Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "family medicine"
This may be a dumb question,but what is the diffrence between a Primary care Physcian and a family medicine physcian?
wayfaringmd wayfaringmd Said:

A primary care physician is a generic term for a doctor who manages a wide array of medical problems including preventive care and chronic disease management.  They will see a patient regularly and repeatedly. This term applies to doctors who are not specialists. Most family doctors are primary care doctors (with the exception of Family docs who work as  hospitalists, urgent care docs, or ER docs). General internists and pediatricians are also considered primary care doctors. 

medmonkey:

My clinic rotation for FM is over, but it was amazing. I loathe living in a non-urban environment (seriously, I need all those fancy stores to live) but I LOOOOOOOOOOVE semi-rural FM and getting to see every age of patient in a day.

I love diabetes and hypertension. I love explaining contraceptives to teens and moms and everyone in between. I love well child physicals and medicare “physicals” and well woman exams. I love that my preceptor handed me a speculum last week and told me to practice my “clickie unclickie” skills, so I could be less nervous about the noise it makes. I love talking with men about BPH. I love the variety of depression and anxiety, and seeing how exercise and the right prescription can help those people get back to their normal and be happy again. 

I don’t love trying to convince parents to get vaccines, or begging a COPD patient to start oxygen or a diabetic to check their feet. I don’t love the hoops to jump through for insurance. I don’t love hearing the patients who treat themselves badly and don’t want to change and say they want to die. 

But I love family medicine… it’s back on the table after medschool professor bitterness and bad experiences with FM docs the past 2 years took it off. So glad that I had such a great preceptor for this rotation, who helped me love it again within the first few days of being her student.

medmonkey makes a very important point here: Family medicine is VERY different in a big academic center than it is in small towns. If academic-center family med has turned you off, please give it another chance in a small town or unopposed program and see if you like it better. 

Also - for you big city lovers - you can practice “small town medicine” in an underserved corner of a big city and have the best of both worlds. Or you can live in a small town not too far from a big city and be less than an hour away from all the amenities you just can’t do without (she writes as she contemplates making that drive for a Trader Joe’s run…).

we have had so many lunch talks at med school and all the family med docs seem the best. you are also the best.
wayfaringmd wayfaringmd Said:

Tee hee…

well thanks!

Family docs have the reputation for being laid back and “nice guys,” so we’re pretty agreeable people for the most part. 

Asker Anonymous Asks:
Which do you prefer: family medicine or pediatrics? I'm trying to figure out which path I want go through with when it comes to striving to become a nurse practitioner, but it's so hard for me to choose between family medicine and pediatrics! :o
wayfaringmd wayfaringmd Said:

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. 

Asker Anonymous Asks:
Are docs at urgent care centers considered family medicine or..?
wayfaringmd wayfaringmd Said:

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. 

Surely there is something absurd when a nation pays a primary care physician poorly relative to other specialists and then wrings its hands over a shortage of primary care physicians.
Uwe Reinhardt, Princeton University economist (via numberneededtotreat)

(via wayfaringmd)

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?

Wayfaring

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.

Wayfaring: Really? image

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? 

Wayfaring: image

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. 

image

hi I am interested in FM with Ob any thoughts? also do you plan on doing a fellowship ?
wayfaringmd wayfaringmd Said:

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. 

Asker Anonymous Asks:
How much time do family med/primary care doctors spend in the hospital vs at their practice?
wayfaringmd wayfaringmd Said:

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.

image

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.

image

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.

Asker Anonymous Asks:
I heard that family doctors/GP's make $200,000 salary? Is this true? and is this the immediate salary they get after their two or three year residency program? Thanks!
wayfaringmd wayfaringmd Said:

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.

Asker Anonymous Asks:
Hi! So I've been reading your answers to questions about what family med doctors do. It's cool that you can do so much, but I was wondering if you end up making a good amount of referrals because you can't be highly trained in everything. For example, if a woman came in and she was, say pregnant with twins or triplets, would you refer her to an ob who had training with more complex pregnancies?
wayfaringmd wayfaringmd Said:

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. 

Asker Anonymous Asks:
is family doctor the official term? or what do they call it in med school
wayfaringmd wayfaringmd Said:

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.