So you want to be a family medicine doctor. You like the idea of primary care, working with patients of all age ranges, and like Vin Diesel, you don’t have friends, you got family. Let’s debunk the public perception myths, and give it to you straight. This is the reality of family medicine.
What is Family Medicine?
Family medicine is the center of primary care, the generalists of generalists. Unlike other specialties that are limited to a particular organ, disease, or age range, family physicians treat the broadest range of ailments and patients, from newborns to seniors, and everything between.
For most people, a family medicine clinic visit is their main input into the healthcare system, their first line of defense for non-urgent health concerns. From their family medicine physician, they can either receive the necessary treatment, or be referred to the appropriate specialist for more complex pathologies.
The overwhelming majority of family medicine physicians practice in an outpatient clinical setting and the bread and butter pathologies they deal with include diabetes, hypertension, hyperlipidemia, and preventive medicine and health screenings.
But there’s much more to the specialty than that. You’ll never have as many procedures as a surgeon, but if you want to be more procedure-heavy, you can set aside a day in the week for steroid injections, wart removal, colposcopies, vasectomies, frenulectomies, circumcisions, and more. Or if you want to tailor your patient population, you can do that too. Maybe you want to focus on pregnant women and delivering babies, or older patients through geriatrics, or keep it broad and include all patients from cradle to grave.
Family medicine is often compared to internal medicine as they have a large degree of overlap, as both often serve in primary care roles in the outpatient clinic, but they have substantial differences. With internal medicine, you’re only dealing with adult patients, but have greater flexibility in specializing in various organ systems, like cardiology, gastroenterology, infectious disease, and others, which are usually 3-year fellowships. With family medicine, you don’t have the same organ-specific options for specialization, serving more as a generalist, but you do have various 1-year fellowship options, which we’ll cover shortly.
There are a few ways to categorize the specialty.
General vs Specialized
As a general family medicine doctor, meaning you haven’t completed a fellowship, you’ll be focusing on preventive health and simple concerns in an outpatient clinic for the broad population. Your hours will be regular 9 to 5, and compensation is on the lower end compared to those who specialized.
As a specialized family medicine doctor, you’re fellowship-trained, and your lifestyle will vary based on your specialization. With sports medicine, you’ll see some athletes, but probably still have your regular family practice too. If you go into obstetrics, you’ll spend some of your time on call in the hospital delivering babies. And if you go into emergency medicine, you’ll have the lifestyle of an EM doctor.
Academic vs Community vs Private Practice
Most family medicine doctors practice in a community setting, either a smaller group or something larger like Kaiser. In this setting, your job first and foremost is to be a family medicine physician, while research and teaching are not primary responsibilities.
In academia, you’ll not only handle patient care but also teach medical students and residents while also tending to some research responsibilities on the side. Of the three, this generally has the lowest compensation.
Finally, private practice is the least common but offers the most flexibility. You’ll be your own boss, running your own practice, and have the highest ceiling in terms of compensation. You are running a business, however, and there will be more hassle and usually longer hours as well.
Misconceptions About Family Medicine
There are a few misconceptions we need to set straight about the specialty.
First, some say that family medicine doctors don’t know much and are constantly sending referrals to specialists to handle what they can’t. The truth is that family medicine doctors are some of the best when it comes to handling common presenting concerns, but need to know where their capabilities are and where to draw the line in seeking help from a specialist. They are often screening and finding conditions that allow for early intervention, like being the first person to find an arrhythmia and referring that patient to a cardiologist.
Additionally, family medicine doctors are the specialists of complexity, the quarterback of the patient’s healthcare needs. Because they have to know a little bit about everything, they can be the best to handle complex situations where a patient is receiving multiple treatments from multiple specialists, some of which may be conflicting. In line with this, family medicine docs are often well suited at approaching each patient holistically and as an individual instead of as the sum of individual organs or chief complaints.
Last, most equate family medicine with outpatient primary care. While most family medicine doctors do practice in a clinical setting and see patients of all age ranges, there is more flexibility to the specialty and you can narrow it down based on your particular interests, whether that’s being a hospitalist, obstetrician, or something else.
How to Become a Family Medicine Doctor
After medical school, family medicine residency is 3 years. It’s categorical, meaning you match into one program and complete all three years there, including your intern year.
During PGY2 and PGY3, you’ll still rotate on various specialties, which is unique to family medicine. In most other residencies, PGY2 and onward are usually dedicated to rotating on just your own specialty’s services. The reason is that family medicine physicians are the generalists’ generalists, and they need to know what they can handle on their own versus what they should refer out or request a specialist consult for.
In terms of competitiveness, family medicine is attainable, with a match rate around 96%, USMLE Step 1 average of 220 and Step 2CK average of 236. In our Med School Insiders Competitive Index, which takes into account match rate, Step scores, publications, AOA, and top 40 NIH schools, it ranks at the bottom of the list with 13 points.
Medical students that choose family medicine are stereotypically the ones who loved everything during their third year rotations, except maybe surgery, and couldn’t find themselves committing to one specialty at the exclusion of others. With family medicine they can truly get a little bit of everything.
Subspecialties within Family Medicine
After completing 3 years of family medicine residency, you can choose to specialize with an optional fellowship, each of which are 1 year in duration.
Sports medicine is for the bros and jocks of family medicine. You’ll be doing various office procedures. Think of orthopedics but without any of the surgery. You can learn more about sports medicine in our So You Want to Be a Sports Medicine Doctor episode.
After completing an obstetrics fellowship, you are a full-scope general OB doctor. You can deliver babies, just like OBGYN doctors, although those who completed an OBGYN residency will have more options for further specialization. It’s an intense specialty that is often polarizing, and people either love it or hate it.
A hospitalist fellowship allows you to practice as a hospitalist, admitting patients to the hospital and handling their medical management while they are inpatient. Stereotypically, this is for the family medicine doctors that have personality tendencies of internal medicine doctors, namely, they love geeking out over the minutiae of medical management.
Emergency medicine gives the option for family medicine doctors to practice as emergency medicine physicians, the same as those who completed EM residency. This is for the family medicine doctors who decide they don’t want longitudinal care and prefer shift work and acuity. You can learn more about the field in our So You Want to Be an EM doctor episode.
Rural & International
Rural and international are two separate fellowships with substantial overlap. Both are focused on underserved populations that have issues in accessing healthcare. These doctors usually practice a wider scope of medicine, as there are fewer specialists around, and are also focused on improving access on a systemic level in these regions. These fellowships are for the highly altruistic and selfless family medicine doctors.
There are additional fellowships you can pursue as well, including geriatrics, adolescent medicine, sleep medicine, palliative medicine, preventative, HIV medicine, and addiction medicine.
What You’ll Love About Family Medicine
There’s a lot to love about family medicine.
Most obviously, FM provides a great deal of flexibility, beyond what most aspiring physicians realize. If you want to deliver babies all day, you can do that. If you want to practice in the emergency department, you can do that too. Or maybe you want to practice inpatient as a hospitalist. All these and more are possible with family medicine.
Family physicians have a desirable schedule, usually working regular 9 to 5 office hours and minimal, if any, call. Note that if you specialize in OB or EM or hospitalist medicine, then your hours will more closely approximate what’s normal for that specialty.
If you enjoy getting to know your patients and building relationships, family medicine offers amazing access to longitudinal care, as you can see patients from the time they’re born through adulthood.
Family doctors also maintain their level of medical knowledge. Medical students in their later years know what I’m talking about. You spend thousands of hours and incredible effort learning about the various organ systems and their pathologies, only to forget much of it as you narrow down with your specialty. I definitely felt that way with plastic surgery. Family medicine is one of the few specialties where you continue to develop that broad knowledge. There’s an inherent satisfaction in knowing you’re able to manage most anything that walks through the door to some extent.
What You Won’t Love About Family Medicine
While family medicine is an awesome specialty, it’s not for everyone.
In terms of compensation, family physicians are bottom of the list, averaging $236,000 per year. Specialists, on the other hand, average $344,000 per year.
Compared to some other specialties, there’s a great deal of charting and computer work. Documentation and billing become an increasingly large part of your day-to-day, as that dictates how much reimbursement or compensation is received from the insurance companies.
FM doctors are also often juggling social issues with patients, such as access to care, insurance coverage, and more, although this does depend on your patient population.
Last, a small number of medical students look down on the specialty, which is backwards and often ego-driven. Many medical students are type A, competitive personalities that often seek some level of prestige. Because family medicine is less competitive, some say if you score well on USMLE that you should aim higher. There have even been recent posts about this on SDN and Reddit, where a high-scoring student seeks input from others, as their own mentors or classmates advised them to go into another specialty that pays better or is more prestigious. This is nonsensical, and not a valid reason to look down on the specialty. You should pursue the specialty that’s most appealing to you without such superficial considerations. I know several brilliant family medicine physicians who could have pursued far more competitive specialties, but they chose FM because they were able to separate the signal from the noise.
Should You Become a Family Medicine Doctor?
If you’re the medical student who went through third year and loved everything non-surgical and didn’t want to give any of it up, including not only organ systems but also age, then family medicine may be a good fit for you.
If your life outside of medicine is important to you, family medicine provides the flexibility to practice as a physician while still having time for your own family and interests.
Are you hoping to become a family medicine doctor? To get into medical school and match into a great FM residency, you’ll need to score well on your class tests and standardized exams. As you look at resources and companies to work with, seek out those who are actual MD physicians, not PhD or other types of doctors that didn’t go to medical school. Look for those who have achieved stellar results themselves, a track record of success with positive ratings from customers, and a systematic approach so you know you’ll always receive high-quality service. If you decide on Med School Insiders, we’d love to be a part of your journey in becoming a future physician.
If you enjoyed this article, check out our So You Want to Be an Internist piece. If you’d like to see what being a family medicine doctor looks like, check out my second channel, Kevin Jubbal, M.D., where we’ll have day-in-the-life episodes of family medicine doctors in the future.