family med or pediatrics residency?

[tourocom2008]

Hello all, interested in these 2 specialties and I am a 4th year trying to decide! I am starting my first inpatient peds (only have done outpatient thus far) next month so hopefully that will help determine. I am interested in doing rural medicine. I like the idea of full spectrum perhaps some ER or OB work maybe..
I also really liked my outpatient peds rotation (my favorite overall). Really liked the outpatient setting and seeing newborns. However I (really) did not like my IM inpatient rotation and I am concerned about doing a residency that is primarily in the hospital. As a pediatrician I would probably want to be primarily outpatient with newborn nursery and maybe basic inpatient if in a small hospital (I do want to practice rurally).
Do FM residents get enough training to have a grip on peds? Is it realisitic to do fm and see kids in the future as peds is a growing speciality?
Is peds residency really worth it to just focus on outpatient when FM can do the same (theoretically) with much less training?
Is one of these fields more or less supceptible to midlevel creep? I do want to have a job for the next 30 years lol.

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[You shall know the Truth]

See if there are any fm programs that focus heavy pads.

 

[risus_sardonicus]

Don’t do either, by the time you’re done a NP with 500 hours will be making just as much if not more than you and will go around calling themself a GP or pediatrician. Unless you want to work in North Dakota, go specialize.

 

[Cranjis McBasketball]

Hello all, interested in these 2 specialties and I am a 4th year trying to decide! I am starting my first inpatient peds (only have done outpatient thus far) next month so hopefully that will help determine. I am interested in doing rural medicine. I like the idea of full spectrum perhaps some ER or OB work maybe..
I also really liked my outpatient peds rotation (my favorite overall). Really liked the outpatient setting and seeing newborns. However I (really) did not like my IM inpatient rotation and I am concerned about doing a residency that is primarily in the hospital. As a pediatrician I would probably want to be primarily outpatient with newborn nursery and maybe basic inpatient if in a small hospital (I do want to practice rurally).
Do FM residents get enough training to have a grip on peds? Is it realisitic to do fm and see kids in the future as peds is a growing speciality?
Is peds residency really worth it to just focus on outpatient when FM can do the same (theoretically) with much less training?
Is one of these fields more or less supceptible to midlevel creep? I do want to have a job for the next 30 years lol.

There are plenty of rural family med docs who see a lot of peds. Some ended up loving it so much they just see peds patients.

 

[Sardonix]

Don’t do either, by the time you’re done a NP with 500 hours will be making just as much if not more than you and will go around calling themself a GP or pediatrician. Unless you want to work in North Dakota, go specialize.

This is pretty terrible advice and this thread doesn't need to be siderailed by a midlevel vs. doctor or primary care vs. specialty pissing match.

There are plenty of rural family med docs who see a lot of peds. Some ended up loving it so much they just see peds patients.

This is much better advice.

OP, it really depends on how much you like kids and what kind of residency you want. Speaking from an FM perspective, FM has the potential to get plenty of peds experience if you go to an unopposed residency and go out of your way to get it. Obviously if you go to an academic residency or have to compete with a peds residency you won't get as much experience, but you will likely still be a well rounded physician.

FM is entirely what you want it to be. Peds will undoubtedly make you an expert at pediatrics in a way that FM won't, but you will still graduate from an FM residency feeling competent to see kiddos.

 

[Drrrrrr. Celty]

Don’t do either, by the time you’re done a NP with 500 hours will be making just as much if not more than you and will go around calling themself a GP or pediatrician. Unless you want to work in North Dakota, go specialize.

This is pretty ridiculous mate.

 

[Drrrrrr. Celty]

So here's my two cents as an IM PGY2. I came in with heavy desire to be exclusively outpatient after I graduated. I am now interested in a mixture of academics, in and outpatient specialty medicine.

Family medicine is a very general and very broad specialty. Many FM programs are also very different from each other. Some are very inpatient oriented and will train you to be able to be adequate hospitalists, or em providers in certain rural hospitals, or delivery staff in rural areas. Though generally most of FM is that it general medicine and outpatient medicine with limited fellowship options to not do those things. There some notable exceptions such as Palliative/Hospice, Sports, and Addictions.
It's a very practical and general overview of how to approach all human beings in the outpatient. Very hands on and you'll learn how to ideally be able to identify, refer out, and manage many diseases. It has very high opportunity for good income with good hours and practice.

Though with being a generalist there comes a lot of consequences. You're responsible for the patient's general well being, msk issues, health maintenance, and because you have so many things to be doing you're often dealing less with the intellectual aspects of medicine and more with the requirements of how to be a good PCP. The allegory that may meaningfully apply is that you'll learn a lot more about how to prepare to work within the FM office and see many FM patients. As opposed to IM or Pediatrics which will give you more broad options to explore many specialties, work with more significantly ill individuals, and to see far more broad, different, and more complicated illness. Which subsequently prepares you to be able to go and do a broad different amount of predominantly hospital based diseases and complications that in and of themselves require the previous understanding and exposure of the full breathe of mild to severe illness.

So at least for me, who values more the broad understanding of adult disease and then the ability to subspecialize, IM was far more appealing than FM. And in the end I don't want to do MSK issues, I don't want to remember that the patient needs PHQ9 this visit, or that they need to be asked if they have all of their medicines. And honestly there are so many patients that don't want to take care of themselves that it can be tough to be their main advocate. I want to practice and think more about certain problems that my patients have and to help treat them. If I as a consultant or a referred physician cannot help the patient, I have still done my job and imparted my recommendations or answered my question.

 

[iforget2]

So here's my two cents as an IM PGY2. I came in with heavy desire to be exclusively outpatient after I graduated. I am now interested in a mixture of academics, in and outpatient specialty medicine.

Family medicine is a very general and very broad specialty. Many FM programs are also very different from each other. Some are very inpatient oriented and will train you to be able to be adequate hospitalists, or em providers in certain rural hospitals, or delivery staff in rural areas. Though generally most of FM is that it general medicine and outpatient medicine with limited fellowship options to not do those things. There some notable exceptions such as Palliative/Hospice, Sports, and Addictions.
It's a very practical and general overview of how to approach all human beings in the outpatient. Very hands on and you'll learn how to ideally be able to identify, refer out, and manage many diseases. It has very high opportunity for good income with good hours and practice.

Though with being a generalist there comes a lot of consequences. You're responsible for the patient's general well being, msk issues, health maintenance, and because you have so many things to be doing you're often dealing less with the intellectual aspects of medicine and more with the requirements of how to be a good PCP. The allegory that may meaningfully apply is that you'll learn a lot more about how to prepare to work within the FM office and see many FM patients. As opposed to IM or Pediatrics which will give you more broad options to explore many specialties, work with more significantly ill individuals, and to see far more broad, different, and more complicated illness. Which subsequently prepares you to be able to go and do a broad different amount of predominantly hospital based diseases and complications that in and of themselves require the previous understanding and exposure of the full breathe of mild to severe illness.

So at least for me, who values more the broad understanding of adult disease and then the ability to subspecialize, IM was far more appealing than FM. And in the end I don't want to do MSK issues, I don't want to remember that the patient needs PHQ9 this visit, or that they need to be asked if they have all of their medicines. And honestly there are so many patients that don't want to take care of themselves that it can be tough to be their main advocate. I want to practice and think more about certain problems that my patients have and to help treat them. If I as a consultant or a referred physician cannot help the patient, I have still done my job and imparted my recommendations or answered my question.

I'm an M3 and I'm fairly certain I'd like to do outpatient in the future, but currently on the fence between IM/FM. I've read on here that if you're sure you'd like to do outpatient to just go into FM as they have more training in the items you listed plus procedures, as well as exposure to peds, OB, and psych. Would you say IM residency would adequately prepare you for outpatient medicine or would you recommend going FM?

 

[FrkyBgStok]

There are a couple questions you need to answer (not to me, to yourself). One being how rural are we talking? Like one of the few physicians in a town of 2,000 people, or like a town of 25,000 outside of a slightly larger city? Do you want to a mixture of patients and want to be prepared for a rural practice or do you want to work with kids and be more prepared?

Keeping in mind what I think of rural (closer to the small town with 2,000 people) and that I am a pediatrician, I would say do family medicine. Rural pediatrics isn't like rural family medicine. I initially thought "i like the idea of all inclusive family medicine but only like kids, rural peds must be for me." So I looked into it and the reality is that if you don't have a hospital specifically set up for peds, those nurses, RTs, techs, and everyone but you will be panicking with every child they have and you won't be doing any inpatient pediatrics. Maybe newborn, but you can do that as an FP. And you will be far more prepared for the bulk of your hospital's population, which is adults.

Now if you are thinking closer to the 25,000 population and there is a hospital that is set up for pediatrics, you can do a little more with peds however most of those are either moving to a hospitalist model (so no inpatient or rounding for you), or you are expected to cover everything by adding it on to your clinic day. so in addition to your normal clinic times, you have to go round. depending on the numbers in your group, this can get very old, very quick. in addition, you may get called regularly for kid related stuff that the FP docs absolutely can do, but don't want to because they "don't feel comfortable." can also get very old very quickly.

So again, if you are thinking true rural, small town, go FP.

 

[DO2015CA]

If you want to be prepared to take care of sick kids then you’ll need to do peds. If you want to do outpatient in genuinely healthy kids doing their wcc, vaccines, and sore throats then FM should be enough

 

[Drrrrrr. Celty]

honestly I think I understand illness in its entrity much more than FM because I have more exposure and experience. I know diseases, fm knows how to deal with diseases outpatient.

however conversely I dont think that's what outpatient is necessary. Its knowing how to manage a patient slowly and dealing with a lot of their general complaints while maintaining them in stability.

in short I think I'm a lot slower at dealing with outpatients than an FM. Exposure and volume of becoming comfortable with a work up outpatient is different.

you'll be able to do outpatient with either specialty. however I have no interest in children, dont care about wasting time training in delivery when I dont want to do anything remotely close to that. For me FM would include an absurd amount of stuff I simply have 0 interest in.

I think IM is great if you may want to do inpatient, may want to subspecialize, or you only want to do adults. In this respect I think IM is more versatile and offers more options because most FM are doing mainly adults if they live in urban areas with enough pediatricians and obgyn.

I'm an M3 and I'm fairly certain I'd like to do outpatient in the future, but currently on the fence between IM/FM. I've read on here that if you're sure you'd like to do outpatient to just go into FM as they have more training in the items you listed plus procedures, as well as exposure to peds, OB, and psych. Would you say IM residency would adequately prepare you for outpatient medicine or would you recommend going FM?

 

[Dr Tapatio]

So here's my two cents as an IM PGY2. I came in with heavy desire to be exclusively outpatient after I graduated. I am now interested in a mixture of academics, in and outpatient specialty medicine.

Family medicine is a very general and very broad specialty. Many FM programs are also very different from each other. Some are very inpatient oriented and will train you to be able to be adequate hospitalists, or em providers in certain rural hospitals, or delivery staff in rural areas. Though generally most of FM is that it general medicine and outpatient medicine with limited fellowship options to not do those things. There some notable exceptions such as Palliative/Hospice, Sports, and Addictions.
It's a very practical and general overview of how to approach all human beings in the outpatient. Very hands on and you'll learn how to ideally be able to identify, refer out, and manage many diseases. It has very high opportunity for good income with good hours and practice.

Though with being a generalist there comes a lot of consequences. You're responsible for the patient's general well being, msk issues, health maintenance, and because you have so many things to be doing you're often dealing less with the intellectual aspects of medicine and more with the requirements of how to be a good PCP. The allegory that may meaningfully apply is that you'll learn a lot more about how to prepare to work within the FM office and see many FM patients. As opposed to IM or Pediatrics which will give you more broad options to explore many specialties, work with more significantly ill individuals, and to see far more broad, different, and more complicated illness. Which subsequently prepares you to be able to go and do a broad different amount of predominantly hospital based diseases and complications that in and of themselves require the previous understanding and exposure of the full breathe of mild to severe illness.

So at least for me, who values more the broad understanding of adult disease and then the ability to subspecialize, IM was far more appealing than FM. And in the end I don't want to do MSK issues, I don't want to remember that the patient needs PHQ9 this visit, or that they need to be asked if they have all of their medicines. And honestly there are so many patients that don't want to take care of themselves that it can be tough to be their main advocate. I want to practice and think more about certain problems that my patients have and to help treat them. If I as a consultant or a referred physician cannot help the patient, I have still done my job and imparted my recommendations or answered my question.

I definitely agree that there is huge variety within FM on how they train you. I think overall if you're doing FM you're more likely to be someone that wants to do outpatient. If you find the right residency, you can get a ton of time in whatever specialty you want.

Overall, I chose FM over IM for the opposite of you. I like helping people with everyday problems and help manage what's going on and prevent them from getting into an illness state where they require hospitalization. I don't mind many of the MSK stuff because it actually allows me to do injections or I can refer PT/OMT/Ortho/Spots depending on their needs. I have never had a problem with PHQ-9 or other stuff like that because we have the MA just screen for stuff and the EMR tells you automatically what routine health maintenance stuff needs to be done. I also like the fact that when you send people to specialists, those specialists tend to be nicer because you're generating money for them. I saw many times in IM when specialists would be snide or not care and dump things on the internist. I'm not saying this at all to criticize IM. I think if you like the complexity, the type of patients, find yourself in the right setting, IM can be a great career.

OP, I think if you have an inkling that you may want to practice full spectrum, FM is the way to go. My friend did peds, and while he loves peds and would never change it, he admits that nowadays they are more likely to ask for a hospitalist peds fellowship if you like the inpatient side

 

[Dr Tapatio]

I'm an M3 and I'm fairly certain I'd like to do outpatient in the future, but currently on the fence between IM/FM. I've read on here that if you're sure you'd like to do outpatient to just go into FM as they have more training in the items you listed plus procedures, as well as exposure to peds, OB, and psych. Would you say IM residency would adequately prepare you for outpatient medicine or would you recommend going FM?

There's no point in putting yourself through IM training if you want to do outpatient. IM likes to say that they can do everything outpatient docs do, but the truth is they have limited training with peds, MSK/ortho, wound care, OB/GYN, urology, ophthalmology and other stuff that you get to use in FM. There's also the fact that there's no reason why you'd make your life hard like that and heavily inpatient if you don't need it or enjoy it. I think going into an FM program that has more electives would pay off more than doing IM. Besides, if you like urgent care, most places prefer FM because we can see peds and women. I've heard of Med-Peds having a harder time than FM finding Urgent Care jobs

 

[Drrrrrr. Celty]

There's no point in putting yourself through IM training if you want to do outpatient. IM likes to say that they can do everything outpatient docs do, but the truth is they have limited training with peds, MSK/ortho, wound care, OB/GYN, urology, ophthalmology and other stuff that you get to use in FM. There's also the fact that there's no reason why you'd make your life hard like that and heavily inpatient if you don't need it or enjoy it. I think going into an FM program that has more electives would pay off more than doing IM. Besides, if you like urgent care, most places prefer FM because we can see peds and women. I've heard of Med-Peds having a harder time than FM finding Urgent Care jobs

The exception ofc is outpatient subspecialties. I don't disagree with the rest. Though idk why on Earth a Med-Peds trained physician would ever want to do urgent care.

 

[solitarius]

Real easy. Do you like adult patients?

 

[hallowmann]

Hello all, interested in these 2 specialties and I am a 4th year trying to decide! I am starting my first inpatient peds (only have done outpatient thus far) next month so hopefully that will help determine. I am interested in doing rural medicine. I like the idea of full spectrum perhaps some ER or OB work maybe..
I also really liked my outpatient peds rotation (my favorite overall). Really liked the outpatient setting and seeing newborns. However I (really) did not like my IM inpatient rotation and I am concerned about doing a residency that is primarily in the hospital. As a pediatrician I would probably want to be primarily outpatient with newborn nursery and maybe basic inpatient if in a small hospital (I do want to practice rurally).
Do FM residents get enough training to have a grip on peds? Is it realisitic to do fm and see kids in the future as peds is a growing speciality?
Is peds residency really worth it to just focus on outpatient when FM can do the same (theoretically) with much less training?
Is one of these fields more or less supceptible to midlevel creep? I do want to have a job for the next 30 years lol.

To be clear, most FM residencies that give you good Peds training are also ones that tend to be inpatient heavy and give you good inpatient treatment training in general. Keep in mind that if you truly want a Peds heavy experience, you'll likely end up and have to work through a lot of inpatient as well.

One thing to keep in mind is that most Peds inpatient is primarily done at a Children's hospital, and so you need to be in a program that's rotating you through one for multiple rotations. Compare this to FM program at my core rotation site in med school, and beyond newborn they would have 2-3 kids at most admitted in the whole hospital at a time. Peds inpatient is where you learn a lot of Peds that is essential for taking care of Peds, even in outpatient. I would be uncomfortable taking care of kids without that experience.

honestly I think I understand illness in its entrity much more than FM because I have more exposure and experience. I know diseases, fm knows how to deal with diseases outpatient.

however conversely I dont think that's what outpatient is necessary. Its knowing how to manage a patient slowly and dealing with a lot of their general complaints while maintaining them in stability.

in short I think I'm a lot slower at dealing with outpatients than an FM. Exposure and volume of becoming comfortable with a work up outpatient is different.

you'll be able to do outpatient with either specialty. however I have no interest in children, dont care about wasting time training in delivery when I dont want to do anything remotely close to that. For me FM would include an absurd amount of stuff I simply have 0 interest in.

I think IM is great if you may want to do inpatient, may want to subspecialize, or you only want to do adults. In this respect I think IM is more versatile and offers more options because most FM are doing mainly adults if they live in urban areas with enough pediatricians and obgyn.

There are plenty of FM programs that provide very good disease exposure, and in the better outpatient places, everyday you should be doing more than just maintaining wellness, you should be managing things that would result in an admission in smaller hospitals. There are many FM programs that are simply not like that though. That said, I'm a believer in having a strong inpatient experience as a generalist, despite hating inpatient for the work hours, bureaucracy, and almost singular goal of stabilization to discharge. If I hated OB, Peds and MSK, it would be foolish to do FM even if I wanted outpatient medicine.

If your goal is specialization or purely hospitalist medicine, then IM is the obvious choice. It is by far where you'll get the most exposure to that work. If you're goal is Peds or Peds specialties, whether outpatient or inpatient, obviously Peds is the way to go. For true rural medicine FM makes the most sense, but if you don't like treating adults like solitarius said, the choice is obvious.

 

[SLC]

OP, like you I enjoyed peds, hated inpatient IM, liked adult outpatient medicine, and was bored in most specialty settings. This steered me to FM. I have ZERO regrets about making that choice.

I have been attending for a bit over 2yrs now. I got excellent inpatient training in residency, our program was intense that way. I am very comfortable with managing very sick, chronically ill patients Both inpatient and outpatient (I have several end stage COPD’s, severe HF’s, Brittle Diabetics, etc). I have several with severe psych issues too.

I’m practicing rurally, which means many of my patients won’t travel to see a specialist even if I wanted them to; and those that are willing, only want to see the specialist once or twice a year and come to me for the rest.


I also do inpatient medicine out here, I learned to like it in residency actually, and see it as a highlight of my job now: Plus I’m paid extra and by the hour to do it. I am admitting multiple times per month. Adults and peds alike. Occasionally I’ll cover the ER as well though I enjoy that less.

Where I see the main difference between me and peds and me and IM is that I’m comfortable with almost everything in those fields, but am also capable and comfortable with women’s health, MSK, Derm, etc. I’ve never seen an IM doctor doing gynecology, or a pediatrician shaving moles or doing LARC’s for their teen patients, but I do those things regularly. I see more variety, and have (I think) similar depth of knowledge.

There’s nothing in FM that prevents you from learning, even about very sick people. And I saw an awful lot of very sick people as a resident and now as attending. Most outpatient IM and peds people I know are referral machines (no offense to those here in those fields), so it’s not like they manage sicker people in the outpatient setting, despite maybe having a few more specialty rotations in residency.

In FM, with the right training program, you can be the single most valuable asset the rural healthcare setting has. Any other field and you’re automatically limited in your ability to care for all comers.

To illustrate my practice setting. Town has 6k people. Mostly young families. County has ~20k. There are zero pediatricians, zero internists, one OB/Gyn, one general surgeon, and a few visiting specialists who come once a month (Cards, Renal, Ortho, Optho, ENT, Derm). I don’t think a pediatrician would have a viable practice here at this point, maybe brought kids would transfer their care there, but I doubt it.
IM, maybe could carve out a niche as a geriatric practice; but even then I doubt it.

I see 20-30% peds, do lots of Gyn care (have a reputation as the IUD/Nexplanon doc), and the rest of the time is generally spent with elderly patients and all the chronic disease that comes with that crowd.

My advice: go FM if you’re going to practice in a rural location.