FP vs. IM

[waverunner]

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I know there have been millions of discussion on this before.
But I would still like to get your opinions on this.
I am a 3rd yr med student trying to figure out which residency to apply to.
I pretty much came down to FP vs. IM but I am not sure how I can r/o or rule in one over the other. What are the pros and cons of both?

If anyone had a similar dilemma in the past or are having one now, please drop your 2 cents on this topic...

(My current understanding is that I should go into FP if I want to work in outpatient / clinic setting vs. I should go into IM if I want to be in the hospital for majority of my practice.
Also I see the draw to IM b/c then you'd be able to subspecialize and this leads to more procedure and more money (in general).

As for me personally, FP seems to be what I want to do for the moment since I like outpatient pt care more than inpatient care and I am thinking of pursuing sports medicine fellowships...but I am still not 100% sure)

Any advice / opinions will be appreciated!

Thanks guys!🙂

 

[deleted87716]

I like outpatient pt care more than inpatient care and I am thinking of pursuing sports medicine fellowships...but I am still not 100% sure

Sound like you've already made up your mind. You'll never be "100% sure" about something before you do it. You have to go with your gut.

 

[John Deere Gree]

I was in the same boat as the OP. It comes down to what you want to do.

For me, I wanted to have some pediatrics in my practice so that's why I chose FM over I'M. I'm still undecided about OBGYN, and if I don't want to deal with OB in my future practice, so be it.

If you are absolutely unsure by application for residency time there are two FM/IM combined programs-St. Vincent in Indianapolis and Eastern Virginia.

Good Luck.

 

[lowbudget]

FM = outpatient and IM = inpatient is an oversimplification. Really, it depends on your training exposure, your comfort in your skills, practice environment, and community needs. There are plenty of outpatient internists and FM hospitalists. If you're not sure, find a training program that's well-rounded.

If you're interested in SM, FM is the way to go. There's more opportunities in FM residencies for you to get experience than there are in IM. Most fellowships favor FM anyways. I believe IM will no longer be able to get their SM CAQ starting next year.

 

[Shinken]

As for me personally, FP seems to be what I want to do for the moment since I like outpatient pt care more than inpatient care and I am thinking of pursuing sports medicine fellowships.

You can do a sports medicine fellowship in IM as well.

 

[waverunner]

Thanks for all your opinions/advices.

I was wondering if anyone can name an IM + Sports Med program...

I cannot seem to find it.

Also I just came across this thing called IM-Primary care track. Could anyone elaborate on the difference btw FP and IM-Primary care track? To me, it seems they are awfully similar...

Thanks!🙂

 

[lowbudget]

Thanks for all your opinions/advices.

I was wondering if anyone can name an IM + Sports Med program...

I cannot seem to find it.

There aren't any anymore. You can look it up on FRIEDA or ACGME Search Program. All IM's looking to get into fellowship apply to SM programs hosted by FM. You can do the fellowship, but I believe starting next year, you can't sit for the CAQ. Unless you create your own opportunities, IM is at a slight disadvantage because SM is not built into their curriculum and therefore opportunities may not be as easily accessible.

Also I just came across this thing called IM-Primary care track. Could anyone elaborate on the difference btw FP and IM-Primary care track? To me, it seems they are awfully similar...

Thanks!🙂

I think in the real world, it doesn't make a difference, aside from the Peds. To me, the difference is in the training structure.

1. Focus on continuity clinic: FM residency views the continuity clinic as "the OR for family physician". You have your own clinic & own patients where faculty will help precept. It's varies from program to program, but generally R1s will have 1-2 half days per week, then it increases to 2-3 in R2, then 3-5 in R3 (ACGME doesn't care how many half days... they only care about how many patients you see). In IM-PC, you have 1 half day of clinic per week for all 3 years.

Generally, most FM programs will be "front-heavy" (i.e. more inpatient months during R1 with more outpatient months in R3). You call schedule lightens up as you advance, which means less post-call days, which means more days available to be in clinic or on rotation. I don't know how IM works, but I imagine they have a lot of inpatient time, which means they'll miss out on outpatient time due to post-call rules.

This scheduling is very important and is something to think about. You don't want to be q3-4 call doing CP rule-outs, cocaine detox with post call days landing on days you could be in ortho clinic, cards clinic, or radiology for example. You'll miss out.

2. Preceptor rule: FM residencies are exempt from certain preceptor rules (where faculty must see every one of your clinic patients after you). I don't know if IM residents are exempt, but in FM, it's thought that faculty going into every clinic visit disrupts continuity of care. And so, you don't need to have a faculty see every patient unless you precept it.

This isn't that important, but does affect your autonomy in making decisions in the clinic. You want to be able to make your own decisions (and live with the consequences). And, you want your patients to respect your decisions and not wait for the faculty to come in to the room and repeat everything you just said. It slows you down in clinic, and you end up seeing less patients. Less patients = less pathology exposure

3. Ambulatory "blocks": In IM-PC, you do these ambulatory blocks to get more outpatient experience. And in these ambulatory blocks (3 months per year), they squeeze in ortho, uro, ophtho, gyn, geri, etc. From what I've read, some programs do a mish-mash of different clinics. In FM, these specialities have their own discrete 4 week blocks (some are 2 weeks).

I don't think it there's that much of a difference. Personally, I like how the FM continuity clinic increases as you advance. It makes you more available to your clinic patients and therefore allows you to see more. Could you imagine if your doctor only had 1 half-day of clinic per week? It'd be impossible to get into to see them that you'd end up going elsewhere.

That said, the disadvantage is that as you advance, your time spent in rotation decreases because your continuity clinic time increases. So the curriculum chart is deceptive because you think you're getting all these blocks of rotations, but the actual time spent isn't that much.

That's why you have to scrutinize the schedule and make sure the important rotations are mostly during 1st and 2nd year and then by the 3rd year, the rotations are there to refine what you've already seen in your continuity clinics.

No curriculum is perfect. No matter what specialty you choose, your time is limited. So spend it wisely.

 

[iatrosB]

I think in the real world, it doesn't make a difference, aside from the Peds. To me, the difference is in the training structure.

In my program (IM-PC), we have less inpatient months in year 2 and 3 (program is "front-loaded" in year 1). We also have 2-3 half days of clinic in year 2-3. Also, the outpatient rotations (more like 4-5 months) in year 2-3 are full months dedicated to ortho, gyn, derm...

I'm sure every programs different so it takes some research...but mine is set up great, more like an FM program without the pesky pregnant ones and really tiny ones.