Wayfaring MD
And for the 5,000th time, let me clarify that I am female.
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.
aconn51 asked:
assuming I get into medical school, I’m interested in going into primary care with a focus on women’s health or do ob/gyn while also doing a full range of primary care for female patients. Any insight as to the best way to go about doing that? Would I need to do an internal med/ family med residency and then just focus on female patients? or is this something where I would need to do a dual/combined residency (does such a thing even exist?). Anything you can offer would be super helpful!
If you did internal med, you wouldn’t be able to do the OB/GYN care. If you just did OB/GYN, you wouldn’t be able to manage all their other conditions (ya know, since ladies are more than boobs and uteruses).
So…shameless plug, family sounds like the way to go. No dual-residency required. Female-only practices are a thing now (my mom and sister actually go to a combined Family Med /OB practice that only sees females aged 12 and up) and are growing in popularity. Actually even now in residency I see a lot more females than males.
Attending during birth control lecture.
My grandmother, about my grandfather.
Sometimes your patients’ complaints are voiced just to make themselves feel better. They’re not always a request for medication.
My grandfather’s response to my “how are you feeling today”.
(After a battle trying to get my grandfather to go to the emergency room when he lost feeling in his leg)
Mama: Ok, he finally decided he would go the ER.
Me: Great. What made him change his mind?
Mama: His neighbor came by. She said her best friend is an ER nurse and the friend told him to go.
Me: Mama… you’re a nurse. I’m a doctor. He wouldn’t go for us but he went for the neighbor’s random friend?
Mama: 
Me: Sounds about right.
In a few months I’ll be choosing a specialty to start my residency and I have doubts between choosing Psychiatry or Family Practice; I like both. Any advice? -entropycomeseasy
When I first started med school, my dean told me “if you like a little bit of everything and you don’t hate psych, you should be a family doctor.” She’s totally right. We see tons of psychiatry in family medicine. And I really enjoy the FM-type psych stuff. I like treating depression and anxiety and cognitive disorders. I am not a big fan of treating acute psychotic breaks and such. Which is why I’m a family doctor and not a psychiatrist.
But if you like it all, why not do both? There are combined Family Medicine-Psych residencies out there. They’re rare, but they do exist. I think in the next few years there may be an expansion in primary care-psych programs, especially considering the shortages of each these days. There was an article about these programs on KevinMD recently.
If you want to choose one or the other, consider the following:
any suggestions, advice, commentary for a first year med student who struggled/failed-to-adapt-quickly enough and made several C’s and is scared for the future! (in addition: want to do family med and try to do other things outside of school to spice up resume, was straight A till med school, etc.) - anon
I’ve written a whole bunch about what to do after getting bad grades. The big thing to do is figure out your weak points, or figure out what modes of studying you were using that weren’t working, and try your best to correct them. Get outside help from a tutor, study group, an advisor, or even an upperclassman who can advise you.
As for spicing up an application for family medicine: FM residencies love seeing commitment to community, so all community service looks great, especially projects involving public health or health education. Free clinics are excellent places to do some volunteering and spice up your CV. They often have patient education workshops, local research opportunities, and of course they serve underserved populations. Check the NAFC website to see if there are any near you. Also check the Society of Student Run Free Clinics website to learn how to start one in your community. Other good opportunities for community service include tutoring science or math at local schools or doing a big brother/big sister type program.
Patient’s visitor: How far are you in your residency?
Me: Just started in July.
PV: My daughter just started too. She got her MD-PhD at [Prestigious University]. Now she’s in residency at [Prestigious Residency] and wants to do a fellowship in [super hard thing]. What kind of residency program is this?
Me: Community based family medicine. 
PV: Oh.
PV’s wife as I leave the room whispers: **I think you made her nervous, honey**
s-tat replied to your post: Family Medicine: Unopposed/Cowboy programs
Can you clarify what an opposed program and unopposed program are? Thanks!
There’s a link to the definition in the original post, but here it is again. They are both on my medicalese page.
What’s your opinion on unopposed/cowboy family med residency programs? -mattjohnson2472
Best thing ever in the history of EVER.
Unopposed programs are hands-down the best if you’re doing family medicine. Think about it: would you rather work in an academic medical center and have to compete with OB/GYN, Internal Medicine, and Peds for patients? And get treated like the red-headed stepchild of medicine?
OR would you rather work in an environment where your service runs everything? A place where other doctors respect you and treat you like the MD/DO that you are?
amners Asks:
wayfaringmd Said:
Yes, doctors DO have doctors!
Legally, we’re not allowed to write prescriptions for ourselves. That’s a quick way to lose your medical license. In many residency programs, residents end up asking other residents for prescriptions for X, Y, or Z, usually without being examined. This gets sticky though for residents in non-primary care programs, though. For things like rashes and colds (acute care stuff), or birth control, I’m ok with doing that as long as I know any major contraindications the person might have to the medicine. But if it’s for chronic diseases or controlled substances, they need to have a steady doctor who sees them. Once you get out in the real world of medicine, you either have one of your partners take care of you, or you go to another town.
Then comes the dilemma of how to find a doctor as a doctor. There are several options.
Option 1: as a resident, pick one of your attendings who you get along with well and respect to be your primary doc (only works if you’re in a primary care residency, of course). Many of the folks in my program picked that option. Several of the girls in our program get their paps or their prenatal care from our attendings.
Option 2: Ask attendings or other doctors who they go to in the community. If you find that 3 or 4 people all recommend the same private doc, that’s probably a good place to start. 
Option 3: Don’t go to the doctor. Don’t get any preventive care during your years of residency, never get sick (or get antibiotics from buddies), never get hurt, and never have any babies. It’s a difficult option, but some do it. And by doing so, you become a total hypocrite when you fuss at patients for not coming to their yearly physicals. 
Actually, I’m going with options 1 & 2. I tried option 3 in med school and I ended up with 11 cavities in my teeth. Poor life choice on my part. Right now I haven’t picked a doctor, but I plan on asking one of my attendings to be my doc. I’ve tried the ask-around thing, and have found that the one private doc that everyone recommends is extremely hard to get an appointment with. However, the ask-around method did get me in with a good ophthalmologist (and hopefully a good dentist soon, as well).
- S (resident): I'm going to see Dr. M next week. I'm nervous! I haven't been to the doctor in like 4 years!
- Me: Geez, you need to work on your compliance, friend. Is Dr. M good? Is she a family doc?
- S: She's an OB-GYN. That's right. I'm a total Family Medicine hypocrite.
ninjatengu replied to your post: Dashboard’s dead, inbox is dead, Skype is dead.
Ask questions? :) So - I guess about family medicine rotation - What resources did you use/recommend for studying that shelf? Are those AAFP board questions from the site pretty good?
I think I used First Aid for Family Medicine and the USMLE World Q bank on shuffle. Having family medicine early in your third year is hard because it covers so many different subjects. It’s a bit easier later in the year once you’ve had Peds and Ob and Medicine. I didn’t use the AAFP board questions for Shelf study, but I think they’d be pretty good, yeah.
Big things to focus on for the Family Med shelf:
- preventive care- know all the ages when certain tests start, how often certain things should be tested for, etc.
- peds developmental milestones. I remember lots of questions along the lines of “is this normal or pathologic behavior”.
- I don’t remember there being much OB on my test, but there was a good bit of GYN. Know about cervical cancer screening, when to do a colpo vs when to do serial Paps, how to test for and treat all the STDs (and know second line drugs. They always throw an allergy in the question).
- basic psych stuff. Depression and anxiety diagnosis and treatment.
- all the internal medicine. It’s slightly more outpatient focused, but there’s plenty of stuff about inpatient care too.
I’m like…
DISLIKE. Family medicine is very important. If you know any specialists who are willing to take care of all their patients’ acute and chronic diseases AND do it as cheaply as a family doc does, I’d be very shocked.
about-hortense replied to your post: Great, lots more people are about to have insurance.
i don’t understand the meaning of that BUT. This topic intrigues me a lot and, as a non-american, I’d like you to stretch out ya point of view which, obviosuly, lingers behind that opening adversative.
What I was referring to is that there’s a huge deficit of primary care doctors in this country, and our system does not do a very good job of encouraging trainees to go into primary care.
Putting it simplistically, billing in the American medical system is based on procedures, tests, and the complexity of diagnoses. Doctors bill a certain amount for different things, and insurance companies generally pay a higher percentage of what doctors charge than government programs like Medicare and Medicaid pay. So the more patients you have with private insurance, the better your reimbursement rates.
The problem is that things like preventive care and regular follow-ups for chronic conditions (things which should theoretically save the system money by preventing conditions that require expensive procedures and tests) are not considered complex enough to warrant decent pay from government payor sources (Medicare/Medicaid). And guess what takes up the majority of primary care docs time? You guessed it, preventive care and follow up visits.
