FP vs IM

</font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by ussdfiant:
<strong>I thought that this trail would be well worn, but a quick search proved fruitless. What exactly can an internist do that a family practitioner cannot do and vice versa? Is ob the only difference?</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">The lines separating the two are frequently blurred. As the name implies, family practice physicians seek to achieve true "continuity of care" -- that is, treating the patient on the long term. This includes infants, children, and adults (i.e., the family). The scope of family practice includes pediatrics, ob/gyn, and adult medicine. A well-rounded family physician can address many of the needs of this patient population. Their patients also end up in the hospital, so their scope of practice isn't limited to the doctor's office either.

Traditionally, internists usually deal with adult medicine. Some are hospitalists, but most have some sort of office-based practice. Often times internists open up office-based practices and see children as well.

But, to address your question specifically, I can't think of anything that an FP can do that an internist can't and vice versa. One may have more experience than the other at certain things, and then there's the ethical question of whether one should be doing certain things (e.g., should an FP with little plastics and surgical experience be removing a suspicious mole from a patient's face? Should an internist be performing prenatal care?). Additionally, I haven't heard of FPs going on to do fellowships as internists do (but I can't say for certain). Moreover, I don't know if an FP can sit for the IM boards and vice versa.

You just have to think of what your ideal scope of practice will be. After you establish what you would like to do, what is the best way to achieve that and how will you best serve your patients?

 

Hi:

I agree with the above post on most accounts. I have never heard of an internist seeing kids. Unless they went back for more education, generally internists don't get any peds training. Most I know would not do prenatal care and they don't do any OB - so if you like doing deliveries then FP is for you.

There are some pragmatic things to think about. FPs are able to augment their income with procedures (like the ones mentioned above - although I don't know any who remove lesions on the face - but most other places are "fair game"). Most internists are not trained in outpatient procedures and I know of one who ended up going back for additional training to help her practice "make it".) To my knowledge, only gerontology and maybe sports medicine are open to FPs as fellowships (if I'm wrong someone will let us know <img border="0" title="" alt="[Wink]" src="wink.gif" /> . If you want to do specialty work then you need to do IM. Hope this helps. Good luck on your decision!

M-

 

Internal Med is becoming a springboard for something else. Doing an Internal Med residency often sets the stage to sub-specialize in GI, Cardiology, Pulmonology, ect... Also, it depends on the size of the hospital. Bigger places will have all the sub-specialists, so general Internal Med folks do a lot general practice stuff. Small places don't have all the sub-specilaists, so Internal Med folks will often be consulted for GI, pulmonology, and cardiology management.

Family Practice has several options for Fellowships. OB, Sports Medicine, Geriatrics, Occ Med, and several others are available. Take a look at the Academy of Family Physicians web site for a more complete list of available fellowships.

In a nutshell, there is a lot of overlap between IM and FP physicians.

Will

 

1) Internists study adult medicine for three years. They recieve no training in peds or ob. They DO recieve varying degrees of training in Gyn.

2) FPs spend three years studying adult med, ped med, ob and gyn. As a result, as compared to IM docs, FPs recieve far broader but less comprehensive trainging.

3) Both internists and FPs do procedures

4) Both FPs and internists may do fellowships, though there options are different. As a rule of thumb, an FP may do a fellowship but will always be in a sense a primary care doc. An internist may do a fellowship (let's say in heme onc.) and never again practice general medicine.

5) The American Board of Internal Medicine requires that 1/3 of time spent during residency for internal medicine be spent on outpatient rotations. This is true for both primary care focused and traditional categorical internal medicine programs. (by the way, you may choose to subspecialize after doing either the primary care or traditional type of program.)

6) As another rule of thumb, typicaly internists care for sicker adult patients with more complex problem. In my experience, an FP is more likely to refer a complex patient to a specialist than an internist. I have found that FPs tend to see healthier patients, and when their patients do get sicker they farm them out of specialists or consultants more familiar with whatever the patient may have. That said, they are still involved with the care, but more in the sense of following up and following through. I have seen many times FPs ask for consultations from internists on complex medical problems.

7) that said, one is not better than the other. I have found the two specialties to be quite different culturaly speaking. I think that this is the most important point. The FP tends to be more laid back and people oriented, while the internist tends to more oriented to solving complex puzzles and making the diagnosis. i know of few people in my class who had a hard time figuring out whether they wanted FP or IM. To the contrary, most people when interested in one where quite sure that the other was not their cup of tea. IM folks would not be happy doing FP and FPs are not interested in doing IM.

8) FP docs may not sit for IM boards, and vice versa.

For more info on internal medicine, I would suggest:

<a href="http://www.acponline.org/" target="_blank">http://www.acponline.org/</a>

 

All these posts were really helpful since I had the same Q as ussdfiant.....
Thanks to all of of u!