The case against family medicine

[obi]

Is there even a single job in any of the more "prestigious specialties?" In Canada that is.

 

yes. Its not an issue of an absolute freeze on job availability. Its a problem of the jobs:applicants ratio along with location being pretty inflexible. Jobs spring up and disappear as they get filled, its a constant ebb and flow as the older physicians retire.

[rmorelan]

You don't call to review admissions or consults? Even if you might need to tPA or lyse someone in the middle of the night?

 

yes. Its not an issue of an absolute freeze on job availability. Its a problem of the jobs:applicants ratio along with location being pretty inflexible. Jobs spring up and disappear as they get filled, its a constant ebb and flow as the older physicians retire.

 

Supply still exceeds demand though - in the end that is probably the most important aspect along that vein.

[Dongzhuo]

The best specialty, in my mind, is plastic surgery. It is the number one most competitive specialty for many reasons. Intellectual stimulation, money, respect, prestige. You are basically the MVP of the medical world. No jobs? No problem. Open up your aesthetic plastic surgery clinic and watch the money pour in.

[A-Stark]

Cosmetic practice is very competitive with high overhead. And the patients are annoying.

 

Otherwise, plastics has the worst patient population around, unless you like dealing mostly with people who "punch walls" routinely or get hit in the face when they were just "minding their own business". It's also pretty divorced from physiology, which for an ICU/resp/anesthesia-oriented person isn't quite enough.

 

I'm not sure resecting BCCs or doing FTSG post-melanoma resection is really so intellectually stimulating. And dealing with those little tiny screws and plates for hands and orbits and zygomatic arches always looked extremely fiddly and annoying to me.

[hexonu]

The biggest case against family medicine is encroachment of NPs and physician assistants as well as the lost respect from the general population. Long gone are the days where a patient will go in with a chief complaint completely blind and respectfully listen what their family physician says. Today, they've already spent hours on the internet and go into the encounter partially convinced that they know more than their GP and all they really need is to see a specialist. It's very sad.

 

Here we go again with the encroachment tripe.

 

I think you're somewhat angered by the power struggle that medicine is facing in this digital age. You should be happy that more people are thinking critically about their health and not blindly following what their doctor says. I've heard of people getting two, sometimes three different medical opinions. The internet empowers people and allows them to advocate for their most important asset, their health.

 

While I'm not saying that people should go and self-diagnose I think that people know themselves best and the internet gives them a basic understanding of medical jargon. The way I see it an informed patient is the best type of patient.

[Dongzhuo]

Cosmetic practice is very competitive with high overhead. And the patients are annoying.

 

Otherwise, plastics has the worst patient population around, unless you like dealing mostly with people who "punch walls" routinely or get hit in the face when they were just "minding their own business". It's also pretty divorced from physiology, which for an ICU/resp/anesthesia-oriented person isn't quite enough.

 

I'm not sure resecting BCCs or doing FTSG post-melanoma resection is really so intellectually stimulating. And dealing with those little tiny screws and plates for hands and orbits and zygomatic arches always looked extremely fiddly and annoying to me.

 

I guess different strokes for different folks. I always liked working with my hands...

[A-Stark]

You can be well assured that the vast majority of patients don't have anything more than a superficial understanding of what's going on with them. Last night I had a patient talk about how her husband had "aspirinated" after surgery requiring a long ICU stay, and that Tyenol was not working for her cold, ahem, "flu" for which she wanted antibiotics since they'd "worked before".

[A-Stark]

I guess different strokes for different folks. I always liked working with my hands...

 

Lots of procedures in other fields.

[leviathan]

Here we go again with the encroachment tripe.

 

I think you're somewhat angered by the power struggle that medicine is facing in this digital age. You should be happy that more people are thinking critically about their health and not blindly following what their doctor says. I've heard of people getting two, sometimes three different medical opinions. The internet empowers people and allows them to advocate for their most important asset, their health.

 

While I'm not saying that people should go and self-diagnose I think that people know themselves best and the internet gives them a basic understanding of medical jargon. The way I see it an informed patient is the best type of patient.

The only "critical thinking" some patients do is read what Jenny Mcarthy has to say about vaccinations or what someone on Youtube posted from their parents' basement. They're mostly unable to help themselves without a basic education of and understanding of critical thinking.

[medigeek]

yes. Its not an issue of an absolute freeze on job availability. Its a problem of the jobs:applicants ratio along with location being pretty inflexible. Jobs spring up and disappear as they get filled, its a constant ebb and flow as the older physicians retire.

 

Yea there's 3 applicants for one neurosurgery job... 2 will be left out though ultimately. (just an example). And that's the issue. There aren't enough people retiring.

 

The lack of jobs, much like the lack of medical school spots, is due to an artificial non-free-market governmental and professional "old boy's club"-like self-regulation that is insulated from true supply/demand economics.

 

All these surgeons would be very eager to work, and the populace eager to let them, if the government would open more ORs or relax restrictions on physician-owned and operated ORs in most provinces. However, this would probably do two things that would irk those in the commanding seats (the currently working surgeons and the government): cost money, and increase competition thereby reducing billings.

 

What a thread tangent!

 

The government doesn't really have much money though lol... and unless you make a drastic cut, there's won't be any drastic differences.

[medigeek]

Here we go again with the encroachment tripe.

 

I think you're somewhat angered by the power struggle that medicine is facing in this digital age. You should be happy that more people are thinking critically about their health and not blindly following what their doctor says. I've heard of people getting two, sometimes three different medical opinions. The internet empowers people and allows them to advocate for their most important asset, their health.

 

While I'm not saying that people should go and self-diagnose I think that people know themselves best and the internet gives them a basic understanding of medical jargon. The way I see it an informed patient is the best type of patient.

 

It's definitely a good idea to be an informed patient, but everyone tends to self-diagnose themselves with an endless number of diseases (all of which they most certainly don't have) over a bunch of vague symptoms that will almost certainly go away and never come back.

A lot of doctors are good at making a statistical judgement.

[medigeek]

The only "critical thinking" some patients do is read what Jenny Mcarthy has to say about vaccinations or what someone on Youtube posted from their parents' basement. They're mostly unable to help themselves without a basic education of and understanding of critical thinking.

 

Don't forget statistical judgement... Also, self-diagnosing is stupid no matter how much knowledge you have. Everyone is more paranoid and less logical when it comes to them self.

[NLengr]

Lots of procedures in other fields.

 

I did plastics as part of my first two years of training for my surgical specialty. Out of all the surgical specialties I rotated through, it was my least favourite. Every procedure just seemed like endless closing. That being said, I can understand how people would find it appealing.

[youngdad]

It has been a long time since I last posted on this forum. I am currently a family medicine resident, and while residency life is relaxing and pleasant in general, and jobs are plentiful in the field, I believe there is a reason why many shy away from the field. If I could choose all over again, I would stay far away from the field. Here is why:

 

Your peers don`t respect you

Everyone who gets accepted to medical school, by and large, are type A personality types (myself included). We all want to be the best of the best, neurosurgeons, cardiologists, plastic surgeons, you name it- family doctors just do not measure up to that. Often times you strike up a conversation with other residents, and when they find out you`re in family medicine, they say ``We definitely need you guys...we need good family doctors for sure`` with an arrogant air. When you`re a family doctor, be prepared for specialists to feel superior to you when talking (despite how unjustified it may be).

 

Your patients don`t respect you

In my experience, patients only rarely come to you for pressing medical concerns. They usually come to you to get something very routine done. For example, getting their medications refilled, annual physical, PAP smears, warts frozen off, getting a work note etc. That`s a significant amount of your practice. They know and you know it doesn`t take a mental giant to do that. And when big problems come up- it`s time for referral to the ``smart ones`. It often times feels as though you`re their homeroom teacher, while the specialists are the ones teaching calculus, physics, and english literature.

 

The public doesn`t respect you

I realize that the public by which I mean your friends, acquaintances etc are often in awe when a person gets into medicine. That`s because of their potential to be a trauma surgeon or something prestigious. Once they find out you`re in family medicine, the wow factor and prestige is gone instantly. I have, some time back, gone on dates with a girl who was a starbucks barista, who asked me ``why family``- with the clear question of - why that and not something greater. The unfulfilled potential will forever haunt you.

 

Family medicine doesn`t respect itself

Recently friends have posted an article, written by a family doctor- you may have seen it, entitled ``Are you going to specialize, or just a gp``. I find self defending articles about respect and being a ``specialist in the person`` and ``specialist in general practice`` quite embarrassing actually. Insecurity seems to abound amongst family practitioners

 

You don`t respect yourself

I don`t truly mean this, but had to go along with the previous headings (lol). I is difficult to be a generalist. The field is just too broad, and it is impossible to know everything. In trying to know everything about everything, you end up knowing nothing. Specialists will always know much more than you in every given subject. Also, since specialists all have their own little area, you, the GP will be left with the scraps. Namely random presenting complaints that no one will ever know like random tingling sensations on a patch of skin or flushing ear wax.

 

LOL

Your insecurity is hilarious and you seem quite oblivious to how bad it is.

You should probably stop as you are embarrassing yourself.

No actually, keep doing it.

LOL

[NLengr]

Otherwise, plastics has the worst patient population around, unless you like dealing mostly with people who "punch walls" routinely or get hit in the face when they were just "minding their own business".

 

Minding your own business is an independent risk factor for getting stabbed.

[youngdad]

Minding your own business is an independent risk factor for getting stabbed.

 

HA! This made me laugh so hard.

 

This thread is awesome. I approve.

[HycrestJIT]

The best specialty, in my mind, is plastic surgery. It is the number one most competitive specialty for many reasons. Intellectual stimulation, money, respect, prestige. You are basically the MVP of the medical world. No jobs? No problem. Open up your aesthetic plastic surgery clinic and watch the money pour in.

 

It's all about the dollah billz, yo.

[A-Stark]

I did plastics as part of my first two years of training for my surgical specialty. Out of all the surgical specialties I rotated through, it was my least favourite. Every procedure just seemed like endless closing. That being said, I can understand how people would find it appealing.

 

If you just want to suture skin, why not just be an emerg doc? It's just not interesting without the viscera, hollow or solid!

 

Minding your own business is an independent risk factor for getting stabbed.

 

I had two night shifts in emerg this weekend. Among the interesting cases were Face vs. Concrete Stair, Face vs. Fist, and a CMC fracture secondary to a drunken altercation NYD.

[HycrestJIT]

Feeding the troll, anyone?

[Dongzhuo]

LOL

Your insecurity is hilarious and you seem quite oblivious to how bad it is.

You should probably stop as you are embarrassing yourself.

No actually, keep doing it.

LOL

 

A guy goes back to a high school reunion working at a fast food joint. His old school friends are now lawyers, doctors, and bankers. If he feels like he should have gone for a more prestigious job, is that insecurity or just logical thinking. Just wanna be a boss yo

[rmorelan]

A guy goes back to a high school reunion working at a fast food joint. His old school friends are now lawyers, doctors, and bankers. If he feels like he should have gone for a more prestigious job, is that insecurity or just logical thinking. Just wanna be a boss yo

 

He has a lot of successful friends

 

And it is by definition insecurity - although like most emotions that isn't necessarily a bad thing - it is just a hint that you could be doing more.

He 'feels' = emotion. He reasons = logical thinking

[Mourning Cloak]

A guy goes back to a high school reunion working at a fast food joint. His old school friends are now lawyers, doctors, and bankers. If he feels like he should have gone for a more prestigious job, is that insecurity or just logical thinking. Just wanna be a boss yo

 

So . . . .

 

what are you going to do?

[rmorelan]

Feeding the troll, anyone?

 

Ha - it is interesting someone is actually arguing for another well known but rarely talked about reason for medicine - people are responding a lot to it with standard examples of money, or dismissing the reason as invalid. Yet this is a reason many do in part go into medicine , and probably is no less valid than many others. For some respect is the most important aspect if at least a minimum level of say finances etc is met. You will meet these people, and they can be quite driven.

[rmorelan]

So . . . .

 

what are you going to do?

 

Ha - very good question

[obi]

If you just want to suture skin, why not just be an emerg doc? It's just not interesting without the viscera, hollow or solid!

 

http://whatshouldwecallmedschool.tumblr.com/post/62424583232/first-time-i-saw-a-plastic-surgeon-close-on-a-patient <-- funny gif someone posted a while back

 

As for my statement on the job situation, it was in response to medigeeks question of "is there even a single job in Canada".. It's an obvious answer to an obvious question. Yes, there physically are jobs (even if one opening pops up a year). The ratio is just prohibitively skewed towards the supply side of things.