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DoctorStrange0101

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I am currently applying to FM resodencies and am looking for those that offer lots of experience in procedures. I want enough numbers to get hospital privileges. I'm interested in doing many vasectomies, colposcopies, tubal ligation (if possible), sports medicine procedures, and anything else I can gain competence in (any surgical procedure would be amazing). Also lots of derm would be great. What programs should I look at? Willing to apply to any state/location.

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Try Rural programs or unopposed programs ( no surgery or IM residents )
there the FM residents do pretty much everything
or partner with one of your private FP attendings ( who do a lot of procedures you like) and do electives with them
whereever you match tell your PD that is your focus and they should help you find those local docs unless ofcourse you are in big city hospital
 
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Try Rural programs or unopposed programs ( no surgery or IM residents )
there the FM residents do pretty much everything
or partner with one of your private FP attendings ( who do a lot of procedures you like) and do electives with them
whereever you match tell your PD that is your focus and they should help you find those local docs unless ofcourse you are in big city hospital
Do you think I'll get enough numbers in a rural setting? Are there really enough people who want vasectomies in a rural area?
 
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Do you think I'll get enough numbers in a rural setting? Are there really enough people who want vasectomies in a rural area?
Wanting to learn everything is residency is all good. It's going to come down whether the site you work at will give you priviliges to do those things. Also, in rural settings you may not have the equipment or the staff who knows how to assist you. Plus, if you have a complication, i.e. perforated bowel during colonoscopy is there going to be a surgeon there to fix your mistake? Have to think about the type of back up you will/won't have in a rural area if something goes wrong. You may be trained but the risk to the patient should there be a complication may bar you from being able to do certain procedures.

I am saying this from experience, not theoretical.
 
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Wanting to learn everything is residency is all good. It's going to come down whether the site you work at will give you priviliges to do those things. Also, in rural settings you may not have the equipment or the staff who knows how to assist you. Plus, if you have a complication, i.e. perforated bowel during colonoscopy is there going to be a surgeon there to fix your mistake? Have to think about the type of back up you will/won't have in a rural area if something goes wrong. You may be trained but the risk to the patient should there be a complication may bar you from being able to do certain procedures.

I am saying this from experience, not theoretical.

Por ejemplo -- One of my patients went in for a nice colonoscopy -- wound up missing the left turn a bit -- wound up injuring the spleen but patient sent home after procedure since no obvious perf detected...wound up going back to ER that night with a frankly bleeding spleen per CT -- admitted to ICU s/p splenectomy for a nice little stay....

and then there was the surgeon who was contracted at a critical access hospital who refused to do anything except colonoscopies because of no support in terms of ICU or agreements with other hospitals to transfer if things went bad -- heck, there weren't even any trained surgical nurses on staff there....yeah, no.
 
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When I was in Wrangell, AK. I had a patient who was in DKA who needed critical care. I knew how to write the orders to treat the patient, but the nursing staff I had had never treated DKA. The nurse manager let me know and the patient was transferred to a hospital that had an ICU. The quality of the staff is EVERYTHING.
 
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When I was in Wrangell, AK. I had a patient who was in DKA who needed critical care. I knew how to write the orders to treat the patient, but the nursing staff I had had never treated DKA. The nurse manager let me know and the patient was transferred to a hospital that had an ICU. The quality of the staff is EVERYTHING.

Would you say this is true for all of Alaska or just the area you were in? I am looking at the Alaska FM residency program (Anchorage) and want to know if the hospital there would have more cases and exposure, experienced staff, etc.
 
Would you say this is true for all of Alaska or just the area you were in? I am looking at the Alaska FM residency program (Anchorage) and want to know if the hospital there would have more cases and exposure, experienced staff, etc.
You will have no problem in Anchorage. It's just like any other big city. I was on an Island with 2000 people.
 
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I am currently applying to FM resodencies and am looking for those that offer lots of experience in procedures. I want enough numbers to get hospital privileges. I'm interested in doing many vasectomies, colposcopies, tubal ligation (if possible), sports medicine procedures, and anything else I can gain competence in (any surgical procedure would be amazing). Also lots of derm would be great. What programs should I look at? Willing to apply to any state/location.

Odds are you won't see many vasectomies unless you get chummy with the Urology group and do an elective with them.
Tubal ligation: You will get some of that but I doubt you will ever do it again in you entire career unless you do an obstetrics fellowship.
Sport medicine you will get plenty.
Derm you will get plenty.
Surgical procedures? like what? No hospital will give you surgical privilege unless you have done a surgical residency. You can get surgical obstetrics if you have done a fellowship.
Colposcopies you can get.
Central lines, A lines etc. you can get if you get real active during ICU, ER rotations.

Cosmetics you will get zero to nil because you are not really there for that. You can get that yourself after residency and pay lots to get it. Things such as lipo, hair transplant, laser skin and body procedures etc. 250 to 500K for training and equipment plus office buildout and training.

There use to be a pain doctor in Alaska who had an interventional fellowship for pain (non-accredited) and would train docs over a year or two to do spine and peripheral joints. FYI, a C-arm is about 100K.
 
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Your handle is "surgeryislife" and you are willing to apply to any state, any program. That sounds like you are an FMG who wants to do surgery but can't get into a surgical program. Is that the case? There are some family doctors who do some of the things you listed, but barely anyone does all of them. If you want to do OB, c-sections and tubals you'll have to do an OB fellowship and trust me, you won't be working on colonoscopies and vasectomies while you are doing that. There's only so much time during training, you kind of have to pick a niche and get good at it.
People end up getting good at colposcopy in residency because they like women's health and usually they like OB as well. It's not just because they "like procedures". There has to be a context. People who like men's health and urology, tend to get into doing vasectomies.
Personally, I liked urgent care/emergency stuff and I spent a lot of time doing lac repairs in the ED. But that doesn't mean I liked doing colposcopy or OB.
Also, there are politics surrounding family docs doing in-hospital surgical procedures. Where I went to residency, we had family docs who were OB fellowship trained that even had a tough time getting precepted to do sections and tubals.
Whether you go to a procedure heavy residency or not, the ACGME requires certain curriculum for a family medicine resident, and it is virtually certain that you will spend the vast majority of your time in residency either in clinic seeing out-patients, or in the hospital seeing inpatients. And while yes, procedures come up all the time, you will primarily be expected to be mastering the medical management of these patients, no matter where you go. And trust me, mastering that takes a lot of time.
I don't say any of this to dissuade you from doing procedures. It just seems like you need a bit of a reality check? Sorry if I misread you here.
 
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Your handle is "surgeryislife" and you are willing to apply to any state, any program. That sounds like you are an FMG who wants to do surgery but can't get into a surgical program. Is that the case? There are some family doctors who do some of the things you listed, but barely anyone does all of them. If you want to do OB, c-sections and tubals you'll have to do an OB fellowship and trust me, you won't be working on colonoscopies and vasectomies while you are doing that. There's only so much time during training, you kind of have to pick a niche and get good at it.
People end up getting good at colposcopy in residency because they like women's health and usually they like OB as well. It's not just because they "like procedures". There has to be a context. People who like men's health and urology, tend to get into doing vasectomies.
Personally, I liked urgent care/emergency stuff and I spent a lot of time doing lac repairs in the ED. But that doesn't mean I liked doing colposcopy or OB.
Also, there are politics surrounding family docs doing in-hospital surgical procedures. Where I went to residency, we had family docs who were OB fellowship trained that even had a tough time getting precepted to do sections and tubals.
Whether you go to a procedure heavy residency or not, the ACGME requires certain curriculum for a family medicine resident, and it is virtually certain that you will spend the vast majority of your time in residency either in clinic seeing out-patients, or in the hospital seeing inpatients. And while yes, procedures come up all the time, you will primarily be expected to be mastering the medical management of these patients, no matter where you go. And trust me, mastering that takes a lot of time.
I don't say any of this to dissuade you from doing procedures. It just seems like you need a bit of a reality check? Sorry if I misread you here.

Actually, I am a USMG and used to want to do surgery--I made this account before med school. I realized that I wanted to be patients' primary physician so I'm doing family. I still like using my hands, hence why I want the ability to do as many procedures as possible. I want to do basic/easy things like vasectomies, colposcopies, derm injections and biopsies, joint injections and aspirations, lac repairs, paracentesis, etc. These are not at all out of the scope of the FM doctor--I've seen doctors who do all of these things! Based on the interviews I've gone on so far, it seems like the more rural or at least unopposed residencies see more of these procedures. Also, some programs teach in first assisting for surgeries and I've met family docs who did surgical assisting once a week just because they wanted to. Lots of physicians I've talked to have an interest in procedures, as opposed to just certain types of procedures in some context as you mentioned.
 
Ah :) Makes sense.
It almost doesn't matter where you go, you're going to have to go after these procedures and do a lot on your own time.
Might help to go really rural, but not a guarantee.
 
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