Umm… I hope I like family medicine better, since I’m in family medicine residency and all…
I like kids a LOT, but I don’t like pediatric medicine enough to do nothing but that forever. I liked it enough to do it part time as a family doc. In family medicine, you have the option of working in a place that sees lots of kids, and you can essentially do both.
You’re lucky, though, greyface, because as a nurse practitioner you are free to change your specialty if you decide you don’t like it. But it sounds like you’re not finished with your training yet, so don’t jump the gun. You’ll figure it out, I’m sure.
Some of them are, if they went to family medicine residency (like cranquis). While there are a few urgent care fellowships out there, most urgent care docs usually come from family medicine, internal medicine, peds, or ER backgrounds.
Hi! This summer I have shadowed a general and colon and rectal surgeon as well as a cardiologist. I’ve been trying to learn about the different fields of medicine and hopefully understand the kind of doctor I would like to become one day. I have noticed that something I really enjoyed was patient interaction and seeing familiar faces. Is this found in every field of medicine?(I would appreciate if you could answer this privately. Thanks) - anon
Um, Greyface, I can’t answer things privately if you’re anonymous. Sorry. So it sounds like you like what we call continuity of care. There is some aspect of continuity in most specialties, but you’ll find the most continuity in primary care. You will see patients for all of their problems rather than those pertaining to one organ system like a specialist would. And you will have the opportunity to see them over many years’ time if you go into Family Medicine or Peds or Internal Medicine. In family medicine you can see entire families (duh) and do cradle to the grave care. For example, I have one family in which I have admitted grandma to the hospital and managed her diabetes and hypertension, followed mom all during her pregnancy, delivered her baby, and now take care of grandbaby, mom, and mom’s 3 siblings as well. All in the span of 2 years. So call some family docs and do some continuity shadowing!
Why did you opt to become a physician instead of a family nurse practitioner? I’m debating between the two and scared of medical student debt! - anon
Links for why I chose to be a doctor, and why I didn’t go the NP or PA route. Yes, the debt is terrible, but NP and PA school ain’t cheap either! Don’t be terrified of the debt. There are plenty of ways to pay for student loans.
I just read this article that said being a doctor is a million-dollar mistake because of the high price of medical school and the drop in salaries. Also doctors apparently have to do way more paperwork than years before. Do you have any worries about this too? I’m still in high school, but I was considering becoming a pre-med student and going to medical school in the future. Now I feel discouraged. Is going to medical school still worth it? Do you enjoy your job?-anon
It is slightly worrysome, but I wouldn’t let it keep me from becoming a doctor. I love my job. If you enjoy medicine and can’t see yourself doing anything else, then it will be worth the cost for you. And it’s not like we make chump change. If you live within your means and focus on paying off your loans before buying vacation homes and fancy cars, it absolutely can be done without making your family starve to death.
I have hope that our system will change and that the outrageous cost of medical education will somehow decrease over the next decade or so. It’s true that we do have a ton of paperwork these days, but I also have lots of time for patient care as well (but if Uncle Sam wants to stop killing some rain forests of insurance paperwork, I’d be cool with that too). But don’t forget that there are tons of ways to pay off student loans (or even better, have someone else pay them off for you!) if you’re willing to give up a little more time.
Patient: So are you just doing family medicine or are you going to do something special?
Well I think Family Medicine IS pretty special, so I’m sticking with it!
Rheumatologist (in patient’s room): Solid answer!
Rheumatologist (out of patient’s room): Ugh, I can’t stand those comments. Little does she know that you family medicine residents know WAY more medicine than I ever will. All I have to know is one tiny corner of the world. How do you guys do it?
Specialist attending: Ugh, I’m exhausted from yesterday. I saw a total of 14 patients! That’s the busiest day I’ve had in weeks.
I thought the morning was pretty slow. I saw 9 patients in just 3 hours yesterday afternoon and it wasn’t bad.
Specialist: WHAT?! How many patients do you guys see in a half day?
Wayfaring: I think the limit for 3rd years is 12 or 15 in a half day.
Specialist: Whoa! How do you guys do it?! I only have to deal with one problem and you guys have to deal with multiple problems in each visit! How can you see 20-30 patients a day?
Um, and out in practice it’s more like 30-40.
Specialist: When do you do your notes?!
Wayfaring: In between patients and at home and after work.
Specialist: You guys amaze me. That’s too much work. I can barely manage work and a baby and I only work 4 days a week.
Wayfaring: Well that’s why they pay us…the little bucks.
If you’re interested in doing OB after residency, it would probably be best to go to an OB-heavy residency program (especially one that teaches C-sections, not one that promises that you can get the experience if you work for it —in my experience, that’s usually a lie). The delivery requirements for family med residents has been significantly reduced this year, so if you go to a program that doesn’t have an OB track or that isn’t very OB focused, then you probably won’t get adequate training to practice prenatal care once you graduate.
I’ve thought about doing an OB fellowship, but there aren’t very many in my area of the country, and I’m not super keen on the idea of moving across the country for a year. If I had gone to a program that offered a fellowship, I’d definitely be up for it. My program was trying to get one off the ground, but it got put on hold because they started a different fellowship.
That varies highly depending on what type of practice they have (this is all referring to jobs after residency, of course.)
Some family docs are hospitalists who spend 100% of their work time in the hospital.
Some do outpatient only and don’t spend any time in the hospital.
Family docs who go into “traditional” practice and see their own patients in the hospital may spend 1-2 hours a day in the hospital, not including time spent following laboring OB patients. Then they might work 7-8 hours in clinic, and possibly go back to the hospital after that.
This type of practice is very draining and is becoming rare with the advent of hospitalists. But if you’re in a small practice or share call with a lot of docs, the mixed practice can still be do-able.
Doctor salaries in the US vary widely based on geographic location, hours worked, years in practice, and practice type (outpatient only, inpatient/outpatient, with/without OB, urgent care, hospitalist, with/without nursing home). But yes, I believe the national average for family doctors is around $185,000 a year. For doctors straight out of residency, it’s a bit lower. The Internet tells me that average starting salary is around $140,000, but in the last few years and my residency program, residents have averaged about $175,000 as a starting salary (and not even working in metropolitan areas). It’s a nice jump from the average $40-$50,000 a year that residents average.
Of course in our current system, salary is based on what you bill for, and procedures generally are reimbursed much higher than office visits. So if you do a lot of procedures, especially if you’ve done something like a sports medicine fellowship and have learned to do ultrasound guided injections or have been trained in endoscopy, your take-home pay will likely be a bit higher.
I don’t do tons and tons of referrals, but I do them when they are warranted. I’ve seen some family doctors that do nothing but refer all day. They even send all of their diabetics to endocrinologists because they don’t know how to manage diabetes. That’s pretty sad to me.
The point of a referral is to get the opinion or skills of someone who has more training than you do once you have exhausted your capabilities. We also refer out for procedures or treatments that are outside of our comfort zone or scope of practice. Laziness is not a good reason to refer people to specialists.
For example, I might refer a patient to G.I. if I think they need endoscopy or to cardiology for an echo. But I am comfortable managing diverticulitis or heart failure without their help in most cases. I am very comfortable cutting off moles off of arms, legs, and abdomens, but if it’s huge or super deep or on the face I send them to dermatology or plastic surgery. If I think a patient has a complex or uncommon medical problem, I will begin the work up and order the appropriate labs before I refer them out.
I may also refer out when I have exhausted all the options I am trained in or am comfortable with. I can manage a patients knee osteoarthritis (or back/neck pain) for years with medication, therapy, and injections before I send them to ortho (or neuro) surgery.
I definitely refer out high-risk pregnancies, which would include multiple gestations, severe preeclampsia and gestational diabetes (though I do manage these frequently if they are not severe), moms with multiple complex comorbidities, and certain fetal defects, to name a few.
Sometimes you also need to refer out because a patient requires a drug that is outside your scope of practice to prescribe, like chemo or certain DMARDs for rheumatologic conditions or certain narcotic pain medications.
Occasionally you get a patient who doesn’t trust you or who has read too much on WebMD and has already diagnosed themselves and they request to be referred to a specialist. Generally I will comply with the request but I will also tell them what I expect the specialist will tell them.
I’ve been looking at the NHSC scholarship, and they distinguish between regular family practice and family practice with OB. If a FP does OB care, is the residency longer, or is that included in the regular FP residency? I don’t want to be an OB/GYN, but I’d like to do low-risk OB care along with my FP practice. -drveebs2b
ALL family doctors are required to do a minimum number of deliveries and learn prenatal care. The minimum number of required deliveries just dropped from 50 to 25 because so many family docs end up not practicing OB once they finish residency (hence the plain FP). Some programs will offer an OB track that affords more opportunities for deliveries, OB/GYN procedures, and prenatal care training. To practice FP/OB, you do not have to have any special training beyond your normal 3 years of family medicine residency. Once you graduate, you are considered capable of managing low-risk pregnancies and deliveries. But some people WILL opt to do an extra 1 year OB fellowship after residency to get more experience and to learn to do C-sections (also, a few FP residency programs still teach C-sections).
I really like the idea of having “long term relationships” with patients, so I’m leaning toward Family Med. BUT I also really like kids and women’s health so I guess I was wondering how often family practitioners see kids since there’s pediatrics or do lady stuff because of OB/GYN. -goldroadtonowhere
On an average day in the office, if I see 10 patients, 1 or 2 are there for an OB or GYN issue, and 2 are kids. Some days are more OB and Peds heavy than others, though. Today I saw 1 pregnant lady, 1 recently post-partum lady, 1 lady who was miscarrying, 2 kids, and 5 adults medicine patients.
Family medicine is great because you can sort of tailor your practice toward what you’re interested in and still practice broad medicine. Once you graduate, if you decide you love caring for women and children primarily (as do I), you may join a practice and make a deal that this is the population you will mostly see. Or you can just decide to accept more of a certain demographic of patient into your practice so that you can do more of the medicine you like doing. And after a few years, you’ll also develop a reputation in the community as having a certain niche, and those patients will find you.
Family medicine residency programs also vary a lot on how much of each patient type you see. There are requirements from the accreditation organizations about how many pediatric and OB encounters and procedures you are supposed to have during your residency, so everyone has the same minimum training. But you will find that some programs are more sports medicine heavy, or geriatrics heavy, or OB heavy, for example. I liked mine because it was very solid all across the board. But if you prefer peds/OB, you may be interested to find a program that has extra strong Peds and OB teaching or even special tracks as mentioned above.
The person is a Family Doctor or Family Practitioner or Family Physician.
The specialty is Family Medicine or Family Practice, which is what they call it in medical school.
Our professional organization is called the American Academy of Family Physicians.
We don’t use the term “General Practitioner,” although the term is sometimes used interchangeably with FP by laypeople. Outside of the US, a GP is probably the closest thing to a Family Doc and has a more specific meaning. Inside the US, the term GP is somewhat vague and dates back to the days before Family Medicine was a recognized specialty with its own training requirements. It described doctors who completed a rotating internship year (the mandatory minimum to practice medicine) but not a full residency program (which weren’t then and still aren’t technically required) and couldn’t claim a certain specialty.
In the fall I’ll be a high school senior and I’m really looking to become a doctor. I know I have awhile before I have to pick my specialty but I was just wondering what you do specifically in family medicine? Do you work in a hospital? How long were you in school? Etc and how do you like if so far? - running-to-be-fit
To be a family doctor, I went to 4 years of regular college, 4 years of medical school, and now I’m in my 3rd (of 3 total) year of residency. At the end of this year I will take Family Medicine Boards, pass, and be a board certified family doctor.
Family docs do ALL THE THINGS.
We work in hospitals, clinics, urgent cares, and ERs.
We take care of babies, pregnant ladies, kids, grown ups, and old people.
We manage contraception, pregnancy, post partum care, GYN issues, and erectile dysfunction.
We focus on both preventive care and acute & chronic disease management.
We manage heart failure, liver failure, and kidney failure. All the failures.
We take care of patients with heart attacks and bad lung function and strokes and infections and endocrine and rheumatic disorders.
We treat psychiatric disorders, tackle complex social environments, and deal with law enforcement and social services regularly.
We cut off moles, lance abscesses, sew lacerations, remove toenails, splint breaks and sprains, inject vaccines and steroids, do Pap smears and colposcopies, and sometimes do colonoscopies and minor surgeries.
It’s hard to narrow down to specifics because family medicine is, by definition, a broad specialty. It is a super great specialty and I wouldn’t want to do any other.
Did you ever consider any other specialties? -anon
Back in the days before college even, I wanted to be a forensic pathologist. I was pretty serious about it. Went to see autopsies and errythang. You can read about what changed my mind here. I also briefly considered infectious disease (cuz it fits with my missions aspirations), but ultimately, I’m too easily bored with seeing the same thing over and over again, and I like live patients, so I went with family medicine.
Did you have to decide between two areas of medicine, for example pediatrics vs. surgery? If so how did you make that decision? -anon
Unlike many med students, my specialty decision was pretty easy for me. When I’m making big decisions, I tend to think in very black and white terms, so I didn’t have a lot of internal struggle about my specialty choice. Surgery was never a consideration for me because I enjoy sleep and my personality wasn’t right for surgery. I enjoy peds but also really like adult medicine —the pathology is very different. I like peds enough to do it as a family doc, but not enough to be a pediatrician. Basically, I like a little bit of everything, so I chose the specialty that lets me do a little of everything.
If you’re trying to decide between 2 specialties, make a list of all the things you love and don’t-so-much love about each. Fast forward 15 or 20 years. Will those same things you enjoy sustain you, or do you think you’ll get tired of them? Are the dislikes minor or are they potential deal breakers? Also think about the practice setting options each will offer and the lifestyle each can afford. Think about your own personality and compare it to the personalities of attendings you have seen in each specialty. Which fits you more? Explain the differences to your significant other; which specialty fits the life that the two of you wish to have?
And if you still can’t decide, apply and interview at both. Your interview process may help you decide.
I think Family med, internal med, peds, OB/GYN, general surgery, or emergency medicine would all be very useful in full-time missions, and pretty much any specialty can be used on short term (at minimum). Family medicine covers the widest range of ages and conditions, so it works perfectly for missions. Plus family docs (and pediatricians) tend to put a lot of emphasis on prevention and continuity of care, which typically have not been strong in countries with developing or under-developed medical systems, though it is improving in some places.
Above all, the best specialty for you is the one that you enjoy most. You can use any specialty on the mission field if you are motivated. But I have to push family med a little, right?
I encourage you in the next few years (yes, even residency) to try to find opportunities in hospitals or clinics overseas that are doing continuity care and are working to improve the access to healthcare in their region. Or you can work with your school to try to start some sort of stable continual project where you can help provide people with primary care, rather than have them depend on mobile clinics to hand out short-term supplies of meds. You can help improve the health literacy of the community, train local health workers, nurses, and even doctors, and improve sanitation and clean water supplies in a region. That’s real primary care.
As for me, I’m applying for a 2 year Christian-affiliated post residency medical missions program, which I will talk about more in detail in a few months once I find out if I’ve been accepted. There are several secular and religious affiliated programs out there that are available for further training during or after residency.