Now that number is closer to 20. She was really candid about how much she had hated being employed, and what she needed to do now to maintain a viable independent practice (long hours, some boutique stuff, being smart about advertising, etc). The reason being that the current model for CMS reimbursement (MIPS) really benefits primary care specialties, since it offers a bunch of performance incentives for meeting criteria related to value-based care. And personally, I find these more challenging patients more rewarding, as we try to manage most things on our own, including HIV, addiction, Hepatitis C, and so on. We do well and at our current level of operation/efficiency we could not be afforded by the hospitals and businesses in the area that have tried to buy up small practices in our area for many, many years. New comments cannot be posted and votes cannot be cast. Most of SDN is cancer, but the professional sections (like FM) are full of practicing docs. Its really unwise and hazardous for the public to let mid level encroachment continue. Primary care PA here. Moreover, when looking back over the past 20 years to 1996 (coincidentally, when I was in the match), while the absolute number of trainees entering family medicine has increased (from 2840 to 3105), the percentage of all trainees matching to family medicine has dropped from 15.8% in … Although we pay well, they still allow us to make a profit. It sucks seeing all the hate around here when some/a lot of us completely recognize and respect the authority and expertise of physicians and just want to do what we can to make the system work smoothly for the patients and the docs. Topping the list is New York, with New Hampshire and Vermont close behind in second and third. Unless they really change their training, I cannot see this changing for the most part. The efforts of every family physician and family medicine ally are necessary to meet the ambitious goal of America Needs More Family Doctors: 25x2030. Does your office have a preference for this? Just because someone can practice in FP doesn't mean they are anymore likely than the physicians who choose to go into specialty. Would appreciate any insight. 2004;2:S3–S32. family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The fact that NP's can practice independently is BS, very special cases such as practicing out in the sticks should be taken on a case by case basis and have significant enough evidence to prove this. They just are not exposed to nearly as much as doctors are over the course of their training. Press J to jump to the feed. Primary care is often responsible for cleaning up the messes that the various midlevels of the world create. Zeeshan Ahmed, director of the new Ahmed Lab at Rutgers Institute for Health, Health Care Policy and Aging Research Date. As a current med student that wants to go into Family Med, would you consider your situation to be the exception or do you think that just the negative voices are louder? "Physician Extenders" will be more of a part of it, but that means more time for you to reddit. As far as I can tell, it is a win-win to have them. NPs are a wonderful asset to the office. I would hope residency could be reformatted to help with the debt and money aspect. I concede that probably noone finds filling out disability paperwork stimulating. Quite possibly one of the highest in demand if you’re willing to live in certain areas that are in high demand for docs. The FM section in particular has a compensation discussion basically on a weekly basis. October 6, 2020. MS4. That being said, the ANA and others are unwisely pushing for this and they are loud and funded. The Nurse Practitioners, however, know their limits. I think mid-levels have a place and can help with case load, but there should always be an actual doctor supervising and around to handle the more complex stuff. 2. Family Medicine is one of the shorter paths in medicine - 4 years of undergraduate work, 4 years of medical school, and then 3 years of residency. Vermont beats the national average by 4.9%, and New York furthers that trend with another $29,863 (14.4%) above the $208,024. Before hiring our NPs, we would see 30+ patients each per day. Posted by. These predictions famously missed their mark — though not for want of trying. I don't actually think patients want more. There's a LOT more to think about than just availability of jobs and salary. Midlevel careers have such a low barrier to entry compared to what med students had to go through. The demand for family medicine doctors is extremely high right now, and they are very large income generators for consolidated healthcare systems. This is a highly moderated subreddit. Hi Reddit Friends – I am a 3rd year DO student interested in family medicine and needing some advice for moving forward into 4th year and applying for residency. When I needed a PCP I didn't want to see someone in our system, so I found the one independent FM doc in the area that took my crappy insurance. In fact, naturopathic medicine is now rated as having an “excellent” career outlook. We’ve identified five states where the typical salary for a Family Medicine Physician job is above the national average. My decision to leave clinical medicine was complex. Media Contact. They’re the most in demand field at the moment. To improve quality of care, practitioners are embracing a model called patient-centered medical home (PCMH).In the past, patients might have relied entirely upon their doctor's knowledge and education -- the physician's decisions were pretty much made solo and he or she provided all treatment. The entire sample rated the future of family medicine, respect of family medicine at their school, and the importance of family medicine to the US health care systems positively (Table 1). Press question mark to learn the rest of the keyboard shortcuts. It seems that value-based care is the future of medicine; and CMS has already issued a new roadmap for providers to accelerate the adoption of value based care and reward pcps for "reducing the effects and incidence of chronic disease and for helping patients improve their health". I know with potential ACA changes the future is in flux. They hope that health insurance companies and other payers will align their payments and reimbursements to family medicine physicians and other primary care providers … Family medicine is changing with the times. Still, as a fourth year I don't think I would be ready to enter the community and practice without performing a residency which is similar to having an NP practice independently. The rest of the report can be found here: https://www.merritthawkins.com/news-and-insights/blog/healthcare-news … It would not lead to cost containment and isn't the solution to the family practice dilemma. Long term future for family med is amazing. Jenny Noonan. I have some concerns. Anecdotally, for graduating family medicine residents whom I have trained, the job offers look even better than most reports. Close. If I went into it, I wouldn’t be an attending until 5 years from now. It is hard to explain the paperwork burden to someone. Average income increased 17% from 2015 to 2017 according to a Merritt Hawkins survey. some more info regarding MIPS: https://www.aafp.org/practice-management/payment/medicare-payment/mips.html, New comments cannot be posted and votes cannot be cast, More posts from the medicalschool community. Average income increased 17% from 2015 to 2017 according to a Merritt Hawkins survey. The future of family medicine: a collaborative project of the family medicine community. I am told nearly 100% of the time to not do family medicine, but reading this is exactly what I would see myself wanting to do post graduation/residency. What this does mean is that on average, the complexity of the patients that the doctors see has gone up. Future of Family Medicine Project Leadership Committee. Whatever the case, I suspect that midlevels and MD/DOs will split the case load in any clinic, with physicians managing those with complex chronic disease and midlevels taking care of the bread and butter. email@example.com. It's soul crushing at times. I think it will require a lot of changes in the way PCPs operate. No one can predict the future, but family medicine physicians and leaders have high hopes for their specialty over the next several years. As far as job outlook: “In spring 2018, the Association of American Medical Colleges (AAMC) predicted that the physician shortage could range from 42,600 to 121,300 physicians by 2030.”. Most of the patients that they see are more acute than the ones the doctors see -- URIs, UTIs, BP or DM checks etc. Personally, I see mostly adults, and only see patients in an office. Fast-forward to 2013 and you’ll find that family medicine and the role of family physicians have changed drastically. Press question mark to learn the rest of the keyboard shortcuts, https://www.merritthawkins.com/news-and-insights/blog/healthcare-news-and-trends/the-future-of-family-medicine/, https://www.aafp.org/practice-management/payment/medicare-payment/mips.html. Hi all! My dad is one of them. 2004;2(suppl 1):S3–32. Definitely not limited to primary care, but it seems like they don't as much sway with the administration since they generate less income, are easily replaceable, etc. I'm of the opinion that it is, but this is obviously biased by my position as s medical student saddled with huge amount of debt. And this is in a suburban/borderline rural area. Nurse practitioners can apply guidelines … I’m strongly considering FM, but what do you believe to be the long-term outlook, as in 20-30 years? You also didn't mention knee injections, pap smears, abscess I&D, elliptical excisions, punch and shave biopsies, suturing, etc... some FP docs find these procedures pretty satisfying, and a good way to mix up the humdrum of listening to complaints all day. It's definitely made me think twice about primary care. The lowest average physician salaries among the most-requested searches were paid to family medicine physicians, with an average salary of $239,000, down just slightly from the previous year. Family is the link between the individual and society. More time to reddit is the big picture and end goal. I make great money and have one of the cushiest schedules out of anybody I know. They had neither seen or heard of these diagnoses before. I am one of 3 physicians in an independent Family Medicine practice. First time posting on this Reddit. A shortage of over 100,000 physicians holy shit, most demanded field, one of the most underpaid fields, i dont doubt there is a shortage, but i wouldnt trust the AAMC numbers. I will say that both the physicians I described seem happy, but also worn out. I've done some reading about this question however I haven't been satisfied with what I've found so far. Ann Fam Med . The future of family medicine: a collaborative project of the family medicine community. I would be willing to bet family medicine continues to be a safe bet. A little bit of context: I have had testing accommodations through undergrad, grad school, and now medical school. This week alone I was able to teach our NPs what Bullous Pemphigoid and Livedo Reticularis were during a patient visit to them. METHODS A national research study was conducted by inde- 5 years ago. I'm indebted to you guys for my education and skill. The resident seemed happier than many of my other rotations, the work was interesting, and I could see myself doing it. Honestly just want to do the best I can for the patients and for my physician colleagues. The future of Family medicine is unknown, but what I know that family physicians can't be replaced by a Nurse practitioners. As it stands FP physicians serve as the gatekeepers for a ton of the referrals in medicine and decide where a lot of health funding is going to go. If you talk to them, they are actually perplexed at the idea of practicing alone. Please read the rules carefully before posting or commenting. I have quite a bit of autonomy. A better question is to ask about the practice models that will be available to you and what that will mean for your day-to-day life. The future of Family medicine is unknown, but what I know that family physicians can't be replaced by a Nurse practitioners. Everyday brings something new. Medscape 2018 reports family medicine average salary to be $219,000 nationwide—a very big change over just around five years. I don't want family practice to be mid-level run (at least independent NP run, PAs your education is superior currently). 81. We will do our best to teach them in both inpatient and outpatient settings and will model the best of the specialty. And having all the tasks passed down to you that are unattractive, don't pay well or don't pay at all (ie. (Family physicians were the most requested specialty among all of those tracked, for the 13 th year in a row.) I didn't think I would want to go into FM, but now that I work in FM, I love it. None of this has ANYTHING to do with intelligence, of course -- it is all a matter of experience. Want to collaborate and work together, not encroach. Any insight will be appreciated. Medicine may be a science, but even scientists will gaze into a crystal ball. “I was shocked at the offers I received,” recalls Samantha. That's fair. I think the long-term outlook is actually quite good compared to other medical specialties. That's fair but with independent practice is that not already the first step towards replacement? Family Medicine Resident. I do think that there is a place for mid level providers to work in conjunction with physicians to provide superior healthcare. The Society of General Internal Medicine (SGIM) is dedicated to improving patient care, education, and research in primary care and general internal medicine. National Conference brings together many of the most promising medical students and residents, who all share a passion for family medicine and a common goal—becoming the best physician possible. It's time for another update on Family Medicine for America's Health: Future of Family Medicine 2.0. Or is it really more augmentation of the existing workforce? Wondering if it's wise to pursue this field for residency? Some people will do a 1 year fellowship in sports medicine, geriatrics, palliative care, or additional training in obstetrics. Spann SJ. Removal of sutures, wound care, ear syringing, government forms, etc). The NP will certainly be able to document and discover everything, but typically the doctor would be the one to put it all together and recognize when a collection of findings is concerning or not. /r/medicine is a virtual lounge for physicians and other medical professionals from around the world to talk about the latest advances, controversies, ask questions of each other, have a laugh, or share a difficult moment. But fundamentally, I realized over time that practicing medicine was not what I had envisioned when I started medical school a … It is dangerous for patients who should be taken care of under supervision. The nursing board has guidelines regarding what they can and can not prescribe, and they are very aware of this. TL;DR NPs are a fantastic asset, but unless training is longer/more intense, they will always need a supervising doctor. The clinic I’m at now is staffed by 3-4 docs and 2 PA’s and they’re still overflowing with patients. In the future will this lead replacement of FP with mid levels? I did medical school in an area that was almost totally saturated by midlevels and ironically it may have actually increased the need for family medicine doctors. If outcomes are similar between NP and FP why would insurance pay more to FP? New M4 planning on family and this is the exact setup I would like. The future of Family Medicine. Very true, there's a such thing as doing more harm than good. However. That’s why naturopathic medicine is a great option for those who want to have a direct impact on the health of others. They know when something is too complex and ask us questions at least hourly regarding management, which we absolutely encourage. So there's more to think about than availability and salary. Become a preceptor. The Future of Precision Medicine. They rated their FMIG involvement at 2.07 on the 4-point scale. They’re seeing both, because there aren’t enough healthcare workers to go around. Press J to jump to the feed. ... help Reddit App Reddit coins Reddit premium Reddit gifts. That one patient with the very rare disease you saw in the ER at 3 in the morning 15 years ago? I do not see NPs taking over for Family doctors. Please, don't take what I said as an insult to your intelligence. Hours have likely plateaued. A team approach includes naturopathic doctors who can help treat a variety of health issues. Nearly all PCPs in my area are owned by a giant hospital system, either through direct employment or because a former group was bought out. NPs aren't likely to have that experience. As far as job outlook: “In spring 2018, the Association of American Medical Colleges (AAMC) predicted that the physician shortage could range from 42,600 to 121,300 physicians by 2030.”, The rest of the report can be found here: https://www.merritthawkins.com/news-and-insights/blog/healthcare-news-and-trends/the-future-of-family-medicine/. Some family physicians like doing those minor procedures you mentioned. That being said many states currently allow for unsupervised PA NP practitioners. Don't go into family medicine unless you love filling out forms and 7-minute visits to deal with multiple complaints in patients with lists of chronic conditions and over a dozen meds. Family medicine because it was broad, all-inclusive, and promoted an ethos of family- and community-centered care that aligned with my ideological predispositions. We know that the future of Family Medicine lies in the students who train with us. The Family and Community Medicine Residency (Reading, Pa.) at Penn State Health St. Joseph strives to provide excellent education in training family physicians to provide comprehensive, compassionate, coordinated and continuous high-quality, patient-centered care to the community served by the program, regardless of background or resources. When you’re having to see 20-30 pts a day you’ll be thankful for whatever help you can get. Out of curiosity, why do you have just NPs and no PAs? The rest lies in MDs having enough of the frustration and being the voice of change in the medical Industry in the US and not insurance or others. What are these common and/or preventable mistakes you are noticing? The preceptors I've worked with have next to no say in who they see, what hours they work, how long appointment slots are, etc. Mainly asking about the availability of jobs and the salary. The primary care MD cannot be replaced but I can see why it's not as sought after due to debt, hours, and everything that leads to burnout. There is the threat of midlevel encroachment -- totally valid threat. In that respect I don't think they are going to be replaced by NP anytime soon. Your hypothetical scenario is already happening, and physicians aren’t just seeing complex cases. But the USA really needs excellent primary care providers, and there may (or may not) be significant restructuring of reimbursement to promote primary care. One preceptor was just told that she needs to increase her patient panel (to generate more income), and that her hours were going to increase to achieve that. Enhance your residency experience with the latest medical news, expert advice, and tools to help you prepare for a career in family medicine. An important part of the Academy's efforts to shape the future of family medicine is a project focused on encouraging more of the most promising medical students to choose careers in family medicine. Nurse practitioners can apply guidelines and protocols, but patients want more than this. Asking in all seriousness, what do you recommend we look out for or do differently? I really think it could go either way. Unusual constellation of findings suggesting malignancy or autoimmunity? They are vital to our practice, and treated like equals, but they certainly know when to ask for help. We have fantastic NPs in my office. (besides just saying quit or go to med school). [Article revised on 25 April 2020.] Compensation is going to keep going up. These are the types of things I'm wondering. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a chang-ing health care environment. They envision that more people and organizations will recognize and embrace the value of primary care--and its providers. Either the education is worthwhile or it is not. We have two nurse practitioners, and if we continue to grow at our current rate, may need a third within 2 years. Welcome to /r/MedicalSchool: An international community for medical students. I also think its logically contradicting to have MDs and NPs providing near the exact same services with vastly differing education. By Jennifer Larson, contributor. Nobody knows but the most common sentiment echoed is that the FP isn't going anywhere. Ann Fam Med. I think its safe to say that there will always be a need for family med physicians. Will FP salaries go down closer to the level of mid level or will FP be relegated to seeing only the more complicated cases? 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