Hello all, I'm a 3rd year med student, new to the forums although I've been reading threads for quite some time now. I'm at the end of my 3rd year now, trying to pin down my specialty decision. At this point, it's most likely between Family and Med-Peds, althought I wouldn't say I've ruled anything out completely. I have enjoyed most all of my other rotations as well and have also strongly considered OB/Gyn and Surgery while on those rotations. However, I feel that I enjoy spending time talking with patients and working on diagnosis too much to do a surgical specialty, although I do enjoy procedures. Because I have enjoyed just about everything, I feel that Family Med would be a natural choice. However, I have several barriers and concerns that keep me from feeling completely comfortable with that choice. Many of them are discussed elsewhere on the forum but I was hoping to get some individualized feedback from the people here and have some discussion. Also, I'm not trying to be inflammatory with any of these comments, and I'm certainly not trying to be offensive. 1. Concern about the future of family medicine and primary care. I realize that there are abundant arguments backed up by good evidence for the importance of family medicine and primary care in general to the future of medicine in this country. That being said, we seem to be at or approaching an important juncture where the US healthcare system will either allow primary care to continue to dwindle and move towards total specialization, or make substantial changes to reimbursement to favor the growth of primary care. I know what I and presumably everyone here thinks (knows) is the better option. But in politics, what is rational or even evidence-based is not necessarily what ends up happening. I realize that no one has a crystal ball, but this is a source of significant worry to me in deciding between primary care or more specialized residencies. 2. Uncertainty about the future of family medicine in the context of primary care. Assuming primary care survives and thrives in the next several decades, will the field of family medicine remain tenable? Based on my limited experiences thus far, it seems that the family physician performs almost the exact same outpatient work as a general internist, a general pediatrician, and also performs the primary care side of OB/Gyn (including high risk OB and even Cesareans in some cases). I suppose in theory each of these other specialists has slightly more expertise than the family physician, but in reality, I would guess that 90-95% of the problems they treat are identical. As medical knowledge continues to expand at an exponential rate, is it really plausible to keep up in these fields, or will primary care itself be forced to "subspecialize"? It already seems difficult to convince parents to use an FP instead of a pediatrician, or for women to use an FP for their routine OB/Gyn issues. And why should they necessarily? I realize that there is value in continuity of care, but given the fact that so many patients self-refer to specialists, is this continuity really that important to patients? And as far as coordination of care across specialties, is this really something that requires an MD to do, or could this function be provided by mid-levels? 3. Reimbursement, or "Why make less when you could make more?" You can't escape this thought. Even though I wouldn't enjoy being a radiologist nearly as much, I might be able to live with it given the lifestyle that it would buy me. It's the whole work-to-live vs live-to-work issue that I haven't totally sorted out yet. On the other hand, if major changes in reimbursement do occur in the next few years-decades, the income gap between primary care and specialists may get smaller. 4. Ego. There is an unmistakable, although generally unspoken sentiment out there that family medicine is for the bottom tier of medical students. I don't agree with it at all; we obviously need excellent physicians in primary care. But it is present nonetheless. As someone who has the grades and scores to do something more competitive and more lucrative, many would look at me and say "Why on earth would you do primary care?" I know that the answer to this is "because it's the best fit for me," but it's still difficult to have to constantly defend this. 5. Practice location. It seems that family medicine thrives in more rural settings. But is it possible to have a broad and diverse practice, including OB and procedures in an urban setting? I plan on having a family someday and I feel that I would want my kids to have access to a wide variety of opportunities that may only be present in urban settings. Those are the concerns that have been on my mind lately. I truly appreciate anyone who took to the time to read this and respond. Thanks.