Let me ask...why do you think that if you “study” a little more, you can do endo or rheum, but have to refer out to gi and cards? Do you really think it’s that easy to pick up?
I’m sure all those mid levels all wanna practice a little internal medicine...and those of us that actually practice IM know what it really entails...
You wanna take care of diabetes and some thyroid ...trust me you will get to do that because there are just not enough of us out there to take care of all the pts out there that have diabetes and hypothyroid pts out there...but there are fellowships in these fields for a reason...
And there are plenty of PCPs here and out in the real world that like their clinics and their pts and are respected...I have mad respect for the PCPs out there...mostly because I do not have the patience that these people have!
If prestige or other external forces are what drives you, then you are going to be disappointed...
To piggyback on my colleagues statement - I'm going to repost an old comment of mine.
So lets answers it in two parts.
1) Can you *theoretically* practice the full breadth of endocrinology as an internist?
Maybe. I can say that I think I was a pretty good internal medicine resident. I passed my IM boards quite comfortably - a standard deviation or two above the mean with endocrine being my best section. I got a single diabetes question wrong - I still have no idea how. So from that background, I can say that I was probably better at Endocrine than the vast majority of fresh IM graduates.
And yet... When I started Endocrine fellowship, there was plenty that I didn't feel comfortable with. Particularly during my first year, I learned a lot - not just on the nuances of DM management (though there was plenty of that), but also about identification and management of rare endocrinopathies. Most (all?) of this information is available in the literature - but learning it under the guidance of current endocrinologists helped me solidify my practice patterns and guide my reading to identify the good literature from the bad.
Could you drill down, read all the guidelines and references, go through JCEM and the other major journals, go to a few endocrine conferences and get much of the same knowledge? Probably, if you worked at it. But you won't have had the dedicated time to apply it in practice.
Other than thyroid aspirations (which many of us don't do - I don't), there's no specific *procedural* training that you can't pick up as you go along, and you can even probably take a few AACE courses on thyroid aspirations if you were interested.
Insulin pump management is nuanced, but don't worry about that - Medtronic would love to train you to manage insulin pumps (and to only prescribe their products, but that's a different story).
2) Can you *realistically* practice the full breadth of endocrinology as an internist?
No. At least not exclusively. To practice as a subspecialist, you need referrals. To get referrals, you need to be on insurance panels as a subspecialist. To do that, you need board eligibility/certification in said specialty.
You *could* practice primary care, focus on endocrinology, and manage the endocrine problems within your practice while referring out the other issues. But then you're
not practicing endocrinology. You're practicing primary care. With all that entails.
When a patient complains to me about their knee pain, I can tell them to follow up with their PCP. When they have fatigue and I've identified it is not from an endocrine etiology, I can tell them to follow up with their PCP. I don't deal with URIs, keeping track of colonoscopies (unless you have Acromegaly) or mammograms (unless I prescribe you estrogen - and I typically decline those consults), etc. I
could - I am in fact a board certified internist - but
I don't want to. The practice of Endocrinology is very different from the practice of primary care - and to me, that difference was worth the $400k opportunity cost. There are plenty of people for whom that is not true - but it is a very valid point.
I enjoy my job. Pretty sure
@rokshana enjoys her job. I'm also reasonably sure neither of us particularly want to do primary care. Oh, and please feel free to send me all of your complex diabetes, osteoporosis, transgender patients... I'd love to see them. Just don't send me undifferentiated fatigue.
