One of the most exciting experiences during medical school is selecting the specialty in which you’ll be practicing. Choosing your specialty is more than picking a career; you are essentially picking an identity, and a rather permanent one as switching residencies and going for second board certification is fairly difficult here in the United States. As such, many factors go into picking your specialty, whether you are consciously aware of them or not: length of residency training, requirement of a fellowship in addition to residency, availability of spots/residency sites, geographic availability, salary as an attending, lifestyle, work-life balance, and other factors as determined by your own individual preferences. Most students tend to gravitate towards specialties with more perceived “prestige,” higher pay, or better “work-life balance.”
As a family medicine physician who serves in a hospitalist function, I am very happy with my choice of specialty. FM is indeed a specialty, often confused with doctors who practice general medicine, many of whom only complete their intern year and no residency. To me, family medicine is an incredible specialty, identity, and career. My goal is not to advertise the field but to present pertinent information and perspective from family physicians who actively pursued the specialty for its merits and its impact on patient care. The hope is that you find an additional option which you may not have considered due to lack of information or popular misconception.
To me, this was absolutely the biggest reason I pursued family medicine. Make no mistake, physicians in general are in high demand, and we do indeed have a shortage of all physicians regardless of specialty. However, the shortage is felt much more acutely in family medicine. Recruiters call me and ask to speak to our graduating class every other day, and one told me it took her one year to find a family physician to fill a job opening in the Los Angeles area (not Anchorage, Alaska, but in LA).
Like many medical students, I applied to medical school because I wanted to pursue a career which makes a positive impact on people’s lives and on society in general. Finding a career with strong purpose and with opportunities to make a difference is one of the most important contributors to career satisfaction and prevention of burnout. Primary care physicians, which also includes general internal medicine physicians and pediatricians, are highly needed in a nation whose age demographic is getting older, whose population is carrying more chronic illnesses, and whose health literacy is very poor. Furthermore, many health plans still indirectly utilize primary care physicians as cost managers by requiring primary care referrals to see a specialist. Family medicine physicians regularly practice holistic care, which can assist patients in cutting costs of their medical care (many prescriptions, tests and specialist visits have a copay), reducing adverse medication reactions (mixing many pills means mixing their side-effects), and reducing pharmacological toxicities (as we get older, our body metabolizes drugs differently). If you are looking to practice in a field which is highly-mission based, is highly influential, and is pivotal to quality of life and health of your patients and their families, family medicine looks like a really good option.
Wider Availability of Residencies
I remember as a fourth year student applying for residency, my graduating class was very specialty heavy. Everyone wanted emergency medicine, psychiatry, or—especially—something surgical. Each student’s motivation for their desired specialty varied of course, but it was a mix of salary, prestige, etc. The biggest concern among my classmates at that time was whether they would match into their specialty based on how few interviews they were getting. As students, we were told that the magic number is 12+ interviews to get your chances to match as high as possible. Most students going for specialty residencies struggled to get this number, at least at my school—a southern California program with hospital connections if that helps you with context.
“As a family medicine bound student, I got nearly 25 interviews invites out of 50 applications before November started,” recalls Jessica, a current intern in family medicine in northern California. “I was definitely very excited with my options. I could go east coast, midwest, stay in California, go academic, community, or choose one of more than half a dozen tracks which included hospitalist, OB-gyn, palliative, geriatrics, etc. I really had an opportunity at anything I could want out of my career.” Family medicine bound students experienced less stress during interview season when I was a student. We had options to pursue our residency training and didn’t feel like our future was in the hands of a few limiting factors.
Work Life Balance, As You Define It
Family medicine is one of the most flexible specialties available for how you can cultivate your practice. Inpatient, outpatient, hospitalist only, procedure-heavy, including OB, adults only, pediatric focus, women’s health focus, geriatric focus, community and preventive health, etc. The opportunities are really broad. With this flexibility comes a unique opportunity which most other fields cannot boast, except in special circumstances: the ability to define what is work-life balance for you. Other specialties may boost work-life balance, but only if your version of it falls in line with the field, and there are fewer opportunities to mold your own practice. For instance, ED physicians often boast that working 12 hours shifts for only 12-15 shifts per month is good work-life balance. However, they cannot leave the hospital, they have to work 12 hours shifts vs 6-8 hours, scheduling is often stricter when emergencies arise, and they do not control how many patients they see in an hour, or in a day.
Speaking to fellow graduates of my family medicine residency program, it is really amazing how different all of our practices have become. Some, including myself, are hospitalists. Some serve strictly as outpatient doctors with no hospital responsibilities. Some see pediatrics, although most don’t. Half of us do women’s health. About a third of us pick up shifts as ER doctors in addition to our full time gigs, and one works completely in the ER as as ER attending, in sunny southern California no less.
“I felt FM has given me incredible work-life balance. I worked two other jobs before landing my current one. First I was a hospitalist, but I didn’t like doing 7 straight days. Then I did a hybrid of both outpatient and inpatient, but being on call for inpatient wasn’t desirable. Neither of those jobs gave the balance I have now as a full-time outpatient physician doing 3 days per week,” states Julia who works in Santa Monica, CA. “I negotiated how many patients I would see in a given day (bonus if I saw more or walk ins) and opted to have light administrative duties.”
Some family physicians have restructured their entire practices after finding a niche group of patients. “I used to see primary care and offer additional pain management and regenerative treatments on the side,” explained Jesse, who owns a clinic in Orange County. “I’m now seeing mainly pain management and regenerative medicine patients, only occasionally taking care of those patients’ primary care needs.”
Length of Residency
How long you train does matter as you progress. The burnout starts to set in and you feel life moves around you while you’re standing in place. At the beginning of medical school, the length of your future residency training may not matter as much. Eight years to become a neurosurgeon doesn’t sound too bad when you are 23 years old. However, this opinion often changes by the time you reach 4th year of medical school. Oftentimes, student fall in and out of love with possible specialties during 3rd year rotations after getting a closer look at how life may turn out. Many students also start thinking about starting a family or buying a home around the time they graduate medical school. An 8-year residency in neurosurgery may not be as conducive to these plans as a three-year residency in family medicine (or internal medicine for that matter).
The majority of emergency medicine programs is also 3 years, however other factors mentioned above effect your experience with pursuing this residency. As you add more years to your training, your risk of burnout will often increase. Residents often tell me how they are the last to get married, have children, or buy a home—all things which were important to them even prior to applying to medical school.
“Residency is living in poverty for the most part,” recalls Jonathan, a current general internist. “My wife and I used to share dishes when we went to dinner with friends while our friends ordered whatever they wanted. I don’t think we personally could have maintained that lifestyle for more than 3 years.”
Bottomline is to anticipate life changes and how this can affect your career goals. Be flexible, and be prepared to weigh your original career goals with what you want out of your personal life. After all, without a balanced personal life, most of us will find it difficult to be an effective physician of any specialty.
The Broad Scope Of The Field
I was initially surprised by how many people said they enjoyed the broad scope of the specialty. I definitely do, but in an era where specialization is the trend, it certainly is something I didn’t expect.
“Seeing patients with complaints across multiple organ systems, age groups, and settings keeps you on your toes. I certainly haven’t gotten bored of my practice,” explains Dr. Brown, who also teaches residents and students. A lot of family physicians don’t keep a broad practice for financial reasons (malpractice, overhead, reimbursement, etc), and most salaried positions do not require that family physician see women’s health, pediatrics, or perform surgery. However, many family physicians do use the wide skill set of their specialty in part time practice as ER shift physicians, urgent care physicians, covering physicians doing locums work, medical missionaries, proceduralists in smaller to medium sized hospitals, and medical directors for various healthcare networks and organizations.
“Even while I don’t always get a chance to see all that my scope allows me, knowing that I’m capable of taking care of different people is a great feeling. I feel I can lend a hand in most situations, regardless of the presenting complaint or who it’s from,” said Dr. Bailly, who works for a primary care group which focuses mainly on adult patients.
The Salary Isn’t As Bad As You Think
A strong motivator for medical students pursuing specialties is salary. I wanted to touch this point last because salary isn’t everything in medicine. However, it would be unrealistic if we didn’t factor it into students’ decision to pursue certain specialties, especially when your annual tuition can range as high as $49,000 to $60,000, not including living expenses. The salary for family medicine, and primary care in general, has drastically changed over the last few years. When I was going through residency, majority of sources reported that the average salary for family medicine was around $170,000. Medscape 2018 reports family medicine average salary to be $219,000 nationwide—a very big change over just around five years. Anecdotally, for graduating family medicine residents whom I have trained, the job offers look even better than most reports.
“I was shocked at the offers I received,” recalls Samantha. “The most lucrative one is for an outpatient only, no weekends, no hospital responsibilities, no holidays, and only 3-4 days per week for a base salary of $275,000. And this is in southern California just outside of San Bernardino. Senior partners were making nearly $500,000 working 4-5 days per week.”
Family medicine salaries can range rather widely. However this isn’t surprising given how broad and varied the practices can be. Other offers reported by other residents were not as lucrative, but not far off either, which is encouraging for young doctors.
Family medicine is a wonderful, flexible specialty with plenty of room for people with different preferences, talents, and life and career goals, and for those who want to make an impact on a grassroots sort of level with preventive care. As broad as your options are for practice as an attending, your options are equally broad in terms of residency, work-life balance, and even salary. (Yes, negotiations are often welcomed when you are apply for a job as a family physician). Of course there are some downsides: lack of available formal specialization training and formal certification, increasing bureaucracy due to insurance and governmental regulations, and heavier administrative burden. However, these factors can be counterbalanced relatively easily by working for a group or medical center or hiring outside consulting firms to deal with administrative work.
Picking your specialty is exciting and perhaps one of the most memorable part of your medical school career. As mentioned above, be flexible with your goals and plans. There are plenty of misconceptions about family medicine as a specialty, which I personally feel are propagated by people outside of the field. If you find that you enjoy spending more time with patients, being a central influencer in their healthcare and their lives, being able to cultivate your own practice, living your life, and make a very decent living doing all of it, it’s hard to not consider family medicine seriously.