Hate inpatient... is FM the answer?

[klake3]

I'm debating between IM, FM, and peds. FM was admittedly never on my radar until recently, since very few people from my school match into FM. I hate inpatient medicine, especially inpatient adult medicine and ICU. I'm admittedly not a fan of OB or surgery either. To be honest I hate hospitals generally and can't believe I made it through med school . I hope to work in an outpatient setting when I leave residency. Would you say FM has a lot more outpatient/ continuity clinic time than the avg IM or peds residency? And what exactly is expected of an FM rotator on an OB service? I guess it's best to match at an opposed program if you aren't interested in OB/surg?

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[DrMidlife]

Can you comment on whether you have any outpatient experience, at this point? Have you had inpatient experience at multiple facilities?

FM has a whole lot of inpatient during residency. After those 3 years you can avoid inpatient, mostly.

If you don't like dealing with sick people, though, maybe rads or path are the way to go.

 

[tony montana]

Hating inpatient and hospitals is why I chose FM. Less inpatient during residency than IM

If you don't like OB choose an opposed or low OB responsibility residency. Then what your OB responsibilities will be will depend on your program (outpatient OB, some assisting in the OR, colpos and some other outpatient procedures)

 

[styphon]

My FM residency had lots of Inpt rotations - so it appears to vary on residency, whereas IM always has lots of inpt rotations.

*BUT* IM has no OB/peds (which you did not mention) and chance to go into a speciality (which you could make outpt only).

*BUT* again - if you really hate people, maybe IM/FM is not the way to go...

 

[klake3]

I am not sure why "i hate inpatient" is being twisted to "i hate people"... I don't hate people, I just prefer the less depressing (IMO) atmosphere of outpatient. I have experience in outpatient prior to school, so I've experienced the difference. I enjoy peds, don't like OB and with malpractice i highly doubt I would want to be involved in it anyway.

 

[KnuxNole]

I'm not a big fan of inpatient and not a big fan of the hospital setting, and much prefer to do outpatient/clinic setting. In fact, that was a big reason going to FM vs. IM....in that in IM there would be too much focus on hospital medicine, where my goals line in with outpatient management. Of course, it's important to understand inpatient, which residencies do a good job doing. Calls and ICU suck, but seeing what "sick" looks like is helpful when they show up in an outpatient setting. The good news is, after residency, you can choose not to do overnight hospital call

You will definitely get MUCH more outpt/cont. clinic in FM vs. IM/Peds. The latter group has clinic once a week or twice a week in the traditional setting...although nowadays more IM programs are doing 1 week/month of pure clinic. All programs have a component of inpatient training, but if your goal is to be an outpatient doctor, FM is a good option. You don't even have to do OB after you finish training. In a FM residency, at least from personal experience, surgery was helpful to learn about working up common "surgical" complaints, basic skills like suturing, I+Ds, and post op care. The surgery people will know you aren't training to be a surgeon. With OB, every programs requires X amount of deliveries. Even if you hate OB, you need to deliver a certain amount to graduate. But, get those done with, and you'll never have to birth a baby even again should you choose.

 

[DermViser]

I'm debating between IM, FM, and peds. FM was admittedly never on my radar until recently, since very few people from my school match into FM. I hate inpatient medicine, especially inpatient adult medicine and ICU. I'm admittedly not a fan of OB or surgery either. To be honest I hate hospitals generally and can't believe I made it through med school . I hope to work in an outpatient setting when I leave residency. Would you say FM has a lot more outpatient/ continuity clinic time than the avg IM or peds residency? And what exactly is expected of an FM rotator on an OB service? I guess it's best to match at an opposed program if you aren't interested in OB/surg?

No question Path or Rads for you.

FM also has a lot of inpatient during residency.

 

[DermViser]

I'm not a big fan of inpatient and not a big fan of the hospital setting, and much prefer to do outpatient/clinic setting. In fact, that was a big reason going to FM vs. IM....in that in IM there would be too much focus on hospital medicine, where my goals line in with outpatient management. Of course, it's important to understand inpatient, which residencies do a good job doing. Calls and ICU suck, but seeing what "sick" looks like is helpful when they show up in an outpatient setting. The good news is, after residency, you can choose not to do overnight hospital call

You will definitely get MUCH more outpt/cont. clinic in FM vs. IM/Peds. The latter group has clinic once a week or twice a week in the traditional setting...although nowadays more IM programs are doing 1 week/month of pure clinic. All programs have a component of inpatient training, but if your goal is to be an outpatient doctor, FM is a good option. You don't even have to do OB after you finish training. In a FM residency, at least from personal experience, surgery was helpful to learn about working up common "surgical" complaints, basic skills like suturing, I+Ds, and post op care. The surgery people will know you aren't training to be a surgeon. With OB, every programs requires X amount of deliveries. Even if you hate OB, you need to deliver a certain amount to graduate. But, get those done with, and you'll never have to birth a baby even again should you choose.

You can also be an outpatient doctor after IM as well. FM has a lot of inpatient residency training.

 

[KnuxNole]

You can also be an outpatient doctor after IM as well. FM has a lot of inpatient residency training.

True, you can be. I liked kids a lot too, which pushed me closer to FM ...plus, the thing about IM I hated is the huge focus on inpatient, ICU, academia stuff, and very few outpatient only rotations. Plus, the culture of specializing, if I did go with IM, I wanted no fellowship tracks, just 3 years and let me do my thing! Which is what FM will do for me and my goals. For me, after intern year, a huge part of residency rotations are outpatient based, which is what I like. Plus, more time in the clinic setting vs. wards(shudders).

 

[klake3]

No question Path or Rads for you.

FM also has a lot of inpatient during residency.

I am ok with some inpatient medicine. I just don't want to spend residency focused on it if I don't have to, which is why I wanted input on FM. I also prefer inpatient peds to inpatient adult medicine... it's depressing but simultaneously more interesting and inspiring IMO. The geriatric patients coding left and right is so draining.

Path job market.. I didn't work this hard to not get a job. Rads... I like diagnostic rads, but I have heard it is becoming a highly procedural field in terms of biopsies, line placement, IR, etc. which doesn't really interest me. I'm not the most dextrous person around. And again.. job market concerns. I want to practice in a suburb close to a major city.

 

[DermViser]

I am ok with some inpatient medicine. I just don't want to spend residency focused on it if I don't have to, which is why I wanted input on FM. I also prefer inpatient peds to inpatient adult medicine... it's depressing but simultaneously more interesting and inspiring IMO. The geriatric patients coding left and right is so draining.

Path job market.. I didn't work this hard to not get a job. Rads... I like diagnostic rads, but I have heard it is becoming a highly procedural field in terms of biopsies, line placement, IR, etc. which doesn't really interest me. I'm not the most dextrous person around.

You don't have to do IR. Why not do Peds?

 

[klake3]

You don't have to do IR. Why not do Peds?

Don't you have to do a fair amount of procedural work even in diagnostic rads? Plus it's a 5 year residency plus mandatory fellowship(s) just to get a job somewhere, anywhere. Yeah, the more I think about it the more I am actually leaning towards peds. I like adult outpatient continuity care though... ughhh decisions.

 

[DermViser]

Don't you have to do a fair amount of procedural work even in diagnostic rads? Plus it's a 5 year residency plus mandatory fellowship(s) just to get a job somewhere, anywhere. Yeah, the more I think about it the more I am actually leaning towards peds. I like adult outpatient continuity care though... ughhh decisions.

I believe you have IR rotations but it is not a majority.

 

[klake3]

I believe you have IR rotations but it is not a majority.

Right, but out in practice I'd imagine you aren't doing just reads unless you are doing a nighthawk type job. Most partnership jobs in diagnostic rads I've seen require procedural work and a preferred fellowship in Body. Rads was actually why I went to med school... until I realized I suck with needles and procedures.

 

[DermViser]

Right, but out in practice I'd imagine you aren't doing just reads unless you are doing a nighthawk type job. Most partnership jobs in diagnostic rads I've seen require procedural work and a preferred fellowship in Body. Rads was actually why I went to med school... until I realized I suck with needles and procedures.

There are many Rads fellowships that aren't procedural.

 

[tony montana]

True, you can be. I liked kids a lot too, which pushed me closer to FM ...plus, the thing about IM I hated is the huge focus on inpatient, ICU, academia stuff, and very few outpatient only rotations. Plus, the culture of specializing, if I did go with IM, I wanted no fellowship tracks, just 3 years and let me do my thing! Which is what FM will do for me and my goals. For me, after intern year, a huge part of residency rotations are outpatient based, which is what I like. Plus, more time in the clinic setting vs. wards(shudders).

arrghhh the academia stuff of IM blows

My FM residency had very little inpatient and I did more deliveries as a medical student than I did as a FM resident. Choose your residency wisely and you will have few inpatient rotations, little academia, enought peds and lots of adult outpatient rotations.

 

[simpler2]

Psych training isn't bad and outpatient job opportunities are fairly abundant, likely zero procedures/surgeries. Just mentioning as no one else has thrown it out as a suggestion yet. As for FM, there are plenty of training programs that are very low stress in training...I wouldn't have gone to one myself. Remember that your residency is training you to practice medicine for the rest of the career, stressing yourself for a few years will likely be worth it in the long run. Just because you train to do many things, you can work at an outpatient only-mostly adult-referral based practice if you like.

 

[klake3]

Psych training isn't bad and outpatient job opportunities are fairly abundant, likely zero procedures/surgeries. Just mentioning as no one else has thrown it out as a suggestion yet. As for FM, there are plenty of training programs that are very low stress in training...I wouldn't have gone to one myself. Remember that your residency is training you to practice medicine for the rest of the career, stressing yourself for a few years will likely be worth it in the long run. Just because you train to do many things, you can work at an outpatient only-mostly adult-referral based practice if you like.

I'm ashamed to admit that I was legitimately uncomfortable on my psych rotation... one of my rotations at county was mostly people released from the local prison and I never really got comfortable with the patients. Does seem like a good lifestyle though.

 

[Mad Jack]

You could always do an IM program with a primary care focus. It's not a much better schedule than general IM, but the number of outpatient blocks is slightly better. Here's an example:

http://gme.uchc.edu/programs/primarycare/rotationschedule.html

5 blocks 1st year, 7 blocks 2nd year, and 6 blocks 3rd year are either electives or in outpatient practice/specialties. It also opens up the opportunity to do a fellowship such as pulm, rheum, gastro, or endo that can easily be done on an outpatient basis and could boost your career opportunities and income potential.

 

[michaelrack]

You could always do an IM program with a primary care focus. It's not a much better schedule than general IM, but the number of outpatient blocks is slightly better. Here's an example:

http://gme.uchc.edu/programs/primarycare/rotationschedule.html

5 blocks 1st year, 7 blocks 2nd year, and 6 blocks 3rd year are either electives or in outpatient practice/specialties. It also opens up the opportunity to do a fellowship such as pulm, rheum, gastro, or endo that can easily be done on an outpatient basis and could boost your career opportunities and income potential.

Pulm usually has a large inpt component. Rheum and endo are mostly outpt. GI fellowships vary

 

[Mad Jack]

Pulm usually has a large inpt component. Rheum and endo are mostly outpt. GI fellowships vary

Post-fellowship, you can do pretty much all of them on an outpatient basis if you are outside of academia.

 

[michaelrack]

Post-fellowship, you can do pretty much all of them on an outpatient basis if you are outside of academia.

Agree, although opportunities in pulm would be limited

 

[Mad Jack]

Agree, although opportunities in pulm would be limited

If the opportunity you want is outpatient pulm, then you're not really limiting yourself, since you don't want the stuff you're not getting.

 

[michaelrack]

If the opportunity you want is outpatient pulm, then you're not really limiting yourself, since you don't want the stuff you're not getting.

I meant that it would be harder to find an outpt pulm job than a traditional pulm job (with a combination of outpt and inpt)

 

[VA Hopeful Dr]

I meant that it would be harder to find an outpt pulm job than a traditional pulm job (with a combination of outpt and inpt)

At present, absolutely. I do wonder though if this will remain true with the increasing use of full-time intensivists.

 

[W19]

arrghhh the academia stuff of IM blows

My FM residency had very little inpatient and I did more deliveries as a medical student than I did as a FM resident. Choose your residency wisely and you will have few inpatient rotations, little academia, enought peds and lots of adult outpatient rotations.

Why? I would be wary of a FM program with very little inpatient...

 

[deleted87716]

Why? I would be wary of a FM program with very little inpatient...

All accredited FM residencies will have approximately the same number of hospital-based rotations. So will peds and IM. You can't escape the hospital in training, but you can in practice.

 

[Ericslv]

I am not sure why "i hate inpatient" is being twisted to "i hate people"... I don't hate people, I just prefer the less depressing (IMO) atmosphere of outpatient. I have experience in outpatient prior to school, so I've experienced the difference. I enjoy peds, don't like OB and with malpractice i highly doubt I would want to be involved in it anyway.

Try psych. All outpatient or a different kind of inpatient.

 

[deleted87716]

Try psych. All outpatient or a different kind of inpatient.

Psych residency will still involve inpatient training, however. The OP's question was about inpatient exposure during residency, not in practice. Since the thread is over three years old, however, I doubt the OP is even around.

 

[Moose A Moose]

I am not sure why "i hate inpatient" is being twisted to "i hate people"... I don't hate people, I just prefer the less depressing (IMO) atmosphere of outpatient. I have experience in outpatient prior to school, so I've experienced the difference. I enjoy peds, don't like OB and with malpractice i highly doubt I would want to be involved in it anyway.

Because some people here make baseless assumptions. Others like to take indirect jabs in attempt to make themselves feel superior.

 

[HipsterLorax]

All accredited FM residencies will have approximately the same number of hospital-based rotations. So will peds and IM. You can't escape the hospital in training, but you can in practice.

While true, there are residencies adopting the "clinic first" model which means you almost always have at least 3-4 half days of clinic per week. Inpatient rotations are shorter but more spread out, schedules overall are more predictable, and they really emphasize continuity and practice management. The residents I met at these programs chose them because of their emphasis on outpatient medicine and they all seemed incredibly happy with their work-life balance.

Clinic First: Prioritizing Primary Care Outpatient Training for Family Medicine Residents at Group Health Cooperative

Something to think about for those folks that aren't huge fans of inpatient.

 

[Bonus Eruptus]

Because some people here make baseless assumptions. Others like to take indirect jabs in attempt to make themselves feel superior.

Absolutely agree. Shades of grey make people who view the world in pure black and white uncomfortable.

 

[coffeeclothesaddict]

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[cabinbuilder]

Once you get done you don't have to do inpatient at all unless you are dead set on rural. But most places have hospitalist service anyway so your life would be M-F 8-5 as a rule. I only urgent care so don't even do primary care any more either.

 

[FrustratedFamDoc]

In a time where we deal with increasing encroachment in to the realm of primary care by mid levels, beware activities that make you look like one. Yes, most fam docs will go in to an out pt only type practice, but the in pt training is still very valuable. A fam doc with limited inpt training sure looks a lot like an NP in the eyes of the bean counters.

 

[cabinbuilder]

In a time where we deal with increasing encroachment in to the realm of primary care by mid levels, beware activities that make you look like one. Yes, most fam docs will go in to an out pt only type practice, but the in pt training is still very valuable. A fam doc with limited inpt training sure looks a lot like an NP in the eyes of the bean counters.

True, having inpatient/ER experience only makes you a better outpatient doctor because you know when a person really needs to be in the ER or admitted.

 

[jm192]

True, having inpatient/ER experience only makes you a better outpatient doctor because you know when a person really needs to be in the ER or admitted.

And vice versa.

I can't tell you how many times I've told an ED doc--man we sent that ish home from the clinic all the time.

 

[jm192]

OP, I think you have to figure out what you wanna do.

Things like Rheum, Derm can often be fully outpt. But you'll go through some inpatient along the way.

FM is nice because of the scope of practice options you'll have after residency. But, you'll do some inpatient. Some places may be lighter than others.

 

[Xorthos]

arrghhh the academia stuff of IM blows

My FM residency had very little inpatient and I did more deliveries as a medical student than I did as a FM resident. Choose your residency wisely and you will have few inpatient rotations, little academia, enought peds and lots of adult outpatient rotations.

You did more than 40 deliveries as a medical student? Wow. They just let me catch placentas back then.

 

[VenusinFurs]

I

You did more than 40 deliveries as a medical student? Wow. They just let me catch placentas back then.

I believe the 40 ob rule was phased out in about 2015?