Some questions from an M3 about FM

[spumoni620]

Hi all,

Spent quite some time reading this forum, and found it useful. I'm posting b/c I'm a little confused at the moment. I'm in the middle of a family medicine rotation, and in short it is just amazing. i have an awesome preceptor and i am essentially functioning at an intern/resident level thanks to her supreme teaching abilities. i had never considered family medicine before, but after the past few weeks i have really, seriously been thinking about this as a career. i love how my preceptor knew the patients so well, had continuity of care and just connected so wonderfully with all the patients. i had thought that the cases would get monotonous/boring/you'd end up referring everything but i can honestly say each day is so different and fulfilling (even if you see lots of diabetes and htn, each pt is still so different and unique - that's what brings the variety) i actually really enjoy talking to patients and that's what is so neat about this rotation. and...finally I love the fact that you can treat all members of a family, look after a pregnant woman (even if you don't want to deliver), take care of the newborn (yay babies!), watch the child as it grows up, take care of the grandparents, etc. etc. As a physician I really want to start some sort of clinic for underserved/homeless patients, and FM seems like the perfect avenue to do so. I guess, in short, i think i love just about every aspect of what i've been doing this month.

So the only thing is, I have had some people dissuading me from my initial thoughts of going into this, saying that "i can do better" based on board scores, etc. etc. People have told me that IM is a better route w/more respect, better earning potential, etc. I guess the reason I'm confused is: it seems as though FM docs have the option of doing so much and getting trained in a huge variety of things but nevertheless experience a general sense of low prestige, low compensation, and a lack of popularity. I just can't seem to understand how/why this is the case. (Is this really the case? this may just be a misinformed m3 speaking...) given the fact that they may well do the same things as an ob/gyn, GI doc, etc. procedure-wise, and are trained in a variety of things, why are they paid/respected less than those counterparts?

And then, two more questions: First, i was wondering if some of you could shed some light as to the level of work in the FM residency. I am really hoping to have time to raise kids, pursue outside interests, volunteer, etc. etc. What is the residency like in terms of workload - is this doable? And secondly, what are some of the top programs out there in FM?

Sorry for the naive questions, but i have a feeling this board is the place to ask. thanks for any help you can provide!

---

Members don't see this ad.

 

[Faebinder]

Hi all,

Spent quite some time reading this forum, and found it useful. I'm posting b/c I'm a little confused at the moment. I'm in the middle of a family medicine rotation, and in short it is just amazing. i have an awesome preceptor and i am essentially functioning at an intern/resident level thanks to her supreme teaching abilities. i had never considered family medicine before, but after the past few weeks i have really, seriously been thinking about this as a career. i love how my preceptor knew the patients so well, had continuity of care and just connected so wonderfully with all the patients. i had thought that the cases would get monotonous/boring/you'd end up referring everything but i can honestly say each day is so different and fulfilling (even if you see lots of diabetes and htn, each pt is still so different and unique - that's what brings the variety) i actually really enjoy talking to patients and that's what is so neat about this rotation. and...finally I love the fact that you can treat all members of a family, look after a pregnant woman (even if you don't want to deliver), take care of the newborn (yay babies!), watch the child as it grows up, take care of the grandparents, etc. etc. As a physician I really want to start some sort of clinic for underserved/homeless patients, and FM seems like the perfect avenue to do so. I guess, in short, i think i love just about every aspect of what i've been doing this month.

So the only thing is, I have had some people dissuading me from my initial thoughts of going into this, saying that "i can do better" based on board scores, etc. etc. People have told me that IM is a better route w/more respect, better earning potential, etc. I guess the reason I'm confused is: it seems as though FM docs have the option of doing so much and getting trained in a huge variety of things but nevertheless experience a general sense of low prestige, low compensation, and a lack of popularity. I just can't seem to understand how/why this is the case. (Is this really the case? this may just be a misinformed m3 speaking...) given the fact that they may well do the same things as an ob/gyn, GI doc, etc. procedure-wise, and are trained in a variety of things, why are they paid/respected less than those counterparts?

And then, two more questions: First, i was wondering if some of you could shed some light as to the level of work in the FM residency. I am really hoping to have time to raise kids, pursue outside interests, volunteer, etc. etc. What is the residency like in terms of workload - is this doable? And secondly, what are some of the top programs out there in FM?

Sorry for the naive questions, but i have a feeling this board is the place to ask. thanks for any help you can provide!

I'm not an FP but I will comment..

1) IM better paid than FP? That's really garbage. The average IM makes more than the average FP because usually they work more hours and end up being hospitalists. As an FP you can be a hospitalist and can work more hours... The difference in the average pay is like 10k a year which is nothing....again looking at the $/hr work rather than the total $$.

2) The flexibility of the hours of an FP is impressive. Truely impressive. Are you jewish and dont want to work Saturday? Fine... Are you Muslim and don't want to work Friday? Fine. Infact, the IM usually try to end up being like FP when they start opening their own private practice after being hospitalists for years. FP has a head run on that business and by the time an IM is ready to open his own practice the FP already has one running and banging $$.

vs

1) IM gets more respect cause the hospital is their domain. FPs that are hospitalists end up with the same respect. So if you are looking for respect from people in the hospitals ... yeah I guess become an IM hospitalist. In your FP clinic... you are the master and the patients love you, you are someone they know.

2) IM gives you the chance of specializing... which goes back to sacrificing time for more $$. This might change in the future.

So in essense they both have goodies.... pick and choose.

 

[deleted87716]

I guess the reason I'm confused is: it seems as though FM docs have the option of doing so much and getting trained in a huge variety of things but nevertheless experience a general sense of low prestige, low compensation, and a lack of popularity.

IM and FM are paid for exactly the same CPT and E&M codes. Any difference in individual incomes is purely a result of hours worked, volume and type of patients seen, coding, etc. The income potential in both fields is, for all practical purposes, identical.

I have no idea what you (or anyone) are talking about when referring to "prestige." Who are you trying to impress?

As for popularity, more patients are seen by family physicians than any other specialty type. If there's ever a popularity contest held among patients, we'll win by a landslide.

The lack of popularity amongst the current generation of medical students is a product of fear, not facts. Misinformed people sharing misinformation isn't the stuff that makes for sound decisions. You see it all the time here on SDN, and it's really a pity. I'll bet there are lots of people who would really like to go into FM, but choose another field because somebody has convinced them that they won't be able to pay off their loans, will have to work 80 hours/week, or will be forced to drive a rusty AMC Pacer and live in tenement housing because they'll "only" be making a measly $160,000 per year. Sad, really.

 

[sophiejane]

While you may be concerned right now with prestige and popularity, because that's what people do in medical school--they jockey around for the best scores and the sexiest residencies...I seriously doubt that once you are practicing medicine that you will care about all that BS.

The irony is, people leave those sexy careers all the time. A lot of them are miserable. Their marriages fail. They hate their lives. This is because they made decisions based on what other people told them to do or on what was "cool"...(see recent post by Secretwave101 on Future of Family Medicine thread--it's great).

I had the same gut feeling about family that you are having. And I tried my best throughout 3rd year to make myself love something else, but I could never do it.

Keep an open mind this year as best you can. There are plenty of people with great grades and test scores in family medicine. That should hardly be a deciding factor about the way you will spend the rest of your career.

Best of luck, and I'm so glad you are having such a great rotation!

 

[spumoni620]

thanks to all of you for the replies...i really appreciate it. just to clarify, $ and prestige aren't particularly important to me at all. i would MUCH rather be happy (i actually gave up another lucrative/prestigious career to enter medicine) and fulfilled, and help patients. i'm just genuinely curious as to why such a broad, hardworking specialty doesn't seemingly get the respect it (in my eyes) deserves. (just basing this on derisive comments made by peers, other ppl, etc.) i also am admittedly quite naive when it comes to the whole prestige/earnings/popularity thing, so my post was just based on what one of my attendings told me (point blank, he said "you essentially can do an extra year of residency, get into IM and probably make twice as much as an FM doc"; another told me the reason fm had trouble filling up spots was because of "money"). no intention of offending anybody with blatant mistruths!


also...if anyone could weigh in on what the residency is like in terms of schedule (i'm aware of the different required rotations from the sticky in the beginning, but just in terms of how a typical day works, if you could have a family during residency, etc. etc.) that would be great! thank you again!

 

[Jack Daniel]

.....will be forced to drive a rusty AMC Pacer and live in tenement housing because they'll "only" be making a measly $160,000 per year. Sad, really.

And maybe the spouse will have to drive the AMC Gremilin as a second car--another fine piece of AMC craftsmanship.

 

[skypilot]

so my post was just based on what one of my attendings told me (point blank, he said "you essentially can do an extra year of residency, get into IM and probably make twice as much as an FM doc"; "). !

IM and FP are both 3 year residencies. Both are not competitive to get into. Why would you need an extra year?

 

[deleted87716]

one of my attendings told me (point blank, he said "you essentially can do an extra year of residency, get into IM and probably make twice as much as an FM doc"; another told me the reason fm had trouble filling up spots was because of "money").

Again, don't believe everything you're told.

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

The average incomes are very comparable.

 

[nerfherder]

Dear Spumoni,
I just graduated from a med school in MI and just started an internship in FM. I had some of the same doubts you have, like lack of prestige and not making enough money to pay off my loans etc, etc. I have actually felt in the last month since starting residency, even though my schedule was very hectic, that I made the right decision b/c I enjoy talking to people, having a broad knowledge base and doing outpatient procedures, contintuity of pt care as well as other things. Since you are just starting 3rd year, don't set your sights on Family Medicine right away, see if you like other rotations, you never know what will interest you the most. You don't need to decide what specialty to go into until the end of the year anyway. If you decide FM is what you want to do then don't let others discourage you. The lack of prestige or " you could have done better" thing rarely ,if ever, happens after med school. I actually had a fellow classmate say to me last year in med school , "I would DIE if I had to do primary care" after they knew I was applying to FM, but to each his own. BTW, FM doctors probably have to know the most out of all the specialties. I know quite a few people with AOA or great board scores and/or clinical grades who went into FM. Also, you have the potential to make more than the average income if you can see more pt per hour, do more procedures, and know how to bill or have an excellent biller.
Good Luck and take it easy, you really have another year to figure out what you're going into.

 

[erichaj]

It's true, if you make 160 K a year, you won't be able to pay off your student loans as fast as someone who makes 250 K a year. Thats simple math.

But you know what, some of those surgeons or cardiologist or etc. Are working 60 + hours a week, and some even more. Some of them are in residency for what seems ever.

Their quality of life is not very good. On the other hand there are some that make 250 K per year or more and have good quality of life.

What's really important here is HOW DO YOU LIKE FP V.S. OTHER. AND HOW MUCH IN LOANS DO YOU HAVE?

If you have 200K in loans, and love FP. You need to understand that you will not be as comfortable as someone who has 50k in loans. Although, after a few years when those loans are payed off, your lifestyle will be just fine.

I remember in you post, you said you LOVED the fp rotation. If you have done many other rotations and can truly compare you experience in these and still love FP. All you have to do is find out if it is financilly feasable (not that you will be working at wendys for money) but that you are ok with working 4 days or 4 1/2 days a week and making something like 150 t0 180 k per year.

If you care about prestige, STOP. DONT. That's your ego talking. When you are on the beach on vacation and enjoying the sun with you childeren, husband etc. and the other guys are working, prestige goes out the door.

I'm not saying the other specialties are bad. they are not. they are very needed, but it's about what you want out of your life.

By the way, IM does not make much more than FP unless they specialize like GI, or cardio etc.

I do think FPs need to make more because we are on the front line of medicine, But that is another story.

 

[tatabox80]

Again, don't believe everything you're told.

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

The average incomes are very comparable.

Something doesn't quite make sense, why does the average salary for fp's w/o ob drop by almost 30K greater than 3 years into practice? I would think the salaries would increase...

 

[deleted87716]

Something doesn't quite make sense, why does the average salary for fp's w/o ob drop by almost 30K greater than 3 years into practice? I would think the salaries would increase...

This is a guess, since it's not explicitly stated on the web site. However, it's well-known that many organizations who employ salaried physicians offer high starting salaries as a recruiting incentive. After a couple of years, however, you wind up having to work even harder to maintain that income level once you're off guarantee and on full production. If you're not productive enough, your income takes a hit. One more reason I didn't want to work for a big health system.

 

[firetown]

It's true, if you make 160 K a year, you won't be able to pay off your student loans as fast as someone who makes 250 K a year. Thats simple math.

What's really important here is HOW DO YOU LIKE FP V.S. OTHER. AND HOW MUCH IN LOANS DO YOU HAVE?

If you have 200K in loans, and love FP. You need to understand that you will not be as comfortable as someone who has 50k in loans. Although, after a few years when those loans are payed off, your lifestyle will be just fine.

To me, with good management of finances, you should be able to pay off your loans and still have a good lifestyle. Your argument presumes that the more you make, the better your lifestyle will be, all things being equal. Pretty far from the truth cause no two lifestyles are the same.

I have seen people who make $300,000 but are so far in debt with some pretty miserable lifestyle. I have met a couple close to retirement whose household income never exceeded $65,000 but owns 2 homes with pretty decent lifestyle and a comfortable savings in their retirements. The decision should be on earnings but on interest and I am sure that whether as an FP or as a Specialist, with proper management, you will earn enough to pay of your loans and have a decent lifestyle.