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What are some of the pros and cons of being a family physician vs the pros and cons of being a specialist?

I am a female in 9th grade and I am considering pursuing a medical career. I love helping people and I love problem-solving. I am deeply analytical and I have always found medicine intriguing. Thank you so much and have a wonderful day!

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Kess’s Answer

Family doctors, often called "womb-to-tomb" physicians, can serve multiple generations within a family. They handle a wide range of health issues, from high blood pressure and diabetes to children's physical exams. Their expertise covers everything from common colds to minor procedures, making their knowledge incredibly extensive. This profession is ideal for those who want to build strong relationships with their patients and adopt a holistic approach to healthcare. Challenges in this field involve understanding the physiological changes from infancy to old age, with a primary goal of maintaining patients' health and addressing or preventing any worsening conditions. Although they may earn less than some other doctors, family physicians can work in various settings, from urban centers to rural areas.

Specialists, on the other hand, possess in-depth knowledge in their specific field but may have limited expertise in other areas. They might not be able to address a wide range of health issues but can identify when a problem requires another professional's attention. Typically, specialists cater to a smaller demographic and employ more potent, invasive, and potentially risky treatments. As a result, they may not have as close a relationship with their patients or their families. While specialists often earn higher salaries, their practice locations may be limited. For instance, a pediatric cardiologist might not be found in a remote rural community.
Thank you comment icon Thank you for the advice. Sophia
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Suzanne’s Answer

Sophia, this is an excellent question and as a retired family physician I'll offer my take on it....perhaps specialist physicians can also weigh in from their perspectives.

I am convinced that some of us have personalities and style preferences which lead us toward "generalist' careers. In other words, we enjoy variety, knowing about a wide variety of topics and, in the setting of health care, being the first person patients turn to when they need help. We enjoy knowing patients in the context of their families, communities and their lives as a whole. We enjoy the continuity of knowing patients/families over time and in many settings. As such a person, I found family medicine to be a very satisfying career and am so glad that I picked that.

The trade-off is that you cannot be an expert on everything and, thank goodness, that's where specialists come in. I assume they are folks more comfortable being highly knowledgeable about a more limited area of expertise. (Help me out here, specialists, I don't want to speak for you.

Family medicine is a three year residency program (following medical school); specialty training is longer. Family physicians, in general, make less money than specialists.

I think it's great that in ninth grade you are thinking about your possible careers and pros and cons. The good thing is you will not have to make the speciality/residency decision until your third year of medical school so you have a lot of time to consider where you fall on this continuum and time to expose yourself to a variety of career options.
Thank you comment icon Thank you so much, Suzanne! Sophia
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Rahul’s Answer

Family physicians are expected to work in the Community primarily and Hospital based models which support them are lacking in developing countries. They are generally considered equivalent to General practitioners in the UK and their scope of involvement might be limited by the expectation that they require specialist opinion (upon correct identification of certain red flags).
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Rita’s Answer

I am a family practice doctor and I'll share the pros and cons. When I was your position, I did not even know that there were different fields of medicine. I'll share the roadmap to medicine:
1. 4 years college
2. 4 years of medical school
3. 3 years or more of internship/residency
For family medicine, step 3 is 3 years. For internal medicine, it's also 3 years but if you want to specialize, you will need to do additional training. For example, if you wanted to be a gastroenterologist (GI), after 3 years in internal medicine, you would need another 2 years. If you specialize in family medicine, you cannot specialize in GI. So, if you possibly want to specialize, I tell students to go into internal medicine.

I think the most difficult issue with being a family doctor is the volume of issues you need to address in a visit. I get 15 minutes per patient and 30 minutes for new patients or a physical. 15 minutes is not a lot of time. I've had patients come in for several refills of medicine. So, if a patient comes in with diabetes, depression and hypertension, I will refill the medications but I will also need to know their last eye exam, how are their sugars, how is their depression, do they have any symptoms with their hypertension. I will then need to draw blood work. Then, there is their maintenance-have they had a colonoscopy, mammogram, etc. Some patients come in with additional problems while they are here for a refill. "By the way, I also have some chest pain or a skin rash." That's a lot to do in 15 minutes and they will get mad at times when I make them come back. For a specialist, they can just address their specialty. A cardiologist can focus on everything dealing with the heart. Any other problem they tell the patient to go to their primary care doctor.

For a family doctor, the pros are you feel like a true doctor who can address a lot of problems. You will never get bored because you just cannot know it all. However, you do get overwhelmed because the sheer volume of information is so high.

Most specialists need to go to the hospital. As a family physician, you can go to the hospital but most doctors stop going because of lack of time. When you go to the hospital, the nurses will often call you if there is a problem so you can be called in the middle of the night or on your weekends. Most of my friends who are doctors in internal medicine or family medicine stop going to the hospital after several years.

Specialists usually make more money than primary care physicians but I think that is up to you. I had my own practice and was making as much as specialists but I was also working long hours and seeing more patients than most doctors. If money is a concern, as a family medicine doctor, you can also "moonlight" at an urgent care. It's hard for specialists to work in an urgent care because they only know their field. When I had my own practice, I also working in clinical medicine--researching new drugs on the market.

I think you need to know your own personality (which is always developing and changing as you grow). Are you a detailed person that wants to know everything about a field? Are you ok being a handyman or do you want to be a plumber? What is your ultimate goal? Do you want a family? How are you going to juggle family and your job? Is your future job allowing you to do both?
Thank you comment icon I'm excited to put your great advice to good use! Sophia
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Midwest’s Answer

Sophia, this is an excellent question! I can add some perspective to the discussion as a specialist. I agree with many of the posts above, but would pushback on a few of the points. First, your excellent traits of loving helping people, loving problem-solving, and being deeply analytical could be applied as either a family physician or a specialist!

The pros of being a family physician include treating a wide spectrum of medical issues and really developing a close relationship with your patients and their families over many years of care. As has been said, you will never be bored or lack variety in what you must address in practice, and you will be the first person that patients turn to for help. This seems highly rewarding. The cons may also be that you are dealing with the full breadth of medical issues including chronic medical issues which may linger over many years or even decades of time. As has been said, generally speaking the pay could be less and the work environment (not pro or con) is different as it most commonly occurs in an office setting rather than a hospital and is more flexible in possible work locations.

The pros of being a specialist are treating a specific disease or set of diseases, you are often able to make a profound and immediate impact in a patient's life, and depending on the specialty you may have the opportunity to perform procedures or surgery, in addition to seeing patients in clinic and a hospital setting. In fact, surgery may comprise the majority of your time. Pay could be higher than as a family physician, but may also depend on the surgical volume and educational expectations in your specific role. Cons include generally a more limited choice of work locations as you are more specialized, less continuity of care over the span of years and decades, and decreasing reimbursement over the past 5-10 years.

In thinking about this decision, by far the most important thing is that you do what grabs your attention and what you love to do. If you are in a role where you work for 50 hours per week but dislike or are apathetic to your work, you will be significantly more miserable than doing something you love for 80, 90, or 100 hours per week. This is true in and out of medicine. You must be honest with yourself in making this assessment. This is not to say that working 80 vs 50 hours is an irrelevant distinction, but it should not be considered in a vacuum nor the most important consideration.

Personally, being a specialist but more specifically being a cardiothoracic surgeon was attractive to me because I saw the opportunity to make a deep, profound, and immediate impact on patients. I was also attracted to procedures and surgery and not only seeing patients in the hospital and office settings but having a major component of my career be in the operating room performing surgery. The daily challenge and tremendous privilege and responsibility of this career can be daunting and difficult but is ultimately rewarding in a way I would not trade for any alternative.

My advice to you is to shadow as much as you can and get as much exposure as possible and then be honest with yourself. Then determine what is it that grabs your attention? What do you WANT to do? Unfortunately, as a female medical student, you may hear questions such as whether you want a family and advice that pursuing cardiac surgery or similar surgical specialties will hinder your ability to have a family. Please DO NOT make a decision based on this advice - it is not true. Many of my best colleagues who are the best technical surgeons and also best doctors are women and in contemporary practice, working as a surgical specialist (including cardiac surgery) and having a healthy family and also successful career is an expectation among both male and female surgeons.

Good luck!

Midwest recommends the following next steps:

Shadow both generalists and specialists in hospital and office settings
Shadow in an operating room
Keep an open mind and gain exposure to as many potential careers as possible
Thank you comment icon Thank you so much for your advice and sharing your experience. That is one thing I was worried about; whether or not you have time for a family and/or personal life. I assume that it is different for everyone based on their abilities, stress/stress management, and other factors, but I am so glad to hear that you know people who are able to have a healthy balance! Sophia
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