What is life like for a family physician? Is there enough time for a good personal life?
Being family-and community-oriented, family physicians strive to achieve balance between personal and professional pursuits. Their work schedules vary considerably, depending on the practice setting and type of medical group. With greater numbers of women entering family medicine and the increased prevalence of two-career families, flexible models of practice, including part-time and shared arrangements, have become more common. The American Academy of Family Physicians reported that family physicians worked an average of 51 hours a week in patient-related activities in 2008, a figure a little below the median number of hours for all specialties.
How satisfied are family physicians with their career choice?
More than 70% of all U.S. physicians report being satisfied or very satisfied with their careers. This is a testament to the enduring rewards of the science and practice of medicine, despite a challenging healthcare environment. Notwithstanding, only about two in five physicians across all specialties are very satisfied with their careers, and one in five are very dissatisfied. Generalists tend to be more satisfied with their ability to make treatment decisions than are subspecialists, and family doctors enjoy the flexibility to tailor their work life to balance professional and personal time.
Within family medicine, the physicians who are most satisfied practice in small group settings, view medicine as a special "calling," and include maternity care in their work. In general, family physicians report being very satisfied with their intellectual stimulation, status within the community, clinical competence, and long-term relationships with their patients.
What is the average income of a family physician? As a family physician, will I be able to repay my student loans and live a comfortable lifestyle?
There is good news about improved income for family physicians. Family physicians earned an average income (after expenses) of $150,000 in 2007, according to the AAFP. Reported average incomes are $160,000 for general internists and $150,000 for pediatricians.
With family doctors in short supply (the second-most recruited specialty), some practices and communities also offer loan repayment benefits as part of newly hired physicians' contracts. Low interest rates for consolidated educational loans can also make it advantageous to invest the repayment allowance and pay off the loan by installments. At any rate, fear of financing loans need not be a deterrent to specialty choice.
What is the scope of practice for family physicians?
The scope of a family doctor's practice is broad and flexible--ranging from the most comprehensive style of family medicine, in which the family physician treats patients in the hospital, office, nursing home, and in occupational and school settings, not to mention performing surgical procedures and delivering infants--to the family physician who limits his or her practice to outpatient care, often in a group setting. Most family physicians function somewhere between these two extremes and are able to tailor-make their practice to particular interests and niches, such as such as sports medicine, geriatrics, preventive and public health, international health, women's health, or adolescent health. Many perform major or minor surgeries and procedures, including Caesarean sections, vasectomies, flexible sigmoidoscopy, colposcopy, skin biopsy and lesion removal, cryotherapy of skin lesions and the cervix, cervical biopsy, endometrial biopsy, spirometry, exercise treadmill testing, splinting and casting, obstetric ultrasound, and endoscopy of the nasopharynx, larynx, and gastrointestinal tract.
Central to all that the family physician does is the doctor-patient relationship, a therapeutic partnership that enables a needs-based and collaborative model of wellness, care, education, and support. This allows the doctor to establish a deep and meaningful understanding of the medical and personal complexity of each patient and by so doing, to provide better care. Family physicians get to know entire families, often starting by delivering a patient's baby and then caring for the mother, infant, and whole family afterwards.
How can I possibly keep current with medical advances in the care of children, adolescents, adults, older adults, men, women, and pregnant women?
Bright physicians who enjoy diversity and continuity are perfect for family medicine. Family medicine was the first specialty to require periodic recertification after a physician passes the specialty Board examination. As part of that seven-year process, every family physician must complete 50 hours of continuing medical education for each subsequent year after residency completion. This education and the required chart review enables family physicians to keep their knowledge base current. In addition, many practicing family physicians are teachers of medical students and residents, another way in which they "learn twice" and stay intellectually challenged.
What is involved in family medicine residency training?
Residency training provides future family physicians with integrated inpatient and outpatient learning over a period of three years. There are more than 460 accredited family medicine residency-training programs in the U.S., many of which are community-hospital based, while others are medical-school based. Required training occurs extensively in inpatient and outpatient settings, and each resident must have an outpatient continuity practice. Teaching more junior residents and medical students is the norm, and residents become skilled at caring for ethnically and socioeconomically diverse patient populations, not to mention for patients who otherwise would be medically underserved. Prevention, wellness, behavioral health, and practice management are important parts of the required curriculum.
What is the difference between a family medicine residency and combined residencies in internal medicine and pediatrics, family medicine and psychiatry, and family medicine and internal medicine?
Dual certification programs offer graduates the opportunity to become Board-certified in each of two specialties. There are a handful of family medicine dual programs with internal medicine as well as with psychiatry. About 100 programs combine family medicine and pediatrics. In all cases, the focus tends to be more on the inpatient, technical side of each specialty, perhaps at the expense of longitudinal patient care experiences. Combined medicine and pediatrics programs lack the emphasis on women's health that many practitioners desire, and they may focus more on NICU training than what the community-based physician caring for infants and children will encounter.
In the real world, there is little difference in privileges sought and obtained by singly versus dually Boarded family physicians, and the dually Boarded physician may have more difficulty finding appropriate coverage (usually needs two different physicians) when taking time off.
Is it important to learn obstetrical skills? Will I ever use them?
Providing maternity care has always been an important piece of family medicine, resulting in the building of one's practice over multiple generations and the provision of care to all members of the family, from [before] cradle to grave. The family physician is truly ingrained in the life of the family, particularly at nodal points in the family life cycle. It goes without mention that young families gravitate to family physicians who provide maternity care. This keeps the numbers of children and adolescents in their practices healthy. Studies also show that the 23% of all family physicians who provide prenatal care and deliver babies are among the most satisfied of their colleagues. For the remainder who do not actively deliver babies, their obstetrical training allows them to provide other medical care to their pregnant and nursing patients in a highly knowledgeable fashion.
While caring for pregnant and laboring patients indeed contributes to time management issues for the physician, choosing not to serve those patients would result in filling a practice up with complex medicine patients. As a result, the family doctor would spend just as much unscheduled time in the hospital as the family physician doing obstetrics. Instead of spending time with a young family that is excited about what is happening in their life, those physicians might spend their unscheduled time taking care of more patients whose lives are complicated by strokes, heart attacks, and other acute problems. Further, family physicians who provide maternity care are able to limit the number of pregnant patients treated at a given time, allowing one the fulfillment that delivering babies provides without excessive hours.
What is the future of family medicine?
The ongoing need for family doctors in the workforce is clear. Family medicine is the only medical specialty in which physicians distribute themselves in the same geographic proportions as the American people. Were all family physicians suddenly withdrawn, 58% of all U.S. counties would become Primary Care Health Professions Shortage Areas. On the other hand, if all general internists, pediatricians, and obstetricians-gynecologists combined were similarly withdrawn, fewer than 8% of counties would become Primary Care Health Professions Shortage Areas. As the baby boomer population ages, family physicians are perfectly situated to meet the demand and to find job security.
In a healthcare system currently plagued by fragmentation and complexity, family doctors are the specialty of choice in providing what the American Academy of Family Physicians and others term a personal, medical home. The U.S. healthcare system should support the integrated care that patients need and want, and family physicians are strong advocates for fixing healthcare funding to insure that all Americans have access to basic services and protection against extraordinary health care costs. Family medicine will continue to be a leader in delivering evidence-based interventions in safe partnerships with patients. In partial fulfillment of this goal, all family medicine residency programs are currently using electronic medical records.
What career opportunities will be available to me as a family physician?
Most family physicians care for patients in group and private practices, with responsibilities and hours that can be altered based on the physician's stage in the life cycle. With a mission to provide high-quality services to all people, family physicians also choose to work in underserved communities in the U.S. and abroad, under the auspices of a variety of organizations. Another option is academic medicine, with numerous faculty openings in residencies and academic departments. In addition, there is a critical need for more investment in and support for primary care research. Finally, opportunities in healthcare leadership and executive medicine abound. Some family doctors have very high-level positions; for instance, former President George Bush's personal physician was a family doctor, and Dr. David Satcher (former U.S. surgeon general) was a family physician.
Can I specialize as a family physician?
Yes, the American Board of Family Medicine currently offers Certificates of Added Qualifications (CAQs) in adolescent medicine, geriatric medicine, sleep medicine, and sports medicine. These CAQs are offered in conjunction with other medical specialty boards. Graduates of family medicine residencis have gravitated to fellowships in faculty development, maternity care, prevention, research and palliative care.