Increasing Internal Medicine emphasis in Family Medicine

[CautiousLearner]

Honestly, this is something that has been on my mind and I wanted to gauge the idea or spirit behind this. I have seen a number of sites I interviewed at and also the program I ended up in putting up more emphasis on Internal Medicine. At our program we struggle to maintain the 1650 pt encounters, however, at the same time we are doing a double the ACGME required time frame [6 months and 750 pts] with far more pt encounters than required.

I am concerned that we should at least make an attempt to reform our IM academic hospitalist teams and use that time to:
1. Increase Clinic rotations
2. clinic call
3. Putting more time in any experience that residents need to meet the requirements be it geriatric or other types of pt encounters or procedures. That time can be also utilized for elective time, so if you are more keen on becoming a hospitalist you can apply for that as an elective.

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[deleted87716]

I'm not sure what you mean when you say "internal medicine." Basically, "internal medicine" is the care of adults (in or out of the hospital). Are you suggesting that you aren't getting enough adult medicine in your FM residency...? That's hard to imagine.

 

[galactus]

Emphasis on "internal medicine"? Don't you mean emphasis on adult medicine, or you're saying more emphasis on inpatient care?

 

[Sardonix]

Your post is kinda confusing, but from what I gathered you're concerned with how much inpatient (hospital IM) FM programs have while they're struggling to meet the 1650 outpatient visits. Every program is struggling to meet 1650 due to COVID--so much so that the ACGME is giving current FM PGY3s a pass on their numbers. This is not due to lack of clinic time, it's because no one is coming in due to COVID. No curriculum change will help with that.

With that said, I am confused as to where you think FM programs are not focusing on outpatient medicine enough. As a PGY1, your post is literally the first time I've heard such a complaint--the vast majority are concerned that they get too much clinic, not enough hospital. Given how little trouble a resident with tons of inpatient experience has transitioning to a mostly outpatient practice vs. how poorly an outpatient heavy resident struggles to adapt to inpatient obligations I don't really see what your concern is.

 

[MedicineZ0Z]

Honestly, this is something that has been on my mind and I wanted to gauge the idea or spirit behind this. I have seen a number of sites I interviewed at and also the program I ended up in putting up more emphasis on Internal Medicine. At our program we struggle to maintain the 1650 pt encounters, however, at the same time we are doing a double the ACGME required time frame [6 months and 750 pts] with far more pt encounters than required.

I am concerned that we should at least make an attempt to reform our IM academic hospitalist teams and use that time to:
1. Increase Clinic rotations
2. clinic call
3. Putting more time in any experience that residents need to meet the requirements be it geriatric or other types of pt encounters or procedures. That time can be also utilized for elective time, so if you are more keen on becoming a hospitalist you can apply for that as an elective.

Inpatient is where you actually learn stuff dude. Seeing more physicals and vertigo and low back pain won't make you a better doc in comparison.
Taking care of a sick hospitalized patient is what makes a real generalist doctor (heavy emphasis on generalist). There's usually a big knowledge gap between docs weak at inpatient and those strong at it.
So no, if anything there should be more inpatient emphasis in FM residency - especially taking care of very sick patients.

You should be competent at clinic with even quite a bit less than 1650 encounters. Also, if inpatient training is weak at a residency then it's almost guaranteed outpatient is subpar. FM faculty who are outpatient only tend to be the ones who are set on just doing bare minimum bread and butter + love referring out anything remotely complex in their clinic.

Your post is kinda confusing, but from what I gathered you're concerned with how much inpatient (hospital IM) FM programs have while they're struggling to meet the 1650 outpatient visits. Every program is struggling to meet 1650 due to COVID--so much so that the ACGME is giving current FM PGY3s a pass on their numbers. This is not due to lack of clinic time, it's because no one is coming in due to COVID. No curriculum change will help with that.

With that said, I am confused as to where you think FM programs are not focusing on outpatient medicine enough. As a PGY1, your post is literally the first time I've heard such a complaint--the vast majority are concerned that they get too much clinic, not enough hospital. Given how little trouble a resident with tons of inpatient experience has transitioning to a mostly outpatient practice vs. how poorly an outpatient heavy resident struggles to adapt to inpatient obligations I don't really see what your concern is.

Any program can put together something that sees local diabetes and hypertension patients. Weak inpatient training is a pretty good indication that the rest of it is weak as well. It usually also means that local complex patients will be followed by IM docs and not FM.