Sunday, May 3, 2015

To be or not to be.....a generalist

Hello MiMers!

I'm nearing the end of my Family Medicine residency and am struggling with the age-old question: To be or not to be?....a generalist.

I've always loved the variety and scope of FM. To me, there is such great appeal of being a jack-of-all-trades kind of doctor. I love being the first point of care, collaborating with specialists, seeing new and unfamiliar problems, and flying by the seat of my pants. Growing up in Canada and being surrounded by a culture of Family Medicine has undoubtedly shaped my love for general practice.

That being said, after countless hours of studying, rotations, patient care, and hard work, I am sometimes weighed down by the questions, "What am I GOOD at? What's my area of EXPERTISE?" Sure, there are the things that I see everyday and feel pretty comfortable with: Diabetes, high blood pressure, back/shoulder/knee pain, asthma, preventive care to name a few. But this always comes with the knowledge that I'm not necessarily an EXPERT in those fields. Can I really be giving my patients the best care for their problems if I'm not an endocrinologist (diabetes)? orthopod (shoulder pain)? pulmonologist (asthma)? Could I give a thoughtful, professional-level lecture on any of those subjects?

I've been seduced many times during residency into doing a fellowship. At one point, I've seriously considered a fellowship in geriatrics, OB, EM, sports med, palliative care, dermatology and HIV/AIDS (to name a few). But I can never seem to commit myself to narrowing down to one subject. I find myself getting back to the same fear of getting pigeonholed into one area and losing my ability to be a generalist. It is quite a humorous mind-loop that I get into time and time again.

Ladies, lets discuss. What do you love about being a specialist? Or a generalist? I'd love to hear your thoughts.



  1. When I was a child, it was my generalist family physician who inspired me to become a doctor. I shadowed him one summer during college and asked him to write one of my letters of recommendation for medical school applications. It was a sweet letter, dotted with white-out, but sincere.

    I'm in general internal medicine. I was at first intimidated by the wealth of information that you feel like you need to know but ultimately could not imagine focusing on just one part of my patient.

    Society of General Internal Medicine recently put together a brief 3 minute video aiming to explain why general internal medicine makes for a rewarding career. I got to be part of it! (totally fun to have a video camera follow me around one day at work). While it is about general internal medicine, it applies to general family medicine and peds too.

  2. I think it's much harder to be a good generalist (e.g. IM, FM, peds) than it is to be a good specialist. Generalists add tons of value to patient care, to the hospital, to our entire health care system. Most physicians know this, whether or not they verbalize it.

    Currently I know generalists (IM, peds, family medicine) are doing very well. They seem to have opportunities to live and work almost anywhere, great pay and lifestyle, etc. I have friends and friends of friends in IM, peds, and FM who are living in their ideal location, working better hours, and making better money (per hour) than friends who are specialists. I have a friend who is only about a year into her FM residency in a very small place most people have probably never heard of, but she's already getting great job offers. On the other hand, I know of a cardiologist who is seriously considering leaving cardiology to work as a hospitalist because the work/life balance and pay (per hour) is actually better as a hospitalist, or so he says.

    My guess is generalists will do better under the ACA, while most specialists will likely lose ground. It seems to me many specialists are hurting - i.e. working crazy hours, making less money per hour, not able to get a job in a location they want or at least not right off the bat. It seems to be a great time to be a generalist.

    Also, some people say being a hospitalist is like being a glorified resident (e.g. getting dumped on by everyone). I suppose that's true to an extent. Although it seems much better to me working as a hospitalist in private practice than it does in academic medicine (e.g. no endless rounding, just get the job done). But at the same time, being a specialist is like being a glorified fellow! It's not as if specialists have it all that easy, and in many cases it looks worse than generalists, at least to me.

    All I've said is obviously anecdotal though. So please keep asking others for their thoughts and opinions to form a better picture in your mind.

  3. I ponder the same question, even though I'm technically in a subspecialty. In my case, the question is also impacted by location. There are enough generalists around where I hope to practice that I may have a much easier time finding a job if I choose a needed subspecialty.

    It's also hard to imagine what private practice would be like. I fortunately had a couple glimpses of a couple different practices, but if the only thing I had to look forward to was continuing with where I'm currently rotating I might look for a different career.

    1. Perhaps I should clarify: My specialty has multiple subspecialties; FM, IM, Peds consult us and we may send patients on to someone even more subspecialized. I'm not in a subspecialty at this point.

  4. I am a family physician and I really enjoy the variety that I see everyday. It is challenging to keep on top of everything, but it's extremely rewarding to see a 100 year old and then see a newborn! I also do OB. We have a large breadth of knowledge, but not the depth that specialists have. The key is knowing when you don't know something and looking it up or asking a partner or running it by a specialist and knowing when to refer.


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