Family Medicine Rotation / Clerkship: How to Survive It

Now THIS was the rotation that I have been waiting for. The one rotation in the field that I want to go to. When I practice medicine, I plan to have my own outpatient clinic for treating adults and children (6 years old and up). Therefore, not only am I going to learn the medicine, I was going to learn how to operate an outpatient practice — from getting patients, to getting paid, to stocking the office, to scheduling the appointments, and to whatever else necessary for a successful thriving practice.

Looking back, I’m not sure if I learned everything that I have hoped to learned. Towards the end, I just couldn’t take it anymore and sincerely wished that the rotation was over. I have been disappointed.

My Experience with Family Medicine Rotation

I started this rotation after my pediatric rotation.

Since my school’s focus is to produce primary care doctors, specifically family doctors, the family medicine rotation was the longest among all the rotations: 12 weeks.

I spent the first 2 weeks in the pain / OMM clinic. There is nothing much to say about this. People came in with complaints of pain. I diagnose a musculoskeletal dysfunction, and then I treat it with my hands (without HVLA or high velocity low amplitude thrust). Personally, I feel that osteopathic medicine has as much benefit as stretching and massage. It makes the person feel good temporarily. I may offer it in my future practice if the demand is there. However, tThe one aspect that I don’t like about osteopathic medicine is that it could be a bit tiring to do.

I then spent the next 10 weeks in my school’s clinic. Originally, I was supposed to work in a local outpatient practice, 5 minutes from my house. I specifically wanted to avoid my school’s clinic because it is not an accurate reflection of a personal business. Unlike a private practice, a school clinic would survive even if it is unprofitable. At the very last moment, one day before I was supposed to start, I received a notice from the school that my preceptor (the doctor I rotate with) wanted to take a break and did not want any rotating students in his practice. So by default, I was placed in my school’s clinic. Just my luck.

I heard I will get to do a lot of things in my school’s clinic. So I fully expected to give shots, draw blood, and more. I gave lots of shots, but only drew blood once. I also wrote out the whole SOAP note, from history all the way to the plan. It was a decent learning experience.

But there was one main thing that drove me absolutely insane

I only had 10 – 15 minutes with a patient!

For a simple upper respiratory infection, the time limit is not a problem. For for someone a bit more complex (i.e. a diabetic, hypertensive, menopausal lady that had surgery 2 weeks ago), the time limit hindered me from giving her quality care. (One of the doctors consistently stayed until midnight because he wanted to give quality care instead of rushing.) I absolutely hate the time limitations with the patients, which are indirectly in-place due to the artificially low reimbursements from government and insurance companies. (Read Are Doctors Going Broke in Today’s Healthcare Environment? to learn more.)

That is why I have resolved not to accept any form of insurance. Doing so prevents me from giving quality care to my patients.

I want to tell you about something I saw that just about broke my heart:

A 20-something year old, African-American girl came in with a complaint of chest pain. She clearly like me and I thought she was pretty cute. I would have asked her out if it wasn’t frowned upon by the medical board. (My view on not being able to date patients will be a subject for another day.) She told me about her job in the warehouse and I made her laugh. Anyways, Lothario here (referring to myself in the third-person) diagnosed her chest pain as costochondritis. I did OMM on her and she felt better. The attending came in and saw her. She was in and out of the door within 30 minutes. (She got more time than usual because she was a new patient.) And I proceeded on to my next patient.

Later on, one of the secretaries told the doctor that the girl was crying as she left the building. Basically, she is making minimum wage and does not have health insurance. Her bill came out to be over $300, for a 30 minute visit. And as she charged the bill to her credit card, tears streamed down her face. It is high-way robbery. If I charge $300 for 30 minutes of my time, I would make $1,200,000 per year before expenses. If the office bills the insurance company $300 for the same visit, you can bet with your life that the company will not pay the full amount. So why should a poor little girl pay more than a rich business entity?

It totally boggles my mind.

The main thing I have learned is that the US health care system is seriously screwed up. 10 – 15 minutes per patient. Crazy high bills for the people can who least afford them. Decreased reimbursements for the services that are most important. That is why I am going to forge my own path and do what is right for my patients. Screw the system.

How to Get Through Family Medicine Rotation in One Piece

By the end of the 12 weeks, I could not wait until the rotation was over.

The medicine aspect is not too difficult. You will see lots of the same things: cough, upper respiratory infection, influenza, hypertension, diabetes, and obesity. Heck, if I had a medical license, I can start a practice this very day and treat 80% of my patients just based on the aforementioned diagnoses.

The challenging part is running on the hamster wheel non-stop and trying to see 20 or more patients per day. It is a test of endurance.

Hopefully, you scheduled the family medicine rotation after the internal medicine, pediatric, and OB/GYN rotation. The family medicine shelf exam will cover the topics in those three fields. If you did, 2 or 3 weeks is enough to prepare for the shelf exam. But if you didn’t, you may need 4 or 6 weeks to prepare instead.

Books for Family Medicine

I treated the shelf exam as if I was studying for COMLEX. Therefore, I used:

If you have the time, try to do all the internal medicine, pediatric, and OB/GYN part on the question bank. Read through the explanations, even if you got the answer right. Then refer to the corresponding sections in the three review books.

Assuming that you have this rotation later on in the school year, the harder you study for this shelf exam, the less work you will have to prepare for COMLEX.

Just as a side note, if you are taking the COMAT, check out this excellent resource straight from the makers of the COMAT. It will show you which topics are tested and will give you a short practice exam — all for free!

Just remember… If you’re like me, the real world of medicine is very disheartening and does not make a lot of sense. Keep pushing forward, have a love for your patients, and do what’s right. The medicine is the easy part. Breaking away from the broken system is the hard part.

This article is part of the How to Survive Medical School series. Click on the link if you want more tips and hints about surviving academic hell.

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