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Not an MS4 but appreciate the thread🙂

Do you plan on moonlighting? If so how much supplemental income could you bring in you think?

Do you have to do any inpatient on your FM service?
 
If you have been in residency interviews or in your own experience interviewing, what makes an FM applicant stand out? My Step 1 is 225-230 with only a little bit of research and not much else. Just wondering if there's still something I can do to help stand out a little more when I apply this year.
 
What did you do to make yourself competitive for a university program as a DO?
 
How big was the learning curve when starting out? What do you wish you would've done fourth year to maybe lessen that learning curve?
 
Not yet an MS4, but I appreciate you making this thread.

What are your thoughts on opposed vs unopposed programs?

What electives for fourth year (outside of the more obvious ones) would you recommend for someone interested in FM?
 
Cranjis McBasketball said:
How big was the learning curve when starting out? What do you wish you would've done fourth year to maybe lessen that learning curve?
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Wonderful question.
1) learning curve hasn't been as bad as I was expecting. That is probably because I tried to use several rotations as an MS4 to train like an intern to become efficient. The most challenging thing is the volume. You go from running 1-3 patients as a med student, to running 5-8 as an intern. Keeping things straight, being efficient is actually the hardest part. The medical knowledge starts to fade, but you mostly do your job and hopefully learn a tidbit of medicine each day. It is uncomfortable how much knowledge you start to lose 1 year after after Step 2. But thats ok, once you learn how to be an intern, you start to have more free time to learn. The first 2-3 months for me was all about learning my EMR and becoming efficient at that.

2) I wish I would have taken Medical Spanish as an MS4. Don't forget to take time off at the very end of med school to rest up and see family / travel. My vacation was canceled because of covid. 😔
 
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OMS-1 hoping to practice rural family med, looking for an UOP. I’ll have a red flag application, I repeated my first semester due to academic failure the first time through. I figured out my issues, improved my study skills and did very well on the second attempt.

What can I do moving forward to prove my chances of matching well? Does FM care about research?
 
Dame_Maggie said:
OMS-1 hoping to practice rural family med, looking for an UOP. I’ll have a red flag application, I repeated my first semester due to academic failure the first time through. I figured out my issues, improved my study skills and did very well on the second attempt.

What can I do moving forward to prove my chances of matching well? Does FM care about research?
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The best thing you can do is work on an upward trend. Residencies care that you pass boards, and that you were very good as an MS3.
When you begin clinical rotations as an MS3, it is kind of like starting med school all over again. However, it is not necessarily about your academic prowess. Rather, its about how well you learn and function in a hospital/clinic. If you want to do rural FM, you need to work hard and do well on all of your rotations - including surgery - Because you have to be very well rounded, and often times do procedures. I’m not saying you have to honor every clinical rotation, just do well. Stay late. Read uptodate and AAFP articles. Volunteer for the occasional topic presentation. But don't be over eager and pester residents too much. There will be times when you’re physically and emotionally drained, but it is worth it, and you will get used to it. If a resident is ever a jerk to you and you feel like crying, just do your best to stay professional and keep putting on foot in front of the other.
Regarding research. I did a good amount of research in medical school. However people rarely brought it up during interviews. They care more about what your passions and interests are, and why you want family medicine, and why are you considering their program. At the end of the day - a passionate (“hard-working”) medical student Will make a much better president than someone who over publishes. However if you have the time to do a research project or two, it might slightly help your ranking at some programs.
 
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Caffeine Matters said:
Probably one of the most important things actually is figuring out which program Unopposed (UOP) vs Opposed (OP).
UOP programs might allow you for more hands on training. More independence in running the hospital. Most importantly, UOP programs are the center of attention at a residency so they get more of the curriculum catered for their specific needs. I know someone at a UOP FM residency who wants to do an OB fellowship, and got to deliver 200+ babies.
OP programs can be wonderful too because you get to learn from specialists. The biggest regret that I have about being at an OP program is that there have been times where my FM program is disregarded, and discriminated against. Part of that is due to the perceived hierarchy and importance of primary care vs specialties. Part of it is due to the challenges of making several residency programs from different specialties integrate cohesively. On my OB rotation, I only delivered 15 babies, because my training was not a priority to the OB residency. That being said, I learned an incredible amount of inpatient medicine from my IM colleagues, and I might not have had that exposure at an UOP program.
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Thank you so much for your very thorough answers! Again, I appreciate you creating this thread and for taking the time to help us. Best of luck with the rest of your intern year.
 
What's your opinion on

1) "Love letters"** to your top program/programs?

2) Asking to tour/visit during this COVID pandemic?

3) More specifically, how to stay in regular communication with programs without just sounding like you're asking questions for the sake of asking questions (I struggle with this sometimes).

**Edit: and by love letters I mean letters sent AFTER interviewing but before rank lists are due (not the letters of intent that are sent before extended an interview).
 
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I am in the middle of third year, and have no LORs. I have not had a rotation with nay family med doctors and will not have any during my third year. I feel I am in huge trouble and have no chance to match. What should I do?
 
garrettp said:
What are good reasons to choose FM over IM besides wanting to treat pediatric patients?
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I'm just a M4, but I can say that some of the reasons that people list for choosing FM>IM include:

1. Peds (as you mentioned)
2. Obstetrics
3. More outpatient training in residency (i.e. if you know that you want to do outpatient primary care, FM is a better option)

The above three make it preferable to work in an urgent care setting, for instance, where you will see kids and adults. Likewise if you're a hospitalist working at a smaller community hospital that admits adults and peds patients.

There are larger differences in residency training, some might say that FM residency is generally "more chill," but that varies greatly from program to program in both IM and FM. I've heard of some FM residents consistently working 70-80 hour weeks.
 
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morningmedicine said:
I'm just a M4, but I can say that some of the reasons that people list for choosing FM>IM include:

1. Peds (as you mentioned)
2. Obstetrics
3. More outpatient training in residency (i.e. if you know that you want to do outpatient primary care, FM is a better option)

The above three make it preferable to work in an urgent care setting, for instance, where you will see kids and adults. Likewise if you're a hospitalist working at a smaller community hospital that admits adults and peds patients.

There are larger differences in residency training, some might say that FM residency is generally "more chill," but that varies greatly from program to program in both IM and FM. I've heard of some FM residents consistently working 70-80 hour weeks.
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pretty much this. we as iM get better inpatient training in general but unless you set up a lot of elective outpatient stuff we do not do a whole lot of clinic time. We are an elective heavy program though so if you know you arent going to specialize you can do outpatient stuff a few extra months a year.
 
ineedhelpnow said:
I am in the middle of third year, and have no LORs. I have not had a rotation with nay family med doctors and will not have any during my third year. I feel I am in huge trouble and have no chance to match. What should I do?
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You will be ok. Have you rotated with pediatrics? You really just need 1 LOR to match FM. Some people scramble into FM without even having any LORs from FM. What you could try is a LOR from faculty from MS1-MS2 if you did any research or TAd a class, or had an advisor. Then try to get a LOR from a pediatrician, or even from an internal med rotation. Then early 4th year try to get your FM letter. You can also submit late letters of rec. So if you do a FM rotation MS4 in the fall/winter, you can quickly try to upload it.
 
Caffeine Matters said:
You will be ok. Have you rotated with pediatrics? You really just need 1 LOR to match FM. Some people scramble into FM without even having any LORs from FM. What you could try is a LOR from faculty from MS1-MS2 if you did any research or TAd a class, or had an advisor. Then try to get a LOR from a pediatrician, or even from an internal med rotation. Then early 4th year try to get your FM letter. You can also submit late letters of rec. So if you do a FM rotation MS4 in the fall/winter, you can quickly try to upload it.
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Great point. I only had one FM letter and did hust fine.
 
Caffeine Matters said:
Very insightful question @garrettp. I like where your head is at. This is something that I struggled with too when I was between IM and FM. To summarize the biggest difference in two words: "Job Flexibility"

First I will address training and job placement.
(I am not doing IM justice, and what I am about to say is a gross simplification) but IM opens two major career paths. Generalist, and specialist. I would say that if you already know that you want to specialize in 1 field, then go IM. For example, if you are passionate about treating (e.g. Infectious Disease cases) and really enjoy homing in on 1 specialty then it makes sense to pursue IM. You will be an "expert", and that means that the buck stops with your decision on a treatment plan. People will defer to (and appreciate) your judgement most of the time. You can always go into IM, and if you decide that you don't really want to focus on 1 subject, then pursue a generalist track and you can either work as an internist in the clinic, or as a hospitalist. I will say that there is 1 major disadvantage of going into IM. The jobs are saturated in desirable cities. I know a lot of IM people who are a little concerned that they may have to get their first job 30-60 mins outside of a desirable city.

FM training can be looked at as rural vs urban. Rural programs offer full scope training, some programs teach you to perform c-sections, appendectomies, colonoscopies, contraception, newborn care ect... (There are even some programs up in Alaska where they fly you on a helicopter to rural villages to treat people who see a doctor once a year.) Urban programs tend to prepare you for common chronic disease that saturates a city. It is a misnomer when medical students make the assumption that FM doctors are not experts, but just a "jacks-of-all-trades"... In reality, in the urban environments FM docs are specialists in common problems. You become an "expert" in common problems like Asthma, COPD, Care of Children and elderly, depression, diabetes, public health, heart disease, hypertension, preventative care, women's health, hyperlipidemia, then then you have a jack-of-all-trades understanding about everything else in medicine like rheum, derm, surgery, ICU, hospitalist ect... You can also do a fellowship if you desire to become a specialist in just 1 thing like sports medicine, palliative care, academics ect. This translates into Family medicine having tremendous job security. Family Medicine is the #1 in demand specialty in the United States. A Major Advantage of FM is that it is easy for FM doctors to find jobs in desirable cities, and if you want to move out to the rural midwest and make 400k+ as an FM doc, you can do that too. You could make a point that "IM generalists" are also specialists in common problems (minus peds). But because of the shortage of FM docs and abundance of IM docs, the job markets look different coming out of training.

Public Service Loan Forgiveness
I actually don't know a whole lot about PSLF for IM physicians. I do know that FM has no trouble finding training and jobs that qualify for PSLF. I know that my EM buddies are concerned that nearly every EM group is private, and therefor nor eligible for PSLF. Whereas, there is an abundance of PSLF jobs for FM. I would imagine that there are many PSLF jobs available for IM, and that might actually work out really well if you are flexible about moving. For example if you do 3 years of IM, and then 2-3 years of fellowship, you would be about halfway done with payment for 10 year PSLF (if you matched at a institution that qualifies). In order to get your 10 years, you would then just have to move somewhere and work for a 501(c)(3) employer for 4-5 more years and you are done. But this kindof relates to the previous point about job demand. It is just going to be a lot easier as an FM doc to find these kind of jobs in the desirable cities.

Moonlighting.
FM docs are trained in peds, and usually peds ER. This means that FM docs can moonlight as residents and even work for urgent cares as first job if desirable. IM docs aren't experts in treating kids, so urgent cares prefer to hire FM > IM (unless they can co-cover a shift with a peds person).

Culture and learning environment
Some of my favorite people and best doctors that I know are IM. However, IM strongly adheres to its roots of a culture of hierarchy. So you will encounter more competitive and condescending IM residents/fellows/attendings. I have witnessed one too many IM attendings/specialists who are harsh, and unprofessional towards others. One positive about IM docs occasionally being "tough" is that they hold each other to higher standards. I think this culture and approach to medicine results in very competent IM doctors as a whole. FM residents are seldom gunners. FM attendings and Peds attendings are typically the nicest people. They typically teach and grow their residents using positive reinforcement, rather than criticism. So it depends on what learning environment you want to be in. Culture is important. I am the best version of myself when I am in an environment of positive reinforcement, wellness, and kindness. I love the people I work with, and this gives me energy to keep reading, learning, and working hard. I shut down when I am criticized. In FM, you will run into the occasional lazy FM resident/doc. We have all seen that one FM doc who does the bare minimum! This is annoying and gives FM a bad name (just like IM gunners give IM a bad name). So contemplate about which kinds of cultures are important for your growth and satisfaction. Whatever you decide, if you work hard, and treat other doctors with respect, then you will be respected and appreciated.
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Just to push back a bit on this, while there is some saturation in big cities for good hospitalist jobs, the primary care IM job market is just as wide open as FM, with massive demand from Manhattan to Dodge City. A large amount of jobs are happy to take either FM or IM interchangeably too.

The IM disadvantage is that very rural areas prefer FM so that you can cover peds and OB.
 
EmergDO said:
Just to push back a bit on this, while there is some saturation in big cities for good hospitalist jobs, the primary care IM job market is just as wide open as FM, with massive demand from Manhattan to Dodge City. A large amount of jobs are happy to take either FM or IM interchangeably too.

The IM disadvantage is that very rural areas prefer FM so that you can cover peds and OB.
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Thank you for your comment. Yes, if you look at the data, the top 2 in-demand specialties are 1) FM, and then 2) primary-care IM.

My PGY3 and recent-grad IM colleagues who have been signing hospitalist contracts are usually forced to move outside of the city. But looking at the data, primary care jobs in desirable cities look sublime for both primary care FM and IM.

Be careful though interpreting the data. The #3 in demand specialty is EM. But if you ask any PGY3 or grad EM, they will tell you that it is impossible to land a job inside of a desirable city because of the EM boom. Most are forced an hour outside of the city for the first job.
 
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Caffeine Matters said:
Thank you for your comment. Yes, if you look at the data, the top 2 in-demand specialties are 1) FM, and then 2) primary-care IM.

My PGY3 and recent-grad IM colleagues who have been signing hospitalist contracts are usually forced to move outside of the city. But looking at the data, primary care jobs in desirable cities look sublime for both primary care FM and IM.

Be careful though interpreting the data. The #3 in demand specialty is EM. But if you ask any PGY3 or grad EM, they will tell you that it is impossible to land a job inside of a desirable city because of the EM boom. Most are forced an hour outside of the city for the first job.
Click to expand...
Yeah, I think the data from recruitment firms can be misleading. My observations are based on my own job searches and what my senior residents are saying.

I will say there are plenty of hospitalist positions open in the cities where I train (big Northeast cities). Every major healthcare system is hiring, including some who will hire FM hospitalists too. But the market is way better for primary care.
 
I realize it's a loaded subject, but what is your take on midlevel creep and FM job security as a result?
 
Looks like it’s been a while since the last post, but any opinions on ranking programs with heavy OB (ex 75-100+ deliveries) if you’re not necessarily interested in doing any after residency? Would it still be worth the experience, or best to avoid in this case? Thanks!
 
Caffeine Matters said:
Very insightful question @garrettp. I like where your head is at. This is something that I struggled with too when I was between IM and FM. To summarize the biggest difference in two words: "Job Flexibility"

First I will address training and job placement.
(I am not doing IM justice, and what I am about to say is a gross simplification) but IM opens two major career paths. Generalist, and specialist. I would say that if you already know that you want to specialize in 1 field, then go IM. For example, if you are passionate about treating (e.g. Infectious Disease cases) and really enjoy homing in on 1 specialty then it makes sense to pursue IM. You will be an "expert", and that means that the buck stops with your decision on a treatment plan. People will defer to (and appreciate) your judgement most of the time. You can always go into IM, and if you decide that you don't really want to focus on 1 subject, then pursue a generalist track and you can either work as an internist in the clinic, or as a hospitalist. I will say that there is 1 major disadvantage of going into IM. The jobs are saturated in desirable cities. I know a lot of IM people who are a little concerned that they may have to get their first job 30-60 mins outside of a desirable city.

FM training can be looked at as rural vs urban. Rural programs offer full scope training, some programs teach you to perform c-sections, appendectomies, colonoscopies, contraception, newborn care ect... (There are even some programs up in Alaska where they fly you on a helicopter to rural villages to treat people who see a doctor once a year.) Urban programs tend to prepare you for common chronic disease that saturates a city. It is a misnomer when medical students make the assumption that FM doctors are not experts, but just a "jacks-of-all-trades"... In reality, in the urban environments FM docs are specialists in common problems. You become an "expert" in common problems like Asthma, COPD, Care of Children and elderly, depression, diabetes, public health, heart disease, hypertension, preventative care, women's health, hyperlipidemia, then then you have a jack-of-all-trades understanding about everything else in medicine like rheum, derm, surgery, ICU, hospitalist ect... You can also do a fellowship if you desire to become a specialist in just 1 thing like sports medicine, palliative care, academics ect. This translates into Family medicine having tremendous job security. Family Medicine is the #1 in demand specialty in the United States. A Major Advantage of FM is that it is easy for FM doctors to find jobs in desirable cities, and if you want to move out to the rural midwest and make 400k+ as an FM doc, you can do that too. You could make a point that "IM generalists" are also specialists in common problems (minus peds). But because of the shortage of FM docs and abundance of IM docs, the job markets look different coming out of training.

Public Service Loan Forgiveness
I actually don't know a whole lot about PSLF for IM physicians. I do know that FM has no trouble finding training and jobs that qualify for PSLF. I know that my EM buddies are concerned that nearly every EM group is private, and therefor nor eligible for PSLF. Whereas, there is an abundance of PSLF jobs for FM. I would imagine that there are many PSLF jobs available for IM, and that might actually work out really well if you are flexible about moving. For example if you do 3 years of IM, and then 2-3 years of fellowship, you would be about halfway done with payment for 10 year PSLF (if you matched at a institution that qualifies). In order to get your 10 years, you would then just have to move somewhere and work for a 501(c)(3) employer for 4-5 more years and you are done. But this kindof relates to the previous point about job demand. It is just going to be a lot easier as an FM doc to find these kind of jobs in the desirable cities.

Moonlighting.
FM docs are trained in peds, and usually peds ER. This means that FM docs can moonlight as residents and even work for urgent cares as first job if desirable. IM docs aren't experts in treating kids, so urgent cares prefer to hire FM > IM (unless they can co-cover a shift with a peds person).

Culture and learning environment
Some of my favorite people and best doctors that I know are IM. However, IM strongly adheres to its roots of a culture of hierarchy. So you will encounter more competitive and condescending IM residents/fellows/attendings. I have witnessed one too many IM attendings/specialists who are harsh, and unprofessional towards others. One positive about IM docs occasionally being "tough" is that they hold each other to higher standards. I think this culture and approach to medicine results in very competent IM doctors as a whole. FM residents are seldom gunners. FM attendings and Peds attendings are typically the nicest people. They typically teach and grow their residents using positive reinforcement, rather than criticism. So it depends on what learning environment you want to be in. Culture is important. I am the best version of myself when I am in an environment of positive reinforcement, wellness, and kindness. I love the people I work with, and this gives me energy to keep reading, learning, and working hard. I shut down when I am criticized. In FM, you will run into the occasional lazy FM resident/doc. We have all seen that one FM doc who does the bare minimum! This is annoying and gives FM a bad name (just like IM gunners give IM a bad name). So contemplate about which kinds of cultures are important for your growth and satisfaction. Whatever you decide, if you work hard, and treat other doctors with respect, then you will be respected and appreciated.
Click to expand...
There isn’t an abundance of IM docs it’s just that hospitalist jobs are tightening up. Primary care for IM is still wide open everywhere.
 
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