Thoughts?

[Tn Family MD]

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I recently read this article and was wondering what everyone else thought about this.

http://www.aafp.org/online/en/home/publications/news/news-now/resident-student-focus/20060920moretraining.html

I have long been a proponent of lengthening the FM training period to four or even five years. At least for full spectrum FM. I think the time has come for FM to split up into full spectrum FM and limited FM. Limited could consist of basically IM and Peds type stuff with the same three years of training that we currently have. Full spectrum could be lengthened to four years and keep OB training or even five years and expand some of the surgical training. With a four year curriculum, we could require that full spectrum FM include C-section skills and post-partum BTL skills. If we went to five years, we could include more training in things like endoscopy and simple surgeries like appy's and chole's as requirements. What does everyone else think?

 

[andwhat]

I recently read this article and was wondering what everyone else thought about this.

http://www.aafp.org/online/en/home/publications/news/news-now/resident-student-focus/20060920moretraining.html

I have long been a proponent of lengthening the FM training period to four or even five years. At least for full spectrum FM. I think the time has come for FM to split up into full spectrum FM and limited FM. Limited could consist of basically IM and Peds type stuff with the same three years of training that we currently have. Full spectrum could be lengthened to four years and keep OB training or even five years and expand some of the surgical training. With a four year curriculum, we could require that full spectrum FM include C-section skills and post-partum BTL skills. If we went to five years, we could include more training in things like endoscopy and simple surgeries like appy's and chole's as requirements. What does everyone else think?

granted being a resident and part of a residency program is nice because you are somewhat "protected" and can always staff things that are unclear, and do procedures with faculty. I think that three years is enough actually. I think that more than three years would be monotonous. Should be lengthened for people that want more Ob experience, which I would never ever want. Yipes! 😱 can you even just imagine a whole year of Ob what a nightmare man

 

[Tn Family MD]

Then you would be perfect for my proposal of a limited FM program that does three years of nothing but IM and Peds type stuff, no?

 

[FPforLife]

I think it's a decent thought, but only as an option not a requirement. I think the training you would get in the fourth year would have to be one that would add to your earning capability. There are already a number of fellowships for family docs, and UofA's program just sounds like fellowships to me. I really don't see this as a 4 year program but really a plus 1 year.

Also the viability of doing OB as a family doc in many parts of the country is limited. The malpractice is just to great if your not delivering a tone of babies. Like I said it's a good thought but really would have to be worth it. For Me three years is great and then CME courses for additional procedures.

 

[sophiejane]

As much as I hate the idea of FM splintering off and becoming more specialized, it's already happening with sports med, OB, and EM fellowships...which are a good thing, don't get me wrong, but are we shooting ourselves in the foot by chipping away at the time-honored profession of the medical generalist?

 

[deleted6669]

as someone thinking about going back to school to do family med I can see the appeal of a 4 yr program. I had been looking at combined 5 yr fp/em(DO) programs but if I could do all electives 4th yr in an fp residency in surgical/high risk ob, general surg( say uncomplicated appys), trauma, em, and rural medicine I would take that option over a 5 yr program as it would meet all my needs.

 

[andwhat]

Then you would be perfect for my proposal of a limited FM program that does three years of nothing but IM and Peds type stuff, no?

IM and Peds nice, would like more exposure to procedures, and EM type of stuff though. that would be better. I mean Urology and Opthalmology and Radiology rotations what the heck is the point of that man... Gyn is horrible but I can understand it bc of Ob at this very moment...

 

[deleted87716]

I think three years is fine. This "optional" fourth year is essentially a fellowship. It would make more sense to call it what it is, IMO.

 

[drwatson]

I think 3 years is fine too but it seems to me that the months spent in Surgery and OB could be better spent on Peds, Elective, additional IM spec. training (Cardio, GI, blah blah). I just don't see many family docs spending much time in the OR anymore so why spend all those months in Surg when it seems like they can be much better used.

Am I off base here?

 

[iatrosB]

I think 3 years is fine too but it seems to me that the months spent in Surgery and OB could be better spent on Peds, Elective, additional IM spec. training (Cardio, GI, blah blah). I just don't see many family docs spending much time in the OR anymore so why spend all those months in Surg when it seems like they can be much better used.

Am I off base here?

That very reasoning is why I'm even considering Med/Peds instead of FP. But Med/Peds is too inpatient focused for my tastes and doesn't provide enough experience in office procedures, so it's a toss up at this point. I just don't see myself using OR and OB experience in practice. But I don't forsee any curricular changes unfortunately

 

[andwhat]

That very reasoning is why I'm even considering Med/Peds instead of FP. But Med/Peds is too inpatient focused for my tastes and doesn't provide enough experience in office procedures, so it's a toss up at this point. I just don't see myself using OR and OB experience in practice. But I don't forsee any curricular changes unfortunately

way on base man those two months were long, fun but long. I mean theres a common misperception, coming out of residency my preceptor said "I used everything that I learned in residency, not anything that was not worthwhile" I beg to differ, spending hours and hours like a surgery resident, slaving till 4 am in the OR knowing that it isnt something that I will be doing in the future, pure waste at times man. Agreed wholeheartedly.

 

[iatrosB]

way on base man those two months were long, fun but long. I mean theres a common misperception, coming out of residency my preceptor said "I used everything that I learned in residency, not anything that was not worthwhile" I beg to differ, spending hours and hours like a surgery resident, slaving till 4 am in the OR knowing that it isnt something that I will be doing in the future, pure waste at times man. Agreed wholeheartedly.

Would you still pick FP over med/peds if you had to do it over again? I like everything about the FP training (length, broad scope, procedures, outpatient focus...). But OB/OR time is hanging me up. What do you think?

 

[medicineman1]

I dont know any FPs nor have I seen any doing OB/surgery for that matter- in my 3rd, 4th years of med school, during internship, or during early part of PGY2- I guess its one of those right of passage things, and the exposure doesnt hurt.

 

[deleted6669]

agree about the surgery but lots of places still have fp doing ob on low risk pts. most of the groups around here have fp doing" simple deliveries" with ob backup available for sections. the avg fp who does ob up here does at least 2-3 deliveries/month to keep credentialed.

 

[andwhat]

agree about the surgery but lots of places still have fp doing ob on low risk pts. most of the groups around here have fp doing" simple deliveries" with ob backup available for sections. the avg fp who does ob up here does at least 2-3 deliveries/month to keep credentialed.

med peds is cool, but FP, our residency program that is, it has daily clinic, I kind of like that about our program, exposure to tons and tons of patients. Averaging 6 to 10 in second year daily in clinic, although first year clinic is very light in clinic usually, due to our other extremely hectic obligations. First year call was the worst man.
IM/Peds is cool, but no the IM aspect of it would drive me nuts too, almost all hospitalist stuff. I like outpatient and procedural work as well in the clinic.
Ob blows man, horrible, have nightmares of that place, dry cafeteria food, rude as hell disrespectful nurses, a bunch of pregnant ladies that would just not deliver and were stuck on 6 to 7 cms and I had to do cervical checks all freakin night. And then at the end of the shift she delivers like two hours after my 24 hour call, pure waste of time man. Unfortunately I have to have a certain number of deliveries in order to graduate. On top of that our preceptor he is such a jerk on call.
The OR Surgery aspect of it, its cool actually, but I agree that there should be more emphasis on consults and hospitalist type of work. Dont get me wrong though, I loved the OR for some odd reason. Procedures are amazing. But could never do a grueling Surgical residency. The hot girls are in the hospital and clinic, not the OR and for sure. J/k of course that last sentence, but just being in the OR your whole life that would be tough in my opinion. Pays quite well, but naw thats just too boring. Aside from the clinic aspect of it, just couldnt do it.