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  • So you want to be a family medicine doctor. You like the idea of primary care, working

  • with patients of all age ranges, and like Vin Diesel, you don't have friends, you got

  • family. Let's debunk the public perception myths, and give it to you straight. This is

  • the reality of family medicine. Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our next installment in So You Want to Be. In this series, we highlight a

  • specific specialty within medicine, such as family medicine, and help you decide if it's

  • a good fit for you. You can find the other specialties on our So You Want to Be playlist.

  • If you want to vote in upcoming polls to decide what future specialties we cover, make sure

  • you're subscribed. If you'd like to see what being a family

  • medicine doctor looks like, check out my second channel, Kevin Jubbal, M.D., where we'll have

  • day in the life episodes of family medicine doctors in the future.

  • Family medicine is the center of primary care, the generalists of generalists. Unlike other

  • specialties that are limited to a particular organ, disease, or age range, family physicians

  • treat the broadest range of ailments and patients, from newborns to seniors, and everything between.

  • For most people, a family medicine clinic visit is their main input into the healthcare

  • system, their first line of defense for non-urgent health concerns. From their family medicine

  • physician, they can either receive the necessary treatment, or be referred to the appropriate

  • specialist for more complex pathologies. The overwhelming majority of family medicine

  • physicians practice in an outpatient clinical setting and the bread and butter pathologies

  • they deal with include diabetes, hypertension, hyperlipidemia, and preventive medicine and

  • health screenings. But there's much more to the specialty than

  • that. You'll never have as many procedures as a surgeon, but if you want to be more procedure

  • heavy, you can set aside a day in the week for steroid injections, wart removal, colposcopies,

  • vasectomies, frenulectomies, circumcisions, and more. Or if you want to tailor your patient

  • population, you can do that too. Maybe you want to focus on pregnant women and delivering

  • babies, or older patients through geriatrics, or keep it broad and include all patients

  • from cradle to grave. Family medicine is often compared to internal

  • medicine as they have a large degree of overlap, as both often serve in primary care roles

  • in the outpatient clinic, but they have substantial differences. With internal medicine, you're

  • only dealing with adult patients, but have greater flexibility in specializing in various

  • organ systems, like cardiology, gastroenterology, infectious disease, and others, which are

  • usually 3 year fellowships. With family medicine, you don't have the same organ-specific options

  • for specialization, serving more as a generalist, but you do have various 1 year fellowship

  • options, which we'll cover shortly. There are a few ways to categorize the specialty.

  • As a general family medicine doctor, meaning you haven't completed a fellowship, you'll

  • be focusing on preventive health and simple concerns in an outpatient clinic for the broad

  • population. Your hours will be regular 9 to 5, and compensation is on the lower end compared

  • to those who specialized. As a specialized family medicine doctor, you're

  • fellowship trained, and your lifestyle will vary based on your specialization. With sports

  • medicine, you'll see some athletes, but probably still have your regular family practice too.

  • If you go into obstetrics, you'll spend some of your time on call in the hospital delivering

  • babies. And if you go into emergency medicine, you'll have the lifestyle of an EM doctor.

  • Most family medicine doctors practice in a community setting, either a smaller group

  • or something larger like Kaiser. In this setting, your job first and foremost is to be a family

  • medicine physician, while research and teaching are not primary responsibilities.

  • In academia, you'll not only handle patient care, but also teach medical students and

  • residents while also tending to some research responsibilities on the side. Of the three,

  • this generally has the lowest compensation. Finally, private practice is the least common,

  • but offers the most flexibility. You'll be your own boss, running your own practice,

  • and have the highest ceiling in terms of compensation. You are running a business, however, and there

  • will be more hassle and usually longer hours as well.

  • There are a few misconceptions we need to set straight about the specialty.

  • First, some say that family medicine doctors don't know much and are constantly sending

  • referrals to specialists to handle what they can't. The truth is that family medicine doctors

  • are some of the best when it comes to handling common presenting concerns, but need to know

  • where their capabilities are and where to draw the line in seeking help from a specialist.

  • They are often screening and finding conditions that allow for early intervention, like being

  • the first person to find an arrhythmia and referring that patient to a cardiologist.

  • Additionally, family medicine doctors are the specialists of complexity, the quarterback

  • of the patient's healthcare needs. Because they have to know a little bit about everything,

  • they can be the best to handle complex situations where a patient is receiving multiple treatments

  • from multiple specialists, some of which may be conflicting. In line with this, family

  • medicine docs are often well suited at approaching each patient holistically and as an individual

  • instead of as the sum of individual organs or chief complaints.

  • Last, most equate family medicine with outpatient primary care. While most family medicine doctors

  • do practice in a clinical setting and see patients of all age ranges, there is more

  • flexibility to the specialty and you can narrow it down based on your particular interests,

  • whether that's being a hospitalist, obstetrician, or something else.

  • After medical school, family medicine residency is 3 years. It's categorical, meaning you

  • match into one program and complete all three years there, including your intern year.

  • During your intern year, or PGY1, you'll rotate on many services, including family medicine,

  • obstetrics, pediatrics, internal medicine, ICU, and others.

  • During PGY2 and PGY3, you'll still rotate on various specialties, which is unique to

  • family medicine. In most other residencies, PGY2 and onward are usually dedicated to rotating

  • on just your own specialty's services. The reason is that family medicine physicians

  • are the generalists' generalists, and they need to know what they can handle on their

  • own versus what they should refer out or request a specialist consult for.

  • In terms of competitiveness, family medicine is attainable, with a match rate around 96%,

  • USMLE Step 1 average of 220 and Step 2CK average of 236. In our Med School Insiders Competitive

  • Index, which takes into account match rate, Step scores, publication, AOA, and top 40

  • NIH schools, it ranks at the bottom of the list with 13 points.

  • Medical students that choose family medicine are stereotypically the ones who loved everything

  • during their third year rotations, except maybe surgery, and couldn't find themselves

  • committing to one specialty at the exclusion of others. With family medicine they can truly

  • get a little bit of everything. After completing 3 years of family medicine

  • residency, you can choose to specialize with an optional fellowship, each of which are

  • 1 year in duration. Sports medicine is for the bros and jocks

  • of family medicine. You'll be doing various office procedures. Think of orthopedics but

  • without any of the surgery. You can learn more about sports medicine in our So You Want

  • to Be a Sports Medicine Doctor episode. After completing an obstetrics fellowship,

  • you are a full scope general OB doctor. You can deliver babies, just like OBGYN doctors,

  • although those who completed an OBGYN residency will have more options for further specialization.

  • It's an intense specialty that is often polarizing, and people either love it or hate it. You

  • can learn more about OBGYN on our So You Want to Be an OBGYN episode.

  • A hospitalist fellowship allows you to practice as a hospitalist, admitting patients to the

  • hospital and handling their medical management while they are inpatient. Stereotypically,

  • this is for the family medicine doctors that have personality tendencies of internal medicine

  • doctors, namely they love geeking out over the minutiae of medical management.

  • Emergency medicine gives the option for family medicine doctors to practice as emergency

  • medicine physicians, the same as those who completed EM residency. This is for the family

  • medicine doctors who decide they don't want longitudinal care and prefer shift work and

  • acuity. You can learn more about the field in our So You Want to Be an EM doctor episode.

  • Rural and international are two separate fellowships with substantial overlap. Both are focused

  • on underserved populations that have issues in accessing healthcare. These doctors usually

  • practice a wider scope of medicine, as there are fewer specialists around, and are also

  • focused on improving access on a systemic level in these regions. These fellowships

  • are for the highly altruistic and selfless family medicine doctors.

  • There are additional fellowships you can pursue as well, including geriatrics, adolescent

  • medicine, sleep medicine, palliative medicine, preventative, HIV medicine, and addiction

  • medicine. There's a lot to love about family medicine.

  • Most obviously, FM provides a great deal of flexibility, beyond what most aspiring physicians

  • realize. If you want to deliver babies all day, you can do that. If you want to practice

  • in the emergency department, you can do that too. Or maybe you want to practice inpatient

  • as a hospitalist. All these and more are possible with family medicine.

  • Family physicians have a desirable schedule, usually working regular 9 to 5 office hours

  • and minimal, if any, call. Note that if you specialize in OB or EM or hospitalist medicine,

  • then your hours will more closely approximate what's normal for that specialty.

  • If you enjoy getting to know your patients and building relationships, family medicine

  • offers amazing access to longitudinal care, as you can see patients from the time they're

  • born through adulthood. Family doctors also maintain their level of

  • medicine knowledge. Medical students in their later years know what I'm talking about. You

  • spend thousands of hours and incredible effort learning about the various organ systems and

  • their pathologies, only to forget much of it as you narrow down with your specialty.

  • I definitely felt that way with plastic surgery. Family medicine is one of the few specialties

  • where you continue to develop that broad knowledge. There's an inherent satisfaction in knowing

  • you're able to manage most anything that walks through the door to some extent.

  • While family medicine is an awesome specialty, it's not for everyone.

  • In terms of compensation, family physicians are bottom of the list, averaging $236,000

  • per year. Specialists, on the other hand, average $344,000 per year.

  • Compared to some other specialties, there's a great deal of charting and computer work.

  • Documentation and billing become an increasingly large part of your day to day, as that dictates

  • how much reimbursement or compensation is received from the insurance companies.

  • FM doctors are also often juggling social issues with patients, such as access to care,

  • insurance coverage, and more, although this does depend on your patient population.

  • Last, a small number of medical students look down on the specialty, which is backwards

  • and often ego-driven. Many medical students are type A, competitive personalities that

  • often seek some level of prestige. Because family medicine is less competitive, some

  • say if you score well on USMLE that you should aim higher. There have even been recent posts

  • about this on SDN and Reddit, where a high scoring student seeks input from others, as

  • their own mentors or classmates advised them to go into another specialty that pays better

  • or is more prestigious. This is nonsensical, and not a valid reason to look down on the

  • specialty. You should pursue the specialty that's most appealing to you without such

  • superficial considerations. I know several brilliant family medicine physicians who could

  • have pursued far more competitive specialties, but they chose FM because they were able to

  • separate the signal from the noise. If you're the medical student who went through

  • third year and loved everything non-surgical and didn't want to give any of it up, including

  • not only organ systems but also age, then family medicine may be a good fit for you.

  • If your life outside of medicine is important to you, family medicine provides the flexibility

  • to practice as a physician while still having time for your own family and interests.

  • Big thanks to Dr. Ethan Jose, family medicine resident and YouTuber in Oklahoma City, for

  • helping me in the creation of this video. Show him some love and go check out his YouTube

  • channel, link in the description. Special thanks to Dr. JP Valette as well, my good

  • friend from medical school and current family medicine and sports medicine attending physician

  • in San Francisco. Are you hoping to become a family medicine

  • doctor? To get into medical school and match into a great FM residency, you'll need to

  • score well on your class tests and standardized exams. As you look at resources and companies

  • to work with, seek out those who are actual MD physicians, not PhD or other types of doctors

  • that didn't go to medical school. Look for those who have achieved stellar results themselves,

  • a track record of success with positive ratings from customers, and a systematic approach

  • so you know you'll always receive high quality service. If you decide on Med School Insiders,

  • we'd love to be a part of your journey in becoming a future physician. Visit us on MedSchoolInsiders.com.

  • Thank you all so much for watching! If you enjoyed this video, check out our So You Want

  • to Be an Internist video, or another specialty on our So You Want to Be playlist. Much love,

  • and I'll see you guys there.

So you want to be a family medicine doctor. You like the idea of primary care, working

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So You Want to Be a FAMILY MEDICINE DOCTOR [Ep. 28]

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    Summer posted on 2021/08/14
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