Why aren't FP Docs more respected in medicine?

[Magree]

Hi:

I was wondering why FPs aren't more respected. When I do my sessions with my FP doc its very intimidating - more so than my specialty rotations. They have to know some much and their patients expect so much of them - more than specialists it seems. When I ask other students who are subspecialty or specialty bound they say that FP they were also intimidated by FP. Just curious as to what others thought.

cheers,

M-

---

Members don't see this ad.

 

[arthur v]

I think it's a case of the old adage: generalists know nothing about everything and specialists know everything about nothing. We are a society that values experts, so the generalists get the short end of the stick in terms of respect and compensation. I have never understood why respect from others in fields outside your own even matters. If you're happy with what you're doing, why should you care what an orthopod or radiologist thinks about your specialty?

AV

 

[Mr. happy clown guy]

Yes, I find it very interesting also. I have such great respect for FP docs and yet I listen to PA's (in their little section on this site) spout that FP's are "Overtrained" for what they do, and that a PA can do 90% if what a FP can.
Perhaps I missed something in medical school? Perhaps I missed the residency that PA's do?! I have seen FP residents work VERY hard in the hospital, and in the clinic. THey must know so much more than mere protocols and yet they recieve little respect from many professionals...but a great amount from their patients.
True, I am not going into Family Practice, but I have the utmost respect for my friends that are matching soon or are PGY1 already.

This is the profession that we must NEVER allow others to tarnish. We, as doctors, must ALWAYS insist upon the most talented and educated primary care providers for our patients. Why, would we EVER accept anything less??

 

[lotchki6]

It is quite funny...this is the first time I have entered this section of the web site because I was particularly interested in the discussion. Upon my entrance, to my amusement I see Mr. Happy Clown continue his ranting and raving about PAs and their "disrespect" for FPs and medicine in general. The individuals on the PA site ("in their own little section") stopped listening to his whinning, so he took it elsewhere -- just find that amusing.
Now to the topic at hand. I agree that FP docs are not given enough credit. They are the type of clinicians that our grandparents and great grandparents saw. They are the ones that are responsible for soo many aspects of the medicine we know today. And lets face it, they are the ones that we all see when we dont feel well. I think we live in a very materialistic society in which those that make the most money(surgeons and other specialists) are the ones that get all the "hype".

 

[Mr. happy clown guy]

Listen Buddy, I am an advocate of the AMA, the AOA, MAOPS, and IOMA...this is what advocates for the rights of physicians and patients do. I am clearly fighting for FP's to retain their practice rights in the sight of continuing graying of borders that were once VERY clear.
If you don't like what I say, then go away. The Family Physician has taken cheap shots by many. And it was NOT I who said that a "PA could do 80-90% of what a FP could". The point being...they simply cannot do it as WELL as a FP. Or that " FP's are overtrained for what they do". I was in the room when a patient quoted a Chiropractor saying that my family physician "wouldn't know what he was looking at if he looked at a spine xray". At least my FP attended 4 years of medical school and 3 years of residency...including training in RADIOLOGY!

I will state it again. MANY of my friends are going into FP and I have the UTMOST respect for them. I would have gone into the same field if it wasn't for interests elsewhere.
My hats off to the Family Physician who is the OB, the Gynecologist, the Pediatrician, the Dermatologist, the Physiatrist, and the Cardiologist all wrapped into one.

 

[godfather]

Actually i think there's a general perception outthere that a good fm or internist is probably the most knowledable person in the health care field because they know something about everything. It is why they quarterback a patient's care and they must be able to recognize when a specialist is needed. If their is a perceived lack of respect it is only because their salaries aren't as high as many of the other disciplines of medicine. otherwise from what i've seen in my limeted two years of med school a good fm or im docs clearly the smartest people in medicine(i do realize that their are also bad im/fm docs, but their are good and bad apples in every field, this is just an unscientific genralization i've based on what i have seen after rotating through every field)

 

[droliver]

Godafther,

I think you will quickly see that once you start your clinicals that your perception of IM/FP as the most knowledgeable person in health care will quickly evaporate. They probably have the least input on complicated hospitalized patients (who quickly become segregated by multiple organ-specific consultants). For my money, I have always been impressed with the Nephrologist or Critical care boarded Surgeons as the best and most thoughtful overall doctors with the most broad-based knowledge.

 

[Freeeedom!]

Besides my high regard for FP...I truly believe the most intelligent and most versatile Physician is the EM doc. Clearly the fastest decision maker, best at managing multiple patients, and the gate way physician for 30% of hospital admissions!

 

[droliver]

freeeedom!,

While i'll agree that ER docs are the "fastest" decision makers, Their scope of knowledge is broad but often superficial and focused on triage rather than treatment or doing very thorough workups. Anything but the most straight forward simple problems they go running for the telephone to turf it to someone else (lots of CYA consults for them )

 

[Freeeedom!]

OHHH my God, you have to be kidding...HAHAHA!

Dude, that is the lamest thing I have heard in a while!! There are 20 people in triage, 20 rooms FILLED in the ED. I have a complete work up to rule out upper GI bleeding. Pt. is anemic, and Guiac stool positive. I need the bed and now you can have em!! THAT IS WHAT I SEE!
Superficial knowledge, you gotta be joking!!
I have seen sooo many types of residents go to the ED and look like a fool during their EM rotation. Completely unable to handle 2-3 cases at once ranging from OD's to peds.
The ED is not a place to OBSERVE patients for hours. Typically the triage is filled, and we need the space. We have to make a decision...admit or street. I'll put YOUR name on the chart and call it simple Gastroenteritis...then they can sue you and not me.

 

[arthur v]

Chalk up another vote for critical care surgeons as perhaps the most complete physician (and I'm not even going into surgery - the ones I have worked with have just been awe-inspiring). Evidently, Freeeedom! believes that all problems can be managed medically.

AV

 

[Freeeedom!]

What a joker.
Did I say all could be managed medically? What are you talking about. I just said the most intelligent physicians I have been around have been EM docs (teaching at university).

What are you even talking about?

I am going to forget this conversation with you, it is about FP docs anyway. Each person has their mentor, and each doc is certainly talented.

 

[droliver]

Freeeedom,

having worked in ER's in settings including a University hospital, a children's hospital, a VA Hospital, and no less than 6 community hopsitals if I ever see an ER physician spend time to do "a complete work up of upper GI bleeding" I will fall over dead

 

[Freeeedom!]

Take a breath everyone...1,2,3 "We all agree to disagree" Wow, pretty easy. We all understand there are interprofessional squabling.

This topic is about FP...Everyone together "This topic is about FP".
Great.

 

[theD.O.C.]

Just a quick question;
If a patient comes in anemic and is guaic positive, wouldn't you be more concerned about a Lower GI bleed?

 

[DO/MBA]

Hematochezia..... Melena..... It's all guaiac positive. Picky, Picky.

 

[brownman]

Hmm...why aren't FP's respected?

Age old question really. My sister is an FP, and I think the respect she wants comes from her patients..not really from staff or other physicians. We physicians, in general, are a pompous, back biting lot. We are as catty as a sewing circle, and think each one of our respective fields is the shizzzz...and everyone else is doing the wrong thing. FP's get respect in ways other physicians probably don't...99% of their patients actually know their name. I can't say that for all specialties. If that in medicine is your primary concern (saving lives or preventing death from the start), then you should be a family physician. AND BY MAKING THAT STATEMENT, I AM IMPLICITLY SAYING NOT EVERY PHYSICIAN CARES ABOUT THAT. And there is nothing wrong with that by the way. We live in a capitalist economy, and some of the greatest discoveries of science (viagra being my favorite) are driven by purely fiscal motives. So, FP's get respect...they may not get salary...but they get respect. From their patients..which for them..matters the most.

THe other myth that needs to be killed right now is that of worth or respect in medicine being linked to money. IF YOU WANT TO BE RICH AS A PHYSICIAN, THEN YOU CAN BE. You just need to choose to do so ahead of time. That's all it comes down to...if you want to do research then accept the consequences of a lower salary. IF you want to be in primary care...then recognize the same. But, if you chase after the money...it's there. And it always will be...managed care or not. The one thing managed care has killed more than anything (financially anyway) is the ability of generalists and/or academic physicians to make gobs of cash. Now..in the hospital system...there just isn't enough to go around. Sad really...because these are the people that make medicine rich...and blend themselves to discovery. All physicians do...but because we need justification for the time via salary (and trust me...we need justification)we chase the fields of tremendous monetary upside. To each his own. Just don't base your respect for a physician on earning capacity. Do it on competency, or level of distinction, or difficulty or level of understanding of the patients needs. That is most important.

Peace

 

[DO/MBA]

You are mostly right, but you assume too much. Managed Care, when given the opportunity, (notice I said not if but when) will phase the physician out of the money. Unless something is done, the money will disappear. Just look at the big three HMO's right there in California, some FP's must turn down contracts just to make ends meet.

 

[brownman]

Well, maybe I do assume too much. To be a generalist of any type in california is definately tough. The cost of living here is so high that being squeezed by HMO's just to make ends meet is difficult. But I think the predicition of managed care being so dire is a little presumptuous. I think medicine, whether it wants to be or not, is becoming far more market driven. And the consequences here in California of squeezing FP's and internists are starting to become evident and will become entirely too obvious in five to ten years. In northern california, it is near impossible to staff hospitals in primary care (whereas everywhere else in the country we face saturation). The Palo Alto Medical Foundation recently had to divert patients BECAUSE THERE AREN'T ENOUGH PHYSICIANS TO STAFF THEM. And new staff they have to hire at rates higher than average compensation. I think managed care has killed autonomy, and it's definately hurt the monetary power of physicians overall. The point of my contention is that specialists I believe will still be payed better than generalists (eventhough their jobs might be fewer; this was my point around if you want the money in medicine it's there), that the entire system will eventually reach an equilibrium, and if as a physician you want to make money there are multiple avenues (definately in the future this is true..including biotech, pharma, consulting, hospital management...even HMO's). Because what physicians I think fail to understand is that managed care is making medicine a business, and any business can be guided to success. In the past we didn't have to care (money just flowed); in the future we will. But healthcare is and always will be (more so in the future) one of the richest fields around. And private practice won't disappear. Even in countries with socialized medicine, private practive hasn't disappeared. In fact, it's analogous to breaking up most monopolies. They only get richer. Anyway...I'm getting circuitous. My point is...if you want to do medicine for the money..or if it's the money you care about the most...then I'm sure you'll be able to find that cash. It may not be as easy as in the past...but it's still there, and will always continue to be. We should fear more for autonomy and patient safety than anything else. And what you have to remember about medicine is..there are very few fields where you can make a six figure salary without being the top of your class at a recognized university (aka law). If you can beat that deal...you should do it. Otherwise, be the best physician you can be, and let the chips fall where they may...

 

[DO/MBA]

Well stated.

 

[Freeeedom!]

theDOC,

Guiac positive screens typically find occult blood found in upper GI bleeds. But, may be positive in both.

 

[Elvis25]

Just curious why everyone is so willing to lump docs by their specialty as to how smart they are. Doesn't everyone here know a surgeon they wouldn't trust to remove a hangnail? Or an FP that treats everything with a shot of Rocephin? If you want an answer to the respect question, it's simply a matter of the baseball card theory. The value all depends on how many there are and how hard it is to get one. Primary care is the least competitive because it's what we need the most of. Of course less competitive fields yield less awe. Big freakin deal. Isn't it the patients that matter?