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For those of you who don't plan on specializing (no fellowship) after IM residency: what thing(s) made you decide to do internal med instead of family med?
glorytaker said:No kids, no pregnant women, almost no surgery. 'Nuff said.
maxpower75 said:...In my opinion if you are sure you want to do outpatient care, FP is probably better especially if you plan to work in an underserved area, that way you can see the entire family...
Good Luck
ekydrd said:Don't forget about med-peds. We can see an entire family, and while we don't do OB (or surgery for that matter) neither do most FP's who practice primary care in underserved areas, as the cost of malpractice is often inhibitory to such practice. I plan to work in a rural, underserved community as a hospitalist/ER physician/clinician, and feel my med-peds training is perfect.
zambo said:Since general IM is "adult" medicine, doesn't it also include gynecology for adult women?
zambo said:For those of you who don't plan on specializing (no fellowship) after IM residency: what thing(s) made you decide to do internal med instead of family med?
zambo said:Since general IM is "adult" medicine, doesn't it also include gynecology for adult women?
esposo said:A lot of people have answered your question but I can summarize what they said. A lot of internist would rather avoid seeing women and children so they can focus on adult medicine. .
Mumpu said:No kids, no pregnant women, better education with the ability to attend an academic institution for residency without becoming everyone's scutmonkey, higher quality of the average colleague, more challenging cases, better income, opportunity to work as a hospitalist.
jocg27 said:Adult medicine = adult male medicine?
brooklyneric said:No (alhtought a literal interpretation of the parent statement would assume that). IM = medicine for adults and most IM docs either prefer not to do, don't know how to do or completely forget to do routine GYN screening and care for their female patients. HTN, DM, cardiac, GI and pulmonary issues are no problem (regardless of the gender of the patient) but most internists don't even think about going "down there" let alone doing routine breast exams or counseling. All too often that part of the H&P boils down to "when was the last time you saw your OB/GYN? you should make an appointment soon.". It's not something we're routinely trained in. More programs are adding Women's Health tracks or ambulatory rotations (required or optional) in a general OB/GYN setting but those are still the overall exception rather than the rule.
Another "problem" with this is that many of us (myself included) have our continuity clinics in VA hospitals. Although the patient mix is changing, the overwhelming majority of VA patients are older (Vietnam era and older) men with a varying mix of HTN, DM, CHF, COPD and various other chronic conditions. When 95% of the patients you see are old men, when a younger woman comes into your clinic it can be easy to forget what a big difference that extra X can make.
BE (now PE)
This is very true. I worked in an office full of male practitioners who referred all paps to ob-gyn and all gyn acute complaints to the PAs/NPs. I did all my own unless the patients were >300 pounds because we had only one type of speculum. (I'm female.) I think that is why I ended up with a lot of female patients...they liked the convenience. And for the ABIM you must be signed off on 5 breast exams, 5 rectals and 5 pelvics including wet mount.There tends to be a large difference between male and female internists as to how many gyn exams they tend to do both during and after residency. This is usually because of patient preference to have a female physician performing their pap smear. Most practicing female internists I know do their own pap smears for their patients rather than refer them out.
signomi said:So for all practicality, internists see the same patients as FP with the exception of women and children. Of course, ideally, you want to have the most knowledge possible to better serve your patients. But realistically, most internists will forget their ward based expertise if they have been in an outpatient setting for years as most of their patients will suffer from the same bread and butter issues that FP patients have.
esposo said:No! Gynecology is practiced nearly exclusively by OB/GYN. Some internists will choose to do pap smears but the vast majority don't particularly in today's litigious society. Most internists will just refer that patient to an OB/GYN.
Mumpu said:No kids, no pregnant women, better education with the ability to attend an academic institution for residency without becoming everyone's scutmonkey, higher quality of the average colleague, more challenging cases, better income, opportunity to work as a hospitalist.
sophiejane said:There's no scutmonkey-ing at unopposed programs, which are pretty much the only programs that people serious about becoming competent FP's are looking at nowadays. The big academic programs where FP is the redheaded stepchild are going the way of the dinosaurs (see Duke FP closing as a recent example). Most opposed academic programs go unfilled or fill with FMGs. The opposite is true with the stronger unopposed programs.
brooklyneric said:Totally OT here but what does opposed vs. unopposed mean? Just curious.
DrMom said:It is bad if IM (or any other service "sharing" patients) gets to cherry-pick their admissions. At my facility there is a ratio of IM:FM admissions from the ED (can't remember exactly what it is, but something similar to the 3:1 you're seeing), but it is randomly assigned based on the ratio. Neither services get to choose which particular patient goes to which service.
KentW said:An "unopposed" residency is one in which your program is the only residency (or one of only a few) in the facility. The generally leads to a better training experience, as you're not competing with other programs for patients and procedures. When I was in residency, there was just the FM residency, a transitional program, and an OB residency. So, we pretty much did everything.
esposo said:No! Gynecology is practiced nearly exclusively by OB/GYN. Some internists will choose to do pap smears but the vast majority don't particularly in today's litigious society. Most internists will just refer that patient to an OB/GYN.
DrRobert said:I've never met an internist who does not do paps when indicated. For certain presentations of abd pain, a pap is part of the standard of care. Shipping that patient to an OBGYN without doing the pap is poor form.
DrRobert said:I've never met an internist who does not do paps when indicated. For certain presentations of abd pain, a pap is part of the standard of care. Shipping that patient to an OBGYN without doing the pap is poor form.
sophiejane said:Not doing a pelvic/pap before referring a patient to Gyn is like not doing an EKG before referring to cards. There's absolutely no reason why IM can't do basic preventive medicine for women as well as men.
novacek88 said:Furthermore, you act like pap smears are an uncomplicated procedure.
sophiejane said:Better education depends on the program. There are plenty of FP programs that rival IM programs in depth of experience caring for sick patients in the hospital. I've seen some pretty abysmal IM programs. Just being IM doesn't make the education superior.
The most recent numbers put FP at an equal or higher average income than a general internist. The potential to make more money in FP exists because of the breadth of experience and procedures. The bottom line is what you can bill for, and a general internist gets paid exactly the same thing for a routine visit or hospital visit that an FP does.
Actually, I beg to differ. You can do as much OBGYN as you want with Family.
FP hospitalists are working happily all over the country and making a fine living.
KentW said:Why the hostility? This thread doesn't have to be "us vs. them" unless you make it that way. Don't.
novacek88 said:Why don't you read her posts on this thread and tell me she wasn't being the least bit condescending toward our field. Do that before you ask me about hostility next time.
KentW said:Well, I deleted my post right after you quoted it, apparently. I don't want to see this thread turn into a pissing contest. I've read the thread, and I think you're overreacting. Take a few deep breaths and think about why anything she has posted bothers you in the first place.
novacek88 said:an FP implying that their training is on par with ours in regards to ward based medicine is pure bunk.
KentW said:I don't think anyone is disputing the fact that internal medicine residents do more inpatient months than family medicine residents. However, that doesn't necessarily mean that a well-trained family physician isn't going to be equally capable of caring for hospitalized patients. Training is as much about quality as it is quantity.
novacek88 said:No one is arguing that family practice physicians are incapable of properly caring for hospitalized patients.
novacek88 said:Where??? Again, evidence would be nice. Show me an FP hospitalist working in NYC, SF, downtown Chicago and Boston? No reputable hospital in one of the 4 largest cities in the United States would consider hiring an FP as a hospitalist.
novacek88 said:While I may have overreacted, it is irresponsible for someone to hyperbolize and embellish the truth to prove a point. I think you are naturally biased because you are in FP but to an internist such as myself, an FP implying that their training is on par with ours in regards to ward based medicine is pure bunk.
novacek88 said:Uh could you provide these so-called "recent numbers" because all of the factual evidence I have read says otherwise. Here is one off the web that shows General Internists earning more than FP
http://www.allied-physicians.com/salary_surveys/physician-salaries.htm
novacek88 said:Where??? Again, evidence would be nice. Show me an FP hospitalist working in NYC, SF, downtown Chicago and Boston? No reputable hospital in one of the 4 largest cities in the United States would consider hiring an FP as a hospitalist.
sophiejane said:FP (with OB) $182,000 $204,000 $241,000
FP (w/o OB) $161,000 $135,000 $239,000
FP - Sports Medicine $ 152,000 $208,000 $363,000
FP - Urgent Care $ 128,000 $198,000 $299,000
Internal Medicine $154,000 $176,000 $238,000
IM (Hospitalist) $161,000 $172,000 $245,000
This was cut and pasted directly from the link you provided.
How did you get the impression that IM makes more than FP?
sophiejane said:Here's a link to a job board on the Society of Hospital Medicine website. It appears that there are hospitals in the Bay area, Sacramento, Denver, Houston, Dallas, San Antonio, and Detroit seeking FP boarded hospitalists.
Are those in your required "4 largest cities?" I'm not sure. I don't know what those cities are. Do they fit your description of reputable? Again, you'd have to elaborate on that. Furthermore, most hospitalists do not work in the top hospitals in the largest cities, simply due to the law of supply and demand.
http://careercenter.hospitalmedicine.org/search/results/?job_category=6794&ss=0&sec=browse
ps: just found out (I'm learning so much from this discussion!) NYC #1, Chicago #3, SF #13, Boston #24
http://www.infoplease.com/ipa/A0763098.html
skypilot said:Yeah, I would like the dollars per hour worked. That is the most important one. A doc can always make a few more dollars by putting in more hours. Maybe the IM docs shown were working 70 hours a week.