Internal Medicine vs Family Practice

Discussion in 'Clinical Rotations' started by Treybird, Apr 1, 2002.

  1. Treybird

    Treybird Senior Member
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    Can anyone tell me the difference between internal medicine and family practice?
    They seem to cover the same thing. Can an internal medicine doc have a family practice?
    HELP.
    Please E-mail me at [email protected]
     
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  2. adjsmj

    adjsmj Member
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    The main difference is family practice docs see children where medicine docs don't. There are some medicine/peds residencies out there however. Medicine docs can be general meaning they dont subspecialize. So in that respect they can have somewhat of a "family practice" Also the medicine docs have more of a hospital base training with lots of ICU time and more complex cases.
     
  3. Maran

    Maran Member
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    In addition to the peds training, many FPs also cover do OB. And once you hit the job market, there is a much higher demand for FPs than IMs (unless, of course, you do a specialty fellowship after your residency.)
     
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  4. alina_s

    alina_s Senior Member
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    I was also wondering about the difference between family and internal medicine residencies. Do family medicine programs devote more time to outpatient practices? Is the atmosphere in internal medicine programs more competitive, since many fields require internal medicine and then a fellowship?
     
  5. Mad Scientist

    Mad Scientist Member
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    Here's my perspective as someone who has been looking at and investigating both fields. Yes, FP sees children and OB whereas IM does not, but there are also significant differences in culture and training. The IM doc is trained primarily in seeing patients in the hospital, and most IM residents go on to specialize (in cardiology, hematology, ID, etc.). The FP doc is trained primarily in outpatient primary care, although they do see enough of the hospital to (hopefully) make them competent in that setting.

    From what I have seen, if you want to specialize or focus on patients in the hospital (e.g. as a hospitalist), go IM. If, on the other hand, you prefer primary care, and want to be able to be something of a "jack-of-all-trades", go FP.

    Another way to think about it is if you don't want to be limited by what kind of patients and problems you see, go FP. If you don't want to be limited by how much you can learn about one aspect of medicine, go IM and specialize. Personally I don't see a real good reason to go general IM unless you want to be a hospitalist. If you go IM and then become a general internist in primary care, you will not have gotten as much training in that setting that you would have as an FP.
     
  6. rad

    rad Member
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    im versus fp: forget about both :cool:
     
  7. EidolonSix

    EidolonSix Member
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    Both afford you the best opportunities to actually take care of patients, especially with options for continuity of care, if those types of relationships are important.

    Job opportunities are abundant in both, but do not pay as well as some other patient oriented specialities or auxillary specialties like radiology. Most of this dissonance in pay is due to poor construction of DRGs, which Medicare and insurance companies use to determine reimbursements. An FP doing a vasectomy may get 1/5th reimbursement compared to a urologist doing an identical procedure. Tough times for the PCP, but then again its tough for a lot of specialists too, with reimbursements decreasing across the board.
     
  8. titan

    titan Senior Member
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    Why don't most all IM people go into a specialty? The benefits of doing a 2-3 year fellowship seem to certainly outweigh the extra 2-3 years beyond residency. Are fellowship positions hard to obtain/very competitive? I am interested in a hematology/oncology fellowship later on when I complete med school and residency. Any insight is appreciated!
     
  9. rtk

    rtk Member
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    It's interesting that whenever I see a post like this, the question is always: "what's the difference btwn IM and FP??, not "what's the difference between Peds and FP or OB/Gyn and FP?". I guess it's because the differences in the later examples are implicit. But the principle making the diffence btwn (choose one: peds, ob/gyn, IM) and FP is the same. An FP gets cursory training in all these fields, where as the other specialties get in-depth training. News flash: all these specialties are considered primary care specialties. The most 'primary' of these specialties arguably being FP...

    An internist is trained to care for adult patients w/ multiple co-morbid conditions and critically ill pts in acute care settings. It's true that residents trained in IM can sub-specialize. Keep in mind that the majority of physician's caring for pt's in metropolitan hospitals are general internists. The traditional setting of hospital and outpt based practice is continually being pushed toward internists. This may not apply in rural settings, where FP's still have hospital priveledges, but it's becoming less-and-less common in metro areas for FP's to care for inpt's, leaving their practices almost entirely outpt driven...

    The match this year may be very telling of the big picture in health care economics. This is an arguable point, but in the eyes of third party payers (i.e.: medicare/medicaid), NP's, PA's and FP's are on equal footing in most outpt encounters. This is because the traditional FP outpt E&M visit is of low-acuity (e.g.: otitis, strep pharyngitis) in healthy patient populations. These 3rd party payers feel care provided to these pts can be equally given by nurse practicioners at 75% a physician's fee. It's true, in several states, NP's can bill Medicare directly (at discounted physician rates), w/o physician oversight. Think the rest of the 3rd-party payers won't catch on that these primary encounters can be provided at 75% less cost...? (Traditionally, what gov't entitilements programs do, private insurers follow in short order). This places entry-level physician providers in a tenous position.

    If for only job security reasons, it's important to have skills that gives you something beyond what can be provided by an allied-health-care provider (i.e.: NP and PA)*. The advanced, specialized training in Peds, OB/Gyn and IM gives you the options to care for acutely ill and complicated pts that is beyond the scope of an FP's training.

    *Disclaimer: I realize that an FP's training is significantly more indepth than allied health care providers, but this is a philosophical argument, and in the eyes of Uncle Sam, they are equal in many respects...
     

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