Ask questions about family medicine here

[1029384756md]

47 minutes ago, MedZZZ said:

If that's the case, wouldn't it be more reasonable to go into FM route and save yourself another 2-3 years of brutal residency to be a GIM doc since you are doing what a GIM does basically with a lot less complexity ... That's my internal dilemma for pursuing FM versus IM ...

If you know you enjoy and plan to do inpatient medicine, do IM. It's a longer and yes brutal residency that will better prepare you for inpatient medicine in the long run. FM is shorter at 2 years but it'll be mostly outpatient medicine which you may not enjoy for the full 2 years.

[Wachaa]

12 hours ago, FrannieLydon said:

I see this mentioned a lot and I am wondering how rural is defined? Let's say you were working in a town with around 20,000 total population – would that qualify as rural? 

It actual depends on the community itself and who's working there, distance from major centre, etc. Bonuses etc depend on what the province classifies as rural and as far as I know there isn't any black/ white definition based on size; just a classification "list".

For example in BC, see here: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/physician-compensation/rural-practice-programs/rural-retention-program

In the Eligibility part of the page you can go to the links for rural definitions, points system, premium % etc.

 

10 hours ago, MedZZZ said:

If that's the case, wouldn't it be more reasonable to go into FM route and save yourself another 2-3 years of brutal residency to be a GIM doc since you are doing what a GIM does basically with a lot less complexity ... That's my internal dilemma for pursuing FM versus IM ...

That's actually a very narrow view of what GIM does. GIM is there as a consultant as well as admitting patients on the wards. I would agree the rounding/ wards are similar. However the scope of the work is very different from that of a GP/ hospitalist. But yes, the argument for going to FM/ IM includes salary, residency training length...but also the scope of your future/ intended practice.

[magneto]

14 hours ago, FrannieLydon said:

I see this mentioned a lot and I am wondering how rural is defined? Let's say you were working in a town with around 20,000 total population – would that qualify as rural? 

Rural is usually defined by the province that you are working in. But I would say 20,000 population would be considered rural.

[magneto]

13 hours ago, MDinCanada said:

So the salary for a hospitalist is comparable to that of a GIM doctor?

I think GIM doctors will bill more (due to billing codes) or have a higher salary. This is a guess.

[magneto]

11 hours ago, MedZZZ said:

If that's the case, wouldn't it be more reasonable to go into FM route and save yourself another 2-3 years of brutal residency to be a GIM doc since you are doing what a GIM does basically with a lot less complexity ... That's my internal dilemma for pursuing FM versus IM ...

I think IM will bill more. They will have different billing codes, which will pay higher. Also their salaries will be higher if the hospital is not FFS. This is all a guess because I am not familiar with IM billings.

[magneto]

10 hours ago, 1029384756md said:

If you know you enjoy and plan to do inpatient medicine, do IM. It's a longer and yes brutal residency that will better prepare you for inpatient medicine in the long run. FM is shorter at 2 years but it'll be mostly outpatient medicine which you may not enjoy for the full 2 years.

Good advice.

[medigeek]

On 5/21/2020 at 1:12 PM, 1029384756md said:

If you know you enjoy and plan to do inpatient medicine, do IM. It's a longer and yes brutal residency that will better prepare you for inpatient medicine in the long run. FM is shorter at 2 years but it'll be mostly outpatient medicine which you may not enjoy for the full 2 years.

Can be residency and individual dependent too.

And I know USA FM programs (relevant with more American grads coming to Canada) are way more inpatient heavy and their graduates (sometimes, not usually) are definitely on par with Canadian GIM.

[MDinCanada]

What are the worst parts of family medicine/things you wish you knew in med school?

[omentum]

What was your study schedule like for the CCFP exam? I.e. did you read a topic a day?

And what resources would you recommend?

 

[gogogo]

I asked this in a separate post, but maybe it'll get more traction here: 

 

I'm still early in med school, but it seems that the bread and butter of family medicine is chronic diseases with little tangible evidence of benefit (e.g., HTN meds, diabetes management) or tenuous symptom management  (e.g., autoimmune conditions). Combining this with patients who may not always be grateful or questioning/not listening to your recommendations (e.g., lifestyle modification), I am wondering where you derive satisfaction? I don't mean to ask this in a critical way, and I also recognize that I'm probably painting a caricatured picture of the specialty. In fact, I am strongly considering family medicine and want to expand my awareness on what makes other family doctors excited and satisfied with their work.

 

Thanks!

[medigeek]

1 hour ago, gogogo said:

I asked this in a separate post, but maybe it'll get more traction here: 

 

I'm still early in med school, but it seems that the bread and butter of family medicine is chronic diseases with little tangible evidence of benefit (e.g., HTN meds, diabetes management) or tenuous symptom management  (e.g., autoimmune conditions). Combining this with patients who may not always be grateful or questioning/not listening to your recommendations (e.g., lifestyle modification), I am wondering where you derive satisfaction? I don't mean to ask this in a critical way, and I also recognize that I'm probably painting a caricatured picture of the specialty. In fact, I am strongly considering family medicine and want to expand my awareness on what makes other family doctors excited and satisfied with their work.

 

Thanks!

You can mix it up and not just do chronic disease. Pick up the skills and also do ED with clinic. Or do inpatient medicine with your clinic set up or whatever else you like. Maybe deliver babies. You don't need to limit yourself to an outpatient practice. 

[Lactic Folly]

22 hours ago, gogogo said:

I asked this in a separate post, but maybe it'll get more traction here: 

 

I'm still early in med school, but it seems that the bread and butter of family medicine is chronic diseases with little tangible evidence of benefit (e.g., HTN meds, diabetes management) or tenuous symptom management  (e.g., autoimmune conditions). Combining this with patients who may not always be grateful or questioning/not listening to your recommendations (e.g., lifestyle modification), I am wondering where you derive satisfaction? I don't mean to ask this in a critical way, and I also recognize that I'm probably painting a caricatured picture of the specialty. In fact, I am strongly considering family medicine and want to expand my awareness on what makes other family doctors excited and satisfied with their work.

 

Thanks!

Traditional family medicine is more about the patient than the disease. Check out the writings of family doctors who share their patients' stories, and how they have built relationships with entire families and cared for them over a lifetime.

[gogogo]

2 minutes ago, Lactic Folly said:

Traditional family medicine is more about the patient than the disease. Check out the writings of family doctors who share their patients' stories, and how they have built relationships with entire families and cared for them over a lifetime.

Thanks for answering. I completely understand that satisfaction may emerge from the relationship building (trust, connection, respect, etc.), but what about the care? I suppose you could argue that developing a relationship is in itself therapeutic. But besides that, do family doctors find satisfaction in making incremental decreases to HbA1c or BP? Do patients appreciate that? I guess I'm trying to understand whether any of the satisfaction in family medicine comes from the medicine/disease side, or if it is exclusively on the communication/relationship/patient side of things. 

[Lactic Folly]

I'm not sure that such a distinction can actually be made. But I do envision dedicated family physicians working to facilitate positive lifestyle changes, help their patients obtain necessary resources and supports (especially those who are underprivileged), detect early signs of disease, and coordinate multiple aspects of a patient's care, and that these are important aspects of medical care and prevention that help patients navigate the often fragmented healthcare system and reduce the burden of disease.

[Rorzo]

On 6/5/2020 at 9:19 PM, gogogo said:

Thanks for answering. I completely understand that satisfaction may emerge from the relationship building (trust, connection, respect, etc.), but what about the care? I suppose you could argue that developing a relationship is in itself therapeutic. But besides that, do family doctors find satisfaction in making incremental decreases to HbA1c or BP? Do patients appreciate that? I guess I'm trying to understand whether any of the satisfaction in family medicine comes from the medicine/disease side, or if it is exclusively on the communication/relationship/patient side of things. 

This is going to be a personal thing. There are absolutely some people who get satisfaction out of getting a bloodwork level the patient will never feel in to target range, but for the majority of people those visits are on auto-pilot by midway through residency.

I've found that satisfaction in a successful Epley, occipital nerve block, bursitis injection, or trigeminal neuralgia treatment. When I've finally been able to get someone to realize what their actual goals of care are despite specialist and hospital visits going no where. Or when they're going through a thousand tests and interventions and they come to you to make sense of it all.

Family is varied and because of that I ended up focusing on palliative. But likewise I have friends who get that feeling with a positive pregnancy test, seeing a newborn in office for the first time, getting athletes back to playing condition, getting an airway in a trauma, cutting out an SCC, counselling patients through a break up, or even jsut getting the right referral after years without an answer. And they're able to have those moments in their typical work weeks where I'm avoiding some of them like the plague. 

At the end of the day a job is a job, and I think going in to family because you like normal BPs makes as much sense as going in to pediatrics because you like normal growth curves. You're going to have boring day to day stuff wherever you go, you have to find something on top of that to give you satisfaction and I honestly think family offers the greatest variety to do that

[F508]

Family medicine is not comprised solely of incremental adjustments of HbA1c and BP...... patients present to you with a multitude of complaints, literally anything and everything. Career satisfaction comes from being a generalist and knowing a little about everything. Throughout my residency, I have counselled parents about newborn problems, delivered babies, inserted IUDs, counselled about diabetes, counselled for depression, performed a multitude of intraarticular injections, accompanied families when their loved ones were losing their autonomy / facing a cancer diagnosis, helped someone quit smoking, diagnosed skin ailments, removed foreign bodies, given patients the knowledge/tools to better their health / to prevent ER visits / reduce their health anxiety, etc. My patients trust me to tell me their secrets and fears. My staff have diagnosed malaria in walk-in, performed abortions, worked in rural Northern Canada, worked for Doctor's Without Borders, worked as hospitalists/in obstetrics/in EM. As a family doctor, you are the first line of contact. You have the flexibility to transform your practice throughout your career.

Throughout my residency, I saw the value of my generalist training. The staff that performs scopes doesn't remember how to treat HTA, defers to the patient's family doctor, delaying care. The IM subspecialist didn't remember how to treat hyperkalemia. The pediatric subspecialist doesn't remember what is a normal adult HR. The medical team doesn't think of fracture to explain the patient's sudden decrease in mobility. Of course for a lot of these specialties, they don't need to know these particular things to function within their domain. I am a specialist of common diseases in the general population. I don't want to only know one organ system. I don't want to only treat one small subspeciality of medicine. I don't want to know how many different ways we can resect a certain body part. I love working with people of all ages. I derive career satisfaction knowing that I have the knowledge to guide my friends and family through a large range of health issues.

 

[medisforme]

On 5/19/2020 at 5:45 PM, magneto said:

I agree with this. Don't talk about that you want to do EM in FM interview.

EM is the obvious one, I think most people know better than to do that.  The couple of times it happened during our interviews, it was applicants discussing wanting to be a hospitalist or a sports med clinician.

[medigeek]

8 hours ago, medisforme said:

EM is the obvious one, I think most people know better than to do that.  The couple of times it happened during our interviews, it was applicants discussing wanting to be a hospitalist or a sports med clinician.

What's wrong with an FM applicant wanting to be a hospitalist? Society of hospital med in USA is co-sponsored by the internal med and family med boards. 

If anything, we should be encouraging more inpatient practice.

[JohnGrisham]

4 minutes ago, medigeek said:

What's wrong with an FM applicant wanting to be a hospitalist? Society of hospital med in USA is co-sponsored by the internal med and family med boards. 

If anything, we should be encouraging more inpatient practice.

Because in Canada, they don't want Family doctors going into only niche-focused areas with laser precision. We know many will do just EM, or just hospitalist, but they ideally want people who will still do full-scope family medicine clinics and primary care.   There is nothing wrong with going into EM or doing mainly hospitalists after a FM residency, programs just want to be able to say they are recruiting the best applicants who will want to do full-scope practice.   

Its a moot point when we need FM docs to do all those roles anyways, so by someone "only" doing EM or hospitalists, isn't as if there isn't a need for that as well! So it's just optics and semantics, in a zero sum game.

[chateau22]

4 hours ago, JohnGrisham said:

Because in Canada, they don't want Family doctors going into only niche-focused areas with laser precision. We know many will do just EM, or just hospitalist, but they ideally want people who will still do full-scope family medicine clinics and primary care.   There is nothing wrong with going into EM or doing mainly hospitalists after a FM residency, programs just want to be able to say they are recruiting the best applicants who will want to do full-scope practice.   

Its a moot point when we need FM docs to do all those roles anyways, so by someone "only" doing EM or hospitalists, isn't as if there isn't a need for that as well! So it's just optics and semantics, in a zero sum game.

What about if you said palliative care? Does it get treated the same as saying you want to do a +1 in EM?

[medisforme]

To clarify my point, it was in reference to residency interviews, nothing more, and I clearly said it doesn't reflect my personal opinion.  There is nothing wrong with voicing interests in areas of family medicine during a residency interview.  The only point I was making is that certain applicants were docked points when they ONLY discussed interest in one area of family medicine and did not touch on the longitudinal aspects of the specialty.

[JTFW]

I don't think there is anything wrong about voicing your interest. Just don't sound like you can only limit yourself doing that during an interview.

[JohnGrisham]

5 hours ago, medisforme said:

To clarify my point, it was in reference to residency interviews, nothing more, and I clearly said it doesn't reflect my personal opinion.  There is nothing wrong with voicing interests in areas of family medicine during a residency interview.  The only point I was making is that certain applicants were docked points when they ONLY discussed interest in one area of family medicine and did not touch on the longitudinal aspects of the specialty.

Exactly!

If all you talk about is EM, procedures, acuity....that *may* be a redflag for some FM programs if you don't at least show some interest in longitudinal care and the rest of FM care.

[magneto]

On 5/23/2020 at 5:23 AM, MDinCanada said:

What are the worst parts of family medicine/things you wish you knew in med school?

It is easy to become 9-5 office family physician and quickly loose your knowledge and skill set. Family medicine physicians are generalist and they should continue to incorporate multiple interests in their practice and not stick solely to 100% bread and butter family medicine office practice. Developing other interests is often hard and sometimes not that financially rewarding. But in my opinion, it helps keep your enthusiasm for medicine and empathy for patients.

[magneto]

On 6/2/2020 at 4:51 AM, omentum said:

What was your study schedule like for the CCFP exam? I.e. did you read a topic a day?

And what resources would you recommend?

 

I am not a good role model for studying schedule.

I attended academic days and tried to stay awake. I read around my patients and looked up things right away when I did not know something. I asked my preceptors lots of questions. I showed up for SOO practice offered by my program.

About 3 months before the exam, I spent money on two books and tried to read them. I was able to finish Guide to the Canadian Family Medicine Examination (second edition) but quickly realized it had a lot of errors and overall it was not that comprehensive.

I also picked up family medicine notes by O'Toole which was very comprehensive but I quickly realized that I did not have enough time to read all of it. So I marked the booked with what I though will be high yield topics and just read those chapters.

I tried to focus only on CCFP priority topics and used that as a guide to prioritize what to read first.