To all the pre-meds out there: If you clearly dont know what you are talking about don't respond like you do.
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What am I...Chopped Liver???...LOL As an FP in PRIVATE PRACTICE who AUTHORED the Family Medicine FAQ...This is my perspective of the differences between FP and IM (Taken from the FAQ).
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What is the difference between family medicine and internal medicine?
The main difference is that internal medicine is the specialty that deals with ADULT disease and treatment ONLY. Nobody under 18 (generally), and no OB. Family medicine deals with adult medicine, but also includes all other age groups (from newborn to elderly) and may or may not include an OB component (depending on region and personal preference of the practitioner). First, let me compare the residency training.
For IM residents, ALL rotations are in adult medicine and subspecialties. There is NO OB or peds. The only interaction with pregnant patients will be as a consultant for women in labor & delivery who develop a medical problem on top of their pregnancy (e.g., out-of-control diabetes, cardiac problems, etc.). As an IM resident, you will get more ICU exposure then the FM residents, and you will get to do more of certain procedures then the FM residents (central lines, Swan-Ganz catheters, etc.)
FM residents not only do adult medicine rotations, but pediatric rotations as well. They also have to do certain months of Labor & Delivery, where they not only play an active role in delivery and management of pregnant women, but also the management of medical conditions on top of the pregnancy that may occur (with the appropriate consultations, of course). Another difference is what occurs after residency. IM residents can do a fellowship in the various subspecialties, whereas FM has a limited number of fellowships. These have been described earlier in this document.
Here is the interesting twist...
In the world of PRIVATE PRACTICE, these differences are not as profound as in residency. The reason being is that as a private practitioner, your malpractice insurance as well as your hospital privileges WILL NOT cover the broad range of things you once did as a resident, especially when there are enough specialists around to do them. YES, an IM resident has put in more central lines than an FM resident, and floated more Swans, etc., but in private practice, you will be HARD PRESSED to find ANY private practice general internist who does those things for the reasons described above.
In a nutshell, when it comes to the private practice world of an IM doc vs. an FP, basically BOTH FPs and IMs on a daily basis handle the SAME bread & butter type of adult cases (hypertension, diabetes, thyroid disorders, upper respiratory infections, gastroenteritis, heart disease, rashes, etc. - which will make up 90+% of your office day), and are reimbursed the SAME from Medicare and managed care insurance companies. A level 3 outpatient visit (there are 5 possible levels) - (a.k.a. 99213) is reimbursed the SAME whether you are an internist or an FP. Anything beyond bread & butter management is referred out for the SAME reasons as I described in my peds vs. FM comparison.
When it comes to inpatient medicine in the PRIVATE PRACTICE world, FM and IM function the same way as well. Both handle bread & butter admissions (exacerbation of CHF, chest pain-r/o MI, sepsis, MI, altered mental status, pneumonia, nursing home "trainwrecks", etc.) and BOTH will obtain the appropriate consults when warranted - no difference. Did the internist get more experience managing a vent in residency? YES, but again, you are going to have a VERY hard time finding an internist in private practice who manages his own vents without calling pulmonology consult, because if there is a bad outcome because you didn't get a consult, you WILL get nailed!
FM and IM are both employed interchangeably by hospital staffs as well as managed care companies. ONE exception is in places that do not have any IM sub-specialists (cardiology, pulmonology, gastroenterology, etc.), the local internist may be the one who has to do certain procedures (reading echocardiograms, placing central lines, floating Swan-Ganz cathethers, stress tests, bone marrow biopsies, etc.), primarily because there is no one else around to do it. This phenomenon exists primarily in small towns with NO sub-specialists.
What is the difference between FM residency and Med/Peds residency, and what is the significance in private practice?
Basically, Med/Peds is a combination residency that combines IM and peds into a 4-year residency (half medicine rotations, half peds rotations). These programs do not include OB rotations or general surgery. At the end, one must obtain and maintain board certification in BOTH specialties (that means 2 separate exams, plus CME and recertification). In FM, there is just ONE board certification to maintain. For Med/Peds, after residency, one may elect to do a fellowship in either an adult, pediatric, or a combined adult/peds subspecialty. In FM, there are limited fellowships which have already been described.
Here is where the differences end. In the world of private practice, BOTH function the same. The only difference is IF the FP decides to include OB in his/her practice, then the med/peds doc cannot cross-cover. BOTH groups will handle the same type of bread & butter adult and peds cases with the APPROPRIATE referrals to specialists when warranted. There is no difference in insurance reimbursement between the two for a particular case. ALSO, if you are Med-Peds, you must take 2 BOARD EXAMS once you are finished with residency, and must RECERTIFY BOTH BOARDS every 10 years. When you are a busy private practicioner, keeping up with 2 boards becomes a MAJOR PAIN IN THE ASS...Whereas in FP, there is only ONE board exam to keep up with every 10 years (use to be 7).
Hope this helps.
-Derek Sampson, MD
