Curious, why isn't ID part of FM?

[robertvaldez]

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I'm just curious. Why isn't infectious disease a fellowship of family medicine or vice versa. I mean I would think a family doctor with experience and knowledge of the infectious disease specialty would be somewhat more versatile.

Or are they really that different.

Do you think they should be paired?

 

[Integrity]

My first thought upon reading the thread was 'why isn't intelligent design...'. 😉

 

[scrambizle]

Interesting thought. Much of the ID training is on the inpatient side dealing with very sick people with crazy infections, for which you may be better prepared with an IM residency. Some Family Medicine physicians have a special interest in HIV/AIDS and can even devote their practice to this patient population (but no board certification that I'm aware of). Historically, I think the ID fellowship and certification came before family medicine was a specialty, so that may be another reason why ID doesn't stem from FM (just a guess).

 

[Speculatrix]

I'm just curious. Why isn't infectious disease a fellowship of family medicine or vice versa. I mean I would think a family doctor with experience and knowledge of the infectious disease specialty would be somewhat more versatile.

Or are they really that different.

Do you think they should be paired?

No, I do not think they should be paired. Patients who need ID consults at the hospital can be exquisitely sick, on death's doorstep. FM is more suited towards primary prevention and outpatient wellness/followup, rather than ordering IV voriconazole or daptomycin. These physicians need to be trained very well with an internal medicine background, especially as complex issues in nephrology/renal status, for example, are often involved. As for outpatient HIV followup, this may be a possibility for a FP, but resistance patterns, side effects, etc. often cloud the picture. When you get into AIDS, that's a whole different ballgame where patients are susceptible to vastly different conditions. That's also when I would want someone with an internal medicine background treating this patient. You don't see an ID doctor because you have a cold or some random skin infection, any FP can take care of that. Since you are a pre-med, I don't blame you for having this thought, but give it a few years and you will see just how complex the field can be.

 

[robertvaldez]

No, I do not think they should be paired. Patients who need ID consults at the hospital can be exquisitely sick, on death's doorstep. FM is more suited towards primary prevention and outpatient wellness/followup, rather than ordering IV voriconazole or daptomycin. These physicians need to be trained very well with an internal medicine background, especially as complex issues in nephrology/renal status, for example, are often involved. As for outpatient HIV followup, this may be a possibility for a FP, but resistance patterns, side effects, etc. often cloud the picture. When you get into AIDS, that's a whole different ballgame where patients are susceptible to vastly different conditions. That's also when I would want someone with an internal medicine background treating this patient. You don't see an ID doctor because you have a cold or some random skin infection, any FP can take care of that. Since you are a pre-med, I don't blame you for having this thought, but give it a few years and you will see just how complex the field can be.

Wow... Never though about it like that.

 

[greenthing]

I also think the reason people go into FM is that they want to remain able to treat a large variety of people and problems. Versatile. Usually the point of a fellowship, which is very intense and time-consuming, is that you would then be an expert in that area but would no longer feel comfortable dealing with the entire span of what FM encompasses. It's hard enough for IM docs (who don't know a thing about OB and peds) to try to dabble into general IM. To learn the entire content of a subspecialty-oriented fellowship and retain all of that knowledge of general IM, peds, and OB seems a little unreasonable.

 

[cardiolipin]

Wow... Never though about it like that.

Because you're a pre-med...no offense.

 

[QuinnB]

That all being said...a huge number of the san francisco HIV docs are essentially primary care physicians for their patients. They just don't take care of child and obstetrical issues (although some are training up to do so). HIV docs have already started specializing in primary care...given that their patients are now dying more often from cardiovascular disease than AIDS defining illnesses.

The rest of ID (non-HIV) is not so into primary management of patients given that, as was previously alluded to, there are fairly specialized and sometimes esoteric niches on the inpatient side (e.g., transplant - BMT or solid organ, neutropenic fever, peri-operative, medical, etc...). On the outpatient side, people tend to focus on a specific area as well (parasitology, mycology, virology - specifically HIV vs non-HIV, etc...), as is the case with most medical subspecialties these days, and is often coupled directly with an academician's research career. I'm not sure what the deal is on the private side of ID.

If the original question is why FPs can't or don't specialize in ID, it's partly because the reason people frequently consider FP in the first place is that they enjoy the diversity of cases and patients. Specializing and then hyper-specializing in a field like ID is sort of antithetical to that notion.