Family practice plus OB/GYN?

[Punchap]

Hi,
I am currently an undergraduate doing a little research...I was wondering what sort of training is involved in this combination (FP plus OB/GYN)? I would love to be a family doc that delivers babies. What sort of lifestyle do these doctors have? Any insight is appreciated. Thanks.

-Punchap

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[raptor5]

The way I see it you have 3 options.
1. Family Medicine (3 years) - @ least two months of required OB/GYN rotations. Many programs have more and if not you may use elective time.
2. Family Medicine + 1 year OB Fellowship (4 years) - Seems like the best option if you are really intent on delivering as an FP. No gyn surgery though.
3. Family Medicine + OB/GYN (~6.5/7 years) - Why would anyone put themself through that torture. Two board certifications. I have never heard of anyone going this route but there is probably someone who has, probably to switch specialties. Heck why your at it tack on EM + Peds Fellowship (Now up to about 12 years). Talk about the ultimate rural doc.

Lifestyle is great if you can find a way to stop women from going into labor in the middle of the night. I can't imagine thinking of OB as a lifestyle specialty. You have to love it. If that's the case the burden on your life will be outweighed by the joy of obstetrics.

 

[skypilot]

I think about 20% of FPs deliver babies. Here are some good facts about FP practice from the AAFP

http://www.aafp.org/facts.xml#x729

Look at the performance of OB table for OB stats.

 

[sacrament]

Hi,
I am currently an undergraduate doing a little research...I was wondering what sort of training is involved in this combination (FP plus OB/GYN)? I would love to be a family doc that delivers babies. What sort of lifestyle do these doctors have? Any insight is appreciated. Thanks.

-Punchap

I hope you also would love to pay outrageous malpractice premiums and get your ass dragged into court on a regular basis because somebody had an ugly baby.

 

[sophiejane]

I hope you also would love to pay outrageous malpractice premiums and get your ass dragged into court on a regular basis because somebody had an ugly baby.

Group practices, HMOs, hospital networks will pay your outrageous malpractice, especially in areas of greater need. I am just learning this little tidbit of info myself from talking to people who are actually doing this combo.

Lots of student docs will tow the party line, or variation of it, but I am seeing a different story in the real world. Party line goes something like this: you have to do so many deliveries to justify your malpractice that it's not worth it financially to only do a few a month.

But apparently, if you are willing to work in underserved areas, and are a good FP who has good experience with OB, you can probably find a town or a hospital or a group practice with aging family docs who are ready to retire who needs you badly enough to pay your malpractice as part of the deal.

As for suing, it doesn't happen nearly as often in small towns. This is just anecdotal, from talking to rural docs, by the way.

 

[skypilot]

But apparently, if you are willing to work in underserved areas, and are a good FP who has good experience with OB, you can probably find a town or a hospital or a group practice with aging family docs who are ready to retire who needs you badly enough to pay your malpractice as part of the deal.

As for suing, it doesn't happen nearly as often in small towns. This is just anecdotal, from talking to rural docs, by the way.

Looking at the tables, most FPs are avoiding high risk OB and C sections. And the Mountain and Western region of the country has the most for FP OB, the least looks like New England and Mid Atlantic (surprise surprise)

 

[sophiejane]

Looking at the tables, most FPs are avoiding high risk OB and C sections. And the Mountain and Western region of the country has the most for FP OB, the least looks like New England and Mid Atlantic (surprise surprise)

The ideal situation seems to be having an OBGYN in th community or nearby that you have a good relationship with and to whom you can refer your high riskers. As for C-sections, you better be able to do them if you are willing to do the SVDs. What will you do if she's laboring along and gets into trouble and you have no choice but to section her? If you can call for backup, great, but that's not always possible. If you aren't comfortable with C-sections you better not do OB at all, IMHO.

 

[skypilot]

If you aren't comfortable with C-sections you better not do OB at all, IMHO.

It looks like the vast majority of FPs (95%) while they may be able to do a C section are not doing them. Do you think they are using OBs to do them or getting General Surgeons to do them?

The rate appears to be only 1% in New England!

 

[Mike59]

3. Family Medicine + OB/GYN (~6.5/7 years) - Why would anyone put themself through that torture. Two board certifications. I have never heard of anyone going this route but there is probably someone who has, probably to switch specialties. Heck why your at it tack on EM + Peds Fellowship (Now up to about 12 years). Talk about the ultimate rural doc

There's an OB attending at my med school who did this....She did FP, decided she didn't like it, went back and did a full 5 years Obs/Gyn residency and now does that exclusively.

 

[lateness]

There's an OB attending at my med school who did this....She did FP, decided she didn't like it, went back and did a full 5 years Obs/Gyn residency and now does that exclusively.

I know someone who did a 5 year general surgery, then years later did pulmonoly/ccc, in IM. i know someone else who did FP then did anesthesiology, so 7 or 8 or 9 years can be done , if one is willing. some people decided to change later in life. no problem for them. i could see myself doing that. its more of your individual personality and monetary situation, if you dont have any problems why not, ?

 

[8744]

But apparently, if you are willing to work in underserved areas, and are a good FP who has good experience with OB, you can probably find a town or a hospital or a group practice with aging family docs who are ready to retire who needs you badly enough to pay your malpractice as part of the deal.

But that's the problem. Just like Captain Picard and the Borg, FP is being forced to fall back further and further under the onslaught of both the lack of interest in the field and the inroads of NPs and PAs.

People make it sound like being able to work in an underserved area is some kind of victory, that is making a virtue out of the necessity of taking jobs nobody else wants. Ten years from now I bet the people will be posting that everything is going to be allright because FP can still practice on Indian Reservations.

I'd rather be a real OB/Gyn and have the option of working in a big city if I wanted to.

The fact that both the scope of practice and potential income of FP are dwindling should be a warning to all of you young folks thinking of a long-term (thirty or forty year) career.

 

[lateness]

But that's the problem. Just like Captain Picard and the Borg, FP is being forced to fall back further and further under the onslaught of both the lack of interest in the field and the inroads of NPs and PAs.

People make it sound like being able to work in an underserved area is some kind of victory, that is making a virtue out of the necessity of taking jobs nobody else wants. Ten years from now I bet the people will be posting that everything is going to be allright because FP can still practice on Indian Reservations.

I'd rather be a real OB/Gyn and have the option of working in a big city if I wanted to.

The fact that both the scope of practice and potential income of FP are dwindling should be a warning to all of you young folks thinking of a long-term (thirty or forty year) career.

All Doctors are a necessity.. Including FP and they serve there purpose, just as a EP and a Psychiatrist does, etc.. I dont know why people are always trying to bring them down, or the field, unless maybe they are threatened by them for some strange reason, like maybe turf wars etc....
Actually the Family Medicine isnt falling back due to NPs and PAs.. THe main reason that Doctors hire them is to see more patients in a more efficient time, and ultimately make more money. It doesnt affect the actual profession, in my opinion. Wherever I have seen them, and asked the docs about them, they all told me they saved them alot of time and they have more time to concentrate either on more serious patients, and the bottom line, which there income had increased significantly. I dont know why people think they can predict anything in medicine after decades.. just practice an dbe happy i say.. to everyone and every specialty


Life is Short

 

[deleted87716]

I would love to be a family doc that delivers babies. What sort of lifestyle do these doctors have?

Dr. Greg Hinson is an FP/OB in solo practice on Nantucket, Mass. Check out his Web site: http://www.ackdoc.com/. Not a bad lifestyle at all, if you ask me.

 

[Newdoc2002]

But that's the problem. Just like Captain Picard and the Borg, FP is being forced to fall back further and further under the onslaught of both the lack of interest in the field and the inroads of NPs and PAs.

People make it sound like being able to work in an underserved area is some kind of victory, that is making a virtue out of the necessity of taking jobs nobody else wants. Ten years from now I bet the people will be posting that everything is going to be allright because FP can still practice on Indian Reservations.

I'd rather be a real OB/Gyn and have the option of working in a big city if I wanted to.

The fact that both the scope of practice and potential income of FP are dwindling should be a warning to all of you young folks thinking of a long-term (thirty or forty year) career.

You must be ignorant or you are ignoring the realities of medicine in a crowded turf battle. Much of what limits FP's in a larger urban areas is turf battles and insurance companies. If the HMO is happy with Megalab or wants the colonoscopy to be done by only certain docs then the patient complies or pays cash. It's the difficulty in the FP being jack of all trades, master of none.

Some of choose FP because we want to live in a small town. I get to practice medicine like no one else can practice medicine (not even the PA's or NP's moving in on my business). Don't assume that we are out in the sticks because we can't get a better specialty and can't get a job in a "big" town.

Things will ultimately change because those paying will force it to change. Don't lament in 15 years when all your insurance company will let your family see is a PA or NP when the barriers are set in place once again by the employers and insurance companies because of the sky rocketing costs of fragmented care by seeing multiple specialists. The cardio can see you for CHF, the GI for the colonoscopy, the endocrinologists for your hypothyroid or me for all of them at a third of the price. Take your pick.

 

[8744]

You must be ignorant or you are ignoring the realities of medicine in a crowded turf battle. Much of what limits FP's in a larger urban areas is turf battles and insurance companies. If the HMO is happy with Megalab or wants the colonoscopy to be done by only certain docs then the patient complies or pays cash. It's the difficulty in the FP being jack of all trades, master of none.

Some of choose FP because we want to live in a small town. I get to practice medicine like no one else can practice medicine (not even the PA's or NP's moving in on my business). Don't assume that we are out in the sticks because we can't get a better specialty and can't get a job in a "big" town.

Things will ultimately change because those paying will force it to change. Don't lament in 15 years when all your insurance company will let your family see is a PA or NP when the barriers are set in place once again by the employers and insurance companies because of the sky rocketing costs of fragmented care by seeing multiple specialists. The cardio can see you for CHF, the GI for the colonoscopy, the endocrinologists for your hypothyroid or me for all of them at a third of the price. Take your pick.

As you know, I am a Family Practice Resident at a prestigious East Coast University (cough...Duke...cough). I don't claim special knowledge or revealed wisdom but our program is betting on "community medicine" as the new paradigm for FP. This is all well and good and I don't doubt they know what they are doing but what this does is emphasise the low-skilled "providor" (NP, PA) over the highly trained physician as the purpose of community medicine is to take basic health care to the previously underserved or "non-paying" customer.

The paying customers are becoming a lot more sophisticated and more intolerant of the "middleman" (or "gatekeeper" if you like.) The death of FP will be when PAs and NP start doing the bulk of the referrels. Once this happens we are never going back.

Medicine is specialzed for a reason, namely that the specialties are so complex that no physician can really have a handle on them all. We get pretty good cardiology training at my program but it is a small, small, fraction of what they get in Internal Medicine not to mention cardiology. Again, if you are in an area with no cardiologists the patients will settle for us but that speaks to my point about the necessity of setting up shop where there is no competition and two traffic lights. (I am from a small town, by the way)

Competition is good. I have been a capitalist for my whole life and I'm not about to start bewailing the unfairness of it all. I'm just voting with my feet and trying like crazy to switch specialties. For the money I'll probably make in FP I probably should have stuck with engineering where my high end earning potential (as a self-employed structural guy) was probably around the low-end FP salary without the mega-debt and the four years of lost income not to mention the three years of Wal-Martish salary.

I see by the difficulty that FP has in filling it's residency spots that most of the medical profession agrees with me on this one too.

 

[Stephanieukmed]

As you know, I am a Family Practice Resident at a prestigious East Coast University (cough...Duke...cough). I don't claim special knowledge or revealed wisdom but our program is betting on "community medicine" as the new paradigm for FP. This is all well and good and I don't doubt they know what they are doing but what this does is emphasise the low-skilled "providor" (NP, PA) over the highly trained physician as the purpose of community medicine is to take basic health care to the previously underserved or "non-paying" customer.

The paying customers are becoming a lot more sophisticated and more intolerant of the "middleman" (or "gatekeeper" if you like.) The death of FP will be when PAs and NP start doing the bulk of the referrels. Once this happens we are never going back.

Medicine is specialzed for a reason, namely that the specialties are so complex that no physician can really have a handle on them all. We get pretty good cardiology training at my program but it is a small, small, fraction of what they get in Internal Medicine not to mention cardiology. Again, if you are in an area with no cardiologists the patients will settle for us but that speaks to my point about the necessity of setting up shop where there is no competition and two traffic lights. (I am from a small town, by the way)

Competition is good. I have been a capitalist for my whole life and I'm not about to start bewailing the unfairness of it all. I'm just voting with my feet and trying like crazy to switch specialties. For the money I'll probably make in FP I probably should have stuck with engineering where my high end earning potential (as a self-employed structural guy) was probably around the low-end FP salary without the mega-debt and the four years of lost income not to mention the three years of Wal-Martish salary.

I see by the difficulty that FP has in filling it's residency spots that most of the medical profession agrees with me on this one too.

Just be careful about 2nd residencies. Once you have COMPLETED one, Medicare/ Federal Government is under no obligation to pay for you to complete another one and a lot of departments are not willing to absorb the costs (e.g. salary, etc) of training you in a second specialty. When my uncle switched from anesthesia to radiology, he had to plan about 3 years in advance because they didn't pay him at all during his radiology residency. Just something to think about before deciding on double and triple residencies. It wasn't like this 15 or 20 years ago, and I've even heard of departments having financial issues with taking resident who switch residencies part way through.

 

[8744]

Just be careful about 2nd residencies. Once you have COMPLETED one, Medicare/ Federal Government is under no obligation to pay for you to complete another one and a lot of departments are not willing to absorb the costs (e.g. salary, etc) of training you in a second specialty. When my uncle switched from anesthesia to radiology, he had to plan about 3 years in advance because they didn't pay him at all during his radiology residency. Just something to think about before deciding on double and triple residencies. It wasn't like this 15 or 20 years ago, and I've even heard of departments having financial issues with taking resident who switch residencies part way through.

Thanks. I'm aware of this and will have only completed one year of FP by June. None of the nine EM programs where I interviewed seemed to think this would be a problem. As it happens, I still have two years of full funding eligiblility. Afte that I am "half-funded" which, since this is based on medicare dollars, does not exactly equate to half of my salary as some programs have less medicare dollars coming in than others.

The rule is pretty complex but that's my sense of it. Only a few programs that I applied to explicitely told me that they require full-funding for the entire three years.

 

[skypilot]

sky rocketing costs of fragmented care by seeing multiple specialists. The cardio can see you for CHF, the GI for the colonoscopy, the endocrinologists for your hypothyroid or me for all of them at a third of the price. Take your pick.

This is a huge problem. My dad has 7 doctors and none of them really know what the other one is doing. He has suffered from polypharmacy and no one doctor takes the initiative to coordinate the care properly.

 

[shemozart]

As you know, I am a Family Practice Resident at a prestigious East Coast University (cough...Duke...cough). I don't claim special knowledge or revealed wisdom but our program is betting on "community medicine" as the new paradigm for FP.

Anytime I hear about someone talking about their FP residency at a "prestigious" university...I wonder. I'm not sure how often realistic expectations of family practice come from someone who chose to get trained "up in the ivory tower".... I'm just joking, just kidding...

BTW, as far as funding goes, I know of plenty of people who switched programs and specialties, and most did okay with funding issues.....

 

[8744]

Anytime I hear about someone talking about their FP residency at a "prestigious" university...I wonder. I'm not sure how often realistic expectations of family practice come from someone who chose to get trained "up in the ivory tower".... I'm just joking, just kidding...

BTW, as far as funding goes, I know of plenty of people who switched programs and specialties, and most did okay with funding issues.....

Well, I did scramble into the spot which shows you how prestigious it really is.

 

[sophiejane]

This is such an amusing discussion.

I know we all feel a need to justify our career path decisions in medicine--they are really big decisions and we need to feel like we've done the right thing, that we have the magic crystal ball that tells us in what direction medicine is moving, and that we can assure ourselves we are on the right path. We're all constantly bashing each other's choices and it's frankly very counterproductive.

Just do what you love, people. If you don't love family, don't do it, but don't try to tell others that they are foolish or wrong for doing it, or to be so unbelievably arrogant and assume that the medical community as a whole agrees with you, Panda Bear, because you have no idea what the future holds. You have done one year of FP residency and that makes you an expert on NOTHING but YOUR OWN EXPERIENCE. You have no right to make assumptions about the opinions of the entire body of physicians in this country. The issues you speak about are far, far more complex than your simplistic argument would have us believe.

I find that the people most confident in their path in life feel no need to justify it or to find fault with what others have chosen.

Something to think about.

PS: the current MEAN gross income for family physicians in my state is $167,000. Please don't insult the hard-working people who are thankful to have jobs at places like Wal-Mart by comparing their salary to those of a family doctor.

 

[sophiejane]

I'd rather be a real OB/Gyn and have the option of working in a big city if I wanted to.

Then do it. More business for me. I choose rural medicine because I am attracted to it. I don't consider it settling at all.

Ten years from now I bet the people will be posting that everything is going to be allright because FP can still practice on Indian Reservations.

Are you now bringing race into the issue? If so, that's a mighty low blow. American Indians need docs, too. Indian Reservation sounds good, too, now that I think about it....maybe I'll do that first and get my loans paid off.

Why are you so concerned with convincing others not to do something you have chosen not to do? Honestly, what business is it of yours? Would you also like to tell me how to raise my children or what type of car to drive?

You don't see people in FP chastizing others for choosing cardiology or EM or whatever. That's because >80% of family docs have very high job satisfaction. Enough said.

 

[8744]

Are you now bringing race into the issue? If so, that's a mighty low blow. American Indians need docs, too. Indian Reservation sounds good, too, now that I think about it....maybe I'll do that first and get my loans paid off.

Hang on a minute. I was just pointing out that if the trend in FP is to only be able to practice in underserved areas then it is inevitable that the profession will be pushed farther and farther into the hinterlands. Having travelled all over the United States I can say with confidence that you can not get farther into the hinterlands than many of the Indian Reservations.

Not too many American medical school graduates want to live in Broken Bow or Elk Jaw, especially for less than they would make somewhere else with better shopping. I would love to live in Idaho or Wyoming myself but not strictly speaking because of any desire to serve the underserved.

I am from a very small town in Lousiana and appreciate small town life.

Of course, many indian tribes have moved into the mainstream of American life and are sticking it back to the white man at their casinos.

No racism intended (although as an unreconstructed white boy of the old school I am certainly not intimidated by being called a racist).

 

[8744]

This is such an amusing discussion.

I know we all feel a need to justify our career path decisions in medicine--they are really big decisions and we need to feel like we've done the right thing, that we have the magic crystal ball that tells us in what direction medicine is moving, and that we can assure ourselves we are on the right path. We're all constantly bashing each other's choices and it's frankly very counterproductive.

Just do what you love, people. If you don't love family, don't do it, but don't try to tell others that they are foolish or wrong for doing it, or to be so unbelievably arrogant and assume that the medical community as a whole agrees with you, Panda Bear, because you have no idea what the future holds. You have done one year of FP residency and that makes you an expert on NOTHING but YOUR OWN EXPERIENCE. You have no right to make assumptions about the opinions of the entire body of physicians in this country. The issues you speak about are far, far more complex than your simplistic argument would have us believe.

I find that the people most confident in their path in life feel no need to justify it or to find fault with what others have chosen.

Something to think about.

PS: the current MEAN gross income for family physicians in my state is $167,000. Please don't insult the hard-working people who are thankful to have jobs at places like Wal-Mart by comparing their salary to those of a family doctor.

A few points:

1. There is no crystal ball and I am not a fortune teller. I am not trying to justify my career path except to the extent that this is a friendly discussion among people who post on this forum and are thus, almost by definition, interested in other people's opinions. You say that everything is fine for the future of FP because we still have the underserved areas as our exclusive domain and I just point out the logical flip-side of that which is that maybe this is neither a great victory nor a good selling point to people interested in Family Practice.

When I scrambled into the field I bought into it from your point of view. After almost a year of reflection I realize that, if I am to believe you not only is my salary going to be on the low end for a physician (but decent enough, I grant you) but that I will be limited as to where I can practice.

2. Of course I am speaking for no one but myself. Isn't his understood? I haven't exactly packed my posts with footnotes from various papers supporting my point of view. On the other hand while I am no expert I can add simple sums and spot big trends, the biggest of which is the increasing unpopularity of FP among American medical school graduates. We cannot all be selfish uncaring bastards. I would suppose that there is something at work which makes the specialty unpopular and I have just pointed out the two most obvious. First that the salaries are low and second that to make the high end of the low salary scale you have to live a nine hour drive form the nearest Starbucks.

I'm not even going to comment about the other things I have grown to dislike about FP because those things are strictly a matter of personal preference and speak more to my easily bored nature than your commitment to medicine.

3. I am not by any means confident on the career path I am on now which is why I am switching. That also should be obvious. Other than the fact that SDN is my only hobby (What else can I afford on an intern's salary) I am a talkative fellow and I believe that people need to know the good and the bad about everything.

4. When you have four years of medical school and three years of low-payed residency behind you as well as mega-debt and lost earnig potential from your previous career the typical starting FP salary of about 130K does not seem like that hot of a deal. I say this as a guy who has worked at everything from short order cook at a Waffle House to landscaping to Structural Engineering and now medicine. Considering that I'll have to send my four children (one on the way in August) to private school in one of those underserved areas this salary rapidly dwindles to strictly upper middle class.

Do we struggle mightily and keep the long watches of the night to be in the middle class? 130K only seems like a lot if all you have to compare it to is your previous low-paying jobs which were more than adequate to support the single young person lifestyle.

 

[sophiejane]

You say that everything is fine for the future of FP because we still have the underserved areas as our exclusive domain and I just point out the logical flip-side of that which is that maybe this is neither a great victory nor a good selling point to people interested in Family Practice.

This is nothing close to what I said. I said that if you want to do OB as an FP that rural areas are a good place to do it. This does not equal at all saying that everything is fine in FP BECAUSE we still have underserved areas in which to practice. I'm not such a pessimist. Otherwise I would do something else which pays more than a measly $165K a year.

I will be limited as to where I can practice.

Are you serious? You can practice anywhere you want in FP.

On the other hand while I am no expert I can add simple sums and spot big trends, the biggest of which is the increasing unpopularity of FP among American medical school graduates. We cannot all be selfish uncaring bastards. I would suppose that there is something at work which makes the specialty unpopular and I have just pointed out the two most obvious. First that the salaries are low and second that to make the high end of the low salary scale you have to live a nine hour drive form the nearest Starbucks.

No Starbucks sounds like heaven to me. You can have the big boxes, the Home Depots and the nameless suburbs. Do you see how subjective all this is? To assume that FP is unpopular because you can't live behind a strip mall in an upscale suburb on an FP salary is absurd. The whole argument is absurd. You are painting with huge strokes and making huge assumptions. I am just pointing that out.

Do we struggle mightily and keep the long watches of the night to be in the middle class?

Who doesn't struggle mightily, my friend? Do you think that the nurses who also "keep the long watches of the night" don't also struggle? What about the factory worker, the longshoreman, the truck driver? Your pity party falls on deaf ears here. Yes we work hard. EVERYONE does. If you are easily bored by engineering and family medicine I doubt you are going to be enthralled by emergency medicine (which has a ton of snotty noses, headaches, and rotavirus, too) for too long.

You will likely always be a part of the middle class, even as an EM doc.

If you have found your passion, wonderful. I'm just reminding you that when you make these huge assumptions about big trends, be careful. You might be surprised to see what the future holds.

 

[8744]

This is nothing close to what I said. I said that if you want to do OB as an FP that rural areas are a good place to do it. This does not equal at all saying that everything is fine in FP BECAUSE we still have underserved areas in which to practice. I'm not such a pessimist. Otherwise I would do something else which pays more than a measly $165K a year.



Are you serious? You can practice anywhere you want in FP.



No Starbucks sounds like heaven to me. You can have the big boxes, the Home Depots and the nameless suburbs. Do you see how subjective all this is? To assume that FP is unpopular because you can't live behind a strip mall in an upscale suburb on an FP salary is absurd. The whole argument is absurd. You are painting with huge strokes and making huge assumptions. I am just pointing that out.



Who doesn't struggle mightily, my friend? Do you think that the nurses who also "keep the long watches of the night" don't also struggle? What about the factory worker, the longshoreman, the truck driver? Your pity party falls on deaf ears here. Yes we work hard. EVERYONE does. If you are easily bored by engineering and family medicine I doubt you are going to be enthralled by emergency medicine (which has a ton of snotty noses, headaches, and rotavirus, too) for too long.

You will likely always be a part of the middle class, even as an EM doc.

If you have found your passion, wonderful. I'm just reminding you that when you make these huge assumptions about big trends, be careful. You might be surprised to see what the future holds.

A fewm more points:

1. 165K is not a measly salary. Neither is 130K or even 75K. I will say that 75K would be measly and a disappointent to anyone who has invested in his human capital to the extent that you and I will. What is the tipping point between a disappointing salary and a decent salary? Who knows and you will forgive me for belaboring the obvious but it depends on who's making the salary. I think we can agree on that.

2. There is nothing wrong with living in the suburbs or in an upscale gated-community close by a strip mall or two. People have got to eat and I'd rather drive five minutes for my groceries than have to make a monthly trek from Sistercouple Station to Butte. In fact, when I lived in Shreveport we had a Lowe's within walking distance which as we are do a lot of home-improvement really added to our quality of living. Target was right across the street so we were set for all of our shopping. If there's one thing I can't stand it's crappy mom and pop stores with poorly paid employees, no selection, and high prices.

And no, I am not a Starbucks afficianado. Likewise do I mightily despise shopping of any kind and view my semi-annual trip to the mall as a soujourn to hell. My wife appreciates this kind of thing however so living in a decent sized community is important to her.

 

[lateness]

A fewm more points:

lets also not forget, one main point, when we are talking about the business aspect. I think that is also hugely up to the individual as well and not the whole average of a specialty. I know a family doc who made more than some cardiologists, in michigan( and he is in the city, detroit area, not a rural doc at all). I knew him personally so i would see his income flow.. but he is also a very hard worker, and smart business person, and just knew how to do it. I am sure there are more like him, but I bet there are many more who make a lot less and are less hard working or less business savvy..


Also there are alot more spots in Fam than other specialties, so obviously there will be many more positions unfilled, but there had to be a reason for the all the hospitals to create all those spots in the first place, being that there is a need for primary care providers in all states and cities.. i mean there are more spots in FP than fellowships in cardiology, even though heart disease is the leading killer/problem in the country, so ther eis a need for both docs from beginning to end...

 

[skypilot]

Also there are alot more spots in Fam than other specialties, so obviously there will be many more positions unfilled, but there had to be a reason for the all the hospitals to create all those spots in the first place, being that there is a need for primary care providers in all states and cities.. i mean there are more spots in FP than fellowships in cardiology, even though heart disease is the leading killer/problem in the country, so ther eis a need for both docs from beginning to end...

Why are American Medical graduates reluctant to choose FP? I think it is because they think that the specialty is too broad. The FP tries to be all things with training in Peds, Obstetrics and even Surgery. And when a student chooses to do FP they are also cutting themself off from so many fellowships as well.

On the other hand a super subspecialist will often not be able to live in a more rural area because they do not have the patient base to support their specialty.

In a way family practice gives you the ultimate in geographic flexibility because you can practice rurally or in urban areas. Subspecialists are limited to urban areas.

 

[firetown]

A few points:

4. When you have four years of medical school and three years of low-payed residency behind you as well as mega-debt and lost earnig potential from your previous career the typical starting FP salary of about 130K does not seem like that hot of a deal. I say this as a guy who has worked at everything from short order cook at a Waffle House to landscaping to Structural Engineering and now medicine. Considering that I'll have to send my four children (one on the way in August) to private school in one of those underserved areas this salary rapidly dwindles to strictly upper middle class.

Do we struggle mightily and keep the long watches of the night to be in the middle class? 130K only seems like a lot if all you have to compare it to is your previous low-paying jobs which were more than adequate to support the single young person lifestyle.

What you say should be a comfortable typical starting salary for you. If really you think that earning a starting salary of $130,000 a year is not a hot deal, you are going to have a big, big problem. Somebody had written something nice that I like - You do not have to drive the latest X5 BMW or whatever more expensive car to live comfortably.

 

[lateness]

Why are American Medical graduates reluctant to choose FP? I think it is because they think that the specialty is too broad. The FP tries to be all things with training in Peds, Obstetrics and even Surgery. And when a student chooses to do FP they are also cutting themself off from so many fellowships as well.

On the other hand a super subspecialist will often not be able to live in a more rural area because they do not have the patient base to support their specialty.

In a way family practice gives you the ultimate in geographic flexibility because you can practice rurally or in urban areas. Subspecialists are limited to urban areas.

that is probably the only thing that bothers me about FP, the paucity of fellowships.. in case one ( i mean hwo knows the future, ) decides they want to go back and specialize in something after years of working... i guess if it did come to that one would have to repeat another residency, other than that I lov the specialty,

 

[sacrament]

Why are American Medical graduates reluctant to choose FP? I think it is because they think that the specialty is too broad. The FP tries to be all things with training in Peds, Obstetrics and even Surgery. And when a student chooses to do FP they are also cutting themself off from so many fellowships as well.

On the other hand a super subspecialist will often not be able to live in a more rural area because they do not have the patient base to support their specialty.

In a way family practice gives you the ultimate in geographic flexibility because you can practice rurally or in urban areas. Subspecialists are limited to urban areas.

I'll throw my 2 cents in, even though nobody asked. Why I didn't choose family medicine:

1. Too broad, too shallow. Personally--and I intend no offense--I probably wouldn't take myself to a family doctor if an internist was available, I wouldn't take my children to a family doctor if a pediatrician was available, and I wouldn't take my pregnant wife to a family doctor if an ob/gyn was available. Unless this was one crazy-good family doctor.

2. I want to live in at least a semi-urban area, where family doctors pretty much do jack.

3. I would never say that family docs don't make a good living, but I'd prefer it if my total debt was not substantially larger than my starting salary.

4. Crazy people. I think this is less of an issue in rural areas, but my experiences in family medicine have been marked by extreme exposure to crazy people. And not fun-crazy like florid schizophrenics off their meds or raging bi-polar cases, but drab, dissatisfied middle-aged women with a questionable physiologic basis for their complaints. I swear to christ these people made up at least 25% of the patient population at the two clinics I worked at. Everybody in medicine sees some of these folks... gastroenterologists get the IBS, rheum gets the fibro, plastic surgeons get body dysmorphic disorder, but the family docs see all of them. Sometimes in a single day. I can't handle it.

5. Clinic. Clinic basically sucks (IMO). I need substantial inpatient responsibility.

6. Zero prestige. Hey, I'm not gonna bullsh1t you. It's a minor factor.

 

[deleted87716]

I didn't choose family medicine

Sounds like you made the right decision.

Too broad, too shallow.

For you, perhaps. Not everyone is comfortable knowing a little about a lot (generalizing...there are certain things I know a lot about, like everyone else). Some people would rather tune out everything else and focus on one thing. To me (and I suspect for most FPs), that would amount to sheer boredom.

I probably wouldn't take myself to a family doctor if an internist was available, I wouldn't take my children to a family doctor if a pediatrician was available, and I wouldn't take my pregnant wife to a family doctor if an ob/gyn was available. Unless this was one crazy-good family doctor.

Believe it or not, some of us don't suck.

I want to live in at least a semi-urban area, where family doctors pretty much do jack.

Well, then...I just finished "doing jack" for thirty people. Why am I so tired?

I'd prefer it if my total debt was not substantially larger than my starting salary.

Most college grads (not even those in medicine) start out owing more than they'll make their first year. This is pretty irrelevant, if you ask me.

Crazy people.

If it bothers you that much, don't cater to them. They'll go someplace else. One of the great things about FP is that you can tailor your practice any way you want. Believe me, if you don't want to specialize in "crazy", you don't have to.

Clinic basically sucks (IMO). I need substantial inpatient responsibility.

Hey, to each his/her own. By the way...I have an office, not a "clinic." I set my own hours, work at my own pace, see patients on my own terms, hire and (when necessary) fire my own staff, etc. Try doing that in a hospital.

Zero prestige.

Whatever that means. Who are you trying to impress, anyway?

 

[sacrament]

For you, perhaps.

I did preface my comments with "why I didn't choose family medicine." It does not come as a revelation to me that people who did choose family medicine had legitimate reasons for doing so.

 

[deleted87716]

I did preface my comments with "why I didn't choose family medicine." It does not come as a revelation to me that people who did choose family medicine had legitimate reasons for doing so.

Noted. But don't expect to make comments like that without some kind of counterpoint.

 

[skypilot]

So Kent, how much Peds and Ob do you practice? Do you manage inpatients? How about surgical procedures including C sections are you among the percentage of FPs that are involved in them? Just would be interested in hearing your take on this. I know some FPs who are procedure happy and others who avoid them like the plague.

 

[deleted87716]

So Kent, how much Peds and Ob do you practice? Do you manage inpatients? How about surgical procedures including C sections are you among the percentage of FPs that are involved in them? Just would be interested in hearing your take on this. I know some FPs who are procedure happy and others who avoid them like the plague.

My practice is primarily adult medicine (probably 90%), and exclusively ambulatory. I do not do OB. This is all by choice, of course. I have friends doing OB and hospital work who love it. It's just not my cup of tea.