The first thread

[mustangsally65]

Wow. I've never posted the first thread in a new forum before.

I hope everyone will see this subforum and start posting. I thought it would be a good place for everyone involved in rural medicine to be able to discuss relevant topics. I'm still pre-med, so I have a lot of questions that I'm sure some of you who work in rural areas could help us pre-meds out with.

I've seen posts about how rural specialties (general surgery, OB/GYN etc.) differ from those in big urban areas, and so I hope we will get a lot of people talking about anything and everything regarding rural medicine, and not just family medicine.

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[sophiejane]

Great idea!

I'm a 3rd year, still very much learning about the field, but willing to answer questions about the residency application process as I go...

 

[mustangsally65]

We should use this thread to introduce ourselves.

I'm Sally, I'm 24, and I will be applying for the third time to med school for the entering class of 2007. I grew up in a rural Appalachian town (NC) and can't imagine living in a big city for very long. I love how you get to know everyone in a small town, and one of the reasons I'm interested in family medicine is because of its diversity.

Your patient population is diverse. You see people of all ages, and you have special insight on possible problems of a patient simply becuase you know their entire family and the health problems of each member.

Primary care is diverse to me as well because some of your patients will receive instant gratification by coming to see you (abx for ear infection etc.) while others need long-term management of chronic problems (hypertension, diabetes). I work in a small hospital now (25 bed, 4 bed ED) and it's amazing the range of problems I see in patients even in such a small place. People who say primary care is boring have probably never worked in primary care because people come in with weird ailments all the time. The added bonus with primary care is that you can establish long-term relationships with your patients and follow them through a good portion of their lives.

 

[deleted87716]

People who say primary care is boring have probably never worked in primary care because people come in with weird ailments all the time.

Ditto. One of my patients yesterday has arthrogryposis multiplex congenita. Heck of a nice guy, too...he's a college graduate, works full-time and supports himself despite having no functional use of his extremities. Seeing him made my day.

 

[mustangsally65]

Seeing him made my day.

That's what it's all about, isn't it? Every time I go see my family physician it always makes my day (as a patient) even if nothing is physically done to allieviate my complaint. It's great to have such a good relationship with patients and to be able to make someone feel better just by your compassion and understanding.

 

[sophiejane]

That's what it's all about, isn't it? Every time I go see my family physician it always makes my day (as a patient) even if nothing is physically done to allieviate my complaint. It's great to have such a good relationship with patients and to be able to make someone feel better just by your compassion and understanding.

Ahh...some positive comments about FP! Let's keep them coming...some days its hard to take all the negativity that is directed in my direction when I say I want to do rural FP.

Even if we are tooting our own horn, toot away! It's good for the soul...

 

[shemozart]

hi guys!

reading this thread made me happy. Let us never let the detractors (sp?) into this subforum.....I'm an FP intern (on call at the moment! heehee - can't wait until my night turns crazy like it always is) - and I am looking so forward to going into rural practice when I'm done with residency. Primary care is awesome (most days, anyway) - you really can see some weird stuff out there! That's part of the reason I love learning everything I can. The day I see Plummer-Vinson syndrome is the day I will know that all that studying for Step 1 boards was totally worth it.

And just knowing that I can take an undifferentiated sx or complaint and figure out what's going on and what the appropriate thing to do is the best. Keep the happy random thoughts coming (yes, yes, I know this is the rural medicine thread, but still....I plan on going into rural medicine, so my thoughts count!)

 

[sophiejane]

And just knowing that I can take an undifferentiated sx or complaint and figure out what's going on and what the appropriate thing to do is the best.

I was writing my personal statement the other day and I finally realized that this is a large part of what attracts me to FP. Specializing to me seems like such a bore--the fun part, the diagnosis, is already done once they come to the specialist 80% of the time, at least if they come with a referral from a decent FP. So they order the chemo or do the echo (FPs are even starting to get training to do these, and do them well) or cut out the bad stuff and then send them back to the FP.

We are the gatekeepers, the night watchmen (and women), the hand holders, the organizers and the advocates for our patients. To me this is the purest form of medicine.

And I think there is no place better to practice that sort of medicine than in rural America. Sure, we have to life flight our critical cases to the city. OK, then, godspeed. But we stablize them before we do. And they come back to us, and we get to keep treating them and monitoring their progress (or helping to prevent their demise). Best of all, we get to see their spouses and kids and grandkids, too...

Not to mention that rush hour lasts about 5 minutes and usually includes a tractor. And no smog. And beautiful sunsets.

 

[Antiviral22]

I was writing my personal statement the other day and I finally realized that this is a large part of what attracts me to FP. Specializing to me seems like such a bore--the fun part, the diagnosis, is already done once they come to the specialist 80% of the time, at least if they come with a referral from a decent FP. So they order the chemo or do the echo (FPs are even starting to get training to do these, and do them well) or cut out the bad stuff and then send them back to the FP.

We are the gatekeepers, the night watchmen (and women), the hand holders, the organizers and the advocates for our patients. To me this is the purest form of medicine.

And I think there is no place better to practice that sort of medicine than in rural America. Sure, we have to life flight our critical cases to the city. OK, then, godspeed. But we stablize them before we do. And they come back to us, and we get to keep treating them and monitoring their progress (or helping to prevent their demise). Best of all, we get to see their spouses and kids and grandkids, too...

Not to mention that rush hour lasts about 5 minutes and usually includes a tractor. And no smog. And beautiful sunsets.

Right on everyone!!! I'm so glad to finally see a form filled with future and current doctors who have joined the profession to make a difference in the lives of the often neglected. The general allopathic forum can sometimes really turn me off. I'm a 1st year medical student at Ben Gurion Unviersity Medical School for International Health (BGU MSIH) in Israel, and although it's quite early, I'm 95% sure I want to do family practice. It's versatility is immense, especially if one decides to get involved with public/community health issues of developing countries, like me. Anyone else thinking of working internationally?

 

[dr_almondjoy_do]

I think I can cry....lol

I am happy to see it! I almost gave up on SDN!

 

[tridoc13]

Right on everyone!!! I'm so glad to finally see a form filled with future and current doctors who have joined the profession to make a difference in the lives of the often neglected. The general allopathic forum can sometimes really turn me off. I'm a 1st year medical student at Ben Gurion Unviersity Medical School for International Health (BGU MSIH) in Israel, and although it's quite early, I'm 95% sure I want to do family practice. It's versatility is immense, especially if one decides to get involved with public/community health issues of developing countries, like me. Anyone else thinking of working internationally?

Awesome! Thanks so much for starting this thread. I am proud to be going into my first year of FP residency in July. This is what I've wanted to do since I was 6 years old, and noone can take the joy of accomplishing this enormous task away from me. NOOOOO negative thinkers here, please! Let's just enjoy chatting with people who share our dreams, and encourage each other to keep fighting the good fight for primary care. The country (and the world) needs us. We are a vital part of our patients' lives, which is most of what makes our job so gratifying and enjoyable. Thanks again for starting this!

And yes, I am also planning to do a TON of international work...PM me off-list if you want to chat about that stuff.

 

[Donkey Hote]

Wow. I've never posted the first thread in a new forum before.

I hope everyone will see this subforum and start posting. I thought it would be a good place for everyone involved in rural medicine to be able to discuss relevant topics. I'm still pre-med, so I have a lot of questions that I'm sure some of you who work in rural areas could help us pre-meds out with.

I've seen posts about how rural specialties (general surgery, OB/GYN etc.) differ from those in big urban areas, and so I hope we will get a lot of people talking about anything and everything regarding rural medicine, and not just family medicine.

Amen everyone!

Thanks for the uplifting comments. I'm about to start my residency in Family Medicine in preperation for a career in rural and international medicine, and can't tell you how many times people have tried to turn me away from family medicine. You're smart enough to do derm, why not med-peds, or ENT or something like that. I tell them, there is nothing more challenging than knowing a lot about each specialty and organ system. That is much harder than knowing everything about the endocrine system or cardiology or the sinuses.

To all the pre-meds and med students who have not yet made their decisions, family medicine is still a great and fulfilling profession. It is up to you, and your dedication to your own learning and your patients, but you can really be the one-stop-doc.

I was recently on a rotation at an excellent family medicine program in Northern California, Sutter Santa Rosa. While I knew of the full spectrum of family medicine practiced by the graduates and faculty of the program, another medical student, one from UCSF, did not. He had never considered family medicine, having come from a prestigious research oriented medical school, and was just there to fulfill his 3rd year requirements. However after only a few days working with the physicians at Sutter, he had a great realization....

To paraphrase...He had no idea what family medicine really meant. He thought it was just a glorified nurse who referred people to the major medical centers. However after being there only a few days, he was starting to consider FM as a career choice. "They should change the name of family medicine to SUPER DOCTOR, and they would probably get alot more applicants", he said.

I think he might be right.

Donkey Hote
(I like Don Quixote, and my friends warmly call eachother Donkeys, hence the name)

 

[sophiejane]

What I find so interesting is that the only people discouraging students from going into FM are people who aren't practicing FM! If you ask the FM docs and residents, they are mostly very satisfied, happy, well-adjusted people.

How is it that these misconceptions of FM have become so widespread? I think we need to be more vocal if we are going to attract the brightest students (as we seem to be doing here).

I'm amazed that even at my school, ranked #23 in the nation for primary care, so many people have no idea what you can do with FM or what a good lifestyle and income you can have.

 

[mustangsally65]

How is it that these misconceptions of FM have become so widespread? I think we need to be more vocal if we are going to attract the brightest students (as we seem to be doing here).

Perhaps it has something to do with the pay? I've had a lot of people roll their eyes at me when I say I'm interested in primary care or family medicine, and they think that if I'm going to med school I should apply myself more and do something more meaningful. I think people do perceive family physicians to be glorified nurses. This is sad.

I was attracted to family medicine because my family doctor is amazing. I've never gone to her with a problem and had it go unsolved. Sometimes I have no idea how she does it, but she can accurately make a diagnosis often from my account of the problem alone. The physical exam and any tests that follow are just a formality.

I think you have to experience family medicine and other primary care specialties to truly develop an interest in them. And most people don't think they're worth pursuing so they spend as little time as possible in those rotations. Also, many med schools don't offer rotations in smaller communities where family medicine is so different than in big urban centers. I'm lucky in that I grew up in a small town (population 1000 permanant residents) and was exposed to rural medicine for most of my life.

But then again sometimes I feel lucky that primary care isn't very competitive. I'm much more likely to get my first choice when match time rolls around, right?

 

[lilnoelle]

I plan on going into rural medicine too. Does anyone know if doing a FM/IM residency will be a useful thing in rural medicine, or would it be better to do one or the other?
The main reason I'm going to go into rural medicine (in addition to the fact that I grew up on a farm and like rural settings) is because I feel as a rural physician I will have a much greater impact on the community around me than I would as a FP in a large city. I really want to deliver babies and be a pediatrician and help my older patients etc. I want to do it all. In a city I would be less likely to get the opportunity to do some of that stuff because of the availability of specialists. Does anyone know how Family Practitioners who also some obstetrics handle malpractice insurance? Is the insurance as high as for regular obstetricians? I want to deliver babies but am pretty sure that as a rural FP I will not be making enough money to carry the expensive malpractice insurance that obstetricians have to carry. Has anyone else considered this?

 

[sophiejane]

I really want to deliver babies and be a pediatrician and help my older patients etc. I want to do it all. In a city I would be less likely to get the opportunity to do some of that stuff because of the availability of specialists.

Maybe, maybe not. FM very regional--especially OB. I would suggest you find out first where you think you want to practice, and second, what those docs are doing, and how they are doing it.

Does anyone know how Family Practitioners who also some obstetrics handle malpractice insurance? Is the insurance as high as for regular obstetricians? I want to deliver babies but am pretty sure that as a rural FP I will not be making enough money to carry the expensive malpractice insurance that obstetricians have to carry. Has anyone else considered this?

I believe that the insurance rates are the same for anyone who delivers babies as part of their practice. It has nothing to do with volume, unfortunately. One baby a year is the same rate as 500. I think there are definitely still rural docs who are delivering enough babies to end up in the black, but it's less and less common, from what I'm learning. Again, it's regional. Some states, like TN, have some of the lowest malpractice rates. I would venture that FM docs in that state are more likely to be able to make money at OB than someone is south Texas, where the rates are among the highest in the country.

I've heard that in areas of very great need, sometimes the local hospital will pay your malpractice.

 

[OrnotMajestic]

I'm Sally, I'm 24, and I will be applying for the third time to med school for the entering class of 2007. I grew up in a rural Appalachian town (NC) and can't imagine living in a big city for very long.

Sounds like you are just over the mountains from me. I go to Quillen (ETSU) which is very well known for their rural and primary care focus. Good luck on the application process!!