As people suggested in my Primary Care post, Family Medicine might have been a better choice for me. I liked outpatient medicine much better than inpatient medicine. I like procedures, even pap smears. The hours are generally regular. Several people suggested family medicine as a good choice for me. Here's why I decided against it:
1) Family medicine is very regional. In some parts of the country, many of the docs are family practitioners. In other parts of the country, there are few and they are not well respected. I trained in an area of the country where family medicine was not as common. Our family med sub-I was a disorganized joke. Almost all the people in my med school class who were interested in primary care did internal medicine or primary care residencies. Only a couple of people matched in Family Medicine.
2) I never wanted to deliver another baby for the rest of my life.
3) If I was overwhelmed by the idea of having to "know it all" in primary care, it's even worse in family medicine, where you're taking care of an even larger spectrum of patients. (Yes, you could restrict your practice, but you don't always have that option.)
4) I worried that family med residency would be like a repeat of third year of med school, where you're always in unfamiliar territory, always fumbling, and always the one who knows the least.
5) Much like primary care, the compensation is not great.
6) Much like primary care, there's pressure to see a large number of patiens in a short number of time, and elderly patients are getting sicker and more complicated.
7) Less chance for subspecialization compared with internal medicine.
Writing this post, I feel slightly regretful that I didn't train in a place where I got more exposure to family med. I liked my family med rotation, and it actually might have been a good fit for me. I might have liked doing women's medicine, as long as I didn't have to deliver any babies.
Just strictly out of curiosity (definitely not judging, just trying to gain your perspective): what is it about delivering babies that you hated? In my experience, people either just absolutely LOVE LOVE LOVE it or hate it. I haven't heard much from people who feel like "eh, whatever".
ReplyDeleteExample: Pediatrics make me cringe. I dislike small children, their "I've read WebMD and the interwebs so I know everything, even more than you" parents, etc. So not my cup of tea. On the other hand, I know there are people who just love the heck out of kids and are called to the field and are amazing with children. Different strokes for different folks, so again not judging you at all for your hatred of delivery :) just curious...
What I dislike about delivering babies is the potential for things to go wrong very quickly, but more than that, the uncertainty of it and the work obligation. The OBs I know in small practices seem like they're literally always on call.
DeleteBecause we are.. ;)
DeleteAre there doctors who only do Gyn? I don't need an OB anymore (no more babies-no uterus) and would gladly do my yearly poke and grope with a doc who just sees women for Gyn and not OB. Not delivering babies probably makes for a much more "normal" schedule.
ReplyDeleteProbably in large cities, most FPs don't do OB and just do gyn. It seems like most women who have a choice would rather be delivered by an ob/gyn than a FP, but in a rural area, you may not have as many options.
DeleteA doctor friend of mine described her OB rotation as 98% boredom, 2% sheer panic. I think that pretty much sums it up.
DeleteAre you sure she wasn't talking about anesthesiology? I definitely didn't think OB was 98% boredom.
DeleteWell that was her experience but it probably depends on where your rotation was. Or maybe that is just how she remembered it.
DeleteHow did you feel about ophthalmology? It involves a lot of outpatient procedures, good work-life balance, and good compensation.
ReplyDeleteYeah, but I'm one of those people who get freaked out by eye stuff. Nothing makes me squeamish anymore except eye pathology.
DeleteToday's ridiculous reader question: What's the difference between primary care and internal med? I know internal med is adult medicine, no?, but primary care is . . ? Thanks. :)
ReplyDeletePrimary care is outpatient medicine... basically, the primary doctor (PCP) that you go to for check-ups, etc. A primary care physician can be trained in internal medicine or family medicine.
DeleteThere are some residencies that are called primary care residencies because they have more of a focus on outpatient practice, but you still get board certified in internal medicine.
We get huge exposure to family med here, but I agree with a lot of your points. I LOVE delivering babies, so that won't be a deterrent for me.
ReplyDeleteHowever, in South Africa a lot of people consider family med to be like a glorified general practitioner, which is not a very flattering thing to hear I suppose.
I worried that family med residency would be like a repeat of third year of med school, where you're always in unfamiliar territory, always fumbling, and always the one who knows the least.
ReplyDeleteThis is true, it does feel like that in residency, maybe less so in unopposed programs. And it is overwhelming to try to keep up in so many different fields.
However, one of our old school type docs always reminds us, "Yes, you DO know less than the pediatricians, but you're a better obstetrician than they are, and you DO know less than the obstetricians, but you're a better internist."
I did move a long distance to go to a more family-med friendly program though.
I'm not a huge fan of OB, but our FP OB department seems to be a happy medium between the OB demographic and those who would choose a midwife (and we work with both on good terms).
Also - not sure I agree with "primary care" as outpatient care. Plenty of family docs in this part of the country are almost exclusively hospitalists, developmental delay/CP docs, geriatricians, or high risk OB exclusive practices.
Honestly, the biggest downside is the pay and being looked down upon and the dealing with bureaucracy of insurance/Medicaid, which I do think hits us worse. But the real job parts of the job are great. Though I think I'd be totally happy in PMR as well.
A primary care physician is generally thought of as a first contact outpatient physician. All family practitioners aren't necessarily PCPs though, as you pointed out. At the point that you're seeing only high risk OB patients, you certainly can't call yourself a PCP anymore.
DeleteI love family medicine... it feels like I am the only medical professional in the patients care that truly is involved entirely in his/her care... all the others only know aspects of the care.
ReplyDeleteAnd yes, I know what you mean about fumbling and having to know everything... but I am honest with my patients... I tell them that there is an issue in an area and that it is not my speciality and I need to refer them on,... but them they come back to me, and we move on together from there.
I really enjoy the continuity and getting to know generations within a family... and the variety of conditions and ages.
It's also nice not having to do hospital rounds on weekends, and being able to use locum services after hours... when I leave my office I am off duty.
But yes - pros and cons... and it is always a balance to weigh.
Hm. Funny how things are so different just over the boarder. All of our primary care with a few exceptions is done by family physicians up here in Canada. Not that many of us do OB, but some (like myself) do. Some do ER, some do hospital care, some do sports med. Mostly we have office practices +/- extras. Most of my OB patients would rather see me than an OB and there are growing numbers of low risk women who don't want to see OBs and would like to be delivered by someone they know.
ReplyDeleteI wish so badly I wouldn't have given into the pressure of my peers and gone into fanily practice. I'm a 2nd year surgery resident and am absolutely MISERABLE :(
ReplyDeleteI hate what my life has become, I'm jealous of some of my med school peers who have finished or are soon finishing residency and moving on with their lives!
Family medicine is awful. I wish I listened to my family and peers and didn't go t family med. I'm 3 yrs in as an attending and hate my job and life.
DeleteAs much as i agree that fam med is important, it is just not for me. Actually sitting in a fam med lecture now (final year MBChB), and I feel like ripping my hair out, so mind numblingly boring!
ReplyDeleteNeurology for the win