Would you prefer a 4-year FM residency over a 3-year one?

[JESSFALLING]

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As you may know, the ACGME is preparing to start a pilot program to test the viability of the 4-year FM residency.
(See: http://www.aafp.org/online/en/home/...fessional-development/20120427acgmepilot.html)

Personally, I think that they should improve the fellowship options for FM residents in lieu of extending the residency. Also, I think that they should make 'General Surgery' and 'OB' optional "Track" components within the programs, which could lead to more training in areas the resident plans to practice in.

Please vote as if you are interested in FM.

Thanks.

 

[deleted127837]

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[Poetic Silence]

FM is already a low pick on the "desirable specialties" list. The most common reason is due to sinking reimbursements. Frankly, I feel that extending the length of the residency will cause even more potential FM groupies to choose another specialty and thus further worsen the primary care shortage we're already experiencing.

It would be pretty cool if we could see a Family Medicine and General Surgery dual residency. Or at least a condensed version resulting in a new specialty. Family Surgery?

I think more training and knowledge is a great thing, but I see its potential to push FM off a student's list of desired specialties if it means even less pay in exchange for expensive loans and a lengthier timeline of paying them back.

Yes, I'm a pre med. *Looks at the ground and walks away in shame*

 

[FSUseminoleEM1]

FM is already a low pick on the "desirable specialties" list. The most common reason is due to sinking reimbursements. Frankly, I feel that extending the length of the residency will cause even more potential FM groupies to choose another specialty and thus further worsen the primary care shortage we're already experiencing.

It would be pretty cool if we could see a Family Medicine and General Surgery dual residency. Or at least a condensed version resulting in a new specialty. Family Surgery?

I think more training and knowledge is a great thing, but I see its potential to push FM off a student's list of desired specialties if it means even less pay in exchange for expensive loans and a lengthier timeline of paying them back.

Yes, I'm a pre med. *Looks at the ground and walks away in shame*

They're so different though. That just sounds like it's for people who can't make up their mind. The reasons people are attracted to surgery are very different from the reasons people are attracted to FM.

 

[NickNaylor]

FM is already a low pick on the "desirable specialties" list. The most common reason is due to sinking reimbursements. Frankly, I feel that extending the length of the residency will cause even more potential FM groupies to choose another specialty and thus further worsen the primary care shortage we're already experiencing.

It would be pretty cool if we could see a Family Medicine and General Surgery dual residency. Or at least a condensed version resulting in a new specialty. Family Surgery?

I think more training and knowledge is a great thing, but I see its potential to push FM off a student's list of desired specialties if it means even less pay in exchange for expensive loans and a lengthier timeline of paying them back.

Yes, I'm a pre med. *Looks at the ground and walks away in shame*

Why on earth would "family surgery" ever be used?

 

[Oxer45]

They're so different though. That just sounds like it's for people who can't make up their mind. The reasons people are attracted to surgery are very different from the reasons people are attracted to FM.

Actually rural FM's used to do appendectomy and c-sections, as well as be the Emergency Physician for the town. Because of malpractice insurance reasons they stopped (costs too much). As far as I know, a FM doc who's trained can still legally do c-sections (although it would not be wise in this malpractice lawsuit environment)

 

[mvenus929]

Not really something I'm concerned about as a pre-med, but I don't see why someone would deliberately choose a 4 year program over a 3 year program. "Hey, I'd like to get paid a grad student salary for an extra year instead of making real money! Yay!"

EM has both 3 and 4 year residency programs, and it's generally accepted that if you want to go into academics, you do a 4 year program or a 3 year program + a fellowship.

 

[JESSFALLING]

EM has both 3 and 4 year residency programs, and it's generally accepted that if you want to go into academics, you do a 4 year program or a 3 year program + a fellowship.

Besides more research opportunities, one argument for a 4-year program is that it could offer more procedural experience (e.g. endoscopy, surgical OB, derm, minor surgery, etc.) which might led to better reimbursement. It could also allow for more experience in other distinct areas of medicine like neurology, psychiatry, PM&R, hospice and palliative, certain IM/pediatric sub-specialties, and the like, which 3-year programs can only briefly offer. The added training would also be useful if one planned on practicing in a rural area where there are fewer specialists.

In case you're interested, here's a link to statistics regarding how FM docs are actually practicing: http://www.aafp.org/online/en/home/aboutus/specialty/facts.html

 

[phltz]

Why on earth would "family surgery" ever be used?

I met an older family practice doc at an alumni event at school. He has a practice in a very remote part of the state, which includes minor surgeries. He was pretty much a badass. I dunno how common that sort of practice is anymore (he was complaining that when he retires his town is screwed), but it's possible.

 

[JESSFALLING]

I met an older family practice doc at an alumni event at school. He has a practice in a very remote part of the state, which includes minor surgeries. He was pretty much a badass. I dunno how common that sort of practice is anymore (he was complaining that when he retires his town is screwed), but it's possible.

Check out my link above. There a definitely a few FM docs still practicing minor surgeries, c-sections, EM, and what not....

 

[AlmostJesus]

Its not a bad idea, but for the people its a good idea for - rural based doctors - there is already rural procedural fellowships.
The idea of reintroducing limited scope abdominal surgery (such as appys) is an interesting thought, but I dont know if the numbers would be there to make it safe.
C-sections for rural FM/OB doctors should almost be required.

 

[Roguelyn]

3 years is plenty if you're doing outpatient FM without OB. OB fellowship entails hundred of sections, operational deliveries and spontaneous deliveries. Hospital fellowships are typically procedure-heavy with more ICU experience than some FM programs offer. Optional 4 year programs could broaden residents' experiences in procedures, or other fields of interest without formal fellowships. But to make 4 years mandatory would certainly drive people out of the field.

There has been talk over the last few years about decreasing the number of required OB continuity patients and even the number of OB deliveries for FM residents and encouraging OB and non-OB options at those programs that are interested in continuing their OB training. It'll be interesting to see if it really happens in the next couple of years.

 

[BigRedBeta]

Three years is an incredibly short time to pick up and be good at 3 distinct specialties.

To be honest, if someone is going to do family med at a program or option without OB...they'd be better off doing a med/peds residency and getting dual boarded in both. They'll be significantly better at taking care of their patients across the spectrum from outpatient clinic to the ICU's (including NICU/PICU). While there are a few unopposed family med programs out there that offer significant critical care experience, they are few and far between.

 

[mvenus929]

To be honest, if someone is going to do family med at a program or option without OB...they'd be better off doing a med/peds residency and getting dual boarded in both. They'll be significantly better at taking care of their patients across the spectrum from outpatient clinic to the ICU's (including NICU/PICU). While there are a few unopposed family med programs out there that offer significant critical care experience, they are few and far between.

We had a resident at our hospital who switched from Med/Peds to FM, primarily because Med/Peds is more of an acute care/inpatient focus, while FM tends to focus more on outpatient and continuity of care. Both are valid options for someone wanting to take care of both adults and kids (though Med/Peds people tend to pick one or the other, not both), but they are designed for people with different career goals. Or so it seemed from listening to that resident talk about why she switched.