Having Second Thoughts about FM

[guy30]

On 4/5/2022 at 3:15 AM, carmsregrets said:

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 is basically how the system works in the UK, Australia, and other similar commonwealth training systems but unfortunately has the unintended consequences of making competitive specialty training programs even more ultra competitive, and training times before becoming a staff attending even longer.

 

In the UK model, people spend years and years as an unaccredited registrar working as a resident essentially but not in a formal training program just to improve their application each year and to earn coveted strong reference letters essential for a successful match.  You end up getting treated like crap with scut work etc. because they know you are desperate to impress in order to have a good application. 

 

People spend thousands and thousands of dollars on additional training courses, certificates, masters, PhD's, time doing research etc. just to differentiate themselves in ultra-competitive fields to gain a training position.  It becomes standard for people to take 10 years or more just to become a staff attending in this type of system or many people never get into training programs in the end and end up settling to less desirable or competitive training programs or in perpetual limbo as a general house officer (license to practice but not in any specific field, not even in family medicine which is considered it's own specialty) in the end.

 

The Canadian and American match and residency systems are not perfect but they do at least put a defined end date on training time and somewhat limits the ability for the healthcare system to abuse junior trainees as cheap labor more than they already do.  Perhaps the option for an internship year can help people improve their applications while still having a defined limit on training times but then there would be no reason why governments would want to provide additional funding towards this unless there was a direct benefit to the healthcare system and people would also argue against this due to extending training times.

[jb24]

7 hours ago, guy30 said:

This is basically how the system works in the UK, Australia, and other similar commonwealth training systems but unfortunately has the unintended consequences of making competitive specialty training programs even more ultra competitive, and training times before becoming a staff attending even longer.

 

In the UK model, people spend years and years as an unaccredited registrar working as a resident essentially but not in a formal training program just to improve their application each year and to earn coveted strong reference letters essential for a successful match.  You end up getting treated like crap with scut work etc. because they know you are desperate to impress in order to have a good application. 

 

People spend thousands and thousands of dollars on additional training courses, certificates, masters, PhD's, time doing research etc. just to differentiate themselves in ultra-competitive fields to gain a training position.  It becomes standard for people to take 10 years or more just to become a staff attending in this type of system or many people never get into training programs in the end and end up settling to less desirable or competitive training programs or in perpetual limbo as a general house officer (license to practice but not in any specific field, not even in family medicine which is considered it's own specialty) in the end.

 

The Canadian and American match and residency systems are not perfect but they do at least put a defined end date on training time and somewhat limits the ability for the healthcare system to abuse junior trainees as cheap labor more than they already do.  Perhaps the option for an internship year can help people improve their applications while still having a defined limit on training times but then there would be no reason why governments would want to provide additional funding towards this unless there was a direct benefit to the healthcare system and people would also argue against this due to extending training times.

I think the US system is the best, because unmatched can do a prelim, intern (ie. surgical or medical), or transitional year (like the rotating internship) in which they can rotate as a an R1 without having technically matched to a program. Some programs like anesthesia give credit for the prelim, intern, or transitional year. 

Some states even let you practice medicine with that one year of rotating internship, although it will hard to be reimbursed by insurers as you are not board certified.

The US has an interesting system, and as bad as it seems in residency, it seems a lot better than most commonwealth countries.

[LoquaciousLoquat]

Take a look at this: https://www.utoronto.ca/news/u-t-scarborough-launches-new-academy-medicine-eastern-gta

Quote

Once operational, SAMIH will graduate up to 30 physicians, 30 physician assistants, 30 nurse practitioners, 40 physical therapists and 300 life sciences undergraduates per year.

Quote

With the establishment of SAMIH, U of T’s Lawrence S. Bloomberg Faculty of Nursing will be the only nursing school to have a nurse-practitioner-led clinic as part of its training program, meaning students can provide direct care while under supervision. 

If you ever thought that family medicine wasn't being replaced... well, here's a wake up call.

Also, notice that this institution is not actually called a medical school but is instead an "academy of medicine". My reading of it is that it's meant to further encourage the notion that NPs and PAs are "equal providers" to physicians by rebranding us all as having graduated from the same medical school err..... Academy of Medicine.

Keep in mind: because of greater need in Scarborough for family physicians.... the solution apparently was to open up the first nursing school with an NP-led clinic in its training curriculum. If that's not a vote against family doctors, I don't know what is.

Expect this model to eventually be replicated in every other nursing school in Canada. Once those NPs graduate, they'll open NP-led clinics of their own and directly compete against family physicians.

Meanwhile our rebuttal is that we are extending the family medicine residency to three years, because "we are not prepared for comprehensive practice". 

[medigeek]

57 minutes ago, brackenferns said:

Take a look at this: https://www.utoronto.ca/news/u-t-scarborough-launches-new-academy-medicine-eastern-gta

If you ever thought that family medicine wasn't being replaced... well, here's a wake up call.

Also, notice that this institution is not actually called a medical school but is instead an "academy of medicine". My reading of it is that it's meant to further encourage the notion that NPs and PAs are "equal providers" to physicians by rebranding us all as having graduated from the same medical school err..... Academy of Medicine.

Keep in mind: because of greater need in Scarborough for family physicians.... the solution apparently was to open up the first nursing school with an NP-led clinic in its training curriculum. If that's not a vote against family doctors, I don't know what is.

Expect this model to eventually be replicated in every other nursing school in Canada. Once those NPs graduate, they'll open NP-led clinics of their own and directly compete against family physicians.

Meanwhile our rebuttal is that we are extending the family medicine residency to three years, because "we are not prepared for comprehensive practice". 

Midlevels will rise and consider themselves as equals. It's inevitable but it can be slowed down (at best). All that can be done is educate the public on the differences, but are we even doing that?

[LoquaciousLoquat]

1 hour ago, medigeek said:

Midlevels will rise and consider themselves as equals. It's inevitable but it can be slowed down (at best). All that can be done is educate the public on the differences, but are we even doing that?

I think the issue is multifactorial but it comes down to a mismatch between supply and demand. Simply put: there are not enough physicians practicing outpatient, clinic-based, primary care.

When there is a dire family physician shortage and we, as physicians, do not address this deficiency, it creates the perfect opportunity for midlevels to justify scope creep by "meeting a need".

A major problem, as I see it, is that the CFPC wastes a lot of political capital trying to legitimize family medicine as a specialty among equals to their Royal College peers. Hence, you see a lot of academic / ivory-tower talking points about being the "patient's medical home", or by increasing the residency length to three years. Meanwhile, there are few practical solutions on how to address the growing primary care gap, which is actually what the public and policy-makers care about.

If physicians really want to stem the encroachment of midlevels, it needs to find a way to train as many primary care physicians as possible, and in the shortest amount of time.

In fact, to that end, I'd propose a "primary care" stream starting in medical school. Applicants are accepted into this stream after 2 or 3 years of undergrad into an accelerated track solely to become future primary care physicians. (Imagine how much time and money we'd save by not having to go through CaRMs or non-relevant core rotations!)

But that will never happen, again, because the CFPC is will never allow family medicine to be "just" a primary care specialty. So the encroachment of midlevels will continue, their compensation will continue to rise, and family physicians in practice will be increasingly incentivized to specialize. The CFPC will pretend this is not a big deal because "family medicine is more than primary care (PDF)".... until one day, they wake up and realize nobody wants to do family medicine anymore.

 

[medigeek]

41 minutes ago, brackenferns said:

I think the issue is multifactorial but it comes down to a mismatch between supply and demand. Simply put: there are not enough physicians practicing outpatient, clinic-based, primary care.

When there is a dire family physician shortage and we, as physicians, do not address this deficiency, it creates the perfect opportunity for midlevels to justify scope creep by "meeting a need".

A major problem, as I see it, is that the CFPC wastes a lot of political capital trying to legitimize family medicine as a specialty among equals to their Royal College peers. Hence, you see a lot of academic / ivory-tower talking points about being the "patient's medical home", or by increasing the residency length to three years. Meanwhile, there are few practical solutions on how to address the growing primary care gap, which is actually what the public and policy-makers care about.

If physicians really want to stem the encroachment of midlevels, it needs to find a way to train as many primary care physicians as possible, and in the shortest amount of time.

In fact, to that end, I'd propose a "primary care" stream starting in medical school. Applicants are accepted into this stream after 2 or 3 years of undergrad into an accelerated track solely to become future primary care physicians. (Imagine how much time and money we'd save by not having to go through CaRMs or non-relevant core rotations!)

But that will never happen, again, because the CFPC is will never allow family medicine to be "just" a primary care specialty. So the encroachment of midlevels will continue, their compensation will continue to rise, and family physicians in practice will be increasingly incentivized to specialize. The CFPC will pretend this is not a big deal because "family medicine is more than primary care (PDF)".... until one day, they wake up and realize nobody wants to do family medicine anymore.

 

 

But why are we saying that we don't have enough people doing family medicine? You can get a primary care appointment in about a week or so in major cities. That is exactly the marker we should be going by, wait times in big cities. Why? Because that's where midlevels will practice anyways. We know this already from USA data, which is basically Canada in the future. 

It's rural areas that have long wait times for everything. And there have been years of debate on how to fix that. But adding more doctors in general, even with targeted regions, does not fix it. And adding midlevels definitely does not help at all. It just saturates the physician job market, which does not have a shortage in desirable areas, and does nothing for areas in need.

Long story short is, the places where people want to live have all the doctors they need. The places where no one wants to live have a shortage of doctors (and everything else too).

[Findanus]

5 hours ago, brackenferns said:

Take a look at this: https://www.utoronto.ca/news/u-t-scarborough-launches-new-academy-medicine-eastern-gta

If you ever thought that family medicine wasn't being replaced... well, here's a wake up call.

Also, notice that this institution is not actually called a medical school but is instead an "academy of medicine". My reading of it is that it's meant to further encourage the notion that NPs and PAs are "equal providers" to physicians by rebranding us all as having graduated from the same medical school err..... Academy of Medicine.

Keep in mind: because of greater need in Scarborough for family physicians.... the solution apparently was to open up the first nursing school with an NP-led clinic in its training curriculum. If that's not a vote against family doctors, I don't know what is.

Expect this model to eventually be replicated in every other nursing school in Canada. Once those NPs graduate, they'll open NP-led clinics of their own and directly compete against family physicians.

Meanwhile our rebuttal is that we are extending the family medicine residency to three years, because "we are not prepared for comprehensive practice". 

Do you think that the extension of FM to 3 years is primarily to provide cheap, well-trained physicians to hospitals? The difference between an R3 income and a staff income is probably 4 to 5x. Same work, except now its cheaper and the worker is trapped. This is an even cheaper option for primary care than NPs.

I can't see why anyone would choose to do FM with it being 3 years now, unless they have plans to do cosmetics or something subspecialized, or if its not a choice. They won't be doing office based FM that's for sure, not with that level of investment.

[carmsregrets]

On 4/12/2022 at 8:38 AM, brackenferns said:

I think the issue is multifactorial but it comes down to a mismatch between supply and demand. Simply put: there are not enough physicians practicing outpatient, clinic-based, primary care.

When there is a dire family physician shortage and we, as physicians, do not address this deficiency, it creates the perfect opportunity for midlevels to justify scope creep by "meeting a need".

A major problem, as I see it, is that the CFPC wastes a lot of political capital trying to legitimize family medicine as a specialty among equals to their Royal College peers. Hence, you see a lot of academic / ivory-tower talking points about being the "patient's medical home", or by increasing the residency length to three years. Meanwhile, there are few practical solutions on how to address the growing primary care gap, which is actually what the public and policy-makers care about.

If physicians really want to stem the encroachment of midlevels, it needs to find a way to train as many primary care physicians as possible, and in the shortest amount of time.

In fact, to that end, I'd propose a "primary care" stream starting in medical school. Applicants are accepted into this stream after 2 or 3 years of undergrad into an accelerated track solely to become future primary care physicians. (Imagine how much time and money we'd save by not having to go through CaRMs or non-relevant core rotations!)

But that will never happen, again, because the CFPC is will never allow family medicine to be "just" a primary care specialty. So the encroachment of midlevels will continue, their compensation will continue to rise, and family physicians in practice will be increasingly incentivized to specialize. The CFPC will pretend this is not a big deal because "family medicine is more than primary care (PDF)".... until one day, they wake up and realize nobody wants to do family medicine anymore.

 

FM needs to accept that they are "just" primary care. It is not the "specialty" of family medicine lol... It's just generalist medicine.

Any specialist has generalist and specialist knowledge lol, whereas family docs only have generalist knowledge.

 

[Soon2BeMD]

Alright this is gonna be a long one but I have to rant. 

Look, for anyone reading this who’s thinking about wanting to be a family doctor, don’t let the negativity above detract you from what you want to do. At the end of the day, people’s opinions are exactly what they are… opinions. You have to keep in mind that a lot of people that end up in family medicine actually never wanted to be there in the first place because they didn’t match into their specialty of choice. So of course, people like that will be pessimistic about every aspects of the career. 
 

As somebody who is actually interested in family medicine, I can give you my thought process behind why I picked this career:

1) FLEXIBILITY

Can we all just acknowledge for a quick second that family medicine isn’t just filling up insurance forms and writing prescriptions? Yes, clinic CAN be part of the practice but it doesn’t need to be 100% clinic. I’ve lost count on how many family doctors I’ve met doing all kinds of different things, from emerg, geri, palliative care, hospitalist work, rural medicine, and some combine this with clinic and others don’t even do clinic! I don’t think people appreciate the beauty of FLEXIBILITY. Do you want to go up North and do some insane medicine while making an insane amount of money? You can. Do you want to hang back and do 3 days of clinic per week while pursuing other things outside of medicine? You can. Do you want to take a more entrepreneurial approach and just run clinics? You can. Do you want to have a mix of hospitalist + clinic practice and keep yourself busy while also having the OPTION of toning it back later on? You-can. It’s up to YOU on how you want to shape your career. To me, that’s VERY valuable and I can’t find anything in medicine that offers this type of flexibility. 

 

2) OPPORTUNITY COST

Here’s the elephant in the room that I feel like nobody wants to talk about. The second you decide to do anything but family medicine, you’re officially investing 5 years minimum + fellowship. You better love every aspect of that specialty because 5-7 years is not trivial. Think about how much has happened in your life in the last 5-7 years… it’s a LONG TIME. That’s 5-7 years of being a resident, always being told where to be, with ZERO freedom of your schedule and essentially being borderline abused. 5-7 years in the prime life building phase of your life. A family doctor will finish in 2 years and start making staff salary right away and will be already 7 figures ahead by the time the specialist finishes fellowship and that’s IF they don’t get convinced into doing 16 more fellowships because they can’t find a job when they finish. If you’re financially savy and know how to make your money work for you, you will reach the path of financial freedom much quicker than any specialist would. (Of course this is debatable but you know what I mean) Why is this important? When you have financial freedom and KNOW that you have the OPTION to NOT be at work, you will enjoy that work MUCH more because you know you can leave whenever you want. Think about it. 

 

3) TIME 

I feel like A LOT of people in medicine fail to realize a fundamental thing: medicine is a very time consuming career. It bleeds into every other aspect of your life so effortlessly. People are so hung up on how much money they will make once they finish their 20 year residency but not on how much TIME THEY WILL HAVE to actually enjoy the fruits of their labour. Time is the most valuable asset you have and it’s not even a guarantee. I rather make 250 k as a fam doc but be in COMPLETE CONTROL of how I use my TIME and make sure that I can actually do the things that actually bring me happiness like spending time with my partner, seeing my family, pursuing hobbies I have outside of medicine, and making sure I don’t miss major events like weddings, travels and even being present in my kids’ future as a committed parent. Cause let’s face it, your job as a physician is not your only job. Being a good friend, a good partner, a good parent are also jobs and they are just as important, at least to me. There’s only so much time in a day and if 90% of it is being spent on my job as a physician, then everything else will suffer, hence why medicine has the highest burn out and suicide rates. 
 

4) THE BAD DAYS 

Every specialty has its bad days. I think it’s overrated to ask yourself whether you love a specialty because honestly, every specialty is cool. I truly mean it when I say I enjoyed every rotation during clerkship. However, the more important question you should be asking yourself is: are you able to TOLERATE the BAD DAYS of said specialty? The worst things I can think of when it comes to family medicine is filling up endless forms and dealing with patients coming in with a wide range of non-specific issues that may be difficult to deal with in an outpatient setting. Will those days be annoying/hard? Yeah, they will. But man, I would take that over being woken up at 3 am while I’m feeling warm under my covers nexto my wife receiving that harrowing phone call that two category 1s just came through and now I gotta go operate while running on a fragmented sleep schedule. Or having to deal with the stress of making sure I don’t kill my patients when I’m opening them up as a surgeon because of course, I’m human and yes, mistakes do and WILL happen. Or dealing with the stress of being the staff in charge of an ICU floor filled with complex patients where you’re on call for every waking minute of that week, praying that someone in your large team doesn’t screw something up under your name. I rather focus on the “boring screening guidelines” that can actually prevent my patients from even being in those situations in the first place. Every specialty has its bad days and each of them interfere with your personal life to varying degrees. So ask yourself what you’re willing to stomach and pick your poison. 
 

I just wanna finish with this. We all have egos and we’re all overachievers. At some point before you came into medicine, you were likely the top of your class. Now imagine taking ALL those people, and shoving them in 1 room. OF COURSE family medicine receives so much heat. It’s just not sexy enough when that’s your target audience. When someone matches ophthalmology, there’s a wow factor but there definitely isn’t one for family medicine. And it’s normal, cause there’s like 3 optho spots in the world versus the 100s for family medicine. Human beings value exclusivity and it’s always been this way. It’s just the nature of the beast. BUT, don’t let your ego force you into a position where you feel compelled to impress other people because once the novelty wears off, you’ll find yourself in a situation where you gotta face the repercussions of your decisions. A job is a job at the end of the day and even the coolest job of all time becomes routine. 

End of rant. 
 

TLDR: Family medicine is the best SPECIALTY. Yup, I said it. If that triggers you, lighten up bud  

[gogogo]

brackenferns and carmsregrets, you're both clearly dissatisfied with family medicine. You should switch careers. It's unproductive and excessively pessimistic for you to come on here and repeat trite criticisms of family medicine while ignoring any evidence to the contrary. I also sense that you've internalized the stereotype of family medicine as a lowly specialty, hence you constantly wanting to distance yourself from it (for more detail, check out an analogous process among races called internalized racism).

Some examples of your bias:

On 4/3/2022 at 3:43 PM, 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.

...

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"). 

It's as if all of those negative aspects of specialties just disappeared into thin air for you. Complexity, acuity, worse work-life balance, overnight call, shift work, higher liability, more prone to be sued, less job opportunities, longer training time...these are emphatically awful attributes of a job for me and for many who go into family medicine. If I had to deal with that long list of negatives, I would be miserable. Apparently you think that it's not so bad...well then why don't you switch? There are options for retraining in Canada and the U.S., but even more easily, there is so much flexibility in family medicine. Thus far, it seems that you prefer to just list reasons for why family medicine is so bad, but yet, you don't actually do anything about it.

Onto more bias....

On 4/3/2022 at 5:35 PM, 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.  

This is absurd. The stress and hours in general surgery are far worse than what you get in family medicine. And like brackenferns, I ask you to put your money where your mouth is: switch. You seem to think that general surgery works family medicine hours, makes more money, and does more interesting work; well, you're in luck, because 25% of the residents in surgery end up leaving. When they leave, they usually choose family medicine, so you've got the perfect situation. This would be far more productive than trying to put everyone else down about family medicine just because you don't like it.

2 hours ago, carmsregrets said:

FM needs to accept that they are "just" primary care. It is not the "specialty" of family medicine lol... It's just generalist medicine.

Any specialist has generalist and specialist knowledge lol, whereas family docs only have generalist knowledge.

Speak for yourself. Just because you're not willing to put in the work to be an exceptional family physician doesn't mean that others won't. For instance, medigeek has consistently provided an example for how to achieve a balanced, lucrative, and clinically strong career in family medicine. Why don't you emulate that instead of just complaining? As much as you think that all of your problems with family medicine are due to family medicine itself, some of it is in fact because of how you seem to approach challenges. Indeed, this defeatist and fatalist attitude wouldn't get you far in a specialty either.

[LoquaciousLoquat]

8 hours ago, gogogo said:

Apparently you think that it's not so bad...well then why don't you switch? There are options for retraining in Canada and the U.S., but even more easily, there is so much flexibility in family medicine. Thus far, it seems that you prefer to just list reasons for why family medicine is so bad, but yet, you don't actually do anything about it.

The context for that post was to point out that family physicians have similar rates of dissatisfaction as specialists. I picked general surgery because it's generally accepted as a non-lifestyle specialty; it's not because I was trying to say general surgery is better or that I'd rather be a surgeon instead.

Most of my dissatisfaction is not even directed at "family medicine". It's more specifically at how primary care is structured and at the poor leadership from the CFPC in addressing the needs of practicing physicians and the wider public.

I'm not sure if you are a part of the "First Five Years of Family Medicine" Facebook group, but if you were, you'd realize my opinions (i.e. being pessimistic / frustrated at primary care) is the general sentiment held by practicing family physicians. Sure, there's a bias there in the sense that people with complaints are the most vocal. But the universal sentiment (even amongst happily practicing family doctors) is that things are getting more difficult. 

EDIT: I feel this will devolve into an un-productive argument so I will just bow out now. I will leave these parting points:

1 - OP made this thread because they had second thoughts about family medicine. That is absolutely normal. Not enjoying a career or being critical of it is not a sign of something wrong with your character or that "you need to switch". Many people work jobs they don't like to make a living; in fact, outside of "passion professions" like medicine / law / etc..., that's is the case rather than the exception.

2 - Family medicine being a "chill" specialty is not completely backed up by fact. Look at the OMA dissatisfaction surveys. Of course there's self-selection and attrition factors involved as discussed, so take those numbers with a grain of salt. 

3 - The experience of practicing physicians advising applicants / pre-meds to not go into their field is not new and fairly common. It doesn't mean that those physicians are bitter or problematic. They just have a different perspective now that they're in practice and are giving the advice they wished they heard. 

[medigeek]

2 hours ago, brackenferns said:

The context for that post was to point out that family physicians have similar rates of dissatisfaction as specialists. I picked general surgery because it's generally accepted as a non-lifestyle specialty; it's not because I was trying to say general surgery is better or that I'd rather be a surgeon instead.

Most of my dissatisfaction is not even directed at "family medicine". It's more specifically at how primary care is structured and at the poor leadership from the CFPC in addressing the needs of practicing physicians and the wider public.

I'm not sure if you are a part of the "First Five Years of Family Medicine" Facebook group, but if you were, you'd realize my opinions (i.e. being pessimistic / frustrated at primary care) is the general sentiment held by practicing family physicians. Sure, there's a bias there in the sense that people with complaints are the most vocal. But the universal sentiment (even amongst happily practicing family doctors) is that things are getting more difficult. 

EDIT: I feel this will devolve into an un-productive argument so I will just bow out now. I will leave these parting points:

1 - OP made this thread because they had second thoughts about family medicine. That is absolutely normal. Not enjoying a career or being critical of it is not a sign of something wrong with your character or that "you need to switch". Many people work jobs they don't like to make a living; in fact, outside of "passion professions" like medicine / law / etc..., that's is the case rather than the exception.

2 - Family medicine being a "chill" specialty is not completely backed up by fact. Look at the OMA dissatisfaction surveys. Of course there's self-selection and attrition factors involved as discussed, so take those numbers with a grain of salt. 

3 - The experience of practicing physicians advising applicants / pre-meds to not go into their field is not new and fairly common. It doesn't mean that those physicians are bitter or problematic. They just have a different perspective now that they're in practice and are giving the advice they wished they heard. 

Dissatisfaction with medicine (or family medicine, or any specialty) comes from people who thought that becoming a doctor would make them some sort of king/queen, super rich, very prestigious, constantly saving lives etc. and/or some combination (or all) of those things.

In reality, none of those things happen. You can make excellent money in medicine but you're not going to be mega rich. The prestige of the 1970s is long gone. And it's rare that someone is actually saving lives directly in medicine with some obvious and impactful way that then returns them to their original lifestyle. 

[regular]

Here’s the BC Health Minister talking about how he thinks NPs provide better care.   The CCFP’s third year isn’t going to change anything.

https://youtu.be/WDnRAt2h6K4

[shikimate]

1 hour ago, regular said:

Here’s the BC Health Minister talking about how he thinks NPs provide better care.   The CCFP’s third year isn’t going to change anything.

https://youtu.be/WDnRAt2h6K4

It's all about the money. They'll let NP replace FM, then RN replace NP, then RPN replace RN, then PSW replace RPN, etc.

just read this few days ago, basically nowadays they wanna get young people into working ASAP, forget about getting your master's degree in basket weaving studies lol.

https://www.cbc.ca/news/canada/london/psw-high-school-certification-program-london-1.6419583

[Redpill]

2 hours ago, regular said:

Here’s the BC Health Minister talking about how he thinks NPs provide better care.   The CCFP’s third year isn’t going to change anything.

https://youtu.be/WDnRAt2h6K4

lol he's getting grilled on that comment in the Leg today, and he's denying he said it.

Of course the media is coming to his defense after the Doctors of BC put out a statement:

 

[Redpill]

I take it back - Zussman retweeted the video of Dix saying the quote

[indefatigable]

Many of the issues regarding FM go well beyond this forum.  The article "Why Would Anyone Choose To Be A Family Doctor" (printed twice) and the CBC podcast with leaders in FM who openly acknowledge issues that have been discussed here with FM as it exists now.

Skimming comments, I get the sense the "Golden Age" of FM has long past and died out before the new millennium.  Many of the the older generation seems pretty happy to be no longer practicing.

I think that rural FM is likely the most engaging and fulfilling, but means practicing in a rural area which most people don't want to do.  

https://www.canadianhealthcarenetwork.ca/why-would-anyone-want-be-family-doctor

https://healthydebate.ca/2022/05/topic/why-want-family-doctor/?utm_source=mailpoet&utm_medium=email&utm_campaign=more-beds-won-t-cure-what-ails-canadian-health-care_54

https://www.cbc.ca/radio/thecurrent/the-current-for-april-28-2022-1.6433870/thursday-april-28-2022-full-transcript-1.6435195

[medigeek]

On 5/12/2022 at 1:58 PM, Redpill said:

I take it back - Zussman retweeted the video of Dix saying the quote

It's the NDP dude. They're very pro midlevel and against physicians. What's the surprise? 

[Redpill]

1 hour ago, medigeek said:

It's the NDP dude. They're very pro midlevel and against physicians. What's the surprise? 

No surprise at the NDP. Annoyance the media was given them a free pass (until he found the video and retweeted it)

[shikimate]

It's not just FM, the "golden age" of medicine has passed. 

1) Some doc was telling me back in the early 90s she didn't know what she wanted to do after undergrad, so she just applied to med school and got in. These days not even 3.9 is enough lol.

2) Old docs tell me they got free cruises and trips to Hawaii for "educational" conferences and didn't spend a penny. Nowadays if you wanna go to these "courses" registration fee alone is like 1500USD lol.

3) We can't forget about the old story of how they practice for like 1-2 years and was able to buy a house and have their spouse stay home lol. Nowadays I see people who bill 500K a year ask if they can afford a house in Toronto lol.

 

[medigeek]

On 5/13/2022 at 7:09 PM, shikimate said:

It's not just FM, the "golden age" of medicine has passed. 

1) Some doc was telling me back in the early 90s she didn't know what she wanted to do after undergrad, so she just applied to med school and got in. These days not even 3.9 is enough lol.

2) Old docs tell me they got free cruises and trips to Hawaii for "educational" conferences and didn't spend a penny. Nowadays if you wanna go to these "courses" registration fee alone is like 1500USD lol.

3) We can't forget about the old story of how they practice for like 1-2 years and was able to buy a house and have their spouse stay home lol. Nowadays I see people who bill 500K a year ask if they can afford a house in Toronto lol.

 

I think what you're saying is mostly true for the US. 

American doctors in the 50s-80s, and somewhat into the 90s, made a killing and got very rich. They had very high end lifestyles. I'm not so sure Canadian doctors did. Salaries were not as high I believe in Canada. I actually don't think Canadian physician incomes even got very high until the late 2000s. 

[Redpill]

On 5/13/2022 at 5:09 PM, shikimate said:

It's not just FM, the "golden age" of medicine has passed. 

1) Some doc was telling me back in the early 90s she didn't know what she wanted to do after undergrad, so she just applied to med school and got in. These days not even 3.9 is enough lol.

2) Old docs tell me they got free cruises and trips to Hawaii for "educational" conferences and didn't spend a penny. Nowadays if you wanna go to these "courses" registration fee alone is like 1500USD lol.

3) We can't forget about the old story of how they practice for like 1-2 years and was able to buy a house and have their spouse stay home lol. Nowadays I see people who bill 500K a year ask if they can afford a house in Toronto lol.

 

There are still opportunities I think. But moreso the golden age of everything is done. North America is more crowded, high incomes don't go as far, and no one can afford a house in Toronto lol

[shikimate]

Well to put things in a bigger perspective, as a public funded service, medicine is not something which easily "booms" with QE and "easy money" like real estate, petrol, NFT, crypto, or WeWork.

But medicine is stable and recession proof, so now with rising interest rate and potential recession, it may become a good time for physicians to go bottom fishing.  Docs are less likely to be caught swimming naked when the tide goes out.

[indefatigable]

Yeah, but I think the concerns/issues for FM run much deeper.  

The Globe & Mail just ran a major pieces mentioning 10 ways how to fix health care .. and one of the Big Ideas is to stop creating/hiring FPs and create/hire NPs instead..  I mean that's pretty shocking and suggests the CFPC has a lot of work in order to justify its existence and importance..  It seems as if the writing is on the wall a little for FM..  

Nearly 15 per cent of Canadians don’t have a family doctor, but the solution isn’t hiring more

https://www.theglobeandmail.com/opinion/article-family-doctor-shortage-nurse-practitioners/

The Fix: Canada needs more primary-care nurse practitioners

"The authoritative Cochrane Library evaluated 18 randomized trials comparing nurse practitioner and physician outcomes and concluded that nurse practitioners “probably provide equal or possibly even better quality of care compared to primary care doctors.” And, according to a 2015 review of 11 scientific studies, the NP care model is 'potentially cost-saving'  [not sure how this could be concluded..] Currently, 25 nurse practitioner-led clinics are successfully operating in Ontario."

If we actually need more NPs and less FPs, should residency be increasingly only RC specialties?  Does FM need to be phased out long term?

[granduc]

14 minutes ago, indefatigable said:

Yeah, but I think the concerns/issues for FM run much deeper.  

The Globe & Mail just ran a major pieces mentioning 10 ways how to fix health care .. and one of the Big Ideas is to stop creating/hiring FPs and create/hire NPs instead..  I mean that's pretty shocking and suggests the CFPC has a lot of work in order to justify its existence and importance..  It seems as if the writing is on the wall a little for FM..  

Nearly 15 per cent of Canadians don’t have a family doctor, but the solution isn’t hiring more

https://www.theglobeandmail.com/opinion/article-family-doctor-shortage-nurse-practitioners/

The Fix: Canada needs more primary-care nurse practitioners

"The authoritative Cochrane Library evaluated 18 randomized trials comparing nurse practitioner and physician outcomes and concluded that nurse practitioners “probably provide equal or possibly even better quality of care compared to primary care doctors.” And, according to a 2015 review of 11 scientific studies, the NP care model is 'potentially cost-saving'  [not sure how this could be concluded..] Currently, 25 nurse practitioner-led clinics are successfully operating in Ontario."

If we actually need more NPs and less FPs, should residency be increasingly only RC specialties?

This kind of article is what makes me most reluctant to go into family medicine. I really like the profession, but I want to be sure that I have a job that I will enjoy. I don't want to do all this to end up being replaced mid-career. I have no doubt that there will always be a place for the GPs, but what will it be?