Why would anyone go into primary care nowadays?

[530364]

Thy name is irony.

Except I'm an MSII. I just never changed my name because I didn't care.

---

Members don't see this ad.

 

[530364]

Feel better?

Where's my snickers? If I actually got one then I might feel better...

 

[username456789]

Except I'm an MSII. I just never changed my name because I didn't care.

You're surely trolling, but tco's comment had nothing to do with your username.

Go back and re-read your cute little rant and realize how much it describes exactly what you did here. The irony is that you were essentially the only person doing everything you were angrily condemning.

 

[tco]

I always thought that lead was a dense element.

 

[KanyeWes]

I'm venting. I'm annoyed because I come on here occasionally to find useful information and respectful conversations and have to wade through the same bull**** posted by the same people. If you don't have something useful to contribute to the conversation or can't say it in a respectful way then just don't say anything. This could be a great resource but it is filled with 99% of meaningless crap. Vent over.

well, there is always osteo forums if you don't like the allo.

just saying

 

[BestDoctorEver]

No one is talking about corporations, tax writeoffs, and capital gains which is taxed differently than income. As an individual living in this country, you owe federal income tax, just like everyone else, no matter what your salary may be. The other side could make the argument that they don't wish to finance food stamps, Medicaid, etc. for those who are lazy and abuse the system. Tough. Both of you have to pay federal income tax, period.

Guess what! I don't want to finance food stamps and Medicaid for any able body either....

 

[dienekes88]

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??

Posted using SDN Mobile

Because people like primary care. And don't want to deal with hospital medicine.

It's the same reason as: why does anyone want to do ENT? Or Vascular Surgery? Because after looking at everything, the operations and disease processes are interesting, and the lifestyle is acceptable.

Do concierge and do it big mang

Yeah. You can keep a pretty small practice, limit overhead, provide better care, etc.

One of the things that attracted me to primary care/concierge was the fact that the couple concierge physicians I knew still admitted their own patients to the hospital, rounded on them, and provided basic specialty care, e.g. guideline-directed heart failure management, COPD management, etc. Having said that, I am in a surgical field.

You won't get "ragged on" for choosing primary care at an MD school. Not sure why you think you would.

Yeah. I think it's like being vegetarian: People don't really understand it; know it would be better for themselves and for the environment; but choose not to do it for a variety of reasons.

 

[530364]

You're surely trolling, but tco's comment had nothing to do with your username.

Go back and re-read your cute little rant and realize how much it describes exactly what you did here. The irony is that you were essentially the only person doing everything you were angrily condemning.

Arguing with you isn't worth my time. I'll see myself out. Apparently you are all ok with the crap and disrespect here. I'll go elsewhere. Peace.

 

[Promethean]

Thy name is irony.

Except that Coloradopremed had a post count of around 5 before coming to this thread... despite having been here since Feb 2013. Took the injunction to LURK MOAR to heart. Hasn't wasted breath on every stupid argument to grace this place in that time.

 

[tco]

Except that Coloradopremed had a post count of around 5 before coming to this thread... despite having been here since Feb 2013. Took the injunction to LURK MOAR to heart. Hasn't wasted breath on every stupid argument to grace this place in that time.

Yeah, my 250 posts per year are pretty ridiculous.

I see why you're targeting me with this idiotic comment.

This thread is rapidly deteriorating. Out before the mods come sweeping through with their new found gusto for banning for derailing threads.

 

[Promethean]

Arguing with you isn't worth my time. I'll see myself out. Apparently you are all ok with the crap and disrespect here. I'll go elsewhere. Peace.

Aw, don't go. I mean, I get why you would. But that is why the voices of reason are so few around here. They get shouted down by the full time trolls, and then realize that if they just stop participating, they stop wasting their time here.

 

[DermViser]

Patriotic duty my a$s when most rich people hire an arsenal of lawyers/accountants to do their taxes so they can get their effective rate to the lowest amount possible... I am not ready to give the government my money to finance individual/corporate welfare, give foreign countries that don't even like us.

Guess what! I don't want to finance food stamps and Medicaid for any able body either....

Yup, I'm not at all surprised that you don't want to finance things that help people underneath you, meanwhile perfectly ok with those above you paying more, while you not wanting to contribute nothing. I'm shocked that the BestDoctorEver, would feel that way.

 

[Promethean]

Yeah, my 250 posts per year are pretty ridiculous.

I see why you're targeting me with this idiotic comment.

I'm responding to your idiotic comment, not targeting you. Colorado's complaint was that he sees the same 10 or so people driving most of the drama. I agree. I have ignored them, and now find the forum much more usable. So, calling his complain ironic was stupid, since he has posted so little himself.

 

[DermViser]

Arguing with you isn't worth my time. I'll see myself out. Apparently you are all ok with the crap and disrespect here. I'll go elsewhere. Peace.

 

[tco]

I'm responding to your idiotic comment, not targeting you. Colorado's complaint was that he sees the same 10 or so people driving most of the drama. I agree. I have ignored them, and now find the forum much more usable. So, calling his complain ironic was stupid, since he has posted so little himself.

By that logic, 40% of his posts to that point were him complaining.

Seriously, getting off now. Wards in the morning.

 

[AlbinoHawk DO]

AlbinoHawk, I get what you're saying and I certainly identify with a lot of it too. That said, I was in a similar position to you and thought I knew best due to my experience and meager upbringings.

The fact is, though, that at some point you'll likely come to realize that, as you progress through the years of medical education and residency training, that outlook is very likely to change. If you take out loans of any significance, that alone begins to really weigh heavily on you and your life plans. Not to mention the slow realization that many people with far less education and medical experience than you are employed solely to limit what you may do and ensure that you get paid less for doing more.

There are a lot of frustrations inherent in medicine. Many of them are not necessarily unique to medicine and can be experienced in prior jobs/careers as well. But there are a significant number of hurdles that are indeed specific to our career paths, and eventually it's very easy to get discouraged.

Of course, I hope that you can keep your perspective throughout your many years of training. I really do. When I was in your shoes, I was absolutely the first one in line to proudly proclaim that I would gladly sign up to work for the lower end of doctor salaries. Hell, that's a whole boatload more than my parents ever made, combined. Maybe it's the ever-increasing costs of medical education combined with the high interest and declining reimbursement/respect/autonomy . . . but man, this **** really starts to kick you around.

Thank you for your response. I'm definitely going to keep these things in mind.

My argument is not so much to just ignore the money side of the equation. I understand it must be frustrating to do 4 years of residency and the guy next to you does the same amount of time in another specialty and starts out making 50k+ more than you. My argument is more that at the end of the spectrum physicians still come out economically better than most other professions out there, and if someone genuinely loves a field, they should give it a shot. I also understand that you can't truly "know" until you're in the middle of it all if you've truly made the right choice.

I hope this clarifies my point a little bit.

 

[calvnandhobbs68]

http://www.nytimes.com/2014/07/03/health/Vaccine-Costs-Soaring-Paying-Till-It-Hurts.html?_r=1

lol that pediatrician is doing better than most of us though...again why you can't take financial advice from attendings

"Those in the refrigerator recently cost $70,000, she said — “more than I paid for four years of medical school.”

 

[KnuxNole]

Why did I choose primary care?
1) I love outpatient medicine. I want adequate, strong training in the outpatient setting so that I could practice good medicine in the clinic. For some, it's disheartening when there are non-compliant patients, chronic illnesses, yearly physicals/well child checks. I personally don't mind these. I like to do what I can to prevent people from going to the hospital. There are people that don't change, but there are that do. And that goes for a lot of different fields. And having to use the ED as a PCP...I'm sure the ED people would be happy to spend their time on real emergencies compared to "Like OMG, I have the sniffles, let's go to the Level 1 trauma ED! Oh, and I'll register my 2 kids who need school physicals, and tell the triage nurse they have fever and sharp belly pain to be seen faster!". Also, I do not like inpatient medicine. In residency, I don't mind because its training requirements. But, it's not something I enjoy. I don't like the setting.

2) I do not want to specialize. I was one of those people that when I was on specialty rotations, felt discouraged that they only focused on one problem. I know the stigma of FM as "know a little about a lot", but I honestly think the more you work hard in residency, the more you learn and bring into your practice.

3) In terms of money, it's not as high paying compared to other specialties, but the money can be good. I don't want to work in a huge metropolitian city. I prefer a smaller city or suburban environment. Having loans forgiven is a sweet deal that I also tend to consider when I get out of residency!

4) Hours are decent. Surgery and OBGYN taught me taking frequent call and being up and illegal hours(5am) is not my style. I HATE, HATE, HATE that ****. I like waking up in the morning, but not that early! Staying late isn't a big deal(stuff happens), but I prefer a field where I wasn't on call at 2am to be in the hospital operating, or admitting several patients.

There might be others, but I am too tipsy to think right now.

I wouldn't say that it's a death sentence to choose a primary care field, but if you enjoy it, don't let things scare you. In terms of money, well if you really want to make money, you'll find a way. Also, in terms of FM not being "lucrative", I don't give a ****. That's my brief response if I get asked why did I choose this instead of a highly competitive field. Protip1: This has never happened before. Maybe I either have been around cool peeps, or people don't blurt this out IRL. Protip2: People in my residency, including myself didn't barely pass med school and the boards. Besides, just coasting through med school gives you a horrid foundation for intern year, which although FM is less competitive, is still something people care about....since it's not cool to have interns kill patients left and right!

 

[BestDoctorEver]

Yup, I'm not at all surprised that you don't want to finance things that help people underneath you, meanwhile perfectly ok with those above you paying more, while you not wanting to contribute nothing. I'm shocked that the BestDoctorEver, would feel that way.

Where do you get that I don't want to contribute nothing? I never said I did not want to contribute... I have been contributing since I was 21... I am just not ok with other people gaming the system by not paying taxes and put their money in banks in Panama/Switzerland etc... If you think this is ok, that says a lot about you; and frankly it is disturbing to see a physician who seems to be ok with people cheating the system...

 

[mcloaf]

I do need a hobby. There are people on SDN who seem to have nothing better to do than rack up high post counts without really contributing anything of substance. I don't intend to be one of them. But this week the fam is away and I am really, really bored, and figured a few flame wars were cheaper than going out. SDN distracts me from checking my inbox every 20 minutes to see if my AACOMAS app is verified yet. So, I can space that out to every 30 or so.

Dude stop trolling the allopathic students forum. Nobody here is interested in hearing an impassioned declaration of why "I chose primary care" from a pre-DO who hasn't even started medical school yet. I say more power to you for being interested in primary care and I hope you find a fulfilling career in medicine regardless of the field in which you land, but this is too much.

 

[BestDoctorEver]

Suddenly PCP has become a pariah in SDN... What will be next?

 

[DermViser]

Where do you get that I don't want to contribute nothing? I never said I did not want to contribute... I have been contributing since I was 21... I am just not ok with other people gaming the system by not paying taxes and put their money in banks in Panama/Switzerland etc... If you think this is ok, that says a lot about you; and frankly it is disturbing to see a physician who seems to be ok with people cheating the system...

Who said I'm ok with corporations gaming the system? We're talking about paying federal income tax. You're the one who went into a tangent rant about it. Point is every individual who works should pay federal income tax. PERIOD.

 

[DermViser]

Suddenly PCP has become a pariah in SDN... What will be next?

PCPs aren't pariahs. However, their satisfaction rates speak for themselves, and there are other avenues that can help you reach that destination with a lot less heartache. You'll figure that out soon enough, when you finish your MS-3 year and apply to become the BestDoctorEver.

 

[DermViser]

Dude stop trolling the allopathic students forum. Nobody here is interested in hearing an impassioned declaration of why "I chose primary care" from a pre-DO who hasn't even started medical school yet. I say more power to you for being interested in primary care and I hope you find a fulfilling career in medicine regardless of the field in which you land, but this is too much.

Thank you for putting his post into context. Makes perfect sense now.

 

[KanyeWes]

Dude stop trolling the allopathic students forum. Nobody here is interested in hearing an impassioned declaration of why "I chose primary care" from a pre-DO who hasn't even started medical school yet. I say more power to you for being interested in primary care and I hope you find a fulfilling career in medicine regardless of the field in which you land, but this is too much.

sounds like over compensation to me

 

[Baller MD]

Yup. I do. That doesn't mean that I didn't graduate from an Ivy with a decent GPA and score better on the MCAT than anybody giving me crap in this thread.

I want to go to a DO school because I think there will be fewer stat obsessed douchebags there. I think that as a DO, I won't get ragged on for actively choosing a primary care specialty without concern about the financial implications of that choice. I work with some exceptional doctors who are DOs, and I have seen that they are not any less than their MD colleagues in the eyes of the people who really matter, that is our patients and their families.

Thanks for the daily lulz.

 

[BestDoctorEver]

PCPs aren't pariahs. However, their satisfaction rates speak for themselves, and there are other avenues that can help you reach that destination with a lot less heartache. You'll figure that out soon enough, when you finish your MS-3 year and apply to become the BestDoctorEver.

I don't see the overall satisfaction rate of some other specialties that good either, but for some reason PCPs always seem to be an easy target by many members here, and you appear to be the one leading the band...

fig25.jpg

 

[DermViser]

Thanks for the daily lulz.

It's always nice when the idealistic thinking from Pre-Allo/Pre-Osteo wafts its way into Allo.

 

[DermViser]

I don't see the overall satisfaction of some other specialties that good either, but for some reason PCPs always seem to be an easy target by many members here, and you appear to be the one leading the band...

fig25.jpg

Try again:

 

[BestDoctorEver]

@DermViser... We are using different sources and I believe yours is bogus...

 

[KanyeWes]

Try again:

I am so jelly of derm

 

[KanyeWes]

sounds like over compensation to me

LOL! me calling out people for overcompensating.

the delicious irony.

 

[DermViser]

@DermViser... We are using different sources and I believe yours is bogus...

In your poll,
Family Medicine ---> 50% are satisfied, 32% would choose their specialty over again
Internal Medicine ---> 47% are satisfied, 27% would choose their specialty over again

You can believe it's "bogus" bc it doesn't comport with your beliefs. Doesn't change anything re: physician satisfaction rates.
http://www.practicelink.com/magazine/vital-stats/whos-the-happiest/

 

[KanyeWes]

Yup. I do. That doesn't mean that I didn't graduate from an Ivy with a decent GPA and score better on the MCAT than anybody giving me crap in this thread.

I want to go to a DO school because I think there will be fewer stat obsessed douchebags there. I think that as a DO, I won't get ragged on for actively choosing a primary care specialty without concern about the financial implications of that choice. I work with some exceptional doctors who are DOs, and I have seen that they are not any less than their MD colleagues in the eyes of the people who really matter, that is our patients and their families.

on a serious note, I hope being a do who wants to do primary care doesn't eat you up.

had friends who lied to themselves about this, and it ate them up on the inside. they were the most miserable.

you can lie to us,but you cannot lie to yourself.

 

[BestDoctorEver]

In your poll,
Family Medicine ---> 50% are satisfied, 32% would choose their specialty over again
Internal Medicine ---> 47% are satisfied, 27% would choose their specialty over again

You can believe it's "bogus" bc it doesn't comport with your beliefs. Doesn't change anything.
http://www.practicelink.com/magazine/vital-stats/whos-the-happiest/

My point was that there are other specialties that are not satisfied either, but FM/IM seem to be your only target... We get it... You smart. You are going to be a dermatologist with a 9-5 M-F job. Give the PCPs bashing a rest!

 

[DermViser]

My point was that there are other specialties that are not satisfied either, but FM/IM seem to be your only targets... We get it... You smart. You are going to be a dermatologist with a 9-5 M-F job. Give the PCPs bashing a rest!

No one here is bashing PCPs (as you interpret it). Have you not seen the post and title of this **** thread? If not, go back and read it. Even FM and IM can do 9 to 5 as well. The point is that IM/FM are the LOWEST in physician satisfaction which is bared out by surveys and is consistent. It has NOTHING to do with my view of IM or FM. Yet you believe the survey I cited was "bogus", while your survey shows the same thing.

 

[Frazier]

@DermViser... We are using different sources and I believe yours is bogus...

No one here is bashing PCPs (as you interpret it). Have you not seen the post and title of this **** thread? If not, go back and read it. Even FM and IM can do 9 to 5 as well. The point is that IM/FM are the LOWEST in physician satisfaction which is bared out by surveys and is consistent. It has NOTHING to do with my view of IM or FM. Yet you believe the survey I cited was "bogus", while your survey shows the same thing.

Dermviser's Table isn't bogus, IMO. Medscape provides a lot of information year in and year out. Granted the table posted above is from 2011, you will find that the trends hold true longitudinally for the most part (for example derm is still top in satisfaction and IM is sadly still near the bottom).

Note the 4 tables on the right hand side. There is more recent satisfaction data. Burnout is also perhaps relevant to the discussion. General internists have it tough.

You can ignore all the highlighted psychiatry fields (as that's the subforum where I took this from).

 

[DermViser]

Dermviser's Table isn't bogus, IMO. Medscape provides a lot of information year in and year out. Granted the table posted above is from 2011, you will find that the trends hold true longitudinally for the most part (for example derm is still top in satisfaction and IM is sadly still near the bottom).

Note the 4 tables on the right hand side. There is more recent satisfaction data. Burnout is also perhaps relevant to the discussion.

Ignore all the highlighted psychiatry fields (as that is the subforum where I took this from).

As an aside, Psychiatry has EXCELLENT physician satisfaction ratings as well.

 

[NontradCA]

PCPs aren't pariahs. However, their satisfaction rates speak for themselves, and there are other avenues that can help you reach that destination with a lot less heartache. You'll figure that out soon enough, when you finish your MS-3 year and apply to become the BestDoctorEver.

What destination is that? I think much of these forums views medicine as in the decline and of no benefit to the patient. "The best course of action would be to work as little as possible for the greatest amount of money." That's the rhetoric of SDN.

 

[DermViser]

What destination is that? I think much of these forums views medicine as in the decline and of no benefit to the patient. "The best course of action would be to work as little as possible for the greatest amount of money." That's the rhetoric of SDN.

Destination = Practicing primary care

Apparently the govt. and architects of the healthcare reform law feel the same way as they have directly stated that PCPs, as heading the PCMH, will be more administrative and as managers, rather than seeing patients full-time. Forget about time and money. If you actually TALK with primary care physicians, you will be able to find out for yourself, why the satisfaction rate is so low.

As I already stated Psychiatry also has high physician satisfaction.

 

[BestDoctorEver]

What destination is that? I think much of these forums views medicine as in the decline and of no benefit to the patient. "The best course of action would be to work as little as possible for the greatest amount of money." That's the rhetoric of SDN.

I am glad that I am not the only one seeing that... This rhetoric has been promulgated here by many, but @DermViser has been the leader... I guess for him/her everyone should try to get into a speciality in which they do the less amount of work for the maximum amount of money, and everyone who spends a day in SDN knows the kind of disdain s/he has for PCPs...

 

[DermViser]

I am glad that I am not the only one seeing that... This rhetoric has been promulgated here by many, but @DermViser has been the leader... I guess for him/her everyone should try to get into a speciality in which they do the less amount of work for the maximum amount of money, and everyone who spends a day in SDN knows the kind of disdain s/he has for PCPs...

You know nothing about me. I know it's hard for you to imagine but one can actually enjoy the intellectual subject of their field of choice AND have a good lifestyle. This isn't just limited to Derm but also to Ophtho, Anesthesiology, Radiology, Path, PM&R, Psych, etc. but also to subspecialty fellowships: Allergy & Immunology, Rheumatology, Breast Oncology (Surgery), etc.

--NPs have already said and convinced the govt. that a) everyone should work at the "top of their license" with all these new patients coming with healthcare reform and b) NPs are primed to deliver good if not better primary care than physicians and that physcians should specialize to be at the top of their license

--Meanwhile you say the survey I posted up is "bogus" regarding physician satisfaction of primary care doctors bc you refuse to believe them (while the physician survey that YOU posted shows the EXACT SAME thing, including the % of those who would do their field again). See @Frazier's posted survey as well (unless you believe he is lying)

--Jonathan Gruber (the architect of Obamacare) has said himself in drafting the law that he believes that PCPs should do 1/3 clinical care - 1/3 answer emails/phone calls - 1/3 administrative, while overseeing NPs and PAs who would be the main ones seeing patients.

And with decreasing reimbursement and autonomy across the board, you're shocked that American medical students are heading into specialties, fellowships, as well as practice models (that includes FM and IM) that allow for a better lifestyle? You interpret all of this as me having "disdain" for primary care? I'm sorry actual facts on the ground are disconcerting to you, but before you get on your pedestal about how medicine should be maybe you should get a little more experience under you belt, as the BestDoctorEver, considering you just started Anatomy.

 

[BestDoctorEver]

@DermViser... Why did you go into medicine? I guess it's always about you as you stated many times in this forum you are fine about some people not having healthcare , thus dying needlessly. I know for some people it's a zero-sum game--patients and everyone else be damned!

 

[DermViser]

@DermViser... Why did you go into medicine? I guess it's always about you as you stated many times in this forum you are fine about some people not having healthcare , thus dying needlessly. I know for some people it's a zero-sum game--patients and everyone else be damned!

What are you talking about? What part of my prior post is wrong? Why are you invoking Burnett's Law already?

 

[Promethean]

Dude stop trolling the allopathic students forum. Nobody here is interested in hearing an impassioned declaration of why "I chose primary care" from a pre-DO who hasn't even started medical school yet. I say more power to you for being interested in primary care and I hope you find a fulfilling career in medicine regardless of the field in which you land, but this is too much.

I am not trolling. It was reading this forum that convinced me to go the DO route. I had been considering MD, but given what I have seen here, I am on the fence about whether I want to just withdraw my AMCAS entirely.

 

[BestDoctorEver]

I am not trolling. It was reading this forum that convinced me to go the DO route. I had been considering MD, but given what I have seen here, I am on the fence about whether I want to just withdraw my AMCAS entirely.

There are some people in here who look down on PCPs, but the relentless attacks on PCPs have been coming from one person-- @DermViser

 

[DermViser]

There are some people in here who look down on PCPs, but the relentless attacks on PCPs have been coming from one person-- @DermViser

Just like I thought. You couldn't actually refute any of my statements in the actual post, so it's easier for you to make things up about me. No one is "attacking" PCPs and what they do. I am stating the facts on the ground on what primary care has to deal with and is dealing with (and I'm not talking about salary here). Hence if you look at match lists - few medical students are going into primary care (most who go into IM and Peds have the intent to subspecialize). That's why established PCPs more and more are turning to direct pay/concierge care practice models.

Feel free to click the "Ignore" button for me, @BestDoctorEver.

 

[BestDoctorEver]

No need on my part to click the 'Ignore' button, @DermViser. It's a debate and nothing harmful is being done here...

 

[DermViser]

No need on my part to click the 'Ignore' button, @DermViser. It's a debate and nothing harmful is being done here...

So then you just wish to argue and make up my positions. Fine. Go ahead.

 

[BestDoctorEver]

So then you just wish to argue and make up my positions. Fine. Go ahead.

This is from you....

In general, my feeling is if you are aiming for primary care - General IM/General Peds/Family Med, then NP or PA is a much better investment, esp. from a student loan standpoint. You can have a very good lifestyle, with good pay being a PA and doing primary care, and if you ever get bored you can always switch over to a specialty field. That's what is so great about PA is its flexibility