IM or FM sports medicine

[bbkl123]

Hey guys. I'm interested in sports medicine and have the choice of entering an IM or FM residency. I like the procedures of FM but I don't like working with children or OB. I don't hate children, but I prefer working with adults. That makes me think IM is the right choice, but is there a disadvantage of IM graduates trying to find a sports medicine fellowship compared to FM? I know IM is a lot less procedure heavy. If I ended up IM and somehow found a fellowship, are the opportunities post-fellowship the same? The FM program that can take me has a sports fellowship if that makes any difference. Both IM and FM programs are community programs. Any input would be great. Thanks!

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[galactus]

Hey guys. I'm interested in sports medicine and have the choice of entering an IM or FM residency. I like the procedures of FM but I don't like working with children or OB. I don't hate children, but I prefer working with adults. That makes me think IM is the right choice, but is there a disadvantage of IM graduates trying to find a sports medicine fellowship compared to FM? I know IM is a lot less procedure heavy. If I ended up IM and somehow found a fellowship, are the opportunities post-fellowship the same? The FM program that can take me has a sports fellowship if that makes any difference. Both IM and FM programs are community programs. Any input would be great. Thanks!

I've seen IM trained sports med docs, but there are few and far in between, and most of the ones I do know, are Med/Peds. I think the issue is not having enough MSK exposure in an IM residency than FM.

The opportunities post fellowship are the same. We all take the same sports medicine board exam (FM, IM, peds, PMR, ER)

Hope this helps.

 

[bbkl123]

Thanks. would you say fellowship opportunities are the same? Do fellowships favor FM and PM&R graduates over IM?

 

[Sportsbound]

I am IM and just matched. I had plenty of interviews and ended up matching at a pretty competitive program. My MSK exposure in residency was probably not as much as most of the other candidates and I had zero research/publications. It certainly would have helped had I done some research or attended conferences though (and probably would have gotten some of the interviews I wanted by didn't) , so try to get involved in this when you start. If your interest is evident through your residency, I really don't think you will have a problem matching.

 

[JonMonkey]

I feel that completing a residency in FM will make you more well rounded than say IM but once you get into fellowship all you do is sports aside from your 1/2 day in your field of training (IM, FM, Peds, ER, PM&R). I agree that the MSK you will get through IM is not what you would get through FM but IMs get into fellowships every year. There are however I feel more positions for FM compared to IM.

http://www.amssm.org/FellowshipsPositions.html

I am not sure how updated this information is but if you click on the listed programs it will tell you how many positions and what training they accept.

 

[septoplasty]

Might be hard, but too many variables/technicalities.

Most if not all fellowships will have peds populations, and as a PCSM, your job is to also manage medical aspect of the athlete. I.e. Asthma for example. If you haven't seen patients <18 in a guided, controlled setting (aka. residency), than it might be even harder when you're sort of "thrown" out there for game coverage/training room/clinic etc.

I agree with the poster of being more well rounded. I don't feel IM will prep you well enough for SM.

 

[TXPMR]

Quoted below is my rundown of the different paths to becoming a sports med doc. In my opinion, family medicine and PM&R are the two best specialties to go into prior to sports med fellowship. FM residents are excellent at taking care of all ages of patients and all of their ailments. Plus, MSK medicine is a core component to FM curricula. PM&R residents get more MSK training in residency than any other non-operative medical field. Plus, besides neurology, PM&R gets more neurologic medicine training in residency than any other field. So PM&R residents come out very proficient in neuromuscular medicine. This actually ends up helping a lot with the sports medicine boards.

One can definitely be a great sports med physician (and I do know them) coming out of IM/Peds/ER, but in my opinion these residents are a little behind initially in fellowship compared to FM and PM&R residents. All the sports med fellowships that I'm familiar with have a strong outpatient component dealing with MSK issues, i.e. most of the clinical time is spent in non-operative sports and orthopaedic surgical sports clinics. So, IM residents typically do not get a lot of outpatient MSK experience. Peds do not get a lot if any adult outpatient MSK experience. ER doesn't get much MSK exposure beyond ruling out and treating the really bad stuff (e.g. fracture vs. patellofemoral syndrome, etc.).

1. Orthopaedic surgery: very competitive, need great board scores. HAVE to like surgery. Residency is grueling but practice, depending on setting, can be very busy to cush-ish. Fast track to "head team physician" for major pro teams if that's your thing. Not as much training in non-operative MSK medicine compared to PM&R. Great pay all around. Only orthopaedic surgery trained physicians can do orthopaedic surgery sports medicine fellowships.

2. PM&R/physiatry: generally less competitive but getting a lot more competitive especially at the "top" places. Have to get over the fact that when you say you are PM&R/a physiatrist most people are like "huh"? (this can actually be a hang up for people). Otherwise have to like a lot of different areas: neuro, ortho, a little bit of medicine. If it's your thing, out all the other paths to sports med docdom PM&R is second to ortho in terms of procedures available (interventional spine, US injections, EMGs). AWESOME lifestyle. Actually great pay when you consider the hours/relative lack of stress involved. PM&R trained physicians are eligible for PM&R based ACGME fellowships (for which only PM&R physicians can do) and primary care/family medicine based fellowships.

3. FM: competitive to not competitive at all: can literally walk in to some of the lower tiered FM programs (but they may not have any sports/MSK faculty). Great jumping off point for the medical care of the athlete since your backbone is the medical care of all ages and types. Much less neuro compared to PM&R and much less ortho compared to ortho/PM&R. But you will be THE medicine guru when it comes to athletes. Ok lifestyle depending on your practice mix. Pay is moderate.

4. IM: competitive to not competitive at all. Have a medicine backbone like FM but get MUCH less outpatient exposure these days in residency in most places. Plus as mentioned never really take care of kids which is a minus for a well rounded sports doc. Lifestyle can be what you make it. Pay can actually be pretty high if you take hospitalist type jobs on the side.

5. Peds: competitive to not competitive at all. Have an excellent pediatric medicine backbone and good training in outpatient medicine, but in general, peds residents are relatively deficient in adult sports medicine when coming of residency compared to all other specialties that feed into sports med. Lifestyle can be what you make it depending if you have a strictly outpatient practice vs. urgent care vs. part-time hospitalist. Pay varies from low to high depending on your practice set up.

5. EM: competitive to moderately competitive...in general you have to actually be a decent candidate to match into any EM program. AWESOME at taking care of acute issues/injuries medical and MSK related, not so awesome at longitudinally taking care of patients (or at least not part of the core residency training at most places). Lifestyle and pay is what you make it depending on how many ER shifts you take on the side.