In general office practice, both have similar scopes of practice, with the following exceptions:
- Family physicians see patients from newborn to geriatrics, while internists will see only late adolescents to geriatrics. No peds in IM. You always know that the screaming kid down the hall is NOT your next patient...
- Many family physicians will do obstetrics, in addition to office gyn and, depending on the area of the country they practice, can also have do their own c-sections. Internists will do office gyn but no obstetrics.
- Internists can work as hospitalists and they usually function with more ease in this environment.
- Family practice physicians are trained to manage their own critical care patients, but the quality and intensity of this training varies from residency program to residency program. Graduates from programs with very little ICU time often will transfer care of their patients to Critical Care specialists or hospitalists until their patient returns to the regular floor. Internists receive much more in depth critical care training. Because of time constrains, many internists with office based practices don't handle their ICU patients themselves either and many, just like many pediatricians, will transfer care of their patients to hospitalists, even for regular floor patients, when their patients get admitted. By and large, though, internists are much better trained at inpatient care than family physicians.
-IM is the "portal", so to speak, to subspecialties: GI, cardiology, Hem/Onc, Critical care, etc. So, if you are thinking you would like to specialize, do IM.
- Although there is a myth that internists are better trained to manage outpatient complex cases, such as pts with several chronic disease, this is more dependet on the quality of the residency program and the graduate. I have observed family practice programs where the residents routinely managed inpatient and outpatient populations with several coexisting chronic conditions, and just as well as any internist. I think FP gets a bad rap here from a handfull of very weak and heavily opposed residency programs where the residents don't get to do/see squat.
- I have noticed that family physicians seem to be better at office procedures (splinting, suturing, etc) than internists. On the other hand, internists seem to be more comfortable with hospital procedures such as central lines. AGain, this reflects training and numbers done, but noth specialties can do all of these procedures, it just boils down to individual comfort levels.
To sum it up:
- if you want to have an office based practice, either FP or IM are fine but:
- if you don't ever want to deal with obstetrics or peds, do IM.
- if you love working with hospitalized patients or are thinking of doing a subspecialty, do IM.
- how much you want to love your 3 years of residency if, from the onset, you are thinking of being an office based general internist??? IM residencies are infamous for the loooooooong rounds, lasting from 8 am to sometimes well into the afternoon (aaargh) and you are going to find yourself spending lots more time in the hospital rather than in clinic. Weigh that against how much you really hate peds and obstetrics, both of which will be plentiful in a FP residency program.
- personally, if I was going to do IM, I would do my residency at a major academic center. On the other hand, if FP was my thing, I would pick an unopposed community program. This goes along the lines of the points I have just outlined.
Just a few things off the top of my head.
