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FM vs IM, having a hard time making a decision


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On 1/22/2022 at 10:07 AM, 1029384756md said:


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.


Prestige should not be relevant. See my post above. 

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I had a similar dilemma and chose family medicine, and I'm currently working as a staff. Here's what I would advise someone in your position:

Family medicine, at least in the sense of general practice, is a "public complaint" centered specialty. People will come to you for undifferentiated symptoms and it's your job is to figure out how much of it (if any) is grounded in real pathophysiology.

In contrast, the work of specialists is often far more streamlined and closer to the level of actual medical science than that of family physicians.

Of course, there are pros and cons to each approach. Family medicine is highly interpretative and contextual, with the downside of being vague and often "not doing real science". Specialists are far more precise and science-based, but their work can be rote and robotic.

I would ask yourself these two questions:

1 - Will you burn out more from dealing with undifferentiated complaints? (i.e. "everything hurts and I don't know why") Or more from not being to effect all aspects of a person's health? (i.e. the hospitalist who has to deal with repeated admissions for alcoholic pancreatitis)

2 - Are you the type of person who likes analyzing an issue at a social level? (i.e.  discrimination, access to care, social determinants of health) Or do you like analyzing issues at a more "mathematical" / scientific level? (i.e. the pharmacologic basis for the latest therapies, cutting-edge algorithms in computer science and how it applies to medicine, etc...)

I think based on how you answer those questions it will be obvious which path you should pick.

As a final note: while lifestyle / prestige / salary are important factors, nothing is more important than finding a field you enjoy. Your unhappiness at work will eventually bleed into your personal / family life no matter how "lifestyle" your specialty is. Happiness in what you do is a foundation for everything else (because you'll spend most of your waking hours doing it!). 

Good luck!





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