FM practice : Emerg, OB and procedures : Help me organize

[no-name]

Someone else in my situation? My favorite things in primary care = emergency, OB and procedures.

Ideally I'd like to be skilled in all 3 but people have told me it's impossible...true?

Starting residency in July. How would you suggest deciding or shaping my future practice to include at least 1-2 of these if not all of them (i.e. if it's not COMPLETELY impossible) I don't mind locuming and/or doing part-time in rural areas.

How would you approach residency if you were at my place (knowing that TONS of other residents are already set on emerg or OB, etc.)?

 

[frenchpress]

“Procedures” is very broad, and the types a procedures one might do would depend on the context - emerg has lots of procedures, for example, but these tend to be different from the sorts of things you might do in an office setting. So in general, there’s lots of ways to combine procedures with other things, but maybe not every procedure possible…

And of course it is not impossible to be skilled in all 3, many doctors in rural areas do this. Although many of the docs I know personally who do this are either old, or from South Africa, where their training exposes them to a tonne of both obstetrics (often low resource) and trauma/the scary parts of emerg. Whether it’s possible to feel confident to do all three after just 2 years of family medicine will really depend on you, what you spend your time doing in residency, and how much experience you need to personally feel confident. 
 

If I were in your position, I’d do as much as I could of emerg and OB and procedures you’re interested in without burning myself out, in part to help you decide if you actually want to do those things in practice. Sometimes things that seem great as a med student suck once you’re more responsible. This will also help you figure out where your gaps are as you go and help you figure out if you need/want to do a +1 in something (e.g. emerg). It’s easier to get extra training in OB later as there are a variety of +1 programs of different lengths (e.g 3 and 6 month options). Whereas for the emerg +1 in addition to being very competitive,  many programs will only accept people at the end / 1 year out of residency - so if you want to do it, you’ll likely need to decide fairly early on during residency. I know several people going into straight into doing OB out of residency because they felt they got enough experience, and far fewer who feel comfortable doing rural emerg and dealing with traumas/air way disasters/etc.

I also know several of people who thought they wants to do a bit of everything in family med, and then realized the lifestyle sucked. Again, not that it’s impossible, but many people realize it’s not worth it

[no-name]

2 hours ago, frenchpress said:

“Procedures” is very broad, and the types a procedures one might do would depend on the context - emerg has lots of procedures, for example, but these tend to be different from the sorts of things you might do in an office setting. So in general, there’s lots of ways to combine procedures with other things, but maybe not every procedure possible…

And of course it is not impossible to be skilled in all 3, many doctors in rural areas do this. Although many of the docs I know personally who do this are either old, or from South Africa, where their training exposes them to a tonne of both obstetrics (often low resource) and trauma/the scary parts of emerg. Whether it’s possible to feel confident to do all three after just 2 years of family medicine will really depend on you, what you spend your time doing in residency, and how much experience you need to personally feel confident. 
 

If I were in your position, I’d do as much as I could of emerg and OB and procedures you’re interested in without burning myself out, in part to help you decide if you actually want to do those things in practice. Sometimes things that seem great as a med student suck once you’re more responsible. This will also help you figure out where your gaps are as you go and help you figure out if you need/want to do a +1 in something (e.g. emerg). It’s easier to get extra training in OB later as there are a variety of +1 programs of different lengths (e.g 3 and 6 month options). Whereas for the emerg +1 in addition to being very competitive,  many programs will only accept people at the end / 1 year out of residency - so if you want to do it, you’ll likely need to decide fairly early on during residency. I know several people going into straight into doing OB out of residency because they felt they got enough experience, and far fewer who feel comfortable doing rural emerg and dealing with traumas/air way disasters/etc.

I also know several of people who thought they wants to do a bit of everything in family med, and then realized the lifestyle sucked. Again, not that it’s impossible, but many people realize it’s not worth it

Thank you for taking the time to answer, I really appreciate it. This all makes sense. Yeah I will try to show interest and get as much exposure as possible. The thing I love about FM is that I can change my scope of practice if I don't enjoy something anymore. I might go for EM for now as it is the more competitive and I feel that I will regret it if I don't at least try. But I guess I need to go back and do some rotations before I decide. Thanks again.

[frenchpress]

6 hours ago, no-name said:

Thank you for taking the time to answer, I really appreciate it. This all makes sense. Yeah I will try to show interest and get as much exposure as possible. The thing I love about FM is that I can change my scope of practice if I don't enjoy something anymore. I might go for EM for now as it is the more competitive and I feel that I will regret it if I don't at least try. But I guess I need to go back and do some rotations before I decide. Thanks again.

It’s helpful to think about residency as being for your learning - it’s there so you’re prepared to be staff at the end of it. It’s different from medical school, where showing interest is enough. In residency the point is to practice doing it, and to fill in the gaps, so that you CAN do the work when you finish. If you come at everything you do in residency from that perspective, you’ll get as much out of it as you can. 

[MDwannabe02]

The more rural you go, the more likely you will be able to do these things. I agree “procedures” is broad and that’s tough to do without the office work and/or rounding that goes along with it. Even surgeons have office days. 
 

You can do lots of derm procedures if you like that area (biopsies, cryo, etc). There are joint injections, but that goes along with a rheum/msk assessment and follow up. You can do lots of fun acute stuff in ER, but the reality is, they’re time killers too (the pro is that they are fun and can pay well too). Hospitalists can do LPs, thoras/paras, and more. Anesthesia has a lot of fun procedures, but you’d be working rurally and/or locuming as a GPA

Are you planning on doing full-service FM that includes EM and OB? If so, that’s tough in bigger centres. Especially EM, unless you’re near enough to a community site that will allow you to work there without a PGY3 (or you could pursue the PGY3 EM, but like an above post said, it’s ++++competitive). 

Rurally, you can definitely do all these things, but keep in mind, you will likely be dipping into some work-life balance with the call, shift work, etc. involved in this combo. Keep these interests in mind as you go through residency and keep an eye on the workload - the TRUE workload (admin things needing to be done, inbox management, follow up, etc). You get shielded from a lot of this stuff as a resident, depending on your program/preceptor(s). Ask any preceptors you work with what they’re typical weekly, monthly, yearly schedules look like and make sure you’re ok with that workload. That being said, you can always give things up once you’re in practice. 
 

Is your residency program urban or rural? If more urban, try to get some rural time to see what true generalist life can be like. That’s my advice as an outgoing FM PGY2 about to start a PGY3 for a focused practice

[no-name]

On 6/27/2023 at 3:16 PM, MDwannabe02 said:

The more rural you go, the more likely you will be able to do these things. I agree “procedures” is broad and that’s tough to do without the office work and/or rounding that goes along with it. Even surgeons have office days. 
 

You can do lots of derm procedures if you like that area (biopsies, cryo, etc). There are joint injections, but that goes along with a rheum/msk assessment and follow up. You can do lots of fun acute stuff in ER, but the reality is, they’re time killers too (the pro is that they are fun and can pay well too). Hospitalists can do LPs, thoras/paras, and more. Anesthesia has a lot of fun procedures, but you’d be working rurally and/or locuming as a GPA

Are you planning on doing full-service FM that includes EM and OB? If so, that’s tough in bigger centres. Especially EM, unless you’re near enough to a community site that will allow you to work there without a PGY3 (or you could pursue the PGY3 EM, but like an above post said, it’s ++++competitive). 

Rurally, you can definitely do all these things, but keep in mind, you will likely be dipping into some work-life balance with the call, shift work, etc. involved in this combo. Keep these interests in mind as you go through residency and keep an eye on the workload - the TRUE workload (admin things needing to be done, inbox management, follow up, etc). You get shielded from a lot of this stuff as a resident, depending on your program/preceptor(s). Ask any preceptors you work with what they’re typical weekly, monthly, yearly schedules look like and make sure you’re ok with that workload. That being said, you can always give things up once you’re in practice. 
 

Is your residency program urban or rural? If more urban, try to get some rural time to see what true generalist life can be like. That’s my advice as an outgoing FM PGY2 about to start a PGY3 for a focused practice

This is such good advice man. I will try to keep an eye on these things. Would love to do the full-scope FM with EM and OB but it seems less and less possible nowadays  . Glad to hear that it might be possible in rural areas. Are you in Ontario? I feel it might be easier than in Quebec where I am. Will need to take a look. My current program is urban. Once I'm done, I wouldn't mind working 3-4 hours from a major city or doing in&outs farther. 

Good luck with your PGY3 and congrats for matching!

 

[MDwannabe02]

On 6/28/2023 at 9:52 PM, no-name said:

This is such good advice man. I will try to keep an eye on these things. Would love to do the full-scope FM with EM and OB but it seems less and less possible nowadays  . Glad to hear that it might be possible in rural areas. Are you in Ontario? I feel it might be easier than in Quebec where I am. Will need to take a look. My current program is urban. Once I'm done, I wouldn't mind working 3-4 hours from a major city or doing in&outs farther. 

Good luck with your PGY3 and congrats for matching!

 

I am in Ontario, so that's where my experience is from. I do have experience across the spectrum of major academic centres to fly-in First Nations, so there's that. I can't speak to other provinces, but I have worked in MANY places in Ontario from London to Kenora/Manitoba border and many, many places in between.

 

That being said, if you're in Quebec, you'd be in a better position to assess the practice opportunities and culture in your own province. I can only speak to my knowledge and experience of my own.