MD & DO What's the point of FM if MedPeds exists?

[TheSpiceMelange]

Current student.

I am wondering why FM exists if MedPeds exists. Arguably MedPeds does pediatric and adult medicine much better than FM, since they get boarded in both Peds and IM. 3 years of FM vs 4 years of MedPeds - the extra year means more training. I know that FM is supposed to include OBGYN training, but like it's a rareity to see FM doing OB, and few FM docs do women's health stuff - it seems they refer all that to an actual OB. And the FM docs I've seen pretty much only do adult medicine in clinic. Few see kids.

If you really wanted to do medicine across all ages, wouldn't it be better to do MedPeds? And if you wanted to do more than primary care, MedPeds would still be better since they have more fellowship options, including everything FM could apply for.

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[Med Ed]

Here is a classic SDN thread on the subject. Perhaps @VA Hopeful Dr will grace us with an update.

 

[ciestar]

I want nothing to do with inpatient medicine, that’s why

 

[ortnakas]

Similar argument could be made for “what’s the point of med/Peds if FM exists” (and that’s coming from an internist)

 

[ciestar]

Also, my program sees a lot of women’s health. I dont refer anyone to OB unless they happen to be pregnant or need something like an endometrial biopsy.

 

[VA Hopeful Dr]

Because they're different fields?

Snark aside, your experience with FM is not typical. I'm in a practice with 7 other FPs. We all see kids from newborn on up, usually several peds appointments per day. We all do basic GYN and one of our female doctors does IUDs/Nexplanon.

It is the rare FP who does OB that's true, but we're much better placed than internists or pediatricians for doing general medicine with pregnant patients given our OB training.

I would also argue that our outpatient training is significantly better than the vast majority of IM programs, especially when it comes to procedures, ortho, GYN, and continuity of care. Sure you can be an FP that refers everything out, but you don't have to be.

As for years of training, that argument can be extended. Why would I take my 6 year old to a med-peds doctor who only did 2 years of peds when a regular pediatrician did 3 years. Same argument for an internist.

If you want to do outpatient primary care for adults, no inpatient or fellowship, FM is the way to go. We're generally speaking more comprehensive in terms of what we can do/offer than med-peds. I will say I think general pediatricians are probably superior to us up to age 10 or so (and the difference might not be clinically significant) but once kids hit puberty I've found that many pediatricians start to get out of their element.

 

[Ganon]

If you want to do outpatient primary care for adults, no inpatient or fellowship, FM is the way to go. We're generally speaking more comprehensive in terms of what we can do/offer than med-peds.

What do you think about Ohio State’s Primary Care IM program?

They focus on adult primary care (largely outpatient, but with tons of inpatient as well) exclusively

 

[VA Hopeful Dr]

What do you think about Ohio State’s Primary Care IM program?

They focus on adult primary care (largely outpatient, but with tons of inpatient as well) exclusively

I don't really know much about those types of programs (they are not uncommon), but it's a sign to me that IM programs recognize that their graduates are often not all that prepared to do outpatient work.

 

[GoSpursGo]

I completely agree with @VA Hopeful Dr . There is sort of no point in doing med-peds if you ultimately just want to practice outpatient medicine. The extra year of training is not an insignificant cost, and unless you enter med-peds training with a good idea of what you're going to do with it (usually some sort of special fellowship where you own the adolescent/young adult patients as they transition from pediatric to adult subspecialists), frequently you'll wind up just taking care of adults and letting your peds boards lapse. The reason for that is manifold, but the simplest explanation is that you make more money treating adults than kids.

 

[TelemarketingEnigma]

I don’t think there’s really a “better” path, they’re just different. As others have pointed out I think there’s a few aspects that tend to pull people one way or the other. I’m applying MP but basically never considered FM because I like inpatient more, not interested in OB, and most likely will be doing fellowship.

If you want to be a really solid outpatient physician with a broad scope of possible practice, I think FM is probably the better choice. MP will prepare you fine, and maybe a bit better to see a larger proportion of children in your practice, but is otherwise pretty inpatient heavy. and I’ve definitely seen more FM docs do basic Gyn care in their offices (things like paps etc) even if they don’t do full OB, whereas I think most internists or pediatricians are not very comfortable with that unless they seek extra training.

If you have inpatient/fellowship interests I think MP is the way to go. I think a lot of the faculty/residents/fellow applicants I’ve met in MP also tend to have somewhat specific interests that tie into transitional care or related MP focuses. Things like cystic fibrosis, sickle cell, developmental conditions, complex medical kids who become complex medical adults all fit quite well into an MP skill set. Even if they end up choosing one or the other, there’s still an underlying academic interest in care across the lifespan.

 

[Med Ed]

These days you can do 3+3 programs like BS/DO and some BS/MD and become a boarded FM physicians 6 years after high school at the age of 24

You forgot the 3 years of FM residency.

I'd be wary of going to a doctor who looks like he just started shaving.

 

[Matthew9Thirtyfive]

Lol... 27% of births are carried out by FM docs
Shorter training, lot of community programs, non of the headaches that come from doing an IM residency

These days you can do 3+3 programs like BS/DO and some BS/MD and become a boarded FM physicians 6 years after high school at the age of 24

I've seen a clinic where one FM doc does tons of psych and also sees kids, the other FM docs mainly see adults (some kids). You can do whatever you like in FM

What programs are there where you’re getting a BS, MD, and completing an FM residency all in 6 years? I think you’re missing the 3 years of residency there. Most BS/MD programs are 6-7 years, but you still have to do residency. Even programs at MD or DO schools that fast track you into a residency are still going to be 6 years total after undergrad.

 

[Ganon]

I don't really know much about those types of programs

This is what every FM doc I have asked has said.
Thank you!

 

[Matthew9Thirtyfive]

I was an early assurance in under grad (essentially BS/MD) and now I'm in a 3+3 program so I'll graduate med school at 24ish. I think that's what theyre referring too

They said boarded physician. Not MD. We cleared it up. They just forgot the residency time.

 

[Drrrrrr. Celty]

Med/Peds is very niche. They have a very strong advantage at transitional care in subspecialty medicine or in fields where you naturally see both kids and adults. Med/Peds is a very strong option for example in Endocrinology as you can help the transition of pediatric endocrinology to adult endocrinology. Also congenital disorders, cystic fibrosis, etc.

Med/Peds is arguably one of the most intellectually focused residencies. One can say to the point that it's so niche it largely is impractial for all but a few folks. FM by comparison is extremely focused on practical medicine and leaving residency ready to do an outpatient job with a variety of skills that make you very marketable. This as opposed to Med/Peds and to some extent IM which is largely focused on preparing you to go seek further training or to think about severe presentations of hospital diseases and illnesses.

Like even from my perspective as an IM trained resident. I am not very comfortable with managing outpatient medicine because I never saw high numbers and all of my patients were almost always extremely sick post-hospital patients that I never did things like wellness visits. My training was largely in keeping very sick people from needing to be hospitalized again. This as opposed to some of my FM colleagues who had a significantly more diverse population including young patients, healthy patients, etc.

 

[Matthew9Thirtyfive]

Like even from my perspective as an IM trained resident. I am not very comfortable with managing outpatient medicine because I never saw high numbers and all of my patients were almost always extremely sick post-hospital patients that I never did things like wellness visits. My training was largely in keeping very sick people from needing to be hospitalized again. This as opposed to some of my FM colleagues who had a significantly more diverse population including young patients, healthy patients, etc.

I think that’s very program dependent. Where I rotated for IM, they had plenty of outpatient months with lots of wellness and general outpatient stuff. They were very comfortable with women’s health, etc.

 

[VA Hopeful Dr]

I think that’s very program dependent. Where I rotated for IM, they had plenty of outpatient months with lots of wellness and general outpatient stuff. They were very comfortable with women’s health, etc.

Definitely, but I think the trend is towards minimizing outpatient. All the programs in my state are notoriously outpatient light. Same with the 2 in NC and GA where my wife interviewed.

Plus we've established that your clinical rotations are far superior to the average.

 

[diamondkings]

Is it pretty location and/or program dependent on FM vs Med-Peds? I'm an M2 at a Southern US medical school, and had about 2 years of working in a hospital as a tech prior to medical school. I worked at a smaller hospital, and so many of the Drs that worked both in the ICU/Floor and ER were Family Medicine docs, and 99% of them were all amazing. Coming up on 3rd year, the more and more I read about Med-Peds and FM, the more and more conflicted I become.

My end goal, at least I think, is to have as much variability in practice possible. My home program has a Med-Peds program, so that would give the benefit of not having to move for residency. On the other hand, part of me thinks going to an unopposed FM residency could get me through a year faster. My conflict mostly comes from what my practice will look like once I get done. I'm afraid what I want now could drastically change post residency. I would love to work in smaller hospitals, as inpatient has been very interesting to me and it would be fun to hopefully pick up some shifts here and there. I'm just ignorant as to how much inpatient training you can get in FM, and if it's enough to comfortably practice in smaller towns in ERs/ICUs. Med-Peds would definitely give me the best inpatient training, and I like this incase I want to get into bigger hospitals or academics, then I could do this with IM & Peds board certifications. I want to do procedures, so I'm just not sure which provides the best opportunity at this to say, work in a small town ER confidently, as I think my state will always need non-EM docs to cover the ER, but again this could change in the coming years. Bottom line, I would like to be as competent at dealing with anything in the hospital (Central lines, intubations, etc.) On the flip side, if I want to run my own clinic I'm also not sure which of the 2 could provide both sides of the coin best.

Would love any insight, thanks in advance!!

 

[TelemarketingEnigma]

Is it pretty location and/or program dependent on FM vs Med-Peds?

Hugely. MP programs are predominantly located in the east and Midwest, with VERY few programs on the western side of the US (there’s only 4 in all of CA for example, and 0 in the PNW at all). There are both rural and urban programs for MP, I don’t know the exact distribution. So geography could be a helpful factor in deciding.

My end goal, at least I think, is to have as much variability in practice possible.

From the way you describe it, I think you want the FM kind of variability. I think MP could give you what you want (and you could always dual apply, as many MP applicants do), but your description gives me stronger FM vibes. Some of the FM folks here could probably give better advice though on what inpatient opportunities are like for FM docs

 

[MedicineZ0Z]

Current student.

I am wondering why FM exists if MedPeds exists. Arguably MedPeds does pediatric and adult medicine much better than FM, since they get boarded in both Peds and IM. 3 years of FM vs 4 years of MedPeds - the extra year means more training. I know that FM is supposed to include OBGYN training, but like it's a rareity to see FM doing OB, and few FM docs do women's health stuff - it seems they refer all that to an actual OB. And the FM docs I've seen pretty much only do adult medicine in clinic. Few see kids.

If you really wanted to do medicine across all ages, wouldn't it be better to do MedPeds? And if you wanted to do more than primary care, MedPeds would still be better since they have more fellowship options, including everything FM could apply for.

Doing women's health as FM is common. Seeing kids also is common.

There's a world outside of your community dude. I hate how some people act like their backyard is the one and only representative area for the country.

 

[VA Hopeful Dr]

Hugely. MP programs are predominantly located in the east and Midwest, with VERY few programs on the western side of the US (there’s only 4 in all of CA for example, and 0 in the PNW at all). There are both rural and urban programs for MP, I don’t know the exact distribution. So geography could be a helpful factor in deciding.

From the way you describe it, I think you want the FM kind of variability. I think MP could give you what you want (and you could always dual apply, as many MP applicants do), but your description gives me stronger FM vibes. Some of the FM folks here could probably give better advice though on what inpatient opportunities are like for FM docs

Inpatient is less easy to find than it used to be but still very doable. It's also somewhat location dependent.

 

[Redpancreas]

Current student.

I am wondering why FM exists if MedPeds exists. Arguably MedPeds does pediatric and adult medicine much better than FM, since they get boarded in both Peds and IM. 3 years of FM vs 4 years of MedPeds - the extra year means more training. I know that FM is supposed to include OBGYN training, but like it's a rareity to see FM doing OB, and few FM docs do women's health stuff - it seems they refer all that to an actual OB. And the FM docs I've seen pretty much only do adult medicine in clinic. Few see kids.

If you really wanted to do medicine across all ages, wouldn't it be better to do MedPeds? And if you wanted to do more than primary care, MedPeds would still be better since they have more fellowship options, including everything FM could apply for.

Major generalization here but will say it for the sake of comparison. Family is for people who know they want to be PCPs for the continuity, etc. They aren’t particularly interested in pathophysiology and all the stuff that comes with IM. MedPeds are for those who want to focus on the advanced pathology of children and adults. If you any to be a pure PCP, I think family is the best. If you want to be a specialist or be able to manage complexity, med/peds is better.

 

[VA Hopeful Dr]

Major generalization here but will say it for the sake of comparison. Family is for people who know they want to be PCPs for the continuity, etc. They aren’t particularly interested in pathophysiology and all the stuff that comes with IM. MedPeds are for those who want to focus on the advanced pathology of children and adults. If you any to be a pure PCP, I think family is the best. If you want to be a specialist or be able to manage complexity, med/peds is better.

Classy