Can any FM or IM residents/staff help me?

[ratatat]

What are the pros and cons of each?

 

Rank day is coming up soon and I'm in a quandary.

[cheech10]

You need to give us more information. These are totally different specialties, with totally different work environments, lifestyles, pay, case mix, subspecialization opportunities...

 

IM and FM themselves are not monolithic specialties, with multiple options in terms of work possibilities, ways to shape/focus your practice, etc. Impossible to answer in a single post.

 

The big question is: what kind of practice do you see yourself in 10 years from now? Do you want: Office based or hospital based? Primary care or referral based? Call responsibilities or not? Subspecialty or area of focus, or generalist?

 

Surely you've experienced both specialties and have thought about this a bit with rank day approaching. What do you dislike/like about each so far? Also keep in mind residency is quite short relative to your practice career; I would weight practice factors much more heavily than residency factors when making this decision.

[ratatat]

I think the big thing that scares me about IM is the job market. I'd love to get into Cardio, GI or Nephrology (who wouldn't), but the job markets are poor.

 

Also, I'm daunted by the first three years of IM.

 

For Family, I love the freedom and flexibility. If I did do Family, I would want to do thorough workups and not be a referologist.

[cheech10]

IM residency is not that rough (surgical residencies are generally much more onerous) and 3 years go by very quickly. The cardio/gi/nephro job situation is likely to be much different 5-6 years from now, when you would be looking for a job. Already there are signs from the R4 match that fewer applicants are interested in these specialties (nephro has been relatively unpopular for a few years) so it's tough to make a prediction at this point. There is always the option of practice as a general internist or hospitalist if a subspecialty job is not available.

 

These jobs are very different from family practice though, even with thorough working up rather then referring. If you think you'd be equally happy with any of these options, then it is a difficult decision, but it sounds like you prefer IM/subspecialties but are worried about the residency (not a big issue IMO) and the job prospects (tough to predict - not great, but likely to improve especially outside of major urban centres).

[Jochi1543]

FM hospitalist is also an option for you. Some family docs do just hospital work. In some other areas, you may have a full-service family practice with hospital privileges. I'm doing my residency in one of those programs.

 

You can do R3 training in FM-hospitalist if you so desire, I don't think it's a full year, some places just do 6 months extra.

[thebouque]

I'd love to get into Cardio, GI or Nephrology (who wouldn't), but the job markets are poor.

.

 

Geez I wouldn't

[A-Stark]

Cardio is alternately cool and irritating (gah unstable angina...), GI is too straightforward, and Nephro is... well, could be much better if we move more people to home hemodialysis. People don't get better with less dialysis.

[burrb]

im residency not that rough?

 

it's the biggest reason im not 100% set on im.

[ratatat]

IM residency is not that rough (surgical residencies are generally much more onerous) and 3 years go by very quickly. The cardio/gi/nephro job situation is likely to be much different 5-6 years from now, when you would be looking for a job. Already there are signs from the R4 match that fewer applicants are interested in these specialties (nephro has been relatively unpopular for a few years) so it's tough to make a prediction at this point. There is always the option of practice as a general internist or hospitalist if a subspecialty job is not available.

 

These jobs are very different from family practice though, even with thorough working up rather then referring. If you think you'd be equally happy with any of these options, then it is a difficult decision, but it sounds like you prefer IM/subspecialties but are worried about the residency (not a big issue IMO) and the job prospects (tough to predict - not great, but likely to improve especially outside of major urban centres).

 

That's true about the job market changing. Decisions, decisions..Thank you for your input.

[ratatat]

FM hospitalist is also an option for you. Some family docs do just hospital work. In some other areas, you may have a full-service family practice with hospital privileges. I'm doing my residency in one of those programs.

 

You can do R3 training in FM-hospitalist if you so desire, I don't think it's a full year, some places just do 6 months extra.

 

Yeah. The hospitalist opportunity in a community setting looks intriguing. Both FM and IM look good...

[ratatat]

Geez I wouldn't

 

lol. why not?

[Jochi1543]

Geez I wouldn't

 

Bahahaha

 

Exactly my sentiments

[medicine man]

I think the big thing that scares me about IM is the job market. I'd love to get into Cardio, GI or Nephrology (who wouldn't), but the job markets are poor.

 

Also, I'm daunted by the first three years of IM.

 

For Family, I love the freedom and flexibility. If I did do Family, I would want to do thorough workups and not be a referologist.

 

Theres lots of freedom and flexibility in IM. You can have very different practice settings depending on community, practice style. You can be the ultimate specialists, you can be the main referral for all weird and wonderful, you can do only hospital consults, you can do outpatient consults alone, whatever you want. You can do procedures or be hands off.

 

Unfortunately, if you're in a family doc's office, you often either don't have time or the experience for the "through workups". Theres a lot of detail and most of the time you will end up referring a medicine case to IM or one its subspecialties because of this.

 

Job market is always in flux. The difference between GI and Cardiac Surgery or Neurosurgery is that even if you do something like GI, you can still make a great living off of general IM and practice GI part of the time and try to work your way to a full-time gig. With the surgical subspecialties or things like Rad Onc there is no base specialty to practice until you find/develop your full time gig, so thats a huge plus.

 

Of note, most people experience IM through CTU at academic centres and thats probably the worst reflection of general IM. CTU at academic centres generally sucks and this is coming from a IM resident who really enjoys IM. GIM at community centres or on Med consults or outpatient IM is way more satisfying/interesting, so don't get down on practicing GIM as well.

[thebouque]

lol. why not?

 

because they're 3 goddamn awful specialties to me (and to a lot of people). To each his own.

[Dongzhuo]

Unfortunately if you do family and do thorough, internal style visits you will be paid worse than a high school principal. So if you want to practice in that fashion you probably should do IM. I had similar thoughts as you did though. Only wabted to grind out an IM residency if I couls be a staff cardiologist or gastroenterologist. Not much point in grinding out the residency to do geri or something like that and make less than a family doc....

[ratatat]

because they're 3 goddamn awful specialties to me (and to a lot of people). To each his own.

 

LOL, point taken. What are you in? An IM subspecialty?

[ratatat]

Unfortunately if you do family and do thorough, internal style visits you will be paid worse than a high school principal. So if you want to practice in that fashion you probably should do IM. I had similar thoughts as you did though. Only wabted to grind out an IM residency if I couls be a staff cardiologist or gastroenterologist. Not much point in grinding out the residency to do geri or something like that and make less than a family doc....

 

That's not too comforting.

[burrb]

I'm going through a very similar decision right now.

 

Family med has a much better lifestyle than most internal specialties. This WILL matter to you when you are old and want to work 8-3 with zero call. It pays decently (especially for the hours), and there are many job opportunities. However your patients will for the most part be healthy and it's not exactly a cerebral specialty. You do a lot of preventative medicine which is pretty boring and anything that may potentially be interesting will likely be outside your scope of knowledge, requiring referral. There's also a lot of social stuff like counselling and psych and being PC. However if you do a +1 you can really branch out and do as much of the +1 you want and as little of the family as you want (ie: work full time in emerg as ER doc and do half a day of family clinic a week).

 

Internal medicine has a significantly tougher residency and most specialties (except maybe allergy, rheum, endo, geriatrics) have a ****ter lifestyle (because of call). It's more exciting though, cause your patients are sicker and with more interesting problems. It can be a lot more acute (critical care, cardiology etc) and is certainly more challenging. But it can be a grind and burn you out as well. If you want a lot of money, GI and cardio pay the best but also have the worst lifestyles. If you want a sweet lifestyle, you generally get paid less but still more than the average family doctor.

 

They're both very different and you need to consider what aspects of a career are most important to you: Lifestyle, nature of the work, money.

 

For me, lifestyle has very gradually beat out nature of the work over time. The cerebral-ness of internal medicine that attracted me to it in the first place is trumped by ****ty lifestyle, and I find myself pulled towards family (especially appealing because of the +1 option), even if I like it less. It's a hard choice...and I have less than a week to finalize my decision lol.

[A-Stark]

Unfortunately if you do family and do thorough, internal style visits you will be paid worse than a high school principal. So if you want to practice in that fashion you probably should do IM. I had similar thoughts as you did though. Only wabted to grind out an IM residency if I couls be a staff cardiologist or gastroenterologist. Not much point in grinding out the residency to do geri or something like that and make less than a family doc....

 

Geriatricians do not make less than family docs, and often are based in hospital with low overhead. Most of them cover CTU and medicine call which is certainly more lucrative than the kind of inpatient work family docs can do.

[thebouque]

LOL, point taken. What are you in? An IM subspecialty?

 

I'm in pathology, a specialty that a lot of people find incredibly boring but I find it extraordinarily fascinating.

[ratatat]

I'm in pathology, a specialty that a lot of people find incredibly boring but I find it extraordinarily fascinating.

 

Nice. We need pathologists.

[ratatat]

It's very easy to underestimate lifestyle.

 

I had the stamina for 11 years of university, in undergrad I worked almost full time, studied full time, volunteered frequently, and had a bunch of hobbies.

I got used to very long days, and in my early to mid 20s, really felt like I could take on a very lifestyle challenging career.

That's sure changed.

 

Everyone is different, and the insanity of some doctor's lives is what drives them. I get that, but lifestyle demands can change DRAMATICALLY as time goes on. A little flexibility can go a long way.

 

I work mon-thu, and I'm so grateful to have a job that pays me very well for such a leisure schedule. I'm busy enough that I could open Fridays and make 20% more salary theoretically, but it's not worth it to me right now, and I love that I have the choice.

 

So you're a fam doc? How did you graduate in 2013 and have your own practice by now? Sorry, I'm just confused.

[Lactic Folly]

malkynn is a dentist...

[ratatat]

malkynn is a dentist...

 

Ok. DMD.....

[Jochi1543]

It's very easy to underestimate lifestyle.

 

I had the stamina for 11 years of university, in undergrad I worked almost full time, studied full time, volunteered frequently, and had a bunch of hobbies.

I got used to very long days, and in my early to mid 20s, really felt like I could take on a very lifestyle challenging career.

That's sure changed.

 

Everyone is different, and the insanity of some doctor's lives is what drives them. I get that, but lifestyle demands can change DRAMATICALLY as time goes on. A little flexibility can go a long way.

 

I work mon-thu, and I'm so grateful to have a job that pays me very well for such a leisure schedule. I'm busy enough that I could open Fridays and make 20% more salary theoretically, but it's not worth it to me right now, and I love that I have the choice.

That's pretty much it for me. I've worked more than people ten years older than me, and once I've paid off my debt, I'm cutting back to a normal person's lifestyle.