University of New Mexico Health Sciences Center
You learn a sufficient amount to care for 90% of patient problems presented. The other 10% is referred, but most of those patients return with a management plan and thus you gain special skills to care for those patients yourself (lifelong learning).
That more quickly trained, lower paid health providers may replace any specialty is a pervasive concern. However, we believe the concern is unjustified. Every specialty has its “cheaper, less trained competitor.” For example, anesthesiologists have nurse anesthetists, ophthalmologists have optometrists, emergency physicians have emergency medical technicians, hospitalists have in-patient mid-levels, psychiatrists have prescribing psychologists, cardiothoracic surgeons have cardiologists doing angioplasty, and so on. Our Family Medicine program welcomes the help of PAs and NPs, for the health needs of our population are growing much faster than the supply of physicians. In fact, our Department runs the School’s PA Program. Increasingly, FM physicians are managing healthcare teams. Mid-levels can make the FM far more efficient by caring for more routine problems, freeing the FM to devote more time to more complex cases and management decisions. FM graduates are so versatile, that they are highly desirable and have no problem finding work in any community, urban or rural. This is not the case with all specialties.
All doctors make comfortable incomes compared to other sectors of society. FM and Gen IM doctors earn on the average ~$160,000/year and this is rising as the need for their services is growing rapidly. Pediatricians and psychiatrists make less, procedural specialists (e.g. surgeons, obstetricians) make considerably more. FM physicians, like all physicians, enjoy among the highest levels of job security and job satisfaction of all professions in the country.
“Prestige” is in the eye of the beholder and notions of “prestige” vary with practice settings. FMs are community leaders within the communities that they serve and form the backbone of rural medicine, community health centers and managed care organizations. They comprise the majority of physicians for such systems as the Indian Health Services and are in leadership roles in International Health. Breadth in the management of individuals, family and communities brings high prestige to this professional field. The term “competitive” applied to residencies is deceptive, for some residencies, like Dermatology are highly “competitive” because they have very few slots compared to the number of applicants but are not very “popular” for few students apply to them. Family Medicine (and Internal Medicine) is the opposite. It remains very “popular” (tends to rank second behind Internal Medicine at UNM in number of students matching in that specialty) but is not highly “competitive” for the number of residency slots (which reflects national need) far exceeds the number of U.S. medical school applicants.
While any specialty choice narrows subsequent options, FM gives you the broadest options – for you can care for both genders, all ages, decide on an inpatient and/or outpatient care focus, provide emergency or obstetrical care, practice public health or international health. If you want to specialize more formally as a family physician, FM has a growing set of fellowships and certificates of added qualification including: adolescent medicine, geriatrics, sports medicine, rural health and public health. Others are emerging.
The most important qualities are clinical ability, compassion, ability to function as a strong team player, potential as a teacher/role model for students and more junior residents, and interest/ability to work in the community. USMLE scores correlate poorly with any of these abilities—they are simply a licensing exam, so what we look for in an applicant’s USMLE scores is ability to pass the test.
Most FM residencies at universities (like UNM’s program in Albuquerque) are referred to as “opposed,” meaning there are residents from other specialties training at the same teaching hospital. The advantages of this arrangement are that FM residents learn to work and learn with other specialty trainees, they usually have medical students to teach, and there is usually more specialty depth in different specialty areas. The disadvantages are that sometimes, when FM residents are rotating on other services, they feel less well prepared than residents spending full time in that specialty and often feel they have to establish credibility with each new rotation. Most FM residencies based in community hospitals are referred to as “unopposed,” meaning the only residents training at that hospital are FM residents, though there are faculty from different specialties. The advantages of this arrangement are that FM residents have the undivided attention of all teaching staff and don’t have to “compete” with other specialty residents for procedures or attention. The disadvantages are that medical students are scarce, there is less depth in particular specialties, and there is not the experience of learning and serving with other specialties.
Training occurs informally by residents watching and doing procedures under supervision. Increasingly, residents in the UNM Program practice procedures such as central lines and intubation in the BAT CAVE before performing them on patients. There is a gamut of procedures FM doctors do from trigger point injections and laceration repair to C sections. Most FM doctors feel comfortable with typical inpatient procedures like lumbar punctures, circumcisions, paracenteses and thoracenteses, and outpatient procedures like laceration repairs, skin biopsy, toenail removal, endometrial biopsies and IUD placement. Some do nonoperative orthopedics including reducing some fractures and dislocations. Residents in some programs or some FM graduates take special training to perform colonoscopy, EGD, hernia repair, post- partum tubal ligation, D and Cs, chest tube placement and caesarean sections. Like other doctors, what procedures a family doctor performs can depend on where she practices and the availability of certain specialists in the local hospital or practice group.
Mailing address: MSC 09 5040
1 University of New Mexico
Albuquerque, NM 87131-0001
(505) 272-2165
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