How did you decide between Family Medicine and Internal Medicine?

[ShenMeYiSi]

Hi All,

I'm a US-IMG applying this fall, quite broadly, but wanted some feedback on how those of you who went into family medicine made your decisions to do so. I have spoken to a few residents and attendings about the same thing as I've been rotating, and I wanted more perspective on what you all thought were benefits and pitfalls of one or the other, if there are any at all.
My main reasoning for focusing in on family practice was how broad the reach is into ob/gyn and peds, which is essentially not part of IM training. I like that at some places there are options to do more of these than pure IM practice, and I enjoy that there is a potential for integrating a tiny bit of psych at times, as well as serving as a 'jack of all trades' kind of physician, which I think is great. I'm not crazy about subspecialization or anything like that, which is why IM for me is not really as attractive. I've heard a lot of people make comments that going into FM would leave me with less 'options' or I would "limit myself" if I were to choose FM over IM, but my question is....how? Why is there this concept that you could sell yourself short by going into FM? Is that even true?
I know different locations have a different attitude and need for family practitioners, so it would be interesting to know what your experiences have been like in that regard as well. How is the general culture of FM programs different from IM programs, and, in places where FM and IM residents/attendings work together, how is the dynamic?

Thanks and looking forward to hearing your responses!

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[Blue Cohosh]

I'm applying FM this year and my final decision was also between FM and IM. I have chosen FM for many of the reasons you stated above. Firstly, I know that I want to do primary care and am 99% sure that I don't want to sub-specialize. Given that, I think that FM offers both more options and better training for what I want to do in my career. By more options I mean the flexibility to do peds and OB/GYN and by better training I mean more experience in the outpatient clinic, more MSK training, more psych training, and more procedural training.

 

[primadonna22274]

Truly my decision came down to which program--not which specialty--was the best fit for me. I interviewed both IM and unopposed FM and a handful of med/psych. I hate hate hate OB but liked the flexibility of FM to do procedures, inpatient medicine, and EM (I've worked the past 9 yr as a PA in EM, 5 years actively and the past 4 per diem, but never wanted to be an EM physician exclusively).
The only fellowships that really interest me are geriatrics and hospice/palliative, both of which I can do as FM or IM. My local program 10 minutes from my house turned out to be where I felt at home and when it came time to rank my programs, although I agonized a bit over giving up my chance at some excellent university IM programs, when I finalized that rank list I was at peace.
FM can be a hard residency at times, but it's also very human. Any ward months in any specialty I imagine are hard. But now as a PGY2 with intern year behind me and finally getting my weekends back I am appreciating that I chose the flexibility and breadth of FM that will prepare me widely to do just about whatever I want to do 2 years from now.
Good luck.

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[organdonor]

I wanted to do deliveries.

 

[ShenMeYiSi]

Truly my decision came down to which program--not which specialty--was the best fit for me. I interviewed both IM and unopposed FM and a handful of med/psych. I hate hate hate OB but liked the flexibility of FM to do procedures, inpatient medicine, and EM (I've worked the past 9 yr as a PA in EM, 5 years actively and the past 4 per diem, but never wanted to be an EM physician exclusively).
The only fellowships that really interest me are geriatrics and hospice/palliative, both of which I can do as FM or IM. My local program 10 minutes from my house turned out to be where I felt at home and when it came time to rank my programs, although I agonized a bit over giving up my chance at some excellent university IM programs, when I finalized that rank list I was at peace.
FM can be a hard residency at times, but it's also very human. Any ward months in any specialty I imagine are hard. But now as a PGY2 with intern year behind me and finally getting my weekends back I am appreciating that I chose the flexibility and breadth of FM that will prepare me widely to do just about whatever I want to do 2 years from now.
Good luck.

Sent from my SAMSUNG-SM-N910A using Tapatalk

Thanks for this! Sounds like my ideal situation.

 

[SLC]

Had some decent interest in Oncology, was planning on IM as a result. Then did an oncology elective 4th year that put me with the Palliative Care team a few afternoons a week. Realized that I like the palliative aspects of cancer care more than the chemo end of it.

So I took stock (because I also hated my IM ward-based rotations) and decided that since I would probably do palliative care of I went fellowship; what did I think about FM vs. IM.

In the end it was the fact that I'm much happier in clinic, that I like Peds and OB, and that I think FM is just a really cool field and a better match for my personality and style. I haven't regretted the decision.

I'm only a few weeks in to PGY-1, but I'm way stoked for residency. I know in IM I would have been dreading all the time on the wards. This year I'll do 4 months of inpatient, 2 months of OB, a month of inpatient peds, and the majority of the rest will be clinic based experience that I'm very happy and interested to be doing.

I would struggle spending the majority of my time on the medicine wards as an IM resident.

 

[Board Vitals]

Hi All,

I'm a US-IMG applying this fall, quite broadly, but wanted some feedback on how those of you who went into family medicine made your decisions to do so. I have spoken to a few residents and attendings about the same thing as I've been rotating, and I wanted more perspective on what you all thought were benefits and pitfalls of one or the other, if there are any at all.
My main reasoning for focusing in on family practice was how broad the reach is into ob/gyn and peds, which is essentially not part of IM training. I like that at some places there are options to do more of these than pure IM practice, and I enjoy that there is a potential for integrating a tiny bit of psych at times, as well as serving as a 'jack of all trades' kind of physician, which I think is great. I'm not crazy about subspecialization or anything like that, which is why IM for me is not really as attractive. I've heard a lot of people make comments that going into FM would leave me with less 'options' or I would "limit myself" if I were to choose FM over IM, but my question is....how? Why is there this concept that you could sell yourself short by going into FM? Is that even true?
I know different locations have a different attitude and need for family practitioners, so it would be interesting to know what your experiences have been like in that regard as well. How is the general culture of FM programs different from IM programs, and, in places where FM and IM residents/attendings work together, how is the dynamic?

Thanks and looking forward to hearing your responses!

Hello,
You are definitely not selling yourself short by going into family medicine. Internal medicine only focus on adults where as family medicine focuses on all aspects of pediatrics, adolescent medicine, OB, adult medicine and geriatrics. You can also work in an outpatient setting, inpatient setting, urgent care and an emergency room. Also you may want to consider Internal Medicine/Pediatrics aka MedPeds. This specialty is very competitive but it allows you to become double boarded in both and you can sub-specialize in basically whichever field you want. There are lots of options in FM and IM however if you want to see kids and pregnant woman then you may be unhappy in IM. I hope this helps. -M.D. Author/Editor BoardVitals

 

[VenturaResident]

Hello,
You are definitely not selling yourself short by going into family medicine. Internal medicine only focus on adults where as family medicine focuses on all aspects of pediatrics, adolescent medicine, OB, adult medicine and geriatrics. You can also work in an outpatient setting, inpatient setting, urgent care and an emergency room. Also you may want to consider Internal Medicine/Pediatrics aka MedPeds. This specialty is very competitive but it allows you to become double boarded in both and you can sub-specialize in basically whichever field you want. There are lots of options in FM and IM however if you want to see kids and pregnant woman then you may be unhappy in IM. I hope this helps. -M.D. Author/Editor BoardVitals

Maybe I'm off the mark here, but it sure seems like you are offering pretty generic comments on all the recent posts in this forum. If didn't *ahem* know better, I might think that you were just using the forum to get your company's logo & website stamped on each page you respond to. I get it that we're forewarned by the "sponsor" on your profile icon, so it shouldn't be surprising, and you certainly can write whatever you want, but the numerous bland vague sounding responses all on the same day are still kind of annoying like pop up ads. I think most applicants already know that IM doesn't treat pregnant women and FM does (or can). If you are going to commit to getting your profile icon on every page, could you try a little harder to at least make it sound like you are a practicing FM doc/resident/interested medical student with some new information or authentic opinions or experiences?

 

[JustPlainBill]

Maybe I'm off the mark here, but it sure seems like you are offering pretty generic comments on all the recent posts in this forum. If didn't *ahem* know better, I might think that you were just using the forum to get your company's logo & website stamped on each page you respond to. I get it that we're forewarned by the "sponsor" on your profile icon, so it shouldn't be surprising, and you certainly can write whatever you want, but the numerous bland vague sounding responses all on the same day are still kind of annoying like pop up ads. I think most applicants already know that IM doesn't treat pregnant women and FM does (or can). If you are going to commit to getting your profile icon on every page, could you try a little harder to at least make it sound like you are a practicing FM doc/resident/interested medical student with some new information or authentic opinions or experiences?

Drop 200 and Fire for Effect -- HE with troops in the open

 

[Board Vitals]

Drop 200 and Fire for Effect -- HE with troops in the open

Hi! I am a trained family medicine physician. I have worked in outpatient, inpatient, academic setting as have experience in obstetrics. I actually debated myself if I wanted to do IM vs. FM and I did not want to give up pediatrics and OB. Although Med/Peds is a great option, it is a longer program, and you are double boarded which is great but many practicing Med Peds physicians only practice in IM or Peds, so that deterred me. In terms of wards vs office..IM residents will do more time in the ICU/CCU where as FM residents usually only do 1 rotation in the ICU and none in the CCU. The main difference, although you seem like you already know this, is all the subspecialty options that are available to IM graduates where as FM subspecialties only include OB, Sports med, ER and geriatrics. In terms of after residency, FM usually practice in an office setting as most hospitalist jobs want IM trained, however this varies vastly between states. To be honest with you, I personally think you have a lot more option as a FM doc than an IM doc, but that is my personal and professional opinion. ~M.D.- Family Medicine Physician/ Editor/Writer Board Vitals.

 

[Moty]

Why do family medicine and internal medicine or pediatrics have different sub-specialties despite having many similarities?

 

[DrMidlife]

Consider your grandma with diabetes and hypertension, and your newborn cousin with a heart murmur, and who you want treating them.

Consider primary care. This is where it should first get noticed that there's a heart problem.

• Peds: kids only.
  
• IM: adults only, no ob/gyn, no surg.
  
• FM: come one come all, such as a pregnant 14 year old with HIV, maybe you catch a murmur as you're excising a suspicious mole etc
  
• Med/Peds: kids and adults, no ob/gyn, no surg
• An outpatient primary care group practice may have all of the above

Consider cardiology. This is where the primary care doc sends the patient with the heart problem.

• Peds cardiology: 3 years of peds residency then 3 years of peds cards fellowship. Example: baby with arrhythmia needing diagnostics & meds. This doc better only deal with kid hearts.
  
• Adult cardiology: 3 years of adult medicine (IM) residency followed by 3 years of adult cardiology. Example: grandma with arrhythmia needing diagnostics & meds. This doc better only deal with adult hearts (dealing with aging & chronic disease burden etc).
  
• Adult hearts plus livers and kidneys and lungs, in the hospital: 3 years of IM or FM residency then maybe 1+ years of hospitalist or critical care fellowship. Example: management of a variety of sick to very-sick people. This doc manages overall inpatient care and then calls the cardiologist etc.

Choosing FM means you are choosing to be a generalist, even if you do a fellowship. Are there FM docs who work as specialists? Yes. Should you do FM if you want to be a specialist? No.

Best of luck to you.

 

[Moty]

Thanks.

 

[styphon]

I did family medicine for the obvious reasons, but one of the most important factors to me was OB care.

In fact, during med school the three fields I was going back and forth were ER, OB, and FM - I didn't even consider IM.

 

[VA Hopeful Dr]

I did family medicine for the obvious reasons, but one of the most important factors to me was OB care.

In fact, during med school the three fields I was going back and forth were ER, OB, and FM - I didn't even consider IM.

For me it was the ability to take care of adults and kids. I enjoyed parts of peds and parts of IM but realized I didn't want to limit myself to either.

 

[ShenMeYiSi]

I did family medicine for the obvious reasons, but one of the most important factors to me was OB care.

In fact, during med school the three fields I was going back and forth were ER, OB, and FM - I didn't even consider IM.

That's exactly the reason I want to do FM as well, but the older attendings (who are not FM docs) I have spoken to said that as an FP in practice, no one will send you OB pts because no malpractice will foot the bill for the minimal OB care you provide in comparison to actual OBs; you won't get to do c/sections and you will end up sending many of the high risks and more complicated gyn cases to the OBs anyway. I really have no idea how the whole thing works, I am curious to know what peoples' experiences have been in this regard.

 

[VA Hopeful Dr]

That's exactly the reason I want to do FM as well, but the older attendings (who are not FM docs) I have spoken to said that as an FP in practice, no one will send you OB pts because no malpractice will foot the bill for the minimal OB care you provide in comparison to actual OBs; you won't get to do c/sections and you will end up sending many of the high risks and more complicated gyn cases to the OBs anyway. I really have no idea how the whole thing works, I am curious to know what peoples' experiences have been in this regard.

Rural FPs can still get decent amounts of OB patients. Even better if you are trained to do c-sections.

If you're hoping to go to DC or Denver or somewhere of decent size as an FP and deliver babies then you're likely to be disappointed.

 

[cabinbuilder]

Rural FPs can still get decent amounts of OB patients. Even better if you are trained to do c-sections.
.

I will add to this. Many rural places are not doing births or C-sections (I'm talking middle of Nevada, Alaska, etc) because there is no support staff to help you in the delivery. Many places, you follow the mother through 37 weeks then they get transferred "to town" to wait to have the baby.

Same goes with scopes: you may have all the training in the world but if the staff can't help you with anesthesia, etc.

 

[DrMidlife]

Mid-atlantic anecdotal report:

I did 3 weeks of my M3 FM rotation in a town of 9,000 about an hour from the nearest major city. Community hospital, has maybe 6 L&D rooms, shares maybe 3 ORs with the rest of the hospital. All the births, including c sections, are split between an ObGyn and an FM doc who did an OB fellowship. The FM doc does c-sections and tubals. Looked like 2-3 births per week. The FM doc spends half her week on primary care, the other on ob/gyn. All the high risk goes east, but they'll keep TOLACs. This FM doc chose to do her own job search out of fellowship because of location constraints, but she said she got sent boatloads of FM+OB jobs from recruiters. Basically she talked the hospital into taking her instead of a 2nd obgyn.

At the big fat county academic hospital here, there's one faculty FM doc doing births and c sections for her own patients, which I believe is subject to the whim of the ObGyn department as much as it is subject to the hospital. She doesn't lighten the ObGyn call schedule (100% high risk MFM faculty) but she's in the same L&D wing.

And then there's another faculty FM doc doing births and c-sections at the, um, let's call it religious/catchment/mini-Detroit hospital the next town over. He doesn't seem to be affiliated with any ObGyns.

Haven't heard of a single FM doc doing deliveries or c sections in the wealthy suburbs.

 

[JustPlainBill]

Mid-atlantic anecdotal report:

I did 3 weeks of my M3 FM rotation in a town of 9,000 about an hour from the nearest major city. Community hospital, has maybe 6 L&D rooms, shares maybe 3 ORs with the rest of the hospital. All the births, including c sections, are split between an ObGyn and an FM doc who did an OB fellowship. The FM doc does c-sections and tubals. Looked like 2-3 births per week. The FM doc spends half her week on primary care, the other on ob/gyn. All the high risk goes east, but they'll keep TOLACs. This FM doc chose to do her own job search out of fellowship because of location constraints, but she said she got sent boatloads of FM+OB jobs from recruiters. Basically she talked the hospital into taking her instead of a 2nd obgyn.

At the big fat county academic hospital here, there's one faculty FM doc doing births and c sections for her own patients, which I believe is subject to the whim of the ObGyn department as much as it is subject to the hospital. She doesn't lighten the ObGyn call schedule (100% high risk MFM faculty) but she's in the same L&D wing.

And then there's another faculty FM doc doing births and c-sections at the, um, let's call it religious/catchment/mini-Detroit hospital the next town over. He doesn't seem to be affiliated with any ObGyns.

Haven't heard of a single FM doc doing deliveries or c sections in the wealthy suburbs.

OMS3 FM rotation in Ft. Worth -- JPS at the time was run by FM -- Ob/Gyn residency was there but FM was the big dog -- there was an FM doc from rural WV that had recently been hired on and had like several hundred if not thousand deliveries/C Sections as primary surgeon -- he did all of his own deliveries/C's at JPS -- or so I was told. It happens, but it's rare these days.....

 

[galactus]

Mid-atlantic anecdotal report:

I did 3 weeks of my M3 FM rotation in a town of 9,000 about an hour from the nearest major city. Community hospital, has maybe 6 L&D rooms, shares maybe 3 ORs with the rest of the hospital. All the births, including c sections, are split between an ObGyn and an FM doc who did an OB fellowship. The FM doc does c-sections and tubals. Looked like 2-3 births per week. The FM doc spends half her week on primary care, the other on ob/gyn. All the high risk goes east, but they'll keep TOLACs. This FM doc chose to do her own job search out of fellowship because of location constraints, but she said she got sent boatloads of FM+OB jobs from recruiters. Basically she talked the hospital into taking her instead of a 2nd obgyn.

At the big fat county academic hospital here, there's one faculty FM doc doing births and c sections for her own patients, which I believe is subject to the whim of the ObGyn department as much as it is subject to the hospital. She doesn't lighten the ObGyn call schedule (100% high risk MFM faculty) but she's in the same L&D wing.

And then there's another faculty FM doc doing births and c-sections at the, um, let's call it religious/catchment/mini-Detroit hospital the next town over. He doesn't seem to be affiliated with any ObGyns.

Haven't heard of a single FM doc doing deliveries or c sections in the wealthy suburbs.

Where I did residency all the faculty but 2 did vaginal deliveries, and we had 6 core faculty that did c-sections as well. It made it easy when you were on call and for various reasons the patient has to go to section; there was always an FM faculty available to do the section with you, and this was at an opposed institution! We never transferred care to ob/gyn, however if MFM was needed they were on consult only and FM was still primary. Let's just say that I was up to my eye balls in OB/deliveries...