IM/FP combined programs

[Peeshee]

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What do you think about combined IM/FP programs? What are the benefits? One benefit I can see is that you will have more fellowships available after your residency with IM. Is it worth the extra year to get board certified in both IM/FP? Any reasons not to do a combined program?
thanks!

 

[lonelywolf]

I found very few programs are combined FP/IM

Also, is it posible/ok to swicth FP to IM ? 😡

 

[fozzy40]

bump

 

[NRAI2001]

What are the major differences between the two? What can a FP do that an IM doc can't do (all i can really think of right now is that FP can do a bit of obstretics)?

 

[dr.smurf]

peds is the big one. oh and dont forget urgent care. FP's are trained in everything (med, peds, surgery, ob, ortho, er, etc.) so make great urgent care doc and even er docs with extra training.

 

[NRAI2001]

peds is the big one. oh and dont forget urgent care. FP's are trained in everything (med, peds, surgery, ob, ortho, er, etc.) so make great urgent care doc and even er docs with extra training.

But can they really do Surgery, ob, or ortho? What types of surgeries could they do? Seems like that would be only in really rural and remote areas?

I ve known many IM docs that have also opened urgent care centers.

But i guess if its only a year long, it might be worth it. I think a Peds/IM program may be better though.

 

[deleted6669]

"I think a Peds/IM program may be better though"

STILL CAN'T DO OB THOUGH.....
HAVE WORKED WITH SEVERAL MED/PEDS DOCS....NOT IMPRESSED. GIVE ME A GOOD FP DOC INSTEAD ANY DAY.

 

[NRAI2001]

"I think a Peds/IM program may be better though"

STILL CAN'T DO OB THOUGH.....
HAVE WORKED WITH SEVERAL MED/PEDS DOCS....NOT IMPRESSED. GIVE ME A GOOD FP DOC INSTEAD ANY DAY.

What type of surgeries can FPs do? What in regards to ortho can they do?

 

[deleted6669]

graduates of a hard core unopposed fp programs may do c-sections(common) and some even do uncomplicated appys(uncommon). the fp residents at ventura county for example run the trauma service and 1st assist all cases with the surgeon.they take atls(adv trauma life support) as a routine part of their training. fp docs in general do more ortho than im as it is a very common outpt primary care complaint. most im docs have trouble working up ortho pts due to their unfamiliarity with nl xrays other than the cxr and abd films. I spend many of my shifts overreading extremity films for local internists who are forced to cover urgent care pts once/week. the fp docs I work with do most of the same outpt ortho procedures as the er docs( reduce dislocations, suture extensor tendon lacs, etc).

 

[skypilot]

My brother in law had his vasectomy by a FP. Turned out fine. 🙂

 

[NRAI2001]

So what are the major differences between IM and FP? There must be things that IM's can do that FPs can't do and vis versa? Has this topic been talked about perviously?

 

[deleted6669]

an fp doc can do anything an im doc can do. an im doc can not do peds or ob.
the only advantage of im is the ability to do a broader variety of fellowships.

 

[NRAI2001]

an fp doc can do anything an im doc can do. an im doc can not do peds or ob.
the only advantage of im is the ability to do a broader variety of fellowships.

Then why can an FP not qualify to do fellowships? There must be difference, or the two would be the same field. Thats like saying a Neurosurgeon can do everything a Neurologist can do; there is overlap, but there are things that both do that the other can not.

 

[NRAI2001]

My brother in law had his vasectomy by a FP. Turned out fine. 🙂

I would never want to know that much info from my brother in law

 

[deleted6669]

Then why can an FP not qualify to do fellowships? There must be difference, or the two would be the same field. Thats like saying a Neurosurgeon can do everything a Neurologist can do; there is overlap, but there are things that both do that the other can not.

fp's have their own fellowship list from which to choose. most of these things make them a specialist in a particular primary care field(geriatrics, sports medicine) while im fellowships delve deeper into a single non-primary care specialty area like nephrology. the fellowships are sponsored by the respective boards and as most folks don't go into fp to become a nephrologist there is no fellowship track for it just as most im folks don't want to practice high risk surgical ob so there is no track in that for them.
I challenge you to tell me 1 thing(other than a specialty fellowship) that an im doc can do that an fp can't.
hospitalist? nope. lots of fp hospitalists now.
procedures? nope. fp docs do more procedures than im docs to include sigs, vasectomies, cosmetic procedures, etc.
im is basically for folks who have 1 of 3 desires:
1. want to do a non-primary care specialty fellowship
2. want to focus on adult medicine
3. don't want to do peds or ob.

I have worked at 2 fp residencies and worked with many internists and med/peds docs over the years so the above is not something I just made up for kicks, it is grounded in almost 2 decades of working with these folks.

partial list of fp fellowships(lots more in rural medicine, faculty development, research, and geriatrics out there too).

American Sports Medicine Institute American Sports Medicine Institute Birmingham AL
Center for Palliative Care Palliative Medicine Birmingham AL
U.A.M.S. Faculty Development/prevention Little Rock AR
Maricopa Medical Center Advanced Hospital Training Phoenix AZ
UCSF-Fresno Family Practice Fresno CA
UCLA Division of Sports Medicine Primary Care Sports Medicine Los Angeles CA
University of CA / Davis Primary Care Outcomes Research Sacramento CA
San Diego Sports Medicine & Primary Care Sports Medicine San Diego CA
University of Colorado Health Science Ce Primary Care Sports Medicine Aurora CO
Yale Occupational/Environmental Med Prog Occupational/Environmental Medicine New Haven CT
Georgetown Univ Medical Ctr Medical Editing/Faculty Development Washington DC
Georgetown University School of Medicine Health Policy Washington DC
Univ. of Florida FP Center Palliative Care Jacksonville FL
Columbus Family Practice Critical Care/Hospital Medicine Columbus GA
Family Practice Residency of Idaho, Inc Primary Care Sports Medicine Boise ID
MacNeal Family Practice Residency Women's Health Berwyn IL
National Headache Foundation Headache Chicago IL
PCC Community Health Center Maternal & Child Health Oak Park IL
University of Illinois - Peoria Women's Health Peoria IL
Univ of Louisville FPR Palliative Care Fellowship Louisville KY
University of Louisville FPR Bioethics & Family Medicine Louisville KY
Institute for Bioethics Bioethics Lousville KY
Commonwealth Fund Minority Health Policy Boston MA
The California Endowment Leadership & Health Policy Training Boston MA
EMMC Family Practice Residency Program Neuromusculoskeletal Bangor ME
Wayne State University Occupational/Environmental Medicine Detroit MI
Univ of MS Medical Center Health Psychology Jackson MS
Duke University Medical Center Community Health Durham NC
Duke University Medical Center Leadership Durham NC
E. Carolina University Primary Care Women's Health Greenville NC
New Hampshire Dartmouth FPR Preventive Medicine/Leadership Concord NH
Dartmouth-Hitchcock Medical Center Palliative/Leadership Preventive Medicine Hanover NH
Cooper Health System Acupuncture & Integrative Medicine Camden NJ
SUNY/Health Science Ctr at Brooklyn Women's Health Brooklyn NY
Highland Family Medicine Research/Faculty Development Rochester NY
Highland Family Medicine Family Systems Medicine Rochester NY
Highland Family Medicine Behavior Change Rochester NY
University of Rochester Patient-Centered Care Rochester NY
University of Rochester Health Care Disparities Research Rochester NY
Univ Hospitals of Cleveland Women's Health Cleveland OH
MAX Sports Medicine Institute, Inc. Riverside Sports Medicine Columbus OH
Lifestyle Center of America Lifestyle Medicine Sulphur OK
University of Oklahoma Emergency Medicine Tulsa OK
OHSU School of Medicine Clinical Leadership Portland OR
OHSU School of Medicine Residency Faculty Development Portland OR
Thomas Jefferson Univ Hosp FPR Primary Care Clinical Research Philadelphia PA
University of Tennessee at Memphis Emergency Medicine Covington TN
University of Tennessee FMRP Emergency Medicine Jackson TN
University of Tennessee Emergency Medicine Knoxville TN
UT Department of FM - Knoxville Behavioral Medicine Knoxville TN
Department of Family Medicine Homeland Security Studies Knoxville TN
Christus Spohn Hospital Memorial Hospitalist Corpus Christi TX
University of Texas Joint Primary Care Houston TX
Marshfield Clinic/St. Joseph's Hospital Palliative Medicine Marshfield WI

Fellowship Programs in Obstetrics
Univ of Alabama School of Med Tuscaloosa AL
Santa Clara Valley Medical Center San Jose CA
Florida Hospital FPRP Orlando FL
West Suburban Health Care Oak Park IL
Memorial Hospital FMR South Bend IN
St. Elizabeth FPC Edgewood KY
LSU Medical Center FPRP Lafayette LA
Moses Cone Health System Greensboro NC
University of Nevada School of Med Las Vegas NV
University of Rochester Rochester NY
Univ Hospitals of Cleveland Cleveland OH
Memorial Hospital of RI Pawtucket RI
Spartanburg Family Med Residency Spartanburg SC
Department Family Medicine Memphis TN
University of Tennessee at Memphis Memphis TN
College of Medicine Memphis TN
Brackenridge Hospital Austin TX
Christus Spohn Hospital Memorial Corpus Christi TX
University of Utah Salt Lake City UT
Swedish Family Medicine Residency Seattle WA
Family Medicine Spokane Spokane WA

Fellowship Directory | AAFP H
Fellowship Directory | AAFP Home Page

 

[NRAI2001]

I see 👍

 

[RuralMedicine]

To PeeShee: I'm not that familiar with FP/IM programs although I believe IM requires 2 years of solely IM training in all combined programs so it would push all the FP training into 2 years. My wonder would be with that how comfortable you would be with anything outside of IM so it might make more sense to simply do an IM residency or perhaps IM-Peds if you wish to care for all ages.

"I think a Peds/IM program may be better though"

STILL CAN'T DO OB THOUGH.....
HAVE WORKED WITH SEVERAL MED/PEDS DOCS....NOT IMPRESSED. GIVE ME A GOOD FP DOC INSTEAD ANY DAY.

The reality is that Med-Peds and FP are very separate and distinct residency programs. I think it is rather short sighted to say that FP is superior solely because of the many other primary care specialties that one is exposed to during residency. In reality an FP residency consists of 36 months and with consistent work hours rules we can truly set a maximum number of hours that would be possible for education. (In the past perhaps the FP residents in unopposed programs were logging 140 hours a month---however, I tend to doubt that as 3 straight years of averaging less than 4 hours of sleep nightly would have to take it's toll on anyone). Over those 3 years theoretically FPs gain enough exposure to become proficient in OB, Pediatrics, IM (and Ortho and Surgery as Dr.Smurf added). Med-Peds residents spend 4 years in residency and focus on Medicine and Pediatrics and their related specialties. At the end of residency they are eligible to sit for the board exams in Internal Medicine and Pediatrics. Sure we have exposure to adjunctive rotations. I did 2 months of Pediatric Surgery as part of my peds requirements but I would never say I could do surgery (pediatric or otherwise) although one of my surgery colleagues joked that I had definitely scrubbed more peds cases in my residency than he did in his (and yes he's pretty open that he has no business doing peds surgery either). I also did a month of Ortho and a month of Dermatology and yes I'll reduce some fractures and remove some skin lesions (but one of the things I got out of my dermatology rotation was where my limitations lie with that so there is a lot that I won't touch and that no one with a few months of Dermatology should be touching either....but apparently some physicians do and then Dermatology gets to clean up their messes later which I consider poor form).

I suppose I should put this in the context of rural medicine because in urban/surburban areas it would be very atypical for FPs to have privileges at Children's Hospitals, do c-sections, work in EDs, do any surgeries etc. In a rural area if you are the only provider in the county then there may be more options but I think we all need to realize that we all have limitations of our training. Sometimes not doing a procedure or stabilizing and transferring a patient early make us the real (albeit often unrecognized) heroes. Some people talk about a different standard of care Yet even in my rural hospital, our FPs do not have Peds admitting privileges for children under 5 (which means that I or the other Pediatrician need to "back them up" on their call nights), do not attend deliveries to resuscitate neonates (they don't deliver either but that is another story). I'm not saying that some FPs may not be able to do certain aspects of IM, Peds, OB, surgery etc but in reality their training will be much less in that area than their colleagues who are boarded in that discipline (which in the year 2005 is a significant liability and malpractice issue) and since FP is only a 3 year residency if you seek out extra training in one area then something has to give.

I'm not saying all of this to be critical, I'm saying it because I wrestled with similar questions when I was a medical student. I looked at a lot of unopposed FP programs before deciding that wasn't the best route for me to practice in a rural area. Sure we're all different people with different abilities and interests. If you tell me you trained at an unopposed FP program and got enough deliveries and c-sections that you think you can do OB you may be right. But I'd be really wary if you followed that up with claims that you are equally qualified in Peds, and IM. It's only a three year residency and something has to give. If I was a rural hospital administrator hiring physicians I'd definitely want at least one OB at my hospital (plus that covers your GYN surgery) I might not be opposed to letting my FPs do uncomplicated deliveries (if they could document sufficient residency volume and sufficient annual volume) but I'd have policies regarding when OB needed to be involved. I realize that these words won't be popular in an FP forum and that people will contend that in rural areas FPs are all we have. But I would contend that it doesn't have to be that way (it isn't at my hospital and we are small). Some people may argue that there is a different standard of care in rural areas and while I recognize that the challenges and resources are very different I would never want to imply that just because one lives in a community where cows outnumber people they have less right to adequate health care than someone who lives in an urban center. We all owe it to our patients to advocate and work within the system to make changes. [And to be honest about our own limitations as I've said several times above---I'm sorry I don't think I can stress that enough.]