Why become a family medicine doctor?

[rokshana]

More power to you if you can successfully see 30-40 patients a day good for you.. But wouldnt that salary be divided right in half on office expenses/nurses/.... everything else. and you dont seem to be accouting for even one second of paper work/insurance/preapprovals/everything else?

ANYWAYS i'm not saying that you cant do well being a FP.. But you could simply do the exact same thing as an NP(with zero debt and only 3 years of schooling).. There is no law that says an NP cant see 30-40 pts per day and make the same salary... Uncle Sam reimburses an NP the exact same as an FP.... (that use to be only 80% and use to require physician oversight.. all equal now)

you obviously do not understand RVUs...

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[MrSunny1]

Fresh out of residency FP and it isn't close.

I disagree, but hey, I know good doctors. As to cost... Well, an NP makes an average of $105,670 while a FP makes an average of 209K. Let's do some math:

First off, the NP with an average debt load will have student loans of $1017/mo.
Let's run an after-tax monthly income for someone working in, say, Texas.
$6,494.08 is what it comes out to after tax, assuming no deductions (there would be deductions, but we're keeping things clean).
Basic cost of living in the Houston area in a decent spot, we'll say you spend $1,600 on rent/mortgage, $600 on a car/insurance, $600 on food, $400 on utilities/communications, that puts you at $4,217 in total expenses per month. This assumes your single and don't have kids by the way, which jacks up costs by another $1,500... But anyways, that leaves you with a net of around $2,500 you can actually save and invest. You get out of school 4-5 years earlier than the doctor, but that's all you've got to work with. Or $1,000 if you've got a couple of kids and you're cheap about it, less if you aren't.

Now as a physician, you'll pull $12,006 after taxes in Texas.
Your loans will cost you $2,441. You've got the same cost of living as above, which gives you total expenses of $5,641. That gives you a net of roughly $6,350 to save and invest per month, or $4,850 with the kid deduction, certainly a lot more wiggle room financially and a lot more opportunity to actually save and invest. You put in an extra half decade, but you get a better rest of your freakin' life.

That's just the averages though. I think the trade off is worth it.

I dont think the cost of living in houston is 4217$ a month thats almost 50k a year just to live(im not talking about living like royalty).... a 2year associate degree plus 1 year online NP is actually free because you can work full time for the year of NP while you are taking your online courses. not 109k. We are using the above average NP here not the straggler that has to take the longest possible route and barely graduated highschool. Remember Im talking about a would be FP so (top of the class) very ambitious hardworker. so If you get out of school 8 years earlier and net invest say 4,000 per month thats almost 50k per year. 50K per year invested at 8% for 8 years is a net savings of 680,000$ of pure cash and no debt. FP would graduate on the same day with 209k debt and zero cash. NOW the point you are missing is that the NP has been practicing for 8 years thats by and far long enough to start solo practice seeing 20-30pts per day(there is no law that prohibits that) so the NP perhaps has already built a large patient panel from 8 years of practice not impractical. While you seem to assume that the FP will just magically open private practice and start making 208k per year? Where will the patients come from? wouldnt it take a few years to establish practice and even start breaking even with all the overhead? Probably another 3-5 years before the FP has enough steady patients to be making 120k per year net. so thats another 3-5 years lost while the FP would have made full physician salary for 3-5 years or another million dollars. Anyways the end result is that they will both eventually have the same practice seeing the same patients making the same money in the long run. Yet the NP would be lightyears ahead of the FP. The catch is the NP doesnt have crushing debt, and has a nice cushion, he can go private and see just 10-15 patients a day and do well. I think an NP with 8 years of clinical experience seeing 15-20 patients per day (or 20 minutes per visit) would have better outcomes than a fresh FP overloaded with patients trying to run 5-10 minute visits to reach that promised 200k salary. Seems to me that both financially and even ethically the NP would be way better off. I know I feel bad rushing in a patient room rambling through a massive H&P so fast that the patients eyes are spinning and wondering if he/she even heard anything I've said.

 

[rokshana]

Well you remember we are talking about someone who would be that exceptional NP and complete an accelerated path assuming he would easily have gotten into a good medical school. I'm not talking about comparing the 2.0GPA highschool certificate NP to a stellar family medicine doctor. Im comparing a would be FP doctor who otherwise chose the path of NP over medical school(which he could have easily been accepted to with his 4.0 GPA and outstanding EC, letters of recs....) who decided that he would rather start practicing in 3 years instead of 11.

the chip...the chip would be a big one for that guy.

 

[IM2GI]

I dont think the cost of living in houston is 4217$ a month thats almost 50k a year just to live(im not talking about living like royalty).... a 2year associate degree plus 1 year online NP is actually free because you can work full time for the year of NP while you are taking your online courses. not 109k. We are using the above average NP here not the straggler that has to take the longest possible route and barely graduated highschool. Remember Im talking about a would be FP so (top of the class) very ambitious hardworker. so If you get out of school 8 years earlier and net invest say 4,000 per month thats almost 50k per year. 50K per year invested at 8% for 8 years is a net savings of 680,000$ of pure cash and no debt. FP would graduate on the same day with 209k debt and zero cash. NOW the point you are missing is that the NP has been practicing for 8 years thats by and far long enough to start solo practice seeing 20-30pts per day(there is no law that prohibits that) so the NP perhaps has already built a large patient panel from 8 years of practice not impractical. While you seem to assume that the FP will just magically open private practice and start making 208k per year? Where will the patients come from? wouldnt it take a few years to establish practice and even start breaking even with all the overhead? Probably another 3-5 years before the FP has enough steady patients to be making 120k per year net. so thats another 3-5 years lost while the FP would have made full physician salary for 3-5 years or another million dollars. Anyways the end result is that they will both eventually have the same practice seeing the same patients making the same money in the long run. Yet the NP would be lightyears ahead of the FP. The catch is the NP doesnt have crushing debt, and has a nice cushion, he can go private and see just 10-15 patients a day and do well. I think an NP with 8 years of clinical experience seeing 15-20 patients per day (or 20 minutes per visit) would have better outcomes than a fresh FP overloaded with patients trying to run 5-10 minute visits to reach that promised 200k salary. Seems to me that both financially and even ethically the NP would be way better off. I know I feel bad rushing in a patient room rambling through a massive H&P so fast that the patients eyes are spinning and wondering if he/she even heard anything I've said.

You've got all the answers. You are not going to convince anyone here on your views, and you certainly are not open to hearing the reality of your position from a physician's perspective.

Troll thread, please lock.

 

[MrSunny1]

Ive seen several patient encounters where doctors missed very obvious things because they only spent maybe 3 minutes on a pressured interview with a patient(and no ROS what so ever). Such as a large DVT that the patient thought was just a bruise completely missed because it wasnt the patients number one priority she came in for a neck pain and symptoms of hyperthyroid and that only would have came up later on in the interview but that time didnt exist there was no "later on" have to get the patient out the door in 15mins to reach that goal salary.

 

[rokshana]

You say bad, but all the studies conducted says great... And thats all uncle Sam cares about (equal pay equal+practice rights as proof) obviously that wouldnt happen if they were "practicing bad medicine"

cite your sources.

 

[kjamess]

go ahead and finish up that online certificate to become a noctor, we approve. expertise of a true doctor with the heart of a nurse!

 

[Mad Jack]

I dont think the cost of living in houston is 4217$ a month thats almost 50k a year just to live(im not talking about living like royalty).... a 2year associate degree plus 1 year online NP is actually free because you can work full time for the year of NP while you are taking your online courses. not 109k. We are using the above average NP here not the straggler that has to take the longest possible route and barely graduated highschool. Remember Im talking about a would be FP so (top of the class) very ambitious hardworker. so If you get out of school 8 years earlier and net invest say 4,000 per month thats almost 50k per year. 50K per year invested at 8% for 8 years is a net savings of 680,000$ of pure cash and no debt. FP would graduate on the same day with 209k debt and zero cash. NOW the point you are missing is that the NP has been practicing for 8 years thats by and far long enough to start solo practice seeing 20-30pts per day(there is no law that prohibits that) so the NP perhaps has already built a large patient panel from 8 years of practice not impractical. While you seem to assume that the FP will just magically open private practice and start making 208k per year? Where will the patients come from? wouldnt it take a few years to establish practice and even start breaking even with all the overhead? Probably another 3-5 years before the FP has enough steady patients to be making 120k per year net. so thats another 3-5 years lost while the FP would have made full physician salary for 3-5 years or another million dollars. Anyways the end result is that they will both eventually have the same practice seeing the same patients making the same money in the long run. Yet the NP would be lightyears ahead of the FP. The catch is the NP doesnt have crushing debt, and has a nice cushion, he can go private and see just 10-15 patients a day and do well. I think an NP with 8 years of clinical experience seeing 15-20 patients per day (or 20 minutes per visit) would have better outcomes than a fresh FP overloaded with patients trying to run 5-10 minute visits to reach that promised 200k salary. Seems to me that both financially and even ethically the NP would be way better off. I know I feel bad rushing in a patient room rambling through a massive H&P so fast that the patients eyes are spinning and wondering if he/she even heard anything I've said.

That was the cost of living PLUS the over $1,000 a month in student loan costs the average NP carries. That 90k of debt really adds up when you consider interest, and it's hard to pay down on a NP's salary.

As to "magically open a private practice," most FPs work for groups that pay a salary. Most new FP practices fill in literally a couple of months though, I spent time with a guy who went from doing 13 patients to 22 patients a day in his first three months of practice. But just to prove the point, here's over 1,700 listings that have a salary of 200k+ for FP physicians. Most FPs are paid on salary plus productivity these days, with a base of around 200k. I don't know anyone making less that isn't in academics, and that's including new grads.

Family Practice Physician $200,000 Jobs, Employment | Indeed.com

 

[MrSunny1]

Aside the point but will the market ever be saturated? I saw that 3 new FPs just moved to a small town this year where my parents live.. The town only has a population of 3600 and there are now 10 FPs in the area. I know thats off topic but its another thought that I had if one were to do rural or open a FP clinic it seems that there could easily be a saturated market if each physician needs 5,000-6000 pt visits per year. The reason I ask this because my friend is a family law attorney and the market is Completely saturated here to where she cannot make a living as a solo attorney in practice for 4 years now. Next year she is closing her practice and will have to pursue other career paths and unfortunately she has 250k in student loans.

 

[akuko2]

@MrSunny1 Why would anyone be an NP or a Family med physician when I clear 90K a month selling essential oils.

 

[MrSunny1]

@MrSunny1 Why would anyone be an NP or a Family med physician when I clear 90K a month selling essential oils.

where can I get those oils? Can I sign up lol.

 

[ThoracicGuy]

Seems pointless now considering nurse practitioner has the same practice authority as a physician and that only takes 3 years total to start practicing out of highschool(and from zero to 40,000$ in student loans)... Kind of feels like losing 8 years of your life for very little and all the stress and board exams.. Turns out NP have the same care levels as physicians(in primary care setting as many studies have shown) which woudlnt surprise me because they spend over twice as long(on average) with each patient encounter.. As we learned in medicine around 80% of the healthcare outcome is from actual patient interaction so it would make sense that an NP who spends twice as long with patients would have better outcomes...

Also NPs have far less stress, much better hours, and vastly superior quality of life not to mention probably a much higher lifetime earnings considering they have an 8 year headstart and zero debt or interest.. I think it all comes down to being able to except a lower salary. An NP is perfectly happy with 90-120k a year and doesnt mind seeing 10-20pts a day... Where as poor FP needs to see 20-40 patients per day in order to pay loans and achieve the 180-220k salary.

 

[Mad Jack]

Aside the point but will the market ever be saturated? I saw that 3 new FPs just moved to a small town this year where my parents live.. The town only has a population of 3600 and there are now 10 FPs in the area. I know thats off topic but its another thought that I had if one were to do rural or open a FP clinic it seems that there could easily be a saturated market if each physician needs 5,000-6000 pt visits per year. The reason I ask this because my friend is a family law attorney and the market is Completely saturated here to where she cannot make a living as a solo attorney in practice for 4 years now. Next year she is closing her practice and will have to pursue other career paths and unfortunately she has 250k in student loans.

In a rural area you can often pull patients from farther away (up to two hours or more in some spots) and you can subsist on smaller patient panels because there aren't specialists, so you end up doing a lot of the management that would normally get referred. In a rural area, you look at things on a "how many people live in this county" not "how many pale live in this town" basis. The other big thing is that as a rural FP, you're far more likely to end up doing inpatient work on your sick patients than you would be in more saturated areas, which further expands the work to be done.

 

[Mad Jack]

This is true. I have a 22 month RN diploma. I could do an online program through Kaplan for 12 months and $20k that would make me an NP. 3 total years to become a dangerously incompetent provider.

From AllNurses:
I started Kaplan University's Family Nurse Practitioner program in Sept 2012. The first year is basically spent taking research and theory courses. There are a lot more classes compared to an average university masters degree program over 100 credits compared to 40-55 in regular universities.

When I finally reached the important classes like advanced pathophysiology and pharmacology, I was really disappointed in the lack of formal testing and the way I was learning in general. I know masters programs are different than undergrad, but I felt extremely under challenged. I felt like I was alone as I had to self-teach myself everything. There is no lecture or really even any guidance from the instructors. The curriculum is set and they just check to make sure you are posting on the discussion board. This form of learning may work for some, but I don't feel like I have enough experience (RN now for 4 years) to feel confident enough to self teach myself to become a nurse practitioner. The flexibility was really nice though. They structure the school week between Wed-Tue so that you still have you weekends to catch up. In the end I just didn't feel confident with obtaining such an important degree from this institution.

After 45 credits, 1 year and 3 months, with still at least another 1.5 years left, I decided to apply to university FNP masters program in FL. It was a hard decision to make because I had to study for my GRE for about 3 months and basically start all over. I was so blessed to find out I got into University of Central Florida's Family Nurse Practitioner Program! I will be starting this fall. Hopefully this helps someone who is struggling to make the same decision.

This is the quality education received by people getting an online NP degree. Yeah... I think I'd rather be a competent physician than a hack NP.

 

[unleash500]

To OP: on paper it might seem better , but real life doesn't work that way . Work and fufillment is very individualized.

I have some friends who are NPs and PAs and a lot of them said they wish they became doctors instead.

They cite factors like : lack of respect from patients, lack of respect from other healthcare providers , difficulty finding a job in metro cities ( unlike FPs you can find.a job easily ).

Personally , I would feel scared taking care of ptients with that little training. I think the extra training of residency is a bonus .

 

[Promethean]

This is the quality education received by people getting an online NP degree. Yeah... I think I'd rather be a competent physician than a hack NP.

Precisely the decision I made, and for the same reasons.

That is one review among hundreds that I read about various programs. Even the in-person NP degrees are no guarantee of a quality education. I have a friend who went through a psych NP doctorate program at a respected private university who found the courses to be pitched at a level that wouldn't have been challenging for her as an undergrad, let alone someone seeking a terminal degree.

I don't want to say that every NP program is crap. But so many of them are, and there is no consistency or standardization of curricula. It is basically the state Medicine was in before the Flexner Report. I would have no problem whatsoever with full practice rights for professionals who were actually uniformly educated to a level of competence that was at parity with physicians. Of course, to do that, they would have to raise admission standards, increase the rigor of the programs, and likely raise the tuition to parity with medical schools...

There are consequences to taking shortcuts. Someone will pay for it, and it is most likely to be the patients... and those poor fools who thought they were going to get a better education than they really did. I'm grateful to have had the foresight to really research the matter and choose the harder, but far more effective and rewarding, route.

 

[RadOncDoc21]

Overall the training is different. Med school then residency gives you an insight that you can not take for granted. Are nurses important, yes, but they do not have appropriate training and rely on docs.

Anybody can follow an algorithm or prescribe antibiotics, order tests for 90% of cases, but I've seen more than enough inappropriate care by NP providers to make my own conclusions.

 

[Winged Scapula]

Given that:

1) the OP is a "Pre-Health", posting in the residency forum with users who've already decided on a specialty is misplaced
2) the OP is either trolling or not willing to have a conversation about this even with users who've been nurses and explained why their plan has some flaws

So closing