Why I love being a family physician

I love being a family physician. If I had to do it all over again I wouldn’t change a thing.

I love the breadth of family medicine. I love being able to take care of just about every person that walks through the door. Even when another doctor is the right person to take care of a niche need, I love knowing that I was usually the person that identified the problem and that I’ll be responsible for the long-term care. I love the fact I can care of patients’ needs from prenatal care to end of life care.

I love taking care of sick patients. I love easing a patient’s pain. I love figuring out why a person can’t catch her breath then treating her to the point she can breathe easy again. I love the procedures we do. I love the challenge of sticking needles and knives into patients to diagnose and treat them.

I love the fact I can competently take care of undifferentiated patients in a clinic, hospital, or ER. I love the fact my comprehensive family medicine training allowed me to care for emergency patients for 11 years.

I love the relationships I’ve had with my residents, colleagues, and patients. My colleagues in private practice talk even more glowingly about their long-term relationships with patients — experiences such as delivering the baby of a young woman he delivered 21 years earlier. The quirks of my residency teaching job have made my career slightly different from my fellow family physicians, so the long-term patient relationships have been a little harder to come by.

I love taking care of complex patients. I love explaining to them why they don’t feel 100%, laying out their options, and then negotiating with them which approaches they’d like to try. I enjoy the intellectual challenge of working with patients who have 5 chronic diseases and 3 new symptoms. I love it when this process causes a patient to sleep better, regain lost energy, regain some self confidence, return to the job, return to their volunteer work, be in less pain, or any number of other positive outcomes.

I can’t say I love telling a patient his cancer has returned, or family members that their loved one just died. However, I would like to believe that if I handle these difficult situations well, maybe it will help ease the suffering and move people along the normal trajectory of grieving.

I am so thankful I have the privilege of having (and I hope earning) my patients and residents trust each day. I am continually amazed at how quickly patients are to tell me their secrets just because I wear a white coat.

I love being a family physician.

Richard Young is a physician who blogs at American Health Scare.

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  • Motaz

    Beautiful..but I didn’t know that family doctors can work in emergency!
    about long term relations, did you mean you enjoy them or you can’t? I didn’t get that bit.
    Thanks Dr. Young.

    • http://www.healthscareonline.com Richard Young, MD

      Motaz,

      Thousands of family physicians work as emergency physicians across America. The distinction between the fields is negligible — both fields involve taking care of any age, any symptom, or any organ. The emergency room merely contains patients with more acute situations, sometimes. The emergency room is a less complicated environment to work in, because all the tools are immediately available: CTs, MRIs, ultrasounds, respiratory therapists, and other support personnel. The unjustified snobbery of the emergency medicine political aparatus is an artifact of the general bigotry against family medicine in America’s medical schools.

      I enjoy long-term relationships, but the peculiarities of my job have made that a smaller part than most family physicians.

  • rich md

    is this some kind of joke? i kept waiting for the punchline, but it never came…

    • kristophine

      Some people are better than others at being happy and at taking responsibility for their own happiness.

      If you’re miserable doing what you do, change. If you aren’t, why are you telling other people that they should be?

    • http://www.healthscareonline.com Richard Young, MD

      Sorry to disappoint. It’s not a joke.

  • http://secondbasedispatch.com Jackie Fox

    Beautiful. We are so lucky to have doctors like you. I am confident you have earned your patients’ trust. I bet they feel just as privileged to be under your care as you feel to care for them.

  • http://www.endoflifeblog.com Jim deMaine, MD

    The backbone of medicine is primary care. It’s very refreshing to hear your story. My GP Dad loved his OB, open-drop anesthesia, minor surgeries, pediatrics – and reached a milestone when he began delivering second generation babies. The breadth of knowledge, the communication skills, the caring attitude, and a sixth sense of tackling the important clues all make for great docs like you. Hope there are many more like you.

    • http://www.healthscareonline.com Richard Young, MD

      There are many happy family physicians. They’re just a little tired from an overall lack of support for the important work they do.

  • Robert Stramski

    I so agree with you! I own a private practice Family NP clinic and have experienced the same feelings as you! Knowing I am the one my patients turn to for everything gives me a lot of happiness. And the ability to care for whatever walks tgrough the door is a very gratifying feeling! I love serving my patients! Thanks for the superb heartfelt post from one private practice owner to another!!

    Robert, ARNP

  • DRJEBJ

    What he said! A few more mentors like Dr Young would end the family doctor shortage in just a few years. There are a few things he left out though. I love being a pillar of the community and sitting on boards and commissions with brilliant people who tech me so much. I love working with a wonderful team of people who do such a great job. I love continuing to learn every day. I love being a small businessman. I love going to my kids school every year to talk about what being a family physician means. I love suprising my patients by being there when they didn’t expect that anyone would. I love that I trained with mentors like Dr. Young. Mine were HW Kilpatrick MD, CA Riser MD and Louis Hughes MD. God bless them all.

    • kristophine

      I wish there were more ways for aspiring family physicians to contact potential mentors. It’s been a constant challenge for me while I try to prepare for med school applications; some doctors don’t even bother responding to requests.

      If family physicians want to create a next generation of family doctors, they need to get involved.

  • http://www.drmartinyoung.com Martin Young

    Hi Dr Young

    I’d like to know whether you get as frustrated as other family physicians who are vocal on this blog, and if not, why that is so? Have you managed to avoid the same issues, or is it your approach that is different?

    It’s good to hear the other side from time to time :)

    • http://deleted pcp

      Read Dr. Young’s outstanding blog. He definitely doesn’t look at the current state of family medicine through rose-colored glasses.

    • http://www.myheartsisters.org Carolyn Thomas

      Dr. (Martin) Young, I was wondering exactly the same thing! Or is it just more that the unhappy family doctors venting on KevinMD are “vocal” while the happy docs are just going about their day-to-day business being . . . happy?

      And Dr. (Richard) Young (– are you two related?!): your post here feels like a breath of fresh air to me. THANK YOU so much for reminding us patients that there are indeed docs out there who believe as you do. :-) You have made my day!

    • http://www.healthscareonline.com Richard Young, MD

      Martin,

      Ooohhh yeeahhhh I get frustrated. Kevin edited the original post just a little. He cut out the part where I said, “I realize I’ve griped a lot in my previous posts, though I don’t see myself as a nattering nabob of negativism. For problems to be fixed they first must be identified, and our healthcare system has lots of problems. However in this season of giving thanks, I thought a few positive thoughts would be appropriate.”

      I’ve been known to spew a little venom also.

  • Michelle

    “I love the challenge of sticking needles and knives into patients…”

    Uh.

  • Maureen

    I love family physicians. Especially the ones that follow their elderly patients. As a discharge planner and social worker for a sub acute/rehab and long term care facility, I often see patients who were not so lucky. They are left to navigate the complicated system all by themselves…..and not able to coordinate their own care.

  • Shahab

    United Kingdom has abundant GP/Family Doctors. And yet patient still fail to get the appointment they need. On average each GP would spend 7 to 10 mins per patient. This does not allow enough time to resolve each patients problems especially if they are elderly with chronic problems. Most patients end up going to the hospital or being referred by their GP for further investiagtions.

    Wouldnt it be better if all doctors went into hospital medicine where every patient goes and gets everything sorted in one go.

    • http://www.healthscareonline.com Richard Young, MD

      If people were Mister Potato Heads and the body parts could be fixed in one go, your model would make perfect sense.

      The 7 to 10 minute visit is one of the limitations of primary care in the UK, though America has much more to learn from the UK system than to criticize. The model where a patient sees her GP for 15 10-minute visits per year wouldn’t go over well in the U.S., where people are used to making one big trip to Wal-Mart each week, not going to the market each day. Family medicine in the U.S. is limited by the the lack of a billing/coding mechanism to fairly pay us for addressing five problems in one visit. The U.S. and the UK share this limitation.

      • Shahab

        You make a good point. If patients had 15minute appointments that would help GP’s address the problem, reassure the patient and educate in terms of prevention. This is the role of a PCP in my view (or the view I have at the moment – sorry if its wrong).
        However – in UK there are more GPs than anyother doctors but still not enough to give each patient a 15minute appointment. How will the US do this with even fewer GP than in UK and more patients.

        I agree that family doctors are an important part of the health system.

  • http://mdwrites.com MD

    Great article. Why not send it to medical school deans to motivate students to enter primary care? I bet a few students may actually choose family medicine if they knew about the great non monetary rewards. I am in a lucrative specialty and after a while the money stops doing it for you. Other rewards such as described in this article seem more important.

    • ninguem

      Feel free to go into primary care any time you want.

    • http://www.healthscareonline.com Richard Young, MD

      MD,

      Thanks for the kind words. You could send the post to all the medical school deans in the country, but nothing will change until their local financial incentives and realities change. When the schools are financially rewarded for producing students who will become empathetic broadly capable family physicians comfortable with applying scientific evidence to their patient care decisions, as opposed to basic scientist/physician researchers who promise miraculous new tests and cures, then American will finally see a meaningful growth in family medicine.

      The healthcare industry bigotry against family medicine starts in America’s medical schools, and it will take significant financial and social forces to reverse it.

  • Steve Harrison

    Finally some who gets it! Thank you for your eloquent words,I couldn’t agree more!
    Our discipline may be dying on the vine because “Medical Students can add” ,but there remains a dedicated core of physicians who understand what a blessing it is to care for patients and their families.
    Steve

    • Family Medicine Doctor

      Dear Steve Harrison,

      You wrote, “there remains a dedicated core of physicians who understand what a blessing it is to care for patients and their families”.

      Wait, are you saying that those of us who are unhappy with the abysmal pay of primary care do not see how professionally rewarding the long-term relationships are between doctor and patient? Are you saying we arent dedicated?

      Gosh, I hope not because our dedication is as high as ever. Our knowledge of the joys of primary care are there. Unfortunately the joy has become overshadowed by the realization that the pay is so terribly bad we are financially struggling too much.

  • Kelly

    Great piece! I’m planning to apply to medical school & am interested in family medicine for all the reasons Dr. Young mentions. This was a refreshing contrast to most writings on family practice I encounter on the web! Thanks for sharing Dr. Young!

    • http://www.healthscareonline.com Richard Young, MD

      Kelly,

      You’re welcome. There are several bastions of confident capable family physicians located across the U.S. Keep the faith as you enter the anti-family medicine world of the American medical school.

  • Wendy

    Dear Dr. Young,

    Thank you so much for this post! I am only an undergraduate student but I aspire to be a family practitioner and this is the type of post that reminds me why I want to be one!

    • Family Medicine Doctor

      Dear Wendy,

      Well, if you must go into primary care, we no longer call our family practitioners, we call our selves “Family Medicine Physicians”.

      Yes, Family Medicine can be emotionally & professionally rewarding in regard to the long term relationships one can maintain. That seems to be the only aspect that keeps me in it. On the other hand, the financial part is so bad, had I known all that I know now in med school, I would have gone into a specialty. The pay is just that bad. Please keep that in mind.

      Good luck & warmest regards.

      • Wendy

        Dear Dr. Young,

        Oh, is the financial situation so terrible? :( I was under the assumption the salary was at least decent (at least after you have some experience), even if it’s not comparable to that of a specialist.

        • http://www.healthscareonline.com Richard Young, MD

          Wendy,

          The 140K figure quoted by Family Medicine Doctor is below national averages. Of course we have no way of knowing why his or her annual income is so anemic.

          There are several sources of estimates for physician pay. I think it’s fair to say for family medicine currently, it’s in the 170-180K range, which is still not enough to attract enough medical students to the field. Many American family physicians earn over $200K if they provide a wide range of services and are willing to work hard (meaning it’s not just a 9-5 M-F job).

          GPs in the UK currently make more like the equivalent of $200-250K, and I’ve heard of numbers over $350K. They also have much less medical school debt. The National Health Service has a more comprehensive, but complicated payment approach for the GPs. They get 20-30% of their income from meeting quality measures. The program is called the Quality and Outcomes Framework, if you’d like to Google it and learn more.

          Feel free to email me at american@healthscareonline.com if you’d like to discuss some of the particulars in more detail.

          Richard Young, MD

  • Dr K

    Family Medicine Doctor

    Although reports are conflicting – supposedly a Family Medicine Physician earns $189.000 on average per year – a few even more. This doesn’t sound that bad!!!!

    • Family Medicine Doctor

      Dear Dr K & Wendy,

      I WISH I made 189 K/yr. Try 140 K last year. And since I live in city, the cost of living is much higher than if I lived in rural America. In my city, on 140 K/yr, try saving for a downpayment on a home, saving for your retirement, & saving for your kids college education. Oh, & don’t forget the 150 K of debt I accumulated while going to medical school that monthly requires a check from me to pay off my student loans-for 30 years mind you. Hhhhm, not bad you say? Call me arrogant, but given the importance of what I do I anticipate a better reward than what I currently receive.

      No, the pay is too low for Family Medicine, even at 189K/yr, & knowing what I know now, I wouldn’t do it again.

      Wendy, more experience doesn’t get you paid more. Medicare, Aetna, Medicaid, Blue Cross etc all pay you the same whether you are just out of residency or been practicing for 30 years.

      Don’t do it Wendy. Go into a specialty.

  • Dr K

    I understand. In the UK Family Doctors earn 140K on average so it is similar to what you are earining. I thought American Family Doctors would earn more.

    • Family Medicine Doctor

      “I understand”

      Yes, you now understand better. See, its easy when you are young to be idealistic, like Wendy above. But when reality sets in, the idealism gets more than a bit frayed. I would have NEVER have dreamed in my twenties that I would have let such a non-issue such as salary come inbetween professional satisfaction. I was way too sophisticated and evolved for such nonsense. But now i realize that im just as human as everyone else and salary does affect me. I would have never gone into primary care had I known then what I know now.

      • Anonymous

        Dear Family Medicine Doctor

        I am not sure what you personal circumstances are and it is sad that you have put so much time and effort and money to reach where you are and do not feel that it is rewarding enough. Family Medicine may not be the best career in US for Doctors. However, fact is that Family Medicine or GPs earn well in UK, Australia, New Zeland and Canada. The majority of GPs here are very satisfied. You should consider these. You may find that you are enjoying your job as well as earing more.

        In addition I am not sure about this but have you thought about non clinical careers with pharmacuetical companies. These are just some of the options that in my humble opinion I may consider exploring if i am not happy with working as a family doctor. Of course I am nowhere near that position and may feel differently when i reeach that stage

  • Dr K

    The situation is not as bad in UK. Family doctors are more appreciated, in demand and get better pay. It is a good career for doctors. Its a pity that its so different in US.

  • Shahab Karim

    where are all the comments gone?

  • Anonymous

    Dr Young. GPs used to earn aroun $300K in UK. However recent changes have meant that now most GPs earn $220K at best. Despite this 60% of medical students still choose GP as their speciality and still there is a huge shortage of GPs in UK.
     
    In US family medicine is not the number speciality. There is a big shortage and much bigger population than UK. How will the shortage of family doctors be filled by 2014. Most of the work will have to be done by PA/NP. Or you could make more family doctors but will you be able to produce enough in 3 years?

  • http://www.facebook.com/people/Isis-Vanessa-Lopez/716044128 Isis Vanessa Lopez

    im currentyly studying for my mcat, and i always hear shit about how being a doctor sucks, so THANK YOU for this post, I know I will be an amazing doctor someday. 

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