Having Second Thoughts about FM

[medigeek]

1 minute ago, brackenferns said:

I think we're on the same page still; I was imagining "several visits" as bringing the patient back for >3 appointments for multiple rounds of investigations while still not having a clear diagnosis. For me at least, that doesn't often happen.

What is more routine is a patient coming in with an undifferentiated complaint, and then I can narrow it down with either 1-2 rounds of investigations, or 1-2 rounds of a medication / treatment / lifestyle intervention that ends up making them better (hence confirming the working diagnosis). 

That probably also depends how much you order the initial visit aka do you have a shotgun approach? That affects follow up visits.

If I have a significant presentation like transaminitis with jaundice and no obstruction, then I'm shot gun ordering a very large serology workup. Versus transaminitis of unknown origin you can space out over a few visits depending on the severity etc. Might I get to a point where I need to refer for biopsy? Sure. But I definitely will exhaust things before then. 

[GH0ST]

On 2/27/2022 at 9:15 PM, brackenferns said:

The issue is that you will see far more patients with self-limiting issues (i.e. viral URIs, contact dermatitis, UTIs, etc...) or secretarial issues (i.e. MD letters, insurance forms, prescription renewals, etc...), than patients with actual medical problems requiring multiple visits for diagnostic or management clarification.

Look I get that people like medical mysteries ... but this really shows your own bias...

Sorry but the vast majority of problems people have is still "real medicine" and managing the social determinants of health is also a part of that. 

Really unfortunate this attitude continues to exist ... 

- G 

[LoquaciousLoquat]

On 3/6/2022 at 8:21 PM, GH0ST said:

Look I get that people like medical mysteries ... but this really shows your own bias...

Sorry but the vast majority of problems people have is still "real medicine" and managing the social determinants of health is also a part of that. 

Really unfortunate this attitude continues to exist ... 

It's not so much bias as it is being realistic about your scope of work and setting proper boundaries.

Recently I had a patient who wanted me to write a note to clear them for a dental operation... and they couldn't even tell me the type of operation, when it would take place, and what type of anesthesia they will receive. When I suggested they obtain this information from their dentist and call us back, they got very upset and basically shoved their dentist's number in my face, and said I should be the one to call RIGHT NOW because "those questions will have more clout coming from a doctor!".

I mean, I'm sure there's some "social determinants of health" at play in that scenario (i.e. low health literacy, prior negative experience with healthcare providers, etc...). But am I going to put my clinic day on hold just be a patient's unwitting medical secretary? Of course not. I ended up delegating it to my office staff to get some more documentation from the dentist's office. Patient left unhappy and probably felt they "didn't receive proper care". But hey, I have to draw the line somewhere.

In fact, I'd opine the reason behind the rise of this type of patient entitlement is precisely because of the teaching in family medicine to "care across the entire spectrum of health". Hence, patients think anything tangentially related to their health becomes our responsibility. So now, not only are we treat the patient's medical conditions, but we have to "treat" (or at least put up with) their entitlement, anger management issues, rudeness, stubbornness, etc...

I'm a family physician. I'm not a family social worker, not a family nurse, not a family marriage counsellor, not a family therapist, not a family medical secretary, not a family dietician, not a family naturopath, and I'm not a family life coach. It's already hard enough being the "jack of all trades" within medicine. But if I were to become the "jack of all trades" across the entire spectrum of every patient's health? Well, then I'd never get anything done, probably burn out, and end up leaving medicine altogether.

[carmsregrets]

On 3/6/2022 at 6:21 PM, GH0ST said:

Look I get that people like medical mysteries ... but this really shows your own bias...

Sorry but the vast majority of problems people have is still "real medicine" and managing the social determinants of health is also a part of that. 

Really unfortunate this attitude continues to exist ... 

- G 

I understand your perspective. However, it  is  not wrong to have a bias and prefer to treat medical mysteries/complex medical problems over dealing with "SDOH" and all the URTI,UTI.... We all have different strength and weakness and some people don't want to mainly deal with SDOH in FM ( and as a result FM is a poor choice for their strengths/weaknesses)

[shikimate]

59 minutes ago, brackenferns said:

I'm a family physician. I'm not a family social worker, not a family nurse, not a family marriage counsellor, not a family therapist, not a family medical secretary, not a family dietician, not a family naturopath, and I'm not a family life coach. It's already hard enough being the "jack of all trades" within medicine. But if I were to become the "jack of all trades" across the entire spectrum of every patient's health? Well, then I'd never get anything done, probably burn out, and end up leaving medicine altogether.

You forgot family wet nurse lol. In all honesty all I've been reading is FMD giving up their community practice in favor of hospitalist or other positions. I don't blame them. 

[MedZZZ]

2 hours ago, brackenferns said:

It's not so much bias as it is being realistic about your scope of work and setting proper boundaries.

Recently I had a patient who wanted me to write a note to clear them for a dental operation... and they couldn't even tell me the type of operation, when it would take place, and what type of anesthesia they will receive. When I suggested they obtain this information from their dentist and call us back, they got very upset and basically shoved their dentist's number in my face, and said I should be the one to call RIGHT NOW because "those questions will have more clout coming from a doctor!".

I mean, I'm sure there's some "social determinants of health" at play in that scenario (i.e. low health literacy, prior negative experience with healthcare providers, etc...). But am I going to put my clinic day on hold just be a patient's unwitting medical secretary? Of course not. I ended up delegating it to my office staff to get some more documentation from the dentist's office. Patient left unhappy and probably felt they "didn't receive proper care". But hey, I have to draw the line somewhere.

In fact, I'd opine the reason behind the rise of this type of patient entitlement is precisely because of the teaching in family medicine to "care across the entire spectrum of health". Hence, patients think anything tangentially related to their health becomes our responsibility. So now, not only are we treat the patient's medical conditions, but we have to "treat" (or at least put up with) their entitlement, anger management issues, rudeness, stubbornness, etc...

I'm a family physician. I'm not a family social worker, not a family nurse, not a family marriage counsellor, not a family therapist, not a family medical secretary, not a family dietician, not a family naturopath, and I'm not a family life coach. It's already hard enough being the "jack of all trades" within medicine. But if I were to become the "jack of all trades" across the entire spectrum of every patient's health? Well, then I'd never get anything done, probably burn out, and end up leaving medicine altogether.

Just out of curiosity, have you thought about retraining/re-entry into another residency?

[gogogo]

6 hours ago, brackenferns said:

Recently I had a patient who wanted me to write a note to clear them for a dental operation... and they couldn't even tell me the type of operation, when it would take place, and what type of anesthesia they will receive. When I suggested they obtain this information from their dentist and call us back, they got very upset and basically shoved their dentist's number in my face, and said I should be the one to call RIGHT NOW because "those questions will have more clout coming from a doctor!".

This obviously sucks, but how often do you experience it? One of the positives of FM I hear from those in the field is the close relationships with patients. Moreover, specialists often have abrasive patients too and hospital politics between specialties makes for frustrating interactions as well. I feel that you are glorifying specialist medicine when it has its own set of problems, many of which overlap with FM because we are all dealing with the public.

[GH0ST]

10 hours ago, brackenferns said:

It's not so much bias as it is being realistic about your scope of work and setting proper boundaries.

Recently I had a patient who wanted me to write a note to clear them for a dental operation... and they couldn't even tell me the type of operation, when it would take place, and what type of anesthesia they will receive. When I suggested they obtain this information from their dentist and call us back, they got very upset and basically shoved their dentist's number in my face, and said I should be the one to call RIGHT NOW because "those questions will have more clout coming from a doctor!".

I mean, I'm sure there's some "social determinants of health" at play in that scenario (i.e. low health literacy, prior negative experience with healthcare providers, etc...). But am I going to put my clinic day on hold just be a patient's unwitting medical secretary? Of course not. I ended up delegating it to my office staff to get some more documentation from the dentist's office. Patient left unhappy and probably felt they "didn't receive proper care". But hey, I have to draw the line somewhere.

In fact, I'd opine the reason behind the rise of this type of patient entitlement is precisely because of the teaching in family medicine to "care across the entire spectrum of health". Hence, patients think anything tangentially related to their health becomes our responsibility. So now, not only are we treat the patient's medical conditions, but we have to "treat" (or at least put up with) their entitlement, anger management issues, rudeness, stubbornness, etc...

I'm a family physician. I'm not a family social worker, not a family nurse, not a family marriage counsellor, not a family therapist, not a family medical secretary, not a family dietician, not a family naturopath, and I'm not a family life coach. It's already hard enough being the "jack of all trades" within medicine. But if I were to become the "jack of all trades" across the entire spectrum of every patient's health? Well, then I'd never get anything done, probably burn out, and end up leaving medicine altogether.

Funny how I've never seen any of those other professions prescribe medications, or use their medical knowledge in other diagnostic considerations... 

You literally also used such an extreme example to illustrate your point as well... 

I mean if the earlier statement doesn't show your bias, this one definitely does.

That said, I'm not saying these biases or opinions are wrong so I don't want you to take this as if I'm trying to make it a personal attack or I'm questioning your thoughts... I think for both of us this falls under "agree to disagree" 

Have a wonderful evening! 

- G 

[GH0ST]

10 hours ago, carmsregrets said:

I understand your perspective. However, it  is  not wrong to have a bias and prefer to treat medical mysteries/complex medical problems over dealing with "SDOH" and all the URTI,UTI.... We all have different strength and weakness and some people don't want to mainly deal with SDOH in FM ( and as a result FM is a poor choice for their strengths/weaknesses)

Thank you for your respectful comment, but I also never said the other opinion was wrong either. But to say that the other aspects that was previously discussed was "not real medicine" is objectively wrong. You can hold the specific opinion you stated without being disrespectful of another profession. 

That said, I fear that the thread is beginning to derail and I apologize for my part in that. I will respectfully bow out as this should ideally be tailored towards the OP's original question. 

Have a wonderful evening. 

- G 

[medigeek]

11 hours ago, carmsregrets said:

I understand your perspective. However, it  is  not wrong to have a bias and prefer to treat medical mysteries/complex medical problems over dealing with "SDOH" and all the URTI,UTI.... We all have different strength and weakness and some people don't want to mainly deal with SDOH in FM ( and as a result FM is a poor choice for their strengths/weaknesses)

I think doing the hard medicine is mainly what we're actually trained for anyway. Doing 4 years of medical school means you accumulate a lot of knowledge. Residency is when you learn to apply it and then afterwards, you should be actually applying it and doing the heavy lifting. 

A lot of the hard medicine will be mixed in with the easy stuff, but that's a good thing though. You need the challenges and then you need the easy cases to take a break. 

1 hour ago, GH0ST said:

Thank you for your respectful comment, but I also never said the other opinion was wrong either. But to say that the other aspects that was previously discussed was "not real medicine" is objectively wrong. You can hold the specific opinion you stated without being disrespectful of another profession. 

That said, I fear that the thread is beginning to derail and I apologize for my part in that. I will respectfully bow out as this should ideally be tailored towards the OP's original question. 

Have a wonderful evening. 

- G 

 

To be realistic and practical, family medicine just sees the whole spectrum.

My hospitalist panel can be a mix of a complex liver patient to a weird organizing pneumonia to social admits. My clinic can be form completion, anxiety follow up in a teenager, a very odd rheum presentation and a chronic follow up for a dozen comorbidities. 

So I think the entire debate is sort of based around how to tackle these. I would only involve consultants in those patients' care if absolutely necessary (truly needed for diagnostic clarity or initiation of advanced therapies or procedure). The counter argument is to refer the hard medicine and just do the easy social stuff/easy medicine. That I strongly disagree with. 

[gogogo]

I just read the Medscape Physician Burnout & Depression Report 2022. It sampled 13,069 physicians across 29 specialties, with decent representation across most specialties. The results show that the gripes commonly encountered by family physicians are not so unique.

Burnout

Besides public health, dermatology, pathology, oncology, orthopedics, ENT, and psychiatry (all <40% burnout rate), every other specialty ranges between 40-60% (EM highest). Sure, family med is one of the "higher" ones at 51%, but 13 other specialties are with 5 percentage points, suggesting no significant difference. In fact, 33% of physicians desired a lighter patient load, and burnout rates were similar whether practicing outpatient (58%) or inpatient (48%). Sadly, 24% of physicians identified as clinically depressed and 64% identified as subclinically depressed.

Lack of respect

One grievance mentioned throughout this thread is that you feel degraded as a family physician (eg, being a "medical secretary," patients trying to exploit you). Yet, 39% of physicians identified "lack of respect from administrators/employers, colleagues or staff" as a source of their burnout (which was the second highest contributor to burnout).

Paper/administrative work

Similar to the idea of being a "medical secretary", we keep hearing that family physicians uniquely have to deal with overwhelming and/or undesirable admin tasks. Yet, 60% of physicians in this report identified "too many bureaucratic tasks (eg, charting, paperwork)" as a contributor to their burnout.

 

So, the anecdotes in this thread should be taken with a grain of salt, because when examined across a large sample, it appears that the issues family physicians face are similar to the issues faced across specialties (as I tried to point out in earlier posts). I used to be swayed and dismayed tremendously whenever I came across the purported negatives of family medicine, but after having worked with many family physicians and specialists (and never noticing much difference in their happiness or the desirability of their practice), I think any stated concerns reflect more about the physician and/or their circumstances rather than the specialty. At the end of the day, being a doctor is a job and a hard one at that--and we are collectively battling through it.

[whatdoido]

On 3/18/2022 at 9:54 PM, gogogo said:

So, the anecdotes in this thread should be taken with a grain of salt, because when examined across a large sample, it appears that the issues family physicians face are similar to the issues faced across specialties (as I tried to point out in earlier posts). I used to be swayed and dismayed tremendously whenever I came across the purported negatives of family medicine, but after having worked with many family physicians and specialists (and never noticing much difference in their happiness or the desirability of their practice), I think any stated concerns reflect more about the physician and/or their circumstances rather than the specialty. At the end of the day, being a doctor is a job and a hard one at that--and we are collectively battling through it.

is the lesson here that medicine is just a bad career? lmao

[1029384756md]

3 hours ago, whatdoido said:

is the lesson here that medicine is just a bad career? lmao

You're missing the point. Medicine is the only career where you get to help people

 

/s

[shikimate]

it's not a bad career if you don't let it take control of your life.

If the hospital/clinic 1) is the only source of income, 2) is the only place you get social interaction, 3) is the only escape you have from family/spouse problems, 4) is the only thing you find meaning/purpose for living, 5) is the only place your mind can think of going when you wake up in the morning.

then yea, medicine is a bad career lol

[carmsregrets]

On 3/18/2022 at 7:54 PM, gogogo said:

I just read the Medscape Physician Burnout & Depression Report 2022. It sampled 13,069 physicians across 29 specialties, with decent representation across most specialties. The results show that the gripes commonly encountered by family physicians are not so unique.

Burnout

Besides public health, dermatology, pathology, oncology, orthopedics, ENT, and psychiatry (all <40% burnout rate), every other specialty ranges between 40-60% (EM highest). Sure, family med is one of the "higher" ones at 51%, but 13 other specialties are with 5 percentage points, suggesting no significant difference. In fact, 33% of physicians desired a lighter patient load, and burnout rates were similar whether practicing outpatient (58%) or inpatient (48%). Sadly, 24% of physicians identified as clinically depressed and 64% identified as subclinically depressed.

Lack of respect

One grievance mentioned throughout this thread is that you feel degraded as a family physician (eg, being a "medical secretary," patients trying to exploit you). Yet, 39% of physicians identified "lack of respect from administrators/employers, colleagues or staff" as a source of their burnout (which was the second highest contributor to burnout).

Paper/administrative work

Similar to the idea of being a "medical secretary", we keep hearing that family physicians uniquely have to deal with overwhelming and/or undesirable admin tasks. Yet, 60% of physicians in this report identified "too many bureaucratic tasks (eg, charting, paperwork)" as a contributor to their burnout.

 

So, the anecdotes in this thread should be taken with a grain of salt, because when examined across a large sample, it appears that the issues family physicians face are similar to the issues faced across specialties (as I tried to point out in earlier posts). I used to be swayed and dismayed tremendously whenever I came across the purported negatives of family medicine, but after having worked with many family physicians and specialists (and never noticing much difference in their happiness or the desirability of their practice), I think any stated concerns reflect more about the physician and/or their circumstances rather than the specialty. At the end of the day, being a doctor is a job and a hard one at that--and we are collectively battling through it.

FM scores as one of the 'worst' on all the above aspects lol. There is a reason why several of my resident colleagues are there not by choice ( they are only there because they were not able to get their first choice specialty).  

[GH0ST]

On 3/18/2022 at 9:54 PM, gogogo said:

I just read the Medscape Physician Burnout & Depression Report 2022. ....

Burnout

Besides public health, ... (all <40% burnout rate),...

 

yeah something about that seems off to me

- G 

[gogogo]

On 3/25/2022 at 12:59 AM, carmsregrets said:

FM scores as one of the 'worst' on all the above aspects lol. There is a reason why several of my resident colleagues are there not by choice ( they are only there because they were not able to get their first choice specialty).  

You're not thinking critically and are letting your biases and own dissatisfaction with FM influence how you view the specialty as a whole. You and your colleagues are what, n = 5? 10? 

For burnout, I already identified that 13 other specialties are within 5% of the burnout rate in FM. Do you consider the 46% burnout rate in rheumatology that different from the 51% rate in FM? What about the 49% burnout rate in radiology and pediatrics? Or how about PM&R--commonly purported as a lifestyle specialty--which actually has a 50% burnout rate?

We can even look at Canadian data through the CMA specialty surveys. Across family physicians surveyed, 48% are "very satisfied or satisfied" with their work/life balance. Rheumatology, considered a lifestyle IM subspecialty, is 54%. That's not a big difference. Dermatology, considered to be a specialty that offers easy hours + $$$, has 37% "very satisfied or satisfied" with their work/life balance. That's 11% lower than family medicine.

Continuing with the CMA data, 71% of family physicians are "very satisfied" with their professional life. How is that "the worst"? In fact, family medicine is similar to other specialties considered "chill": occupational medicine (70%), endocrinology (73%), hematology (70%), and dermatology (68%).

Look across the specialties and you'll find that besides some outliers, most are very similar in terms of burnout, professional satisfaction, and work/life balance.

As for the lack of respect issue, again, 39% of physicians find that it contributes to their burnout. That's approaching half of physicians. 60% of physicians stated that admin work burns them out. That's more than half of physicians. This is not an FM issue; this is a medicine issue.

If you go on other medicine forums, you'll find people groaning about being a physician regardless of their specialty. Just the other day I came across a thread where anesthesiologists were complaining about being disrespected by surgeons. There was also a radiologist complaining about having to read an overwhelming number of images with no or poorly formed clinical questions on a daily basis and he/she carries high liability despite that (remember when brackenferns said that only family physicians have to deal with being consulted with stupid questions?--that's also wrong).

My point is that the vast majority of physicians are burnt out regardless of specialty, and we have to realize that it's being a physician that's hard no matter what. FM isn't "special" in how hard it is. 

[LoquaciousLoquat]

On 3/26/2022 at 2:41 AM, gogogo said:

My point is that the vast majority of physicians are burnt out regardless of specialty, and we have to realize that it's being a physician that's hard no matter what. FM isn't "special" in how hard it is. 

The issue is that specialists, when compared to family doctors, have far more risk factors for burn out (i.e. complexity, acuity, worse work-life balance, overnight call, shift work, higher liability, more prone to be sued, less job opportunities, longer training time...), yet apparently the data doesn't really show a significant difference.

For example: in the CMA surveys, family medicine has 30% dissatisfaction in work-life balance, and 13% dissatisfaction in professional life. Now we look at a more "burn-out prone" specialty... general surgery: 29% dissatisfaction in work-life balance, and 12% dissatisfaction in professional life. 

I mean... does it make sense that family physicians are EQUALLY dissatisfied by their work-life balance as general surgeons?

What the data shows me is that family medicine, despite a shorter training time, more job opportunities, more chances to "rebalance" your work (i.e. part-time work, mix clinic with hospitalist, etc...), less acuity, less call requirements, less chance of being sued, more longitudinal care to make patients happy, less complexity... actually still have comparable levels of burn-out (or to be technical here in keeping with the CMA survey, "dissatisfaction"). 

Sure, you can make the argument for self-selection: i.e. surgeons may already expect a poor balance going into their specialty, whereas family physicians don't. But if anything, that probably just illustrates that family physicians, on average, tend to underestimate the work-life imbalances in their specialty and end up surprised and unhappy (which is what I believe).

 

[carmsregrets]

2 hours ago, brackenferns said:

The issue is that specialists, when compared to family doctors, have far more risk factors for burn out (i.e. complexity, acuity, worse work-life balance, overnight call, shift work, higher liability, more prone to be sued, less job opportunities, longer training time...), yet apparently the data doesn't really show a significant difference.

For example: in the CMA surveys, family medicine has 30% dissatisfaction in work-life balance, and 13% dissatisfaction in professional life. Now we look at a more "burn-out prone" specialty... general surgery: 29% dissatisfaction in work-life balance, and 12% dissatisfaction in professional life. 

I mean... does it make sense that family physicians are EQUALLY dissatisfied by their work-life balance as general surgeons?

What the data shows me is that family medicine, despite a shorter training time, more job opportunities, more chances to "rebalance" your work (i.e. part-time work, mix clinic with hospitalist, etc...), less acuity, less call requirements, less chance of being sued, more longitudinal care to make patients happy, less complexity... actually still have comparable levels of burn-out (or to be technical here in keeping with the CMA survey, "dissatisfaction"). 

Sure, you can make the argument for self-selection: i.e. surgeons may already expect a poor balance going into their specialty, whereas family physicians don't. But if anything, that probably just illustrates that family physicians, on average, tend to underestimate the work-life imbalances in their specialty and end up surprised and unhappy (which is what I believe).

 

You probably end up working the same number of hrs in general surgery as in FM. Except in FM you spend most of your time doing charting and paperwork and administrative work ( mostly unpaid work), whereas in surgery you are doing procedures ( and more fun work) and residents do most of the charting/paperwork.  You also end up being paid less per hour for the work you do as a FM doc. Not to mention, if anything in your work becomes interesting you need to refer to ED or a specialist. The specialists will tell you what to do once the pt is discharged.  Being a FM doc means mainly administrative duties/secretarial work/ and preventative work.  

On 3/26/2022 at 12:41 AM, gogogo said:

You're not thinking critically and are letting your biases and own dissatisfaction with FM influence how you view the specialty as a whole. You and your colleagues are what, n = 5? 10? 

 

I don't have actual data to support what I am saying but I'd say I personally know at least 25 residents in my program who did not pick FM by choice ( and I don't even know half the people in my program). Once you go into FM residency, you will similarly realize that a lot of your colleagues did not pick FM by choice. Some old stats show that ~30% of individuals in FM did not pick FM as their first choice. Even the individuals who picked FM by choice are not disillusioned by the field and are already dissatisfied by the field. 

FM is a great field if you are looking for shorter training or the fact that you can get hired anywhere once you graduate. However, you are not an expert in your field,and you lack specialized knowledge, and your work will lack complexity/thinking and you will probably end up with worst work life balance because you will probably spending a lot of your time doing charting and other unpaid work. Furthermore, to make a decent living, you will have to work way more than your specialist colleagues ( which may lead to burnout).  In general,it is not a field I'd recommend.  I remember as a clerk rotating through FM,I had several residents advise me with all the above and they blatantly told me that I am a good clerk and I am better off backing up with speciality training over FM ( and that's what they would personally do if they would go back in time). However, I did not think much of their advise at the time and decided to back up with FM... but now I fully realize what they were trying to tell me.

 

[medigeek]

2 hours ago, carmsregrets said:

You probably end up working the same number of hrs in general surgery as in FM. Except in FM you spend most of your time doing charting and paperwork and administrative work ( mostly unpaid work), whereas in surgery you are doing procedures ( and more fun work) and residents do most of the charting/paperwork.  You also end up being paid less per hour for the work you do as a FM doc. Not to mention, if anything in your work becomes interesting you need to refer to ED or a specialist. The specialists will tell you what to do once the pt is discharged.  Being a FM doc means mainly administrative duties/secretarial work/ and preventative work.  

I don't have actual data to support what I am saying but I'd say I personally know at least 25 residents in my program who did not pick FM by choice ( and I don't even know half the people in my program). Once you go into FM residency, you will similarly realize that a lot of your colleagues did not pick FM by choice. Some old stats show that ~30% of individuals in FM did not pick FM as their first choice. Even the individuals who picked FM by choice are not disillusioned by the field and are already dissatisfied by the field. 

FM is a great field if you are looking for shorter training or the fact that you can get hired anywhere once you graduate. However, you are not an expert in your field,and you lack specialized knowledge, and your work will lack complexity/thinking and you will probably end up with worst work life balance because you will probably spending a lot of your time doing charting and other unpaid work. Furthermore, to make a decent living, you will have to work way more than your specialist colleagues ( which may lead to burnout).  In general,it is not a field I'd recommend.  I remember as a clerk rotating through FM,I had several residents advise me with all the above and they blatantly told me that I am a good clerk and I am better off backing up with speciality training over FM ( and that's what they would personally do if they would go back in time). However, I did not think much of their advise at the time and decided to back up with FM... but now I fully realize what they were trying to tell me.

 

A lot of this post is false and borderline trolling. 

FM docs are not working 60-80 hour weeks routinely in total if their actual hours are around 40. No one is doing 30 hours a week of charting. And you quickly compare a community FM doc to an academic surgeon that has residents? What about a community surgeon who does the same surgeries every time and does all of his own charting? What about surgery call? If an FM doc is doing actual call, it's for inpatient work. I'm not taking away from surgery, the people who do it are passionate about it and that's great. But if someone is neutral about it, I definitely would not say it has higher potential than FM in Canada. 

And if you're referring everything out, that's your choice. I've worked up and diagnosed things like membranous nephropathy, wilson's, vasculitis, HIV complications among many other things. That's just on the outpatient side. Hopefully you didn't forget some (many) of us also work inpatient and emerg.

 

It's obvious that at your center, residents are trained to be admin-referologists. Some places are like that. But do not apply that broadly to all places.

 

[carmsregrets]

2 hours ago, medigeek said:

A lot of this post is false and borderline trolling. 

FM docs are not working 60-80 hour weeks routinely in total if their actual hours are around 40. No one is doing 30 hours a week of charting. And you quickly compare a community FM doc to an academic surgeon that has residents? What about a community surgeon who does the same surgeries every time and does all of his own charting? What about surgery call? If an FM doc is doing actual call, it's for inpatient work. I'm not taking away from surgery, the people who do it are passionate about it and that's great. But if someone is neutral about it, I definitely would not say it has higher potential than FM in Canada. 

And if you're referring everything out, that's your choice. I've worked up and diagnosed things like membranous nephropathy, wilson's, vasculitis, HIV complications among many other things. That's just on the outpatient side. Hopefully you didn't forget some (many) of us also work inpatient and emerg.

 

It's obvious that at your center, residents are trained to be admin-referologists. Some places are like that. But do not apply that broadly to all places.

 

It's true that one's view of FM is heavily dependant on your site/preceptor choices, and I guess most residents could choose how they would like to practice once they graduate and seek additional training to compensate for the gaps in their training. Currently, I am trained to refer simple DVTs to the ED or a coagulation clinic  -It will be difficult for me to learn how to manage these things in an outpatient settings in the future ( unless I seek additional training). I think future FM residents should select their sites wisely ( to avoid dissatisfaction with the field)

Like  you mentioned, FM can also be great given the flexibility  and ability to work at multiple settings( outpatient/inpatient/emerg). However, it is really essential to see these role models in your training - otherwise how can you aspire to be like them?

[medigeek]

1 hour ago, carmsregrets said:

It's true that one's view of FM is heavily dependant on your site/preceptor choices, and I guess most residents could choose how they would like to practice once they graduate and seek additional training to compensate for the gaps in their training. Currently, I am trained to refer simple DVTs to the ED or a coagulation clinic  -It will be difficult for me to learn how to manage these things in an outpatient settings in the future ( unless I seek additional training). I think future FM residents should select their sites wisely ( to avoid dissatisfaction with the field)

Like  you mentioned, FM can also be great given the flexibility  and ability to work at multiple settings( outpatient/inpatient/emerg). However, it is really essential to see these role models in your training - otherwise how can you aspire to be like them?

Are you at an urban center site? 

It's a great disservice to your education that DVTs are being sent to the ED/coag clinic. Likewise for new onset Afib >48hrs (assuming not RVR) among many other things. 

[1D7]

On 4/3/2022 at 3:43 PM, brackenferns said:

Sure, you can make the argument for self-selection: i.e. surgeons may already expect a poor balance going into their specialty, whereas family physicians don't. But if anything, that probably just illustrates that family physicians, on average, tend to underestimate the work-life imbalances in their specialty and end up surprised and unhappy (which is what I believe).

Self-selection goes beyond that. There is survivorship bias too—most general surgery programs have an attrition rate between 15-20%. Lots of the tougher surgical subspecialties have a fairly high attrition rate, meaning those who were most burnt out aren't practicing in those specialties at all.

The numbers are further skewed with how FM is not the #1 choice for a small but sizeable minority of applicants. It's not hard to see how someone who didn't want to do FM in the first place, would be unhappy with it... that is actually the expected outcome.

My personal experience is that most of the FM preceptors I worked with in medschool were happy people. Not all of them loved their job but they were content to get home on time. Usually the ones who liked their job more developed some sort of a niche (e.g. ER, palliative, even admin). When you can help fulfill a community/population need with a skillset you can pride yourself on, you will grow to like your job more. These physicians invested more into their careers and got more personal satisfaction out of it.

[carmsregrets]

5 hours ago, 1D7 said:

 

The numbers are further skewed with how FM is not the #1 choice for a small but sizeable minority of applicants. It's not hard to see how someone who didn't want to do FM in the first place, would be unhappy with it... that is actually the expected outcome.

My personal experience is that most of the FM preceptors I worked with in medschool were happy people. Not all of them loved their job but they were content to get home on time. Usually the ones who liked their job more developed some sort of a niche (e.g. ER, palliative, even admin). When you can help fulfill a community/population need with a skillset you can pride yourself on, you will grow to like your job more. These physicians invested more into their careers and got more personal satisfaction out of it.

~30% of residents in FM- is not a small minority.  I wish there was a system where people who don't match to their desired specialty, have a choice to develop and improve their application and apply next year ( instead of just applying to FM as a default/ backup specialty/schools forcing you to apply to whatever is left in second iteration). This trend will create so many bitter FM docs. It  will also probably lead to worse outcomes for these docs and the pts they are supposed to take care of.  I am happy to see a lot of these misplaced residents trying to transfer and/or looking for opportunities in the US. It truly does not benefit anyone when residents are doing specialities they don't care about. I am not saying that everyone should get the specialty they want either, but there should be a better system.

[Findanus]

9 hours ago, carmsregrets said:

~30% of residents in FM- is not a small minority.  I wish there was a system where people who don't match to their desired specialty, have a choice to develop and improve their application and apply next year ( instead of just applying to FM as a default/ backup specialty/schools forcing you to apply to whatever is left in second iteration). This trend will create so many bitter FM docs. It  will also probably lead to worse outcomes for these docs and the pts they are supposed to take care of.  I am happy to see a lot of these misplaced residents trying to transfer and/or looking for opportunities in the US. It truly does not benefit anyone when residents are doing specialities they don't care about. I am not saying that everyone should get the specialty they want either, but there should be a better system.

I think that the Canadian match system is predicated on maintaining a particular health care environment in Canada. To that end, if one would prefer to be more self-directed in their career prospects rather than a cog in the Canadian healthcare machine, falling to whichever field is deemed in need, preparing an application to the USA is essential. Not to mention it gives Canadian doctors and students more bargaining power against a mostly hostile government, although with the present administration and their policies I would not be surprised if they opened the floodgates to FMGs to mitigate any 'brain drain'.