Bard-Parker asks: “Can the availability of fellowships leading to high-paying specialist postitions explain how IM and Pediatrics outperform FP?”
The answer is yes. Consider the following rant from an unhappy FP:

Finished FP Residency in 1992. The worst decision I ever made in my life was Family Practice! For the last 16 years or so I have have watched it continually decline in every single way. My income hasn’t kept up with inflation, while the other specialties are reimbursed more than double for way less than half the work. Huge decline in prestige….we are Primary Care Providers now….lumped in with nurses and PA’s and “advanced nurse practictioners”. I can’t believe that anyone would make Family Practice a career choice. Complete and total waste of my young adult years in training and waiting like a fool for FP to make a resurgence. FP is dead. It is no wheresville. I harbor so much anger towards the AAFP and all those who killed Family Practice. I cant even set up a no insurance practice without having to opt-out of medicare which would then make me unemployable. We as Primary Care Providers are held hostage by the Federal Government and insurance companies. Wasted my young life becoming a Family Practioner totally blinded by what others said about how noble it was. Any career choice would have been better for me. Most people with four year degrees have done way better than Primary Care Providers….what a demeaning term given to us now. I hate it.

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