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answerman

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I am a current 3rd year internal medicine resident at a southern california residency. I have no idea what I am going to do after I finish. There are no particular fellowships that excite me. I just keep remembering that as a medical student I had always thought about doing family practice. Then somewhere in my fourth year, I kept hearing that since family medicine and intenal medicine are the same thing - why don't you just do internal medicine. So I ended up matching in internal medicine. Then as an intern, I tried to switch to family medicine - however my ego (won't get as respected in family medicine and its the same thing anyway) got in the way and I ended up staying in internal medicine.

Now I am desperately unhappy and I wake up EVERY MORNING wishing I had done family medicine (because my deep down gut had always said so). For example, I always saw myself working as a kaiser family practice doc. I hate kaiser internal medicine because all they have you see is patients >65. Kaiser family practice is so much easier, fun, and nicer - you see a lot younger patients and a lot more preventive medicine type exams.

I like to see younger patients (less than 65). I like seeing kids - but just once in a while just to keep me fresh.

Someone please help me - i just don't know what to do from here.
 

lowbudget

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One option is to do more training:
1. Do Pedi - 3 more years
2. Do FM - <3 years because you should get credit for IM
3. Do Adolescent Fellowship - 1-3 years

Another option is to join a private group. Or join an FP group. Or move somewhere where IMs call themselves "family doctors" (East Coast).
 

cooldreams

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why do u think you HAVE to work for kaiser???
 
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I also had that same ego-driven thinking for a while, re: IM vs. family. Fortunately I came to my senses and realized that what matters is my happiness and not the level of prestige I hold in the medical community. I am learning that if you are a good doctor, you will be respected, no matter what your specialty.

I am sorry that you are unhappy but I know you will find your niche--there is a place for everyone...and you can build your practice the way you want to. I don't know what a Kaiser doctor is, but I think you might have more freedom if you set up your own practice or join a smaller group. I think the adolescent medicine fellowhip is also a great idea.

Is it too late to find a meds-peds program that will accept you? Maybe that way you could get some credit for your time in IM.

Best of luck to you.
 

answerman

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Thank you for your help. I really wish I wasn't in this stressful and unhappy situation.

Just wondering, what would you guys do if you were a 3rd year IM resident stuck in my position?
 

cooldreams

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start my own practice :D... i know my strong suits, from being trained in IM, so market that, and things im interested in i will try to attend seminars or train with fellow docs to gain better understanding in those areas and then i could also incorporate into my practice. you will make more money if you do it on your own than working for kaiser or any other insurance company. the first few yrs may be slow and take extra effort but like anything, it will pay off with the extra work...

you should never let your self come to the conclusion of being overly stressed and locked in a dead end. there are many choices and avenues you can always make.

also, very dear to my heart, praying to God. seriously. pray for encouragement, for guidance, for faith, for a better relationship with Him.
 

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cooldreams said:
Then as an intern, I tried to switch to family medicine - however my ego (won't get as respected in family medicine and its the same thing anyway) got in the way and I ended up staying in internal medicine.

omg - are you reading my mind?! i have been tihhnking this for a LONG TIME. my dad is a doc and when i was growing up, he told me i was not 'allowed' to be an FP, pathologist, or psychiatrist. the thing is, i've been drawn to FP ever since the beginning. if i have to hear one more time how i won't get any respect, i'm gonna lose it! similarly, i had a big ego thing as well cuz i've got the ivy background for college and med school and keep hearing, "but you CAN'T do FP, blah, blah, blah"....i would AHTE to be in your shoes. i love adolescents, which sealed hte deal for me, cuz in my mind, IM is just geriatrics in disguise, and i hate geriatrics.

if i were you, i'd join an FP practice. i think you'd end up seeing younger patients. don't do another residency - just start marketing yourself as something more than just a "regular IM"...good luck, and i'm sorry you're so sttressed (though given teh circumstances, sounds totally reasonable).
 

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I don't know much about it, but the previously mentioned fellowship in Adolescent Medicine might help accomplish your goals...
 

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answerman said:
Thank you for your help. I really wish I wasn't in this stressful and unhappy situation.

Just wondering, what would you guys do if you were a 3rd year IM resident stuck in my position?
I think I would look for a job in outpatient internal medicine where there is a decent range of patient ages. Work for a few years before considering my fellowship options.

You could also do some charity or volunteer work to broaden your horizons.

Your future is unlimited. You can make your career into whatever you want it to be.

:)
 

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answerman said:
I am a current 3rd year internal medicine resident at a southern california residency. I have no idea what I am going to do after I finish. There are no particular fellowships that excite me. I just keep remembering that as a medical student I had always thought about doing family practice. Then somewhere in my fourth year, I kept hearing that since family medicine and intenal medicine are the same thing - why don't you just do internal medicine. So I ended up matching in internal medicine. Then as an intern, I tried to switch to family medicine - however my ego (won't get as respected in family medicine and its the same thing anyway) got in the way and I ended up staying in internal medicine.

Now I am desperately unhappy and I wake up EVERY MORNING wishing I had done family medicine (because my deep down gut had always said so). For example, I always saw myself working as a kaiser family practice doc. I hate kaiser internal medicine because all they have you see is patients >65. Kaiser family practice is so much easier, fun, and nicer - you see a lot younger patients and a lot more preventive medicine type exams.

I like to see younger patients (less than 65). I like seeing kids - but just once in a while just to keep me fresh.

Someone please help me - i just don't know what to do from here.
The world is your oyster, Answer. You just can't see it.

Finish your IM residency. Become board certified.

Then expand your horizons. Moonlight in a pedi ER. Do some work somewhere which will expose you to family medicine type areas.

Move where you wanna live. Hang your sign. Start a "family" practice.

20 years ago, dudes would emerge from med school, do an internship, and go into business.

You can do the same.
 

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jetproppilot said:
Moonlight in a pedi ER.
Good luck with that. If an ED is big enough to have a Peds ED, they will not hire an IM grad - they can get pediatricians to moonlight, and the liability is less (ie, by having a trained pediatrician seeing the peds).
 

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I'm still really confused....but thanks for the help so far?

Anybody have any more ideas for me? :(
 
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Thanks - actually I did figure out the website. I meant that I'm still trying to figure out what to do next so I can stop regretting my past! :eek:
 

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answerman said:
Thanks - actually I did figure out the website. I meant that I'm still trying to figure out what to do next so I can stop regretting my past! :eek:
Do you regret becoming a physician? If it is just the difference between FP and Internal medicine then you are certainly fine. No specialty is ever going to be a perfect fit. You have to mold your career to fit your preferences.

That may mean making sacrifices to take your first job at a place which has the patient population you are interested in caring for.
 

emedpa

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skypilot said:
Do you regret becoming a physician? If it is just the difference between FP and Internal medicine then you are certainly fine. No specialty is ever going to be a perfect fit. You have to mold your career to fit your preferences.

That may mean making sacrifices to take your first job at a place which has the patient population you are interested in caring for.
as an internist though he has no training in seeing kids or ob pts so it is a liability bordering on criminally negligent to use him with these populations.internists learn adult medicine, period.
imagine a bad outcome peds case that goes to court:

prosecutor:so dr smith, how many months of peds rotations did you do in residency?
md: none
P: and peds er?
md: none
and peds icu, surgery, or critical care?
md: none
P: so you thought you could intubate a critically injured child having never done so before? and then you didn't recognize that you had not done so successfully? hope you don't work on my kids....

jury returns verdict for plaintiff for 10 gazillion dollars and dr smith loses license......
 

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It's amazing to hear how many of us have gone through the same thought process having to "justify" to ourselves and others the fact that we're going into FP. I did the same ego thing and finally came to the conclusion that I shouldn't give a (@#* what anyone else thought and that I had to do what I knew would make me a happy, well-rounded, well-balanced doctor.

I also always thought that I would go into FP and had my cardiologist father tell me that I would do no such thing. I was lured away by trauma surgery for almost 2 1/2 years but eventually found my way back. My answer to your question would be if you want to be an FP, be an FP. Go back and do an FP residency, having gotten some credit for your IM work. Life is way toooooo short to be stuck doing something that you don't want to do, and another 2 or 3 years will mean nothing in the long run if you're doing what you love to do for the rest of your life. Believe me...I'm 35 having come back to medicine after a very successful side jaunt into finance (where I was absolutely positively miserable). Follow your heart, my friend. It will never lead you astray.

tridoc13
 

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tridoc13 said:
It's amazing to hear how many of us have gone through the same thought process having to "justify" to ourselves and others the fact that we're going into FP. I did the same ego thing and finally came to the conclusion that I shouldn't give a (@#* what anyone else thought and that I had to do what I knew would make me a happy, well-rounded, well-balanced doctor.

I also always thought that I would go into FP and had my cardiologist father tell me that I would do no such thing. I was lured away by trauma surgery for almost 2 1/2 years but eventually found my way back. My answer to your question would be if you want to be an FP, be an FP. Go back and do an FP residency, having gotten some credit for your IM work. Life is way toooooo short to be stuck doing something that you don't want to do, and another 2 or 3 years will mean nothing in the long run if you're doing what you love to do for the rest of your life. Believe me...I'm 35 having come back to medicine after a very successful side jaunt into finance (where I was absolutely positively miserable). Follow your heart, my friend. It will never lead you astray.

tridoc13
very well said
 

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emedpa said:
as an internist though he has no training in seeing kids or ob pts so it is a liability bordering on criminally negligent to use him with these populations.internists learn adult medicine, period.
imagine a bad outcome peds case that goes to court:

prosecutor:so dr smith, how many months of peds rotations did you do in residency?
md: none
P: and peds er?
md: none
and peds icu, surgery, or critical care?
md: none
P: so you thought you could intubate a critically injured child having never done so before? and then you didn't recognize that you had not done so successfully? hope you don't work on my kids....

jury returns verdict for plaintiff for 10 gazillion dollars and dr smith loses license......
Yes Peds ER is out without more training, but he was complaining about seeing only patients 65 and older and wanting to do more outpatient medicine.

Many FPs don't practice OB so I don't think that was the issue. Certainly alternatives are available that might fill the bill. For example, get a job as a physician on a college campus.
 

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Greeting from the private practice trenches,
Doing another residency would be a waste of time for the dollar YIELD that it would bring. You will piss away 3 years of your life at 40K per year when you could be in a group practice and generate 3+ times that amount. A more efficient solution to your problem would be to load up on CME's pertaining to the younger populations. If additional training is needed, there is a PLETHORA of CME's and training courses to take. What you spend on the CME and travel to them is TAX DEDUCTIBLE!!!.
Also, the AAFP convention has a TON of workshops that can provide education. Youn should committ yourself to attend every year. TAX DEDUCTIBLE.
For practical experience, you may need to get out of Kaiser and into a group practice with FP's in it. OR moonlight in an ER or urgent care center. This experieince plus the CME courses will let you achieve your goals without wasting any time. Hope thie helps...PEACE!!

-Derek
 

emedpa

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dksamp said:
Greeting from the private practice trenches,
Doing another residency would be a waste of time for the dollar YIELD that it would bring. You will piss away 3 years of your life at 40K per year when you could be in a group practice and generate 3+ times that amount. A more efficient solution to your problem would be to load up on CME's pertaining to the younger populations. If additional training is needed, there is a PLETHORA of CME's and training courses to take. What you spend on the CME and travel to them is TAX DEDUCTIBLE!!!.
Also, the AAFP convention has a TON of workshops that can provide education. Youn should committ yourself to attend every year. TAX DEDUCTIBLE.
For practical experience, you may need to get out of Kaiser and into a group practice with FP's in it. OR moonlight in an ER or urgent care center. This experieince plus the CME courses will let you achieve your goals without wasting any time. Hope thie helps...PEACE!!

-Derek

my point wasn't about peds em actually it was about practicing in any area in which he doesn't have experience. some urgent care ctrs and er's will use internists but generally they should not work solo coverage in this type of environment as sick kids and ob emergencies do present to these places and working alone at an urgent care center is inviting disaster without the right training. codes/trauma/peds emergencies/ob emergencies present regularly to these types of settings and may require emergent tx before an ambulance can arrive.
that many fp's don't practice ob is beside the point as every fp resident has to do several months of ob training in order to complete residency and should remember the basics of placenta previa, abruptio placenta, precipitous delivery, postpartum infections, etc
 
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Looks like the 2 choices for residency (if that's what I choose) would be pediatrics or family practice. I know that pediatrics board can give board certification in 2yrs to someone with prior internal medicine board certification. FP could take 2 yrs or 2.5yrs (should get some credit) depending on what spot/program is available.

Which would you choose of the above if you were in my position?

1) Pediatrics (2 more yrs)

2) Family medicine (2 more yrs)
 

emedpa

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answerman said:
Looks like the 2 choices for residency (if that's what I choose) would be pediatrics or family practice. I know that pediatrics board can give board certification in 2yrs to someone with prior internal medicine board certification. FP could take 2 yrs or 2.5yrs (should get some credit) depending on what spot/program is available.

Which would you choose of the above if you were in my position?

1) Pediatrics (2 more yrs)

2) Family medicine (2 more yrs)
fp ...offers more choices. you can see anyone in a clinic with an fp background. even as a dual im/peds you still couldn't see ob pts. also if you wanted to work in an er at some point im/fp would be a much better combo than im/peds.if you want to work with sick kids in an inpt setting I would do peds/im but if you plan on doing mostly outpt work you will do the same stuff as an fp that a pediatrician would do. you will both send sick kids to the hospital.
 

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answerman said:
Looks like the 2 choices for residency (if that's what I choose) would be pediatrics or family practice. I know that pediatrics board can give board certification in 2yrs to someone with prior internal medicine board certification. FP could take 2 yrs or 2.5yrs (should get some credit) depending on what spot/program is available.

Which would you choose of the above if you were in my position?

1) Pediatrics (2 more yrs)

2) Family medicine (2 more yrs)
surgery :D
 

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emedpa, quick question for you. Are you a physician or med student? I'm asking out of honest curiosity.
 

emedpa

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emedpa, quick question for you. Are you a physician or med student? I'm asking out of honest curiosity.
neither- I'm an emergency medicine pa and former paramedic considering going to D.O. school. I have worked at facilities with 2 fp residencies and done a lot of research on the topic over almost 20 yrs. fp is probably what I would do after medschool.
 

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emedpa said:
as an internist though he has no training in seeing kids or ob pts so it is a liability bordering on criminally negligent to use him with these populations.internists learn adult medicine, period.
imagine a bad outcome peds case that goes to court:

prosecutor:so dr smith, how many months of peds rotations did you do in residency?
md: none
P: and peds er?
md: none
and peds icu, surgery, or critical care?
md: none
P: so you thought you could intubate a critically injured child having never done so before? and then you didn't recognize that you had not done so successfully? hope you don't work on my kids....

jury returns verdict for plaintiff for 10 gazillion dollars and dr smith loses license......
How many months of Peds ICU does an FP resident do? How many intubations on neonates does an FP resident do (exclude meconium intubations unless they were reintubated after suctioning and required ventilatory support)? How many 1-7 year olds do FP residents intubate over the course of residency? How many 7-16 year olds? How many months do FP residents spend in a designated Pediatric ED? I'm asking honestly...I do know the FP program at the institution where I trained (not in FP) for the typical resident the answers to those questions would be. None, <2, None, None. They do 1 month of pediatric wards and a month in a pediatric sick visit (slightly below the level of a UVC) clinic. They used to do a month in the NICU where they functioned at the sub-I level but I believe that has been phased out as it was creating too many problems. In theory they are also able to admit children to their service but usually they get bypassed for pediatrics or they grumble about taking the admission and it goes to pediatrics.

To the OP, if you desire to take care of kids then I'd recommend doing Pediatrics. Picking up an FP residency to get Pediatrics training seems very inefficient. If you merely desire to take care of younger, healthier patients gear your practice that way. A significant portion of my current practice consists of 25-40 year olds (ironically the parents of my pediatrics patients). I love Med-Peds but it sounds like you don't truly want pediatrics but more just the thirty something crowd (which is totally fine).
 

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the more aggressive/unopposed fp programs have fp residents running traumas, covering pts of all ages in the er, doing neonatal resuscitations, and doing anesthesia rotations.if one wants to specialize in peds then peds is the obvious choice of residency but if one seeks a broad based education fp is the way to go. my point about a peds intubation was that an fp doc would have more exposure to that type of situation than an internist. certainly a peds resident gets more exposure to this than an fp resident.
 

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This is to the original post.

Why don't you do adult medicine. No ob or pediatrics. 18 and older.

OR

You can become a hospitalist.

Or

You can work for 5 to 6 years, then do botique medicine.
 

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answerman said:
Thank you for your help. I really wish I wasn't in this stressful and unhappy situation.

Just wondering, what would you guys do if you were a 3rd year IM resident stuck in my position?
I am a fourth year medical student and as my name implies, was headed for radiation oncology. I changed my mind this year after I did a rural family medicine rotation and loved it, just like I did during my third year. For me, too, it was an ego issue, and I had a lot of myths running around in my head that were, thankfully, disspelled by a great fp. It was a gut-wretching decision to change my mind, and agonizing at times. But now, it feels like the right choice.

What to do? It's not too late to change your mind and do what you want to do. One thing I learned after 3 months of rad onc is that life is SHORT. No guarantees at all, for anyone at anytime. If you want to do FP, then by all means, GO FOR IT.

You're not stuck. You've just got to make a choice about what you really want to do. What kind of doctor do you want to be? How do you want to work? What kind of relationships do you value with your patients? How do you enjoy spending your day?

They are core questions that I think you're already answered. It's just matter of you truly commiting to what you really want.

I made my decision by realizing that I loved rural medicine, and would do whatever it took to have a life with a career like that. I didn't feel that way about rad onc - it was just work.

Do whatever you have to do to bring yourself happiness.



Best of luck to you,
radonc_gal
 

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tridoc13 said:
Believe me...I'm 35 having come back to medicine after a very successful side jaunt into finance (where I was absolutely positively miserable). Follow your heart, my friend. It will never lead you astray.

tridoc13
except where it comes to women...from what i've learned :(
 
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p54 said:
except where it comes to women...from what i've learned :(
That's not your heart you were following ;)
 

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answerman said:
Looks like the 2 choices for residency (if that's what I choose) would be pediatrics or family practice. I know that pediatrics board can give board certification in 2yrs to someone with prior internal medicine board certification. FP could take 2 yrs or 2.5yrs (should get some credit) depending on what spot/program is available.

Which would you choose of the above if you were in my position?

1) Pediatrics (2 more yrs)

2) Family medicine (2 more yrs)
At this juncture, Peds may be the way to go. A lot of FM doctors don't do OB once they finish. Primarily, you would see OB in a rural practice, but you'd still need OB backup if things go south. There's no two ways about that.

As for the respect thing: back when I was on the interview trail, what I noticed about the doctors I spoke with (and this was literally all over the country) is that they had a certain whimsy about them. They frankly did not care what other doctors thought of them (and I'm not talking about one or two doctors--I believe I spoke to around 60). Their main concern what was their PATIENTS thought of them. From friends and from PDs I spoke with, most of what an FM doctor sees in practice, 85-90% s/he can handle without referral. And the variety is what keeps one from getting bored. In IM you'd see primarily diabetes and hypertension, and CAD with a smattering of other assorted things, but primarily those, I believe. FM is diverse that if you get the education, you can easily segue (as friends I know have years later because needs change) from a rural setting to an urban setting or to a suburban setting (the three arms of family medicine). In the case of one friend, he hated continuity of care because his patients were notoriously non-compliant. He's the director now of a university out-patient program in the southwest and very happy with his change. Another closed a private practice after nine years, moved to another state and is now doing urban medicine. The idea is one never knows what ten years down the road brings. If you dedicate a year or two more in training, it's not that great a sacrifice for the long haul.

FM docs are very much a part of the community they live in (and this is an attractive plus): you'll see them as the high school basketball team's physician, or pitching in when the community has group events and a physician is an added bonus, being there making sure all goes well.

You might want to consider a sports medicine fellowship. That, too, might compliment things nicely and from what I understand you can get that from the IM direction or the FM direction.

Because you're coming from IM and you need to finish two years of FM, as per the board's requirements, you'd see some overlap in your IM training. Not that you wouldn't need it, but so much of that is practice and you'd see that once you open your office. Time might be better spent with some concentration in pure peds. Just a thought.

Some things to ponder. Hope this helps,

Nu
 

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I was lucky in retrospect to have been stuck on the unofficial nursing home geriatrics team my first week of IM clerkship. By Friday I knew I'd never do that residency and headed straight to peds (though unfortunately I have adult neuro, ER and a med subI left in my fourth year). So I definitely sympathize.

But a peds residency may not neccesarily be the answer either - you just want a few kids for variety, not all or even most of the time. And you've got to love babies, because well checks are a pretty large proportion of your outpatient peds clinic population (and there's a lot of inpatient too!) My best suggestion would be to get through the time left and then do outpatient medicine in a substantially young area (definitely not Pittsburgh, despite their good children's hospital). The adolescent fellowship may also work if that age group is particularly appealing to you. In any case you shouldn't have to be stuck treating the elderly if you choose your location wisely and tailor your practice accordingly...best of luck!
 

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i'm a second year MS... what is the difference between family medicine and internal medicine? to what extent does it become cases for the IMs.... thx
 

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landa29x said:
i'm a second year MS... what is the difference between family medicine and internal medicine? to what extent does it become cases for the IMs.... thx
hi.
there are many differences and many similarities. Fam med, usually has more procedures and you get to see/ treat, peds patients and OB/gyn cases as well as internal med. the internal med part of it, is the same pretty much as internal medicine. but if you want to specialize further and do more residency you ened to do int. med,, for ex, cardiology, oncology. but for just the residency it is pretty similar but Fam med you get a good variety of patients and you can tailor you practice to how you want usually
there are many more examples too
 

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Since you're still in residency, what I would do is look into transferring into an FP program. If you really want to be an FP, then be an FP...not some sort of hybrid. You're not getting any younger, so the time is now.

OTOH, if you're not up for that, you can leave your staff-model HMO and go someplace where you can practice medicine the way you want to. As others have said, joining a group of FPs is one way to go. Your IM training should let you comfortably see patients from the teens on up. If you lack training in gyn or other aspects of practice that you'd like to do, you can take CME courses in these areas to become proficient.

Don't be misled, however...even family docs see a ton of patients over the age of 65. On some days, it seems like it's most of 'em. In the coming years, it's only going to get worse. If that's not what you like, maybe what you really want to be is a pediatrician. ;-)
 

answerman

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I was struggling between med/peds and family practice as an intern in internal medicine. I ended up doing just straight internal medicine because I thought med/peds (2 residencies at once) would be overwhelming and I slightly prefer medicine over peds; I decided against family practice because I wanted to keep my options open. Now I am in my final year of internal medicine residency and realize that I really miss the pediatrics alot (though I do like working with adults). I am also tired too from all the internal medicine call after 3yrs. In my heart I always wanted to do family practice, but practically speaking I think peds after med could be a good idea too since i keep all options open.
What would the family practice residents do if they were in my position?
What would the med/peds residents do if they were in my position?
 

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answerman said:
I was struggling between med/peds and family practice as an intern in internal medicine. I ended up doing just straight internal medicine because I thought med/peds (2 residencies at once) would be overwhelming and I slightly prefer medicine over peds; I decided against family practice because I wanted to keep my options open. Now I am in my final year of internal medicine residency and realize that I really miss the pediatrics alot (though I do like working with adults). I am also tired too from all the internal medicine call after 3yrs. In my heart I always wanted to do family practice, but practically speaking I think peds after med could be a good idea too since i keep all options open.
What would the family practice residents do if they were in my position?
What would the med/peds residents do if they were in my position?
From FM intern's perspective (who also weighed med/ped vs FM), you need to ask yourself how likely are you to pick a primary care practice over a specialty practice. If you want to do a primary care practice, it doesn't matter if you're Med/FM or Med/Pedi. I would pick the residency that will give you breadth (either in the form of a preset curriculum or in the form of electives), with exposure to Neuro, ENT, Ophtho, Ortho/Sports, Gyn, and Derm. If you choose FM, these are usually built into the curriculum and you can use your electives for more Pedi prn. If you pick Pedi, you can use your electives to pick up these specialties prn.

If you want to do more of a specialty practice (i.e. keep your options open), remember you are already medicine trained. And there are very few combined Med/Ped specialties (I think ID is one, Rheum may be the other). So if you want to be a specialist, it wouldn't make sense to pick Pedi as your 2nd residency unless you want to Med/Ped ID or Med/Ped Rheum or some Pedi specialty. What I mean is, obviously, you don't want to do 3 more years of Pedi only to decided to do adult GI or Cards fellowship simply because you have always wanted to be a specialist. You don't need a Pedi residency to specialize.

But given that you said you've always wanted to do FM... that means in your heart, you probably will pick primary care. **So if I were you, don't place any value in "keeping your options open" by picking Pedi.** If you want more in-depth Pedi training, pick Pedi, knowing that you will need to make up for your outpatient adult non-medicine subspecialties using your electives. If you simply want to have kids in your practice, pick FM, knowing that you may be at a marketing disadvantage if the community you practice in shunts all kids to pediatricians... so you'll have to compensate for that from a marketing standpoint.

My guess is that at the end of the day, it won't matter because it'll all depend on where you practice and what kinds of doctors are around you. Heh.

BTW, congrats on almost finishing Medicine <sigh>. I love my intern year, but, man, that light at the end of the tunnel just ain't bright enough...
 

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It certainly is wonderful to finish, but I guess the question is where to go from here...
 

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Thanks for all your help so far! Any more suggestions will be greatly appreciated!
 

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I find your post interesting because as a medical student I too was interested in familly but then the salary vs questionable flexibility (some say you have it - some say you dont).. but I think I would love it because it keeps the variety going and I love that.. almost anything you read healthwise is impt in your field.. bt the problem is I don't feel there is enough guidance and students do not hear the reality of being an FP and you hear more negative than anything else re fp.. I am almost expecting to be in your situation years from now.. I hope to match this year (IM) though this confusion is making me want to wait out a year .. Then I was thinking what I would do if I did end up feeling the way you do and I thought I would do a peds resid (but arent there problems with funding from gov when doin 2 residencies?) I applied for fam med also and decided not to interview because of this confusion but in hindsight it may have helped to see programs.. I have this inkling of a feeling that I will end up not smooth sailing through residency and will meander into different rds than the one I started on.. just a feeling.. wish i knew more abt fam med - anyhow do you think it is too draining to think of doing peds now? and practicing as im/peds? medicine really needs more info on specialties.. i have been looking for mentors since 3rd yr began and feel so confused.. there has got to be an eeasier way so people dont keep doing IM as a default and hating it..

answerman said:
Thank you for your help. I really wish I wasn't in this stressful and unhappy situation.

Just wondering, what would you guys do if you were a 3rd year IM resident stuck in my position?
 

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MDgirl76 said:
I find your post interesting because as a medical student I too was interested in familly but then the salary vs questionable flexibility (some say you have it - some say you dont).. but I think I would love it because it keeps the variety going and I love that.. almost anything you read healthwise is impt in your field.. bt the problem is I don't feel there is enough guidance and students do not hear the reality of being an FP and you hear more negative than anything else re fp.. I am almost expecting to be in your situation years from now.. I hope to match this year (IM) though this confusion is making me want to wait out a year .. Then I was thinking what I would do if I did end up feeling the way you do and I thought I would do a peds resid (but arent there problems with funding from gov when doin 2 residencies?) I applied for fam med also and decided not to interview because of this confusion but in hindsight it may have helped to see programs.. I have this inkling of a feeling that I will end up not smooth sailing through residency and will meander into different rds than the one I started on.. just a feeling.. wish i knew more abt fam med - anyhow do you think it is too draining to think of doing peds now? and practicing as im/peds? medicine really needs more info on specialties.. i have been looking for mentors since 3rd yr began and feel so confused.. there has got to be an eeasier way so people dont keep doing IM as a default and hating it..
I read these posts and find some amusing, some confusing. Then I realize this is b/c the vast majority of posters are students, not theres anything wrong w/that...we were all there at one time or another...but for students to give advice to other students re:income, lifestyles is akin to the blind leading the blind.
I have been out of residency for 6 years and have done it all..solo, large practice, urgent care, work comp, and now medical director. I am only here to help, I gain nothing by convincing anybody anything.
First-nothing beats the variety of FP (ahem, Family Medicine, as what the AAFP wants to change our field name to). Anything can walk thru my door from MI's, to appendage amputations, to a lady in labor. God I could not imagine doing the SAME thing day in and day out..whether it be cards, prostates, or god forbid teeth or feet :laugh: :laugh: :laugh:
Second-the salary and lifestyle arguments are laughable. EVERY hospital I know count full time FP's as 30-35 hrs/week. Personally I work 29 hrs/wk in my office and 10 hrs/wk as a medical director for a local insurance company. You will have MORE than enough time with the family.
Now having said that....yes there are docs who voluntarily pulls 50-60 hrs/wk-financial reasons I am sure, but you don't HAVE TO. The MGMA states the avg FP makes about $165k/yr...not shabby for 35 hrs a week. If you are of the financial persuasion....just open your own practice and hire a stable of PA's and NP's....these are the million dollar guys.
For me, I do labs, sell my own scripts and vitamins, and do lots of moles, derm stuff. DO FP IF THIS IS WHAT YOUR HEART SAYS, YOU WILL NOT BE DISAPPOINTED W/LIFE STYLE OR INCOME.
 

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To the OP,
Another option would be to pick an IM subspecialty like Cards or GI -- the patient referral pool is younger than GIM, and the interactions are more succinct.
 

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Can't you be a hospitalist for a couple of years? Im not sure if that position the west coast is like that but over here on the east coast, there are a lot of 3rd year residents going into hospitalist.
 

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MDgirl76 said:
I find your post interesting because as a medical student I too was interested in familly but then the salary vs questionable flexibility (some say you have it - some say you dont).. but I think I would love it because it keeps the variety going and I love that.. almost anything you read healthwise is impt in your field.. bt the problem is I don't feel there is enough guidance and students do not hear the reality of being an FP and you hear more negative than anything else re fp..

I find this really sad. I recently spoke with a resident at a very well respected FM program who graduated from a bigger-name medical school. She said that she was actively discouraged from going into FM by the attendings and faculty at her school. Why would they do that? Do they think it makes the school look bad to have more grads going into FM?

Needless to say, she followed her heart and not the advice of her faculty and is very happy.

One of the hardest things about medicine is navigating the landmines of egos and pretension that are so pervasive. You just have to cut through the cr*p and listen hard to the little voice inside you that knows what you really desire...
 

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sophiejane said:
I find this really sad. I recently spoke with a resident at a very well respected FM program who graduated from a bigger-name medical school. She said that she was actively discouraged from going into FM by the attendings and faculty at her school. Why would they do that? Do they think it makes the school look bad to have more grads going into FM?

Needless to say, she followed her heart and not the advice of her faculty and is very happy.

One of the hardest things about medicine is navigating the landmines of egos and pretension that are so pervasive. You just have to cut through the cr*p and listen hard to the little voice inside you that knows what you really desire...
I can tell you why I don't want to do family medicine. :) JMHO, but it is too broad a field. You have to know essentially everything, but maybe barely grasping the surface of it. It is mainly outpatient and that is not my style. I prefer sick patients to healthy patients, not that people you'd see as a FP won't be sick. That's why Im planning to do internal medicine. But Im just a fourth year medical student LOL. What do I know?
 

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Benzo4every1 said:
I can tell you why I don't want to do family medicine. :) JMHO, but it is too broad a field. You have to know essentially everything, but maybe barely grasping the surface of it. It is mainly outpatient and that is not my style. I prefer sick patients to healthy patients, not that people you'd see as a FP won't be sick. That's why Im planning to do internal medicine. But Im just a fourth year medical student LOL. What do I know?
I wasn't really asking for individual reasons why people don't choose FM, but thanks for sharing anyhow. I'm glad you found your niche. That's the great thing about medicine--someplace for everyone. (By the way, I completely disagree about only grasping the surface...I've seen FPs with a much better grasp on IM issues than some IM docs. Just depends on your training, intelligence, and ability. Also, you can do as much inpatient medicine as you choose to with FP. It's a very flexible field. And as for sick patients...well, I'll take issue with that as well. "JMHO", but from what I have seen, general internists are FPs who don't see kids. :))

What I was talking about are people who express an interest in FM but are discouraged by their faculty and administration.
 
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