IM vs FM - Help!

[eg87]

I really enjoy both IM and FM, and tried to read through some of the other threads with this type of info. I think I've narrowed down my questions to the following. . .

 

1.To what extent are FM doctors able to practice hospitalist medicine? Does this only really occur in rural areas?

 

2. How much ob/gyn or peds do FM docs really get to do in the urban setting? Do the majority of pts simply get referred away.

 

If you had the IM vs FM dilemma, please shed light on how you came to your final decision.

 

Thanks!

[Starling]

1.To what extent are FM doctors able to practice hospitalist medicine? Does this only really occur in rural areas?

I don't know much about current hospitalist job opportunities, but it's not limited to rural.

 

2. How much ob/gyn or peds do FM docs really get to do in the urban setting? Do the majority of pts simply get referred away.

Where I am (and it does vary depending on where you are), kids are generally cared for by family docs, and only get referred to peds if they're complex. You can do low-risk OB as a family doc.

 

If you had the IM vs FM dilemma, please shed light on how you came to your final decision.

I chose FM over IM because, while I enjoyed several IM subspecialties, I like peds and OB and didn't want to cut those out.

[Alastriss]

Think of Lifestyle as well. An IM residency can be pretty tough (take it from me lol) and you need to really love the medicine to justify the 1:4 call and the general hours/grind that comes with it.

[NLengr]

Think of Lifestyle as well. An IM residency can be pretty tough (take it from me lol) and you need to really love the medicine to justify the 1:4 call and the general hours/grind that comes with it.

 

Plus the endless discussions about Na values

[A-Stark]

Plus the endless discussions about Na values

 

Well, these days whenever I see someone with hyponatremia, I conclude that it must be (delayed) TURP syndrome.

[The Journey Man]

I really enjoy both IM and FM, and tried to read through some of the other threads with this type of info. I think I've narrowed down my questions to the following. . .

 

1.To what extent are FM doctors able to practice hospitalist medicine? Does this only really occur in rural areas?

 

2. How much ob/gyn or peds do FM docs really get to do in the urban setting? Do the majority of pts simply get referred away.

 

If you had the IM vs FM dilemma, please shed light on how you came to your final decision.

 

Thanks!

 

As far as I've seen, all the hospitalists are FM. IM would unlikely be community hospitalists. Even at academic centres, they are running CTU which would generally have higher acuity patients and the less acute patients would be admitted/transferred to a hospitalist service run by FM.

 

If you want to practice OB/Peds as FM in urban setting, it generally be low risk and healthy population. Well check ups, vaccinations, uncomplicated deliveries. Patients outside of that will normally get referred to Peds or OB, especially in urban settings. Rural, i have no clue, but i guess you will be able take on more complications.

 

IM and FM personalities are quite different IMO. IM has lot more acuity, a lot more in depth medicine, will be 5 years at least (even GIM will be 2 year fellowship after 3 year core). FM has very little acuity, more breadth.

 

If you want a little bit of everything and want to take care of potentially a little bit more than just office visits for OB/Peds, consider ER as well with the +1 fellowship.

[HycrestJIT]

The key factor between FM and IM is the relationship that you develop with your patient (this is my bias as someone who chose FM).

 

As a family physician, you develop longitudinal relationships with patients that span years and sometimes decades. These relationships include not only the patient themselves, but their families (and generations of families). You are their entry point of contact into the medical system. This is unique to family medicine.

 

Quite frankly, a lot of the time a visit in family medicine is equally (if not more) about the relationship you have developed (or are developing) as it is about the medicine. Remember those days with your family preceptor where they would BS for 13 minutes about work, hockey, the weather, etc with a patient who they've known for years and then spend 2 minutes talking about changing a BP or diabetes medication? That's what I'm talking about.

 

 

Patients see you as their family physician. That in and of itself says a lot about the specialty.

 

This is not for everyone. A lot of the intricacies of medical knowledge are less developed in family medicine because of the emphasis on your role as a primary caregiver. Which isn't inherently a bad thing at all; in fact, it's quite valuable to both the patient and the system in many ways. I can tell you that your average family medicine patient cares less about what the ALLHAT trial demonstrated, and more about how you're able to help them deal with the issues of treating hypertension. Which is again what FM is about: helping the patient navigate medical knowledge and decisions.

 

If you have a burning desire to be THE medical expert, then family medicine may not be completely satisfactory for you. If you're content knowing that you don't have all of the answers (but know where to find them/who to refer a patient to) and appreciate the stories that people have to share, then family medicine is likely going to be satisfactory (not to say that you won't find that kind of satisfaction in IM).

 

Please pardon the "family medicine is sunshine and roses" patient-centered care bias that I have.

 

And speaking of medical experts, as a family physician, you can do a TON of medical management and be significantly knowledgeable if you're motivated to put in the effort to learn it. Some family docs I know are freakin' geniuses.

 

Random ramblings aside, my final point is this; the reason I chose FM was because I value the relationships I develop with people. I'm content to say that I don't know the latest breast cancer treatment, but that I can appropriately screen my practice population and investigate people with suspicious histories to find and diagnose it. And once I do diagnose breast cancer, I know who to talk with on the phone and send the patient to. And once the patients treatment with the oncologist, surgeon and/or radiation oncologist is over, I'm content to be the one to follow them after and support them as they deal with the ongoing issues in life once their specialized treatment has ended. Finally, I love being the one who also gets to see the husband and the children of that same patient with breast cancer in clinic as they deal with the emotions occurring through it all.

 

Family medicine is both unique and immensely satisfying if you can appreciate what it has to offer.

 

I dunno if that helps with your question, but I'm post-call and tried to shed some insight into why I chose FM and what I see as some of the differences between FM and other specialties (including IM).

[rogerroger]

Think of Lifestyle as well. An IM residency can be pretty tough (take it from me lol) and you need to really love the medicine to justify the 1:4 call and the general hours/grind that comes with it.

 

 

People over look this fact too often IMHO. Lifestyle is so key. You must truly love some of the more time demanding specialties in a special way in order to justify the personal sacrifices required.

 

What is considered a good lifestyle is very individual dependent. But do reflect on what this means to you. There is a potentially large difference between these two specialties in this regards.

 

Personally, I would gouge my own eyes out if I had to do either. However, because of this I have huge respect for those who choose either. You all have a much better sense of patience than I do.

[BoyInTheBubble]

As far as I've seen, all the hospitalists are FM. IM would unlikely be community hospitalists. Even at academic centres, they are running CTU which would generally have higher acuity patients and the less acute patients would be admitted/transferred to a hospitalist service run by FM.

 

?

 

I guess this depends on what you are talking about, and how you define hospitalist. Lots of IM is in community hospitals, and there is a huge need for more.

 

In academic centres, the "hospitalists" tend to have a limited role and seem to only look after patients who are ALC while they wait for a long term care placement. (This is hardly medicine, and mostly just a burden on the system.) These are family docs. In community hospitals, lots of family docs manage high acuity cases and only refer to the internist when it's very weird or complicated. It really depends on what you want to do, and what the specific hospital lets you do.

[The Ace of Spades]

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[eg87]

Thanks for the replies everyone! It's given me some good perspective! =)