what is it? and is internal medicine harder to get into?
difference between family practice and internal medicine?
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deleted87716
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The short version: Family Medicine is a specialty designed to train physicians to take care of the most common medical problems of an entire family with members of all ages. Although the training includes obstetrics, some family practitioners (many, actually) do not do deliveries due to the huge increase in malpractice premiums it requires.
Internal Medicine is a specialty which treats both common and complex/chronic medical problems of adults, generally age 18 and up (although the technical definition I've often seen used is, once you're sexually active, you're IM and no longer pediatrics). Internal Medicine training is also, of course, the gateway to all the subspecialty fellowships (cardiology, GI, etc).
Neither family medicine nor categorical internal medicine is especially competitive but, of course, they both have top-notch programs that are quite difficult to get into. All depends on where you apply.
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deleted87716
I would agree with the rest of this post, note that the above part of it differentiates peds vs IM, not family med vs IM. In family med, you see patients throughout the lifespan. Its rare for a family doc to suddenly stop seeing a pt because they've turned 18 or have become sexually active.
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IM, although not particularly competitive compared to "ROAD" specialties, is more competitive than FP because of the subspecialties it is a gateway to.
You will always hear about a few top students opting to do IM to get to GI, Cards, ID, Nephro, etc. By contrast, at many schools FP residencies don't fill.
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deleted87716
FM had an 88% fill rate in 2007 (42% US grads). Med-Peds had a 91% fill rate (73% US grads), and general IM had a 98% fill rate (56% US grads).
There are always a few "top students" in FM, too.
Source: http://www.nrmp.org/res_match/tables/table6_2007.pdf
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There are always a few "top students" in FM, too.
OK - I didn't mean to bash. I just know from schools which have top ranked students picking IM over derm etc, and happen to be unable to come close to filling their FM slots. Sorry to extrapolate this nationally.
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You can't believe how much I wish this were true...
http://archpedi.ama-assn.org/cgi/content/full/153/1/9 gives an idea of the usual distribution of pediatric general care. Most pediatricians are primarily seeing children < 12 yrs of age. However, there is a substantial specialty of adolescent medicine within pediatrics that routinely cares for sexually active teens. Some general pediatricians will provide care for older adolescents (regardless of their sexual activity), some do not. Training in this area is an obligatory part of all pediatric training programs (which is why I WISH it were true...wasn't my favorite part).
Specialty peds, especially cardiology, will routinely follow their patients, e.g. congenital heart patients, into adulthood, although this is changing (and beyond the scope of this discussion).
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deleted87716
In my experience, it's usually more often the patient's preference to stop going to their pediatrician than it is the doctor's.
There are certainly pros and cons to seeing a pediatrician as a teenager. I imagine having a Pap smear or urethral swab performed in a room papered with cartoon characters could be a bit disconcerting. However, the waiting room full of screaming babies and ill-behaved toddlers would probably reinforce the importance of contraception.
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There are specific AAP guidelines and recommendations for general pediatricians who wish to have a substantial adolescent practice, especially if reproductive care is being given. This is becoming more common especially with recently trained graduates who are interested in and comfortable with this area. These include separate hours for routine visits, separate waiting room areas, etc. Just depends on the practice. Of course, adolescent medicine clinics at Children's Hospitals are designed for these issues. A lot of college kids will still go to their pedi for minor stuff, but some of the women will have started seeing an OB/Gyn for reproductive care.
This is moving off-topic for the OP, so f/u on scope of pediatric care should go to pedi forum.
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deleted87716
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There are always a few "top students" in FM, too.
Source: http://www.nrmp.org/res_match/tables/table6_2007.pdf
We had our #1 the last 3 years go into FP. (also #1 in step 1 this year).
#2 went into neurosurgery.
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We consistently have top students go into FP. We also consistently have bottom students go into FP. Kudos to anyone who goes into what they want because it's what they want to do.
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As a general rule, an internal medicine physician will see older, and much sicker, patients than an FP will. Primarily, an FP will be concerned with continual care of an individual on an outpatient basis throughout the course of the patient's lifespan. They will serve as a manager of illness, controlling what can be controlled, and referring to appropriate specialists when necessary. In the days of yore, internal medicine was considered a specialty (as opposed to a PCP) that took care of very sick patients. Internists traditionally care for an illness, particularly in an inpatient setting, and turn care back over to the GP (nowadays, FP) when the illness is either cured or controlled.
Nowadays, due to various insurance, hospital, and government policy, the line is blurring between IM and FP. Roles are being combined, as evidenced by the recent addition of FP hospitalist fellowships. I personally feel that this is a dramatic disservice to family physicians everywhere. FP's as an organized entity seemed to be more concerned with "playing catch-up" with Internal Medicine than with finding and developing their own unique niche. With the trend in reimbursements and scope of practice, it is currently a very real possibility that Internal Medicine is the future of American healthcare. Instead of FP's screaming "We're just as good!" as IM, they could dig out their own niche. Fellowships could focus training on "private practice organization" and "midlevel management" instead of directly competing with IM. Until FP's embrace their role as outpatient managers, they'll continue to struggle to recruit students and gain respect as competent specialists.
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I'm just planning on shipping them off to an internist as soon as they stop being cute....
Probably not something you have to worry about OBP.
(Sorry to continue the thread hijack)
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deleted87716
Incorrect. I'm not even sure where you're getting that idea.
IM is slightly more popular match-wise than FM simply because it offers an avenue for specialization. Primary care, whether you're talking about general IM, FM, or general peds, is not particularly popular these days simply because of student preference for what they perceive to be higher-paying specialty fields. It has little, if anything, to do with the viability of any of the primary care fields themselves, or even the nature of primary care in general.
Incidentally, FM isn't simply outpatient medicine, although there are a growing number of us who limit our practices to ambulatory care by choice. That's not what the specialty is all about, however. The scope of FM already sets it apart from IM. No "catch-up" is needed.
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First off, IM is infinitely more popular than FP. It is quite well known amongst medical students that while it takes very competitive boards scores and evals to match at a top IM program, one could theoretically fail boards, pass upon retaking them, fail a clerkship, pass it upon retaking it, and still match into the FP program of choice. This is not my perception or my own bias. It happened to a recent graduate. IM is more popular for many reasons that the idea of specialization, not the least of which is more respect amongst the academic community, if for no other reason than is indicated by my initial remarks here. Also, because of the relative newness of the specialty (it was created in the late 60's when the popularity of specialization, the explosion of medical advancement, and legal atmosphere, required that a new "specialty" be formed to train in the field of general care for a variety of patients), combined with the fact that a very high proportion of FMG's/IMG's end up in the practice (and, conversely, a very low proportion of US trained graduates end up in the specialty), there is a distinct lack of prestige amongst the specialty. It is not unusual to hear the phrase "Why would anyone go into Family Practice over Internal Medicine?" Save delivering babies (not often done due to malpractice restraints), or caring for kids (see: pediatrics), it's hard to argue.
Also, I know that FP's do more than outpatient medicine. In fact FP has a great diversity of scope that, to its detriment, is not often emphasized. However, from my own personal experience with FP's, I've noted two distinct personality types: 1- those who think highly of their specialty, enjoy it, and realize not everyone is suited for it, and 2- those who adamantly defend it's worth to anyone who will listen, and violently degrade anyone who is considering anything else. It is the latter to which I direct my previous post. And I use the example of the hospitalist fellowship to make the point that Hospitalist is a field very well incorporated in Internal Medicine, and Family Physicians need not spend their time trying to squeeze their way into this role. It is a perfect example of the idea of "playing catch up," much like General Surgeons who pursue training in Hand Surgery (and are, hence, quite disrespected by Orthopods and Plastics). I argued that FP's should try to dig out their own niche as outpatient providers, as this is the most logical progression from the current state.
And before I am dismissed as "one of them," I'd like it noted that I am very seriously considering FP as a future career. I greatly enjoy the diverse work inherent within the specialty, and can appreciate as well as anyone the regular (at least, more regular) hours that come with working in a clinic. However I do feel that there are a great deal of FP's that are fighting an unnecessary battle to gain respect in the medical community. I say that instead of fighting for respect, FP's should carve out their own, separate identity. The very title of this thread suggests that they are doing a poor job. If FP's were to create their own niche and identity, the respect would eventually come as students who are attracted to that identity begin to go into the field more often.
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You have to have ninja skillz to be IM
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At some programs, computer hacking skillz will be enough.
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deleted87716
This could be said of any specialty.
I'm solidly in the "type 1" camp, as even the most cursory review of my post history here will reveal.
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True, however you rarely see a surgeon or radiologist defending their specialty. While we've all met many practitioners who will degrade other specialties, I've only met FP's who feel it necessary to defend themselves.
Granted that is based completely on my own personal experience.
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deleted87716
Nah. You'll see the same thing in all of the professional forums.
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Interesting. I've also heard FPs getting very defensive, but I've also heard pediatricians, pathologists, and psychiatrists getting extremely defensive as well. Pathologists seem really quick to remind you that they do take care of people.
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