Viability of a career in family medicine (vs. IM-PC)

[Treebeard]

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I am very interested in primary care and starting to think about residencies in family vs internal medicine.

Overall, I would say that all else equal I would probably choose family. I am drawn toward family medicine due to its comprehensive nature: I like the idea of being able to take on patients' children as my patients, continue taking care of patients when they get pregnant, and admit patients to the hospital as needed. I also think that I philosophically align with many of the family doctors that I have met, and if my goal is primary care I don't think it makes a ton of sense to do an intense hospital based internal medicine residency when I could do a family residency and actually focus on the skills I want to have (rather then spending months in the ICU and various IM specialties).

That being said, it seems that 1) nowadays most family doctors just see adults and don't actually do much peds or OB 2) there are very few jobs available for family physicians unless you want to go very rural (I don't). Internal medicine residencies with a primary care track seem to set one up for a more viable career (nearly all of the PCPs at my institution trained IM). As I said, I like the idea of doing some pediatric and OB care, but I would be willing to give those up in exchange for greater job security and the ability to live in a medium sized city (I am not particularly interested in NYC, Boston, LA, but I am interested in say Denver, Phoenix, Philly, San Diego, Austin...).

Any advice would be greatly appreciated.

 

[SLC]

You should see my email inbox if you think there aren’t many jobs for FM docs in medium to large cities. I get like 40 advertisements per day, and I’m focused in on AZ, UT, CO, OR, WA, MT.

There are tons of jobs literally everywhere. You can write your ticket to wherever you want to live in Family Med.

 

[Treebeard]

You should see my email inbox if you think there aren’t many jobs for FM docs in medium to large cities. I get like 40 advertisements per day, and I’m focused in on AZ, UT, CO, OR, WA, MT.

There are tons of jobs literally everywhere. You can write your ticket to wherever you want to live in Family Med.

Interesting. Perhaps I am misinformed on this. I thought FM was a lot like gen surg in that you can do it very rurally these days. I ran some searches on Merrit-Hawkins, which I've been told is the best source, and only really found FM jobs in pretty rural areas (and the odd job here and there in a big city).

 

[SLC]

Meh, I’ve had adverts for LA, SD, SF, SanJose, Portland, Seattle, Phoenix, Tucson, and Denver this week already. Plenty of smaller, near-by towns mixed in too.

Trust me, plenty of jobs anywhere you want to be.

 

[Money Moniker]

Interesting. Perhaps I am misinformed on this. I thought FM was a lot like gen surg in that you can do it very rurally these days. I ran some searches on Merrit-Hawkins, which I've been told is the best source, and only really found FM jobs in pretty rural areas (and the odd job here and there in a big city).

I think just about all jobs posted at that site are like 2 hours away from the closest bona-fide city, regardless of the specialty. That's why they keep the location vague but broadcast the salary lol.

 

[softball2344]

I always though that family med (and other less specialized fields) were the easiest to get jobs...

 

[Treebeard]

Meh, I’ve had adverts for LA, SD, SF, SanJose, Portland, Seattle, Phoenix, Tucson, and Denver this week already. Plenty of smaller, near-by towns mixed in too.

Trust me, plenty of jobs anywhere you want to be.

Do those jobs in nice cities pay a decent amount? I am not overly interested in getting rich but I do have loans and would like to make at least 200.

 

[Treebeard]

I think just about all jobs posted at that site are like 2 hours away from the closest bona-fide city, regardless of the specialty. That's why they keep the location vague but broadcast the salary lol.

I think maybe I let that site lead me the wrong way. What is a better source for a picture of job opportunities for physicians?

 

[Mad Jack]

Interesting. Perhaps I am misinformed on this. I thought FM was a lot like gen surg in that you can do it very rurally these days. I ran some searches on Merrit-Hawkins, which I've been told is the best source, and only really found FM jobs in pretty rural areas (and the odd job here and there in a big city).

Merrit-Hawkins is a recruitment firm. They generally only get paid to recruit people for the least desirable sites out there, or in fields that are extremely high demand to the point that competition is fierce. There are plenty of FM jobs in any city you'd want to go.

 

[814965]

No idea where you're getting your info from. The market for FM is definitely not in danger of being saturated.

 

[Treebeard]

No idea where you're getting your info from. The market for FM is definitely not in danger of being saturated.

Where is a good place to be getting this type of info from?

 

[SLC]

Where is a good place to be getting this type of info from?

I get it from all the job adverts I get on a regular basis. There are not many job posting repositories I’ve found. But once I put myself out there as looking in certain areas (registered for practicelink, NEJM career center, etc), job openings found me.

And $200,000 is not hard to do in FM.

 

[W19]

Not familiar with the job market for FM in a lot of states, but you can find a job as a FM doc almost anywhere in FL and GA....

 

[ortnakas]

From my understanding, FM jobs aren't hard to find. You might be correct that you're more likely to be seeing OB and peds patients in a rural setting-- that hunch is based on hearsay and my own experience of urban/suburban vs rural FM rotations-- but FM docs aren't having trouble finding positions in urban areas.

 

[Ho0v-man]

An FM doc could get a job anywhere in less time than it took you to read this post.

 

[AsianPersuasion]

Where I'm at, FM doesn't have privileges when it comes to OB. Apparently, it's too much of a liability...

I can see what you mean in regards to not focusing so much on intense hospital side of the work, but you have to remember, sometimes those large wards, big centers is what giving you the experience you need as FM and set you aside from mid-levels who wants to steal our cake but make us pay for it. (Nothing against mid-levels, just the ones who thinks they're equivalent to physicians).

 

[guytakingboards]

Anecdotally a friend of mine did a pretty inpatient heavy inpatient IM residency and is now a primary care doctor. She claims that her clinic evaluation/workup of acute patients is much better than her clinic FM colleagues. Things like CHF exacerbation and PNA that are bread and butter for IM doc's but maybe not as heavily emphasized in a FM residency as prevention. She does well-woman exams too.

It somewhat depends on your practice population. My friend happens to work for a primary care group that exclusively sees geriatric patients, so her not having peds or OB-training is entirely moot to her clinic experience.

And my personal experience: at my university hospital the FM docs are the last people you want managing inpatients with multiple co-morbidities; their inpatient skills are severely lacking compared to internal medicine.

 

[MedicineZ0Z]

I am very interested in primary care and starting to think about residencies in family vs internal medicine.

Overall, I would say that all else equal I would probably choose family. I am drawn toward family medicine due to its comprehensive nature: I like the idea of being able to take on patients' children as my patients, continue taking care of patients when they get pregnant, and admit patients to the hospital as needed. I also think that I philosophically align with many of the family doctors that I have met, and if my goal is primary care I don't think it makes a ton of sense to do an intense hospital based internal medicine residency when I could do a family residency and actually focus on the skills I want to have (rather then spending months in the ICU and various IM specialties).

That being said, it seems that 1) nowadays most family doctors just see adults and don't actually do much peds or OB 2) there are very few jobs available for family physicians unless you want to go very rural (I don't). Internal medicine residencies with a primary care track seem to set one up for a more viable career (nearly all of the PCPs at my institution trained IM). As I said, I like the idea of doing some pediatric and OB care, but I would be willing to give those up in exchange for greater job security and the ability to live in a medium sized city (I am not particularly interested in NYC, Boston, LA, but I am interested in say Denver, Phoenix, Philly, San Diego, Austin...).

Any advice would be greatly appreciated.

Jobs are everywhere and you can definitely do 250k/year and for sure 300k+ if you're efficient/fast and can do higher volume.

 

[HueySmith]

Question is: How is the pay in large cities like LA, SD, NY, LV, whatever....

 

[Poit]

With the exception of minimum wage work in San Francisco and child psych, FM has the best job market of any job in this country.

 

[W19]

Question is: How is the pay in large cities like LA, SD, NY, LV, whatever....

Doximity Compensation Report 2018

 

[VA Hopeful Dr]

I get it from all the job adverts I get on a regular basis. There are not many job posting repositories I’ve found. But once I put myself out there as looking in certain areas (registered for practicelink, NEJM career center, etc), job openings found me.

And $200,000 is not hard to do in FM.

The AAFP has a job listing area that's pretty good as well.

 

[SLC]

The AAFP has a job listing area that's pretty good as well.

Good to know, I found mine in NEJM

 

[VA Hopeful Dr]

Anecdotally a friend of mine did a pretty inpatient heavy inpatient IM residency and is now a primary care doctor. She claims that her clinic evaluation/workup of acute patients is much better than her clinic FM colleagues. Things like CHF exacerbation and PNA that are bread and butter for IM doc's but maybe not as heavily emphasized in a FM residency as prevention. She does well-woman exams too.

It somewhat depends on your practice population. My friend happens to work for a primary care group that exclusively sees geriatric patients, so her not having peds or OB-training is entirely moot to her clinic experience.

And my personal experience: at my university hospital the FM docs are the last people you want managing inpatients with multiple co-morbidities; their inpatient skills are severely lacking compared to internal medicine.

And I think that is a problem with big university FP programs at times. For instance - in my unopposed FM residency we admitted 5 unassigned patients every day. In the university where I went to med school, the FM service admitted 1 unassigned every day. As these patients tend to be the more trainwrecky, that's where the good inpatient training comes from to my mind.

As for your anecdote, hogwash. I'd put my outpatient management of CHF and PNA up against pretty much any general internist, and my other acute skills way above them. IM programs don't teach MSK very well in my experience which is something like 18% of acute outpatient PCP chief complaints.