IM vs. FM: what's the difference when it comes to IM

[DrDude]

Having done both these rotations, it seems IM and FM residents/attendings know the same amount when it comes to general internal medicine. FM physicians can handle the same stuff a general IM physician does (HTN, DM, COPD, asthma, etc).

Both IM and FM also refer out/consult to specialists when things get complicated. But I've yet to see an FM refer/consult out to an IM physician. When they do consult it's to a IM subspecialist (cardio, nephro, pulm, etc).

So if both IM and FM physicians consult IM subspecialtists for similar cases, doesn't it imply their level of general IM knowledge is about the same?

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[pmpkn219]

I would say, in my limited experience they're probably more similar than not in regards to "IM knowledge"

Seems to me the FM team does more outpatient (inpatient too, but less % than IM). Whereas IM teams here do more inpatient/ICU type things. But I personally don't see a huge glaring difference.

 

[domer621]

IM patients are way sicker and more complicated than FM patients.

 

[MrBurns10]

IM patients are way sicker and more complicated than FM patients.

This is correct. It's kind of like how General OB/Gyn and MFM relate to each other.

 

[Law2Doc]

So if both IM and FM physicians consult IM subspecialtists for similar cases, doesn't it imply their level of general IM knowledge is about the same?

Not really, and here's why. The more you spread out your focus, the more you lose on the specifics. By expanding coverage to eg. children, womens health issues, geriatrics, etc, the family medicine folks have opted to know a little bit about a lot of things, rather than a lot about a smaller core focus. The whole jack of all trades, master of none concept. Which works for FP, because if you are out in suburbia and the only doc around, then it pays to know a little bit about everything, even if your focus is diverted. IM tends to focus on non-peds, non-womens health, (sometimes even non-geriatric, to the extent it is a separate subsepecialty) folks, and as such, can delve deeper into the specific ailments in their focus patient base. Plus IM has its own specialties so you can become even more focused. The fewer subjects you divert to the more of an expert you can be. So do you want to be a generalist or an expert? FP offers more of the former while IM offers opportunities to be the latter. But as you suggest there can be a ton of overlap, depending on how various practitioners operate.

 

[Ypo.]

IM patients are way sicker and more complicated than FM patients.

I don't think so. While I agree that IM docs in hospital setting see higher numbers of sick, complicated patients, there isn't any particular rule that FP patients will be less complicated. The FP service here takes care of all their patients admitted to the hospital. I didn't see a difference between the FP and IM service except for that IM always had more numbers of older patients.


To the OP; it's the difference between outpatient and inpatient medicine, plus FPs see kids and pregnant women. IM residency you'll get more exposure caring for acutely ill patients in the hospital setting. Plus you can then follow any of the fellowships open to IM docs.

However, I worked with IM docs in outpatient who were essentially identical to FP.

 

[diosa428]

This is correct. It's kind of like how General OB/Gyn and MFM relate to each other.

Not really - MFM is a specialty within Ob/Gyn. FM and IM are different residencies.

 

[domer621]

Not really - MFM is a specialty within Ob/Gyn. FM and IM are different residencies.

His point was that MFM specialists see the most complicated OB patients, kind of like how IM physicians see the most complicated medicine patients.

 

[diosa428]

His point was that MFM specialists see the most complicated OB patients, kind of like how IM physicians see the most complicated medicine patients.

HER point. And, yes, I got the point. I was just giving her a hard time b/c we know each other.

 

[misery]

ever see a FP resident on an ICU rotation? If you have you'll have seen the difference.

 

[eyesarecool]

they pretty much do similar things, except internists specialize a little bit more in the internal stuff of a patient such as cardio or gastro, while a family medicine person specializes a little bit more in the family issues of a patient such as obgyn or pysch

 

[MrBurns10]

HER point. And, yes, I got the point. I was just giving her a hard time b/c we know each other.

After that sushi the other night, I would have had to go to an IM doc.

Too much information? maybe. but I've been forced to stay awake in the hospital for the past 13 hours, so that makes it okay.

 

[Ypo.]

ever see a FP resident on an ICU rotation? If you have you'll have seen the difference.

Or if you've ever seen an IM doc on the maternity or pediatric ward. 😉

 

[Biscuit799]

Or if you've ever seen an IM doc on the maternity or pediatric ward. 😉

Well, considering it's usually for a consult, they usually hold their own pretty well as they tend to stick to what they know... which is a lot.

 

[Ypo.]

Well, considering it's usually for a consult, they usually hold their own pretty well as they tend to stick to what they know... which is a lot.

You would think, wouldn't you? I'm on psych, and I just saw two IM consults royally screwed up. One was for diabetes and the other was for HTN. The psych residents had to fix it and basically the pt would have been better off if IM had never been consulted. (one pt was taken off clonidine and BP soared. The other patient was put on a high dose of pramlintide without adjusting insulin and their glucose dropped and they were found unresponsive in the a.m.). People are usually good at what they do a lot of. So why the IM residents screwed up HTN and diabetes for Christ sake, I can't understand.

Another thing I see IM residents do is order tons of unnecessary tests. They can be worse than the ER. It makes them good at finding zebras, but hey if I could order every test in the world, I'd probably find a lot of zebras too.

Basically I think it's highly dependent. I've seen some awesome IM attendings and I've seen some really poor ones, too. Same for FP.

If I were going to be managed in the hospital for a serious illness, I would probably want to be cared for by a hospitalist.