Are there any procedure-heavy IM programs?

[Pyroclast]

Does anyone know of any IM residencies that provide more procedural/outpatient training than is the norm? I'm looking into outpatient primary care, and I think I'd rather do IM than FP, but it seems ridiculous to do a residency where I'll spend a half day a week doing outpatient training and the rest of the time on inpatient care when I don't want to be a hospitalist. I'd like to find a program that provides the depth of IM while also giving experience in the minor procedures people expect from their primary care physician. I'd hate to have to refer my patients to a specialist in order to cut off a toenail or remove a benign mole, and I personally know internists and pediatricians who never learned to do basic stuff like that in all their years of training. So, are there IM programs that actually train you to work in an office setting instead of in the ICU? Why does FP seem to have a lock on all the run of the mill procedures besides stress tests and endoscopes?

Sorry if this has already been addressed, but I couldn't find anything in the old posts.

-Pyroclast

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[angel80]

Look for programs that have Primary Care Tracks. These programs generally offer a lot more outpatient training than traditional IM programs. In my program, if you do the Primary Care Track, you have 3 months in 2nd year and 3 months in 3rd year devoted to rotating through various clinics like Derm, Gyn, Optho, Urology, ENT, Ortho, etc and learn how to do more outpatient procedures. You can find out which programs offer primary care tracks using FREIDA. In additon, a lot of programs have outpatient medicine integrated into their subspecialty months (ie, when you do GI, Nephro, Heme-Onc, Cards, Endocrine, etc, you spend part of the month doing inpt/consult, and part of the month in the clinic.) You should ask about that when you go on interviews.

 

[Pyroclast]

Thanks angel, that's a good idea. I've looked at the web sites for some primary care track programs and they seem promising.

 

[madcadaver]

When you say procedures, outpatient medicine is not the first thing that comes to my mind. Yes, you may be able to do skin biopsies, flex sigs, and toenail avulsions in the outpatinet setting. But the vast majority of your "procedures" in internal medicine will be inpatient-- lumbar punctures, para- and thoracentesis, central lines, etc. So before you set your mind on a primary care track (which tends to emphasize outpt training at the expense of inpt training) make sure that you are not interested in doing these more invasive procedures. Best of luck.

 

[Pyroclast]

That's true, madcadaver, and I appreciate the advice. There are a number of procedures that internal medicine routinely trains for. But I'm 99% sure I would stick to an outpatient setting and use a hospitalist when I need to admit patients. Which is something that seems to be getting more common everyday. I'm sure that even if I kept hospital privileges, I would eventually get pretty rusty at LPs, placing central lines, etc. compared with someone who practices inpatient medicine full time.

 

[uscimdoc]

I agree with the above. My institution is very much an inpatient oriented program. However, it is a smaller program, so we work with the private groups in the outpatient arena a fair deal. As an intern, I logged 99 procedures!!! That wasn't even all I did. I became lazy after about a dozen central lines, so I stopped logging. This is my 3rd month in the 2nd year, and since those initial 99 I have done an additional 12 central lines, 1 dialysis catheter, 4 lumbar puncture, 2 arthrocentesis, 3 thoracentesis, 1 paracentesis, 6 bronchoscopies (2 of which were under fluroscopy with transbronchial biopsies, 1 was a Wang needle biopsy, 2 were plain biopsies, and 1 was a little looksie- all of which I drove from outside the nose to the end), 5 intubations, ran 5 codes, and read about 30 PFTs!!! It has been an awesome last 3 months. For those that are freaking out, I do the procedures because I want them, not because I have to do them. If you want procedures, you should strongly consider Palmetto Health Alliance/University of South Carolina.

 

[DoctorSax]

I agree with the suggestion to look at primary care tracks. I'm currently in one and we spend time rotating through various outpatient clinics including derm, ENT, OB/Gyn, orthopedics, podiatry, and optho--about 12 different specialties in total. Next time I go to ortho clinic, I plan to have them teach me how to do joint injections. In derm clinic, I hear that you can learn skin biopsies if you choose. Opportunities to do I&Ds abound at the walk-in clinic we rotate at. A lot of learning outpatient procedures is up to you.

We get three outpatient months in the intern year, three in the second year, and then I don't know how many in the third. I agree that much of the procedure load during residency is centered on the inpatient setting (LPs, thoracentesis, lines, etc) but I think that that is because our place of employment is currently a hospital. If you are anything like me, you would rather practice IM in the outpatient milieu and keep folks as far away from the hospital as possible, which demands a different arsenal of procedures.

Pretty impressive list of procedures, though, to the previous poster--well done!

DS

 

[Clemson Doc]

If you are anything like me, you would rather practice IM in the outpatient milieu and keep folks as far away from the hospital as possible, which demands a different arsenal of procedures.

I totally agree. This is exactly what I want to do.

For the original poster, I think the suggestion of looking at IM programs with primary care tracks is a great one. They give you more time at ambulatory sites, while still exposing you to hospital medicine. 👍