Small hospitals are much better
for FM. The smallest the better, you might work harder.. In Bigger hospitals you will most likely be treated worst than a medical student..
that concept applies to the vast majority of the hospitals ( FM in small vs big hospitals )
Smaller hospital you get to do everything.
I seem to be in disagreement with most here.
I chose to do my residency in a large, tertiary care center w/ extensive specialist services while my outpatient clinic was in the poor inner city area. The hospital had 3 internal medicine teams + FM teams. We alternated patients who were "unassigned" + would take patients from ours or the other 3 FM outpatient clinics.
I was involved in cases most would never get to see considering the size and tertiary care status of the hospital. I have managed extensive HIV patients, endless hospice/end of life patients, rare/tropical diseases. Thru consults/sub-specialists I think my knowledge advanced greatly. I am very procedure based and did not have a problem getting the procedures I wanted- I had done >30 paracentesis, countless (>100) joint injections, a couple thoracentesis, >10 IJ lines, >20 ABGs before residency was over.
We did our OB/womens health at the Womens/childrens hospital. I had >80 vaginal deliveries - including VBACs and augmented labor/delivery, lots from a FM group who did refugee medicine. I have done multiple 1/2/3 degree perineal repairs, lots of amniotomy, FHT monitor placements, >10 vacuum assisted deliveries.
For outpt, a large amount of our innercity patients were uninsured and medicaid. Often they could not get access to specialists due to financial or transportation reasons (lots of our pt's walked to the clinic), and we were the first and last line for these patients.
If I was to do it again I would do it the exact same way. I loved being in the inner city, talking with gangstas/homeless/mentally ill. I had families were I would see the kids, parents, grand parents, and cousins. There was a rawness/realness that I do not think you will get in a suburban community.