Tuesday, March 8, 2011

The Hazing of Family Medicine

Every one of us who practices family medicine has had to defend our chosen profession against a myriad of antagonists. As mentioned in the post ‘Family Medicine is a Waste of Your Talent,’ we are sometimes told that we are too smart to pursue family medicine. Other topics range from salary comparisons between specialties to scope of practice. I’ve been told on many occasions that I should specialize for many different reasons but am rarely commended for choosing primary care. Luckily, most of us are unphased by such comments. However, I believe that there are students who are pulled from primary care because of what I like to call the hazing process. I conducted a small but national scale survey of students, residents, and attendings to see how others handled this phenomenon.

Students who are unwaveringly committed to primary care are not influenced. Students who are unsure about what they want to do are highly susceptible to take the criticisms as fact and start to question their dedication to primary care. These two findings did not surprise me as I had seen many students fluctuate in and out of favor of family medicine over the past four years. What I did not expect to find is the attitude that the established, experienced family docs had. As a whole, they vastly underestimated the effect this process has on students’ career choice. Most of the responders were academics who I thought would be more tuned in to the problem, but they seemed to have been in the ‘immune’ group when they themselves were students and thus, assume that everyone knows the negative comments are not well-founded. One felt that it is simply unprofessional to speak ill of another field while another described the issues as ‘tired old clichés’. I had a lengthy discussion with another physician who felt there must be some difference between those students who are susceptible to changing their interests at the suggestion of a peer or authority figure versus those who are not.

One thing stood out to me about the wavering group of students. They all had questions. They wanted to know if the things they were hearing were true. They’re not! Family medicine trained physicians work as hospitalists, they see plenty of kids (if they want), they do procedures (sometimes even operative ones like appendectomies), and they are not poor. Even being one of the lower paid specialties with an average income of $150,000, it still ranks in the top 5% income bracket in the US. And according to the 20th COGME report, the U.S. is going to have to increase its recruiting efforts because we will need so many more family physicians in the coming years. So the potential for employment is about to skyrocket as explained in the post ‘Analyzing COGME: Increase the Number of Primary Care Physicians.’ Family medicine will be growing faster than any other specialty.

America wants more family physicians. When I meet people (who don’t work at the hospital) who ask me what my specialty is and I have the pleasure of saying family medicine, I am encouraged. At my local farmer’s market the vendors thank me for being interested in rural primary care. I met some people cross-country skiing who hugged me when I said family medicine. I often ask people how far they have to drive to see a doctor, where the nearest pharmacy is, or if there is a community health center in town. This facilitates a conversation about what primary care providers do for a community, even if the person doesn’t necessarily have a well defined perception of what a family physician is…and they like what they hear.

So my recommendation to students who are undecided is to take your concerns to the family medicine departments at your schools or to private practice family physicians in your communities. Not only can they first-handedly dispel these myths but they will hear loud and clear that family medicine needs to be promoted. If our students don’t know the truth about the potential within the field, how will our community members? If you ask someone what they would like from the medical system they will describe a family physician in a patient centered medical home. So let’s spread the word that it already exists and that we are happily working there by doing the following:

1. Help stop the hazing by confronting the hazers with data and confidence. Be proud of your choice because you will help lower health care costs and provide a much needed service to your community.

2. Get involved with your family medicine interest group, the AAFP, or your state chapter where you will be exposed to resources and peers because even if you are the only student in your class who is interested in family medicine, there are thousands around the country.

3. Attendings and residents need to reach out to students and be more active in representing the field of family medicine.

4. Do what you love and do it well. Explain why primary care is so important to your family members because the ultimate reward is choosing the right career, not making the most money.


  1. #FMRevolution = Family Medicine Revolution! Viva la resistance!

  2. This I believe -- "one per 10,000 population increase in the supply of family physicians was associated with a decrease in mortality of .65 per 100,000 population. That is, a onethird
    increase in the supply of family physicians was associated with a 20% lower mortality from cervical cancer." (Barbara Starfield, MD)

  3. A prominent AOA student in my class decided to drop dermatology and apply for family medicine residencies. She got her first choice for residency and is very happy. It's amazing how many "What was she thinking?!" comments have been made behind her back. The real point is that someone with an obviously bright future in medicine turned down the a highly-coveted speciality and decided to do what she felt called to do. People are getting the point ... Slowly.