Family Medicine, choosing a specialty and “the Match” Sally P. Weaver, PhD, MD Glenna Walker, Residency Coordinator McLennan County Medical Education and Research Foundation FPRP, Waco, Texas

There are nearly 70,000 practicing family physicians in the U.S. About one in four of all office visits are made to family physicians annually. In 2001, office visits to general and family physicians numbered more than 210 million million more than to any other specialty.

Distribution Of Office Visits By Physician Specialty: U.S Physician Specialty Number of Visits General and Family Practice 24.2% Internal Medicine 17.6% Pediatrics 13.5% General Surgery 1.9% Obstetrics and Gynecology 7.9% Cardiovascular Diseases 2.3% Dermatology 3.6% Psychiatry 2.4%

Today, family physicians also provide the majority of care for America's underserved rural and urban populations. In fact, more than 1/3 of all U.S. counties (40 million Americans) depend on family physicians to avoid designation as primary care health profession shortage areas.

TRAINING in Family Medicine Family physicians complete a three-year residency program after graduating from medical school. Resident family physicians receive training in six major medical areas: pediatrics, obstetrics and gynecology, internal medicine, psychiatry and neurology, surgery and community medicine. They also receive instruction in many other areas including: geriatrics, emergency medicine, ophthalmology, radiology, orthopedics, otolaryngology and urology.

Phillips & Haynes, Fam Med 2001;33(4): What is Family Medicine “Family physicians acquire and maintain a broad and varying array of competencies, depending on the needs of the populations they serve…”

Although all family physicians share a core of information, knowledge and skill vary with the individual family physician based on patient needs and the physician's continuing education. For example, the knowledge and skills used by a family physician practicing in an inner city may vary from those utilized by a family physician practicing in a rural setting.

Phillips and Haynes, 2001 “Family physicians are experts at managing common complaints, recognizing rare but dangerous and treatable diseases, uncovering hidden conditions, and managing most acute and chronic illnesses.”

Family physicians provide: cost-effective care… that is based on best evidence… responsive to the needs and preferences of patients… respectful of patients’ families, personal values, and beliefs.

Haynes and Phillips, 2001 “[Family physicians] emphasize health promotion and disease prevention and aim at optimal outcomes for each person.”

Haynes and Phillips, 2001 “Family physicians do not treat diagnoses, disorders, or diseases.” “They take care of people.”

A Specialty is Born In the two decades following World War II, the number of specialists and subspecialists increased at a phenomenal rate, while the number of general practitioners declined dramatically. The public became increasingly vocal about the shortage of personal physicians who could provide initial, continuing and comprehensive care. The specialty of family medicine was created in 1969 to address this problem.

A Unique Specialty The family physician is the physician of first contact in most situations and is in a unique position to form a bond with the patient. The family physician evaluates the patient's total health needs. The family physician's care is: comprehensive and not limited by age, sex, organ system or type of problem, be it biological, behavioral, or social.

The family physician's care utilizes knowledge of the patient in the context of the family and the community. This care emphasizes disease prevention and health promotion. The family physician refers the patient when indicated to other sources of care while preserving continuity of care.

Income Level Family physicians earned an average income (after expenses) of $150,000 in 2002, according to the Medical Economics Continuing Survey. By comparison, Medical Economics reported average 2002 incomes (after expenses) of $150,000 for internists, $130,000 for pediatricians, $300,000 for gastroenterologists and orthopedic surgeons, and $230,000 for general surgeons.

FPs work fewer hours than many other specialists Medical Economics, Nov. 21, 2003 three hours fewer than internists worked; 10 hours fewer than OB-Gyns worked.

Alternative practice styles for family doctors “Boutique” practice, resort doctor, prison doctor, legislator, medical director, locum tenems, urgent care and emergency medicine, hospitalist, administrator, public health and epidemiology, research, teaching/education, private business (lecturer, author, consultant, and sales, etc…)

How to Choose a Specialty

Use your 3 rd year to figure out which specialties you do not want to go into. Take a specialty aptitude test at: ed.virginia.edu/specialtieswww.med- ed.virginia.edu/specialties American Academy of Family Physicians website: Careers in Medicine website:

How to Choose a Specialty Use each rotation to learn as much as you can about that particular specialty. Keep a journal of your experiences At the start of each rotation write down your expectations and goals. At the end of the rotation, summarize things you learned about yourself and that specialty.

How to Choose a Specialty Identify a resident, attending physician and/or community physician from each rotation who inspires you. Ask them questions: What do you like most about your specialty? What do you like least? What is your typical daily schedule? What skills/talents are important for someone in their specialty?

The “Match” What is it and How it works

The NRMP (National Residency Matching Program) provides a uniform system by which residency candidates simultaneously “match” to first year postgraduate training positions. The entire Match process is conducted via the internet. All documents (letters of reference, Dean’s letter, transcripts, personal statement, etc.) are transmitted to prospective residency programs via ERAS (electronic residency application system).

Time Line for the Match Fill out application for the Match in early fall. Get an ERAS packet from your Dean’s office late summer of your 4 th year. Access the ERAS website and complete your application. Residency interviews usually begin in October and end the last of January. Request residency applications early fall. By mid-February submit your ‘rank order list’ listing your choice of residency programs in the order you would prefer to go to them from #1 through ?. On match day (mid-March), you find out where you will be going for your residency.

Selecting a Residency Program Visit local, regional or national residency fairs. AAFP’s (American Academy of Family Physician’s) annual resident/student conference (held each summer in Kansas City, MO) is a great place to visit Family Practice Residency Programs from across the country. Interview at all programs you are interested in – request applications in early fall for interviews October through January.

References AAFP website: fmignet.aafp.org/medicalschool.xml Phillips, WR and Haynes, DG. The Domain of Family Practice: Scope, Role, and Function. Fam Med 2001;33(4): NRMP website Medical Economics journal