Specialize AND practice primary care????

[crazylegs]

I would definitely appreciate any kind of feedback on this....

One of the big reasons why TCOM was my first choice was because of their emphasis on primary health care in South Texas. However, my dream has always been to specialize as an orthopedic surgeon (providing that my grades in medical school would score me a residency in the field, of course!). I grew up in a medically underserved area in south Texas and do desire to go back and practice as a physician there. My question is, would it work out to do both specialty and primary care at the same time?

I spoke to a friend of mine who is a year 1 PA student, and he plans to do extra training after finishing school to work in a surgical subspecialty. He eventually wants to work under a surgeon during the week and spend his weekends working in a primary care clinic. I agree with his thinking and would love to do the same. This type of schedule would definitely work out for a PA as far as time spent in post-grad training is concerned, but I am not sure if a physician can do the same. Is a residency in general or family medicine absolutely essential for this type of 'part-time' practice? If so, then I would be spending upwards of seven years just in residency training following med school!!

I foresee myself having to decide between the two in MS4, but the dreamer in me is hoping to find a way to do both. Anyone have any real-life situations or thoughts that pertain to this??

Thanks!

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[Goofyone]

Hey crazylegs:

I'm not really sure how feasible that plan would be. Somehow I don't think it'd work out well.

But, it sounds to me like obstetrics would be the perfect specialty for you.

Think about it: surgery, office cases, and you ARE the primary care provider to a lot of women.

Just a thought

 

[H0mersimps0n]

I'm not sure if Ortho surg is a subspeciality of IM but if you could settle for one of the IM subspecialities, I don't see why you couldn't IM stuff on the weekend and surgery during the week? From my (little to no) understanding of how it all works you would be qualified?

My peditrician did an IM and Peds residency (back in the day before family practice residency's existed) and because of that I never had to change doc's when I hit 18. Pretty sweet.

No family life for you eh?


I am in a dilemma worse than yours, week by week my love for manipulation grows yet I am compelled to specialize due to financial and personal reasons (I want some surgical/invasive skill), so right now my interest is Cardiology but I've considered EM, IM, Neuro and GI. Who know's if I didn't have such bp problems I'd probably go EM- too much daily stress probably ain't going to help the ole bp though. DARN

 

[sophiejane]

Orthopedic surgery is not a medicine subspecialty, but a surgical subspecialty.

The IM fellowships are: cardiology, infectious disease, rheumatology, endocrinology, urology, gastroenterology, oncology, geriatrics, pulmonology, and nephgrology.

Do you want any sort of life outside of your work whatsoever, crazylegs?!

The main problem would be having two separate practices with separate malpractice insurance (very expensive). How about you just do ortho and go do some mission trips or medical relief work now and then to satisfy your desire to serve the needy?

 

[skb21]

Originally posted by Goofyone
Hey crazylegs:

I'm not really sure how feasible that plan would be. Somehow I don't think it'd work out well.

But, it sounds to me like obstetrics would be the perfect specialty for you.

Think about it: surgery, office cases, and you ARE the primary care provider to a lot of women.

Just a thought

Goofyone,

That's my line of thinking as well. When I choose my speciality, I would really like to do a surgical speciality, but I do not want to lose the practical aspects of being a doctor. I've worked as an O.R. Tech for the past two years and really like the work done in surgery.

I have two qualms with OB/GYN though. I don't know if I want to limit myself to treating just females, and there is a big malpractice issue when it comes to OB/GYN. The latter is especially true in Mississippi, where I live and plan on coming back to set up my practice.

I do like the surgeries that OB/GYN's perform. There's nothing quite like bringing a baby into the world, even if the liability issues are a problem.

One solution could be doing a family practice residency and an obstetrics fellowship. The hospital I work at just recently got a D.O. doc who did this. In fact, he went the same route I have gone. He graduated and then worked for a couple of years as an O.R. Tech at the same hospital.

Doing this would allow a person to do C-sections, D & C's, and PP BTL's while not relegating yourself to just women. I don't know though. If I'm going to go that far to be able to do some surgery, maybe I should go all out where I can do the hysterectomies and diagnostic laps as well.

Then again, maybe I should just go into general surgery.

 

[sophiejane]

Originally posted by H0mersimps0n

I am in a dilemma worse than yours, week by week my love for manipulation grows yet I am compelled to specialize due to financial and personal reasons (I want some surgical/invasive skill), so right now my interest is Cardiology but I've considered EM, IM, Neuro and GI. Who know's if I didn't have such bp problems I'd probably go EM- too much daily stress probably ain't going to help the ole bp though. DARN

Talk to some OMM specialists--those guys (and gals) get paid in cash mostly, have low malpractice, and many are extremely busy. I think you can do quite well for yourself if you are good at manip--especially if you are open to providing or at least having someone you will refer for alternative modaliites like accupuncture and herbs. There is a lot of money to be made in that little niche.

 

[Kalel]

Some medicine subspecialists maintain the board certification in IM and keep primary care practices on the side. I wouldn't reccomend trying to run a primary care practice if you went into surgery; even though it may be legal in many states, you'd be really unprepared for primary care with a surgical background.

 

[Goofyone]

Originally posted by skb21
Goofyone,

That's my line of thinking as well. When I choose my speciality, I would really like to do a surgical speciality, but I do not want to lose the practical aspects of being a doctor. I've worked as an O.R. Tech for the past two years and really like the work done in surgery.

I have two qualms with OB/GYN though. I don't know if I want to limit myself to treating just females, and there is a big malpractice issue when it comes to OB/GYN. The latter is especially true in Mississippi, where I live and plan on coming back to set up my practice.

I do like the surgeries that OB/GYN's perform. There's nothing quite like bringing a baby into the world, even if the liability issues are a problem.

One solution could be doing a family practice residency and an obstetrics fellowship. The hospital I work at just recently got a D.O. doc who did this. In fact, he went the same route I have gone. He graduated and then worked for a couple of years as an O.R. Tech at the same hospital.

Doing this would allow a person to do C-sections, D & C's, and PP BTL's while not relegating yourself to just women. I don't know though. If I'm going to go that far to be able to do some surgery, maybe I should go all out where I can do the hysterectomies and diagnostic laps as well.

Then again, maybe I should just go into general surgery.

I know what you mean. I'm hoping that next year (year 3) I will have an epiphany and decide on either an IM or a Gen Surg residency

In fact, every time I have a new systems course in school, that's what I want to do for the next month or so

 

[Dr JPH]

Originally posted by H0mersimps0n


I am in a dilemma worse than yours, week by week my love for manipulation grows yet I am compelled to specialize due to financial and personal reasons

You kidding me?

Do you know what you can make doing just OMM providing you are good and get the right referalls? Who do you think the richest guy in Pikesville, KY is?

Wow.

 

[skb21]

Originally posted by Goofyone
I know what you mean. I'm hoping that next year (year 3) I will have an epiphany and decide on either an IM or a Gen Surg residency

In fact, every time I have a new systems course in school, that's what I want to do for the next month or so

Yeah. I was talking to that D.O. doc I mentioned in that post. I asked him when he decided to go into family practice and obstetrics. He said it was during his rotations. He told me that when he got into medical school, he was dead set on becoming a general surgeon. Nothing was going to stop him. I asked him why he changed. He said he absolutely hated the rotation, citing that the guys on that rotation were miserable.

A rotation like that would make me decide real quick! I never thought to ask him whey he didn't choose to go all the way and become an OB/GYN. I'm sure the liability issues are relatively the same considering both do obsetrical work.

 

[Goofyone]

Originally posted by skb21
Yeah. I was talking to that D.O. doc I mentioned in that post. I asked him when he decided to go into family practice and obstetrics. He said it was during his rotations. He told me that when he got into medical school, he was dead set on becoming a general surgeon. Nothing was going to stop him. I asked him why he changed. He said he absolutely hated the rotation, citing that the guys on that rotation were miserable.

A rotation like that would make me decide real quick! I never thought to ask him whey he didn't choose to go all the way and become an OB/GYN. I'm sure the liability issues are relatively the same considering both do obsetrical work.

Wow that's an interesting story. I'm just a lowly second year so I don't know WTF I'm talking about, but I wonder if people are placing too much importance on rotations in deciding their specialty. Seems to me like a bad idea to base your career on one bad experience in one bad rotation in one bad place--although it sounds like it may be true more often than not for surgery.

 

[ID4me]

An orthopedist is not really qualified to practice primary care. The residency is focused on orthopedics, and that's it. At best you could work as a GP based on just having had a degree and a year of residency, but even then you're not really qualified to do that job if all you've had is an ortho residency. If you want to specialize and do primary care, the best ways are either to specialize in something in medicine but still practice medicine (you will have completed an IM residency and be board-certified), or be an FP and broaden your skills to include things like OB/Gyn and colonoscopy.

 

[stoic]

It's definately possible to specialize in a medicine field and maintain a primary care angle in your practice. One of the local gastroentrologist does primary care for a good number of patients.

It's also possible to do maintain a part time OMM practice outside of your main speciality. Their director of my hometown ER has an office practice, strictly limited to OMM, one day per week.

 

[crazylegs]

Thanks for all of the input, you guys.. you definitely gave me more than I was expecting!!

Sophiejane, the mission trips/medical relief work sound enticing .. will they take just anyone, or do you have to go through a fellowship or family practice residency before you can participate in something like that?

As far as a life outside of medicine is concerned, right now I am single and unattached, so naturally I think of my career in terms of that. Of course, I hope to eventually get married and start a family.. and I will have to adjust my work life according to that, and who knows what I will end up doing! Which brings me to ask, how often do you hear of med students marrying classmates?? I get different responses every time I ask this...

 

[crazylegs]

Okay, many of you talked about running practices part-time outside of the subspecialty work that will be done on more of a full-time basis.. but what if you worked with a group of doctors?? Would that necessarily make the schedule more flexible without having the worries of running two separate practices? If it were me, I would only want to run one practice on my own and just collaborate with some peers in another. Same amount of service provided, but half of the worries, right?

 

[sophiejane]

Originally posted by crazylegs
how often do you hear of med students marrying classmates?? I get different responses every time I ask this...

Our class has one couple so far that is engaged--they met here. I think there are at least two in 2006. There are tons of other engagements but they are not classmates.

 

[sophiejane]

I think it's one thing to be a GI doc and do primary on the side, because they do an IM residency first, or an ER doc and do OMM on the side--but to be a surgeon and do FP I think poses an entirely different set of problems. I would that think that surgeons don't really keep up their diagnostic/medicine skills while they are learning to cut, and while you are doing an FP residency your surgical skills would lapse.

Anyone can do mission/relief work. There's a huge need.

 

[kendall]

you might consider ENT. incredibly diverse field. plenty of OR and office time. very difficult field to get into, but you could be treating allergies one day, and performing a trans-sphenoidal hypophysectomy the next (and the money's not bad either).

k

 

[ussdfiant]

Originally posted by sophiejane
The IM fellowships are: cardiology, infectious disease, rheumatology, endocrinology, urology, gastroenterology, oncology, geriatrics, pulmonology, and nephgrology.

Urology is not an IM fellowship, it has its own residency.

 

[sophiejane]

I thought that looked like too many...thanks!