Who wants to go into Primary Care?

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I do!!!!!!! I was just wondering who would like to go into primary care and your reasons why? Or if you don't want to go into Primary Care why?
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Worry about getting into med school and doing well on the boards before trying to narrow down specialties.
 
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ensuii said:
Worry about getting into med school and doing well on the boards before trying to narrow down specialties.
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I'm already accepted!!!!!!! This thread was just to see who was interested in primary care.
 
I'm interested in primary care and preventative medicine. I like the idea of continuity, not the one-time visit while they're in the hospital type.
 
I love EM, I hate continuity care of chronic disease, I would shoot myself in the head if I had to understand the management of diabetes and hypertension. I would love for there to be more primary care-oriented people though and wish they could convince everyone to stop trying to use the emergency room for primary care:)
 
Rendar5 said:
I love EM, I hate continuity care of chronic disease, I would shoot myself in the head if I had to understand the management of diabetes and hypertension. I would love for there to be more primary care-oriented people though and wish they could convince everyone to stop trying to use the emergency room for primary care:)
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What? This has been our national healthcare plan for the last 8 years. Change takes time.

Anyway, what is Preventative Medicine? Unfortunately, it is not patient education on topics like nutrition and exercise. You, as a primary care doc, will not have time to do this in your 15 minute appointment. Even if you do have time for it, nobody is going to pay you for it. Even if you do it for free, you may eventually get disgruntled when your patients ignore your advice.

Preventative medicine in doctor speak is a bit different. It involves the understanding of public health and epidemiology. It involves knowing what populations are at risk for XYZ, and how to provide Primary Prevention, or Secondary Prevention. What does that mean?? It means knowing which disease-free person needs to be on statins right now. Who needs to be on aspirin? When do you do Pap smears... annually? more? less? How often do you need to send the patient for a colonoscopy?

This is about as good as it gets. Preventative medicine isnt that interesting anymore, is it?

That said, preventative medicine in the non-medical sense is very do-able. It just takes some time, patience, and effort. One my my cardiology attendings was very interested in preventative medicine, and made his patients keep food journals, and exercise journals. He'd only have to take a couple of minutes to scream at some of his patients for eating like a pig, or skipping breakfast.

So, if you have the drive, and the patience for primary care, go for it. But its important to know what you're getting yourself into early on - otherwise we'll continue this problem of med students who realize in their 4th year that
a) primary care doesnt pay enough to offset their $300K in loans
b) as the government gets their grubby paws deeper into the medical field, the "selling points" which draw us to primary care... such as promoting healthy habits, getting to be part of the patient's world, and individualizing care to suit that specific patient... will start disappearing.... if they havent already.
 
I like primary care, but I think I would get bored... If I could work for an international organization doing primary care, I would do so in a flash. But that is just a dream :D
 
Do you mean IM, Ob/Gyn, Peds, FP? Or just FP? I'm into pediatrics right now, but even then I want to do a neonatal fellowship, so I guess either way I'm not really primary care oriented as of now...
 
Primary care all the way. Physicians really can make a difference with the help of other health care professionals to change the way people approach their health. It seems like everyone here is so pessimistic, I mean, I know that most people will just ignore a physician's pleas. But there really are people who don't know what they are doing is wrong, and with a little encouragement they can turn their life around.
 
If you work and live in the right area, then you can still work as a very happy primary care provider. My wife chose Family Medicine and she has no regrets. She loves her work and all the people she has gotten to know over the years.
 
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Well those of you who are interested in primary care can at least rest easy knowing your specialty of choice will probably be the only one NOT ****ed by any upcoming health care reform.
 
Howel-Jolly is right about trauma surgeons. Trauma across the country is way down. Trauma surgeons I know with the exception of a fw also work as general surgeons to make ends meet (or more than make tm meet) or take on other xta duties. That said traumasurgeons are awesome (when they're not complaining about how the ED is stabilizing their patients lol)

Preventive medicine though is a different beast. Some of it works, some of it does not work (from what I've learned, telling people to eat healtheir for heart disease doesn't do ****. telling people to stop smoking does work. However, for the ones that do work, you do not get to see the results, nor does it seem as if they do so because of your suggestions. People know smoking's not good for them, they won't quit because you tell them to. But behavior change is all about seed planting. A few of them sprout after you leave them alone in the ground while you're not looking.
 
Rendar5 said:
Howel-Jolly is right about trauma surgeons. Trauma across the country is way down. Trauma surgeons I know with the exception of a fw also work as general surgeons to make ends meet (or more than make tm meet) or take on other xta duties. That said traumasurgeons are awesome (when they're not complaining about how the ED is stabilizing their patients lol)

Preventive medicine though is a different beast. Some of it works, some of it does not work (from what I've learned, telling people to eat healtheir for heart disease doesn't do ****. telling people to stop smoking does work. However, for the ones that do work, you do not get to see the results, nor does it seem as if they do so because of your suggestions. People know smoking's not good for them, they won't quit because you tell them to. But behavior change is all about seed planting. A few of them sprout after you leave them alone in the ground while you're not looking.
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How's neurosurgery doing?
 
combined primary care and psychiatry :highfive:
 
I've been looking at primary care for a while now... just seems to me that it's the best way to just get to know patients and help them handle everyday issues. The competition for stuff like neurosurgery is just too intense for me. You guys fight it out for surgeon of the year, I'll just quietly do what I do.

And maybe pay off my med school loans eventually, right?
 
Many people won't go into primary care for the poor compensation as compared to other specialties. It's the sad truth.

10-15 years ago, no one was going into anesthesiology. Now that the compensation has increased, it is a relatively hot field. They make around ~250k for updating their facebook pages in the OR, while occasionally checking vital signs.

Wonder if such a trend will occur in the compensation of PCPs?! We clearly need primary care physicians.
 
according to the new HC plan, more weight will be shifted to primary care physicians, so there's some good news for you guys.
 
Rendar5 said:
Howel-Jolly is right about trauma surgeons. Trauma across the country is way down. Trauma surgeons I know with the exception of a fw also work as general surgeons to make ends meet (or more than make tm meet) or take on other xta duties. That said traumasurgeons are awesome (when they're not complaining about how the ED is stabilizing their patients lol)

Preventive medicine though is a different beast. Some of it works, some of it does not work (from what I've learned, telling people to eat healtheir for heart disease doesn't do ****. telling people to stop smoking does work. However, for the ones that do work, you do not get to see the results, nor does it seem as if they do so because of your suggestions. People know smoking's not good for them, they won't quit because you tell them to. But behavior change is all about seed planting. A few of them sprout after you leave them alone in the ground while you're not looking.
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:thumbup: Most Trauma Surgeons also do General but that's what makes it exciting--the variety...at least for me.
 
holiday1 said:
They make around ~250k for updating their facebook pages in the OR, while occasionally checking vital signs.
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I kinda feel that this is an unfair sterotype. I've been shawdowing anesthesiologists for about a year and its a myth that their in the OR reading or on facebook. I have around 100hrs shadowing them and I never seen them do that. Not even once!

Most of the time they are back and forth between OR and talking to pre-op and post-op patients.





..............ummm, But then again, I could just have found really productive anesthesiologist :)
 
No, holiday1 went off the deep-end with his comment.
 
hey, i've seen 2-3 anesthesiologists in the OR. One was reading up on sarah palin when she was all up in the media. the other was on espn. maybe i caught them at the wrong times. but, i'll cut them some slack --we all take mini-breaks here and there.

what i honestly think is gonna happen with the healthcare plan and all that is the compensation of PCPs won't go up (like we've seen with the anesthesiologists). instead everyone else's compensation will be decreased (somehow who knows) so more people will realize the time and effort to become an internist will make financial sense compared to the trauma surgeon, for example, who makes a little more. therefore, more people will go into primary care.

i mean already general surgeons are complaining for the compensation they get. emergency appendectomies are not well compensated procedures these days compared to the risks and complications involved.
 
I'm very interested in primary care especially since I want to go D.O. (even though this is a "M.D." thread, sorry :p) But who knows? I might want to apply to a M.D. residency once I'm finished with med school...but for now, I love the primary care side of medicine and I want to own my own practice. :)
 
I am definitely interested in it...if i had to list my top 5 right now it would be...ortho, Fp, EM, IM, Rads
 
Thank you for all of your responses!!!!!!! I was just curious what current pre-med students feel about this issue. I fell in love with primary care when I worked in a FP office in High school and carried that love into college working on a med-surg floor with IM docs.

Now that I am accepted to med school everybody asks "what do you want to go in?" I tell them primary care and they respond "why would you want to go into that, there is no money?"

I love the continuity of care, preventative medicine aspect, and the fairly regular lifestyle that PCP's see (that is if they give their hospital coverage to the hospitalists). I also like the variety you see with FP. It just feels what I am meant to do and I don't care if I will make less money. You ultimately have to do what makes you happy not what pays more.:)
 
howelljolly said:
Trauma management is becoming increasingly non-operative. By the time you all will be in business... admit, and observe.
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i think that as long as we have guns, knives and cars, trauma surgeons will be in high demand. especially in big cities
 
I don't want to go into primary care!


O
and my reasons:

:laugh:
 
runrunrudolph1 said:
i think that as long as we have guns, knives and cars, trauma surgeons will be in high demand. especially in big cities
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Not really. Even in the big cities, trauma surgeons are having to suppliment their income by doing general surgery. But my point was, that the latest literature tells us that non-operative management often has better outcomes than immediate surgery.

Weve known for decades that percutaneous crics are better than trachs

We know that emergent thoracotomies dont do anyone any good. So the guidelines for when these are indicated say that they almost never are.

All sorts of studies are coming out that are telling us that as long as the patient is hemodynamically stable, patients do better if we do not take them to the OR and open up their abdomen.

If the patient has trauma to the pelvis, theres a lot of evidence that tells us that we better not take them to the OR.... send them to the interventional radiologists.
 
runrunrudolph1 said:
i think that as long as we have guns, knives and cars, trauma surgeons will be in high demand. especially in big cities
Click to expand...

There are certain specialities that are really sexy from the outside, but once people get into it they balk. Trauma is one of those. The surgical aspect gives way to lots of babysitting and even more ungrateful patients that make bad decisions. Not saying to give up hope or anything, but your mind WILL change nearly every day the first 2 years. I'm only in anatomy and doctoring and my mind changes. I've never really been too interested in primary care and even I catch myself liking it once in a while. If I ever did go into primary care then it'd most likely be in a very rural area where I get to do a lot more.
 
MossPoh said:
There are certain specialities that are really sexy from the outside, but once people get into it they balk. Trauma is one of those. The surgical aspect gives way to lots of babysitting and even more ungrateful patients that make bad decisions. Not saying to give up hope or anything, but your mind WILL change nearly every day the first 2 years. I'm only in anatomy and doctoring and my mind changes. I've never really been too interested in primary care and even I catch myself liking it once in a while. If I ever did go into primary care then it'd most likely be in a very rural area where I get to do a lot more.
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I am very open to the idea that my mind will change (especially for subspecialty since i have 12 years to make up my mind) but i think that if your heart is set on something and you know you love it (surgery) there really is no alternate route for you. At least thats how I feel it is in my case.
 
runrunrudolph1 said:
I am very open to the idea that my mind will change (especially for subspecialty since i have 12 years to make up my mind) but i think that if your heart is set on something and you know you love it (surgery) there really is no alternate route for you. At least thats how I feel it is in my case.
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Thats a very appropriate quote you have on your signature. Hesse is a very thought provoking individual.

Nobody is trying to change your mind about what you want to go into. Every pre-med has their "heart set on" something or other. If you didnt, you wouldnt have anything to write about in your admission essays.

But you can't really have your heart set on surgery at this point. (unless you are currently a First-Assistant or something) Because, you couldnt possibly know what surgery really is. And even them, you can't know what it's like to have to operate when youve been awake for 28 hours, and you havent seen your kid in two days. But its particularly easy to pick on you because you choose a glamorous subspecialty, which is on its way to being "obselete". The only way you'll stick with trauma surgery in 12 years from now is if you have your heart set on the non-operative management of trauma patient's fluids, electrolytes, respiration, and perfusion in the ICU.

As I mentioned above... Its kinda important to know what the reality of medicine is. If we - as the future of healthcare - can appreciate a field for what it is, rather than what we think it is, we'll be less apt to throw our arms up in dispair in our 4th year, and choose to go into radiology, optho, derm, pathology, anesthesia....

None of us go into medical school "hating" patient care, but half of us do hate it by the time we finish med school. Really. Just do a search on the SDN for threads where a 3rd year is asking what field they should go into if they hate patient care. And everyone hates primary care.

Why? Maybe because the reality is so far from what students expect... and if you cant beat 'em, join 'em.

ER docs will be doing primary care half the time, because thats how the system is set up in the US.

Trauma surgeons are not doing surgery as much, because thats the best way to treat trauma patients.

Cardiothoracic surgeons dont operate as much because surgery, vs. angio vs. medical management are all just as good as the next. However, surgery has an increased morbidiity over the rest.

Primary care docs can not do what is in the best interest of their patient, because they have to do what the government and the insurance companies tell them.

Who wants to deal with this? Nobody. Unless, of course, you know what you are getting yourself into, and are willing to deal with it.
 
howelljolly said:
Thats a very appropriate quote you have on your signature. Hesse is a very thought provoking individual.

Nobody is trying to change your mind about what you want to go into. Every pre-med has their "heart set on" something or other. If you didnt, you wouldnt have anything to write about in your admission essays.

But you can't really have your heart set on surgery at this point. (unless you are currently a First-Assistant or something) Because, you couldnt possibly know what surgery really is. And even them, you can't know what it's like to have to operate when youve been awake for 28 hours, and you havent seen your kid in two days. But its particularly easy to pick on you because you choose a glamorous subspecialty, which is on its way to being "obselete". The only way you'll stick with trauma surgery in 12 years from now is if you have your heart set on the non-operative management of trauma patient's fluids, electrolytes, respiration, and perfusion in the ICU.

As I mentioned above... Its kinda important to know what the reality of medicine is. If we - as the future of healthcare - can appreciate a field for what it is, rather than what we think it is, we'll be less apt to throw our arms up in dispair in our 4th year, and choose to go into radiology, optho, derm, pathology, anesthesia....

None of us go into medical school "hating" patient care, but half of us do hate it by the time we finish med school. Really. Just do a search on the SDN for threads where a 3rd year is asking what field they should go into if they hate patient care. And everyone hates primary care.

Why? Maybe because the reality is so far from what students expect... and if you cant beat 'em, join 'em.

ER docs will be doing primary care half the time, because thats how the system is set up in the US.

Trauma surgeons are not doing surgery as much, because thats the best way to treat trauma patients.

Cardiothoracic surgeons dont operate as much because surgery, vs. angio vs. medical management are all just as good as the next. However, surgery has an increased morbidiity over the rest.

Primary care docs can not do what is in the best interest of their patient, because they have to do what the government and the insurance companies tell them.

Who wants to deal with this? Nobody. Unless, of course, you know what you are getting yourself into, and are willing to deal with it.
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That's kind of a bold assessment to make....and I completely disagree with you that Med Students "hate" patient care....Every time I'm in the OR I have conversations with Medical Students third/fourth year and they don't mind patient care and tell me it's good that I've chosen an interest in surgery at a young age because I can explore all the different specialties it has to offer like General Surgery, Ortho, Neuro, GI Oncology, etc.
 
runrunrudolph1 said:
I am very open to the idea that my mind will change (especially for subspecialty since i have 12 years to make up my mind) but i think that if your heart is set on something and you know you love it (surgery) there really is no alternate route for you. At least thats how I feel it is in my case.
Click to expand...

i think what howelljolly posted was great but i think i can rephrase it slightly so that a point that is very relevant to you specifically is more clear:

if you want to do 'surgery', meaning 'operate', you should probably do anything but trauma.
 
YouNeverKnow22 said:
That's kind of a bold assessment to make....and I completely disagree with you that Med Students "hate" patient care....Every time I'm in the OR I have conversations with Medical Students third/fourth year and they don't mind patient care and tell me it's good that I've chosen an interest in surgery at a young age because I can explore all the different specialties it has to offer like General Surgery, Ortho, Neuro, GI Oncology, etc.
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Yeah well... like I said, troll around the SDN. Instead of talking to med students in the OR, talk to the ones in the path lab, or radiology reading room. You'll find plenty that hate patient care.

You may as well have selected Internal Medicine, so you can explore all the different specialties it has to offer, like Cardiology, Pulmonology, Nephrology, Endocrine, Heme/Onc, GI, ID, etc.

Argue if you want...

Youre missing my point.
 
JJFoshay said:
How exactly is the compensation poor? An average yearly income of slightly under $200k is an amazing prospect to me -- granted, I come from a middle class background and my parents never made anything near that. No layperson is going to sympathize with doctors saying PC doesn't pay enough.

I think the simple fact is that new doctors are steering for the most pay for the least work, and that's in highly specialized subfields. My yearly cardiologist visit -- with an ECG, ultrasound, Holter monitor, and MRI -- nets my cardiologist several thousand dollars for work that I doubt amounts to more than a couple days. Meanwhile, my PCP can't spend more than 10 minutes with me in order to make the six-figure salary doctors are accustomed to. Since my PCP can't spend any time on me or other patiens, if any moderately serious problem (which they are trained to handle) comes up, they'll forward it to one of the specialists whose ranks are balooning and demand to be fed more cash!

Despite all their altruistic claims in their applications and interviews, the lazy bastard priciple holds and most medical graduates aren't going to do the (comparatively) thankless work of primary care. If our medical system starts to compensate primary care fairly -- recognizing than preventing heart attacks is more commendable than pumping patiens full of drugs and doing a quadruple bypass after the fact -- then the current pre-med and med student populations won't balk at it so much.
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I agree.

The reason why compensation is so awful is that the overhead costs of the office and malpractice insurance come out of that just-under-200K.
 
VoiceofReason said:
i think what howelljolly posted was great but i think i can rephrase it slightly so that a point that is very relevant to you specifically is more clear:

if you want to do 'surgery', meaning 'operate', you should probably do anything but trauma.
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yup
 
well thats a definitely a lot to think about, I guess the best plan of action would be to wait and see where med school takes me. I hear you guys though, I know that the medical field is romanticizes by the media and we all have this vision of what our lives as doctors is going to be like and come reality it's nothing like that, but I think there is one thing we can agree on- medicine is the most rewarding field (regardless of specialty)... I appreciate the advice though :)
 
JJFoshay said:
How exactly is the compensation poor? An average yearly income of slightly under $200k is an amazing prospect to me -- granted, I come from a middle class background and my parents never made anything near that.
Click to expand...


Thank you JJFoshay! Coming from someone like me who came from a middle class family just under $200k is a very very very great income that I will be fortunate to have when I am done with med school.

I agree that there are so many people that pick specialties based on money and not where their heart lies (unless that is money).

I will most likely end up in PC because I feel thats whats most suited to me.
 
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