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Does anyone think that family med is heading extinction? It seems that medicine is becoming more specialized by the day, even in rural communities. Why should I go into family med vs. med.peds?
Why family med, when we have med/peds?
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murph79 said:
I think the real question is, why bother doing a four-year residency in med-peds if you're interested in primary care? The option to head down an IM or peds subspecialty track is the only attraction that I can see for med-peds.
See article: Where do med-peds fit? in Medical Economics for more info.
As for FP becoming "extinct", I wouldn't hold my breath.
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KentW said:I think the real question is, why bother doing a four-year residency in med-peds if you're interested in primary care?
As for FP becoming "extinct", I wouldn't hold my breath.
i totally agree on both points. if you know that you're interested in primary care, there's no reason to do medpeds. and in the real world, as soemone once stated here, who is goign to take call for you? it's hard enough finding one person, but being med peds, you'd be forced to find an internist AND a pediatrician. good lord. if you want ot speciailize, that's totally cool, but it would therefore most likely be in either internal med OR pediatrics, not both. i just don't get med-peds. doesn't make any sense to me.
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KentW said:I think the real question is, why bother doing a four-year residency in med-peds if you're interested in primary care?
As for FP becoming "extinct", I wouldn't hold my breath.
i totally agree on both points. if you know that you're interested in primary care, there's no reason to do medpeds. and in the real world, as soemone once stated here, who is goign to take call for you? it's hard enough finding one person, but being med peds, you'd be forced to find an internist AND a pediatrician. good lord. if you want ot speciailize, that's totally cool, but it would therefore most likely be in either internal med OR pediatrics, not both. i just don't get med-peds. doesn't make any sense to me.
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ramonaquimby said:
Or, an FP.
Of course, this would depend on how tough your peds patient population was. If you had a lot of really sick and complicated kids, you probably would need coverage by a pediatrician as well.
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The main difference as I see it b/w med-peds and FM is the focus of residency -- inpatient and ICU experience vs. outpatient training -- this difference is reflected in the length of training. Med-peds trainees fit well into an academic med-peds program but I wonder if, in the real world, many med-peds graduates really practice both IM and peds and do admissions, ICU and outpatient medicine.
Can you do both? Probably, but only if you are focused on primary care/ outpatient care and then I would argue that FM would make more sense. And what about women's health visits? Prenatal visits? You'd still be limited, even with more training.
The issue with fellowship opportunities is also confusing to me -- you could, I suppose, do a peds cards and IM cards fellowship but what would you be accomplishing (other than training for the rest of your life). More likely, a fellowship would be in one or the other and would necessarily pull you away from seeing the other patient population.
I hope some med-peds people can shed some light on this topic, people ask me about it all of the time. Coming from an academic institution, many people (medicine and peds) have discouraged FM and pushed med-peds but can't really describe the advantages of this track. I argue that academic FM offers the same # of research opportunities (in my opinion, more meaninful opportunities) and definitely more demand for academic leadership. The position of the FM doc in a larger academic institution is often appreciated not only because they represent the gateway to patients for studies but also because of the unique, grounded, generalist perspective that is often missing from internists and specialists who are designing studies.
Can you do both? Probably, but only if you are focused on primary care/ outpatient care and then I would argue that FM would make more sense. And what about women's health visits? Prenatal visits? You'd still be limited, even with more training.
The issue with fellowship opportunities is also confusing to me -- you could, I suppose, do a peds cards and IM cards fellowship but what would you be accomplishing (other than training for the rest of your life). More likely, a fellowship would be in one or the other and would necessarily pull you away from seeing the other patient population.
I hope some med-peds people can shed some light on this topic, people ask me about it all of the time. Coming from an academic institution, many people (medicine and peds) have discouraged FM and pushed med-peds but can't really describe the advantages of this track. I argue that academic FM offers the same # of research opportunities (in my opinion, more meaninful opportunities) and definitely more demand for academic leadership. The position of the FM doc in a larger academic institution is often appreciated not only because they represent the gateway to patients for studies but also because of the unique, grounded, generalist perspective that is often missing from internists and specialists who are designing studies.
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murph79 said:
What is it about this notion about fam med and primary care going to extinction. There is no way primary care is going away, done deal. YOu can debate it forever but there are thousands of doctors practicing and the healthcare system in this country is integrated and feeds off those practioners. No matter how many, ideas, PAs, NP, turf wars, those doctors all still practicing, and will be practicing for a long time to come ( maybe they arent making as much as they used to, but i would blame that on insurance). Remember medicine is an integrated field and everyone works together for referrals and consults, and it is an extreemly cooperative system that could not survive; if one whole part of the system would just completely collapse, become extinct ( primary care ), then since everyone is connected, other primary care providers, specialists, and so on would feel the effect and begin to collapse as well.. (theoritcally
) Now there are many factors as to reimbursement issues and other such things that cant comment on since i am not in the private world yet, but will see in the times to come. I think it is just times are changing, and everyone will have to change to meet the times type of a thing, just adapt to some of the changes, but i dont feel FM/primary care will ever become extinct.
on a side note, i know on a personal level about 7 or 8 FM docs and a couple of IM primary care docs who are great friends of mine, and they are all doing very well. So i dont see the issues that are often generated in discussion here, come up with them.
Med/Peds, as for that , i agree with everone else, i think it is good if you want to specialize only, not for private practice, but i would like to hear input from those guys who have done it to know more.
interesting subject though.
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I'm a Med-Peds attending in a hospital owned private practice. Contrary to popular belief I DID choose Med-Peds over FP. My reasoning was that in a rural area the ability to stabilize sick patients is much more important than in a more urban or suburban practice where you likely have board certified EM docs in your ED, intensivists in your ICUs, neonatologists to attend your deliveries etc. Obviously we utilize our tertiary care hospitals and do transfer patients to them for stuff we can not (or should not) do at our rural hospital. However, often it is our actions in the initial stabilization and workup of the patient that significantly impact overall outcome.
Additionally I felt that pediatric training was sorely lacking in most FP programs I looked at. I did not see myself being competent doing much more than well child care and I really wanted to do more than that. At the same time I didn't want to focus solely on pediatrics. I liked the idea of taking care of the whole family. I currently have a very family centered practice and have several families that I care for 3 or more generations of. My practice is still growing but ultimately I see myself doing about 60% Peds 40% IM (largely because I practice in a community with 4 other IM providers and only one other pediatrician the pediatrics need is greater).
As far as the OB or general surgery thing...none of our FPs do deliveries or any surgeries. We are fortunate to have two very good general surgeons and are in the process of recruiting additional OB providers.
Our hospital is covered by an institutional call group [our bylaws require you to take rotational call if you have admitting privileges--therefore medicine call rotates 1 in 7 with 4 IM trained and 3FP. Our FPs do not have Peds admitting privileges so they are not in the group so call is 1 in 2 (and I have slightly less to compensate for my medicine call responsibilities). At least one of the FPs does do some well child care but is rather selective in who he will see and is very quick to send them away if the sneeze the wrong way. I frequently get referrals from him for kids with medical problems or adults with multiple medical problems that "need an internist!". In our system Med-Peds (and straight IM and Peds) act as FP extenders. It seems to work.
Additionally I felt that pediatric training was sorely lacking in most FP programs I looked at. I did not see myself being competent doing much more than well child care and I really wanted to do more than that. At the same time I didn't want to focus solely on pediatrics. I liked the idea of taking care of the whole family. I currently have a very family centered practice and have several families that I care for 3 or more generations of. My practice is still growing but ultimately I see myself doing about 60% Peds 40% IM (largely because I practice in a community with 4 other IM providers and only one other pediatrician the pediatrics need is greater).
As far as the OB or general surgery thing...none of our FPs do deliveries or any surgeries. We are fortunate to have two very good general surgeons and are in the process of recruiting additional OB providers.
Our hospital is covered by an institutional call group [our bylaws require you to take rotational call if you have admitting privileges--therefore medicine call rotates 1 in 7 with 4 IM trained and 3FP. Our FPs do not have Peds admitting privileges so they are not in the group so call is 1 in 2 (and I have slightly less to compensate for my medicine call responsibilities). At least one of the FPs does do some well child care but is rather selective in who he will see and is very quick to send them away if the sneeze the wrong way. I frequently get referrals from him for kids with medical problems or adults with multiple medical problems that "need an internist!". In our system Med-Peds (and straight IM and Peds) act as FP extenders. It seems to work.
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RuralMed,
You are the exception to the rule as a good chunk of Med-Peds gravitate one way or the other.
Your experience in your practice is one of hundreds of possibilities when discussing who practices what and what admitting privleges one has.
We have two internists at our hospital that act as consulting physicians for our ICU. As an FM doc, I consult them about 50% of the time I have a patient in ICU (as in no turf wars). All the FM docs admit peds but we do not take care of any PICU situations (wouldn't want to either). I feel comfortable seeing peds from 1 day old up and adults to 95 year old little ladies in my practice. I handle people with complex and multiple problems without huge amounts of input from specialists.
I think you made it clear that your situation is individualized but I didn't want students or even residents on this board thinking they can't practice a very broad based medicine in FM or feel too limited in what they can handle in-patient. If you want to admit peds, focus on that in residency and make it a priority in your learning.
You are the exception to the rule as a good chunk of Med-Peds gravitate one way or the other.
Your experience in your practice is one of hundreds of possibilities when discussing who practices what and what admitting privleges one has.
We have two internists at our hospital that act as consulting physicians for our ICU. As an FM doc, I consult them about 50% of the time I have a patient in ICU (as in no turf wars). All the FM docs admit peds but we do not take care of any PICU situations (wouldn't want to either). I feel comfortable seeing peds from 1 day old up and adults to 95 year old little ladies in my practice. I handle people with complex and multiple problems without huge amounts of input from specialists.
I think you made it clear that your situation is individualized but I didn't want students or even residents on this board thinking they can't practice a very broad based medicine in FM or feel too limited in what they can handle in-patient. If you want to admit peds, focus on that in residency and make it a priority in your learning.
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Interesting post! I also was struggling between med/peds and family practice at first. I ended up doing just straight internal medicine because I thought med/peds (2 residencies at once) would be overwhelming and I slightly prefer medicine over peds; I decided against family practice because I wanted to keep my options open. Now I am in my final year of internal medicine residency and realize that I really miss the pediatrics alot (though I do like working with adults). I am also tired too from all the internal medicine call after 3yrs.
What would the family practice residents do if they were in my position?
What would the med/peds residents do if they were in my position?
What would the family practice residents do if they were in my position?
What would the med/peds residents do if they were in my position?
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Hi guys, interesting thread! I'm an FP intern - I went through some of the same questioning when I was deciding what to do into - for me it was FP vs. Med/Peds vs. IM. I chose FP because in the state I'd like to practice in - FPs still do a ton of deliveries in 90% of locations, and OB is attractive to me (I like the continuity of care that comes with that - I might even do an OB fellowship after residency). And I'd like to go rural - most of the groups I've seen have been 95% FP with an occ internist. Thus, someone needs to cover the peds call when that internist is taking call for the group. However, with med-peds that would NOT be an issue. I simply liked OB (and gyn) and ended up going the FP route. I like kids and babies, adolescent med, procedures, sports med, hospital work, too, so that fit as well. As for surgeries (hernias? appys?), good god, no way, not appropriate for me (and for most FPs). I know my limits - I'd rather be in the clinic or ICU or ER or in a code - I'm more "medicine" than "surgery".
However, if I've learned anything along the way - you can always gain experience in an area of interest and add it on to your residency training. On a medicine rotation at a community hospital, I was being wooed by the internist I was working with towards medicine, and he tried to tell me about about an internist he worked with who got "some peds training" and now did tons of urgent care. That wasn't for me (I need more peds than that!) but it brought up an interesting point that you can always get add'l experience.
One more thing - my residency is at a large "community" hospital - there are some hospitalists that cover for some of the private groups in town. ONE of the hospitalists is med-peds, and does inpatient peds care for random FPs and pediatricians in town. However, all the hospitalists are internal medicine-trained. It HAS led to coverage issues - which are being worked out. I thought med-peds was a "newer" residency, though - if true, there should be more med-peds docs coming into the workplace soon, and coverage issues should be resolved. I personally think that would be a really cool job (med-peds hospitalist!) - but I think everything sounds cool. As well, as pointed out above, there are TONS of practice situations - something for everyone. It's just figuring out what you think you'd like to do, and getting the training for it. And having the proper level of comfort and knowledge for what you're doing. Uncomfortable with kids? Don't do peds or see kids. Uncomfortable with complicated geriatrics? Don't see adults. Uncomfortable with crashing ICU patients? Don't do ICU. OR get the training you need to be comfortable and GOOD at it.
Sorry for the length...once I get going.....
And it's blizzarding here so I am stuck inside with plenty of time to write!
However, if I've learned anything along the way - you can always gain experience in an area of interest and add it on to your residency training. On a medicine rotation at a community hospital, I was being wooed by the internist I was working with towards medicine, and he tried to tell me about about an internist he worked with who got "some peds training" and now did tons of urgent care. That wasn't for me (I need more peds than that!) but it brought up an interesting point that you can always get add'l experience.
One more thing - my residency is at a large "community" hospital - there are some hospitalists that cover for some of the private groups in town. ONE of the hospitalists is med-peds, and does inpatient peds care for random FPs and pediatricians in town. However, all the hospitalists are internal medicine-trained. It HAS led to coverage issues - which are being worked out. I thought med-peds was a "newer" residency, though - if true, there should be more med-peds docs coming into the workplace soon, and coverage issues should be resolved. I personally think that would be a really cool job (med-peds hospitalist!) - but I think everything sounds cool. As well, as pointed out above, there are TONS of practice situations - something for everyone. It's just figuring out what you think you'd like to do, and getting the training for it. And having the proper level of comfort and knowledge for what you're doing. Uncomfortable with kids? Don't do peds or see kids. Uncomfortable with complicated geriatrics? Don't see adults. Uncomfortable with crashing ICU patients? Don't do ICU. OR get the training you need to be comfortable and GOOD at it.
Sorry for the length...once I get going.....
And it's blizzarding here so I am stuck inside with plenty of time to write! Similar threads
