Primary Care

[ScarletKnights]

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So I'm just trying to clear up some confusion I have. Alot of DO schools push for primary care. But when I began doing more research I saw that internal medicine is considered primary care, but this includes cardiology, nephrology, etc. I always thought becoming a cardiologist or whatever was considered specializing and not primary care.

If there's confusion as to what I'm saying looking at the wikipedia article for internal medicine.

http://en.wikipedia.org/wiki/Internal_medicine

 

[Bacchus]

General internal medicine, the treatment of adults, is considered primary care. The internal medicine sub-specialties are not.

 

[gatorfann14]

So I'm just trying to clear up some confusion I have. Alot of DO schools push for primary care. But when I began doing more research I saw that internal medicine is considered primary care, but this includes cardiology, nephrology, etc. I always thought becoming a cardiologist or whatever was considered specializing and not primary care.

If there's confusion as to what I'm saying looking at the wikipedia article for internal medicine.

http://en.wikipedia.org/wiki/Internal_medicine

I believe it is only primary care when it is general internal medicine and the doc is acting as a FP type physician. When you are a pulmonologist you have the ability to see patients as both a primary care physician and as a specialist(like a doc I shadowed), but when you do this then most people consider you a specialist as most specialists seem to only do their specialist work and not use their primary care abilities. Inconclusion do a fellowship after IM => specialist. stop after IM residency => PCP

 

[PinkStarburst]

I also noticed that during my interviews that primary care included ob-gyn, pediatrics, and EM as well. I didn't know EM was considered primary care..?

 

[cbrons]

Emergency medicine: saving the w0rld from seein their primary care physician.

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[ScarletKnights]

Oh okay so what exactly is general internal medicine?

 

[cliffhuxtableDO]

Oh okay so what exactly is general internal medicine?

its primary care. basically family medicine, but no children. only adults.

 

[st2205]

As far as what you're asking, cardiology, nephrology, etc. will all appear[/] to be primary care on a match list (and thus the proportion of graduates that enter "primary care") since there's no way to tell who's going on to fellowship. One thing is for sure is that cardiology and the likes will never show up on a match list or on residency placement statistics. The same holds true for any school, allopathic or osteopathic.

 

[cliffhuxtableDO]

As far as what you're asking, cardiology, nephrology, etc. will all appear[/] to be primary care on a match list (and thus the proportion of graduates that enter "primary care") since there's no way to tell who's going on to fellowship. One thing is for sure is that cardiology and the likes will never show up on a match list or on residency placement statistics. The same holds true for any school, allopathic or osteopathic.

can you apply for IM residency and fellowships simultaneously, similar to a PG1 slot and a specialty like Derm/PM&R/etc?

i have a feeling the answer is no, but figured i'd ask to be sure.

 

[lftbndlbrnchblk]

can you apply for IM residency and fellowships simultaneously, similar to a PG1 slot and a specialty like Derm/PM&R/etc?

i have a feeling the answer is no, but figured i'd ask to be sure.

I've heard of EM/IM and Med/Peds but nothing beyond that.

 

[cliquesh]

can you apply for IM residency and fellowships simultaneously, similar to a PG1 slot and a specialty like Derm/PM&R/etc?

i have a feeling the answer is no, but figured i'd ask to be sure.

Nope. You have to apply to fellowships during your final year of residency or after you complete your residency.

 

[st2205]

No, but there are a couple minor exceptions like matching into a general psychiatry residency and a child and adolescent fellowship at the same time, or if you matched directly into a specialty (i.e. Plastic surgery) that is also accessable via fellowship after a separate residency (in this case general surgery).

 

[Dr Yiot]

im pretty positive that 1 orginization considers EM as primary care, I just can't remember whether it was AOA or AMA. but 1 one of them considers it a specialty and one of the considers it primary.

 

[lftbndlbrnchblk]

im pretty positive that 1 orginization considers EM as primary care, I just can't remember whether it was AOA or AMA. but 1 one of them considers it a specialty and one of the considers it primary.

I think they'd both consider it to be a specialty. If you look at the ACEP logo on the acep.org website for the American College of Emergency Physicians, it's basically a grid made up of white boxes apart from one empty box. It symbolizes that EM is the "last specialty" in a way. DOs and MDs both belong to ACEP, so my guess is they both consider it to be a specialty. Some docs I know who specialize in what most consider specialties (neuro, cards, surgeons) look down on EM docs because they consider it to not be a "real specialty." EM docs I know, understandably, resent that sentiment.

 

[munchymanRX]

im pretty positive that 1 orginization considers EM as primary care, I just can't remember whether it was AOA or AMA. but 1 one of them considers it a specialty and one of the considers it primary.

We're splitting hairs. Emergency medicine, while technically a specialty, serves a primary care role in this country, as it ends up being the primary care center for those who do not have insurance, are indigent, or otherwise cannot see their regular primary care physician.

Both the AMA and AOA recognize this as such.

Also, stop trolling, Dr. Yiot.

 

[Dr Yiot]

I think they'd both consider it to be a specialty. If you look at the ACEP logo on the acep.org website for the American College of Emergency Physicians, it's basically a grid made up of white boxes apart from one empty box. It symbolizes that EM is the "last specialty" in a way. DOs and MDs both belong to ACEP, so my guess is they both consider it to be a specialty. Some docs I know who specialize in what most consider specialties (neuro, cards, surgeons) look down on EM docs because they consider it to not be a "real specialty." EM docs I know, understandably, resent that sentiment.

hmm, i could have swore that i thought one considered it differently. i guess your right then. its still good to know cause i am considering em.

We're splitting hairs. Emergency medicine, while technically a specialty, serves a primary care role in this country, as it ends up being the primary care center for those who do not have insurance, are indigent, or otherwise cannot see their regular primary care physician.

Both the AMA and AOA recognize this as such.

Also, stop trolling, Dr. Yiot.

i thought differently. guess i was wrong.

and why the hell does everyone keep thinking im trolling? i just like to have fun in some threads that are pointless and virtually will lead to bieng closed. i just put in my 2 weeks at my jobs and im waiting for my post bacc to start in january. I am a little bored. but im certainly not trolling. trolls are people who like to start things or spread false information. im just joking around and a select few people are taking it personally. others who really know me on the board know im not bieng serious

 

[JaggerPlate]

Different organizations classify PC fields differently. The most common I've heard are: FM, Gen IM, Gen Peds, Gen OB/GYN.

However, I've seen EM, Gen Psych, and a few others before.

 

[cbrons]

EM is classified as PC in most rural medicine programs.

 

[cbrons]

And primary care doesn't necessarily mean unspecialized. The family medicine physician is still a specialist; they specialize in general adult and pediatric medicine (+ob to a certain extent). Their scope of practice is unique and different than that of an internist or an OB/GYN but just because it isn't (or is) limited to one part of the body or specific situations (i.e. emergency med, critical care) doesn't mean its not a 'specialty' in the true sense of the word. Which is why mid-levels will never make sufficient substitutes for the board certified family physician.

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[Bacchus]

I would use the Nat'l Health Services Corp. definition. Since they're really the only organization that pays for PCPs they're really the only group that matters. Follow their classification.

 

[smq123]

I also noticed that during my interviews that primary care included ob-gyn, pediatrics, and EM as well. I didn't know EM was considered primary care..?

In most places, according to most definitions, EM is NOT considered primary care. Part of the thing about primary care is "continuity of care" - i.e. seeing the same patient over a spectrum of time. In FP, there are some patients who have had the same FP since they were babies. In peds, you see them as a newborn all the way until they are 18. In OB, you will see the same woman as she goes through pregnancy all the way until menopause and beyond. You don't get that in EM.

can you apply for IM residency and fellowships simultaneously, similar to a PG1 slot and a specialty like Derm/PM&R/etc?

i have a feeling the answer is no, but figured i'd ask to be sure.

Some allopathic places are now doing "fast track" fellowships, where you are guaranteed a position in the cardiology fellowship/GI fellowship program from the first day of internship. You basically apply for both an abbreviated IM residency and a cardiology/GI fellowship when you are an MS4. These are still pretty rare, though, and mostly at the big academic centers (Penn, Duke, etc.). I don't know where you are in the training spectrum - these may be more common by the time you apply for residency.

 

[cliffhuxtableDO]

In most places, according to most definitions, EM is NOT considered primary care. Part of the thing about primary care is "continuity of care" - i.e. seeing the same patient over a spectrum of time. In FP, there are some patients who have had the same FP since they were babies. In peds, you see them as a newborn all the way until they are 18. In OB, you will see the same woman as she goes through pregnancy all the way until menopause and beyond. You don't get that in EM.



Some allopathic places are now doing "fast track" fellowships, where you are guaranteed a position in the cardiology fellowship/GI fellowship program from the first day of internship. You basically apply for both an abbreviated IM residency and a cardiology/GI fellowship when you are an MS4. These are still pretty rare, though, and mostly at the big academic centers (Penn, Duke, etc.). I don't know where you are in the training spectrum - these may be more common by the time you apply for residency.

awesome! thanks for that information. i'll be starting med school in the fall (woo woo!)

 

[st2205]

And primary care doesn't necessarily mean unspecialized. The family medicine physyician is still a specialist per say, they specialize in general adult and pediatric medicine. Their scope of practice is unique and different than that of an internist or an ob or whatever. Just because it isn't limited to one part of the body or specific situations doesn't mean its not a 'specialty' in the true sense of the word. Which is why midlevels wiLl never make sufficient substitutes for the physician board certified in family medicine.

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All excellent points.