Family Med. vs. Internal Med

[Spectator]

It seems that many 3rd/4th year students go through the "Family Med vs. Internal Med" debate.

 

I'm currently trying to decide between the two fields.

 

To 3rd year medstudents and beyond:

- Are you currently deciding between these two fields?

- How are you making your decision/how did you?

 

I'm feeling quite torn right now.

Any helpful thoughts would be appreciated.

[Jochi1543]

2 vs. 5 years

Rounds vs. no rounds

Paged all night long vs. not

[bloh]

Easy bridge to research vs not

Largely time-based/fee for service vs salary

[A-Stark]

2 vs. 5 years

Rounds vs. no rounds

Paged all night long vs. not

 

That's residency and shouldn't really be the consideration for a career. Family physicians working as hospitalists still round and community internists typically work primarily as consultants. And at an academic centre, staff aren't getting called all night...

 

The bottom line is that they're very different careers.

[DeeDoc]

That's residency and shouldn't really be the consideration for a career. Family physicians working as hospitalists still round and community internists typically work primarily as consultants. And at an academic centre, staff aren't getting called all night...

 

The bottom line is that they're very different careers.

 

This.

 

However, the hospitalists I've seen are some of the hardest working people I know. Then there's lazy internal medicine docs... you're going to find a plethora of people in each specialty.

 

Internal medicine gives you more in depth training and allows you to deal with problems that a family medicine doc would refer to YOU.

 

In the end, it's what you want.

 

Although, family medicine in Canada is not a bad gig, you can do 2+1 with emerg, anesthesia, sports med... and in some municipalities that can make you a hot commodity.

[medaholic]

Most obvious differences

 

Family medicine has Peds, Obsgyn and more psychiatry. Usually more community/clinic based with more continuity of care. More focus on prevention, quite flexible in terms of how you want to shape your career.

 

Internal medicine more complex patients, opportunities to specialize. Perhaps a bit more academic in terms of teaching and research.

[Smurfette]

Internal medicine

- you like sick/complex patients

- you like inpatient medicine

- you are interested in academic medicine or want to subspecialize (not necessary, but can't do this in family as well)

 

Family medicine

- you like flexibility

- you like peds/obgyn

- you like healthier patients

 

Chances are you'll do your rotations in clerkship and it'll be obvious to you.

[moo]

I almost never refer to general internists. The only times i really referred was when I did hospital work and I had a febrile neutropenic or an old lady with an NSTEMI (who I only usually would refer because it was standard practice) or other more complicated rarer things, but this was because in this semi rural hospital where I worked, there were no sub specialists. In clinic, I'm quite comfortable managing complex patients and I usually refer to subspecialists. In terms of academic medicine, i get enough of that in my second career as a public health doc, and I feel I'm way more equipped than most specialists in reading and interpreting studies and even interpreting most tests.

[Spectator]

Thanks for the input, everyone.

 

I love the continuity of care from Family Medicine. I love seeing grandparents, their grandchildren, and everything in between. The variety of primary care is an interesting challenge: being a Jack-of-All Trades. I like the pace of out-patient clinic (5 patients an hour in clinic vs. 5-6 patients a day on the ward [at least for a clerk]). The flexibility of FM is also cool: Emerg, Obs, Hospitalist, Inner City Medicine, Methadone clinic, .....

 

But to be frank, I worry about not seeing enough sick patients.

Internal Medicine is just so cool. I love learning on the ward and dare I say on CTU. And (when the personalities click) the team aspect of ward medicine is pretty cool and fun.

 

BUT: maybe I'm just getting seduced by the novelty of seeing sick complex patients. The medicine seems cool from my perspective as a clerk, but internal medicine as a career? And I would never sub-specialize--I could only see myself as a GIM with a robust clinic.

 

I dunno, I feel myself rambling now. Either way, I want to be an excellent FM or excellent GIM, and in the end, we all just want to be happy with our live's right?

[moo]

Listen, you can still see sick patients while being a FP. The thing is, we need a ton more FPs like you who will be willing to see the chronic diabetics and the complex patients (there are lots of incentives nowadays but FPs still don't wanna see sick patients). If you feel you can handle it there's no need to refer to GIM, as that is well within the scope of FP. If you want to see sick patients you can be a hospitalist as well.

[deeman101]

I think I can summarize it like this....

 

 

IM: hard

FM: easy (if you want it to be)

[goleafsgochris]

You guys are exaggerating.

 

You DO NOT see anywhere close to the quantity of sick ppl in FM. Even if you tailor your practice to take on more very sick patients, your average patient would be light years away from the complexity of the average IM patient. You would still have tons of sore throats, well baby visits, etc, etc.

 

I realize you guys are all trying to defend FM as being adequately "hardcore," but I really dont think its fair to the OP to twist the reality to make your point when he was looking for serious advice.

 

I realize I may get flamed for this, but its the obvious truth IMO

[m1428]

I think job outlook has become a major consideration as well.

 

At the moment, almost all of the internal medicine sub-specialties are saturated. With the exception of GIM and geriatrics, positions right out of residency are tough to come by across the country.

 

This is concerning... could someone please elaborate more on this? For some reason I thought they always neeed more people in IM...

[LostLamb]

Another thing about family med is that you see a lot of undifferentiated patients...maybe they will be quite sick sometime but at the point you see them not all the classic signs and symptoms are there yet to really know what is going on.

 

Can't answer your questions about subspec saturation. All I know is that nephro is very hard to find a position...i am sure there are more.

[rmorelan]

You guys are exaggerating.

 

You DO NOT see anywhere close to the quantity of sick ppl in FM. Even if you tailor your practice to take on more very sick patients, your average patient would be light years away from the complexity of the average IM patient. You would still have tons of sore throats, well baby visits, etc, etc.

 

I realize you guys are all trying to defend FM as being adequately "hardcore," but I really dont think its fair to the OP to twist the reality to make your point when he was looking for serious advice.

 

I realize I may get flamed for this, but its the obvious truth IMO

 

I think in general that is true but I am still having problems putting it in absolutes like that. I have worked with hospitalists that seem to be effectively shift work general internists, and family docs working full time as palliative care docs. I have seen internal medicine docs with the most chill pratices with chronic but not immediately threatening conditions (diabetic clinics anyone?

 

Frankly the division between a GM and FM just seems to be really blurry at times and on some level I think that is exactly what the college family physicians wants I mean if a 2+1 family doc can do EM, anesthesia, hospital care on a regular "internal medicine floor", and even still obstetrics that leaves you with the impression there is an awful lot of overlap possible.

[bloh]

I guess that depends on your definition of sick. None of us are trying to say that the patients you seen in FM are as sick as patients seen in internal medicine (definition being that FM sick patients are seen in outpatient setting and that IM patients seen in inpatient setting), just saying that they are more sick than people make them out to be. There's more to family medicine than sore throats and Rx refills. Definitely saw MS, patients with active cancer, parkinsons, you name it in FM (in 2 weeks).

 

Alternatively, a lot of people who have gone through IM (not me) have said that patients are often "too sick" on internal, most of them essentially on the road to death. To many, that's often a turn off.

 

Well of course you will see people with MS, Parkinsons, cancer, etc.. They need general care for other issues just as well as anyone else. But don't be fooling yourself and be thinking that you'll actively be managing and balancing their parkinsons with med hallucinations, etc. You will (and should be) referring those to IM/neurology, as an example.

 

It's like saying that you 'see and do' a variety of surgical procedures as an anesthetist. Sure, you're there and watching, but for a complete different purpose.

 

I think goleafsgochris phrased it the best.