Family Medicine VS Internal Medicine

[Future_D.O.]

I'm looking into both family medicine and internal medicine as options in residency. I'm not set in stone on either and wanted the opinions of those on the inside to help guide my decision.

From my understanding, Internal medicine only deals with adults, while family medicine, just as the name says, deals with the entire family. Are internists more qualified to deal with adult patients than family docs? I really think I'd like to work with children also, and that is a negative I can see with internal medicine. There seems to be a slightly higher salary for internists. It also appears that internists have a bit more opportunity as far as where they can practice, such as internists being able to practice as hospitalitsts, can family doctors practice as hospitalists too?

Overall I'm interested in all aspects of medicine and want to be able to help people live healthy long lives, and avoid ever needing to be admitted to the hospital, I think I would be much happier as a primary care physician, but in the event that I ever got burnt out or unfulfilled feeling in primary care, woulld it be possible to go into a specialty residency with both family med and internal med? What I mean is, like in cardiology, you have to do 3 years of internal medicine first, so does this mean if you do 3 years of family med you can't go on to be a specialist?

Thanks for your help : )

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[Serous Demilune]

http://forums.studentdoctor.net/threads/pros-and-cons-of-family-medicine.1111793/

This thread answers a lot of your questions.

 

[Ismet]

Moving to pre-osteo

 

[AlteredScale]

I'm looking into both family medicine and internal medicine as options in residency. I'm not set in stone on either and wanted the opinions of those on the inside to help guide my decision.

From my understanding, Internal medicine only deals with adults, while family medicine, just as the name says, deals with the entire family. Are internists more qualified to deal with adult patients than family docs? I really think I'd like to work with children also, and that is a negative I can see with internal medicine. There seems to be a slightly higher salary for internists. It also appears that internists have a bit more opportunity as far as where they can practice, such as internists being able to practice as hospitalitsts, can family doctors practice as hospitalists too?

Overall I'm interested in all aspects of medicine and want to be able to help people live healthy long lives, and avoid ever needing to be admitted to the hospital, I think I would be much happier as a primary care physician, but in the event that I ever got burnt out or unfulfilled feeling in primary care, woulld it be possible to go into a specialty residency with both family med and internal med? What I mean is, like in cardiology, you have to do 3 years of internal medicine first, so does this mean if you do 3 years of family med you can't go on to be a specialist?

Thanks for your help : )

For the bolded - they're both qualified to deal with adult patients. Neither is "more qualified" unless we are talking acutely ill patients or patients with very rare type disease then yes, IM would be a better suit for that situations not because they are "better" per se but normally are immersed in not just patient care but also scholarly work (research) that will make them more aware and perhaps better prepared to manage diseases that are far off the typical things you would see in outpatient. Does that make sense?

Family med is usually an outpatient/clinic service but they do rotate inpatient services as well. I think I know of two FM docs who are inpatient hospitalists at UCSD.

In terms of doing specialty, you can do a dual residency program in bot family medicine and internal medicine:

https://www.evms.edu/education/cent...esidencies/combined_family_internal_medicine/

http://www.abim.org/certification/policies/combinedim/comfm.aspx

 

[SLC]

I'm looking into both family medicine and internal medicine as options in residency. I'm not set in stone on either and wanted the opinions of those on the inside to help guide my decision.

From my understanding, Internal medicine only deals with adults, while family medicine, just as the name says, deals with the entire family. Are internists more qualified to deal with adult patients than family docs? I really think I'd like to work with children also, and that is a negative I can see with internal medicine. There seems to be a slightly higher salary for internists. It also appears that internists have a bit more opportunity as far as where they can practice, such as internists being able to practice as hospitalitsts, can family doctors practice as hospitalists too?

I'll take a whack at this, as someone who was dead set on IM until late in 3rd year, I've now switched to (and applied and interviewed) Family Med...

You are correct, IM is typically referred to as the "adult doctor" while FM treats the whole family (or more accurately, FM treats everyone). I wouldn't necessarily say that internists are more qualified to treat adults than FM's, but some might argue that they are. FM docs split time in residency between peds, OB, and general adult medicine. They also sprinkle some surgery in there too (not that FM docs are doing a lot of, or any, surgery). Because FM docs split time in residency, their training isn't quite as focused. But that's not automatically a bad thing.

FM docs and Internists both can practice as hospitalists. But it's more common for internists to do this. IM residency is almost entirely inpatient based. FM residency has a lot of inpatient medicine ward duties, but again, there's peds and OB etc.

Overall I'm interested in all aspects of medicine and want to be able to help people live healthy long lives, and avoid ever needing to be admitted to the hospital, I think I would be much happier as a primary care physician, but in the event that I ever got burnt out or unfulfilled feeling in primary care, woulld it be possible to go into a specialty residency with both family med and internal med? What I mean is, like in cardiology, you have to do 3 years of internal medicine first, so does this mean if you do 3 years of family med you can't go on to be a specialist?

Thanks for your help : )

Yes and no. You don't do cardiology, GI, HemeOnc, etc. from family med. You can do primary care sports med from FM (not from IM), and you can do palliative care (can also do after IM).

Most FM fellowships are meant to augment your abilities as a FM doc rather than make you into a specialist. OB fellowship teaches C-sections etc, ER fellowship teaches more acute emergency care (and some FM docs do work in the ER, but they aren't board certified ER physicians, gotta do ER residency for that), geriatrics teaches more care of the elderly, but with the idea that you will incorporate these things into a FM practice rather than focus solely on them.

 

[allantois]

What I mean is, like in cardiology, you have to do 3 years of internal medicine first, so does this mean if you do 3 years of family med you can't go on to be a specialist?

Thanks for your help : )

The bolded part is correct. Top Internal Medicine programs are competitive, as they give you best opportunity to subspecialize.

On the other hand, if you want to become a specialists for kids, you need to pursue a residency in pediatrics first (I don't believe their income grows anywhere as much as it does for internists though after they specialize).

It's good to enter medical school knowing that you will be happy to do primary care.

 

[Future_D.O.]

I'll take a whack at this, as someone who was dead set on IM until late in 3rd year, I've now switched to (and applied and interviewed) Family Med...

You are correct, IM is typically referred to as the "adult doctor" while FM treats the whole family (or more accurately, FM treats everyone). I wouldn't necessarily say that internists are more qualified to treat adults than FM's, but some might argue that they are. FM docs split time in residency between peds, OB, and general adult medicine. They also sprinkle some surgery in there too (not that FM docs are doing a lot of, or any, surgery). Because FM docs split time in residency, their training isn't quite as focused. But that's not automatically a bad thing.

FM docs and Internists both can practice as hospitalists. But it's more common for internists to do this. IM residency is almost entirely inpatient based. FM residency has a lot of inpatient medicine ward duties, but again, there's peds and OB etc.



Yes and no. You don't do cardiology, GI, HemeOnc, etc. from family med. You can do primary care sports med from FM (not from IM), and you can do palliative care (can also do after IM).

Most FM fellowships are meant to augment your abilities as a FM doc rather than make you into a specialist. OB fellowship teaches C-sections etc, ER fellowship teaches more acute emergency care (and some FM docs do work in the ER, but they aren't board certified ER physicians, gotta do ER residency for that), geriatrics teaches more care of the elderly, but with the idea that you will incorporate these things into a FM practice rather than focus solely on them.

Really learned a lot from your post, thank you! One question I have after reading your reply, is if Internists MUST work in inpatient care? If I'm not mistaken, I thought internists worked in outpatient care too, much like a Family doc. I might be happy working as a hospitalist, but its not something I want to be forced to do, I want to have options. At this point in time, I think I'd be happier working in outpatient care, like for an outpatient clinic, or partner in a private practice, do internists do this as well? To me, internal medicine offers the most flexibility, but has its downfalls. It kinda saddens me to think about not being able to work with children, but maybe that's something I can get over.

 

[SLC]

Really learned a lot from your post, thank you! One question I have after reading your reply, is if Internists MUST work in inpatient care? If I'm not mistaken, I thought internists worked in outpatient care too, much like a Family doc. I might be happy working as a hospitalist, but its not something I want to be forced to do, I want to have options. At this point in time, I think I'd be happier working in outpatient care, like for an outpatient clinic, or partner in a private practice, do internists do this as well? To me, internal medicine offers the most flexibility, but has its downfalls. It kinda saddens me to think about not being able to work with children, but maybe that's something I can get over.

Absolutely, internists work outpatient as well. I guess I should just say that if you took a random sample of medicine hospitalists, the vast majority would be internal medicine trained, with a smattering of FM trained docs in there too.

This is something that you'll figure out on your own when the time comes, but for me what steered me to FM over IM was the procedures. The outpatient internists I've worked with didn't do a lot of procedures, while the FM guys do wound repair, fracture care, minor surgery, Gyn office procedures, obstetrics, and occasionally even endoscopy. If I'm gonna be a clinic doc (and that's what I saw myself doing if I stayed in Primary Care) I'd personally much rather be doing what FM docs do. But that's just me.

Once I lost my interest in HemeOnc, I knew I would switch to FM; haven't looked back.

 

[AlbinoHawk DO]

The bolded part is correct. Top Internal Medicine programs are competitive, as they give you best opportunity to subspecialize.

On the other hand, if you want to become a specialists for kids, you need to pursue a residency in pediatrics first (I don't believe their income grows anywhere as much as it does for internists though after they specialize).

It's good to enter medical school knowing that you will be happy to do primary care.

Of course you can become a specialist with family medicine. There are fellowships in geriatrics, sports medicine, rural medicine and others. Maybe I'm misunderstanding what you mean by specialist?

 

[allantois]

Of course you can become a specialist with family medicine. There are fellowships in geriatrics, sports medicine, rural medicine and others. Maybe I'm misunderstanding what you mean by specialist?

For all practical purposes, OP was inquiring about subspelizations within IM (e.g. Cardiology).

 

[hallowmann]

IM-Peds is also an option. Just throwing that put there since OP mentioned liking IM and working with kids.

 

[67552931811]

I'm looking into both family medicine and internal medicine as options in residency. I'm not set in stone on either and wanted the opinions of those on the inside to help guide my decision.

From my understanding, Internal medicine only deals with adults, while family medicine, just as the name says, deals with the entire family. Are internists more qualified to deal with adult patients than family docs? I really think I'd like to work with children also, and that is a negative I can see with internal medicine. There seems to be a slightly higher salary for internists. It also appears that internists have a bit more opportunity as far as where they can practice, such as internists being able to practice as hospitalitsts, can family doctors practice as hospitalists too?

Overall I'm interested in all aspects of medicine and want to be able to help people live healthy long lives, and avoid ever needing to be admitted to the hospital, I think I would be much happier as a primary care physician, but in the event that I ever got burnt out or unfulfilled feeling in primary care, woulld it be possible to go into a specialty residency with both family med and internal med? What I mean is, like in cardiology, you have to do 3 years of internal medicine first, so does this mean if you do 3 years of family med you can't go on to be a specialist?

Thanks for your help : )

Do Med-peds.

EDIT: @hallowmann beat me to it.

 

[primadonna22274]

After 3 wk on OB service I'm asking myself again why I didn't do med-peds lol

 

[67552931811]

Nvm.

 

[tapatio4life]

I'm looking into both family medicine and internal medicine as options in residency. I'm not set in stone on either and wanted the opinions of those on the inside to help guide my decision.

From my understanding, Internal medicine only deals with adults, while family medicine, just as the name says, deals with the entire family. Are internists more qualified to deal with adult patients than family docs? I really think I'd like to work with children also, and that is a negative I can see with internal medicine. There seems to be a slightly higher salary for internists. It also appears that internists have a bit more opportunity as far as where they can practice, such as internists being able to practice as hospitalitsts, can family doctors practice as hospitalists too?

Overall I'm interested in all aspects of medicine and want to be able to help people live healthy long lives, and avoid ever needing to be admitted to the hospital, I think I would be much happier as a primary care physician, but in the event that I ever got burnt out or unfulfilled feeling in primary care, woulld it be possible to go into a specialty residency with both family med and internal med? What I mean is, like in cardiology, you have to do 3 years of internal medicine first, so does this mean if you do 3 years of family med you can't go on to be a specialist?

Thanks for your help : )

MS3 Here. FM docs usually practice outpatient medicine and are trained in OB/GYN, Pediatrics & Adult/Geriatric Medicine (IM). FM docs in certain settings, e.g., rural also round AM's/PM in hospitals (acting as the hospitalist) if the area is super rural. Lots of rural docs also round AM's/PMs in nursing homes to see elderly patients recovering from hospital discharges. Most of FM practice is in the clinic though seeing patients q15-40min.
Internal medicine docs can work in outpatient or inpatient settings. They can remain generalized or specialize in cardiology, oncology, etc.. with fellowship training after residency. In the outpatient setting, IM docs take care of the medically complex adult patients (patients w/ heart failure, kidney failure, etc.. and all risk factors for those hyperlipidemia, hypertension, diabetes)... These patients are almost always more complicated than the adult patients FM docs take care of because FM usually refer super complicated adult patients to IM or specialists. So IM docs take care of sick sick people. IM docs if they specialize can also dedicate a portion (high or low) of their work life to research as opposed to clinical work.

 

[Peach Newport]

My perspective, as a lowly oms2:

An internist is a true doctor’s doctor. Emphasis is on inpatient medicine, and medical management of severely ill patients. The training prepares you best for a hospitalist role. In a nutshell, an IM guy is the doctoriest doctor there is.

FM is the generalist’s generalist - mostly outpatient based, with emphasis on health maintenance, preventative medicine, and management of chronic conditions in the long-term.

 

[harkas]

For all practical purposes, OP was inquiring about subspelizations within IM (e.g. Cardiology).

IM-Peds is also an option. Just throwing that put there since OP mentioned liking IM and working with kids.

Not trying to hijack this thread, but does a combined residency such as IM-Peds, IM-Psych, or IM-EM hinder your chances of subspecialization?

 

[AnatomyGrey12]

Not trying to hijack this thread, but does a combined residency such as IM-Peds, IM-Psych, or IM-EM hinder your chances of subspecialization?

No but I don’t know why you would do a combined residency if you then plan to go on to an IM fellowship.

 

[harkas]

No but I don’t know why you would do a combined residency if you then plan to go on to an IM fellowship.

I’ve just thought about the possibility of going into IM/Peds or IM/Psych with the intention of going into primary care, but then after being in residency, changing my mind and wanting to further specialize (I pretty much love all the IM sub specialties). Obviously I’m not in medical school yet and have no idea if this really happens to people.

 

[AnatomyGrey12]

I’ve just thought about the possibility of going into IM/Peds or IM/Psych with the intention of going into primary care, but then after being in residency, changing my mind and wanting to further specialize (I pretty much love all the IM sub specialties). Obviously I’m not in medical school yet and have no idea if this really happens to people.

It happens a lot actually. Basically you just stop practicing the other field. Like say you went IM/Peds and then decided to go on to do and IM cardiology fellowship, you would basically just leave the peds training behind from my understanding. That's why a number of people just suggest to pick one instead of doing a combined residency

 

[DO2015CA]

My perspective, as a lowly oms2:

An internist is a true doctor’s doctor. Emphasis is on inpatient medicine, and medical management of severely ill patients. The training prepares you best for a hospitalist role. In a nutshell, an IM guy is the doctoriest doctor there is.

FM is the generalist’s generalist - mostly outpatient based, with emphasis on health maintenance, preventative medicine, and management of chronic conditions in the long-term.

Don’t worry your view will change once you get onto rotations. The most bad ass hospitalist at my site is FM.

It all depends on the training of the FM doctor. Some are geared to majority outpatient and some have the opportunity to do a crap ton of inpatient months.

Residency is for competency not mastery. Sooo the FM that then takes a hospitalist gig and continues learning will be just as doctory as an IM hospitalist. Also, the IM doc that goes outpatient can continue learning and will be just as qualified as a FM doc. Most IM residencies only have 1/2 day a week outpatient so they don’t have as much experience as FM. But if one decides they want outpatient then they can do months in outpatient. (All community hospitals of course. Most academic centers like hospitalists to be IM).

The real benefit to IM is if you are unsure if you want to specialize. And the real benefit of FM is if you are really interested in outpatient and know you don’t want to specialize. Otherwise they are comparable in job prospects and salaries in community hospitals.

 

[workaholic181]

I’ve just thought about the possibility of going into IM/Peds or IM/Psych with the intention of going into primary care, but then after being in residency, changing my mind and wanting to further specialize (I pretty much love all the IM sub specialties). Obviously I’m not in medical school yet and have no idea if this really happens to people.

Yep just the other day I spoke to a doc who did IM/Peds and subsequently completed a pulmonary fellowship. I do think his residency was longer though.

 

[hallowmann]

It happens a lot actually. Basically you just stop practicing the other field. Like say you went IM/Peds and then decided to go on to do and IM cardiology fellowship, you would basically just leave the peds training behind from my understanding. That's why a number of people just suggest to pick one instead of doing a combined residency

Yeah, if you plan to subspecialize, it usually makes more sense not to go combined.

There are some examples where combined training with a fellowship might actually work out for the best though. One example where you could do a fellowship would by something like FM/Psych and an addiction fellowship if you wanted to run like a rehab facility or something. You could do that with just Psych, but having both means you'll be comfortable managing the medical side of care as well. Another example would be IM/Psych and Geri fellowship with the plan to run a Med/Psych or Geri Psych unit.

Another one would be something like IM/Peds and doing a developmental fellowship with the plan to work with ASD patients, ID patients, or individuals with metabolic diseases. There's a big need right now for individuals with those conditions to have transitional and Adult level care. A doc who could follow a child through the transition to adulthood or even into old age could really use all of that training.

 

[rg2o3]

Just scrolling through and don't want to hijak (even though this is an extremely old post, haha), but I am wondering if a FM residency would make it harder to gain employment as a hospitalist as opposed to IM residency. Any insight? Thanks.

 

[BJC2011]

I am currently at an unopposed Family Medicine Residency program. We do a lot of EVERYTHING and last year half of our graduating class all got hospitalist jobs from a variety of states. Most of the time Hospitals will hire you to be hospitalist as long as you are comfortable with in-patient work and can be efficient.