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deleted421268
What are the pros and cons of first going into FM then doing a sports medicine fellowship??
Pros and Cons of going into FM then doing Sports Medicine Fellowship
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You might get better answers when the PCSM Fellows chime in, but here was my opinion when considering a SM Fellowship:
Pros:
- increased exposure to sports medicine
- ability to work at the collegiate / professional level
- looks good on a resume
Cons:
- spend an extra year (or two) getting paid as a resident
Pros:
- increased exposure to sports medicine
- ability to work at the collegiate / professional level
- looks good on a resume
Cons:
- spend an extra year (or two) getting paid as a resident
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I'll chime in. The key advantage in doing FM prior to a sports med fellowship is that sports medicine is built into the standard curriculum, both programmatically and nationally. Primary care sports medicine is built on the principles of family medicine and everything that you train to do in a sports medicine fellowship is an enhancement of the scope of a family doctor. ABFM runs the CAQ boards, and all other specialties are welcome to sit alongside family docs to take the test.
You can get into PCSM by way of IM, Peds, EM, and PM&R. But for the purists, each of those specialties focuses only on 1 slice of PCSM. In practice and the real world, it's all jumbled together... but that's what FM is all about! So that's the 2nd advantage.
The 3rd advantage is just statistics. There are more fellowships and thus slots available for FM residents than there are for other specialties. Just check FRIEDA.
The 4th advantage is training. Because sports med/ortho is built into the curriculum (go ahead and head-to-head compare IM/Peds/ER/PM&R curriculum against FM), there are therefore more opportunities to train and gain experience as a resident in preparation for a fellowship in sports med than say the other specialties because there are less sports med doctors of non-FM origin than FM. You can see why just comparing curriculum head-to-head. IM & Peds spend so much time in the inpatient and critical care setting in their standard curriculum that they need to catch up to a FM resident with sports med aspiration. (It's analogous to the FM resident who needs to do extra electives in the ICU to catch up with aspiring hospitalists).
The 5th advantage is procedural training. It's very person dependent, but your exposure to practical primary care outpatient procedures is much more in FM than it is in the other specialties. If you want to stick a needle in someone's spinal cord... well... Advantage: PM&R, but that's one procedure, I'm happy to write the referral.
The 6th advantage is continuity of care (as a weapon to help you learn, take care of patients, and manage costs) and the outpatient mentality. FM curriculum is built with continuity of care in mind which gives you a chance to stage your work up, test your hypothesis, observe the outcome, and revisit your assumptions. This enhances your understanding of the disease process, diagnostic challenges, treatment efficacy and shortfalls. I really don't know how ER doctors learn without doing follow ups... But, maybe that's why they're high cost providers and have high malpractices...
The main disadvantage in going in to FM is that you have very little time to learn a lot. So if you blow off your time during medical school, you are that much more behind during residency and fellowship. I blame IM and Surgeons dominating and perverting medical education and not preparing medical students for primary care. Most medical students do NOT graduate medical school knowing how to examine a shoulder or a knee. For most medical students, the last time you even looked at anatomy was 1st year. Maybe 2nd year Physical Diagnosis and then after that it's like a foreign country. The only students who can get face-time in the orthopedic department are those interested in orthopedic surgery. Students smart enough to know that you NEED TO KNOW MSK medicine as part of general primary care can't get training during medical school because medical school isn't really about learning. Rotations are like job fairs, career days. Students are discouraged from learning because it gets in the way of the fraternity/sorority rush and they can't get into rotations that are critical to their success. It's all very shortsighted in my insignificant opinion.
Anyways, the main disadvantage in going into FM is that you have so little time to learn so much, and if you don't invest the time or the effort to learn and train, opportunity blows by you. It truly takes 7 years to train a family doc, 8 if you add fellowship. But not 2, like some clown midlevel advocates would like you to believe. So, if you wait until residency... or even fellowship (!) to start learning or studying, you're already behind what you need to know.
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deleted421268
Great Response. Also how long is a typical sports medicine fellowship take in years. I know FM residency is 3 yrs. Also how many hours you work a week during FM residency and how is it compared to others?
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Primary care sports medicine is 1 year. Fellowships that are 2 years are usually have the 2nd year funded either through research grants and thus are driven towards sports med research.
I'll defer to others regarding your questions about hours.
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Dr low budget,
Thanks for your reply. I was always wondering why family med residency was so diificult for me and it was because of all those things you mentioned. I'm trying to study now to get ahead but wow there's just too much to learn. Ah I wish I retained more stuff during med school. I'm getting better each year though. I'm getting those review courses and such to help me. Sometimes I think about retreading some texts such as pathophys and pharm just to review and really analyze things now since I got some medical knowledge. Back in medschool most items were just weird words, now I am in the field I actually know what it is, or what it's for, ie cardio version,
I hope someone stickies your post as I think it is a spot-on assessment of fm.
SJ
Thanks for your reply. I was always wondering why family med residency was so diificult for me and it was because of all those things you mentioned. I'm trying to study now to get ahead but wow there's just too much to learn. Ah I wish I retained more stuff during med school. I'm getting better each year though. I'm getting those review courses and such to help me. Sometimes I think about retreading some texts such as pathophys and pharm just to review and really analyze things now since I got some medical knowledge. Back in medschool most items were just weird words, now I am in the field I actually know what it is, or what it's for, ie cardio version,
I hope someone stickies your post as I think it is a spot-on assessment of fm.
SJ
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You know, I don't really think that having a short time to learn everything is really that big of a disadvantage. Sometimes, in some specialties, they like to drag the same boring topic on and on and on. Even tell the same stupid stories over and over again. I think we've all had attendings and rotations that were begging for you to jump on a sword.
When you have a short time to learn something, you're forced to focus and prioritize. And, if you can integrate with something you've already learned or seen, that frees your mind to learn something new or learn something more in depth or see some nuances that you never saw before. To me, I really enjoyed my FM training and enjoy being a family doc. And, whenever I get together with my med school friends or medical colleagues around town, I really enjoy discussing and learning new things from everyone and seeing how much we're different and same all at the same time.
This whole idea that there are SO many reasons NOT to go into FM is lost on me. I mean, I got an earful as a med student; but what people don't know about me is that the more you tell me that I can't or shouldn't do something, the more I want to do it and do it better than anyone else. I guess you can spend your life worrying about what other people think but those b*tches ain't gonna be around when it's all said and done. Hell, I can throw in my 2 cents about every specialty out there too, light a fire, and walk away but who the hell cares what I have to say? So, why should I care what others have to say about mine?
I think there are many great reasons to pick IM, Peds, EM, and PM&R over FM if you want to be a sports med doc. I mean, I can't think of them, but I'm sure there are at least 1 or 2 or more good reasons.
What's really nice about medicine is that there's something for everybody, which is not the case in any of the other fields that are out there. Medicine has so many smart people. And dumb people. But there's something for everybody, which is why it bothers me to no end thinking that there's someone out there who is not happy being a physician. How the hell can you be not happy as a physician? Did someone take away your cookie? When you put yourself in a good position, you will always have choices. And when you have choices, there's always bound to be one that's right for you.
When you have a short time to learn something, you're forced to focus and prioritize. And, if you can integrate with something you've already learned or seen, that frees your mind to learn something new or learn something more in depth or see some nuances that you never saw before. To me, I really enjoyed my FM training and enjoy being a family doc. And, whenever I get together with my med school friends or medical colleagues around town, I really enjoy discussing and learning new things from everyone and seeing how much we're different and same all at the same time.
This whole idea that there are SO many reasons NOT to go into FM is lost on me. I mean, I got an earful as a med student; but what people don't know about me is that the more you tell me that I can't or shouldn't do something, the more I want to do it and do it better than anyone else. I guess you can spend your life worrying about what other people think but those b*tches ain't gonna be around when it's all said and done. Hell, I can throw in my 2 cents about every specialty out there too, light a fire, and walk away but who the hell cares what I have to say? So, why should I care what others have to say about mine?
I think there are many great reasons to pick IM, Peds, EM, and PM&R over FM if you want to be a sports med doc. I mean, I can't think of them, but I'm sure there are at least 1 or 2 or more good reasons.
What's really nice about medicine is that there's something for everybody, which is not the case in any of the other fields that are out there. Medicine has so many smart people. And dumb people. But there's something for everybody, which is why it bothers me to no end thinking that there's someone out there who is not happy being a physician. How the hell can you be not happy as a physician? Did someone take away your cookie? When you put yourself in a good position, you will always have choices. And when you have choices, there's always bound to be one that's right for you.
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I am a family medicine resident finishing first year... and I agree that their is a lot more to family medicine then people think. The wide spectrum of knowledge that we have to keep fresh is crazy.(adult, gero, peds, ob, gyn). That being said.. the post about being more focused in med school and all that.. showing up as results of being better prepared for residency and after... i think thats nonsense... until you are the one doing the physical exam.. making the diagnosis with the assistance of a good preceptor.. following up the results.. sending for a test.. writing your signiture on the prescription and reading up on the illness you have right in front of your eyes... it will not stick..
we all studied in med school or else we wouldn't be in residency and practicing but let's be honest.. the set up for med school is to pass your USMLE's well.. and this goes from US med student, carib and forign... no one no matter how much they studied in med school or in residency will know everything about every system.
you want to be a good practicing physician ... learn as much you can from your preceptors in residency and in rotations.. ask as many questions.. and don't be affraid to seek help... and most of all.. enjoy it... if your enjoying residency.. you will build knowledge passively without even knowing...
we all studied in med school or else we wouldn't be in residency and practicing but let's be honest.. the set up for med school is to pass your USMLE's well.. and this goes from US med student, carib and forign... no one no matter how much they studied in med school or in residency will know everything about every system.
you want to be a good practicing physician ... learn as much you can from your preceptors in residency and in rotations.. ask as many questions.. and don't be affraid to seek help... and most of all.. enjoy it... if your enjoying residency.. you will build knowledge passively without even knowing...
"I really don't know how ER doctors learn without doing follow ups... But, maybe that's why they're high cost providers and have high malpractices... "
Low Budget, I am EM trained and routinely follow the FM threads, mostly because I have contemplated doing a sports med fellowship for some time. I have always found your posts helpful and insightful. But I have to repsectfully disagree with your suggestion that ER doctors' high costs and malpractice rates are due to inadequate follow-up. In training, we are responsible for follow-ups and many in the "real world" still follow-up with pts and cases that are both admitted and discharged.
There are many reasons for higher rates of utilization of medical dollars in the ED....mostly higher acuity and dealing with a higher risk population (vague early presentations, pts without PCPs, pts without follow-up due to lack of health insurance, pressure to move the department, lack of on-going relationship with the pt, and of course, pts with unrealistic expectations).
I will admit that there are some unneccessary expenditures in the ED, and admittedly some of it is due to inexperienced clinicians and defensive medicine. Some of it is due to requests for studies by admitting physicians and community physicians that send their pts to the ED. But I don't believe that these things are responsible for the majority of the increased costs of ED physicians.
Forgive me if I am just being too sensitive or read too much into your comment.
Low Budget, I am EM trained and routinely follow the FM threads, mostly because I have contemplated doing a sports med fellowship for some time. I have always found your posts helpful and insightful. But I have to repsectfully disagree with your suggestion that ER doctors' high costs and malpractice rates are due to inadequate follow-up. In training, we are responsible for follow-ups and many in the "real world" still follow-up with pts and cases that are both admitted and discharged.
There are many reasons for higher rates of utilization of medical dollars in the ED....mostly higher acuity and dealing with a higher risk population (vague early presentations, pts without PCPs, pts without follow-up due to lack of health insurance, pressure to move the department, lack of on-going relationship with the pt, and of course, pts with unrealistic expectations).
I will admit that there are some unneccessary expenditures in the ED, and admittedly some of it is due to inexperienced clinicians and defensive medicine. Some of it is due to requests for studies by admitting physicians and community physicians that send their pts to the ED. But I don't believe that these things are responsible for the majority of the increased costs of ED physicians.
Forgive me if I am just being too sensitive or read too much into your comment.
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There are many similiarities and differences between EM and FM, but one advantage in honing a FM doc's skill is the ability to tell a patient, "let's try this and see how you do in 1 month." Sometimes things get better. Other times the pathology evolves. There are many reasons why the ED is expensive and why malpractice insurance for EP's is expensive. My point is that EM as a field stands by itself, differs from FM and other fields, and its appeal is equally tempered by things that make it less appealing.
In the context of sports medicine, I think it's interesting because PCSM draws in multiple specialties and you get a chance to see how people differ in their treatment philosophy. In training, EM docs don't train as an athlete's primary care doc and don't follow longitudinally. It's only once they train side by side with FM docs during fellowship do they pick up some of these skills (and vice versa with FM docs training next to EM docs for other skills). When my SM friends and I work medical tent for triathlons/marathons, it's always interesting to us how quick EM docs are to intervene with IV fluids and lab tests when research shows with an intact gut, these athletes just need a little time to recover and they'll do fine. Marine Corp presented 2 case studies on how different heat stroke was managed at the Marine Corp Marathon by managing one on site in the med tent while sending another to the ED. And they found delay in care, delay in diagnosis, and improper treatment with the soldier who went to the ED. (Heat stroke, being a true endurance event emergency). Hey, no one's perfect; but there's something to learn from everyone. I asked an EM resident who I've watched from a distance as a 1st year and now 3rd year whether she wanted to do a SM fellowship like she once wanted to, and she said, no, that she thinks she can do this without further training. That's cool with me, but I think she's closing her mind to learning something new that she didn't know she didn't know.
I'll say this. One of the greatest rewards as a doctor in being in primary care sports medicine is that when I go to a sports med conference, I have the chance to listen, sit next to, and learn from people with a various background in FM, IM, Peds, EM, PM&R, Ortho, Neuro/Neurosurg, Psych background as well as nutritionist, exercise physiologists, biomechanical engineers, strength & conditioning, physical therapists, and athletic trainers. I know for me as an FM doc, I'm accustomed through residency training to keep an open mind about how various disciplines approach a problem and I think the founders of primary care sports medicine did it right when they "made" the field all-inclusive. It's just a natural dovetail of how FM docs think. I think many medical students don't get a chance to see this or understand this because they train under people who's personal need for self-importance get in the way of higher learning and progress.
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If you think the set up for med school is to pass your USMLE well, you've wasted your tuition and you owe me, a taxpayer, my money back. You've totally missed the purpose of what medical school is about. AND, the joke's on you, because you don't even need a high USMLE to get into FM.
Those who've trained medical students over the years have watched the gradual erosion of competency and medical students are graduating with less and less skills. Few know how to suture, less have ever delivered a baby, etc etc. After a few cycles of this erosion, people start believing that this norm is the new reality as demonstrated above.
Believe it or not, learning MSK takes time. You need to know the anatomy, know what's involved when it goes into motion, know what tests to perform, know what those tests mean, their sensitivities/specificities and limitations, BEFORE you can treat the patient. If you think that intern year is the time you'll start learning this, you're late. That's like learning your alphabets in the 8th grade. In PM&R you have 3-4 years to get it right, because the neuroMSK system is the only one you really need to know. In FM, it's not. FM residency is ADHD meets schizophrenia with an occasional oppositional defiance disorder. If you don't have a good medical school foundation to launch pad your learning and understanding, you'll probably still be ok, except that you have so much more gap to close. What it takes is a combination of books and hands-on learning, success and failure, to get it right. You can't say, well, I'll wait until residency to learn it, so that you can say, well, I'll wait until fellowship to learn it. Don't kick the can down the road.
What that means is that you get the most out of your medical school experience right here right now and quit standing in the corner apologizing for how scared you are and step up front and center, get some hands-on experience. And, if that means suffering ridicule and getting yelled at, GOOD. Smile, because that's what you paid for. Go home read about it, and come back tomorrow stronger and better and do it all over again.
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Well, I thought the original questions was what do we think about first going into FM in order to get to SM. Pro's & cons of SM fellowship are pretty straightforward:
Cons:
- You have to apply, you have to interview, you have spend money, you have to be judged, you may possibly be rejected.
- For programs that only take 1 fellow a year, you can be everybody's #2 pick... and possibily go unmatched.
- You're down 1 year's income, and up 1 year's interest accrual.
- You may have to move across the country for 1 year.
- You may be a board certified by the time you start fellowship, but you will feel as dumb as an intern, learning something new all over again. Very humbling.
- You are someone's slave for yet another year.
- Sports medicine is a small community. If you act stupid, everybody knows.
Pro:
- One of the most enjoyable fellowships out there. For some, you're actually living out your childhood fantasies.
- Expand the skills and knowledge of what you already know, including new procedures
- A chance to remediate the things you didn't learn
- A chance to do something even if you never ever get to do it ever again.
- A chance to teach and share your knowledge with residents and students who, for better or worse, look up to you
- A chance to work outdoors, which is a nice break from the typical grind
- Since most fellowships are 1-2 fellows, one big pro that I will always be thankful for is the mentor-mentee relationship I formed with my director. Imagine that. A whole training program system dedicated to training you and only you.
- Along the same lines, you make a lot of cool friends during that year. I partied with the athletic trainers.
- There aren't a lot of primary care sports med physicians out there, partly because nobody wants to do primary care. So it's a small community you get to be a part of.
- You have a chance to make a little bit more money.
D
deleted421268
Also asides from salary, what are the differences in the job of a PCSM physician and a plain Athletic Trainer because to me it seems as if both jobs are the same in description??? Also what is salary of PCSM physician vs that of a regular FM physician???
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Huge difference. Athletic training is a bachelors level occupation. On the collegiate and professional level, most have a masters degree. To be licensed in most states, they need to complete an internship year. Unfortunately, in many states their scope of practice can be limited. ATs are my eyes and ears to how my college athletes are doing. ATs are to athletes as nurses are to hospital patients. But even though ATs may have more years of training compared to nurses, their clinical exposure usually is limited to young athletes. ATs can range from those with very good clinical acumen, exam skills, and rehab knowledge to simply a water boy, depending on how good they are. I place ATs on the level of of a MSK oriented RN/BSN and PT-lite. In most states, ATs work under the supervision of a physician. In most states, ATs work under the direction of a physical therapist.
ATs are usually on the sideline with the athlete during games and practice. On the college and pro level they travel with the team. Depends on the situation, but i generally don't travel with the team and I rarely go to practice. While I may cover games, I serve as the ATs back up. ATs get the first exam, I'll do the 2nd. It's very important that I empower my ATs because they are usually first contact with athletes and athletes must have trust in the ATs. I will take over the case when they ask me to or when there is an obvious medical issue: cardiac death, dislocated limb, etc. For me, I respect the ATs skills and we work as a team on the sideline. They tape athletes for a living. When teams travel, most colleges will have reciprocity with physicians, meaning they cover my traveling team and I cover theirs when they visit. We're all here to protect the athletes.
Depending on the skill of your AT and your style, you may serve more as a primary or consultant. For me, I respect my ATs skills and learned their strength and weaknesses so I serve as their consultant for all primary care medicine issues and some ortho issues. If an AT wants an athlete to see ortho first, I'm fine with that. It all depends on availability. My ortho and i work well together and our ATs call or text us 24/7.
ATs as a whole are uncomfortable by knowledge, training, and experience with medicine. They spend a large portion of their training with ortho, PTs, and other ATs. In that sense nurses have better knowledge, but nurses are very poor at MSK.
Lastly while we may both evaluate and manage non-operative injuries, I can prescribe meds, perform medically related exams better (like heart, abdomen, genital, etc), can order and interpret imaging. ATs are good at splinting, some with casting. I do both. They don't do injections, while I do though rarely in college kids. They don't suture and mine dont start IV's. And of course, I'm more suited to handle STD's, immunizations, recognition and treatment for psychiatric disorders like depression/anxiety, drug abuse, eating disorders, suicidal, ADHD, as well as other non-ortho problems like thyroid, migraines, concussion, hypertension, skin disorders.
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Pay is a harder question to answer because it's multivariate. You can go from 200-300k if you're private practice with partnership equity and good payer mix to 70-80k working student health with 2-3 months off with no call and no complicated patients. There are averages out there but it really depends on (for now) how many patients you see, the level of complexity, the number of procedures you do, whether you get a cut of the ancillaries, what your collections are, and what your overhead is. These averages are well publicized on the internet, but there are huge variations. I will tell you on average being a fellowship CAQ is a good thing and you may get skills in things you otherwise would not have done without it. Also, by licensing laws, you can publicly regard yourself as a sports medicine physician, which confers a marketing advantage over other primary care physicians and you can call yourself a primary care physician to avoid the need of depending on other physicians' referral, and you can provide complementary or frontline services to an orthopedist.
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deleted421268
How about if you work at say for example UPMC's Sports Med hospital like http://www.upmc.com/Services/sportsmedicine/Pages/default.aspx this hospital. What would your pay be then??? I think it would be unfair to go through all the hard earned years and only earn 70-80 k like you mentioned. I would say 150 k at least should be fine.
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Not even close to being the same. I mean that'd be like comparing an EMT to a surgeon..
1) I think Texas is the only state that allows an athletic trainer to become licensed after completing an internship. The national certification (required in all but Texas, California, and Alaska) requires one graduate from an accredited athletic training education program which is a minimum of 2 consecutive years.
2) I've never thought of it that way and I think it is an interesting way of putting it. Won't completely agree, but what you said here does make a lot of sense! I think we have a lot more legal ability to make decisions that many nurses do.
3) Athletic Trainers don't work "under a physical therapist." We should work alongside a PT and physicians on a regular basis. But we are also more than qualified to practice in a rehab setting without a PT. "Working under a PT" is much more of a clinic-specific thing than it is law.
4) If you have a strong background in emergencies this is absolutely a place for a physician to step in! If a physician is not comfortable dealing with an emergency room, it can sometimes be best to stay out of the way! I've seen physicians take over with on-field emergencies and do great and I've seen other physicians who have no business attempting to handle something on the field.
5) If you truly respected an athletic trainer, you'd know we do much more than "taping for a living."
It is all about the athlete and that's the way it needs to be. Individuals in all professions must be willing to work together to make the sports medicine team successful..
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I have no idea what those people make, nor will I venture to guess. What I do know is no one is going to give you money just because you exist. You have to go out there and earn it.
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Believe it or not, taping is a reimbursable procedure code under Medicare and other insurances. My volume of taping is no where near those of an ATC, but I've learned a couple of tricks from ATC's to help me when I cover events and play sports with my own friends where ATC's are not available. A PCSM's volume of taping is no where near that of an ATC. For those of us who know what ATC's do, we know you do more than just tape for a living but I can see how the line could be taken out of context if you didn't know what they did.
Agree with all else stated above.
