family practice or IM

[Scotty6278]

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I was just curious what the difference is between IM and FP...I realize that all of the fellowships are done after Internal med residency and know that FP see a broad scope of patients in terms of age, an OB component, and even have some ER exp. I was just wondering what would make one choose one residency over the other (assuming they were looking to stay in primary care and not looking to specialize)...thanks

 

[Willamette]

I was just curious what the difference is between IM and FP...I realize that all of the fellowships are done after Internal med residency and know that FP see a broad scope of patients in terms of age, an OB component, and even have some ER exp. I was just wondering what would make one choose one residency over the other (assuming they were looking to stay in primary care and not looking to specialize)...thanks

I'm choosing FP over IM for two inter-related reasons. First of all, with FP you have the opportunity to serve your community by providing obstetric, neonatal, pediatric, adolescent, adult, geriatric, orthopaedic, and emergent care. Coupled to this is the fact that these skills allow a single physician to provide a wide range of services for a smaller community. Depending upon the physician and who you are asking, a good FP can take care of about 85-95% of a person's medical problems.

On the flip side, a physician who chooses IM focuses on care of the adult or geriatric patient populations. What they lack in breadth they can make up for in depth, allowing them to be more familiar with the more complex or esoteric problems that plague their adult patients.

Both specialties have fellowships, but the IMs list is longer.

Since I will choose to practice in a rural area, and since I see myself as a generalist type of guy, I feel that the breadth of FP training is more important than the depth provided by IM.

Best of luck!

Willamette

 

[PACtoDOC]

Agree with Willamette!! Plus, I hate being on IM service so badly that I think doing an IM residency would likely cause PTSD!!!

 

[GeddyLee]

Go with IM.

Internal medicine docs are more respected, better trained and overall more knowledgeable than FP docs. This makes sense, seeing that FP residents waste their time doing pediatrics and ob/gy. No person in their right mind should be seeing an FP for their obstetric care...sorry! Plus, once you get bored with FP, too bad, you're stuck, but with IM you can always subspecialize.

Honestly though, your making a big mistake with either one. Good Luck!

 

[UseUrHeadFred]

Go with IM.

Internal medicine docs are more respected, better trained and overall more knowledgeable than FP docs. This makes sense, seeing that FP residents waste their time doing pediatrics and ob/gy. No person in their right mind should be seeing an FP for their obstetric care...sorry! Plus, once you get bored with FP, too bad, you're stuck, but with IM you can always subspecialize.

Honestly though, your making a big mistake with either one. Good Luck!

Ah, optimism at its finest.

 

[PedsEndo]

Obviously I was once thinking Peds Endo, but now I have decided on FM and have few remarks regarding a prior post...
1. FP's should not be doing OB-- I agree in most larger settings there are many docs more qualified for OB than an FP but in rural settings, as long as the FP is comfortable handling routine OB, he is providing his patients a great service by saving them a 30-45 min or longer drive...
2. Once you get bored with IM you can always specialize-- That is such a perverted view of the future. Very, very, very few docs do IM, then decide 10 yrs later "OK, I'm bored..guess I will be a cardiologist now"..and then do fellowship. The vast majority do fellowship right out of residency. So, yes, if you think you want to specialize do IM but if you are trying to leave options open for the future, when "you get bored" I would re-evaluate my career choice and find one I don't anticipate being bored at in 10 years.
3. IM docs are more respected than FP docs-- This is mostly true only in academic settings. These intellectual egg-heads get on their high horse and look down those noses at everybody..lets be honest don't IM docs think they are better than everybody, including FP, surgery, neurology, etc. Once away from the academic setting, the amount of respect an FP receives increases greatly. Besides, practicing in a rural setting, an FP will not work real close with other docs so as long as the patients respect and trust you what difference does it make what IM docs think of you...

 

[DOtobe]

I am choosing FP for a reason similar to Willamette - because I like the wide range of patients I will be able to take care of. I like kids, adult medicine, gyn office stuff...I want to do a little bit of everything. I also would like to do outpatient medicine in a more rural setting, so FP is perfect in that respect. I'm not going into academic medicine, so I don't give a **** about whether some old IM doc respects me. All I will care about is that my patients respect me.

And Geddy Lee, why such a downer?

 

[Willamette]

Go with IM.

Internal medicine docs are more respected, better trained and overall more knowledgeable than FP docs. This makes sense, seeing that FP residents waste their time doing pediatrics and ob/gy. No person in their right mind should be seeing an FP for their obstetric care...sorry! Plus, once you get bored with FP, too bad, you're stuck, but with IM you can always subspecialize.

Honestly though, your making a big mistake with either one. Good Luck!

I'm not sure where the "overall more knowledgeable" part comes from...


Willamette

 

[doc05]

I have to second everything that Geddy said.

 

[PACtoDOC]

I have to second everything that Geddy said.

And thats why you and Geddy will be living where cement is the dominant soil type, and where the wadded up paper sack is the most abundant flower. But for us who wish to go out to rural America and make people's lives better, don't judge us. If one is intelligent and works hard, they can be good at many different things in medicine. My suggestion would be that you keep yourself, your buddy the Rush-wannabe, and your sub-average stats over in the Narcissist's Forum where you can flex your specialist muscles all day long. Did you think you were going to come in to the FP forum and talk down at people without having any real knowledge of the profession?

And we're also talking about the same person who said this in a recent post:
"medicine is not a very rewarding career; you can make good money but are nothing more than a slave to all of your mostly ungrateful patients. you mostly don't save lives, but rather just adjust medication doses and other incredibly dull things"

You truly have no idea what medicine is really about. I can only pray that when I am a senior resident that I get some smartmouth like you on my service!

 

[Willamette]

I have to second everything that Geddy said.

Garbage squared is still garbage...


Willamette

 

[DrSambo]

Go with IM.

Internal medicine docs are more respected, better trained and overall more knowledgeable than FP docs. This makes sense, seeing that FP residents waste their time doing pediatrics and ob/gy. No person in their right mind should be seeing an FP for their obstetric care...sorry! Plus, once you get bored with FP, too bad, you're stuck, but with IM you can always subspecialize.

Honestly though, your making a big mistake with either one. Good Luck!

I guess you're entitled to your opinion. I happen to disagree with it however.

First off, right now in my state a helluva lot of folks are seeing nurse practitioners and midwives for their O.B. care because there is a tremendous shortage of folks doing O.B. here (thank-you trial-lawyers). The training in my residency in O.B. was more than adequate for the majority of O.B. patients. Obviously, a high risk or complicated patient is better served by an O.B. and thus they get referred. This is no different than somebody with diabetes. The vast majority of these folks can be treated quite well by F.P. docs. The occassional complicated or unusually difficult ones are better served by an endocrinologist and get referred.

As far as wasting time with peds and O.B., again I think this is a dumb opinion. A significant portion of my patient population is children and women.
I'm glad I had some exposure to peds and O.B. during my residency.

Finally, it's interesting what you said about getting bored with F.P. and being stuck with it. That argument was one of the biggest reasons I went into F.P. instead of E.R. With F.P. if I get bored with traditional clinic practice I can become a hospitalist. If I get bored with that, I can work in an E.R. Bored with that, I can work in occupational health. Bored with that I can do nursing home medicine. Bored with that, I can become a housecall doc. I could go on and on and on. All of these can be done without having to go spend another three or more years in some damn fellowship.

But, if a fellowship I crave, we've got a handful of those in our specialty as well.

I had a med school classmate who put it this way. "I like cardiology. I thought about becomming a cardiologist. I could spend six years of training and then make a living seeing a bunch of people with heart trouble bad enough to require a cardiologist. Or, I could spend three years of training in F.P. and see the 95% of patients with heart trouble who never get bad enough to need a cardiologist. Plus, I won't be limited to just hearts. I can also see everything else and get some variety."


Of all the things you said, I would have to say that your "It's boring" argument is by far the stupidist. No other specialy comes close in level of variety to F.P.

 

[GeddyLee]

And thats why you and Geddy will be living where cement is the dominant soil type, and where the wadded up paper sack is the most abundant flower. But for us who wish to go out to rural America and make people's lives better, don't judge us. If one is intelligent and works hard, they can be good at many different things in medicine. My suggestion would be that you keep yourself, your buddy the Rush-wannabe, and your sub-average stats over in the Narcissist's Forum where you can flex your specialist muscles all day long. Did you think you were going to come in to the FP forum and talk down at people without having any real knowledge of the profession?

And we're also talking about the same person who said this in a recent post:
"medicine is not a very rewarding career; you can make good money but are nothing more than a slave to all of your mostly ungrateful patients. you mostly don't save lives, but rather just adjust medication doses and other incredibly dull things"

You truly have no idea what medicine is really about. I can only pray that when I am a senior resident that I get some smartmouth like you on my service!

Wow, someone really got their knickers in a twist.

I wasn't really talking down at anyone, just offering advice to someone considering between IM and FP. And yes, I think IM docs are more knowledgeable in medicine issues than FP docs, simply because they spend more time on medicine, rather than peds and ob/gyn. Of course, if you're dead set on rural medicine, then FP is probably a better choice between the two. If you're planning on practicing in any environment resembling civilization though, I don't think OB is going to be a big part of your practice. Women will (and really should) seek out the greater specialization of the Ob/Gyn where available. I wouldn't send anyone I know to anything less than a board certified Obstetrician for pre-natal care and delivery, simply because they have the best training. FUrthermore, I imagine obstetric malpractice premiums will be a limiting factor on FP's practice of OB. I don't think I really said anything that my classmates were thinking when deciding between FP and IM. In fact, one of my best friends went into FP, so don't go acting like I piss on FP whenever I get the opportunity.

A good, viable option, in my opinion is to do Med/Peds. Basically does what an FP can do, but more training in each area, and with the option to specialize in medical or pediatric specialties.

Think about it though...an FP can train in 3 years to do OB, Peds, and IM, whereas IM docs train for 3 years just for IM. I'm not saying FP docs are all *****s, but you must admit that they receive less training in each specialty than their specialized counterparts in each field. It's been said many times...if you want broad, less deep knowledge, go with FP. IF you want deep knowledge on a narrower spectrum of topics, do IM or another specialty. I don't see why you take such offense to just stating what anyone else would say?

As far as my sub-average stats, I'd be curious to know just what you think my "stats" might be, but I'd bet they're better than average. Maybe you're assuming that because I didn't match for OPH I must be at the bottom of my class with a step I of 200...obviously you don't know much about the OPH match, where even the average unmatched applicant has above average "stats". And I see no sense it dissing on my screen-name, that's just below the belt and childish!

 

[DrSambo]

Dude, you're backpedaling now.

You posted a very condescending little paragraph in which you totally disrespected family medicine. You then try to act all innocent when folks call you on it.

You did not in your original post state that IM docs are more knowledgable than FP's in (internal) medicine issues. You stated, and I quote, "Internal medicine docs are more respected, better trained and overall more knowledgeable than FP docs."

You then go on to slam their training by stating, and again I quote, "FP residents waste their time doing pediatrics and ob/gy."

Now when folks call you on it, you try to pass your comments off as all a big misunderstanding. "I'm not a big condescending arrogant dork. You guys all just misunderstood me."

Unfortunately, in you defense you further define your arrogance with comments like "If you're planning on practicing in any environment resembling civilization" as though anywhere other than a big city with an academic hospital is somehow not civilized. Got news for you pal. The majority of the world and the majority of the U.S. is rural.

You then go on to further denegrate family medicine by saying "I'm not saying FP docs are all *****s" and "A good, viable option, in my opinion is to do Med/Peds. Basically does what an FP can do, but more training in each area, and with the option to specialize in medical or pediatric specialties. "

Face it. You may not want to admit it, but it's pretty apparent that you've got a chip on your shoulder about Family Medicine and equally obvious that you really don't have much of a clue about the training in a family medicine residency or the practice of family medicine post-residency.

As far as your screen name goes, I used to be a big Rush fan many years ago, when I was in junior high school, so I won't slam you on that.

 

[emtp2pac]

from an er standpoint I much prefer to work with fp docs than med/peds docs(having done both)
the fp doc can see whatever comes in the door. the m/p doc picks up every 4 th chart and says for the others:
"I don't do trauma"
"I don't do vag bleeds"
" I don't reduce dislocations"
" I don't suture"
etc........
I would rather have a 2nd pa to work with than an m/p doc who sees only chest pain and febrile kids all day long

 

[erichaj]

To The Idiot Who Wrote Im Docs Are Better Trained And More Respected Than Fp Docs.

Here Are The Facts:

I An Board Certified And Can Do Hospital Medicine, Outpatient Medicine, Ob/gyn, Pediatrics, Office Orthopedics Including Joint Injections To The Lumbosacral Regions, Urgent Care Medicine Dealing With All Pt. Groups.

I Know For A Fact That No Im Doctor Deals With Pediatrics, Ob/gyn,
They May Do Some Office Orthopedics But Most Are Not Trained In This.

So, Who Is More Trained? The Answer Is Neither.

Both Are Trained In Specific Aspects Of Medicine. The Im Doctor Works More With Elderly And Hospital Medicine. That Is Wher Their Primary Training Is Focused.

The Fp Works More With Outpatient Medicine, This Is Where Most People Are, In An Outpatient Setting. However, I Know Many Hospitalists That Are Fp's.

Try Not To Make Yourself Look And Sound Stupid By Saying Things Like You Said In Public.

Eh.

 

[DrDre']

Is There A New Fad Going On That We Need To Be Aware Of? As A Crappy Typist, I Sure Hope Not!

 

[GeddyLee]

To The Idiot Who Wrote Im Docs Are Better Trained And More Respected Than Fp Docs.

Here Are The Facts:

I An Board Certified And Can Do Hospital Medicine, Outpatient Medicine, Ob/gyn, Pediatrics, Office Orthopedics Including Joint Injections To The Lumbosacral Regions, Urgent Care Medicine Dealing With All Pt. Groups.

I Know For A Fact That No Im Doctor Deals With Pediatrics, Ob/gyn,
They May Do Some Office Orthopedics But Most Are Not Trained In This.

So, Who Is More Trained? The Answer Is Neither.

Both Are Trained In Specific Aspects Of Medicine. The Im Doctor Works More With Elderly And Hospital Medicine. That Is Wher Their Primary Training Is Focused.

The Fp Works More With Outpatient Medicine, This Is Where Most People Are, In An Outpatient Setting. However, I Know Many Hospitalists That Are Fp's.

Try Not To Make Yourself Look And Sound Stupid By Saying Things Like You Said In Public.

Eh.

So you're stating you do OB/Gyn as well as a board certified Ob/Gyn, Pediatrics as well as a board certified Pediatrician, Sports medicine as well as an Orthopedist, and hospital medicine as well as an Internist?

You guys must train awful hard.

 

[erichaj]

This just shows that you are still either in medical school or a resident. Either way you are still getting spanked.

Time for some more.

I'm saying that I'm boarded in FP. An Fp does ob/gyn, pediatrics and adult medicine.

On the other hand, IM doctors focus only on Adult medicine. Then they go and specialize on one system (Gi, Cardiology etc.), but you should know this already.

But when you get out of medical school or residency you will realize that your attitude will get you very little respect. I suggest you work on finding out how you will pay back your student loans than spending time insulting a whole group of your future associates by calling them poorly trained.

EH

 

[GeddyLee]

This just shows that you are still either in medical school or a resident. Either way you are still getting spanked.

Time for some more.

I'm saying that I'm boarded in FP. An Fp does ob/gyn, pediatrics and adult medicine.

On the other hand, IM doctors focus only on Adult medicine. Then they go and specialize on one system (Gi, Cardiology etc.), but you should know this already.

But when you get out of medical school or residency you will realize that your attitude will get you very little respect. I suggest you work on finding out how you will pay back your student loans than spending time insulting a whole group of your future associates by calling them poorly trained.

EH

I'm sorry I got you all in such an uproar as to start calling me names. So much for the compassion and humanity of the Family Practicioner. However, you must admit, in each given area in which the FP practices, they ARE less well trained than their specialist counterparts. Unless you are practicing family medicine with board certification in Peds, IM, and OB/Gyn, you are not as well trained in each of these specialties as those who are boarded. Hence, you are not as knowledgeable and able to practice within these areas. I dare say none of you would argue this point. As much as you want to be the jack-of-all trades, you cannot do this without sacrificing the more in depth knowledge of the specialist.

Deep narrow depth ----specialize. Broad, shallow depth ---FP. Which is what most people try to decide when they are considering the primary care specialties. If you can be happy practicing pediatrics without feeling you have the expertise of a pediatrician, then fine...FP is for you. I find it a little scary, myself, because I know I want to feel that I have absolute knowledge in the area in which I'm practicing. This certainly is more difficult when practicing across multiple disciplines.

However, I am sorry I may have upset some of you. I was only trying to give my perspective to the original poster who wanted advice on choosing between IM and FP. I'm not sure if your hostilities are due to my comments or your personal attitudes, but either way, I wasn't attempting to start a flame war.

 

[UseUrHeadFred]

The impression I'm getting from your statements is that patients should not go to FP docs. If you're an adult you should go to an IM, if your kids are sick go to a pediatrician, if you're pregnant go to an OB/GYN. In fact, in your original post you basically say that IM is generally a better specialty than FP. This impression may be wrong, but I'm certain you can see how it's not difficult to jump from your statements to that conclusion.

That would definately generate some hostility, wouldn't you say?

 

[lowbudget]

Whatever. That's just ridiculous.

If you're comfortable and competent, you can do whatever you're interested in doing. 120 babies is 120 babies. A good FP stays current with lit and guidelines and consults when appropriate, which is why a good FP is one who steps up when training opportunities present itself and steps back when things are over his head. And don't EVEN talk about how great IM/Pedi/OB docs are. IM residents at my school are too incompetent when it comes to doing trauma, surgical procedures, and anything genital. They consult 400 people for 1 patient. Our pedi residents freak out during traumas and are totally ******ed when it comes to adolescent/adult issues, like pregnancy, IBD. And let's not even talk about how OB/Gyn are totally ******ed when it comes to managing medical issues... what, intubate a crashing pregnant mom? Duh... call anesthesia! Give me a break, intubate her yourself.

Listen, everyone is good at something... that's why we have division of labor in medicine. If you're interested in doing peds, you can be as good as pedi up to a limit on certain things. If you take care of 500 kids with AIDS, you should be comfortable if not more competent than the gen pedi who cranks out sports physicals. Same with anything else. If you have never taken care of a kid with special needs, then you consult out, get the answer, and do your best. There's NO reason why a patient h/o HTN, chronic low back pain, asthma and CHF needs to go see a nephrologist, an orthopedist/neurosurgeon/neurologist/psychiatrist, a pulmonologist/allergist, AND a cardiologist all the time for their medical care. INAPPROPRIATE. And your patients will be lost to follow up. AND you'll have patients on 200 medications because no one will d/c anyone else's meds. I would hate to be this patient. I'd never go to work because I'd always at your hospital.

Thinking about this subject really makes me laugh. Could you imagine how ridiculous it would be without FPs?

 

[dr_almondjoy_do]

Women don't only go see a doctor when they are pregnant. We happen to have other issues besides having babies. I know for a fact that, if they want, an FP can examine all gyn cases and refer to an OB/GYN when their pt is pregnant or needs surgery.

FPs are needed for gyn visits especially when there is a shortage of OBs due to malpractice premiums. Having to wait 3 months to be treated for abnormal bleeding or to get an evaluation on birth control options/pap smears/well pt visits is a little rediculous.

We are all aiming to be in the business of treating people, so why all the bs argueing all the time?

 

[erichaj]

I could not have said it better myself. The last two posts tell what an FP bring to the table when it comes to medicine.

I have read many studies that compare our system of medicine to other western nations like Englan, France, Germany. We rank 24th in healthcare delivery. We rank number one in technology. What good is having all this technology when we can't treat HTN and Diabeties in this country.

We have one of the poorest outcomes when it comes to the above problems and many more.

I have read many studies, one which was in JAMA that clearly found that countries with FP doctors had far better outcomes than countries with specialists.

Family Practitioners know how to relate with their patients. I'm not saying that IM docs don't, but to say that they are somehow better trained is a mistake. "Trained" is a relative term. They may know all about the studies of many obscure diseases but what it comes down to is how you can manage a pt. The best doctors understant every aspect of pt. management, not just the facts of diseases and medicine.

I have a great deal of respect for IM doctors. They fill a role that is needed. Just like we fill a role that is needed.

SO TO ANSWER THE ORIGINAL QUESTION OF WHICH SPECIALTY TO GO TO,
I WOULD SAY TO YOU TO GO OUT AND FIND OUT HOW AND WHERE YOU WANT TO MANAGE YOUR PT. WHAT DO YOU LIKE BEST. HOSPITALS, CLINICS, ER , RURAL MEDICINE? THEN LOOK AT WHICH ONE FP OR IM BEST SUITS YOUR NEEDS.

To the idiots that started this problem. You don't deserve compassion at this time. you deserve to be set straight on your ignorance. One day you are going to be a doctor or maybe you are a resident now. But as long as you have an attitude like that, you will NEVER BE RESPECTED.

EH