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Choosing my Niche in Medicine

A family medicine doctor sees a broad range of patients. Whether in the urgent care or the primary care clinic, you see diabetes, pediatric foreign body, postpartum care, and mild trauma. But after a while, perhaps you realize that you’d instead focus on a particular topic – so, should you have just been a specialist from the get-go? Obviously, choosing my niche in medicine doesn’t mean that I have to go back to residency.

Specializing in Family Medicine

Another word for a niche would be a specialty. If I only see diabetic patients, I would be a diabetic specialist. The good thing about family medicine doctors is that we don’t have to go back to residency to treat only patients with a particular diagnosis.

I can’t call myself a dermatologist, but I can open a dermatology clinic. I can even call myself a derm expert. But the terms “Dermatologist” or “Dermatology Specialist” are copyrighted by the ABMS and reserved only for derms.

Yet, many FPs have aesthetic derm practices. Some only do laser, and others will do the whole gamut of derm care.

In urgent care, as a family medicine doctor, you are essentially an urgentologist. You manage all the acute trauma and acute issues without being an emergency medicine doctor.

A Niche in Family Medicine

I don’t think we have taken this concept far enough in family medicine. Too often, many of us do a little bit of everything and feel overwhelmed with the burden of knowledge we need to carry.

Just with Type 2 Diabetes, there are so many new medications and so many new regimens. I’m exhausted by the ongoing changes, medication side effects, and contraindications.

But that’s what’s great about family medicine – there are so many specialties or niches we can focus on. So here is a list I made off the top of my head:

  • dermatology
    • acne
    • skin cancer screening
  • pain management
    • chronic pain management without medication
    • acute pain management with/without medication
  • ortho
    • osteoarthritis management
    • joint injections (would require a PA-run clinic)
    • trigger point injections (would require a PA-run clinic)
  • ophtho
    • dry eyes management
    • floaters management
  • pediatrics
    • immunizations clinic (PA-run)
    • virtual developmental assessment
    • breastfeeding weaning
    • infant/toddler sleeping problems
  • neurology
    • neuropathy management
    • migraines prevention
  • surgery
    • post-op care
    • surgical 2nd opinion (is surgery even needed)
  • emergency medicine
    • IV fluids (PA-run clinic or NP)
  • ENT
    • chronic sinusitis
    • tinnitus management
    • herpes labialis treatment
    • TMD
  • radiology
    • 2nd opinion
  • urology
    • BPH
    • chronic dysuria
    • phimosis
    • ED
  • psychiatry
    • ADHD
    • anxiety
    • med refill
  • OB
    • fertility
    • miscarriage
    • postpartum care
  • gyn
    • chronic yeast infection
    • vaginal odor
    • endometriosis
    • PCOS
    • dysmenorrhea
    • menopause
  • physical therapy
    • initial assessment
    • virtual PT
    • specific sport injuries
  • cardiology
    • palpitations
    • hypertension
    • MI prevention
    • POTS
  • preventatitve medicine
    • cancer prevention
    • MI
    • stroke
    • diabetes
    • dementia
    • CKD
  • GI
    • IBS
    • GERD
  • endocrinology
    • diabetes
    • insulin tapering
  • geriatrics
    • exercise
    • ADLs
    • polypharmacy
  • hospice
    • 2nd opinion
  • rheumatology
    • fibromyalgia
    • diet & exercise
    • steroid tapering
  • pulmonology
    • asthma
    • COPD lifestyle
  • nephrology
    • improving GFR
  • ID
    • MRSA recurrence prevention
    • long COVID management
  • podiatry
    • ulcer prevention in diabetics
    • bunion care without surgery
  • vascular
    • PVD management, lifestyle program
    • varicose vein care without surgery
  • sports medicine
    • injury prevention
    • injury care for a specific sport
    • diet strategy for optimal performance
    • weight loss
    • muscle gain
    • testosterone
  • travel medicine
    • medical advice when traveling

Virtual vs Physical

I have decided to have a virtual practice for the next few years. It would be great to select a niche topic from which I can profit in a physical clinic—for example, joint injections or laser treatments.

A virtual practice has the advantage of being automated. While a physical practice generally requires a little more overhead and direct oversight.

Both can be lucrative. When it comes to the income potential, it’s hard to predict which would be better.

My Criteria for the Niche

This particular niche has to meet my criteria for a virtual practice. I have created the following list as a guide.

  1. interest in the topic
  2. patient demographic
  3. growth
  4. income
  5. automation

1. Topic Interest

I have to be interested in the topic. I always have been curious about women’s health. But am I interested in learning more about menopause? Is there more to know about menopause?

I don’t find IBS very interesting, but it can be pretty lucrative.

A topic that interests me is one I’d like to learn more about. So it’ll scratch the curiosity itch, but my efforts have to pay off somehow. I can learn everything about lipidology, but if my patients have to cut out meat in the end – what’s the point?

2. Patient Demographics

I have to market to patients, and I have to enjoy the patients I deal with. Drug-seeking patients? No. Grumpy octagenarians? Hell no.

A niche topic is always cheaper to purchase keywords for when marketing. And having a conversation with an informed patient is always easier. Fibromyalgia, for that reason, may not be a satisfying patient niche.

3. Growth

I don’t want to limit my market to the USA. For that reason, the niche practice I choose should include an international audience.

Therefore, my chosen patient population should ideally understand English. Or I can market in a different language and rely on translators. That seems a bit messy to me, however.

What is the growth potential in a particular niche field – say, styes? Perhaps I can service more and more patients. But will that require more medication prescribing? That, too, is messy.

4. Income

I ranked this criterion lower because I don’t care about income. In my experience, whatever value you deliver to people, there is always a way to profit from it.

But I want to be able to charge a premium for my services. I am not about to copy the insurance model here; there is a reason why it sucks.

I want to be an expert in my field and charge accordingly. My target patient needs to have the appropriate income or place enough value on their health to pay me a fair market value.

5. Automation

If I prescribe antibiotics and assess each patient, it becomes a big time sink unless I enjoy such patient interactions.

I can screen a patient with an online tool. Or sell them a video course on top of my clinical assessment of their condition.

A PA or NP can do the majority of the data gathering. With this information, I swoop in and make the clinical assessment.

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