Oh dear. Family Medicine.

So, on the first day of the family medicine rotation, the clerkship director gave a presentation about family medicine--what it is, why one would go into it, etc. And something seriously bizarre happened.

I have wanted to become an OB/GYN for something like eight years. Family med has always been the second choice, but it was always dismissed because of things like a preponderance of metabolic syndrome (ugh), no surgical components (double ugh) and excessive government oversight (triple ugh).

But as that clerkship director was talking, I began to seriously think family med deserved a more than serious look. I began to really want to be a family doctor. I began to think so seriously that I started making a list of pro's and con's on my orientation packet. And I didn't even call the con's "con's," I just wrote them under a list I labeled "Hm."

Hm

1. I would miss the OR and surgery. I really like anything that requires manual dexterity.
2. Every time someone suggests FM as a way to go, they mention rural care and mentally I go "ACK! NO!!" I don't want to do rural care. Sorry, but I want to stay in my city! I'm happy to serve the urban poor, and that's what I want to do, but no rural care until my parents are deceased. That's the law (right now).
3. The government looooooooves primary care. FM is the answer to ALL Obama's problems. Hence, I don't want to go into a field where I become Big Brother's employee or marionette.
4. SYNDROME X. Nuff said?

Pro

1. I love to educate, and that is what a lot of FM is. I love to bring people up to speed by going to meet them where they are and encouraging them. That was in my personal statement.
2. Better hours than OB/GYN!
3. FM is actually the answer to MANY of the nation's healthcare spending problems. I don't want to be a governmental employee, but it would be good to actually help with a big problem.
4. I used to want to be a family doctor but somewhere along the line I learned that the golden age was over and family docs were referral machines (it was a job for the dumbest med students). But I don't think that's true anymore, not after meeting some of the faculty here and elsewhere.
5. I was complaining after psychiatry that I wish I'd become a therapist instead of an MD, since they seemed to do more for people. FM would be more like the therapist and less like the drug pusher.
6. It's natural. It's basic. I like that.
7. It's the most helpful, in terms of morbidity and mortality.
8. I LOVE the idea that one person has one doctor, or at least one main doctor managing the team. The patient centered medical home model really appeals to me, as does the ACO, multispecialty practice, and group visit.
9. I like the idea of managing complexity. Although I don't want to manage everyone's unmanageable syndrome X, I do like to use my brain. (IMED, is that you calling?)
10. I like the idea of being able to everything (ish) for the poor.
11. It has a lower income.
12. It's almost all outpatient. One thing I didn't like about psych and a few of the docs I've shadowed is that they have inpatient and outpatient, and spend a lot of time driving.
13. It has a shorter residency AND (get this) you can do a year-long fellowship in OB and then *poof* I would have spent the same amount of time (four years) getting ready for prenatal care as I would in an OB/GYN residency. I'd miss the surgery (except C-sections) but I would be out from under the thumb of ACOG and not responsible for IUDs, sterilizations, and IVF while still managing what matters most to me anyway (prenatal care, birth, miscarriage, prenatal hospice, NFP, STDs, sex and abstinence ed, and postabortion recovery).
14. I might be able to do residency more easily in my home city. And that means, I might be rotating where I will eventually be a resident. (Better shape up!)

I still have a lot of questions, but that is a long list (and it surprised me how quickly I was able to write it out, as though I'd been thinking about this for a while). I'm still in the first week of the rotation, which has all been lectures, so I haven't seen a single real patient. Time will tell. Please say a short prayer so that I can see what God wants me to do.