Without much fanfare, my current plan is to aim for Family Medicine.
Ironically, the rotation I haven't done yet that might change my mind is Family Medicine. If I have a truly awful experience there it'd certainly alter my approach, but at this point I've had quite a bit of direct FM exposure and generally enjoyed it, so I don't see that happening. Even if I don't find my FM rotation as exhilarating as some other rotations, that probably won't change my plans, the rotation just has to be sufficiently pleasant.
My thought process here isn't all that unique, and I've been a bit hesitant to make this post at all, but I figure it's worth spelling out.
1) I like outpatient medicine
Through my rotations thus far, there's been a bit of a recurring theme: I love my time in outpatient clinics (I'll throw ER in there as well), but get completely worn out by inpatient services. Basically if I can see a patient for a short period of time and send them on their way, I'm pretty happy. These services tend to have a bit more face-to-face time with patients, which is a big plus for me.
Inpatient medicine I find tends to get bogged down in bureaucracy and problematic miscommunications are routine. Too many providers with too little coordination between them. There's a reason being in hospital is a major risk factor for death and while it's a problem I would love to tackle at some point in my career, it's not an environment I particularly want to practice in for an extending period of time. Maybe community hospitals, with fewer services to manage, do a better job of this, but that brings me to my next point...
2) I want a residency that reflects my outpatient preference
There are a number of specialties that allow for a primarily-outpatient practice, not just family medicine. The problem is that most of them require a rather inpatient-heavy residency, especially in the first few years. I don't think I would enjoy years of an inpatient-dominated residency. Residency may be a short time compared to a whole career, but 5 years isn't exactly nothing. I'm coming up on my 5 year anniversary with my SO and it feels like a lifetime - a very happy one - since I met them. Add on the inevitable fellowship(s) required in many fields and the time difference between FM and Royal College specialties becomes pretty substantial. I don't want to spend that amount of time being miserable. FM doesn't avoid all inpatient work, but it does limit it to about 9 months or so maximum, mostly in the first year.
3) I'm eager to practice
To put things bluntly, a short residency is very attractive. I've mentioned before that I have some life goals to accomplish over the next 10 years or so, the biggest and most time-sensitive one being kids. A shorter residency means maybe having them after residency or at least getting to a point of professional and financial independence early in their lives.
I'm also getting a little tired of being a learner. Not tired of learning, of course, just tired of having that learning be subject to a bunch of extra requirements that come with being a learner - directed (rather than independent) learning goals, the endless evaluations, rapidly shifting from topic to topic... I'd like to be more able to tailor my education to my needs, rather than what others have determined I need to study. That won't likely happen until I'm out in practice.
4) I want a job
Few specialties have great job prospects and none are as flexible as Family Medicine. It's one thing to put in extra time to be a specialist, it's another matter entirely to do so without a desirable job at the end of it. There are one or two specialties that might be worth the extra training time, but not if I can't get a job I'm happy with at the end. FM pretty much comes with a guarantee of reasonable employment and for the foreseeable future, also a guarantee of location preference.
5) Trading ambition for stress reduction
The main thrust of my thought process leading to Family Medicine is stress reduction. Outpatient medicine is less stressful to me, for a variety of reasons. A residency that's shorter and outpatient-focused is similarly less stressful. Knowing I'd have a job at the end is a huge stress reducer.
In many ways, simply making the choice to pursue FM has been in keeping with the goal of stress reduction. FM doesn't require amazing LORs, heavy research experience, or specific electives to have a successful match. I've been able to focus on clerkship rotations more than filling out my CV, my elective choices have reflected my preferences rather than those of program directors, and I'll have many more options for where to do my residency. I wanted to take back some control over my education and my life - simply making the choice to pursue Family not only helps that goal in the future, it had an impact right now. I really can't express how much a difference that sense of control has made to my own well-being.
I've been hearing a lot about the draw to FM because of the 2+1 program. It almost sounds too good to be true (a backdoor to specializations w/ less competition and less time req). Is doing a +1 subspecialty/fellowship something you are considering? Say you do a +1 in ER, would you be able to bill as an ER doc when working?
ReplyDeleteIn most cases, a +1 isn't a backdoor to specialization, merely a way to focus or tailor an FM practice. The exception is the Emerg +1, where the opportunities and billings are almost the same as they are for someone who did the 5 year EM program, but it is incredibly competitive to get into - about as competitive as the 5 year Royal College program.
DeleteI am considering a +1, but likely oriented towards research or education rather than tailoring my clinical practice. We'll see how I feel about that in two years though, as many people indicate an interest in a +1, but only about a third of all FM residents complete one.
Thanks for the info, ralk! Hm, since FM-EM and EM have the same opportunities/billing, I wonder why would anyone opt for the two year longer EM route (that does not have the dual credential of FM as well).
ReplyDeleteThere's a number of reasons to shoot for the 5 year program. First, not everyone interested in FM wants to do - or even touch - FM. Going the 2+1 route leaves a ~40% chance of being an FM doc only if you don't get into the +1 program. The 5 year program is very competitive too, but once you're in, you're in.
DeleteSecond, the 5 year program is naturally more extensive and in-depth in its training than the 2+1. Hard to get around that. Even in the most EM-focused 2+1 training, you're really getting no more than 18 months of real EM experience, a fraction of what the 5 year residents get. The 5 year program has far more opportunities for fellowships, research, and subspecialization as well, often included within the standard 5 years of training. For example, some EM docs do a fellowship in critical care, which isn't available for those who go the 2+1 route.
Third, while there isn't much difference in job opportunities between the 5 year and 2+1 route, they may not be exactly equivalent. Most departments have a mix of both, but there's a perception that 5 year EM docs are more common in large, academic centres, while 2+1 EM docs are more common in smaller, regional ERs. How true that is, and to what extent it affects career prospects, I can't really say as I have no inside perspective and no good data on that on hand.