IM vs FM

[palipad123]

I am a 4th year us md student who will be applying to match 2021. I am trying to decide between family medicine and internal medicine. I know I want to work in primary care ( so I will definitely not specialize if I do internal medicine). However, once I am an attending I want to work like 4 days a week ( or even better 3 12 hour clinic days). But based on the many posts that I have seen on sdn and reddit, it seems like this flexibility is more common in family medicine rather than IM primary care. Do you think I can easily find some clinic job with this flexibility in a location I want ( I do not want to be near any big cities. My ideal location to live in would be something like the suburbs of plano texas or Raleigh NC). I am asking because I feel like I will have a higher chance of matching close to my family if I chose internal medicine compared to family medicine. However, if internal medicine does not provide that flexibility than I would rather choose family medicine.

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[Domepiece]

I believe this will be much more up to the practice that you associate with than the different inherent employment opportunities between these two specialties. Maybe @NickNaylor has more insight

 

[PugsAndHugs]

Pick FM if you want only outpatient clinic work only with some peds and obgyn.

Pick IM if you want both outpatient and inpatient with no peds/obgyn and option to specialize.

Sounds like FM is for you.

 

[FutureInternist]

IM leaves the possibility of specialising later if plans change whereas with FM you’re essentially “stuck”.

 

[Splenda88]

IM leaves the possibility of specialising later if plans change whereas with FM you’re essentially “stuck”.

I agree. I know one FM doc who later on had to do IM then ID because he was not happy with his career.

 

[palipad123]

thanks everyone for the responses. There is no chance that I will specialize. Also I am fine either taking care of kids or not so that is not a big factor. Also i will not be doing OB if I go FM but I am fine just doing some months of it in residency. The main factor for me now is if it is relativly easy to find an IM primary care job that allows you to work 3 12 hours clinic days or 4 days a week. If it is relativly easy than I would choose IM because there is a higher chance of matching close to my family. However, if it is more common in FM than I would choose FM.

 

[palipad123]

IM leaves the possibility of specialising later if plans change whereas with FM you’re essentially “stuck”.

Thank you for your response. Based on your knowledge of the IM primary care job market, is it easy to find an IM primary care job that allows you to work 3 12 hours clinic days or 4 days a week ( near decent locations like plano texas or raleigh nc). Also would the salary still be same since technically you will be working similar patient hours but it is just concentrated in fewer days. Thank you so much for your time.

 

[VA Hopeful Dr]

If you are 100% certain you want to do outpatient primary care, do FM. The training prepares you better for that and while the job market for both is excellent FM has an edge in that regard.

Most jobs want you to work a certain number of hours, how you do that within reason is up to you. I have 1 partner who takes every other Friday/Monday off - basically every other weekend is a 4 day weekend (and is still 4 days/week just different days off every other week). One who works 7:30-3 every day and another who works 4 days a week 9 hour days.

 

[MissRibeye]

Both IM primary care physicians I shadowed worked 3.5-4 days a week for what it's worth. It's definitely possible. Also remember that if you're a good candidate for any job you are applying for, you can always negotiate. This is something I didn't realize when I was younger. If they want you, they will try to make it work.

 

[InternistDO]

Thank you for your response. Based on your knowledge of the IM primary care job market, is it easy to find an IM primary care job that allows you to work 3 12 hours clinic days or 4 days a week ( near decent locations like plano texas or raleigh nc). Also would the salary still be same since technically you will be working similar patient hours but it is just concentrated in fewer days. Thank you so much for your time.

There should be absolutely no difference in the sort of schedules you can have with IM or FM. Most of the jobs will even say they will accept either IM or FM boards because the markets are basically the same. The difference is that very few IM grads go into primary care while almost all FM grads do.

If you are certain you don't want to specialize or be a hospitalist I would go with FM.

 

[Oedipa Maas]

Both IM primary care physicians I shadowed worked 3.5-4 days a week for what it's worth. It's definitely possible. Also remember that if you're a good candidate for any job you are applying for, you can always negotiate. This is something I didn't realize when I was younger. If they want you, they will try to make it work.

I also had experience with this. The IM doc I scribed for was nearing the end of her career and was doing 3.5 outpatient days a week. The whole practice was run by a big box healthcare brand and only had docs that were working part time, but I don't know the specifics of the others schedules. Some were relatively fresh out of residency, some were close to retirement, all had families and hobbies that they were enjoying in their spare time. This was in a suburb of the Phoenix greater area so not necessarily OP's target area, but it was not quite a big city but not quite rural either.

Edit: I also wanted to add that she had no shortage of patients. Some even specifically sought the practice out because they were told by one of their specialists that their primary care doc should be an internist due to their medical history. Also there are IM residencies with "primary care tracks" out there now that you should look into!

 

[FutureInternist]

Thank you for your response. Based on your knowledge of the IM primary care job market, is it easy to find an IM primary care job that allows you to work 3 12 hours clinic days or 4 days a week ( near decent locations like plano texas or raleigh nc). Also would the salary still be same since technically you will be working similar patient hours but it is just concentrated in fewer days. Thank you so much for your time.

IfI had to do clinic, I would shoot myself in the head... ;-).
I am a hospitalist so don’t really know about job market.
Some friends do do FP as outpt and based on very limited knowledge, you do seem to lose out on lots of bonuses unless you are working at a certain pointage (which varies with the practice)

 

[Damson]

I agree. I know one FM doc who later on had to do IM then ID because he was not happy with his career.

hey what's ID?

 

[Oedipa Maas]

hey what's ID?

Infectious disease!

 

[Sleepingdoc]

If you want to do outpatient do FM... if inpatient- do IM...

 

[allantois]

12 hour days outpatient sounds like UC land. While both FMs and IMs staff UC, it's probably better to have training in peds if you will work in that setting

 

[deleted1049832]

How does residency compare for both of them?

 

[Sleepingdoc]

How does residency compare for both of them?

3 years for both:
FM- more clinic time, more broad, more or less equal time in OB, pedes, adult medicine (although some programs are more equipped to handle one more than another)
IM- Mostly hospital work... Adult medicine only- electives in more specialized field... You can sub-specialize, is the advantage of IM.

 

[deleted1049832]

3 years for both:
FM- more clinic time, more broad, more or less equal time in OB, pedes, adult medicine (although some programs are more equipped to handle one more than another)
IM- Mostly hospital work... Adult medicine only- electives in more specialized field... You can sub-specialize, is the advantage of IM.

How are the hours/intensity? Or is it more program-dependent?

 

[cookiegrub]

thanks everyone for the responses. There is no chance that I will specialize. Also I am fine either taking care of kids or not so that is not a big factor. Also i will not be doing OB if I go FM but I am fine just doing some months of it in residency. The main factor for me now is if it is relativly easy to find an IM primary care job that allows you to work 3 12 hours clinic days or 4 days a week. If it is relativly easy than I would choose IM because there is a higher chance of matching close to my family. However, if it is more common in FM than I would choose FM.

In rural areas and even cities you are bound to find groups offering this. There are several rural sites that are desperate for primary care doctors. I wouldn't worry about the job prospects but more on whether or not this is the fit for you. I know you probably know/guess this but once you become FM doctor you can literally select the type of population you want to deal with. My rotation was pretty nonrepresentative as my physician took only the older generation (I don't have a problem with that but with later rotations and covid I never worked with kids or adolescents...). Other FM doctors have obesity clinics where they focus on weight loss. Essentially, the world is your oyster and if you can imagine your preference, I'm sure you will find a niche to practice in provided that you know the limitations around other specialization skills outside of FM.

 

[InternistDO]

How are the hours/intensity? Or is it more program-dependent?

Because it's more inpatient heavy, IM tends to have longer hours and a higher workload in residency. However there are inpatient heavy/full spectrum FM programs that are also very intense.

 

[Sleepingdoc]

How are the hours/intensity? Or is it more program-dependent?

Residency is grueling no matter what program you go to... IM and FM alike... IM I would say would require more hours inpatient so may be considered more intense... but FM can be equally bad as far as hours especially when you are on inpatient.