Family Vs. Internal Medicine?

[passthebiscuits]

Hey guys...first post so help me out-I'm at a real crossroad here and I want a sounding board to help me figure this out from people who understand.

I am finishing up my fourth year, and I have had several interviews in both Internal Medicine and Family Practice. Why you may ask? Because I love primary care. Now my problem comes in the fact that I really like Pediatrics, but don't want to be isolated to just Peds. I am not too keen on OB, though I don't mind it if I have to do it for three years as part of FM. The thing that really interests me about IM is that it seems (whether real or imagined) to be generally more respected as a specialty in that they typically deal with more difficult disease states. (Before anyone flames on me, I do understand that FPs are more than able to handle the same patients) I do not want to specialize at this time, however, if I choose IM at least I can change my mind. I also might like hospital medicine or ER, which I am told I can do with either specialty if I really wanted to>

So the million dollar question is FP or IM? and why? Hey thanks guys for any advice that you may have...

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[Doctor Bagel]

med/peds? that way you could do peds and still skip ob. you also have the option of more fellowships afterwards and dealing with complex adult and pediatric cases. my brother does med/peds and seems to like it.

as for the general im v. fp thing, i don't know because i don't really know anything (haven't even started school yet), but i think there have been several threads about this topic both in the family practice and internal medicine residency forums. one thread i read somewhere said that people basically have a feeling of where they're more comfortable -- im and fp seem to attract different personalities for that reason. do you have any gut feelings of where you fit more?

 

[Claymore]

Who cares which is more respected. It's your happiness you're talking about. Basically it sounds like it comes down to your desire to include Peds vs. the opportunities that IM might provide you down the line. I agree that Med/Peds sounds like an ideal situation for you, but since you are already applying now I'm not sure how you can swing that. Maybe start with IM and try to match somewhere that has a Med/Peds program and try to add the Peds part next year. Keep in mind you can also do a fellowship in adolescent medicine after IM, which would at least get you some Peds exposure. Good luck.

 

[OSUdoc08]

Hey guys...first post so help me out-I'm at a real crossroad here and I want a sounding board to help me figure this out from people who understand.

I am finishing up my fourth year, and I have had several interviews in both Internal Medicine and Family Practice. Why you may ask? Because I love primary care. Now my problem comes in the fact that I really like Pediatrics, but don't want to be isolated to just Peds. I am not too keen on OB, though I don't mind it if I have to do it for three years as part of FM. The thing that really interests me about IM is that it seems (whether real or imagined) to be generally more respected as a specialty in that they typically deal with more difficult disease states. (Before anyone flames on me, I do understand that FPs are more than able to handle the same patients) I do not want to specialize at this time, however, if I choose IM at least I can change my mind. I also might like hospital medicine or ER, which I am told I can do with either specialty if I really wanted to>

So the million dollar question is FP or IM? and why? Hey thanks guys for any advice that you may have...

If it were me, I'd do Meds/Peds.

I'd never do family practice. You are just too limited in your opportunities.

I know a large number of patients that choose internists over family physicians for various reasons, including the correct or incorrect assumption that they have better training.

 

[Clue]

If you like working in hospitals, do IM, if you see yourself ending up in a mainly outpatient practice, do Family medicine. Med-Peds is a waste of a year if you want to do outpatient medicine. Most med-peds doctors choose one or the other or specialize. If you like kids don't do internal medicine.
All are primary care, you will have all the patients you can handle in either specialty. 99% of patients don't care if their doctor is a family doctor, internal medicine doctor, DO, MD or FMG. They just want you to write them an antibiotic for a viral infection.

 

[OSUdoc08]

If you like working in hospitals, do IM, if you see yourself ending up in a mainly outpatient practice, do Family medicine. Med-Peds is a waste of a year if you want to do outpatient medicine. Most med-peds doctors choose one or the other or specialize. If you like kids don't do internal medicine.
All are primary care, you will have all the patients you can handle in either specialty. 99% of patients don't care if their doctor is a family doctor, internal medicine doctor, DO, MD or FMG. They just want you to write them an antibiotic for a viral infection.

Why not do IM in an outpatient practice? Why do you say family medicine?

Many practices employ both family physicians and internists. I'm not clear on the reasoning here.

 

[raspberry swirl]

i was dead set on med/peds for awhile, but after talking to some of the interns and residents i worked with, now im sort of iffy on it. what i gathered from them was basically, if you try and do med/peds, you'll never be as good at either of them in comparison to if you did just the one, and 99 times out of 100, you'll end up picking one or the other anyway, as far as practicing is concerned, so it will have sort of been a waste. my problem is that i absolutely love working with kids over adults. adult patients depress me, but i loved seeing the kids every day, especially the babies in the nursery. however, the adult diseases are far more interesting to me . .. what to do? i think med/peds is good if you simply just dont know which one you like, and you need a way to have some more time to do both and figure it out. but in the end, if you do med/peds, you probably wont end up practicing both, whereas if you do FP, you will.

 

[raspberry swirl]

i dont know why it popped up twice, but its not letting me delete it . . . sorry

 

[OSUdoc08]

i was dead set on med/peds for awhile, but after talking to some of the interns and residents i worked with, now im sort of iffy on it. what i gathered from them was basically, if you try and do med/peds, you'll never be as good at either of them in comparison to if you did just the one, and 99 times out of 100, you'll end up picking one or the other anyway, as far as practicing is concerned, so it will have sort of been a waste. my problem is that i absolutely love working with kids over adults. adult patients depress me, but i loved seeing the kids every day, especially the babies in the nursery. however, the adult diseases are far more interesting to me . .. what to do? i think med/peds is good if you simply just dont know which one you like, and you need a way to have some more time to do both and figure it out. but in the end, if you do med/peds, you probably wont end up practicing both, whereas if you do FP, you will.

My primary care provider was dually boarded in Meds/Peds. He worked at a clinic and so patients of all ages, and then was an attending at a local children's hospital. I find it hard to believe that he wasn't just as "good" as any singly boarded pediatrician.

 

[passthebiscuits]

very good replies all--
Some good advice.
I got a couple of interviews in Med/Peds, but I too think it is a bit of a waste. If you like Peds, do Peds...if you like IM, do IM...seems like it would be better to do FP if you like both.

I suppose I am leaning toward FP at this point, it's just really tough.
thanks!

 

[OSUdoc08]

very good replies all--
Some good advice.
I got a couple of interviews in Med/Peds, but I too think it is a bit of a waste. If you like Peds, do Peds...if you like IM, do IM...seems like it would be better to do FP if you like both.

I suppose I am leaning toward FP at this point, it's just really tough.
thanks!

The only problem I have with this is that everyone in my family (and friends) takes their child to a pediatrician.

It seems to me that only the lower classes would take their child to a family practitioner over a pediatrician. You are really limiting your pediatric patient population here.

I know my child will be going to a pediatrician.

 

[cooldreams]

The only problem I have with this is that everyone in my family (and friends) takes their child to a pediatrician.

It seems to me that only the lower classes would take their child to a family practitioner over a pediatrician. You are really limiting your pediatric patient population here.

I know my child will be going to a pediatrician.

lower classes??

 

[OSUdoc08]

lower classes??

Poor people.

 

[cooldreams]

Poor people.

duh.

why are you singling out poor people??

 

[OSUdoc08]

duh.

why are you singling out poor people??

If you are rich, you will take your child to a pediatrician.

There is absolutely no reason to take your child to someone who has less training, and does not devote their practice to children.

 

[DrMom]

That's quite a generalization.

 

[OSUdoc08]

That's quite a generalization.

Please explain to me the reasoning for sending your child to a family physician over a pediatrician.

I'd never even heard of a family physician until I moved to Oklahoma. Every child I grew up with in the Dallas area went to a pediatrician.

The only reason I can think of is money.

 

[DrMom]

Please explain to me the reasoning for sending your child to a family physician over a pediatrician.

I'd never even heard of a family physician until I moved to Oklahoma. Every child I grew up with in the Dallas area went to a pediatrician.

The only reason I can think of is money.

I can't think of any reason that it would be cheaper to go to a FP over peds. It is a personal preference. Some people like their family doc & are more comfortable having their child cared for there.

I'm absolutely amazed that you'd never heard of a family physician before you started med school.

 

[OSUdoc08]

I can't think of any reason that it would be cheaper to go to a FP over peds. It is a personal preference. Some people like their family doc & are more comfortable having their child cared for there.

I'm absolutely amazed that you'd never heard of a family physician before you started med school.

Oh I heard of them, but I've never heard of anyone taking their child to one.

Most adults in my family go to Internists, and their children go to Pediatricians. It may have to do with the amount of those specialties in the Dallas area, but this is more common in my experience than family practice.

The reason I bring up the pay thing is that Family Physicians are paid less than Internists and Pediatricians. If they are seeing the same patient population, then why the difference in pay?

 

[DrMom]

Oh I heard of them, but I've never heard of anyone taking their child to one.

Most adults in my family go to Internists, and their children go to Pediatricians. It may have to do with the amount of those specialties in the Dallas area, but this is more common in my experience than family practice.

So I guess that Dallas is the standard for everywhere & you knew everyone's medical care habits.

I'm quite certain that there are FPs in practice in Dallas and they're doing well despite the fact that your family doesn't go to them.

The reason I bring up the pay thing is that Family Physicians are paid less than Internists and Pediatricians. If they are seeing the same patient population, then why the difference in pay?

This salary survey (and others like it) show that peds actuallly make less on average than FP.

 

[OSUdoc08]

So I guess that Dallas is the standard for everywhere & you knew everyone's medical care habits.

I'm quite certain that there are FPs in practice in Dallas and they're doing well despite the fact that your family doesn't go to them.



This salary survey (and others like it) show that peds actuallly make less on average than FP.

Looks like that survery has been updated since I last looked at it.

Either way, if you had a straight on choice between a pediatrician and a family physician, why not choose the pediatrician?

I suppose the only reason, as you stated, is that you possibly also go to the family physician?

Otherwise, is there any other reason?

It just seems to me that the pediatrician is more capable of caring for your child than the FP. If not, then what is the purpose of having such specialty?

 

[cooldreams]

Looks like that survery has been updated since I last looked at it.

Either way, if you had a straight on choice between a pediatrician and a family physician, why not choose the pediatrician?

I suppose the only reason, as you stated, is that you possibly also go to the family physician?

Otherwise, is there any other reason?

It just seems to me that the pediatrician is more capable of caring for your child than the FP. If not, then what is the purpose of having such specialty?

well i guess like you said, if you're a slobby poor person that knows nothing, spend the 20 dollar copay on the fp instead of the ped... right??? thats what you said right???

good for you, your family is rich. mine not at all. but i love them the same. please dont disrespect people for their socialeconomic status. some people chose to make money, some chose to spend more time with their family - this is the case with my dad and mom.

 

[smgilles]

well i guess like you said, if you're a slobby poor person that knows nothing, spend the 20 dollar copay on the fp instead of the ped... right??? thats what you said right???

good for you, your family is rich. mine not at all. but i love them the same. please dont disrespect people for their socialeconomic status. some people chose to make money, some chose to spend more time with their family - this is the case with my dad and mom.

I think you and everyone else that frequents SDN on a regular basis realizes that OSU speaks out of his 'A-- because his mouth knows better.'

Just one person's opinion though.

 

[OSUdoc08]

well i guess like you said, if you're a slobby poor person that knows nothing, spend the 20 dollar copay on the fp instead of the ped... right??? thats what you said right???

good for you, your family is rich. mine not at all. but i love them the same. please dont disrespect people for their socialeconomic status. some people chose to make money, some chose to spend more time with their family - this is the case with my dad and mom.

I was just stating the fact that pediatricians and family practitioners may see a different patient population.

I'm looking for reasons this may or may not be true.

There is no reason to make this personal. Chill.

 

[cooldreams]

I was just stating the fact that pediatricians and family practitioners may see a different patient population.

I'm looking for reasons this may or may not be true.

There is no reason to make this personal. Chill.

oh you were? im sorry, i thought you said only poor people take their kids to an fp....

 

[OSUdoc08]

oh you were? im sorry, i thought you said only poor people take their kids to an fp....

Yeah, it's not problem. You'd have to read the conversation from the beginning instead of just starting halfway through it to understand what was going on.

 

[oldbearprofessor]

I'm out of my territory here and certainly don't wish to get into the middle of a flame war about pediatricians vs family docs in the care of children, but one thing here was the statement that med/peds are not as good at either as individual specialists.

I have worked with many, many med/peds residents and seen them after their residency was over. I can't comment on the IM side, but I do not agree that they are not as good pediatricians as regular pedi residents. A good med/peds program will give you plenty of opportunity to become an excellent pediatrician and you will even gain some insights into the care of children from your adult training. Please don't ask for an "amp" of anything in my NICU please

Also, I would like to see data that 99% of med/peds graduates only do one or the other. There are definitely more than a few that do this, but, especially in larger cities there are med/peds general practices (even in academic medicine!), and others who cross over via combined fellowships and adolescent medicine.

Finally, if you really like the babies, consider neonatology. I promise you that we do more than well-baby checks and it isn't boring....

Regards and back to the pedi/FP flame war.


OBP

i was dead set on med/peds for awhile, but after talking to some of the interns and residents i worked with, now im sort of iffy on it. what i gathered from them was basically, if you try and do med/peds, you'll never be as good at either of them in comparison to if you did just the one, and 99 times out of 100, you'll end up picking one or the other anyway, as far as practicing is concerned, so it will have sort of been a waste. my problem is that i absolutely love working with kids over adults. adult patients depress me, but i loved seeing the kids every day, especially the babies in the nursery. however, the adult diseases are far more interesting to me . .. what to do?

 

[cooldreams]

The only problem I have with this is that everyone in my family (and friends) takes their child to a pediatrician.

It seems to me that only the lower classes would take their child to a family practitioner over a pediatrician.

so, you are saying that you are not saying that only poor people take their kids to a fp?

 

[OSUdoc08]

so, you are saying that you are not saying that only poor people take their kids to a fp?

I actually don't know. This was just an idea.

Do you have some other ideas on why someone might choose a family practitioner over a pediatrician?

I find that in suburban areas that have upper-middle class people, the pediatrician is the provider for that area's children.

It may be different in a rural area, but I don't know that either.

 

[cooldreams]

I actually don't know. This was just an idea.

Do you have some other ideas on why someone might choose a family practitioner over a pediatrician?

I find that in suburban areas that have upper-middle class people, the pediatrician is the provider for that area's children.

It may be different in a rural area, but I don't know that either.

well answer this, why does a FP have to treat everyone, why cant an FP clinically specialize in peds? not nessesarily having gone to do peds in residency.

 

[Doctor Bagel]

i was dead set on med/peds for awhile, but after talking to some of the interns and residents i worked with, now im sort of iffy on it. what i gathered from them was basically, if you try and do med/peds, you'll never be as good at either of them in comparison to if you did just the one, and 99 times out of 100, you'll end up picking one or the other anyway, as far as practicing is concerned, so it will have sort of been a waste. my problem is that i absolutely love working with kids over adults. adult patients depress me, but i loved seeing the kids every day, especially the babies in the nursery. however, the adult diseases are far more interesting to me . .. what to do? i think med/peds is good if you simply just dont know which one you like, and you need a way to have some more time to do both and figure it out. but in the end, if you do med/peds, you probably wont end up practicing both, whereas if you do FP, you will.

not necessarily true. my brother does both peds and adult medicine in his practice. his hospital work is all adult work (no pediatric unit), but tons of his clinic patients are pediatric. also, you do both in your residency to the same extent that you would do them if you did either im or peds singly, so i don't see why you'd be lacking with skill in either. also, you generally take both boards, so med/peds docs are generally board ceritified in both pediatrics and im. i doubt you see any true reduction in quality. you see the same patients as an fp doc (well aside from ob), but the focus and training are different.

 

[OSUdoc08]

not necessarily true. my brother does both peds and adult medicine in his practice. his hospital work is all adult work (no pediatric unit), but tons of his clinic patients are pediatric. also, you do both in your residency to the same extent that you would do them if you did either im or peds singly, so i don't see why you'd be lacking with skill in either. also, you generally take both boards, so med/peds docs are generally board ceritified in both pediatrics and im. i doubt you see any true reduction in quality. you see the same patients as an fp doc (well aside from ob), but the focus and training are different.

Which brings up another thought that is intricately related to the previous discussion. Why would anyone choose to go to an OB vs. a Family Physician for a pregnancy?

I understand that it is "continuity of care" for those that currently have a Family Physician, but what about those that see a Pediatrician, Internist, or Emergency Physician as their primary care provider?

Although we agree that a dually boarded Internist/Pediatrician is competent in both areas, how competent is a Family Physician in the areas of Obstetrics?

Surely they aren't as competent as an Obstetrician, right?

 

[nerdgrrl]

Which brings up another thought that is intricately related to the previous discussion. Why would anyone choose to go to an OB vs. a Family Physician for a pregnancy?

I understand that it is "continuity of care" for those that currently have a Family Physician, but what about those that see a Pediatrician, Internist, or Emergency Physician as their primary care provider?

Although we agree that a dually boarded Internist/Pediatrician is competent in both areas, how competent is a Family Physician in the areas of Obstetrics?

Surely they aren't as competent as an Obstetrician, right?

Personal opinion only, but if I were to see a physician during my pregnancies (which I have no intention of doing when the time comes, unless medically necessary), I would choose a FP. And I say this as a woman who has worked in ob/gyn offices for three years, and wants to be an ob/gyn. Then again, if it is necessary for me to see a physician instead of a midwife, it's likely I'll need to see an OB/maternal-fetal medicine specialist. anyway, I hope none of the above is necessary.

 

[nerdgrrl]

Personal opinion only, but if I were to see a physician during my pregnancies (which I have no intention of doing when the time comes, unless medically necessary), I would choose a FP. And I say this as a woman who has worked in ob/gyn offices for three years, and wants to be an ob/gyn. Then again, if it is necessary for me to see a physician instead of a midwife, it's likely I'll need to see an OB/maternal-fetal medicine specialist. anyway, I hope none of the above is necessary.

Um, point being. It's about personal preference, nothing more, as far as I'm concerned.

 

[rack]

id get to know a specialist in every field by buying them steak dinners and foot massages. then i would proceed to only goto that specialist depending on my ailments. this way, i am invincible.

honestly, id take my kid to a ped. but its all subjective. you do what you wanna do.

id pick whatever field i was more interested in.

 

[Dr Alo]

It seems to me that only the lower classes would take their child to a family practitioner over a pediatrician.

Wow. I don't really know what to say. Do you have any studies, research or evidence to justify this? Or do you just make stuff up as you go along based on your pre-conceived notions?

It seems like we have a lot of people just talking without any experience or without proper information.

In the real world, people take their kids to a doctor they trust. It doesn't matter if they are IM, Peds, or FP. The good thing about FP is that you can see all patients, newborns, teens, adults, geriatrics, and just about anything. If you are peds, you are usually pretty limited to peds.

There is no rule anywhere about "lower classes" or "higher classes". In fact, I have no idea how or why that was even suggested. In America, we don't have a class or caste system. People are people. They usually go to a physician they trust or the one that their health plan allows.

I'm just shocked by statements that we sometimes make. Come on people, we need to be more professional.

 

[Krazykritter]

I think you and everyone else that frequents SDN on a regular basis realizes that OSU speaks out of his 'A-- because his mouth knows better.'

Just one person's opinion though.

I totally agree...no matter what forum OSU always has an opinion that he/she passes off a fact that you should have already known.

Here's a surprise for you OSU...regardless what field you end up going into, you are likely to be working with significant number of "poor" people.

 

[OSUdoc08]

I totally agree...no matter what forum OSU always has an opinion that he/she passes off a fact that you should have already known.

Here's a surprise for you OSU...regardless what field you end up going into, you are likely to be working with significant number of "poor" people.

I was just indicating the fact that in the "upper class" portion of north Dallas, there many pediatricians and very few family practice physicians. I was wondering if there was a correllation.

This also stems from the fact that when I was younger, everyone I knew went to a pediatrician, and I did not even know that a "family physician" could treat children until later on in life.

I never stated it as a fact, and was asking about other people's opinions.

I'm not sure why everyone got so "uptight" about my question. Chill.

P.S. I know I'll be working with poor people----I'm doing ER.

 

[dr.z]

I totally agree...no matter what forum OSU always has an opinion that he/she passes off a fact that you should have already known.

Here's a surprise for you OSU...regardless what field you end up going into, you are likely to be working with significant number of "poor" people.

 

[RuralMedicine]

i was dead set on med/peds for awhile, but after talking to some of the interns and residents i worked with, now im sort of iffy on it. what i gathered from them was basically, if you try and do med/peds, you'll never be as good at either of them in comparison to if you did just the one, and 99 times out of 100, you'll end up picking one or the other anyway, as far as practicing is concerned, so it will have sort of been a waste. my problem is that i absolutely love working with kids over adults. adult patients depress me, but i loved seeing the kids every day, especially the babies in the nursery. however, the adult diseases are far more interesting to me . .. what to do? i think med/peds is good if you simply just dont know which one you like, and you need a way to have some more time to do both and figure it out. but in the end, if you do med/peds, you probably wont end up practicing both, whereas if you do FP, you will.

I may be biased because I'm a Med-Peds attending now but I would strongly disagree with this statement. If you are willing to work hard at a strong Med-Peds program you'll come out very competent in both disciplines. I personally felt that my medicine background at times made me a better pediatrician and vice versa. The categorical pediatrics program director used to tell everyone that her Med-Peds upper levels were always among her strongest residents and there were definitely times even as a PGY2 when I was being asked to help PGY3 categoricals with procedures, look at EKGs for then, or they deferred to me in a code situation. As an attending I see both kids and adults and feel comfortable with both. On call last weekend my age spectrum went from 12 days to 102 years (and this is not an atypical range for me). My practice will probably eventually be more like 60% peds 40% adults (but only because this community has only one other pediatrician and 3 other internists and 4 FPs (who do not have admitting privileges for children under 6) so there is more need in this community for me to do pediatrics presently). My situation is a little atypical perhaps because I'm in a rural area, however, I have former residency colleagues in urban areas doing Med-Peds with close to 50/50 splits of their practice.

 

[RuralMedicine]

well answer this, why does a FP have to treat everyone, why cant an FP clinically specialize in peds? not nessesarily having gone to do peds in residency.

In my experience (I considered FP before doing Med-Peds) FP has very little Peds training [the FP residents at the institution I did my Med-Peds residency at did 1 month of Peds floor and 1 month of Peds sick visit clinic--when I was an intern they were also doing 1 month of NICU where they functioned at the sub-intern level (needing orders cosigned etc) but this created too many problems and was dropped]. If someone wants to specialize in Pediatrics then why spend nearly 95% of your residency taking care of a population other than the one you intend to specialize in?

 

[OSUdoc08]

In my experience (I considered FP before doing Med-Peds) FP has very little Peds training [the FP residents at the institution I did my Med-Peds residency at did 1 month of Peds floor and 1 month of Peds sick visit clinic--when I was an intern they were also doing 1 month of NICU where they functioned at the sub-intern level (needing orders cosigned etc) but this created too many problems and was dropped]. If someone wants to specialize in Pediatrics then why spend nearly 95% of your residency taking care of a population other than the one you intend to specialize in?

Finally a voice of reason!

 

[passthebiscuits]

Wow-Sorry to bring this back to the original question...BUT!

Anyway, can't really decide what to do, and I am still pretty lost for the exact reasons that have been discussed. I think (and I believe this is fair) that if we had to sum up the discussion here we would have to say that chosing Peds vs FP vs IM is mostly in personal preference. They all make about the same amount when it comes down to it and the experiences of each in practice are probably mostly determined by how much the physician works, his/her rapport with patients, and the location of their practice.

As for the "poor people" thing, you must be compensating for something.
I think I understand what you meant, or atleast I hope you meant.