Typical hands-on experiences in Family Medicine

[Spin]

How many, and what kinds of, hands-on experiences can FM doctors get in outpatient clinics most days? I'm really interested in family medicine, but I want to do more than just talk and listen, even if I end up in a suburban or urban area. The hands-on experiences that I can think of are below.

Key:
* = something that would probably require FM residents to seek out additional training either during or after residency.
+ = difficult to do in urban areas:

Removing skin tags/lesions
Pap smears
Physical exams
Joint injections *
OMT * (because I'm in an MD program)
Botox *
Ob: regular deliveries + (not personally interested in these)
Ob: c-sections *+ (not personally interested in these)
Colonoscopy *+
Sigmoidoscopy *+
Wound dressing, diabetic ulcer care
Sutures +? (not sure if people who need sutures typically see their primary care doctors)
???

Please let me know if I'm mistaken about any of these, and add any others that you can think of. I don't care how minor the experience is; if it's hands-on and I don't have it listed, please let me know.

Finally, realistically, what percentage of patients would I be able to do these things with? I'm interested in other aspects of primary care, but I think I'd go crazy if I didn't do at least one hands-on thing every day.

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[Smokemont]

Great thread, I would also be interested in hearing about this from those with experience.

 

[smq123]

How many, and what kinds of, hands-on experiences can FM doctors get in outpatient clinics most days? I'm really interested in family medicine, but I want to do more than just talk and listen, even if I end up in a suburban or urban area. The hands-on experiences that I can think of are below.

As a resident, you have to do a certain number of procedures in order to graduate. Whether or not you continue doing them as an attending depends on you - whether or not you want to.

Key:
* = something that would probably require FM residents to seek out additional training either during or after residency.
+ = difficult to do in urban areas:

Removing skin tags/lesions
Pap smears
Physical exams
Joint injections *
OMT * (because I'm in an MD program)
Botox *
Ob: regular deliveries + (not personally interested in these)
Ob: c-sections *+ (not personally interested in these)
Colonoscopy *+
Sigmoidoscopy *+
Wound dressing, diabetic ulcer care
Sutures +? (not sure if people who need sutures typically see their primary care doctors)
???

For reference, I did my residency in a suburb that was 10 miles away from a major city in the Northeast.

Skin tags - yep, did a ton of those. Not just in the outpatient office, but on my derm rotation too.

Pap smears - Did at least 3 a week; can do them in my sleep. I've found that comfort level with paps vary. Women are generally much more comfortable than male doctors are; I think that females just get more "Well Women" exams than men do.

Physical exams - you should do a physical exam on almost every single patient that walks through the door.

Joint injections - lots of opportunities in the outpatient office, as well as on the sports med rotation.

OMT - I saw a fair amount of OMT, and had some done to me, because I was in a dual MD/DO program. There is OMT CME courses available if that interests you.

Botox - Saw it done. It's not a hard thing to DO, it just hard to know WHERE to inject it. I personally had no interest in learning how to do it, to be honest. The technique of actually injecting the Botox is easy - draw it up in a syringe and push on the plunger.

OB - You'll do SVDs on your own patients as well as your OB rotations. We did not do c-sections at our program, but that could have been geographic.

Colonoscopy/sigmoidoscopy - We did not do them at our program, and in the northeast, no FM physician that I know of does them. That said, one of my classmates went back to his hometown in another region of the country, and was told by his future practice partners that they will teach him how to do colonoscopies. They each do about a dozen colonoscopies a month. So it varies by region.

Wound dressing - yes. OMG, yes.

Sutures - yes, both placement and removal.

We also did skin biopsies (shave, excisional, punch), colposcopies, IUD placement, toenail removals (YES! really!), splints and casts, incision and drainage of abcesses, and (my personal favorite) cerumen removal.

 

[SnakeOil]

I think your list accurate for the most part. I'd say joint injections and botox really aren't hard to do in urban areas.

To answer your question, how many procedures you're going to be doing each day depends a lot on where you practice and what you're comfortable with. There are FM docs who aren't comfortable doing procedures, do strictly outpatient work, refer everything, etc. and there are FM docs who practice rural and do many of the procedures you mentioned routinely. It all comes down to what you're interested in doing and your level of training. Some FM programs don't place much emphasis on procedures, some are procedure heavy. Again, it all depends on where you want to practice, how motivated you are, where you train, etc.

 

[Leukocyte]

Also if you work at urgent cares/doc-in-a-box shaks, then you will have to do procedures, including:

-Suturing
-Splinting
-FB removals from skin or eye (if there is a slit lamp)
-Tick removals
-Wound care
-Impacted ear wax removal
-Nose bleed packing or couterization
-Bleeding site couterization
-I&D of abcess and packing
-Ingrown nail managment
-Nail avulsion injury managment
-Sebacious cyst managment

 

[MOHS_01]

It takes more than doing a few to be proficient. I thought I was competent -- good even -- at surgery after finishing residency. Boarded and all that jazz. Found out over the course of the fellowship that ignorance is blinding....

Nail surgery sucks. You can have it.

 

[grumbo]

There are a few more I do that I haven't seen mentioned:
-GXTs
-colpos
-Endometrial biopsy
-vasectomy
-implanon insertion/removal
-trigger point injections
-lipoma removal
-mole/neoplasm removal
-cryo (warts, SKs, etc)

There are tons of things you can do, it just depends on your interest. In the past week, I've done a shoulder injection, knee injection, cryo for a wart, trigger point injection, and an implanon removal. And that was with limited time in the clinic.