The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, April 02, 2006

I AM a Specialist, for God's Sake!

In the old days, after medical school everyone did what was called a 'rotating internship'. After a year of rotating through various specialties, doctors were awarded a general license. They could either practice as a General Practitioner, or they could return to residency to specialize. Since everyone had a GP license after one year of residency, they could also moonlight for extra money through the rest of their residency.

Things are different today. They did away with the rotating internship years ago, and along with it went the concept of the General Practitioner. All areas of medicine required a unique residency-- two for family medicine, four for internal medicine and pediatrics, and five for most other areas of medicine.

Having recently switched from a five year program to a two year program, I've been on the receiving end of a special brand of elitism. Many doctors have the mistaken impression that family medicine is something that anyone can do. Many feel that they are somehow better clinicians than family doctors because they have specialized training. I didn't think I felt like this before I changed programs, but it still surprised me how much about family medicine I didn't know when I started. Most specialites know a lot about a narrow range of topics... family doctors are expected to know a little bit about everything. Sure, if you're working in a mid-to-large sized centre you can refer anything that you're not comfortable that you can manage effectively, but in many cases you're expected to know as much about prostate cancer as you do about chronic sinusitis.

So it's no surprise that I find it irritating when people declare themselves specialists as though it's something more impressive than family medicine. Family docs are more likely to really be making a difference in people's lives than the surgeon who took out your gallbladder, the dermatologist that fixed your rash or the radiologist who read your CT scan but has never actually seen your face. Not to bash any of these specialties, I just don't understand why family docs are seen as the generic version of the physician. Of course, the ability of your family doctor to actually make a difference in your life depends entirely on whether or not you've lucked into a good one. And at a time when over 4 million Canadians don't have ANY family doctor, even having a bad one is sometimes the lesser of two evils.

I do honestly believe that family doctors are underappreciated and underpaid. But that's another post.

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Blogger ArizonaDB said...

I have been lucky enough to find a great GP and have been seeing him for a couple years now. Although I am being treated by a specialist for my chronic back problems, my GP treats me for pretty much everything else. Like you said, he has seen me for a variety of reasons, anything from a plantars wart to immunizations to pink eye. He has to be versed in it all.

I count myself very lucky to have found a good one, and I agree that people in general underestimate the amount of knowledge one must acquire to be a good GP. Dont let others devalue your contribution to the medical field.

My two cents,

Desert Imaging

11:45 PM

Blogger Nikki said...


Couldn't agree more. And we wonder why we don't have enough family docs. Maybe if we paid them more respect AND more money?

9:39 PM

Anonymous Anonymous said...

I totally agree. I am in the midst of clerkship wondering whether I should be a GP who does a lot of OBS or an OBS/GYN. It would be a much easier choice if the specialists valued the GP's position in medicine.

1:14 PM

Blogger Couz said...

In the community, they do.

The relationship between the GP's and the obs/gyn's in this community is amazing. The GP's that deliver babies have a great relationship and lots of respect from the community, the specialists and the hospital.

If you want uncomplicated obstetrics and aren't all that enamoured by the OR, I'd go with the GP stream. You can always do the +1 obstetrics after your CCFP if you want to focus on the obstetrics aspect of it.

1:52 PM

Anonymous Anonymous said...

That is good to know. My problem is that I would hate having to refer my patients to Obs/Gyns if they are high risk. I'd love to be able to do all the obs surgeries/assisted deliveries. I am not a fan of the Gyne surgeries but I was assured that once residency was over I may not have to (i.e. I could do a fellowship in high-risk obstetrics). However, the thought of doing five years of residency with a huge component of that being gyne surgery sounds horrible. Thanks for the advice. I didn't know you could do the one year of obs after the 2 year GP. May I ask what residency you switched from to do family medicine?
How do you like your residency so far? And is it very hard to pay off loans/get off your feet by being a GP? It's nice to find someone who is doing what I am considering. My friends in the program here have pretty much all decided to specialize and I get a lot of "humms and haass" when I ask specific questions to the docs. The obs/gyns all say they love their job and the GP's all say the same. It's making the decision pretty tough :)

Thanks again
btw- this is Jaya from the bells site. Feel free to message me there if you are more comfortable and if you have time :)

4:25 PM

Blogger Jess said...

As a patient who has delivered twice with a family prac doc, I have to say: the more of you, the better! It was much more low pressure than I've heard OB deliveries can be, and it's great to be able to deliver a kid, and then have your delivery doctor instantly turn into your kid's doctor, along with still being the fellow you'll go to for your six week follow-up, and anything else that happens in the meantime. I'm a big fan of my family practice doc.


5:25 PM

Anonymous jojo said...

I know your pain. After FOUR YEARS of pediatric training people still asked me if I was going to specialize. Uh, what do you think I've been doing all this time?

And I agree, in the hospital you see people putting down the family doctor, or primary pediatrician, who saw the patient previously and missed rare diagnosis xyz. It's all very well in hindsight once you know the patient has cerebral vasculitis, but the fact is 99.9% of kids looking the way that child looked last week would have had a self-limiting viral illness, and who's to say any of us wouldn't have said the same thing as that primary care doc? It drives me nuts.

9:41 AM

Blogger Michael said...

I hear you!

In Australia, General Practice is basically a specialty. Here, we have to do a minimum one year of internship (rotating terms) and then it is either a 3 or 4 year program before we get our fellowship in general practice. One of those years is a further hospital year with a number of mandated terms (including ED, general medicine, general surgery and paediatrics). Most people I know would have in addition worked one or more additional years in hospital resident/senior resident/registrar jobs.

However, as a "specialty" goes, we have relatively little respect, though most patients do appreciate having a good general practitioner. In the end, that makes it all worthwhile.

Michael Tam
vitualis' Medical Rants

5:35 PM

Blogger adventures in disaster said...

A bad family doc is WORSE than having no doc at all. There are walk in clinics everywhere. It's easy to have a family doc when your walk in has the three same docs, just pick the one you like and find out his schedule. Instant family doc with some fine skills. Walk in docs are incredible experts at identifying bad things very quickly.

I like my family doc but he is not a good one. He believes that all women need anti depressants and all men can solve all problems by exercising a little more.
I like him because he is open to just about anything and when he doesn't know something he doesn't bs it. He goes and looks it up.
I wish he would stop pushing prozac and ativan but that's his thing..I just have to ignore it.
My worry is one day he will miss something of vital importance because he thinks it's a "stress" thing.
Ativan wont help you survive an MI.

2:57 AM


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