Tuesday, December 21, 2010

'Family Medicine is a Waste of Your Talent'

There are many things medical students interested in family medicine hear from other students, residents, and attending physicians when bringing up their desire to go into the specialty.

Here are some things I have heard recently
"Family Medicine is a Back-Up Plan"
"Sub-specialize until you can't specialize anymore"
"The IOM sold out on primary care & now want ARNPs to pick up the slack"
"Aww family medicine? That's so nice of you."
"You're Too Smart For Family Medicine"
"The ship may have already sailed on primary care"
First, I will start out by saying that every time I hear this or read it, I get an acidic taste in my mouth, probably signifying vomit encroaching on my pharynx (5-yard penalty on the vomit).

When I look back on reasons for going into family medicine, I would consider myself a student who was "on the fence" about the specialty. In its current state, going into primary care is a decision that my financial planner would probably strangle me over.
The primary care loan forgiveness programs provide financial relief over several years that could be made up over 1/2 to 1 year in most specialties. Nursing leaders are advocating that they can provide the same care just as good as I will while lobbying for equivalence in pay but deny they are trying to replace primary care physicians. Then there is the SGR, the RUC, hospital network/ACO-wannabes taking over private practice....
I initially wanted to go into orthopaedics - not because I wanted to hit the "ROAD" (though it must be nice), but because of my love for sports and desire to have a niche in something. It was not until my first time rotating with a family medicine physician with a CAQ in sports medicine that I realized it was possible to help athletes and non-athletes with musculoskeletal issues, not go through an ortho residency that could potentially ruin my marriage, and continue to see patients without sports medicine issues as a primary care physician.

After $280,000 of student loan debt it may seem crazy but with these past 4 years of medical school with a graduate degree thrown in-between an undergraduate degree, I feel like specializing would only hurt the non-financial gains I have made in my education. I have learned so much about pathology, disease-processes, prevention and clinical practice, that specializing would only end up wasting all of the talent I have accumulating along the way. Family medicine allows me to continue to provide healthcare to everybody - newborns, children, women regardless of hCG status... what we usually refer to as "womb-to-tomb" or "all stages and all ages".

It also allows me to "specialize" in any area at any point no matter where I am in my career. The CAQ in sports medicine is going to be a given in my case - but if one day I decide that I want to be more proficient in cardiac health, I do not need to take a pay cut to do a fellowship in cardiology to focus my attention on that area. If I want to have a niche in diabetes management, I do not need to do a fellowship in endocrinology. And even though those with fellowships are getting paid more to provide these services (note: current tense), this flexibility will keep me from burning out, maintain my interest and desire to further my education as a life-long student, and keep me from losing the huge investment I made which I will be reminded about each month as I make my student loan payments.

Family Medicine - Make the Most of Your Talent, Make the Most of Your Investment - It Is Impossible To Be Too Smart For Family Medicine


  1. Looking back over 40 years of practice, I agree with you. It is a damn shame that all that education is wasted when students decide to specialize right away. I did gen med for five years prior to specializing, and even then twenty years later I took a break from my specialty to work with a GP while I was recovering from heart surgery. In essence our system is very screwed up. Good luck with whatever you decide to do .

  2. Very well put. I've worked in underserved communities as a family doc for 8 yrs; it's been very worth it.

  3. Family physicians are the doctors who don't forget everything they learned in medical school. They need to really be on top of things, because anything could be waiting in the next exam room.

    It's puzzling why anyone would want the fragmented care of a dozen specialists instead of having one doctor. When I say my doctor, I mean the doctor who practices family medicine and treats my entire family. I see a couple specialists, but that's not who I mean when I say "my doctor."

  4. "Family physicians are the doctors who don't forget everything they learned in medical school. They need to really be on top of things, because anything could be waiting in the next exam room."

    What would you say to someone who said that it doesn't really take much knowledge to be able to figure out what kind of specialist you'll have to refer each interesting case to?

  5. Then you would be practicing triage and not to the full capacity of your license in family medicine. There are physicians that choose to do that and there are physicians who choose to use evidence-based medicine to truly manage and coordinate care of a patient. That's the best part of family medicine - you can choose to do whatever you want to do with it. If you choose a practice to refer patients all day, then I respect your decision.

  6. To build on that thought, I would question exactly what Joe means by an "interesting" case. To me, as a 4th year student entering FM, the most interesting thing to me IS the patient and his family. I get to find out what motivates him, what he likes and dislikes, who his favorite sports team is. I also get to find out the patterns of health problems he has over the course of his life. The relationship is what makes a family doctor so vitally important, because often a very "interesting" or rare disease can be picked up more efficiently if a primary care relationship is already established. On the flip side, it might also mean that a good established history (rather than an ER visit and a CT scan) can keep many patients from having to be referred, because a disease that might be rarely seen by one doctor isn't necessarily an unknown to another.

    For example, some family medicine docs are now specializing in HIV care in places where HIV is prevalent, and no doubt studies will show that now that HIV has become something of a chronic disease, that it can best be managed by family docs who can treat these patients for their non-infectious health issues in addition to prescribing their HIV meds.

    Besides, if we as family docs referred everyone out, what fun would that be? And think how much money our health care system would be wasting!

  7. Although I'm only in my first year, I think I'd have to agree with you that you will lose a lot of what you learn in med school by going into a specialty. In our curriculum, we spend hours and hours each month learning physical exam skills, interviewing techniques, taking histories on real patients, discussing end-of-life care, CAM, and other things that really only apply, or best apply, to family practitioners. Were I to go into, say, surgery, I'm sure many of those skills would go out the window. I'm not saying there's anything wrong with that, but I personally really enjoy those aspects of medicine. To me, that's the best part of being a doctor.