Primary Care Provider wannabes: Internal Medicine vs Family Practice?

[Spin]

Which do you think is a better specialty for someone who wants to be a PCP, and why? I have no interest in treating children so I'm leaning towards IM personally, but it seems like FM residencies prepare you more for PCP-like daily activities.

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[ozzi22]

Family med and internal med are similar but personally for me, I would go with I'M cuz;
1) they make a little bit over the salary of FM according to payscale.com
2) you have more fellowship you can pusrue incase you change your mind someday
3) you get to handle more severe cases than FM

 

[LizzyM]

If you have no interest in treating children, why spend three years training to treat children? IM is the clear choice.

 

[DrYoda]

but it seems like FM residencies prepare you more for PCP-like daily activities.

Many IM programs have a primary care track. Even in the ones that don't you could use your electives on primary care. I'd go with one of those options if you want to be a PCP who doesn't deal with kids.

 

[Spin]

Family med and internal med are similar but personally for me, I would go with I'M cuz;
1) they make a little bit over the salary of FM according to payscale.com
2) you have more fellowship you can pusrue incase you change your mind someday
3) you get to handle more severe cases than FM

Good point. It's nice to have the option to specialize later, even if it adds a bit more total residency time than starting out on a pre-specialization IM track. I didn't know the thing about getting to handle more severe cases too, but that can only be a plus IMO.

If you have no interest in treating children, why spend three years training to treat children? IM is the clear choice.

True. It is pretty obvious with that consideration.

Many IM programs have a primary care track. Even in the ones that don't you could use your electives on primary care. I'd go with one of those options if you want to be a PCP who doesn't deal with kids.

I knew about the primary care track, but I didn't know if I'd be able to prepare myself for primary care while still leaving myself open to going straight into a two year fellowship or something. For example, I read that a combination IM residency + endocrinology fellowship is 5 years total, but if you do them separately I think they take a total of 6 years.

As far as using electives on primary care: I do like that idea, but if I'm going to spend my life as a generalist, shouldn't I use med school to learn as much as I can about medicine's specialties? When else will I be able to learn about, say, surgery and radiology first-hand? Generalists need to know as much as they can about every aspect of medicine.

 

[ILikeDrugs]

With IM you can flex more muscle if you ever want to become a hospitalist. Someone on the pre-DO forum said that larger hospitals/those in metropolitan areas tend to prefer IM for their hospitalists.

 

[smq123]

Family med and internal med are similar but personally for me, I would go with I'M cuz;
1) they make a little bit over the salary of FM according to payscale.com
2) you have more fellowship you can pusrue incase you change your mind someday
3) you get to handle more severe cases than FM

Where do you get that idea?

In our FM practice, we take care of people who are on ventilators, who are paraplegics, who have severe CP, etc. In my patient panel, I have someone with advanced MS who needs a lot of help and a lot of care. They're just as sick, if not sicker, than the people I took care of on IM as a med student.

And looking at average salary doesn't make any sense - people who specialize but still keep up their IM board certification get included in those averages, which artificially raises them. A general outpatient IM physician doesn't often make much more than a general outpatient FM physician, if they have similar patient populations. The only difference is if the FM physician sees a lot of children (who often do not have great health insurance) or if they do a lot of OB (and have to pay much higher malpractice premiums).

Which do you think is a better specialty for someone who wants to be a PCP, and why? I have no interest in treating children so I'm leaning towards IM personally, but it seems like FM residencies prepare you more for PCP-like daily activities.

Don't forget - if you do an FM residency, not only will you have to do peds, you will have to do a lot more obstetrics/gynecology/women's health than you would in an IM residency. A LOT more.

With IM you can flex more muscle if you ever want to become a hospitalist. Someone on the pre-DO forum said that larger hospitals/those in metropolitan areas tend to prefer IM for their hospitalists.

Meh. I think that that's up for debate. My inbox gets filled every week with recruiters offering hospitalist positions for FP in urban areas.

 

[raltima07]

Id g with IM

 

[Spin]

And looking at average salary doesn't make any sense - people who specialize but still keep up their IM board certification get included in those averages, which artificially raises them. A general outpatient IM physician doesn't often make much more than a general outpatient FM physician, if they have similar patient populations. The only difference is if the FM physician sees a lot of children (who often do not have great health insurance) or if they do a lot of OB (and have to pay much higher malpractice premiums).

...

Don't forget - if you do an FM residency, not only will you have to do peds, you will have to do a lot more obstetrics/gynecology/women's health than you would in an IM residency. A LOT more.

Ooh, I didn't know the that FPs do more ob/gyn/women's health. It makes sense, though; my FP does pap smears and all that jazz. Right now I like the idea of working with women's health so I personally consider that a plus (it's another way to improve my patients' overall health), but I guess it would be a bad thing in terms of malpractice insurance.

 

[LizzyM]

Ooh, I didn't know the that FPs do more ob/gyn/women's health. It makes sense, though; my FP does pap smears and all that jazz. Right now I like the idea of working with women's health so I personally consider that a plus (it's another way to improve my patients' overall health), but I guess it would be a bad thing in terms of malpractice insurance.

It all depends on whether you do OB or not. Office based GYN as would be done by a FM attending is relatively low risk in terms of malpractice. (As with IM, a major reason to be sued is a failure to detect cancer.) Add gyn surgery and there are issues but not with the big payouts that go with birth injuries.

 

[familyaerospace]

I'd probably lean IM personally.

Although I will say that all my primary care doctors have been boarded as family medicine, but none see kids and none do paps. I think that confused me for a while until I shadowed a family doc who saw kids and did paps and shadowed an internist who just saw adults and didn't deal with obgyn stuff. I'm not great with kids and I don't want to do paps.

 

[Bacchus]

With IM you can flex more muscle if you ever want to become a hospitalist. Someone on the pre-DO forum said that larger hospitals/those in metropolitan areas tend to prefer IM for their hospitalists.

I'd have to agree with smq. If you get the time in the -icu and the experience you really shouldn't have a problem.

 

[2012mdc]

Where do you get that idea?

In our FM practice, we take care of people who are on ventilators, who are paraplegics, who have severe CP, etc. In my patient panel, I have someone with advanced MS who needs a lot of help and a lot of care. They're just as sick, if not sicker, than the people I took care of on IM as a med student.

And looking at average salary doesn't make any sense - people who specialize but still keep up their IM board certification get included in those averages, which artificially raises them. A general outpatient IM physician doesn't often make much more than a general outpatient FM physician, if they have similar patient populations. The only difference is if the FM physician sees a lot of children (who often do not have great health insurance) or if they do a lot of OB (and have to pay much higher malpractice premiums).



Don't forget - if you do an FM residency, not only will you have to do peds, you will have to do a lot more obstetrics/gynecology/women's health than you would in an IM residency. A LOT more.



Meh. I think that that's up for debate. My inbox gets filled every week with recruiters offering hospitalist positions for FP in urban areas.

I guess it depends on where you practice and how you set it up. As a whole the patients on IM were much sicker than the patients on FM. Don't know what the norm is but I know a lot of people assume that is the norm.

FM and IM are pretty different and most of my classmates haven't had a hard time deciding between the two

 

[DoctaFuture]

I've been confused for awhile. What does an IM doc do? B/c i know there are cardiologists, docs w/ specialty titles etc. I always assume a PCP is an IM doc or pretty much like one.

 

[ILikeDrugs]

Meh. I think that that's up for debate. My inbox gets filled every week with recruiters offering hospitalist positions for FP in urban areas.

I'd have to agree with smq. If you get the time in the -icu and the experience you really shouldn't have a problem.

Yeah, I should have mentioned that the attending in pre-osteo said that a FM residency should be fine as long as they get ICU (ventilator, really sick people) experience.

 

[Tappinfool66]

I've been confused for awhile. What does an IM doc do? B/c i know there are cardiologists, docs w/ specialty titles etc. I always assume a PCP is an IM doc or pretty much like one.

IM doctors can do a variety of things, as far as I know. My PCP is an Internist (and a DO), as are most, if not all of the other doctors in his practice. Internists can also work in hospitals and can sub-specialize by doing fellowships (cardiology, nephrology, oncology, immunology, endocrinology, etc.).

 

[LizzyM]

A primary care internist SHOULD do pap smears. That's basic preventive care. There is no point in sending a woman to a second provider for something that is so basic.

 

[Spin]

I guess it depends on where you practice and how you set it up. As a whole the patients on IM were much sicker than the patients on FM. Don't know what the norm is but I know a lot of people assume that is the norm.

FM and IM are pretty different and most of my classmates haven't had a hard time deciding between the two

How so? That's basically what I'm trying to figure out here. I'm under the impression that IM residency is more hospital-centric than FM residency, but if you join a branch of a large group as a private practice PCP afterward, wouldn't your job be about the same? I mainly want to work with adults, diagnose their conditions as soon as the first symptom crops up, and do a decent bit of preventive medicine. I want to do the residency that would best prepare me for that.

 

[twick121]

I'd go with trying to get in and then make it through the 1st 3 years of medical school first. It is really stupid to think about what you want to do in residency before your clinical years. My opinion anyway

 

[smq123]

I guess it depends on where you practice and how you set it up. As a whole the patients on IM were much sicker than the patients on FM. Don't know what the norm is but I know a lot of people assume that is the norm.

It also depends on what your rotation experience was. At most schools, IM is mostly inpatient, while FM is mostly outpatient....and patients you see in the hospital will, obviously, always be much sicker than what you see in the office. As a resident in either, you'll have to do some of both.

I'd go with trying to get in and then make it through the 1st 3 years of medical school first. It is really stupid to think about what you want to do in residency before your clinical years. My opinion anyway

I don't think that it's "really stupid" to think about which residency interests you before your clinical years. I mean, it'd be stupid to go around telling the whole word that you'll "be a pediatrician or die!", or have "Future Cardiologist!!!" tattooed on your forehead or something. But putting some thought into what general type of physician you want to be (internist vs. surgeon, inpatient vs. outpatient) isn't stupid.

 

[mvenus929]

As far as using electives on primary care: I do like that idea, but if I'm going to spend my life as a generalist, shouldn't I use med school to learn as much as I can about medicine's specialties? When else will I be able to learn about, say, surgery and radiology first-hand? Generalists need to know as much as they can about every aspect of medicine.

Pretty sure they're referring to elective rotations in residency, not medical school. You don't just do one thing during residency, you rotate through different services to learn as much as you can.

I'd go with trying to get in and then make it through the 1st 3 years of medical school first. It is really stupid to think about what you want to do in residency before your clinical years. My opinion anyway

While I wouldn't put it as harshly, I agree. You can't really say now whether FM or IM will be better for you, because you haven't worked in either field yet. Saying 'ok, I think I want to do primary care' is one thing, trying to tease out the differences between FM and IM as a primary care specialty is something better left for when you'll actually be working on the wards.

Just go to the interest meetings for both (and other specialties... you never know, you may change your mind) during your pre-clinical years and give it your all during clinical years, then decide from there. You have quite a few steps to get to before you make your decision.

 

[DrYoda]

I knew about the primary care track, but I didn't know if I'd be able to prepare myself for primary care while still leaving myself open to going straight into a two year fellowship or something. For example, I read that a combination IM residency + endocrinology fellowship is 5 years total, but if you do them separately I think they take a total of 6 years.

I'm not sure what you mean by combined residency, the research pathway? The research pathway cuts one year off IM and it's only really done by aspiring physican scientists.

As for endocrinology it's a two or three year fellowship depending on the program, some have 2+optional third year (the third year is a research year).

As far as using electives on primary care: I do like that idea, but if I'm going to spend my life as a generalist, shouldn't I use med school to learn as much as I can about medicine's specialties? When else will I be able to learn about, say, surgery and radiology first-hand? Generalists need to know as much as they can about every aspect of medicine.

I'm talking about residency elective time.

I'd go with trying to get in and then make it through the 1st 3 years of medical school first. It is really stupid to think about what you want to do in residency before your clinical years. My opinion anyway

I agree with smq. I actually think it's stupid not to think about what you want to do, it's just that you shouldn't decide what you want to do before rotations.

 

[2012mdc]

How so? That's basically what I'm trying to figure out here. I'm under the impression that IM residency is more hospital-centric than FM residency, but if you join a branch of a large group as a private practice PCP afterward, wouldn't your job be about the same? I mainly want to work with adults, diagnose their conditions as soon as the first symptom crops up, and do a decent bit of preventive medicine. I want to do the residency that would best prepare me for that.

Yeah, I guess I should have said the residencies are pretty different. From what I know, what you're describing can be done from both routes. I guess it will just depend if you prefer inpatient or outpatient (although you will see both like smq said) and whether you want to see kids and OB patients etc

 

[AsianPersuasion]

Hospitalist sounds pretty interesting

 

[LizzyM]

Hospitalist sounds pretty interesting

If I understand correctly, hosptialist is a style of practice, not a specialty. They handle patients while in the hospital to save the primary care provider the daily trip to the hospital to follow patients who need hospital care. At teaching hospitals, hospitalists handle the "bread and butter" admissions (heart attacks, community acquired pneumonia, etc) freeing up the residents to treat the uncommon conditions from which they learn the breadth of medicine. Hospitalists also handle the medical conditions of patients admitted to surgical services including ordering and reviewing pre-op tests to clear patients for surgery. As such they may practice in a pre-op ambulatory setting (like a clinic) as well as in a hospital building.

The difference from a regular IM or FM practice is that the relationship (if you can call it that) lasts only the length of the hospitalization and afterward the patient goes back to the usually PCP.

 

[AsianPersuasion]

If I understand correctly, hosptialist is a style of practice, not a specialty. They handle patients while in the hospital to save the primary care provider the daily trip to the hospital to follow patients who need hospital care. At teaching hospitals, hospitalists handle the "bread and butter" admissions (heart attacks, community acquired pneumonia, etc) freeing up the residents to treat the uncommon conditions from which they learn the breadth of medicine. Hospitalists also handle the medical conditions of patients admitted to surgical services including ordering and reviewing pre-op tests to clear patients for surgery. As such they may practice in a pre-op ambulatory setting (like a clinic) as well as in a hospital building.

The difference from a regular IM or FM practice is that the relationship (if you can call it that) lasts only the length of the hospitalization and afterward the patient goes back to the usually PCP.

oh, I see

Do they get to care for severe or harder cases too? do they revolve around all part of the hospital or in only certain area?

I misinterpret thinking that hospitalist was a fellowship after IM my apology.

 

[smq123]

oh, I see

Do they get to care for severe or harder cases too? do they revolve around all part of the hospital or in only certain area?

I misinterpret thinking that hospitalist was a fellowship after IM my apology.

It depends on the hospital.

Some hospitals have "closed" ICUs, where, once the patient is in the ICU, he is cared for by an ICU specialist.

Other hospitals have an "open" ICU, where the hospitalist follows the patient while they are in the ICU.

They take care of patients on all different types of floors - med/surg, telemetry (constant heart monitoring), etc.

 

[xanthomondo]

Where do you get that idea?

In our FM practice, we take care of people who are on ventilators, who are paraplegics, who have severe CP, etc. In my patient panel, I have someone with advanced MS who needs a lot of help and a lot of care. They're just as sick, if not sicker, than the people I took care of on IM as a med student.

And looking at average salary doesn't make any sense - people who specialize but still keep up their IM board certification get included in those averages, which artificially raises them. A general outpatient IM physician doesn't often make much more than a general outpatient FM physician, if they have similar patient populations. The only difference is if the FM physician sees a lot of children (who often do not have great health insurance) or if they do a lot of OB (and have to pay much higher malpractice premiums).



Don't forget - if you do an FM residency, not only will you have to do peds, you will have to do a lot more obstetrics/gynecology/women's health than you would in an IM residency. A LOT more.



Meh. I think that that's up for debate. My inbox gets filled every week with recruiters offering hospitalist positions for FP in urban areas.

That should answer your question right there. Go IM and never look back.