Why isn't FM more competitive than it is now?

[Angus Avagadro]

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My son is in ACGME FM residency and he delivers babies, takes care of the drug addicted newborns in theNICU, takes care of in patients and ICU when on the IM servic, scrubs c sections and surgery when on service. They are the only residents at a large hospital. It's pretty brutal with regards to hours, but will be a very well rounded doc when he's done . Not all FM residencies are cush.

 

[SLC]

I still want to work with kids. Plus the women’s health/OB training.

Also an IM residency is brutal in comparison to FM.

Nope, there are brutal and less difficult programs in both fields.

FM residency where I was seemed harder than IM (we had quite a few FM-IM couples. But the FM residents were happier.

 

[ciestar]

Nope, there are brutal and less difficult programs in both fields.

FM residency where I was seemed harder than IM (we had quite a few FM-IM couples. But the FM residents were happier.

I guess that is true. The two programs ive rotated through thus far werent nearly as bad as IM. They weren’t miserable. This is the direction I am going.

 

[galactus]

I did an Academic FM residency. We did all the outpatient procedures which were previously mentioned, plus surgical OB. 2nd year residents were expected to scrub in on our own c-sections, but then again we had 6 FM faculty that had surgical OB privileges. Half my graduating class still does surgical OB. All of us still do inpatient.

Someone mentioned fellowships in FM. There are plenty. I tell students the different between IM and FM fellowships is that IM concentrates on an organ system, while FM concentrates on a population. The most popular fellowship in FM is sports medicine, and for those students who want to do sports medicine from the get go (and not want to go into ortho), they know the best way to get there is through FM first. SM fellowships were created from FM! Other fellowships include geriatrics, hospice & palliative care, OB, rural, adolescent, HIV, global health, faculty development, women's health, etc.

I did FM because I can customize my career to whatever I want. I do a hybrid FM/SM practice that includes inpatient. I treat college and pro teams, and also take care of the coaching staff and their families. It's great!

 

[radsisrad]

If you are willing to live in rural America and/or are capable of not glancing over your shoulder every say and wondering how much $ you'd have if you'd gone into radiology or neurosurgery, FM is a wonderful specialty. There are many paths you can take with the training - "traditional" primary care, 3-day work-weeks, urgent care, telemedicine, and even hospitalist or ED positions in certain parts of the country.

But know yourself. If you care about prestige, FM will not fulfill you in the training arena - an MGH-trained FM physician is still looked upon by the hoity-toities as "just" a FM physician. That said, good primary care physicians are loved and deeply respected by the community, particularly in small towns.

 

[SLC]

I guess that is true. The two programs ive rotated through thus far werent nearly as bad as IM. They weren’t miserable. This is the direction I am going.

Obviously I can’t speak for all, but I’d be miserable in any IM program; but that’s down to culture/personality incompatibility I found between me and the programs/internists I worked with. And also largely due to a narrower scope of practice in IM vs FM.

Plus all the wards months. I like taking care of inpatients as much as the next guy, I’m doing it voluntarily as an attending; but people who complain that primary care is all HTN and DM must’ve not spent much time on an inpatient service with seemingly 100% hypertensive diabetic CHF’ers. It’s like 5 different presentations that make up over 90% of admissions I swear.

But top to bottom, a solid well rounded full spectrum FM program trains and expects you to be a solid internist/pediatrician/obstetrician/Gynecologist/EM/non-surgical orthopedist at a minimum. And a truly skilled FM doc is irreplaceable to a community, large or small. (Not saying I am one yet, but that’s the life goal).

 

[ciestar]

Obviously I can’t speak for all, but I’d be miserable in any IM program; but that’s down to culture/personality issues I found between me and the programs/internists I worked with. And also largely due to a narrower scope of practice in IM vs FM.

Plus all the wards months. I like taking care of inpatients as much as the next guy, I’m doing it voluntarily as an attending; but people who complain that primary care is all HTN and DM must’ve not spent much time on an inpatient service with seemingly 100% hypertensive diabetic CHF’ers. It’s like 5 different presentations that make up over 90% of admissions I swear.

But top to bottom, a solid well rounded full spectrum FM program trains and expects you to be a solid internist/pediatrician/obstetrician/Gynecologist/EM/non-surgical orthopedist at a minimum. And a truly skilled FM doc is irreplaceable to a community, large or small. (Not saying I am one yet, but that’s the life goal).

I definitely typo’d lol
No, the IM residents I rotated with were absolutely miserable. I couldnt put myself through that.

What I like about FM is the wide scope.

 

[fldoctorgirl]

No, the IM residents I rotated with were absolutely miserable. I couldnt put myself through that.

Curious about this as a lowly M2. I have a slight interest in ob/gyn but lately have been circulating back to the FM/IM path as I enjoy having a life, and I also enjoy the thought process that goes along with IM (based on what I've heard, obviously not my own experience). I was leaning a bit more towards IM because I've heard it's easier to get a hospitalist position post-IM, especially in bigger metro areas which is where I would like to end up. Also, I figured IM would keep more options open fellowship wise as I don't think I'm really that interested in any of the FM fellowships, although right now I'm anti-fellowship all together.

Can you talk a bit about IM vs. FM residency? Most of the outpatient FM docs in my hometown seem to practice basically like IM docs; one that I shadowed even told me that he didn't see kids because there were so many pediatricians around that he felt more comfortable just having them go across the street to someone with more expertise (his words, not mine). If I end up practicing the same way whether I do an IM or FM residency, and FM residency is "much easier", then I would think it would make more sense to go that route....

 

[Chelsea FC]

Even fields like PM&R where you do procedures its very uncompetitive.

 

[libertyyne]

Curious about this as a lowly M2. I have a slight interest in ob/gyn but lately have been circulating back to the FM/IM path as I enjoy having a life, and I also enjoy the thought process that goes along with IM (based on what I've heard, obviously not my own experience). I was leaning a bit more towards IM because I've heard it's easier to get a hospitalist position post-IM, especially in bigger metro areas which is where I would like to end up. Also, I figured IM would keep more options open fellowship wise as I don't think I'm really that interested in any of the FM fellowships, although right now I'm anti-fellowship all together.

Can you talk a bit about IM vs. FM residency? Most of the outpatient FM docs in my hometown seem to practice basically like IM docs; one that I shadowed even told me that he didn't see kids because there were so many pediatricians around that he felt more comfortable just having them go across the street to someone with more expertise (his words, not mine). If I end up practicing the same way whether I do an IM or FM residency, and FM residency is "much easier", then I would think it would make more sense to go that route....

It is going to be harder getting a hospitalist gig in bigger metro areas as a fp doc where there are plenty of IM docs to go around. A majority of FM docs do not do hospitalist work.It may also pose some difficulty in credentialing as a hospitalist in some areas , espscially large metro areas. If you are planing on being a hospitalist in a large city/metro go the IM route.

 

[AMEHigh]

It is going to be harder getting a hospitalist gig in bigger metro areas as a fp doc where there are plenty of IM docs to go around. A majority of FM docs do not do hospitalist work.It may also pose some difficulty in credentialing as a hospitalist in some areas , espscially large metro areas. If you are planing on being a hospitalist in a large city/metro go the IM route.

I don’t necessarily think this is true. I think it’s self-selection bias as you are correct in that many FM docs don’t want to be hospitalists. However, I don’t think hospitals forbid FM. I’ve had several colleagues in FM who wanted to be hospitalists in very large cities have no problem getting jobs, even at academic places. I get lots of job offers via email for hospitalists.

I just say that for those who are still undecided. Being FM doesn’t shut you out of being a hospitalist just like IM doesn’t shut you out of being a outpatient pcp.

 

[libertyyne]

I don’t necessarily think this is true. I think it’s self-selection bias as you are correct in that many FM docs don’t want to be hospitalists. However, I don’t think hospitals forbid FM. I’ve had several colleagues in FM who wanted to be hospitalists in very large cities have no problem getting jobs, even at academic places. I get lots of job offers via email for hospitalists.

I just say that for those who are still undecided. Being FM doesn’t shut you out of being a hospitalist just like IM doesn’t shut you out of being a outpatient pcp.

I will defer to you. however, I have worked at a few places in cities where the credentialing was restricted to IM docs.
Maybe they were the exception.

 

[galactus]

I sit on the credentialing committee for our hospital/med school. We credential FM trained hospitalists for both the teaching hospital and the private hospital. Some FM docs still do inpatient if they want to admit their own patients. It does exist!

 

[CidHighwind]

I feel like a lot of the people that may like FM probably end up doing EM since it’s seen as “competitive” and they’re also generalists.

 

[SLC]

I don’t necessarily think this is true. I think it’s self-selection bias as you are correct in that many FM docs don’t want to be hospitalists. However, I don’t think hospitals forbid FM. I’ve had several colleagues in FM who wanted to be hospitalists in very large cities have no problem getting jobs, even at academic places. I get lots of job offers via email for hospitalists.

I just say that for those who are still undecided. Being FM doesn’t shut you out of being a hospitalist just like IM doesn’t shut you out of being a outpatient pcp.

One of my residency classmates went immediately into academic hospital medicine from residency. At a top 25 medical school, in a major metro area. No fellowship, just a stated desire to be a hospitalist and avoid outpatient practice.

It’s not uncommon, but lots of FM people don’t exactly dig Hospital Medicine so I’m sure applications for privileges are pretty rare.

I also get adverts for metro area hospitalist jobs regularly as an FM doc.

 

[raiderette]

Forgot anyone who says low pay, because all the numbers show a very healthy market. If you like it, apply and be successful. It is a critical part of medicine.

 

[siliso]

Can it be simply supply? There are way more FM slots than US grad applicants. There are 14 FM programs in my state, 3 IM, 2 gen surg, and just 1 of quite a few other more competitive residencies. Seems easier to establish an FM residency in more outlying areas without extensive academic and subspecialty experiences available. Therefore more spaces to fill = less competitive, without any bearing on how rewarding/remunerative/fulfilling your career can be as a family doc.

 

[slowthai]

Forgot anyone who says low pay, because all the numbers show a very healthy market. If you like it, apply and be successful. It is a critical part of medicine.

This reminds me, I have heard that you can make a lot of money in FM and other relatively lower paying fields if you're willing to put in the hours. I suppose that if you're willing to work like 70+ hours a week, 400K+ shouldn't be impossible. In this case you wouldn't have to move to a rural area. The caveat is that your "lifestyle" will be like nonexistent, lol.

 

[SLC]

This reminds me, I have heard that you can make a lot of money in FM and other relatively lower paying fields if you're willing to put in the hours. I suppose that if you're willing to work like 70+ hours a week, 400K+ shouldn't be impossible. In this case you wouldn't have to move to a rural area. The caveat is that your "lifestyle" will be like nonexistent, lol.

How many hours do you think that interventional cards guy is putting in for his $600k plus?

In my experience it was somewhere north of 90; because I kept track of my hours and I did 90. And the doc was still reading echo’s when I’d head home at night.

All I know is that as an FM I do less than 40hrs per week of actual work; and I’m nipping at $300k which is plenty of money. On production I’ll be closer to $350k for the same hours (assuming a full clinic schedule of 20-25pts daily.

 

[NITRAS]

I don’t necessarily think this is true. I think it’s self-selection bias as you are correct in that many FM docs don’t want to be hospitalists. However, I don’t think hospitals forbid FM. I’ve had several colleagues in FM who wanted to be hospitalists in very large cities have no problem getting jobs, even at academic places. I get lots of job offers via email for hospitalists.

I just say that for those who are still undecided. Being FM doesn’t shut you out of being a hospitalist just like IM doesn’t shut you out of being a outpatient pcp.

There’s like 45 Hospitalist in my group, plus 28 PAs. Only one was FM and he left cause he felt he couldn’t advance into hospital admin. If Hospitalist is your dream, go IM. If you want to practice a broad range of medicine, FM will get you there.

 

[shemer77]

2 p's: Prestige and paper work. Low in one and high in the other makes it kinda offputting for some compared to other specialties

 

[Giovanotto]

2 p's: Prestige and paper work. Low in one and high in the other makes it kinda offputting for some compared to other specialties

But the paperwork isn't tied to the specialty, it has to do with the outpatient setting correct? How is paperwork in outpatient FM compared to outpatient peds/gyn/cardio/etc.?

 

[throwaway1939]

I have talked to a couple PGY3 FM residents at my place and they are already getting great offers... 225k+/ year, 20k+ sign-on bonus, M-Thur (8-5pm or 9-5pm) and half day on Friday. And these offers are NOT in the middle of nowhere... Are these kind of offers a recent trend? if not, why isn't FM more competitive? Is there a stigma associated with being a FM doc that I am not aware of?

By comparison, for IM, these were the offers I was getting for hospitalist work.

7/7 x20 weeks (140 shifts), 250k + 30K sign-on bonus. 5k CME, 401k matched to 15k/year, additional tax deferred retirement plan ~10k/year.

In additional contrast, these were the jobs graduating cards fellows got:

4 days of clinic, 1 week of call/month. 450k/year.

5 days of clinic (1 for EP procedures), 1:6 EP call/year, 3 weeks of general call/year. 550k + bonus structure.

4 days of clinic, 1 day of procedures, 1 week call/month, 400k + rvu bonus + partnership track, supposedly partners make >700k.

FM is a good paying gig and important, but it's not lucrative compared to much of medicine in general.

 

[Dro133]

By comparison, for IM, these were the offers I was getting for hospitalist work.

7/7 x20 weeks (140 shifts), 250k + 30K sign-on bonus. 5k CME, 401k matched to 15k/year, additional tax deferred retirement plan ~10k/year.

In additional contrast, these were the jobs graduating cards fellows got:

4 days of clinic, 1 week of call/month. 450k/year.

5 days of clinic (1 for EP procedures), 1:6 EP call/year, 3 weeks of general call/year. 550k + bonus structure.

4 days of clinic, 1 day of procedures, 1 week call/month, 400k + rvu bonus + partnership track, supposedly partners make >700k.

FM is a good paying gig and important, but it's not lucrative compared to much of medicine in general.

Bananas...

 

[Oh_Gee]

It’s a bit complicated because I’m on a salary guarantee, but I plan on the mid $300’s. I’m upper $200’s right now.

Also...I’ve got a busy practice, but it’s still growing. 1 year in, I have about 700 established patients; with a goal of getting to 1,600. I don’t have a jam packed schedule every day, and am averaging around 16-18 office visits per day right now.

Also, my hours/lifestyle are nice. I work from 8:15-8:30 to 5pm M-F; I take a 2hr lunch break. I only work the hospital 1-2 weekends per month, and it’s 48h of call from home; only going in for clinical status changes, AM rounds, Admits.

I take a lot of quick weekend mountain biking vacations, which keeps me very happy.

any charting or random stuff (calling insurance companies, etc) after office hours?

 

[Postictal Raiden]

By comparison, for IM, these were the offers I was getting for hospitalist work.

7/7 x20 weeks (140 shifts), 250k + 30K sign-on bonus. 5k CME, 401k matched to 15k/year, additional tax deferred retirement plan ~10k/year.

In additional contrast, these were the jobs graduating cards fellows got:

4 days of clinic, 1 week of call/month. 450k/year.

5 days of clinic (1 for EP procedures), 1:6 EP call/year, 3 weeks of general call/year. 550k + bonus structure.

4 days of clinic, 1 day of procedures, 1 week call/month, 400k + rvu bonus + partnership track, supposedly partners make >700k.

FM is a good paying gig and important, but it's not lucrative compared to much of medicine in general.

True but don't discount the opportunity loss endured by earning 60k/year for the extra 5 years of training to become an IC while your counterpart hospitalist is making 250k+.

If a hospitalist decides to work as rigorously as a typical cardiology fellow, they'd make 500k+. By the time you complete your interventional cards or EP fellowship, your counterpart could have generate 2M more income that you have. It would take 5-10 years to financially catch up.

With that said, I'd much rather be a specialist than a generalist, so I wouldn't mind the delayed gratification in order to do a job that I enjoy more.

 

[nimbus]

Seems like in outpatient primary care, they are trading more paperwork for little or no call/nights/weekends/holidays.

 

[nimbus]

Can it be simply supply? There are way more FM slots than US grad applicants. There are 14 FM programs in my state, 3 IM, 2 gen surg, and just 1 of quite a few other more competitive residencies. Seems easier to establish an FM residency in more outlying areas without extensive academic and subspecialty experiences available. Therefore more spaces to fill = less competitive, without any bearing on how rewarding/remunerative/fulfilling your career can be as a family doc.

I don’t think that is the issue. Nationally there are are 4xxx FM slots per year vs 8xxx IM slots. I think it’s the ability to further specialize after residency.

 

[Dr.Bruh]

Yep. Welcome to medicine and the prestiges ****** that come with it

The idea of prestige is so funny to me. Prestigious to who? You? Your family? The public? Bc no matter what specialty you’re in if you’re a doctor you’re prestigious to the public. You could be a GI doc that trained at an Ivy League and you may feel prestigious compared to your few friends, but to the whole non medical public you’re a “butthole doctor”. Lol. Sometimes I feel like I’m in the minority of people who just wants to train at a residency in the city I want and don’t care how prestigious the program is.

 

[slowthai]

The idea of prestige is so funny to me. Prestigious to who? You? You’re family? The public? Bc no matter what specialty you’re in if you’re a doctor you’re prestigious to the public. You could be a GI doc that trained at an Ivy League and you may feel prestigious compared to your few friends, but to the whole non medical public you’re a “butthole doctor”. Lol. Sometimes I feel like I’m in the minority of people who just wants to train at a residency in the city I want and don’t care how prestigious the program is.

Yeah, I think prestige is completely irrelevant in terms of actual added value to your life. I don't give a crap about prestige, personally.

 

[MedicineZ0Z]

The idea of prestige is so funny to me. Prestigious to who? You? Your family? The public? Bc no matter what specialty you’re in if you’re a doctor you’re prestigious to the public. You could be a GI doc that trained at an Ivy League and you may feel prestigious compared to your few friends, but to the whole non medical public you’re a “butthole doctor”. Lol. Sometimes I feel like I’m in the minority of people who just wants to train at a residency in the city I want and don’t care how prestigious the program is.

Lol very true. No one could care less. Your mom may be proud but that's literally as far as it goes.

 

[DNAJB6]

. wrong forum/thread

 

[DNAJB6]

.. wrong forum/thread

 

[throwaway1939]

True but don't discount the opportunity loss endured by earning 60k/year for the extra 5 years of training to become an IC while your counterpart hospitalist is making 250k+.

If a hospitalist decides to work as rigorously as a typical cardiology fellow, they'd make 500k+. By the time you complete your interventional cards or EP fellowship, your counterpart could have generate 2M more income that you have. It would take 5-10 years to financially catch up.

With that said, I'd much rather be a specialist than a generalist, so I wouldn't mind the delayed gratification in order to do a job that I enjoy more.

True, but also remember every cards fellow is board eligible/certified in IM. It's easy to make money as a hospitalist picking up PRN/overflow shifts which lessens the gap at the expense of free time.