FM to CC?

[YCAGA]

Your argument doesn’t make sense. As long as hospital admin doesn’t want to pay for an intensivist, hospitals that staff these places with non-intensivists will continue to do so. Whether or not there is a pathway for FM docs to become intensivists doesn’t change this.

Rereading my post it sounds like I’m arguing that, but I’m more asking a question than arguing. If IM and FM can both work in that open-ICU setting, why can’t they both do a CC fellowship?

Not really wondering about historical reasons or “ABIM won’t let them”, but what skills is FM lacking that IM and EM both have? I’m genuinely curious, not trying to argue.

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[CCM-MD]

Rereading my post it sounds like I’m arguing that, but I’m more asking a question than arguing. If IM and FM can both work in that open-ICU setting, why can’t they both do a CC fellowship?

Not really wondering about historical reasons or “ABIM won’t let them”, but what skills is FM lacking that IM and EM both have? I’m genuinely curious, not trying to argue.

The flaw with that argument is you can say that about most things. Both manage acute coronary syndromes as hospitalists, why can’t they become cardiologists? Both manage skin diseases, why isn’t there a pathway to dermatology? Both staff ERs of those same tiny hospitals why can’t they do an EM fellowship? Both manage thyroid disorders and diabetes why can’t they do endocrinology?

 

[YCAGA]

The flaw with that argument is you can say that about most things. Both manage acute coronary syndromes as hospitalists, why can’t they become cardiologists? Both manage skin diseases, why isn’t there a pathway to dermatology? Both staff ERs of those same tiny hospitals why can’t they do an EM fellowship? Both manage thyroid disorders and diabetes why can’t they do endocrinology?

I think you are still misunderstanding me. I am not arguing that FM should be 100% be allowed to do CC because of X, Y, and Z. I am asking why can't they do it? Or why can't FM do a fellowship in endocrinology or cardiology? I have no idea, that is why I am asking you all who have actually done IM, FM, EM, etc residency. And I am wondering about actually differences in competence and training, not X organization won't let them, because that is always the reason until it isn't, see EM and critical care.

 

[CCM-MD]

I think you are still misunderstanding me. I am not arguing that FM should be 100% be allowed to do CC because of X, Y, and Z. I am asking why can't they do it? Or why can't FM do a fellowship in endocrinology or cardiology? I have no idea, that is why I am asking you all who have actually done IM, FM, EM, etc residency. And I am wondering about actually differences in competence and training, not X organization won't let them, because that is always the reason until it isn't, see EM and critical care.

One meets the requirements to graduate an FM residency after seeing 15 ICU patients and 600 hours caring for adult inpatients. Most would agree these minimum requirements are not sufficient to produce comparable CCM fellows/specialists. So that might be one reason.

 

[VA Hopeful Dr]

One meets the requirements to graduate an FM residency after seeing 15 ICU patients and 600 hours caring for adult inpatients. Most would agree these minimum requirements are not sufficient to produce comparable CCM fellows/specialists. So that might be one reason.

And beyond even the educational aspects of the argument, FM is first and foremost a primary care specialty. We all knew that going in. If you don't want to be primary care (or something primary care adjacent), don't go into FM.

Its not that hard to match into IM if you think you want to be a subspecialist.

 

[MedicineZ0Z]

Alumni from FM/IM residency or a cc fellowship?

FM residency

 

[MedicineZ0Z]

One meets the requirements to graduate an FM residency after seeing 15 ICU patients and 600 hours caring for adult inpatients. Most would agree these minimum requirements are not sufficient to produce comparable CCM fellows/specialists. So that might be one reason.

That's obvious. I think ones in those settings though post residency were well above requirements.

 

[Splenda88]

This was briefly touched on before some classic SDN s*** flinging started, but how do you all feel about the numerous IM/FM trained doctors that are more or less acting as an “intensivist-lite” at critical access hospitals? I have seen literally hundreds of locums and FT job postings that have in the requirements: open ICU, must be comfortable managing ICU patients, intubation, central/art lines, vent management required.

Not saying doing those procedures = being a true CCM doctor, but it seems like FM/IM are already practicing aspects of critical care medicine in the community. Should it be this way? Probs not but it is a reality and cheap hospital admin isn’t going to stop requiring it anytime soon, so why not let FM doctors with equivalent ICU and inpatient time an EM/IM do a CC fellowship?

There are multiple threads about IM residents getting <10 intubations, central/art, etc by PGY3. Counter argument is that they probably wouldn’t be competitive for critical care fellowship since they most likely didn’t do extra ICU time. But, it does open up the argument that a motivated FM resident at an unopposed program could easily surpass an IM resident in both critical care procedures and ICU time. No way any FM resident is going to match IM in terms of inpatient months (30+ months I think?), but that is true for EM too, which already struggles to get 6 months of ICU experience before CC fellowship.

I will defer to actual critical care doctors on what they think is most important coming into a CC fellowship…procedural experience? ICU experience? Non-ICU inpatient experience?

I’m not remotely qualified to say what is most important and how much time/experience in each is needed, but I can say that an unopposed FM resident could get similar procedures and ICU time to an IM/EM resident.

Critical care is a LOT more about procedures...

NP do procedures where I am, but that do not make them critical care docs...

 

[YCAGA]

Critical care is a LOT more about procedures...

NP do procedures where I am, but that do not make them critical care docs...

If only I had said something like “Not saying doing those procedures = being a true CCM doctor”. Anyways…

“NP’s can do it!!!!” brings nothing to the discussion. NP’s can legally do almost anything a physician can do if the are “supervised”, so bring it up in every discussion is pretty tiring.

At this point we should just create a bot that will post something about NP’s if they aren’t already been mentioned by the 10th post in an SDN thread. Wouldn’t be a very busy bot though…

 

[Lexdiamondz]

There are multiple threads about IM residents getting <10 intubations, central/art, etc by PGY3. Counter argument is that they probably wouldn’t be competitive for critical care fellowship since they most likely didn’t do extra ICU time. But, it does open up the argument that a motivated FM resident at an unopposed program could easily surpass an IM resident in both critical care procedures and ICU time. No way any FM resident is going to match IM in terms of inpatient months (30+ months I think?), but that is true for EM too, which already struggles to get 6 months of ICU experience before CC fellowship.

Not all unopposed programs are created equal - quite the contrary to what you're saying, many unopposed programs simply dont have the inpatient acuity necessary to host an IM program. With some exceptions, most FM grads aren't getting tons of intubations and cvls at these unopposed programs. Those ICUs tend to ship out anyone sick, you're not getting a robust critical care experience in most of these places.

And no EM program struggles to get 6 mos of ICU experience when we're required to have 4 mos and almost all of us have 2-3 mos of elective time (3 yr programs) up to 6 mos electives (4yr programs).

 

[MedicineZ0Z]

Not all unopposed programs are created equal - quite the contrary to what you're saying, many unopposed programs simply dont have the inpatient acuity necessary to host an IM program. With some exceptions, most FM grads aren't getting tons of intubations and cvls at these unopposed programs. Those ICUs tend to ship out anyone sick, you're not getting a robust critical care experience in most of these places.

And no EM program struggles to get 6 mos of ICU experience when we're required to have 4 mos and almost all of us have 2-3 mos of elective time (3 yr programs) up to 6 mos electives (4yr programs).

Many lower quality unopposed programs are low quality due to culture. It's actually not that uncommon. Only residents in the hospital, but a lot of the rotations aren't very good because of the rotation setup/attendings.
But I'd say interested residents can get a lot of procedure practice at many unopposed programs. I interviewed at places where the 1-2 interested residents would get paged to come intubate in the icu/ed while in clinic or wherever else. If it's a decent sized community hospital (common), there's enough acuity.

 

[spacegun]

I mean if we want to start from scratch, then we could just make critical care its own residency. Isn't that already the case in Canada, the UK, some European nations? After graduating med school, and doing a general intern year like anesthesia does for example, then PGY2 is the start critical care residency. (I know this probably isn't realistically going to happen, but just saying).

 

[betamale]

Are FM docs not capable of learning CCM in 2 years like EM, IM folks?

FM curriculum have significant rotations in inpatient surgery, GYN, OB, peds which can be useful CCM; not so in IM, EM

 

[YCAGA]

Are FM docs not capable of learning CCM in 2 years like EM, IM folks?

FM curriculum have significant rotations in inpatient surgery, GYN, OB, peds which can be useful CCM; not so in IM, EM

Just to play devil's advocate, are OB and peds relevant to adult CCM? Also, the FM programs I have looked at get 1-2 months of general surgery and gyn each, that probably is very program dependent though. Don't EM/IM get around that amount of gyn and surgery?

 

[YCAGA]

Not all unopposed programs are created equal - quite the contrary to what you're saying, many unopposed programs simply dont have the inpatient acuity necessary to host an IM program. With some exceptions, most FM grads aren't getting tons of intubations and cvls at these unopposed programs. Those ICUs tend to ship out anyone sick, you're not getting a robust critical care experience in most of these places.

And no EM program struggles to get 6 mos of ICU experience when we're required to have 4 mos and almost all of us have 2-3 mos of elective time (3 yr programs) up to 6 mos electives (4yr programs).

How do you know about the quality of "many" unopposed FM programs as an EM resident, presumably at a tertiary hospital? To be fair, I know even less than you do, but I don't think either of us are qualified to make statements about unopposed FM programs in general. I was talking about a few specific FM programs I have found that are at level 1/2 trauma centers, unopposed, and have lots of elective time for ICU, anes, EM, trauma, etc.

 

[betamale]

Just to play devil's advocate, are OB and peds relevant to adult CCM? Also, the FM programs I have looked at get 1-2 months of general surgery and gyn each, that probably is very program dependent though. Don't EM/IM get around that amount of gyn and surgery?

OB, peds, GYN, surg, rads, Neuro, psych... have critical pathologies, toxicities, nuances, doses, syndromes that you have to know as a doctor with a broad scope (CCM, FM, EM...)... info that is not intuitive but may not come naturally to doctors who practice only on a specific age group or body part

 

[SpacemanSpifff]

And beyond even the educational aspects of the argument, FM is first and foremost a primary care specialty. We all knew that going in. If you don't want to be primary care (or something primary care adjacent), don't go into FM.

Its not that hard to match into IM if you think you want to be a subspecialist.

I feel like this is the crux of the matter. The truth is that anesthesia and, more recently, EM have pathways to CCM because there are a good chunk of trainees who want to work in the ICU. These discussions (which have happened before on the FM and CCM forums) always seem to rotate around perceived attacks on the competency and theoretical abilities of FM trainees - a small, vocal minority are offended by this and defend the quality of their training over and over and over, ad nauseum. As @VA Hopeful Dr said, the lack of a pathway to CCM for FM primarily reflects that fact that the vast vast majority of FM trainees are not interested in CCM. I believe that most medical trainees have the grit and intelligence to practice most specialties, if they have the desire.

Some FM docs will work in ICU’s, and CCM docs get irked by that because of a lack of training, just like some EM docs will bristle at the idea of FM trainees working primarily in ED’s. Everyone knows we don’t have enough CCM or EM docs to fill the need. If an FM doc is stepping up, great - as long as they are interested in filling their knowledge gaps as best they can.

 

[MedicineZ0Z]

Are FM docs not capable of learning CCM in 2 years like EM, IM folks?

FM curriculum have significant rotations in inpatient surgery, GYN, OB, peds which can be useful CCM; not so in IM, EM

I think we need to keep opening more midlevel residencies for critical care and EM. I mean, we already we rapidly growing those. Why support doctors? Just open a 1 year program where you teach a nurse or PA to be an intensivist. For doctors, we should keep quadrupling the requirements.

How do you know about the quality of "many" unopposed FM programs as an EM resident, presumably at a tertiary hospital? To be fair, I know even less than you do, but I don't think either of us are qualified to make statements about unopposed FM programs in general. I was talking about a few specific FM programs I have found that are at level 1/2 trauma centers, unopposed, and have lots of elective time for ICU, anes, EM, trauma, etc.

If someone who is a year above you says something, it is 100% undoubtedly correct.

 

[Katheudontas parateroumen]

I mean if we want to start from scratch, then we could just make critical care its own residency. Isn't that already the case in Canada, the UK, some European nations? After graduating med school, and doing a general intern year like anesthesia does for example, then PGY2 is the start critical care residency. (I know this probably isn't realistically going to happen, but just saying).

I would have probably been one of the crazies who would have chosen this if available haha. But CC is broad. There’s also a lot of subspecies units within CC nowadays with CV and especially neuro making their own certification. With a CC residency we could do away with all this super sub specialties within icu. 4yr ICU residency. Something like 30-36 months of ICU and 12 months of inpatient electives.

 

[YCAGA]

If someone who is a year above you says something, it is 100% undoubtedly correct.

I honestly can’t tell if you’re being sarcastic here too

 

[MedicineZ0Z]

I honestly can’t tell if you’re being sarcastic here too

And that demonstrates my point. A lot of attendings or people with higher education in general tend to think their opinions are concrete fact. The idea that someone lower on the hierarchy can challenge them, is mind blowing to them. There are pre-meds who get advice from 60 year old attendings on med school apps that are 3 decades outdated for example.
We also have attendings or even senior residents (who have done med school/residency in the same place and never worked elsewhere) who think they got it all figured out. So you'll see a lot of statements thrown out with major confidence.

 

[GoSpursGo]

I swear, in 2021 Burnett's Law needs to be changed to "As a thread grows longer, the probability of it being de-railed into a midlevel discussion approaches 1."

Let's please try to focus the OP's original question of how to pursue practicing in CC coming from an FM background. The whole midlevel side-conversation really isn't relevant.

 

[Splenda88]

The way we train physicians here need a major overhaul. There are too many players who are getting rich at the expense of docs, so that will never happen. We are still using the 1910 Flexner report and the older physicians think it is still ok. I must admit that they have a point. Why fix something that is not broken? But I think we can do better.

 

[MedicineZ0Z]

I swear, in 2021 Burnett's Law needs to be changed to "As a thread grows longer, the probability of it being de-railed into a midlevel discussion approaches 1."

Let's please try to focus the OP's original question of how to pursue practicing in CC coming from an FM background. The whole midlevel side-conversation really isn't relevant.

I think if someone says that FM shouldn't practice CC, it's natural to next question why unsupervised midlevels can do it.

 

[YCAGA]

And that demonstrates my point. A lot of attendings or people with higher education in general tend to think their opinions are concrete fact. The idea that someone lower on the hierarchy can challenge them, is mind blowing to them. There are pre-meds who get advice from 60 year old attendings on med school apps that are 3 decades outdated for example.
We also have attendings or even senior residents (who have done med school/residency in the same place and never worked elsewhere) who think they got it all figured out. So you'll see a lot of statements thrown out with major confidence.

Couldn't agree more. And yes, that demonstrates your point completely. Some version of "seniors always are irrefutably correct" is said fairly often on the SDN emergency medicine forum...although with no hint of irony or sarcasm.

 

[Lexdiamondz]

How do you know about the quality of "many" unopposed FM programs as an EM resident, presumably at a tertiary hospital? To be fair, I know even less than you do, but I don't think either of us are qualified to make statements about unopposed FM programs in general. I was talking about a few specific FM programs I have found that are at level 1/2 trauma centers, unopposed, and have lots of elective time for ICU, anes, EM, trauma, etc.

The same way you know how many ICU rotations the average EM resident gets.

Are FM docs not capable of learning CCM in 2 years like EM, IM folks?

FM curriculum have significant rotations in inpatient surgery, GYN, OB, peds which can be useful CCM; not so in IM, EM

Dude ¼ of our patient volume in EM is peds and we all do trauma, OB and GYN. What are you talking about?

 

[Splenda88]

It's a strange system guys/gals. I know that ID doc who did FM--->IM--->ID

 

[Lexdiamondz]

And that demonstrates my point. A lot of attendings or people with higher education in general tend to think their opinions are concrete fact. The idea that someone lower on the hierarchy can challenge them, is mind blowing to them. There are pre-meds who get advice from 60 year old attendings on med school apps that are 3 decades outdated for example.
We also have attendings or even senior residents (who have done med school/residency in the same place and never worked elsewhere) who think they got it all figured out. So you'll see a lot of statements thrown out with major confidence.

Pot reeeeeeeeallly calling kettle black here

 

[NITRAS]

It's a strange system guys/gals. I know that ID doc who did FM--->IM--->ID

It just is. To do an IM sub specialty, you have to do IM. We can argue about whether it is right or wrong. It just is. It isn’t going to change.

I also wanted to say this. I went to a busy community IM program. I had 7.5 months of dedicated ICU time (I did some extra), I did 2 months of nights where I covered the ICU and every call day (ICU or wards) I admitted to ICU. I did a ton of icu. Plenty of lines, and lots of tubes. I have lots of really good ICU docs who let me practice pretty independently and aI could manage a vent pretty well. I thought i was tough **** when I graduated.

Now, 5.5 years later, I’ve been a hospitalist at a tertiary center with a closed MICU, SICU, CTICU (which I don’t work in). I didn’t know what I didn’t know. I’ve learned a lot the last few years.

 

[YCAGA]

The same way you know how many ICU rotations the average EM resident gets.


Dude ¼ of our patient volume in EM is peds and we all do trauma, OB and GYN. What are you talking about?

I know how many ICU rotations the average EM resident gets because 4 months is the ACGME requirement plus maybe a month or two of electives in the ICU…it’s public, easily accessible knowledge.

Evaluting the quality of 300+ unopposed FM programs when you are an EM resident is nothing like knowing how many ICU months EM residents do when I am a medical student.

 

[Lexdiamondz]

I know how many ICU rotations the average EM resident gets because 4 months is the ACGME requirement plus maybe a month or two of electives in the ICU…it’s public, easily accessible knowledge.

Evaluting the quality of 300+ unopposed FM programs when you are an EM resident is nothing like knowing how many ICU months EM residents do when I am a medical student.

You made a blanket statement that "an FM resident in an unopposed residency could easily surpass an IM resident in ICU time and procedures"

All I did was add nuance in that a number of unopposed FM programmes are unopposed for a damn good reason.

Yes, some can offer robust training in diverse clinical settings. But not every unopposed residency is JPS or Ventura.

As for how I know? Like you said, I'm a resident at a referral centre. I take transfers from these places *all the time*

One literally transferred us a patient for an LP today. In a blizzard. Despite having 27 FM residents.

But sure, please tell me more about these unopposed residencies where people are doing crics in the CT scanner.

 

[Splenda88]

You made a blanket statement that "an FM resident in an unopposed residency could easily surpass an IM resident in ICU time and procedures"

All I did was add nuance in that a number of unopposed FM programmes are unopposed for a damn good reason.

Yes, some can offer robust training in diverse clinical settings. But not every unopposed residency is JPS or Ventura.

As for how I know? Like you said, I'm a resident at a referral centre. I take transfers from these places *all the time*

One literally transferred us a patient for an LP today. In a blizzard. Despite having 27 FM residents.

But sure, please tell me more about these unopposed residencies where people are doing crics in the CT scanner.

I agree that the reality of FM residency out there is not what @MedicineZ0Z describes in many of the forums where there is a FM discussion. Our FM program is a good one, but their residents only rotate have 1 month ICU and 1 month of cardio. They don't rotate in GI, Nephro, ID, Pulm etc...

You can not half ass theses things... The same reasons that the average FM doc is better than IM in outpatient medicine right after residency is the same reasons that the average IM is more equip than FM to deal with inpatient medicine.

Because there is so much overlap between FM and IM in term of their role, it seems like FM physicians are very sensitive when they get compared with IM in regard to inpatient medicine. I have noticed that sensitivity a lot in social media.

 

[chocomorsel]

I think you are still misunderstanding me. I am not arguing that FM should be 100% be allowed to do CC because of X, Y, and Z. I am asking why can't they do it? Or why can't FM do a fellowship in endocrinology or cardiology? I have no idea, that is why I am asking you all who have actually done IM, FM, EM, etc residency. And I am wondering about actually differences in competence and training, not X organization won't let them, because that is always the reason until it isn't, see EM and critical care.

You will not get a real answer from biased people on here.
As an anesthesiologist, before Covid hit, I was discriminated against while looking for jobs as an ICU doc. You will still find plenty of people, even on this board who don’t think that we measure up to IM standards. Because in the US, IM and traditionally Pulm, run the community ICUs.
I for one hope OP and other FMs who are interested succeed in becoming CCM docs. I had five months of CCM in residency and really did prefer the MICU rotation much better because of less politics and better pathology compared to SICU plus I hate trauma patients. Doesn’t mean the real world ICUs in the community have all those weird Zebras I saw in residency and fellowship. It’s a lot more bread and butter ICU patients and we honestly can all do it, from different backgrounds if interested. It’s opened up for EM so maybe with continued push and interest it may open up to FM.

So the answer to your question is really and truly, politics, turf protection and money. Don’t listen to any other reason. It’s just how it’s always been.
Full stop, end of story.

 

[YCAGA]

You will not get a real answer from biased people on here.
As an anesthesiologist, before Covid hit, I was discriminated against while looking for jobs as an ICU doc. You will still find plenty of people, even on this board who don’t think that we measure up to IM standards. Because in the US, IM and traditionally Pulm, run the community ICUs.
I for one hope OP and other FMs who are interested succeed in becoming CCM docs. I had five months of CCM in residency and really did prefer the MICU rotation much better because of less politics and better pathology compared to SICU plus I hate trauma patients. Doesn’t mean the real world ICUs in the community have all those weird Zebras I saw in residency and fellowship. It’s a lot more bread and butter ICU patients and we honestly can all do it, from different backgrounds if interested. It’s opened up for EM so maybe with continued push and interest it may open up to FM.

So the answer to your question is really and truly, politics, turf protection and money. Don’t listen to any other reason. It’s just how it’s always been.
Full stop, end of story.

Thanks for your honest reply.

Were you discriminated against for community ICU jobs with mixed SICU/MICU, or just jobs if you wanted to work in a MICU only?

 

[YCAGA]

You made a blanket statement that "an FM resident in an unopposed residency could easily surpass an IM resident in ICU time and procedures"

All I did was add nuance in that a number of unopposed FM programmes are unopposed for a damn good reason.

Yes, some can offer robust training in diverse clinical settings. But not every unopposed residency is JPS or Ventura.

As for how I know? Like you said, I'm a resident at a referral centre. I take transfers from these places *all the time*

One literally transferred us a patient for an LP today. In a blizzard. Despite having 27 FM residents.

But sure, please tell me more about these unopposed residencies where people are doing crics in the CT scanner.

Your program’s catchment area accounts for what, 5, MAYBE 10 different FM programs? You seem to be missing the point that your anecdotes from your little slice of the country don’t speak for the 300+ unopposed FM residencies that exist in (almost?) all 50 states.

 

[chocomorsel]

Thanks for your honest reply.

Were you discriminated against for community ICU jobs with mixed SICU/MICU, or just jobs if you wanted to work in a MICU only?

Mixed places. I never specified I wanted to work in the MICU. I bet most medium sized hospitals with 200-400 beds are a mixed situation.
The pulmonologists tend to hold the contracts and do pulmonary consults as well. And if they have the contract, forget about it for the most part. If they are employed it will be all about, we need someone who does pulmonary consults from Human Resources/Physiocian or plain and simple, we have always done it this way and aren’t changing kind of answer.
Alof if it is they want to protect their territory or want someone who can do outpatient clinic in pulmonary or just don’t trust anyone other than other pulmonary docs.
EM docs also get discriminated against.

 

[Lexdiamondz]

Your program’s catchment area accounts for what, 5, MAYBE 10 different FM programs? You seem to be missing the point that your anecdotes from your little slice of the country don’t speak for the 300+ unopposed FM residencies that exist in (almost?) all 50 states.

I'm not the one speaking in absolutes here, YOU are.

As someone who has never practiced clinically in any context and who has erroneously mischaracterized the training and scope of practice of now THREE different specialties (EM, FM and IM) I'm not sure what value you even add to this discussion.

I said what I said. An FM resident (who I generally don't agree with in these discussions) basically corroborated what I said. Take it or leave it but you, my friend, have neither facts nor experience to stand on.

 

[MedicineZ0Z]

You will not get a real answer from biased people on here.
As an anesthesiologist, before Covid hit, I was discriminated against while looking for jobs as an ICU doc. You will still find plenty of people, even on this board who don’t think that we measure up to IM standards. Because in the US, IM and traditionally Pulm, run the community ICUs.
I for one hope OP and other FMs who are interested succeed in becoming CCM docs. I had five months of CCM in residency and really did prefer the MICU rotation much better because of less politics and better pathology compared to SICU plus I hate trauma patients. Doesn’t mean the real world ICUs in the community have all those weird Zebras I saw in residency and fellowship. It’s a lot more bread and butter ICU patients and we honestly can all do it, from different backgrounds if interested. It’s opened up for EM so maybe with continued push and interest it may open up to FM.

So the answer to your question is really and truly, politics, turf protection and money. Don’t listen to any other reason. It’s just how it’s always been.
Full stop, end of story.

^ Truthful post. This is the real answer.

Your program’s catchment area accounts for what, 5, MAYBE 10 different FM programs? You seem to be missing the point that your anecdotes from your little slice of the country don’t speak for the 300+ unopposed FM residencies that exist in (almost?) all 50 states.

If someone above you tells you they're right based on *their* experience, they just are. Don't question it.

 

[smq123]

I think you are still misunderstanding me. I am not arguing that FM should be 100% be allowed to do CC because of X, Y, and Z. I am asking why can't they do it? Or why can't FM do a fellowship in endocrinology or cardiology? I have no idea, that is why I am asking you all who have actually done IM, FM, EM, etc residency. And I am wondering about actually differences in competence and training, not X organization won't let them, because that is always the reason until it isn't, see EM and critical care.

I think these kinds of philosophical debates (as to why FM can't do an endocrinology fellowship, etc.) are outside the scope of this forum. As VAHopeful said, it's not like it's a secret that FM is primarily geared towards outpatient primary care, at least on the east coast, and if that's what you choose to apply in, that's likely what you will end up doing.

In any case, I think this topic has been beaten to death.

OP - good luck; I hope you figure out a way to carve out a career that makes you happy.

Everyone else - I'm closing this thread.