So what is the major difference in the lives and practice of Family and internal medicine docs...??

[license43]

Hi all. I really enjoy physiology and I was contemplating doing Family med or internal med.
From my understanding, family med docs are a 'jack of all trade,' dealing with all sorts of conditions for newborns, peds patients, ob patients, and adults, while internal medicine docs deal with 18> and have trading in more chronic and complete adult conditions. Correct me if i'm wrong but thats my perspective.

Is there a big difference in the pay O), demand, and day to day practice between internal med and family docs..?

I mean I wouldn't mind seeing any age, although I hate when kids cry, but just wondering if you are at a disadvantage in patient size, salary by becoming an internal med doc.

Also generally what is the pay? Mainly in upper east coast, particularly NYC. . thanks all

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[SLC]

Hi all. I really enjoy physiology and I was contemplating doing Family med or internal med.
From my understanding, family med docs are a 'jack of all trade,' dealing with all sorts of conditions for newborns, peds patients, ob patients, and adults, while internal medicine docs deal with 18> and have trading in more chronic and complete adult conditions. Correct me if i'm wrong but thats my perspective.

Is there a big difference in the pay O), demand, and day to day practice between internal med and family docs..?

I mean I wouldn't mind seeing any age, although I hate when kids cry, but just wondering if you are at a disadvantage in patient size, salary by becoming an internal med doc.

Also generally what is the pay? Mainly in upper east coast, particularly NYC. . thanks all

Not a ton of difference for people doing primary care in these fields. With the exceptions you mentioned (mainly pediatrics).

Also, I get the sense that Family medicine trained docs are a fair bit more comfortable with women's health than the IM doctors I've encountered. It hasn't been uncommon at all for IM trained PCP's I've known to ask their female patients to maintain an OB-Gyn for their Pap-smears etc; I've never seen a FM doc who did this.

 

[FamilymedMD]

One DPC family doc's heavily biased opinion/experience-

If you go to internal medicine or med/peds, you always have the option to go on to fellowship training. Family medicine fellowships are much more limited and you won't be recognized as a subspecialist. As insurance and government paid primary care pay has declined and hassles have worsened dramatically over the last twenty year's, that has meant that family medicine grads are stuck in primary care and general internal medicine grads have fled to the subspecialties.

A few IM docs do paps and procedures including endoscopy but they are rare. Maybe I'm paranoid but I still perceive echos among older docs of the attitude that IM docs are better trained and more suitable for inpatient work than family docs. (IMHO that varies more among individual docs and their attitude toward the profession, more so a few years or more out of training.) Family docs do seem to have more pseudoscience advocates than IM. Family docs spend a lot of time in residency doing Ob that very few of us do anymore. Without the Ob, it's harder in many locations to keep a good number of peds cases in the office. Recently, at least one local hospital expects to be able to hire IM grads as hospitalists right out of residency but expects FM grads to do extra training before becoming hospitalists. I'm not sure how common that is.

The last twenty years experience is not predictive of the next twenty. My best guess would be skills such as minor surgery, ultrasound, office orthopedics, Holters/stress tests and office gyn will become more important as more patients are spending their own money and they will value docs who can do these things sustainably in the office for a fraction of the price of a hospital based clinic. There's no reason an IM doc couldn't learn these skills but that depends upon the residency.

 

[deleted87716]

It's a wash.

10-y/o data, but things really haven't changed that much: https://www.managedcaremag.com/arch...s-vs-internists-state-state-salary-comparison

 

[JustPlainBill]

Well, then you have to consider the personality types --- most FM docs tend to be rolling-one-man-frat party types where IM tends to be more analytical/bookish; who do you want to hang around -- people who's idea of fun is pimping each other on various medical minutiae or people who's idea of fun is Top Golf, wings and drinks? Your call -- FM types also tend to be better looking, but that's a personal opinion....

 

[cabinbuilder]

In my personal experience the IM folks are very cerebral and analytical and like to number crunch and manage lots of complicated multiple problems. FM folks are more down to earth, jack of all trades multi taskers who can suture and do great splints. Have you have seen an IM try to suture? It doesn't really happen very well or very quickly.

 

[northernpsy]

FM types also tend to be better looking

Have you ever wondered if there was more to life, other than being really, really, ridiculously good looking?

 

[northernpsy]

Also, I get the sense that Family medicine trained docs are a fair bit more comfortable with women's health than the IM doctors I've encountered. It hasn't been uncommon at all for IM trained PCP's I've known to ask their female patients to maintain an OB-Gyn for their Pap-smears etc; I've never seen a FM doc who did this.

This fits with my experience of FM vs. IM types too. How much you loved or hated ob/gyn might be something to think about in deciding which direction to go in.

 

[JustPlainBill]

Have you ever wondered if there was more to life, other than being really, really, ridiculously good looking?

Not really. Although I do confess that at times I ask God why I couldn't have been born rich instead of good looking....

 

[northernpsy]

Not really. Although I do confess that at times I ask God why I couldn't have been born rich instead of good looking....

It's quite a burden to be so good looking that you have to spend precious time in clinic fighting off prospective suitors that you could otherwise be using to click checkboxes in Epic.

 

[JustPlainBill]

It's quite a burden to be so good looking that you have to spend precious time in clinic fighting off prospective suitors that you could otherwise be using to click checkboxes in Epic.

Reason why I carry a cane -- to keep all the nurses at bay so I can get my charts done....

 

[psychMDhopefully]

Most of the salary surveys I come across have IM usually about 20k higher the FM, I think thats because more complex cases are reimbursed higher, and FM does peds too which tends to reimburse lower.

 

[VA Hopeful Dr]

Most of the salary surveys I come across have IM usually about 20k higher the FM, I think thats because more complex cases are reimbursed higher, and FM does peds too which tends to reimburse lower.

Its also much harder to find internists willing to do outpatient these days, so many go into hospitalist work. Scarcity runs price up as well.

Besides, complex cases aren't reimbursed enough more than simple ones to make up the difference. Why do you think urgent cares are popping up all over the place? Hint: its not out of a sense of community service.

 

[septoplasty]

One DPC family doc's heavily biased opinion/experience-

If you go to internal medicine or med/peds, you always have the option to go on to fellowship training. Family medicine fellowships are much more limited and you won't be recognized as a subspecialist. As insurance and government paid primary care pay has declined and hassles have worsened dramatically over the last twenty year's, that has meant that family medicine grads are stuck in primary care and general internal medicine grads have fled to the subspecialties.

I disagree with the bolded point. The fellowships offered through the ABFM are recognized as sub-specialists, and based on credentialing your salary will reflect that as well (as with any other boarded sub-specialist).

 

[VA Hopeful Dr]

I disagree with the bolded point. The fellowships offered through the ABFM are recognized as sub-specialists, and based on credentialing your salary will reflect that as well (as with any other boarded sub-specialist).

Eh, kinda. Every fellowship we have isn't limited to us like the IM ones are. So yes, you can be a sleep physician but so can the internist, psychiatrist, and probably a few others.

 

[cabinbuilder]

Most of the salary surveys I come across have IM usually about 20k higher the FM, I think thats because more complex cases are reimbursed higher, and FM does peds too which tends to reimburse lower.

20K in the overall scheme of things really isn't that much.

 

[septoplasty]

Eh, kinda. Every fellowship we have isn't limited to us like the IM ones are. So yes, you can be a sleep physician but so can the internist, psychiatrist, and probably a few others.

Yea, but thus still would be a sub specialist, even based on definition, and based on salary/income/credentialing.