What is the reason for choosing Family Medicine over Internal Medicine?

[RosenthalFiber]

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I don't understand why one would prefer to family as an alternative to IM...but I've heard this a ton from people. I suppose the argument is that they like OB and Peds too or something, but the OB/Peds FM docs do is likely at a PA/general level. It seems like you end up knowing everything in all of medicine but at a PA esque level- which honestly is extremely and impressive- but I would have to think somewhat unsatisfying.

These are just my opinions and I know many exceptional FM docs

 

[VA Hopeful Dr]

I don't understand why one would prefer to family as an alternative to IM...but I've heard this a ton from people. I suppose the argument is that they like OB and Peds too or something, but the OB/Peds FM docs do is likely at a PA/general level. It seems like you end up knowing everything in all of medicine but at a PA esque level- which honestly is extremely and impressive- but I would have to think somewhat unsatisfying.

These are just my opinions and I know many exceptional FM docs

Umm, the general level is exactly what we're shooting for. Of note, there is a huge difference between my knowledge of Peds/OB and a PAs knowledge of OB/Peds.

I enjoy knowing that I can handle 99% of what walks through my office doors of all ages. That other 1% I still almost always know what's going on, I just can't do what needs to be done to handle it - surgery, cath, complex rheum stuff.

My peds patients are no different from what general pediatricians deal with. My adult patients are no different from what general internists deal with. However, each of those cannot do what the other one can. I, on the other hand, can.

 

[deleted87716]

 

[RosenthalFiber]

Umm, the general level is exactly what we're shooting for. Of note, there is a huge difference between my knowledge of Peds/OB and a PAs knowledge of OB/Peds.

I enjoy knowing that I can handle 99% of what walks through my office doors of all ages. That other 1% I still almost always know what's going on, I just can't do what needs to be done to handle it - surgery, cath, complex rheum stuff.

My peds patients are no different from what general pediatricians deal with. My adult patients are no different from what general internists deal with. However, each of those cannot do what the other one can. I, on the other hand, can.

Makes a lot more sense. And I'm sorry if that came off as offensive- I promise I did not mean it to- I grew up in an area where we didn't have a lot of family docs. Thanks!

 

[RosenthalFiber]

 

[DIce3]

I don't understand why one would prefer to family as an alternative to IM...but I've heard this a ton from people. I suppose the argument is that they like OB and Peds too or something, but the OB/Peds FM docs do is likely at a PA/general level. It seems like you end up knowing everything in all of medicine but at a PA esque level- which honestly is extremely and impressive- but I would have to think somewhat unsatisfying.

These are just my opinions and I know many exceptional FM docs

Your question is posted on the wrong board to make a statement like that one. I am a general internist and I think you are probably not far off. There is a significant difference between a university trained traditional general internist and an unopposed trained family physician. Few FPs really take care of NYHA 2/3 heart failure, cirrhosis, MGUS, end-stage COPD, stage IV CKD, or brittle diabetes mellitus without a consultation. Many internists care for these patients solo but there will be no cute kids to play with.

 

[deleted87716]

Few FPs really take care of NYHA 2/3 heart failure, cirrhosis, MGUS, end-stage COPD, stage IV CKD, or brittle diabetes mellitus without a consultation. Many internists care for these patients solo

Got data?

If it's true, I'm sure the ACP makes it easy to find on their web site. Go ahead...we'll wait.

 

[DIce3]

ARNPs make equivalent compentency claims versus family physicians. The problem is that the data strongly supports the ARNPs position. It is a sad state of affairs because I think that there is a very significant difference between an ARNP and a FP.

Data... you and I really really wish there was something... anything to show an objective verifiable difference versus MDs and ARNPs.

The internal medicine versus FP argument is a much older one and I think it is very similar to the above argument. But there are so few American grads really going into general internal medicine, it has become not worth discussing. The average internist compared to the average FP is better at managing medically complex inpatient and outpatient adults the day after graduation from residency. I am not sure the difference holds for very long, however.

That said, your graphic post to the OP is uncalled for, hence I spoke up.

 

[deleted87716]

The average internist compared to the average FP is better at managing medically complex inpatient and outpatient adults the day after graduation from residency. I am not sure the difference holds for very long, however.

😕

That said, your graphic post to the OP is uncalled for, hence I spoke up.

I'm tempted to post it again.

 

[VA Hopeful Dr]

Your question is posted on the wrong board to make a statement like that one. I am a general internist and I think you are probably not far off. There is a significant difference between a university trained traditional general internist and an unopposed trained family physician. Few FPs really take care of NYHA 2/3 heart failure, cirrhosis, MGUS, end-stage COPD, stage IV CKD, or brittle diabetes mellitus without a consultation. Many internists care for these patients solo but there will be no cute kids to play with.

Umm.. yes, yes we definitely do. In fact, as my clinic caters to mostly Medicaid, I have a very hard time getting consultants even when I want them. We just had our monthly business meeting. Of all of my consults, if we ignore pain management and referrals for specific procedures, I had the following....

Gout with huge tophi referred for IV uricase, Type 2 DM in need of u-500 (will get sent back to me once that's established), severe allergic asthma to pulm for Xolair, and RA having failed methotrexate and is a good candidate for biologic agents.

As for you other statement. I'm an unopposed FM grad and my wife is a university trained internist. We manage the same types of outpatients in the same way. I'll be the first to admit that her inpatient training exceeds mine, but our outpatient knowledge base is pretty much the same as far as we've been able to tell.

 

[Dharma]

ARNPs make equivalent compentency claims versus family physicians. The problem is that the data strongly supports the ARNPs position. It is a sad state of affairs because I think that there is a very significant difference between an ARNP and a FP.

Data... you and I really really wish there was something... anything to show an objective verifiable difference versus MDs and ARNPs.

The internal medicine versus FP argument is a much older one and I think it is very similar to the above argument. But there are so few American grads really going into general internal medicine, it has become not worth discussing. The average internist compared to the average FP is better at managing medically complex inpatient and outpatient adults the day after graduation from residency. I am not sure the difference holds for very long, however.

That said, your graphic post to the OP is uncalled for, hence I spoke up.

Big claims (mostly your first post, which I mistakenly did not quote). Anything to back them up besides opinion?

 

[smq123]

My personal experience is that outpatient IM physicians, once they graduate, have a hard time thinking outside of the inpatient box. Anything that was refractory to first-line treatment got referred out, and NOTHING got empirically treated - everything was referred out for imaging. This was despite the fact that we work in an underserved clinic, and getting a referral for imaging takes a minor miracle.

If you honestly think that an ARNP is anywhere equivalent to an FM physician, you must work with some pretty crappy physicians. In my experience, the ARNPs were actually closer to the IM physicians in that both referred EVERYONE out. Again, do you have data to back up your assertions? I thought IM was all about evidence based medicine....

Furthermore, many of my patients come in demanding referrals....because the IM-trained hospitalist that saw them in the hospital told them that they should see "xyz specialist 4-7 days after discharge." Despite the fact that what they have is really not that complicated, when you tell them that they don't need to see a specialist, they look at you blankly and say, "But the hospital doctor told me that I did!" 🙄 While I get that some of that is CYA, it's not necessary to make everyone see a specialist after they get out of the hospital.

 

[MedicineDoc]

Your question is posted on the wrong board to make a statement like that one. I am a general internist and I think you are probably not far off. There is a significant difference between a university trained traditional general internist and an unopposed trained family physician. Few FPs really take care of NYHA 2/3 heart failure, cirrhosis, MGUS, end-stage COPD, stage IV CKD, or brittle diabetes mellitus without a consultation. Many internists care for these patients solo but there will be no cute kids to play with.

Pretty ridiculous and completely false post which appears to be an idiotic attempt at self aggrandization suggesting a possible personality disorder and liklihood of conflicts with piers and inability to work in a team environment a skill essential for hospitalist medicine. 😉

I have done a university based IM prelim yr prior to switching from a specialty to an unoppsed FM residency with open ICU and can tell you my unopppossed FM inpatient training was far and away better than the IM inpatient training i recieved as part of my IM prelim yr.



Also, there is a point at which not consulting specialists on patients that they feel they should be consulted on where the specialist will begin to question the care and judgement of the physician acting as the primary in the hospital. None of the examples you cite necessarily which are bread and butter both IM and FM and for the most part suprising that you would cite as examples without some complicating other factors. If you have a train wreck and the patient goes south and then you call the specialist after the patient is worse instead of better you are not a very good doc in their opinion and not performing your role which includes appropriate care coordination. If all you throw them are patients you attempted to treat but failed in some way leaving them worse than before then neither the specialists, nursing or administration are going to have a very favorable opinion of you if it happens on a regular basis. By contrast if you build trust and cooperation and seek to learn specialists preferences and expectations and develop a good working relationship then you will be appreciated. Of course an academic environment where specislist don't get paid based on who they see and are still in training are of course going to want to do as little as possible and would be happy to have you do work that would ordinarily go to them and assume the liability as their main concern is their level of sleep deprivation not an IM doc stepping on their specialty or pushing them out of the hospital inappropriately.

 

[thethom]

To the OP, you will hear plenty of opinions and anecdotes but outpatient IM and FM practice is essentially the same with the exception of seeing pediatrics in the FM office.

The same goes for outpatient FM and pediatrics practice, generally the same with the exception of seeing adults as well in FM practice.

Outpatient orthopedics and procedural training are more extensive in an FM residency.

I haven't done OB or prenatal care since residency.

My salary and productivity model is awesome and I live more than comfortably. Median pay for IM and FM (based on the most recent MGMA survey) are comparable, of course what you make is all based on your productivity model and efficiency.

 

[MJB]

Mostly so I don't have to call people like you and other arrogant internists "partner".

Other reasons:
Inpatient medicine is for non-compliant people that earned their disease (for the most part)
Inpatient medicine sucks
Shift work sucks
Inpatient "rocks" for patients
I like kids
I don't care to see old people that don't take care of themselves all the time with nothing else thrown in to kill the monotony.
I didn't wanna run like a little girl if a patient had the audacity to have a positive pregnancy test.


I knew within 6 hours of my first inpatient medicine rotation as a student that I wanted NOTHING to do with it.


It is pretty evident you are talking out of your ass and clearly have little experience. In one DAY, I've taken care of babies in a NICU, managed a labor of a high risk OB patient and then assisted on a section, cared for new onset A-fib w/RVR, new onset CHF on top of CKD, DKA, etc...in one DAY. I'm a 3rd year resident.

I don't know many PA's or NP's that do that.

 

[styphon]

Although I am sure this is just a troll post, likely by a medical student with no experience in medicine outside of a medical school structure, I will respond.

Why do family medicine? Because the job I do would require either a family medicine doctor, or THREE different doctors to cover me for one day.

Sure, a peds/NICU PA/NP can cover for my peds/nursery, but they will not be able to do my deliveries or see my adult patients. So on and so forth.

I can do urgent care/ER one day, see my nursery patients in the morning, then see my adult inpatients, then go to clinic. I can cover call, which may consist of inpatient admissions, women in labor, or problems in the nursery.

If I get burned out in any area, I can just drop it and focus more on one of the other areas.

 

[Bacchus]

Although I am sure this is just a troll post, likely by a medical student with no experience in medicine outside of a medical school structure, I will respond.

Why do family medicine? Because the job I do would require either a family medicine doctor, or THREE different doctors to cover me for one day.

Sure, a peds/NICU PA/NP can cover for my peds/nursery, but they will not be able to do my deliveries or see my adult patients. So on and so forth.

I can do urgent care/ER one day, see my nursery patients in the morning, then see my adult inpatients, then go to clinic. I can cover call, which may consist of inpatient admissions, women in labor, or problems in the nursery.

If I get burned out in any area, I can just drop it and focus more on one of the other areas.

You're in New York. I'm assuming a pretty far distance from NYC, Albany, Rochester, Buffalo, etc?

 

[styphon]

You're in New York. I'm assuming a pretty far distance from NYC, Albany, Rochester, Buffalo, etc?

I am in the rural area outside one of the smaller cities in the state.

 

[Bacchus]

I am in the rural area outside one of the smaller cities in the state.

I just saw your post in pre-allo.

 

[Silent Cool]

I don't understand why one would prefer to family as an alternative to IM...but I've heard this a ton from people. I suppose the argument is that they like OB and Peds too or something, but the OB/Peds FM docs do is likely at a PA/general level. It seems like you end up knowing everything in all of medicine but at a PA esque level- which honestly is extremely and impressive- but I would have to think somewhat unsatisfying.

These are just my opinions and I know many exceptional FM docs

"I'd like to make sure that I won't be able to do a lucrative fellowship."

 

[Kahreek]

ARNPs make equivalent compentency claims versus family physicians. The problem is that the data strongly supports the ARNPs position. It is a sad state of affairs because I think that there is a very significant difference between an ARNP and a FP.

Data... you and I really really wish there was something... anything to show an objective verifiable difference versus MDs and ARNPs.

The internal medicine versus FP argument is a much older one and I think it is very similar to the above argument. But there are so few American grads really going into general internal medicine, it has become not worth discussing. The average internist compared to the average FP is better at managing medically complex inpatient and outpatient adults the day after graduation from residency. I am not sure the difference holds for very long, however.

That said, your graphic post to the OP is uncalled for, hence I spoke up.

Better at managing inpatient? Sure, oupatient, meh, i dont know. Being at primary care outpatient is very different from im outpatient.
And if by complex diseases you mean situations where being in a bed is a requisite (hence the name internal medicine) i agree.

 

[Bostonredsox]

This is really a pointless argument. Dlce3 is a very rare breed. For the most part there are no general internists practicing in the clinic. The FPs are running the outpatient world. Sadly the noctors are cutting into this and giving substandard care which is why so many of my admissions are in such bad shape. I wish there were more FPs caring for the community.

And as the years go by there will be less and less general outpt internists. We will all be fellows or hospitalists. 9/10 already are one of the two.

 

[JoBreeze]

I didn't wanna run like a little girl if a patient had the audacity to have a positive pregnancy test.

Hahahaha I'm no FP, but touche.

 

[VenusinFurs]

I mean, maybe no one is going to agree with me on this one, but I feel like at least 50% of the difference between people who choose to go into FP vs the people who choose to go into IM is due to different personality types. This is speaking generally, there are obviously tons of exceptions.

 

[CDI]

This is really a pointless argument. Dlce3 is a very rare breed. For the most part there are no general internists practicing in the clinic. The FPs are running the outpatient world. Sadly the noctors are cutting into this and giving substandard care which is why so many of my admissions are in such bad shape. I wish there were more FPs caring for the community.

And as the years go by there will be less and less general outpt internists. We will all be fellows or hospitalists. 9/10 already are one of the two.

I know plenty of outpatient internists, even know one who banks $300k/yr with routine 40 hr weeks. No call, no hospitals, no nursing homes.This is suburbs of a major city.

They still exist, it's just much more difficult to get it going and to stay afloat unless you're able to adapt fast.

 

[Bostonredsox]

I know plenty of outpatient internists, even know one who banks $300k/yr with routine 40 hr weeks. No call, no hospitals, no nursing homes.This is suburbs of a major city.

They still exist, it's just much more difficult to get it going and to stay afloat unless you're able to adapt fast.

We all know some. But the ratio of non outpt Internists (fellowship trained sub specialists + hospitalists) significantly outweighs the PCPs in a landslide.

 

[drcrispmd]

I chose Family because I wanted to treat all ages and practice in a rural area. As a family med doc I can see prenatal to death. I do not think I will do OB deliveries after residency but do plan on doing low risk prenatal and referring out closer to delivery date. I get to see a whole family as patients. I also can take care of women's health and not have to send them to a GYN for their paps. My experience with IM residents is that they are terrified of vaginas. Everyone has their own reasons. Not everyone wants to specialize. I do not like inpatient work that much so that much. Others do. We have had residents from my program go on to do hospitalist jobs in the recent years.

The IM residents we do an inpatient rotation only had 1 afternoon a week of clinic. To me that is not much. That was as 2nd and 3rd years. As FM residents we have a lot more. As a 3rd year I have about 2.5 days of clinic a week at least depending on rotation. We also have a full month of just clinic. We have a requires 1650 clinic visits to complete residency. I do not know if IM had a requirement or what it is. I do think we are better trained for OP than IM (or at least compared to the IM residency here).