Hospitalist Route: FM or IM?

[septoplasty]

I'll be applying this year, and as an IMG, so wont really have a wide variety of options/places to chose from.

I've had my hearts set on IM/FM, with being a hospitalist as the most ideal day-to-day practice setting I'd want to be in.

Things I do not like STRICTLY:
- Obs
- Peds

So in this scenario, coupled with liking inpatient only practice, does FM seem like a waste?

The other thing that's also puzzling me is that I've liked working in the ER, which would definitely help if I was trained in FM more so than IM (as it would cover Obs/Peds -- Not sure to what scope IM would cover Ob/Peds) if I chose to work in an rural ED setting.

Now I know that FM/IM would both possibly be able to work in the ER setting, but what about the hospitalist setting? Are they getting "replaced/dominated" by IM-hospitalists?

Any help deciphering my situation would be appreciated!

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[MedicineDoc]

You can be a hospitalist as either FM or IM. There are more IM than FM although the number of FM is going up. Some programs prefer IM others have no preference. Some are run by FM, some are IM/FM, some only IM. I believe the true number of FM hospitalists is approaching 10 percent currently. No one is going to replace someone they feel is working well in their program with an unknown quantity. Dominated? I haven't seen a noticeable difference between the two. Differences are mostly based on personality and individual abilities that I don't think would be different with IM or FM based training. There is a shortage of hospitalists just as there is a shortage of PCPs. I would think an unopposed FM residency would provide better inpatient preparation than an opposed FM residency program. My program was unopposed and included rounding on ICU patients which I think was a plus. Different programs have different needs and will want someone who can provide that need. Very small hospitals may expect procedures/vent management. These places may also have less flexibility in scheduling and if they are short staffed you may wind up doing more work than you are comfortable with or were sold on when hired. Some larger places may not require procedures as they may be covered by intensivist etc and have less staffing problems. Places where you are it without much specialty backup may offer better pay but be more "hairy" and potentially higher risk both to the patient and in terms of possibly getting sued. Often these type of places often have a larger hospital where they often transfer patients not doing well or requiring a service that is not available at the smaller hospital. Be sure to educate yourself about "tail coverage" before seeking any job in medicine once you have completed whatever training you pursue.

 

[septoplasty]

You can be a hospitalist as either FM or IM. There are more IM than FM although the number of FM is going up. Some programs prefer IM others have no preference. Some are run by FM, some are IM/FM. I believe the true number of FM hospitalists is approaching 10 percent currently. No one is going to replace someone they feel is working well in their program with an unknown quantity. Dominated? I haven't seen a noticeable difference between the two. Differences are mostly based on personality and individual abilities that I don't think would be different with IM or FM based training. There is a shortage of hospitalists just as there is a shortage of PCPs. I would think an unopposed FM residency would provide better inpatient preparation than an opposed FM residency program. My program was unopposed and included rounding on ICU patients which I think was a plus. Different programs have different needs and will want someone who can provide that need. Very small hospitals may expect procedures/vent management. These places may also have less flexibility in scheduling and if they are short staffed you may wind up doing more work than you are comfortable with or were sold on when hired. Some larger places may not require procedures as they may be covered by intensivist etc and have less staffing problems. Places where you are it without much specialty backup may offer better pay but be more "hairy" and potentially higher risk both to the patient and in terms of possibly getting sued. Often these type of places often have a larger hospital where they often transfer patients not doing well or requiring a service that is not available at the smaller hospital. Be sure to educate yourself about "tail coverage" before seeking any job in medicine once you have completed whatever training you pursue.

Thanks!

I guess i'll apply to some IM programs, but lean more towards FM.

So is it okay to explain to a PD (if asked why FM or why this program), that since this program is unopposed, and it provides quality inpatient experience, once licensed, I could act as a hospitalist as well in addition to doing normal FP (outpt).

Or is that equivalent to saying "oh i'm doing IM cause I want to subspecialize later on"?.

 

[MedicineDoc]

Thanks!

I guess i'll apply to some IM programs, but lean more towards FM.

So is it okay to explain to a PD (if asked why FM or why this program), that since this program is unopposed, and it provides quality inpatient experience, once licensed, I could act as a hospitalist as well in addition to doing normal FP (outpt).

Or is that equivalent to saying "oh i'm doing IM cause I want to subspecialize later on"?.

As far as FM programs, I would research programs well. I would ask if other residents have become hospitalist or are doing ER work. I would ask if residents follow their patients into the ICU and about ICU rotations. I would ask about ER rotations and possible moonlighting opportunities in 2nd year and or 3rd yr but not focus on potential money or hours but on possible experience/learning opportunities. I would say in personal statement that i am interested in an unopposed FM program that will prepare me for fullscope family medicine including inpatient, outpatient and potentially rural ER. If asked about OB and peds I would tell the truth but not bring it up if I didn't care to pursue these areas of practice or relate that I wanted to be prepared to see kids in the ER if necessary while doing rural ER.

 

[septoplasty]

As far as FM programs, I would research programs well. I would ask if other residents have become hospitalist or are doing ER work. I would ask if residents follow their patients into the ICU and about ICU rotations. I would ask about ER rotations and possible moonlighting opportunities in 2nd year and or 3rd yr but not focus on potential money or hours but on possible experience/learning opportunities. I would say in personal statement that i am interested in an unopposed FM program that will prepare me for fullscope family medicine including inpatient, outpatient and potentially rural ER. If asked about OB and peds I would tell the truth but not bring it up if I didn't care to pursue these areas of practice or relate that I wanted to be prepared to see kids in the ER if necessary while doing rural ER.

Okay thank you so much for the tips!

One thing that did come up while I was looking at your post, doesn't it seem crazy if I make it seem like I'm only looking for the experience/learning opportunities while doing moonlighting and not the financial gain? (making it seem too altruistic).

 

[MedicineDoc]

Okay thank you so much for the tips!

One thing that did come up while I was looking at your post, doesn't it seem crazy if I make it seem like I'm only looking for the experience/learning opportunities while doing moonlighting and not the financial gain? (making it seem too altruistic).

I remember FM candidates that came off as mostly interested in the money from moonlighting and they were all denied and our director made a point to tell us that was one of the main reasons. While its true you can make money moonlighting (our program had alot of moonlighting inhouse which made it very convenient) it was mostly set up by our director to facilitate learning. Seeming too "altruistic" as a medical student or resident is almost impossible. It's their job to make you competent and altruistic and most likely they take it very seriously. Remember when you get there as a 1rst yr in their eyes you are a dangerous person with good intentions until you allay their fears that you aren't competent or haven't reached competency and different directors will deal with this and the process attempting to make you competent in their own way. Coming across as thinking about money when in their eyes you still lack skills and should know that this is the most important thing will be concerning to them. By contrast appearing to know that your main goal is to get to the point where you can stand competently alone as a physician will ease their mind and give them confidence in you. Extra money is nice in residency but coming out with the skills you want and need is the name of the game. Moonlighting for us was almost like an extra leg of our program as our hours didn't approach the limit except only on certain rotations. Usually "service" rotations when we ran the FM hospital service including those patients destined for the ICU.

 

[scube]

If u STRICTLY don't like OB or peds. Why do FM? You will have to learn it.

 

[septoplasty]

If u STRICTLY don't like OB or peds. Why do FM? You will have to learn it.

But I figure if I want to do rural ER or something of that sort, then its a good idea to have experience in that, because I'd rather not be dumbfounded when I see a case of premature labor or something :/.

Versus if I tried doing IM w/ rural ER, it'd be more difficult because I'd miss out on those aspects.

 

[septoplasty]

I remember FM candidates that came off as mostly interested in the money from moonlighting and they were all denied and our director made a point to tell us that was one of the main reasons. While its true you can make money moonlighting (our program had alot of moonlighting inhouse which made it very convenient) it was mostly set up by our director to facilitate learning. Seeming too "altruistic" as a medical student or resident is almost impossible. It's their job to make you competent and altruistic and most likely they take it very seriously. Remember when you get there as a 1rst yr in their eyes you are a dangerous person with good intentions until you allay their fears that you aren't competent or haven't reached competency and different directors will deal with this and the process attempting to make you competent in their own way. Coming across as thinking about money when in their eyes you still lack skills and should know that this is the most important thing will be concerning to them. By contrast appearing to know that your main goal is to get to the point where you can stand competently alone as a physician will ease their mind and give them confidence in you. Extra money is nice in residency but coming out with the skills you want and need is the name of the game. Moonlighting for us was almost like an extra leg of our program as our hours didn't approach the limit except only on certain rotations. Usually "service" rotations when we ran the FM hospital service including those patients destined for the ICU.

Okay, this sounds perfect!

I was under the impression that they would be resistive to such a perspective.

Thank you so much.

 

[nd92]

If you want to do emergency medicine, you need to do an EM residency. Even at our pretty rural location the hospital (25 bed) is only hiring EM trained physicians. There are a couple of FM guys, but they were "grandfathered" in and are board-certified in EM. You may be able to find a couple of emergency medicine jobs somewhere in the US that will still hire a non-EM trained physician, but it will continue to become increasingly rare. I certainly wouldn't have that as a career plan today.

As a general rule, there are no backdoors into a speciality (and the few that exist will quickly close). You need to pick what you want to do and train in that specialty. If you are convinced that an IM/EM position will exist and be viable, then do a dual residency.

 

[MedicineDoc]

If you want to do emergency medicine, you need to do an EM residency. Even at our pretty rural location the hospital (25 bed) is only hiring EM trained physicians. There are a couple of FM guys, but they were "grandfathered" in and are board-certified in EM. You may be able to find a couple of emergency medicine jobs somewhere in the US that will still hire a non-EM trained physician, but it will continue to become increasingly rare. I certainly wouldn't have that as a career plan today.

As a general rule, there are no backdoors into a speciality (and the few that exist will quickly close). You need to pick what you want to do and train in that specialty. If you are convinced that an IM/EM position will exist and be viable, then do a dual residency.

Here is an email I recieved yesterday:

KENTUCKY:​

Are you available for Locum Tenens Emergency Medicine Coverage in KY??

We have multiple locations all over the state of KENTUCKY in need of EM Coverage with IMMEDIATE and ONGOING needs.

Volume and Trauma Level: Ranges from low to high depending on your preference

Location: all over Kentucky

Shifts: ranging anywhere from 8-24 hours

Training: Depending on Facility, may be IM/FP trained with EM experience

Coverage: Double MD Coverage, as well as Mid-Level Support Depending on Volume

PAID: TRAVEL, LODGING, and MALPRACTICE

If you are interested and have October/November availability ongoing, please contact me ASAP or forward me a copy of your CV along with your available dates.​

Thank you!

Erika

$$$$ If you don't have availability but know who might be interested in learning more about this opportunity, feel free to forward this email. We pay a referral bonus! $$$$​

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