Who here is interested in becoming a primary care physician?

[CaliSurferDoc]

I've always been interested in primary care, yet the debt-to-compensation, or return-on-investment factor has pushed me away from it. With the passage of the Healthcare Reform Bill, among other immanent changes to the system, this field of medicine has become increasingly enticing to me.

Primary care physicians are in great demand. I think there are estimates that some 40% increase will be needed in the coming years. Under this bill, the compensation of specialists like internal med, OBGYN, pediatrics, etc will likely increase, while more higher-paying specialties will see a modest decrease or level off.

Any insights into this topic? Are any of you more likely to enter this field of medicine more-so now than before?

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[MilkmanAl]

The recent changes have increased your interest in primary care? Hmmm...

 

[jgauger]

I sort of agree. I will being going into rural medicine. I could be being naive, but I feel that these changes will actually be a good thing. I've talked to a few physicians that I have shadowed back home. They were on the fence, but I got the impression that they were more optimistic than most of the sdn world. They are also salaried clinicians that are making quite a bit above the FP average so they might have a different perspective than a lot of docs.

 

[MichaelRW]

I would like to practice in an under-served setting, not necessarily rural, though. My background allows for a unique relationship with an under-served population. At the same time, my personality goes hand-in-hand with environments of high pressure and intense situations. Hence general surgery or emergency med. would be great on that level. Either way, I don't feel that I would not be disappointed.

 

[surftheiop]

I will definitely consider primary care pediatrics, I like the idea of being able to work with parents and kids in order to keep their kids as healthy as possible. Also compared to most people I think I would actually enjoy the "staying in school talks","Say no to drugs", etc. aspects of being in general Peds.

 

[FirefighterDoc]

For similar reasons i have been leaning away from it. I do think it might be somewhat enjoyable though, my uncle is a FM doc and is like our whole familys doctor.

I think this has sparked my interest in becoming dual certified....like maybe
EM/IM or EM/FM. Something to that extent.

I feel that i could gain a lot from those two completely different approaches to medicine.....one focused on long term and preventative medicine and the other focused on short term emergency situational medicine ( not to say that half the pt.s in the ER couldnt get the problem solved with their PCP).

Dual residencies for this have just sparked my interest.

I've always been interested in primary care, yet the debt-to-compensation, or return-on-investment factor has pushed me away from it. With the passage of the Healthcare Reform Bill, among other immanent changes to the system, this field of medicine has become increasingly enticing to me.

Primary care physicians are in great demand. I think there are estimates that some 40% increase will be needed in the coming years. Under this bill, the compensation of specialists like internal med, OBGYN, pediatrics, etc will likely increase, while more higher-paying specialties will see a modest decrease or level off.

Any insights into this topic? Are any of you more likely to enter this field of medicine more-so now than before?

 

[SweetRain]

I'm definitely going into primary care in peds. I do think SDN is more pessimistic about the bill, only because many of them are the ones entering the field.
I'm an idealist and believe in the idea of universal health care itself. HOW we do it is where we should disagree on. I've volunteered at a free clinic and shadowed a pediatrician there. A lot of my peer premeds think that I'm being an idealist and naive. They also think that everyone is lying deep inside when they say they want to help people. Well there are free clinics out there and there are doctors who devote their time...not everyone who wants to help others is lying

 

[CaliSurferDoc]

I have had longstanding interest in primary care. The type of medicine seems more holistic for me, utilizing a wide scope of what is learned during medical school and residency in the application of diagnostics and treatment.

Despite my lack of support for the reform that was passed yesterday, I am excited and optimistic to see how our healthcare system evolves. There is too large a demand for new physicians (in general) to see a significant decrease in return-on-investment for those of us masochistic future physicians 😉

 

[surftheiop]

I'm definitely going into primary care in peds. I do think SDN is more pessimistic about the bill, only because many of them are the ones entering the field.
I'm an idealist and believe in the idea of universal health care itself. HOW we do it is where we should disagree on. I've volunteered at a free clinic and shadowed a pediatrician there. A lot of my peer premeds think that I'm being an idealist and naive. They also think that everyone is lying deep inside when they say they want to help people. Well there are free clinics out there and there are doctors who devote their time...not everyone who wants to help others is lying

The pre-Med world needs more folks like you, don't let the SDN pessimism get you down.

 

[NerdyAndrea]

I want to do rural/underserved Family/Emergency Medicine. My mind is not changed. I am still a ways from that decision but it's what I want.

A

 

[orthomyxo]

The recent changes have increased your interest in primary care? Hmmm...

That's exactly what I was thinking...

 

[EddieL]

I can see myself becoming a pediatrician. Obviously though, I'll want to see how health reform plays out. It could be really good or bad for PCP's based on which way you look at it.

 

[she woolf]

I'm also interested in Internal Med/Emergency Med, who knows I may change my mind during rotations/residency. I took a Med personalit test and I was most suited for Rheumatology LOL [sp]

 

[lovemesomeTJ]

So far I want to do Pediatrics in the hospital setting.

 

[mvenus929]

I'm strongly considering pediatrics, though I've bounced around in my interests to some degree.

 

[startswithb]

It's good to see people wanting to do pediatrics. I am the most awkward person ever around children. It'd just be a disaster.

I've considered searching for a specialty based on self-preservation, but then I realized that the whole reason I was going into medicine was to follow my passions.

 

[morning]

<----

I'm very interested in pediatrics, although I can't swear I won't change my mind. I could see myself doing general pediatrics, pediatric EM, and pediatric hospitalist work above all. What I like about general pediatrics is the continuity of it. It would be so cool to have a patient from age 1 to age 20 and be able to see them grow up. I really DO NOT mind the low salary, I'm just hoping I can make it out of med school with sub-200k debt.

I'm curious to see the genders of folks in this thread. 75% of all peds residents are female, as well as 75% of OB/GYN residents and 55% of family medicine. Primary care seems to be a common interest for us 🙂

 

[Beignet87]

As of right now, I'm really thinking about going into Family Medicine. If not that, maybe Pediatrics but definitely primary care.

 

[metalgirl14]

I'm currently interested in doing a pediatrics specialty but that will likely change...

 

[OliverNCo]

Family practice all the way! My mind has not been changed by the healthcare bill. I'm involved internationally with a medical relief organization now, and I don't intend for that to ever change. Plus, I like the idea of doing a little bit of everything 🙂

 

[surftheiop]

You can count me as one guy who is interested in peds 🙂

 

[ArkansasRanger]

For me, family practice has always been the most attractive residency due to both the generality of it and my own perception of FPs being doctors. When I think of a doctor or imagine being a doctor I think of family practice. I bet this is what I end up doing if I'm fortunate enough to make it that far as a non-trad.

That said, emergency medicine has a lot of appeal for me because it's also a generalized specialty, plus in that area one doesn't have to worry much about practice management.

Ideally, I'd train in family medicine and then work in an emergency department somewhere, but by the time I'm able to get there that may not be as common as it is now, even in Arkansas, and of course my interests can change. The combined residencies that are emerging and will probably continue to grow are attractive, but that point the two additional years required will probably dissuade me from that path.

The only two other specialties that have really ever had an appeal to me are vastly different: psychiatry (which I wouldn't do anyway) and anesthesiology because, having trained around anesthesiologists in paramedic school, they just seem so sharp.

 

[SusGob711]

I'm going to say what you're not supposed to say--I'm definately interested in primary care, all but pediatrics that is. While this would normally be my first choice if no other factors mattered, compensation is simply too low in this particular field. They are certainly making more than $35,000/year but with the amount of education required and the debt aquired, pediatrics is out my friends. I will probably pursue internal medicine or OB/GYN.

 

[FlowRate]

I'm stuck between primary care and specialty. If I did primary, I'd want to be working with rural populations, but if I did specialty, I'd want to be in a larger city. I think my personal interests lie in larger cities, so a specialty would probably be a better life decision for me.

But who knows? A lot changes in 5 years.

 

[stromijj]

i'm interested in doing Infectious Disease. From what i've read and talking to ID doc's, most ID doc's practice infectious disease and still do internal medicine. I'm wondering with this new healthcare bill if they consider ID to be a specialty or primary care? i see it as a specialty, but ID doc's don't have a primary organ and don't have their own specific procedure. basically it's internal medicine with a greater knowledge of infections.

 

[Bacchus]

ID won't be primary care.

 

[Sweetpea MD]

i am interested in primary care, but i have an open mind. i do know that whatever field i go into, i will practice in an urban setting, in the inner-city. i'm committed to working with underserved patient populations!

 

[surftheiop]

I'm going to say what you're not supposed to say--I'm definately interested in primary care, all but pediatrics that is. While this would normally be my first choice if no other factors mattered, compensation is simply too low in this particular field. They are certainly making more than $35,000/year but with the amount of education required and the debt aquired, pediatrics is out my friends. I will probably pursue internal medicine or OB/GYN.

Not that I advocate choosing a specialty before going into med school, but money seems pretty similar in primary care IM/Peds.

family med, internal med and peds are all almost identical on this survey (~205k median salary)

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

In this one both IM/Peds is around 175k w/ >3 years experience
http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

 

[FirefighterDoc]

You can do ER/IM residencies? How does this work? How long is it, and how much time is devoted to each?

Yes, there are currently 11 accredited EM/Im residencies in
Cali
Delaware
Illinois
Louisiana
Maryland
Mich
Minnesota
NY
North Carolina
and Penn

http://www.saem.org/saemdnn/Home/Co...dicineInternalMedicine/tabid/278/Default.aspx

And there are also 2 EM/FM in Delaware and Louisiana

http://www.saem.org/saemdnn/ResidencyCatalog/EmergencyMedicineFamilyMedicine/tabid/1262/Default.aspx

They are 5 year residencies as opposed to 3 years for regular EM or regular IM. They are accelerated programs though so obviously you would be missing out on certain rotation time than if you would be doing 3 years of IM and then 3 years of EM training.

 

[Auriga]

I have had longstanding interest in primary care. The type of medicine seems more holistic for me, utilizing a wide scope of what is learned during medical school and residency in the application of diagnostics and treatment.

Despite my lack of support for the reform that was passed yesterday, I am excited and optimistic to see how our healthcare system evolves. There is too large a demand for new physicians (in general) to see a significant decrease in return-on-investment for those of us masochistic future physicians 😉

Agreed!!! This is not a business venture for me, I'm doing it because I can't see myself doing anything else with the rest of my life. I'm in it regardless of salary changes. Masochism 4tw

I just don't see how they can make healthcare reform work while not increasing the # of med school available seats nationwide. It's ridiculous that 43% got in last year. Dr's are already so short in supply now when a huge chunk of the population can't even get any access to the real care they need.

When the country finally becomes humane enough to see healthcare as a human right not a wealthy privilege, we physicians are going to be overrun. It's what needs to happen, but they aren't forward-looking enough to prepare for it.

Force insurance companies to go non-for-profit! 😀 That would never happen here, but really should.

 

[Charles_Carmichael]

Agreed!!! This is not a business venture for me, I'm doing it because I can't see myself doing anything else with the rest of my life. I'm in it regardless of salary changes. Masochism 4tw

I just don't see how they can make healthcare reform work while not increasing the # of med school available seats nationwide. It's ridiculous that 43% got in last year. Dr's are already so short in supply now when a huge chunk of the population can't even get any access to the real care they need.

When the country finally becomes humane enough to see healthcare as a human right not a wealthy privilege, we physicians are going to be overrun. It's what needs to happen, but they aren't forward-looking enough to prepare for it.

Force insurance companies to go non-for-profit! 😀 That would never happen here, but really should.

This doesn't matter. You can add an infinity number of new medical seats and nothing really will change. It's the number of residency slots that matters, not the number of medical school seats. Increasing medical school seats without increasing residency slots would just mean that there would be more unemployed med school graduates with huge debt, assuming residency slots are saturated. That would be a really bad thing; I wouldn't wish that upon my worst enemy.

I, for one, would hate to go into primary care. More stressful, not as interesting (as in I don't want to keep telling people they need to lose weight or stop smoking everytime I see them), and I feel like I'll have to refer out to specialists often to protect my butt (since, even though I'd be able to handle a minor CV issue, if I get sued, the first question will be "Why didn't you consult a cardiologist?"). Forget it. If, for some odd reason, I end up going into IM, it'll probably be because I want to pursue a fellowship afterwards.

 

[7starmantis]

Force insurance companies to go non-for-profit! 😀 That would never happen here, but really should.

Yeah, those fathers who feed their children on the profits they make from insurance is terribly evil. 🙄

 

[GH253]

Yes.

 

[dweji16]

I've always been interested in primary care, yet the debt-to-compensation, or return-on-investment factor has pushed me away from it. With the passage of the Healthcare Reform Bill, among other immanent changes to the system, this field of medicine has become increasingly enticing to me.

Primary care physicians are in great demand. I think there are estimates that some 40% increase will be needed in the coming years. Under this bill, the compensation of specialists like internal med, OBGYN, pediatrics, etc will likely increase, while more higher-paying specialties will see a modest decrease or level off.

Any insights into this topic? Are any of you more likely to enter this field of medicine more-so now than before?

PEDIATRICS all the way. I love kids... screaming or silent. Although I have a habit of pinching cheeks.. gotta break that or I'm gonna have some annoyed parents later...

 

[lorenzomicron]

Definitely. Nothing as rewarding as family medicine.

 

[surftheiop]

PEDIATRICS all the way. I love kids... screaming or silent. Although I have a habit of pinching cheeks.. gotta break that or I'm gonna have some annoyed parents later...

Lol, transition to high fives! For some reason kids are amused high fiving for like 10 minutes straight even if they won't sit still for more than 10 seconds otherwise

 

[Geekchick921]

General peds is a BIG maybe for me. If I decide to go into pediatrics I am fairly certain I would go for a fellowship and become a neonatology. A few IM subspecialties interest me, but general IM, not so much.

I am very interested in general Ob/Gyn, though, which is sometimes considered primary care.

 

[kansaskid]

<----

I'm very interested in pediatrics, although I can't swear I won't change my mind. I could see myself doing general pediatrics, pediatric EM, and pediatric hospitalist work above all. What I like about general pediatrics is the continuity of it. It would be so cool to have a patient from age 1 to age 20 and be able to see them grow up. I really DO NOT mind the low salary, I'm just hoping I can make it out of med school with sub-200k debt.

I'm curious to see the genders of folks in this thread. 75% of all peds residents are female, as well as 75% of OB/GYN residents and 55% of family medicine. Primary care seems to be a common interest for us 🙂

same here. I am very excited about peds, but not sure if I want critical care, general, or hospitalist. The money isn't super important to me; anything at 100,000 is more than enough imo. I am also thinking of doing the kansas rural scholars program which pays tuition for each year of primary care service post residency in a rural county in KS. Sounds like a pretty sweet deal to me =D

 

[ResIpsaLoquitur]

Agreed!!! This is not a business venture for me, I'm doing it because I can't see myself doing anything else with the rest of my life. I'm in it regardless of salary changes. Masochism 4tw

I just don't see how they can make healthcare reform work while not increasing the # of med school available seats nationwide. It's ridiculous that 43% got in last year. Dr's are already so short in supply now when a huge chunk of the population can't even get any access to the real care they need.

When the country finally becomes humane enough to see healthcare as a human right not a wealthy privilege, we physicians are going to be overrun. It's what needs to happen, but they aren't forward-looking enough to prepare for it.

Force insurance companies to go non-for-profit! 😀 That would never happen here, but really should.

Hey Auriga...well said. It is people like you that make me believe in all the reasons I chose medicine. I can tell you are a mature person just from your perspective on this subject - I wish you all the best in your plans for medical school and if I ever find my way to Kansas and need someone to set up a practice with, you would be candidate numero uno!! What we need is more people like us getting into medical school...I personally think that inasmuch as the insurance companies dictate the politics of healthcare, physicians have taken a backseat for far too long because there's a deeply entrenched reluctance that stems from a money driven and egotistical participation in the profession. I've spoken to some immature undergrads on the interview trail that laughed at the idea that I'd want to be a family doctor!! They ofcourse had their eyes set on cardiology or some other 'dignified' specialty. I know I can be anything I want to be but I chose family medicine because of my passion for community development, preventive medicine, and an overall desire to support 'health care' and not 'disease care'. Kudos to you for overcoming a sketchy undregrad record...you will make a great physician👍

 

[Eddie777]

I'm thinking about going into internal medicine specializing in cardiology, neurology, or infectious diseases. Thinking about Anesthesiology becaiuse of the higher pay. It all depends on how much more primary care physcians are going to make after the health care reform bill.

 

[Auriga]

Yeah, those fathers who feed their children on the profits they make from insurance is terribly evil. 🙄

lol I think you're mistaken on the definition of not for profit. I work for a not for profit hospital. Every employee gets paid, they just don't (quote) "distribute its surplus funds to owners or shareholders" instead they use them to help pursue its goals." In our case, upgrading equipment and employee market adjustments. Insurance companies' for-profit surplus funds aren't invested back into improving jack. That's the last place money needs to be leaking into peoples' pockets - between a patient's wallet and the hospital.

 

[Auriga]

This doesn't matter. You can add an infinity number of new medical seats and nothing really will change. It's the number of residency slots that matters, not the number of medical school seats. Increasing medical school seats without increasing residency slots would just mean that there would be more unemployed med school graduates with huge debt, assuming residency slots are saturated.

That's a good point! I guess both need to be increased. Besides the obvious fact that if everyone who needs care can actually GET care, as opposed to the system now where you can get it if you pay, it will be apparent how much they need more of us. A doc friend of mine says he gets offers constantly from places begging him to work at their hospital instead.

refer out to specialists often to protect my butt (since, even though I'd be able to handle a minor CV issue, if I get sued, the first question will be "Why didn't you consult a cardiologist?")

Hahaha I have thought about that! I'm torn between ER and PM b/c there's a constant variety of challenges. But after working 2 yrs in the ER, I really would like to have more followup with patients.

 

[Auriga]

Hey Auriga...well said. It is people like you that make me believe in all the reasons I chose medicine. I can tell you are a mature person just from your perspective on this subject - I wish you all the best in your plans for medical school and if I ever find my way to Kansas and need someone to set up a practice with, you would be candidate numero uno!! 👍

😀 Sounds great! I'm looking into the underserved area scholarship program...and I hope to band together with other like-minded physicians to tackle health disparities. I have to see them, for 8 hours a day Monday through Friday, and I have hundreds of horror stories that run through my veins reminding me of why I'm doing this. I don't intend to be one of the ones who become jaded and cynical after weathering the storms of med school and residency. I am thrilled to see there are others who feel the same ^_^

 

[LebLlama]

I am. Not sure if its the best thing to do, but i am considering it.

 

[Bakfiets]

i am interested in primary care, but i have an open mind. i do know that whatever field i go into, i will practice in an urban setting, in the inner-city. i'm committed to working with underserved patient populations!

Your quote and others in the thread talking about primary care with the underserved is refreshing... Different training programs and medical schools offer different levels of exposure to underserved training so you really have to look around and keep an open mind. I think the underserved population itself is so complex, just primary care may not be enough. Take a look at www.combinedresidency.org to see what I mean. Not every program merges university academics with a clinic based in a homeless shelter, but there are many out there that can get you where you want to be.

 

[smarty666]

I've always wanted to go into primary care as a internist, but the debt to compensation ratio, also, has made me hesitant. I most likely would wait to see what the climate is like and then possibly specialize in Endocrinology, Allergy/Immunology, Infectious Disease, or Pulmonology and focus in clinical practice/primary care in one of those areas.

The only disadvantage I have seen with my own internist, is that, if you have a specific problem he just sends you off to or tells you to follow up with a specialist. When I had a UTI, he sent me off to a urologist, when I had vertigo problem, I was sent off to a neurologist, when I had PVCs, I was sent off to a cardiologist and so forth. I don't know if that is exactly the best way for the General Practitioners to operate, but what do I know.

 

[FloatOn]

General peds is a BIG maybe for me. If I decide to go into pediatrics I am fairly certain I would go for a fellowship and become a neonatology. A few IM subspecialties interest me, but general IM, not so much.

I am very interested in general Ob/Gyn, though, which is sometimes considered primary care.

Even though I read/hear about Ob/gyn as primary care, I never thought of it that way. The field really is in its own category.

This looks interesting:

MEDLINE Abstracts: The Practicing Ob/Gyn: Primary Care Provider
http://www.medscape.com/viewarticle/457790

Edit: I don't know why I didn't remember this before. Ob/gyn as a PCP is one of the reasons why I want to be an Ob/gyn doctor! You really get to form a close bond with females of all ages and talk to them about important issues that they would otherwise feel uncomfortable talking about with other people/doctors.

 

[Auriga]

The only disadvantage I have seen with my own internist, is that, if you have a specific problem he just sends you off to or tells you to follow up with a specialist. When I had a UTI, he sent me off to a urologist, when I had vertigo problem, I was sent off to a neurologist, when I had PVCs, I was sent off to a cardiologist and so forth. I don't know if that is exactly the best way for the General Practitioners to operate, but what do I know.

Very interesting! I just recently noticed that myself. The concept of a type of triage doctor is what it reminded me of. But in reality, that was me coming to her with PVC's and weird kidney issue. Not her specialty. But for everything else, she's awesome at problem solving and putting pieces together. That's the portion of it that gets me revving up.
What you said about the OB/GYN interaction with pts is really important. That's the other portion of the PCP role that interests me - discussion with patients and providing education/explanations. Women hold the health of the next generation in their hands as parents, so a good PCP or OB/GYN has an opportunity to really reach them with health education more than any other physician than maybe ER (but ER is so quick, no relationship built).

I'd be big about ER except for that relationship/education piece.