some docs' negative comments about FP

[mamadoc]

I had lunch with a friend today, an IM doc I like a lot. She wrinkled her nose when I said I had really enjoyed working with an FP on my primary care rotation, and questioned why I would want to go for "breadth rather than depth." She said, "You can never know it all - you won't have expertise in any one area."

Part of my friend's objection was that the 3-year FP training doesn't give you enough exposure to the weird zebras of medicine - you aren't as well-versed in the esoteric stuff. She admitted that most of real-world IM practice is pretty much identical to real-world FP practice, but continued to express concern that you just don't learn enough medicine during an FP residency.

Now, to be honest, this was my view of FP too until I spent time with one - I used to describe it as "jack of all trades, master of none." (without knowing anything about it of course, but then when does that stop any of us from forming opinions??!!)

but now I am really psyched about the field - loved the variety, loved the connection with whole families, appreciated the strong emphasis on health promotion. Another thing is that I really enjoyed the outpatient part of my peds rotation but I definitely would NOT want to do peds all day (ugh)... I like the idea of doing a little bit o' everything.

I suppose someone in peds could object to FP on the basis that if I don't like it well enough to do it full-time then I shouldn't do it, period. I don't agree, but I can see that point.

So that's one objection - my view is that FP's body of knowledge, while broad, isn't necessarily lacking in depth and that there isn't nearly as much difference between IM and FP as my friend was implying. I'd like others' comments.

The other negative comment came from my IM preceptor on my primary care rotation - he said that FP docs often "don't get respect" in academic settings, although that was slowly changing, and cautioned me that if I was interested in pursuing academic medicine, I might be wise to prefer IM to FP.

Soooooo what have you all heard and what's your response? In the end I am almost surely going to go FP regardless of these negative comments, 'cause I loved it, but I want to be able to battle that "breadth not depth" remark!

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[DrMom]

There is nothing wrong with deciding to go into family practice (and you're right about general IM not being all that different in the breadth vs. depth arena). As to the academic medicine circles, is that really important to most physicians? And there certainly are academic family practice physicians (every school I know of has a FP department).

Choose your specialty based on what you like & how you'd like to live your life. There are pros and cons to every specialty, you just have to choose the right balance of them for you.

 

[deleted6669]

WHILE IM DOCS PROBABLY MAKE BETTER HOSPITALISTS OR INTENSIVISTS THEY CAN'T DO ANYTHING WITH KIDS, OB, OR MANAGE ANY TYPE OF TRAUMA. THE IM DOCS IN THE ER LOOK LOST AND KEEP LOOKING FOR CHEST PAIN PTS TO WORK UP WHEN THE RACK IS FULL OF KIDS AND BROKEN BONES. IF YOU WANT PRESTIGE GO IM, IF YOU WANT TO BE ABLE TO TREAT THE VAST MAJORITY OF THE PTS YOU EVER SEE, GO FP

 

[PACtoDOC]

Absolutely,

IM qualifies you to find the zebras in the world of horses. And if you are at the top of your class and decide to do FP, you will learn as much as you want to in your residency. All the internists I know are strange people who want to be able to rescite the nine causes for hypokalemia and the treatments for each upon being asked. That doesn't make you a good doctor; it makes you a smart ass! The only reason to go into IM is if you want to subspecialize, or if you hate children, hate OB, love Geriatrics, and love being paid the least of all specialties even when you may be smarter than most of them. Family medicine is the place for people who genuinely care about their patients and their lives, and for people who want the best of all worlds. You can truly do it all as an FP.

 

[Magree]

Hi:

There always seems to be a lot of "back-biting" in medicine people make jokes about surgeons, psychiatrics etc. The old "he/she knows a lot about nothing" vs. "he/she knows nothing about a lot" etc. etc. You really need to do what makes you happy. I have spent a lot of time with rural FPs and have to say that they are absolutely AMAZING. If anything, when you get these "smart asses" to tell the truth they will say they were totally intimidated by what an FP has to know and do.

I think I was most saddened, however, because these truly fabulous FPs believed all the stuff specialists said about them. A lot had "inferiority complexes" about their worth in the world of medicine. Really a shame. I watched them resuscitate in the morning, do caesers at night and handle everything in between - and they had no blood gas machine, no battery of ancillary staff, techs etc. they put in chest tubes, took their own x-rays (and developed them) - did their own casts. I can't say how admiring I am of them. Do they do orthopedics as well as someone who just does that? Probably not - but they were pretty capable just the same.

M-

 

[Apollyon]

20 to 25% of FP residency graduates go to work in ED's - so that shows you how wide the training is. If you want to just work in the ED, and not move up the academic ladder, there it is.

When I did my FP rotation as a student, at the hospital I was at, FP was the only residency program there - so they didn't do the cush "q7" call - they were ALL the residents...from FP, to IM, to Peds, to Ob, to Psych, to Surgery - all were blocks in the program.

 

[im4real]

I don't want to group all IM's in one big 'ole category, but from my husband's experience and me going on interviews with him, I've picked up much of that negativity from IM's saying those EXACT same comments. My husband considered IM and FP when deciding on what residency speciality area he was interested in and we are both so grateful he chose FP. And as with all things, residency is what you make of it. You can learn as much or little as you want to, that's all up to you!! Hey, as my husband says, there is such a variety in FP. You don't spend you're whole day doing wellness checks & sick children, nor do you spend your whole day with geriatrics patients. You get some that and a whole lot more. It is very rewarding... and personal too!

Just my 2c,
Christy

 

[mamadoc]

thanks - these sorts of experiences are exactly the sort of feedback I was looking for. I think my friend started out with a narrow view of FPs and chose not to broaden her perspective, for whatever reason. (I love her but she can be a snob.) I feel fortunate to have seen the terrific potential in FP and certainly don't need to be constrained by others' opinions. I know I'll be able to be expert *enough* about *enough* things to be a really good doctor. And I'll have fun, too!

 

[DrMom]

Originally posted by mamadoc
I love her but she can be a snob.

See, you already knew enough to answer your own question!

 

[Kellishka]

I am not into bashing other specialties; we need to learn to work WITH each other, for heaven's sake. But for anyone like Mamadoc who is considering joining my esteemed speciaty, this is why I chose FP. FP is really an outpatient specialty. While many other fields spend the majority of their training learning inpatient medicine, FP's focus is on perfecting skills in the office setting. As the title implies, we take care of entire families, which affords us the unique ability customize our treatments to the patient as a person. For instance, in my field I can deliver a woman's baby, AND follow through by caring for the child. We focus very much on the psycosocial aspect of health.

Another reason for my choosing FP was the ability to treat all sorts of patients. In one day in the clinic, I can see a newborn, an adolescent, a pregnant woman, a grandfather, and yes- they may all in fact be members of the same family!!! Or, if I chose, I could tailor my practice to any particular interests- for instance, gyn, peds, alternative and complementary medicine, etc.

I also get to perform procedures like Pap smears, circumcisions, suturing, casting, flex sigmoidoscopies, etc.

Finally, for all those who might judge their success by the admiration of their sub-specialist colleagues: I would much rather be known around town as everyone's favorite doctor than for my extensive knowledge on some esoteric subject. But again, I am not everyone. You will find what works for you in the end. My advice, follow your heart and your gut.

1st year Family Practice Resident

 

[pecksmedical]

I personally hold the FP in the highest possible regard.

I have worked in an FP office for almost 9 years and the cases that they see, and can treat! Wow, it amazes me.

"Jack of all trades, master of none"

Yeah, but to be able to just DO all trades, what an accomplishment. Try to get a surgeon to treat a URI, or an orthopedic surgeon to do a pap smear.

Just my two cents worth.

 

[PACtoDOC]

As a PA in FP and a medical student also, I think IM docs are highly overtrained to do what they do. Most of them end up in office settings seeing the same stuff that FP's do but knowing a whole lot more. Why spend three years in a hellacious residency learning how to hunt zebras when you will usually only see horses. FP docs rarely refer to IM anyway because if it is something that bizarre, you will probably find a sub-specialist in that particular bizarre area. And sadly enough, everywhere I have worked, the FP docs make a lot more money because they generally see everyone in the family including the newborn. They often have more time to be entrepreneurs because they have less people in the hospital!! FP is the bomb, but I do feel IM docs are much more qualified to find zebras.

 

[SRR]

Originally posted by Kellishka

Finally, for all those who might judge their success by the admiration of their sub-specialist colleagues: I would much rather be known around town as everyone's favorite doctor than for my extensive knowledge on some esoteric subject. But again, I am not everyone. You will find what works for you in the end. My advice, follow your heart and your gut.

1st year Family Practice Resident [/B]

I agree whole-heartedly with Kellishka. To me the greatest satisfaction comes from the taking care of patients. To earn their respect and trust is more important to me than going into a specialty based on perceived prestige or status.

SRR

 

[scrub monkey]

i have a lot of respect for family practice docs as well.
the nicest and most compassionate docs i've met in med school have been family practice docs.

i was a big family practice fan before too. being able to deliver babies, manage diabetes, do minor surgeries, take care of young folks and old folks, all sounded really neat. that's the way family practice is supposed to be practiced. unfortunately if you want to live in a big city, don't plan on practicing that way. i think you end up just doing outpatient internal med, since nobody wants you to deliver their babies or take care of their kids when they have ob/gyn docs and pediatricians to do that. since i want to live in a city, i think i would just choose for internal med instead, and be better trained for it.

 

[FireAway]

I know lots of FPs I like as people, but there are so many disadvantages to the field I wouldn't even consider it. Problems with FP:

1. Getting ICU privileges is difficult at best, since FPs are not trained in intensive medicine.

2. Only in rural areas do FPs get lots of OB, ER, and lets not even include trauma because that is and always will be handled by surgeons (not ER docs, they play a supporting role only).

3. Malpractice insurance for FPs who want to do OB is incredibly expensive, and most do not offer these services as a result.

4. The field is (unfortunately) disrespected at nearly all allopathic academic centres, and by most docs from other fields out in private practice. No one really trusts their diagnoses.

5. Unlike IM, you can't specialize in cards, GI, etc., so the residency is a dead end. Obviously this is fine if you are 100% sure of what you want to do down the road.

6. The patient population has an overabundance of drug seekers, hypochondriacs, and others who read the media and suddenly have an emergent case of the "BS-disease of the week" (i.e. fibromyalgia, interstital cystitis, chronic fatigue, multiple chemical sensitivity, etc.). Dealing with mentally ill patients can be rewarding, but dealing with patients who are truly mentally ill but have not been diagnosed as such is a nightmare.

If you are more medically inclined, think about an IM residency, even a more cush/less academic one.

 

[deleted6669]

at some of the better fp residencies, the fp dept is unopposed by other residencies and runs the icu, ED, and trauma resuscitations.these residencies also train their staff to perform c-sections and other complex surgical interventions. a few even train their residents to be primary surgeon on appys.
check out the programs at ventura county and contracosta county, both in california for examples of this type of residency.
in IM you are limited to the care of adult pts(mostly older trainwrecks) so no ob, peds, trauma cases.there are several fellowships that can be done through FP including sports medicine, emergency medicine, and inpatient hospitalist training. I see IM as more of a dead end than fp so I am at the opposite end of the spectrum from the above poster. would not do IM for a miilion dollars a year. FP and EM are the only options I am considering.
ps who cares what docs at allopathic academic medical centers think anyway...
A LITTLE INFO FROM THE CONTRACOSTA COUNTY FP RESIDENCY PROGRAM:
No Competing Residency Programs
We train residents to practice comprehensive Family
Medicine -- Preparing graduates for practices in
underserved, rural, inner city communities
Many of our graduates are now faculty at other
residency programs
Extensive training in inpatient and outpatient
procedural skills
Strong Obstetrics training: average 140 deliveries per
resident, including 30 C-sections
High responsibility: we emphasize the resident is the
patient's doctor
4 block months Emergency Medicine plus rotating
shifts through the year
Residents run the Intensive Care Unit
Certification in ACLS/NALS/ALSO
Problem based learning curriculum for outpatient
medicine
3.5 months of electives -- on-site and away (including
overseas) options
Family Physician dominated medical staff and faculty
Many faculty active in international relief work

this is a partial list of fp fellowships:Other Types of Fellowships

--------------------------------------------------------------------------------
Maricopa Medical Center Advanced Hospital Training Phoenix AZ
Maricopa Integrated Health Systems Indigent Care Phoenix AZ
UCSF-Fresno Family Practice Fresno CA
Loma Linda University Substance Abuse Loma Linda CA
UCLA Division of Sports Medicine Primary Care Sports Medicine Los Angeles CA
University of CA / Davis Primary Care Outcomes Research Sacramento CA
San Diego Sports Medicine & Primary Care Sports Medicine San Diego CA
Geriatric - Osteopathic Colorado Springs CO
University of Colorado Primary Care Sports Medicine Denver CO
Yale Occupational/Environmental Med Prog Occupational/Environmental Medicine New Haven CT
Georgetown Univ Medical Ctr Medical Editing/Faculty Development Washington DC
Georgetown U. Medicial Center Community Medicine Washington DC
Georgetown University School of Medicine Health Policy Washington DC
Georgetown University Medical Center Primary Care Informatics Washington DC
Family Practice Residency of Idaho, Inc Primary Care Sports Medicine Boise ID
MacNeal FPR Family Systems Medicine Berwyn IL
MacNeal Family Practice Residency Women's Health Berwyn IL
National Headache Foundation Headache Chicago IL
PCC Community Health Center Maternal & Child Health Oak Park IL
Women's Health Peoria IL
Indiana University Underserved Medicine Indianapolis IN
The Commonwealth Fund Minority Health Policy Boston MA
Commonwealth Foundation Leadership & Health Policy Training Boston MA
EMMC Family Practice Residency Program Osteopathic Manipulative Medicine Bangor ME
Wayne State University Occupational/Environmental Medicine Detroit MI
Univ of MN Medical School Clinical Research Minneapolis MN
Univ of MS Medical Center Health Psychology Jackson MS
Duke University Medical Center Preventive Medicine/Occupational Med Specialty Durham NC
E. Carolina University Primary Care Women's Health Greenville NC
New Hampshire Dartmouth FPR Preventive Medicine/Leadership Concord NH
Cooper Health System Medical Acupuncture Camden NJ
UMDNJ-Robert Wood Johnson Health Policy New Brunswick NJ
UMDNJ-RWJ Medical School Women's Health New Brunswick NJ
Epicd Palliative Care Palliative Care Albuquerque NM
SUNY/Health Science Ctr at Brooklyn Women's Health Brooklyn NY
Family Medicine Center Family Planning & Reproductive Health Rochester NY
Family Medicine Center Family Systems Medicine Rochester NY
Family Medicine Center Behavior Change Rochester NY
Family Medicine Center Patient-Centered Care Rochester NY
University of Rochester Public Healthcare & Health Services Research Rochester NY
OHSU School of Medicine Clinical Leadership Portland OR
Oregan Health Sci University Residency Instructor Portland OR
Montgomery FPRP Family Practice Hospitalist Norristown PA
University of Pennsylvania Health System Research/Faculty Development Philadelphia PA
University of Tennessee at Memphis Emergency Medicine Covington TN
University of Tennessee Emergency Medicine Knoxville TN
UT Department of FM - Knoxville Behavioral Medicine Knoxville TN
Palliative Medicine Memphis TN
University of Texas Primary Care Houston TX
Swedish Family Medicine Residency Advanced Training in Geriatrics Seattle WA


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Fellowship Directory | AAFP Home Page
--------------------------------------------------------------------------------

 

[FireAway]

What insurance company would grant coverage to a nonsurgeon to do a major abdominal operation (i.e. appy)? Its an interesting idea for FPs to be doing simple surgeries given the coming shortage of general surgeons, but really that's entirely unrealistic unless you happen to practice somewhere where there isn't a major hospital or another doc for hundreds of miles. In any case, this is not by any means the norm for 99% of FPs, and personally I think its a dangerous idea for a patient to be operated on by an FP, especially if they trained at an osteopathic institution.

 

[deleted6669]

All of the more aggressive fp residencies are allopathic...

 

[mjg]

Please don't say IM docs are overtrained "strange" people who hate children, women, and hunt zebras so that they can tell you the causes of hypokalemia at a moment's notice. That's just silly. And it reflects badly on the FP who thinks this.

You know why they look for zebras? It's their job. Moreover, it's YOUR JOB as well. Patients don't need doctors to tell them to elevate the swollen knee or to take antibiotics for their purulent sputum. They can figure that out. What they can't figure out are the zebras - and THAT'S WHY THEY GO TO THE DOCTOR. Zebras kill, or at least cause long term damage. Horses run away with time. It's your job to know the difference and the better you know that difference, the better a doctor you are. It IS that simple.

And I rail against the notion that the causes of hypokalemia are esoteric minutiae. Come on. If you don't know it, who should? You're the doctor! I refuse to believe that interpreting a basic metabolic panel is beyond the reasonable scope of a doctor's abilities. That's scary. Don't say things like that.

And that's why some people don't go to FPs. It's the ole' pat on the back, "It's nothing to worry about," that worries people.

That said, I love FPs. I almost entered this year's match as an FP. I'm IM. And I'll tell you what you already know, you have the hardest job in medicine. But you can't relax your standards and say, "I'm just a General Practitioner." If you hang the shingle to take all comers, then you're obligated to to know the zebras as well as IM, OB-GYN, and PEDI docs.. or else, why should I come to you?

I think there's a fantastic place in medicine for FP.. if you guys are willing to step up to the plate and work harder than anyone. Otherwise, I'm safer going to IM, sending my girlfriend to OB, and leaving my baby cousin to Pedi. It's easier to see one of you... but not when you think zebras are a waste of time.. becuase to every one of your patients, zebras are the only reason they need you.

 

[PACtoDOC]

Fireaway is obviously stuck in the 60's mindset. There are plenty of excellent FP programs that are osteopathic. In fact, some of the most credible FP residencies based on academic status are not the best actually. If an FP resident has to constantly compete with other residents for complex procedures, they are not getting the same education that their counterparts are getting in small community based residencies where they are the only residents. There is a residency here in Fort Worth for DO's in FM that has them spread around through all the county and city clinics, as well as one on one with surgeons and specialists in major hospitals. To use the term osteopathic the way you did showed your lack of current knowledge regarding the profession. This forum is run by DO's. DO's fill so many of the allopathic residencies that they would have to shut down if we stopped coming to them. The word has been out for years that DO's and DO institutions educate well. I guess you have a pair of original corduroys folded right next to that stigma in your closet right?

 

[FireAway]

PACtoDOC-
Well I don't know if I'm stuck in the 60s or not, but I do know that you're sounding an awful lot like a chiropractor. I think FPs do have an important place in the medical system, they are the primary care first contact for the majority of patients seeking care. There is a definite role for this triage in our system.

However, I find it disturbing that ppl are sold on this profession by being told they will be doing abdominal operations, staffing traumas and ICUs, etc. While this does happen in certain locales, as I said it is by no means the norm for most FPs.

Osteopaths are suited to the primary care disciplines, but there is simply no substitute for training at a major academic institution for those wanting to do complex procedures. You sound very insecure in your degree. And to answer your question, I have pressed white shirts next to the stigma, along with everyone else in my profession.

 

[save10]

Fireaway. Your positive attitude and maturity screams compassion. I'd love for you to be my doctor

 

[PACtoDOC]

Fireaway,
Your profession is my profession, and vice versa. There is nothing that I said that shows that I am insecure with my training. I was only trying to show you that your comment stating that an osteopathic FP is somehow less than an MD FP was incorrect. As you know I am sure, most FP programs, allopathic or osteopathic, are not in major medical centers. The vast majority of FP residencies are in community places. So if you want to change your statement and say that physicians who train in community based programs get less intensive surgical training than those that train at major academic medical centers, then I would agree. But when you compare community DO versus community MD FP residencies, they are the same. In fact, the trend sweeping the country is to make virtually every residency training program dually certified by the AOA and AMA, and it is starting at the FM residencies. UNM, TTech, Texas A&M, AEinsteen, St.Barnabas NYC, and many community residencies are doing such. Once a DO gets on faculty, its simply a matter of time before it is dually accredited. What does this mean for MD's, nothing. But for DO's, it means we can be certifed by both boards if we wish. I do get your original point, and I wasn't trying to throw large flames (just small ones) at you about the "Stigma". But, I think your original comment did not need to be directed at DO's, and instead at lame FP residency programs. And any FP that goes into FM thinking they will be doing any sort of surgeries under general anesthesia is crazy. It is done rarely and usually by old experienced guys that are grandfathered in on hospital priviledges in some small town. Can we agree somewhat Firestarter, or whatver the hell your name is

 

[deleted6669]

the one exception to your statement is c-sections. lots of fp residencies train their residents as primary surgeon on this procedure.