Why would anyone go into primary care nowadays?

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I have seen many PA/NP in Derm, EM, psych etc... Yes there are a lot more in primary care, but it appears they are starting to invade the non-surgical specialties as well.. Lets face it, everyone is after the $...
Yes, but the NPs have "established" with "studies" that they have just as good outcomes as PCPs. They have not made the same claim with specialists (then people would know they're really nuts). In specialty medicine, their role is more supplementary.
 
Yes, but the NPs have "established" with "studies" that they have just as good outcomes as PCPs. They have not made the same claim with specialists (then people would know they're really nuts). In specialty medicine, their role is more supplementary.
Completely agree, but I just wanted to point out that they are not only in primary care... I think these politicians are nuts for letting these people practice without physician's supervision in some states...
 
Completely agree, but I just wanted to point out that they are not only in primary care... I think these politicians are nuts for letting these people practice without physician's supervision in some states...
No one has issue with NPs working under supervision, it's when they wish to work autonomously and independently which is the problem. Esp. since they have many less contact hours before getting a full license (under Nursing).
 
@DermViser so if someone had to go into a primary care field, which field do you speculate would be best based on the current direction medicine is going? Inpatient IM? Psych?

Edit: Assuming individual interest in specialties is equal
 
I think this idea of the education component as being something that one has to get through in order to reach a finish line is part of the problem.

I am looking forward to the time I spend in school and residency. That isn't an onerous burden that I have to slog my way through to get to something better... it is something that, in itself, I have wanted to experience my whole life long. People who skip over it aren't getting ahead of me, and I don't envy the way that they are missing out on the training that I am going to such trouble to experience.

Don't delay gratification. Find gratification in what you are doing right now, in the process. This is life, today.
How can you say that when you haven't gone through any of it? You're preaching about how you aren't going to dislike how demanding residency is all while making very little money and watching loans compound and how once you are a resident you aren't going to envy those who have had a fairly generous steady pay since when you joined med school and are able to have a family, buy a house, car, travel, etc, but you haven't even come near to any of those things. I think it's naive to say how you are going to enjoy it and how the negative aspects aren't going to phase you when you have absolutely no clue how you will feel in the future. You don't think that many of the people in med school, or residency, or practicing physicians didn't feel exactly the way you did before getting into med school? Don't be so sure that you're "better" or will be different than them...
 
@DermViser so if someone had to go into a primary care field, which field do you speculate would be best based on the current direction medicine is going? Inpatient IM? Psych?

Edit: Assuming individual interest in specialties is equal
Psych is not primary care. The only primary care fields are General IM/General Peds/Family Medicine.
 
How can you say that when you haven't gone through any of it? You're preaching about how you aren't going to dislike how demanding residency is all while making very little money and watching loans compound and how once you are a resident you aren't going to envy those who have had a fairly generous steady pay since when you joined med school and are able to have a family, buy a house, car, travel, etc, but you haven't even come near to any of those things. I think it's naive to say how you are going to enjoy it and how the negative aspects aren't going to phase you when you have absolutely no clue how you will feel in the future.
If you read his other posts, he has quite a few knee-slappers as a pre-med about to enter med school.
 
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Psych is not primary care. The only primary care fields are General IM/General Peds/Family Medicine.
While psych is not primary care, but there are some encroachment by non-physicians as well in the field...
 
@DermViser so if someone had to go into a primary care field, which field do you speculate would be best based on the current direction medicine is going? Inpatient IM? Psych?

Edit: Assuming individual interest in specialties is equal
Well with the choices Gen IM/Gen Peds/FM, Hospitalist tends to be quite popular. We don't have midlevel hospitalists. Yet.
 
Noob question, but is that a difficult position to get? It's just a general IM residency right?
You can be a pediatric hospitalist as well. And no, it's not a difficult position. I imagine there are FM board certified hospitalists as well.
 
Mid level hospitalist have been attempted, but they struggled with managing really sick patients and call consults all day.

"The midlevels we hired at Mt. Zion didn’t necessarily have a full grasp of the larger medical service and the type of patients we had coming over, so they frequently needed to consult with the hospitalists,” Dr. Sehgal said. “Over time, it just became easier to hire hospitalists to do everything directly. This was in part related to the unique aspects of our service structure and operations.”
A similar thing happened at the University of Michigan Health System at Ann Arbor (UMHS), where there is a very diverse patient population. The hospital started using midlevels with its resident-based hospitalist service in 2000, then moved them to the nonresident service in 2004. It is now in the process of closing down the midlevel component.
“With our patients, no single diagnosis is more than 5% of our patient population; they tend to be pretty ill and complex,” said Vikas Parekh, ACP Member, associate director of the UMHS hospitalist program. “It’s not even easy for the faculty to care for the patients, and we found that with the midlevels, it was challenging to get them to a level where they could take care of enough patients to justify the investment
.”

http://www.acphospitalist.org/archives/2009/04/cover.htm
 
While psych is not primary care, but there are some encroachment by non-physicians as well in the field...

psych isn't primary care? News to me. A friend just completed a Family Medicine and Psychiatry combined residency program. Psych is primary care enough to be covered by at least some primary care scholarship/loan forgivenness programs, if you are willing to do it in an underserved area.

How can you say that when you haven't gone through any of it? .... Don't be so sure that you're "better" or will be different than them...

I am not saying I am better. I am saying that I am older, that medicine is my (EDIT: third) career, and that I have experience that informs my beliefs. Residency money isn't "not very much" if you are used to living on much less. And while making less money than most residents, I've managed to have a family, a house, a car, and to be content with what I have. Most of the people that I am going to be treating don't live as well as I do now, or I will in residency. I already work 60 hour weeks and did while I was in my last couple of years of undergrad. I don't think I am better than anyone. I just think that the way most people focus on the destination rather than the journey is the reason they end up miserable and feeling unfulfilled when they get there.
 
Mid level hospitalist have been attempted, but they struggled with managing really sick patients and call consults all day.

"The midlevels we hired at Mt. Zion didn’t necessarily have a full grasp of the larger medical service and the type of patients we had coming over, so they frequently needed to consult with the hospitalists,” Dr. Sehgal said. “Over time, it just became easier to hire hospitalists to do everything directly. This was in part related to the unique aspects of our service structure and operations.”
A similar thing happened at the University of Michigan Health System at Ann Arbor (UMHS), where there is a very diverse patient population. The hospital started using midlevels with its resident-based hospitalist service in 2000, then moved them to the nonresident service in 2004. It is now in the process of closing down the midlevel component.
“With our patients, no single diagnosis is more than 5% of our patient population; they tend to be pretty ill and complex,” said Vikas Parekh, ACP Member, associate director of the UMHS hospitalist program. “It’s not even easy for the faculty to care for the patients, and we found that with the midlevels, it was challenging to get them to a level where they could take care of enough patients to justify the investment
.”

http://www.acphospitalist.org/archives/2009/04/cover.htm
From what I gather, hopitalist work has its own set of headaches but this seems to give a glimmer of hope to those of us who don't want to lose everything to the NP/PA expanding scope of practice
 
Lol @ the pre-med who somehow isn't going to ever waver in their journey, will enjoy all the negative parts of the it and etc etc. Said every single pre-med before you. Do you think all of us that tell you " thats not reasonable" are crazy? I don't care if you're mother theresa, if you truly enjoy every step of the journey and never question what the f you are doing, then either a) You're on some good **** b) you're not human. So naive. Literally every pre-med has said the things you are saying. You're not special, snowflake. There's a difference between hating the whole experience and having normal human emotion and not enjoying bad parts of a journey. So sick of people trying to act like they're the second coming of christ. You aren't, I promise.
 
I am not saying I am better. I am saying that I am older, that medicine is my (EDIT: third) career, and that I have experience that informs my beliefs. Residency money isn't "not very much" if you are used to living on much less. And while making less money than most residents, I've managed to have a family, a house, a car, and to be content with what I have. Most of the people that I am going to be treating don't live as well as I do now, or I will in residency. I already work 60 hour weeks and did while I was in my last couple of years of undergrad. I don't think I am better than anyone. I just think that the way most people focus on the destination rather than the journey is the reason they end up miserable and feeling unfulfilled when they get there.
Another non-trad who thinks that his extra experience will help him deal with med school better. Now your posts make sense. Keep this quote and I want you to look at this after you match or during internship and see how much you focus on the journey.
 
Honestly why do these insufferable premeds post in allo? You are the only one who is impressed by your age and supposed experience. Is someone advertising for uninformed, naive opinions in preallo and preosteo
Been wondering that too. Premeds and their absolute vast life experience (including non-trads) who seem to know more about how medicine actually works, than people who've actually gone thru it.
 
I don't know **** about anything, I just know that basically nothing in life is ponies and rainbows and only a fool would think something is.
 
Honestly why do these insufferable premeds post in allo? You are the only one who is impressed by your age and supposed experience. Is someone advertising for uninformed, naive opinions in preallo and preosteo
I've noticed that accepted students are amongst the most arrogant and pretentious group of people I've ever met in life. I've recently done a pre matriculation program which also had some summer pre med students in it along with numerous TAs. The attitudes between the premeds, accepted students and medical students were drastically different.
 
I presume you're one of those rare humble med students right?
Keywords here are uninformed and naive, which is what premeds in this thread are, hence making them insufferable. Not surprising as they haven't rotated.
 
Been wondering that too. Premeds and their absolute vast life experience (including non-trads) who seem to know more about how medicine actually works, than people who've actually gone thru it.

Most med students or residents who just started residency haven't really gone through anything either. Some of the non trads here have actually lived in the real world and had real jobs before.
 
Most med students or residents who just started residency haven't really gone through anything either. Some of the non trads here have actually lived in the real world and had real jobs before.
Again (for like the millionth time), the "experience" that non-trads come in with isn't even close to what medicine, esp. residency is like. In fact, many of those non-trads who claim how somehow they're more prepared bc of it, are the biggest whiners on rotations when it comes to other people accomodating them.
 
podiatry> primary care? i dont hold an opinion either way just curious too see what others think
 
podiatry> primary care? i dont hold an opinion either way just curious too see what others think
I don't know what podiatry education is in terms of # of years and tuition costs.
 
psych isn't primary care? News to me. A friend just completed a Family Medicine and Psychiatry combined residency program. Psych is primary care enough to be covered by at least some primary care scholarship/loan forgivenness programs, if you are willing to do it in an underserved area.

I completed an IM/psych combined residency program. Psychiatry is not primary care. It is covered by some scholarship/loan forgiveness programs because it is a needed specialty that performs some important public health services.
 
psych isn't primary care? News to me. A friend just completed a Family Medicine and Psychiatry combined residency program. Psych is primary care enough to be covered by at least some primary care scholarship/loan forgivenness programs, if you are willing to do it in an underserved area.
It's a combined program. The FM part is what allows it to qualify, not psych.
 
dermviser; pod education is 4 years- 2 years basic sciences, 2 years rotations- all the same classes/rotations as DO except I believe ob and psych. than a 3 year surgical residency. 7 years total. i heard those nails and bunions pay pretty good but am curious to hear how others feel podiatry would compare to primary care

tuition at most is 35k a year for a private such as WesternU
 
Completely agree, but I just wanted to point out that they are not only in primary care... I think these politicians are nuts for letting these people practice without physician's supervision in some states...
Why? It's not like they will be seeing them for their care. They'll be demanding a physician.
 
Yup. I do. That doesn't mean that I didn't graduate from an Ivy with a decent GPA and score better on the MCAT than anybody giving me crap in this thread.

I want to go to a DO school because I think there will be fewer stat obsessed douchebags there. I think that as a DO, I won't get ragged on for actively choosing a primary care specialty without concern about the financial implications of that choice. I work with some exceptional doctors who are DOs, and I have seen that they are not any less than their MD colleagues in the eyes of the people who really matter, that is our patients and their families.

That's very naive considering how our culture is and our comfort level with making medical decisions based upon numbers.

FWIW, It's doubtful the typical patient gives a poop about degree origin or maintains many of the attitudes you're read here. 🙂
 
Again (for like the millionth time), the "experience" that non-trads come in with isn't even close to what medicine, esp. residency is like. In fact, many of those non-trads who claim how somehow they're more prepared bc of it, are the biggest whiners on rotations when it comes to other people accomodating them.

Oh my God, quoted for truth.
 
Again (for like the millionth time), the "experience" that non-trads come in with isn't even close to what medicine, esp. residency is like. In fact, many of those non-trads who claim how somehow they're more prepared bc of it, are the biggest whiners on rotations when it comes to other people accomodating them.
I like how you counter a generality with another generality.

*edit*So far in my experience, at my school it is the presumptuous early 20s that seem to be know it alls. I'm looking forward to the humbling experience that is sure to come to them.
 
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Did I say ALL non-trads are like that?
No. But I tend to think that most who've worked in the medical field switch to medicine realizing they knew nothing, and did so wanting to expand their knowledge.
 
No. But I tend to think that most who've worked in the medical field switch to medicine realizing they knew nothing, and did so wanting to expand their knowledge.
Hence my qualifier: "many of those non-trads who claim how somehow they're more prepared bc of it,"
 
Hence my qualifier: "many of those non-trads who claim how somehow they're more prepared bc of it,"
You're saying that people are claiming to know more about medicine because of their experience? If so then I agree with you. I think however, that older individuals will have less difficulty adjusting to the academics and clinical duties of med school. Having life experience, no matter what the background usually translates to confidence, problem solving and an appreciation for what matters most.
 
You're saying that people are claiming to know more about medicine because of their experience? If so then I agree with you. I think however, that older individuals will have less difficulty adjusting to the academics and clinical duties of med school. Having life experience, no matter what the background usually translates to confidence, problem solving and an appreciation for what matters most.
Except many times it doesn't change the final result. It's a feather in the cap, but 9 times out of 10 doesn't make them "more prepared" for doing well in med school.
 
Except many times it doesn't change the final result. It's a feather in the cap, but 9 times out of 10 doesn't make them "more prepared" for doing well in med school.
You're right. I think the only difference is the age at which someone decides to pursue medicine. I was going to say that I would not have been prepared for medical school at 22, but I realize it's because I had no desire to be a physician at the time. I'd be naive and extremely cocky but I'm not sure what that translates to in clinical practice or if that mentality would even prevail through med school.
 
I'm entering medical school next month and I'm basically taking loans for my entire COA. That + my undergraduate loans make my total debt close to $300k once I graduate. That is the equivalent to a down payment for a $1.5 million mansion. After I pay it all back in 10-20 years, I will probably have paid a total of close to $500k.

My question is, what possible reason would a med student in my situation have for pursuing primary care or related fields? And why do medical schools not address this problem especially when everyone and their grandma are saying that there is a great need for primary care docs??


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What part of your argument is specific for primary care, instead of ALL medicine, includingspecialties? I mean, you can pay off your loans ultra fast on a PCP's salary too, just won't be AS fast as a specialist could (and you will need to stick to a resident's budget, unlike specialists).
 
What part of your argument is specific for primary care, instead of ALL medicine, includingspecialties? I mean, you can pay off your loans ultra fast on a PCP's salary too, just won't be AS fast as a specialist could (and you will need to stick to a resident's budget, unlike specialists).
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@Pattycake25, yeah living like a resident for the rest of your life.
 
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What part of your argument is specific for primary care, instead of ALL medicine, includingspecialties? I mean, you can pay off your loans ultra fast on a PCP's salary too, just won't be AS fast as a specialist could (and you will need to stick to a resident's budget, unlike specialists).

Ultra fast? Not really. Living like a resident isn't realistic when you are an attending.... Just because something is possible doesn't mean it's right or acceptable... No idea what you are trying to say. A doctor COULD live on 50k a year, yet it obviously wouldn't be worth it, unless you're one of those calling people, which would mean you're full of ****.
 
Ultra fast? Not really. Living like a resident isn't realistic when you are an attending.... Just because something is possible doesn't mean it's right or acceptable... No idea what you are trying to say. A doctor COULD live on 50k a year, yet it obviously wouldn't be worth it, unless you're one of those calling people, which would mean you're full of ****.

Errrr...instead of saying random words, why don't you make an actual argument against my post? What is unrealistic and/or wrong and/or unacceptable about living like a resident for an extra 2-3 years as an attending to pay off your loans?
 
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@Pattycake25, yeah living like a resident for the rest of your life.

Learn math. The resident's lifestyle is only necessary for an extra*5-6 years in order to pay off loans ASAP (maybe 4 if you have remarkable debt), not the "rest of your life".

Edit: I was wrong to be snarky. We still have a long way to go towards "rest of your life", though.
 
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Learn math. The resident's lifestyle is only necessary for an extra 2-3 years in order to pay off loans ASAP (maybe 4 if you have remarkable debt), not the "rest of your life".
You're right. The only expenses you will have after finishing residency are your student loans. It's not like you'll want to get married, have children, get a house, etc. Nope just student loans. Learn common sense.
 
Errrr...instead of saying random words, why don't you make an actual argument against my post? What is unrealistic and/or wrong and/or unacceptable about living like a resident for an extra 2-3 years as an attending to pay off your loans?

Just how much disposable income do you think the average PCP has? You make it sound like they have living expenses they can just magically cut to pay off loans. Yes of course there are ways to cut, but it's not like you can just cut out 50K at the blink of an eye. 2-3 extra years ? So you're saying a newly minted attending is going to live like a resident for 4-6 years? Yeah, good luck with that. If you can do it, more power to you, but I think you're drastically over-estimating the money you'd be able to save "living like a resident" vs just living like an average PCP and being able to put towards your loans. Pretty sure the average indebtedness is roughly 300K. Not even sure that's possible to pay off w/ PCP salary in 4-6 years unless your cost of living is insanely low, but I'd rather not live with my parents when I'm 30.
 
Just how much disposable income do you think the average PCP has? You make it sound like they have living expenses they can just magically cut to pay off loans. Yes of course there are ways to cut, but it's not like you can just cut out 50K at the blink of an eye. 2-3 extra years ? So you're saying a newly minted attending is going to live like a resident for 4-6 years? Yeah, good luck with that. If you can do it, more power to you, but I think you're drastically over-estimating the money you'd be able to save "living like a resident" vs just living like an average PCP and being able to put towards your loans. Pretty sure the average indebtedness is roughly 300K. Not even sure that's possible to pay off w/ PCP salary in 4-6 years unless your cost of living is insanely low, but I'd rather not live with my parents when I'm 30.

My reasoning is as follows:

-Average resident's salary: 48K
-Median starting FM attending salary: 138K
-Difference between the two: 90K
-Average indebtedness: 300K
-300K/90K = 3.3 years ** - I don't know and didn't research where you got 300K from, but I'm treating it as the amount you owe upon getting your MD. If that's the amount you ultimately pay back over 20 years, however, obviously a major perk of my plan is to not have to pay nearly that much, thanks to avoiding most interest.

You and @DermViser : I am aware that of course, I have to spend money on more things than just loan repayment. However, that is true for residency as well. The way I see it, graduating residency into an attending position is roughly equivalent to a 90K/year raise, with no other immediate changes in lifestyle expenses (bolded because this is an assumption essential to my post, so if I'm wrong, please let me know). Instead of using that raise to drastically improve your SoL right away, save it for a few years to wipe out your loans, THEN start living the high life.
 
My reasoning is as follows:

-Average resident's salary: 48K
-Median starting FM attending salary: 138K
-Difference between the two: 90K
-Average indebtedness: 300K
-300K/90K = 3.3 years ** - I don't know and didn't research where you got 300K from, but I'm treating it as the amount you owe upon getting your MD. If that's the amount you ultimately pay back over 20 years, however, obviously a major perk of my plan is to not have to pay nearly that much, thanks to avoiding most interest.

You and @DermViser : I am aware that of course, I have to spend money on more things than just loan repayment. However, that is true for residency as well. The way I see it, graduating residency into an attending position is roughly equivalent to a 90K/year raise, with no other immediate changes in lifestyle expenses (bolded because this is an assumption essential to my post, so if I'm wrong, please let me know). Instead of using that raise to drastically improve your SoL right away, save it for a few years to wipe out your loans, THEN start living the high life.
You forgot this little thing called taxes.
 
My reasoning is as follows:

-Average resident's salary: 48K
-Median starting FM attending salary: 138K
-Difference between the two: 90K
-Average indebtedness: 300K
-300K/90K = 3.3 years ** - I don't know and didn't research where you got 300K from, but I'm treating it as the amount you owe upon getting your MD. If that's the amount you ultimately pay back over 20 years, however, obviously a major perk of my plan is to not have to pay nearly that much, thanks to avoiding most interest.

You and @DermViser : I am aware that of course, I have to spend money on more things than just loan repayment. However, that is true for residency as well. The way I see it, graduating residency into an attending position is roughly equivalent to a 90K/year raise, with no other immediate changes in lifestyle expenses (bolded because this is an assumption essential to my post, so if I'm wrong, please let me know). Instead of using that raise to drastically improve your SoL right away, save it for a few years to wipe out your loans, THEN start living the high life.

But who was tax brackets(and tax itself as previously mentioned)? Who was interest? The bolded is an unwise assumption, as there are multiple other costs inherent to being an attending that aren't to a resident. You're using gross figures to try to do financial calculations, which I have no idea how that makes sense to you. Like I said, I think the net take home pay of being a newly minted PCP attending is closer to that of a resident than you think.
 
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