What are the benefits of doing FM over IM?

[deleted87716]

Thanks @Blue Dog! I don't want to take up too much of your time (which I appreciate), so this is my last question, but does this mean employers are determining FM gets lower RVUs than IM, generally speaking?

(I assume this doesn't apply to PCPs that aren't employed by a hospital or other system. So if it's true employers are giving lower RVUs for FM than IM, then maybe this is a good reason not to be employed, which as far as I know is still very possible in primary care, unlike specialties that are mostly hospital-based like EM, anesthesia, hospitalists, critical care, etc.)

No idea. Hospitalists could account for some of the discrepancy, I suppose.

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[spacegun]

No idea. Hospitalists could account for some of the discrepancy, I suppose.

Thanks again @Blue Dog. Just wanted to say, for whatever it's worth, if anything, that the source that @door_to_balloon_knot cited does seem to differentiate between hospitalists and IM and FM (and urgent care).

 

[Splenda88]

I am assuming they take into account coding; otherwise, it would not be a comparison at all. The question is why?

 

[sunshinefl]

I am assuming they take into account coding; otherwise, it would not be a comparison at all. The question is why?

Well, on that source, Peds and ObGyn are lower than IM (and Peds is lower than FM) so maybe those components of FM are pulling it down from IM?

 

[VA Hopeful Dr]

I am assuming they take into account coding; otherwise, it would not be a comparison at all. The question is why?

Coding doesn't affect $/wRVU

 

[brianmartin]

FM is not being "phased out". There will always be a need for generalists who can see kids, do women's health, and just generally know what the heck is going on in most situations because they did a broad residency and saw everything. People like family doctors and demand them, even. We aren't being phased out. The benefits of FM are you get a more broader age range of patients. That's hugely important to some people, including me. And its important to primary care organizations, because when a family doc is on call, they can take the calls about kids, which many mid levels can't do, and no internists can do. Family doctors are the grease in the machine of primary care, an essential component.

 

[AMEHigh]

I actually recently switched my own pcp to an internist due to location and I'm kind of bummed. I'm thinking of switching back to someone who is FM. I'm thinking about having kids in the somewhat near-ish future and would love to have someone in FM for me and my hypothetical child. Obviously I'm biased, but I don't know why everyone (especially women) wouldn't want FM for a 1 stop shop! I live in a large city, so it is a little harder to find a FM doctor who truly does practice full spectrum, but it is still out there and there are several residency programs in the area as well.

 

[VA Hopeful Dr]

I actually recently switched my own pcp to an internist due to location and I'm kind of bummed. I'm thinking of switching back to someone who is FM. I'm thinking about having kids in the somewhat near-ish future and would love to have someone in FM for me and my hypothetical child. Obviously I'm biased, but I don't know why everyone (especially women) wouldn't want FM for a 1 stop shop! I live in a large city, so it is a little harder to find a FM doctor who truly does practice full spectrum, but it is still out there and there are several residency programs in the area as well.

I've had a number of older patients who were alive a good while before FM was a thing so they think we're the same as the old GPs and that internists are who you go to when you get lots of problems.

I will say anecdotally, my internist wife is better at picking up zebras than I am. On the other hand, I'm a good bit better at MSK than she is (I taught her how to do several injections).

 

[sunshinefl]

I actually recently switched my own pcp to an internist due to location and I'm kind of bummed. I'm thinking of switching back to someone who is FM. I'm thinking about having kids in the somewhat near-ish future and would love to have someone in FM for me and my hypothetical child. Obviously I'm biased, but I don't know why everyone (especially women) wouldn't want FM for a 1 stop shop! I live in a large city, so it is a little harder to find a FM doctor who truly does practice full spectrum, but it is still out there and there are several residency programs in the area as well.

I'm going into IM On a personal level, I always get my women's health stuff done through my internist PCPs (plural due to moving around for school).

 

[VA Hopeful Dr]

I'm going into IM On a personal level, I always get my women's health stuff done through my internist PCPs (plural due to moving around for school).

My wife does way more pap smears than I do just by virtue of being a woman. There's nothing wrong with seeing an internist, its all personal preference.

 

[sunshinefl]

My wife does way more pap smears than I do just by virtue of being a woman. There's nothing wrong with seeing an internist, its all personal preference.

yeah that makes sense. I'm female as well and plan on doing basic women's health stuff. I even ask about that at interviews (and behavior health since I know I want to be a PCP).

 

[AMEHigh]

I'm going into IM On a personal level, I always get my women's health stuff done through my internist PCPs (plural due to moving around for school).

That’s great! Like I said obviously I’m biased, you just gotta do what you love
I do know internists will do repro health stuff, but it def seems much more rare that they’ll do a lot of repro procedures (larc, colpo, biopsies) and be as comfortable with more complex birth control options, pregnancy, postpartum, breast feeding, and then on the other spectrum peri-menopause and menopause, etc.
But all specialties have their pros and cons obviously!

I recently had to starting going to the dermatologist. And the internist I go to doesn’t do any repro health, like even really seem to prescribe birth control, so I got an obgyn and then thinking about adding a kid to the mix to need a pediatrician, it just seems like so much lol.

 

[sunshinefl]

That’s great! Like I said obviously I’m biased, you just gotta do what you love
I do know internists will do repro health stuff, but it def seems much more rare that they’ll do a lot of repro procedures (larc, colpo, biopsies) and be as comfortable with more complex birth control options, pregnancy, postpartum, breast feeding, and then on the other spectrum peri-menopause and menopause, etc.
But all specialties have their pros and cons obviously!

I recently had to starting going to the dermatologist. And the internist I go to doesn’t do any repro health, like even really seem to prescribe birth control, so I got an obgyn and then thinking about adding a kid to the mix to need a pediatrician, it just seems like so much lol.

I see that. I actually dislike procedures and have seen that FM seems to be more one-stop-shop and in-office procedure than IM (from what I've seen). On the "being the doctor" side, I actually prefer that lol. I can see the appeal of more comprehensive FM PCP for some patients though.

 

[MedicineZ0Z]

I've had a number of older patients who were alive a good while before FM was a thing so they think we're the same as the old GPs and that internists are who you go to when you get lots of problems.

I will say anecdotally, my internist wife is better at picking up zebras than I am. On the other hand, I'm a good bit better at MSK than she is (I taught her how to do several injections).

I've seen this somewhat the opposite too in some cases. It's dependent on the pathology exposure in med school and residency and most importantly, how often the doctor goes looking for zebras. I work up zebras on a daily basis and find lots of them, but I also have a very weird patient population.
Some of it is cultural too. My co-residents use MKSAP (IM board material) to study and are generally pretty driven and try to do exceptionally well.

 

[Splenda88]

I've had a number of older patients who were alive a good while before FM was a thing so they think we're the same as the old GPs and that internists are who you go to when you get lots of problems.

I will say anecdotally, my internist wife is better at picking up zebras than I am. On the other hand, I'm a good bit better at MSK than she is (I taught her how to do several injections).

So your wife is a lot smarter than you...

 

[Splenda88]

I've seen this somewhat the opposite too in some cases. It's dependent on the pathology exposure in med school and residency and most importantly, how often the doctor goes looking for zebras. I work up zebras on a daily basis and find lots of them, but I also have a very weird patient population.
Some of it is cultural too. My co-residents use MKSAP (IM board material) to study and are generally pretty driven and try to do exceptionally well.

I will say it. You are better than most internists.

 

[VA Hopeful Dr]

So your wife is a lot smarter than you...

Without a doubt

 

[VA Hopeful Dr]

I've seen this somewhat the opposite too in some cases. It's dependent on the pathology exposure in med school and residency and most importantly, how often the doctor goes looking for zebras. I work up zebras on a daily basis and find lots of them, but I also have a very weird patient population.
Some of it is cultural too. My co-residents use MKSAP (IM board material) to study and are generally pretty driven and try to do exceptionally well.

MKSAP is a pretty solid resource, but in many areas it goes into details that even the internists think are a bit much. I don't really see the need to know specific chemotherapy regimens for various types of cancer, for example.

 

[TwistedTea]

If you compare our IM curriculum and rotations to the FM program at my univ we get a lot better hospitalist training/consult services (in and outpatient) so we are trained to handle a lot more things inpatient. But on the flipside I think the FM program here gets better MSK/derm training and obviously better OBGYN and peds since we dont do kids or birthing. I know some FM programs are inpatient heavy but they miss out on the amount of ICU month amounts we do and usually they only do cardiology as a consult services... the rest of the time that they would otherwise spend on these things is spent on peds and clinic.

So basically depends what you wanna do lol I dont like kids or OB so wasnt going to spend time in FM doing those things. Obv you get good at what you do more.

 

[hallowmann]

Without a doubt

Smart man.

I'd like to take this opportunity to also say that my wife is smarter than me. Has nothing to do with medicine, simply stating a fact.

 

[NITRAS]

Smart man.

I'd like to take this opportunity to also say that my wife is smarter than me. Has nothing to do with medicine, simply stating a fact.

I can safely say that I married up as well. My wife isn’t a physician.

 

[VA Hopeful Dr]

I can safely say that I married up as well. My wife isn’t a physician.

I suspect lots of people feel the same way, and even if they don't they should be smart enough to still say that sort of thing.

 

[Splenda88]

Smart man.

I'd like to take this opportunity to also say that my wife is smarter than me. Has nothing to do with medicine, simply stating a fact.

Well, I would not feel comfortable marrying someone who is smarter than me. That's just me

 

[MedicineZ0Z]

I suspect lots of people feel the same way, and even if they don't they should be smart enough to still say that sort of thing.

Did you both take an IQ test while dating, engaged or after getting married?

 

[sunshinefl]

I suspect lots of people feel the same way, and even if they don't they should be smart enough to still say that sort of thing.

what if you're the smarter spouse but also not smart enough to say you aren't....

 

[spacegun]

As a single person, I am both the smartest and the dumbest one in my relationship...with myself.

 

[VA Hopeful Dr]

what if you're the smarter spouse but also not smart enough to say you aren't....

Then you're not the smarter spouse

 

[VA Hopeful Dr]

Did you both take an IQ test while dating, engaged or after getting married?

No. Who on Earth would do that?

 

[deleted87716]