Family Med Residency Pro/Con

[SMC123]

I have a question regarding FM in regards to IM. I have asked multiple people the real difference between the two residencies, but have had little success. I understand with FM you will have to deal with a lot more peds and OB during residency. I also understand that for IM, you may be dealing with more serious conditions for which the pt is admitted to the hospital.

In general, in terms of call schedule, is FM very similar to IM? I know each program differs, but in general, do FM have night call just as much? Or is it mostly home call ?

Also, in terms of ICU experience, does FM have to rotate through it too?

Is the breadth of the residency pretty similar overall? Hours, workload, similar diagnosis and plans?

I am trying to really determine this before I apply one or the other. Thank you!

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[cabinbuilder]

I don't think anyone can really answer your questions. Every residency is different, the dynamics, the rotations, the call schedule. Some have actually ICU months, mine had ICU incorporated into the hospitalist rotation. If our patient ended up in ICU we took care of them there. I don't think anyone has ever done an IM residency and an FP residency. Call schedules are different for each program depending on how big the hospital is, how many residents there are, etc. I never took home call since my residency covered then entire building when all call and we did every admit that came through. Your questions are WAY too broad to even scratch the surface that is why you have been unsuccessful. Not sure what you are looking for? What you are afraid of? The call? The OB? The Peds? The ICU? What exactly?? FP deals with serious conditions just like IM. Half of my attendings in residency were IM so there wasn't any difference in training. It's not like they said to us, "oh you don't have to know this since you are FP". Not a chance.

 

[deleted6669]

I don't think anyone has ever done an IM residency and an FP residency. .

Interesting aside- one of my former er chiefs(now retired) did the following for his training in the 70s:
completed FM residency...really liked hospitalist duties so applied for IM residency with plan of being hospitalist
Completed IM residency but really like pulmonology so did fellowship
Completed pulmonary fellowship but really liked the acute nature of EM which he had been doing part time
accumulated enough hrs to challenege em boards and became EM boarded
got burnt out of EM and wanted pts who couldn't talk back so
Completed anesthesiology residency but realized that he hated working with suregons so
Went back to full time EM
retired with 5 board certifications. he got partial credit from prior residencies each time he started a new program so in total was a resident for something like 10 years.

 

[smq123]

Interesting aside- one of my former er chiefs(now retired) did the following for his training in the 70s:
completed FM residency...really liked hospitalist duties so applied for IM residency with plan of being hospitalist
Completed IM residency but really like pulmonology so did fellowship
Completed pulmonary fellowship but really liked the acute nature of EM which he had been doing part time
accumulated enough hrs to challenege em boards and became EM boarded
got burnt out of EM and wanted pts who couldn't talk back so
Completed anesthesiology residency but realized that he hated working with suregons so
Went back to full time EM
retired with 5 board certifications. he got partial credit from prior residencies each time he started a new program so in total was a resident for something like 10 years.

That's insane. Holy crap.

 

[DrMidlife]

I don't think anyone has ever done an IM residency and an FP residency.

There are 2 combined FM/IM programs, one at my school. I asked some of my school's FM/IM residents what the point was, and they said it removes barriers to admission privileges and to hospital work such as ICU, without losing the breadth of FM (ob/gyn, peds, surg). At 4 years, I guess it's an alternative to doing FM plus a hospitalist fellowship. Neither of these 2 residency programs is unopposed, which I imagine is part of the story.

 

[cabinbuilder]

Man you guys sure like to nit pick. I meant doing two separate residencies in 2 places. So how would you even compare that?

 

[DrMidlife]

Man you guys sure like to nit pick. I meant doing two separate residencies in 2 places. So how would you even compare that?

Not trying to be nitpicky at all - just submitting anecdotal info for consideration on the OP's questions. I'd be interested in hearing your take on the combination. Similarly with combined FM/EM.

The motivations, overlaps and boundaries between FM, IM and med/peds have been very difficult for me to tease apart as an M2. Combined residencies remove some confusion and add other confusion.

I think it'd be depressing to do FM and then do IM. Even if it would be the only way to do the work you want, such as endo etc.

 

[cabinbuilder]

Fair enough. For me it comes down to how you envision your career and the type of location that is agreeable to you and personal expectations. I find IM extremely cerebral and boring. I refer to them as the "thinkers" and FP as the "doers" With that said I do plenty of "thinking" every day at work too. But I am a shoot from the hip kind of doctor, I am impatient, I don't like patients to have to "wait and see", I want the control over their care, and I want it fixed right now. Since I work only in rural areas I don't have to worry about what I can and cannot do. My residency trained me to do it all medicine wise and I pretty much have for the most part out of necessity, not because some hospital admin person said I could or could not.

For example: I am currently doing urgent care in a larger place (95,000) where specialists are "available". My IM counterpart had a patient with a new hyperpigmented spots on her wrists she asked me to consult on. Her plan was to try a cream and refer to derm (4-6 month waiting list) because she doesn't know how to biopsy or suture. My plan, I got out my supplies, took a biopsy, threw in 3 sutures, and set the tissue to pathology for identification - took 5 minutes. Done, then the patient didn't have to wait 6 months.

I guess for me my residency was taught by a combo of FM and IM attendings both in the hospital and the clinic. I learned both sides and am comfortable with ICU management (not vents), DM management, HTN management, CHF, COPD, PNA- but I sure don't want to do it day after day. But on the flip side I also know how to deal with kids, can run and ER, know my GI, my ortho, and my derm. I can bipsoy, suture, cast, splint, read my own plain films, CT, and MRI's. I am not afraid to stick a needle anywhere or cut out a decent sized lesion, or open up a huge abcess and most days I throw in some manipulation for an aching back.

I always wanted to work in the sticks and catered my residency to be a rural doctor. To deal with what comes through the door. With that said I also know what I don't know and refer when needed because at the end of the day it's not about me, it's about patient care and giving them the best chance to recover. Many times, though, the patient is uninsured, doesn't have gas money, or the nearest specialist is out of reach due to location and distance. It's in those times I'm on the phone with colleagues about what is urgent or emergent or what can wait. I work with what I have and the patient's are grateful that at least I tried.

 

[drcrispmd]

Like mentioned before it will depend on the residency. My residency we do a lot of impatient. We have our own service with our clinic patients (FM doc can and do air their own patients to the hospital and follow them). Our ICU is open so we follow our patients in the ICU as well and consult critical care if we need them. We also do a month on ICU with the IM residents. We also do impatient rotations with the IM residents that come to our hospital too. FM does more clinic. The IM residents typically have 1 half day of clinic a week. As a pgy 3 FM I'm in clinic about 2.5 to 3 days a week. We can take care of peds. We do women's health (IM typically does not). FM does more than preventative care. We manage diabetes, HTN, hyperlipidema, thyroid issues, obesity, depression, anxiety, chronic pain, social issues, etc. we coordinate care with specialist when needed. we do not refer everything to specialists. We can do OB. FM can do hospitalist, urgent care, ER, outpatient only, both outpatient and inpatient, full scope with OB. I do think FM is trained better at outpatient which deals with socials issues as well as patient's medical problems. When trying to decide you need Start thinking what you want to do after residency. If you do not like peds at all and do not want to do women's health at all then IM is probably a better choice.

 

[DrMidlife]

Thanks you guys for taking the time to share. I'm really liking the "swiss army knife" aspects of FM.

 

[JustPlainBill]

Thanks you guys for taking the time to share. I'm really liking the "swiss army knife" aspects of FM.

For another perspective -- I trained at a University based, opposed residency in the SouthWest in FM --

We had 6 months of hospital medicine, spread out over 3 years, 2 months of OB, 1 month of ER (both adult and pedi), 1 month of inpatient peds, 1 month of outpatient peds and 1 month of ICU (we were actually second years but sent in there as interns), 6 weeks of Geriatrics and a bunch of electives --- along with 3 months of night float.

The IM guys had 6 months of wards and 6 months of ICU their first year, then they had ward months as the senior with 2 interns and a bunch of time with ologists -- don't know what else but they were always in the hospital as the program was hospitalist/preparing for specialties heavy --

While I would like to have a bunch of ICU and know WTF I'm doing in there, in the end, my family was more important than my career ---

So I'm now happily working in an outpatient clinic, taking hospital call once a month, seeing everything from peds to not so peds and shipping out what I don't feel comfortable handling....

What sort of life do you want -- and the nice thing about medicine - you can always go back for retraining if needed.

 

[SMC123]

cant you live that life doing outpatient im too though?

 

[VA Hopeful Dr]

cant you live that life doing outpatient im too though?

Yep, easily.

 

[Bacchus]

Thanks you guys for taking the time to share. I'm really liking the "swiss army knife" aspects of FM.

As you can see, there are so many components you can incorporate. The primary determining factor of what you can and can't do will be comfort in doing it (obviously you won't be doing SVDs if you hadn't done any for 20 years) and location of practice. The more specialists there are, the harder in general it will be to get privileges. Working at a University hospital? Probably not going to be a hospitalist or work in the ICU. Working in downtown NYC? Probably not going to be doing any deliveries. Just don't fall into the "ship it out" mentality and you'll have a varied practice.

 

[1direction]

There can be huge differences in IM and FP depending on the location. Overall IM is mostly inpatient things, with lots more ICU time and other subspecialty services during residency. FP is mostly outpatient. Patient acuity is lower but volume is generally higher. FP rotates through inpatient services and ICU as well, but there isn't as much of an emphasis on that. In the city, most large academic centers will higher IM for hospitalist jobs and even out patient jobs. They higher pediatricians to see kids and ob/gyn to see women. Most of the FP doctors in big city are associated with huge hospital groups in the city that are generally less academic oriented.

So basically, its going to depend on what you want. Do you like inpatient more or outpatient more? There is obviously some cross over/exceptions but for the most part, thats where the lines are drawn.