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Can FM just do the niches?

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25 minutes ago, medigeek said:

How about instead of letting non physicians take over our role, like they do in the US, we keep our current duties? 

It's a realistic take on things given how things are moving. For family medicine residency education has moved away from that (and is moving further). Many programs no longer have any surgical exposure during residency, and a part of that is because most FM residents and attendings don't feel there is commensurate value in learning how to mostly do surgical floor work/consults in exchange for an exceptionally bad lifestyle for 1-2 months.

I believe this is in part due to the personality various specialties attract and also because modern medicine has reduced the autonomy of residents. E.g. In the old days a pathology resident rotating through OB for whatever reason was expected to catch babies. Nowadays the nurses won't even bother calling you even when you leave your pager # up on the board. If you want to be first assist, or deliver babies, or put in chest tubes, you have to be highly self-directed because there are plenty of other people who are eager to learn and are easier to teach.

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2 hours ago, 1D7 said:

It's a realistic take on things given how things are moving. For family medicine residency education has moved away from that (and is moving further). Many programs no longer have any surgical exposure during residency, and a part of that is because most FM residents and attendings don't feel there is commensurate value in learning how to mostly do surgical floor work/consults in exchange for an exceptionally bad lifestyle for 1-2 months.

I believe this is in part due to the personality various specialties attract and also because modern medicine has reduced the autonomy of residents. E.g. In the old days a pathology resident rotating through OB for whatever reason was expected to catch babies. Nowadays the nurses won't even bother calling you even when you leave your pager # up on the board. If you want to be first assist, or deliver babies, or put in chest tubes, you have to be highly self-directed because there are plenty of other people who are eager to learn and are easier to teach.

I agree and this is a universal issue. Only a minority of programs truly maximize resident training.

But I don't think we should willingly just give things up. You can learn stuff on the fly, same as how midlevels do. And I don't think committing a profession to managing algorithmic hypertension and diabetes is the best way to go in the era of technology and proliferating non-physicians. Easy tasks are much easier to replace. 

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The times I have seen surgical assists (in obs by FM-ob and in a rural area with surgeon IMG who didn't have surgical license in Canada), the assists never did anything more than retraction/direct laparoscopic camera. They didn't even close up. Unless you're actively doing something surgical, I think it's a waste of government money both in MD billing and lost potential (all those years of training to just retract...)

I think we can put our FM training to more useful skills. There's plenty of other areas needing FM (clinic, hospitalist, ER, obs...)

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