the BAD side of FM residency programs

[SomedaySoon]

I'm switiching into family and couldn't be happier, but to avoid being disillisuioned, especially since my med school exposure was shorter than I would have liked, I want to find out about the bad side, the disappointments, frustrations, etc of being a fammed resident.

What annoys you, angers you, makes you want to quit? That way, when it happens to the rest of us, we'll know that it is normal and will get better!

On the flip side, you can share the happy stuff too.

TIA!

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[andwhat]

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[thedman888]

fm has a lot of balance and flexibility. the fact that there is a huge demand is not surprising. compare GPs to specialists in general, there are way more specialists than generalists, therefore fm itself as a specialty is much smaller in # compare to all other specialty as a whole. i digress...
the dislikes...hm, prob the underappreciatedness from the medical society, but they kno they cant live w/o us... so wudevers

 

[sophiejane]

I think that the things that annoy residents are pretty common across specialties. Family medicine specific...I'd have to say that not being able to get things done for my patients due to Medicare/caid BS, no insurance, etc has to top the list. Likely you will work with a poorer population (unless you are at a cush residency in the 'burbs and have low volume, which I don't recommend for learning), and you will be pressed for time and resources will be limited. But then you also learn to be creative, which is a good thing.

Sometimes I feel like just when I am starting to get the hang of a rotation it's time to move on, but then other (many) times, the month ends just as I am about to tear my hair out and need a change of pace.

In all, I would venture we are among the happiest residents in any specialty, but that's just my hunch.

 

[Leukocyte]

-Most annoying aspect:

1) Lack of focus (I like to focus on a single organ system and know it real well. I prefer to be a consultant rather than a generalist. I guess I am in the wrong specialty.
2) Need to know an overwhelming amount of material.

-Most rewarding:

1) It is gratifying to "practice" and have knowledge of all aspects of medicine.

As FM docs we have a wider knowledge base than any other doctor or surgeon. We can pretty much handle most things. We know a little about everything, while a specialist knows alot about one thing only.

 

[dr0277341283141]

Biggest problem- watered down science. It drives me nuts. I have a hard time with EBM.

Best feature- you can really live anywhere you want to, including out among the wheat fields.

 

[Ypo.]

Biggest problem- watered down science. It drives me nuts. I have a hard time with EBM.

.

I'm with you on that one. And the way people throw around the term "EBM" without even knowing what it means.

 

[dirtridndoc]

EBM? I'm about to finish my third year in FM and I've never heard the term. Good thing I'm switching to another specialty.....Then again, it might just be my program......

 

[HarveyCushing]

EBM? I'm about to finish my third year in FM and I've never heard the term. Good thing I'm switching to another specialty.....Then again, it might just be my program......

I believe they are referring to Evidence Based Medicine (EBM).

 

[AwesomO]

I certainly think EBM is beneficial but what I can't stand are people rattling off things then slapping the EBM label without knowing why. IMO if you don't understand why you are doing a particular treatment other than it's the correct treatment according to EBM maybe you shouldn't be doing it. Or just spend some time understanding why you are doing it.

 

[dirtridndoc]

Ahhhhh....THAT EBM.....!

Hey, Harvey....I PM'd you about Casper.....

 

[Matthew33]

Biggest cons for me:

Only a few months doing specialty rotations, especially ER, doesn't give me a lot of confidence in being able to run a rural ER when I graduate. If I hoped to work as a rural/missionary GP, I would want to do a lot of electives in ER to boost my confidence and I still don't know if I would get enough exposure.

Difficult to follow patients. I have my own patients but have to order tests on my preceptor's lab reqs. They are sent back to him and he quickly signs off all the ones in his pile each morning. I miss the results unless he notices that they are my patient (rarely), or I search for them in the files myself.

Also difficult to follow prenatal patients and referred patients to see what became of them when you are constantly moving to other rotations.

Some preceptors make you so mad. You go from a rotation where the preceptor gives you tons of independence, to one who doesn't trust you on your assessment of an ear infection. Some will scrutinize you, never comment on anything positive, and treat you like you are a first year medical student or worse. And the worst thing is, you depend on these people to pass your rotation evals. Personally, I've found it to be more of a problem as a fm resident on certain specialty rotations.

Because of the vast scope of FM, I never feel like I know enough. I worry that I'll refer on patients I should have been able to treat myself. I also worry that I won't refer patients I should have referred.

 

[andwhat]

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[predodoc]

This thread is real interesting to me b/c Im have the same predicament . I’m a third year torn between FM and IM (and also a few more). I liked FM for its regular hours, low call and Lower stress lifestyle. I didn’t like FM for the low pay future, having to know about everything and the tons of URI's(jees).
As for IM, I wasn’t the biggest fan of the super complex pts and less regular hours but liked the higher pay.
I think I like outpatient stuff better so right now I have to decide b/t FM(b/c I like outpatient) or IM (and specialize to a mostly outpatient subspecialty). Im getting to the point where I’m real tired of kissing butt and trying to look good all the time and I feel that if I go into IM I’ll be doing it for 3 more years to get that sub-specialty. Part of me says screw the extra money and go FM and the other says you’ve got this far do it a few more years. Then another part of me says go for something totally different (like PM&R or Anesthesiology). I am really torn.

 

[m3unsure]

This thread is real interesting to me b/c Im have the same predicament . I’m a third year torn between FM and IM (and also a few more). I liked FM for its regular hours, low call and Lower stress lifestyle. I didn’t like FM for the low pay future, having to know about everything and the tons of URI's(jees).
As for IM, I wasn’t the biggest fan of the super complex pts and less regular hours but liked the higher pay.
I think I like outpatient stuff better so right now I have to decide b/t FM(b/c I like outpatient) or IM (and specialize to a mostly outpatient subspecialty). Im getting to the point where I’m real tired of kissing butt and trying to look good all the time and I feel that if I go into IM I’ll be doing it for 3 more years to get that sub-specialty. Part of me says screw the extra money and go FM and the other says you’ve got this far do it a few more years. Then another part of me says go for something totally different (like PM&R or Anesthesiology). I am really torn.

I just say try out a bunch of stuff. I kind of liked a lot of stuff and really only hated psych and OB. So the last one maybe made me move away from things like FM.

Another way of looking at it, you can always switch into FM if you don't like your residency. I mean no disrespect to any FM peeps out there, but logistically, it's much easier than the other way around. So really make sure you don't like something else better than FM. I have been toying with this idea, but I guess the 70-80 hr/wk is getting to me in general.

 

[andwhat]

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[sophiejane]

the way that things look, are bleak.

My only real life experience is the job offers I am seeing our graduating residents getting. Particularly the rural ones are offering procedures (everything from OB to endoscopy) and compensation that will allow you a very comfortable lifestyle.

Perhaps I am naieve, but I never went into this expecting to make more than $175-200K for a 40-45 hour work week. And plenty of folks are approaching that goal. For me, that's enough.

 

[sophiejane]

I have been toying with this idea, but I guess the 70-80 hr/wk is getting to me in general.

Really? What FM docs are working 80 hours a week, other than residents?

That hasn't been my experience in working with and talking to docs in my area, all of whom are quite comfortable and happy with their jobs.

 

[andwhat]

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[sophiejane]

yes SophieJane, FM is 'comfortable' but certainly not even CLOSE to where it ought to be compensation wise.

What do you feel is appropriate compensation?

I am working with a colorectal surgeon right now. He is on call every other weekend and takes county call several times a month. He works about 60-70 hours a week, sometimes more. He gets up in the middle of the night to come in and do surgery, takes calls on his patients at home all night, etc. He does a fair chunk of pro-bono work for pts without insurance. I don't know what he makes/takes home, but his overhead is HUGE--has a staff of 6--and I don't see how he'd really reduce that overhead. He doesn't live extravagantly by any stretch of the imagination. His malpractice insurance is probably huge as well

I agree that better compensation for primary care is certainly necessary, but lets compare apples to apples and consider the increased expense of operating a specialty practice versus a primarily office-based one.

I chose this field because I DON"T want the life of a surgeon. I want the life of an FP, which means making it home for school plays, infrequent call, lower overhead than specialists, and a relatively low stress. It would be great to make $500K, but nobody takes that home without paying the piper in one form or another, be that lifestyle, overhead, call, etc.

As for loans, well, I have them too. But I think it's also time for people to start being responsible about those loans. Who doesn't take the max out in loans? Not many. If people choose to go to more expensive private or offshore schools versus state schools, and always take the max in loans (how about working for a few years before medical school and saving some money--do we always have to dive straight in after undergrad?), they should expect to have to work harder to pay those back. There are also numerous repayment programs (for many specialties, but there are lots for primary care), some of which will repay your ENTIRE loan in exchange for a few years service. There is also the military.

I'm just tired of the whining about loans as a reason not to go into primary care. We are in charge of how much we borrow and essentially, whether or not we choose to attend a more expensive medical school. I saw plenty of folks in medical school taking all of the offered loans and yet also taking some very nice vacations with that money every year. Then they whine about how they can't do primary care because their loans are so big. I'm not passing the tissues on that one.

 

[Frijolero]

What do you feel is appropriate compensation?

I am working with a colorectal surgeon right now. He is on call every other weekend and takes county call several times a month. He works about 60-70 hours a week, sometimes more. He gets up in the middle of the night to come in and do surgery, takes calls on his patients at home all night, etc. He does a fair chunk of pro-bono work for pts without insurance. I don't know what he makes/takes home, but his overhead is HUGE--has a staff of 6--and I don't see how he'd really reduce that overhead. He doesn't live extravagantly by any stretch of the imagination. His malpractice insurance is probably huge as well

I agree that better compensation for primary care is certainly necessary, but lets compare apples to apples and consider the increased expense of operating a specialty practice versus a primarily office-based one.

I chose this field because I DON"T want the life of a surgeon. I want the life of an FP, which means making it home for school plays, infrequent call, lower overhead than specialists, and a relatively low stress. It would be great to make $500K, but nobody takes that home without paying the piper in one form or another, be that lifestyle, overhead, call, etc.

As for loans, well, I have them too. But I think it's also time for people to start being responsible about those loans. Who doesn't take the max out in loans? Not many. If people choose to go to more expensive private or offshore schools versus state schools, and always take the max in loans (how about working for a few years before medical school and saving some money--do we always have to dive straight in after undergrad?), they should expect to have to work harder to pay those back. There are also numerous repayment programs (for many specialties, but there are lots for primary care), some of which will repay your ENTIRE loan in exchange for a few years service. There is also the military.

I'm just tired of the whining about loans as a reason not to go into primary care. We are in charge of how much we borrow and essentially, whether or not we choose to attend a more expensive medical school. I saw plenty of folks in medical school taking all of the offered loans and yet also taking some very nice vacations with that money every year. Then they whine about how they can't do primary care because their loans are so big. I'm not passing the tissues on that one.

Sophie, I'm usually with you, but I'm going to have to respectfully disagree. While one can attempt to minimize costs I would hardly call that being in charge of how much one borrows. COA as budgeted by the school does not have a lot of fluff in it, I'll be graduating from a state school with over $150k in debt, drive an old car, and don't buy much of anything extravagant. That's with zero undergrad debt. I think you also assume a lot when you state that people "essentially" have a choice of expensive vs. state school. Many had little choice if any at all; I know I didn't.

You also mention that specialties who earn the most have to "pay the piper". While that is true in some fields like surgery, it is most certainly not the case in quite a few. Think about derm, IR, rads in general, ophtho, GI, gas. The ratio of pay to effort/hours in these fields far exceeds that in FM. It is this disconnect that a lot of people take issue with.

While practicing in a shortage area will help pay off some loans, for many it does not come close to covering the total. Besides, why should someone have to practice in a specific area to pay of loans when other specialties don't? While I plan on practicing in at least a semirural area myself, making it a practical prerequisite for others who don't feel the same removes valuable people from the field. "There is also the military"? Don't get me started...

It's ridiculous to think loan burden doesn't (or even shouldn't) have a significant impact on choice of specialty. I think we'll be seeing some big changes coming down the pipe, likely changes that level the playing field by bringing other salaries down as opposed to FM going up (much, anyway). Chalking up loan burden and potential future income to minimal concerns only for the greedy and financially foolish does little to further our cause as a field.

...and long live FM!

 

[andwhat]

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[andwhat]

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[Frijolero]

I agree with you, but chalking up loan burden and potential future income for greedy and financially foolish, TRUST ME the match proves it this year and almost every year the past several several years.
Alot of people like FM, but chalk it out to financial issues, and student loans. Believe me, if compensation wasn't so poor, there would be more people going into FM.
Are you honestly happy with working significantly harder and making less?
I love FM for personal reasons, but looking at the big picture, its ridiculous considering that FM doesn't make nearly enough.
There is an overabundance of specialists, and they are growing, due to financial motivation -- the ability to pay off student loans quicker, have a better lifestyle, enjoy quicker easier money.
I have directly observed trends in health care and number of residencies obtained, and changes for about the past 5 years.
It is glaringly evident that nobody cares about the situation in Family Medicine. The match statistics back that up, not too many people are going into primary care, yet the salaries remain the same. I guess that they are trying to "wing it" and see how far they can go with it.
Primary Care is going in the wrong direction, and specialists are over abundant. What is the solution? Specialists perform procedures on themselves and try to reimburse for it? I don't see any improvement at all quite frankly. I am referring to monetary and lifestyle issues.


Like I stated several times, Family Medicine is on its way to bottoming out, and people don't care.

Perhaps I wasn't clear. I was intending to say that debt and future salary considerations ARE important.

Reimbursement, if anything, has declined or remained steady in this primary care shortage. That proves that its not an important societal issue.

Wow, that's quite a jump. Reimbursement has much more to do with the Medicare committee which sets rates (which has a disproportionate amount of specialists sitting on it) than it does with what is a "societal issue". I think the situation is much the opposite. Whenever I see a lay health story it usually has to do with rising costs or lack of primary care. FM is a huge part of the solution to our current problem and is not going anywhere any time soon.

 

[andwhat]

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[sophiejane]

Bottom line: keep up your membership in AMA and/or AOA, vote, do well by your patients and your staff, pay your bills, and don't waste money. And try to chill, friends. The sky isn't falling.

I don't have on rose-colored glasses, but at the same time, I guess because I've got some years of living under my belt before coming to medicine...what matters to me is my health and happiness and that of my family and friends, and that I am doing good work that means something.

I chose this field because I love it, and beyond doing the above, there isn't a whole lot I can do but enjoy the ride. Those of you who have the energy, time, and drive--by all means, take up leadership roles, but sitting around stewing about this isn't going to solve anything.

 

[Frijolero]

Hopefully FM makes a bounce back at some point.

Here:

http://www.aafp.org/online/en/home/residents/match/table1.html

Total FM positions offered has increased for the first time in a decade, % filled is the highest it's been in over a decade, and that increase in fill rate came largely from U.S. seniors. I think that's a good start.

 

[HarveyCushing]

Here:

http://www.aafp.org/online/en/home/residents/match/table1.html

Total FM positions offered has increased for the first time in a decade, % filled is the highest it's been in over a decade, and that increase in fill rate came largely from U.S. seniors. I think that's a good start.

I'm not sure that is the correct analysis of the situation. I think this might be a more accurate assessment. To each his own on how to look at the provided data:

IMHO the article is a propaganda piece.
Look carefully at the match results:
http://www.nrmp.org/data/advancedatatables2008.pdf

Allopathic schools have been markedly increasing enrollments ( http://www.aamc.org/data/aib/aibissues/aibvol8_no2.pdf) and there are now more U.S. seniors than ever entering the match. Also see Table 7 of NRMP data
So with increasing enrollments it would not be surprising to see some increase in the raw numbers of US students going into FM.
However, lets look at the percentage of US senior medical students going into FM (see Table 10)
2004 1185/13572 = 8.7%
2005 1117/13798 = 8.1%
2006 1123/14059 = 8.0 %
2007 1096/14201 = 7.7 %
2008 1156/14359 = 8.1%
IMHO, to call this an upward trend in interest in FM among US medical students is laughable at best and downright deceitful at worst.

Other factors to consider as we go forward:
1) Osteopathic medical schools have been markedly increasing enrollments and there are more osteopathic students than ever entering the match.
2) There is a trend of more IMGs entering the match.
3) The number of PGY-1 residency spots has gone up proportionately less than the medical school enrollment increases (the funding for residency slots is capped by Medicare) - 21192 PGY-1 spots in 2004, 22240 PGY-1 spots in 2008 (see Table 7)

So basically you have a larger number of candidates than ever competing for a proportionately decreased number of spots. This means each and every residency slot has a higher likelihood of filling. You should expect that overall match rates will continue to rise in the future due to the med school enrollment increases.

Excellent analysis of the numbers, statistically it seems like the percentage of US graduates entering family practice residencies is almost flat, unless you call an increase of 7.7% to 8.1% a trend, I guess then the 8.7% of U.S. med students entering Family Practice in 2004 was a Golden Age of Family Practice for PDs! It seems like the authors of the article were trying to say that Family Practice is now becoming a "hot specialty" for U.S. graduates perhaps trying to recruit more medical students into family practice or to improve its image? Despite the aging and growth of the U.S. population the absolute number of people entering family practice has decreased by about 500 spots since 1997 in the U.S. . . . it leaves me to wonder if some of the so-called "physician surplus" is a self-manufactured crisis to increase the job opportunities for newly graduated family practice residents. The article does talk about the excellent job opportunities available:

"Family medicine and other primary care specialties have ranked tops in the number of recruitment requests fielded by Merritt Hawkins, a national physician recruitment firm. The company's report, 2007 Review of Physician and CRNA Recruiting Incentives, (17-page PDF; About PDFs) showed an 84 percent increase in demand for family physicians since 2003-04 and an 11 percent increase in FP compensation offers from 2005-06 to 2006-07. Moreover, signing bonuses for primary care physicians are virtually universal, the report said."

I think that this demand is because there is such a shortage in hard-hit areas, so I think it is weird that the article at the same times extolls the benefits of more pay & bonuses (etc. . . at the expense of having regions that are chronically overstaffed and desperate) while also acknowledging that 4,000 FP residents a year need to be produced. I wonder if they really plan to increase family practice residency PG-Y 1 spots? It will be great I think if the government helps make more healthcare available to more people, . . . but where are the doctors going to come from? Maybe there isn't really a physician shortage in primary care, but the number of bonuses and such seem to show that there is. . . judging by the number of residency slots that were lost over the last 10 years Family Practice has been the Incredible Shrinking Specialty!

Year Total Number
. . . .of Family Practice
. . . . Positions

1997 2,905
1998 2,814
1999 2,697
2000 2,603
2001 2,363
2002 2,357
2003 2,239
2004 2,273
2005 2,292
2006 2,318
2007 2,404

At this rate I think that even if 100 new positions were created a year, it will take until 2012 just to get back to 1997 levels of Family Practice Residents graduated each year . . . the most I've seen similar residencies add positions nationwide is about 40 positions a year, so it will take them until maybe 2024 to just inch back to near 3,000 . . . in 2000 there were over 281 million people in the U.S. today:

Based on a population clock maintained by the U.S. Census Bureau, the current U.S. population, as of 11:13 GMT (EST+5) March 13, 2008 is 303,622,602.[8] The US population is meant to increase by one third by the year 2050.

So about a 8 percent increase in the U.S. population from 2000 to 2008, roughly the 1% per year growth of the population, however, also should be factored in older patients who will need more visits and care and also expanding healthcare coverage and maybe the number of patients needing doctors is really increasing faster than anyone thought . . . I don't think increasing the number of M.D. or D.O. students in the U.S. will help the problem per se as foreign trained doctors fill the remainder of any
family practice spots that are left in the match, therefore there should be an effort to increase residency spots and then worry about how many U.S. grads are entering the field

 

[HarveyCushing]

As for loans, well, I have them too. But I think it's also time for people to start being responsible about those loans. Who doesn't take the max out in loans? Not many. If people choose to go to more expensive private or offshore schools versus state schools, and always take the max in loans (how about working for a few years before medical school and saving some money--do we always have to dive straight in after undergrad?), they should expect to have to work harder to pay those back. There are also numerous repayment programs (for many specialties, but there are lots for primary care), some of which will repay your ENTIRE loan in exchange for a few years service. There is also the military.

I'm just tired of the whining about loans as a reason not to go into primary care. We are in charge of how much we borrow and essentially, whether or not we choose to attend a more expensive medical school. I saw plenty of folks in medical school taking all of the offered loans and yet also taking some very nice vacations with that money every year. Then they whine about how they can't do primary care because their loans are so big. I'm not passing the tissues on that one.

No offense but I have always enjoyed what you have written in the past but I have to respectfully disagree with you on this. As a medical student going to a private medical school I can assure you that I am doing as much as I can to limit my educational debt. However when you put in my undergrad loans, health insurance, care insurance, rent, food, books, gas....etc. it adds up. Especially for someone that doesn't get support from my parents or have a significant other that works. You are also forgetting the cost of USMLE/COMLEX, travel costs for step II, cost of interviewing/application for residency. I am sure you realize this since you have been through it. But to say that loans shouldn't be a reason to question about going into PC is not good advice imho. I will most likely be $240-250k in debt by the time I enter residency. Add residency time and interest and that sum starts growing quickly. This is all with me eating Raman, rice/beans, cereal during med-school and college. Not even close to the high life if you ask me. Throw in a mortgage after residency, new car and things start getting tight on $150k. That is the reality of it.

I have looked head over heels for these so called "areas that will pay off your entire student loans for a few years of service" and have come up empty handed. I have been searching since last spring. The best non-gov. (i.e. HPSP/NHSC) program that I have been able to find is state funded programs that will offer $30k per year for 3yrs. Better than nothing, but that is a small drop in the bucket with +$300k in student loans. So all of these magical programs in rural areas are not as abundant as people on sdn have made them out to be. So you can see where a $150k salary starts becoming an issue when you have +$600k in loans (~$300k for school, ~$300k for house/car). While I wasn't a business major in college, I took enough business classes to realize that this is going to be hard to do financially. Ask any of your friends that went to business school.

With the way the economy is going and states/fed gov. having their own financial issues, I doubt there will be many of these financial incentives by underserved areas to draw in physicians. If the state that I spoke to (very underserved in regards to ratio of population to physicians/size of state) can only offer $30k a year, that is very sad. While I really like FM, it is clear that something needs to be done about the wages of FP or the rising cost of medical education. I doubt anything will be done about either.

 

[HarveyCushing]

Bottom line: keep up your membership in AMA and/or AOA, vote, do well by your patients and your staff, pay your bills, and don't waste money. And try to chill, friends. The sky isn't falling.

I don't have on rose-colored glasses, but at the same time, I guess because I've got some years of living under my belt before coming to medicine...what matters to me is my health and happiness and that of my family and friends, and that I am doing good work that means something.

So at what point is the sky falling? For too long the AAFP & ACOFP have sat by and done nothing. AMA/AOA are also to blame for the decreasing reimbursement of physicians. However while other specialties have fought for themselves AAFP/ACOFP haven't done much. So what point is the sky falling? Decreasing reimbursement rates for the past decade seems pretty dim for me. The rising cost of medical school education looks dim to me. Maybe the ski isn't falling yet, but it sure looks bleak to me.

I completely agree that knowing you do a good work and make a difference everyday is very important. However as physicians we also have this other responsibility of paying back our loans.

 

[dr aaron]

No offense but I have always enjoyed what you have written in the past but I have to respectfully disagree with you on this. As a medical student going to a private medical school I can assure you that I am doing as much as I can to limit my educational debt. However when you put in my undergrad loans, health insurance, care insurance, rent, food, books, gas....etc. it adds up. Especially for someone that doesn't get support from my parents or have a significant other that works. You are also forgetting the cost of USMLE/COMLEX, travel costs for step II, cost of interviewing/application for residency. I am sure you realize this since you have been through it. But to say that loans shouldn't be a reason to question about going into PC is not good advice imho. I will most likely be $240-250k in debt by the time I enter residency. Add residency time and interest and that sum starts growing quickly. This is all with me eating Raman, rice/beans, cereal during med-school and college. Not even close to the high life if you ask me. Throw in a mortgage after residency, new car and things start getting tight on $150k. That is the reality of it.

I have looked head over heels for these so called "areas that will pay off your entire student loans for a few years of service" and have come up empty handed. I have been searching since last spring. The best non-gov. (i.e. HPSP/NHSC) program that I have been able to find is state funded programs that will offer $30k per year for 3yrs. Better than nothing, but that is a small drop in the bucket with +$300k in student loans. So all of these magical programs in rural areas are not as abundant as people on sdn have made them out to be. So you can see where a $150k salary starts becoming an issue when you have +$600k in loans (~$300k for school, ~$300k for house/car). While I wasn't a business major in college, I took enough business classes to realize that this is going to be hard to do financially. Ask any of your friends that went to business school.

With the way the economy is going and states/fed gov. having their own financial issues, I doubt there will be many of these financial incentives by underserved areas to draw in physicians. If the state that I spoke to (very underserved in regards to ratio of population to physicians/size of state) can only offer $30k a year, that is very sad. While I really like FM, it is clear that something needs to be done about the wages of FP or the rising cost of medical education. I doubt anything will be done about either.

The state of south carolina will pay $25,000 per year for up to 7 years for educational loans, you need to keep looking, thy are out there.

 

[sophiejane]

I understand all that, Harvey. I really do. I was simply trying to make the point that when we are applying to medical school, we just can't wait to get in...anywhere...we don't think about private vs public...we don't really even consider what it will mean to be $250K in debt. We just want to be docs.

The NHSC Scholars program is one that will reimburse you and basically pay for everything just like the military, but you have to sign up BEFORE medical school and you owe them year-for-year, just like the military.

I'm not accusing you of being a spendthrift, but--and this particularly applies to DO schools--I don't think many people consider the tremendous financial burden of going to a private school. I guess if we did, and we understood how it will affect the very specialty we choose in the future, we might reapply and try for a state school (though I know even some of these are high), or apply for military or NHSC scholarships . I was very fortunate to have 7 state schools to apply to on one common application, and I know most people are not in that boat.

I just find it hard to be terribly sympathetic when here we are, in the top probably 1% of high-functioning individuals, and most of us make these decisions about where to go to medical school and how to pay for it based on very little consideration about what it will mean for our future. I am not pointing individual fingers, mind you, we are all guilty of this to some degree.

At some point, we need to take some responsibility instead of complaining about how little FPs earn and how much debt we have. We knew how much it would cost, we knew how much we would have to borrow (we all attended those classes before signing on the dotted line for our loans), and we had a pretty good general idea of the range of earnings for doctors in different specialties. We all took calculus and statistics and we could have done the math, even if we chose not to at the time.

So, we fell in love with FM with all of its uncertainties and admittedly too low compensation. No one forced us to go to medical school, borrow the money, or become FPs. I think it's time to just suck it up, which is what I am doing with my debt and my decisions. I came into this eyes wide open, as I hope the rest of us did as well.

I do think that improving the compensation for FPs would attract more people to the specialty. But in the meantime, I also think if you love it, you will find a way to make it work. By the world's standards, even with my resident's salary, even with my debt, I am unimaginably wealthy, and have a pretty darn cush way to make that money.

 

[VuDOo]

Throw in a mortgage after residency, new car and things start getting tight on $150k. That is the reality of it.

So you can see where a $150k salary starts becoming an issue when you have +$600k in loans (~$300k for school, ~$300k for house/car). While I wasn't a business major in college, I took enough business classes to realize that this is going to be hard to do financially. Ask any of your friends that went to business school.

Who says you have to drop $300K on a home and car right after finishing residency?

 

[HarveyCushing]

Who says you have to drop $300K on a home and car right after finishing residency?

That was just a rough estimate including brokerage fees, closing costs, loan origination fee..etc. ($250K house, $20k fees, $25-30k car). Not sure where you live but $250K doesn't buy much of a house where I am. Also rather than putting in $800-1000 in rent a month, I think it is a wise decision to begin putting that money towards a mortgage. You can criticize the numbers, but the concept that I am trying to portray you can't.

 

[sophiejane]

Who says you have to drop $300K on a home and car right after finishing residency?

Who says you have to buy a house, period? Plenty of residents and even young doctors rent, there is no shame in that.

Again, we make these choices. You want to live where crackerbox houses cost $250K, you deal with the debt you will incur to do so.

 

[HarveyCushing]

Who says you have to buy a house, period? Plenty of residents and even young doctors rent, there is no shame in that.

Again, we make these choices. You want to live where crackerbox houses cost $250K, you deal with the debt you will incur to do so.

Whether you put your money towards a mortgage or put it towards renting an apartment/condo/townhouse you will still be spending money each month to have a roof over your head. I'm not saying any one has to buy a house or rent, but a lot of people will buy a house once they complete their residency or even while in it. So to say that having a mortgage is a non issue for someone wanting to go into PC is totally faulty logic. If you don't want your own place that is fine, but I think most people would like to have their own house once they are done with residency. As a result that is something for students to consider along with their student loans when looking at residency.

 

[HarveyCushing]

The state of south carolina will pay $25,000 per year for up to 7 years for educational loans, you need to keep looking, thy are out there.

Any links for this or other programs?

 

[HarveyCushing]

Again, we make these choices. You want to live where crackerbox houses cost $250K, you deal with the debt you will incur to do so.

That is the same attitude that has gotten FPs where they are. Watch reimbursement rates drop and do nothing about it. "Hey if you don't like what you are getting reimbursed you don't have to practice medicine." That is a poor attitude to take in a profession that you should be proud of and take care of so future physicians don't have to deal with what we have to deal with.

 

[andwhat]

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[sophiejane]

That is the same attitude that has gotten FPs where they are. Watch reimbursement rates drop and do nothing about it. "Hey if you don't like what you are getting reimbursed you don't have to practice medicine." That is a poor attitude to take in a profession that you should be proud of and take care of so future physicians don't have to deal with what we have to deal with.

You are missing the point of what I was trying to say. I keep saying I agree we need better reimbursement, and I keep active memberships in the AOA and AMA and I vote and I do everything in my power at this point in my life while I am an intern and a wife and a mother and trying to keep it together...I can't fix it myself right now, but I can accept what I have chosen, and know that I went into in with full disclosure of what I was getting myself into. I don't think whining is going to solve the problem. I do think I can accept my decision and do everything in my power to make a good life for me and my family and do my best to be proactive in my profession to help bring about positive change.

What have YOU done lately to help keep reimbursement rates from declining, sir? Now is my chance to roll my eyes. Please. You are still a medical student. Talk to me when you are in the trenches.
Just because I'm not jumping up and down stamping my feet and whining about how little I get paid and how much I owe does not mean I am not proud of my profession. And it is in fact my profession, however, it is not yet yours, and you still have time to find something else to do.

I guarantee you it won't be fixed by the time you or I are in practice, so what I'm saying is that if you come into this field, you better get used to how things are now or you are going to be an unhappy camper for some time to come. Again, this doesn't mean I am throwing up my hands and giving up. On the contrary, I am taking responsibility for the path I have chosen and doing what I can to make it better.

 

[andwhat]

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[HarveyCushing]

There is no point at all of going into FM, if the salaries and reimbursements do not follow logistical lines. If you work hard, you should get rewarded for it. Family Medicine is a lot of work, and not at all alot of money comparatively.
I read a job offer the other day, that offered physicians student loan assistance. Interestingly, it excluded Primary Care specialties. Alot of appreciation there, thats really nice.

+1. One of my mentors as a pre-med was a FP. I shadowed him quite a bit over the 4yrs of college. I learned a lot from him about how medicine works and just how an office functions. He was really open with me about everything and mentioned what his salary was. For a guy that had been working in FM for 20-25yrs I was surprised by the figure he mentioned (I think it was ~$150-160k a year, ~50hrs/wk). Basically he topped out his salary with what entry FPs are making. If you notice, the entry salary of FPs stays pretty steady throughout their career. Look at gas/rads, entry of $250-300k and then making $400-500k after 3-5 yrs. It really is sick that FP salaries don't follow logistical lines as "andwhat" mentioned. I love FM, the patient interaction, scope of practice, relationships built with patients, life style..etc. But I am a little hesitant with the reimbursement levels where they are. Have the fed gov. subsidize my medical school education and give me a $130k salary and I would be as happy as a beaver.

 

[sophiejane]

you should be able to live well, and be able to handle debt appropriately.
Family Medicine salaries do not offer any sort of relief from student loan debt. I could work as an Anesthesiologist for two years and eliminate the majority of my debt.
Why is the compensation in Family Medicine so ridiculously poor?

Where is Kent when I need him....ahhh....

Okay, so, what are YOU doing about it? You knew what it was like, you chose it, now you are unhappy, so go out there and do something about it. Run for office, vote, but for Pete's sake, going on and on about how unfair it is will get you nowhere. Again, nobody put a gun to your head and made you do FM.

A little less talk and a little more action, my friends.

 

[andwhat]

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[andwhat]

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[sophiejane]

Sophie I am not just a medical student. Your arguments are very impressive, but seriously, can you swallow everything that is going on right now with Family Medicine?
I think that personally got hit the hardest, when the match statistics came out. That is plain ridiculous. People choosing higher paying specialties, with a much better lifestyle.
Full disclosure? I cannot say that I expected for things to fall this hard, watching my debt loom and loom, and looking at physician reimbursement in Family Medicine.
Your standpoint is a very very mature and respectable one. However, there are several in positions of authority, that are sighing and relieved, that people are just accepting their significantly reduced roles -- comparatively.

I was not addressing you, I was addressing Mr. Harvey Cushing. I am aware you are a resident.

Believe me, we are on the same page. But really, you thought your debt wouldn't grow? You thought somehow salaries might skyrocket by the time you were done with residency? Come on.

I did the math, and figured it was worth it to me. In exchange for being the kind of doc I want to be, and living the life of my choosing, I know I won't be paid what I should--but I also have to power to increase that earning potential with procedures, since I am going to do rural med. I'm not saying I can swallow it or that it is right. I am saying that I accept MY responsibility for choosing this and knowing that change, if it occurs at all, is slow to come, so I better buck up and start dealing with the way things are while I am doing what I can help the situation.

Jeeze I sound like a broken record. I'm done. Point made. Off to study for Step 3 so I can hopefully get a license someday...

 

[HarveyCushing]

I can't fix it myself right now, but I can accept what I have chosen, and know that I went into in with full disclosure of what I was getting myself into. I don't think whining is going to solve the problem. I do think I can accept my decision and do everything in my power to make a good life for me and my family and do my best to be proactive in my profession to help bring about positive change.

Bringing up the reality that FM is in is not winning. First you say that you should do something, then you say you shouldn't whine about things. While I wouldn't call it whining, I believe this is an issue that needs to be addressed. Medical students are not dumb. They realize how much they are in debt. They realize the problems that FM is faced with. So many will choose another specialty just for that reason. Can you blame them? You can work as hard as you want, but with $250k in debt and dropping reimbursement levels it doesn't take much to figure out that FM has troubled water ahead.

What have YOU done lately to help keep reimbursement rates from declining, sir? Now is my chance to roll my eyes. Please. You are still a medical student. Talk to me when you are in the trenches.
Just because I'm not jumping up and down stamping my feet and whining about how little I get paid and how much I owe does not mean I am not proud of my profession. And it is in fact my profession, however, it is not yet yours, and you still have time to find something else to do.

Wow where did the pretentious attitude come from? I always loved the FM forum for the easy going and laid back nature of the members. While I am a medical student that doesn't void my opinion. If anything I am surprised that I as a medical student can see where things are heading and you as an intern can't see that FM is going to have problems in the future drawing US graduates. As a matter of facts I am a member of ACOFP, AOA/SOMA. Whenever I get the emails about Congress voting to pass a bill to lower reimbursement levels for physicians I always call my representative and let him know that I am apposed to such a bill. Besides that and reading as many articles on the topic as I can, there isn't much that I can do. Seems even the government can't/won't do anything about it. So it seems like you are in the same boat as me, can't really do much about fixing it, but at least we can raise our voices and let them know that we are not happy with the way things are.

I guarantee you it won't be fixed by the time you or I are in practice, so what I'm saying is that if you come into this field, you better get used to how things are now or you are going to be an unhappy camper for some time to come. Again, this doesn't mean I am throwing up my hands and giving up. On the contrary, I am taking responsibility for the path I have chosen and doing what I can to make it better.

Why should one be happy with the way things are? AAFP/ACOFP are having issues drawing US grads into FM residencies. It is an issue, and one doesn't have to look too far for an answer to the problem. Your house is on fire, are you going to just stand outside and watch it burn up, or are you going to do something productive and proactive to stop things from being the "way they have always been"?

 

[HarveyCushing]

I am saying that I accept MY responsibility for choosing this and knowing that change, if it occurs at all, is slow to come, so I better buck up and start dealing with the way things are while I am doing what I can help the situation.

You accepted your "responsibility" because you really wanted to do FM/rural. That is admirable, but to say that just because you knew what you were getting yourself into it is okay to accept dropping reimbursement rates is completely irresponsible. Also the added fact that you were able to go to a public medical school and have considerably lesser debt than many graduates also changes the scope of the discussion. To sum up the discussion: Rising cost of medical school education + dropping reimbursements for family physicians= a problem for FM residencies to attract US grads.

Good luck on Step III studying!

 

[andwhat]

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[sophiejane]

Why should one be happy with the way things are? AAFP/ACOFP are having issues drawing US grads into FM residencies. It is an issue, and one doesn't have to look too far for an answer to the problem. Your house is on fire, are you going to just stand outside and watch it burn up, or are you going to do something productive and proactive to stop things from being the "way they have always been"?

You really are not paying any attention to what I have said, so this is going nowhere. You have decided that I am happy with the status quo and disrespectful of my profession, and not doing anything to change it, and you really won't hear otherwise. I keep telling you I am doing what I can while being a resident. I already CHOSE this field, which is the biggest thing I can possibly, personally do to remedy the shortage of FPs. Not only that, I am going to practice in an underserved area. Seriously, what more can I offer as proof?? What would you have me do differently? Am I not complaining enough on SDN about how unfair it all is?

There is a difference between accepting responsibility for the path I have chosen, which includes my debt, and saying things don't need to change. They do need to change. But expecting the medical universe to realign overnight is pretty naieve.

You can be exempt, you are not in it yet. Those of us who signed up for it have no excuse for being surprised at the average FP salary and all of a sudden getting indignant because the end of residency and the beginning of repayment is staring them in the face and lo and behold, reimbursements and salaries are pretty much the same!

Of course we know the answer is better pay, you are not really revealing a great truth there. But I can tell you, having just finished reviewing applicant files, there are some extremely qualified folks choosing FM because they like the lifestyle and the job.

No, really. I'm really out this time...