A bunch of little questions about FP

[BellKicker]

Okay, here goes. I'm strongly considering family practice in the upper midwest (which to me is WI, MN, and the UP).

Can someone enlighten me on these matters......

First of all, if your only source to US medicine was SDN (and for me, it has been so far!) you might think that family docs are the complete losers of medicine and that nurses will take over the entire field anytime soon. Someone please tell me that's not true!

Secondly, I know residency is only 3 years. Does that mean that after 3 years you're sort of a free agent that could go anywhere? That seems like very little time to me. Is that right, though?

How hard is it to find a job after residency?

How important is it where you did your residency? What exactly will a "competitive" residency do for you? Will you make more money? How does it work 10 years down the line? Does it still matter?

And finally, in some other threads people are talking about very short work weeks. What about residency? Pretty much the infamous 100-hour weeks all over?

If someone actually decides to answer this, I'll really appreciate it.

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[shockdoc]

SDN is your only news? You need to get out anymore.
I'm an FP so I'll put in my 2 cents...

Believe me 3 years is enough. They recently tried to go to 4 years but was shot down. You won't know everything when you go out ,but that's life. During my 3 years out of residency, there's always something new I'm learning...

Finding a job out of residency is easy. Finding a job in sunny Malibu making $200,000 year with a 3 day work week is hard. Although we may not make as much as our surgeons and specialists, I do have a life. Where FP does excel is in flexibility. In my situation I pretty much have a 4 1/2 work week with hospital call twice a month. The more I see patients the more I make. I was offered a 4 day work week with no call with less pay. I have a buddy who is a hospitalist in a crappy area in Texas with no managed care bringing home $300,000 a year but is working his butt off. I have a friend who is a soloist who is doing "boutique medicine" working with personal trainers and exercise machines and having a ball. They're all FPs. It's all relative.

As for reducing hours, I'll have to see when I'll believe it. My record was a 46 hour work day.

BTW yesterday I saved a woman's life. Money and managed care aside, that is always cool about being a doctor.

 

[gherelin]

Well Bell-Kicker, I'm an FP intern and I have to confess I'm feeling pretty demoralized and wondering whether I made the right decision....(could be that I'm post-call, with the usual ZERO minutes of sleep or even chill- out- in- a- corner- by- myself- time)Make very sure you are honest with yourself about what you want and can handle. You gotta want any of the specialties pretty bad, imho, to put up with residency happily. Once the decision is made, you're trapped for at least a year.

 

[UHS2002]

Originally posted by gherelin
Well Bell-Kicker, I'm an FP intern and I have to confess I'm feeling pretty demoralized and wondering whether I made the right decision....(could be that I'm post-call, with the usual ZERO minutes of sleep or even chill- out- in- a- corner- by- myself- time)

Yep, as another FP intern, I would second all of the above. Glad I am not the only one feeling like crapola right now, though... sorry gherelin, misery likes company, you know

 

[SDN]

To those in their internship year -- it doesn't matter what field you are specializing in -- you'll always think that you made a big mistake. In fact, it will probably get worse after daylight-savings-time changes in the Fall. It's just a real down time during this period. I've experienced it, I've seen it many times with many classes, and we even used to tell our interns to expect it at UCI. You'll be a lot happier towards the Spring, and even happier as an PGY-II and III. But it won't be great until after graduation. You'll just have to trust me on that!

Regarding nurses -- they're making inroads -- but patients always will prefer doctors to NPs or PAs. Additionally, PAs need doctors to supervise them. NPs are going out on their own -- but I haven't seen any open an office in my area, and I never will. They wouldn't survive without the support of a physician's office. I've heard about NPs that set-up and run their own office, but it's a very rare thing.

On 3 years: 3 years is not enough time. It's not enough for IM docs, FP docs, or any of the other 3 year residencies. 30 years is not enough time either -- medicine is always changing and evolving -- you've got to learn how to study on your own and keep-up. Residency is about learning to think for yourself, learning how to self-motivate, self-educate, and manage your professional life -- it's impossible to learn all the facts and figures for any field, but you need to know how to access them.

FP jobs: it depends on what you want. Some FPs make 500+ a year, others make less than 100. There is sooo much flexibility with this field, you decide what you want to do.

Residencies: they all suck. Every residency in every field everywhere sucks. I hear the hours are better now, but you'll still be working longer hours than you imagined you could work. You'll be responsible for more in-patients than you think is safe or reasonable. You'll eat crappy food, gain 20 lbs, work every holiday, have strained relations with your family, and at times want to smother your fellow residents to put them out of their misery (and yours). If you don't feel that way during residency, you should question your sanity or the quality of your program.

The most competitive FP residency is probably Ventura County. It's like the Special Forces of the FP world -- they call them "super-docs." These docs can do unassisted appendectomies, c-sections, etc.... They're trained to work in very rural communities, where they may be the only physician around. If that is your goal, look into that -- there are a few super-doc programs and they're all very competitive. If you want to be a regular FP, any program will work, but stick with well-established programs. Make sure to do your research before applying to programs.

Finally, competitive residencies will not make you more money. It's all about what you want to do when you graduate.

I hope that helps!

 

[gherelin]

Slept all day of course now will be up all night .
it IS good to know you're not the only miserable one. And thanks for the pep talk Lee. it really helps. i keep asking friends and family for pep talks - just to get me through the day or even the moment sometimes, but they mostly
1. can't understand and so tell me how hard THEIR jobs are or 2.tell me to drop out or try and transfer or
3.remind me i need to at least suck it up long enough to get out get a job and pay back these loans (starting to wonder the point of tht last one-I went in as an non-traditional student so will be probably be dead before they're paid off anyway.)
what happened to FP as the "benign"residency? if this is benign then i can't help thinking there's something seriously wrong with me and/or i should have done path (which i liked anyway but like more and more thinking about the call.)

 

[BellKicker]

Great input, everybody.

I don't know, gherelin, I wouldn't want my residendy to be known as "the benign residency". I guess I worry too much about stuff like that but it would really bug me if people would view as a half doctor because I was an FP.

This doesn't mean I don't sympathize with you. Hang in there, now. In 10 years you'll be telling stories about it!

I have to say right now I'm pretty psyched about family practice. Lee (kind master of the universe) those super-docs sound fricking cool!

Later.

 

[droliver]

Lee,

I thought the days where FP's would attempt non-obstetric surgeries has been over for a long time? (excluding cutaneous procedures). Even in the most rural areas of the country, there are general surgeons within ambulance or helicopter distance especially for non-emergent procedures like appendectomies. The valuable skills for areas like that would be the few truly emergent procedures which cannot be delayed (trauma laparotomies or thoracotomies, intracranial hemmorhage evacuation, ruptured AAA) for which I'm not sure an FP program can train you for

 

[UHS2002]

Thanks Lee,

I too need all the pep talks I can get right now. I am soooo relieved that I am not the only one who has had visions of smothering my fellow residents particularly the ones that like stepping on you when you are post call and feeling especially down.

 

[gherelin]

Originally posted by BellKicker
Great input, everybody.

I don't know, gherelin, I wouldn't want my residendy to be known as "the benign residency". I guess I worry too much about stuff like that but it would really bug me if people would view as a half doctor because I was an FP.

Bell-kicker: Yeah-I know-it is silly because you'll hear every specialty dissing every other specialty so there's no real point worrying in my view, although it bothers me too. Your other issue though, I completely disagree with and since it's been endlessly debated here and elsewhere (does abuse and overwork equal better medical training or not) I won't say anything except in my view NOT.

 

[SDN]

Originally posted by droliver
I thought the days where FP's would attempt non-obstetric surgeries has been over for a long time? (excluding cutaneous procedures). Even in the most rural areas of the country, there are general surgeons within ambulance or helicopter distance especially for non-emergent procedures like appendectomies. The valuable skills for areas like that would be the few truly emergent procedures which cannot be delayed (trauma laparotomies or thoracotomies, intracranial hemmorhage evacuation, ruptured AAA) for which I'm not sure an FP program can train you for

In most areas of the country, FPs don't act as primary surgeon -- they assist (only if they want to, because assisting doesn't pay anymore). But a good rural FP physician needs to be able to do solo appys and c-sections. If you're in a rural community and it's snowed-in -- you need to be able to remove a bad appendix or handle a complicated delivery. Even on Catalina Island (just a few miles from LA) the fog can be so bad that helicopters can't land -- if a complicated delivery occurred, there's no way to get a patient to the mainland in time.

 

[droliver]

Lee,

I still think that the indications for a FP doing an appendectomy in the United States @ this point in time would be very,very rare & I can't even imagine it in most realistic scenarios. It's just not an acute enough problem to warrent this the overwhelming amt of the time that you can't tx. it medically until a surgeon can be found. C-sections are a different story, in areas without OB coverage (or general surgeons in many small towns) the skills to do this are an immeadiate life-saving skill that you should be able to do if you plan on doing obstetrics as a FP.

 

[SDN]

Droliver-

Yeah, I agree, I don't think there are many FP doing appys on a regular basis, but I bet we could find some that do it.

Nevertheless, it is good to know how to efficiently perform basic surgeries such as appys. Most FP programs train residents to be good assists, but few train to actually perform the surgery.

I'm more interested in figuring-out who'd be doing the anesthesia in these one-doc scenarios -- I'd hate to be running anesthesia and doing a c-section at the same time!

 

[droliver]

I know in a lot of third world countries & on a# of certain procedures in this country, the surgeon will be dictating the anesthesia to a nurse or assistant who pushes the drugs & monitors the vitals while they do the procedure. I've seen it in this country for plastic surgery, hand surgery, and a bunch of smaller general surgery procedures & endoscopies (all heavy conscious sedation)

 

[DDuncan]

Bellkicker-

You should check out www.aafp.org

There is a ton of information there on FP. You can also join for nearly nothing as a student member.

--Derek