Disclaimer: this is all just my subjective personal experience based on my own experiences applying to FM residency/being an FM resident, and what I've heard from attendings and residents in both specialties.
Relative difficulties of residencies: Highly program dependent. There are both IM and FM programs where you will routinely hit 80 hrs, and ones where you'll be mostly in the 50-60 range (for IM this is mostly the primary care-directed programs). I would say on the average IM ones tend to have longer hours but if you want to do more than just bread and butter outpatient FM, you need to be at a more intense program to get the training to do so.
Scope of practice/career pathways:
- Every FM program will prepare you for outpatient primary care, and a solid number of office procedures like skin stuff, basic gyn, and joint injections. Many will prepare you for basic adult inpatient stuff. Some will prepare you for inpatient peds, OB, and more critical/less common adult inpatient stuff. The benefits of FM over IM for scope of practice are the ability to do peds and OB, and generally speaking better gyn and office-based procedure training as well.
- IM will prepare you for inpatient and outpatient adult medicine. The added benefit is the ability to specialize.
- Fellowships also play into this which I'll get to in a minute.
Amount and type of paperwork: basically the same, more dependent on practice setting than residency training.
Hospitalist work: Yes, FM can do hospitalist - but in some areas it's less common than IM hospitalists, and you need to graduate from a program that will train you well for it. The community I'm in for residency is very FM-friendly, and almost all of my FM faculty members do inpatient work, as do lots of FM community docs. Some places, generally academic centers in bigger cities, prefer IM-trained docs.
Academics: Yes FM can do academics, though I'm not sure exactly what you mean by "academics." There are literally hundreds of FM residencies out there in pretty much any location you might want to be where you could teach and do research.
Fellowships:
- Generally, IM fellowships will restrict your scope of practice to that specialty (cardiology, heme-onc, nephrology, etc.). Yes, it generally focuses on an organ system.
- I would agree that FM fellowships are more population focused - women's health/OB, geriatrics, adolescent medicine, addiction medicine, sports medicine, etc. Generally these will expand your scope of practice, e.g. learning to provide more advanced maternity care and do C-sections, or learning to do medication-assisted treatment for opioid addiction, but still doing all the other FM things along with those skill sets.
