FM vs IM

[DD214_DOC]

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So, really what are the big differences? I know IM can have their own outpatient clinics (adult only). I'm pretty sure they can't do any outpt gyn. Can they do procedures like FM? The military trains their FM docs to do a lot of procedures, like flexible sig, EGD, blah blah blah.

Just trying to find which has the most options. I think I would like being a hospitalist, but I think I would only want to do that if I tried the solo private practice thing and failed.

 

[iatrosB]

So, really what are the big differences? I know IM can have their own outpatient clinics (adult only). I'm pretty sure they can't do any outpt gyn. Can they do procedures like FM? The military trains their FM docs to do a lot of procedures, like flexible sig, EGD, blah blah blah.

Just trying to find which has the most options. I think I would like being a hospitalist, but I think I would only want to do that if I tried the solo private practice thing and failed.

This is a tough choice...although plenty of folks will tell you otherwise. If you go to a primary care track IM program, you can learn all the procedures that FM actually does in practice (excluding OB stuff like C-sections). You can absolutely do gyn, as much or as little as you want. The only thing you really can't do is kids less than 17 or so.

A good FM program will train you for hospital work so don't worry about that.

 

[HoloDoc]

IM also leaves you a door open to subspecialize through a fellowship (cards, GI, CCM, etc.).

IM grads are often better trained at inpatient procedures, like Swan-Ganz catheters, and ventilator management, which could be important if you pursue the hospitalist route.

IMO, IM offers more inpatient training due to the nature of IM's aging population, often with complex problems. I personally would probably go IM if I wanted to become a hospitalist. Establishing a solo private practice (and keeping it afloat!) is very hard in today's practice environment, so you may want to give some serious thought to the alternative IM-hospitalist route.

 

[piggie]

i dont see why FM is not allowed to specialize
who is to say FM is not capable of being trained in pulm/crt, endo, rheum, cards

 

[iatrosB]

Look, bottom line, make it easy on yourself. Do you want to take care of little kids or not? If the answer is no...obviously do IM. If the answer is maybe, think about IM. If the answer is yes...don't do IM. Both are great fields and I do think that you will be prepared for hospitalist either way (maybe more so in IM) and as long as you go to a primary care track IM program (don't think the Army has one) you will be prepared for office practice (probably more so with FM). It's a tough call, don't let others make it for you. Wait till you do your rotations, you'd be suprised at how much a difference that will make. Good luck.

 

[DD214_DOC]

Look, bottom line, make it easy on yourself. Do you want to take care of little kids or not? If the answer is no...obviously do IM. If the answer is maybe, think about IM. If the answer is yes...don't do IM. Both are great fields and I do think that you will be prepared for hospitalist either way (maybe more so in IM) and as long as you go to a primary care track IM program (don't think the Army has one) you will be prepared for office practice (probably more so with FM). It's a tough call, don't let others make it for you. Wait till you do your rotations, you'd be suprised at how much a difference that will make. Good luck.

This is the problem, I have been doing rotations for almost a year now and still can't decide. If their lifestyle didn't suck I'd do gen surg.

 

[iatrosB]

This is the problem, I have been doing rotations for almost a year now and still can't decide. If their lifestyle didn't suck I'd do gen surg.

yeah, but you haven't done FM or IM yet...judging by your timeline as your signature.

If you really like procedures, but want lifestyle maybe you should be pursuing Uro, Optho, Anes, or ENT...those are obviously competitive, not impossible.

 

[DD214_DOC]

yeah, but you haven't done FM or IM yet...judging by your timeline as your signature.

If you really like procedures, but want lifestyle maybe you should be pursuing Uro, Optho, Anes, or ENT...those are obviously competitive, not impossible.

I'm almost finished with FM now, and I did an IM selective a few months ago, although presumably the IM subspecialty rotation would be dramatically different from the general IM rotation.

 

[EdibleEgg]

Everyone has a bias on this one, but for practical purposes there is very little difference between FM/IM in the real world. Your patient care abilities will depend primarily on your hard work and motivation; not your speciality.

If you think you may want to be a partialist... then IM is the way to go. If are sure you want to do outpatient primary care with the option to be a hospitalist (or better yet do both), then family medicine is probably a better choice.

Either way, your choice of residency and your attitude/motivation are more important than IM vs FM.

 

[deleted87716]

Internal medicine is a subset of family medicine.

Seriously. I'm not saying that to piss anyone off. IM is adult medicine. It's even their slogan, for crying out loud.

A good FM program will teach you exactly the same things that you'll learn in an IM program, and then some. A crappy FM program is about as useful as a crappy IM program, so don't even go there.

Do IM if:
1) You never want to treat a child ever again
2) You never want to deliver a baby ever again
3) You really like seeing pretty much all old people, all the time
4) You aren't particulary interested in office procedures
5) You don't really care all that much about learning how to practice in the ambulatory setting, or don't mind having to figure it out on your own (because they aren't going to teach you how to do it in residency)
6) You want to specialize, even though specialty reimbursement is practically guaranteed to go way, way down in the not-too-distant future
7) You can't get into an FM program (there are way more spots in the Match)

😉

 

[DD214_DOC]

I know FM isn't all that competitive. I do not yet have my step I score back yet, but let's say I end up having to retake it -- I can still match into FM?

 

[deleted87716]

I know FM isn't all that competitive. I do not yet have my step I score back yet, but let's say I end up having to retake it -- I can still match into FM?

A definite "maybe."

 

[iatrosB]

Internal medicine is a subset of family medicine.

7) You can't get into an FM program (there are way more spots in the Match)

😉

👍

 

[iatrosB]

3) You really like seeing pretty much all old people, all the time
4) You aren't particulary interested in office procedures
5) You don't really care all that much about learning how to practice in the ambulatory setting, or don't mind having to figure it out on your own (because they aren't going to teach you how to do it in residency)

I have to contend with these though. If you go to a traditional IM program...I agree wholeheartedly. But if you go one that has a primary care track...it's a different story all together. You will learn procedures, how to run an office, and even do rotations in adolescent medicine.

 

[iatrosB]

I know FM isn't all that competitive. I do not yet have my step I score back yet, but let's say I end up having to retake it -- I can still match into FM?

If not match, then at worst case scenario...scramble. You'll get a spot SOMEWHERE.

 

[DD214_DOC]

I really should qualify my statements with, "get into a residency period". How common is it for people with retakes to not match, not get anything in a scramble, and basically have a doctorate to go work at mcdonald's?

 

[skypilot]

I know FM isn't all that competitive. I do not yet have my step I score back yet, but let's say I end up having to retake it -- I can still match into FM?

If you are a US grad and everything else on your record is ok and you pass step 1 the second time then take step 2 and pass it the first time you will have no problem matching into many specialties. (maybe not the most competitive ones).

 

[iatrosB]

I really should qualify my statements with, "get into a residency period". How common is it for people with retakes to not match, not get anything in a scramble, and basically have a doctorate to go work at mcdonald's?

Quit spazzing. You'll be fine, pass or fail.

 

[Drawing Dead]

I really should qualify my statements with, "get into a residency period". How common is it for people with retakes to not match, not get anything in a scramble, and basically have a doctorate to go work at mcdonald's?

If you don't get a residency slot at all, it's not just your boards, and probably how you interview as well. In that case, yes you can be the smartest fry cook at McDonalds.

 

[dr0277341283141]

FM people really are cogs. In FM, you are concerned primarily with evidenced-based medicine and memorizing guidelines. My FM faculty hated when I looked at uptodate and pushed Dynamed all the way. When a speaker came who had raw data from experiments, the faculty protested that the residents had no experience looking at such data and that something more digested should be presented.

If you enjoy reading the New England Journal of Medicine and like going to journal club, go into IM. It's not about pediatrics or not, because you could do an IM/Peds program. Although IM does involve evidence-based medicine, only that it's presented in the context of an understanding of the pathophysiology. It's about understanding what's behind the guidelines versus simply regurgitating them.

This is simply my observation.

 

[iatrosB]

 

[lowbudget]

If you enjoy reading the New England Journal of Medicine and like going to journal club, go into IM.

And that makes it... reason #107 to go into FM.

I am convinced they use journal clubs in Gitmo.

 

[lowbudget]

FM people really are cogs. In FM, you are concerned primarily with evidenced-based medicine and memorizing guidelines. My FM faculty hated when I looked at uptodate and pushed Dynamed all the way. When a speaker came who had raw data from experiments, the faculty protested that the residents had no experience looking at such data and that something more digested should be presented.

If you enjoy reading the New England Journal of Medicine and like going to journal club, go into IM. It's not about pediatrics or not, because you could do an IM/Peds program. Although IM does involve evidence-based medicine, only that it's presented in the context of an understanding of the pathophysiology. It's about understanding what's behind the guidelines versus simply regurgitating them.

This is simply my observation.

1. UpToDate is a good reference, but often times not EBM as it reflects the opinions of 1 author and his/her practice. It's good background information, but doesn't always answer patient-specific questions you might have. I don't believe it goes through a peer review process. Never used Dynamed though.

2. Obviously, speakers need to be careful when they present "raw data" or preliminary data. Because, well, it's exactly that.

3. If attendings are going to regurgitate something, I'd rather it be guidelines than some flawed study published in NEJM just because the author has political pull.

The issue you presented here isn't one about FM vs. IM... it's about practical vs theoretical and there are FM & IM's from both camps. A good FM/IM program should have faculty from both sides and should train you well in the theoretical and practical realm.

 

[deleted87716]

If you enjoy reading the New England Journal of Medicine and like going to journal club, go into IM.

I couldn't have said it better myself.

 

[deleted6669]

I am convinced they use journal clubs in Gitmo.

not under the new administration...in fact they are closing all journal clubs under an executive order and letting the captives do self study or work with their colleagues informally

 

[andwhat]

If you don't get a residency slot at all, it's not just your boards, and probably how you interview as well. In that case, yes you can be the smartest fry cook at McDonalds.

what does being a doctor have to do with being the smartest fry cook at McDonald's? ?????

 

[DD214_DOC]

what does being a doctor have to do with being the smartest fry cook at McDonald's? ?????

It means if you screw up too badly you can still graduate but never secure a residency, therefore rendering you extremely educated but completely unmarketable.

 

[AFSmiley]

not under the new administration...in fact they are closing all journal clubs under an executive order and letting the captives do self study or work with their colleagues informally

Additionally. GITMO detainees will be encouraged to read up on Epidemiology journals and to educate themselves about STD rates here in the United States.

Then they can qualify for well paid government jobs where they explain the difference in Herpes and Hepatitis prevalence in public school settings.