Family Medicine = Done

So yesterday was my last day of family medicine. There is some excitement as well as some sadness in this statement. Going into the family medicine rotation I did not expect to like it it too much. After completing a month of it, I can say that there were many aspects of it that I enjoyed. I do not think that I would choose family medicine as a career. Last night I was speaking with a someone on the phone and they asked me; "What did you like about family medicine and what did you dislike?" Although that is a difficult question I will attempt to break it down in today's post.

Here are the things I like about family medicine:

There was a lot of variety day to day. Essentially you could see a sports physical followed by congestive heart failure followed by HIV. Hopefully you did not see all of these in the same patients. Also family doctors have a wide range of things they can do in their practice. They can do cosmetic type procedures, Gi / colonoscopy, OB / deliver babies, wound management, urgent care, etc. Basically a family doctor could choose to focus on almost any area of medicine and make a practice around that area. Another thing I noticed about general family medicine is that it was fairly simple and not very stressful from a medical management aspect. There is a running joke with some doctors that says, family medicine doctors so not see sick patients. There is some truth to this which makes their day to day medical management stress not as intense as some other specialties. These are a few of the things I enjoyed about family medicine.

Now for the things I did not like. It seems that reimbursement has been lowered so much that it is difficult for family medicine doctors to make decent money. Especially in their own private practice. This financial stress, takes the joy out of the work. The average family physician needs to see between 30 - 40 patients / day to make a decent living. With this volume it is hard to practice quality medicine and everyone suffers. Then at the end of the day the doctor spends most of the evening charting and returning calls. This makes for long hours and a stressful life. Although family docs can pursue a wide variety of different practices within medicine they are often politically blocked from doing such things. For example, a properly trained family medicine doctor has no problem delivering babies, however in today's world most babies are delivered at hospitals. In order to deliver a baby at a hospital the doctor must have delivery privileges at the hospital. Often the OB/GYN doctors at the hospital will block family medicine doctors from getting privileges to deliver babies and without the privileges they obviously can't deliver any babies. 

These turf wars are common and the family practice doctor always loses as they are not considered the foremost specialty in OB, GI or other areas that they may want to focus on. Even if a hospital does give the family doctor privileges to do the different procedures they will always require that they have a back up doctor in the given specialty on staff at the hospital. It is difficult to find a doctor that you are competing with to want to take back up and liability for you as a family practice doctor. This prevents many family doctors from being able to practice in the many diverse areas of their training. 

In the increasing world of specialization the family doctors seem to be stuck in an overworked, underpaid and under appreciated capacity in our complicated medical world. I think the only way I would consider going into family medicine would be to work in a rural area or as a 2nd / combined specialty. There are some combined residencies that someone can pursue like emergency medicine / family practice or psychiatry / family medicine. The advantage of a combine residency is that you get trained in both specialties and end up being board certified in both specialties and overall you cut down on the training by 1 year. A psychiatry residency is 3 years and a family medicine residency is 3 years but if you do a combined psychiatry / family medicine it is only 5 years so you save a year.