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Why not family med?


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10 hours ago, ellorie said:

Psychotherapy is also a controlled act, is it not?

Yes, in Ontario it is.  And we dietitians are rather upset that we weren't included in the list of health professionals who can perform psychotherapy, given that we use a lot of counselling techniques when working with patients (i.e. Motivational interviewing, etc.). Yet OTs can perform psychotherapy.  Doesn't really make sense to me.  *shrug*  I guess our college didnt' do as good a job at advocacy as the OT's college.  Still, it is within my scope of practice to counsel clients (with respect to nutrition and diet), using whatever techniques are appropriate.  And I refer out (to social work mostly, since they are part of our interdisciplinary team) where required.

While I can't communicate a diagnosis, I'm not sure I'd always want to, given the level of denial I see from some clients.  While I can talk about general healthy eating with a person who has diabetes who denies they have diabetes, it's a lot harder for the family physician to convince the individual to take metformin if they don't believe they have diabetes (even when their HbA1c clearly indicates that they do).

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On the positive side, a lot of ER docs are FM trained. You could always do ER without the extra year of CCFP-EM in most community hospitals.

In community hospitals where I did FM ER, a lot of ER docs didn't do the plus 1 in EM. After a few years of practice, they are as proficient as a CCFP-EM or FRCPC in my humble opinion. I think that in medicine, you learn more when you have the total responsibility and you make the clinical decision without relying on someone else. Especially for technical skills, you tend to gain more confidence and more reassured, when you know that no one is looking over you, and you are the doc!

If you are interested in academic EM in critical care, big trauma center, then, FRCPC is a better road.

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3 hours ago, LittleDaisy said:

On the positive side, a lot of ER docs are FM trained. You could always do ER without the extra year of CCFP-EM in most community hospitals.

In community hospitals where I did FM ER, a lot of ER docs didn't do the plus 1 in EM. After a few years of practice, they are as proficient as a CCFP-EM or FRCPC in my humble opinion. I think that in medicine, you learn more when you have the total responsibility and you make the clinical decision without relying on someone else. Especially for technical skills, you tend to gain more confidence and more reassured, when you know that no one is looking over you, and you are the doc!

If you are interested in academic EM in critical care, big trauma center, then, FRCPC is a better road.

Isn't this changing? I was under the impression that EM is a newer speciality and since FM docs traditionally had been working in ER, we still see FM physicians in rural ER. 

In the future, do you still envision many FM doctors to be working in the ER? 

 

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4 hours ago, prehealth101 said:

Isn't this changing? I was under the impression that EM is a newer speciality and since FM docs traditionally had been working in ER, we still see FM physicians in rural ER. 

In the future, do you still envision many FM doctors to be working in the ER? 

 

Not really. EM is a newer specialty, but when it was formed, two certification pathways sprung up, one as an add-on to standard FM training, one as a direct, 5-year Royal College specialty. Both work in major centres' EM departments. That means that many freshly-certified EM physicians - most, actually - are FM-trained first.

Rural ERs are often staffed by FM doctors without additional training and while there is some encroachment there was some of these departments grow in size, there's not enough volume to justify dedicated EM physicians in these smaller rural centres, especially not on a 24/7 basis.

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3 hours ago, ralk said:

Not really. EM is a newer specialty, but when it was formed, two certification pathways sprung up, one as an add-on to standard FM training, one as a direct, 5-year Royal College specialty. Both work in major centres' EM departments. That means that many freshly-certified EM physicians - most, actually - are FM-trained first.

Rural ERs are often staffed by FM doctors without additional training and while there is some encroachment there was some of these departments grow in size, there's not enough volume to justify dedicated EM physicians in these smaller rural centres, especially not on a 24/7 basis.

I am not that clear on this - but there is some 3rd route too isn't there where you can challenge the exam as a family doctor if you work in an emergency department(?)

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4 hours ago, rmorelan said:

I am not that clear on this - but there is some 3rd route too isn't there where you can challenge the exam as a family doctor if you work in an emergency department(?)

Yes, you can challenge the +1 EM exam as an FM physician who has had sufficient ER experience. Don't believe this changes much besides having that extra couple of letters behind the name though - haven't personally heard of any newer grads working in a rural setting to challenge the +1 exam and then working in a setting that they wouldn't have been able to with just the straight CCFP qualification.

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3 hours ago, ralk said:

Yes, you can challenge the +1 EM exam as an FM physician who has had sufficient ER experience. Don't believe this changes much besides having that extra couple of letters behind the name though - haven't personally heard of any newer grads working in a rural setting to challenge the +1 exam and then working in a setting that they wouldn't have been able to with just the straight CCFP qualification.

not sure how much of a difference it makes either - I do know that I have a couple of friends that I have just confirmed are going that route. They must feel they are getting something out of it or what is the point of it(?).  Both of them were unable to secure a standard +1 EM fellowship to top of their family medicine training. 

 

 

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  • 3 months later...
On 2017-07-11 at 8:44 AM, qnzjlo said:

"The more critical the problem (sicker the patient), and the more rapid these mentioned things occur in succession, the bigger I find the satisfaction." - this is classic case of God complex. 

 

 

Old post but just noticed this response. 

If taking great satisfaction in successfully managing multiple critically ill patients gives me a "complex", then I will wear it with pride.

But if you or a loved one ever require the services of my colleagues or myself then you should be thankful such career satisfaction is found in these trying circumstances. Otherwise there would be few people around to help. Such motivations are found often in critical care, trauma, emergency medicine and many other specialities that manage the most acute patients day and night. 

Such motivation is every bit as valid as those who enjoy building longitudinal patient care relationships etc. in family medicine or elsewhere. 

Different people like different things. It is a good thing it's like that considering the diversity of care settings existent. 

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  • 2 weeks later...

Most people will say that money plays a very small factor but I'll guarantee you that if you boosted FM pay so that it was more than the average specialist, within a matter of years the scale would tip so dramatically that no one would even know what ROAD stood for.

 

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As a specialty resident, sometimes I do wonder why I didn't pick family medicine. I think I would have been happy in it and the career options in family medicine are so broad.

I don't think it's necessary for everyone but I think many people, even those who choose other specialties, could have been quite happy in family medicine. 

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  • 2 months later...
1 hour ago, JohnGrisham said:

Quite a lot of people? 

Kk because I hear so many stories of people saying that they ended up doing something completely unrelated to what their initial idea was, but for some reason, I feel like I know what I wanna do (FM) and it isn't gonna change, and just wanted to see if anyone else was like that too. 

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