Why is family medicine viewed as a low quality field?

[MedicineZ0Z]

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I'm definitely not going into family med but why is the field disliked? The money really isn't bad. 250k is easily doable if you're anything close to efficient. And if you can see more patients, 300k+ is as well without insane hours. The job market is excellent including saturated areas (unlike specialties). And every single field has bread and butter cases that bore you to death if you don't like it, can't pick on FM for its bread and butter.

So... why the hate exactly?

 

[Oso]

- relatively uncompetitive / not prestigious
- " just a bunch of well visits + referrals"
- some fellowships, but not like IM/peds

 

[Wordead]

2 billion NPs graduating every year and they're going to end up somewhere

 

[MedicineZ0Z]

2 billion NPs graduating every year and they're going to end up somewhere

Don't assume it'll be FM. It still has the best job market...

 

[DocWinter]

You operate as an ER doc for less pay, seeing less interesting cases in a dull office environment.

But I agree with you the distain is largely misplaced. The money is decent and opportunity is wide open

 

[Ho0v-man]

I'm definitely not going into family med but why is the field disliked? The money really isn't bad. 250k is easily doable if you're anything close to efficient. And if you can see more patients, 300k+ is as well without insane hours. The job market is excellent including saturated areas (unlike specialties). And every single field has bread and butter cases that bore you to death if you don't like it, can't pick on FM for its bread and butter.

So... why the hate exactly?

Bc med students are sheep. Eff the haters and do what you want.

In general bc people want to keep their options open, IM is more appealing than FM d/t fellowship variety. But if you dont want to live in the hospital after residency go FM.

 

[FistLength]

I don't know many students that crap on FM, its more crapping on outpatient settings, and FM is hit by association. I have a lot of respect for FM, most people hate what FM docs have to deal with, not the profession, IMHO.

 

[The_Sunny_Doc]

I don't get it either. Outpatient medicine = happiness, sunshine, decent hours, the possibility of helping someone help themselves, as opposed to kicking them out of the hospital only to readmit a week later.

 

[W19]

Don't let elitist med students dissuade you from doing FM... FM is a lifestyle specialty if you are ok making 200-250k/year

 

[sliceofbread136]

I think there is a fairly strong association with being an outpatient physician and having no idea what you are doing, especially in a rural setting. Same with rural Eds.

 

[Giovanotto]

You operate as an ER doc for less pay, seeing less interesting cases in a dull office environment.

But I agree with you the distain is largely misplaced. The money is decent and opportunity is wide open

Can you explain this? I don't understand what a FM doc has to do with an ER doc.

 

[NRP]

I think if the pay was better around 225-250 at the least it would be a solid place to go into. Instead, the numbers for average pay range efrom 200-250k. How many hours do you need to work to hit the 300k? What are you sacrificing location wise? Nobody wants to live in the middle of nowhere just for more money.

 

[MareNostrummm]

Can you explain this? I don't understand what a FM doc has to do with an ER doc.

A large amount of patients rely on the ED for their primary care, so could just see them as a EM physician but make more money and still have the higher acuity cases for variety and more procedures.

 

[PantsOnFire]

My dad used to love to say that trade is lost in America, and that we need more people to go into trade school. Of course, he was had a PhD, and would not have let me even consider to go to trade school. FM is really the "trade school" of medicine. Everyone loves to go on about the how cush it is, but, as described in the OP, always puts the disclaimer that they themselves are not pursuing it.

 

[naway]

Is family medicine salary really solidly in the 200K's nowadays? I thought it averaged closer to 150K.

 

[curiousneuro]

FM is one of the last "generalist" specialties out there. Most medical students are more into subspecialty training, for probably a variety of reasons. Compared to the other main generalist specialties, it doesn't have as much of a "sexy" vibe or comparable salary (like EM). As other posters mentioned as well, it really has very little in the way of further training for better pay. I think there's a sizable IM population that go into IM without a clear idea of what they eventually want to do - and that's ok, because they have a variety of options. To do FM, you truly have to love the generalist view from the get-go, and essentially know that you aren't really going to pursue a significant fellowship afterwards (at least not one that will change your salary much).

 

[spacegun]

FM is good for all the above reasons. But I hear FM is a lot of dealing with insurance companies and filling out all their forms and having patient care decisions dictated by insurance algorithms. But that might be true for other specialties too like hematology and oncology with NCCN guidelines.

 

[ERDOC555]

Is family medicine salary really solidly in the 200K's nowadays? I thought it averaged closer to 150K.

Absolutely. Anyone making less than 200k better be working part time or in a completely saturated area, otherwise they are likely being taken advantage of by their employer.

Most salary surveys put family in the 220-250k range and I have yet to see anything reliable that has less than 200k. Anecdotally residents are getting offers all over the country for 200k+ with signing bonuses and/or loan payoffs. There are also many PP/Group Family Medicine Physicians who make 300k+.

I've also heard a few other people mention that they thought family medicine only makes 125-150k and I always wonder how such an obviously false rumor gets spread around.

 

[naway]

Absolutely. Anyone making less than 200k better be working part time or in a completely saturated area, otherwise they are likely being taken advantage of by their employer.

Most salary surveys put family in the 220-250k range and I have yet to see anything reliable that has less than 200k. Anecdotally residents are getting offers all over the country for 200k+ with signing bonuses and/or loan payoffs. There are also many PP/Group Family Medicine Physicians who make 300k+.

I've also heard a few other people mention that they thought family medicine only makes 125-150k and I always wonder how such an obviously false rumor gets spread around.

Huh, that certaintly makes the accelerated primary care track at the school I'm starting at in August seem like more of an attractive option to consider.

It also makes me even more annoyed that my own primary care doctor has begun rushing me in and out of my appointments within 3 or 4 minutes lately, barely letting me get a word in edgewise. During my last physical, all she did was listen to my heart, look in my ears, and then say, "Okay, you look good" and try to rush out of the room. I had to stop her while she was already heading towards the door to let her know I actually had a concern I wanted to ask about. I had some sympathy before because maybe she was just completely burnt out on doing such a demanding job for such little pay, but she's getting 200K+ to treat me like that? I really need to find a new doctor accepting new pts...

 

[AlexMack12]

Different fields of medicine all have something different to offer the patients they take care of, and help patients in a particular way. The problem becomes when people who are looking to help patients in a certain way view another speciality through a lens it was never meant to be viewed through.

For some people, it might be their goal to help others by jumping in and cauterizing a bleeding artery or doing an emergency triple A repair. To them, skill is being good with a cautery or scope or what have you. When this person forms an opinion on family medicine, they’ll see it as “lame,” perhaps, or “boring” or “unskilled.”

But of course, family medicine isn’t about saving a life in a split second. That’s not its purpose and not its strength. The strength and function of family medicine derives from its longitudinal relationships with patients (even when other specialities have longitudinal relationships with patients, by and large, most people still see their PCP as most accessible, spending the most time with them, etc) and the trust that comes from these relationships.

I’m not going into FM, but throughout all of my hospital experiences, I’ve seen the incredible importance of the family physician. I’ve seen patients and their families where hospice was appropriate decide to forgo aggressive, invasive (and futile) care agree to finally meet with the palliative care team after a conversation with their PCP. I’ve seen patients finally consent to a colonoscopy or some other assessment by a specialist after consulting with their trusted PCP. Ive seen patients finally agree to try smoking cessation after counseling by their PCP.
So no, a family medicine doctor might not be jumping into the trenches and dramatically saving lives or be a world-renowned expert in some rare disease, helping to develop its cure or treatment. But there is something quietly noble in the speciality that can very often play a role in patients making better lifestyle decisions and even pursuing additional care by the very specialities whose practitioners may thumb their nose at family medicine.

The lesson? Do what you love. Every speciality is special and important in its own way.

(And yes, for sure there are PCPs that don’t counsel the patients, or listen to them, or spend enough time with them. There are things like paperwork and pressure to see ever more patients in a day to the point where care is compromised. These are real problems and limitations in FM and should be considered by people thinking about the field. My post above was more in reference to people who aren’t considering family medicine due to very real logistical and practical issues, but rather to a philosophical dismissal of the field as somehow inferior or less than others)

 

[DocWinter]

Can you explain this? I don't understand what a FM doc has to do with an ER doc.

Similar patient population in many people who don't follow your advice and keep returning with the same problems.

The ER has become the go to for people without insurance and a PCP... it may be more accurate to liken the ER doc to the FM, but with better pay and more variety.

 

[IntheClouds4ever]

Similar patient population in many people who don't follow your advice and keep returning with the same problems.

The ER has become the go to for people without insurance and a PCP... it may be more accurate to liken the ER doc to the FM, but with better pay and more variety.

With horrible hours, shift-work disorder, and far greater stress because you never know what’s going to come through the door when you are already overflowing with impatient patients in the waiting room. I like ER but would never consider it, because it would suck the more you age. Doing FM will still allow you to do Trauma 2 level work (especially in rural areas with populations <70,000) and get out after a few years to slow life down. Just my opinion though.

 

[AsianPersuasion]

Hmmm....different stroke for different folks. I, myself, prefer a 4.5 work week, 8 AM - 4PM, home call / triage of 1:15, possibility to make share holder, 6 weeks vacation, 220K salary with bonus for production, chances of walking it with establish patient roster, living basically anywhere in the country...but living 30 min away from a major metro area where cost of living is cheap...and if things goes according to plan, my fiance will be working as a trauma surgeon with good shift work...and over half a mil of income of two with no kids. We plan on building our dream home and traveling the world.

Trust me, those of us who are choosing this are NOT sad that the general physician community view it as "low quality".

 

[RangerBob]

Hmmm....different stroke for different folks. I, myself, prefer a 4.5 work week, 8 AM - 4PM, home call / triage of 1:15, possibility to make share holder, 6 weeks vacation, 220K salary with bonus for production, chances of walking it with establish patient roster, living basically anywhere in the country...but living 30 min away from a major metro area where cost of living is cheap...and if things goes according to plan, my fiance will be working as a trauma surgeon with good shift work...and over half a mil of income of two with no kids. We plan on building our dream home and traveling the world.

Trust me, those of us who are choosing this are NOT sad that the general physician community view it as "low quality".

One of the underappreciated things about FM (as well as psych, peds, etc.)--you can pretty much find a job anywhere you want, and often you'll have multiple choices. I am in PM&R--there is one inpatient unit within 2hrs of my family, and I was lucky enough a position opened in time for me. When I was a med student I was thinking primarily about what job I thought I'd enjoy the most (it was between PM&R, psych, and FM). I didn't give much thought at the time to whether I'd be able to find a job near family, which became suddenly extremely important once we had our first son.

Pay is good, (most!) patients love you, you'll always be in demand and can work anywhere, and can often work part-time easier than other fields. I don't get why FM isn't more competitive.

 

[Hippocrates II]

Also worth noting that being afraid of midlevels is not a great reason to avoid FM. My SO is a recent NP grad and almost every job she has looked at has been in a specialty position. Almost all places now seem to be farming out the bread and butter stuff to NPs/PAs, doesn't matter if it's FM or cardiology.

 

[VA Hopeful Dr]

One of the underappreciated things about FM (as well as psych, peds, etc.)--you can pretty much find a job anywhere you want, and often you'll have multiple choices. I am in PM&R--there is one inpatient unit within 2hrs of my family, and I was lucky enough a position opened in time for me. When I was a med student I was thinking primarily about what job I thought I'd enjoy the most (it was between PM&R, psych, and FM). I didn't give much thought at the time to whether I'd be able to find a job near family, which became suddenly extremely important once we had our first son.

Pay is good, (most!) patients love you, you'll always be in demand and can work anywhere, and can often work part-time easier than other fields. I don't get why FM isn't more competitive.

$$$

I'll be pretty happen somewhere in the 200s, but other fields can make multiples of that...

 

[WaterIsGood]

Absolutely. Anyone making less than 200k better be working part time or in a completely saturated area, otherwise they are likely being taken advantage of by their employer.

Indeed. Come to Maryland and you'd be lucky yo get anything over 200k, regardless of the primary care specialty.

 

[LoGo]

Hmmm....different stroke for different folks. I, myself, prefer a 4.5 work week, 8 AM - 4PM, home call / triage of 1:15, possibility to make share holder, 6 weeks vacation, 220K salary with bonus for production, chances of walking it with establish patient roster, living basically anywhere in the country...but living 30 min away from a major metro area where cost of living is cheap...and if things goes according to plan, my fiance will be working as a trauma surgeon with good shift work...and over half a mil of income of two with no kids. We plan on building our dream home and traveling the world.

Trust me, those of us who are choosing this are NOT sad that the general physician community view it as "low quality".

 

[MedicineZ0Z]

I think if the pay was better around 225-250 at the least it would be a solid place to go into. Instead, the numbers for average pay range efrom 200-250k. How many hours do you need to work to hit the 300k? What are you sacrificing location wise? Nobody wants to live in the middle of nowhere just for more money.

Lots of FMs make 250, 300 or more... without crazy hours. Just see the right volume of patients with high efficiency. There's also bonuses/incentives which rack up.

 

[The_Sunny_Doc]

$$$

I'll be pretty happen somewhere in the 200s, but other fields can make multiples of that...

When you start making 200k do you start pining for more?

 

[The_Sunny_Doc]

We saw patients today who my FM preceptor helped lose 60 lbs and quit smoking. It would be so gratifying to guide someone to better health in that way.

 

[You shall know the Truth]

FM is an integral member of the medical commUnity. I wish them the best and if you find a good one let me know. I can always use a great team around me to help pt.

 

[Tenk]

The big downside of FM is due to insurance companies and all the paperwork not because of the actual practice. Sure you can make 200-300k but your $/hr sucks when you account for all the extra work you have to do outside the usual 7-5 to make your business run smooth.

Same thing applies for academic medicine. You take a pay cut to begin with and then you have to do a lot of stuff for free (teaching, lectures, research, meetings) such that at the end of the day your $/hr is garbage.

 

[darklabel]

NPs and PAs already can make in the low 100s so any FM doc making 150k is getting hosed or working part time.

Hell I got pissed when I learned that CRNAs in some parts of the country can make 250k.

 

[psychMDhopefully]

NPs and PAs already can make in the low 100s so any FM doc making 150k is getting hosed or working part time.

Hell I got pissed when I learned that CRNAs in some parts of the country can make 250k.

250k isnt the norm for CRNAs ( more like 150-180) but if they are willing to live in really rural areas they can make that easily. Anesthesiologist rarely ever oppose them, their idea of fighting back is running into specialties like " i'm gonna do pain so I dont have to worry about CRNAs" its kinda pathetic how medicine continually craps on their own trainees and then bow and scrape to the nursing lobby, its something I could never understand or respect.

 

[Mad Jack]

Hmmm....different stroke for different folks. I, myself, prefer a 4.5 work week, 8 AM - 4PM, home call / triage of 1:15, possibility to make share holder, 6 weeks vacation, 220K salary with bonus for production, chances of walking it with establish patient roster, living basically anywhere in the country...but living 30 min away from a major metro area where cost of living is cheap...and if things goes according to plan, my fiance will be working as a trauma surgeon with good shift work...and over half a mil of income of two with no kids. We plan on building our dream home and traveling the world.

Trust me, those of us who are choosing this are NOT sad that the general physician community view it as "low quality".

Easy to be like, "this is the best job ever" when you've got a husband working trauma surg lol

Not quite the best job for a one doctor marriage.

 

[darklabel]

250k isnt the norm for CRNAs ( more like 150-180) but if they are willing to live in really rural areas they can make that easily. Anesthesiologist rarely ever oppose them, their idea of fighting back is running into specialties like " i'm gonna do pain so I dont have to worry about CRNAs" its kinda pathetic how medicine continually craps on their own trainees and then bow and scrape to the nursing lobby, its something I could never understand.

You're right, it's 160k and Montana has the highest at 243k

CRNA average hourly wage & salary for all 50 states — Montana tops the list at $243k

Still the fact a CRNA can actually make that much at all and it is more than some practicing physicians infuriates me. They can't even pass a watered down Step 3 but want to be seen the equivalent of an Anesthesiologist.

 

[Mad Jack]

When you start making 200k do you start pining for more?

Depends on your goals.

If I had kids or planned on having them in my life, I'd certainly want an extra 100k over 200 to look after them with and to plan for their futures. As a primary breadwinner in a fairly frugal relationship, 200k is fine, but I'd certainly prefer to make 300-400k so that I can retire more quickly. Extra money+compound interest=exponentially faster portfolio growth

 

[VA Hopeful Dr]

Easy to be like, "this is the best job ever" when you've got a husband working trauma surg lol

Not quite the best job for a one doctor marriage.

Depends on one's priorities. Less money but more free time appeals to plenty of people.

 

[Money Moniker]

Also worth noting that being afraid of midlevels is not a great reason to avoid FM. My SO is a recent NP grad and almost every job she has looked at has been in a specialty position. Almost all places now seem to be farming out the bread and butter stuff to NPs/PAs, doesn't matter if it's FM or cardiology.

It's still a great reason to avoid FM. It's also a great reason to avoid the other specialties which are beginning to see midlevel infestation. There is no reason to view the two concepts as mutually exclusive.

What makes FM worse than a field like cardiology though is that a FM midlevel just refers the complicated stuff to a specialist, bypassing the FM doctor completely. Theoretically speaking, there is no role for an FM doctor whatsoever in a heavy midlevel utilization model where midlevels take the bread and butter and refer everything else out. On the other hand, who is the cardiology midlevel going to refer the complicated cardiology stuff to? The cardiologist. Not ideal for a specialty whose residency training numbers assume a model where cardiologists take care of both the simple and hard stuff, but better than literally nothing.

At the end of the day, if you're not doing a surgical specialty, you're basically betting on one very simple metric: that you'll have made enough money by the time midlevel numbers get high enough to displace you from the job market. The limiting factor to midlevel takeover of non-surgical fields is the quantity of midlevels out there, not their capability, because the vast majority of "work" for doctors is by definition bread and butter, and bread and butter ain't hard.

 

[Mad Jack]

Depends on one's priorities. Less money but more free time appeals to plenty of people.

But if you can get more money for the same time, why not?

 

[psychMDhopefully]

At the end of the day, if you're not doing a surgical specialty, you're basically betting on one very simple metric: that you'll have made enough money by the time midlevel numbers get high enough to displace you from the job market. The limiting factor to midlevel takeover of non-surgical fields is the quantity of midlevels out there, not their capability, because the vast majority of "work" for doctors is by definition bread and butter, and bread and butter ain't hard.

That's a little extreme, talk to a few nursing students and you'll see these people will never completely replace physicians, as a group they just don't have the brain power.

 

[LebronManning]

It's still a great reason to avoid FM. It's also a great reason to avoid the other specialties which are beginning to see midlevel infestation. There is no reason to view the two concepts as mutually exclusive.

What makes FM worse than a field like cardiology though is that a FM midlevel just refers the complicated stuff to a specialist, bypassing the FM doctor completely. Theoretically speaking, there is no role for an FM doctor whatsoever in a heavy midlevel utilization model where midlevels take the bread and butter and refer everything else out. On the other hand, who is the cardiology midlevel going to refer the complicated cardiology stuff to? The cardiologist. Not ideal for a specialty whose residency training numbers assume a model where cardiologists take care of both the simple and hard stuff, but better than literally nothing.

At the end of the day, if you're not doing a surgical specialty, you're basically betting on one very simple metric: that you'll have made enough money by the time midlevel numbers get high enough to displace you from the job market. The limiting factor to midlevel takeover of non-surgical fields is the quantity of midlevels out there, not their capability, because the vast majority of "work" for doctors is by definition bread and butter, and bread and butter ain't hard.

It's not that bad lol. Unless you have a crystal ball, most of the claims you've made in this post are completely bogus. Midlevels have been around for a very long time yet physician salaries have mostly stayed the same or gone up. Guess who's salary has gone up the most in the past 5 years? Primary care. While the midlevel leaders can sometimes be vocal about wanting independence, most midlevels don't actually care and are happy with their jobs.

Don't forget the AMA is the most powerful healthcare lobby in this country and one of the top 5 of all lobbies.

 

[NITRAS]

Procedures are compensated higher than thought. That’s life.

FM is the ultimate generalist in a country where we practice specialist medicine.

It is my opinion that FM has no business doing surgery, delivering babies, or being hospitalist without some level of extra training.

 

[Hippocrates II]

It's still a great reason to avoid FM. It's also a great reason to avoid the other specialties which are beginning to see midlevel infestation. There is no reason to view the two concepts as mutually exclusive.

What makes FM worse than a field like cardiology though is that a FM midlevel just refers the complicated stuff to a specialist, bypassing the FM doctor completely. Theoretically speaking, there is no role for an FM doctor whatsoever in a heavy midlevel utilization model where midlevels take the bread and butter and refer everything else out. On the other hand, who is the cardiology midlevel going to refer the complicated cardiology stuff to? The cardiologist. Not ideal for a specialty whose residency training numbers assume a model where cardiologists take care of both the simple and hard stuff, but better than literally nothing.

At the end of the day, if you're not doing a surgical specialty, you're basically betting on one very simple metric: that you'll have made enough money by the time midlevel numbers get high enough to displace you from the job market. The limiting factor to midlevel takeover of non-surgical fields is the quantity of midlevels out there, not their capability, because the vast majority of "work" for doctors is by definition bread and butter, and bread and butter ain't hard.

Agree to disagree. The model is the same, whether it's FM or cardiology IMO. The complicated FM issues go to the physician, the bread and butter/simpler cases go to the midlevels. In cardiology, it's the same thing. Just what I've seen, your experiences may differ.

If you want to actually use midlevels as a rationale for avoiding a specialty, the list of specialties to avoid becomes so long that it becomes a fairly useless metric IMO. Midlevels are pretty much everywhere now, and the only areas that are safe in that sense are radiologists, surgeons, pathologists, etc. I'm not going to plan my future around fearing midlevels because that pretty much cuts out FM, all of IM/subspecialties, neuro, and so on.

Not to mention, if you just look at reality itself, midlevel fear-mongering has pretty much no justification. FM salaries are up up up despite NP/PA roles being around for decades. People sit around on the internet complaining about NP/PA roles, but the reality that I have seen is that the physician-NP/PA interaction works out just fine.

Just my $0.02.

 

[Stagg737]

I don't get it either. Outpatient medicine = happiness, sunshine, decent hours, the possibility of helping someone help themselves, as opposed to kicking them out of the hospital only to readmit a week later.

Yea, but then everyone craps all over the Outpt doc for not managing their patient properly. I can't tell you how oftend I heard "If the FM was managing this guy's DM/COPD/HTN/whatever correctly he wouldn't need to be here" when I was doing rounds.

We saw patients today who my FM preceptor helped lose 60 lbs and quit smoking. It would be so gratifying to guide someone to better health in that way.

And those are the truly gratifying experiences. But for every one of those, there are 20 people who are 50+ pounds overweight with an A1C over 8 who doesn't understand why they aren't healthier while at the same time they tell you they don't take their meds regularly and eat Big Macs five days a week. And when those non-compliant patients end up in the hospital, the FM people start getting blamed when the patient just sucks.

I think if the pay was better around 225-250 at the least it would be a solid place to go into. Instead, the numbers for average pay range efrom 200-250k. How many hours do you need to work to hit the 300k? What are you sacrificing location wise? Nobody wants to live in the middle of nowhere just for more money.

Depends on how business-savvy you are. I know FMs working in mid-sized and major metros (500k+ population) clearing $300k working ~50 hours per week. It's amazing how much the difference in salary can be between someone who has a solid business plan vs. someone who is completely clueless about the financial side of medicine.

I've also heard a few other people mention that they thought family medicine only makes 125-150k and I always wonder how such an obviously false rumor gets spread around.

Because many med students are sheep who listen to whatever their attendings/professors tell them and trust it to be right without looking at the actual data out there. I can't completely blame them, as so much is already crammed into their schedules, but imo medicine as a whole values brute memorization and overworking oneself too much while discouraging critical thinking whenever it goes against the authority's views.

Also worth noting that being afraid of midlevels is not a great reason to avoid FM. My SO is a recent NP grad and almost every job she has looked at has been in a specialty position. Almost all places now seem to be farming out the bread and butter stuff to NPs/PAs, doesn't matter if it's FM or cardiology.

Agree. I just saw a post on FB that was a compilation of NPs commenting on FB about how much they hate working as FNPs and are switching into other fields like cards, derm, EM, or GI. Some of them even said they planned on or had returned to their previous RN jobs because they hated being FNPs so much. The encroachment is certainly a problem, but I think it's hyperbole to say FMs are going to be disappearing in the near future because of NPs taking over.

 

[Money Moniker]

It's not that bad lol. Unless you have a crystal ball, most of the claims you've made in this post are completely bogus. Midlevels have been around for a very long time yet physician salaries have mostly stayed the same or gone up. Guess who's salary has gone up the most in the past 5 years? Primary care. While the midlevel leaders can sometimes be vocal about wanting independence, most midlevels don't actually care and are happy with their jobs.

Don't forget the AMA is the most powerful healthcare lobby in this country and one of the top 5 of all lobbies.

I don't have a crystal ball, but I have a basic competency in arithmetic. Bruh

Midlevels have existed for a very long time, but the explosion in their training spots is a very recent phenomenon that started in the early 2010s. In 2011 there were only 11,000 NPs graduating per year, then just 5 years later that number has nearly tripled to >25k. Please pause a second and wrap your head around that because it's truly remarkable. Without a doubt the number has grown even more since then. Right now there are 250k NPs in the USA, but a graduating class size of 25k will lead to a steady state NP workforce of 750,000 assuming a rather optimistic (ie low) 30 year average active career. This is also assuming that NP training slots have been frozen at 2016 levels, in reality when you account for future growth in training programs the steady state workforce is probably more like 1 million.

Please continue to tell me that it's "bogus" to worry about a source of low cost competition that will quadruple in size over the course of our careers. Also, the AMA is a pathetic joke that is not only weak, but actively works to undermine the future of the rank and file physicians.

 

[VA Hopeful Dr]

I don't have a crystal ball, but I have a basic competency in arithmetic. Bruh

Midlevels have existed for a very long time, but the explosion in their training spots is a very recent phenomenon that started in the early 2010s. In 2011 there were only 11,000 NPs graduating per year, then just 5 years later that number has nearly tripled to >25k. Please pause a second and wrap your head around that because it's truly remarkable. Without a doubt the number has grown even more since then. Right now there are 250k NPs in the USA, but a graduating class size of 25k will lead to a steady state NP workforce of 750,000 assuming a rather optimistic (ie low) 30 year average active career. This is also assuming that NP training slots have been frozen at 2016 levels, in reality when you account for future growth in training programs the steady state workforce is probably more like 1 million.

Please continue to tell me that it's "bogus" to worry about a source of low cost competition that will quadruple in size over the course of our careers. Also, the AMA is a pathetic joke that is not only weak, but actively works to undermine the future of the rank and file physicians.

It's bogus, mid-levels are a problem but they don't even crack into my top 5 of things I worry about

 

[VA Hopeful Dr]

Yea, but then everyone craps all over the Outpt doc for not managing their patient properly. I can't tell you how oftend I heard "If the FM was managing this guy's DM/COPD/HTN/whatever correctly he wouldn't need to be here" when I was doing rounds.



And those are the truly gratifying experiences. But for every one of those, there are 20 people who are 50+ pounds overweight with an A1C over 8 who doesn't understand why they aren't healthier while at the same time they tell you they don't take their meds regularly and eat Big Macs five days a week. And when those non-compliant patients end up in the hospital, the FM people start getting blamed when the patient just sucks.



Depends on how business-savvy you are. I know FMs working in mid-sized and major metros (500k+ population) clearing $300k working ~50 hours per week. It's amazing how much the difference in salary can be between someone who has a solid business plan vs. someone who is completely clueless about the financial side of medicine.



Because many med students are sheep who listen to whatever their attendings/professors tell them and trust it to be right without looking at the actual data out there. I can't completely blame them, as so much is already crammed into their schedules, but imo medicine as a whole values brute memorization and overworking oneself too much while discouraging critical thinking whenever it goes against the authority's views.



Agree. I just saw a post on FB that was a compilation of NPs commenting on FB about how much they hate working as FNPs and are switching into other fields like cards, derm, EM, or GI. Some of them even said they planned on or had returned to their previous RN jobs because they hated being FNPs so much. The encroachment is certainly a problem, but I think it's hyperbole to say FMs are going to be disappearing in the near future because of NPs taking over.

I have no doubt that hospitalists and Specialists say those kind of things amongst themselves, but in almost a decade of being a family doctor not a single one of them has ever said it to me or to my patients about me.

They know who the patients like more, and Trust more, and it's not them.

If they piss off the primary care types, their income will take a drastic hit and they know it.

 

[VA Hopeful Dr]

But if you can get more money for the same time, why not?

There are very few fields in medicine that pay significantly more than us and work similar hours.

Derm, but that is amazingly competitive so not an option for 99% of medical students.

EM on a purely hourly basis, but you have to factor in nights weekends and holidays.

Am I missing any others?