Why is family medicine viewed as a low quality field?

[W19]

FM does not put in 70 hours a week

They do at my home institution (PGY1/PGY2)... It's probably ~60 at most programs.

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[VA Hopeful Dr]

FM does not put in 70 hours a week

On inpatient months, I absolutely did.

 

[VA Hopeful Dr]

OP is a med student, so I am pretty sure he knows that. I think he is probably pointing out the arbitrary nature of these things.... 3-yr EM residency vs. 4-yr

They were even talking about adding an extra year to FM... I know someone will come up with the example of England and Australia etc... without mentioning they don't put in ~ 70 hrs/wk like us... It's just like someone in a leadership position woke up one day and say let's make money out of docs... There are many examples of these things--board recertification Q10yrs... Was there problem they are trying to correct?

I mean it's kinda arbitrary, but in his ill-conceived example it's because the amount of knowledge and procedural information is significantly greater than it was when Cardiology was a one-year Fellowship. Part of the same reason that you don't see GPS around anymore - there's just way more to know that can't be done in just intern year than there was 40 years ago

 

[W19]

I mean it's kinda arbitrary, but in his ill-conceived example it's because the amount of knowledge and procedural information is significantly greater than it was when Cardiology was a one-year Fellowship. Part of the same reason that you don't see GPS around anymore - there's just way more to know that can't be done in just intern year than there was 40 years ago

I agree.... But a 2 yr FM will probably not do any harm to the system... PY3 FM/IM residents are completely autonomous at my home institution. They will tell you that there is nothing they do during PGY3 that they have not seen before... Don't get me wrong here: More training is ALWAYS better, but there is a point you have to say: Does the extra training justify the time commitment, opportunity cost etc...?

Look back when you were a FM PGY3: Do you think you would not be able to function independently if you were an attending? Do you think you would have caused a lot harm to patients? Of course you would feel inadequate for the first few months because you are out of comfort zone (i.e. residency). It's just human nature. But you will be fine after 3-6 months.

Another thing is that: If we cut physician training from 11-14 years to 8-12 yrs, it will be a huge deterrent to people (aka mid levels) using back door to practice medicine ...

 

[VA Hopeful Dr]

I agree.... But a 2 yr FM will probably not do any harm to the system... PY3 FM/IM residents are completely autonomous at my home institution. They will tell you that there is nothing they do during PGY3 that they have not seen before... Don't get me wrong here: More training is ALWAYS better, but there is a point you have to say: Does the extra training justify the time commitment, opportunity cost etc...?

Look back when you were a FM PGY3: Do you think you would not be able to function independently if you were an attending? Do you think you would have caused a lot harm to patients? Of course you would feel inadequate for the first few months because you are out of comfort zone (i.e. residency). It's just human nature. But you will be fine after 3-6 months.

Another thing is that: If we cut physician training from 11-14 years to 8-12 yrs, it will be a huge deterrent to people (aka mid levels) using back door to practice medicine ...

I learned quite a bit during third year. It's when I fined tuned weaker areas or learned new skills since I knew what my job was going to be after residency.

You're dreaming if you think that cutting two years or even three years out of medical education is going to make a damn bit of difference to the mid-level issue.

 

[W19]

I learned quite a bit during third year. It's when I fined tuned weaker areas or learned new skills since I knew what my job was going to be after residency.

You're dreaming if you think that cutting two years or even three years out of medical education is going to make a damn bit of difference to the mid-level issue.

Hahaha...

A lot people I went to nursing school with went to NP/PA route because of the time commitment it requires to become a physician... If med school were a 3-yr commitment and residency were 2-6 yrs, these people would have tried to go to med school...

 

[VA Hopeful Dr]

Hahaha...

A lot people I went to nursing school with went to NP/PA route because of the time commitment it requires to become a physician... If med school were a 3-yr commitment and residency were 2-6 yrs, these people would have tried to go to med school...

So 5 years minimum versus 2 years for NP? Yeah that's going to change a lot of minds

 

[W19]

So 5 years minimum versus 2 years for NP? Yeah that's going to change a lot of minds

Possibly...

 

[VA Hopeful Dr]

Possibly...

So you want to make major changes on both undergraduate and graduate medical education based on possibly, got it

 

[W19]

So you want to make major changes on both undergraduate and graduate medical education based on possibly, got it

Seriously! Suggesting to make changes in undergrad and med school (which are already happening) has nothing to do with MLP... I was merely saying it might ALSO deter some people from using back door to practice medicine.

Questioning an inefficient system is my ONLY sin here...

 

[VA Hopeful Dr]

Seriously! Suggesting to make changes in undergrad and med school (which are already happening) has nothing to do with MLP... I was merely saying it might ALSO deter some people from using back door to practice medicine.

Questioning an inefficient system is my ONLY sin here...

Fair enough, and I do get where you're coming from.

There was a thread over a year ago where people were talking about what some of their third-year family medicine rotations would like. As I was hosting 3rd year medical students at the time and letting them do way more than most of these people, all of a sudden all of y'all complaining about med school made a whole lot more sense.

With that being the case, I believe everyone would be better served by improving the medical school experience such that most of the four years were actually valuable. As the body of medical knowledge continues to increase, I really don't think decreasing the amount of time in school (or residency for that matter) is ideal. I think four years is a decent amount of time assuming we use it efficiently.

 

[W19]

@VA Hopeful Dr

My point exactly... If 4th year does not add that much to our experience (as the vast majority of med students would acknowledge) while costing 50k+ (plus 200k+ attending salary) and the product (physicians) come out ok, why even use it? Physicians will be ok with/without it whether they fix it or not... Therefore, we shouldn't need it since it cost a lot of $$$$.

 

[W19]

@VA Hopeful Dr

Let's say we adopt 18 months basic science across the board, which is the case right now at the majority of med schools ( it's ~20 months at my shop)..

and clerkship is also 18 months, and each rotation (IM/FM/Psych/Obgyn/Neuro/GenSurg/Peds/EM/Rad) last 4 weeks. The other 9-10 months can be used for subI/electives/Step2 prep... and residency interviews. I do not think that will have deleterious effect to med school education. I might be wrong here. Tell me where I am wrong. Be specific!

 

[Mt Kilimanjaro]

Good read.

Why I'm Becoming a Primary-Care Doctor

 

[ortnakas]

It's almost like all the different schools agreed to not charge each other students and keeping your tuition at your home institution makes up for that.

I don't know if that's the case, but it doesn't seem unreasonable to think it might be.

There are sites that do charge for aways (won’t name names that’s not the point of the thread); I agree that most schools are in an unofficial agreement like you stated.

I hate how much debt I have, and my school is cheaper than most, but time wise, I don’t know what I’d cut out. I thoroughly enjoyed undergrad and used my degree for a couple years before deciding to go to medical school. My fear is that a system where you were locked into a shorter track out of high school would lock out career-changers like me (or even just people with multiple interests), or would lock in people who turned out to not want to be doctors who than would have a few years of debt without so much as a “useless” bachelors to show for it.

 

[W19]

There are sites that do charge for aways (won’t name names that’s not the point of the thread); I agree that most schools are in an unofficial agreement like you stated.

I hate how much debt I have, and my school is cheaper than most, but time wise, I don’t know what I’d cut out. I thoroughly enjoyed undergrad and used my degree for a couple years before deciding to go to medical school. My fear is that a system where you were locked into a shorter track out of high school would lock out career-changers like me (or even just people with multiple interests), or would lock in people who turned out to not want to be doctors who than would have a few years of debt without so much as a “useless” bachelors to show for it.

No one is talking about HS---->Med school directly. Other people should be paying an extra 60k+/yr and loss 500k+/yr in income because YOU enjoyed undergrad. This is insane!

No one would stop anyone if they want to spend 10 yrs in undergrad...

 

[NontradCA]

Because being a doctor is just like Greys Anatomy and they don’t have FM docs on that show. But in all seriousness, I think med students tend to romanticize medicine, and FM just isn’t a sexy field. It’s filled with people who have never worked a real job in their life, and then have this notion that their “dream job” will hold some sort of fulfillment supported by external validation. It’s not until they’re in residency or done that they realize being a physician is a job, and doesn’t define them as a person.

 

[ortnakas]

No one is talking about HS---->Med school directly. Other people should be paying an extra 60k+/yr and loss 500k+/yr in income because YOU enjoyed undergrad. This is insane!

No one would stop anyone if they want to spend 10 yrs in undergrad...

I guess I can’t think of a period of time in my education I’d cut out— I got a lot out of undergrad, would have struggled hugely if the preclinical curriculum was more intense/condensed, and think shortening clinical would make it even more difficult to choose a specialty.

I don’t disagree with you that the cost is ridiculous but I think the solution is in cost control, not time control.

 

[W19]

I guess I can’t think of a period of time in my education I’d cut out— I got a lot out of undergrad, would have struggled hugely if the preclinical curriculum was more intense/condensed, and think shortening clinical would make it even more difficult to choose a specialty.

I don’t disagree with you that the cost is ridiculous but I think the solution is in cost control, not time control.

As far as making it difficult to choose a specialty, see post #113.

 

[VA Hopeful Dr]

It's not about YOU... As far as making it difficult to choose a specialty, see post #113.

I suspect he's not the only one that feels that way.

 

[W19]

I suspect he's not the only one that feels that way.

I guess the minority rules. I address her genuine concern about difficulty in choosing a specialty in post #113... The other things about enjoying HS/college are the typical Americans thinking they are snowflakes...

I have nothing to gain in this fight since I am done with med school and heading for residency in < 6wks... As someone who worked in other industries before going to med school, I was shocked seeing so many inefficiency in system that cost students so much $$$ and everyone just throws their hands in the air and accept things as they are...

 

[VA Hopeful Dr]

I guess the minority rules. I address her genuine concern about difficulty in choosing a specialty in post #113... The other things about enjoying HS/college are the typical Americans thinking they are snowflakes...

I have nothing to gain in this fight since I am done with med school and heading for residency in < 6wks... As someone who worked in other industries before going to med school, I was shocked seeing so many inefficiency in system that cost students so much $$$ and everyone just throws their hands in the air and accept things as they are...

Part of that is because if 2000 med students resigned in protest, there would be 5000 people waiting to snatch up their spots.

Part of that is that our system produces good doctors so it's obviously doing something right.

 

[W19]

Part of that is because if 2000 med students resigned in protest, there would be 5000 people waiting to snatch up their spots.

Part of that is that our system produces good doctors so it's obviously doing something right.

We can use a more efficient system that produces the same 'good doctors'....


Look at the CS exam... EVERYONE (except for the people who are pocketing $$$ from it) thinks it adds nothing to our medical education. And as soon as the NBME stated that they will raise the passing cut off when Harvard students raised concern about the usefulness of that exam, instead of fighting with NBME so they can get rid of that BS, med students started pointing fingers at Harvard students. What a bunch of cowards!

 

[VA Hopeful Dr]

We can use a more efficient system that produces the same 'good doctors'....


Look at the CS exam... EVERYONE (except for the people who are pocketing $$$ from it) thinks it adds nothing to our medical education. And as soon as the NBME stated that they will raise the passing cut off when Harvard students raised concern about the usefulness of that exam, instead of fighting with NBME so they can get rid of that BS, med students started pointing fingers at Harvard students. What a bunch of cowards!

So make the rotations and classes that are not exist higher yield. That's pretty easy to do.

 

[psychMDhopefully]

We can use a more efficient system that produces the same 'good doctors'....


Look at the CS exam... EVERYONE (except for the people who are pocketing $$$ from it) thinks it adds nothing to our medical education. And as soon as the NBME stated that they will raise the passing cut off when Harvard students raised concern about the usefulness of that exam, instead of fighting with NBME so they can get rid of that BS, med students started pointing fingers at Harvard students. What a bunch of cowards!

Yeah dude, the situation with the CS exam is complete bull, its a useless exam that does nothing but line the pockets of the useless, and no one can defend it. Part of the reason it is so hard to change anything in medicine is because the people who go into medicine are usually beta science nerds, and like the guy above said, medicine has done a great job of promoting itself as the ultimate profession, even though people in the training queue know its abusive and depressing. If 2000 med students quit, 2000 more naive ones would quickly snatch up the spots. Students have no rights, no voice, and no protection in medicine so they are abused accordingly but NO ONE should be okay with that.

 

[VA Hopeful Dr]

Yeah dude, the situation with the CS exam is complete bull, its a useless exam that does nothing but line the pockets of the useless, and no one can defend it. Part of the reason it is so hard to change anything in medicine is because the people who go into medicine are usually beta science nerds, and like the guy above said, medicine has done a great job of promoting itself as the ultimate profession, even though people in the training queue know its abusive and depressing. If 2000 med students quit, 2000 more naive ones would quickly snatch up the spots. Students have no rights, no voice, and no protection in medicine so they are abused accordingly but NO ONE should be okay with that.

Abused?

Hardly. I remember one resident who has kind of a jerk but otherwise I never felt belittled or anything like that.

 

[Treebeard]

Both 1st and 4th year are largely wastes of time. 1st is redundant - for example, my school required me to take a biochemistry class to matriculate and then taught me the exact same biochemistry again when I got there. 4th year is like 2 difficult rotations, some interviews, and a 6 month glorified vacation.

 

[VA Hopeful Dr]

Both 1st and 4th year are largely wastes of time. 1st is redundant - for example, my school required me to take a biochemistry class to matriculate and then taught me the exact same biochemistry again when I got there. 4th year is like 2 difficult rotations, some interviews, and a 6 month glorified vacation.

The 1st year issue is your school, not medical education as a whole.

4th year was your fault. I took a number of great electives that still pay off.

 

[NITRAS]

The reason for the CS is because of FMGs. Their pass rates are significantly lower.

 

[W19]

Yeah dude, the situation with the CS exam is complete bull, its a useless exam that does nothing but line the pockets of the useless, and no one can defend it. Part of the reason it is so hard to change anything in medicine is because the people who go into medicine are usually beta science nerds, and like the guy above said, medicine has done a great job of promoting itself as the ultimate profession, even though people in the training queue know its abusive and depressing. If 2000 med students quit, 2000 more naive ones would quickly snatch up the spots. Students have no rights, no voice, and no protection in medicine so they are abused accordingly but NO ONE should be okay with that.

They have done a really great job at promoting medicine as the pinnacle of all professions. It's amazing how I got treated once people know that I am a resident physician.

 

[TheIllusionist]

licensing is a waste. people should be allowed to sell medical services no matter what

 

[MrSunny1]

Not sure why anyone would do family medicine. My NP friend is 8 years ahead of me in salary and has zero debt... his patient even call him doctor because he has an additional 1 yr online doctorate. We grew up in the same small town of about 10k. He has been practicing for 8 years and I’m midway finished with residency with 400k in debt and exactly zero assets... he already has a large patient base and makes the same rate as a pcp and has the same prescribing license. Technically is there even a difference between pcp and Np? I did complete a 5yr undergrad and an accelerated masters to be more competetive for medical school as well so that was a set back.

 

[W19]

Not sure why anyone would do family medicine. My NP friend is 8 years ahead of me in salary and has zero debt... his patient even call him doctor because he has an additional 1 yr online doctorate. We grew up in the same small town of about 10k. He has been practicing for 8 years and I’m midway finished with residency with 400k in debt and exactly zero assets... he already has a large patient base and makes the same rate as a pcp and has the same prescribing license. Technically is there even a difference between pcp and Np? I did complete a 5yr undergrad and an accelerated masters to be more competetive for medical school as well so that was a set back.

If you are not a MD or DO, you're not part of the big league...

 

[VA Hopeful Dr]

Not sure why anyone would do family medicine. My NP friend is 8 years ahead of me in salary and has zero debt... his patient even call him doctor because he has an additional 1 yr online doctorate. We grew up in the same small town of about 10k. He has been practicing for 8 years and I’m midway finished with residency with 400k in debt and exactly zero assets... he already has a large patient base and makes the same rate as a pcp and has the same prescribing license. Technically is there even a difference between pcp and Np? I did complete a 5yr undergrad and an accelerated masters to be more competetive for medical school as well so that was a set back.

State dependent. NPs don't have independent practice everywhere, so that's one difference.

Beyond that, I've yet to meet an NP that was my equal in the practice of medicine. I supervise one now and she comes to me quite often with what to me are fairly basic questions.

I also see notes from the NPs at other offices within the hospital system. The urology NP didn't do a prostate exam on the guy with urinary frequency (I did, his prostate was huge - one week later on Flomax and he's happy as can be). The NP in urgent care noted in his HPI that the guy with gout has CKD but give him indomethacin anyway. I'm sure his GFR of 30 appreciated that.

That's why you go to medical school, to be better.

Also, the 400k debt is not standard. If I started at my med school next week, in 4 years I'd have less than half of that debt.

 

[Crayola227]

State dependent. NPs don't have independent practice everywhere, so that's one difference.

Beyond that, I've yet to meet an NP that was my equal in the practice of medicine. I supervise one now and she comes to me quite often with what to me are fairly basic questions.

I also see notes from the NPs at other offices within the hospital system. The urology NP didn't do a prostate exam on the guy with urinary frequency (I did, his prostate was huge - one week later on Flomax and he's happy as can be). The NP in urgent care noted in his HPI that the guy with gout has CKD but give him indomethacin anyway. I'm sure his GFR of 30 appreciated that.

That's why you go to medical school, to be better.

Also, the 400k debt is not standard. If I started at my med school next week, in 4 years I'd have less than half of that debt.

I agree with you all around, and I think that's great your med school is so cheap, but that's very close to how much debt I had graduating. I borrowed all my money and it was all public loans not over the COA of my school. Not to mention the numbers change if you only look at med students who do not have any private funding for their medical education, ie like parents or PLUS loans going in, so the dept burden is certainly more than what you're saying for anyone paying their own way through med school, and is anywhere between $200-$350K at least

 

[Crayola227]

https://members.aamc.org/iweb/upload/2017 Debt Fact Card.pdf

 

[Crayola227]

And yeah, midway through residency, on IBR, my loan burden was $400K. And that was only including $20K low interest public loans from undergrad. The rest was med school and I didn't borrow a dime more than what my school offered in public loans going toward COA.

 

[Perrotfish]

Why not enter medicine after having had a succesful career where earnings were set aside to avoid said debt? I never understood the rush to start the long, arduous career of medicine at the ripe age of twentysomething, where maturity (XXI Century) is dubious and life experiences slim. Better to have had under your belt a well paying career in x, y or z, married / children, lived your dreams of a, b and c, and then hunker down for BOHICA.

1) Medical training is a non-stop parade of indignities, and that's a lot easier to deal with in your 20s when you don't have a lot of dignity built up yet

2) Medical training was originally designed for young, single people and it hasn't adapted particularly well to trainees who are older or who have families. 100 hour weeks are a lot easier to adapt to single life than when you have three children, and while 30 hour shifts suck for everyone they are much easier on a 20 year old body than a 35 year old body.

3) Because the reward for medical training is life as an attending. And it is a reward. Its still work, but your bosses will be relatively hands off, the work is rewarding, the pay is excellent, and you have lots of time free to do other things you find meaningful. If you have dreams a, b, and c they're a lot easier to achieve as an attending on a 7 on 7 off schedule than as a 20 year old trying to work 60 minimum wage hours per week to scrape rent together. Similarly its a lot easier to pay off medical school debt as an attending than to build up 250K in savings in a nonmedical job. If you wait until later to begin medical training you get the same amount of misery as everyone else, but fewer years working as an attending and less of a payoff for all of your hard work.

 

[Crayola227]

I definitely understand the rush in, and I'm not even saying it isn't worth the money, or that the debt, as massive as it is, and the amount of interest paid large, isn't manageable. Just that it ain't cheap and it ain't usually a less than $200K deal. Closer to 400 than 200 for most.

 

[Perrotfish]

Indignities are part of life be it as an Attending, an OR Orderly, a prisoner, a priest, or a prostitute.

Seriously?

 

[IMreshopeful]

I for one am glad I did my residency and fellowship in my 20s. I don’t think my body would have handled the exhaustion and stress of being on call as well when 40.

Also my career life expectancy would be rather short if I started at the age of 40... I’d be finishing residency and fellowship at age 46 and be working for maybe 20 more years max (while paying off debt). I plan to live cheaply and pay off all my debt on an attending salary first five years.

 

[814965]

People seem to forget that family docs can wield quite a bit of influence because they control who gets which patient referrals to a large degree. If you decide to go family med and a specialist gives you problems or doesn't respect you, you have the power to damage them financially by not sending them any referrals or to cause them a lot of headaches by only referring patients that you know will give them problems. I saw this with a neurologist I worked for because a certain primary care doc he didn't get along with would only send him difficult patients with poor insurance, addiction problems, psych issues, etc. while other neurologists in the area got the stable patients with good insurance.

And their hours and pay aren't that bad anyway depending on where they work and what procedures they elect to do.

 

[Crayola227]

People seem to forget that family docs can wield quite a bit of influence because they control who gets which patient referrals to a large degree. If you decide to go family med and a specialist gives you problems or doesn't respect you, you have the power to damage them financially by not sending them any referrals or to cause them a lot of headaches by only referring patients that you know will give them problems. I saw this with a neurologist I worked for because a certain primary care doc he didn't get along with would only send him difficult patients with poor insurance, addiction problems, psych issues, etc. while other neurologists in the area got the stable patients with good insurance.

And their hours and pay aren't that bad anyway depending on where they work and what procedures they elect to do.

I mean, ideally you're actually doing what's right for the patient, not just use them in your petty vendetta against another doctor. And you would be a good steward of limited healthcare resources.

Or just glory in abusing your power, whatevs floats your boat, I guess.

 

[Crayola227]

Your reward is the problem.

When your vocation is medicine then all else is tertiary.

I worked as an orderly in an OR turning over rooms after surgeries. I had an Ortho Surgeon, Chief of Admissions at the state university SOM where I was applying at the time, who helped me haul red bags full of bone chips, guts and more after he wiped down the OR table. He was studying to be a Jesuit in a prior life and decided to be a physician in his later years. I had a heart surgeon help me clean a room after a bloody ascending AAA case. He had been a Lutheran minister seminirian in his earlier years. Indignities are relative

When medicine is a vocation, the journey is the thing. Arriving is no where on the horizon.

Indignities are part of life be it as an Attending, an OR Orderly, a prisoner, a priest, or a prostitute. Pope Francis receives indignities daily by thousands of enemies. Mother Teresa of Calcutta is still vilified and she has been dead for years.

The word Vocation is rarely mentioned these days. It should be part of the selection criteria for medicine otherwise we have this

Many Physicians Regret Career Choice, Survey Says
June 18, 2014
Nearly a quarter of physicians (23 percent) would not choose to become a physician again if they could turn back time, according to a survey by The Medicus Firm.

In fact, looking back on their careers, 21 percent of respondents said that they would not choose a healthcare profession at all.

The two greatest concerns with both participating physicians in-training and practicing physicians are compensation and reimbursement and a lack of work/life balance, according to the study.

These concerns, in addition to dissatisfaction with their income (61 percent), seem to be not only factors with regard to physician burnout but also the nationwide physician shortage as a whole.

This study was conducted in April to May 2014 via online survey. There were 2,272 participating providers across 19 specialties and 50 states.

did you read my post where I actually linked to the wiki page on vocation???? yay

this is a nice post

 

[Crayola227]

Seriously?

do you really not get his point?

 

[814965]

I mean, ideally you're actually doing what's right for the patient, not just use them in your petty vendetta against another doctor. And you would be a good steward of limited healthcare resources.

Or just glory in abusing your power, whatevs floats your boat, I guess.

I'm not saying I'd personally do anything like that if I went family med, especially if it would be to a patient's detriment. I'm just saying that from a pragmatic point of view it would be unwise for a specialist to openly look down on them or not be nice to them for the reasons stated above.

 

[VA Hopeful Dr]

I agree with you all around, and I think that's great your med school is so cheap, but that's very close to how much debt I had graduating. I borrowed all my money and it was all public loans not over the COA of my school. Not to mention the numbers change if you only look at med students who do not have any private funding for their medical education, ie like parents or PLUS loans going in, so the dept burden is certainly more than what you're saying for anyone paying their own way through med school, and is anywhere between $200-$350K at least

Private school?

 

[smq123]

I mean, ideally you're actually doing what's right for the patient, not just use them in your petty vendetta against another doctor. And you would be a good steward of limited healthcare resources.

Or just glory in abusing your power, whatevs floats your boat, I guess.

I’ve done this before.

Generally speaking, if you’re dumb enough to piss off your referrings, you’re probably not a stellar physician. At least, that’s been my experience.

 

[W19]

There is a lot of ego in medicine... I would prefer these ego to be directed at NP, but unfortunately they are often directed toward other docs..

 

[Crayola227]

Private school?

Nope. Public MD. But not a cheap one.

I would have saved a ton of money at the private acceptance I had, actually.