Family Medicine in USA: Best Choice For IMG

Family medicine is the backbone of health-care system in America, and family physicians take care of most health care problems and needs regardless of age and gender.  

Family doctor in USA takes care of the whole family, creating caring relationships with patients and their families. That’s why family practitioners are trained to provide fully comprehensive care through all the stages of his patient’s life.

All family practice physicians are specially trained in preventive medicine, because preventing a health problem is better than having to overcome one. Family doctor help patients to make the right health choices to keep them and their families healthy.

Salary of  Family Practitioners in USA 

According to the Bureau of Labor Statistics, the average salary in family practice medicine is $168,550. As you can see, family doctor salary is lower than that in Cardiology or Radiology - that's why the American Grads with huge loans take up the specialties while Foreign grads with much lesser or nil loans increasingly do not mind taking up primary care.
  • Houston, TX = $156,000/-
  • Los Angeles = $168,000/-
  • Miami, FL = $170,000/-
  • New York, NY = $178,000/-
  • Seattle, WA = $159,000/-

Family Practice Pros and Cons

Let’s start with pros:
  • Cool and 'un-hectic' Family Medicine Residency, easier to get. Good choice for International Medical Graduates.
  • If you prepared work hard - pays can match Internal Medicine and even more in the rural areas as you handle more than just family medicine - like Psychiatry,  Pediatrics and Ob-Gyn.
  • Due to the restructuring of health system economy in the US, aimed to cut down spending on specialist and improve primary care, the demand for Family practice doctors  has seen a whopping growth over the decade.
Here are the main cons:
  • You get a 'Jack-of-All-Master-of-None' Feeling
  • Got to stick to the primary care-world
  • Apparently, there's a perceived "lack of respect" from other specialties
  • Though a majority report career satisfaction, a recent survey tells us most of the primary care physicians are not happy with their salaries.
But again, there are ways to increase that bottom-line with Family practice, which you will begin to understand better once you know how the insurance system and physician compensation works. Here are some that you should know:
1. Office Procedures and Cosmetic procedures will shoot your incomes up, so if you are planning on a residency or end up doing a residency in family medicine, make sure you choose a program that trains you well enough in these - like colonoscopies, etc. Some residency programs even offer dual training - like Family Practice-Psychiatry, which by the way is pretty hot at the moment. As a friend tells me, his senior resident in Family-Psychiatry program recently accepted a job offer in an underserved area of Texas for a salary of $335,000/- per annum !!

2. Another pathway in gaining hotness with family practice guys and also with other primary care folks (internal medicine, pediatrics, etc.) is the Hospitalist Pathway. Technically, a hospitalist would be defined as a physician who devotes more than 25% of his work-time to a hospital. But hospitalists today prefer to be full-time with better pays and benefits. What's more, Internal medicine board is coming up with a hospitalist track fellowship that will accept residents from internal medicine, family medicine, pediatrics and psychiatry into the track. 

3. Yet another pathway that's helping family physicians rope in big money and have a more relaxed, controlled lifestyles is that of "concierge medicine", "concierge practice" or "concierge doctoring". Also know as "Boutique" or "Retainer Practice". The principle is simple - instead of cramming tons of patients in a single day that are insured by third party payers like Medicare, Medicaid and private insurances, you let loyal patients in your area 'sign-up' or 'subscribe' to your clinical primary care service for a yearly fee. In other words, you provide your own insurance and provide a prepaid primary care model.
This makes both patients and the physician happy ?
Family practitioners in USA no longer needs to work 12 hours a day just to have critical volume to make a good salary rather only needs to see about 2 to 5 patients a day or less and make the same or even MORE money. The patients in-turn get more quality time with their doctor and less waiting time. I once read an article on how a family physician made 300,000/- a year with 3-4 hours work a day after having about 200 patients subscribe to his practice at two-levels. Basic service at about $1200/- a year and Plus-service that includes round-the-clock access even on weekends at a higher fee. 

Who loses ? The Medicare-Medicaid patients who cannot afford those rates....even if they could afford, it is illegal for a physician to charge "extra" for services already covered for patients paying through their Medicare coverage. As this article that appeared on the AAFP says:

"Physicians who charge Medicare beneficiaries additional fees for "boutique" or "concierge" care might be violating Medicare laws. An alert issued recently by the Department of Health and Human Services Office of Inspector General  reminded physicians that charging extra for services that are already covered by Medicare could result in fines or exclusion from Medicare."

4. And finally, the latest trend amongst all physician non-specialists and specialists in USA (and probably will catch on with the world) is setting up a parallel "medical spa" practice for cosmetic treatments like Botox, laser hair removal and lip remodelling.

How to Become a Family Practitioner In USA ?

A three year Residency in Family Medicine following Medical school makes one a Family Doctor. Most Family Medicine Residency programs have urban tracks or rural tracks or both and also train doctors in routing Obstetrics and Gynecology.

How to Prepare for USMLE Step 1? Read UUSMLE Step I – Frequently Asked Questions and USMLE Step 1 Preparation Books Review.

What Fellowship Options are Available After Family Medicine Residency ?

Not as many as in Internal Medicine, but here are some:

  •  Sports Medicine Fellowship
  •  Geriatrics Fellowship 
  •  Internal Medicine Fellowship 
  •  Emergency Medicine Fellowship 
  •  Hospitalist Fellowship 
  •  Urgent Care Fellowship