Family Medicine Popularity

[BeentheredonetheDAT]

Just out of curiosity, why has family med suddenly become so popular? There are a lot of grads now that are applying only to family med. I understand that there are many lifestyle benefits that come with family practice, but what about pay? Can't an MD make significantly more as a specialist than a family doctor, and in addition to that many specialties offer the same lifestyle benefits as family, like radiology, dermatology, etc. But with significantly higher pay.

[JohnGrisham]

Just out of curiosity, why has family med suddenly become so popular? There are a lot of grads now that are applying only to family med. I understand that there are many lifestyle benefits that come with family practice, but what about pay? Can't an MD make significantly more as a specialist than a family doctor, and in addition to that many specialties offer the same lifestyle benefits as family, like radiology, dermatology, etc. But with significantly higher pay.

FM pays well, has great hours and flexibility.   Want to only work a few days a week? Check. Want to a lot of hours and do locums all across the country? Go ahead. Want to do a +1 in EM, Anesthesia, etc etc ? Go ahead.

 

Not everyone can become a radiologist or derm, nor does everyone have an interest in them (Not to mention, if you want to do derm stuff, you can do it as a FM doc for the luxury cosmetic stuff(botox etc), obviously nowhere near the same extent as a royal college dermatologist, but some of the smaller more "service-oriented" things you can!).

 

Also, 2 years of residency and then start making attending level money right away? Check. Also, note that not everyone has a desire to make 500-1000K a year...many people are just fine working much less hours and have take-homes of <200K.   There are a lot of ways to make money with FM, and ways to be flexible. 

 

Then again, I don't want to promote FM...because then everyone will keep going for it and make it more difficult for me

 

So yes, don't go into FM, its not good and you can make way more money elsewhere

 

(Which is true, specialists have potential and on average make significantly more...but not without trade offs of longer training times, being tied to resources like hospitals etc etc)

[BeentheredonetheDAT]

Commons, thanks for the reply. 

 

Yes, that's a very valid point. So, I'll be honest, money is a huge factor for me. Although I'm only in my first year, my goal has always been to end up in a speciality that nets 700k+ a year. It seems unusual to me that the majority of people in med don't also have that same ambition to do specialities like radiology, ophthalmology or dermatology ( while they seem competitive, from the numbers I don't think they're THAT competitive. if I wanted one of the three and was willing to go far, I could land one) that can bring in a lot of money. Especially when you think about the fact that you can retire early, 3 years of extra training seems a small trade off for a difference of around 500k a year in potential earnings. 

[LittleDaisy]

It's not just 3 years more for specialties...you are looking at 1-2 years of fellowship at least to work in an academic hospital. So overall, 4-5 years more training and more stress! When you hit 30s as a R4-R5, you might not even know where you are going to end up working. 

The job market for radiology and ophthalmology are not that bright if you would like to remain in urban centres; at least in Quebec. 

I don't know about ambition for medical students. Even if I were paid 700K+ as a radiologist, I would not consider it since I am easily bored in a dark room and I like seeing patients. 

Commons, thanks for the reply. 

 

Yes, that's a very valid point. So, I'll be honest, money is a huge factor for me. Although I'm only in my first year, my goal has always been to end up in a speciality that nets 700k+ a year. It seems unusual to me that the majority of people in med don't also have that same ambition to do specialities like radiology, ophthalmology or dermatology ( while they seem competitive, from the numbers I don't think they're THAT competitive. if I wanted one of the three and was willing to go far, I could land one) that can bring in a lot of money. Especially when you think about the fact that you can retire early, 3 years of extra training seems a small trade off for a difference of around 500k a year in potential earnings. 

[Lactic Folly]

Commons, thanks for the reply. 

 

Yes, that's a very valid point. So, I'll be honest, money is a huge factor for me. Although I'm only in my first year, my goal has always been to end up in a speciality that nets 700k+ a year. It seems unusual to me that the majority of people in med don't also have that same ambition to do specialities like radiology, ophthalmology or dermatology ( while they seem competitive, from the numbers I don't think they're THAT competitive. if I wanted one of the three and was willing to go far, I could land one) that can bring in a lot of money. Especially when you think about the fact that you can retire early, 3 years of extra training seems a small trade off for a difference of around 500k a year in potential earnings. 

 

I suspect you are both overestimating specialty earning potential and lifestyle, and underestimating family practice earning potential. Remember, in a fee-for-service environment, the amount you make is directly tied to the amount you work. I highly doubt there is a difference of 500k/yr for people working similar hours per week..

[BeentheredonetheDAT]

I suspect you are both overestimating specialty earning potential and lifestyle, and underestimating family practice earning potential. Remember, in a fee-for-service environment, the amount you make is directly tied to the amount you work. I highly doubt there is a difference of 500k/yr for people working similar hours per week..

 

 From my discussion with several FPs, they all complained that specialists were working less and making more, especially subspecialties that don't require OR time or hospital resources. But yeah, that does seem to conflict with the popular opinion that you can make the same amount, or close to it, as an FP and have a much better life-work balance. 

[JohnGrisham]

 From my discussion with several FPs, they all complained that specialists were working less and making more, especially subspecialties that don't require OR time or hospital resources. But yeah, that does seem to conflict with the popular opinion that you can make the same amount, or close to it, as an FP and have a much better life-work balance. 

Well, as a FM doc you can have a lot more flexibility to CHOOSE when and how much you want to work. I think that is the take-away and the flexibility of switching things up more readily.  

 

But yeah, if you want a lot of money with a more clear path, then a ROAD's specialty might be the better choice, but still very difficult and alot of extra years of training.

 

And remember take what you hear with a grain of salt. My GP gross's over 500K(some years 700k+) and says he wishes he went into dentistry since a dentist friend of his has 5 chairs going at once and clears "way more" than him.

 

A lot about perspective. And relativity.  Also, if you're making a lot more, but also working alot more hours...well, what is the utility of that extra $$ if you don't have the time to spend it etc. OR the flexibility to do what you want when you want.

 

If you're in a hospital or tied to OR time, you're much less flexible with how you can go about your work life balance.

[ralk]

 From my discussion with several FPs, they all complained that specialists were working less and making more, especially subspecialties that don't require OR time or hospital resources. But yeah, that does seem to conflict with the popular opinion that you can make the same amount, or close to it, as an FP and have a much better life-work balance. 

 

FM salaries are lower overall and workload is only slightly lower when compared to royal college specialties, but there's a lot of variation. If you're willing to work in a rural or remote place, especially in a town that has FPs (without +1s) covering long Emerg shifts in rural hospitals, FPs can gross over 500k while working a very reasonable set of hours. That's a job most people don't want, but these positions do exist. Most will make ~200-225k gross while working around 50 hours a week though.

 

As for the bigger question as to why FM is so popular, as someone who's very well set up to match to one of those higher-paying specialties, but is leaning heavily towards FM at this time, I'll give you my perspective as to why I'm likely choosing not to go into a higher-paying specialty.

 

First, jobs. Aside from Derm, most high-paying specialties have pretty poor job markets. More importantly, jobs exist only in specific locations or in specific settings that are not always that desirable. FM has plentiful job opportunities and they're everywhere. Of equal importance, as Commons mentions, FM docs have far more latitude to tailor their practices, especially in the early stages. Specialists have some control over their schedule as well, but there are limits on that flexibility, and it can take some time to gain some flexibility, depending on the specialty. I'd like a job at the end of this. I'd also like some control over where that job is located and what my schedule looks like. FM fits the bill a lot more than most other specialties.

 

Second, time. As LittleDaisy pointed out, it's not a 3 year difference, it's generally 4-5 years of difference before you can start full practice. Those 4-5 years additional aren't just a little bit of extra hard work, they're quite life-disrupting if you have any ambitions outside of medicine. I've got a lot of non-career life goals and the next 10 years or so are going to be critical in achieving some of them. Having a short residency that gives me some flexibility in life earlier on helps me do what I want to in life far more than a high salary that I won't realize for at least 8 years.

 

Third, having tons of money just isn't that important to a lot of people, myself included. There's not much I could do with a household income of ~700k that I couldn't do with ~200k, at least not anything I consider overly meaningful. I certainly wouldn't say no to some extra cash, but the extra time, effort, or stress needed to achieve those higher incomes isn't a worthwhile trade-off for me. Money's a means to an end and I see some pretty steep diminishing returns from a higher income beyond the salary of a typical FM doc. You say money is an important factor so I presume you have some goals in life that require a higher income, but that's just not the case for me.

 

Enjoying the job is also a major factor for many people - a lot of medical students simply don't want to spend their days looking at images, eyes, or skin lesions. But, even for someone looking at aspects of a specialty beyond the work itself, there are still some rather compelling reasons to go into FM instead of a traditionally high-earning specialty.

[rmorelan]

be careful with the highly paid specialties because there really isn't much that inherently makes them worth that much more than other specialties in terms of value per hour worked. Why does a rad earn more than an internal medicine doc? - that is mostly a by product of historical funding models rather than a rad is doing twice as much "stuff" per hour (although now I suppose with extreme work load on rads it can feel more like we are ha). Same with derm for that matter. The point is that is an unstable situation - and one that eventually will correct itself - and the government is working hard to do exactly that. There have already been big adjustments in the states on this stuff much to the annoyance of radiologists down there.

 

The exception would be if you could bill privately for something - but even there for optho there is market saturation (when ever you start seeing signs like pay in 20XX for laser eye surgery today! you know they are starting to hit a bottom to the market ha. The price for that has fallen considerably over the last 10 years).

 

Personally I am not a big believer in chasing the money - but if you are then you have to really think about it. Think about why something is able to charge for something and to think like Warren Buffett ask yourself if there is a big, deep and wide moat around that money making system so the advantage is permanent. If it isn't then the situation is fragile. Think about what that means.

[ellorie]

Doctors will always do well compared to many, many other people, even in the lowest paid specialties.  And I'd rather make a bit less doing a job where I love going to work every day than make more money doing something that I don't find as fulfilling.  In medical school I found most specialties other than mine pretty boring.  Doesn't mean they ARE boring - lots of people like them and that's fine - but personally I just didn't enjoy the work.

 

I'll probably be able to have the things I need in life and many/most of the things I want, and that sounds like a really great deal to me.

[Bambi]

Speaking of Warren Buffett, who is at the top in his field, who is incredibly wealthy, he has always lived a modest lifestyle and thoroughly enjoys what he does - it just so happens in his field of expertise money is the yardstick. And most of his wealth will go to charitable endeavours.

 

Money can only have so much meaning. How much money do any of us really need, after providing for a reasonable lifestyle, our future families, education of our children and retirement? Moreover, doctors have a reputation I am told for being poor in the investment department. So, to create a fortune and invest it poorly, what is the point? 

 

I am in a surgical residency where I imagine eventually I will earn gross in the area of $350K or so, which is more than I will need. My field will give me a good balance of family-work and professional satisfaction, which is worth more than money! To accumulate money for the sake of accumulation makes no sense to me, to have more investments than I need is not one of my goals, nor do I wish to live a luxurious lifestyle, which brings unwanted attention and potentially would make my family candidates for kidnapping. Enough is quite enough. And, yes, family medicine was one of my choices @ CaRMS, and I would have been very happy in this field.

[mononoke]

You're also going to think about how to manage all that money, you're going to be taxed at the highest bracket with 700K so even if you're earning that much you may not actually be taking home all of it

[rmorelan]

you definitely won't be taking home all of it

 

You're also going to think about how to manage all that money, you're going to be taxed at the highest bracket with 700K so even if you're earning that much you may not actually be taking home all of it

[Arztin]

 ( while they seem competitive, from the numbers I don't think they're THAT competitive. if I wanted one of the three and was willing to go far, I could land one) 

I would tend to think that most people who don't back up + ending up unmatched say that to themselves, until they find out their disastrous match results.

[rmorelan]

I would tend to think that most people who don't back up + ending up unmatched say that to themselves, until they find out their disastrous match results.

 

unfortunately that is true - eventually in this game of competitive fields almost everyone rises to the level where they are surrounded by very hard working, smart people trying to get exactly what they are after. It would be foolish to think that anything would be guaranteed in that sort of situation.

 

The number of people that go unmatched completely is few (although don't let that fool you into thinking everyone got what they wanted - people do end up with a backup field regularly) - it is quite stressful when it occurs.

[shikimate]

My thoughts are two factors that contribute to the perceived popularity of FM is lack of spots for other desired specialties, and lack of jobs for other specialties. I'd imagine if suddenly there are 10x the current number of popular FRCPC spots for EROAD a lot of FM applicants would be diverted. Needless to say this is partially artificial (eg the US/CA government restrict # of spots by restricting funding) but also partially a natural oligopoly situation (eg. a small town is incapable of training an ophthomologist). 

 

I think med students are also keen on jobs and geographic flexibility, and many above have already discussed this in detail.

 

Finally I wonder if many people are just fed up with calls, school and exams. Like other said it's nice to just "move on" with life's other priorities and not worry about studying for massive multiple choice exams when you are in your 30s. 

[rmorelan]

My thoughts are two factors that contribute to the perceived popularity of FM is lack of spots for other desired specialties, and lack of jobs for other specialties. I'd imagine if suddenly there are 10x the current number of popular FRCPC spots for EROAD a lot of FM applicants would be diverted. Needless to say this is partially artificial (eg the US/CA government restrict # of spots by restricting funding) but also partially a natural oligopoly situation (eg. a small town is incapable of training an ophthomologist). 

 

I think med students are also keen on jobs and geographic flexibility, and many above have already discussed this in detail.

 

Finally I wonder if many people are just fed up with calls, school and exams. Like other said it's nice to just "move on" with life's other priorities and not worry about studying for massive multiple choice exams when you are in your 30s. 

 

You know a lot of my class really did just have enough of school. 4 undergrad, some had masters, 4 years of medical school and then they were looking down the gun as it were at that only being the half way mark before really being a full staff (5 years of residency, 1-2 fellowships (maybe more), then probably locums for 1-2 years until maybe finally finding a more permanent spot they liked - let alone the job stress of actually finding something etc). Those aren't easy years either mind you ha

 

I think it is actually the same way with many people thinking they will do a 2+1 in family medicine - a big number of people I know in FM said absolutely they wanted to do a +1 in something. Then come around to the actual point of doing it and then many people simply changed their minds. They wanted off the train as it were.

 

Many of my friends did exactly that. Now they are earning  in a day roughly what I am in a week and have all their weekends and evenings free forever, ha They are enjoying life - I am starting to see 6 months now post 40% of my class graduating FM and yup they are going on fancy trips to far off lands, buying houses, starting families or whatever....popping up all the time on facebook. I like what I am doing but I know I have at least 6 more years to go and probably that will be more than that - you can see the appeal. ha, even now I could switch to FM and probably be practising in that area in about 16 months (just don't tell me that at 4am on another one of my roughly 135 all nighters in my program).

[JohnGrisham]

You know a lot of my class really did just have enough of school. 4 undergrad, some had masters, 4 years of medical school and then they were looking down the gun as it were at that only being the half way mark before really being a full staff (5 years of residency, 1-2 fellowships (maybe more), then probably locums for 1-2 years until maybe finally finding a more permanent spot they liked - let alone the job stress of actually finding something etc). Those aren't easy years either mind you ha

 

I think it is actually the same way with many people thinking they will do a 2+1 in family medicine - a big number of people I know in FM said absolutely they wanted to do a +1 in something. Then come around to the actual point of doing it and then many people simply changed their minds. They wanted off the train as it were.

 

Many of my friends did exactly that. Now they are earning  in a day roughly what I am in a week and have all their weekends and evenings free forever, ha They are enjoying life - I am starting to see 6 months now post 40% of my class graduating FM and yup they are going on fancy trips to far off lands, buying houses, starting families or whatever....popping up all the time on facebook. I like what I am doing but I know I have at least 6 more years to go and probably that will be more than that - you can see the appeal. ha, even now I could switch to FM and probably be practising in that area in about 16 months (just don't tell me that at 4am on another one of my roughly 135 all nighters in my program).

A preceptor in our program did just that... did 2 years of radiology and then jumped ship to family practice. Never looked back and it was the right decision for them - mind you, back in his day, they didn't need to do another residency, they just went for it!

[rmorelan]

A preceptor in our program did just that... did 2 years of radiology and then jumped ship to family practice. Never looked back and it was the right decision for them - mind you, back in his day, they didn't need to do another residency, they just went for it!

 

ha true  Even now it isn't exactly hard to do.

 

I know other radiologist residents (well ex radiology residents now ) that have done the same thing - zipped off to for them greener pastures. Doing just fine thank you very much.

[JohnGrisham]

ha true  Even now it isn't exactly hard to do.

 

I know other radiologist residents (well ex radiology residents now ) that have done the same thing - zipped off to for them greener pastures. Doing just fine thank you very much.

From the limited exposure I've had to radiologists -it seems most really enjoy their training(to an extent), so they obviously pick the right people for the challenge!! That said, life happens and peoples minds change etc- so i'm glad to hear that some people are still able to change their choice and not end up being permanently miserable and "stuck". 

 

I wonder if we will read much from you at this time next year when you're gearing up for licensing exams etc  

 

Someone better get preparing to become your apprentice!

[NLengr]

If I decided to do rads/derm in order to earn an extra 200k/yr, I'd use that 200k to buy a gun to shoot myself. I could live with Optho (although I think I'd find it more boring than my current surgical specialty).

 

Honestly, if you look at all the research on pay and happiness, you end up realizing that once you earn enough to cover your basic needs (say 60k), more money doesn't really correlate with increased happiness.

[BeentheredonetheDAT]

Yeah, that makes a lot of sense now actually. I'm starting to think family med is a good option after all lol. Does a +1 for family practitioners translate to significantly higher pay?

[ralk]

Yeah, that makes a lot of sense now actually. I'm starting to think family med is a good option after all lol. Does a +1 for family practitioners translate to significantly higher pay?

 

Depends on the +1 and the kind of practice it leads to. Generally speaking I'd say no it doesn't, +1s are more about tailoring the practice of the FM doc than they are about increasing earning power, but there are exceptions. For example, a +1 in Emerg leads to a salary pretty much on par with RCPSC-trained ER docs, which is a bit higher than that of the typical FP. No +1 will vault you to the higher ends of an FP's potential salary though.

[JohnGrisham]

Depends on the +1 and the kind of practice it leads to. Generally speaking I'd say no it doesn't, +1s are more about tailoring the practice of the FM doc than they are about increasing earning power, but there are exceptions. For example, a +1 in Emerg leads to a salary pretty much on par with RCPSC-trained ER docs, which is a bit higher than that of the typical FP. No +1 will vault you to the higher ends of an FP's potential salary though.

This. It allows you to have more comfort in training to expand scope of practice.

[shikimate]

In the society we live in it's just not worth it to work extra hard to earn that 100K more.