Hi, I am definately interested in working with underserved populations in the future. I was just wondering, though, if you are going to work with urban underserved communities, is there really a need for family docs (more so than internal med docs)? What specialty would be most useful to go into for this? thanks!
Well, considering the high rates of STD's and children with asthma, among other OB/Gyn and peds type cases in urban areas, I believe an IM doc would be less efficient in caring for an urban underserved area. I believe an FP doctor would be most proficient in this case (or at least more EM docs in the local EDs, as they all seem to use those facilities as their primary care, on top of the fact that the ED is pretty much the only facility that will take public aid insurance). Actually, with that in mind, I think any physician who takes public aid would be a great asset in an urban setting.
Many of the "urban underserved" are women and children. FM will prepare you better to treat that population than IM.
Many of the urban underserved jobs are in FHQC (federally health qualified centers). These are federal government subsidized (your malpractice falls under sovereign immunity) and the clinic must provide certain services in order to qualify for aid. Generally speaking, they must provide adult, children, and women's health (many centers provide prenatal care and may or may not deliver). Clinics tend to prefer FM because they are versatile. Some places will employ IM, Peds, Ob/Gyn... but staffing can be an issue especially when people take vacation, call in sick, quit, etc.
Some FQHC's offer loan repayment as well. Another benefit of working for an FQHC is that your malpractice is covered, and your defense attorney is the US Attorney General. How's that for helping you sleep at night?
Have you actually done this? Just curious. This month I abandoned my otherwise dorothy-and-toto existence to face the full fury of underserved urban medicine. In all honesty, I'd rather be a vet than spend the rest of my life doing this. Fortunately, tomorrow I get to leave and come back to America.
I did rural rotations in med school to see if I could survive exile in BF No Where and concluded that a city rat like me couldn't cut it. There's a reason why so many people like to live around so many people. People (i.e. AAFP, STFM) don't talk about "Urban Family Medicine" anymore. Don't know why. But there are some places you can look to if you're interested in modeling your training experiences. I'd recommend reading academic medical education literature published by Ohio State Urban Track faculty, faculty from Columbia University in NYC, the Institute of Urban Family Health at Beth Isreal in NYC, and UCSF at San Francisco General. I can't vouch for their residency programs... you'll have to make the decision if that's those are the programs you want. Most county hospitals have good urban underserved programs... but those tend to be opposed programs. If you're hard core about it, consider them. Or, you can check out the unopposed county programs. Contra Costa is a good one. JPS is a good one. When you shop around, ask about HIV experience. That's a good feather to have in your cap. Did a little research myself back in the day. Found some stuff. I didn't do one of these "urban programs". Sounded more like a marketing ploy to me. Instead, I picked a residency that I liked and focused my electives/selectives and tailored my residency experiences to things I was interested in per below. Good luck... ------------------------ http://www.aafp.org/online/en/home/policy/policies/u/urbaninnercity.html An "Urban/Inner-City Training Program in Family Medicine" may be defined by any one of the following three criteria: A program with at least 80% of training based at an inner-city location. A program from which at least 50% of its graduates in the previous three years have chosen to practice in an inner-city Community Health Center (CHC), Federally Qualified Health Center (FQHC), or similar clinical setting serving low-income patients. A program that includes all of the following components in addition to the longitudinal experience of clinical practice in the urban/inner-city environment: A mission statement that includes a commitment to care of the urban underserved. A Family Medicine Center located in and serving an urban/inner-city patient population; Training to provide culturally effective community-responsive primary care; At least one month or 100 hours (may be longitudinal) of clinical experience in an urban community health center, homeless shelter or similar facility; At least one month or 100 hours (may be longitudinal) experience in an urban public health department setting; At least two months clinical hands-on experience in the Emergency Department of an urban/inner-city Level II or higher trauma center; At least one month or 100 hours (may be longitudinal) of clinical hands-on experience in an HIV/AIDS clinic or similar setting; A required structured educational experience in occupational health; A required structured educational experience in adolescent medicine; A required structured educational experience in the care of patients with acute and chronic mental illness; A required clinical hands-on experience in a substance abuse treatment facility or program; The current federal definition for an urban/inner-city metropolitan area is one with a population of 500,000 persons or more. There may be many family medicine residency programs that can meet the elements of A. above in a metropolitan area of less than 500,000 persons. (2004)
You know, there's a lot of negativity on SDN about primary care, but if you're looking to be inspired about Family Medicine, you should check out probably one of the classic books called Big Doctoring in America: Profiles in Primary Care. http://books.google.com/books?hl=en&id=sunupAuQoBsC&dq=big+doctoring+in+america&printsec=frontcover&source=web&ots=AHYN5rtPoz&sig=fDTeRw7dSk3YlhTWvQT73QakcB0&sa=X&oi=book_result&resnum=3&ct=result It's a nightstand book. It's a great collection of stories from people in primary care. I was really inspired by Calman's and Wispa's stories. Calman from BI/NYC has also been profiled in FMIG. http://fmignet.aafp.org/online/fmig/index/resources/profiles.html
