"Just" a GP...

[Guest Elliott]

I was reading a previous post and noticed a user said "...becoming just a family doc...". This made me think that there have been many times when I am telling someone about going into medicine, etc., etc. and when they ask me what area I want to specialize in and I say "Family Practice", it seems to have such a lackluster effect.

Is there something I am missing? Is being a GP looked upon as "just" being a GP? Do you go to functions with other doctors where the GPs all have to sit together in the cordoned off area because we are the underachiever losers? I have no desire (at this time) to specialize in any other area (who knows after rotations) but I really can't see myself wanting to do anything else.

I am saddened by the negative things I hear others saying about GPs... has anyone else ever encountered this? Are there really feelings of "I am better than you because you are a GP and I am an Orthopedic Surg"... and all that business?

 

Thanks,

 

Elliott

[Guest mesoderm]

Hey dude

i was just saying that if one "just want to be a family doc" (translation, if one doesn't want be a specialist), i thought that you prolly dun need an honours degree.

Sorry about that. plz duntake it the wrong way.

[Guest cptn med]

Hey Elliott

I think it is great to want to be "just" a GP for many reasons. You are willing to take less money and a lot more flack from the gov't. I don't know if there is snobbery among MD's about this but I do know that Canada is in serious need of GP's and frankly they are the gateway for everyone into almost all fields of medical care. How do you know if you need a specialist? How do you get referred to the right place? ...and the list goes on.

Just do what you feel will help people to the best of your ability and talent.

[Guest 007]

I agree that considering becoming a GP/family doc seems to be looked down upon by my family and friends. So, up until the past year or so, I felt as though it wouldn't be worth it to go through all of the hard work to become a doctor if I just wanted to be a GP. I was only looking at possible specialties. More recently though, I've realized that my talents and goals are probably more suited to being a GP and that they are so desperately needed in the community makes me want to be one even more. I think that just like how it used to be that if you were a smart kid, you had to become a lawyer or doctor etc, in order to fulfill your potential, now being a doctor isn't enough, you have to specialize to fulfill your potential. I think that this is a complete misconception among my peers and I think that it's important for the powers that be to correct these false beliefs to recruit more GP's and solve some of the shortages.

[Guest moo]

This kind of elitist attitude occurs everywhere, not just medicine. When I was in math you got the algebraists looking down on the applied math people. In physics, you got your theorists looking down on experimentalists. And both groups even look down on medical doctors! (My cousin is one such person.) I know this is corny but you just gotta do what you really feel is right, regardless of what others think. Unfortunately too many people (myself included) care too much about what others think and don't even want to entertain the notion of becoming a GP even though we may very well enjoy it.

[Guest CaesarCornelius]

I just thought I would point out that the term GP no longer applies. A GP was someone who graduated from medical school and immediately went into practice.

 

I also would like to point out that the statement "just want to be a family doc" (translation, if one doesn't want be a specialist)," is incorrect as people wanting to go into Family medicine must complete a 2 year residency. Therefore, you must SPECIALIZE to go into family medicine.

 

I think from this thread you can clearly see there is a huge bias against family medicine. People commonly use the words "just family" and it creates a stigma. I must say though that I haven't felt that at all at Dalhousie among the students... Among the staff, yes it exists.

 

CC

[Guest mesoderm]

a family doctor is a specialist??? okay...

 

how about this, "just want to be a family doc" (translation: one wants to SPECIALIZE in family medicine, and NOTHING else)

[Guest not rex morgan]

I'm finding that the public has really varied ideas of what it is to be a doctor. When applying to med school, perhaps the most shocking misconception was that it wasn't competitive to get in, and you basically just had to apply and then you were in. When I tell some people I'm studying medicine, they ask how I like nursing (guess what gender I am). I've had numerous patients ask me if I wanted to specialize or be a doctor. Ie, they think of family practitioners as docs and specialists as something else, I don't know what. I've been called nurse many many times, and it's interesting to see how people react when they find out I'm going to be a doctor. It varies from "oh yeah, I meant that," to the overcompensatory "oh, good for you. It's nice to see women in this field."

 

Yeah, family medicine does have a bit of a stigma, but as stated earlier, everything has a stigma, depending on who you're talking to. Good family docs are well respected by their patients. I've had patients pull me aside to tell me how lucky I was to work with their beloved family docs. Specialists are often seen as heartless, and inapproachable. Surgeons, especially are constantly defending the misconception that they all have a lousy bedside manner. The point is, if you are good at what you do, you will likely garner mostly respect. (you can't win them all) If you want to be good at something, you have to have a passion for it.

[Guest Ian Wong]

Family Medicine has really had a hard time recruiting applicants over the past decade, if not longer. Ten years ago, it was common for half of each graduating class in a Canadian medical school to go into Family Medicine. That number has been falling by a few percentage points annually, and the last year we have numbers for, that being 2003, only 24% of Canadian medical school graduates picked Family Medicine as their #1 choice of specialty. This is the lowest number in Canadian history...

 

This is a multi-factorial problem, and as such, I doubt there are any simple solutions. Here are a few of the potential reasons why Family Medicine has become less appealing:

 

1) Lower income. It is true that you can go into rural areas and make a large amount of money, but the majority of Canadian physicians want to live in urban areas, and in that setting, the income of your average family physician is going to be significantly less than virtually any specialist.

 

2) Higher tuition fees. Medical school tuition fees have never been as high as they are today in Canada. When you have students graduating with six figures worth of debt, heading into a lower-income primary care field such as Family Medicine is less appealing.

 

3) Tons of paperwork. Medical students didn't become medical students to fill out forms and do officework, they decided on medicine because they wanted to help people (in general). Yet there's probably more paper-pushing in primary-care fields than anywhere else (disability forms, routine charting, doctor's notes, reimbursement forms, social work issues, etc).

 

4) Less "prestige". Let's face it, everyone has an ego. Some have big ones, and some have small ones, but everyone has one to some degree. As a family physician, you really are on the front lines seeing patients and keeping the health care system afloat, yet for some reason, rarely get this acknowledgement from either the public at large, or other physicians. It's an unfortunate reality that prestige probably does drive medical students in their decision-making processes to some degree.

 

5) Lack of mentors. Lots of family physicians in Canada are not happy. They have comparitively lower salaries despite working longer hours than many specialists, have seen working conditions steadily deteriorating over the past decade, and will not recommend Family Medicine to their students. I've had far more family physicians recommend to me to stay far clear of Family Medicine than I've had family physicians who would recommend it.

 

In the same vein, family physicians aren't really represented throughout medical school. During your first two years of med school, you are receiving most of your teaching from specialists in that field. When you learn about the heart, you are probably getting a lecture from an internal medicine physician. When you learn about the brain, it may well be a neurologist giving the talk. When you are in third year, most of your rotations are done in the hospital, where you again are being taught by specialists (your cardiology rotation is led by cardiologists, and your surgical rotations are done with surgeons). As a result, unless you are really proactive, you could easily go through third and fourth year medical school (where many medical students finally decide on which field to pursue), without ever working alongside a family physician.

 

During your third year rotations, you'll probably hear specialists criticizing the management decisions of family physicians on a fairly regular basis. It's easy to do so if you are a cardiologist, and only have to focus on a very narrow part of each of your patients, but a lot harder to do so as the family physician who is trying to manage all the other problems that the patient might have had.

 

As a result, not having those family physician mentors during third year at such an important period of choosing your career could be a significant reason why medical students have been drifting away from family medicine.

 

6) Concerns regarding replaceability. There's a huge push in the US (this is probably more of a US reason than a Canadian reason), for physician extenders in the form of nurse practitioners and physician assistants. These extenders are gaining/have gained the rights to prescribe, see patients by themselves, and essentially have captured part of the primary care market. As a family physician, you may have to worry about being replaced or undercut by a lesser-trained, less expensive physician substitute. If you were a medical student looking to choose a career path, that's a significant factor to consider.

 

7) Expansion of medical knowledge. Every year the medical literature gets broader, and every year it becomes easier for physicians and non-physicians alike to access this information. It's a lot easier to keep on top of this growing base of knowledge as a specialist, and is downright intimidating if you actually need to know it all, as a family physician might need to do. After all in a typical year, you might get a different recommendation for hormone-replacement therapy in post-menopausal women, there might be a change in the recommendations for mammography screening for breast cancer, a new medication might come out for combatting depression, there may be a change to vaccination guidelines for your pediatric patients, there may be a change to treatment guidelines for your HIV-positive patients, there may be a different recommendation for treating your patients with high blood pressure, etc, etc.

 

A psychiatrist needs only to keep up with the newest literature on psychiatric topics, just like a pediatrician needs to worry about vaccination guidelines but probably doesn't care too much about hormone-replacement therapy in post-menopausal women. The family physician, on the other hand, might be expected to know all of this in order to practise medicine to the standard of care expected of him or her. For medical students who are accustomed to trying to "know it all", it's a humbling reality when you discover that each specialty alone has more information in it than you could ever know, let alone trying to keep up with all the specialties like a family physician might attempt to do.

 

Still, Family Medicine has some very cool things going for it. It's an infinitely flexible specialty, as you may be responsible for patients in all ages, of both genders, in either an office or hospital setting. You have long-term followup of your patients, and can really build relationships with them over time, which can be very satisfying. Because you can set up your own office, you can become independent of the hospitals and other organizations, and design your practice and tailor your working hours in whichever fashion you desire.

 

It really depends on what you want out of a medical career as to whether or not Family Medicine would be a good fit for you.

 

Ian

[Guest Elliott]

Hey - I just wanted to say thank you to everyone who has responded/will respond. Ian - thanks for the mini book, a wealth of very interesting information, especially that tidbit about med school teaching techniques.

Also, to clarify, I think most people now understand that family medicine is considered a specialty in the sense that you have to do two years residency... At the same time I am unsure about non-usage of the term GP as I hear it referred to often, especially in media, i.e.: pharmaceutical commercials "consult your GP"..., etc.

I am sure about my wishes to specialize in the field of family practice, I have a strong feeling that I need to somehow defend this position. My worry from time to time is that the family physician's position in society is fading. Of course MY personal opinion is that with this loss of family physicians we move away from a more preventative based treatment to treating only when problems arise (i.e.: seeing a specialist). I am an advocate for nurse practitioners but at the same time I know that many patients (especially in rural areas) wish to have their physician oversee all their medical issues/procedures unless absolutely necessary.

Either way, I encourage all those who feel a calling to family practice to at least give it a fair chance in rotations. Although I find many other fields of medicine unbelievably interesting, there is nothing that sparks my passion as much as family practice. I look forward to a rewarding career as a family physician every day - but on the other hand if it doesn't work out, one can always specialize in something different.

 

Kudos to family docs.

 

Cheers,

 

Elliott

[Guest Elliott]

Hey meso - btw, no worries. I didn't mean to single you out. Your post just spurred a thought in my head and prompted me to express something that I encounter on a regular basis.

 

Cheers,

 

Elliott

[Guest UWOMED2005]

My experience has been that in my first year of medicine, people would often say something like "do you want to be a cardiac surgeon or just a GP"?

 

Now that there has been so much press about the family doc shortage though, it's not uncommon for people to ask "Don't you want to be a GP? Why not? We need so many of them!!"

 

Go figure.

[Guest coastal79]

Last article in the current CMAJ is basically the lamentations of a "stupid GP", which is what the author (a GP) says he or she hears all the time in hospitals. Interesting.

[Guest 0T6]

Pg 69 of Perri Klass's "A Not Entirely Benign Procedure"...

 

Biomedical research on rare and peculiar diseases has contributed a great deal to the understanding of disease and to the care of patients, even patients with more common problems. But if the general attitude is that rare diseases are somohow the real "prizes" in the grab bag of clinical medicine, then students may stop caring so much about the more mundance medical problems, or at least may give less credit to those who concentrate on them. And the condescension that the medical student feels toward people who devote themselves to the study of what we call "bread-and-butter medicine" may not completely disappear as that student grows older and (one hopes) wiser. Academic medicine is a prestige-conscious world, and some people have trouble getting funding for their work. Bread-and-butter medicine isn't necessarily the path to prfessional advancement in this world; it sometimes seems that brownie points are awarded in a fashion rather parallel to that facing the student on rounds."