Why would anyone go into primary care nowadays?

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PL198 said:
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.
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I got very high step 1 and step 2 scores. Because of non-academic problems in medical school, and prior transgressions I did not want opened up, I only managed to scramble into a rural FM program. Fortunately, I befriended a IM PD and referred patients to him, and managed to switch over to a field I liked. My point is, PD's look at more than USMLE, and I am proof of that. I am trying to help you here.
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thelord'sdoctor said:
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.
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Are you in medical school? The majority of med schools don't have letter grades and there's no "taking the easy rotations" because you have very little choice over your courses until 4th year.
 
That's the thing. Those non-academic problems were brought on by himself. Most med students most make those students. And agreed, you can't pick easy rotations unless your med school sucks donkey balls haha
 
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thelord'sdoctor said:
I got very high step 1 and step 2 scores. Because of non-academic problems in medical school, and prior transgressions I did not want opened up, I only managed to scramble into a rural FM program. Fortunately, I befriended a IM PD and referred patients to him, and managed to switch over to a field I liked. My point is, PD's look at more than USMLE, and I am proof of that. I am trying to help you here.
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you had non-academic problems. the avg person doesn't have that.
 
Would you guys consider general surgery to be primary care? I've heard people argue it either way.
 
famoussquamous said:
FM, IM, Psych, Peds, OB/Gyn are all considered Primary Care, so some could think general surgery would be as well.
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Really the only thing "primary care" about psychiatry is the lower average salary data.

They are specialists.

They will not be (or at least should not be) the physician responsible for managing your HTN, DM, or other similar chronic conditions. They will not be your initial and primary point of contact in the healthcare sector -- the one being responsible for coordinating the specialist care that you'll need for the suspicious pulsatile mass in your abdomen.

In other words, psychiatrists primarily deal with a specific wedge of the pie (psychiatric conditions, behavior, mental well-being). Folks in primary care primarily deal with the whole enchilada, referring out when necessary.

When I think primary care, I think comprehensive -- I think FM, Peds, IM.
 
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famoussquamous said:
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%).
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I've very strongly considered FM. About a quarter of my class wants to do FM, and another quarter wants to do general IM, as that is what my school tends to select for.

FM has a great deal of flexibility, and you can easily secure a position pretty much anywhere. You've got a very broad range of things you can do, from peds to adults to hospitalist to the ED to urgent care. In some hospitals, you can even dabble in critical care. It's a good gig if you like variety and flexibility, but a bad one if you want money and prestige.
 
Frazier said:
Really the only thing "primary care" about psychiatry is the lower average salary data.

They are specialists.

They will not be (or at least should not be) the physician responsible for managing your HTN, DM, or other similar chronic conditions. They will not be your initial and primary point of contact in the healthcare sector -- the one being responsible for coordinating the specialist care that you'll need for the suspicious pulsatile mass in your abdomen.

In other words, psychiatrists primarily deal with a specific wedge of the pie (psychiatric conditions, behavior, mental well-being). Folks in primary care primarily deal with the whole enchilada, referring out when necessary.

When I think primary care, I think comprehensive -- I think FM, Peds, IM.
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Psych is considered a primary care specialty due to the fact that treating psychiatric illnesses can lead to substantial reductions in morbidity and mortality- it's preventative care as much as any STD screening, script for cholesterol meds, or pelvic exam. It's a primary health need that only psychiatrists are properly equipped to provide.
 
Mad Jack said:
Psych is considered a primary care specialty due to the fact that treating psychiatric illnesses can lead to substantial reductions in morbidity and mortality- it's preventative care as much as any STD screening, script for cholesterol meds, or pelvic exam. It's a primary health need that only psychiatrists are properly equipped to provide.
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I am undecided. The intricacies can be looked at from multiple angles. Off the top of my head, fields like ophthalmology and nephrology can fit a lot of those parameters that seems to follow the defining characteristics of primary care above.

Treating/managing renal diseases lead to substantial reductions in morbidity and mortality. It is preventative care as multiple other systems in the body can have negative ramifications if not addressed. It is a need that only nephrologists are properly equipped to provide.

Treating/managing ocular ailments lead to substantial reductions in morbidity. Getting that iridotomy was preventative care from bad outcomes [going blind] -- just as any STD screening, script for cholesterol meds, or pelvic exam. It is a health need that only ophthalmologists are properly equipped to provide.

I don't think nephrologists or ophthalmologists are PCP's.
I don't think psychiatrists are PCP's either.

Another angle we can look at for consideration is if everyone in a population will/should at some point utilize the respective specialties services. All kids should have a pediatrician, all adults should have a FM/IM doc...with this logic, I guess OBGYN might fit as all women should have one of those, no? However, only a fraction will need to utilize a psychiatrist's services.

Backing up, I have had trouble finding resources that would consider psych is one of the "primary care fields":

http://www.aafp.org/about/policies/all/primary-care.html
http://www.hrsa.gov/loanscholarships/loans/primarycare.html
http://www.medicare.gov/physicianco...efinitions.html?AspxAutoDetectCookieSupport=1
https://www.ummchealth.com/Health_C...are_Specialties/Primary_Care_Specialties.aspx

I'm sure there is something out there that says otherwise, but it apparently isn't as common as the opinions above.
 
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Frazier said:
I am undecided. The intricacies can be looked at from multiple angles. Off the top of my head, fields like ophthalmology and nephrology can fit a lot of those parameters that seems to follow the defining characteristics of primary care above.

Treating/managing renal diseases lead to substantial reductions in morbidity and mortality. It is preventative care as multiple other systems in the body can have negative ramifications if not addressed. It is a need that only nephrologists are properly equipped to provide.

Treating/managing ocular ailments lead to substantial reductions in morbidity. Getting that iridotomy was preventative care from bad outcomes [going blind] -- just as any STD screening, script for cholesterol meds, or pelvic exam. It is a health need that only ophthalmologists are properly equipped to provide.

I don't think nephrologists or ophthalmologists are PCP's.

I don't think psychiatrists are PCP's either.

Backing up, I have had trouble finding resources that would consider psych is one of the "primary care fields":

http://www.aafp.org/about/policies/all/primary-care.html
http://www.hrsa.gov/loanscholarships/loans/primarycare.html
http://www.medicare.gov/physicianco...efinitions.html?AspxAutoDetectCookieSupport=1
https://www.ummchealth.com/Health_C...are_Specialties/Primary_Care_Specialties.aspx

I'm sure there is something out there that says otherwise, but it apparently isn't as common as the ideals above.
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Per the NHSC and federal government, psych qualifies as primary mental health services, and thus primary care.

Most ophthalmological and nephrological disease is secondary to an underlying disease process or lifestyle issue. Mental illness is usually a primary issue that is not a the result of another disease process, but which can lead to the development of disease, disability, and death if unchecked. Nephrological and ophthalmological disease is generally the result of unchecked disease and lifestyle. There is one service that would largely be considered primary care in ophtho- simple corrective lenses, eye screenings, and the like- but this function is largely filled by optometrists while ophthos focus on surgery, a secondary treatment of underlying disease.
 
Mad Jack said:
Per the NHSC and federal government, psych qualifies as primary mental health services, and thus primary care.

Most ophthalmological and nephrological disease is secondary to an underlying disease process or lifestyle issue. Mental illness is usually a primary issue that is not a the result of another disease process, but which can lead to the development of disease, disability, and death if unchecked. Nephrological and ophthalmological disease is generally the result of unchecked disease and lifestyle. There is one service that would largely be considered primary care in ophtho- simple corrective lenses, eye screenings, and the like- but this function is largely filled by optometrists while ophthos focus on surgery, a secondary treatment of underlying disease.
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Well, at least one branch of the federal government.

As cited above, for example, the federal government [HRSA, Medicare] do not consider psychiatry as a primary care specialty.

Psychiatric conditions are very often secondary to other disease processes, lifestyle choices, or sociological issues.
 
Mad Jack said:
Per the NHSC and federal government, psych qualifies as primary mental health services, and thus primary care.

Most ophthalmological and nephrological disease is secondary to an underlying disease process or lifestyle issue. Mental illness is usually a primary issue that is not a the result of another disease process, but which can lead to the development of disease, disability, and death if unchecked. Nephrological and ophthalmological disease is generally the result of unchecked disease and lifestyle. There is one service that would largely be considered primary care in ophtho- simple corrective lenses, eye screenings, and the like- but this function is largely filled by optometrists while ophthos focus on surgery, a secondary treatment of underlying disease.
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And here I was, under the impression that doctors determined what medical care was, rather than the government
 
Psai said:
And here I was, under the impression that doctors determined what medical care was, rather than the government
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Primary care is a nebulous term that can mean, quite frankly, damn near whatever you want it to mean. I was just using the NHSC definition because their scholarship is probably one of the best reasons to go into primary care.
 
Mad Jack said:
Per the NHSC and federal government, psych qualifies as primary mental health services, and thus primary care.

Most ophthalmological and nephrological disease is secondary to an underlying disease process or lifestyle issue. Mental illness is usually a primary issue that is not a the result of another disease process, but which can lead to the development of disease, disability, and death if unchecked. Nephrological and ophthalmological disease is generally the result of unchecked disease and lifestyle. There is one service that would largely be considered primary care in ophtho- simple corrective lenses, eye screenings, and the like- but this function is largely filled by optometrists while ophthos focus on surgery, a secondary treatment of underlying disease.
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Using the ophthalmology vs optometry example, I would consider psychiatry to be the specialists (optho) vs psychology to be the general primary care of mental health. Most psychiatrists today are not doing intensive behavioral therapy sessions - they are managing medicines, doing ECT, and other specialized treatments.
 
Hey there—I'm the author of "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school," which someone linked to earlier in this thread (and a bunch of people have been following that link in the last couple days). Many of the answers here are reasonable, but I'd emphasize two points:

1. Mathematically speaking, there aren't enough specialty residency slots to accommodate all med school grads, so a fair number of people must end up as PCPs (or skip residency, which is often financially disastrous).

2. PCP residencies are mostly short. You get the money early. I lived next to a guy who was in PGY-10 (!). To be fair he's now a microvascular surgeon and makes a zillion dollars a year, but damn. He was at it a long time. I know another woman who quit after her third year of surgery residency. Had she done a family residency, she'd at least be able to make a fair amount of money working half time as a family doc. Now she's outside of medicine altogether.

Everyone starting med school is of course planning to be "above average," as in Lake Woebegone, but not everyone can be in a given circumstance.
 
PL198 said:
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.
Click to expand...

This is highly speciality specific. For instance, in EM, LORs and grades are supposedly most important. Step1 is used as a screening tool for many programs. On the other hand, step1 is king when it comes to IM. So yeah, the importance of board scores can't be overly generalized in my opinion.
 
JimmyB123 said:
This is highly speciality specific. For instance, in EM, LORs and grades are supposedly most important. Step1 is used as a screening tool for many programs. On the other hand, step1 is king when it comes to IM. So yeah, the importance of board scores can't be overly generalized in my opinion.
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I think the programs that say they use it as a screening tool just say that so people don't understand its true importance. Not to mention the idea that a standardized exam basically determines someones career choices is an extremely morose idea.

My opinion, is that if anything, the importance of step 1 is understated, not overstated. I hear countless testimonies of people seeing their step 1 score written and circled on paper in the interviewer's hands. The PDs don't have 1000 hours to go over every students academic creds and a step 1 score is a really easy way to have a reasonable evaluation of someone's basic science knowledge and their effort. LOR and grades? I don't buy that at all. Both of those are 100x more subjective than your board score.
 
JP2740 said:
Hi Mr. SouthernSurgeon, have you been in for your yearly lipoma and gallstone check?
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So dermatologists are also primary care because of routine skin screenings?
 
who goes to a dermatologist for yearly skin screenings? only at risk people, right?

a cardiologist isn't primary care because a dude checks up with them every once in a while after an MI
 
As someone who just signed his contract, I can tell you there are a lot of benefits to primary care if you care about lifestyle. My residency was pretty relaxed and I got to have my choice of cities that I wanted to live in. I'd say I averaged 55 hours a week and only worked 14 weekends during my 3rd year. I have gotten to spend a lot of time with my family during residency. As an attending, I will be working 4.5 days a week, seeing 18 patients a day, and I will start at $189,000 a year with 21% more into retirement. The benefits are also amazing. I can cut down to 32 patient hours a week if I choose in the future. I will have no call (not even phone calls) and essentially no weekends (about 3 paid urgent care shifts a year at $100/hr). I also got to pick not only the city I wanted live in, but a clinic 2 miles from the exact neighborhood where I wanted to live. That sounds like a good deal to me...
 
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100 dollars an hour for urgent care? you're getting robbed bro
 
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PL198 said:
I think the programs that say they use it as a screening tool just say that so people don't understand its true importance. Not to mention the idea that a standardized exam basically determines someones career choices is an extremely morose idea.

My opinion, is that if anything, the importance of step 1 is understated, not overstated. I hear countless testimonies of people seeing their step 1 score written and circled on paper in the interviewer's hands. The PDs don't have 1000 hours to go over every students academic creds and a step 1 score is a really easy way to have a reasonable evaluation of someone's basic science knowledge and their effort. LOR and grades? I don't buy that at all. Both of those are 100x more subjective than your board score.
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i think people misunderstood what "using it as a screening tool" means

at my mom's residency they look at all applicants above 230

but after the screening, the Step 1 score is still used to evaluate applicants

a charismatic 230 will beat out a 240 or 245, but isn't going to take a 260+ spot
 
BobbyB said:
i think people misunderstood what "using it as a screening tool" means

at my mom's residency they look at all applicants above 230

but after the screening, the Step 1 score is still used to evaluate applicants

a charismatic 230 will beat out a 240 or 245, but isn't going to take a 260+ spot
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Eh... from someone who's been on the other end of the interview trail, it depends on who is doing the selecting, really. Our Dept. Chair likes to angle for the high scores and the top tier schools to look nice on a resident list, but he isn't really clinically involved. Everyone else from the PD to the clinical profs to the senior residents pretty much looking to find the people who are going to have the lowest chance of being a d-bag over the course of a residency. We need people who are going to fit in both the personality profile of the residents and with our patient population (some experience working with URMs is a massive plus).

We aren't just looking for students to teach when we select residents. We're looking for co-workers who we're going to be spending A LOT of time with over the next few years. We are just one program but we will and have taken 225s over 270s for a number of reasons.
 
WingedOx said:
Eh... from someone who's been on the other end of the interview trail, it depends on who is doing the selecting, really. Our Dept. Chair likes to angle for the high scores and the top tier schools to look nice on a resident list, but he isn't really clinically involved. Everyone else from the PD to the clinical profs to the senior residents pretty much looking to find the people who are going to have the lowest chance of being a d-bag over the course of a residency. We need people who are going to fit in both the personality profile of the residents and with our patient population (some experience working with URMs is a massive plus).

We aren't just looking for students to teach when we select residents. We're looking for co-workers who we're going to be spending A LOT of time with over the next few years. We are just one program but we will and have taken 225s over 270s for a number of reasons.
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guess it depends on the chair's influence on the final decision

also, i'm talking about applicants whose only difference is charm and board scores. i'm sure if there were red flags on a 270, it would be a totally different story.
 
WingedOx said:
Eh... from someone who's been on the other end of the interview trail, it depends on who is doing the selecting, really. Our Dept. Chair likes to angle for the high scores and the top tier schools to look nice on a resident list, but he isn't really clinically involved. Everyone else from the PD to the clinical profs to the senior residents pretty much looking to find the people who are going to have the lowest chance of being a d-bag over the course of a residency. We need people who are going to fit in both the personality profile of the residents and with our patient population (some experience working with URMs is a massive plus).

We aren't just looking for students to teach when we select residents. We're looking for co-workers who we're going to be spending A LOT of time with over the next few years. We are just one program but we will and have taken 225s over 270s for a number of reasons.
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do you really get that many dbags? it seems kinda sad to me that just not being a tool puts you a leg up on competition
 
PL198 said:
do you really get that many dbags? it seems kinda sad to me that just not being a tool puts you a leg up on competition
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The d-bag concern is a little hyperbolic (though it exists... we have one out of 35ish residents who fits that description and it creates A LOT of problems, so we're a little hypersensitive to it this year)

The more likely thing that will trump your numbers is basic concern about your social skills, which is something that is WAY WAY more common. There's more than a few high stat (and low-stat if we're honest) applicants who are just plain odd. We had a "research track applicant" dinner a couple years back that seemed like an Asperger's convention.

FWIW, there are sometimes just some applicants who don't have the world's greatest numbers who impress us when we meet them. The issue is more about people on the lower end rising up than people on top falling.
 
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BobbyB said:
guess it depends on the chair's influence on the final decision

also, i'm talking about applicants whose only difference is charm and board scores. i'm sure if there were red flags on a 270, it would be a totally different story.
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There's a power play that goes on about our chair's influence that's too complicated to be described here. Basically, back before I arrived he pre-matched an applicant he liked who turned out to be an epic disaster for us, so the match list is something he's been forced to cede at least some influence over.

As for the second point, that's kind of like the "two identical applicants except for [URM status or whatever]" threads that pop up over on pre-allo. It's not really a real-life comparison. There are concerns of varying degrees about every applicant that walks thru the door. "Red Flag" is kind of a black and white way of looking at things.
 
Psai said:
And here I was, under the impression that doctors determined what medical care was, rather than the government
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insurance companies have been doing that for decades now
 
seminoma said:
Can't believe only 3 people liked this.
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Know what's cool? As you go through med school, you finally figure out what some people's name means! 35% are malignant counter of gonadocytes. Use radiation to treat. :bucktooth:
 
W19 said:
Is it even possible to make 250k+/year as a FM physician working <60hrs/wk?
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kinda strange to go from " everyone doesn't want to be a specialist to this" which would seem to indicate otherwise

 
Why would anyone do primary care?

Because primary care/hospitalists are making bank. You can outearn several medicine specialists being in primary care. If you do the math on fellowship vs just going into hospital medicine or primary care, the finances do not at all add up in favor of fellowship for any I.M. specialty.
 
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Private practice in my area, which some considers to be rural in a sense are constantly looking for FM /IM for 4.5 clinic days, no rounding, 1:20 call, opportunity to make shareholder / partners, starting $230K salary, 6 weeks vacation, 2 weeks CME, $3K moving expenses...all major holidays off. Yeah, that is why I'm going into FM.
 
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Lev0phed said:
Why would anyone do primary care?

Because primary care/hospitalists are making bank. You can outearn several medicine specialists being in primary care. If you do the math on fellowship vs just going into hospital medicine or primary care, the finances do not at all add up in favor of fellowship for any I.M. specialty.
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I agree with your point the FM/Hospitalist can out-earn most IM sub-specialties, but I think fields like GI, Cards, and Heme Onc will still win by a large margin over a lifetime of work.
 
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