but various states have granted the Business Class Stewards Association the abilty to fly under the loose supervision of an FAA pilot. In fact, several states even allow then to fly alone. To add insult to injury these Steward Pilots can make as much as you and have smaller loans to service. But of course, you smile and say "good luck to them". Like hell you would.

My often quoted comparison to CRNA's actually has more to do with attitude than money. We can see mid-level providers practicing medicine without a medical degree, and that's a threat to us all and society in general. That's because it demonstrates an underlying principle of increasing rights and autonomy to mid-level providers. This while the RRC requires less of FM grads - no need for flex sig, now they're removing the ICU requirement. So, as their rights and autonomy increases, our's decreases. Eventually, we will meet in the middle - and guess who will win out on pure cost.

It also shows the difference between a true and a perceived shortage. We hear about shortages of nurses and FP's. This isn't reflected in salaries because there are various ways for hospitals and insurance companies to get round the issue - such as LPN's, PCT's and of course mid-level providers. But, in anesthesia there is a true shortage and the only way around it is to use CRNA's. So, we see their salaries are often higher than FP's.

And, perhaps the most important issue is the overall attitude of medicine as a whole to primary care. We are being forced into a high volume triage system, dealing with only the most basic of complaints. Primary care will become a mid-level provider service in the US. There is no way to stop this happening because American medicine is not primary care driven as it is in most other countries. Most people in primary care already recognise this. In fact, most med school grads already know this - that's why only about 80% of residency slots are filled each year. And, if it wasn't for IMG's then it would be about 50%.

And I'm sorry if this is doom and gloom, but before you can fix something you need to recognise it's broke.

What are you basing all of this on? Who or what is "forcing us into a high volume triage system"?

First of all, as far as being replaced by mid-levels; as has been pointed out several times in this thread, in the U.S., healthcare is a consumer driven business with patients free to select from whom they recieve their care. This is not a socialist system where people are not free to choose their PCP. If as an MD (or DO), you really feel as though the average person would preferentially seek care from a PA or CRNP instead of you, then there is little I can say to alleviate this irrational fear.

As far as being a high volume triage system, that totally depends on what kind of doctor you want to be. If you want to be the guy who when the patient says "It hurts when I do this...", you say "Then don't do this...", then you certainly can and still make a living. If you want to refer out everything that walks in the door, then be my guest, but recognize that you are actually being overpaid at 120K or so a year for this kind of service.

I'm not aware of any pressures or incentives to refer patients quickly or provide less comprehensive care to patients. This is irregardless of whether you own your own practice or work for a salary (assuming you have a productivity bonus incorporated into the contract). I think you should clarify where this "pressure" is coming from. Patients? Insurance companies? I just don't see it.

 

[McDoctor]

So, now you have someone who works 50 hrs per week as a doctor and his quality of life (home, cars, travel, retirement) is not much better than someone who went makes 100K or 90 K and is not in debt for student loans and did not have to go to school for as long.

This brings up the question: What is the point then?

.

How about the perk of being a well respected and trusted member of the community? When I see patients outside of the workplace, I am greeted by them with a unique sense of respect that is not extended towards, say, their accountant or their car mechanic.