How much +1 ing can you do in fm without actually having done a +1?

[MDee2B]

Suppose one didn’t want to see any kids in their practice, but had an interest in palliative care for example, or sports, or psychotherapy with adults etc.

How much can an fm doctor tailor their practice to a specific niche without having actually done a +1 in said niche (just the 2 year fm residency)? Would billing suffer if one “closed off” their practice to a specific patient population (ie kids), or is there enough demand that one could still earn similarly while focusing only on a specific niche in fm?

Are fm docs even allowed to turn down certain pt populations that don’t fit the niche they’re targeting?

I know, one could do IM for adults, psych for psychotherapy, or a +1 in fm in various areas. I’m just curious what the possibilities are for running a niche fm practice if you only go the basic 2 year fm residency route, and how the corresponding earnings might compare to a general (non-niche) fm practice.

Thanks 

[gangliocytoma]

You can certainly do exclusively palliative care or psychotherapy. In these services you are a "consultant" and will need to be referred patients (not 100% sure about that for psychotherapy). When you are a consulting physician you can choose which consults you accept.