Med/Peds vs IM vs FP

[NRAI2001]

So if someone is interested in doing a general practice what are the benefits and disadvantages of the three options:

1)Med/Peds
2)FP
3)Primary care IM

Obviously IM can only see adults but even for FP and Med/Peds i think the majority of your patients will be adults?

Please help I must rank next week. I m ranking Med/Peds programs and general IM programs... didnt apply to FP, mainly because I was interested in the fellowship options but lately I think I would just like to be a general physician (but who knows about the future)..

Thanks

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[mercaptovizadeh]

So if someone is interested in doing a general practice what are the benefits and disadvantages of the three options:

1)Med/Peds
2)FP
3)Primary care IM

Obviously IM can only see adults but even for FP and Med/Peds i think the majority of your patients will be adults?

Please help I must rank next week. I m ranking Med/Peds programs and general IM programs... didnt apply to FP, mainly because I was interested in the fellowship options but lately I think I would just like to be a general physician (but who knows about the future)..

Thanks

If you are truly dedicated to general practice, I don't see much advantage in med-peds over FP. If you aren't sure, med-peds gives you a stronger inpatient training, so you can do felllowships, which FP doesn't really allow. Also, med-peds gives you equal adult and pediatrics exposure. FP is much more adult than pediatric exposure. FP also has ob/gyn, but I'm guessing that doesn't interest you too much, since you didn't mention it.

Straight IM, just like med-peds, gives you good training for outpatient practice, plus it opens up a whole bunch of fellowship opportunities. Advantage vs. med-peds: more elective time, probably a bit more inpatient time. Also 3 vs. 4 years. Disadvantage is you don't see kids anymore.

 

[group_theory]

So if someone is interested in doing a general practice what are the benefits and disadvantages of the three options:

1)Med/Peds
2)FP
3)Primary care IM

Obviously IM can only see adults but even for FP and Med/Peds i think the majority of your patients will be adults?

Please help I must rank next week. I m ranking Med/Peds programs and general IM programs... didnt apply to FP, mainly because I was interested in the fellowship options but lately I think I would just like to be a general physician (but who knows about the future)..

Thanks

For future references, don't cross-posts in multiple forums. Not only is it against SDN rules, but as you can see, there is misinformation about med-peds in the categorical forums (which is why we have our own combined forum). Fortunately you were wise enough to spot the errors, but if you were new, you might take the misinformation as facts
http://forums.studentdoctor.net/showthread.php?t=984165

Please realize that Pros/Cons can differ from each individual perspective, a pro may be someone's con, and vice versa. Take your time to decide what you want to do.

Pros/Cons

1. Med/Peds - very broad training. You are your patient's Internist, and you are your patient's Pediatrician. There is a lot of overlap in training and your skills and knowledge in one field can complement the other fields. Fellowship opportunities on both sides, and in some fellowships, being med-peds trained is an advantaged (ie pediatric cardiology, adult or pediatric pulmonology, endocrinology, adult/pediatric critical care medicine, etc). I've had allergy/immunology directors tell me that Med-Peds residents have an advantage over categorical for Allergy/Immunology (in their eyes). You have fewer electives, and more wards/ICU (if you count wards/ICU from medicine and pediatrics) compare to your categorical colleagues.

But it is 4 years (compare to 3), and if you want to do both, you have to take both boards. And compare to family medicine, you have fewer outpatient clinic exposure (and less outpatient procedures). But you're more comfortable doing inpatient procedures (on adults and kids) because of your internal medicine and pediatrics training (of course, relative comfort of doing procedures will be program dependent)

A lot of Med-Peds residencies occur in university programs, and those not in university programs have strong academic affiliation with nearby medical schools.

2. Family Medicine - broad training, all in 3 years. Includes (require) OB experience during training. Have option of doing OB as attending (but high malpractice premiums due to OB). You spend more time in outpatient clinic, where that is their domain and where they excel. Limited TRUE fellowship options. I've noticed that FM residencies can be variable - some offer more comprehensive pediatrics exposure, while others have minimal pediatrics exposure (and the vast majority of their peds exposure is in outpatient clinic). I have a few friends who finished FM residency (and board-certified by ABFM or AOBFM) that have never placed a central venous catheter, or done a paracentesis, or thoracentesis. But he's in outpatient clinic where he doesn't need to know how to do central lines/paras/thoras. He knows how to do joint injections, punch skin biopsies, sebaceous cyst removal, colposcopy, and other outpatient procedures.

3. IM Primary Care Focus - you don't see kids and you don't do OB. Still need to take ABIM, still need do the require rotations (wards, cards, ICU, heme/onc, etc). You just have more clinic time and more electives compare to your other IM residents. But more clinic time means you will be more comfortable in the outpatient settings compare to your IM residents. Otherwise, you're a general internist, expected to be able to comprehensively treat your adult patient, whether outpatient for primary preventive care, disease management, or sick visits, or inpatient either on the floor, ICU, or subspecialty service. Only 3 years, same ABIM board. Fellowship opportunity is available as an ABIM grad if you decide you want to specialize while in residency or even after residency when you;re out in practice.

In terms of Med-Peds seeing mostly adults, see my post in the IM forum where I cited some literature that disproves that common line of thinking. But in the end, it's up to you and what type of patients you want to see - if you want to join a pediatric group and see only kids - you have that option. If you want to join an IM group and see only adults - you have that options. If you want to join a FM group that sees both, and you want to see both, you have that option (your patient mix will depend on the clinic population, and if you can pick/choose which patients you want to see). *if you join an FM group that does OB, then arrangement will have to be made on who will cover OB when you're on call

Also, Med-Peds programs tend to be more regional. There are fewer Med-Peds programs in the West Coast, so fewer people will know about Med-Peds. The concentration of Med-Peds programs tend to be in the Northeast and Midwest

Hope this is helpful.

 

[jl lin]

In terms of Med-Peds seeing mostly adults, see my post in the IM forum where I cited some literature that disproves that common line of thinking.

Good summary for comparing/contrasting (previous reply).

I'm interested, and I wanted to read what you posted in the IM forum, but finding your post is a bit like searching for the needle in the haystack. What was the title of the thread?

Thanks.

 

[lowbudget]

So if someone is interested in doing a general practice what are the benefits and disadvantages of the three options:

1)Med/Peds
2)FP
3)Primary care IM

Med/Peds spend way more time in the ICU, PICU, and NICU than FP's. Most Med/Peds programs are at tertiary care centers and therefore either see referred cases or will see patients in the local community where there are a lot of physicians around.

FP's have more outpatient experience built into the curriculum than a categorical IM. If you're primary care (point of first contact), you'll be asked to do a good portion of MSK, Derm, and Gyn along with a rudimentary ENT, Uro, Ophtho... and the procedures that go with these. These are things that are built into the FM curriculum. Most FM programs (outside of the university setting) will mirror the medical needs of the community.

The fellowship "option" is merely an option. There's value to having options but if you've already decided on what you want to do, the option is useless. Most people at the end of their 2nd year (and definitely at the end of the 3rd year) of residency are done with training; so the option to decide is most valuable when you're a medical student and when you're an intern.

Put another way, don't think you have a whole bunch of time to make a decision on what you want to do. You'll generally need to make a decision by the end of intern year because there's prep that needs to go into fellowship. If you're not committed to prepping for a fellowship, the option of being able to pursue a fellowship is useless; and therefore the advantage goes away.

You should pick a field you like. You should pick a field that gives you options. But, don't pick a field you don't like, just because it has options... So, at some point, make a decision on whether or not the things that make your field of study unique is of any value to you.