Why would anyone go into primary care nowadays?

[Kahreek]

Annnnnd we're off the rails again. Go on usenet or the chans or reddit anywhere else where libertarians tend to congregate and you'll find that there are plenty of unsuccessful basement-dwelling weirdos. I've never met a libertarian in meatspace that wasn't a nutty conspiracy theorist that had trouble getting a girlfriend. And I've straight up never met a female one, ever.

Anyway, there won't be a massive libertopia springing from the 2020 elections or beyond for various reasons, so we can neglect fringe politically unpalatable views in regard to the primary care market for the indefinite future.

The NHS doesn't decide what money is spent on.



The UK is two tier, so you can be private if you want to be.

The assertion that believers of a universal health care provider are "libtards" is just ridiculous. The NHS is not perfect, but living in this country I wouldn't trade it for anything else. There are obviously negatives, but I have the chose to piss off and go private.

i dont know about politics, but liberalism would advocate free choice private health. Not state healthcare, that would be termed socialism.
Libertarianism is not even a real politic ideology, is just something invented in america by republican and democrat fights.

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[PL198]

i dont know about politics, but liberalism would advocate free choice private health. Not state healthcare, that would be termed socialism.
Libertarianism is not even a real politic ideology, is just something invented in america by republican and democrat fights.

I would argue that the libertarian party is how the republican party should actually be. BUT I'M NOT EVEN MAD BECAUSE IT WILL BE IN UNDER 10 YEARS

 

[Kale01]

Reasons I can think of:
- Seems chill compared to most practice areas
- Relatively easier residency
- Low Step 1 scores

 

[tdram]

Reasons I can think of:
- Seems chill compared to most practice areas
- Relatively easier residency
- Low Step 1 scores

It doesn't seem that chill to me. Seems really tedious to me.

 

[BobbyB]

the better question to me is "why doesn't every primary care doctor practice in Canada?"

same or better pay with a lot better malpractice coverage

 

[NontradCA]

the better question to me is "why doesn't every primary care doctor practice in Canada?"

same or better pay with a lot better malpractice coverage

Dat dere visa.

 

[styphon]

the better question to me is "why doesn't every primary care doctor practice in Canada?"

same or better pay with a lot better malpractice coverage

Plus lots of hockey games and the "good side" of niagara falls.

 

[KnuxNole]

To help people. Like you said on your personal statement.

You must have read the wrong personal statements.

 

[KnuxNole]

Plus lots of hockey games and the "good side" of niagara falls.

Don't forget BAGGED MILK and NESQUIK CEREAL!

 

[VenusinFurs]

My residency isn't really that easy. Also I'm sort of thinking I don't really want to do primary care anymore. I am a bad family medicine resident.

 

[DermViser]

Reasons I can think of:
- Seems chill compared to most practice areas
- Relatively easier residency
- Low Step 1 scores

Try again. Maybe easy only in # of years, but not what they actually do.

 

[KnuxNole]

My residency isn't really that easy. Also I'm sort of thinking I don't really want to do primary care anymore. I am a bad family medicine resident.

Ditto, it's far from easy. Compared to a surgery resident working 100+ hours every week, sure it's easier by comparison. But, it's still VERY challenging. There is so much to learn, and so little that I know = outside reading to not feel like a dum dum. Rotations with long days, ED rotations(which are draining), and calls add on to it.....as with most residencies.

 

[Arkangeloid]

I also laugh at the people who listed "P=MD Mentality" as a plus.

Just so you know, it's not a plus. I speak from personal experience. It sucks to go through medical school knowing that every 2 weeks, you could face the end of your career from just one slip-up.

And I don't think anyone says "well, I'm going to be a P=MD student!" No, you don't get into medical school with that mentality. Let me quote TI: "I don't want no mediocre."

 

[DermViser]

I also laugh at the people who listed "P=MD Mentality" as a plus.

Just so you know, it's not a plus. I speak from personal experience. It sucks to go through medical school knowing that every 2 weeks, you could face the end of your career from just one slip-up.

Maybe you should start changing your mindset and stop looking at it in that way. No that's just silly.

 

[Arkangeloid]

Maybe you should start changing your mindset and stop looking at it in that way. No that's just silly.

What do you mean? I failed Anatomy last year, and was scared throughout the rest of the year that one more failure would mean repeating the year. And I know failing one class (and successfully remediating it) isn't the end of the world, but failing a year would be.

 

[DermViser]

What do you mean? I failed Anatomy last year, and was scared throughout the rest of the year that one more failure would mean repeating the year. And I know failing one class (and successfully remediating it) isn't the end of the world, but failing a year would be.

Even remediating a year isn't "the end of the world". The fact that you still approach med school that way is concerning. It will only hurt, not help.

 

[sinombre]

What do you mean? I failed Anatomy last year, and was scared throughout the rest of the year that one more failure would mean repeating the year. And I know failing one class (and successfully remediating it) isn't the end of the world, but failing a year would be.

I have a buddy repeating first year right now. As far as I know his world is not over. I'm sure it's very difficult to deal with, but he'll get through it.

 

[RJGOP]

Try again. Maybe easy only in # of years, but not what they actually do.

I wouldn't say what they do is that hard, not that it's easy but compared to the technicality of surgery it pales in comparison. It's certainly a broad area and I'm sure there is a lot to know and do though. But, technically, it's not as challenging.

 

[DermViser]

I wouldn't say what they do is that hard, not that it's easy but compared to the technicality of surgery it pales in comparison. It's certainly a broad area and I'm sure there is a lot to know and do though. But, technically, it's not as challenging.

Yes, it's certainly not a procedure intensive specialty. But it's still difficult with respect to breadth of knowledge and hours in residency are also difficult. Everything pales in comparison to surgery and surgical subspecialties.

 

[styphon]

Yes, it's certainly not a procedure intensive specialty. But it's still difficult with respect to breadth of knowledge and hours in residency are also difficult. Everything pales in comparison to surgery and surgical subspecialties.

Considering FM is a medicine speciality, it is not surprising that it is much less technical than Surgery. You could say the same with any medicine fields, does an ID or non-operating Cardiology really need dexerity?

But, in a perfect world, the smartest would go into family medicine - as it requires the widest berth of knowledge.

 

[Medguy22]

I'm entering medical school next month and I'm basically taking loans for my entire COA. That + my undergraduate loans make my total debt close to $300k once I graduate. That is the equivalent to a down payment for a $1.5 million mansion. After I pay it all back in 10-20 years, I will probably have paid a total of close to $500k.

My question is, what possible reason would a med student in my situation have for pursuing primary care or related fields? And why do medical schools not address this problem especially when everyone and their grandma are saying that there is a great need for primary care docs??


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If you are in this field for money then there is something wrong.

 

[PL198]

If you are in this field for money then there is something wrong.

wrong

 

[DermViser]

wrong

Maybe he's talking about Family Medicine?

 

[PL198]

Maybe he's talking about Family Medicine?

I guess it's possible but since the other student said they were just entering school, I find it kinda strange if that was the intended message and obviously a new student isn't in any particular field.

 

[ketosisevangelist]

My residency isn't really that easy. Also I'm sort of thinking I don't really want to do primary care anymore. I am a bad family medicine resident.

Bad. Bad Venus.

 

[Slaol]

As someone who recently signed a contract in Family Medicine, my thoughts on this have changed. I have to say that those who think that it is not worth it to go into primary care are misinformed.

There are many advantages to doing primary care.

I work as a resident at a very busy inner-city teaching hospital. We work pretty much up to the duty hour limit all the time and do not have patient caps on our service due to it being a safety net referral center. You get to do procedures, manage large volumes of complex situations, working alongside specialists. I know there is a perception that primary care is all sore throats and well-child checks... but it isn't. Sure, you get to see a few worried moms with perfectly healthy kids come in for reassurance, but this is the minority (at least where I train). Many of these worried well are seen by nurse practitioners, and we are left with chronic disease management and more acute problems/procedures. I think many places are moving more towards that kind of triage model.

Also, the perception that you are very limited by going into primary care is simply not true. After graduation, you can do outpatient, OB, hospitalist, urgent care, ER, academics, sports medicine, addiction medicine, sleep medicine, administration, pediatrics, dermatology, aesthetic medicine... pretty much whatever you want (you can also find someone to train you in the future to do just about any procedure).

If you do a job search, the sky is the limit for primary care right now. There are literally thousands of jobs out there (granted, less if you are very picky about location/need visa waiver etc). I find that most of the people who complain about primary care jobs are upset because they can't find premium jobs in places that are already saturated with physicians (major cities, resort towns, etc). Obviously the laws of supply and demand are going to dictate that jobs in these places are going to be less lucrative.

In my search for jobs, I found many jobs for primary care that are far above the national average. For example (and granted this is a major outlier), I talked to one recruiter who was recruiting family docs for "Fast Track ER" positions in Texas that were quoting salaries of $160-180.00 per hour with basically unlimited income potential (easy to make upwards of $350 - 500k per year + production). Granted, this is not L.A., New York City or San Francisco... but the world is a lot smaller now, and traveling is easy.

The average starting salary for most Family Medicine jobs w/o OB for someone just fresh out of residency is now $180 - $225k (based on my calling and speaking to many recruiters and employers) - and this is for your basic, outpatient only w/ light call, office hours jobs. If you do full spectrum OB (I do not), I've seen jobs closer to $300k. This is not including bonuses based on production/RVU/whatever. Many rural positions will literally throw money at you to sign on for 2-5 years.

All this to say, primary care is an awesome choice. You get broad training and it opens up many opportunities for you to live and work wherever you want.

 

[PL198]

Just seems like a huge risk with mid-level creep

 

[KnuxNole]

I'm worried there won't be anymore FM jobs that are traditional, or have outpatient + inpatient duties....that is my desired path after residency, but it seems everything I look for in terms of recruiters only show outpatient-only stuff...

 

[Ismet]

I'm worried there won't be anymore FM jobs that are traditional, or have outpatient + inpatient duties....that is my desired path after residency, but it seems everything I look for in terms of recruiters only show outpatient-only stuff...

I rotated at a community hospital where the FM docs do inpatient medicine (adult and peds) and OB. Perhaps that niche is dying out, though :/ Feel free to PM me if you want info about the place.

The more inpatient work I do, the more I am drawn towards primarily outpatient. If I liked working with the adult patient population more I would probably do FM, but 1) I don't know if I could totally give up inpatient service and 2) I mainly want to work with kids.

 

[jeffk805dent]

ok I have to ask even though its been mentioned a couple of times in the past this but hows the salary/working environment for primary care physicians in SF/LA/San Diego? Is it very low and are the docs overworked?

If I were to go to a dental office and ask for more than 120k I'd get laughed out of the office. Since FM is in more demand than dentistry, I was curious to know how much the salary for primary care physicians is affected by the saturation, since these three cities are widely popular.

 

[Slaol]

I'm worried there won't be anymore FM jobs that are traditional, or have outpatient + inpatient duties....that is my desired path after residency, but it seems everything I look for in terms of recruiters only show outpatient-only stuff...

Most of the full spectrum jobs are going to be rural or residency programs, simply due to the fact that big cities have plenty of OBGYN docs.

There are plenty of FM jobs out there that have inpatient and outpatient duties w/o OB. Try one of the job search sites (practicelink, healthecareers, etc...). Good luck!

 

[thelord'sdoctor]

Most people who go into FM do not have a choice in the matter.

 

[PL198]

Plus lots of hockey games and the "good side" of niagara falls.

seriously the US got screwed with niagra falls, our side is crap

 

[KnuxNole]

Most people who go into FM do not have a choice in the matter.

Uh, wrong.

There are peeps who choose FM from an allopathic US school with step scores in the 240s.

I could have chosen IM, EM, or Peds. But out of the 4, the one I wanted overall was FM, and here I am.

 

[NontradCA]

I'm worried there won't be anymore FM jobs that are traditional, or have outpatient + inpatient duties....that is my desired path after residency, but it seems everything I look for in terms of recruiters only show outpatient-only stuff...

What about academics?

 

[famoussquamous]

Uh, wrong.

There are peeps who choose FM from an allopathic US school with step scores in the 240s.

I could have chosen IM, EM, or Peds. But out of the 4, the one I wanted overall was FM, and here I am.

How many of those in FM percentage wise would you say are like you (could choose to do whatever but wanted to do FM)?

 

[PL198]

How many of those in FM percentage wise would you say are like you (could choose to do whatever but wanted to do FM)?

there's not this false dichotomy where it's like either
a) you're a stud and can reasonably match into most things
b) you barely passed step 1 and you'd be lucky to match

 

[Frazier]

Most people who go into FM do not have a choice in the matter.

How many of those in FM percentage wise would you say are like you (could choose to do whatever but wanted to do FM)?

It is a ridiculous claim and an inherent flaw in all of medicine [crapping on other specialties].

Looks like a lot of those FM docs could have gone into other specialties if they chose. Hell, that nice chunk of 237 people in the "211-220" range could have had a decent shot at Gas or Rads.

In rads, 42 out of 44 applicants matched in the 211-220 range.
In gas, 167 out of 174 applicants matched in the 211-220 range.

Oh, maybe there is a selection bias in play? For what? Research? A lot of applicants in both of those ROAD specialties had zero pubs on their application and matched. It isn't exactly hard to get involved if you want it.

...Oh and how about those other 540 people with even higher scores.
See FM:

It is a preposterous ideal that should really be extinguished at pre-med.

EDIT: ...and I'm not even in the slightest interested in pursuing FM. It is just that aggravating to make me dig these stats up.

 

[famoussquamous]

there's not this false dichotomy where it's like either
a) you're a stud and can reasonably match into most things
b) you barely passed step 1 and you'd be lucky to match

We were pretty much told straight up that we shouldn't have too many conceptions on what we want to do until we take Step 1 because we don't know what we're locked out of. I guess it's the PC thing to say that people with great Step 1 scores still choose to do Primary Care, and I'm certain that's true in some cases, but most of my class seems to be gunning for ROAD and surgical sub-specialties (probably about 70%).

 

[thelord'sdoctor]

It is a ridiculous claim and an inherent flaw in all of medicine [crapping on other specialties].

Looks like a lot of those FM docs could have gone into other specialties if they chose. Hell, that nice chunk of 237 people in the "211-220" range could have had a decent shot at Gas or Rads.

In rads, 42 out of 44 applicants matched in the 211-220 range.
In gas, 167 out of 174 applicants matched in the 211-220 range.

Selection bias for what? Research? A lot of applicants in both of those ROAD specialties had zero pubs on their application and matched.

...Oh and how about those other 540 people with even higher scores.
See FM:

It is a preposterous ideal that should really be extinguished at pre-med.

Grades and recommendations also matter. You can have a high USMLE scores, but if you have low grades and bad reccs, the only option open for you is FM, my friend.

 

[famoussquamous]

Grades and recommendations also matter. You can have a high USMLE scores, but if you have low grades and bad reccs, the only option open for you is FM, my friend.

Then why is the advice on this site always that grades really don't matter?

 

[thelord'sdoctor]

Then why is the advice on this site always that grades really don't matter?

Those people haven't applied to residency. C's will absolutely hold you back. Many people have same or similar USMLE scores, how are those applicants differentiated, especially for the competitive residencies? By grades, research, recommendations.

 

[Frazier]

I don't feel like doing the photoshop cut and paste job again, so if you're interested in the comparative weight of pre-clinical grades to, say step 1 scores, they are pretty far apart. (READ: 27% vs 94% residency directors even considering it as a factor).

http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf

Then why is the advice on this site always that grades really don't matter?

Clinical grades are more important. It is useful to make that distinction between those and pre-clinical grades.

 

[panamerica]

Grades and recommendations also matter. You can have a high USMLE scores, but if you have low grades and bad reccs, the only option open for you is FM, my friend.

Yeah, but do you really think that the people who fit that narrow description are at all common? In general Step 1 correlates pretty strongly with how well people do in clinical rotations, at least in my experience. I'm sure there are some folks who love to fantasize about the "good test takers" bombing in rotations, but that is really the exception.

Honestly, it kind of seems like grasping at straws to explain away why other people of equal intelligence might choose something you yourself do not like. Some people just like FM, and that is a okay.

 

[PL198]

We were pretty much told straight up that we shouldn't have too many conceptions on what we want to do until we take Step 1 because we don't know what we're locked out of. I guess it's the PC thing to say that people with great Step 1 scores still choose to do Primary Care, and I'm certain that's true in some cases, but most of my class seems to be gunning for ROAD and surgical sub-specialties (probably about 70%).

cool because you're probably an m1 and everyone just decides what they want to do by looking at salaries. look at the scoring distro posted above for FM. people aren't forced into it that often.

you realize FM isn't like magically lowest tier? Like if you barely passed step 1, you'd have a shot at FM, peds, IM at crappy places and psych. yet you're acting like you can get " stuck" in FM. You can get stuck in any of those 4.

 

[PL198]

Grades and recommendations also matter. You can have a high USMLE scores, but if you have low grades and bad reccs, the only option open for you is FM, my friend.

lol no. If you get a 240 on step 1, no one is going to care that you got a C in anatomy and biochem.

 

[thelord'sdoctor]

lol no. If you get a 240 on step 1, no one is going to care that you got a C in anatomy and biochem.

You are correct, if your transcript is littered with C's, if you have no research, and if you take the easiest rotations and screw around on them, but get a 240, the sky's the limit.

 

[PL198]

You are correct, if your transcript is littered with C's, if you have no research, and if you take the easiest rotations and screw around on them, but get a 240, the sky's the limit.

I mean you're not going to match into derm but for reasonably competitive specialties I think you'd be alright. Step 1 is the reflection of a students basic science knowledge as a whole . I also think due to step 1 being a standardized test, PDs are going to understate its importance when asked because people don't like the thought of one test being so significant.

 

[KnuxNole]

Grades and recommendations also matter. You can have a high USMLE scores, but if you have low grades and bad reccs, the only option open for you is FM, my friend.

Once again, extremely wrong. The people who think that have horrid advisors, lmao. If you have high Step scores, low CLINICAL grades(lol basic sciences), and bad recs(how can you get bad recs, it's INSANELY EASY TO GET GOOD RECS UNLESS YOU SUCK AT LIFE!), you can match a huge number of specialties. Besides, it's not like FM is at the absolute bottom.

As YOU know, it's easy to get into half the specialities out there anyway. Unless you did med school the wrong way....

 

[KnuxNole]

We were pretty much told straight up that we shouldn't have too many conceptions on what we want to do until we take Step 1 because we don't know what we're locked out of. I guess it's the PC thing to say that people with great Step 1 scores still choose to do Primary Care, and I'm certain that's true in some cases, but most of my class seems to be gunning for ROAD and surgical sub-specialties (probably about 70%).

You should have SOME idea. Remember, your app isn't just grades. Only idiots have that mentality.