FM vs IM

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my greatest fear.
no thoughts on doing psych?
 
I'd say do the one you feel like you want to do and don't buy into the negativity the old program tried to sell you. They may say that you failed but they also failed. If all they could do is tell you your style of presentations was bad maybe they didn't have that much to teach and they had a problem with someone who actually could benefit from some teaching as in young self doubting attendings who may not be too stellar themselves. Go somewhere you respect and and learn from people you think will be willing to teach you the most in the field you're most interested in. Ob is not that tough and tends to be getting by the weird personalties it tends to attract more than anything else. Read the book ob/gyn blueprints before you startif you go fm. It is the best in that series and will give you a firm foundation if you decide on FM. If you want an IM fellowship go IM. Critical care is mostly just knowing ACLS algorythms, pressor drips levophed and maybe dobutamine if needed after fluids fail, For mrs vanc then linezolid then maybe daptomycin in that order if the first one fails, for possible pseudomonas doublecover (zosyn and something else), good broad spectrum coverage vanc and zosyn, obstructive pneumonia mabe clinda, consult when needed (inviting more flags to a sinking ship or rubber stamping when needed as in a surgical issue in someone who isn't in good enough shape to withstand surgery who needs a surgeon to say that) and knowing the protocols to institute such as heparin drips for pulmonary embolism. Know the basic vent settings and use the nomogram if you want for quick acid base diagnoses. Use your tools ie epocrates for your iPhone and up to date. Give the attendings what they want. Accept what they tell you even if it is or just seems wrong. Don't make waves with anybody including nurses even if they seem to be itching for a confrontation. Stay under the radar and learn as much as you can everyday. Ask questions as much as you think you can get away with without pissing anyone off. My 2 cents.
 
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yikes...stife bud. it was just a suggestion..no wonder they let u go.....i kid i kid.
i know what the nhl and ahl are.🙄
 
I switched from a program with a bunch of crappy young attendings who acted like they were trying to teach something when they were bitching people out about their "presentation style" or not having labs from 2 weeks ago on little sheets. They weren't fit to be chief servor at a kindergarten fantasy tea party much less try to teach me medicine. I would go with the attendings who have been in medicine a long time. There are some really good young attendings but statistically I would think there are alot more really good ones that have been around along time. Wouldn't look so much at the name. Look for the ones who seem to know something and have something to say about everything. Also if you go FM go for the unopposed programs from regional medical centers where FM docs ICU work. That way you get one on one with attendings of various specialties. Try to make sure they got a full deck of specialists that residents rotate with. My particular program has everything but neurosurgery with a 25 bed icu. Our residents go into straight FM, ER, and hospitalist medicine. Just my 2 cents.
 
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Interesting thread, and interesting questions raised by freeagent. I myself am going through the same decision process, and have applied in both FM and IM and will see what happens. One thing I found that I didnt know about earlier is preventive medicine/public health medicine. There are also 2 others like aerospace med and occupational med.
These are PGY2 and 3 - so only 2 years - and if you have 1 year already - you can go straight into them. Best thing is 1 year is for MPH full time, and the other is clinical rotations. You get a salary while doing MPH, as opposed to shelling out more dough. I've applied for this too.

I liked IM, and went into it through my own choice. But I dont know if the program was malignant or 'not a good fit'. I was on remediation (not probation) because I was slow to pick up clinically. Perhaps because I did 3 years of research before matching I dunno. But I got over it, and in the end attendings and PD were happy. Point is - when u interview or make your rank list - how can you tell if you'll be a good fit for a particular program?
Are community progs better in terms of less malignant and less eyes on you than univ progs? I ask because my other family members all went to community progs and got great evaluations (and are probably great docs too) but weren't on remediation. I think everyone probably has trouble adjusting in the beginning of the year to a new environment, new culture, new computer system, etc, and some get over it faster than others. My prog has put many others on remediation or probation, only to have them all lifted 2-3 months later. Is it appropriate for a program to say someone needs remediation after their first several weeks of starting!? Too me that is a bit excessive....

As others have mentioned, attending types and personalities differ greatly in terms of 'support' they provide to residents. I mean thats the whole of training and thats why its called residency right - theyre meant to teach you and help you overcome your deficiencies. But not everyone does that.

There will also be different rotations that you like or dislike, and some that you will excel and some you wont. I myself had trouble with CC - as it was too overwhelming for me to decipher the multiple problems ICU had and prioritize and treat them.

In the end, I figured FM may be a lot more 'benign' than IM, and the variety of ages and symptoms will keep me on my toes. If you're a big picture like myself, perhaps primary care is more suited to our personalities that super-sub-specialization in which you know more and more about less and less and go to minutiae and are expected to know esoterics. That's when I'd refer to my more experience colleagues hehe 🙂
 
Personally, I wouldn't go anywhere you thought it might be round two of the same thing. I hated some of the main players so much at my old program that I felt that it was bad for my health. It wasn't the long hours or the work. It was the lack of teaching, the lies, the evals that were complete bs and 6 months late. It was the nurses that felt so empowered that the could walk all over residents and then just lie about crap. Douchebags with a capital D ran the place. It was all scut all the time with no time to study and extreme work hours violations.
 
Hey snowbank,

I responded to your private message but got no response. Let me know if you received my message.

As for MedicineDoc, thanks again for your response. I can always count on you for some cheerleading.

On another note, anybody know a good website for residency reviews besides scutwork.com?

Thanks.
 
Why would you want to go into family medicine if you don't love doing pediatrics and ob/gyn as well?

I get what you don't like about internal medicine--but do you like all of the parts of family medicine?

Best of luck to you!
 
....
 
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There was a post here. I removed it because this is not the proper venue for this discussion.
 
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jackieMD2007 said:
Why would you want to go into family medicine if you don't love doing pediatrics and ob/gyn as well?

I get what you don't like about internal medicine--but do you like all of the parts of family medicine?

Best of luck to you!
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I'm post call, so if this comes out sounding like I'm a jackass you'll have to forgive me.

You don't have to like every aspect of FM to want to do it. I dislike delivering babies. Luckily for me, I only have to do that 40 times. If you dislike newborn exam, you only have to do those for a handful of months. Granted if you hate adult medicine, then family isn't the place for you.

FM's strength, to my mind, is that you can pick and choose exactly what type of outpatient medicine (or inpatient if that's your thing) you want to do and just do it.
 
I'll toss my two cents in here. As an FP trained doc, I lament the fact that I didn't do med-peds for the simple reason that I love things like cardiology, gastroenterology, etc. Had I done med-peds, I would have had more ICU/critical care exposure AND had the field wide open to fellowships. I don't have those options being a family medicine doc. I can't even do a freaking allergy/immunology fellowship, and that should be one of the ones I AM allowed to do.

Also, in FP, I got a lot of OB exposure at my program (I was Air Force and placed into a residency program...I didn't have a choice) and I never use it. It was like wasted time for me. Someone mentioned that they only had to do it 40 times. Well, if you don't like it, that's 40 times too much.

With medicine being so specialized anymore, you can't afford to waste any time learning skills you'll never use again. Plus, let's face the facts. Family practice docs, in general, are looked up with general disdain by not only the medical community, but patients. I had a guy tell me today "I don't expect you to really take care of me, I just need you for referrals". I was pissed, and at the same time understood his point of view. I can't possibly have the kind of knowledge that his dermatologist, gastroenterologist, and cardiologist have about his complicated issues. When you're an FP, your knowledge is about a mile wide and a few inches deep. When I was in clinic today I was switching gears like crazy.....vaginal bleeding 23 year old, dementia in a new 88 year old patient, ADHD evaluation/med f/u for a 12 year old, and a 2 month new baby visit. Sounds fun, sounds exciting, but I stress with wondering how I keep all of that in my head.

Finish what you started, knock out your IM residency, and it leaves the fellowship training field wide open. And work on any personality defects you have and play nice.
 
FlyDoc34 said:
Family practice docs, in general, are looked up with general disdain by not only the medical community, but patients. I had a guy tell me today "I don't expect you to really take care of me, I just need you for referrals". I was pissed, and at the same time understood his point of view. I can't possibly have the kind of knowledge that his dermatologist, gastroenterologist, and cardiologist have about his complicated issues.
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Oh, really?

Next time you get a note back from one of those specialists, look to see who actually saw the patient. Was it the doctor, or their mid-level?

I haven't met a cardiologist yet who treats cardiovascular risk factors as aggressively as I do. Most of them don't even order Lipomed profiles. Heart disease is a primary care disease state.

Find me an endocrinologist whose diabetics are better controlled than mine. Diabetes is a primary care disease state.

I could go on and on.

Most of my referrals to specialists are for procedures. I can handle the "thinking part."
 
Then you are a very rare FP doc. For those of us with average intelligence, we're just not as good as you. If you can manage that 79 year old's problems that well in a 15 minute visit, then you should write a book on how to do it.
 
FlyDoc34 said:
Then you are a very rare FP doc. For those of us with average intelligence, we're just not as good as you.
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That may be true, but you shouldn't sell yourself short. Most patients will benefit far more from a single specialty of breadth than multiple specialties of depth.
 
I've come to believe the mantra of "You don't become a master by doing 6,000 things, you become a master by doing 12 things 6,000 times".

Another nice thing about being a specialist is you can say "Nope, it's not your heart/liver/anus/lungs/sinuses. Go back to your PCM and reengage with him/her." I can't turf my patients back to their PCM because I AM their PCM. I suppose I could always piss them off and they'd leave the practice, but I hate rejection, even from psychopaths.
 
FlyDoc34 said:
I've come to believe the mantra of "You don't become a master by doing 6,000 things, you become a master by doing 12 things 6,000 times".
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I guess mantras don't necessarily have to make any sense. I've certainly never heard that one before.

Another nice thing about being a specialist is you can say "Nope, it's not your heart/liver/anus/lungs/sinuses. Go back to your PCM and reengage with him/her."
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That's not nice, that's lame! Do you really think patients want to hear that? Let them send the patient back to you. They're doing both you and the patient a favor.

I can't turf my patients back to their PCM because I AM their PCM.
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Anyone can turf anything anywhere. Or not. It's entirely up to you.
 
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FlyDoc34 said:
When I was in clinic today I was switching gears like crazy.....vaginal bleeding 23 year old, dementia in a new 88 year old patient, ADHD evaluation/med f/u for a 12 year old, and a 2 month new baby visit. Sounds fun, sounds exciting, but I stress with wondering how I keep all of that in my head.
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Sounds like a great day to me. I'm sorry you didn't choose the residency that best fits your personality, but that doesn't make IM a better choice than FM.
 
FlyDoc34 said:
I had a guy tell me today "I don't expect you to really take care of me, I just need you for referrals".
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Hahaha... Yea, I've had these comments too. People don't know how insulting those comments are. The thing is, I'm bold enough to tell them that if that's how they feel, they need to switch to an insurance that doesn't require a referral from me. Quit wasting your & my time, Ms. Cheapskate. I lose the patient, but they didn't reject me. I rejected them. Most, however, appreciate my honesty.

The irony in your post is that you, on one hand, lament how patients who don't need you except for referrals, & then on the other, lament that they keep coming back to you even if you want to turf them.

My practice sounds like yours, and sounds like I practice like Blue Dog.

You're right about the mastery thing. I think, I do what I do well because I do it all the time. You don't need to be fellowship trained to be good at what you do.

My guess is that you're a much better doc than what you're telling us?
 
FlyDoc34 said:
I'll toss my two cents in here. As an FP trained doc, I lament the fact that I didn't do med-peds for the simple reason that I love things like cardiology, gastroenterology, etc. Had I done med-peds, I would have had more ICU/critical care exposure AND had the field wide open to fellowships. I don't have those options being a family medicine doc. I can't even do a freaking allergy/immunology fellowship, and that should be one of the ones I AM allowed to do.
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This sounds like it has more to do with your choice of Family Medicine than it does with Family Medicine as a field.
 
drwatson said:
This sounds like it has more to do with your choice of Family Medicine than it does with Family Medicine as a field.
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That was my thought as well. We all know that a) We have to do 40 deliveries but fewer and fewer FPs do any OB b) we can't do any IM fellowships c) there are people (patients and specialists) that underestimate what we can do. Those things sound like a big problem to a medical student, he/she should not do family medicine.
 
There was a post here. I removed it because this is not the proper venue for this discussion.
 
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freeagentmd said:
I want to provide good primary care, perhaps also see my patients in the hospital if they require admission. Do people feel FM docs are spread too thin? That was the major reason why I initially chose IM. That being said, few IM residents are interested in primary care and I felt my primary care training was weak (particularly in regards to procedures; most preceptors refused to precept procedures because they were uncomfortable performing them). So in regards to my interest in being a primary care provider that also provides some in-patient care, what field do people recommend?

Thanks again to all the contributors.
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Family Medicine, in my mind, does the best job of training primary care docs. You have required SportsMed/Ortho experience, training in Derm, psychiatry, Women's Health and behavorial medicine. This comprises a lot of what you will see in clinic as a PCP. Not only that, most programs offer 3 months of elective to gain experience in whatever field you choose. Additionally you will get 6-12 months of inpatient exposure as well.

The exposure to outpatient procedures is great. It is very gratifying to see a skin lesion, biopsy it and then remove it (if need be). Same for injecting a shoulder or knee. I see and do all of these in my clinic routinely and I'm a resident. Additionally I will feel very comfortable rounding on my hospitalized patients before clinic each day, when I grow up and get a real job.

Granted this comes at the expense of sub-speciality exposure like Heme/Onc or Pulmonology but it all depends on what you want out of your career and how you see yourself practicing. If you see yourself working with a more specific group you can always do more elective time in sub-speciality areas as well.

Don't forget Family Medicine still has fellowships too. Sports Medicine, Palliative Medicine, and Women's Health to name but a few.

In short, I feel Family Medicine has it for teaching full scope Primary Care.
 
drwatson said:
Family Medicine, in my mind, does the best job of training primary care docs. You have required SportsMed/Ortho experience, training in Derm, psychiatry, Women's Health and behavorial medicine. This comprises a lot of what you will see in clinic as a PCP. Not only that, most programs offer 3 months of elective to gain experience in whatever field you choose. Additionally you will get 6-12 months of inpatient exposure as well.

The exposure to outpatient procedures is great. It is very gratifying to see a skin lesion, biopsy it and then remove it (if need be). Same for injecting a shoulder or knee. I see and do all of these in my clinic routinely and I'm a resident. Additionally I will feel very comfortable rounding on my hospitalized patients before clinic each day, when I grow up and get a real job.

Granted this comes at the expense of sub-speciality exposure like Heme/Onc or Pulmonology but it all depends on what you want out of your career and how you see yourself practicing. If you see yourself working with a more specific group you can always do more elective time in sub-speciality areas as well.

Don't forget Family Medicine still has fellowships too. Sports Medicine, Palliative Medicine, and Women's Health to name but a few.

In short, I feel Family Medicine has it for teaching full scope Primary Care.
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I think our procedural training is what really makes us great PCPs compared to IM/Peds. I'm working in the local peds clinic and in the last week alone I've seen 2 patients referred out for stuff that wouldn't make anyone bat an eye in an FP office. Before I got there yesterday, we referred a 9 year old kid out to a dermatologist to get 3 warts frozen off. Earlier this week, we sent a kid with an ingrown toenail to podiatry (I'm an intern and haven't done one of those yet, otherwise I'd have offered to do it myself).

I'm sure the pediatricians are better at LPs than I will likely be, but fairly straightforward outpatient procedural work seems more important in a PCP.
 
"working out the personality kinks on ur downtime".🙄...you're weird dude...
no but seriously, buddy, sounds like you got a beat personality....maybe an only child...a little selfish...upper crust...mmmmm
good luck marcy, you're gonna need it.
go play for the nhl.:laugh:
:diebanana:....you need a lil of this
 
There was a post here. I removed it because this is not the proper venue for this discussion.
 
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Well, congratulations in the slew of interviews lined up free. I, on the other hand, only have 2 FM and 2 IM (and some of those were from personal referrals to boot).

But let's get back to you - can certainly understand the thought process behind conspiracy (they manufactured the eval to support their decision) vs. self-doubt (maybe I DO have those deficiencies). God knows I'm going through the same thought process myself these days!

On a much more simplistic level though - if you're 'worried' about critical care - I dont know about others, but at least in my program, the FM residents have 1 ICU month - and whenever they are on call, they are not alone and an IM resident (usu. a senior as opposed to intern) tag teams along with them. There's always support that way, and FM residents aren't expected to individually admit and make decisions on a patient.
 
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