Why isn't FM more competitive than it is now?

[Splenda88]

I have talked to a couple PGY3 FM residents at my place and they are already getting great offers... 225k+/ year, 20k+ sign-on bonus, M-Thur (8-5pm or 9-5pm) and half day on Friday. And these offers are NOT in the middle of nowhere... Are these kind of offers a recent trend? if not, why isn't FM more competitive? Is there a stigma associated with being a FM doc that I am not aware of?

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[slowthai]

Low prestige, low pay relative to specialties (meaning non-primary care), mounds of paperwork (more than other fields on average), a relative excess of residency spots, etc. There are more reasons but I can't think of them atm.

Personally, I would hate to manage cholesterol and diabetes every day. Sounds extremely boring. Plus, the knowledge base is way too broad. I would rather know one thing extremely well than know a lot of things well enough to pass a pt off to a specialist.

Edit: I will add that those offers definitely aren't a recent trend. I will say that you may be looked down upon (stupidly so) by your classmates for choosing primary care because there's no glamour associated with it and it's what people that didn't do well on step, have red flags, etc match into. This is not to say that there aren't plenty of people that are highly competitive that choose primary care. It's all about what you want at the end of the day. Who cares what anyone else thinks. It's your life.

 

[libertyyne]

There are too many spots for the residency programs, so there is little to no competition for them. Since there is no competition for them , now they have the red flag crew going into them since the positions are easier to procure vs something more selective.
The reason things become competitive is because there are too few spots and too many people interested in them. When you ask what are the most comeptitive specialties you will see that they also have the smallest number of residency positions available.

 

[ciestar]

Ive encountered enough people that think people that are in FM are only there because they werent “good enough” for anything else. Some see those in FM as lesser doctors.

 

[907914]

Ive encountered enough people that think people that are in FM are only there because they werent “good enough” for anything else. Some see those in FM as lesser doctors.

I kinda like FM because it has a lax lifestyle and residency if you want and a broad spectrum of knowledge...I would love to do FM in a rural area where I can do procedures and such.

 

[slowthai]

Ive encountered enough people that think people that are in FM are only there because they werent “good enough” for anything else. Some see those in FM as lesser doctors.

Honestly, I think that's an extremely immature and unacceptable attitude/view to have. It's just a senseless superiority complex.

 

[ciestar]

I kinda like FM because it has a lax lifestyle and residency if you want and a broad spectrum of knowledge...I would love to do FM in a rural area where I can do procedures and such.

This stuff helps fuel my decision for FM. That, and you might not even have call. If you’re a PCP, nights and weekends can not be a thing too. I LIKE the fact that you can do a little of everything in FM.

 

[ciestar]

Honestly, I think that's an extremely immature and honestly unacceptable attitude/view to have. It's just a senseless superiority complex.

Yup. Completely agree.
Not swaying my decision at least.

 

[DrRealistic]

What benefit would you have choosing FM over IM?

 

[ciestar]

What benefit would you have choosing FM over IM?

I still want to work with kids. Plus the women’s health/OB training.

Also an IM residency is brutal in comparison to FM.

 

[907914]

Do people literally just not pick FM because it has a stigma even though it can be pretty Cush?

 

[Chibucks15]

Do people literally just not pick FM because it has a stigma even though it can be pretty Cush?

Yep. Welcome to medicine and the prestiges ****** that come with it

 

[907914]

Yep. Welcome to medicine and the prestiges ****** that come with it

Are there even any ‘prestigious’ FM residencies? What about academic FM?

Note: IDC personally, just curious if there are any.

Also, that is really stupid. FM is Cush. Nothing wrong with it.

 

[Chibucks15]

Are there even any ‘prestigious’ FM residencies? What about academic FM?

Note: IDC personally, just curious if there are any.

Also, that is really stupid. FM is Cush. Nothing wrong with it.

There isn’t a need for “prestigious” FM. Nobody cares at the end of the day. You go to a top notch neurosurgeon, not a FM doc. People just are wayyyy too into prestige when 90% of people don’t care at all. It’s largely a salary thing too but 250k ain’t nothing to scoff at

 

[907914]

It’s largely a salary thing too but 250k ain’t nothing to scoff at

n=1 but I know rural FM can make bank. Shadowed a gal in middle of nowhere (15 minutes from hot springs free for hospital employees, surrounded by 7,000 foot peaks - I would love it) Montana who worked 12 hour shifts 7-on/7-off with three additional full weeks of PTO a year (so, 23 weeks a year she worked - like 1932 hours?) with no call working as a hospitalist (ran both the inpatient and the ER, no clinics). She was salaried at $345,000...

 

[Lawpy]

How effective is FM in paying off debt quickly? Right now, there's the trend of people specializing because the debt is so burdensome that FM salary alone isn't enough to pay it off quickly. Adding in other costs like mortgage, the total costs swell up. Location also matters for some and as easy it is for SDN to blindly suggest working a few years in a rural area, this isn't always practical

 

[slowthai]

n=1 but I know rural FM can make bank. Shadowed a gal in middle of nowhere (15 minutes from hot springs free for hospital employees, surrounded by 7,000 foot peaks - I would love it) Montana who worked 12 hour shifts 7-on/7-off with three additional full weeks of PTO a year (so, 23 weeks a year she worked - like 1932 hours?) with no call working as a hospitalist (ran both the inpatient and the ER, no clinics). She was salaried at $345,000...

But the thing is that no one wants to live in a rural area.

 

[Chibucks15]

How effective is FM in paying off debt quickly? Right now, there's the trend of people specializing because the debt is so burdensome that FM salary alone isn't enough to pay it off quickly. Adding in other costs like mortgage, the total costs swell up. Location also matters for some and as easy it is for SDN to blindly suggest working a few years in a rural area, this isn't always practical

True. But the rural thing isn’t a lie. I know of a few very solid offers but you’re out in the middle of nowhere. But whatever it takes for the loans I guess

 

[slowthai]

How effective is FM in paying off debt quickly? Right now, there's the trend of people specializing because the debt is so burdensome that FM salary alone isn't enough to pay it off quickly. Adding in other costs like mortgage, the total costs swell up. Location also matters for some and as easy it is for SDN to blindly suggest working a few years in a rural area, this isn't always practical

I think it's pretty effective if you marry a spine surgeon. Jokes, lol. The only real way to handle that is by living like a resident for however long it takes. Not very practical either (especially with a family), but it might be easier than living in some rural area.

 

[Lawpy]

The fact that FM is uncompetitive should be viewed as a blessing. It's basically a guaranteed job with a good salary and less stress involved in the education process. Also it's completely idiotic and elitist to look down on them when they play a critical role in healthcare and are major players for providing referrals to specialists (and thus contributing to their earnings).

 

[907914]

But the thing is that no one wants to live in a rural area.

I guess I am an outlier...I would pick Missoula, MT (not really middle of nowhere, that’s about 30,000 people?) over a city of >1 mil any day.


Not middle of nowhere Midwest or fly over...but middle of nowhere out west? Hell yeah.

 

[Lawpy]

True. But the rural thing isn’t a lie. I know of a few very solid offers but you’re out in the middle of nowhere. But whatever it takes for the loans I guess

Yeah but in the end it really is based on individual and family obligations, and prioritizing what's important.

There are still lots of FM jobs in suburban areas that pay well so location probably isn't as severe an issue compared to specialties with saturated job markets. And living frugally for few years would help control costs and pay off the debt quickly.

 

[SLC]

Simple answer, it’s hard to write a gripping medical drama about the MI a patient didn’t have because their FM doc managed them well. Same goes for the cancer that was caught before metastasis etc. I picked up two Gyn cancers/precancers this past week. Endometrial and Cervical respectively.

But in women who took a bit of convincing to get their regular screenings done.

It wasn’t glamorous, but it may have saved their lives.


Complex answer, most students just have no real exposure to what FM can be while in school. Which means they get no real sense of just what a full spectrum FM practice can look like.

I’m a rural FM doc, I’ve got (what I think is) a killer job. I work in a small college town, I do regular office work, a metric ton of minor trauma, and walk-in illnesses; and lots of procedures (mostly women’s health procedures…IUD’s etc) due to my location next to a college.

I also cover the inpatient service at the hospital on weekends 1-2x Monthly.

It took a bit of pride swallowing to get here (lots of folks said I was too smart for FM, or it was a waste of potential. But they’re just ignorant), I legitimately love my career and would 100% do FM again.

 

[Chibucks15]

Yeah but in the end it really is based on individual and family obligations, and prioritizing what's important.

There are still lots of FM jobs in suburban areas that pay well so location probably isn't as severe an issue compared to specialties with saturated job markets. And living frugally for few years would help control costs and pay off the debt quickly.

Exactly. People somehow view FM in such low regard that they’d never do it. No matter what if you get through medical school you are guaranteed one of the best jobs in the world. Sure loans suck but as long as you aren’t expecting to live lavishly right away you’ll be okay

 

[Lawpy]

I don't remember the results from job satisfaction surveys but I don't think FM suffers from burnout as opposed to many other competitive specialties.

If that's the case, FM being uncompetitive should really be viewed as a blessing. I mean just think about it. It's not needed to bust your rears in school to get 250+, straight/near straight Honors, dozens of papers and other stuff to match super high, then go through years of sheer torture in residency followed by an attending life that isn't always that smooth since the job can still be personally stressful and damaging to quality of life.

Just passing everything in school and matching anywhere followed by a good residency that isn't a torture and a relaxed attending life where patient satisfaction is high and specialists all love you for referrals. It's really a good career and it's stupid to look down on it.

 

[Splenda88]

I still want to work with kids. Plus the women’s health/OB training.

Also an IM residency is brutal in comparison to FM.

^This

 

[907914]

I don't remember the results from job satisfaction surveys but I don't think FM suffers from burnout as opposed to many other competitive specialties.

If that's the case, FM being uncompetitive should really be viewed as a blessing. I mean just think about it. It's not needed to bust your rears in school to get 250+, straight/near straight Honors, dozens of papers and other stuff to match super high, then go through years of sheer torture in residency followed by an attending life that isn't always that smooth since the job can still be personally stressful and damaging to quality of life.

Just passing everything in school and matching anywhere followed by a good residency that isn't a torture and a relaxed attending life where patient satisfaction is high and specialists all love you for referrals. It's really a good career and it's stupid to look down on it.

Any idea if there are any FM fellowships or anything that allow more procedures? Or what academic FM is like?

 

[Splenda88]

Any idea if there are any FM fellowships or anything that allow more procedures? Or what academic FM is like?

If you want a program that is heavy on procedures, your best bet is to go to an unopposed one...

 

[DarkHorizon]

Because you can make more money in other fields. If rural FM is paying 300k, rural gen surg would pay 500k+, surgical sub specialties even more.

 

[ciestar]

Are there even any ‘prestigious’ FM residencies? What about academic FM?

Note: IDC personally, just curious if there are any.

Also, that is really stupid. FM is Cush. Nothing wrong with it.

It’s also no secret that in FM the best programs aren’t necessarily the academic ones.

 

[ciestar]

Any idea if there are any FM fellowships or anything that allow more procedures? Or what academic FM is like?

You can back door your way into OB with a fellowship it that tells you anything. That just furthers your need to work in rural locations if that is what you desire to do.

Academic FM? Forget it. You’ll get passed over for the residents/attendings that did 4 years of training in that field every time. That’s the problem with academic FM. As i said in my last post, academic FM isn’t necessarily the “best” or “most prestigious” simply because you have to work along side people that trained in OB, EM, etc.

 

[deleted1005514]

It’s also no secret that in FM the best programs aren’t necessarily the academic ones.

FM “gunner” here, and this is actually one of the draws of FM, that the better training is found in community programs rather than large academic ones.

I’m from a very rural area, and hoping to return to one. I don’t care if it’s prestigious or not...my whole goal in medicine is to be a rural FM doc, and use that expertise to help the less fortunate in some way too.

 

[Kkshake]

I kinda like FM because it has a lax lifestyle and residency if you want and a broad spectrum of knowledge...I would love to do FM in a rural area where I can do procedures and such.

What kind of procedures can you do in FM (I just did a rotation in FM any they didn't do a single one, not even like removing impacted cerumen)?

 

[VA Hopeful Dr]

What kind of procedures can you do in FM (I just did a rotation in FM any they didn't do a single one, not even like removing impacted cerumen)?

Commonly: joint injections, skin stuff, cryo, trigger point injections.

More rare but you still see it: vasectomy, IUD placement, colposcopy, infant circumcision, endoscopy.

 

[SLC]

What kind of procedures can you do in FM (I just did a rotation in FM any they didn't do a single one, not even like removing impacted cerumen)?

My office procedure list (stuff I do commonly)

Joint injection/aspiration
Skin biopsy
Endometrial biopsy
IUD
Nexplanon
I&D
Circ
fracture reduction
Toenail removal
Lac repair
Foreign body retrieval (eyes, orifices)
Nerve blocks


Hospital procedures:
Central lines
Intubation
Suprapubic bladder aspiration
Conscious sedations


There are others but that’s all I can get out of my foggy brain this early on a Sunday.

 

[zanzizic]

My office procedure list (stuff I do commonly)

Joint injection/aspiration
Skin biopsy
Endometrial biopsy
IUD
Nexplanon
I&D
Circ
fracture reduction
Toenail removal
Lac repair
Foreign body retrieval (eyes, orifices)
Nerve blocks


Hospital procedures:
Central lines
Intubation
Suprapubic bladder aspiration
Conscious sedations


There are others but that’s all I can get out of my foggy brain this early on a Sunday.

Nice. That’s like the GPs (general practitioners) of old who did everything.

Not asking your compensation, but what is ballpark for a procedure heavy FM doc who is doing some inpatient work vs the FM who is clinic primary care without procedures?

 

[Ho0v-man]

How effective is FM in paying off debt quickly? Right now, there's the trend of people specializing because the debt is so burdensome that FM salary alone isn't enough to pay it off quickly. Adding in other costs like mortgage, the total costs swell up. Location also matters for some and as easy it is for SDN to blindly suggest working a few years in a rural area, this isn't always practical

The super specialist will pay off debt quicker once they’re an attending. BUT if I trained for say 6 years post med school to be an IM sub specialist and you train 3 years then by the time I’m an attending you’ve likely paid off your debt by the time I’ve made my first attending paycheck. In the meantime, my debts have just been accruing and compounding.

So while the specialist who trained twice as long is going to pick up shifts to pay off loans ASAP, the FM doc is cutting back hours to 4 days/week and planning a vacation.

This also ignores the fact that an FM doc can get a job anywhere in the country before you finish reading this post while an interventional cardiologist might end up in a city they’ve never heard of.

TLDR; med students are dumb bc FM is a great gig.

 

[SLC]

Nice. That’s like the GPs (general practitioners) of old who did everything.

Not asking your compensation, but what is ballpark for a procedure heavy FM doc who is doing some inpatient work vs the FM who is clinic primary care without procedures?

It’s a bit complicated because I’m on a salary guarantee, but I plan on the mid $300’s. I’m upper $200’s right now.

Also...I’ve got a busy practice, but it’s still growing. 1 year in, I have about 700 established patients; with a goal of getting to 1,600. I don’t have a jam packed schedule every day, and am averaging around 16-18 office visits per day right now.

Also, my hours/lifestyle are nice. I work from 8:15-8:30 to 5pm M-F; I take a 2hr lunch break. I only work the hospital 1-2 weekends per month, and it’s 48h of call from home; only going in for clinical status changes, AM rounds, Admits.

I take a lot of quick weekend mountain biking vacations, which keeps me very happy.

 

[SLC]

This also ignores the fact that an FM doc can get a job anywhere in the country before you finish reading this post while an interventional cardiologist might end up in a city they’ve never heard of.

TLDR; med students are dumb bc FM is a great gig.

Very true. I hand picked this gig way back when I was an intern. They held it open for 2 years, paid me $20k signing bonus and $2400/month retainer fee while I was a resident. I get similarly enticing job adverts to the tune of 18-20 per day (and those are just the ones that get through my email’s spam filter).

 

[zanzizic]

Very true. I hand picked this gig way back when I was an intern. They held it open for 2 years, paid me $20k signing bonus and $2400/month retainer fee while I was a resident. I get similarly enticing job adverts to the tune of 18-20 per day (and those are just the ones that get through my email’s spam filter).

No kidding. That would have come in handy

 

[Ho0v-man]

Very true. I hand picked this gig way back when I was an intern. They held it open for 2 years, paid me $20k signing bonus and $2400/month retainer fee while I was a resident. I get similarly enticing job adverts to the tune of 18-20 per day (and those are just the ones that get through my email’s spam filter).

Holy ****! So you got paid an additional 28k/year so you could get locked into a 300k+ gig with great hours? With offers like that, and any moonlighting it would be super easy to hit 100k as a resident!

Meanwhile, the med school super stars are getting murdered in IM and supposed to have multiple pubs and maybe do a chief year or some nonsense...

Again, med students are dumb.

 

[AMEHigh]

Low prestige, low pay relative to specialties (meaning non-primary care), mounds of paperwork (more than other fields on average), a relative excess of residency spots, etc. There are more reasons but I can't think of them atm.

Personally, I would hate to manage cholesterol and diabetes every day. Sounds extremely boring. Plus, the knowledge base is way too broad. I would rather know one thing extremely well than know a lot of things well enough to pass a pt off to a specialist.

Edit: I will add that those offers definitely aren't a recent trend. I will say that you may be looked down upon (stupidly so) by your classmates for choosing primary care because there's no glamour associated with it and it's what people that didn't do well on step, have red flags, etc match into. This is not to say that there aren't plenty of people that are highly competitive that choose primary care. It's all about what you want at the end of the day. Who cares what anyone else thinks. It's your life.

I agree with most of what you’re saying but I think there’s a HUGE misconception that FM "just" manages diabetes and cholesterol. Sure if that’s how you set up your practice, then that’s how it’s going to be, but it definitely DOES not have to be that way.

I’m obviously biased since I am FM, but where I work now most of my panel of patients is younger. In our health system FM does inpatient, OB, obviously a lot of peds, A LOT of gyn and related procedures, HIV care, Hep C management, LGBTQ care including hormone treatments, and the list goes on. In addition we have 4 procedure clinics per week so doing everything from IUD placements, to ear lobe repairs, etc.

I’m a part of a list serve of FM physicians who take care of a certain population of patients (leaving it vague for anonymity) and there was just a "getting to know you" thread and the care I just described above is what a lot of FM physicians are doing around the country.

You can work as a college physician, at planned parenthood, seeing prenatal/OB...the list is endless where you won’t be "just" managing diabetes and cholesterol. That’s a big misconception that I wish med schools would emphasize more. FM can be pretty great if you want it to be!

Yes paperwork sucks, but every field has it’s pros and cons.

 

[slowthai]

I work from 8:15-8:30 to 5pm M-F; I take a 2hr lunch break.

Boy...just cushtie

 

[Splenda88]

Very true. I hand picked this gig way back when I was an intern. They held it open for 2 years, paid me $20k signing bonus and $2400/month retainer fee while I was a resident. I get similarly enticing job adverts to the tune of 18-20 per day (and those are just the ones that get through my email’s spam filter).

The people I talked are getting good offers where if they want to work a little bit more they can make 300k+ working 50-55 hrs/wk...

 

[AMEHigh]

Any idea if there are any FM fellowships or anything that allow more procedures? Or what academic FM is like?

You don’t need a fellowship to do procedures. I just described below what I do. Our clinic has 4 procedure clinics per week. We train FM residents. You can get all the training you need during residency. If you’re out in the non-academic world you can also certainly do just as many procedures, but you’ll just have to make sure you’re working somewhere that they are open to you having the equipment and supplies and medical staff that can set up things sufficiently for you. It’s all about how you set up your practice and word of mouth gets around.

 

[AMEHigh]

Also for me, I’m all about flexibility.
FM pretty much allows you to work in any setting anywhere. I personally don’t want to be tied down to 1 or 2 locations. If I want/need to move I can. If I get sick of my current job I can EASILY find a new one.

My friend and her spouse are physicians. He’s just finishing fellowship and there are literally 3 places with potential job openings for his fellowship specialty. After 6+ years of training where med school and residency doesn’t give you much freedom to choose where you live I would not be happy being limited even further.

 

[SLC]

The people I talked are getting good offers where if they want to work a little bit more they can make 300k+ working 50-55 hrs/wk...

It’s not at all hard to find. You just gotta watch out for the really terrible places to work, they often tease with high salaries/big signing bonuses etc., then try to ruin your life once you’re there.

 

[SLC]

Also for me, I’m all about flexibility.
FM pretty much allows you to work in any setting anywhere. I personally don’t want to be tied down to 1 or 2 locations. If I want/need to move I can. If I get sick of my current job I can EASILY find a new one.

My friend and her spouse are physicians. He’s just finishing fellowship and there are literally 3 places with potential job openings for his fellowship specialty. After 6+ years of training where med school and residency doesn’t give you much freedom to choose where you live I would not be happy being limited even further.

This, very much this.

I could literally answer an email, be interviewed and on my way to a new job/location of my choosing within a month if I needed to.

Also, I’d get so mind numbingly bored being too specialized. I’ve yet to look back and think to myself “I wish I could just focus on hearts, Autoimmunity, Endocrine, etc”

And paperwork? My workflow/practice style kills most of it before it happens. And what little paperwork I do, I’ve trained up my MA to do for me, I just review and sign.

I don’t feel burdened by paperwork/administrative junk at all.

 

[ciestar]

Procedural stuff.. ive done rotations at an opposed and an unopposed program. Stark differences as the unopposed got more procedural stuff. They routinely do joint injections, nexplanon/IUD insertions, derm clinic does mole removals and therefore suturing as well.. loads of things, but also a busy OMM clinic.

 

[VA Hopeful Dr]

Also for me, I’m all about flexibility.
FM pretty much allows you to work in any setting anywhere. I personally don’t want to be tied down to 1 or 2 locations. If I want/need to move I can. If I get sick of my current job I can EASILY find a new one.

My friend and her spouse are physicians. He’s just finishing fellowship and there are literally 3 places with potential job openings for his fellowship specialty. After 6+ years of training where med school and residency doesn’t give you much freedom to choose where you live I would not be happy being limited even further.

Yep. I have been out of residency for 6 years. In that time I've moved 2 times and had 5 different jobs (finally found a good fit, thankfully). Not many fields in medicine where I could pull that sort of thing off.