Thoughts on GP/Family Medicine/Hospitalist paths

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RNtoMD87

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Any thoughts on whether these are "good" fields to go into all else considered? I would enjoy them based on the patient populations, but what about taking other factors into account?

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Any thoughts on whether these are "good" fields to go into all else considered? I would enjoy them based on the patient populations, but what about taking other factors into account?
Everybody that's into primary care early on doesn't realize how much better speciation fields can be wrt hours, pay, interesting work, etc. Hospitalist work is a brutal, challenging juggling act where you are functionally a slave to hospital management. Either field can be rewarding if they work with your personality, but there is a reason few third years are clamoring for spots in outpatient general medicine or as hospitalists
 
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The main thing I like about GP is that I could live on my farm a couple hours away from the big city, and even with less pay I have few expenses and could easily live within my means. Ive been told many times "Its not worth it not to specialize" but my cousins wife is doing it, and sounds very convincing in her reasons why.
 
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The main thing I like about GP is that I could live on my farm a couple hours away from the big city, and even with less pay I have few expenses and could easily live within my means. Ive been told many times "Its not worth it not to specialize" but my cousins wife is doing it, and sounds very convincing in her reasons why.
If you're the sort of person who finds joy in longitudinal personal relationships, then private practice general Internal Med or Family Med is a good path. If you can be satisfied with intense, but brief patient encounters (where you never know the "end of the story"), or prefer shift work, then hospitalist would work. You can do either with the same residency training.
 
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I guess ill just have to wait and see if it will be enough to interest me. Its really difficult weighing career satisfaction with relationships and outside of work. Balancing work has always been my hardest pursuit in life.
 
Don't forget about EM. A county emergency room in the middle of North Dakota would allow you to live on your farm. Potentially hundreds of miles away from any specialty or trauma center, you'd also be the go-to for anything emergent
 
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Any thoughts on whether these are "good" fields to go into all else considered? I would enjoy them based on the patient populations, but what about taking other factors into account?

“Good” is relative and primary care doesn’t typically rank high among all fields within medicine. There are many reasons for that which can be pulled up online with a quick search. Have you completed all your core rotations yet?


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Well I know they don't particularly pay as well and that is a large factor that people consider.

I have not completed premed yet. The only knowledge I have is from what I've seen as a Registered Nurse in 3 years time, speaking to SDN members, and a few physician friends. I am just exploring my options as early as possible. I realize that once I go to med school I will gain much understanding of different fields that will make it easier for me to choose. I just don't feel it's ever too early to think about it.
 
Most hospitalists do one week on one week off so that's actually a pretty good deal.
Yes, but pulmonologists at my hospital do the same, I'm failing to see any advantages of being hospitality over pulmonology aside from shorter school.
 
Yes, but pulmonologists at my hospital do the same, I'm failing to see any advantages of being hospitality over pulmonology aside from shorter school.

If you look at it in terms of cost. Being a hospitalist means you're earning attending salary after 3 years of residency vs having to do another 4 years of pulm/critical care fellowship where you're only earning resident salary + moonlighting if allowed. So that's about 4 years of lost income or 1 million given the average hospitalist salary is 250K. The average pulm crit salary is 300K which isn't that significant of a difference.

A big reason people choose Pulm would be patient acuity. Hospitalists do the bread and butter pts with CHF exacerbation, pneumonia, etc etc. While Pulmonolgists staff the ICU. Also if you want to be hands on, pulm is better since it's a more procedural specialty. You can do bronchs, EBUS, lung biopsies, VATS, central and alines in the ICU. So depending on what type of person you are and what kind of patient population you want to take care pulm could be worth it.
 
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And I could go between PCP and hospitalist easily correct?

I'm looking for specialities that would support being available for my future wife and kids, and allow me to have time on my farm. I don't plan on heavily farming but I do enjoy planting a garden, tending to fruit trees, hunting, landscaping etc.

And I'm 31 and won't matriculate until I'm around 33-34 years old..
 
And I could go between PCP and hospitalist easily correct?

I'm looking for specialities that would support being available for my future wife and kids, and allow me to have time on my farm. I don't plan on heavily farming but I do enjoy planting a garden, tending to fruit trees, hunting, landscaping etc.

And I'm 31 and won't matriculate until I'm around 33-34 years old..

Well, although you're doing and approaching the same problems as a PCP and hospitalist the major difference is again acuity. As a PCP you're mostly doing outpatient clinics, med adjustments, tuning the pts HTN and referring out to specialists for more complex issues. The patient's medical issues tend to be more stable. Hospitalists are by nature only staffing hospitals and by virtue of being in the hospital you'll be dealing with those health issues when they're having an exacerbation. Like a patient with hypertension having a hypertensive crisis or a patient with heart failure acutely in exacerbation or the patient with COPD having an acute attack and can't breath. So, the mental mindset is different.

Hence, as a hospitalist you have to be more aware what the next step in intervention is. I remember when I was still an intern we would have the outpatient clinic guys staff our medicine teams during the weekends and they're often very clueless or scared since they aren't experienced dealing with acute issues. Any acute problems that arise in the clinics they send the patient to the ER or hospital to be admitted. It doesn't make them worse, it's just that they're focus is slightly different and when you don't deal with these problems on a consistent or daily basis you're just not comfortable. So this is all to say that switching back and forth from PCP to hospitalist may not be as easy as one may think.
 
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I'm not too stuck on acuity. I find pretty much anything with some depth interesting. This is the sole reason I'm leaving nursing and don't have interest in NP.

I would like to suffer through some harder experiences to temper my knowledge and become a "better doctor", but as I get older be able to just relax and not have as much career demand.

But yes, what you say makes complete sense. I had anticipated this to an extent. If anything, I would work as a hospitalist first and later on move to PCP.

The dilemma is I had to move to baton rouge in order to work as a nurse at a facility I enjoyed working at. However, I have a 84 acre farm about an hour and 45 minutes away that I long to return to. And my girlfriend is 30 with a 4 year old child and we plan on settling down when it is feasible.
 
Unrelated note- just learned a lesson I can remember as a resident

Fellow nurse had a resident for ENT tell her to call the Attending CCMS to discuss something, said CCMS attending is furious, and says this shows a lack of professionalism, and is abusing the nurse, himself, and the patient. That the resident should have contacted him directly physician to physician.

Ill have to make sure never to do that.
 
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