DO attending AMA

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Sorry if you've already mentioned this. Did you consider going IM and doing primary care that way? Pros and Cons of IM-PCP vs FM-PCP in your experience?

I did, especially since I did plan to become an Oncologist right before I switched. But IM PCP route wasn’t as idea in my experience. I feel like you end up doing too much geriatrics, which I don’t mind but don’t want to be the main focus of my practice.

In FM, you’ll see kids, you’ll be infinitely more prepped for women’s health, and you’ll get better outpatient training and learn more office procedures. That’s why when I finally decided that I wanted primary care, I knew FM was the optimal route.

At this point, I see more 20 and 30 somethings than any other group. I do tons of women’s health, I do family planning, and pediatrics.

my practice/area of expertise would be very different if I were an internist.

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To piggyback off this, how would one know whether the deal is sour or not? Let's say, for instance, the hospital system that currently employs you as a resident offers you a contract to stay on as an attending. Assuming you've had a good experience with your program, what sorts of things would be red flags to look out for?

Hospitals that recruit and sign residents that early usually have difficulty attracting/retaining physicians to the area - whether it is the remoteness, the location, low pay, surrounding town/city (and quality of life), etc. You are committed to the hospital 3-4 years from now (which is a long time in hospital to fill vacant shoes). It ties up hospital resources for a physician that won't start for a few more years. You can sometimes get a signing bolus that large (or larger) as a lump sum instead of spreading it out over the years in residency (although I do see a nice tax implication for getting the bonuses as a resident instead of a new attending). It's not unheard of for new attendings to get $60k as a sig on bonus. Depending on field, location, and "desirability" the sign on bonuses can be higher.

And hospital administrators do change. The current hospital administrator may be good and fair, but can be replaced by someone with an MBA, MHA, FACHE, etc. that will view physicians as a resource to extract the maximum amount of dollars and work. You could sign a contract and the working condition could change, meaning you're stuck a hefty payback if you leave. Unless written into the contract, they could ask that you see a certain amount of patients/day, or have unrealistic RVU expectations (be in the top 95% in RVU generation but get paid 25% of median MGMA salary, etc). May mandate you cover call in the hospital every weekend or every other weekend, require you to cover the Open ICU, attend all newborn nurseries admissions and C-sections, etc. Your new boss may place the business of medicine over what's right/good for the patient, putting you in an ethical dilemma.

Ultimately you have to earn your keep - generate more revenue than expenses (unless you are loss leader for the healthcare system, but then good luck getting them to listen to your wants/needs). Ultimately you need to generate enough revenue to cover your salary and benefits, plus the benefits of ancillary staff there to help you, plus the facility expenses, plus pay the hospital administrators and hospital.
 
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Do y’all need a rural orthopaedic surgeon?
 
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Hi! Thank you for doing this! I'm entering DO school in July and have a special interest in some primary care field - likely FM as well. How tough was it to associate yourself in a rural community? That's my ultimate goal - as I'm going west for medical school and plan to stay there!

(sorry if you've already answered this, CARS was never my strong suit).
 
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I am almost done with undergrad and am starting to put together my application. I read so much about how DO med students are at tremendous disadvantages when getting into residencies and attending jobs so this has made me feel that it may not even be worth applying to DOs at all, so I guess my question would be have you felt that being a DO graduate affected you negatively in any way or has anyone in your med school graduation class experienced difficulties that would be less likely to happen if you are an MD student?
 
DO med students are at tremendous disadvantages when getting into residencies and attending jobs
Getting into competitive residencies: true.
Getting attending jobs: patently false. Aside from some snobby program directors, no one on the planet will ever care again which degree you have post-residency.
 
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getting real with myself meant that I finally quit telling myself that primary care was not good enough for me. That I needed to be a specialist. My personality is much better suited to being a jack of all trades. It’s why at one point along the way I thought about most other medicine specialties. The only thing I’d definitively ruled out was any type of surgery.

I have used OMM, maybe a handful of times in the past 2.5 years as an Attending. Mainly when I’ve had DO students rotating with me.

My life is better for having chosen FM because I’m content. I realize now that I’m drawn to the work-up of malignancy much more than the actual treatment. And I identify more with the palliative care aspect of cancer care more than the treatment as well. All very much in the realm of a quality Family Physician. I really value having the broad scope of practice I maintain. Also, I got out of training 3yrs sooner by going FM, and in the end that was HUGE too. I’m not sure I even had 3 more years left in my tank to give to a training program.
I appreciate this candidness. I've had similar thoughts as a high-stat applicant who wants to do primary care (IM) or be a hospitalist-- am I "wasting" my potential? Like you, I've thought about most specialties outside of surgery. "I'm drawn to the work-up of malignancy much more than the actual treatment" really resonates with me, as I've had similar thoughts when seeing cards come around once the patient has pretty much been worked up just to ok the treatment plan (obviously I realize they do much more and this is a simplification) etc with other specialties. I've always enjoyed reading your posts on here over the years. Your happiness is my end goal and I am glad that you have found it.
 
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Getting into competitive residencies: true.
Getting attending jobs: patently false. Aside from some snobby program directors, no one on the planet will every care again which degree you have post-residency
That's great to know, I was getting worried that if I decided to go to a DO program that I would be condemning myself. Would you be able to explain to me your thoughts on residencies, why it is more difficult? Is it that residency programs feel DOs are less competitive than MDs or something?
 
I realize now that I’m drawn to the work-up of malignancy much more than the actual treatment. And I identify more with the palliative care aspect of cancer care more than the treatment as well. All very much in the realm of a quality Family Physician.
What type of clinical experiences helped you come these realizations about where in the process of treatment you thrived most?
 
That's great to know, I was getting worried that if I decided to go to a DO program that I would be condemning myself. Would you be able to explain to me your thoughts on residencies, why it is more difficult? Is it that residency programs feel DOs are less competitive than MDs or something?
It's been posted to these forums ad nauseum. The gist is that DO students have a more variable clinical education and generally less access to research opportunities. These things are important to the ultra-competitive specialties. The same can be said about low tier MD schools.
 
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Thank you for this! I’m starting med school in August with the goal of doing exactly what you are. I grew up in a rural area and want to go back and practice family med. I fell in love with the idea of it while working at our hospital. That’s where I realized our local docs delivered babies, rounded on THEIR own patients in the hospital, took ED shifts and had clinic. I just loved the variety of their job and the continuity in care. I mean, the same doc that was there for my delivery was my doc for almost 25 years.

Here lately I’ve been seeing how people are crapping on medicine. From mid-level encroachment, burn out and how terrible doing FM is. So thank you for posting this!
 
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What I’m less satisfied with is what it took to get here. Which was: a lot of money, time, and missed opportunities to build closer relationships with my kids. That was a byproduct of being a non-trad though.
As a non-trad who is currently applying to med school. This scares me because I have a super close relationship with my children. I am very active with them and my kids often look to papa for life advice. Did your relationship with your children turn sour? Any advice or tips? Thanks!
 
On the whole, yes. I love what I do 100%. I don’t ever wish I had someone else’s job, except maybe a pro downhill MTB racer’s. 😉. I don’t envy other specialties, only their paychecks. I couldn’t be happy doing another job in medicine. I’m a Family Doc through and through.

What I’m less satisfied with is what it took to get here. Which was: a lot of money, time, and missed opportunities to build closer relationships with my kids. That was a byproduct of being a non-trad though.
Retinal and neurosurg paychecks!
 
Do you have any advice for a DO wanting to go into PM&R or another specialty that lets you spend more time at home with family without burnout? I start DO school in July and although I don’t have to worry about all of this for a little while, I do want to know about the different residency options that will give me good family/work balance so I can have my babies (once I get married and stuff). No rush right now but I’d want to start around the time I turn 28/29 which is when I’ll be graduating Med school Godwilling. Any advice/feedback is greatly appreciated!
 
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Do you have any advice for a DO wanting to go into PM&R or another specialty that lets you spend more time at home with family without burnout? I start DO school in July and although I don’t have to worry about all of this for a little while, I do want to know about the different residency options that will give me good family/work balance so I can have my babies (once I get married and stuff). No rush right now but I’d want to start around the time I turn 28/29 which is when I’ll be graduating Med school Godwilling. Any advice/feedback is greatly appreciated!
PM&R is very DO friendly. How much you work obviously impacts burnout, but working less hours of a job you hate is just as likely to cause burnout imo. Residency hours will suck in pretty much any field except for psych, so if you're planning on having kids in residency that is something to consider.
 
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Hello all, I’m bored and have some time this weekend. Figured I’d start an AMA thread that anyone here can ask questions in. I am ~3yrs graduated from residency and life is finally slowing down and feeling chill. Time to pay it forward:

About me:
- Former member of the OG underdogs thread. Only went on one med-school interview and was accepted. This was 2011.
- SDN member for the past 11or so years.
- Went to ATSU-SOMA, 100% LOVED the school.
- Changed my specialty plans several times. Thought I’d be an Oncologist until literally 1 week before ERAS opened, then got real with myself and applied FM. I have zero regrets and am legit in-love with my specialty and career.
- Residency apps didn’t go smooth. See itching specialties until the last possible moment probably didn’t help that. SOAP’d into a great program though. Top 20 out of over 400 FM programs.
- Signed an employment contract in Intern year. Got paid $$$ on the side just to not go looking for another job. I’m 3 years out at that job and still very happy with it.
- I am a rural FM doc now. I do a LOT of stuff. Inpatient, Outpatient, procedures, etc.

Happy to answer any burning questions. Pre-med, OMS1-OMS4, even any upcoming interns or current residents.

How can I help?
Hi. Just read your thread- interesting. I am a 58 yr. old chiropractor embarking on applying to med school next year. I have also been teaching A&P I/II for the last 24 years at a CC. Took the MCAT's 4 years ago; I know they are expired. I am interested in either internal, FM, or Derm specialties. Your thoughts/ suggestions. Thanks.
 
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Thank you for the super informative and reassuring AMA - your line of work is my DREAM. Any Northeastern/New England programs or systems you'd recommend keeping in mind for away rotations or residency applications? Thanks again :)
 
Hi. Just read your thread- interesting. I am a 58 yr. old chiropractor embarking on applying to med school next year. I have also been teaching A&P I/II for the last 24 years at a CC. Took the MCAT's 4 years ago; I know they are expired. I am interested in either internal, FM, or Derm specialties. Your thoughts/ suggestions. Thanks.

It isn’t worth it. You don’t want to be a senior citizen when you’re starting residency training, working 80+ hours a week and being bossed around and judged by people half your age. You may be in perfect health and have unlimited stamina at age 58, but it’s far from a guarantee that your physical and mental status will remain exactly the same a decade from now.

I would consider taking the GRE and going to PA school. Save money, save time, reduce stress. After 2-3 years of schooling/training, you could work 40 hours/week as a healthcare provider at a primary care or dermatology office.
 
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Thank you for the super informative and reassuring AMA - your line of work is my DREAM. Any Northeastern/New England programs or systems you'd recommend keeping in mind for away rotations or residency applications? Thanks again :)

I did my residency in that part of the country. I’ll send you a PM
 
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Hi. Just read your thread- interesting. I am a 58 yr. old chiropractor embarking on applying to med school next year. I have also been teaching A&P I/II for the last 24 years at a CC. Took the MCAT's 4 years ago; I know they are expired. I am interested in either internal, FM, or Derm specialties. Your thoughts/ suggestions. Thanks.
Agree with Osminog, at 58 it’s not worth it. Look into PA. Too long and too expensive that late in life.
 
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As a non-trad who is currently applying to med school. This scares me because I have a super close relationship with my children. I am very active with them and my kids often look to papa for life advice. Did your relationship with your children turn sour? Any advice or tips? Thanks!

it didn’t turn sour, but I wish I had more time. Still, I was reviewing one of my kids text messages the other day (we do this randomly, our kids know may happen and agreed to it as a condition of getting a cell phone), and I came across a message from my teenager to a friend, and in the convo she mentioned how I was her hero, and she wants to be just like me one day.
She’s never told me that, but things between us must be OK.

I am trying to work hard to repay my family for lost time. It’s nice that we can now do some more interesting things that were out of reach before (I take my kids on trips that are build around each of their individual recreational interests, and took my wife to Europe in 2019 etc.).
 
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What type of clinical experiences helped you come these realizations about where in the process of treatment you thrived most?

in the end, I latched on to aspects of almost all my rotations. And took that as a symbol that I belonged in primary care. And I like to read and study and learn, variety is important to me.
 
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PM&R is very DO friendly. How much you work obviously impacts burnout, but working less hours of a job you hate is just as likely to cause burnout imo. Residency hours will suck in pretty much any field except for psych, so if you're planning on having kids in residency that is something to consider.

Aside from a few programs, residency hours in PM&R are very reasonable as well.
 
in the end, I latched on to aspects of almost all my rotations. And took that as a symbol that I belonged in primary care. And I like to read and study and learn, variety is important to me.
I may have missed it, but how old are you? I'm turning 34 this year and am still convinced that DO is the right path right now with another ~30 years of work ahead of me. How old are you?

I saw you were thinking about Oncology, what made you change your mind? You mention being a "jack of all trades" type, so why did you not think about EM as well? Thank you for doing this AMA.
 
I may have missed it, but how old are you? I'm turning 34 this year and am still convinced that DO is the right path right now with another ~30 years of work ahead of me. How old are you?

I saw you were thinking about Oncology, what made you change your mind? You mention being a "jack of all trades" type, so why did you not think about EM as well? Thank you for doing this AMA.

I started my first semester of med school at age 30.

I never considered EM because I didn’t love the ER. The pace and schedule turned me off big time. I also don’t suffer fools well, and the ER is full of them. I like a consistent, predictable schedule. I also like knowing more or less what’s in front of me each day. And I like having the right to dismiss a fool from my practice and tell them to never come back again.

Put bluntly, I’d burn out so hard and so fast in EM.
 
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Hi. Just read your thread- interesting. I am a 58 yr. old chiropractor embarking on applying to med school next year. I have also been teaching A&P I/II for the last 24 years at a CC. Took the MCAT's 4 years ago; I know they are expired. I am interested in either internal, FM, or Derm specialties. Your thoughts/ suggestions. Thanks.
If you started med school in the fall, you wouldn’t be out of debt until you’re about 70. I’m going to finish residency at 40 and that’s just barely worth it.

On a larger scale, there’s a finite amount of doctors that our country can produce every year. Accepting you to medical school is quite frankly a waste of a spot. You’ll only be able to practice a few years at best and contribute very little to health of a community/our nation as a whole. That assumes you remain in perfect health between now and the end of your training.

Seriously. You’ve probably got children, grandchildren, etc who don’t want their final memories of you to be of you stressed out doing flash cards and practice questions for 10 hours per day. What are you thinking?
 
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Hi. Just read your thread- interesting. I am a 58 yr. old chiropractor embarking on applying to med school next year. I have also been teaching A&P I/II for the last 24 years at a CC. Took the MCAT's 4 years ago; I know they are expired. I am interested in either internal, FM, or Derm specialties. Your thoughts/ suggestions. Thanks.
@Deecee2DO is an M3 who was a chiropractor before med school, he may be able to offer some words of advice. I would agree with others, though. 58 seems like it may be pushing it, and I'm not sure if you know exactly what you're getting yourself into.
 
Hi. Just read your thread- interesting. I am a 58 yr. old chiropractor embarking on applying to med school next year. I have also been teaching A&P I/II for the last 24 years at a CC. Took the MCAT's 4 years ago; I know they are expired. I am interested in either internal, FM, or Derm specialties. Your thoughts/ suggestions. Thanks.

I don't like to say no to anyone aspiring medicine but what Osminog and SLC said should be read
 
I started my first semester of med school at age 30.

I never considered EM because I didn’t love the ER. The pace and schedule turned me off big time. I also don’t suffer fools well, and the ER is full of them. I like a consistent, predictable schedule. I also like knowing more or less what’s in front of me each day. And I like having the right to dismiss a fool from my practice and tell them to never come back again.

Put bluntly, I’d burn out so hard and so fast in EM.
Currently on my ER rotation and I felt this in my bones as I read it
 
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Maybe a bit esoteric, but... Is there a tactic to negotiating with IHC? Like if I wanted to settle down near St. George as a psych do I need to be under the IHC umbrella? It seems like they know darn well people want to practice in UT and they can wantonly lowball salaries.


Also, you open to hanging out next time I go visit my in-laws? :cool:
 
Did you have a girlfriend/wife? How was the time management in that aspect?

Is it really hell until after residency?

I had a wife and 2 kids when I started. It wasn’t hell, but I was busy. I don’t know, my wife might say it was hell; but she’s stronger than I can really put into words and didn’t complain much. We
had a 3rd kid in renal block during 1st year, and a 4th in 2nd year of residency.

Med school and residency were manageable with the right mindframe and expectations. Looking back now I don’t know how we did it, but in the heat of battle it didn’t seem completely terrible.
 
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Maybe a bit esoteric, but... Is there a tactic to negotiating with IHC? Like if I wanted to settle down near St. George as a psych do I need to be under the IHC umbrella? It seems like they know darn well people want to practice in UT and they can wantonly lowball salaries.


Also, you open to hanging out next time I go visit my in-laws? :cool:

meh, the salaries are a little low to start, but the earning potential is on par with any other legitimate place. They don’t do negotiation much though, but the contracts are fair and they treat docs well overall.
 
I had a wife and 2 kids when I started. It wasn’t hell, but I was busy. I don’t know, my wife might say it was hell; but she’s stronger than I can really put into words and didn’t complain much. We
had a 3rd kid in renal block during 1st year, and a 4th in 2nd year of residency.

Med school and residency were manageable with the right mindframe and expectations. Looking back now I don’t know how we did it, but in the heat of battle it didn’t seem completely terrible.
it also depends on the specialty during residency. Some of them average close to 80/wk for the entirety of residency. Mine tends to average 60-65 except during service months. Another 15 hours/wk every single week would put me into hell.
 
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it also depends on the specialty during residency. Some of them average close to 80/wk for the entirety of residency. Mine tends to average 60-65 except during service months. Another 15 hours/wk every single week would put me into hell.

Yeah, 90-100 hrs was pretty usual for me. Except on outpatient months, when I could average closer to 40
 
How does one get over the prestige and salary issues of family medicine? These are the main factors holding me back from wanting to pursue the field. I don't mean this to be offensive in any way... this is just something that I struggle with internally.
 
How does one get over the prestige and salary issues of family medicine? These are the main factors holding me back from wanting to pursue the field. I don't mean this to be offensive in any way... this is just something that I struggle with internally.

Prestige should be a pretty easy thing to get over, especially if you are a DO. Doctors as a whole are just less respected these days. People don’t care as much anymore. And within physicianhood, once you are done training and enter the real world no one cares. Cardiologists like and respect their FM colleagues because that’s where they get referrals.

As for money, fm is one where you can hustle more. They’re the easiest ones to hustle too. If your goal is money then you can as fm. Do your clinic 40 hours per week. Pick up urgent care shifts at night. Then you can round at a couple rehab hospitals or even be a hospice physician. With all of that you will eclipse 400k easy
 
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Yeah, 90-100 hrs was pretty usual for me. Except on outpatient months, when I could average closer to 40
ya for me intern year required essentially 8 months like that, but it slowly decreased. 2nd year only 6 and 3rd year 4. So throughout residency you can choose to get closer to 40 more often
 
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@SLC I’m gonna find out Monday if I matched and I’m prepping for SOAP. Looking at the data, there are actually more IM spots than FM that go into SOAP. Were you tempted to go after those spots in soap? I personally think I’d be happier in FM cause I could work in a rural ER or potentially deliver babies, but I am so terrified of not having a spot this July that right now I just want to maximize my chances in the SOAP. I’m also leaning further away from just taking a surgery prelim, although my goal field was Gen surge. That’s simply because my prelim pals got basically zero love this year in app season.
Was it hard to find a decent FM spot? Thanks!
Fellow Mormon, 4 kids, not beautiful stats, but no ugly red flags for sure (if that helps).
 
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@SLC I’m gonna find out Monday if I matched and I’m prepping for SOAP. Looking at the data, there are actually more IM spots than FM that go into SOAP. Were you tempted to go after those spots in soap? I personally think I’d be happier in FM cause I could work in a rural ER or potentially deliver babies, but I am so terrified of not having a spot this July that right now I just want to maximize my chances in the SOAP. I’m also leaning further away from just taking a surgery prelim, although my goal field was Gen surge. That’s simply because my prelim pals got basically zero love this year in app season.
Was it hard to find a decent FM spot? Thanks!
Fellow Mormon, 4 kids, not beautiful stats, but no ugly red flags for sure (if that helps).
You're gonna match on Monday my guy. I can feel it in my bones!
 
@SLC I’m gonna find out Monday if I matched and I’m prepping for SOAP. Looking at the data, there are actually more IM spots than FM that go into SOAP. Were you tempted to go after those spots in soap? I personally think I’d be happier in FM cause I could work in a rural ER or potentially deliver babies, but I am so terrified of not having a spot this July that right now I just want to maximize my chances in the SOAP. I’m also leaning further away from just taking a surgery prelim, although my goal field was Gen surge. That’s simply because my prelim pals got basically zero love this year in app season.
Was it hard to find a decent FM spot? Thanks!
Fellow Mormon, 4 kids, not beautiful stats, but no ugly red flags for sure (if that helps).

I didn’t find it hard to find a decent spot. But there may have been more FM spots in the SOAP back then. But I got interviewed at almost all the spots I applied to in SOAP. Several were basically begging me to go there and one even tried to interfere with me interviewing with other programs (offered to fly me out there during SOAP interview time to check them out).

I bet you match, it if not, I would just make sure you maximize your programs applied to, and maybe put in a healthy mix of both IM and FM programs. But if you’re more into FM, then apply to FM programs.


Someone without red-flags, a normal person, and from a US school is going to do well in SOAP if it comes to that. Definitely hit me up if you need advice or support.
 
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@SLC I’m gonna find out Monday if I matched and I’m prepping for SOAP. Looking at the data, there are actually more IM spots than FM that go into SOAP. Were you tempted to go after those spots in soap? I personally think I’d be happier in FM cause I could work in a rural ER or potentially deliver babies, but I am so terrified of not having a spot this July that right now I just want to maximize my chances in the SOAP. I’m also leaning further away from just taking a surgery prelim, although my goal field was Gen surge. That’s simply because my prelim pals got basically zero love this year in app season.
Was it hard to find a decent FM spot? Thanks!
Fellow Mormon, 4 kids, not beautiful stats, but no ugly red flags for sure (if that helps).
if you want to specialize after IM then do iM but again most soap IM spots are trash community programs you can't get good fellowships out of. I would do FM before I did community IM
 
How does one get over the prestige and salary issues of family medicine? These are the main factors holding me back from wanting to pursue the field. I don't mean this to be offensive in any way... this is just something that I struggle with internally.
Im IM not fM but most of the "prestige people" back in medical school who made fun of everything less than cardiothoracic surgery, or neurosurg, or plastics were all talk and no bark fools who barely passed steps/classes and failed to make it into those specialties.

So who cares what everyone else thinks, everyone starts all gung ho first year of medical school then those with some sense calm down by third year and the tools just dont match.
 
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Im IM not fM but most of the "prestige people" back in medical school who made fun of everything less than cardiothoracic surgery, or neurosurg, or plastics were all talk and no bark fools who barely passed steps/classes and failed to make it into those specialties.

So who cares what everyone else thinks, everyone starts all gung ho first year of medical school then those with some sense calm down by third year and the tools just dont match.
Good to know. Lots and lots of idiots at my school are rearing their heads now it’s come board study time. Why care what other people do when it doesn’t affect you?
 
Good to know. Lots and lots of idiots at my school are rearing their heads now it’s come board study time. Why care what other people do when it doesn’t affect you?
They want to feel important. Most of those who do well and match competitive stuff are 1. Normal 2. All bite. Hence why they match.

the fools who rant and rave about being awesome are no different than the people at the gym that call themselves day traders or real estate investors at the gym because they read some investing blog for five minutes and think they can beat the market.
 
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@SLC
Thank you for taking the time to do this AMA!

I am planning to go to SOMA and wanted to know your thoughts about the match list/board scores/residency prep. I saw that you initially wanted to go into oncology, but switched to FM which is awesome! I don't have a particular field I would like to go into at this moment, but I also don't want to be limited in my residency competitiveness. What were your experiences like going towards oncology/FM? Did you feel like the school prepared you well to be competitive in any field?

Thanks again for your insight.
 
Do you find yourself continuing to learn new things after residency or is it mostly the same things once you're done?
 
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