Family medicine is amazing for so many different reasons– I don’t even know where to start.
First let me define a couple of confusing terms:
Internal Medicine – The specialty of medicine that only sees adults (18+). From an internal medicine residency you can work in a doctor’s office, in the hospital, or do a fellowship and specialize (cardiology, pulmonology, etc.).
Pediatrics – The specialty of medicine that only sees children (newborn – 18 years old). Similarly to internal medicine, you can work inpatient or outpatient or specialize further (pediatric cardiology).
Family Medicine – The specialty of medicine that sees children, adults, and ob/gyn patients. You can also work in a doctors office or in the hospital as a hospitalist. The ‘specialization’ that you can do is a little different. Rather than doing fellowships in cardiology, nephrology, rheumatology, etc., the further training you can do is more broad.
Internal medicine, pediatrics, and family medicine are all considered ‘primary care‘ specialties. However, once you do a fellowship to specialize further with internal medicine or pediatrics, you are no longer considered ‘primary care.’ Some also consider ob/gyn, emergency medicine, and psychiatry primary care as well.
Thoughts on Choosing a Specialty
I have always been interested in emergency medicine. Being an EMT and volunteering in the ED is what really started my love for medicine, and specifically emergency medicine. In medicine (and many areas of life), I am all about the ‘jack-of-all trades, (yet, master of none)’ thing. It is more appealing to me to be able to know what to do in almost any scenario rather than be super focused into one specific area of medicine.
I love the excitement of the ER and being open to handling anything that comes through the door. I also am very interested in global health and working with humanitarian organizations after residency, so emergency medicine would be a great fit for that. However, family medicine might even be a better fit. Family medicine physicians get more training in pediatrics and ob/gyn than emergency medicine physicians do (more on this in a minute). In terms of global health, this is definitely a plus.
Right out of residency, family medicine physicians can work in an outpatient private practice, in the hospital as a hospitalist, in the emergency department or go on to get even more training. There are fellowships in sports medicine, wilderness medicine, global health, ob/gyn, emergency medicine, and even… rural surgery. The bottom line is that you can really tailor your practice to however you like as a family medicine physician. Granted, if you want to do surgery or a lot of ob/gyn… it’s best to do a residency in those specialties. Family medicine docs are still the jack-of-all-trade docs. If you want to be super specialized, then go do a residency in that.
New Thoughts on Emergency Medicine
One huge thing that I discovered this rotation: all of the cool cases that come into the emergency department get admitted to the hospital and transferred over to the hospitalist (either family med or internal med). This is definitely an obvious fact, and I always knew this… but admitting people from the ED on this rotation really put that into perspective for me.
The ED is all about getting people in and out. Assessing them quickly and either sending them on their way or sending them to surgery or a floor in the hospital. That is an awesome and exciting piece in the overall care of a patient. But it is also cool to really dive into the problem and look at the whole patient to figure out what is going on (family medicine at it’s finest).
Looking at the Big Picture
First of all, family medicine docs can see any kind of patient (adults, teens, babies, obstetrics, geriatrics, etc.). But besides that, I am really in love with the family medicine’s role in patient care. In the hospital, the family medicine doc is the one who looks at the entire person and puts all of the pieces together. Rather than just looking at the kidneys or just at the heart, the family med doc sees it all and makes sure they the treatment is right for the whole person. They definitely consult specialists to get a better picture of the details, but they are in charge of taking a step back and looking at the whole picture. I LOVE that.
What else is also cool is that you are constantly interacting with specialists. So you are always learning new things from all of the different specialties of medicine. The most appealing aspect of family medicine, however, is that you can see kids and adults (rather than choosing either/or).
The Family Medicine Rotation in Medical School
I was fortunate enough to do my family medicine rotation half inpatient and half outpatient in the clinic. This really helped me get a good idea of what family medicine is all about. I also was working with interns and residents, so it made me SO excited for residency.
I will admit, I wish that I didn’t have this rotation first. It was challenging because I haven’t rotated in pediatrics, internal med, or ob/gyn… yet we saw all of those types of patients. On top of that, I started with inpatient and with residents, so it wasn’t the one-on-one teaching scenario that the majority of our rotations are like. Despite the huge learning curve, I still loved this rotation so much.
Resources for the Wards
UptoDate (uptodate.com) – Oh my… I cannot believe that I didn’t use this more extensively in years 1 and 2. This resource is seriously amazing. I have the app downloaded on my phone and can look up the current data and guidelines for anything instantly. It does cost a lot of money, but my school pays for us all to have subscriptions.
Online MedEd (onlinemeded.org) – This is an amazing (and FREE) online video resource. HIGHLY recommend. It is nice to learn through books, experiences, and videos. Very good for the self exam and Step/Level 2 as well.
Resources for the Self Exam
The shelf exam for family medicine is said to be the toughest because you get questions on adults, kids, and ob/gyn. So you have to know it all. Here is what I used to study:
Step Up to Medicine (Amazon) – This book is awesome. It is for internal medicine (so just adults), but it really explains things well and points out key facts. Definitely saving this one and will continue to use it through the rest of my rotations.
UptoDate – I honestly felt that looking things up on UptoDate whenever it would come up in the clinic and the hospital was the best way to learn. Almost everything that was tested on the COMAT, I saw in the hospital or clinic.
Online MedEd – (see above)
COMBANK (True Learn) – For practice questions. Our school provides this question bank for free. I decided that I am not going to purchase Uworld for my shelf exams. I will wait and get it a few months out from Level 2 of the boards.
AAFP Practice Questions (AAFP) – You can sign up for a free student membership through the American Academy of Family Physicians to get access to their practice questions.
Overall, I LOVED this rotation and I LOVE family medicine. It is definitely up there in terms of choices for residency. However, I have a nagging suspicion that I am going to love basically every rotation that I do. I did find myself drawn to the ob/gyn patients and the newborn babies the entire rotation. Although you get ob/gyn cases in family medicine, I have been told that if you really want to work with pregnant patients, you need to do an ob/gyn residency. Definitely looking forward to it! I did also love seeing adults and children, which I wouldn’t get if I were to do ob/gyn. But man… let me tell you. I certainly chose the right field to be in.