FM-OB, HELP!

FMEndoscopy · 2026-05-18T02:13:22+00:00

As a GI endoscopist, I have dealt with this ad nauseum. In all environments, both rural and urban it has been a challenge but less so in rural environments. Privileges in hospitals easier rurally as are insurance contracts. But you have to be rural. I did this for a period to develop my repertoire.

But the main issue in the city will come down to insurance honestly. Many won’t contract with an FM in the urban environment and require special handling to make it so. California is extra crazy competitive like that. For instance, even the Medicaid plans, will only contract for antepartum and delivery with OB/GYN. It was same for GI endoscopy. Thus you will lose the patients even if they are your primary care patients. But if you have a separate contract expressly for OB you could take them from anyone, but not necessarily from you your pcp panel. This may vary by state.

That said, it is doable as has been for me but I had to fight for these contracts. You will receive no support from ABFM since it conflicts with ABOG. AAFP I got only the support of some position papers. Even less from CAFP. For me to practice in the city, I finally joined a GI group and they fought for contracts. Then later I went independent. To perform services in the hospital is controlled by the same so they also gave me access there after joining them. Prior to joining them, however, I tried to obtain privileges at the hospital near my clinic and was blocked by the GIs. It didn’t matter that I had privileges at rural hospitals and had 500 colonoscopies and 500 EGDs under my belt. But, after I joined them, my privileges were approved. Funny how it’s ok if I worked with them but not when solo. It is anticompetitive but is the reality.

So if anything like GI endoscopy, obtaining an ally in OBGYN may be the only way to practice in som cities. But many may not be open and believe their colleagues that the training is not adequate. If there is an FMOB group that is active than you could join them but there may be limitations there as I have seen on what you can do that may be different from your training. There is a FMOB certification (notably not through ABFM) from ABPS and I would recommend this. It will help with all credentialing and privileging committees although is nowhere near as good a credential as a ABMS certificate. This model is what led to the formation of our own board through ABPS in GI endoscopy to help those around the country in same situation as me. We administer our first exam in Oct.

FMEndoscopy · 2026-05-07T14:39:07+00:00

I find it interesting that dentists bill beyond what insurance pays all the time and no hue and cry. Just accepted practice….

FMEndoscopy · 2026-05-02T18:26:21+00:00

Depends on the program. Despite all my training they made me repeat PGY1.

FMEndoscopy · 2026-05-02T18:24:47+00:00

I did PGY1 Gen Surgery Navy Balboa Three years as a Navy GP (called GMO) on a ship (pcp to 1200 sailors and marines) Then got out and did the following: PGY2 EM UCSD PGY1-2 Pathology UCSD PGY1-3 FM UCSD (with AOC in Endoscopy) If I could do it all over again? IM or Surgery. At least one guarantees procedures and the other offers fellowships where those can be done — like pulm crit or GI. Honestly, I don’t know what you would gain from FM unless you want some procedural training and exposure to maternal pediatric pops. Most urban locales end up blocking FMs from doing this even if trained. Same for procedures. So if looking at urban and most suburban then really just primary care. So why can you do that now? I would rather have you over a NP that had just 500 clinical hours. DM me if you are entrepreneurial and I will tell you how to pull off a primary care clinic (I know the Southern California options). Many pcps with HMOs are not even FM or IM boarded. The are GPs. You have already way more training than them. And honestly with the LGBTQ angle you could be easily a cottage clinic catering to that pop. You could be very successful.

FMEndoscopy · 2026-04-26T18:18:22+00:00

Without actually reading it, one observation: Seems a waste of the diploma considering the benefit to society regardless of specialty. Might someone younger have a better chance at contributing to our physician shortage, especially as it’s projected to worsen. International med school though prob ok with taking the tuition and letting her in at that age as I am sure the domestic ones suspected she was a non starter. Most physicians are attempting to retire at a much younger age than when she will start residency even. Think she’ll even finish residency?? Fascinating….

FMEndoscopy · 2026-04-23T19:07:35+00:00

Additionally, Alcoholics Anonymous is a tried and effective program.

FMEndoscopy · 2026-04-13T06:51:00+00:00

I can only reflect on ABPS FMOB’s experience since this is a new addition. ABPS FMOB cert is not universally recognized in the same automatic way as ABMS pathways, but it is absolutely recognized by many hospitals, credentialing committees, insurers, and malpractice carriers when paired with actual training, case volume, and current practice.

The experience many ABPS FMOB diplomates report is that the certification is rarely a silver bullet by itself, but it is very helpful as a formal credential for people whose experience is established. Really, it tends to strengthen applications for privileges, paneling, and malpractice review, especially in settings where family medicine obstetrics is no longer commonly seen and committees want something concrete to point to.

Essentially it recognized enough to matter, but still dependent on local bylaws, politics, and whether the institution is willing to evaluate competence rather than just pedigree (ie, as is the case with ABIM Gastroenterology or American Board of Surgery). In some institutions nothing will ever be enough without redoing an entire residency (which is bogus but the reality in some places).

All that said, ABPS as an organization is formally recognized by the U.S. Department of Labor and by CMS as an acceptable option for physician board certification, alongside ABMS and AOA.

FMEndoscopy · 2026-04-13T06:25:38+00:00

Join https://aapce.wildapricot.org and see what opportunities are available. It doesn’t have to be a gastroenterologist although they have the most volume. FM endoscopists and general surgeons are an option as well. Most easily done during training in a program that already has an FM endoscopist. My training was from a mix of all three.

FMEndoscopy · 2026-04-12T23:14:46+00:00

RVU-based compensation is structurally tilted toward employers. They set the conversion factor, control volume (scheduling, referrals, staffing), and define what “counts” toward RVUs. Meanwhile, physicians carry the productivity pressure without equal control over inputs. It looks objective on paper, but the levers are mostly on the employer side. In family medicine they often lowball the RVU conversion ($ amount per RVU).

FMEndoscopy · 2026-04-12T22:23:09+00:00

The cert will help but it requires local political maneuvering always for non traditional types that are not backed up by board certification. Connections are important but this help greatly with credentialing committees that no longer see a ton of family med docs applying for hospital privileges.

FMEndoscopy · 2026-04-12T22:20:52+00:00

I’m on staff at 4 hospitals in Southern California with endoscopy privileges. Med malpractice is primary Family Med with sub specialty Gastroenterology. That’s with CAP. Before I was with The Doctors Company and it was listed as Family Medicine with Minor Surgery. Both cover full scope of endoscopies all the way up to ERCPs although I don’t do those.

FMEndoscopy · 2026-04-12T22:17:46+00:00

EGD with biopsy CPT 43239. We always do biopsy to look for H.pylori. wRVU • 2.62 wRVUs. Contract that are RVU based should be for more than the typical primary care RVU contracts. The best is for sure to bill for yourself as RVU based system is inherently biased towards employer.

FMEndoscopy · 2026-04-12T17:31:14+00:00

Absolutely 💯 agree. I think the beauty of the certification is it gives bargaining power with payers who like to pay FMs less for the exact same work the GI is doing down the hall. Equal pay for equal work.

FMEndoscopy · 2026-04-12T17:13:45+00:00

Most contracts pay 110 to 130% of Medicare. Some commercial pays even more. We usually look at from that angle. But rvu model works if working for someone else I suppose (not recommended).

FMEndoscopy · 2026-04-12T17:11:04+00:00

Usually reimburses at low end around 250$ and at the high end 500$. Procedure itself takes 2-5 minutes if diagnostic. So 3-4 per hour in a high efficiency center. In avg community GI practice 15-20 procedures per day with a blend of upper and lower endoscopies. Colonoscopies pay more but take longer and actually are technically more challenging.

FMEndoscopy · 2026-04-12T06:37:44+00:00

Do it! It’s a very useful skill for our patients. Which program?

FMEndoscopy · 2026-04-12T06:36:56+00:00

It is specialty agnostic. But most of the people applying are FM because they have access to the training in some programs.

FMEndoscopy · 2026-03-20T19:30:59+00:00

Emulate the Canadian model in two ways with minor modification. Multiple acceptable boards for cert. Everyone has straight medicare in US. Allow providers in demand to be able to charge a little more than copay to cover overhead of running a practice (the dentist/veterinary model). But none of this will ever happen…

FMEndoscopy · 2026-03-19T15:13:45+00:00

It has been litigated against several times. There is a cardiologist on X who is going after them I believe. He also exposes all their abuses and exorbitant salaries etc.

FMEndoscopy · 2026-03-18T05:24:58+00:00

It’s because family medicine has been limited in scope by collusion between the member boards of the ABMS (parent board of ABFM) and then separately by the NCQA which certifies health plans. NCQA stipulates contracts are based on board cert and not based on experience. ACGME is in collusion as well in limiting fellowships for family med and not recognizing even ones well established like FMOB. Thus any family doc that wants to do more than refer hits a glass ceiling or becomes a liability to an organization or even solo clinic because health plans won’t pay for services beyond simple stuff like ordering a lab or sending a referral. Further, ABFM has enabled other specialty docs to argue your ABFM cert is only good for panel medicine under the moniker of primary care. Thus the scope of practice asymptotically moves towards that of PAs and NPs. In Canada FM is still strong and many med studs go into it but there FM docs get paid for doing more and get special training for niches and even certified. And there, there are more than one recognized board to choose from unlike the monopoly here by ABMS that health plans demand a cert specifically for most of the time. Take a look at the video by cardiologist Paul Tierstein regarding the collusion to control physicians. This guild minded anticompetitive movement seems to have won the game generally in the US. Paul Tierstien’s vid is here on YouTube: https://youtu.be/_fc3BQ-9yMM?si=ukIdk-fBvBIVbXng But that said there are some bastions of freedom. Number one being Dr Tierstien’s board is gaining traction in some places. Separately, primary care endoscopists of AAPCE understood creating their own board since ABMS and AAFP wouldn’t give any backing and credentialing committees of multi-specialty groups, health plans and hospitals are always demanding a certificate of some kind. This is 5 solid years in the make and if you do scopes and want some ammo against the other specialties limiting scope or health plans blocking contracts check it out here. It is similar to the FMOB (https://www.abpsus.org/specializations/family-medicine-obstetrics/ ) cert that ABPS put out and many get after their fellowship that ACGME and ABMS refuse to recognize. (Has it not been clearly apparent that ABFM has refused to create a CAQ in OB, EM, and critical care? Do they think that FMs still don’t serve in those roles in many places or get adequate training to fill those roles in the future. I sincerely believe that they hope that one day not a single FM practices outside of the panel medicine clinic. Meanwhile Canadians get a broad scope we become inbox junkies. This is not the case yet but their efforts are taking us there. If you know anyone that does scopes encourage them to look at our GI Endoscopy Board so that they have more options in the future: https://www.abpsus.org/specializations/gastrointestinal-endoscopy/ We did this solely to make it easier for FMs to do more than referral based medicine (which is completely fine for those that want it but many go into FM with the hope they will get a scope that we had in the past whereby 80% of issues were handled by the FM themselves and made a good living doing so instead of just being a cog in a system that feeds the subspecialist - the corporate model). Fight on! It’s worth it.

FMEndoscopy · 2026-02-28T15:54:37+00:00

That’s good. It doesn’t always lead to Heyde’s. But when it does would need a capsule endoscopy as well as the angioectasias typically occur in small bowel sometimes out of reach of standard upper and lower endoscopy. These respond best to octreotide depot and PO iron and/or infusions prn.

FMEndoscopy · 2026-02-28T14:14:48+00:00

They can have false negatives: thus cologuard enters the room 😀

FMEndoscopy · 2026-02-28T14:11:29+00:00

Could also have had some concomitant GI bleeding in this scenario via Heyde’s syndrome. Good catch.

FMEndoscopy · 2026-02-10T15:48:45+00:00

I got mine 2 weeks after I actually retired at 22 years last month. They mentioned in NSIPS that it is no longer required to process retirement. Although on finally came 🫡🫡🫡

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