is it too late to switch from FM to IM one week before ERAS

[naoxher]

Is it too late to switch specialties from FM to IM? I have been between these two for months now, but I'm realizing I prefer hospital medicine to outpatient. Do I reach out to my LoR writers and update my application, or should I continue with FM and hope I can become a hospitalist in the future?

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[deleted1168269]

Do I reach out to my LoR writers and update my application, or should I continue with FM and hope I can become a hospitalist in the future?

Are any of them family docs?

 

[naoxher]

Are any of them family docs?

One of them yes, other two are IM

 

[deleted1168269]

One of them yes, other two are IM

Don’t ask the FM one to change their letter.

 

[Drrrrrr. Celty]

One of them yes, other two are IM

The question is whether those two letters are good quality ones that describe you as someone interested in medicine.
Likewise whether they're from places that show you work well with residents cohorts.

I wouldn't go into FM if you already think you're going to want to do hospital based medicine. While you certainly can be a FM hospitalist, it's not the best route. You lose out a lot on subspecialty medicine and ICU time in FM.

 

[FutureInternist]

Is it too late to switch specialties from FM to IM? I have been between these two for months now, but I'm realizing I prefer hospital medicine to outpatient. Do I reach out to my LoR writers and update my application, or should I continue with FM and hope I can become a hospitalist in the future?

You can be a hospitalist even if you do FM, but you lose the option to ever do a hospital based subspecialty - Cardio, ICU, GI, ID etc

Also, from what I remember, any and all previous LoRs remain in ERAS and the updated version gets uploaded as well…. If someone were to read the older ones, they may question your commitment etc and that may pose problems.

 

[Dantes]

You can be a hospitalist even if you do FM, but you lose the option to ever do a hospital based subspecialty - Cardio, ICU, GI, ID etc

Also, from what I remember, any and all previous LoRs remain in ERAS and the updated version gets uploaded as well…. If someone were to read the older ones, they may question your commitment etc and that may pose problems.

You assign letters to programs and can send a new link URL to letter writers for a separate slot if needed. As long as you don't send an outdated one by accident there shouldn't be an issue.

OP, if you're sure about doing hospitalist medicine go IM. Far easier to become a hospitalist and won't limit you geographically.

 

[deleted1168269]

You can be a hospitalist even if you do FM, but you lose the option to ever do a hospital based subspecialty - Cardio, ICU, GI, ID etc

Also, from what I remember, any and all previous LoRs remain in ERAS and the updated version gets uploaded as well…. If someone were to read the older ones, they may question your commitment etc and that may pose problems.

ERAS states that LOR writers have the right to change their letter at any time. Though I stand by what I said earlier that OP definitely shouldn't ask the FM writer to switch out of FM.

 

[AlbinoHawk DO]

Is it too late to switch specialties from FM to IM? I have been between these two for months now, but I'm realizing I prefer hospital medicine to outpatient. Do I reach out to my LoR writers and update my application, or should I continue with FM and hope I can become a hospitalist in the future?

Change now. FM is okay if you know that you want to do full-spectrum outpatient medicine. Otherwise, it's not the right specialty for you. Even if you can do hospital-based FM, you will not have the knowledge base and skills of IM. During residency, it was easy for me to identify their gaps. As a specialist, the quality of their inpatient consults are poorer than those coming from IM. Even if you want to do outpatient, I'd say IM is better if you go to a primary care IM residency than an FM one. The only exception, again, if you want full-spectrum with kids and ob/gyn

 

[dj-Roomba]

Change now. FM is okay if you know that you want to do full-spectrum outpatient medicine. Otherwise, it's not the right specialty for you. Even if you can do hospital-based FM, you will not have the knowledge base and skills of IM. During residency, it was easy for me to identify their gaps. As a specialist, the quality of their inpatient consults are poorer than those coming from IM. Even if you want to do outpatient, I'd say IM is better if you go to a primary care IM residency than an FM one. The only exception, again, if you want full-spectrum with kids and ob/gyn

Just curious if you could provide some examples. I SOAPed into FM because I thought it was the right choice for me over IM. At this point I much prefer hospital over clinic and know there will be deficits to overcome that I will need to work on with my 3rd year electives.

 

[Splenda88]

Just curious if you could provide some examples. I SOAPed into FM because I thought it was the right choice for me over IM. At this point I much prefer hospital over clinic and know there will be deficits to overcome that I will need to work on with my 3rd year electives.

You will be ok. I work with FM docs and after a few months, they are just as good as IM.

I have noticed they struggle mostly with ICU patients at the beginning, and they are a little bit quick to consult for things they should not consult IMO.

Be also mindful that there are academic centers in big cities/suburbs that might be reluctant to hire you.

 

[Drrrrrr. Celty]

Just curious if you could provide some examples. I SOAPed into FM because I thought it was the right choice for me over IM. At this point I much prefer hospital over clinic and know there will be deficits to overcome that I will need to work on with my 3rd year electives.

A lot of it is also dependent on your program as I'm sure some FM programs have robust ward experiences, have high expectations for their ICU rotation, etc. And electives certainly can help bridge the gap.

But in short:

1) ICU - IM spends 3-6 months of their residency in the ICU.
2) Rapids/Codes - IM graduates will run codes and rapids.
3) Subspecialty medicine - you learn how to manage a lot more, finer details, get exposed to more complicated cases that you can triage until the specialist gets there. Or frankly just manage them on your own.
4) "medicine paradigm"


Alternatively most IM residencies have trash clinics. I basically never took care of well patients or did well visits. 90% of my patients were in some degree of a CHF AE. And generally I felt like continuity clinic was triage for keeping my patients out of the ED. So I felt entirely unprepared for outpatient.

You will be ok. I work with FM docs and after a few months, they are just as good as IM.

I have noticed they struggle mostly with ICU patients at the beginning, and they are a little bit quick to consult for things they should not consult IMO.

Be also mindful that there are academic centers in big cities/suburbs that might be reluctant to hire you.

Again, probably depends on the FM or the IM in their background training. But most IM doctors are going to have their medicine down a lot more than FM. Employment also is a big one. IM can work open icus much easier if there is less procedural support from NP or line teams or anesthesia. Bigger hospitals are much more willing to let IM soft specialist too, i.e cardio hospitalist, GI hospitalist, pulmonary ward hospitalist, etc.

 

[AlbinoHawk DO]

Just curious if you could provide some examples. I SOAPed into FM because I thought it was the right choice for me over IM. At this point I much prefer hospital over clinic and know there will be deficits to overcome that I will need to work on with my 3rd year electives.

From a specialist POV, the quality of workup and consult question shows the difference in training. Lacking ICU training really shows as well as overall having less months in inpatient medicine and specialties. You can't expect to do 3 years of FM where you spend the equivalent of at least 1 years doing OB/Gyn and Peds and expect to do as well as someone that spent 3 years only doing medicine. The math doesn't add up. The FM teams and attendings operate more closely to what I'd expect from a PGY-2 at middle of the year

For the record, I'm not trying to hate on FM doctors. I would automatically defer to them for any ob/gyn question or peds question if someone in that specialty is not in the room. FM's modern purpose is more outpatient and do come ahead in areas like orthopedics and derm for outpatient complaints, whereas IM outpatient comes out stronger in the subspecialties of medicine

 

[Drrrrrr. Celty]

From a specialist POV, the quality of workup and consult question shows the difference in training. Lacking ICU training really shows as well as overall having less months in inpatient medicine and specialties. You can't expect to do 3 years of FM where you spend the equivalent of at least 1 years doing OB/Gyn and Peds and expect to do as well as someone that spent 3 years only doing medicine. The math doesn't add up. The FM teams and attendings operate more closely to what I'd expect from a PGY-2 at middle of the year

For the record, I'm not trying to hate on FM doctors. I would automatically defer to them for any ob/gyn question or peds question if someone in that specialty is not in the room. FM's modern purpose is more outpatient and do come ahead in areas like orthopedics and derm for outpatient complaints, whereas IM outpatient comes out stronger in the subspecialties of medicine

And the truth of outpatient is that a lot of your really advance medicine is more often than not, not really helpful. For an outpatient career you're far more better off being able to know how to deal with orthopedic issues, psych issues, etc than what most IM residents train on in the ICU or XYZ ward.

The bottom line is no matter what medicine is a lot of learning after you finish residency/fellowship. But it's gonna be hard going into either direction from the other.

 

[AlbinoHawk DO]

And the truth of outpatient is that a lot of your really advance medicine is more often than not, not really helpful. For an outpatient career you're far more better off being able to know how to deal with orthopedic issues, psych issues, etc than what most IM residents train on in the ICU or XYZ ward.

The bottom line is no matter what medicine is a lot of learning after you finish residency/fellowship. But it's gonna be hard going into either direction from the other.

I I learned a lot from specialty clinic. Many little factoids and tips on how to better manage before referring

I do think there's a lack of ortho, derm, and psych in most IM programs, but FM usually only rotates one time on these. If someone in IM wants outpatient, they can get these experiences as electives

 

[Splenda88]

I I learned a lot from specialty clinic. Many little factoids and tips on how to better manage before referring

I do think there's a lack of ortho, derm, and psych in most IM programs, but FM usually only rotates one time on these. If someone in IM wants outpatient, they can get these experiences as electives

There was zero derm and psych in my IM program.

 

[AlbinoHawk DO]

There was zero derm and psych in my IM program.

You didn't see any in continuity clinic and there was no elective option?

 

[Splenda88]

You didn't see any in continuity clinic and there was no elective option?

There was primary care continuity clinic and a few electives. Our residency was very inpatient heavy. We did 6 months of ICU, 2 months in cardio and nephrology. Some of us also did 2 months in GI. Time in these specialties were mostly spent in the consult service (probably 75%).

All of us spent 1 month in ID, Heme/onc, endo etc... We all had 6 months of general IM in both PGY 1/2

We pretty much functioned as fellows when we were doing nephro as we were the ones putting dialysis lines and and order HD because there was no nephro fellows.

I don't remember having electives as a PGY 1/2. Might have had 2-3 months as a PGY3.

 

[AlbinoHawk DO]

There was primary care continuity clinic and a few electives. Our residency was very inpatient heavy. We did 6 months of ICU, 2 months in cardio and nephrology. Some of us also did 2 months in GI. Time in these specialties were mostly spent in the consult service (probably 75%).

We pretty functioned as fellows when we were doing nephro as we were the ones putting dialysis lines and and order HD because there was no nephro fellows.

I don't remember having electives as a PGY 1/2. Might have had 2-3 months as a PGY3.

Wow, that's heavy. We only had 4 mandatory ICU and 1 mandatory of each cardio, GI, neuro, nephro, ID, and Endo. 10 inpatient rotations. The rest was purely electives. I knew people that did derm, ophtho, women's health, sports medicine, radiology, etc.

 

[Splenda88]

Wow, that's heavy. We only had 4 mandatory ICU and 1 mandatory of each cardio, GI, neuro, nephro, ID, and Endo. 10 inpatient rotations. The rest was purely electives. I knew people that did derm, ophtho, women's health, sports medicine, radiology, etc.

Some of us did 2 weeks of ortho.. No derm, women's health, radiology, ophtho

 

[Drrrrrr. Celty]

You didn't see any in continuity clinic and there was no elective option?

Pretty limited. As I said before my continuity clinic was honestly a hospital follow up clinic.
I diagnosed more cancers in my patients than I managed rashes.

I think it would have taken a lot from me to feel comfortable being a good quality PCP.

 

[Drrrrrr. Celty]

There was primary care continuity clinic and a few electives. Our residency was very inpatient heavy. We did 6 months of ICU, 2 months in cardio and nephrology. Some of us also did 2 months in GI. Time in these specialties were mostly spent in the consult service (probably 75%).

All of us spent 1 month in ID, Heme/onc, endo etc... We all had 6 months of general IM in both PGY 1/2

We pretty much functioned as fellows when we were doing nephro as we were the ones putting dialysis lines and and order HD because there was no nephro fellows.

I don't remember having electives as a PGY 1/2. Might have had 2-3 months as a PGY3.

Basically what my residency was.