FM changing to IM

[blackandtan]

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I'm a PGY3 FM resident graduating and going straight into a PGY2 IM spot for personal reasons. Just wondering if there are any fellow traitors out there that have made the switch and have any advice.

 

[dragonfly99]

Someone did that at the hospital where I am. Actually he did 2 years FM then 3 of IM or something. At least you won't have to be an intern again!
The potential problem I see is burnout...5 years is a long damn time to be a resident.

Just be sure to study up on ICU stuff, particularly if the IM residency is heavy on ICU months. Tread carefully the first couple of months, because sometimes the IM way of doing things might be different than the way(s) you were taught in fp.

 

[blackandtan]

Yeah, I totally plan on taking the sponge way of life at my new residency. I'm pretty excited about it, especially the ICU stuff, so I can't wait. I look at the burnout possibility like this: I'll be BE if not BC in FM, and that backup is not half bad, but my passion is hospital medicine and critical care (definately not outpatient) so at the very least, after these 2 years I'll be dual boarded in IM/FM, and be eligible for any primary care job out there, including hospitalist, as of now, I was having a lot of trouble finding hospitalist jobs in the area that my family will be living.

 

[mochief2000]

I was wondering why not just get a job somewhere else as a hospitalist for a year or two and then come back to the town you want. You will have the hospitalist experience, not take a pay cut, and avoid being a resident for two more years. It kind of seems like you are looking for an IM residency anywhere so you may be away from home anyway. But if you going into IM as more of an interest, as opposed to looking for a hospitalist job then disregard. But what do I know I am just a med student.

 

[DrJosephKim]

Don't forget about the joint programs that include family med plus internal med. Or, you could transition into med/peds. Are you restricted to a certain area of the country?

 

[Leukocyte]

... after these 2 years I'll be dual boarded in IM/FM, and be eligible for any primary care job out there, including hospitalist, as of now, I was having a lot of trouble finding hospitalist jobs in the area that my family will be living.

It is strange to know that you are having a hard time finding a hospitalist job coming from FM. 75% of my FM graduating class wants to be full-time hospitalists, and all of them found hospitalist jobs...VERY easily, and they had multiple picks too. Not sure were you are looking or were you want to work, but to do a second residency just to work as a hospitalist sounds pretty extreme to me. 😕

 

[blackandtan]

I was looking on the east coast, and I couldn't get near a hospital within 2 hours of where I'd be living (due to my wife's residency starting in July). Plus, I'm very interested in Critical care, which further fuels the transition to IM. Truth is, I'll be tied to a major metropolitan area of some sort for the next 6 years plus for my wife's plans, and I couldn't get the recruiters to even send my CV out to the hospitalist jobs out there, and I just couldn't find any advertisements myself.

I've been considering this change for most of my residency, but didn't want to separate from my wife for a year or more while I did it. This way, it appears to be the perfect situation for my family.

I just found out too late that you can't do as much as I wanted with family medicine, in the areas my family will be tied to. Plus, as things continue medicopolitically speaking, I don't see the family doctor's rights to practice full scope or even hospitalist increasing any time soon. If anything, FP appears to heading toward all outpatient by the day.

 

[lowbudget]

I had a conversation about this hospitalist thing with a few FM residents seeking hospitalist positions in the east coast. There are soooo many FP's doing hospitalist jobs & IM's doing outpatient that it really doesn't matter... where I'm at.

One thing that makes no sense to me is why, instead of doing a whole new IM residency, do you simply not go into practice, take call, & admit your own patients?

Why must you be a hospital"ist"? I mean, are the hospitals up in the east coast restricting privileges to FPs (they're stupid if they do)? Or is it simply because hospitalists groups don't want to hire? Why can't you have a "traditional" FM practice which includes inpatient & outpatient? Take care of your own patients (in the clinic & hospital)! There's no shame in that!!!

And once you're on the ground, THEN you can look for job with a hospitalist group, if you really want to, OR you can drop your outpatient practice & simply do inpatient from that point on.

 

[lowbudget]

I was looking on the east coast, and I couldn't get near a hospital within 2 hours of where I'd be living

See, I don't understand what this means. You're telling me that no hospital within a 2 hr radius wants to grant you admitting privileges? Or are you saying that there is no hospitalist group that is hiring within a 2 hr radius? Because A would be an FP professional issue whereas B is a private practice preference issue. It's important to distinguish A from B.

All you need is admitting privileges to practice inpatient medicine. *Even if* the hospital forces you to make a mandatory consult to an intensivist/pulmonologist, that CC patient, as the admitting attending, is still your patient & you can still write orders & bill for the problem you are taking care of provided that it's not duplicated ("concurrent care").

I mean, if you want to do a fellowship in critical care that's a different story because a closed ICU is a closed ICU. But if it's a closed ICU, it's not closed to FP's but open to IM... it's closed to everyone who is not Pulm/CC. They don't single out FP's from IM's in CC. I mean, maybe they do, but you'll have to look at the privileging specifically to see if that's true.

I dunno. I don't want to go on & on about this, but I think you're more of the exception instead of the rule. That's all I'm saying.

 

[blackandtan]

sorry for the delay, been busy with the move.

To answer a few questions: I'm moving from the midwest to the east coast. No recruiter would even forward my CV to hospitalist groups, saying that I couldn't bill the same, so they won't even consider me (which I know is completely false, but whatever, they have reasons that they will not look at FMs for hospitalist).

I looked at traditional practice opportunities as well, none of those really exist either, at least not in the job search I conducted (using multiple web sites, and e-mailing hospitals directly). No Luck.

My own preference, I found too late, is inpatient medicine. I love the idea behind family medicine, but I was too niave to see that that model doesn't work in reality except for an ever shrinking rural america and the west coast, which my family won't be near any time soon.

So rather than sacrifice my marriage for money and lifestyle (I would be miserable, and therefore my wife by proxy, in outpatient only medicine), I chose to expand my possibilities with internal medicine. I think I may end up in Critical Care, something not possible currently in FM.

 

[warrenMD]

Hello blackandtan, I'm in a similar dilemma, currently doing 2nd year of FM but seeing that I'm more interested now in hospital based medicine and not outpatient. I'm considering joining an IM program after I finish my residnecy as well, was wondering if you can give me some info on how you went through it. Thanks!!