Outpatient focused FM residencies

[WhatIsGoingOn219]

Am looking for outpatient focused FM residencies! Any programs come to mind? I want to practice outpatient FM after residency so I'm thinking those will prepare me best.

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[cj_cregg]

The majority of FM programs are outpatient focused only, and the relatively smaller number of inpatient-focused FM programs will prepare you well for outpatient practice as well. I'd recommend looking at the websites for some of the programs that interest you or the ones in your area if you're not sure yet. Their curriculum and list of recent alumni should give you a sense of what the program prepares you for.

 

[VA Hopeful Dr]

I would advise against choosing an outpatient heavy FM program. All of FM has plenty of clinic but the inpatient rotations, in my opinion, help prepare you better since you're dealing with sicker patients.

Being able to rapidly determine sick v. not sick is a crucial skill that takes significant practice to acquire.

 

[Sardonix]

I would advise against choosing an outpatient heavy FM program. All of FM has plenty of clinic but the inpatient rotations, in my opinion, help prepare you better since you're dealing with sicker patients.

Being able to rapidly determine sick v. not sick is a crucial skill that takes significant practice to acquire.

This is ridiculously overdramatic. What you just described boils down to three very simple steps:

1. See patient
2. Find physician who DID undergo rigorous inpatient training.
3. Ask them, "Hey is this guy sick or not sick?"

See, easy as that.

 

[Drrrrrr. Celty]

This is ridiculously overdramatic. What you just described boils down to three very simple steps:

1. See patient
2. Find physician who DID undergo rigorous inpatient training.
3. Ask them, "Hey is this guy sick or not sick?"

See, easy as that.

I think that you really get a poorer perspective on a lot of the pathophysiology, natural progression, and decompensation patterns of disease without following it inpatient. It may be myopic, but inpatient is where you learn and outpatient is where you practice and apply what you've learned.

Though, this is the perspective of an IM guy.

 

[WhatIsGoingOn219]

I see. I didn't realize that. Thank you all for your advice.

 

[VA Hopeful Dr]

I think that you really get a poorer perspective on a lot of the pathophysiology, natural progression, and decompensation patterns of disease without following it inpatient. It may be myopic, but inpatient is where you learn and outpatient is where you practice and apply what you've learned.

Though, this is the perspective of an IM guy.

I interpreted that post as sarcasm

 

[Drrrrrr. Celty]

I see. I didn't realize that. Thank you all for your advice.

You really should go to a program that offers you the best training in both worlds. Like my program doesn't do outpatient very well, which upsets me a bit. If I could go back I'd choose a program with a solid selection of subspeciality clinic, bit more robust outpatient, as well as inpatient oppertunities.

You only do residency once. You don't want to end it and feel like you didn't get enough training to be able to handle most of what you want to do.

 

[VA Hopeful Dr]

You really should go to a program that offers you the best training in both worlds. Like my program doesn't do outpatient very well, which upsets me a bit. If I could go back I'd choose a program with a solid selection of subspeciality clinic, bit more robust outpatient, as well as inpatient oppertunities.

You only do residency once. You don't want to end it and feel like you didn't get enough training to be able to handle most of what you want to do.

I think IM programs generally don't do outpatient well.

 

[Drrrrrr. Celty]

I think IM programs generally don't do outpatient well.

Nope, not at all. It's just too disorganized and I often am seeing other people's patients.

 

[Sardonix]

I think that you really get a poorer perspective on a lot of the pathophysiology, natural progression, and decompensation patterns of disease without following it inpatient. It may be myopic, but inpatient is where you learn and outpatient is where you practice and apply what you've learned.

Though, this is the perspective of an IM guy.

I interpreted that post as sarcasm

Yes to both.

 

[InternistDO]

I think IM programs generally don't do outpatient well.

How dare you suggest that completely neglecting women’s health, procedures, or any real sense of continuity doesn’t train excellent PCPs.

 

[FrustratedFamDoc]

Many programs, unfortunately do not prioritize teaching as primary objective. You're a worker bee who will tend the hive until the next crop comes in. You'll get morsels of non-work oriented teaching along the way, but in general expect to have the Daniel-san/Mr Miagi relationship. I am a proponent for inpatient heavy programs. If you don't learn take care of it in residency, then the ship has sailed on that one. To be outpatient heavy and inpatient light, you further blur the line of distinction between physicians and mid-levels.

 

[IntheClouds4ever]

PGY2 in an inpatient/ ER heavy program. Highly encourage this as continuity is easier for follow ups since you know what should’ve been done, what needs to be continued, and warning signs to send them inpatient before they wind up in the ER in a completely decompensated state. There are So many podcasts and other resources for outpatient medicine to learn preventative stuff on your own. I felt it was easier to learn inpatient medicine and adapt to outpatient rather than the opposite. Just my .02 though

 

[WhatIsGoingOn219]

How many months of inpatient hospital medicine in the curriculum (over the course of the 3 years) are an enough amount to have? How many months is too little? Sorry, I'm still learning about how to interpret the residency curriculums on program websites.

 

[MedicineZ0Z]

Am looking for outpatient focused FM residencies! Any programs come to mind? I want to practice outpatient FM after residency so I'm thinking those will prepare me best.

"Outpatient focused" residency usually means crap program. A poor inpatient setup means the department isn't well respected in the system and won't be taking care of any sick or complex patients in clinic either.
In other words, inpatient quality is like a surrogate for how good the program is in general.

I think that you really get a poorer perspective on a lot of the pathophysiology, natural progression, and decompensation patterns of disease without following it inpatient. It may be myopic, but inpatient is where you learn and outpatient is where you practice and apply what you've learned.

Though, this is the perspective of an IM guy.

Pretty much this. Decent inpatient training also prevents you from becoming a referologist. There are primary care docs who aren't comfortable with new onset Afib....

 

[MedicineZ0Z]

How many months of inpatient hospital medicine in the curriculum (over the course of the 3 years) are an enough amount to have? How many months is too little? Sorry, I'm still learning about how to interpret the residency curriculums on program websites.

At least 3 months of days and nights per year, assuming the program has quite a bit of call + more ICU time, ED time, etc. If lighter on call and other inpatient rotations, then more than 3 months per year.

Keep in mind there are programs with quite a few months and long hours but the census size/breadth of pathology and other things are weak.

Find out the census size first... are interns carrying 6-9 patients a day? How's the pathology? Is it all pneumonia, copd, chf? Or do you see atypical cases and see a good number of rare pathology as well? Are you consulting for everything or do you manage lots of things on your own? Are you doing your own paras/thoras/LPs? Is the ICU training very good? Are attendings making all the decisions or do residents make the majority?