This is my perspective of "what family medicine is all about" from the standpoint of an FP resident. What follows is mostly true, thickly embellished with personal experience and authoritative anecdote. It comes in the form of questions asked by an inquisitive first-year med student, eager as a beaver for career guidance, followed by responses from an overworked and harried resident; it is arranged in no particular order (read: flight of ideas).
What is family medicine?
Family medicine is the heir to the GPs of yore, and is about as general a field as you can get. Of all the specialties, it is the most diverse in terms of scope of practice. It was known as family practice until recently, when it became politically incorrect to do so (out of fear of being confused with nurse pracs).
What do FPs do?
They do a lot, although the reality is that their scope of practice is largely defined by region, locale, and interest. The rural FPs I worked with did their own C-sections, were first assist for their patient's appy's and whatnot, saw their own at the ED, and took care of their own peds and adult inpatients. Others I've known have a more limited practice consisting of mainly ambulatory medicine.
Isn't family like a watered-down hybrid of medicine and peds?
In a way, yes, as well as of surgery and OB. And that's not necessarily a bad thing. Although folks assume family is a poor version of medicine and/or peds, they do receive sufficient training for the more common diseases of both, as well as some additional things that the other two don't get much of, like time in the OR or delivering babies. Even for those FPs that don't do much of that in the real world, it's good experience and provide them with a unique perspective that even some of the other primary care specialties may not get. Essentially, FPs treat the most common diseases; just because they aren't cardiologists or peds id specialists doesn't mean that they aren't qualified to do routine workups of common things like MIs or childhood sepsis. And although these may not be sexy topics and even though they're common as all get out, they're still pretty darn important.
Will I be respected as an FP? What about fame? Fortune?
In truth, it depends. Let's start with respect. Short answer: at an academic center, NO, NO, and HECK NO; in the real world, yes, if the specialists want your business; by your patients, yes, if you're good. Long answer: do you need a long answer? I think it's pretty self-explanatory.
One funny thing is that although it's inherently uncool to want to go into family when you're at Tertiary Care U, it can become eerily nice to have in your back pocket later on in life. Take Howard Dean, for instance. During the recent (2004) Democratic primaries, he proudly trumpeted the fact that he was a "family doctor" (he's an internist). Now, I don't begrudge the man that he called himself a family doctor (after all, I wouldn't want to have to explain what an internist is to the lay public), but here's my point: a) people know what a family doc is and b) it's a good thing to be known as one (at least Dean thought so).
Now about the money thing: you won't become filthy rich. Oh, you'll do all right, but you'll never approach the levels of your invasive cards buds. If you dig lots of money, then do something else. The average (off the top of my frenzied mind) is like 120-140. It ain't pocket change, but it ain't the Taj Mahal, either. And you'll always be towards the bottom of the barrel (although not at the bottom); primary care is always reimbursed at a lower rate. (I'm actually okay with that; I don't begrudge my specialist buddies; after all, they trained longer and are being paid to be 'the final word'.)
But isn't family for the med students that took the 'slow bus'?
It is true that FP is the least competitive of all specialties and that it's dropping like a rock. (Let's face facts, after all.) And it has more total slots than any other specialty, which makes the job of filling them that much harder. As a result, the qualifications of landing an FP slot are: pulse > 40 bpm and ICU euboxemia (ie, air goes in and out, blood goes round and round, glucose is good.) And as a result (please don't take this the wrong way) there are lots of IMG's in the field. Now, the IMGs at my program are no dumber/smarter than the US grads (some are dumb and some are smart but no more or less so than the rest of us.) But, fair or not, FPs lose 'status points' for not filling their slots in the US match. On a related note, FP often is a backup for those who 'didn't match derm (or OB, or EM, or _____)'. Also not cool. ("So, going into family, huh?" [Couldn't make it in the real world, eh?])
One thing that came as sort of an epiphany for me was the realization that ambulatory medicine (which I had always relegated to the status of 'easy medicine') is actually pretty darn hard, that is, hard to do right. You need to know a heck of a lot and to be able to apply it right now. Unless you've done a lot of it, you don't know how hard it is: it ain't all runny noses and stubbed toes.
What is the residency like?
FP is a three-year residency; there are ACGME fellowships in Sports Med and Geriatrics, as well as a multitude of non-ACGME fellowships, including Rural Med, OB, Adolescent Med, Women's Health, etc, etc, etc. The residencies tend to be front-loaded with the intern year being hard and the other two somewhat lighter. A common misperception is that FP is an easy residency (and profession, for that matter.) Although the hours aren't as bad as a lot of specialties (like gen surgery, for instance), it ain't a walk in the park, either. I've gone over 100 hours a couple of times thus far as an intern.
So who wants to go into family, anyways?
Given the breadth of the field, it's not surprising the variety of personalities it attracts. A typical family program will have one 'cowboy' do-it-all, do-it-yourselfer, full scope of practice, practice in Armpit, Alaska; one tree-hugging granola type who is planning on an MPH after residency and before working for either Doctors without Borders or the local inner-city clinic; and a good-sized handful of suburbanites heading back to suburbia. And, yes, there are the "couldn't get into EM/OB", per above.
What personality type do you need for FP?
See descriptions above. FP docs place a high premium on practicality but lack the ADHD needed for EM (and substitute it with passive-aggression.) They are medicine/surgery hybrids who enjoy ruminating over the weird but subacute offings of human pathology that frequent their offices, but at the end of the day would rather be sewing lacs, taking off lumps and bumps, or injecting a joint.
That pretty much sums it up for now; I'd be happy share my blatant opinions, unadulterated with knowledge or foresight, with anyone who might have any questions.
And that's all I have to say about that.
