Dilemma - Seeking Advice IM vs FM for primary care

[KeikoTanaka]

I have wanted to do primary care since before starting medical school. Now, I am a 3rd year, and I think this is still the case. However, I always envisioned doing Family Medicine for residency. With that being said, the hospital I'm currently doing rotations at is starting an IM-Primary Care track residency and I would be able to apply and be part of the first class.

However, I am nervous because I didn't envision myself doing IM solely and seeing adults. I just finished Peds, and it was fun. I enjoyed it, and I'm not sure I wouldn't ever wanna see kids again?

But also, my other concerns is that 1.) I would be the first class at a residency program and I'm not sure if this is a good or bad thing. I feel like it'd be a good thing in that I can pave the way and help shape the program, but it could also be a bad thing not having senior residents to learn from or teach me. 2. My other concern is I'm not sure how this program would differ from FM programs in terms of outpatient procedural skills and abilities.

Would it be worth listing this program amongst other FM programs for applications, and maybe looking at other IM-Primary Care tracks as well?

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[deleted480308]

I have wanted to do primary care since before starting medical school. Now, I am a 3rd year, and I think this is still the case. However, I always envisioned doing Family Medicine for residency. With that being said, the hospital I'm currently doing rotations at is starting an IM-Primary Care track residency and I would be able to apply and be part of the first class.

However, I am nervous because I didn't envision myself doing IM solely and seeing adults. I just finished Peds, and it was fun. I enjoyed it, and I'm not sure I wouldn't ever wanna see kids again?

But also, my other concerns is that 1.) I would be the first class at a residency program and I'm not sure if this is a good or bad thing. I feel like it'd be a good thing in that I can pave the way and help shape the program, but it could also be a bad thing not having senior residents to learn from or teach me. 2. My other concern is I'm not sure how this program would differ from FM programs in terms of outpatient procedural skills and abilities.

Would it be worth listing this program amongst other FM programs for applications, and maybe looking at other IM-Primary Care tracks as well?

Not if you want to see kids

 

[tylerb1800]

If you want to see kids, then do FM. IM certainly gives you more options if you decide that you do not want to do outpatient IM during residency. If you envision yourself only seeing adults, I would lean toward IM. Of course, there is always Med-Peds as an option too

 

[SeldingerTechneek]

FM lends itself better to outpatient - especially if you enjoy caring for children and Gyn.
IM moreso for inpatient medicine and subspecialty training. Yes, GIM advocates for outpatient in IM and you certainly can do so, but in most training programs IM is tending to stray more towards inpatient medicine

 

[KeikoTanaka]

FM lends itself better to outpatient - especially if you enjoy caring for children and Gyn.
IM moreso for inpatient medicine and subspecialty training. Yes, GIM advocates for outpatient in IM and you certainly can do so, but in most training programs IM is tending to stray more towards inpatient medicine

this program would be specifically aimed at outpatient given it's specifically a primary care track, and of course I’m sure some inpatient, maybe more than FM would, but less than a traditional IM residency. It would be a brand new program, and honestly I haven’t done IM or FM yet. So for all I know I may come to find I actually like focusing on adults. I guess my concern would then come down to: do i trust a brand new program? I have a nepotistic connection to this program... and I feel like that could make it a great opportunity, but I also fear not having senior residents above me to teach me. I would be the first senior to go through should I get accepted, I guess that would mean more direct access to the attendings... hmm so it's a lot about pros and cons!

 

[SeldingerTechneek]

Sounds like an individual decision. And you have some exposure yet to happen, including your IM/FM rotations.

 

[InternistDO]

I don't really see an advantage to going to a brand new IM program with all the headaches that come with it, unless you have a strong desire to stay in that area or have a lot of red flags on your application and can't afford to be picky.

As others have said, FM > IM most of the time for outpatient, though IM gives you a better "escape plan" if you change your mind. I'm in IM with the goal of primary care and sometimes I think I should have just done FM and called it a day.

 

[aafisahar]

IM, gives you several outs if you hate PC. Most FM practices don't do OB anyways and you'll never be as good as a pediatrician for peds. In the US, specialization is king. FM is too spread thin and serves as a master of none.

 

[KeikoTanaka]

IM, gives you several outs if you hate PC. Most FM practices don't do OB anyways and you'll never be as good as a pediatrician for peds. In the US, specialization is king. FM is too spread thin and serves as a master of none.

Is 18 the absolute youngest patient you can reasonably see in IM? Is 16 too young?

 

[VA Hopeful Dr]

IM, gives you several outs if you hate PC. Most FM practices don't do OB anyways and you'll never be as good as a pediatrician for peds. In the US, specialization is king. FM is too spread thin and serves as a master of none.

You don't need to be a master of everything to provide good care.

99% of diabetics don't need an endocrinologist. 50 year old with an a1c of 6.0 on metformin monotherapy. What's endocrine going to do that I can't? Interestingly, in the attending section us FPs have the same general protocols for treating diabetes as the endocrinologists do up to and including insulin in the discussions we've had there. Actually made me feel pretty good about how I do things if I'm being honest.

Vast majority of hypertension doesn't need a nephrologist or cardiologist. BP on benicar monotherapy 110/75 doesn't need a specialist.

Every case of allergic rhinitis doesn't need an ENT or allergist to manage. Zyrtec and flonase in April and October, no treatment the rest of the year. Sure, let's waste an allergist's time with that one.

Beyond that, there are not enough of those specialists to manage all of that even if they wanted to (spoiler: they don't want to).

 

[VA Hopeful Dr]

Is 18 the absolute youngest patient you can reasonably see in IM? Is 16 too young?

Combination of personal preference and malpractice insurance rules. I've never heard of an internist seeing younger than 16 but plenty do down to that level.

 

[KeikoTanaka]

Combination of personal preference and malpractice insurance rules. I've never heard of an internist seeing younger than 16 but plenty do down to that level.

I've worked intimately as the scribe for an old school IM PCP for 10 months straight prior to medical school. He saw a lot of medicare/medicaid, but was also in an inner city office connected to the hospital, so given the region, the population made sense. With that being said, he was able to make a huge difference in so many people's lives, but, he did see A LOT of old people. I feel like I am having a hard time distinguishing between my own desire to have a "livelier patient population" and "wanting to see kids" - Like maybe I'd actually be happy seeing young athletic 20 year olds for their MSK complaints (I want to do Sports Medicine regardless if I do FM or IM - Both can lend themselves to that, albeit I understand FM does get more access to Orthopedics) and that would satisfy my desire for a younger population, and perhaps I don't necessarily need to see pediatrics to do that. And patient population is perhaps more based on region/geography than it is my own specialty choice.

This definitely gives me a lot to think about. I wouldn't really have thought about it otherwise, but because this program is opening up at the very hospital I'm rotating through, I almost feel like it could be an amazing opportunity and it would be a super "unopposed" primary care residency in a great area with high resident pay, low COL, and great name affiliation. And it would definitely be a big help with starting a family in this area with a lot of immediate family in the area for support.

Sorry, thank you all for being a great soundboard for me to talk out ideas and hear feedback

 

[VA Hopeful Dr]

I've worked intimately as the scribe for an old school IM PCP for 10 months straight prior to medical school. He saw a lot of medicare/medicaid, but was also in an inner city office connected to the hospital, so given the region, the population made sense. With that being said, he was able to make a huge difference in so many people's lives, but, he did see A LOT of old people. I feel like I am having a hard time distinguishing between my own desire to have a "livelier patient population" and "wanting to see kids" - Like maybe I'd actually be happy seeing young athletic 20 year olds for their MSK complaints (I want to do Sports Medicine regardless if I do FM or IM - Both can lend themselves to that, albeit I understand FM does get more access to Orthopedics) and that would satisfy my desire for a younger population, and perhaps I don't necessarily need to see pediatrics to do that. And patient population is perhaps more based on region/geography than it is my own specialty choice.

This definitely gives me a lot to think about. I wouldn't really have thought about it otherwise, but because this program is opening up at the very hospital I'm rotating through, I almost feel like it could be an amazing opportunity and it would be a super "unopposed" primary care residency in a great area with high resident pay, low COL, and great name affiliation. And it would definitely be a big help with starting a family in this area with a lot of immediate family in the area for support.

Sorry, thank you all for being a great soundboard for me to talk out ideas and hear feedback

Something that got repeated to me often was "your practice ages with you". Meaning when you first start, you get lots of kids and younger adults because you're also young. They stick with you so the older you get the older your patients are.

I just took over for a retired partner. 99% of his patients are over 65. Most of mine are under 50.

 

[Drrrrrr. Celty]

Depends on how sure you are about doing primary care. I think that if you're very sure then FM. You'll have better training and be able to out the door handle a strong census of patients. Likewise chances are your patient continuity will be stronger and you'll be a lot better at managing the patients that will need to come in every 3 months as opposed to me that has a lot of handing off patients between residents.

Likewise you'll probably be better at dealing with some primary care stuff that I don't generally do, like treating dermatological things, more joint injections, abscess drainage, etc. I'm honestly not too good at these.

But if you're considering that you may not be sure about outpatient then it becomes more difficult.

There is always the 3rd option which is primary care oriented IM programs.

 

[tantacles]

If you're certain you want to to adult primary care, family medicine and internal medicine are two great options.

However, if you desire to have pediatrics in your primary care practice in any quantity, I would strongly suggest you pursue med-peds. The peds training is far more robust, and in order to get good at evaluating children, you need numbers. I say this as a person who hates med-peds after having done the residency, but it really is one of those things that generally only pediatricians really get good at. If you're at a program that is unopposed, you may get more volume, but your census is still likely to be at least 90% adult.

 

[VA Hopeful Dr]

If you're certain you want to to adult primary care, family medicine and internal medicine are two great options.

However, if you desire to have pediatrics in your primary care practice in any quantity, I would strongly suggest you pursue med-peds. The peds training is far more robust, and in order to get good at evaluating children, you need numbers. I say this as a person who hates med-peds after having done the residency, but it really is one of those things that generally only pediatricians really get good at. If you're at a program that is unopposed, you may get more volume, but your census is still likely to be at least 90% adult.

Nonsense. A decent FM program will get you plenty of peds for outpatient work.

 

[tantacles]

Nonsense. A decent FM program will get you plenty of peds for outpatient work.

Maybe. That hasn't been the case in the urban centers I've worked in, but rural is another ball game that I haven't played in. Parents in the urban and suburban areas I've worked in specifically seek pediatricians over family medicine physicians for their children, and the family medicine physicians in those areas (who all came from "decent" FM programs), have a census full of adult patients with very few pediatric patients. So lopsided was their training and now so adult-focused is their practice that many don't even feel comfortable providing care to pediatric patients.

 

[VA Hopeful Dr]

Maybe. That hasn't been the case in the urban centers I've worked in, but rural is another ball game that I haven't played in. Parents in the urban and suburban areas I've worked in specifically seek pediatricians over family medicine physicians for their children, and the family medicine physicians in those areas (who all came from "decent" FM programs), have a census full of adult patients with very few pediatric patients. So lopsided was their training and now so adult-focused is their practice that many don't even feel comfortable providing care to pediatric patients.

Well sure, once you leave residency if you don't see many kids for several years then of course your skills atrophy.

But if you keep seeing kids the whole time, no reason FPs can't competently see peds patients.

 

[tantacles]

Well sure, once you leave residency if you don't see many kids for several years then of course your skills atrophy.

But if you keep seeing kids the whole time, no reason FPs can't competently see peds patients.

I’m talking about someone just out of residency. The volume for pediatrics, as I alluded to, needs to be at least comparable to your volume of adult patients to develop meaningful competency. This just doesn’t happen in most family medicine residencies from what I’ve seen and heard from my colleagues.

I am certain there are exceptions, particularly at unopposed programs.

 

[VA Hopeful Dr]

I’m talking about someone just out of residency. The volume for pediatrics, as I alluded to, needs to be at least comparable to your volume of adult patients to develop meaningful competency. This just doesn’t happen in most family medicine residencies from what I’ve seen and heard from my colleagues.

I am certain there are exceptions, particularly at unopposed programs.

If you aren't comfortable seeing peds fresh out of residency, your residency failed you miserably.

 

[tantacles]

If you aren't comfortable seeing peds fresh out of residency, your residency failed you miserably.

sounds like there’s a lot of failure out there, then.

having done med-peds, I would 100% choose a pediatrician over a family medicine physician for pediatric primary care. The training really is markedly more robust.

 

[VA Hopeful Dr]

sounds like there’s a lot of failure out there, then.

having done med-peds, I would 100% choose a pediatrician over a family medicine physician for pediatric primary care. The training really is markedly more robust.

Good for you. Do you have any evidence that we are providing substandard peds primary care or is this just your personal bias talking?

 

[tantacles]

Good for you. Do you have any evidence that we are providing substandard peds primary care or is this just your personal bias talking?

Oh, definitely personal bias. There's no question. Fortunately, opposing bias is in no short supply! The world is full of anecdotes, and I very much doubt we'll ever have a randomized control trial comparing family medicine physicians and pediatricians. That being said, considering the fact that pediatrics residents receive three full years of supervised training caring for only children, and the family medicine requirement for pediatrics is months:

Residents must have at least 200 hours (or two months) and 250 patient encounters dedicated to the care of ill child patients in the hospital and/or emergency setting.

Residents must have at least 200 hours (or two months) or 250 patient encounters dedicated to the care of children and adolescents in an ambulatory setting.

Residents must have at least 40 newborn patient encounters, including well and ill newborns.

Do I think that you personally provide substandard care to children? Don't know. I don't know you. Do I think there are pediatricians who practice primary care less skillfully than you? Probably. But if one recognizes children as an entity deserving of educational and training attention separate from adults, which I do, then there is a clear difference, and I would posit that that difference is likely to be amplified in a center that also has pediatrics opposing as the exposure to pediatrics in continuity clinic is likely to be less, as it was in my tertiary care program. Perhaps your program was set up in such a way to mitigate this lack of exposure, like having a full day of contuity clinic with the pediatricians once per week or something. I don't know. I'm just a simple caveman. Unlike Miss Cleo, I don't see all.

And with regard to experience with newborns, having done NICU, PICU, pediatric emergency, and myriad ward months as an intern and as a senior resident, there is no number of newborns that you can see that can truly make one appropriately comfortable with their care. They can become critically ill very quickly, and the signs are subtle. I don't think anyone expects a primary care physician to handle the 26 weeker immediately out of the womb in their outpatient clinic (EDIT), but much of pediatric care is intensely baby-focused because babies are the population most vulnerable to medical illness of all the pediatric ages. 40 babies is a pretty small number. Now granted, even at my program, the family medicine residents probably exceeded that number because of our extremely busy nursery rotation that they came to for a full month, but it's just not enough.

Now, one could argue that pediatric primary care is largely protocol based. And sure. The vaccines are. The HEADSSS exam is. The basic preventive care is reasonably routine (which is why I don't enjoy pediatric primary care). But when it gets complicated, it needs to be recognized fast, and even now after 2 full years of pediatric training I feel like there's a great deal I could still miss, and if I hadn't had the training I had I simply wouldn't know.

Edit: second to last paragraph, immediately out of the womb

 

[VA Hopeful Dr]

Oh, definitely personal bias. There's no question. Fortunately, opposing bias is in no short supply! The world is full of anecdotes, and I very much doubt we'll ever have a randomized control trial comparing family medicine physicians and pediatricians. That being said, considering the fact that pediatrics residents receive three full years of supervised training caring for only children, and the family medicine requirement for pediatrics is months:

Residents must have at least 200 hours (or two months) and 250 patient encounters dedicated to the care of ill child patients in the hospital and/or emergency setting.

Residents must have at least 200 hours (or two months) or 250 patient encounters dedicated to the care of children and adolescents in an ambulatory setting.

Residents must have at least 40 newborn patient encounters, including well and ill newborns.

Do I think that you personally provide substandard care to children? Don't know. I don't know you. Do I think there are pediatricians who practice primary care less skillfully than you? Probably. But if one recognizes children as an entity deserving of educational and training attention separate from adults, which I do, then there is a clear difference, and I would posit that that difference is likely to be amplified in a center that also has pediatrics opposing as the exposure to pediatrics in continuity clinic is likely to be less, as it was in my tertiary care program. Perhaps your program was set up in such a way to mitigate this lack of exposure, like having a full day of contuity clinic with the pediatricians once per week or something. I don't know. I'm just a simple caveman. Unlike Miss Cleo, I don't see all.

And with regard to experience with newborns, having done NICU, PICU, pediatric emergency, and myriad ward months as an intern and as a senior resident, there is no number of newborns that you can see that can truly make one appropriately comfortable with their care. They can become critically ill very quickly, and the signs are subtle. I don't think anyone expects a primary care physician to handle the 26 weeker immediately out of the womb in their outpatient clinic (EDIT), but much of pediatric care is intensely baby-focused because babies are the population most vulnerable to medical illness of all the pediatric ages. 40 babies is a pretty small number. Now granted, even at my program, the family medicine residents probably exceeded that number because of our extremely busy nursery rotation that they came to for a full month, but it's just not enough.

Now, one could argue that pediatric primary care is largely protocol based. And sure. The vaccines are. The HEADSSS exam is. The basic preventive care is reasonably routine (which is why I don't enjoy pediatric primary care). But when it gets complicated, it needs to be recognized fast, and even now after 2 full years of pediatric training I feel like there's a great deal I could still miss, and if I hadn't had the training I had I simply wouldn't know.

Edit: second to last paragraph, immediately out of the womb

Now we're talking.

I'll be the first to admit that medically complex kids absolutely benefit from a pediatrician. Really premature, medically fragile, cancer, congenital hearts, uncommon syndromes, all of that absolutely needs a pediatrician. But healthy kids, including picking up on when they stop being healthy, is easily within the wheelhouse of decently trained FPs. I'm not surprised your tertiary center's FPs aren't great at it. I've long felt, especially more recently, that the training in those places for FPs isn't doing us any favors since we're second class citizens on pretty much every rotation.

For comparison to the numbers you posted, my residency program had 6 months of peds the first 2 years. Mornings in the hospital (including nursery level 2 NICU), if you weren't on call the afternoon was spent in the outpatient peds clinic. Q4 call (my intern year was the last that had 30 hour shifts for interns), usually 6-8 nursery admits per call. During summer months, usually 4-6 floor admissions. My record during RSV season was 15. The half days in the clinic was 6-8 patients at the start of the year, 12-14 at the end of the year.

Then 3rd year we had 1 month in the peds urgent care and 1 doing full peds clinic days as 3rd years. Plus in my FM clinic I'd say probably 15% or so of my patients were kids (most of which I picked up in the nursery and stayed with me all 3 years).

 

[KeikoTanaka]

To reply to Tentacles and VA Hopeful,

I think the thing that appeals to me about FM is that, while Pediatricians may very well be more suitable for the most complex/high risk children, FM opens a pathway for you to see all people of all ages. If you're truly a lifelong learner which many of us strive to be, the fact I don't cross off children right away gives me the opportunity to always learn and see more. Plus, I think given many populations in the US not being upscale urban, they cannot afford to go to a pediatrician, or, their time is so limited working multiple jobs, having a very multigenerational household, many would be happy to see a single physician for everyones needs.

I think too there is a big component of truly being trained in everything - ObGyn, ED, IM, Peds that you have the potential to truly connect many dots within a family, and in an individual, depending on how complex they are. Every physician has their strengths. The one who isn't comfortable and always asks why is the one who is going to grow and learn more. A Pediatrician, while very comfortable with the most complex kids coming right out of residency could easily become complacent (as anyone in any specialty/career) and ultimately just refer refer refer without giving much thought to something that couldn't easily be figured out and isn't life threatening. I can't tell you how many Osgood Schlatters or random non-emergent things I've seen pediatricians poke at for 2 seconds, couldn't immediately identify the cause, and refer to Ortho or Rheumatology/Endo, etc without even a thought as to the workup.

I'm not saying this to attack Pediatricians, but rather that even a Pediatrician can become complacent with care of kids, just as a FM doc could. I think that if passionate enough, and with never stopping seeing kids, and being highly involved with pediatrics in residency, a FM doc can very well see kids for countless things until they need to see a specialist.

I mean the alternative is FM doesn't see anymore kids, we create a massive pediatrician supply/demand mismatch, and allow Pediatric Nurse Practitioners to see your children. I'm gonna still put my money with the FM doc seeing my kid as long as they've always seen kids.

 

[KeikoTanaka]

Depends on how sure you are about doing primary care. I think that if you're very sure then FM. You'll have better training and be able to out the door handle a strong census of patients. Likewise chances are your patient continuity will be stronger and you'll be a lot better at managing the patients that will need to come in every 3 months as opposed to me that has a lot of handing off patients between residents.

Likewise you'll probably be better at dealing with some primary care stuff that I don't generally do, like treating dermatological things, more joint injections, abscess drainage, etc. I'm honestly not too good at these.

But if you're considering that you may not be sure about outpatient then it becomes more difficult.

There is always the 3rd option which is primary care oriented IM programs.

Thank you for the input. As I went through various job searches, what I came to realize was there is nothing IM can do that FM cannot do, but many things FM can do that IM cannot do, assuming IM doesn't specialize. I think for this reason, I have actually made it clear to myself that FM really is the way to go. I have slightly better than average board scores (80% percentile COMLEX, 50-55% percentile USMLE) so perhaps this could even allow me to get into a slightly better program than I would have otherwise gotten into given that FM tends to be less competitive overall. We will see. I am halfway through my core rotations, I definitely need to start planning out which residencies I want to rotate through. I want to find unopposed FM residencies in the Northeast.

 

[Drrrrrr. Celty]

Thank you for the input. As I went through various job searches, what I came to realize was there is nothing IM can do that FM cannot do, but many things FM can do that IM cannot do, assuming IM doesn't specialize. I think for this reason, I have actually made it clear to myself that FM really is the way to go. I have slightly better than average board scores (80% percentile COMLEX, 50-55% percentile USMLE) so perhaps this could even allow me to get into a slightly better program than I would have otherwise gotten into given that FM tends to be less competitive overall. We will see. I am halfway through my core rotations, I definitely need to start planning out which residencies I want to rotate through. I want to find unopposed FM residencies in the Northeast.

Eh. As a FM resident you're going to have a lot weaker critical care experience and inpatient training. If you decide to do an adult hospitalist your going to be a less desirable candidate for open icu hospitals because you won't be able to do lines or intubations. So if you have an inkling that you want to take care of very sick patients, you're not going to be as prepared for that from FM as much.

Likewise you really cannot talk about IM without also talking about subspecialization. It's a huge draw of the field. If you decide you really love an organ system it'll offer you the ability to do just that and possibly do academic opportunities. Not only does this intellectually have benefits, but it also monetarily could double your income.

So in many respects IM is an open door with many opportunities. It's something to think about.

 

[tantacles]

Thank you for the input. As I went through various job searches, what I came to realize was there is nothing IM can do that FM cannot do, but many things FM can do that IM cannot do, assuming IM doesn't specialize. I think for this reason, I have actually made it clear to myself that FM really is the way to go. I have slightly better than average board scores (80% percentile COMLEX, 50-55% percentile USMLE) so perhaps this could even allow me to get into a slightly better program than I would have otherwise gotten into given that FM tends to be less competitive overall. We will see. I am halfway through my core rotations, I definitely need to start planning out which residencies I want to rotate through. I want to find unopposed FM residencies in the Northeast.

I think that med-peds training would be the stronger choice. 4 years to have the full choice of all specialties in internal medicine and pediatrics.

 

[VA Hopeful Dr]

I think that med-peds training would be the stronger choice. 4 years to have the full choice of all specialties in internal medicine and pediatrics.

In my area of the country, outside of academics it is very very rare to find med-peds actually doing both adult medicine and peds.

 

[rokshana]

In my area of the country, outside of academics it is very very rare to find med-peds actually doing both adult medicine and peds.

I think he is saying that one has the choice of all fellowships available by going the meds/peds route.

 

[andrek82]

In my area of the country, outside of academics it is very very rare to find med-peds actually doing both adult medicine and peds.

I think he is saying that one has the choice of all fellowships available by going the meds/peds route.

There are certainly going to be local practice differences. That said, data shows that consistently grads of med peds programs predominantly practice both. For fellowship, having all the options is certainly nice. I am in a combined fellowship, personally. All this said, it is not a failure for a grad to gravitate to a certain age range. The broad experience gives you a leg up regardless. The same applies for FM - staying away from OB is not a failure, just a choice. Every specialty has a group that pursued generalization and a group that didn't.

For OP, if IM is really great when you do it, and peds and FM are as well, at least look into Med Peds. There are great primary care tracks with clinics just like you would have in FM, the training is strong with consistent exposure to complex care, you are highly marketable, and all for 1 more year. It is at least worth a read.

 

[VA Hopeful Dr]

There are certainly going to be local practice differences. That said, data shows that consistently grads of med peds programs predominantly practice both. For fellowship, having all the options is certainly nice. I am in a combined fellowship, personally. All this said, it is not a failure for a grad to gravitate to a certain age range. The broad experience gives you a leg up regardless. The same applies for FM - staying away from OB is not a failure, just a choice. Every specialty has a group that pursued generalization and a group that didn't.

For OP, if IM is really great when you do it, and peds and FM are as well, at least look into Med Peds. There are great primary care tracks with clinics just like you would have in FM, the training is strong with consistent exposure to complex care, you are highly marketable, and all for 1 more year. It is at least worth a read.

Do you happen to have that data? I went looking and couldn't find anything more recent than about 2005 or so.

 

[mdjo]

I've worked intimately as the scribe for an old school IM PCP for 10 months straight prior to medical school. He saw a lot of medicare/medicaid, but was also in an inner city office connected to the hospital, so given the region, the population made sense. With that being said, he was able to make a huge difference in so many people's lives, but, he did see A LOT of old people. I feel like I am having a hard time distinguishing between my own desire to have a "livelier patient population" and "wanting to see kids" - Like maybe I'd actually be happy seeing young athletic 20 year olds for their MSK complaints (I want to do Sports Medicine regardless if I do FM or IM - Both can lend themselves to that, albeit I understand FM does get more access to Orthopedics) and that would satisfy my desire for a younger population, and perhaps I don't necessarily need to see pediatrics to do that. And patient population is perhaps more based on region/geography than it is my own specialty choice.

This definitely gives me a lot to think about. I wouldn't really have thought about it otherwise, but because this program is opening up at the very hospital I'm rotating through, I almost feel like it could be an amazing opportunity and it would be a super "unopposed" primary care residency in a great area with high resident pay, low COL, and great name affiliation. And it would definitely be a big help with starting a family in this area with a lot of immediate family in the area for support.

Sorry, thank you all for being a great soundboard for me to talk out ideas and hear feedback

If you want to do sports medicine, have you thought about PM&R? Keep your mind open as you do your rotations!

 

[rokshana]

Do you happen to have that data? I went looking and couldn't find anything more recent than about 2005 or so.

My question too...can you give a source.

My personal experience( friends that have done med/peds) have ended up doing one or the other...but they are PP not academic, so if more med/peds trainer people end up in academia that may be true...but would like to see the data.

 

[andrek82]

I think the most recent stuff in peer reviewed lit was 2015. There is more recent data that I've seen referenced at conferences but I don't have ready access to that either.

Field Bibliography | NMPRA - The National Med-Peds Residents Association

medpeds.org

The top 2 to 3 articles are most relevant. I'm sure if you got more granular there may be geographic trends but I haven't seen that data.

Do you happen to have that data? I went looking and couldn't find anything more recent than about 2005 or so.

My question too...can you give a source.

My personal experience( friends that have done med/peds) have ended up doing one or the other...but they are PP not academic, so if more med/peds trainer people end up in academia that may be true...but would like to see the data.

 

[tantacles]

My question too...can you give a source.

My personal experience( friends that have done med/peds) have ended up doing one or the other...but they are PP not academic, so if more med/peds trainer people end up in academia that may be true...but would like to see the data.

I’m less interested in what they actually do after residency and more interested in what they’re able to do competently. Practicing one or the other is not a failure (I personally only practice adult medicine because I stopped enjoying pediatrics during residency). Med-peds makes you capable of a great deal of practice options. I personally know many in the region where i did residency who practice combined primary care.

Unfortunately, pediatric subspecialties are becoming more and more restrictive, and the advent of a pediatric hospital medicine fellowship, which I consider to be a disgraceful scam to use fully boarded pediatricians for cheap labor with the threat of not being the kind of generalist they want, makes med peds a much less desirable option for anyone who does not want to do primary care or subspecialty training. Med-peds hospitalist used to be a robust option for new grads that now simply is off limits to all but those who are grandfathered in or have done a fellowship.

 

[KeikoTanaka]

If you want to do sports medicine, have you thought about PM&R? Keep your mind open as you do your rotations!

Yeah, I have looked at PM&R, however I do love general medicine as well, and it is something I would not want to let go of. I'd rather be less good in Sports Medicine and refer to Ortho than really great in Sports and much less good in medicine medicine

 

[KeikoTanaka]

I think the most recent stuff in peer reviewed lit was 2015. There is more recent data that I've seen referenced at conferences but I don't have ready access to that either.

Field Bibliography | NMPRA - The National Med-Peds Residents Association

medpeds.org

The top 2 to 3 articles are most relevant. I'm sure if you got more granular there may be geographic trends but I haven't seen that data.

Wow... thank you for this link. This is actually amazing. I thought it would be 5 years. The fact it is only 4 is... quite enticing. I have never really considered Med-Peds before, and I am going to 100% be looking into this much more deeply. Thank you.

 

[tantacles]

Wow... thank you for this link. This is actually amazing. I thought it would be 5 years. The fact it is only 4 is... quite enticing. I have never really considered Med-Peds before, and I am going to 100% be looking into this much more deeply. Thank you.

yup, just one extra year to be boarded in both specialties.

 

[MedicineZ0Z]

Eh. As a FM resident you're going to have a lot weaker critical care experience and inpatient training. If you decide to do an adult hospitalist your going to be a less desirable candidate for open icu hospitals because you won't be able to do lines or intubations. So if you have an inkling that you want to take care of very sick patients, you're not going to be as prepared for that from FM as much.

Likewise you really cannot talk about IM without also talking about subspecialization. It's a huge draw of the field. If you decide you really love an organ system it'll offer you the ability to do just that and possibly do academic opportunities. Not only does this intellectually have benefits, but it also monetarily could double your income.

So in many respects IM is an open door with many opportunities. It's something to think about.

Open ICU hospitalist jobs are almost universally very FM friendly (whereas academic center jobs are not). You should look at actual job ads and not just speculate based off your imagination. My program puts out grads who take those jobs every year.

 

[MedicineZ0Z]

To reply to Tentacles and VA Hopeful,

I think the thing that appeals to me about FM is that, while Pediatricians may very well be more suitable for the most complex/high risk children, FM opens a pathway for you to see all people of all ages. If you're truly a lifelong learner which many of us strive to be, the fact I don't cross off children right away gives me the opportunity to always learn and see more. Plus, I think given many populations in the US not being upscale urban, they cannot afford to go to a pediatrician, or, their time is so limited working multiple jobs, having a very multigenerational household, many would be happy to see a single physician for everyones needs.

I think too there is a big component of truly being trained in everything - ObGyn, ED, IM, Peds that you have the potential to truly connect many dots within a family, and in an individual, depending on how complex they are. Every physician has their strengths. The one who isn't comfortable and always asks why is the one who is going to grow and learn more. A Pediatrician, while very comfortable with the most complex kids coming right out of residency could easily become complacent (as anyone in any specialty/career) and ultimately just refer refer refer without giving much thought to something that couldn't easily be figured out and isn't life threatening. I can't tell you how many Osgood Schlatters or random non-emergent things I've seen pediatricians poke at for 2 seconds, couldn't immediately identify the cause, and refer to Ortho or Rheumatology/Endo, etc without even a thought as to the workup.

I'm not saying this to attack Pediatricians, but rather that even a Pediatrician can become complacent with care of kids, just as a FM doc could. I think that if passionate enough, and with never stopping seeing kids, and being highly involved with pediatrics in residency, a FM doc can very well see kids for countless things until they need to see a specialist.

I mean the alternative is FM doesn't see anymore kids, we create a massive pediatrician supply/demand mismatch, and allow Pediatric Nurse Practitioners to see your children. I'm gonna still put my money with the FM doc seeing my kid as long as they've always seen kids.

Yeah lets be real, ain't no Gen Peds actually truly managing any complex issues. They're coordinating subspecialist care. Do I think they should be followed by Peds? Likely yeah. But it's not like their care won't be heavily subspecialty driven (and rightfully so).

 

[Drrrrrr. Celty]

Open ICU hospitalist jobs are almost universally very FM friendly (whereas academic center jobs are not). You should look at actual job ads and not just speculate based off your imagination. My program puts out grads who take those jobs every year.

Look man. We all have medical licenses. If you know how to do stuff, then you can do stuff. It's not a dick measuring contest. It's literally about whether or not you're going into the training that prepares you with the least hiccups to do a job.

 

[tantacles]

Look man. We all have medical licenses. If you know how to do stuff, then you can do stuff. It's not a dick measuring contest. It's literally about whether or not you're going into the training that prepares you with the least hiccups to do a job.

Yes, and do your meepmorps match your fleepflorps.

 

[CCM-MD]

Look man. We all have medical licenses. If you know how to do stuff, then you can do stuff. It's not a dick measuring contest. It's literally about whether or not you're going into the training that prepares you with the least hiccups to do a job.

He may not have a license yet he’s an FM intern. Maybe pgy2 now.