Specializing on your first job

[FSUnoles]

interesting question which i wonder about as well. Though when i think about it i have absolutely no desire to go into primary care with the was medicine is now adays.  I enjoy learning one aspect of medicine really well. I deal with a high patient volume but the primary care sector is going to be inundated with a large amount of patients with the affordable care act.  It also didnt help that no job were available in my area and the one Internal Medicine practice i was talking to as a potential employer was unsure of what was to come in regards to hours and volume.

 

When my job came up he told me to go into it and stay away from Primary Care right now. I think it was the right choice for me because i do love the specialty and i only see it growing with our aging population

[Guest Paula]

I'm in primary care and so far we have not seen any change in our patient volume (re ACA) and it is probably too early to tell if we will get inundated with new patients.  I started out first in PC at a reservation, only practitioner with the SP 2 hours away at the sister reservation.  We communicated by phone and I learned alot those first few years. I was there 4years.  Saw lots of stuff I would not have been able to see if I was working for a large HMo or hospital/clinic group.  Plus I worked part-time at an UC with ER and learned all three discipline at the same time.  Did this for 4 years, then wandered off rez for a strictly UC job and learned a ton more as the UC was basicially "unsupervised" by the MD (long story).  1/3 patients were the run of the mill URIs, UTI, colds, flu, 1/3 injury related and 1/3 were all the emergency patients who refused to go to the ER.  The last third were by for the most interesting to work up with somewhat limited tests and kept my EM skills sharp.  I left after three years and wandered back to the rez where I belong.

 

I don't regret any of the experiences I had and the learning curve at each job was different but added to my knowledge and skill set. Now at my job as a FP provider I am considered the diabetes specialist only because I am responsible for the IHS diabetes grant.   It is another area to specialize in within a family practice setting and offers an advantage if I ever need to change jobs.   I could go into a diabetes specialty I suppose and am looking at getting the CDE certification.  

 

Ultimately you need to  figure out what "rings your bell" and go for it. 

[Rojo5]

This is a very helpful post..

 

Does anyone have an opinion on inpatient infectious disease consulting (in a high acuity hospital that sees just about everything) as a first job when I eventually want to do work in Family Practice or outpatient/ inpatient IM? I would really enjoy this ID job (I had a rotation with the MD), but I don't want to get passed over for a good GP job b/c I don't have general enough experience. 

[electric130]

I went straight into GI right after graduating.  Did a little bit of UC part time for a couple years but not enough for me to really solidify those skills.  In hindsight I wish I would have done more UC or ER for a few years.  I am now 13 years in and looking to change positions. I know I would take a large paycut doing FM or UC, I am really surprised at how much lower the pay is as opposed to the GI offers I have had.   I do feel like I have picked up a lot of general IM taking care of patients in the hospital, but I have never completely managed diabetes or hypertension those sort of things.  I know what I don't know well and always either consult with their Primary care, but there have been many times I wish I had a better FP or IM background.  It is funny because my SP says I am the "primary care" in our practice so every time a rash or something of that sort comes in he wants me to treat it.  So, MDs in a specialty also get to be quite narrowly focused, but they had a residency where they had more time to solidify general medicine skills.  In all honesty I never wanted to do Primary care and even in school I knew I wanted to go into some sort of specialty.  I would say if you want to do derm go for it, but really try to do UC or ER on the side for as long as possible.  At that point just go into your specialty after you at least have some sort of primary care experience. 

[newton9686]

I would argue taking a job in primary care could pigeon hole you as well. Once someone gets the taste of being essentially an autonomous provider, they may find it difficult to return to a speciality field where there is more of the traditional PA/MD hierarchy. I for one am looking at Orthopedic surgical residency after I graduate, spend several years in Orthopedics and use that experience as a foundation to open my own clinic that focuses on non-operative orthopedics or a family care practice that provides more extensive musculoskeletal treatment than a traditional PCP.

 

There are pros and cons to do everything. So weigh your options, then do what best allows you to help those you care about.