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Swon

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  1. Like
    Swon reacted to gogogo in If you like FM, is there any point in exploring other specialties?   
    I am very interested in FM and definitely recognize its benefits, but it is important to be critical of any specialty so that we can understand what we are getting into. It's important to remember that all specialties will exaggerate their pros and downplay their negatives; it's marketing just like anything else. So, for the sake of being a devil's advocate, let me give a different perspective on the benefits of FM:
    Jobs
    It's true, FM has jobs everywhere. But let's be realistic: How many job openings do you actually need? It's not as if you're going to switch your clinic every year. You'll find a clinic you like and stay there, in all likelihood. I also think that the tight job market in at least some of the other specialties might be overplayed. Speaking to people in certain specialties, they seem to be confident about the job market, even in specialties that, from the outside, I'm told have a tight job market. Of course, if you want to work downtown Toronto, then it'll be difficult to get a job. But if you're okay with working in the suburbs/community, it seems there are jobs available. I think it's important to talk to people in the field, especially residents in their final year, to get a different perspective.
    Lifestyle
    FM has the best lifestyle, but other specialties have it pretty good as well, like dermatology, ophthalmology, and outpatient IM specialties. I've also been told that you have a lot of control over your hours as a staff even in the more demanding specialties. I also check the hours of FM clinics in my area, and there definitely are FM doctors who are working 50-60 hours a week, including on weekends, and pretty late into the evening. Residency lifestyle seems awful for any specialty and is temporary, so probably not worth thinking about.
    Income
    I'm still learning about FM salaries, but it seems AB is an outlier (isn't AB in the news now for trying to unilaterally slash funding?). In ON, it seems reasonable that, on average, you'll make ~200-250k as an FM working 40-50 hours/week. Some are efficient and can do more, but some are not as efficient and work more hours for less (especially when you include the time they spend doing paperwork outside of clinic hours). And being efficient to make more money might not be enjoyable for some people because it requires faster appointments. 
    Of course, 200-250k is a good salary, but your colleagues, who only put in ~3 years more than you, are making 100-200k more (or even 2-3x more in specialties like ophthalmology or dermatology, with an equally good lifestyle). I know this shouldn't matter, but as med students with type A personalities, it's hard not to allow comparison to be thief of joy. And to elaborate, you have to be in the 80th percentile of FM in ON to make 320k after overhead (see here). It's good to be ambitious and be inspired by these numbers, but there is a reason that only 20% of FM in ON are billing that high. We can't just say that 80% of FM in ON are lazy or inefficient doctors. If so, then perhaps be prepared to be like them, because by definition, we can't all be in the top 20%.
    Scope
    There are niches in FM, but again, there is probably a reason most don't do them. For example, to be a cosmetic FM, you have to build a clientele and compete against other specialties doing cosmetics, like derm, ENT, and plastics. Splitting your time between regular FM and a niche could also prove to be difficult, because the days you spend doing the niche (e.g., cosmetics) are days that you're not giving time to your regular FM patients. The latter patients will then be angry with you. ER has a rough lifestyle, OB has a rough lifestyle and probably requires that you work outside of the city, etc.
    I also find it almost self-denial to say you want to go into FM because of the +1 opportunities. It's basically saying that you want to go into FM so that you can *not* do FM. If you are interested in a niche, perhaps it's better to just go into a specialty that does that niche?
    Matching
    I agree with this. But there are negatives to everything. Instead of sucking up to staff and residents to get research opportunities, as an FM doctor, you have to "suck up" to patients by putting up with their vague complaints and frustrations with the healthcare system (because you are their primary care provider/their first exposure to healthcare). For example, dealing with a chronic back pain patient who says nothing works for them is a very frustrating experience for everyone involved.
     
    Overall, despite everything I said above, based on my limited training thus far, I think FM is great. But I think it's important to critical. FM is not an easy waltz into a 300k salary and requires sacrifices just like any specialty. 
  2. Like
    Swon reacted to bruh in If you like FM, is there any point in exploring other specialties?   
    If you woke up every day knowing you literally hate what you do for a living, would you still do it just because it offers good money and lifestyle? 
    There is a lot more to life than making good money and having home/work balance. At the end of your life, you want to be happy knowing you did things in your life that you actually enjoyed and had a passion for. 
    Going into FM won't necessarily bring you happiness or satisfaction in life or work. In fact, FM never ranks at the top in terms of happiness or self-esteem at or outside work. According to the CMA, more general surgeons are satisfied with the work/life balance AND their professional life, compared to family physicians. Also more FM docs are dissatisfied with their work/life balance AND their professional life, compared to general surgeons. Now, I'm not saying you should go into surgery to be happier, I'm just saying there is more to life than money and length of training. 
    FM: https://www.cma.ca/sites/default/files/2019-01/family-e.pdf
    General Surgery https://www.cma.ca/sites/default/files/2019-01/general-surgery-e.pdf
    Medscape data for the US https://www.medscape.com/slideshow/2019-lifestyle-happiness-6011057#3
  3. Like
    Swon reacted to MDinCanada in If you like FM, is there any point in exploring other specialties?   
    I would argue that a good portion of the FM doctors who are unhappy would also be unhappy in any other specialty. 
    Probably a big portion of the people who chose FM are those who realized that medicine isn't what they expected, they became burnt out towards the end, etc,
    I also noticed that surgeons are happy being surgeons even while being bullied by their seniors, working awful hours, etc., not because they find the job itself fun, but just because they have intrinsic "happy" personalities or it's a cemented defense mechanism to prevent them from having an existential crisis/dropping out of residency.
     
  4. Like
    Swon reacted to DrOtter in If you like FM, is there any point in exploring other specialties?   
    I think bruh has a point. They're clearly not saying that all FM doctors are unhappy with their careers, but a measurable portion are. Hence, money and lifestyle are not the sole basis for choosing a specialty. If you're deeply interested in an IM subspecialty say Oncology, I'd imagine it would suck to wake up every day to deal with patients with general malaise and rashes.
    Also not everyone wants to practice in AB, where you keep pulling your data from. Not everyone can have both practicing in AB or other well-paying provinces and living close to their families and support network. 
  5. Like
    Swon reacted to Butterfly_ in Is family medicine really that bad?   
    I think with proper communication litigation can be avoided.
     At the end of the day, it’s up to the patient to decide whether or not they want to to the ER. You shouldn’t tell them to go, you should provide them with the pros and cons and explain to them your rationale.
     
    if you said, “ I know you feel fine, And the risk of you actually having a PE is low, I still think it’s a good idea to run some tests at the ER just to be sure because of xyz reasons.”
    Same in the case of a sick kid. If you give proper instructions for returning to clinic or going to ER, you shouldn’t be sued. “Currently, your child’s vitals signs are stable, and the symptoms are likely caused by a viral urti, however, if your child’s condition worsens, aka Less wet diapers, becoming lethargic, not drinking etc, make sure you go to ER right away.
    if you document and communicate  properly, you probably won’t be sued.
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