Please convince me to stick to FM and not pursue IM

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

AW125

Membership Revoked
Removed
Joined
Jan 12, 2024
Messages
52
Reaction score
18
I will be attending a DO program for the fall and I have always been set on FM and working in an outpatient setting.

Whenever I tell my attending friends about my goals, they laugh at me and say that IM is the "better bang for buck" specialty and I can still go back to working outpatient exclusively. They say that the people who go FM are the people who don't match IM or failed their boards. (Their words not mine!)

The other week, my cousin was saying "FM won't be around in a few years." He was probably being sarcastic in that assessment but he was referring to midlevel encroachment. I disagree with his outlook though and I personally believe that FM has amazing job security and I don't think it is going anywhere anytime soon.

My buddy who is three years out of IM residency just signed a new hospitalist position for 300K with a 7on and 7off schedule. He said I won't get that pay in FM unless I see an absurd amount of patients. He also says IM is "well trained to treat inpatient and outpatient" while FM is only outpatient-focused. As far as pay, I have heard some people say that if you are business savvy that even FM can bring in a lot of money in certain locations.

I'm one of those guys who's really for improving primary care and the community as I have a public health background as well but my motivation is going to decline if IM is the better and perhaps even more lucrative path to take to accomplish that goal.

Any advice you can give me to help me think about this for the next few years?

Members don't see this ad.
 
If you want to work only in the hospital and have no interest in seeing peds or OB patients do IM. If you want to specialize in something like cards, GI, rheum, allergy, pulm yada yada do IM.

If you want to potentially do clinic, hospital, ER, OB, procedures then do FM. IM docs tend to be pretty clueless (on average) about most outpatient procedures. Naturally they do central lines, LPs inpatient.

FM doctors can easily reach +$300k per year. Starting FM docs should not be making anything less than $250K. Yes you will on average make more money as a hospitalist, but again FM docs can make a killing.
 
  • Like
Reactions: 1 users
I will be attending a DO program for the fall and I have always been set on FM and working in an outpatient setting.

Whenever I tell my attending friends about my goals, they laugh at me and say that IM is the "better bang for buck" specialty and I can still go back to working outpatient exclusively. They say that the people who go FM are the people who don't match IM or failed their boards. (Their words not mine!)

The other week, my cousin was saying "FM won't be around in a few years." He was probably being sarcastic in that assessment but he was referring to midlevel encroachment. I disagree with his outlook though and I personally believe that FM has amazing job security and I don't think it is going anywhere anytime soon.

My buddy who is three years out of IM residency just signed a new hospitalist position for 300K with a 7on and 7off schedule. He said I won't get that pay in FM unless I see an absurd amount of patients. He also says IM is "well trained to treat inpatient and outpatient" while FM is only outpatient-focused. As far as pay, I have heard some people say that if you are business savvy that even FM can bring in a lot of money in certain locations.

I'm one of those guys who's really for improving primary care and the community as I have a public health background as well but my motivation is going to decline if IM is the better and perhaps even more lucrative path to take to accomplish that goal.

Any advice you can give me to help me think about this for the next few years?

My experience with IM trained outpatient PCPs has….not been stellar. In my experience, they have very limited experience (or frankly, interest) in women’s health and contraception. They have minimal procedural experience. Almost all of them left outpatient to become hospitalists after a few years. So I don’t know about “well trained” for outpatient; that seems a bit generous.
 
  • Like
Reactions: 3 users
Members don't see this ad :)
If you want to work only in the hospital and have no interest in seeing peds or OB patients do IM. If you want to specialize in something like cards, GI, rheum, allergy, pulm yada yada do IM.

If you want to potentially do clinic, hospital, ER, OB, procedures then do FM. IM docs tend to be pretty clueless (on average) about most outpatient procedures. Naturally they do central lines, LPs inpatient.

FM doctors can easily reach +$300k per year. Starting FM docs should not be making anything less than $250K. Yes you will on average make more money as a hospitalist, but again FM docs can make a killing.
This is exactly what I wanted to hear. The only thing I don't want to do is OB. I don't mind women's general health but no OB.

Regarding the business side of FM, do you have any advice on what to read or who I can talk to to understand how the money part? I'll be honest, taking out the loans I am about to take out plus my undergrad loans does not make me very excited to be on the low end of the pay scale one day so if there is a way to catch up to my IM buddies, I'd like to know how to do that.
 
My experience with IM trained outpatient PCPs has….not been stellar. In my experience, they have very limited experience (or frankly, interest) in women’s health and contraception. They have minimal procedural experience. Almost all of them left outpatient to become hospitalists after a few years. So I don’t know about “well trained” for outpatient; that seems a bit generous.
That's great advice. I'll keep that in mind.

This might sound naive but the reason I don't want to pursue IM is I really don't want to see patients die all the time. Even with my shadowing, I have seen enough death that I know that it doesn't match my personality and I would not handle that well for the duration of a career.

I always saw FM as that specialty where if it is done well, you can help these patients avoid chronic illnesses and trips to the hospital and I find a lot of satisfaction in that.
 
I’m FM. I made the same as my IM counterparts. You’ll hit 300K easily as a hospitalist regardless of FM/IM.

I recently switched to outpatient clinic. I think the ability to see Peds is a nice bonus.
 
This is exactly what I wanted to hear. The only thing I don't want to do is OB. I don't mind women's general health but no OB.

Regarding the business side of FM, do you have any advice on what to read or who I can talk to to understand how the money part? I'll be honest, taking out the loans I am about to take out plus my undergrad loans does not make me very excited to be on the low end of the pay scale one day so if there is a way to catch up to my IM buddies, I'd like to know how to do that.

Look up White Coat Investor. If you have already, look at the reddit for WCI (r/whitecoatinvestor) to see more lively discussions for what issues and numbers people are dealing with.

I have +310,000 in student loans. I had 345,000 when I graduated med school. I will have them paid off by 2029 with plenty of savings and investments. Unless you have 6 kids and 5 divorces, you will be fine.
 
  • Like
Reactions: 1 user
Look up White Coat Investor. If you have already, look at the reddit for WCI (r/whitecoatinvestor) to see more lively discussions for what issues and numbers people are dealing with.

I have +310,000 in student loans. I had 345,000 when I graduated med school. I will have them paid off by 2029 with plenty of savings and investments. Unless you have 6 kids and 5 divorces, you will be fine.
With FM specifically, how much leverage would I have when it comes to negotiating student loan forgiveness for a significant amount or even ALL of my student loans irrespective of geographic location? In other words, would I get a better forgiveness offer by choosing FM over another specialty?
 
With FM specifically, how much leverage would I have when it comes to negotiating student loan forgiveness for a significant amount or even ALL of my student loans irrespective of geographic location? In other words, would I get a better forgiveness offer by choosing FM over another specialty?

Primary care (whether IM, FM, or peds--but in all cases only for those primarily working in a clinic) will have lots of opportunities for loan forgiveness.

Honestly though, these days it seems the best deal is public service loan forgiveness--10 years working for a nonprofit (residency counts) making minimum payments and the rest is forgiven. While a program like the NHSC will give you a full ride, you will have substantially more limitations on where you work, and PSLF doesn't care if you're a PCP, hospitalist, or a neurosurgeon as long as the health system is not for profit.


Disclaimer, I'm in internist who does mostly primary care. For IM vs FM, the pay is the same if you do outpatient. Paradoxically I think FM hospitalists make more money on average since they tend to be more rural and less ivory tower than IM ones but you could make that money as an internist as well. 300k is very doable in primary care as long as you aren't in a major Northeast city and even then you can still swing it.

Realistically you should do IM if you want to specialize or think you might want to specialize, want to do mostly inpatient, or hate the idea of OB or peds so much that you will spend 3-5 extra months in the ICU to avoid them. FM will prepare you more to be a generalist outpatient physician--I had to go out of my way to learn outpatient procedures and basic gynecology in residency in IM.
 
  • Like
Reactions: 2 users
Primary care (whether IM, FM, or peds--but in all cases only for those primarily working in a clinic) will have lots of opportunities for loan forgiveness.

Honestly though, these days it seems the best deal is public service loan forgiveness--10 years working for a nonprofit (residency counts) making minimum payments and the rest is forgiven. While a program like the NHSC will give you a full ride, you will have substantially more limitations on where you work, and PSLF doesn't care if you're a PCP, hospitalist, or a neurosurgeon as long as the health system is not for profit.


Disclaimer, I'm in internist who does mostly primary care. For IM vs FM, the pay is the same if you do outpatient. Paradoxically I think FM hospitalists make more money on average since they tend to be more rural and less ivory tower than IM ones but you could make that money as an internist as well. 300k is very doable in primary care as long as you aren't in a major Northeast city and even then you can still swing it.

Realistically you should do IM if you want to specialize or think you might want to specialize, want to do mostly inpatient, or hate the idea of OB or peds so much that you will spend 3-5 extra months in the ICU to avoid them. FM will prepare you more to be a generalist outpatient physician--I had to go out of my way to learn outpatient procedures and basic gynecology in residency in IM.
You covered everything in that post!

What I still don't understand is why some medical students and even physicians somehow look down on FM when I think it really aligns well with what being a doctor is all about...and what most people actually want to do when they first decide that they want to study medicine.

I have another buddy who is five months into his first EM attending job and he already told me "I don't know how long I will be able to do this."
 
You covered everything in that post!

What I still don't understand is why some medical students and even physicians somehow look down on FM when I think it really aligns well with what being a doctor is all about...and what most people actually want to do when they first decide that they want to study medicine.

I have another buddy who is five months into his first EM attending job and he already told me "I don't know how long I will be able to do this."
All the usual reasons, primary care isn't sexy, FM isn't competitive as a med student so some duds end up in the specialty, specialists are seen as more prestigious, and far more importantly than anything else, PCPs make on the lower end of physician pay (thought you will be perfectly comfortable, I live just fine in NYC).

I will say just make sure to keep your options open until you actually are in your clinicals though. I thought I was going to do EM until late 3rd year, I know a few "future surgeons" who are now anesthesiologists and PM&R docs, and I know a few "primary care for life, underserved care" students who realized they hated clinic.
 
  • Like
Reactions: 4 users
All the usual reasons, primary care isn't sexy, FM isn't competitive as a med student so some duds end up in the specialty, specialists are seen as more prestigious, and far more importantly than anything else, PCPs make on the lower end of physician pay (thought you will be perfectly comfortable, I live just fine in NYC).

I will say just make sure to keep your options open until you actually are in your clinicals though. I thought I was going to do EM until late 3rd year, I know a few "future surgeons" who are now anesthesiologists and PM&R docs, and I know a few "primary care for life, underserved care" students who realized they hated clinic.
I'll keep that in mind.

I will admit that even though I consider myself level-headed, the thoughts of money and prestige do creep up from time to time but I'm a little older so I have the added benefit of being able to have a better vision of what my life will probably look like at 70 and I'd rather be very happy with what I'm doing professionally than a few more material things.
 
That's great advice. I'll keep that in mind.

This might sound naive but the reason I don't want to pursue IM is I really don't want to see patients die all the time. Even with my shadowing, I have seen enough death that I know that it doesn't match my personality and I would not handle that well for the duration of a career.

I always saw FM as that specialty where if it is done well, you can help these patients avoid chronic illnesses and trips to the hospital and I find a lot of satisfaction in that.

Any outpatient primary care physician will not see as many super-sick, on the verge of death patients. It doesn’t matter if they’re FM or IM.

It’s good that you realize this about yourself now. A lot of people don’t realize this until it’s too late and are trapped in a career like EM without an exit strategy.
 
  • Like
Reactions: 3 users
Members don't see this ad :)
It sounds like you're going through the generic US medical education thing where all your friends and mentors are like "LOL, FM docs are poor! And dumb! But not internists or pediatricians tho!"

It's just a thing that happens, don't sweat it. If you like FM, do FM. Everybody else here has given you reasons. But the FM bashing in the states is SUPER prevalent, and I don't know where it comes from......

If you scroll back through threads you'll see this kind of thing pop up quite frequently. I'm fortunate enough to have good mentors at my med school, so the bashing is less frequent, but it's still a thing.
 
Last edited:
  • Like
Reactions: 1 users
Yeah as someone else has mentioned, FM gets lots of hate in many med schools.

Its not sexy. We aren't the ones wrist deep in someone's body fixing anything. We aren't curing their cancer or stenting their arteries so their MI doesn't kill them.

The pay is on the lower end. I said lower end, not low. Sure, the urologist and the anesthesiologist are going to make above 600k. Ortho and cardiology above that.

We can't really subspecialize. Outside of hospice and pain management, most of our followships don't allow you stop practicing FM completely.

However, all of those have an upside which makes FM appealing to many.

Yes, we aren't sexy. But we don't work nights, weekends, holidays. We don't have to code people or tell someone's family that their loved one is dead. Call consists of making sure you phone is handy, there's none of this going into the hospital call that almost every one else does.

Our pay is still quite good. Breaking 300k is pretty easy. Breaking 400k isn't hard if you're willing to put in the effort.

We have the (tied for) shortest post med school training. Opportunity cost is a thing.

Our job market is the best in medicine and its not even close. I doubt there is a town/city in America that doesn't have job openings for family doctors.

Now that all being said, you still have to like the work. But that's important in every specialty.
 
  • Like
Reactions: 4 users
Be efficient in the right job and you can clear 800k as FM
IMG_2197.png
 
  • Like
Reactions: 1 user
I will be attending a DO program for the fall and I have always been set on FM and working in an outpatient setting.

Whenever I tell my attending friends about my goals, they laugh at me and say that IM is the "better bang for buck" specialty and I can still go back to working outpatient exclusively. They say that the people who go FM are the people who don't match IM or failed their boards. (Their words not mine!)

The other week, my cousin was saying "FM won't be around in a few years." He was probably being sarcastic in that assessment but he was referring to midlevel encroachment. I disagree with his outlook though and I personally believe that FM has amazing job security and I don't think it is going anywhere anytime soon.

My buddy who is three years out of IM residency just signed a new hospitalist position for 300K with a 7on and 7off schedule. He said I won't get that pay in FM unless I see an absurd amount of patients. He also says IM is "well trained to treat inpatient and outpatient" while FM is only outpatient-focused. As far as pay, I have heard some people say that if you are business savvy that even FM can bring in a lot of money in certain locations.

I'm one of those guys who's really for improving primary care and the community as I have a public health background as well but my motivation is going to decline if IM is the better and perhaps even more lucrative path to take to accomplish that goal.

Any advice you can give me to help me think about this for the next few years?

I’m going to respond to each paragraph you wrote.

1. FM is most definitely not for IM match failures or Board failures. Sure, there will be folks in the field who meet those criteria, but they struggle and commonly wash out in residency. A good FM doc is intelligent, open minded, and capable of, and willing to, learn anything. We’re like the Swiss Army knives of medicine. The one field that doesn’t have the luxury of forgetting large parts of our medical education. We need more smart and high performing folks, not less.

2. FM is not going anywhere. In my area, the main large group has learned the hard way that PA’s/NP’s are not who patients want to see; and a LOT of mistakes and frankly bad care is delivered by mid-level providers. We’ll take a physician any day over an NP/PA. I’d argue that the days of assuming that a mid-level can be a quality PCP are coming to an end. In this field, you may need to work with/adjacent to them from time to time, but they’re not taking our jobs. I think a mid level is better served working directly under a specialist where they can have a very narrow job description and learn that job inside and out. There’s too much to know in FM, mid-levels struggle and usually want out.

3. Money is getting better all the time in FM. My base income has literally nearly doubled in the past 5 years; and this year it’s at $300k for 4clinic sessions/week. New grads get that too. Expectation is 16patients per session. I can make more if I go above that. I also get bonus money for quality, and I have ample moonlighting opportunities when I want them. I’ll clear $400k in 2024 most likely. In the past 2 years I’m on call 1 week in 6, by phone only. And I’ve got RN’s to triage calls. I have probably answered the phone 10-12 times in those 2 years so even call is an afterthought. That combined with a 32hr work week (8am-4pm) and I’d say I’m quite well paid.
 
Last edited:
  • Like
  • Love
Reactions: 3 users
Any outpatient primary care physician will not see as many super-sick, on the verge of death patients. It doesn’t matter if they’re FM or IM.

It’s good that you realize this about yourself now. A lot of people don’t realize this until it’s too late and are trapped in a career like EM without an exit strategy.
This is a very good point that pre-med's and medical students, I would hope, understand very well.

Some people are programmed to turn their emotions on and off better than others and I already know that I could never see myself in oncology, dealing with very sick kids, or having patients code and die under my care for a whole career. I don't know if that is a weakness but I already know I can't handle that no matter how much you pay me and then claim to be happy.

Everything about FM matches my personality and my career goals but the noise from others feels like gaslighting to me.

Sometimes I wonder that when doctors say they are burned out, is it because of more work and less reimbursement or could it be that they are just in the wrong field altogether? I don't know if a survey exists to figure that out.



Also, I will send a private message to a few of you either today or in a few days. I just don't want to post my life story here or where I will be attending because apparently my school's admissions officers browse this website too!

But thank you, this is great info and sadly most people in my spot probably don't quite understand all of this yet.
 
I think a mid level is better served working directly under a specialist where they can have a very narrow job description and learn that job inside and out. There’s too much to know in FM, mid-levels struggle and usually want out.
I was never able to put this statement into my own words quite succinctly but you did it well!

But now tell me, why don't the others see it like this and why do they lead people like me to believe that mid-levels will replace FM docs in the near future...just like they lead us to believe that nurses will replace anesthesiologists?

The reality is that patients want to be seen by physicians and I don't think that will ever change. A few years ago I had a minor elective procedure and I made to clarify how anesthesia was provided and that I did not want a CRNA. I don't know if that's right or wrong but that's what my gut told me to ask.
 
If you're seeing 45 patients per day (or 25+ per half day), there is no way you're doing a good job at primary care.

For context. See attachments. Don’t do things for free. Lawyers charge for their time. So should we. Doesn’t matter if it it’s virtual or in person, or how long it takes.
IMG_2211.png
 

Attachments

  • IMG_2210.png
    IMG_2210.png
    259.3 KB · Views: 44
  • Like
Reactions: 1 user
For context. See attachments. Don’t do things for free. Lawyers charge for their time. So should we. Doesn’t matter if it it’s virtual or in person, or how long it takes.
View attachment 381034
I switched to primary care in November and have really tried to implement this from the start. I'm honestly surprised at the number of people that call in for something they haven't been seen for recently and expect us to address it over the phone.
 
If you're seeing 45 patients per day (or 25+ per half day), there is no way you're doing a good job at primary care.
As a patient myself, I would need AND want at least 20 minutes for a visit to cover everything I need to cover. I would never go back to a doctor who spent 5 minutes with me.

On that note, can FM providers practice concierge medicine? On paper, concierge medicine looks like it will make both the doctor and patient happy.
 
  • Like
Reactions: 1 users
I switched to primary care in November and have really tried to implement this from the start. I'm honestly surprised at the number of people that call in for something they haven't been seen for recently and expect us to address it over the phone.
Yeah exactly. And employers like Kaiser gaslight their FM docs to answer these inbox messages uncompensated. Leads to high burnout. Don’t perpetuate free labor. We trained hard. We trained a long time. We are smarter and harder working. We deserve to get paid. Know your worth.
 
  • Like
Reactions: 1 users
You're just starting med school. You have a long time before having to decide your specialty.
I was never able to put this statement into my own words quite succinctly but you did it well!

But now tell me, why don't the others see it like this and why do they lead people like me to believe that mid-levels will replace FM docs in the near future...just like they lead us to believe that nurses will replace anesthesiologists?

The reality is that patients want to be seen by physicians and I don't think that will ever change. A few years ago I had a minor elective procedure and I made to clarify how anesthesia was provided and that I did not want a CRNA. I don't know if that's right or wrong but that's what my gut told me to ask.
Because that was the argument used to expand school admittance and increase building more PA schools and starting a bunch of online NP schools. The argument used was theres a massive shortage in primary care and this would address that. Fast forward and it wont for reasons @SLC said. I have a handful of friends/family that are PA's/NPs and every single one started off in primary care because the job market is so great, and every single one left because of all the things you have to remember and know. They all switched to specialized care so that they could focus on their niche.
 
  • Like
Reactions: 1 user
For context. See attachments. Don’t do things for free. Lawyers charge for their time. So should we. Doesn’t matter if it it’s virtual or in person, or how long it takes.
View attachment 381034
Yeah that guy is a jackass and I would not want to be his patient.

Some of those I agree with - no new antibiotics without a visit. No adjusting meds without a visit.

You address lab abnormalities in the lab result note, if they have a question that requires more than a single sentence then it needs a visit. If its as simple as "ignore the MCHC since your H/H is normal", I don't make someone come back in for that.

But giving a single diflucan after an antibiotic (assuming I prescribed the antibiotic) is a no brainer to just send it in.

Changing from one med to another in the same class because of insurance coverage shouldn't require a visit.
 
  • Like
Reactions: 7 users
Yeah that guy is a jackass and I would not want to be his patient.

Some of those I agree with - no new antibiotics without a visit. No adjusting meds without a visit.

You address lab abnormalities in the lab result note, if they have a question that requires more than a single sentence then it needs a visit. If its as simple as "ignore the MCHC since your H/H is normal", I don't make someone come back in for that.

But giving a single diflucan after an antibiotic (assuming I prescribed the antibiotic) is a no brainer to just send it in.

Changing from one med to another in the same class because of insurance coverage shouldn't require a visit.
He doesn’t really make the patients come back though. Just squeezes them into a virtual visit. Patient enjoys the convenience. He gets paid for his time. What’s wrong with that?

If you’re going to make the case that insurance shouldn’t pay for that, physician incomes only make up 10% of healthcare expenses. We are at the very bottom of the totem pole.
 
He doesn’t really make the patients come back though. Just squeezes them into a virtual visit. Patient enjoys the convenience. He gets paid for his time. What’s wrong with that?

If you’re going to make the case that insurance shouldn’t pay for that, physician incomes only make up 10% of healthcare expenses. We are at the very bottom of the totem pole.
Patient pays the same for a virtual visit versus an in-person one.

I don't give a rat's ass about the insurance company at any point. I'm looking at this from the patient's perspective.

I'm a big fan of not working for free, but there are some things that just don't need a visit.
 
  • Like
Reactions: 4 users
Patient pays the same for a virtual visit versus an in-person one.

I don't give a rat's ass about the insurance company at any point. I'm looking at this from the patient's perspective.

I'm a big fan of not working for free, but there are some things that just don't need a visit.
Fair enough. Different people have different thresholds for what deserves to get paid. He does mention his employers are ok with him practicing this way as long as his patient panel is happy. Seems like his patient panel is happy.
 
  • Like
Reactions: 1 user
Yeah that guy is a jackass and I would not want to be his patient.

Some of those I agree with - no new antibiotics without a visit. No adjusting meds without a visit.

You address lab abnormalities in the lab result note, if they have a question that requires more than a single sentence then it needs a visit. If its as simple as "ignore the MCHC since your H/H is normal", I don't make someone come back in for that.

But giving a single diflucan after an antibiotic (assuming I prescribed the antibiotic) is a no brainer to just send it in.

Changing from one med to another in the same class because of insurance coverage shouldn't require a visit.
I agree with all of this.

We get a lot of the "I have a UTI, can you send in abx" calls. Sorry, that's going to require a visit. "My BP is 160's, do I need more BP medicine?" Sure, come on in.

But the minor lab abnormalities, and diflucan sort of stuff, I wouldn't be able to talk to someone for more than 2 minutes about that stuff in an office visit or video visit. And if you're already busy, trying to churn more $$ out of something minor like that just makes the day more miserable.
 
  • Like
Reactions: 2 users
Find a place that values primary care. Your office should be staffed and trained to efficiently let you see patients. Your nurses should be trained to do much (most) of the BS paperwork that comes with practicing medicine.

I'm able to see 25-28 patients per day because I don't have to do PAs. I have my patients trained to know they need an appointment if their meds are about to run out. Most of them are stable so the appointments are fairly quick. They know to schedule appointments for most problems. My employer pays fairly for productivity.

We also get bonuses based on quality metrics which I have learned to either meet or know how to game the system.
 
  • Like
Reactions: 1 user
400K sounds really good. That seems like appropriate compensation for the training and what FM docs have to do on a daily basis.
I find it interesting that even at my stage, as in incoming M1, I find 250K to be on the low end of compensation for all the hell I've gone through UP TILL NOW! There is no way I could go through another four years of med school and even three years of residency for anything less than 300K. That's why 400K sounds really good lol.
 
  • Like
Reactions: 1 user
As I have said before, It's all about your efficiency and your CONTRACT. Of course I am FP trained but I only do urgent care. I see a ton of patients and do a ton of procedures. Depending on how many extra shifts I pick up a month I make between 400 -600K/yr.
 
  • Like
Reactions: 1 users
As I have said before, It's all about your efficiency and your CONTRACT. Of course I am FP trained but I only do urgent care. I see a ton of patients and do a ton of procedures. Depending on how many extra shifts I pick up a month I make between 400 -600K/yr.
This gives me stress lol

You have no idea how many people have told me and are currently telling me that FM is the wrong move...even though my gut is telling me it is the absolute best move for me.

The reason they all say it's the wrong move is that they feel it doesn't pay.
 
This gives me stress lol

You have no idea how many people have told me and are currently telling me that FM is the wrong move...even though my gut is telling me it is the absolute best move for me.

The reason they all say it's the wrong move is that they feel it doesn't pay.
And if you aren't in a good set up and willing to work hard, it won't pay that much. And we still as a rule make less than almost everyone else who isn't some brand of peds.
 
  • Like
Reactions: 1 user
And if you aren't in a good set up and willing to work hard, it won't pay that much. And we still as a rule make less than almost everyone else who isn't some brand of peds.
The part that I don't understand is why this "inside information" on FM is not readily available.

Seriously, even M3's think FM does not pay well.

Where should I be looking to learn more about "lucrative" FM jobs and strategies?

I actually do have that White Coat Investor book you referenced earlier. I must have bought that a few years ago. I guess I should start reading it!
 
The part that I don't understand is why this "inside information" on FM is not readily available.

Seriously, even M3's think FM does not pay well.

Where should I be looking to learn more about "lucrative" FM jobs and strategies?

I actually do have that White Coat Investor book you referenced earlier. I must have bought that a few years ago. I guess I should start reading it!
Go to a residency where they do a good job of teaching about billing/documentation, efficiency, quality improvement, etc. If you go to a conference and see they have sessions on these topics (FMX usually does!), attend those sessions. AAFP also has a journal you can access for free online called Family Practice Management that is geared towards this.
 
  • Like
Reactions: 6 users
I find it interesting that even at my stage, as in incoming M1, I find 250K to be on the low end of compensation for all the hell I've gone through UP TILL NOW! There is no way I could go through another four years of med school and even three years of residency for anything less than 300K. That's why 400K sounds really good lol.
300K is kind of the magic number in my mind.

I've never hit 400K. I've really only worked as a hospitalist until recently. I switched to outpatient in November.

Out of residency, I was making in the 330's. At my max, I've hit 370's a couple of times. It's great. We live very comfortably. We travel a ton. We save a lot in retirement accounts. You'll be happy in the 300's.

From there, you can decide how many you can comfortably see and if you want to work to get to the 400's.
 
Last edited:
  • Like
Reactions: 2 users
The part that I don't understand is why this "inside information" on FM is not readily available.

Seriously, even M3's think FM does not pay well.

Where should I be looking to learn more about "lucrative" FM jobs and strategies?

I actually do have that White Coat Investor book you referenced earlier. I must have bought that a few years ago. I guess I should start reading it!
I think if I could give ever medical student/resident one piece of advice only--it would be to learn that stuff now.

I think White Coat investor does a great job. I haven't used other sources to compare. But Dr. Dahle really does a good job of breaking it down, and it's designed around physicians. So it's probably the most applicable source.

The book is a good initial resource. That will get you very comfortable with the basics.

He has a Blog and podcast. A lot of the podcasts are kind of recreations of the blog posts. But you can get as advanced as you want on any given subject. And the more you learn, the more questions you'll know to ask. And he has a blog post for every question you can come up with.
 
  • Like
Reactions: 1 user
300K is kind of the magic number in my mind.

I've never hit 400K. I've really only worked as a hospitalist until recently. I switched to outpatient in November.

Out of residency, I was making in the 330's. At my max, I've hit 370's a couple of times. It's great. We live very comfortably. We travel a ton. We save a lot in retirement accounts. You'll be happy in the 300's.

From there, you can decide how many you can comfortably see and if you want to work to get to the 400's.
From time to time, we need to hear this.

A lot of people will have you believe that even as a doctor making 300K that you will somehow end up broke in the end. It's a scary thought too.
 
  • Like
Reactions: 1 user
FM vs IM outpatient is the same. Nice 4 day workweeks making 250-300k, more if you find a nice practice

FM vs IM inpatient is also same. FM “may” make it harder to get certain hospitalist jobs, but that really wasn’t the case for me. (FM, got multiple job offers in metro areas). Most of my colleagues are IM. We get paid the exact same. Probably about 330-350k not including benefits.

The difference comes from specialties. FM specialties really dont bring in any more money than a generalist. IM has cards, GI, heme/onc. But then we’re talking about fellowships, different work hours, etc

Ultimately, FM vs IM basically has same job outlook/salaries unless you specialize.

Training and competency is a whole diff topic thats likely more residency-specific than anything.
 
  • Like
Reactions: 2 users
If you want outpt, FM.
If you want inpt, IM.

You can do either of them with the other residency, yes. However, you will have more training as outpt PCP in FM and more inpt training in IM. It doesn't mean that you will be incompetent doing the opposite, just facts.

Also, you shouldn't have a hard time making $300k as a PCP and you likely can earn $350k+ if you know how to bill somewhat accurately and you are at least halfway efficient. I averaged 16 ppd during my 2nd year with my new group, have 1/2 day Fridays, took 6 weeks PTO, and still earned ~$290k. That number should continue to increase this year and beyond as I continue to build my panel and fill my days out more.

The above is not hard.... know your billing, know your value, and join a practice/health system that values you.... primary care....
 
Last edited:
  • Like
Reactions: 1 users
Looks like membership was revoked, but you might still be lurking. My two-cents as someone trained in IM is that you can come out proficient in both inpatient and outpatient in IM-primary care programs. Some programs have become so inpatient heavy that you may actually come out deficient in certain outpatient aspects. The same can be said that there are FM programs that don't have heavy inpatient exposure. If your overall goal is to give comprehensive care, especially in the outpatient setting, including women and children, obviously FM offers that. I don't think you should choose your specialty based on your friends or other people's judgment. Everyone I know that chose FM (it wasn't a backup) is very happy with their decision
 
  • Like
Reactions: 4 users
Top