Trying to decide between FM vs. EM-- please help

[Chas99]

Hey guys,

I'm at the end of my 3rd year, and I am having a VERY hard time deciding between Emergency med vs. Family med-- please offer any words of wisdom.

I had pretty much decided on Emergency, but then I started my Family clerkship, and I am enjoying it way more than I expected. I did 2 months in a level 1 trauma ER, and I really liked the constant stimulation, having tons of things going on at once, procedures, but I also found myself following up on several patients after admission to see what happened to them. In my family clinic, patients are generally healthy. It's way different to see a type II diabetic taking an active role in managing his glucose versus. the necrotic foul-smelling diabetic feet that came through the ER daily.

I love interacting with patients of all ages, I find it very rewarding. But I also like the shift-work of the ER (no call).

Yes, I'm a lost soul right now. Unfortunately I'm in med school amongst a mecca of specialists, and the opinion of family practice here is pretty low, it's seems to be the running joke of many of my classmates (the option if all others fail). So, I am really limited to obtain advice.

I really appreciate any counsel you may have, in favor or in opposition to either choice. Thanks.

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[JudoKing01]

I think if you like the er lifestyle but you want more of a continuity of care, family might be good for you. True, I don't have the experience of some of the others on this forum, who will hopefully give you some advice, but I'd think that FP isn't exactly a call heavy residency, and then after residency, your call schedule depends on how you practice. You have a lot more control than in say Gen. Surg. or even IM I'd think.

Plus, as a FP you could still deal with emergencies, especially in rural areas, and you might even get to do more.

 

[SansaStarkMD]

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[akilysa]

In Family medicine there is a lot of control over what your schedule is. I have known family physicians who worked shift work acute care, who worked shift work on L&D, who just ran a 9-5 office clinic, who did shift work with inpatient, or some mix of the above. There are so many jobs and opportunities out there that after residency, I think you can really pick and choose the lifestyle that works best for you.

If you like the idea of preventative medicine and following up on patients, FM is a good choice. That was what bothered me the most about the shifts I have done on EM (you end up seeing a lot of patients that have been failed by the system and keep coming to the ER for management of conditions that should be managed by primary care, and the EM docs do not have the bandwidth normally to do much follow-up of these patients). They just have to be stabilized acutely and sent out even if that means they will be back next week.

In FM on the other hand, you are seeing people and preventing them from having to go to the ER in the first place.

I also went to a medical school that was not appreciative of FM and so had to really seek advice outside of my medical school faculty. It is good to go to the FM conference in Kansas City to see what FM looks like in other parts of the country where it is respected, and FM physicians take care of complex patients in the same ways that an IM doctor would, etc.

On the other hand, if you know for sure you want to work in the Emergency Room / want to do trauma, EM is probably better. There are a lot of FM-trained people that work in EM but you will get better EM training with an EM residency.

 

[simpler2]

"I had pretty much decided on Emergency, but then I started my Family clerkship, and I am enjoying it way more than I expected. I did 2 months in a level 1 trauma ER, and I really liked the constant stimulation, having tons of things going on at once, procedures, but I also found myself following up on several patients after admission to see what happened to them. In my family clinic, patients are generally healthy. It's way different to see a type II diabetic taking an active role in managing his glucose versus. the necrotic foul-smelling diabetic feet that came through the ER daily."

If you work with impoverished populations, you will see much more advanced pathology on a regular basis and your patients will be far from 'generally healthy'. In my FQHC practice, I get to see people that should be admitted along side folks just in for refills on a daily basis.

"I love interacting with patients of all ages, I find it very rewarding. But I also like the shift-work of the ER (no call)."

Myself and most people I know in FM don't really take call beyond answering a few phone issues 1-2x monthly.

"Yes, I'm a lost soul right now. Unfortunately I'm in med school amongst a mecca of specialists, and the opinion of family practice here is pretty low, it's seems to be the running joke of many of my classmates (the option if all others fail). So, I am really limited to obtain advice."

In my community, the specialists often feel the need to mumble what they do, not those in Family Medicine. I think their is a recognition that primary care here is extremely difficult and requires significantly greater knowledge base to do well than most specialty care. My med school was similar. I recommend ignoring the opinions of students and residents as they really lack experience and insight to know what any medical specialty is really like.

 

[Merely]

FM works 9-5 and makes 200k+ in a nice office setting with no call, very little stress, etc. Am I missing something or should this be like really competitive?

 

[SansaStarkMD]

FM works 9-5 and makes 200k+ in a nice office setting with no call, very little stress, etc. Am I missing something or should this be like really competitive?

Shhh lol.

 

[FrustratedFamDoc]

FM works 9-5 and makes 200k+ in a nice office setting with no call, very little stress, etc. Am I missing something or should this be like really competitive?

I wouldn't exactly say no call. I am on 24 hour call for my patients mon-thurs and up to lunch on Friday. I am in a pool with 5 other family docs and do call 1 in every 6 weekends. It is only phone call so it's not bad at all. I've yet to be called after 11 pm.

Very little stress is also not entirely correct. The more and more the .gov intervenes in primary care, the more stressful it gets. They've been doing a lot of that here lately. Double that when you work for a hospital system. Secondly, as much as you would like to just be the medicine man at times, you're often forced in to the role of social worker, DME pimp, counselor, and family arbitrator. Some patients will want you to be their dope man. Good psychiatry takes time that you often don't have to give. There are other options besides working for 'the man,' but that's where most of us are at these days. There's more that I'd like to say but I've got to do a 9 page mandatory Cigna Healthstream 360 assessment on a patient.

 

[SansaStarkMD]

What is a Cigna health stream 360? Sounds like some BS created by people who shouldn't have a job and got bored.

 

[FrustratedFamDoc]

So yesterday at my office I coined a new phrase. "No adult left behind."

Similar to what's going in public education, modern government envisioned primary care is very much a nanny state. Check boxes, protocols and surveys. Medicare and some private insurance companies are requiring an annual 'wellness assessment' for all their participants. We have to tow the line or risk having our credentialing dropped. Cigna Healthspring is a provider that insists on a 9 page assessment that I have to document every current medical condition a patient has and what my plan is for addressing them, along with listing patient's family history, health maintenance, do you feel safe, depression/anxiety, are you falling, etc. After doing a few they go better but overall it is still arduous and frustrating. If they were helpful in me delivering better patient care I could be more understanding, but all they end up accomplishing is putting me behind on the day.

 

[JonMonkey]

There are opportunities for FM trained physicians to work in ERs after residency. You will not be in a level 1 trauma center but you can still work in small town ERs if you want. Not to burst your bubble but if you ever see a type 2 diabetic taking "an active role" in managing their condition let me know cause I don't think they exist. <-- Only joking...not joking...you'll see what I mean one day

 

[SansaStarkMD]

So... cash only FM and moonlight in rural ER's. check.

 

[deleted87716]

So yesterday at my office I coined a new phrase. "No adult left behind."

Similar to what's going in public education, modern government envisioned primary care is very much a nanny state. Check boxes, protocols and surveys.

Good analogy, actually. Sad, but true.

It's not just primary care, either. Specialists are dealing with similar stuff. Primary care just gets an extra helping 'cause we're the ones who can actually prevent things from going bad, er...getting expensive.

 

[Elevencents]

So... cash only FM and moonlight in rural ER's. check.

Would love to hear how feasible this is and if anyone on here is doing it. I'm also very interested in FM with some ER on the side; or ER moving to FM later in life.

 

[NRAI2001]

I sometimes hear about EM docs that got burnt out and then went on to do urgent care only practices.. IMHO urgent care is the worst of all worlds. No continuity, simple cases, the constant push to move faster and faster.

My question is have any EM docs later gone on to do primary care? Being a current FM resident I can say that primary care is very very different than urgent care... though some of my friends in other fields may not understand the differences.