drmamu
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This post is for that large number of people who beleive that primary care without fellowship does not carry a bright future. I am sure that 99% or more of people going into internal medicine want to do a compititive fellowship. It is good to hope for the best. But it is also a good habit to understand the truth. About 1 out of 20 will end up in a compititive fellowship provided fmg and img are treated alike . So 19 out avery 20 people will not make to compititive fellowship the same year. All of us beleive that we wont be in that 19. But someone has to be in that 19. But most of these people have lead a successful and happy life. So primary care is not bad. I am trying to put together some of the facts below. I am aslo planning to work hard for a very compititive felloship. But this post is for people who beleive that life without fellwship is not worth living and also for people who take enormous risk of not accepting premaches only because they beleive that their chance of fellowship is very low in that program. I support all those who turn down prematches because they did not like that program.
The main differene between the payment system in India and Us is that the doctors are payed by the insurance company. 99% of super specialist do not accept direct patient with out reference of their primary physicians. If an isolated spacialist sees such patients without reference of the primary physician, he is welcome to do that, but the patient has to pay billed amount directly. Most insuranse companies pay 75$ per patient to super specialist and 50$ to primary physician. They compensate by the better cut off patient load-most insurance companies allow 20 for primary care and 15 for specialist. Now if the insurance decides to refuse the payment, patient has to pay the direct billed amout- which is usually 150 for specialist and 130$ for primary. So it is very unlikey for a patients to go for a visit that will not be covered by the insurance. So in US, the insurance company practically decides a large part of your practice. So fp physician will get the patient load designated by the insurance company he is obliged to as PPO, HMO or PPP. That is the reason why there is so much demand for derm because majority of the procedures in derm are not insurance covered. So they can give direct bill.
So where does the specialist make more money? Procedures. Eg- primary care are certified for simoidoscopy which is recommended by USPSTF for screening. But during patient education when you tell that colonoscopy may be more predictive than sigmoidoscopy, they may opt later and this can be done only by gastroenterologist. Simillarly catheterisation proceedures for cardiologist.
So please dont underestimate or discriminate any particular residency without correct information. If you are not planning to do fellowship, family practice is as good as im. But also remember that there are abot 800 or so fellowships for 20000 internal medicine residents each year.
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| chemamr
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very interesting and realistic information drmamu (as usual with your messages).
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| kgyi2003
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interesting facts really. but on the other hand, i can't understand why people don#t choose easy going life of a FP. there must certainly be a reason as we all are not mad.
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| drmamu
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Please dont misundrstand me. I only told that the future of family practice is also very good. I would never agree if any one says that family practice is easy going. I beleive that the major reason why fp is easier to get than imis because most of candidate are interested in getting fellowship at some point in life. So, as i said, if someone decides that they dont want to do a fellowship, fp is a very good choice.
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| drgoyal
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But what if my plan is to go back to India?
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| nihadam
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THat's a good question.I'm planning to go back to Sudan too,But AS far as I know from the small # of iv I attended if you want to go to fellowship you can do it wherever you are. a small program where I went,their residents went to avery competive Fellewship programs like cornel,Harvard,Duke and this program is aprimary care program.The senior resident who toured with us told me that one of the attendant is very helpfullwhen it comes to fellewship she will write very good lor and call they people she Knows in order to help the residents.I hope this will brghten the picture for some of you. And as amatter of fact to get something you have work realy hard.
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| usmleed
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as far as i know fp have a greater chance of making money than IM contrary to the common perception. that is becoz FP do a more wider range of procedures and are also trained for simple gyn/obs procedured, surgical procedures and derm etc. the reason why they dont usually is becoz they dont want to risk their practice doing procedures which they are not specialised in.(they do have training but not the same as the specialist right?) So the potential is there. It depends on u , how confident u are in these areas of practice.
PS: i havent applied for fp
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| chemamr
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there is also a crisis period right now and will be much more in the future due to the lack of primary cary practicioners (IM, FP), they say theyīll have to do some change in politics to fix this. Why? because right now the main tendency is to study something and a fellowship after that. So, i guess, an IM or FP will always have a job. I mean, there are shortage of IM and FP practicioners.
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| drmamu
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One of the good things about US is their feed back system. So it is important that we follow what the government has to say about doctors. I hope mst of you heard the state of the union adress of preisdent. The only field where there is a shortage of doctors is obgyn and not primary care or specialist. This country has not reached a state where more doctors are produced than what is needed by the country. If such a situation arises, we can be sure to face some severe restriction regarding visa and green card.
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| chemamr
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why is obgyn the only field with shortage?? malpractice issues or what??
my comment was based on an article i read on the web, it wasnīt an official letter but it was based on some statistics and real data. They also commented about obgyn, now i remember, but i didnīt pay much attention about it  .
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| dr_singh246
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usmleed what is the source of information that u posted . please let me know.
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| Veer-Zaara
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drmamu, there is comething fundamentally wrong in your calculation for fellowship chances.
Each year there are 6000+ residency spots in IM and 800+ opening for fellowship spots.......to technically it should be approx 1/6(or where abouts) chances of getting fellowship.
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| drmamu
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Hai Veer Zaara,
The number I quoted above are the ones that had been posted here in the forum under the topic"why do people take take prematches" I thought that it was very convincing. 6000 seems like a very low number of applications because every program claims that they received 2000 to 3000 applications. Hope someone could carify these numbers.
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| Veer-Zaara
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The positions are given in Freida.....its 6000+ positions/year in total if you include PGY-1,2 and 3 then its closer to 20,000
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| rashmi_k3
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Yes IM total position is 4,500. Fellowship No. is 900.
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| afds
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so u people mean that if not fellow than FP is better than IM
correct m if I m wrong
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| chemamr
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yes, thatīs one of the points.
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| bigcat
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But I always concerns about the confidence a FP docotor have comparing with a IM doc. Since FP is trained at so many areas, it'd be hard if possible to be as good at each of these fields as those that are specially trained. For example, will FP doc be confident at seeing IM cases as good as an internist? I agree that there must be some super smart people out there that are doing FP, but I am talking about the percentage...
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| Veer-Zaara
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FP only treat basic ailments.....anything complicated which is beyond their skills/knowledge is referred. Thats why it has a relaxed lifestyle becoz you mainly deal with patients in the clinic and not admitted under you.
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