FM vs. IM

[lloyd braun]

I am a fourth year trying to decide between family medicine and internal medicine. I am attracted to family medicine because of its public health and underserved emphasis. However, I am primarily interested in working with adults, but in an underserved location, doing public health work and/or research. Would anyone recommend completing FM over IM in my situation?

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[Faebinder]

The choice of Family Medicine vs Internal Medicine shouldnt really be based on what you stated, although they are definitely other important factors.

You have to ask yourself this question....

Do you always want to be a hospitalist for adult medicine? Or do you like practicing in "your" clinic and dealing with a more mixed variety of patients. I am not preaching either.... but that is what they honestly do.. I mean yeah FM prepares you as a hospitalist as well and IM also prepares you to do ambulatory work (adult)... but how important are those for you? All these questions you have to ask yourself... When you are 50 years old.... do you want to be mostly in the clinic seeing a variety of patients or rounding in a hospital?

Lets sum it up...

When you are 50 years old do you want to be in the hospital or in the clinic mostly?

Hospital mostly? Go IM.
Clinic Mostly? Then go FM.

Otherwise... all the other factors are comparable...

 

[sophiejane]

I am a fourth year trying to decide between family medicine and internal medicine. I am attracted to family medicine because of its public health and underserved emphasis. However, I am primarily interested in working with adults, but in an underserved location, doing public health work and/or research. Would anyone recommend completing FM over IM in my situation?

You can always find ways to work in public health and with the underserved, regardless of your specialty.

If you want to do specifically rural underserved medicine, there are often more jobs for family docs because they need someone with broader training who can also see kids and pregos.

You will have a significant amount of peds and OB/Gyn as an FM resident. If you really don't plan on practicing full scope family medicine, I would go IM.

Not to say there aren't family physicians who primarily treat adults--there are many who do. But if you know at this point that's what you want to do, I'd seriously consider the need to learn peds and OB.

 

[iatrosB]

You can always find ways to work in public health and with the underserved, regardless of your specialty.

If you want to do specifically rural underserved medicine, there are often more jobs for family docs because they need someone with broader training who can also see kids and pregos.

You will have a significant amount of peds and OB/Gyn as an FM resident. If you really don't plan on practicing full scope family medicine, I would go IM.

Not to say there aren't family physicians who primarily treat adults--there are many who do. But if you know at this point that's what you want to do, I'd seriously consider the need to learn peds and OB.

Yeah, but how many FM docs that you know of are practicing OB...none that I know of (some used to, but quit due to schedule and malpractice). So the million dollar question becomes, do you go ahead and choose FM even though you KNOW you won't practice OB or do you go med-peds (four years, mostly hospital training...no thanks). So to me, it makes sense just to deal with the wasted OB time and go with FM (unless you don't want to see kids either, then go IM).

 

[YouDontKnowJack]

but, aren't the kids gonna go see the peed anyway?

don't fm's see much much fewer kids than peds?

 

[sophiejane]

Yeah, but how many FM docs that you know of are practicing OB...none that I know of (some used to, but quit due to schedule and malpractice).

OB in FM is regional. I personally know of about 15-20 family docs who are doing OB quite successfully. This is all in my state (or Republic, shall we say ) and are preceptors I've heard about or met/worked with, or graduates of some of the programs I've applied to.

 

[deleted87716]

don't fm's see much much fewer kids than peds?

Well, considering that peds sees 100% kids, I'd say...yes.

 

[lateness]

is that from dumb and dumber

 

[oldbearprofessor]

Well, considering that peds sees 100% kids, I'd say...yes.

Well, I'd say it's about 98.43% - more than a few "kids" who are >18 y/o (some > 30 y/o) with CHD, CF, etc show up in tertiary care center Children's Hospitals.

 

[raptor5]

This is all in my state (or Republic, shall we say )

Some would say it's a whole other country

 

[McDoctor]

I am a fourth year trying to decide between family medicine and internal medicine. I am attracted to family medicine because of its public health and underserved emphasis. However, I am primarily interested in working with adults, but in an underserved location, doing public health work and/or research. Would anyone recommend completing FM over IM in my situation?

I did a year and a half in IM before switching to Family Medicine. I can mention some differences I found between the two, but of course every training program is different.

In internal medicine, I didn't really have a concept of public health. I spent most of my time admitting patients and getting them well enough to discharge them. I felt my main responsibility was to diagnose and treat illness period. Concepts of patient education, preventive medicine, outpatient continuity clinic all pretty much got lip service where I trained.
Also, The patients in IM generally had more pressing medical problems than what I usually see now in Family Medicine. This made the job more rewarding at times, but also more stressful.

I think in Family Medicine, if you think your job is strictly to diagnose and treat urgent medical issues and get everyone well, then you will be very frustrated. When you write an order in the hospital it (usually) gets done. In family med, where the focus will be on outpatient, you pretty much count on a certain percentage of patients not taking their meds, getting tests done, etc. So you have to look at yourself primarily as an educator, as well as someone who diagnoses and treats acute conditions. Patient interaction in Family medicine is usually more fun, since the people are healthier and (usually) don't smell like bedpans and bedside urinals.

I think if you like Public Health, you should go into FM, or least be very discriminatory about which IM or IM/PEDS programs you look at. The OB/GYN department is a fun place to visit as a FM resident, and the Peds exposure generally is a healthy population in FM, so I wouldn't let those two aspects scare you off. Most of your patients will be adults.

Hope some of this helped.

 

[sophiejane]

but, aren't the kids gonna go see the peed anyway?

don't fm's see much much fewer kids than peds?

Hmm, not sure, but I know they see more kids than geriatricians.

 

[iatrosB]

Hmm, not sure, but I know they see more kids than geriatricians.

Geriatricians seeing kids is regional

 

[efex101]

So another question...we know that during residency IM is mostly hospital based but what about AFTER residency? I hear this about IM is mostly hospital work but outside of academia I seen tons of IM docs with private practices similar to FM right? I am also not sure where to head...I am so confused right now. I know for sure that peds is not my thing...I can endure the training but after that I don't see myself interacting with kiddos...now teens I love but not little ones. Any advice? btw I love doing procedures and whatnot...so my differential right now is FM/IM/Ob/Gyn

 

[nobrainer]

I did a year and a half in IM before switching to Family Medicine. I can mention some differences I found between the two, but of course every training program is different.

In internal medicine, I didn't really have a concept of public health. I spent most of my time admitting patients and getting them well enough to discharge them. I felt my main responsibility was to diagnose and treat illness period. Concepts of patient education, preventive medicine, outpatient continuity clinic all pretty much got lip service where I trained.
Also, The patients in IM generally had more pressing medical problems than what I usually see now in Family Medicine. This made the job more rewarding at times, but also more stressful.

I think in Family Medicine, if you think your job is strictly to diagnose and treat urgent medical issues and get everyone well, then you will be very frustrated. When you write an order in the hospital it (usually) gets done. In family med, where the focus will be on outpatient, you pretty much count on a certain percentage of patients not taking their meds, getting tests done, etc. So you have to look at yourself primarily as an educator, as well as someone who diagnoses and treats acute conditions. Patient interaction in Family medicine is usually more fun, since the people are healthier and (usually) don't smell like bedpans and bedside urinals.

I think if you like Public Health, you should go into FM, or least be very discriminatory about which IM or IM/PEDS programs you look at. The OB/GYN department is a fun place to visit as a FM resident, and the Peds exposure generally is a healthy population in FM, so I wouldn't let those two aspects scare you off. Most of your patients will be adults.

Hope some of this helped.

excellent post!

 

[elizabeth5863]

So another question...we know that during residency IM is mostly hospital based but what about AFTER residency? I hear this about IM is mostly hospital work but outside of academia I seen tons of IM docs with private practices similar to FM right? I am also not sure where to head...I am so confused right now. I know for sure that peds is not my thing...I can endure the training but after that I don't see myself interacting with kiddos...now teens I love but not little ones. Any advice? btw I love doing procedures and whatnot...so my differential right now is FM/IM/Ob/Gyn

I know an internist who does only outpatient medicine. Her job is basically like that of an fp except she sees only adults. She went to IM residency with primary care track/focus. (I'm not exactly sure if that's the correct name of the track but there are two types of IM residency programs - the more traditional one and the one that is more primary care/outpatient focused). She got to spend more time in clinic than her colleagues in the traditional track and does preventative health, chronic disease management, urgent care clinic, etc. If you think there is a possibility that you might specialize in areas not available in fp, then I think IM would be a better choice.

UC Davis and University of Colorado are two programs I know of (off the top of my head) that offer IM residency with a more primary care/preventative health/outpatient focus.

Hope that helps! Good luck!

 

[deleted87716]

There are also a few four-year combined IM/FM programs out there, if you want to hedge your bet.

 

[Faebinder]

From a business stand of point... as an FM doc, your patients (whom are insured cause you are picky) will come to you for their kids problems (minor ones) and you will get well compensated for it.... Likewise for OBGYN pap smears, kolposcopy for their daughters.... You are just a lot more accomodating than the specialist and generally a lot more receptive of their issues (like they dont want to schedule for an appointment 10 days from now!)

As an IM, you will be missing out on this. You might think it's not a big deal.. but it sorta is.. mother comes in for a pap smear and brings the kid cause he is having a cough.

I don't know... just pick your cup of tea... In an ambulatory setting, versatility is a lot more important in my opinion cause it provides customer service....

 

[lloyd braun]

Thank you to all who posted. They have been very helpful--keep 'em coming if you have an opinion.

By the way, Lloyd Braun is a character from Seinfeld.

 

[deleted87716]

By the way, Lloyd Braun is a character from Seinfeld.

"Serenity now!!!"

 

[lloyd braun]

"Serenity now!!!"

"insanity later..."

 

[lateness]

"insanity later..."

now i remember,, the "crazy" one who sold computers..

 

[tatabox80]

now i remember,, the "crazy" one who sold computers..

wasn't he also running for public office?

 

[mamadoc]

So another question...we know that during residency IM is mostly hospital based but what about AFTER residency? I hear this about IM is mostly hospital work but outside of academia I seen tons of IM docs with private practices similar to FM right? I am also not sure where to head...I am so confused right now. I know for sure that peds is not my thing...I can endure the training but after that I don't see myself interacting with kiddos...now teens I love but not little ones. Any advice? btw I love doing procedures and whatnot...so my differential right now is FM/IM/Ob/Gyn

I'd love to know what it's like elsewhere, but in my part of the country (mid-Atlantic) IM docs don't do procedures unless they're hospitalists placing lines. Whereas we FM folks love those simple office procedures; I love cutting and stitching and burning!

I went to a presentation recently that quoted statistics (unfortunately I have NO idea from where) stating that a surprisingly small number of IM-trained physicians go into primary care practice - maybe only 25%. The rest are going into fellowships, e.g. cards, rheum, ID, GI. And IM residents get very little clinic time as part of a traditional residency..... so one could argue that your standard IM residency doesn't prepare you nearly as well for the outpatient setting as an FM residency.

Offering this FWIW.....

 

[iatrosB]

And IM residents get very little clinic time as part of a traditional residency..... so one could argue that your standard IM residency doesn't prepare you nearly as well for the outpatient setting as an FM residency.

....

Agreed. If one were to choose an IM program with the plans of practicing primary care, it would be essential to select a program that has a primary care track. These programs expose you to more clinic time than traditional IM.

 

[lateness]

wasn't he also running for public office?

thats right. didnt he also make jerry chew some bad gum and wear some glasses..

 

[lloyd braun]

Glad to see so much interest in both my decision to enter IM vs. FM, as well as Lloyd Braun.

Lloyd Braun is one of my favorite characters on Seinfeld. You are all correct with your remembrances.

Here is a nice Wikipedia summary of the character for all who are interested:

http://en.wikipedia.org/wiki/Lloyd_Braun_(Seinfeld)

 

[iatrosB]

Somewhat back to the topic on hand...

Can anyone tell me the difference in a FM doc in private practice and an IM doc? Besides the obvious difference of the FM doc seeing kids, how does the adult population compare (are they more complex, sicker in IM...or the same)?

 

[deleted87716]

Can anyone tell me the difference in a FM doc in private practice and an IM doc? Besides the obvious difference of the FM doc seeing kids, how does the adult population compare (are they more complex, sicker in IM...or the same)?

The adult medicine patients seen by FPs and internists are identical in terms of their complexity (I can't think of any reason why they wouldn't be). However, general internists tend to see primarily older adults, while FPs typically see a more varied mix of adults of all ages, women, children, etc. There's plenty of room for individual practice variability in both IM and FM, however.

 

[Tn Family MD]

If you were any sicker than some of my clinic patients, you would be dead.

 

[Faebinder]

Personally, when it comes to private practice... there is no way you can convince me that Internal Medicine is superior to Family Medicine....

You have a LOT more to pick and choose from as an FM doc.... and your training is much broader so you're comfortable taking on the families who usually are insured..... IM is slowly reducing their ambulatory training as per some press release I saw in another thread (I'd have to hunt it down).

So if you pretty much wanna be a hospitalist... the supposed IM is a better route, though I know some successful FM hospitalists as well.... we all bill using the same ICD codes if that is the issue. (And I do know... IM gets eventually burnt out of hospital work but that's much later in the career, which is why they try to switch to ambulatory later....) In ambulatory... you can't treat everything like Zebras... gotta sift through horses.

 

[deleted87716]

In ambulatory... you can't treat everything like Zebras... gotta sift through horses.

Inpatient medicine consists of pretty routine stuff too, for the most part.

 

[halal meat]

How about dual residencies such as Psych/FP and Psych/IM?

Do they practice both concurrently? Or split them through out the week?

This is the post where I got the dual programs from btw.
http://forums.studentdoctor.net/showpost.php?p=4480609&postcount=17