FM vs IM, having a hard time making a decision

[FMvsIM]

To those who were struggling between choosing FM vs IM, why did you choose one over the other. Any regrets? Any things you wish you knew about FM/IM before making your rank list?

Thanks

[frenchpress]

5 hours ago, FMvsIM said:

To those who were struggling between choosing FM vs IM, why did you choose one over the other. Any regrets? Any things you wish you knew about FM/IM before making your rank list?

Thanks

Chose FM because 1) 2 years vs 5 years, and 2) I didn’t want to never see babies/kids/adolescents again. No regrets. In retrospect IM probably would have been fine, but I am happy with my choice. 

[1029384756md]

I chose FM for its shorter residency, job location flexibility, and non-clinical career paths. FM also got me to my personal finance goals by age 30, where a FRCPC specialty couldn't have.

The medicine in IM is way more interesting and IM residency does prepare you better for complex patients. Had I gone into IM, I would've missed the opportunities that got me where I am today, but would've possibly led to a much more fulfilling clinical career.

If you are not sure, do IM then transfer to FM if that's the right path later on.

 

[Redpill]

11 hours ago, 1029384756md said:

I chose FM for its shorter residency, job location flexibility, and non-clinical career paths. FM also got me to my personal finance goals by age 30, where a FRCPC specialty couldn't have.

The medicine in IM is way more interesting and IM residency does prepare you better for complex patients. Had I gone into IM, I would've missed the opportunities that got me where I am today, but would've possibly led to a much more fulfilling clinical career.

If you are not sure, do IM then transfer to FM if that's the right path later on.

 

Can you expand on these non-clinical career paths?

[1029384756md]

6 hours ago, Redpill said:

Can you expand on these non-clinical career paths?

Consulting, finance, pharma, etc. Anything health care related an MD brings unique insights and value propositions. All of these opportunities are equally accessible regardless of medical specialty. But if you know you want a non-clinical career, then it's better to get started early and while young i.e. do FM.

[trimethoprim]

I was also conflicted between the two. I originally gunned FM due to flexibility, but ultimately chose IM in my final year due to the following factors:

1) I don't want to see peds

2) option to subspecialize 

3) option to work in community/clinic and/or hospital

4) pay/volume of work - don't need to see as many patients in a day compared to FM. can spend longer time per patient

5) prestige - even in residency, preceptors (especially those from other disciplines) treat you as though you have a huge differential for every presentation

6) satisfaction working up challenging cases 

[lovemedicinesomuch]

FM main advantage is life style. IM though is more intellectually stimulating and challenging. I'd recommend IM and if you don't like it switch to FM.

 

[bellejolie]

I chose FM - job market (employable anywhere), flexibility (can have a really mixed practice, work as little or as much as you want), pay (every staff I know makes over $400K, and if u want more money you can make more, if u want to work less you'll make less), short residency (i'm ready to make staff money asap haha).

You can also do hospitalist work which is similar to IM, not have to worry about job security, and tailor your practice to your life stage (work less when you have younger kids, do hospitalist when you're younger, gradually do more clinic as you age etc). 

and for the pay that people have spoken about - well i have 5 years of staff money on you so overall it kind of evens out.

the main thing you need to decide (as compensation really shouldn't be a factor, everyone in medicine makes decent money) is lifestyle, city you want to live in (are you flexible because job markets are not great for all subspecialties), longer residency vs short, and the kind of medicine you want to do (e.g. peds, adolescent, geri, ob vs. adult medicine only with more complexity). I don't like "intellectually stimulating" because that means something different for everyone - yes the IM resident may have a much longer differential for a certain presentation, and know all the weird and wonderful, but they have no idea how to prescribe methadone or suboxone, deal with chronic pain, no idea what to do with a kid, and not know how to manage psychiatric illness, pregnancies etc. We have to know quite a lot about a LOT of things. It's very difficult and I'm always learning. When i feel it's out of my scope I refer, to someone who also sees a lot of the same thing over and over again and has expertise in a specific field. I also read the specialist reports after which can be really helpful for learning too. 

There is bread and butter in every field, you have to choose the bread and butter you enjoy the most. Don't focus on money or prestige, you won't be happy if that's how you make your decision. Focus on the medicine that YOU find most interesting. Also residency is hard, 5 years is a long time. I'm 6 months in and can't wait to be done. It's a grind. 

[shikimate]

"intellectual simulation" is bit overrated for most people.

It's like decreasing marginal utility, cool to learn about immunotherapy once or twice. By the Nth time, it just means more time spent on zoom instead of signing out cases and more paperwork to send out those molecular tests.

Maybe that's why back in R1 I wanted to write up case reports for every weird case I see. Now I just punt them off to academic centers and hope the consult reports come back before I go on vacation haha.

[bellejolie]

1 minute ago, shikimate said:

"intellectual simulation" is bit overrated for most people.

It's like decreasing marginal utility, cool to learn about immunotherapy once or twice. By the Nth time, it just means more time spent on zoom instead of signing out cases and more paperwork to send out those molecular tests.

Maybe that's why back in R1 I wanted to write up case reports for every weird case I see. Now I just punt off them off to academic centers and hope the consult reports come back before I go on vacation haha.

exactly - you develop expertise by seeing a lot of the same thing over and over again, and understanding it better, knowing the patterns and knowing when things don't fit the patterns and need further investigation. it's about which bread and butter is the most interesting and fun for you. because everything gets repetitive after a while. 

[lovemedicinesomuch]

2 hours ago, bellejolie said:

exactly - you develop expertise by seeing a lot of the same thing over and over again, and understanding it better, knowing the patterns and knowing when things don't fit the patterns and need further investigation. it's about which bread and butter is the most interesting and fun for you. because everything gets repetitive after a while. 

 

2 hours ago, shikimate said:

"intellectual simulation" is bit overrated for most people.

It's like decreasing marginal utility, cool to learn about immunotherapy once or twice. By the Nth time, it just means more time spent on zoom instead of signing out cases and more paperwork to send out those molecular tests.

Maybe that's why back in R1 I wanted to write up case reports for every weird case I see. Now I just punt them off to academic centers and hope the consult reports come back before I go on vacation haha.

I think you have to figure out  your  own personalitylikes/dislikes and how much in depth you want to learn medicine. Some people love learning minutia and learning medicine in depth and don't mind spending years of their life doing so --> if that's you do then do IM. I do agree that specialty residency is a grind, but I think an extra 3 years in the grand scheme of things is absolute nothing. It will actually be a fun time because you are learning medicine in detail, you will make rare diagnosis, you will develop your knowledge and competence, and you will be challenged beyond your comfort zone! It's totally worth it.

In FM, you don't have the training time to learn the minutia and the details, you won't be able to make rare diagnosis. If you are okay with that, then do it.  

 

[frenchpress]

1 hour ago, lovemedicinesomuch said:

 

I think you have to figure out  your  own personalitylikes/dislikes and how much in depth you want to learn medicine. Some people love learning minutia and learning medicine in depth and don't mind spending years of their life doing so --> if that's you do then do IM. I do agree that specialty residency is a grind, but I think an extra 3 years in the grand scheme of things is absolute nothing. It will actually be a fun time because you are learning medicine in detail, you will make rare diagnosis, you will develop your knowledge and competence, and you will be challenged beyond your comfort zone! It's totally worth it.

In FM, you don't have the training time to learn the minutia and the details, you won't be able to make rare diagnosis. If you are okay with that, then do it.  

 

I think it’s inaccurate to say family doctors never make a rare diagnosis or won’t be able to. Like @bellejolie says, GP’s bread and butter may not be the weird and wonderful. But GPs can see unusual stuff with a fair amount of regularity, and often are the ones to initiate the workup, even if they may might not always ultimately cinch the diagnosis. I have seen some weeeeeird diseases in family practice.

[zxcccxz]

16 minutes ago, frenchpress said:

I think it’s inaccurate to say family doctors never make a rare diagnosis or won’t be able to. Like @bellejolie says, GP’s bread and butter may not be the weird and wonderful. But GPs can see unusual stuff with a fair amount of regularity, and often are the ones to initiate the workup, even if they may might not always ultimately cinch the diagnosis. I have seen some weeeeeird diseases in family practice.

Exactly, family doctors have the advantage of being able to whittle down the long laundry list of diagnoses. No one in their right mind would see anemia and fatigue and put “rare genetic condition X” at the top of their differential. Only once all the common stuff has been ruled out can you get the patient to a specialist for that evaluation. I would argue that the role of the family doctor is vital in diagnosis of such cases.

[GeriGIM]

I find the depth of knowledge between an FM and an IM is mostly indistinguishable. GIMs with a particular focus (thrombosis, periop, POCUS, cardio dx, geriatrics) might have more sophistication in their particular focus.  And the FMs know peds and OB. 

[carmsregrets]

Do yourself a favour and don't pick FM.   I originally wanted to match  ENT and FM was my back up.

I only ranked FM ( and unfortunately match to it) b/c I was mainly afraid of being unmatched .

If I go back in time, I'd prefer to go unmatched over matching to FM. 

Here are my reasons for not liking FM:

- You are not an expert in anything.

- FM is not an academic field

- You will never learn pathophysiology or disease processes in details.

-  You will be spending 50% of your time doing insurance forms, referral letters and doctors note. You need absolutely no brain power to do any of that.

Here are some reasons people pick FM:

- It is a very easy residency - you don't get challenged. You don't expand your knowledge beyond a medical student level. For some people that may be an advantage. For me, it is not an advantage.

- No standard is required to get into FM; it is quite easy to get into FM residency.  The only credential required is a pulse and MD degree. No need to work hard during medical school. 

I have met so many family doctors lacking fundamental medical knowledge - I often times felt scared that these individuals are responsible for people's health. It is so sad that I belong to a profession with such low accreditation standards. There are so many incompetent family doctors.  I can't say that this is true about most other medical specialties. 

 

 

[Pakoon]

7 hours ago, carmsregrets said:

Do yourself a favour and don't pick FM.   I originally wanted to match  ENT and FM was my back up.

I only ranked FM ( and unfortunately match to it) b/c I was mainly afraid of being unmatched .

If I go back in time, I'd prefer to go unmatched over matching to FM. 

Here are my reasons for not liking FM:

- You are not an expert in anything.

- FM is not an academic field

- You will never learn pathophysiology or disease processes in details.

-  You will be spending 50% of your time doing insurance forms, referral letters and doctors note. You need absolutely no brain power to do any of that.

Here are some reasons people pick FM:

- It is a very easy residency - you don't get challenged. You don't expand your knowledge beyond a medical student level. For some people that may be an advantage. For me, it is not an advantage.

- No standard is required to get into FM; it is quite easy to get into FM residency.  The only credential required is a pulse and MD degree. No need to work hard during medical school. 

I have met so many family doctors lacking fundamental medical knowledge - I often times felt scared that these individuals are responsible for people's health. It is so sad that I belong to a profession with such low accreditation standards. There are so many incompetent family doctors.  I can't say that this is true about most other medical specialties. 

 

 

I don't know how you have the audacity to talk so much trash about FM when people like you flooding the field after going unranked in your specialty of choice contributes to a lot of the issues you highlight.

You sound like you have a god complex, if CARMs couldn't humble you then you may be a lost cause.

 

But hey, maybe if you had the  "need to work hard in medical school" you would have matched into ENT right? But something tells me the reason may be a little bit deeper than your CV.

[granduc]

9 hours ago, carmsregrets said:

Do yourself a favour and don't pick FM.   I originally wanted to match  ENT and FM was my back up.

I only ranked FM ( and unfortunately match to it) b/c I was mainly afraid of being unmatched .

If I go back in time, I'd prefer to go unmatched over matching to FM. 

Here are my reasons for not liking FM:

- You are not an expert in anything.

- FM is not an academic field

- You will never learn pathophysiology or disease processes in details.

-  You will be spending 50% of your time doing insurance forms, referral letters and doctors note. You need absolutely no brain power to do any of that.

Here are some reasons people pick FM:

- It is a very easy residency - you don't get challenged. You don't expand your knowledge beyond a medical student level. For some people that may be an advantage. For me, it is not an advantage.

- No standard is required to get into FM; it is quite easy to get into FM residency.  The only credential required is a pulse and MD degree. No need to work hard during medical school. 

I have met so many family doctors lacking fundamental medical knowledge - I often times felt scared that these individuals are responsible for people's health. It is so sad that I belong to a profession with such low accreditation standards. There are so many incompetent family doctors.  I can't say that this is true about most other medical specialties. 

 

 

You remind me a lot myself when I was in pharmacy school and it wasn't my first choice. I hated it so much and I had such a negative view on pharmacists. So much saltiness. But when I finally change in medicine I realize that my view was greatly modulated by my sadness and my anger to not be where I wanted to be. It's probably impossible right now because of your state of mind, but I really hope someday you will realize that FM is not really what you think it is. Good luck to you to achieve what you want to achieve, no one should be this bitter.

[carmsregrets]

2 hours ago, Pakoon said:

I don't know how you have the audacity to talk so much trash about FM when people like you flooding the field after going unranked in your specialty of choice contributes to a lot of the issues you highlight.

You sound like you have a god complex, if CARMs couldn't humble you then you may be a lost cause.

 

But hey, maybe if you had the  "need to work hard in medical school" you would have matched into ENT right? But something tells me the reason may be a little bit deeper than your CV.

Yes, I agree with you that perhaps it was my "God complex" that led me to match to FM. 

8 minutes ago, Monocor said:

You remind me a lot myself when I was in pharmacy school and it wasn't my first choice. I hated it so much and I had such a negative view on pharmacists. So much saltiness. But when I finally change in medicine I realize that my view was greatly modulated by my sadness and my anger to not be where I wanted to be. It's probably impossible right now because of your state of mind, but I really hope someday you will realize that FM is not really what you think it is. Good luck to you to achieve what you want to achieve, no one should be this bitter.

 

You are right, maybe I feel that way because I never cared about FM, yet this is where I ended. Perhaps my brain register all the negative things about FM - and I don't think about all the positives about FM.

 

[stayblessed]

Hey @carmsregrets don't lose hope on a very fulfilling career in FM. 

Beyond the fact that you will live a life of autonomy you can never have in a surgical speciality where you are constantly dealing with hospital politics, you can truly make a difference in people's lives being a well versed fam doc. You are right, not all fam docs embody the principles family docs should. But the ones that do, they are a game-changer in patient's lives. They truly become the cornerstones of entire communities, and that's sick (no pun intended). 

As for the expertise matter, and coming from a resident in a 5 year surgical specialty, it's almost embarrassing at times how niche my knowledge-base has become. While my anatomical and specialty-specific knowledge is wicked, I struggle to come up with differentials that a med student can with no issue for common presentations. Who do I turn to for this? Family medicine and hospitalists. 

As for the residency being "easy", which I don't think is entirely true considering the breadth of family medicine and the fact that you're learning all of it in 2 years, that extra time could be another strong advantage for you to take the extra time you have at your hands to build a well-rounded life (i.e. setting up personal finances, etc.). As any physician will tell you, you don't build wealth in this profession through our salary. It's through how you manage your funds. And the advantage family medicine starting early financially and having the ability to pick up additional streams of income due to your extra early earnings cannot be understated.

Having said the above and going back to your point about family docs out there not always having the strongest knowledge-base, I think their approach to family med residency was that it should be "easy" and did not do their own self-directed learning in spare time. So I think leveraging your surgery mindset to family med can really set you apart.

Regarding the expertise bit - the flexibility of family medicine that can allow you to build your own skill set and niche practice is abundant. Not only that, but you will have the leg up on 5-year specialists in being able to set up private clinics etc. For example, you want to set up an MSK clinic where patients pay out of pocket for PRP where you make 50% of the cost they pay, do it up. You want to set up a cosmetic clinic for newly minted dermatologists or other fam docs who have derm certifications to use the space and pay overhead, do it up. You want to be that expert, take the courses and be it. You have an MD, and you can augment that with any necessary certifications to make similar amounts of money for out of pocket services as your 5-year specialists. But back to the previous point, you will have the time advantage to set up clinics/spaces that will allow you to not work for an hourly wage, but to have "employees."

If the business aspect of medicine is not for your, do hospitalist or ED and work whenever you please.

I'm not going to ignore the salary differences between a family physician and an ENT surgeon doing cosmetic rhinos. But as long as the ENT surgeon is getting paid directly for their time, they will never attain freedom and autonomy. 

I sometimes wish I was in family medicine and out of the 5-year specialist hamster wheel as I see the abundant opportunities afforded to family docs. Perhaps I'm surrounded with FDs that are very fulfilled, doing innovative things, and living very cushy lives due to getting ahead on their financial goals and entrepreneurship ventures in early practice whereas that may not be the case in your situation. 

Anyways, I don't often post on this forum but I'm a believer in "you get what you look for in life" and I think you're overlooking a lot of amazing opportunities in family medicine. Just looking out.

[bearded frog]

I didn't back up with FM as I know I would be much more miserable doing it vs what I do now. That being said, I would have happily backed up and taken a FM residency and ran with it if that's what I got my second time around, and found my niche. I think med school advisors do a disservice to some students with recommendations to back up when they very clearly do not have an interest in the back-up (they just want everyone to match somewhere for the school's match rate).

[z12345]

24 minutes ago, bearded frog said:

I didn't back up with FM as I know I would be much more miserable doing it vs what I do now. That being said, I would have happily backed up and taken a FM residency and ran with it if that's what I got my second time around, and found my niche. I think med school advisors do a disservice to some students with recommendations to back up when they very clearly do not have an interest in the back-up (they just want everyone to match somewhere for the school's match rate).

Backing up or not is also very much guided by personal circumstances. Regardless if schools are pushing you to back up or not, if you're a non-trad with high debt burden and a family to support, the gamble is much higher vs. a traditional student with little to no debt that could choose to walk away from medicine all together if they never match.

[bellejolie]

20 hours ago, stayblessed said:

Hey @carmsregrets don't lose hope on a very fulfilling career in FM. 

Beyond the fact that you will live a life of autonomy you can never have in a surgical speciality where you are constantly dealing with hospital politics, you can truly make a difference in people's lives being a well versed fam doc. You are right, not all fam docs embody the principles family docs should. But the ones that do, they are a game-changer in patient's lives. They truly become the cornerstones of entire communities, and that's sick (no pun intended). 

As for the expertise matter, and coming from a resident in a 5 year surgical specialty, it's almost embarrassing at times how niche my knowledge-base has become. While my anatomical and specialty-specific knowledge is wicked, I struggle to come up with differentials that a med student can with no issue for common presentations. Who do I turn to for this? Family medicine and hospitalists. 

As for the residency being "easy", which I don't think is entirely true considering the breadth of family medicine and the fact that you're learning all of it in 2 years, that extra time could be another strong advantage for you to take the extra time you have at your hands to build a well-rounded life (i.e. setting up personal finances, etc.). As any physician will tell you, you don't build wealth in this profession through our salary. It's through how you manage your funds. And the advantage family medicine starting early financially and having the ability to pick up additional streams of income due to your extra early earnings cannot be understated.

Having said the above and going back to your point about family docs out there not always having the strongest knowledge-base, I think their approach to family med residency was that it should be "easy" and did not do their own self-directed learning in spare time. So I think leveraging your surgery mindset to family med can really set you apart.

Regarding the expertise bit - the flexibility of family medicine that can allow you to build your own skill set and niche practice is abundant. Not only that, but you will have the leg up on 5-year specialists in being able to set up private clinics etc. For example, you want to set up an MSK clinic where patients pay out of pocket for PRP where you make 50% of the cost they pay, do it up. You want to set up a cosmetic clinic for newly minted dermatologists or other fam docs who have derm certifications to use the space and pay overhead, do it up. You want to be that expert, take the courses and be it. You have an MD, and you can augment that with any necessary certifications to make similar amounts of money for out of pocket services as your 5-year specialists. But back to the previous point, you will have the time advantage to set up clinics/spaces that will allow you to not work for an hourly wage, but to have "employees."

If the business aspect of medicine is not for your, do hospitalist or ED and work whenever you please.

I'm not going to ignore the salary differences between a family physician and an ENT surgeon doing cosmetic rhinos. But as long as the ENT surgeon is getting paid directly for their time, they will never attain freedom and autonomy. 

I sometimes wish I was in family medicine and out of the 5-year specialist hamster wheel as I see the abundant opportunities afforded to family docs. Perhaps I'm surrounded with FDs that are very fulfilled, doing innovative things, and living very cushy lives due to getting ahead on their financial goals and entrepreneurship ventures in early practice whereas that may not be the case in your situation. 

Anyways, I don't often post on this forum but I'm a believer in "you get what you look for in life" and I think you're overlooking a lot of amazing opportunities in family medicine. Just looking out.

Just want to point out a few things here:

1. My residency isn’t “less hard” in fact I have to manage all my 250 patients assigned to me on a regular basis while being off service (manage their labs, documents, forms, and have a half day clinic each week). In addition I’m expected (at least at my site and school) to know a lot about a lot of things and if we as fm physicians miss something, it can do a LOT of harm for patients. You as specialists don’t see everything cuz we obviously manage so much as first line. In addition, fam docs have a HUGE impact on their patients lives - I had a pt who was recommended to start a med by a psychiatrist but didn’t want to start anything until talking to or seeing me first. It’s a very special relationship that you just don’t get in any other field. 
 

2. Toronto star published physician salaries in 2018 and the highest paid ENT had a salary of 1.2 mil whereas the highest paid physician in general was a family doctor who raked in 4.2 mil (were not restricted by requiring an OR or a hospital to do things). Of the top paid physicians in that article about half were family doctors just FYI. To me it is unethical that anyone was paid this much using tax dollars in general but that’s not the point of this convo 

3. there are incompetent doctors in EVERY specialty and family medicine is no different. I’ve seen incompetent ER docs who just consult specialists for stupid things, I’ve seen surgeons be really unsafe in the OR and also have some really sour personalities, and I’ve seen IM docs also just rely on residents to run everything and would not be able to manage CTUs on their own. There’s just way more fam docs out there straight number wise so of course you’re going to have incompetent physicians. Let’s just not forget this is not specific to family. I can def comment that there’s prob people in my graduating class that I would never want them to be my doctor no matter what field they’re in just cuz they’re bad doctors at baseline.   

also for the original poster of that inflammatory post, getting into and matching to a specialty is not just about your “abilities.” They can’t even really check that before CaRMS. My friends who matched to surgery had to be good scut monkeys and do research. They stood out if they worked really hard to make resident lives easier (which involves no actual surgical skills), and we’re likeable people. There is also a lot of nepotism and CaRMS is not immune to bias and things like that. It’s easier to match to family because that’s what we need in this country, and therefore they are funding spots for that. Some people really forget that is our job - we are paid by public funding and therefore there is a responsibility to serve the community who pays our salary. 
 

if you’re that unhappy, you’re probably better off not doing family because you won’t be good at it either. Consider switching or like you said, changing your attitude and looking at the positives.

[PsychiaTube]

On 1/20/2022 at 12:59 AM, carmsregrets said:

Do yourself a favour and don't pick FM.   I originally wanted to match  ENT and FM was my back up.

I only ranked FM ( and unfortunately match to it) b/c I was mainly afraid of being unmatched .

If I go back in time, I'd prefer to go unmatched over matching to FM. 

Here are my reasons for not liking FM:

- You are not an expert in anything.

- FM is not an academic field

- You will never learn pathophysiology or disease processes in details.

-  You will be spending 50% of your time doing insurance forms, referral letters and doctors note. You need absolutely no brain power to do any of that.

Here are some reasons people pick FM:

- It is a very easy residency - you don't get challenged. You don't expand your knowledge beyond a medical student level. For some people that may be an advantage. For me, it is not an advantage.

- No standard is required to get into FM; it is quite easy to get into FM residency.  The only credential required is a pulse and MD degree. No need to work hard during medical school. 

I have met so many family doctors lacking fundamental medical knowledge - I often times felt scared that these individuals are responsible for people's health. It is so sad that I belong to a profession with such low accreditation standards. There are so many incompetent family doctors.  I can't say that this is true about most other medical specialties. 

 

 

Thanks for sharing your experience candidly, it's important to get information from people who don't filter their thoughts through what forum members will want to hear.

For OP I think there are a few important considerations:

1. Will you miss anything from FM in IM (Peds, OB/Gyn, Emerge, Psych, Short training period)?
2. Salary (If you want to do clinical work only, IM will pay more; but if money is your main goal, probably easier/faster to do FM with some derm/pain/addictions work)

3. Prestige (If this is important to you, IM has more but as soon as you're in you're going to compare yourself to GI/Cards/Surgeons - this may just be a  bandaid solution to the treadmill of prestige chasing)

4. Lifestyle (DURING and AFTER residency - Family has more control over hours/schedule, have you earning faster, more geographically mobile for setting up practice)
People thinking about entering medicine always weigh the "wasting my 20s" element of the long road; in residency you're still relatively young(er), and if you want flexibility during those years for vacations, time after work to date/socialize, and lower stress weighing on you, the less call-heavy programs/specialties get the edge IMO.

5. Nature of the work - Do you WANT to manage patients (coordinating care/referrals/, or do you want to manage their diseases mostly? Family has a certain fulfilling element that few other specialties offer, managing the family and multiple issues/organ systems within the same patient. I'd imagine a business-related mindset would be more rewarded in family where you can seek out work/set-ups that maximize your time/income to a level suitable to you, but that takes work. In IM, most of the weird and strange complex illnesses will eventually seem rote to you down the line, everyone will find their work monotonous as they get good - but if you nerd out on this kind of stuff that's a good sign that it will remain engaging even when you can recite protocols in your sleep.

6. Research - Can still be done in family in a variety of fields, but IM handedly beats it out in terms of depth. Family docs can benefit from going to conferences from all of medicine, so it is what you make it in terms of being engaged with latest research or resting on your laurels and following UpToDate for best practices. Same case for all specialties.

 

If you really are 50/50, Family is the easy choice for length of training, portability, and personalizing your practice.
If you have doubts about IM, remember you will only get better as training goes on, you still have flexibility to tailor your training/practice within the field as you progress, and it earns higher for the same patient. Prestige seeking is normal but people tend to downplay it's importance when talking about it to not seem clout-hungry, it is a factor you should consider too. 

Good luck on your choice, I'd guess most people that are having a real tough time choosing between FM/IM end up happy regardless of their ultimate choice, or what field they end up in. It's a good problem to be stuck between two desirable specialties.

 

[1029384756md]

18 hours ago, PsychiaTube said:

If you really are 50/50, Family is the easy choice for length of training, portability, and personalizing your practice.
If you have doubts about IM, remember you will only get better as training goes on, you still have flexibility to tailor your training/practice within the field as you progress, and it earns higher for the same patient. Prestige seeking is normal but people tend to downplay it's importance when talking about it to not seem clout-hungry, it is a factor you should consider too. 


 

 

Prestige was a big factor for me going through med school too, but it has little to do with your specialty choice and mostly to do with who you're surrounded by. I've seen electrophysiologists shitting on general cards for misreading ecgs, GIs with advanced endoscopy fellowships shitting on general GIs and gen surg for sucking at scopes, etc. Happens all the time in academic centers. I picked FM and I'm in a niche field where I'm the only MD around. People think I'm special being a doctor and all. I'm not but it feels good.

 

[medigeek]

On 1/10/2022 at 9:23 PM, lovemedicinesomuch said:

 

I think you have to figure out  your  own personalitylikes/dislikes and how much in depth you want to learn medicine. Some people love learning minutia and learning medicine in depth and don't mind spending years of their life doing so --> if that's you do then do IM. I do agree that specialty residency is a grind, but I think an extra 3 years in the grand scheme of things is absolute nothing. It will actually be a fun time because you are learning medicine in detail, you will make rare diagnosis, you will develop your knowledge and competence, and you will be challenged beyond your comfort zone! It's totally worth it.

In FM, you don't have the training time to learn the minutia and the details, you won't be able to make rare diagnosis. If you are okay with that, then do it.  

 

I definitely disagree here. You can learn the medicine on your own time and make the rare diagnosis if you have the time and energy to do the workup. Nothing is stopping you from ordering the appropriate workup to make the diagnosis. 

 

On 1/10/2022 at 11:12 PM, zxcccxz said:

Exactly, family doctors have the advantage of being able to whittle down the long laundry list of diagnoses. No one in their right mind would see anemia and fatigue and put “rare genetic condition X” at the top of their differential. Only once all the common stuff has been ruled out can you get the patient to a specialist for that evaluation. I would argue that the role of the family doctor is vital in diagnosis of such cases.

You can still proceed with subsequent further workup yourself too. It's not like the patient is seeing the specialist the next day anyway. It's true you may not be treating that condition, but again there is nothing stopping you from doing the workup.

 

On 1/21/2022 at 3:29 PM, PsychiaTube said:

3. Prestige (If this is important to you, IM has more but as soon as you're in you're going to compare yourself to GI/Cards/Surgeons - this may just be a  bandaid solution to the treadmill of prestige chasing)



 

Reply only to say that prestige is completely nonsense in medicine in 2022 and does not exist. I mean who are you impressing lol. Your family and maybe a subset of coworkers?