Questions about FM residency to hospitalist route

[jdh71]

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I mean the fact that they exist is proof that a FM hospitalist in a typical avg sized hospital w/ a closed icu is quite easy for most grads.

How many fm programs provide weak inpatient training?

"Quite easy"?

I have no clue how many provide "week inpatient training"

A FM hospitalist working in an ICU is often a necessary but not optimal thing - a feature of markets, economics, and lack of critical care physicians. The fact that they exist isn't an argument "it's just so easy to be a critical care doctor".

Are you high?

 

[MedicineZ0Z]

"Quite easy"?

I have no clue how many provide "week inpatient training"

A FM hospitalist working in an ICU is often a necessary but not optimal thing. The fact that they exist isn't an argument "it's just so easy to be a critical care doctor".

Are you high?

Thats literally not what I said dude. Im saying most FMs should be able to do hospitalist.

 

[jdh71]

Thats literally not what I said dude. Im saying most FMs should be able to do hospitalist.

Probably. But based on training the best way to step into that role coming out of resident is IM.

Dude.

 

[Splenda88]

Quality matters too. I have up to 10 patients as an intern (usually 5-6) and most are complex which covers the quality aspect.

Do you want to work as a hospitalist? It's best to be an IM doc for that type of work. That will give you more confidence and it will open more doors. But I don't see any issues with FM docs working as hospitalists.

 

[Danbo1957]

No. The Hospitalist service is IM.

 

[MedicineZ0Z]

Probably. But based on training the best way to step into that role coming out of resident is IM.

Dude.

I don't disagree if we're making generalizations but there are A LOT of IM residencies which provide subpar in the context of managing critical care patients and/or procedural competency. If you're a PGY2 who's placed like 2 lines, you aren't at a program that's going to get you competent at doing them for an open ICU setting.
This usually occurs due to relatively lower patient complexity which isn't uncommon at community hospitals + inadequate volume. Especially when these places have lots of fellows.

You can say the same for most other hospitalist positions. If your inpatient service isn't super busy and lacks patient complexity/good teaching, you aren't super prepared to be a hospitalist just because you spent more time doing inpatient.

No. The Hospitalist service is IM.

"No" what?

 

[jdh71]

I don't disagree if we're making generalizations but there are A LOT of IM residencies which provide subpar in the context of managing critical care patients and/or procedural competency. If you're a PGY2 who's placed like 2 lines, you aren't at a program that's going to get you competent at doing them for an open ICU setting.
This usually occurs due to relatively lower patient complexity which isn't uncommon at community hospitals + inadequate volume. Especially when these places have lots of fellows.

You can say the same for most other hospitalist positions. If your inpatient service isn't super busy and lacks patient complexity/good teaching, you aren't super prepared to be a hospitalist just because you spent more time doing inpatient.

"No" what?

Spending more time doing IN PATIENT is exactly what is going to better prepare you to be a hospitalist because that is what you do, take care of adult patients IN the hospital.

IM residencies will require more ICU time than FM. Placing central lines is largely not something that is required of a hospitalist anywhere. An ICU is simply one more kind of nursing floor where you can place a patient, if you have an open ICU you keep there what you think you can handle and transfer out what you cannot.

People can learn and pick up a lot after training. The overarching point here in this thread is that IF your goal is hospitalist medicine and your choice is IM vs FM, the choice is simple, and why waste your time learning a craft (pediatrics and obstetrics plus lots of outpatient clinic) you are not planning to use when done?

My anecdotal experience is that for many years after training FM trained hospitalists are simply not as good - they are not killing people or anything, they are adequate - and are much more uncomfortable with the sick and the complicated (they seem to find some parity after 3-5 years). This also does bias my opinion in the direction of recommending IM for someone interested in doing hospitalist medicine.

I really cannot change my recommendation because you can come up with a hypothetical scenario where an FM trained person will be better than an IM trained person starting a hospitalist jobs. I'm sure it can and does happen. It's not, however, enough to persuade me that those situations are occurring so often or at equal enough rates that FM is just and fine as IM.

This isn't personal, nor me taking a crap on FM.

 

[MedicineZ0Z]

Spending more time doing IN PATIENT is exactly what is going to better prepare you to be a hospitalist because that is what you do, take care of adult patients IN the hospital.

IM residencies will require more ICU time than FM. Placing central lines is largely not something that is required of a hospitalist anywhere. An ICU is simply one more kind of nursing floor where you can place a patient, if you have an open ICU you keep there what you think you can handle and transfer out what you cannot.

People can learn and pick up a lot after training. The overarching point here in this thread is that IF your goal is hospitalist medicine and your choice is IM vs FM, the choice is simple, and why waste your time learning a craft (pediatrics and obstetrics plus lots of outpatient clinic) you are not planning to use when done?

My anecdotal experience is that for many years after training FM trained hospitalists are simply not as good - they are not killing people or anything, they are adequate - and are much more uncomfortable with the sick and the complicated (they seem to find some parity after 3-5 years). This also does bias my opinion in the direction of recommending IM for someone interested in doing hospitalist medicine.

I really cannot change my recommendation because you can come up with a hypothetical scenario where an FM trained person will be better than an IM trained person starting a hospitalist jobs. I'm sure it can and does happen. It's not, however, enough to persuade me that those situations are occurring so often or at equal enough rates that FM is just and fine as IM.

This isn't personal, nor me taking a crap on FM.

Your (incredibly biased attack) anecdotes mean nothing. We have midlevels doing nearly independent inpatient. Go deal with them first.
And no, more time spent rounding on a small low complexity doesnt =/= better training. You're literally saying quantity is everything and quality means nothing. You're either a troll or have literally 0 insight into education.

 

[VA Hopeful Dr]

Your (incredibly biased attack) anecdotes mean nothing. We have midlevels doing nearly independent inpatient. Go deal with them first.
And no, more time spent rounding on a small low complexity doesnt =/= better training. You're literally saying quantity is everything and quality means nothing. You're either a troll or have literally 0 insight into education.

That is not what he's saying at all.

Not sure why midlevels came up, except that they always do with you. But it's not relevant to this discussion.

He's not saying FPs as hospitalists are dangerous, he even specifically says they aren't harming patients. Just that the average IM grad is more comfortable with the spectrum of hospital medicine than the average FP. Are there ****ty IM hospitalists? Of course. Are there rock star FP hospitalists? Also of course. But ON AVERAGE IM prepares you better for being a hospitalist just like on average FM prepares you better for outpatient practice than IM.

 

[jdh71]

Your (incredibly biased attack) anecdotes mean nothing. We have midlevels doing nearly independent inpatient. Go deal with them first.
And no, more time spent rounding on a small low complexity doesnt =/= better training. You're literally saying quantity is everything and quality means nothing. You're either a troll or have literally 0 insight into education.

I didn't attack anything or anyone. If you felt "attacked" maybe you need to do some work on your own self-confidence and complex of inferiority.

I don't see APP's working independently on the inpatient side. I don't see anything to "deal with" there.

More time rounding on in-patient, in the hospital, is going to be BETTER training to . . . round on in-patients, in the hospital. Sorry. One complicated case doesn't like equal 10 non-complicated ones. I'm not sure who exactly you think IM residents are admitting to hospitals, just the easy cases?

I'm definitely not a troll, and I know a lot about how to learn in-patient medicine as I had to.

I explained my recommendations and the rationale around why I even admitted some of my bias. This conversation has probably ran it's course as you are completely all over the place and can't keep the train of thoughts together. Good luck in residency.

 

[Danbo1957]

Wow, a total disconnect...

If you want to DO inpatient medicine as a hospitalist (the job description is in the word) DO an IM residency. If you have DONE an FM residency you could do inpatient medicine, but you will NOT have the same abilities concerning the standard of care as IM trained. Think about it.

 

[Splenda88]

Your (incredibly biased attack) anecdotes mean nothing. We have midlevels doing nearly independent inpatient. Go deal with them first.
And no, more time spent rounding on a small low complexity doesnt =/= better training. You're literally saying quantity is everything and quality means nothing. You're either a troll or have literally 0 insight into education.

Why did you choose FM if you want to do hospital medicine? IM is not competitive, so almost everyone who got into FM could have gotten into IM.