Difference between Family Medicine, Internal Medicine, and Primary Care?

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hellocubed

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I was wondering if anyone could elaborate on the differences between these 3 specialties.

Thanks~

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Oh boy, before the community eats you alive for your lack of researching skills...may I suggest Google or checking out each of these specialty's threads here on SDN

Or try the search function.

Best of luck to you, boyyo.
 
Oh boy, before the community eats you alive for your lack of researching skills...may I suggest Google or checking out each of these specialty's threads here on SDN

Or try the search function.

Best of luck to you, boyyo.

With the time you took to write that you could have answered the question
 
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I did some research, but cannot really ascertain the difference in their "work."

Internal medicine is adult medicine, family med is all ages, and primary care is just care from a healthcare provider?

It seems like all three physicians do the same basic job, and the titles are merely formalities concerning who and where they decide to practice.
 
I did some research, but cannot really ascertain the difference in their "work."

Internal medicine is adult medicine, family med is all ages, and primary care is just care from a healthcare provider?

It seems like all three physicians do the same basic job, and the titles are merely formalities concerning who and where they decide to practice.
Primary care is not a specialty, while the other two are. Internal medicine is adult medicine, and internists often run primary care practices. Internists can also sub specialize into fields like cardiology, oncology, etc.

Family medicine is the most "general" of the specialties, as they learn adult medicine, pediatric medicine, and OB/GYN. A few family medicine doctors specialize in something such as sports medicine, but sub specializing is not as common for them as for internists.

Pediatricians are often also in a primary care role, and OB/GYNs are as well.

Essentially, and someone else could probably define it better than I, primary care is your first, or "primary" physician contact, while specialists are those you go to for more specialized and specific treatment or consultation. Several specialties have primary care aspects.
 
On the most basic of levels of definition (to the best of my ability, I could be wrong):

Family - treats all age ranges from the tiniest of humans to the wrinkliest of humans
Internal - treats mainly adults
Primary - outpatient only, probably the type of doctor you'd see if you went to the E.R. for a cold but could also be one you see on a regular basis.
 
Of course you can read the posts below and do some of your own research.

My advice would also be to connect with some docs that practice in each of those fields and talk to them about their daily work, the types of patients they see, etc. This will give you a better idea of the differences. You could even ask your own PCP!

And by the way, I love the description of Family Med below!
 
On the most basic of levels of definition (to the best of my ability, I could be wrong):

Family - treats all age ranges from the tiniest of humans to the wrinkliest of humans
Internal - treats mainly adults
Primary - outpatient only, probably the type of doctor you'd see if you went to the E.R. for a cold but could also be one you see on a regular basis.

Hmm... i don't know. When i shadowed a pediatrician who worked at an urgent care, he made it clear that he wasn't a primary care doc.

However, and unfortunately, nowadays many people would consider an ER doc their primary care physician...
 
FM = stuffs that nurse practitioners can do.
IM = gateway to a whole varieties of disciplines.
 
itt: pre-meds groping at the truth (and failing)

Primary care is long-term care, specializing in the management of chronic diseases and in preventative care. Think your pediatrician, geriatrician, or the guy you get physicals from once every few years. Primary care physicians (PCPs) can be board certified in family medicine, internal medicine, pediatrics. Some people consider psychiatry and ob/gyn to have primary care components, since these physicians see the patient throughout their lives for stable outpatient care (well woman exams, managing chronic mental illness).

Urgent care (urgent care clinics, emergency departments) can be done by internal medicine, emergency medicine, family med, pediatrics, etc, but is not considered "primary care". Also, nobody but emergency medicine physicians is staffing an emergency department (I'm ignoring trauma surgeons and liason psych people).

Basically, primary care is a type of healthcare delivery, while internal medicine and family medicine are board-certifications. Many internists and family physicians do primary care, but many don't.

Does that make sense?
 
Family = obgyn, peds, im, psych, and bff all rolled into one.

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FM=jack of all trades master of none
IM = Specialist in adult medical management and preventative care.
PDs= Specialist in child medical and preventative care
OnG= Medical and surgical management of Reproductive system.

Ideally everyone should consult FM then they will refer to the relevant specialties
 
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So, since FM is more general than IM, is that one of the reasons why on average, IM's require a higher Step 1 score than FM?

Nice to see you have your head firmly planted in your ass prior to matriculation.

Well played. :laugh:
 
Primary care physician/provider (pcp) is usually used by insurances to denote your personal 1st line doc ( usually family med or im for an adult, fm or ped for a kid). The go to guy who is in all aspects of your personal medical care whether in depth or topically.
 
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Nice to see you have your head firmly planted in your ass prior to matriculation.

Don't blame me. I got the "FM is replaceable by Nurses" straight out of a doctor's mouth, a seasoned doctor.

We premeds are impressionable.
 
Don't blame me. I got the "FM is replaceable by Nurses" straight out of a doctor's mouth, a seasoned doctor.

We premeds are impressionable.
I remember one General surgeon saying Obgyn specialists arent really doctors. :laugh: Its a culture in medicine. One Obgyn referred to neurosurgeons as those guys who chops brains up and paralyze patients.
 
I remember one General surgeon saying Obgyn specialists arent really doctors. :laugh: Its a culture in medicine. One Obgyn referred to neurosurgeons as those guys who chops brains up and paralyze patients.

And I've heard OB-GYNs say that neonatolgists are pediatricians who went to medical school. :laugh:

Also: The internist knows something and does nothing, the surgeon knows nothing and does everything and the pathologist knows everything but too late.
 
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itt: pre-meds groping at the truth (and failing)

Primary care is long-term care, specializing in the management of chronic diseases and in preventative care. Think your pediatrician, geriatrician, or the guy you get physicals from once every few years. Primary care physicians (PCPs) can be board certified in family medicine, internal medicine, pediatrics. Some people consider psychiatry and ob/gyn to have primary care components, since these physicians see the patient throughout their lives for stable outpatient care (well woman exams, managing chronic mental illness).

Urgent care (urgent care clinics, emergency departments) can be done by internal medicine, emergency medicine, family med, pediatrics, etc, but is not considered "primary care". Also, nobody but emergency medicine physicians is staffing an emergency department (I'm ignoring trauma surgeons and liason psych people).

Basically, primary care is a type of healthcare delivery, while internal medicine and family medicine are board-certifications. Many internists and family physicians do primary care, but many don't.

Does that make sense?

Bolded is not necessarily true. Community EDs are often staffed by family medicine doctors, internists, or hell even moonlighting internal medicine residents. At large shops (trauma centers, stroke, STEMI, or servicing large populations), then yeah almost always EP.
 
Bolded is not necessarily true. Community EDs are often staffed by family medicine doctors, internists, or hell even moonlighting internal medicine residents. At large shops (trauma centers, stroke, STEMI, or servicing large populations), then yeah almost always EP.

Yeah, I know of a few physicians that were IM and after working so long in the ED got grandfathered in (perhaps those are special cases).

But I have also heard that in smaller cities some IM docs can moonlight at ED's. Has anyone heard of this or seen this?
 
Yeah, I know of a few physicians that were IM and after working so long in the ED got grandfathered in (perhaps those are special cases).

But I have also heard that in smaller cities some IM docs can moonlight at ED's. Has anyone heard of this or seen this?
Yes and so can family med docs.
 
FM = stuffs that nurse practitioners can do.

It's easy to be a crappy primary care doc. It's really hard to be a great one.

Also: The internist knows something and does nothing, the surgeon knows nothing and does everything and the pathologist knows everything but too late.

And the psychiatrist knows nothing and does nothing.
 
I'm surprised it has taken this many replies...

Primary Care This is more of a job description than a specialty. Physicians from any of several specialties can serve in a primary care role, but it is most commonly done by internists (internal medicine), family doctors, and pediatricians. Gynecologists often will take on a primary care role as part of their work. Primary care is the job of being someone's main doctor - the one who does annual checkups, coordinates care with specialists, manages medications for chronic problems, and sees generally non-life threatening acute complaints.

Internal Medicine These guys are the specialists in adult medicine. They know all sorts of disease inside and out. Some who become internists go on to do fellowship training to become cardiologists, gastroenterologists, nephrologists. Others work in primary care. Others take care of hospital patients. Others do a mix of primary, specialty, and hospital care. There are a lot of options.

Family Medicine They specialize in primary care, but rather than just pediatrics or just adults, their training covers a very broad spectrum of diseases and age ranges. They can take care of hospitalized patients, although this is less common than with IM. This specialty is very much oriented towards primary care and typically involves lots of training in social determinants of health, public health efforts, etc.
 
Don't most FM and IM docs provide mostly "primary care"? That seems to be the rule, rather than the exception. For the purposes of quick, simple definitions.

Most FMs do, for sure. For IM, it depends. Most of the IM residents where I am are going into specialties, but away from major academic centers there tends to be more of a focus on primary care. It depends, and I have no idea what the overall balance is.

I'm not doing IM, so I'm not the best to ask.
 
I meant people practicing general internal medicine. Should have been more specific. Cardiology, gastroenterology, etc. are clearly not primary care.

I think we may be misunderstanding one another, but I'm not sure where.

Although to answer what I think your question is, I have no idea what percentage of internists actually practice general internal. I'd venture to guess it's a sizable majority, but I see the world through the bubble that is a major academic medical center and don't actually know.
 
I've seen these posts many times, but to this day I am still confused; probably because of the vagueness of all of the responses. OP, I definitely don't blame you for your question.

In terms of training, what is the difference between IM and FM? It is obvious that FM gets exposed to more age groups, but besides that, in terms of "adult medicine", don't they both get exposed to the same exact pathologies?

If so, then why should I choose an Internal Medicine physician, if a Family Medicine doctor learned the same exact adult diseases AND MORE. Obviously if this was the case, there wouldn't be a dichotomy....soooo.... specifically, what do internists learn that family docs don't?


And no offense but descriptions like "FM=jack of all trades master of none" are awesome (for 5th graders, and general laymen trying to learn more about these fields), but they are pretty useless because they are so vague. So lets try to be a little bit more precise...
 
I've seen these posts many times, but to this day I am still confused; probably because of the vagueness of all of the responses. OP, I definitely don't blame you for your question.

In terms of training, what is the difference between IM and FM? It is obvious that FM gets exposed to more age groups, but besides that, in terms of "adult medicine", don't they both get exposed to the same exact pathologies?

If so, then why should I choose an Internal Medicine physician, if a Family Medicine doctor learned the same exact adult diseases AND MORE. Obviously if this was the case, there wouldn't be a dichotomy....soooo.... specifically, what do internists learn that family docs don't?

Somebody actually in one of these would give the best answer, but I'll try to give an overview that is only a little bit of a disservice to both specialties (both of which I have great respect for).

Your typical IM resident will spend more time in the hospital, more time rotating on specialty services like cardiology, nephrology, etc, more didactic time on detailed pathophysiology, and in general more time seeing and treating much sicker patients. They're learning adult medicine in more depth, but aren't covering as much peds, ob, or gyn.

Your typical FM resident will spend more time in clinic, more time rotating on services like the ED, peds, and OBGYN, have more continuity with patients they see in clinic during residency, and in general spending more time training for prevention on an outpatient basis. They're learning about a broader swath of medicine, but with less depth than the internists.

That's a really crude description that doesn't do either specialty justice. Which one makes you better prepared to take care of patients in a primary care setting? I am not touching that with a thirty foot pole.
 
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Somebody actually in one of these would give the best answer, but I'll try to give an overview that is only a little bit of a disservice to both specialties (both of which I have great respect for).

Your typical IM resident will spend more time in the hospital, more time rotating on specialty services like cardiology, nephrology, etc, more didactic time on detailed pathophysiology, and in general more time seeing and treating much sicker patients. They're learning adult medicine in more depth, but aren't covering as much peds, ob, or gyn.

Your typical FM resident will spend more time in clinic, more time rotating on services like the ED, peds, and OBGYN, have more continuity with patients they see in clinic during residency, and in general spending more time training for prevention on an outpatient basis. They're learning about a broader swath of medicine, but with less depth than the internists.

That's a really crude description that doesn't do either specialty justice. Which one makes you better prepared to take care of patients in a primary care setting? I am not touching that with a thirty foot pole.

No need, you did a fair job at addressing my question, so thanks for that! What I particularly wanted to know was, do FM docs cover everything that IM docs do? I presume they do..... the only difference is that they get less exposure/cases (in particular fields). I'm certain that FM docs encountered all types of cardio, nephro, neuro, and gastro pathologies that an IM doc encounters during residency...

This is important because at least I know that they have been exposed to the same thing (in terms of adult medicine)...which of course doesn't occur in other specialty comparisons such as derm vs. neurosurgery... where there is little to no overlap.

To further my ridiculous thought process, would it be fair to say that an experienced FM doc that has accumulated enough exposure (in terms of amount) to adult pathologies, would rival a fresh IM residency graduate in terms of knowledge?
 
To further my ridiculous thought process, would it be fair to say that an experienced FM doc that has accumulated enough exposure (in terms of amount) to adult pathologies, would rival a fresh IM residency graduate in terms of knowledge?

I'd say those are apples and oranges.
 
On the most basic of levels of definition (to the best of my ability, I could be wrong):

Family - treats all age ranges from the tiniest of humans to the wrinkliest of humans
Internal - treats mainly adults
Primary - outpatient only, probably the type of doctor you'd see if you went to the E.R. for a cold but could also be one you see on a regular basis.

That is incorrect. Primary care encompasses several specialties. It is not a specialty in and of itself, but rather an umbrella term.
 
I'd say those are apples and oranges.

thanks buddy.

Ultimately I got my answer; in one way or another, an internal medicine doctor comes across all of the patients that a family medicine doctor would come across. (not vice versa though).
 
No. Internists don't usually treat kids, like a family doc would.

"Doctors of Internal Medicine. Doctors for Adults.® "

http://www.acponline.org/patients_families/about_internal_medicine/

****. Sorry. Meant it the other way around. A Family Medicine doctor covers the same spectrum that an Internal Medicine doctor does - and then some.

I don't mean to say that one is better than the other, this is just important to note so that when one chooses a field and they want to avoid certain areas of medicine, they will have a better understanding of who actually gets exposed to what; irrespective of the frequency,
 
It seems like all three physicians do the same basic job
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No definitely not. Internists knows diagnosis and drug management better, FM knows other specialties better.
If you have life threatening systemic disease, you are better off with an internist . if you consult for the first time, you are better of with a FP because of their broader knowledge.
 
****. Sorry. Meant it the other way around. A Family Medicine doctor covers the same spectrum that an Internal Medicine doctor does - and then some.

I don't mean to say that one is better than the other, this is just important to note so that when one chooses a field and they want to avoid certain areas of medicine, they will have a better understanding of who actually gets exposed to what; irrespective of the frequency,

Well in general, yes, the same sorts of cases IM sees, plus those Peds sees, plus those OB/GYN sees. The difference is, Peds, OB/GYN, and IM each spend three years on their specific patient type/case type (minus off service rotations), while FM spends three years total and covers all three. In that way, FM trains in a broader range, but in less depth.
 
No definitely not. Internists knows diagnosis and drug management better, FM knows other specialties better.
If you have life threatening systemic disease, you are better off with an internist . if you consult for the first time, you are better of with a FP because of their broader knowledge.

This is so inaccurate, I don't know where to begin.
 
This is so inaccurate, I don't know where to begin.
i obviously don't know as much as you so il have to agree with you. this is the information i got from our family medicine consultant. what he told me is that during their training program, FM spends time in different specialties including, Paeds, ENT, Obgyn internal medicine etc. with that said, they are not gonna know this specialties as good as those doing it since they spends less time.
Maybe its because im from a different country with a different setting or maybe im just misinformed. anyway one thing that maybe i should ask clarity on is psych. In South Africa, no one considers Psych a primary care specialty because most Psych patients are admitted by Paeds and internal medicine to rule out medical causes. If they don't find anything then they refer to Psych.
 
i obviously don't know as much as you so il have to agree with you. this is the information i got from our family medicine consultant. what he told me is that during their training program, FM spends time in different specialties including, Paeds, ENT, Obgyn internal medicine etc. with that said, they are not gonna know this specialties as good as those doing it since they spends less time.

You learn diagnosis and drug management just by seeing patients. Internal Medicine is not the only specialty that learns that.

Internal medicine is not the only specialty that sees sick patients, either. Just because you have a "life threatening" illness doesn't mean that the only person who can take care of you is someone in internal medicine....actually, I would argue that a critical care medicine doctor is what you need. And you can specialize in critical care through internal medicine, surgery, Emergency Medicine, or anesthesia.

The main difference between family medicine and internal medicine is that family medicine does peds and OB/gyn, while internal medicine does not. Family medicine also focuses more on outpatient clinic medicine, while internal medicine focuses on inpatient hospital medicine.
 
You learn diagnosis and drug management just by seeing patients. Internal Medicine is not the only specialty that learns that.

Internal medicine is not the only specialty that sees sick patients, either. Just because you have a "life threatening" illness doesn't mean that the only person who can take care of you is someone in internal medicine....actually, I would argue that a critical care medicine doctor is what you need. And you can specialize in critical care through internal medicine, surgery, Emergency Medicine, or anesthesia.

The main difference between family medicine and internal medicine is that family medicine does peds and OB/gyn, while internal medicine does not. Family medicine also focuses more on outpatient clinic medicine, while internal medicine focuses on inpatient hospital medicine.
so do you get the same experience(hours) in management of adult conditions as a family physician?:confused:
 
so do you get the same experience(hours) in management of adult conditions as a family physician?:confused:

The experience is very similar, it is just in a different setting (outpatient vs. inpatient).

It depends on the program, too. Some residency programs are basically internal medicine programs, with a few months of peds and OB/gyn thrown in. Others are very much outpatient based.
 
The main difference between family medicine and internal medicine is that family medicine does peds and OB/gyn, while internal medicine does not. Family medicine also focuses more on outpatient clinic medicine, while internal medicine focuses on inpatient hospital medicine.

This. For outpatient stuff related to adults, a general internist and a family practitioner are probably pretty equivalent. Just based on their training, the family practitioner might be more holistic/touchy-feely and the internist might be more into the pathophysiology, but that's a broad generalization that doesn't mean much individually. (It's just from how the residencies are often structured, and tbh the individual providers personality usually trumps that)

On the other hand, the internists are experts at hospital medicine. Those months the family practice residents are brushing up on their Ob, psych, or pediatrics, the IM residents are spending on the wards or the ICU, dealing with the sickest patients and learning how to manage them. Hence why the vast majority of hospitalists (all of them in certain parts of the country) are IM trained.

And the reason why you'd want to be IM trained instead of FM trained is pretty much the fact that FM is a "dead end". If you want to do primary care +/- Ob and nothing else, FM is a fine career choice. But if you want to do a fellowship (other than sports med) or if you want to do inpatient work, IM offers you those opportunities. These days, only about 30% of internists do general internal medicine/primary care, with the remainder either working as hospitalists or doing a fellowship.

(Of course, there's also always the option of doing a medicine-pediatrics residency. Which is 4 years rather than 3, leaves you board certified in both med and peds, and gives you the option of working outpatient, inpatient for either patient population, or doing any fellowship for medicine, pediatrics, or a combination of the two. The only thing you can't do is Ob.)
 
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This. For outpatient stuff related to adults, a general internist and a family practitioner are probably pretty equivalent.

As an FYI, some hospitalists are FM trained. And some FM practices require that all the doctors take turns rounding on their patients in the hospital.

I would say that a general internist is NOT pretty equivalent to a family practitioner in the outpatient setting. Most FM programs offer more outpatient experience, including procedural (skin biopsies, toenail removals, joint injections, IUDs, womens health, paps, colpos, etc.) The practice that I joined hires both IM and FM for outpatient care....the IM people that I have met have had far fewer clinic hours, have less experience with the business side of medicine (coding, etc.), and almost no procedure experience. Most of the IM people also have not rotated through ortho or derm, which is a huge part of outpatient medicine.

If you think you want to do outpatient, go FM. If you think you want to go inpatient, go IM. If you think you want to do both....tough choice. :laugh:

(And, depending on which patient you ask, I'm NOT touchy feely! :p The whole holistic, touchy-feely stuff that they shoved down your throat in med school is overblown, in my opinion.)
 
This. For outpatient stuff related to adults, a general internist and a family practitioner are probably pretty equivalent. Just based on their training, the family practitioner might be more holistic/touchy-feely and the internist might be more into the pathophysiology, but that's a broad generalization that doesn't mean much individually. (It's just from how the residencies are often structured, and tbh the individual providers personality usually trumps that)

On the other hand, the internists are experts at hospital medicine. Those months the family practice residents are brushing up on their Ob, psych, or pediatrics, the IM residents are spending on the wards or the ICU, dealing with the sickest patients and learning how to manage them. Hence why the vast majority of hospitalists (all of them in certain parts of the country) are IM trained.

And the reason why you'd want to be IM trained instead of FM trained is pretty much the fact that FM is a "dead end". If you want to do primary care +/- Ob and nothing else, FM is a fine career choice. But if you want to do a fellowship (other than sports med) or if you want to do inpatient work, IM offers you those opportunities. These days, only about 30% of internists do general internal medicine/primary care, with the remainder either working as hospitalists or doing a fellowship.

(Of course, there's also always the option of doing a medicine-pediatrics residency. Which is 4 years rather than 3, leaves you board certified in both med and peds, and gives you the option of working outpatient, inpatient for either patient population, or doing any fellowship for medicine, pediatrics, or a combination of the two. The only thing you can't do is Ob.)

this i what i knew too.
 
Hmm... i don't know. When i shadowed a pediatrician who worked at an urgent care, he made it clear that he wasn't a primary care doc.

However, and unfortunately, nowadays many people would consider an ER doc their primary care physician...

A bit annoying. I've even seen a pt have one of our ER docs listed as their primary care physician on their chart. Coincidentally, it was the same doc working that night.
 
Also, nobody but emergency medicine physicians is staffing an emergency department (I'm ignoring trauma surgeons and liason psych people).

False. Many EDs, especially those in smaller communities, are staffed by those 'on call' for various specialties (mostly FM, I think). EM as a specialty is fairly new, and there definitely are NOT enough EM docs to staff all the EDs in the country full time.

Don't most FM and IM docs provide mostly "primary care"? That seems to be the rule, rather than the exception. For the purposes of quick, simple definitions.

More and more, people are becoming hospitalists after residency, rather than doing clinic medicine. So while the majority of general IM and FM people are going to do outpatient medicine, more and more are sticking with hospital medicine.

I meant people practicing general internal medicine. Should have been more specific. Cardiology, gastroenterology, etc. are clearly not primary care.

My school sends students to rotate with a couple of cardiologists who serve as PCPs for many of their patients, because they're located in an area where there aren't a lot of physicians. Also, for those with certain chronic diseases (mostly in the peds world), such as diabetes and CF, specialists can be PCPs because the patients see them so often. Heck, several of the CF kids in the clinic I worked in had to see the pulmonologist every 4 months or so, which is far more often than they'd see their PCP, and any sick visits were generally directed towards the pulmonologist (mostly because they were typically URI/pneumonias).

In terms of training, what is the difference between IM and FM? It is obvious that FM gets exposed to more age groups, but besides that, in terms of "adult medicine", don't they both get exposed to the same exact pathologies?

Yes, but the residencies are the same length, so the FM people are always going to feel 'behind' their colleagues in Peds, IM, and OB when rotating through those fields, because they have to rotate through all of them. I believe the FM people also don't get as much training in the IM and Peds subspecialties (and OB/Gyn, though that's mostly because they don't do Gyn surgeries); they tend to rotate on the general wards services in the hospital, rather than cardiology, for instance, whereas everyone in IM and Peds will rotate through cardiology at some point.

If so, then why should I choose an Internal Medicine physician, if a Family Medicine doctor learned the same exact adult diseases AND MORE. Obviously if this was the case, there wouldn't be a dichotomy....soooo.... specifically, what do internists learn that family docs don't?

It's really personal choice at that point, because in the outpatient setting, the variations between IM and FM are really due to the individual people rather than the training they receive in their residencies. It's generally easier to transition from a pediatrician to an internist than a pediatrician to a family medicine doc, largely because the areas with lots of pediatricians tend to have more IM than FM docs around. The advantage (particularly if you're a woman) of going to FM is that you don't have to change providers as often, and everyone in your family can see the same doc.
 
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