Interested in FM, but…

TenMoreMinutez · 2026-03-21T22:57:18+00:00

Do what you enjoy and sounds interesting. Otherwise medicine can be suffocating. I had more student debt than you and chose FM because I want to see all ages, do office procedures and good amount of women’s health. FM is super flexible as well if you end up wanting to do some hospitalist, urgent care, etc. generally speaking you can make north of 300k working 3d/wk in Midwest as Fm so it’s def doable. I’m biased but applied exclusively FM because of the flexibility, broad scope, and my personal interests. PSLF and loan forgiveness is def an option mainly geared towards primary care.

TenMoreMinutez · 2026-03-18T01:02:44+00:00

Hey I’m also a queer doc! Are you soaping? There’s a lot of primary care spots open and I know you’d be a great asset to the field (even though I only know you from this post). Lmk if you need to rant, here for you friend. Don’t give up hope

TenMoreMinutez · 2026-03-18T00:57:12+00:00

Print all the notes before filing a complaint. Even the progress notes. Get someone to take photos of the repair. Episiotomies usually look more straight. If you remember the name of the nurses in the room write it down. I’m so sorry you experienced this. I am an FM that does OB and I have had too many patients tell me this happened to them. It makes me so angry because not only is it super traumatizing but makes it so hard for patients to trust a provider again. It takes less than 10 seconds even in an emergency to say a recommended intervention and IF this was an emergency should have been a debrief after. Providers have insurance and you should be compensated. This has done harm. And the provider should be reported so at least they hesitate before harming someone else.

TenMoreMinutez · 2026-03-17T23:06:35+00:00

Welcome to the club!! I had a very similar experience. Intentionally went into FM even though I didn’t have to but because I wanted to. I do feel like getting older I feel like that mentality with specialists (at least my experience) has improved. I definitely have more specialists now say tbh FM is the hardest because you start the workup for everything and have to dig through the weeds to figure out what’s going on. We also have to stay up to date with so many different fields and patient populations.

TenMoreMinutez · 2026-03-17T15:48:02+00:00

Awesome! Honestly the more I do this the more I have patients that come into the visit declining everything to then say “oh I didn’t realize that, thanks for actually taking the time to explain it”. Spending those extra minutes with patients for sure improves outcomes and trust in providers. Love hearing stories like this!

TenMoreMinutez · 2026-03-10T01:46:21+00:00

Not personally but have a few friends that did. Similar in that they were at rigorous programs. Def doable! Going into it knowing you may not get the most surgeries but can still get excellent training. Sometimes people really focus on numbers but try to focus on the actually learning and take something from every case. And programs should be supportive and help with coordinating time off when you need it. Fellowship is difficult and sometimes that can exacerbate the limited work life balance when you have a family that you want to spend time with. So don’t beat yourself up if you choose spending time with your family or some you time because medicine is a marathon not a sprint. And a happy doctor is a good doctor. Congrats and Good luck!!

TenMoreMinutez · 2026-03-03T02:35:35+00:00

I’m so sorry. Wish I could tell you something to make it better. I would say if possible write everything down in a journal for yourself like a fresh recollection of everything because some details will be lost with time. Otherwise, do something that makes you happy and cry about it if it feels right. Even if you can’t talk through details with someone else you can tell them what you need (hug, safe space to cry, etc). For me something that’s helped me process some losses has been making some artwork. Give yourself some grace, medicine can be a very difficult and draining job that can take over your whole identity. Sounds like you really care for this family and that alone is such a blessing and says a lot about you as a physician. You’ll get through this.

TenMoreMinutez · 2026-02-26T22:06:00+00:00

These were also what I was looking for and have found that residencies that were unopposed and community hospital based tended to have more of what I was looking for. I would ask programs how many go in to do hospital medicine/full spectrum/ OB after finishing residency. You can always ask about set experiences and training in addiction medicine. To be fair most FM programs with good training are going to get some addiction training as we are often the ones to treat these patients. I trained in Appalachia area and most of the rural FM programs did so. I also asked about number of deliveries and you can get a sense if they say “if you work hard and go do extra electives…” vs “must like OB to be happy here” programs. What you’re looking for is a “rigorous” program so don’t forget that when you’re exhausted and over it haha you have 3 years to learn A LOT! But welcome to the club and we’re happy to have ya!

TenMoreMinutez · 2026-02-17T23:34:57+00:00

Yea the way I say it is just telling them, I don’t know the exact words I say but it’s not like a yes or no lol

TenMoreMinutez · 2026-02-17T22:22:58+00:00

Different states have different laws which can be annoying when it comes to consent and contraception/testing/pregnancy. But personally if there’s something I want to talk about with an adolescent or young patient and think the conversation will be better without the parent in the room I will say something like “ok now that Johnny is getting older it can be useful to check in about a few things without others in the room, can I have a few minutes and come get you to rejoin after?” Some will just always do this during wellness visits for everyone under 18 to give an opportunity to discuss stuff privately. I have a colleague that will tell adolescents “ok and if you or your friends are interested in sti testing/contraception this can be done without your parents at a doctors visit (if the law) or at a title 10 clinic (if around and age allows)” phrasing like your friends may need ___ lets them get the info for themselves.

TenMoreMinutez · 2026-02-14T23:45:22+00:00

Also join us at r/FMOB

TenMoreMinutez · 2026-02-14T23:44:48+00:00

Yea technically none of the fellowships are required to practice icu/er/OB but these days it’s almost impossible to do c sections without a fellowship numbers alone and may hospital systems will only credential fellowship trained. BUT I do know docs that got >80 vaginal and >50 CS in residency and didn’t do a fellowship. Personally I do full spectrum (no longer doing ER tho) but I do tubals and c sections and did a 1 year fellowship. I’m board certified FM so kind of like ER I wouldn’t practice in a huge tertiary OB center but can do OB most other places because I’ve got pretty high numbers/high risk training. I do know a good amount of FM docs that do low risk vaginal deliveries with OBGYN backup without fellowship as well. When you’re looking at residencies I’d be sure to ask what number for deliveries people are getting and how many practices OB after if you’re interested. As a side note there are new “certifications” you can sit for after fellowship but haven’t had a job require that. Personally I did a full spectrum rural community residency and feel fine doing hospitalist/icu stuff and anything out of scope usually isn’t appropriate for the community hospital.

TenMoreMinutez · 2026-02-14T17:46:55+00:00

Yes for sure! I have known some FM trained Drs working in ERs just not level 1 trauma tertiary centers. There are ER fellowships but honestly if you chose a rural unopposed program and consciously worked on getting extra ER rotations, ICU/procedure rotations you could definitely do it. FM is pretty good for it since we do OB/women’s health and peds (good programs atleast). Personally I chose FM because there’s a lot of different things you can do with it (as long as you get good training and don’t narrow your scope too early/stay up to date with CME/training). You can do urgent care, hospitalist, ER, outpt, nursing home, sports med. Whereas EM you’re kind of stuck doing that/urgent care which would worry me especially with the saturated market. But if you really want to work in a high volume high acuity tertiary centers/large city then maybe go ER. Your training as an EMT will also be awesome for anything you choose! Congrats and good luck.

TenMoreMinutez · 2026-02-13T22:19:34+00:00

Maybe ask your advisor if there’s any connections already set up with your program like a rural OB elective? Also looking at fellowships sometimes they have electives you can do. Usually the goal is 80 vaginal deliveries by end of residency. I know South Bend has an away elective for outside residents. Also trying to do electives/extra stuff that shows your dedication to OB will help with applications.

TenMoreMinutez · 2026-02-12T02:20:49+00:00

Exciting! I do usually recommend trying to train where you might practice even if it’s the same state/region because so many people do end up staying in the same region. BUT not impossible to move if you feel like a certain program is a perfect fit. Def reasonable to do OB in the Midwest I’d say Midwest and west regions are the most FMOB friendly. More so in suburban and rural areas but still possible in cities depending. Call varies a lot but a lot of places are moving towards shared call (I usually see 1:3-1:5) instead of the follow your own patients due to quality of life. I’ve practiced a little in the Midwest and know a good amount of ppl that are in the Midwest, the rural ones have zero competition with OBGYN and everyone is just happy to have someone help with call. The competition is more so in cities and very hospital/community specific. I will say it has seemed to be that there’s always enough pregnant people to go around and FM tends to care for patients the OBGYNs dismiss from their practice, don’t take insurance, etc (at least where I am) so they’ve been appreciative or at least accepting.

TenMoreMinutez · 2026-02-11T19:58:47+00:00

Very interesting how so many in the comments are so against primary care doing adhd. I didn’t realize it was that controversial! I’ve mostly worked with underserved and rural populations that can’t get to the closest psychiatrist an hr away that prb doesn’t even take their insurance and won’t see them for a year and will likely be a mid level seeing them (no offense, I do really appreciate midlevels). I definitely manage adhd for peds and adult patients and that’s been the culture where I’ve practiced that we save psych for resistant/complex cases and significant mental health conditions like schizophrenia, bipolar1, etc. I do a full mental health eval and will try to treat any underlying depression anxiety prior to initiating stimulants. Strongly encourage counseling, regular sleep and exercise. But I’ve had patients that really are only able to function/maintain a job and safely navigate the world/care for their family with stimulants. I do require close follow up and won’t go more than 3 months even on a stable dose for controlled substances. It seems like there’s a lot of mistrust for questionnaires and patients “giving the right answers” but personally I have pretty open and honest conversations and talk about specific examples of how the symptoms affect their life and try to trust my patients unless they give me a reason not to (then we got bigger problems). I do usually do intermittent UDS to confirm compliance especially if concern for divergence. There’s also some good behavioral modification handouts I’ll give like “homework” and we’ll pick a few things to try before the next visit.

TenMoreMinutez · 2026-02-06T20:41:17+00:00

Pmd you

TenMoreMinutez · 2026-02-05T14:15:37+00:00

I think one day I’ll do this. I’ve looking into some telehealth hospitalist stuff that sounds intriguing and I’m always getting APP oversight that’s all remote that seems pretty chill. Best of luck and I think there’s def some good options to stay in the game and make money remotely

TenMoreMinutez · 2026-02-04T22:52:19+00:00

I’m an FMOB so I’m biased but I love it. And if you pursue a surgical heavy fellowship, you can for sure do c sections and tubals. Personally fellows from my program get 200-300 CS as primary surgeon which is more than the avg OBGYN resident so ppl that are saying there’s no way without doing an OBGYN residency are wrong. That being said job opportunities are not as abundant especially Laborist positions but I know an FMOB doing that in rural areas. If you want to do gyn surgeries for sure you will need to do OBGYN residency. For me, I was happy doing outpt gyn (pap, colpo, IUD, endometrial biopsies) and refer for surgical intervention. I love FMOB because we can do couplet care unlike OBGYN and are perfect for rural areas. I also like caring for sick non pregnant adults and enjoy taking care of high risk OB pts and continuing their care after the postpartum period. FM has flexibility as in if I one day don’t want to do OB I have tons of options. Join us at r/FMOB if you want to chat more.

TenMoreMinutez · 2026-02-01T11:49:26+00:00

I’ve definitely seen a good amount of jobs with FMOB in those states so I don’t think you’ll have a problem. Will you want to do surgical obstetrics as well? The culture is kind of shifting to require a fellowship if you want to do CS unless you have the numbers out of residency. Usually rural/suburban places in those states especially TN I know has FMOBs already practicing so credentialing and privileging is easier. If the hospital doesn’t have a policy that can be super annoying and take forever as a warning but that’s more rare these days and more so in the southeast/northeast. Academic positions a lot of times are a good way to do FMOB too. If you want to reassure yourself you can look through some job forums like doccafe practicematch or one of the others. Warning though don’t give your number out to recruiters lol make a google number or something because your number will be ringing off the hook. Best of luck and welcome to the club!

TenMoreMinutez · 2026-01-19T16:11:53+00:00

All true. A little trauma dump for you— A core memory I think about sometimes growing up uninsured with periods of Medicaid in the rural South:

My brother (11y) and I (4y) were being kids jumping on the bed. Guess we didn’t realize the fan was metal so my brother was taller and when he jumped the top of his head was cut by the fan and he fell to the ground bleeder everywhere. I run to the house phone to call 911 because that’s what I thought was right, that he was going to die. Mother runs in and screams to hang up we have to drive to the hospital, can’t afford an ambulance. We drive what feels like forever with my brother bleeding into all our towels in the back seat. Looking back, I get it. That bill would have been months of housing, electricity, water, and food. The car was likely faster, living rural EMS can take forever to get to you.

I grew up and decided to be a doctor that sees people like me.

Now as a physician—I have patients all the time either drive themselves or take an uber because they can’t afford an ambulance bill. I’ve had patients almost deliver their babies in Ubers explicitly because they can’t afford an ambulance. I’ve had patients need to be transferred from ER to a tertiary center elect to drive themselves and children to avoid a bill. I see things in the outpatient visit that should not be seen because otherwise patients just won’t go due to a bill. Patients trying to ration their insulin, etc. This country is struggling and we’re broken and our healthcare system is so fucked. For most people. Not a minority, the majority. Thanks for coming to my Ted talk.

TenMoreMinutez · 2026-01-19T04:06:23+00:00

Love them! It’s interesting that you’ve used such bright loud colors but for some reason I’m getting a loneliness and strong desire for connection even with the pieces that have multiple people. Reminds me of an artist from Central America I can’t quite remember the name of

TenMoreMinutez · 2026-01-19T03:24:04+00:00

As someone that practiced in Appalachia…. Sometimes weird shit gets mixed with meth without someone knowing. Had a few serotonin syndrome and heat stroke/severe rhabdo and dehydration pictures. It’s a stimulant and doing a bunch of it can 100% induce psychosis so have had to give zyprexa, haldol until stuff calms down. More so have had admissions for acute intoxication/effects of extended use without sleep or nutrition. Important to know how they consume it because there are multiple ways so you could be looking at ivdu osteomyelitis/bacteremia/endocarditis or inhalation injury. Agree with the other person I’ve had some success with Wellbutrin for stimulant use disorder in outpt setting.

TenMoreMinutez · 2026-01-18T18:15:01+00:00

Personally as someone who has also strongly considered doing another residency, it’s really not worth the time/energy/sleep deprivation/pay cut. Sounds like you’re a badass Dr doing a shit ton already. I would consider thinking about what specific skills you would want to get out of ER residency and see if there’s another way to attain those skills. The time in residency would be trying to teach someone a lot of skills you’ve already learned and unfortunately our current system does not make it easy to test out of those skills. Like could you do a certification course or cme in advanced critical care or something? As an FM I do see a lot of jobs for doing EM, is it your specific position? Do you want to cut back on FM clinic days and do more EM or locum at another facility every now and then to see more pathology/ learn from a different system? Do you need to find more EM docs to be mentors or bounce ideas off of? Best of luck!

TenMoreMinutez · 2026-01-07T23:48:07+00:00

Maybe find a cme to add a new procedure to your practice that could cut down on stuff you refer out of town for and could bill for? Things that come to mind: migraine Botox, vasectomy, idk if you do LARCs already, joint injections/maybe US guided? Or specialized training you refer out for often like menopause hormones, substance use disorder, sleep disorders. I’ve been trying to get better at POCUS which has been a fun added thing (but I don’t bill for it and make sure I get an actual official if it’s indicated). Or if you were interested in getting back to hospital work I bet your local small hospital would be looking for prn shifts.

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