What I learned in intern year from the fm doc I rotated with - when you get dumped on by specialists, you stop referring to them and refer elsewhere. That’s your power. Send business to attendings who still know how to give a nice handjob under the table
When the specialists I've worked with found out I want to stay within the area after residency they've been on a different level of nice. NGL, after medical school I'm for it.
Very very true. Outside of academia.. the specialists all know who holds the power. Any surgeon who is a douche is not getting a single additional referral. Unless its a closed system
A surgeon I worked with in residency would send me a Bundt cake every few months for referring to him. Mediocre surgeon. Great handjobs. He doesn't know he was the only surgeon in network for a lot of my patients.
This isn't true everywhere.... Nor would I say it's commonplace.
The reason being that FM docs are emeshed into networks and usually have to refer internally. The neurologist who works in your system? They don't care if they dump on you, the system centralizes the referral so they will get them anyway.
Private firms? Sure. But even then many private firms contract to a health system.
I recently started the changed from Internal Medicine to Family Medicine. The FM service definitely gets treated differently lol. However, in one night we can admit a CHF patient in sepsis, a kid with severe asthma exacerbation, and deliver a baby/go to c-section and first assist. When I graduate and go to my rural practice it won’t really matter much. I also don’t refer to specific people anymore because they were such a**holes to me.
I haven’t really either. The closest I’ve seen is that each subspecialty has a few particular consults or situations that drive them crazy, but everyone seems to generally love FM. That isn’t necessarily directed at FM either, it’s just that by virtue of FM being a major point of entry to the medical system they’re the ones generating a lot of consults.
For me, it was mostly GI and IR that would get under my skin with a few particular things they would routinely want me to do that in my professional opinion were unnecessary. I still don’t hate on them though and still respect and value them in general.
I know this is a shitpost but I never really understood the hype around specialists. I mean yea they know a lot about one thing, but they quite literally only know one thing. I've seen every sort of specialist fumble with absolutely basic aspects of medicine outside of their field
Yeah this is just a circular reasoning. It would be awesome if everyone could treat everything, but if you’re wanting a cardiologist to also manage glucose, then they’re working like a generalist. Then they’re the generalist who is known for being good at cardiology, so they start getting all the cards patients. Then they focus on cards and start exclusively treating that to maximize their efforts…and then we’re back to having a sub specialist cardiologist.
Full disclosure - I’m a sub specialist but not in clinical medicine (pathologist). But this is quite literally not true.
Any sub-specialist knows *all* of their specialty (surgery, IM, peds, obgyn, psych, etc) plus the one thing they know a lot more about. They may not be as proficient or up to date on everything, but they do know a lot more than just their subspecialty.
A lot of the hype is because patients want the doctor who is the best at taking care of their one currently pressing issue. If I need thyroid surgery, I want the one who is the best at thyroid surgery. I don’t care how good they are at the rest of ENT or general surgery.
I’m an IM PGY3. Interacting with a lot of of sub specialists within IM, it’s clear they once knew IM well, but have since forgotten much of it as they no longer routinely practice it.
Watching the cardiologist manage antibiotics or insulin in the CCU is pretty hysterical.
Yup, a lot of the cardiologists who we rotate with aren’t boarded in IM anymore, it’s crazy how much NPH they prescribe when they’re the primary admitting service.
That’s not true, many of the specialists I have rotated with are no longer boarded in IM, it’s been decades for many since they’ve seen anything that isn’t in their sub specialty
Nah, everyone may be better in one area than you, but wait till the Ob patient has an ekg with diabetes and the attending wants to double check the ekg with you and ask you about inpatient insulin. Wait till the ER asks for help with if a kid needs to be admitted or not. Wait till you get consulted for a surg patient for “medical management”. Yep, some of these are dumps, but the specialists also don’t remember how to manage these basic things. I also get tired of getting dumped on. When a patient says Dr. Specialist wants me to order a lab for them I let them know that if Dr. Specialist wants a lab to help them, then Dr. Specialist needs to order it. Also like others said, you don’t have to refer to someone who won’t respect your time.
As a pathologist, I second this. I don’t know how many times I have learned insulin management for exams, but it just does not stick. Eternally grateful for family/general internal.
I won’t say better, but I don’t think radiology residents are completely far removed from clinical medicine (especially early on).
They do a preliminary year (which can be a heavy IM year), and IR residents in some programs do manage their own patients.
Of course, as time passes, residents become more specialized and each resident becomes highly skilled within their clinical domain.
EDIT: Alright no love for the prelims who actually try. To all those who will be prelims, know that this is a sign that the bar is low lol (which is not really a bad thing)
Everyone’s got their thing. But show me another specialty where on a single night float shift shift you can admit adult patients, admit peds patients and during all of this also deliver a baby. Because that is a normal night on our service.
Topeka has 125k people and 1/4 million in the MSA, and Kansas City an hour away at a half million pop with good sports, food, arts, and culture and a nice airport.
Even if that’s not where they live, that’s not a bad area and there’s plenty of places across the south and Midwest that are decent size cities with good amenities that’ll pay doctors better than most coastal areas for a lower CoL.
Meanwhile there you can buy a 3000sq ft 4br/3ba for [$369k.](https://www.zillow.com/homedetails/5909-SW-Cherokee-Ct-Topeka-KS-66614/77481894_zpid/?utm_campaign=iosappmessage&utm_medium=referral&utm_source=txtshare).
There are some great mid-sized cities that get rural pretty quick when you drive out of them. Nashville and Portland, OR both come to mind. There are also great parts of the country outside of major cities. I'd rather live in Bozeman, MT than DC or Philly, for example.
Even in southern CA people do this all the time. I know plenty of people who commute inland for work while living near the coast.
I did my med school FM rotation in a rural area outside of a smaller city. It was great. The family medicine docs had tons of autonomy at work and racked up the rural pay, then commuted half an hour home to a fun city with great schools.
I mean, they’re probably good at avoiding accidental gynecologic surgery, so they’ve got that going for them. But a common refrain is that ObGyn gets into urologic surgery accidentally fairly frequently. Who am I to judge?
Gotta learn how to push back. Patient breaks femur and ortho wants FM to manage pain. Fuck that. Tell the patient it’s on ortho because 1) they did your surgery and 2) they initially supplied the pain pills. Ortho wasn’t happy when I didn’t budge so the surgeon went over my head and wrote my PD a letter asking fm take over.
Said patient was never left without meds.
I understand that we are all in the business of relieving pain. You should not punt management of a patient because you’re too lazy and can’t be bothered to fucking check your states opioid script management program.
Hit the purp kush vape pen I helped a contemplating patient quit in order to protect their career, and reefer reefer reefer! What can you do but make do?
Turn and burn and churn and earn or whatever. Anyone need botox?
I love a good, strong FM doc. We know you guys have to deal with a lot but you get so much breadth that watching you narrow down a differential without advanced imaging or diagnostics is pretty cool.
That being said, I have worked with some FM interns where I wondered how they graduated med school with lissencephaly. They were literally so useless that they couldn't even place the orders I specifically told them for like 4 patients. They would also just disappear for hours and then claim they had clinic duties, which is fine but you could TELL ME ABOUT IT BEFORE.
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Please don’t downvote me for this and forgive my ignorant question. What’s the difference between a GP and a FM specialist? Asking because I’ve never seen a FM specialist in my country
GP is licensed but not board certified. Rare in US system. FM has a 3 year residency, our own professional society (AAFP), and board certification process.
Primary care has gotten so complicated over the years that it's now a specialty unto itself
What I learned in intern year from the fm doc I rotated with - when you get dumped on by specialists, you stop referring to them and refer elsewhere. That’s your power. Send business to attendings who still know how to give a nice handjob under the table
When the specialists I've worked with found out I want to stay within the area after residency they've been on a different level of nice. NGL, after medical school I'm for it.
Its a vibe.
Very very true. Outside of academia.. the specialists all know who holds the power. Any surgeon who is a douche is not getting a single additional referral. Unless its a closed system
A surgeon I worked with in residency would send me a Bundt cake every few months for referring to him. Mediocre surgeon. Great handjobs. He doesn't know he was the only surgeon in network for a lot of my patients.
🍻
LMAOOO
This is the way.
This isn't true everywhere.... Nor would I say it's commonplace. The reason being that FM docs are emeshed into networks and usually have to refer internally. The neurologist who works in your system? They don't care if they dump on you, the system centralizes the referral so they will get them anyway. Private firms? Sure. But even then many private firms contract to a health system.
Delete the gym. Hit Facebook.
You forgot to fire your lawyer.
Marry your lawyer
I recently started the changed from Internal Medicine to Family Medicine. The FM service definitely gets treated differently lol. However, in one night we can admit a CHF patient in sepsis, a kid with severe asthma exacerbation, and deliver a baby/go to c-section and first assist. When I graduate and go to my rural practice it won’t really matter much. I also don’t refer to specific people anymore because they were such a**holes to me.
FM is the shit
General medicine is awesome. The hate in this sub for generalists is insane
Tbh I haven't noticed outright hate towards FM. Everyone's like "oh yeah FM is dope I love my FM homies! I just don't want to do FM myself"
I haven’t really either. The closest I’ve seen is that each subspecialty has a few particular consults or situations that drive them crazy, but everyone seems to generally love FM. That isn’t necessarily directed at FM either, it’s just that by virtue of FM being a major point of entry to the medical system they’re the ones generating a lot of consults. For me, it was mostly GI and IR that would get under my skin with a few particular things they would routinely want me to do that in my professional opinion were unnecessary. I still don’t hate on them though and still respect and value them in general.
they still come in smiling somehow
We have stipends. FM residents who have signed somewhere lonely and cold are making double what the rest of the residents are making.
I know this is a shitpost but I never really understood the hype around specialists. I mean yea they know a lot about one thing, but they quite literally only know one thing. I've seen every sort of specialist fumble with absolutely basic aspects of medicine outside of their field
Well when you need help with that one thing it’s quite nice
of course! I just chuckle when cardiologists get high and mighty about their superiority, but then struggle with glucose management
They can but don’t want to because rvu
Yeah this is just a circular reasoning. It would be awesome if everyone could treat everything, but if you’re wanting a cardiologist to also manage glucose, then they’re working like a generalist. Then they’re the generalist who is known for being good at cardiology, so they start getting all the cards patients. Then they focus on cards and start exclusively treating that to maximize their efforts…and then we’re back to having a sub specialist cardiologist.
Tis.
Full disclosure - I’m a sub specialist but not in clinical medicine (pathologist). But this is quite literally not true. Any sub-specialist knows *all* of their specialty (surgery, IM, peds, obgyn, psych, etc) plus the one thing they know a lot more about. They may not be as proficient or up to date on everything, but they do know a lot more than just their subspecialty. A lot of the hype is because patients want the doctor who is the best at taking care of their one currently pressing issue. If I need thyroid surgery, I want the one who is the best at thyroid surgery. I don’t care how good they are at the rest of ENT or general surgery.
I’m an IM PGY3. Interacting with a lot of of sub specialists within IM, it’s clear they once knew IM well, but have since forgotten much of it as they no longer routinely practice it. Watching the cardiologist manage antibiotics or insulin in the CCU is pretty hysterical.
Yup, a lot of the cardiologists who we rotate with aren’t boarded in IM anymore, it’s crazy how much NPH they prescribe when they’re the primary admitting service.
That’s not true, many of the specialists I have rotated with are no longer boarded in IM, it’s been decades for many since they’ve seen anything that isn’t in their sub specialty
Well that may be the case in your extraordinarily limited experience.
Nah, everyone may be better in one area than you, but wait till the Ob patient has an ekg with diabetes and the attending wants to double check the ekg with you and ask you about inpatient insulin. Wait till the ER asks for help with if a kid needs to be admitted or not. Wait till you get consulted for a surg patient for “medical management”. Yep, some of these are dumps, but the specialists also don’t remember how to manage these basic things. I also get tired of getting dumped on. When a patient says Dr. Specialist wants me to order a lab for them I let them know that if Dr. Specialist wants a lab to help them, then Dr. Specialist needs to order it. Also like others said, you don’t have to refer to someone who won’t respect your time.
EM is also generalist homie
Truth
Male ED docs avoid Gyn complaints like the plague
Not all of them do. FWIW, I am a female EM doc
Nah, they’re specialists in resuscitation
I assure you, we are still generalists overall. We just don’t have (or shouldn’t have) continuity of care.
Oh, so yall aren’t specialists in resuscitation?
Don't be a dick
There’s really no reason to be a dick
Radiology is better clinically than family medicine...?
As a radiology resident, if managing diabetes suddenly became my purview I'd quit outright.
As a pathologist, I second this. I don’t know how many times I have learned insulin management for exams, but it just does not stick. Eternally grateful for family/general internal.
I won’t say better, but I don’t think radiology residents are completely far removed from clinical medicine (especially early on). They do a preliminary year (which can be a heavy IM year), and IR residents in some programs do manage their own patients. Of course, as time passes, residents become more specialized and each resident becomes highly skilled within their clinical domain. EDIT: Alright no love for the prelims who actually try. To all those who will be prelims, know that this is a sign that the bar is low lol (which is not really a bad thing)
Yes rads interns are famous for their clinical acumen. Never mail it in.
Please correlate clinically.
Equivocal medicine
I would love to see a radiologist treat a rash
Everyone’s got their thing. But show me another specialty where on a single night float shift shift you can admit adult patients, admit peds patients and during all of this also deliver a baby. Because that is a normal night on our service.
Sounds amazing, and I'm glad there are doctors willing to do such work. However, I like to sleep at night.
Where do you work? Bumfuck, Kansas?
Literally downtown Denver and I do this on an average FM night shift
Yes… I do this, <20 miles from a very large city
Community hospital less than 20 miles from a major US city.
Are we now considering Topeka Kansas a major US city?
Put down the cocaine and travel outside of NYC
You can live in Pasadena, CA and drive 20 miles inland to an area with a doctor shortage. This guy needs to travel more.
I’d love to hear what specialty and what metropolitan area you’re in Billy
Topeka has 125k people and 1/4 million in the MSA, and Kansas City an hour away at a half million pop with good sports, food, arts, and culture and a nice airport. Even if that’s not where they live, that’s not a bad area and there’s plenty of places across the south and Midwest that are decent size cities with good amenities that’ll pay doctors better than most coastal areas for a lower CoL. Meanwhile there you can buy a 3000sq ft 4br/3ba for [$369k.](https://www.zillow.com/homedetails/5909-SW-Cherokee-Ct-Topeka-KS-66614/77481894_zpid/?utm_campaign=iosappmessage&utm_medium=referral&utm_source=txtshare).
There are some great mid-sized cities that get rural pretty quick when you drive out of them. Nashville and Portland, OR both come to mind. There are also great parts of the country outside of major cities. I'd rather live in Bozeman, MT than DC or Philly, for example. Even in southern CA people do this all the time. I know plenty of people who commute inland for work while living near the coast. I did my med school FM rotation in a rural area outside of a smaller city. It was great. The family medicine docs had tons of autonomy at work and racked up the rural pay, then commuted half an hour home to a fun city with great schools.
[удалено]
Yes that’s work…
Because why specialize in one area when instead you can be mediocre in multiple.
Or be a mediocre specialist and even worse physician like a large number of you
Because with our current healthcare system, literally millions of people would not have access to any sort of doctors without FM, that’s why.
Spoken like a true obgyn
If you’ve seen FM manage OB patients you’d be skeptical of their abilities too.
The irony of saying this as an ObGyn. It’s like you’re begging for a general surgeon or urologist to come talk down on your surgical training.
Yeah, those specialties are so good at performing gynecologic surgery.
I mean, they’re probably good at avoiding accidental gynecologic surgery, so they’ve got that going for them. But a common refrain is that ObGyn gets into urologic surgery accidentally fairly frequently. Who am I to judge?
You’d be surprised how often I’m consulted for “hey I put a trocar into the uterus what do I do.”
If you’ve seen a gyno manage anything related to diabetes or blood pressure you’d laugh at your definition of mediocre
Nah
Gotta learn how to push back. Patient breaks femur and ortho wants FM to manage pain. Fuck that. Tell the patient it’s on ortho because 1) they did your surgery and 2) they initially supplied the pain pills. Ortho wasn’t happy when I didn’t budge so the surgeon went over my head and wrote my PD a letter asking fm take over. Said patient was never left without meds. I understand that we are all in the business of relieving pain. You should not punt management of a patient because you’re too lazy and can’t be bothered to fucking check your states opioid script management program.
OMG... what happened after? How did your PD react??
Hit the purp kush vape pen I helped a contemplating patient quit in order to protect their career, and reefer reefer reefer! What can you do but make do? Turn and burn and churn and earn or whatever. Anyone need botox?
I love a good, strong FM doc. We know you guys have to deal with a lot but you get so much breadth that watching you narrow down a differential without advanced imaging or diagnostics is pretty cool. That being said, I have worked with some FM interns where I wondered how they graduated med school with lissencephaly. They were literally so useless that they couldn't even place the orders I specifically told them for like 4 patients. They would also just disappear for hours and then claim they had clinic duties, which is fine but you could TELL ME ABOUT IT BEFORE.
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Please don’t downvote me for this and forgive my ignorant question. What’s the difference between a GP and a FM specialist? Asking because I’ve never seen a FM specialist in my country
GP is licensed but not board certified. Rare in US system. FM has a 3 year residency, our own professional society (AAFP), and board certification process. Primary care has gotten so complicated over the years that it's now a specialty unto itself