I wish I had done family medicine

[deleted87716]

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.

Pretty much. I have a number of friends who are general internists, and our adult patient types are identical. I utilize IM subspecialists pretty much the same way my general internist colleagues do, as well, and I don't think I'm unique in that respect.

One significant difference we've noticed is that FPs tend to be better prepared for ambulatory care at the end of their residency than their IM counterparts. In most IM programs, "continuity clinic" is often viewed as an odious chore rather than a central part of their training, and preventive care receives less emphasis than in an FP program. I'm sure this varies from program to program, but it's something to keep in mind if you're waffling between FP and general IM.

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[dwil75]

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.

Hi, I am a medical student going into FP, one of only about 6 people in my class of 170. Our school doesn't even have an FP residency or any advisors -no one discouraged me at all, but instead my problem was that the administration flatly told me they don't know anything about FP or FP programs and couldn't help me with advice on different programs to apply to this year, or even tell me what to look for or ask about. I'm glad I chose it, I know it's perfect for me, I just wish I had more people who were in the field to talk to about it. I think it would have made selecting a program much easier. I wonder if other students who were more on the fence than I was turned away from FP for the lack of guidance.

 

[sophiejane]

One significant difference we've noticed is that FPs tend to be better prepared for ambulatory care at the end of their residency than their IM counterparts. In most IM programs, "continuity clinic" is often viewed as an odious chore rather than a central part of their training, and preventive care receives less emphasis than in an FP program. I'm sure this varies from program to program, but it's something to keep in mind if you're waffling between FP and general IM.

In the IM residency programs I have seen, this is very true. These programs are often heavily weighted toward inpatient care, when in fact, the IM generalist is going to spend a lot more time in the clinic than the hospital.

This makes me wonder if IM generalists won't start being replaced by hospitalists in the future. It would make sense if they enjoy hospital work more that they should make that their primary practice and leave the ambulatory folks to us...

 

[meltorme]

Not trying to hijack answermans thread but in reading this it brought up some second guessing on my part. I considered FM but for a combination of reasons, some good, some not so good (as mentioned on this thread) I decided to go into EM. However, this thread has made me do some thinking/gut check. My current thoughts are that its still easier to move from EM into FM if I realized somewhere along the way that my choice of going into EM was wrong. Second, there is so much cross-over between the two that urgent care would be a happy medium that can be accessed from the EM route. I guess I'm just looking for a little reassurance as I certify my rank list (I didn't apply or interview at any FP programs) and I think it would seem a little rash to not certify and decide to scramble into a FM program based on reading a thread right before the deadline when nerves are at their height. My only caveat is that if I were to eventually switch residencies somewhere down the road I would feel terrible for my co-residents/faculty by putting them in that position. Any thoughts?

 

[sophiejane]

Not trying to hijack answermans thread but in reading this it brought up some second guessing on my part. I considered FM but for a combination of reasons, some good, some not so good (as mentioned on this thread) I decided to go into EM.

What were your good and not so good reasons?

 

[deleted87716]

This makes me wonder if IM generalists won't start being replaced by hospitalists in the future. It would make sense if they enjoy hospital work more that they should make that their primary practice and leave the ambulatory folks to us...

General internists and family physicians face exactly the same obstacles when trying to mix inpatient and outpatient care. Many choose to focus on one or the other. Commonly, you see the FPs gravitating towards ambulatory care, and the internists becoming hospitalists, but there are exceptions on both sides. Some FP colleagues of mine recently changed their practice from mostly ambulatory to mostly hospital almost overnight by becoming hospitalists at one of our community hospitals. It's what they enjoy, and they've found a way to make more money doing what they like to do. Better them than me.

 

[FamilyMD]

That's the beauty of medicine in general, and FP in particular...you are NOT locked in! You want inpatient? You can do it! Want just outpatient? Great! Like procedures? You can do vasectomy, lasers, lesion removals, cryos, colonoscopies, colposcopies, circs...you get the idea. You can do OB, newborn, peds, adult, geriatrics, nursing home, sports medicine. Tell me...what other field can come even close to the flexibility FP's have???

 

[sophiejane]

That's the beauty of medicine in general, and FP in particular...you are NOT locked in! You want inpatient? You can do it! Want just outpatient? Great! Like procedures? You can do vasectomy, lasers, lesion removals, cryos, colonoscopies, colposcopies, circs...you get the idea. You can do OB, newborn, peds, adult, geriatrics, nursing home, sports medicine. Tell me...what other field can come even close to the flexibility FP's have???

I have heard a lot of poo-pooing of the reality of FPs doing colonoscopies and OB in particular lately.

What do you guys out in the real world see? Is it happening? Is it feasable financially? What about OB specifically? I know it's regional...but are new FPs going to be able to really make OB part of their practice in the coming years?

 

[FamilyMD]

I have heard a lot of poo-pooing of the reality of FPs doing colonoscopies and OB in particular lately.

What do you guys out in the real world see? Is it happening? Is it feasable financially? What about OB specifically? I know it's regional...but are new FPs going to be able to really make OB part of their practice in the coming years?

OB is purely regional. You obviously need a certain volume of deliveries to justify the bump in malpractice insurance. In my areas, I would estimate only about 20% do OB. I chose to give up OB and hospital care for a better lifestyle, but if that's what floats your boat, it certain can and is being done.

 

[Newdoc2002]

You definitely don't want an FP doing scopes without plenty of training or experience under their belt. You will find FM docs that do however. I did a ton of scopes with a very good GI group throughout residency. That's what's great about FM. I can choose not to do OB but gravitate towards procedures and patients that I enjoy.