Choosing where to apply for FM residency

[DoctorStrange0101]

I'm considering apply to FM. There's a few factors that influence my decision and I'd really appreciate any input you all can offer.

I mostly want to do FM in order to be able to do procedures. Ideally, I'd be able to do colposcopy and LEEP, tubal ligation, any type of OR procedures, vasectomies, etc. I think in order to do any procedure or have hospital privileges I need to have a certain number of said procedures under my belt during my time in residency. How do I choose a residency that'll allow me to get enough procedures of each type in so I can do them on my own afterward?

Also, is there any benefit in choosing rural vs urban programs or is it totally program-specific regarding how much hands on training I'll get?

Lastly, is it possible to do procedures as a family doc and still maintain a good lifestyle (by good I mean I want to be home for dinner by 7 most nights and I'd like to have most weekends off as well as little call). Am I completely naive or is this possible?!!

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[Atlas Shrugged]

"Any OR procedures"?

You cannot be serious? FM does a lot of procedures, but let's not pretend "most" OR procedures are a part of that. Very, very few procedures (I cannot emphasize how few, even in the military which usually has a broader scope) FM docs do, including simple surgeries and cesarean sections. Tubal ligation is out of the question without an OB fellowship. Even with fellowship, if you aren't rural it isn't happening.

Army docs are lucky to be doing c-sections and tubal ligations (and they are ready to admit this, despite being fully competent in these skills; I've seen an OB trained FM doc save a private practice OB/GYN's ass during a difficult c-section. He literally saved this child's life. But the fact of the matter is, the law generally prefers OB/GYNs delivering babies.

Even colonoscopies, so few are done by FMs.

I say this as a military MS3 interested in FM, originally interested in surgery. I like the variability and the many procedures. But let's not kid ourselves and even mention the OR.

P.S.: That physician, a family physician, made me respect the specialty. So many people **** on FM. But they do not realize what an excellent generalist is capable of. As an MS3 I've been disappointed in NP and PA notes. One such case was (a patient I saw alone) an NP who referred an otherwise healthy woman with menorrhagia to heme/onc for simple iron deficiency anemia. I spent 20 minutes trying to tease out why she saw heme/onc before guaranteeing she had iron deficiency anemia (backed up with labs). (btw heme/onc in the Army are champs, or very bored, because their note was excellent and without condescension)

I'm a little drunk, and ranting, but FM truly is the penultimate generalist. I thought I would hate my FM rotation. And yet I am now battling between FM and EM. And honestly, FM will probably win for a myriad of reasons.

 

[Natividad Resident]

Thing I didn't understand before residency about tubal ligations: there are 3 ways to play.
1. Postpartum infra-umbilical laparotomy is often done a day or two after vaginal delivery. (I'd never even heard of this in med school.)
2. Can ligate those tubes before closing during a c-section (I knew this.)
3. Non-perinatal laparoscopic surgery. (Plus the rare open procedure.)

FM docs don't do laparoscopic surgery with very very few anecdotal exceptions. FM docs are rarely certifiable for c-section or umbilical laparotomy after 3 years of residency. Docs who didn't do surgical residency (FM IS NOT SURGICAL RESIDENCY) are subject to the approval of a surgeon (ObGyn, General, etc) for privileges to use the OR - no matter how rural you get. An FM program like JPS has grads who get the necessary procedure counts to get privileges, but I'm skeptical that you can assume high procedure counts at any residency. There's a lot of luck of the draw.

As for having a procedure-driven practice, I don't know of any FM docs who do this, because patient sorting is what primary care is. Patient sorting means sending a patient to another provider to get something done that you don't want to do or can't do. But the billing for a procedure is generally a positive aspect of all-comers primary care, so there's no incentive to shop out procedures that you can do as a primary care doc. I guess there's a possibility to have a practice where you have PAs or NPs doing primary care visits and they send procedures to you, but you'd have exactly no influence on what procedures will come in the door. And there's no practice overlap between outpatient lumps&bumps/toenails/vasectomy and OR procedures.

My suggestion: find an FM doc doing what you want to do.

 

[VA Hopeful Dr]

Generally speaking, for the more advanced procedures you can choose a couple to be good at. The family doctor that's doing c-sections, colonoscopies, vasectomies, and tubals is very very very rare these days.

If you're wanting to do mainly procedures, I'll be honest and say you need to consider a different specialty.

 

[cabinbuilder]

I'm considering apply to FM. There's a few factors that influence my decision and I'd really appreciate any input you all can offer.

I mostly want to do FM in order to be able to do procedures. Ideally, I'd be able to do colposcopy and LEEP, tubal ligation, any type of OR procedures, vasectomies, etc. I think in order to do any procedure or have hospital privileges I need to have a certain number of said procedures under my belt during my time in residency. How do I choose a residency that'll allow me to get enough procedures of each type in so I can do them on my own afterward?

Also, is there any benefit in choosing rural vs urban programs or is it totally program-specific regarding how much hands on training I'll get?

Lastly, is it possible to do procedures as a family doc and still maintain a good lifestyle (by good I mean I want to be home for dinner by 7 most nights and I'd like to have most weekends off as well as little call). Am I completely naive or is this possible?!!

Agree with above. If you want to be in the OR, then be a surgeon.

 

[Hakuna Matata]

I have to disagree with some of these comments. The FM doc who practices full-scope medicine does still exist. Sure, it's not extremely common. I've worked with many FM docs who do c-sections, tubals, colonoscopies, work routinely in the ER, etc. And didn't need to do a fellowship (although some hospitals will require that). Find the right residency that will train you in these procedures. And be aware that you likely will need to practice in a fairly rural setting to be able to offer these services.


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[VA Hopeful Dr]

I have to disagree with some of these comments. The FM doc who practices full-scope medicine does still exist. Sure, it's not extremely common. I've worked with many FM docs who do c-sections, tubals, colonoscopies, work routinely in the ER, etc. And didn't need to do a fellowship (although some hospitals will require that). Find the right residency that will train you in these procedures. And be aware that you likely will need to practice in a fairly rural setting to be able to offer these services.


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There's a difference between doing those procedures, as you've seen, and what the OP said which was "I mostly want to do FM in order to be able to do procedures".