Questions and Differences between Primary Care, Family MD

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Questions and Differences between Primary Care, Family MD

Postby tangent1.57 » Tue Feb 16, 2010 1:45 am

I read this quote from
http://www.nytimes.com/2010/02/15/educa ... hools.html :

"Supporters of the expansion say that having more doctors will improve care, by getting doctors to urban and rural areas where they are needed, by shifting care to primary and family practice physicians rather than expensive specialists, and by reducing long waits for people to see a doctor and get the care they need."

From this article, they seem to equate, or nearly equate, primary care physicians (PCP) with family doctors (FD). I have quite a few questions as to what they do, and what their differences are. Please help me with this:
1. Can a person do a residency in Primary Care Physician Medicine? I realize that a person can do a residency in internal MD and become a PCP. I believe that pediatricians and ob-gyns can also qualify as a PCP.
2. I know for a fact that a person can do a residency in Family Medicine. They are non-specialist doctors who treat both genders, all ages, and all systems of the human body. Are FDs the doctors who administer annual physical checkups? I noticed that my MD who gives me physicals is an internal medical MD.
3. Can an FD specialize or do a fellowship?
4. What are the residencies like for PCPs and FDs? For FDs, I am under the impression that their residency hours are like 60 hours a week, since I dated a girl who worked at a great Family Care Hopital in Lawrence, Massachusetts, and this was her typical workload.
5. Can a PCP who did internal medicine gets a fellowship, does this nullify his primary care status? I'm very confused as to whether or not a PCP is simply a physician who didn't do a specialty, fellowship, and simply did the "base requirements."
6. I understand that someone who did their residency in surgery CANNOT be considered as a PCP. What other specialties can't be considered PCP?
Any and all help is appreciated.
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Re: Questions and Differences between Primary Care, Family MD

Postby Adminnaoum » Mon Mar 15, 2010 11:07 am

OK, lot's of good questions. I'll answer what I can.

1. There isn't an explicit "primary care physician specialty, but family medicine is the closest to it. And you are correct that internists, OB/Gyns and pediatricians can be PCPs. Family docs who work in underserved areas often do some common surgeries as well.

2. Any physician should be able to do an annual exam, but PCP are the ones who do (and as you noted, Family Medicine doctors are just one type of PCP).

3. FD can do fellowships; among the most common are OB/Gyn fellowships.

4. Resident work hour restrictions prevent residents from working more than 80 hours a week. However, because of scheduling rules (required nap breaks, limits on contiguous hours in the hospital) work hours end up being around 60 h/week. Some residents and programs (usually high-powered surgical residencies) try to skirt these rule but get in trouble for it (even Mass Gen's surgery program got dinged for going over 80 h/week for their residents). So most residents now work about 60-80 h/week.

5. Any physician can take on a primary care role, even if they have subspecialized. This rarely happens though because primary care does not pay as well as specialty care. So most physicians who specialize don't do much primary care.

6. If surgeons wanted to do primary care they could, but that would cut their income by about 2/3 on average.

The hoped-for shift to primary care won't prevent specialists from doing primary care, but it might limit their specialty income. Over time the plan seems to be to train more PCPs to reduce the overall cost on the system. Right now the payment structure is a big disincentive to do PCP.
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Re: Questions and Differences between Primary Care, Family MD

Postby tangent1.57 » Mon Mar 15, 2010 11:17 am

Thank you very much. Very informative!
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Re: Questions and Differences between Primary Care, Family MD

Postby IMNOTDRPHIL » Tue Mar 30, 2010 5:03 pm

tangent1.57 wrote:I read this quote from
http://www.nytimes.com/2010/02/15/educa ... hools.html :

"Supporters of the expansion say that having more doctors will improve care, by getting doctors to urban and rural areas where they are needed, by shifting care to primary and family practice physicians rather than expensive specialists, and by reducing long waits for people to see a doctor and get the care they need."

From this article, they seem to equate, or nearly equate, primary care physicians (PCP) with family doctors (FD). I have quite a few questions as to what they do, and what their differences are. Please help me with this:


That is because the New York Times writer who wrote that probably doesn't have the greatest grasp on medicine. It's typical to see journalists make small mistakes like that; if you want to see gross errors, read some of their writing on scientific topics and technology :oops:

Snarky comments aside, "primary care" basically refers to physicians practicing in an office-based setting that see patients for routine and preventative medical care. In short, it's the physician that somebody refers to as "their doctor." Generally, primary care is practiced by family physicians, general internists, and pediatricians. Some might add OB/GYN to that as well as some women only see a physician when they need contraceptives, pelvic exams/Pap smears, and prenatal care, and OB/GYNs tend to sometimes also handle some other conditions that they find at these visits as well, such as diabetes or high blood pressure that can be well-controlled on a single oral medication.

1. Can a person do a residency in Primary Care Physician Medicine? I realize that a person can do a residency in internal MD and become a PCP. I believe that pediatricians and ob-gyns can also qualify as a PCP.


Like I said above, family medicine, internal medicine, and pediatrics are the typical primary care medicine disciplines. You can do a residency in any one of those and end up a primary care physicians. However, family medicine residencies are probably the most tailored to developing primary care physicians, while internal medicine residents almost always go on to specialty training. Pediatrics is somewhere in between.

2. I know for a fact that a person can do a residency in Family Medicine. They are non-specialist doctors who treat both genders, all ages, and all systems of the human body.


Family docs actually are specialists since major operative procedures are not part of standard training and very few family physicians do surgery beyond simple in-office skin excisions and such. It's just a very broad specialty rather than a very narrow one like gynecologic oncology.

Are FDs the doctors who administer annual physical checkups? I noticed that my MD who gives me physicals is an internal medical MD.


Any primary care doc can give their particular patient clientele an annual physical. Family doctors see all ages, internists (internal medicine physicians) see adolescents and older, while pediatricians see children up to about the age of 18. You are an adolescent or older, so you could go see either an internist or a family physician for your annual physical.

3. Can an FD specialize or do a fellowship?


Yes and no. There are no family medicine specialties that are officially recognized by the American Association of Family Physicians, but they can undergo additional training to get what is known as a Certificate of Adequate Qualification in a few fields. They can also go get further training in another discipline if they so wish and thus do things that most family doctors aren't trained to do. Most physician licensure boards let physicians do procedures and manage patients that they feel comfortable managing, so with additional training, a family doc could very well manage patients that would have otherwise required a specialist to manage. They can also choose to "specialize" by simply not seeing a certain group of patients, such as children or by making it known to their fellow physicians that they like to manage a certain group of conditions (such as sports medicine issues) and mostly dealing with those conditions.

4. What are the residencies like for PCPs and FDs? For FDs, I am under the impression that their residency hours are like 60 hours a week, since I dated a girl who worked at a great Family Care Hopital in Lawrence, Massachusetts, and this was her typical workload.


Average (mean) number of hours varies by institution. Some average as few as 50 hours, while some average all the way up to the legal maximum of 80 hours/week. The number of hours any particular resident works any particular week varies as well depending on their schedule. Clinic weeks tend to be closer to 50, while inpatient weeks are more like 80. However, the national mean number of hours per week is right around 60/week. That is one of the lower numbers in medicine as many specialties, particularly surgery, are 80* hours/week.

*What they officially report. Actual numbers may be somewhat or significantly higher, which occasionally gets a program in trouble with the ACGME.

5. Can a PCP who did internal medicine gets a fellowship, does this nullify his primary care status? I'm very confused as to whether or not a PCP is simply a physician who didn't do a specialty, fellowship, and simply did the "base requirements."


Primary care medicine is practicing outpatient medicine treating a wide variety of conditions. All primary care providers in the U.S. underwent residency training in a specific specialty, such as internal medicine, family medicine, or pediatrics. Internal medicine physicians who do fellowships can still be a primary care physician, but few do. The whole point to spending additional years of training making a low salary and working long hours is to end up with specific knowledge you will use frequently. Getting a fellowship in a discipline and then returning to the same primary care practice you were at before doesn't make much sense, either in time or money.

6. I understand that someone who did their residency in surgery CANNOT be considered as a PCP. What other specialties can't be considered PCP?
Any and all help is appreciated.


Any physician who feels comfortable practicing general outpatient medicine can be a primary care provider if they decide to open up an office and see patients who come in off the street. However, physicians outside of family medicine, internal medicine, or pediatrics generally aren't well-trained to practice primary care medicine. They wouldn't feel comfortable in practicing that kind of medicine, just like most internists wouldn't feel comfortable in performing an appendectomy.

________________________________________________________________________________________

I hope that my responses help as you seem pretty confused. I suggest you do some further reading on the subject of primary care medicine, such as this website on the AAFP's website.
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Re: Questions and Differences between Primary Care, Family MD

Postby tangent1.57 » Thu Apr 01, 2010 11:30 am

This was, by far, the most informative thing that I read on studentdoc.com
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