Why not Family Medicine instead of IM for primary care?

[psychMDhopefully]

For you guys who are outpatient IM, why not pick FM if you are going to do primary care? FM can treat kids, adults, do ob/gyn seems it would be a better deal for primary care.

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[KLycos]

I guess it depends on whether you like working with kids and doing the ob stuff. if you do fam med you are still required to maintain your knowledge in all that stuff for recert exams. also, internal med gives you more flexibility down the road for different jobs, if you decide during residency that primary care isn't your jam. but to your point, fam med residency does give a lot more exposure to outpatient medicine.

 

[gutonc]

Kids are great...to do chores around your house. I know that's why I have one.

Recreational GYN (or male GU, if that's your preference) exams are great...professional ones not so much.

Don't get me started on OB.

I gave serious consideration to both IM and Peds but never to FM...not my bag.

And you can will never want for patients (or procedures, or variety, or whatever you think you're giving up by doing IM) in either FM or IM as a PCP.

(Note...I'm completely ignoring the depth vs. breadth of knowledge argument here, both of which are legit issues.)

 

[psychMDhopefully]

Kids are great...to do chores around your house. I know that's why I have one.

Recreational GYN (or male GU, if that's your preference) exams are great...professional ones not so much.

Don't get me started on OB.

I gave serious consideration to both IM and Peds but never to FM...not my bag.

And you can will never want for patients (or procedures, or variety, or whatever you think you're giving up by doing IM) in either FM or IM as a PCP.

(Note...I'm completely ignoring the depth vs. breadth of knowledge argument here, both of which are legit issues.)

If you want to do primary care IM, should you go to a community program where you get to do more outpatient and procedures? There is a new community program around here that says their residents do lots of procedures, but im unsure of the academic quality of new community IM programs and if they prepare students to pass IM boards. Are ACGME standards high enough that even new community programs prepare residents to pass IM boards?

 

[KLycos]

the ABIM pass rates are available online for free: http://www.abim.org/~/media/ABIM Public/Files/pdf/statistics-data/residency-program-pass-rates.pdf

Not all programs are the same, and I personally was not interested in programs with pass rates lower than 90%. Its not the most amazing indicator of how good a program is, but there is something wrong if residents don't have enough time or support in residency to prepare.

 

[jdh71]

For you guys who are outpatient IM, why not pick FM if you are going to do primary care? FM can treat kids, adults, do ob/gyn seems it would be a better deal for primary care.

I don't do out-patient IM, but I think while you have good points about the "well rounded" nature of FM, and the fact that they likely come out of training better prepared for out-patient medicine. I think IM will better prepare you to deal with complicated adult patients to a level of complication rarely seen in kids. And while you will get good at whatever you see a lot and apply yourself to, I think if your interest is the management of multiple chronic illness + diagnosis within that context IM arguably is the better pathway for training.

 

[shiftingmirage]

For me, one of the perks of IM was avoiding kids, their parents, and OB.
Child wellness visits are boring. Medicine as a career was interesting as you got to diagnose and treat patients. Telling parents their kid is fine is not interesting. In my medicine clinic (I'm a resident), I don't like when people come in and say everything is great, they are here just for their annual. I feel bad doing nothing for them.
If you like the appeal of clinic (8-5 office hours, weekends off), if you cover OB, you have the trips to the hospital for 3 am deliveries. Kinda what people wanted to avoid when they chose outpatient medicine.

 

[IMreshopeful]

So I went into IM with a pretty open slate and was not opposed to the idea of outpatient medicine (even though I'm now doing fellowship). I liked the intense training to deal with complex medical issues and dealing with multiple comorbidities. I think FM is great if you are interested in taking care of all ages and doing some OB. But I personally find that IM tends to be more up to date, evidence based, and less referral happy as compared to FM when it comes to adult medicine as well. Hence why I prefer to work up the patient's dyspepsia or chest pain to great detail or whatever prior to a blind referral to a specialist. Also I think we are given in IM the opportunity to sub specialize more readily if we aren't pleased with outpatient medicine...FM has rather few subspecialty options by comparison.

 

[mercaptovizadeh]

Subspecialization possibility

Greater depth of knowledge and intensity of training (ED, ICU) and therefore more competent with inpatient medicine

I did med-peds

 

[VA Hopeful Dr]

So I went into IM with a pretty open slate and was not opposed to the idea of outpatient medicine (even though I'm now doing fellowship). I liked the intense training to deal with complex medical issues and dealing with multiple comorbidities. I think FM is great if you are interested in taking care of all ages and doing some OB. But I personally find that IM tends to be more up to date, evidence based, and less referral happy as compared to FM when it comes to adult medicine as well. Hence why I prefer to work up the patient's dyspepsia or chest pain to great detail or whatever prior to a blind referral to a specialist. Also I think we are given in IM the opportunity to sub specialize more readily if we aren't pleased with outpatient medicine...FM has rather few subspecialty options by comparison.

Meh, the real world doesn't quite work this way. FM/IM doesn't matter when you have 7 minutes to see a patient.

Truthfully, I've found the biggest difference isn't between FM v. IM but more relatively new grad v. been out of residency more than 15 years. The former group is much more likely to try and keep things in house compared to the latter.

To address the thread topic as a whole, I think in truth the difference in quality for outpatient between the two specialties is fairly small. IM will likely pick up an occasional zebra that FM would miss and FM, generally speaking, usually is a bit more outpatient-procedure trained (especially GYN). Otherwise, not a huge difference.

I would say that if you are absolutely 100% sure you want to do general outpatient medicine, do FM - easier residency on the whole, more geographic options, and the job market is wider open (rural places love us and the pediatric component opens some doors). If you are not 100% sure, or if you hate pregnancy/kids, then definitely go IM.

 

[cbrons]

Kids are great...to do chores around your house.

And work in coal mines.