What to look for in good FM Programs

[septoplasty]

I'm sure this is the perfect time to address this issue, before the interview takes places to determine what I need to exactly look for in a program.

I'm quite confused in terms of determining the "quality".

While they are all UNOPPOSED, the programs I've gotten interviews vary considerable in the sense of procedural training, location, type of program (urban vs. rural), etc. etc.

Is it necessarily wise to train in a setting where you want to practice one day? (which sort of puts me in another hole because I don't know yet).

Also, when asked something like "what do you feel are challenges facing family medicine in the next 10 years"

Is a response like "Lack of compensation, lack of recognition as well as increased use of mid-level providers has started to eat away at the scope of a family practitioner. " Appropriate? I merely want to dodge a bullet and not attempt to take sides.

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[MedicineDoc]

I'm sure this is the perfect time to address this issue, before the interview takes places to determine what I need to exactly look for in a program.

I'm quite confused in terms of determining the "quality".

While they are all UNOPPOSED, the programs I've gotten interviews vary considerable in the sense of procedural training, location, type of program (urban vs. rural), etc. etc.

Is it necessarily wise to train in a setting where you want to practice one day? (which sort of puts me in another hole because I don't know yet).

Also, when asked something like "what do you feel are challenges facing family medicine in the next 10 years"

Is a response like "Lack of compensation, lack of recognition as well as increased use of mid-level providers has started to eat away at the scope of a family practitioner. " Appropriate? I merely want to dodge a bullet and not attempt to take sides.

Medium sized hospital, unopposed, open ICU with at least 25 beds with residents following their patients into the ICU. Ask about what areas of practice residents have gone into. If its a mix of outpatient, hospitalist and ER that would indicate they are more likely preparing residents for full scope. Ask about opportunities to put in central lines, intubate, preliminary vent setting? or vent management, lumbar punctures, running codes, injections, draining knee effusions, I & Ds, and if residents moonlight in 2nd and 3rd yr and if so where. Ask about the call schedule as to whether the FM residents take on whatever walks in the door. I would just respond with what I believe is the truth and say something like FM docs are like "cock roaches" they will always be there and adapt". I would stay away from speculating on future compensation which really has no bearing on whether they want you. Midlevels are going into every area of practice by the way. There are GI, anesthesia, cardiology mid levels. They are everywhere.

 

[lowbudget]

Cockroaches. Hilarious. What about fungi?

 

[MedicineDoc]

Cockroaches. Hilarious. What about fungi?

Fungi will only still be prevalent if it remains moist.

 

[JustPlainBill]

Medium sized hospital, unopposed, open ICU with at least 25 beds with residents following their patients into the ICU. Ask about what areas of practice residents have gone into. If its a mix of outpatient, hospitalist and ER that would indicate they are more likely preparing residents for full scope. Ask about opportunities to put in central lines, intubate, preliminary vent setting? or vent management, lumbar punctures, running codes, injections, draining knee effusions, I & Ds, and if residents moonlight in 2nd and 3rd yr and if so where. Ask about the call schedule as to whether the FM residents take on whatever walks in the door. I would just respond with what I believe is the truth and say something like FM docs are like "cock roaches" they will always be there and adapt". I would stay away from speculating on future compensation which really has no bearing on whether they want you. Midlevels are going into every area of practice by the way. There are GI, anesthesia, cardiology mid levels. They are everywhere.

And do not forget that all important question,"Who is doing the teaching?"....we're with the midwives to learn deliveries while every other residency where I'm at (ED, anesthesia,etc.) do their deliveries over in the high risk deck with the OB/Gyn residents and attendings -- we get to go with the medical students (who take priority) and EMS personnel....be sure to get the answer to "Who's doing the teaching" in some way, shape or form....

And as always, do a rotation month at your top 2 or 3 choices....see what it's like from the inside for a month....

 

[MedicineDoc]

And do not forget that all important question,"Who is doing the teaching?"....we're with the midwives to learn deliveries while every other residency where I'm at (ED, anesthesia,etc.) do their deliveries over in the high risk deck with the OB/Gyn residents and attendings -- we get to go with the medical students (who take priority) and EMS personnel....be sure to get the answer to "Who's doing the teaching" in some way, shape or form....

And as always, do a rotation month at your top 2 or 3 choices....see what it's like from the inside for a month....

That's true if you're interested in OB or plan on doing academic medicine where you will teach/do OB. Myself I don't like OB especially getting a call in the middle of the night for a delivery that could take hours. Also, the malpractice insurance with the baby being able to sue up until age 18 and the need for back up ob/gyn in case the baby doesn't just fall/get pushed out like most of the time.

 

[rachmoninov3]

ah the million dollar interview season question: what makes for a strong FM residency?

Everyone likes the 'unopposed' residencies. However, often they are in small towns and many will have you doing a ton of away rotations just to get things you need, like peds, icu, etc. Community hospitals can also be really busy or super slow.

The university residencies often are busier, and depending on where you want to practice (inner city/street med) can offer you more volume.

Even if a residency doesn't have what you're looking for, you can still do these great things called electives in your 2nd and third year to increase your OB or OB surgical skills if you need to. Furthermore, there are fellowships that can get you even more (and some states require these for FM to have CS priviledges)

Finally, and most importantly for the next 5 months until the match: Rank where you will be happiest. It doesn't matter how 'good' a program is if you and your spouse hate the city, the people, and there is nothing to do besides go to the hospital and come home and sleep. Residency is hard enough, rank by what program you like the best, not what program is the strongest. Does it really matter if you got into "Best Family Medicine" if it is in "Deargawdhowmanydaysuntilileavethisplaceville?"

 

[MedicineDoc]

I did my residency in a small town in a 400 bed hospital with 25 ICU beds. We had call from home and probably got called in on average of 3-5 to admit on call nights although there was an occasional "no hitter" in addition to taking nurses calls and going in if someone was going south. Admits were divided based on whose turn between FM service and a parallel hospitalist service. We got a lot of weekends off unlike the university based prelim yr I did before switching to FM where there it was called a "golden weekend" and It seemed to me that I got scutted out. At my rural residency we got all holidays off as first yrs, we had to pick one holiday to work as 2nd and third yrs, we go 2 weeks vacation that could be scheduled between weekend days which didn't count as vacation days. When I wasn't working I went back to my home city about 2 hours away on weekends in addition to Panama City beach, New Orleans, and myrtle beach. Some rotations had no weekends like outpatient peds, psych, behavioral medicine, sports medicine electives if not on call for the FM service which was rotated with 2 residents of 16. We also saw our own clinic patients if they were in the hospital in the mornings before going to our rotations but not on the weekends unless we were already supposed to be on call. Vacations did not count conferences with CME money. For rotations that were hospital based then I was on call whenever my attending was on call which obviously wasn't every weekend or if mu turn to be on for the FM service. We also got rotating weekday call for the FM service which worked out to once a week. If on the FM service it was 2 weekends per month call and no weekday night. If you got the weekend it was the whole weekend on or the whole weekend off. The muslim residents did Christmas by their choice. I'm pretty sure I not only got better training but had a much better quality of life than I would have had at a university based program although we did have ties with my old medical school with a few of the med students doing there 2nd and 3rd yrs at our hospital by their choice. Which was smart because there was really good arrendings who taught one on one or one on two. One resident and maybe one med student.

 

[Dharma]

Fungi will only still be prevalent if it remains moist.

ah, but the persistent mycelium withstands harsh conditions... most of its life underground, only reaching out to expand and move elsewhere, when conditions permit; opportunists, they spring up to do so, even if only after a few days' rain, that followed a seemingly never-ending wave of dry heat.

interesting creatures indeed.

 

[SuckySurgeon7]

ah, but the persistent mycelium withstands harsh conditions... most of its life underground, only reaching out to expand and move elsewhere, when conditions permit; opportunists, they spring up to do so, even if only after a few days' rain, that followed a seemingly never-ending wave of dry heat.

interesting creatures indeed.

And that's a thread breaker, lol. Last one out, hit the lights!