these two feilds are so similar . differences are really very subtle. so how do u guys decide on one? i'm having a tough time with it. keep jumping from one to the other.

these two feilds are so similar . differences are really very subtle. so how do u guys decide on one? i'm having a tough time with it. keep jumping from one to the other.

IM focuses on adult medicine and enables one to pursue a lucrative fellowship after 3 years of residency. FP includes some IM, peds, non-complicated OB, and sometimes minor surgery. FP right now has alot of outside pressures forcing down revenues. I would go IM if I were you since I am not so sure about the future of FP. But that is just my observation.

these two feilds are so similar . differences are really very subtle. so how do u guys decide on one? i'm having a tough time with it. keep jumping from one to the other.

right now i want to go FP. it seems more broad, and more applicable to rural meds. there are numerous unopposed FP programs, and i think that is what i want to do.

who cares about money, especially when you are making over 100k. wow! student loans? there are many communities that will pay like 20-25k on your loans per year you agree to work in their community.

if you see them as being so similiar, perhaps, look closer at what you perceive to be the differences.

I don't think the fields are similar at all. Internal Medicine is the opposite of pediatrics in which you specialize in adult medicine. Family Practice encompasses adult medicine, pediatrics and OB/GYN. And although, most city dwelling FP don't practice OB, they still incorporate a lot of gynecological related procedures like pap smears.

I don't think there is any purpose going into IM if you want to go into general practice. In regards to general practice, internal medicine would limit you because you wouldn't be able to see pediatric or gynecological problems. If I was going to practice general medicine, I would specialize in IM/Peds as opposed to just IM by itself. Some would argue that Family Practice physicians don't have the fund of knowledge as Internists in regards to adult medicine. This is certainly true but the reality is most cases an General Internist in private practice sees on a daily basis are cases any FP can handle without difficulty. The same applies to pediatrics. The majority of cases a general pediatrician in private practice sees are cases any FP can deal with. Of course, things are different when you are talking about the academic world (aka residency) in which you will a large number of rare or unusual cases related to your field.

Most people who go into IM, go into the field with the intent of pursuing a fellowship. And there are so many IM related fellowships that you are pretty much guaranteed one. Not all IM fellowships are as competitive as GI, Cards and Allergy. And those who fail to match into those 3 usually will reapply or pursue a less competitive fellowship like endocrine or rheum which are pretty much guaranteed if you are willing to live in any part of the country.

Money can be made in FP. I know several FP that earn in excess of 500K per year. And these physicians are not living in Timbuktu or performing procedures that specialists perform. They live in large cities but they see a large volume of patients. They will hire 2 or 3 PA's and see 180-200 patients per day. Granted, these physicians are earning every penny because they are often working 10-12 hours per day. It takes a lot of stamina to personally see around 60-80 patients every single day. They can't take much vacation either. And don't believe the myth that city dwelling FP don't perform procedures. Many FP in large cities perform stress tests, colonoscopy and skin tests as examples. Many patients don't mind going to an FP for these procedures because it usually means they don't have to wait 3 months to see a specialist.

I don't think the fields are similar at all. Internal Medicine is the opposite of pediatrics in which you specialize in adult medicine. Family Practice encompasses adult medicine, pediatrics and OB/GYN. And although, most city dwelling FP don't practice OB, they still incorporate a lot of gynecological related procedures like pap smears.

I don't think there is any purpose going into IM if you want to go into general practice. In regards to general practice, internal medicine would limit you because you wouldn't be able to see pediatric or gynecological problems. If I was going to practice general medicine, I would specialize in IM/Peds as opposed to just IM by itself. Some would argue that Family Practice physicians don't have the fund of knowledge as Internists in regards to adult medicine. This is certainly true but the reality is most cases an General Internist in private practice sees on a daily basis are cases any FP can handle without difficulty. The same applies to pediatrics. The majority of cases a general pediatrician in private practice sees are cases any FP can deal with. Of course, things are different when you are talking about the academic world (aka residency) in which you will a large number of rare or unusual cases related to your field.

Most people who go into IM, go into the field with the intent of pursuing a fellowship. And there are so many IM related fellowships that you are pretty much guaranteed one. Not all IM fellowships are as competitive as GI, Cards and Allergy. And those who fail to match into those 3 usually will reapply or pursue a less competitive fellowship like endocrine or rheum which are pretty much guaranteed if you are willing to live in any part of the country.

Money can be made in FP. I know several FP that earn in excess of 500K per year. And these physicians are not living in Timbuktu or performing procedures that specialists perform. They live in large cities but they see a large volume of patients. They will hire 2 or 3 PA's and see 180-200 patients per day. Granted, these physicians are earning every penny because they are often working 10-12 hours per day. It takes a lot of stamina to personally see around 60-80 patients every single day. They can't take much vacation either. And don't believe the myth that city dwelling FP don't perform procedures. Many FP in large cities perform stress tests, colonoscopy and skin tests as examples. Many patients don't mind going to an FP for these procedures because it usually means they don't have to wait 3 months to see a specialist.

I have practiced as an FP for the past four years. I think that an IM doc has more practice options.Most hospitalist are IM docs. FPs can do most of what IM docs do but you have to face it, no one can be an expert at everything.
The option of being able to do a fellowship also makes IM a more attractive option.

I believe that there are FPs who make 500k yearly. The problem with that is there is no way to give good care seeing 50+ patients daily. I know of a doc who sees 50 patients daily.

Your best bet would be to go into IM and then find a fellowship. What has happened to FP and actually primary care is a shame. you will have to hit the ground running to be competitive for a good field but it can be done and is worth the effort.

Some will disagree with me but I am in the real world and I see what is going on out there.

CambieMD

As other posters have said, IM and FP are actually VERY different fields. For one, just look at the training...it's radically different. FP training generally incorporates surgery, OB, peds, etc., while IM residency focuses entirely on adult medicine and its subspecialties, and is much more directed towards inpatient and ICU type of care. FP training is definitely much broader in scope, but as a consequence it's also more superficial. I also think IM tends to be much more academic, although this varies quite a bit from program to program.

It's really important to consider what type of training you'd prefer. I for one really abhor the FP training I've seen. At large academic centers it seems like FP residents are just glorified med students, rotating through various services, never really feeling like part of the team, and not really being wanted there. I'm sure it's not like this everywhere, but after seeing what I've seen I'd never do a FP residency. Even classmates of mine who're interested in FP have said they plan to train in a much less antagonistic setting.

Granted, you can of course choose to PRACTICE in very similar ways by doing either FP or IM, but I tend to agree with other posters who've said that IM gives you so many more options for further training. That said, I know some great FP docs who are also smart businessmen, and they've managed to set up a very lucritive practice that allows them to spend more time with each of their patients without sacrificing their salary or extending their office hours or taking call. So don't let the doom and gloom picture that's often painted of FP get you down.

IM and FP are essentially the same. It is a well known fact that, although it's the fellowships that lure students into IM, most residency graduates still practice general internal medicine. Outpatient. With a pediatrician as a partner. With 1 or 2 PAs/NP/LPN/RNs working with them. Making the same salary as FP. Working with FPs. Working for FPs. I just love when people split hairs between primary care specialties.

It is a JOB, and if you like primary care, then do it. If you really want to specialize, then do it. You will be paid more, but you also will be a PGY4,5,6,7 before you see the money. So don't let money decide for you. Many residents are on student loans too. So imagine tacking on post graduate loan debt on top of undergrad and med school debt.

You don't become an endocrinologist/allerist/gastroenterologist right out of residency. And chances are you need a good research portfolio to get in somewhere good. Do you want to do research?

IM and FP are essentially the same. It is a well known fact that, although it's the fellowships that lure students into IM, most residency graduates still practice general internal medicine. Outpatient. With a pediatrician as a partner. With 1 or 2 PAs/NP/LPN/RNs working with them. Making the same salary as FP. Working with FPs. Working for FPs. I just love when people split hairs between primary care specialties.

Hmmm, interesting comments, although I disagree with most of what what said. First, about 50-60% of IM residency graduates go on to pursue subspecialty fellowships. Among the people who don't, a growing number are pursuing hospitalist medicine -- it is really an up and coming field. Now out of the IM residency graduates who end up doing outpatient primary care, yes they can certainly choose to have a similar practice as an FP if they want to (minus the kids and OB of course - a big selling point for those of us who dislike peds!). As far as working with a pediatritian or FP as a partner, though, I don't think it's that common anymore, at least not in my area. Most of my classmates who are graduating this year and doing primary care are joining Internal Medicine practices, composed solely of IM physicians. Many of these practices that my classmates are joining specilaize in treating older patients with much more complex medical problems than one would typically see in an FP clinic.

It is a JOB, and if you like primary care, then do it. If you really want to specialize, then do it. You will be paid more, but you also will be a PGY4,5,6,7 before you see the money. So don't let money decide for you. Many residents are on student loans too. So imagine tacking on post graduate loan debt on top of undergrad and med school debt.

As far as the student loan issue, I don't know anyone who's still taking out loans as a resident, and I live in one of the most expensive areas of the country. Unless you are grossly mismanaging your finances, you should not be taking out student loans after you have finished med school.

You don't become an endocrinologist/allerist/gastroenterologist right out of residency. And chances are you need a good research portfolio to get in somewhere good. Do you want to do research?

I'm not sure about your point here -- you actually do start subspecialty training right out of residency. Some people will take a year or two off and work as hospitalists or in urgent care before fellowship to make some extra money or to take a break, but most people don't take any time off. You also don't necessarily have to do research for fellowship. Many academic fellowships are starting to have "clinician educator" tracks, where instead of doing the research time, you work on things like your teaching skills in academic medicine, etc.

Sorry, I don't mean to stray away from the topic. FP vs IM can be a difficult choice, especially if you are interested in primary care.

Some questions to ask yourself in your decision:
Do I truly want to do primary care, or do I want to keep other options open?
Do I want to deal with peds and OB? Or do I only want to take care of adults?
Do I like inpatient medicine? Might I consider hospital medicine in the future?
Do I like taking care of really sick patients?
Do I like to take care of complicated patients or do I want to avoid them like the plague?
Do I like dealing with diagnostic dilemmas (people who go into IM love this stuff)
Am I interested in geriatrics? (IM might be more appropriate if this is so - lots of geriatric training during residency and many geriatrics fellowships available)


Just a few thoughts. Everyone has their own favorite patient population, there's no "right" one. See if you can think of which population you'd rather deal with.

Good luck!

these two feilds are so similar . differences are really very subtle. so how do u guys decide on one? i'm having a tough time with it. keep jumping from one to the other.


if you have no inclination to specialize please DO FP; you'll probably have your pic of a good cush program- don't listen to the stigma of "family malpractice" and lack of respect from some other docs

I have practiced as an FP for the past four years. I think that an IM doc has more practice options.Most hospitalist are IM docs. FPs can do most of what IM docs do but you have to face it, no one can be an expert at everything.
The option of being able to do a fellowship also makes IM a more attractive option.

I believe that there are FPs who make 500k yearly. The problem with that is there is no way to give good care seeing 50+ patients daily. I know of a doc who sees 50 patients daily.

Your best bet would be to go into IM and then find a fellowship. What has happened to FP and actually primary care is a shame. you will have to hit the ground running to be competitive for a good field but it can be done and is worth the effort.

Some will disagree with me but I am in the real world and I see what is going on out there.

CambieMD


We are not in disagreement. I just inferred from the OP that he was asking whether he should pursue IM or FP if he wants to practice primary care. I wasn't arguing whether primary care was worse than subspecializing. Whether you practice as an FP or an internist, your practice will be run roughly in the same manner with the same amount of time alotted to each patient. And although IM specializes in adult medicine, IM also has so many subspecialities associated with it that patients, if given a choice, will avoid seeing the general internist and go straight to the cardiologist, allergist, GI etc. After all, if I have issues seeing an FP for a condition, chances are I'm not going to waste my time seeing another middle man in an internist when I can see the subspecialist.

It seems like the OP was asking whether he should pruse FP or IM if he is considering primary care. Based on that scenario, I think he should go into FP because it encompasses more. However, I agree that IM gives you more options but if someone told me their aspiration was to open their own clinic and treat a lot of patients for varying conditions, I would tell them to pursue FP over IM in a heartbeat.

I would only encourage one to purse IM if they want to subspecialize or practice as a hospitalist otherwise it makes no sense to purse IM. In private practice, internists and FP see roughly the same cases except that FP has the option of treating women and children not to mention having a much cushier residency.

We are not in disagreement. I just inferred from the OP that he was asking whether he should pursue IM or FP if he wants to practice primary care. I wasn't arguing whether primary care was worse than subspecializing. Whether you practice as an FP or an internist, your practice will be run roughly in the same manner with the same amount of time alotted to each patient. And although IM specializes in adult medicine, IM also has so many subspecialities associated with it that patients, if given a choice, will avoid seeing the general internist and go straight to the cardiologist, allergist, GI etc. After all, if I have issues seeing an FP for a condition, chances are I'm not going to waste my time seeing another middle man in an internist when I can see the subspecialist.

It seems like the OP was asking whether he should pruse FP or IM if he is considering primary care. Based on that scenario, I think he should go into FP because it encompasses more. However, I agree that IM gives you more options but if someone told me their aspiration was to open their own clinic and treat a lot of patients for varying conditions, I would tell them to pursue FP over IM in a heartbeat.

I would only encourage one to purse IM if they want to subspecialize or practice as a hospitalist otherwise it makes no sense to purse IM. In private practice, internists and FP see roughly the same cases except that FP has the option of treating women and children not to mention having a much cushier residency.

That was very well said. I completely agree.

Hmmm, interesting comments, although I disagree with most of what what said. First, about 50-60% of IM residency graduates go on to pursue subspecialty fellowships. Among the people who don't, a growing number are pursuing hospitalist medicine -- it is really an up and coming field. Now out of the IM residency graduates who end up doing outpatient primary care, yes they can certainly choose to have a similar practice as an FP if they want to (minus the kids and OB of course - a big selling point for those of us who dislike peds!). As far as working with a pediatritian or FP as a partner, though, I don't think it's that common anymore, at least not in my area. Most of my classmates who are graduating this year and doing primary care are joining Internal Medicine practices, composed solely of IM physicians. Many of these practices that my classmates are joining specilaize in treating older patients with much more complex medical problems than one would typically see in an FP clinic.

As far as the student loan issue, I don't know anyone who's still taking out loans as a resident, and I live in one of the most expensive areas of the country. Unless you are grossly mismanaging your finances, you should not be taking out student loans after you have finished med school.



I'm not sure about your point here -- you actually do start subspecialty training right out of residency. Some people will take a year or two off and work as hospitalists or in urgent care before fellowship to make some extra money or to take a break, but most people don't take any time off. You also don't necessarily have to do research for fellowship. Many academic fellowships are starting to have "clinician educator" tracks, where instead of doing the research time, you work on things like your teaching skills in academic medicine, etc.

I'm sticking to my opinion because, much like your post, it is not the gospel, but if you think 50% going into a specialization is a good thing for specialty practice, then you are right. The other 50% is practicing like an FP who sees adults, which actually happens in NY....

And a fellow is still a student who, although has an income, will not make the salary that a real, certified, graduated specialist will.

FP clinics see comorbid patients much like IM docs do. IM is a training that is catered to the inpatient setting, so you should see sicker patients. FP is centered on outpatient care, and these are people who may or may not need admission.

It is just as hard to keep a comorbid patient out of the hospital as it is to get a comorbid pt. out of the hospital once admitted. We all treat the same patients.

If NYC is not a major city, I don't know what is...what I see is subjective to may area, so please remember that before you get all defensive.

And yes, there are residents in NY that take out loans to help with the cost of living. I know a few who are.

One of the things that worried me when choosing IM (I myself was deciding b/t IM and FP) was that IM residency training would be all wards and inpatient consults. If I do not specialize, I plan to practice mostly ambulatory medicine. What portion of your training in IM is ambulatory based, and are you as well prepared to treat adults in the ambulatory setting as FPs?

One of the things that worried me when choosing IM (I myself was deciding b/t IM and FP) was that IM residency training would be all wards and inpatient consults. If I do not specialize, I plan to practice mostly ambulatory medicine. What portion of your training in IM is ambulatory based, and are you as well prepared to treat adults in the ambulatory setting as FPs?

If you can handle inpatient work I think you will be fine in the outpt setting....i believe that these days most generalists refer, even if they do know what the heck they're doing....at least after their first law suit they learn to defer to the specialist and put the burden on them(just defensive medicine i guess). This is just my view.
gl

If you can handle inpatient work I think you will be fine in the outpt setting....i believe that these days most generalists refer, even if they do know what the heck they're doing....at least after their first law suit they learn to defer to the specialist and put the burden on them(just defensive medicine i guess). This is just my view.
gl

In IM residencies yuo have out patient clinics. It is very truee that you refer refer refer. That is how you protect yourself out there.If a patient under the care of cards has a massive mi you are ok. No consultation and you caused the patient to have an mi.

CambieMD

The FP residency at my hospital has 3-4 half day clinics a week (part of why they are not liked on rotations- they are never there!). The IM program has only one half day clinic which we all almost dread. There are IM residents who chose outpatient practices. And, they do do gyn procedures, skin biopsies, joint aspirations/injections, sigmoidoscopies, stress tests, etc. It is all a matter of what your training program offers and how comfortable you feel doing those procedures.

Thank you for the viewpoints, everyone. Cambie, in the "real world" do most internist practice mostly outpatient medicine (assuming that they do not specialize) or are there about as many hospitalists. I always thought that internist mostly practiced ambulatory medicine, so I was suprised that more of the training was not devoted to this.