What was your exposure to Family Practice like at your school?

[sophiejane]

I have a theory that people who have good experiences with family medicine in medical school are more likely to choose it for a career. I had great FM experiences, though I know not all of my classmates did. I know some schools provide more and better experiences than others.

What has your experience been with FM as a medical student?

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[raidermedic]

I really enjoyed my FM rotations (hence my interest in it). At our program we spend two weeks at the clinics of the two residency programs in town and a month at a private preceptors office.

I personally loved the outpatient office. Anyone who thinks FM is just runny noses and stomach aches should rotate with my preceptor. We had a lot of interesting cases. And even the "bread and butter" cases had the complications of HT, DM, and the like to consider. Some may not like dealing with such chronic issues but I personally loved it. It was like IM but without the 4 hours of rounding and having to memorize the CMP for all my patients

When I originally entered school I had EM and Anesthesia as my top choices and said I would consider fields such as FM and IM. After having now done my FM rotation my outlook is that I want to do FM and that while I am still considering EM and Anesthesia it will take a lot on those rotations to get me to change my mind. I guess we'll see what happens.

 

[sophiejane]

I like that you got to see both academic and private FM, raidermedic. Also getting to see a residency program is probably eye-opening.

My school makes a huge big deal about being ranked in the top 20 nationally for primary care, so as you can imagine, we got ample servings of it starting in first year. However...more does not necessarily = better...

We did about a week total of preceptorships in FM or general IM in 1st year and again in 2nd year. Out FM core in 3rd year was 8 weeks, and we had another 4 required in 2nd year, which could also be IM.

What did it for me was rural track. I was IM all the way until I got a taste of rural family medicine, which, admittedly, I only signed up for because I had heard you got to do more and see more at the rural sites.

I also did an optional program in 2nd year (which is now sadly discontinued) where I spent one afternoon a week with a family doc. It was nice to get out of the classroom and have some real clinical experiences as a second year. More schools should do this.

Anyway, let's hear from some more of you. I may be the only one, but I find this really interesting!

 

[Tn Family MD]

At my school, there was a decided slant to pushing people towards primary care in general. Lots of people in our class rebelled agaist that, so to speak. However, for what it's worth you were allowed to tailor your experience in primary care rotations to your specific interests to some extent. For example, we had a required third year rotation in a rural primary care setting. Within that constraint, you were allowed to pick between IM, Peds, or FM. Your other two rotations in primary care were done at the university medical center.

Muck like sophie, we also had primary care experiences set up in our first two years as well. One week of IM, Peds, or FM each in a rural setting working one on one with an attending. It was a fun experience, but in all honesty it still did not influence my decision as much as third year and fourth year.

I did my third year rural rotation in FM. It was my last rotation of the year, and it was awesome. Not only did it tie everything together I had learned so far, but the clinic where I rotated was outstanding. In my opinion, it was in a lot of ways a model practice and is the framework within which I plan on designing my practice with some minor alterations. It wa a three physician practice with a PA on site as well. It had lots of cool revenue producing extras such as on site lab, on site x-ray, one of the very few DEXA scanners in the rural area where it was located, PFT's, etc. These guys folowed their patients in the hospital, which is definitely something I want to do as well. They were in the process of getting colonoscopy equipment as the newest doc there had gotten that training in his residency and wanted to offer that service. Really just a fantastic experience and so different from the university FM program that I would observe on my fourth year FM rotation at my med school. It is definitely what sold me on FM.

I went into third year thinking I would probably do surgery, with Ortho and possibly General as my top two with other surg sub-specialties on the list as well. I ended up hating every second of my surgery rotations. They were sort of boring, sort of exciting at times. I hated the personalities most of all, and I hated being away from my family so much.

I guess FM was tailor made for me in a way. I kinda liked OB, but didn't get along with the sorority mentality that was prevalent in the OB program at my med school. I kinda liked peds. I liked seeing kids to some extent and even enjoyed the well child checks to some extent, but did find it quite boring after about noon every day. It was just so mundane most days. And I loved the chronic disease management of IM, but the endless rounding each day was more than my mild ADHD could stand.

 

[OrnotMajestic]

Tn_Family_MD,

Did you go to Quillen? Just curious because your experience sounds a lot like my school.

 

[ajce9]

At my school, there was a decided slant to pushing people towards primary care in general. Lots of people in our class rebelled agaist that, so to speak. However, for what it's worth you were allowed to tailor your experience in primary care rotations to your specific interests to some extent. For example, we had a required third year rotation in a rural primary care setting. Within that constraint, you were allowed to pick between IM, Peds, or FM. Your other two rotations in primary care were done at the university medical center.

Muck like sophie, we also had primary care experiences set up in our first two years as well. One week of IM, Peds, or FM each in a rural setting working one on one with an attending. It was a fun experience, but in all honesty it still did not influence my decision as much as third year and fourth year.

I did my third year rural rotation in FM. It was my last rotation of the year, and it was awesome. Not only did it tie everything together I had learned so far, but the clinic where I rotated was outstanding. In my opinion, it was in a lot of ways a model practice and is the framework within which I plan on designing my practice with some minor alterations. It wa a three physician practice with a PA on site as well. It had lots of cool revenue producing extras such as on site lab, on site x-ray, one of the very few DEXA scanners in the rural area where it was located, PFT's, etc. These guys folowed their patients in the hospital, which is definitely something I want to do as well. They were in the process of getting colonoscopy equipment as the newest doc there had gotten that training in his residency and wanted to offer that service. Really just a fantastic experience and so different from the university FM program that I would observe on my fourth year FM rotation at my med school. It is definitely what sold me on FM.

I went into third year thinking I would probably do surgery, with Ortho and possibly General as my top two with other surg sub-specialties on the list as well. I ended up hating every second of my surgery rotations. They were sort of boring, sort of exciting at times. I hated the personalities most of all, and I hated being away from my family so much.

I guess FM was tailor made for me in a way. I kinda liked OB, but didn't get along with the sorority mentality that was prevalent in the OB program at my med school. I kinda liked peds. I liked seeing kids to some extent and even enjoyed the well child checks to some extent, but did find it quite boring after about noon every day. It was just so mundane most days. And I loved the chronic disease management of IM, but the endless rounding each day was more than my mild ADHD could stand.

Wouldn't it be nice if you could do all of those thing in a non-rural setting? If you could open your practice and just see and treat patients the way you were trained?

 

[Tn Family MD]

Tn_Family_MD,

Did you go to Quillen? Just curious because your experience sounds a lot like my school.

Nope. I went to the University of Kentucky.

 

[Tn Family MD]

Wouldn't it be nice if you could do all of those thing in a non-rural setting? If you could open your practice and just see and treat patients the way you were trained?

Ya know, I am not totally convinced that you can't do this. If you have read my other recent posts, I have referenced the Medicos para la Familia Fellowships. These are located in urban areas (at least what I call urban -- Nashville, TN and Memphis, TN). They each provide training in c-section, D&C, c-scope, EGD, even spinal epidural anesthesia and other advanced procedures. These are FM docs that set these up as clinics in which to train other FM docs in these procedures, and obviously in order to train others you have to have the volume. I readily admit that these programs are set up to serve the underserved, but it is my feeling that the underserved exist in all cities as well as all rural areas and represent upper as well as middle and even lower class people. Obviously not all people feel this way, but I do not feel constrained geographically because of my choice of FM and my intention to do procedure rich FM. The bottom line is that nobody can tell you how to run yoru practice. Customers (patient in this case) vote with their wallets and their feet. If you provide a set of services that are needed or necessary or even just wanted and you are pleasurable to work with, people will come to you for your services. Listen, I highly doubt that most patients even know the real difference in training between FM and other specialties such as IM or GI or even Ob/Gyn. All they know is that Dr. X provides service Y and that Dr. X is a nice guy and easy to work with.

Here is a little experiment for you to try. Get out your phone book and call some local physicians and ask about some of these services. Call some GI docs and see when their next available appointment is and when you can schedule a colonoscopy The two more urban areas I have lived in had waits to see specialists that numbered in the months. If there was an FM doc that was out there offering c-scopes and you could get one next week versus three months from now, how many consumers (again patients in this case) would just go ahead and have the FM doc do their c-scope? I know I would personally just go ahead and have the FM doc do it. And I ain't the regular lay person, I'm a doc myself.

Maybe I am an idealist, but I just don't see that we are all that limited geographically. That being said, I intend to practice in a more rural area, but that is because I despise city traffic, the anonymity of being one of a half million residents in my city, and lots of other crap that goes along with city life.

I'm sure there are tons of people that are gonna hafta jump in and tell me how stupid I am. But, the bottom line is it is being done and FM docs have been and continue to be successful with these types of practices in more urban areas. You will have more work to do to be successful in that you will have to market yourself more aggressively, target populations that are more underserved (and this may mean learning to speak Spanish for instance), or other ways to get your name out there. But it can be done and is being done. And that is the bottom line.

 

[sophiejane]

Let's try to keep this one on track, folks. Please see new thread re: procedures and move it over there.

Thanks!

 

[ajce9]

Ya know, I am not totally convinced that you can't do this. If you have read my other recent posts, I have referenced the Medicos para la Familia Fellowships. These are located in urban areas (at least what I call urban -- Nashville, TN and Memphis, TN). They each provide training in c-section, D&C, c-scope, EGD, even spinal epidural anesthesia and other advanced procedures. These are FM docs that set these up as clinics in which to train other FM docs in these procedures, and obviously in order to train others you have to have the volume. I readily admit that these programs are set up to serve the underserved, but it is my feeling that the underserved exist in all cities as well as all rural areas and represent upper as well as middle and even lower class people. Obviously not all people feel this way, but I do not feel constrained geographically because of my choice of FM and my intention to do procedure rich FM. The bottom line is that nobody can tell you how to run yoru practice. Customers (patient in this case) vote with their wallets and their feet. If you provide a set of services that are needed or necessary or even just wanted and you are pleasurable to work with, people will come to you for your services. Listen, I highly doubt that most patients even know the real difference in training between FM and other specialties such as IM or GI or even Ob/Gyn. All they know is that Dr. X provides service Y and that Dr. X is a nice guy and easy to work with.

Here is a little experiment for you to try. Get out your phone book and call some local physicians and ask about some of these services. Call some GI docs and see when their next available appointment is and when you can schedule a colonoscopy The two more urban areas I have lived in had waits to see specialists that numbered in the months. If there was an FM doc that was out there offering c-scopes and you could get one next week versus three months from now, how many consumers (again patients in this case) would just go ahead and have the FM doc do their c-scope? I know I would personally just go ahead and have the FM doc do it. And I ain't the regular lay person, I'm a doc myself.

Maybe I am an idealist, but I just don't see that we are all that limited geographically. That being said, I intend to practice in a more rural area, but that is because I despise city traffic, the anonymity of being one of a half million residents in my city, and lots of other crap that goes along with city life.

I'm sure there are tons of people that are gonna hafta jump in and tell me how stupid I am. But, the bottom line is it is being done and FM docs have been and continue to be successful with these types of practices in more urban areas. You will have more work to do to be successful in that you will have to market yourself more aggressively, target populations that are more underserved (and this may mean learning to speak Spanish for instance), or other ways to get your name out there. But it can be done and is being done. And that is the bottom line.

I couldn't agree more. I've said basically the same thing on another post.

The key word is Marketing.

If you want more derm cases market for it. If you want more ortho cases market for it.

Go to the spanish popullation.

I met one doctor at at meeting that only saw the hispanic popullation and charged cash. Her practice was booming. By the way she did not speak spanish. All her staff did.

Specialist don't need to diversify their practice because they already get many cases. Fps can develop niche markets and get enough cases to keep them happy.