Honest input needed...

[bluealiendoctor]

My pride is gone, along with my money. I started this medical adventure late in life, 13 years post undergrad in fact. I struggled all through medical school but never failed a semester. My step scores are dismal, but passing. I know that my only options will be FM, IM or maybe Peds. Fine with me, those were what I was considering in the first place. Can anyone, preferebly residents or attendings, tell me what to weigh in comparing FM and IM? I'm not looking to make any magazine covers, I'm just an easy going, kind and compassionate person who loves medicine. I enjoyed all of my rotations save Psych..just wasn't for me. I am hoping to start residency July '09. I really don't know if I should focus on IM or FM. There are fewer Peds programs in the area I am applying to (wife is resident so must stay near her) so my chances are less. I was similar to Patch Adams in school with the exception of his grades (lol). Can someone without too much sarcasm give me some ideas? I just can't seem to decide which route to go. I am thankful to have gotten this far and I truly admire those Step 1,2 240+ people..amazing. I have lots of experience from being a Paramedic and critical care tech. I know I will make a good physician with good residency training. So guys what do you think, FM, IM or Peds? I would really appreciate your opinions.

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[Doctor Grim]

So guys what do you think, FM, IM or Peds? I would really appreciate your opinions.[/quote]


If you're even thinking about Peds, then I'd recom FM. You will also have a decent lifestyle during residency (except during your internship year and months on the wards) and as an attending. You certainly have a shot with your credentials at these specialties. Good luck!!

 

[dragonfly99]

Don't worry about your step scores...you passed and that's what counts in the end. Step scores matter a little more for IM, but there are plenty of places that would let you in I'd think.
For IM, remember you'll have lots of elderly patients with chronic diseases. You'll do more ICU/critical care time. You won't see any peds patients. I seldom see people <40 years old...well occasionally I do, in clinic.
If you do IM you could further specialize if you chose to later (same for peds).

If you do family medicine you'll probably take quite a bit less call as a resident. You'll probably do some more procedures. You'll probably see more younger folks and pregnant women. You might have more chance of working urgent care and/or ER later on in your career (fp folks usually preferred over internal medicine). You'll do more clinic and less inpatient stuff as a resident.

You should really talk to some middle aged practicing fp and IM and peds folks, if you're still undecided. Don't think about what you'll be doing in residency so much as what you want to be doing the rest of your life.

Be aware there is quite a bit of generalized unhappiness in family practice and general internal medicine right now...polls show quite a few of these docs wish they'd chosen a different specialty. There is quite a bit of financial pressure and pressure to see too many patients in too short a time. Opportunities to work as a hospitalist are prevalent,however, and the urgent care/doc in the box market seems good also.

 

[bluealiendoctor]

Thank you both. I really appreciate your input and thought it was very helpful. My true passion is EM, but I know I'd just be kidding myself with my scores. I was hoping some day FP might allow me to do some ER time. I know there are some FP's unhappy, but with my wife being a doctor also and who will make 250K+, I'm not looking to hit the big bucks. Don't need a mansion or a BMW just a comfortable life. I considered IM due to the wide range of specialties available, but in the end I think I just like the idea of having patients from all areas. Remember the movie 'Arachnophobia'? I liked Jeff Daniel's character....that sort of an environment..nothing real fancy, or even working at a community hospital. Anyway, I appreciate your input and thanks again.

 

[dragonfly99]

OK, so you like EM.
Well no sweat.
You could basically make yourself into an ER-like doctor (except without the major trauma cases, etc.) by going the family practice route. I am not kidding. I get job solicitations not that infrequently (since I am internal medicine) and a lot of the ones that are urgent-care or ER type opportunities in smaller towns or resorts say "family practice or med/peds doctor" - they want someone who can see kids AND adults or all ages. I am not fp, but I know there are even some 1 year-type added qualification/fellowship like things you can do in ER, if you are a family practice doc.

Also, there are IM docs who work mainly or only in the ER too. Likely peds types like that also. You won't be the attending in some big city hospital or academic med center, but you can be one of the docs (or the doc) in many medium and smaller hospitals. The VA also hires internal med and probably fp types to work in urgent care/lower acuity type ERs. I am internal med and I actually moonlight in a VA urgent care/ER type place. There really aren't enough ER docs around to staff every single ER in the world, plus those smaller less wealthy hospitals can't pay the amounts the ER docs want to make.

So one thing I wish I knew how to do better...or at all, really...is to sew up cuts/suture. That would really help me in the ER. Currently I have to call the surgery residents to do it for me (which is fine b/c we are a teaching hospital). I learned pretty well in medicine residency how to deal with most other emergencies I'd deal with in our ER (since we don't do major trauma), and I can do incision and drainage OK, but putting in those stitches...I just never learned. Also, you might want to try and get good at doing lumbar punctures...not necessarily as a med student, but focus on that when you are a resident. People who come in with headache and fever to the ER often need an LP.

By the way, internal med residents do about 2-3 months total in ER for a 3 year residency (I think I did 2). I'm not sure how much family practice docs do...but it does seem they do more procedures and perhaps more ER/acute care time.

I'm not sure you should just totally give up on ER if that is your passion...you could just cross-apply to a few ER residencies, along with applying either family practice, IM, or peds along with it. ER is harder to get in to that several other specialties, but if you could get to know an ER doc(s) at a particular residency they might be able to pull strings for you.

How about your medical school career advisor? Can't they help you out with this type of stuff?

 

[Lokhtar]

Have you thought about other specialties that are not as competitive? For example, Neurology, or Pathology? Just two cents.

Internal Medicine gives you more options to specialize later, but it doesn't sound like you would be competitive for high end academic places. Working as a Hospitalist is a very good option these days, where you get predictable hours and no call, so IM is always good.

 

[bluealiendoctor]

I lean towards FP because I hope to one day get some ER time. I want to go to a rural area eventually so I hope this might become possible. I am considering IM, but I know I won't get any fancy specialty. Pathology? Well, I know my scores are silly but in all honesty I just have too much personality to be stuck behind a microscope, or in a lab for that matter. It's really one of the best things going for me. I was a very successful paramedic, loved by the community and my peers, blah, blah. I really enjoy patients for the most part so I just don't see my spending my life in a field with so little patient interaction. I'm hoping for FP at this point, but will take IM if it comes. I guess I'll know in March! All said, I really appreciate all of your input. You guys have been very helpful!

 

[RussianJoo]

I say try to get into IM, doing an im residency leaves you a lot more doors open and not every fellowship is hard to get into, GI and Cards are really hard others you just need to pretty much apply and you'll get in. Also after an im residency worst case senario you'll end up doing exactly what you would if you went the FP route, i.e. start your practice or whatever.

 

[cleothecat]

Family practice (FM down there) and PEDS both have the option to do a fellowship in EM, In Canada this leads to board certification in EM.

I am biased towards FM (Father, wife ,and sister are family docs). You choose your lifestyle, and in the right practice is very gratifying .... and in Canada more remunerative than southside).

So cheer up. You will still be a doc and your choices are awesome. If you want to do a fellowship year in EM though you may need to excel in your residency years.

 

[windycityguju]

Have you thought about other specialties that are not as competitive? For example, Neurology, or Pathology? Just two cents.

Internal Medicine gives you more options to specialize later, but it doesn't sound like you would be competitive for high end academic places. Working as a Hospitalist is a very good option these days, where you get predictable hours and no call, so IM is always good.

pathology is more competitive than internal med. you can verify this from the latest NRMP match statistics. EM is harder than IM as well. you can forget about those with "dismal" step 1 scores (i'm assuming in the upper 70's)

For match '09, you can bet your highest chances are FM. they will take dismal scores, especially if you wanna be picky with location (being close to your wife). If you are in a big metropolitan location, it'll be harder. However, even EM is attainable if you try to go for some research positions. I've seen some IMGs get insanely competitive spots because they chose to do a year of research or sub-I's in that field. So technically, with time, it is all possible. Without time, your best bet is FM.

 

[bluealiendoctor]

Man, I can't think of a time when I had better responses to a question than this thread. All of you have offered some real good advice. I am finding myself leaning towards FM. I also know this is the most likely outcome of the match. Maybe I will find a way to get into EM a few years down the road. I was once quite an athlete so even Sports Medicine crossed my mind. I wished I had done an elective in SM so I could get an idea what this job/lifestyle entails. Any of you know?

 

[dragonfly99]

From what I know, there are about 4 ways to get in to sports medicine:
1) ortho sports med - that's out for you and most of us other mere mortals
2) family practice - has sports med fellowships...if you want to do that I'd try and go to some family practice program that has a sports med fellowship, otherwise you'll end up moving 2x. Also, I think if that is your interest you should mention that on your applications to those family practice residencies where they have a sports medicine fellowship. Everyone wants a resident who is interested in their program - it may make a difference for you.
3) pediatrics - some pediatricians do a sports med fellowships
4) ER - I think ER has sports med fellowships also
For what it's worth, internal med really doesn't have sports med fellowships any more. They have kind of been phased out. It's kind of a shame. I actually thought about sports med at one point, but once you get in IM you realize that most of the patients are pretty much decrepit and old, and IM residency, at least at an inpatient-oriented, academic hospital type place, really doesn't prepare one to do sports med. I believe the internal med accrediting folks got risk of sports med fellowships because they somehow felt it didn't fit in with internal med, or not enough people were doing the fellowships, or something.