Outpatient focussed family medicine residencies

[Nerdbomb99]

Hello everyone,
I'm a graduate of bachelors in medicine from Singapore.I am keen on pursuing medical residency in the U.S. I searched through the threads and found the following one: Inpatient vs. outpatient time on a FM residency on the same lines as the one i just started,but it doesn't quite clear my queries or render further guidance on the topic.
Now my case:I would like to pursue medical residency which trains majorly in outpatient medicine.I am aware there are such programs in the 'Medicine-primary care' category and in the thread i reffered to,somebody mentioned of these being available in family medicine too and am also aware that a spot in E.M. would be suitable but very difficult for an IMG to match,into even with my good scores.My questions are:
A)Are the family medicine programs focussed on outpatient care in abundance?how many spots roughly?
B)Are there 'medicine-primary care' and outpatient focussed family medicine programs which are IMG friendly?Does a good proportion of IMGs occupy such spots?
C)From what i gather,with the training i would get in such programs i could work in emergency rooms in rural areas across the U.S.,is this an often occurance?,also is there a good demand for outpatient medicine jobs,like maybe in an outpatient clinic or a primary care doctor in a hospital who refers patients to specialists(which i know is normally done by E.M. Physicians)?I wouldn't like to start a private practice,rather practice as a primary care giver in a setup,something like Mon-friday,9-9.Money is not a big concern to me.
Any helpful responses will be greatly appreciated.Thank you .

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[Natividad Resident]

I'll assume you've already absorbed the IMG basics on ecfmg.org, such as USMLE tests etc.

Generally you need to get US hospital experience before you try to get a US residency. Hopefully that's something you've done or will do. Generally residencies don't have time to help you recover from the initial shock of exposure to the US healthcare non-system. (Also, fun fact, almost nobody in residency can give knowledgeable answers to questions about why US healthcare is the way it is. Or why it's STILL the way it is.)

FM residency is 3 years. It's a thing you have to get through, to get to practice the way you want, afterwards. You might find that you want as much elective time as you can get, and you might be willing to put up with more inpatient work to get those electives. Electives can get you more, and more interesting, time in an outpatient setting, such as to get more musculoskeletal or procedures or gyn.

There are more than 500 FM residency programs across a very diverse massive country. You won't make progress in focusing your search by thinking "outpatient" is a characteristic that differentiates residencies. You'd do better to decide if you want to live and work in a state that went majority Trump vs. not. Or to decide which major city you want to be closest to. Or where it's cheap to live. Proximity to a major airport. Etc.

FM programs are not "focused" on outpatient. There are some that have less time allocated to inpatient. All FM residencies require inpatient training. All require outpatient training. Some are loosely affiliated with the hospitals where residents (are required to) train. Some are hosted at specific hospitals. All FM programs require inpatient obstetrics, inpatient adult and pediatric medicine, etc.

The way to find IMG-friendly residencies is to find residencies that have IMGs. See nrmp.org and websites for FM residencies. There are plenty.

EM is not outpatient. You would be completely unqualified to work in an ED, rural or not, by "focusing" on outpatient. A rural ED that will let an FM doc take shifts is interested in how many lines & intubations you've done, how many codes you've run, how much trauma you've done. Not outpatient.

Those of us in FM residencies start getting recruited for 100% outpatient jobs, with much better hours than M-F 9-9, by about the 3rd month, from all over the country. No shortage of jobs.

Lastly, the way you're forming your question makes it sound like somebody's feeding you the words to describe what you should care about. Again, hopefully you're able to get over here and spend time in the practice environment, finding out what you personally care about first hand, before you invest in trying to match.

Good luck!

 

[SterlingMaloryArcher]

Hello everyone,
I'm a graduate of bachelors in medicine from Singapore.I am keen on pursuing medical residency in the U.S. I searched through the threads and found the following one: Inpatient vs. outpatient time on a FM residency on the same lines as the one i just started,but it doesn't quite clear my queries or render further guidance on the topic.
Now my case:I would like to pursue medical residency which trains majorly in outpatient medicine.I am aware there are such programs in the 'Medicine-primary care' category and in the thread i reffered to,somebody mentioned of these being available in family medicine too and am also aware that a spot in E.M. would be suitable but very difficult for an IMG to match,into even with my good scores.My questions are:
A)Are the family medicine programs focussed on outpatient care in abundance?how many spots roughly?
B)Are there 'medicine-primary care' and outpatient focussed family medicine programs which are IMG friendly?Does a good proportion of IMGs occupy such spots?
C)From what i gather,with the training i would get in such programs i could work in emergency rooms in rural areas across the U.S.,is this an often occurance?,also is there a good demand for outpatient medicine jobs,like maybe in an outpatient clinic or a primary care doctor in a hospital who refers patients to specialists(which i know is normally done by E.M. Physicians)?I wouldn't like to start a private practice,rather practice as a primary care giver in a setup,something like Mon-friday,9-9.Money is not a big concern to me.
Any helpful responses will be greatly appreciated.Thank you .

FM doctors in a practice work 9-9?

 

[Nerdbomb99]

I'll assume you've already absorbed the IMG basics on ecfmg.org, such as USMLE tests etc.

Generally you need to get US hospital experience before you try to get a US residency. Hopefully that's something you've done or will do. Generally residencies don't have time to help you recover from the initial shock of exposure to the US healthcare non-system. (Also, fun fact, almost nobody in residency can give knowledgeable answers to questions about why US healthcare is the way it is. Or why it's STILL the way it is.)

FM residency is 3 years. It's a thing you have to get through, to get to practice the way you want, afterwards. You might find that you want as much elective time as you can get, and you might be willing to put up with more inpatient work to get those electives. Electives can get you more, and more interesting, time in an outpatient setting, such as to get more musculoskeletal or procedures or gyn.

There are more than 500 FM residency programs across a very diverse massive country. You won't make progress in focusing your search by thinking "outpatient" is a characteristic that differentiates residencies. You'd do better to decide if you want to live and work in a state that went majority Trump vs. not. Or to decide which major city you want to be closest to. Or where it's cheap to live. Proximity to a major airport. Etc.

FM programs are not "focused" on outpatient. There are some that have less time allocated to inpatient. All FM residencies require inpatient training. All require outpatient training. Some are loosely affiliated with the hospitals where residents (are required to) train. Some are hosted at specific hospitals. All FM programs require inpatient obstetrics, inpatient adult and pediatric medicine, etc.

The way to find IMG-friendly residencies is to find residencies that have IMGs. See nrmp.org and websites for FM residencies. There are plenty.

EM is not outpatient. You would be completely unqualified to work in an ED, rural or not, by "focusing" on outpatient. A rural ED that will let an FM doc take shifts is interested in how many lines & intubations you've done, how many codes you've run, how much trauma you've done. Not outpatient.

Those of us in FM residencies start getting recruited for 100% outpatient jobs, with much better hours than M-F 9-9, by about the 3rd month, from all over the country. No shortage of jobs.

Lastly, the way you're forming your question makes it sound like somebody's feeding you the words to describe what you should care about. Again, hopefully you're able to get over here and spend time in the practice environment, finding out what you personally care about first hand, before you invest in trying to match.

Good luck!

Well aware of the system/non-system of health care in the U.S.,the time duration,required clerkships,l.o.rs,connections,the states that went "Trump vs not".Not being fed words to describe what i "should care about",i know what i "should care about" and not..been in the practice enviroment,worked as an e.c.g technician for a reputed cardiologist in Florida.It's obvious anybody who's been through med school wouldn't assume there would be any family physicians who've ONLY been trained in outpatient medicine,they wouldn't be called family physicians if they din't know how to treat hospitalised patients upto a certain extent.What all you've blabbered is already generally known,i mentioned i've been through threads and anybody who's taken the steps and scored well on them(i mentioned that too) would be filled in on what all said.You commented on the manner i formed my question,i should on yours:it's like you're speaking out of the blue(i mean where did you even come from talking about the health care system etc.),assuming stuff,trying to talk down on someome who's reaching out for help,blabbering trying to shell attitude on a non-u.s. Citizen.You havn't helped at all.

 

[Nerdbomb99]

FM doctors in a practice work 9-9?

In a private practice,isn't it ones wish to set it up however he/she wants? In practices tied to hospitals/group clinics(if there are such in the U.S.),i don't know,i wouldn't mind working round the clock 5 days a week to get 2 days off during the weekend for leisure.

 

[Hakuna Matata]

In a private practice,isn't it ones wish to set it up however he/she wants? In practices tied to hospitals/group clinics(if there are such in the U.S.),i don't know,i wouldn't mind working round the clock 5 days a week to get 2 days off during the weekend for leisure.

You'll be hard pressed to find a FM doc who works "round the clock 5 days a week" to get the weekends off. The vast majority of outpatient FM docs work 4-5 days a week, 8-10 hrs a day. Of course that's not true for everyone.

Also, @Natividad Resident was trying to help you and your response was rude and ungrateful. So good luck with that.


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[Nerdbomb99]

@Natividad Resident My apologies.I guess i should be sportive enough to tolerate a little harmless bullying which comes with the valuable guidance.Thank you for your response.

 

[Nerdbomb99]

Going by the statistics,ratio of no. of imgs applying:no. Of imgs matched,imgs seem to match lesser into family medicine compared to internal medicine,can i assume that is because a lot of them have internal medicine as their 1st priority and have matched into that field? I prefer FM to IM because during my medical school rotations i enjoyed the clinics,the little surgical procedures,seeing dermatological cases more than in-hospital rotations.I would like to be trained in a more broader clinical orientation than deeper,also i would like to be able to treat any acute pathologies and emergencies.I noticed during my visit to a hospital in Florida for my clerkship is that family medicine residents strived just as hard as internal medicine residents to be adept at treating in-patient admits.There were procedures that family medicine residents were not allowed to perform,but they stood around and watched.So family medicine to me seemed like (internal medicine-interventional procedures)+peds+obs.I've never heard a family physician say "a general internist would know about this better than me",but known them to obviously refer to the subspecialist.

 

[septoplasty]

Going by the statistics,ratio of no. of imgs applying:no. Of imgs matched,imgs seem to match lesser into family medicine compared to internal medicine,can i assume that is because a lot of them have internal medicine as their 1st priority and have matched into that field? I prefer FM to IM because during my medical school rotations i enjoyed the clinics,the little surgical procedures,seeing dermatological cases more than in-hospital rotations.I would like to be trained in a more broader clinical orientation than deeper,also i would like to be able to treat any acute pathologies and emergencies.I noticed during my visit to a hospital in Florida for my clerkship is that family medicine residents strived just as hard as internal medicine residents to be adept at treating in-patient admits.There were procedures that family medicine residents were not allowed to perform,but they stood around and watched.So family medicine to me seemed like (internal medicine-interventional procedures)+peds+obs.I've never heard a family physician say "a general internist would know about this better than me",but known them to obviously refer to the subspecialist.

I think what you're seeking if a bit of a grey spot.

Residency programs in general have to meet ACGME guidelines on what needs to be "taught" to FM residents.

This, unfortunately for you, does include inpatient months (adult, pediatric), and fortunately for you some ER (adult and peds), as well as outpatient.

You will not find any residency in the country that is all 100% outpatient.

Sure there will be programs that have more inpatient, or less, but the minimum has to be met. Which you WILL have to do.

Hope that helps?

Also, alot of the questions you've asked "demand for FM" etc. are answered multiple times in the FM program forum.

There are many programs (perhaps less desirable ones), that are completely filled by IMG's, but again, this is multifactorial, and isn't just based on what shape or colour you are. If you're an IMG, where exactly did you go to school (certain programs, have historically accepted img's from one country > another country), what their visa status is, board scores above all as well. As well as extracurriculars.. volunteer, rotations, clubs, etc. Often people apply to FM as a back up, and programs recognize this, which makes it harder for FM grads as they have to prove genuine interest.

Yes, alot of IM people apply to FM as a back up. Than they often try and re apply after 1st year, and potentially leave, which screws the FM program.. so they don't want this.

 

[deleted87716]

So family medicine to me seemed like (internal medicine-interventional procedures)+peds+obs.I've never heard a family physician say "a general internist would know about this better than me",but known them to obviously refer to the subspecialist.

In general, I've found that FM refers far less than IM. I've inherited enough patients from internists over the years to have observed the "pan-referral" phenomenon firsthand.

 

[SterlingMaloryArcher]

Going by the statistics,ratio of no. of imgs applying:no. Of imgs matched,imgs seem to match lesser into family medicine compared to internal medicine,can i assume that is because a lot of them have internal medicine as their 1st priority and have matched into that field? I prefer FM to IM because during my medical school rotations i enjoyed the clinics,the little surgical procedures,seeing dermatological cases more than in-hospital rotations.I would like to be trained in a more broader clinical orientation than deeper,also i would like to be able to treat any acute pathologies and emergencies.I noticed during my visit to a hospital in Florida for my clerkship is that family medicine residents strived just as hard as internal medicine residents to be adept at treating in-patient admits.There were procedures that family medicine residents were not allowed to perform,but they stood around and watched.So family medicine to me seemed like (internal medicine-interventional procedures)+peds+obs.I've never heard a family physician say "a general internist would know about this better than me",but known them to obviously refer to the subspecialist.

Just wondering, what are bread and butter IM procedures?

 

[Nerdbomb99]

Just wondering, what are bread and butter IM procedures?

Well,as much as what i've seen: pleural fluid aspiration,ascitic fluid aspiration,lumbar punctures,liver biopsies,offcourse-methods of intubation, occasionally pericardiocentesis,once i saw an attending perform a spinal tap.

 

[Hakuna Matata]

Well,as much as what i've seen: pleural fluid aspiration,ascitic fluid aspiration,lumbar punctures,liver biopsies,offcourse-methods of intubation, occasionally pericardiocentesis,once i saw an attending perform a spinal tap.

All of these can be done by FM- they are not limited to IM. Possible exception of liver bx (haven't seen that done by FM to date but I have seen the rest done by FM).


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[Harm None]

Hello everyone,
I'm a graduate of bachelors in medicine from Singapore.I am keen on pursuing medical residency in the U.S. I searched through the threads and found the following one: Inpatient vs. outpatient time on a FM residency on the same lines as the one i just started,but it doesn't quite clear my queries or render further guidance on the topic.
Now my case:I would like to pursue medical residency which trains majorly in outpatient medicine.I am aware there are such programs in the 'Medicine-primary care' category and in the thread i reffered to,somebody mentioned of these being available in family medicine too and am also aware that a spot in E.M. would be suitable but very difficult for an IMG to match,into even with my good scores.My questions are:
A)Are the family medicine programs focussed on outpatient care in abundance?how many spots roughly?
B)Are there 'medicine-primary care' and outpatient focussed family medicine programs which are IMG friendly?Does a good proportion of IMGs occupy such spots?
C)From what i gather,with the training i would get in such programs i could work in emergency rooms in rural areas across the U.S.,is this an often occurance?,also is there a good demand for outpatient medicine jobs,like maybe in an outpatient clinic or a primary care doctor in a hospital who refers patients to specialists(which i know is normally done by E.M. Physicians)?I wouldn't like to start a private practice,rather practice as a primary care giver in a setup,something like Mon-friday,9-9.Money is not a big concern to me.
Any helpful responses will be greatly appreciated.Thank you .

Hi Nerdbomb99,
There are programs in both FM and IM which focus on Primary Care in the outpatient setting. Residents still complete some hospital rotations and learn these skills, but the focus is on learning clinical skills and providing continuity of care. A few of these programs are examined in an AAMC publication: High-Functioning Primary Care Residency Clinics. (I am unable to include the link as I haven't posted enough on the forum.)
I hope you are/were able to find the information you wanted in time to make the choices best for you and your future patients.
Best wishes!