Ok. I’m going to be honest here.

Ever since Carina decided to become a doctor about eight years ago, I’ve always sorta felt sorry for FM docs. I mean, they go to all that stress, time and effort to plow through medical school, and then they never got to do any of the really cool doctor stuff, like see the insides of people’s bodies, or send probes into blood vessels, or insert gigantic needles into spinal columns, or even intubate emergency patients in the ER. They just sit in a clinic, see endless cases of runny noses, acne, and skin rashes, hand out prescriptions, and refer away anything remotely interesting to the specialists.

So recently, when Carina decided to take the Beaumont pre-match offer to do Family Med and start six months early, I have to admit that it was a bit of hit to my pride. I LIKED the idea of Carina being an oncologist (which was her original goal).

However, since we’ve known that Carina will become an FM, and not an oncologist, I’ve been doing a lot of research on what family med docs can do after they finish residency. And I thought I’d share my findings here.

One of the first things I did when Carina got the offer was to call Mike McGlue, a fellow AUC grad (and who’s wife Cheyenne was our Spouse’s Org sponsor as we came to the island) who is half way through his FM residency. I also called Matt Lew, a student who is a semester ahead of Carina, and who’s dad owns his own FM practice in California. After his FM residency he plans to work for his dad and eventually take over the practice. And, I spoke with the accountant in the office where I work whose son is almost done with his FM residency.

From these conversations, and from the research, I began to formulate a very different idea of what life can be like for general practitioners when they are done with residency.

Fellowships for Family Medicine Doctors

A fellowship is a way for a doctor to further specialize in his or her selected field. Had Carina decided to pursue oncology, she would have done a three year residency in Internal Medicine, followed by a two year fellowship in Oncology. Until I began to research FM, I had no idea that there are fellowships available for FM docs as well. If you have finished a residency in FM, you can do any one of the following fellowships:

Emergency Medicine

Learn to do everything an ER doctor does. Many (but not all) end up in rural hospitals, and they do everything an ER physician would who did a full residency in Emergency Medicine.

Board Certification: After completing a full residency in Family Practice, Internal Medicine, Pediatrics, or General Surgery, followed by an approved one-year fellowship in Emergency Medicine, a physician is eligible to become an ABPS* board certified specialist in Emergency Medicine. This is controversial, and I’ll cover it more further down this post.  (More info at the website of the American Board of Physician Specialties.)


Spend an entire year immersed in an OB department learning to deliver babies. Become certified and trained in everything an OB physician does, including c-sections and high-risk deliveries. Then, become the primary care physician for both the mother and the baby. Usually, but not always, this is meant for FM docs who will work in smaller or rural hospitals. One of the smaller Beaumont hospitals where Carina is a resident has multiple FM doc who specializes in OBGYN.

Board Certification: After completing a full residency in Family Practice, followed by an approved one-year fellowship in Obstetrics, a physician is eligible to become an ABPS* board certified specialist in Family Medicine Obstetrics.  More info on eligibility at the American Board of Physician Specialties.

“ABPS also has a program to allow general practitioners and family physicians to become certified in obstetrics. A GP [general practitioner] or FP [family practitioner] in a rural area with little or no access to an Ob/Gyn residency program nonetheless delivers a lot of babies. He or she is doing the work of an obstetrician and has the qualifications. With our certification, he can get reimbursed as a specialist.”

— Herbert Pardell, a DO in Hollywood, Florida, and past President of the American Association of Physician Specialists

Women’s Health

While the Obstetrics fellowship focuses on labor and delivery, a Women’s Health fellowship focuses on Gynecology. As an example, the University of Michigan offers a one to three year fellowship in Woman’s Health. From their website:

“You will be a fellow in the department of OB/GYN… focusing on… Women’s Mental Health, Adolescent Gynecology, Urogynecology, Breast Disease, Endocrinology, Adolescent Health, Pulmonary Diseases, Women’s Heart Disease, Hysterectomy alternatives, Complementary and alternative medicine, Medical Education, and research.”

Board Certification: Don’t quote me on this, but unlike Obstetrics, I was unable to find any board certification options for FM physicians who complete a Women’s Health fellowship.

Hospital Medicine

Spend a year doing in-patient, with the goal of becoming a Hospitalist when done. Exciting, fast paced, and something new every day. The vast majority of hospitalists come from an Internal Medicine residency, but more Family Medicine residency programs are gearing their curriculum to prepare their physicians for careers as a hospitalist. (Source, and more info.) The advantage of coming from FM instead of IM is that FM physicians have been trained to care for patients of all ages.

However, you probably don’t even need a Hospitalist fellowship to land a job as a Hospitalist after an FM residency.  Many hospitals will take you right out of residency.

Board Certification: After completing a full residency in Family Practice, followed by an approved one-year Hospitalist fellowship,a physician is eligible to become an ABPS* board certified specialist in Hospital Medicine.  More info on eligibility at the American Board of Physician Specialties.

Integrative Medicine

Combine conventional and traditional medicine with alternative, Eastern style, holistic medicine. This is an emerging field, and it’s developing as you read this.  Recently, teaching hospitals around the country have begun to offer these fellowships to meet a rapidly growing demand.  I’ll talk about this more a little later in this blog post, as Carina is interested and curious.

Board Certification: After completing a full residency in Family Practice, followed by an approved one-year Integrative Medicine fellowship, a physician is eligible to become an ABPS* board certified specialist in Integrative Medicine.  More info on eligibility at the American Board of Physician Specialties. Also, more later in this blog post.

Sports Medicine

Become a team doctor for a college sports team, or professional sports team. This is a sub-specialty of several top-level specialties, including Family.  I learned a lot about what this career track could look like from Duke’s School of Primary Care Sports Medicine Fellowship web site.  And, the American Osteopathic Academy of Sports Medicine’s web site has a great FAQ about Sports Medicine in general.

Sleep Medicine

Self explanatory.  This is a sub-specialty of several top-level specialties, including Family.  It’s popular with some doctors because it’s more lucrative than clinical work, and it can be done part-time in conjunction with their normal practice.

Behavioral Health

There are a few one-year post FM residency Behavioral Health fellowships for rural physicians who would like to also be able to offer psychiatric services to their patients.

Other Fellowships Available to FM Physicians:

  • Addiction Medicine / Substance Abuse
  • Faculty Development
  • Geriatrics
  • Hospice / Palliative Care
  • International
  • Preventive Medicine
  • Research
  • Rural Medicine
  • Under-served Dermatology
  • Urgent Care

If you would like to learn more about any of these fellowship programs, I found this info on the web site of The American Association of Family Practitioners.  It’s a fantastic place to research fellowships for FM doctors.

Integrative Medicine:

Duke's Center for Integrative Medicine

Duke’s Center for Integrative Medicine

The quick way to explain Integrative Medicine is that it integrates Eastern style, holistic treatment of the entire body with traditional Western medicine.  There is an extensive article on Integrative Medicine on WebMD.com.

“Integrative Medicine combines conventional Western medicine with alternative or complementary treatments, such as herbal medicine, acupuncture, massage, biofeedback, yoga, and stress reduction techniques — all in the effort to treat the whole person. Proponents prefer the term “complementary” to emphasize that such treatments are used with mainstream medicine, not as replacements or alternatives.” [emphasis added]

This is a fairly new field in Western medicine, and as fate would have it, the hospital system where Carina is doing her residency, Beaumont, is one of the hospitals that has embraced this specialty.  They are not alone.  Some of the largest and most famous hospitals in the world have as well, including the Mayo Clinic, and Duke University.

Duke’s Center for Integrative Medicine

Duke’s Center for Integrative Medicine

The American Board of Physician Specialties has recently created a board certification for Integrative Medicine.  Their website lists more details, with information on eligibility requirements, and a list of hospitals which offer approved fellowships. The University of Michigan, among others, offers a one year Integrative Medicine fellowship program for physicians who have completed a Family Medicine residency.

A large percentage of the patients at Beaumont’s Center for Integrative Medicine are cancer patients who, in conjunction with their oncologists, are also seeking treatment for their entire bodies, and not just for their cancer.

When Carina first heard about this, she became acutely curious and interested.  During her second and third years as a resident, she plans to rotate through Beaumont’s department, and to explore it as a possible career path.

(In fairness to the scientific method, Integrative Medicine has it’s share of skeptics.)

Medical Procedures for Family Medicine Doctors

Many family medicine doctors refer away to specialists a lot of procedures (and thus, money) that they very well could be doing themselves.

In addition to being able to specialize by doing a fellowship, family med docs are also able to become trained in, and to perform a wide variety of medical procedures that we often think of as being done exclusively by specialists.

I first became aware of this when having a water-cooler chat with the accountant where I work. Her son is almost done with his FM residency, and in the process, he became trained and certified to do colonoscopies. He has a job lined up with a rural group where he will do normal clinicals four days a week, and one day a week he will be in the hospital performing colonoscopies. He’ll earn as much in that one day as he will all the other four days in the clinic.

About the same time, I had a conversation with Matt Lew, a fellow AUC grad, who told me that his father has privileges in a hospital associated with his practice, and if any of his patients are hospitalized, he is their primary care physician while they are admitted. He also told me about an FM doc in the same group as his father who greatly supplements his practice’s income by performing cardio stress tests.

These two conversations sent me online to do some research, where I found the National Procedures Institute, a company that trains FM docs on how to do procedures they probably won’t learn in residency, but which they can legally do in their own practice.  The idea is to keep FM physicians from referring away procedures to specialists, and to teach them how to do them themselves.  Some of the procedures they teach:

  • Aesthetic Procedures (botox, laser, etc)
  • Allergy testing
  • Dermatology procedures (biopsies, wart removal, etc)
  • Colonoscopies
  • Cardio Stress Tests
  • Hospitalists Procedures (deep sedation, lumbar punctures, ultrasound diagnostics, intubation, etc)
  • Imaging Interpretation (reading x-rays)

See the complete list here.

Also, while recently doing a surgical rotation as part of her FM residency, Carina had a revealing conversation with an ENT surgeon.  He told Carina that he would like the FM docs in their hospital to become trained and certified to do ENT scopes, so that they could diagnose patients before they send them to surgery.  And, he said, doing so would allow the FM docs to bill for this (lucrative) procedure.

Rural Medicine for FM Doctors — Do It All!

Mike McGlue, the doctor with whom we crossed paths for one semester on the island, is in a residency program that is unopposed, which means that Family Medicine is the only residency program in his hospital. He’s not competing with other residents for the time and attention from the attending physicians (like the surgeons, for example) who normally would not be able to spend much time with him.

He is learning to do a LOT of things that an FM doc in a much larger hospital (with residents in various specialties) would not be able to learn. He is spending a lot of time in the Emergency Room, and in the Operating Room. And when he’s done with his residency, he plans to either stay put in this hospital, or find a position in another rural hospital where he can fully utilize the emergency medicine and surgical skills his is currently learning.

If you are willing to do an FM residency in a small rural hospital, and then to also practice in such a hospital, your options are WIDE open, and on a routine basis, you will do procedures than most FM docs will never do.

International Opportunities for FM Doctors

There are places in the world that are desperate for general practitioners, and there are companies that will send American FM docs to those places. Global Medical Staffing works with American doctors and with foreign governments and hospitals to put the two together. Doctors can go for a few months, a few years, or stay their entire career. Some of the top countries and locations where they place doctors are New Zealand, Australia, the Pacific Islands, and the Caribbean, to name just a few.

Also, the US State Department places a general practitioner doctor in each one of their embassies around the world to serve the US Citizens working in the embassies. They are always hiring!

Bottom Line… You Are The Master of Your Career

The career options for Family Medicine doctors are much more vast, wide, and deep then I ever imagined.  This brand of medicine can be about just being a clinical doctor, if that’s what you want. (And that is what some of Carina’s fellow residents want.)

But, it can also be so, so much more.

What I’ve learned is that it’s really up to each FM doctor to set their own career path. You just need to decide what you want to do, and then be assertive about making it happen.

Smaller hospitals around the country are desperate for doctors to join them.  In your third year of FM residency,  you will be bombarded by recruiters trying to coax you to come work for their group or their hospital.  And because they are desperate, you can dictate some of the terms, and you can be picky.

If you want to spend some days in their Emergency Room and some days in the clinic, let them know.  If you want to do minor surgical procedures, then do some electives in surgery, let the surgeons know you want to master a few of the more simple surgeries they do (ex: cyst removal, vasectomy, colonoscopies, etc), then let potential employers that you want to do these procedures.

The worst they can say is “No”, but eventually, you will find one that will be willing to accommodate your career desires, and in fact be excited to make sure it happens.

And in the mean time…. a residency in Family Medicine is less hours, less stress, and less years than many of the other residency options.




*Becoming “Board Certified”

There are three organizations which provide Board Certification in the United States for M.D.’s and D.O.’s:

  • American Board of Medical Specialties (ABMS) 
    • Recognizes and board certifies 24 specialties, 147 sub-specialties
    • Recognizes the following sub-specialties of Family Medicine, for which they issue Certifications of Added Qualifications (CAQs):
      • Adolescent Medicine
      • Geriatric Medicine
      • Hospice and Palliative Medicine
      • Pain Medicine
      • Sleep Medicine
      • Sports Medicine
    • Oldest, established in 1933
    • Largest, by number of doctors certified
    • Their website
    • More on Wikipedia
  • American Osteopathic Association (AOA) Bureau of Osteopathic Specialists
    • Recognizes and board certifies 18 specialties
    • Primarily for D.O. physicians who complete a residency that is AOA approved, but not ABMS approved
    • Recognizes the following sub-specialties of Family Medicine, for which they issue Certifications of Added Qualifications (CAQs):
      • Addiction Medicine
      • Adolescent & Young Adult Medicine
      • Correctional Medicine
      • Geriatric Medicine
      • Hospice and Palliative Medicine
      • Pain Medicine
      • Sleep Medicine
      • Sports Medicine
      • Undersea and Hyperbaric Medicine
    • Established in 1939
    • Second largest, by doctors certified
    • Their website
    • More on Wikipedia
  • American Board of Physician Specialties (ABPS)
    • Recognizes and board certifies 20 specialties
    • From what I can tell, they don’t offer any Certifications of Added Qualifications (CAQs) for sub-specialties.
    • Claims to blend the approaches of the other two boards, and fill gaps which they leave out.
    • Created 5 top-level “board certification” specialties which do not exist in the other two.  All five are available to physicians who have completed a residency in, and are board certified (by any of the three) in Family Medicine:
      • Urgent Care
      • Disaster Medicine
      • Family Medicine Obstetrics
      • Hospital Medicine
      • Integrative Medicine (this is brand new) — (more on this later, as Carina is curious)
    • The ONLY of the three boards what will grant top-level board certification in Emergency Medicine to physicians who have completed a residency in, and are board certified (by any of the three) in Family Medicine, Internal Medicine, Pediatrics, Anesthesiology or General Surgery.  ABPS says this is to try and fill the massive need in EM physicians, especially in rural areas.  However, this is highly controversial, and has deeply angered many traditional Emergency Medicine physicians.  (Here’a an interesting third party perspective, in favor of the ABPS cetification.)
    • Established in 1952
    • Their website
    • More on Wikipedia

ABMS and AOA are the two most widely recognized boards by hospitals.  ABPS is growing in popularity, and while recognized almost as widely as the other two, there are still a few small pockets of resistance. To have privileges in a hospital, you will need to be board certified by a board that the hospital recognizes.

Each state, per specialty, has their own laws about how physicians may promote themselves as “board certified”. With some exceptions, physicians are legally allowed to advertise themselves as “Board Certified” if they have received certification from any one of the three organizations. But there are still a small number of state/specialty combinations in which a board certification from ABPS is not recognized.  (Source, and more details.)

Medscape has an in-depth article about these three board certifying bodies.


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    Jack Castellanos commented

    I found your blog from an entry into SDN when you have decided to go to medical school in the Caribbean back in 2011. I have a few questions that I would like to ask you but not in a public forum like this one. Can you send me an email where I can send you my questions? I really would appreciate your time.

    August 23, 2016 at 3:10 pm
      Casey Crookston commented

      Hey Jack! I sent you an email. Happy to help!

      October 4, 2016 at 3:58 pm
    Elise Shammami commented


    My name is Elise Shammami and I interviewed Carina Crookston about a year ago for my senior year project focusing on her career. Since then I have graduated and I now attend Oakland University. For my Writing 150 class in college I am required to conduct another interview and I was wondering if she would mind participating in it! I sent her a message on Facebook but im not sure if she checks it regularly. If interested it would be great if she could email me!


    October 25, 2016 at 6:00 am
      Casey Crookston commented

      I will make sure she see’s your request. Thank you!

      January 23, 2017 at 1:10 am
    Sunny commented

    THIS IS AMAZING!! I came here after reading your thread on the studentdoc forum from way back. It is awesome to see that you guys proved everyone wrong! It gives me much more confidence as a prospective carib med student. I hope you continue to post on this blog.

    January 12, 2017 at 2:38 am
      Casey Crookston commented

      Thank you! I wish you all the luck in your med-school journey!

      January 23, 2017 at 1:09 am

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