Ok this question was prompted by a TV show I saw called Everwood.

Synopsis...a big city neurosurgeon moves to small town after his wife dies and practices family medicine.

Can this really happen without a FP residency? I've heard of small town FP's doing ER...but I was wondering if this is even possible?

Yes, it's possible. There are many general practitioners who work side by side with FP or IM. Once you complete an internship...get a license...essentially (at least in California) you can do whatever you can get a job (and malpractice insurance coverage) doing. Now, obviously, it's not a good idea to try and do heart surgery just because you *can*...especially if you really can't. But, family practice-like medicine is something that most physicians can do, and are qualified to do with a medical license. I actually did general practice after my internship to make some extra money. Basically I was like a family practice doctor, but they (of course) got paid a bit more than me (being that they were specialists and all) and they (probably) had more job options, and more leverage...but I was able to find a job just fine.

The only bad things about doing what the surgeon did is:
#1 sometimes surgeons -turned -FP are a little scary ( ie it has been twenty yrs since they treated an ear infection on a baby)
#2 you get very DUBIOUS looks from prospective employers who figure you are a quack who was getting sued too often doing your subspecialty and you must;'ve seen FP as an easy way out...( a former surgeon at the age of fity considered our practice and I doubt we even gave him an interview)

That's too bad that the fifty year old former surgeon didn't get a chance to discuss why he was at a stage in his life to consider FP without negative assumptions being made about him. Everyone has a story to tell as many of the women who post here do! In my former practice we had a 60 year old former surgeon who simply wanted to have more of a "life", especially after becoming widowed and having to finish raising his youngest children by himself. Also he didn't feel that he wanted to run at a surgeon's pace any longer. He did mostly urgent care and was a real benefit to the group because he took care of a number of minor outpatient surgical procedures quite competently and efficiently.

Anyway, that's been my experience with that type of specialty change... btw, I never saw the TV show so the situation sounds a bit like my former colleague as his wife also passed on.

What a coincidence. Anyway, not to get off topic but I have a question kind of relating to this. First off, if you are going into a specialty that requires a 3 year residency, does the first year of internship count? Another question I have is if say a ped doc wanted to go into EM, would that have to have another 3 yrs of residency in that field? How would that work?

Dana,

Yes, internship counts.

And, no, one cannot be a specialist in one area then simply switch and be considered specialist in another area without taking the board exam for that specialty. And most specialties (if not all) require the completion of a accredited residency in that area to be eligible to sit for the exam. Some areas will allow special circumstances to prevail (such as extensive time/experience practicing in an area) and permit one to sit for the board exam despite not having completed a residency.

If a pedi doc wanted to to EM, she would have to do an EM residency...take the board, then she can call herself an emergency medicine specialist (and of course she'd be double boarded as a pediatrician as well.)

-Mya

Oh thanks Mya! How long is EM residency? I know you are an EM doctor.

---Dana

3 years, but some require a preliminary year (internship) prior to starting your training in EM, so that's 1+3.

Thanks, so I guess for some, that year of internship doesnt count?

Thanks everyone,
I know it's kind of silly, but it is nice to know as a doctor you have "options." Thanks everone for your answers.

Diana :p

This is an interesting post...kind of as a side-note to this subject, I've noticed that a lot of docs are going back and retraining in new specialties....at least where we live. Of our hospitalists, two have left after working for a few years to go back and do fellowship and one is going back and doing a whole new residency (radiology) with the reason that it is unfair that he is "smarter and better" than the radiologists and earns 1/3 what they do :rolleyes: . So...he matched and is started radiology in July....go figure.

kris

The intern is the first year resident (no matter the specialty). Some specialties have decided that they don't want brand new just outta school interns training in their specialty (for various reasons), so they require the new grad to "go get some experience" in the form of an internship. Since it is required in order to begin training in that particular area..it does count. It's all in the way you view the years. Pediatrics, for instance, requires 3 years....anesthesia requires 4 (one year prelim, and 3 additional years in anesthesia).

I'm not sure I'm making myself understandable.

I think I get what you are saying now, depending on where you go for your residency, it maybe 3-4 years of residency including internship, for EM anyway. Right?

Okay, now Im loaded with more questions:
1. I totally am confused with the matching of residencies, dont you have to go and interview rather than you just being randomly picked according to your choices?

2. Fellowship is after residency? If so, what is the point? Is it required for some specialties?

The Match.

As a 4th year medical student you finalize your decision as to which specialty you're going to pursue. (I don't remember exact dates but) sometime in the late summer of your 4th year you submit your application to ERAS (the central application receiving computer center via internet). The programs which you've selected to receive your application, receive it...and subsequently (hopefully most) offer you an interview. Interviews are in the late fall/winter. During these interviews the programs mostly try to sell you their program.

In February (or so) you decide which programs you liked...and rank them in order of preference. You input these desires into the central computer (NRMP match website).

At the same time...the programs rank in order of preference the applicants they like most.

The computer goes thru both lists and *matches* the applicants (4th year students) with the programs that chose them (and vice versa). This is a computer doing all of this...

In March the results are made known to both the programs and the students.


Fellowship.

Some (most) specialties break-down into *sub*specialties. For instance....medicine...you do 3 years of residency (intern year included)...and graduate...pass a test. Congratulations, you are an internal medicine specialist. Stop there and do general internal medicine.

But say, you're really into cardiology. Well, you apply for a fellowship in *cardiology* and do an additional (I think it's 2 years, but I'm not sure)...take a test...and congratulations, you are a cardiologist (a subspecialist of internal medicine).

The specialty of emergency medicine has subspecialtes in toxicology, sports medicine, pediatric emergency medicine, EMS, wilderness medicine....etc.

Oh, I see. I understand now, thanks for the wealth of information!

some other helpful websites for understanding this process are:

www.nrmp.org

www.meded.umn.edu/students/residency/index.htm

http://www.ama-assn.org/ama/pub/category/3159.html
which is the American Medical Association website...if you just type in www.ama-assn.org and go to physicians and then medical education there is a wealth of info including "becoming a doctor" and the residency data base "FRIEDA"

I also recommend Kenneth Iserson's book "Iserson's Getting into a Residency: A Guide for Medical Students" which can be purchased through Amazon.com (support Mommd!). This book can not be read too early!

Good luck!

Mya and momsurg, you two are a wealth of information...wow, thank you so much. It's nice to have someone explain things to you.
thanx,
Diana