treejay Posted December 20, 2013 Share Posted December 20, 2013 I interviewed and will probably be offered positions in both outpatient IM and FM at a regional integrated healthcare org. They are both primary care jobs, pay and benefits will likely be the same, and I liked providers from both specialties. With all things being equal, I need to decide which of the 2 practices I'd rather take. I need help deciding between the 2. What factors should I be considering? What characterizes each specialty that I need to weigh in on? The obvious to me are that FM sees the full age spectrum, probably healthier patients and younger ones. IM probably has older patients with more chronic disease management. What else to consider? Any help appreciated. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 20, 2013 Moderator Share Posted December 20, 2013 can you see yourself being happy never dealing with peds and OB? choose IM would you miss peds and OB? choose FP. I would miss working with kids and pregnant pts. Link to comment Share on other sites More sharing options...
primadonna22274 Posted December 20, 2013 Share Posted December 20, 2013 can you see yourself being happy never dealing with peds and OB? choose IM would you miss peds and OB? choose FP. I would miss working with kids and pregnant pts. Not to derail this thread, but I'm facing the very same dilemma in ranking residencies. I applied regionally to both IM and unopposed FM (also have a couple oddball combined Medicine-Psych interviews in Jan). All programs have their strong suits. I am really an internist at heart--I enjoy acute hospital medicine, chronic disease management, geriatrics and palliative medicine. I would be ecstatic to never deal with a birthing vagina ever again and I wouldn't miss the little peds. But I like where I live, 10 min away from a level 1 trauma center with an excellent, well established, unopposed FM residency that is inpatient-heavy and OB light. They have actually developed both hospitalist and geriatric/palliative medicine tracks for FM--almost as though it was made for me--and it would be easier to get my occasional EM fix if credentialed as an FM physician than IM physician. The nearest IM program is 80 miles away, 10 residencies and 5 fellowships, a city I like but not commutable on a daily basis. So two households again if I want to stay married. This one has an outstanding geriatrics fellowship which appeals to me. I liked faculty and residents at both programs very much and they liked me. Decisions, decisions...I have until mid-Feb to decide (when rank lists are due). *sigh* Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 20, 2013 Moderator Share Posted December 20, 2013 I myself enjoyed adult pathology, kids are enjoyable would not every day, pregnancy is nothing I've ever had experience with. I've chose internal medicine/geriatrics. Link to comment Share on other sites More sharing options...
KMD16 Posted December 20, 2013 Share Posted December 20, 2013 EM w/ sport med fellow. Med Business minded. IME & UC owner. Or IM w/ GI fellowship. I've got to pursue field w/ ability to specialize + potential to moonlight for extra $$ as a PGY1 (rare) or PG2. If I was younger (traditional student) definitely Ortho or neurosurgery (do or die). PC (IM/FM) out! Do not see myself chasing after continuous mounting paper work/forms & ungrateful pt population. FM/IM hospitalist yes! No call responsibilities and picking up/locum in the ED or volunteer at free clinic or travel medicine (travel the world). Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 20, 2013 Moderator Share Posted December 20, 2013 as prima mentioned em is much easier as an fp than as an internist. general internists have no business covering an e.d. at which kids and pregnant vag bleeds make up a large portion of the visits. one of my largest accomplishments as an em pa lead/asst. chief of dept. a decade ago or so was firing all of the moonlighting IM residents and replacing them with em pas. productivity went way up and costs went way down. the IM residents were averaging 1 pt/hr and asking the pas about all kids, trauma, and ob issues anyway while making twice our salary. canned the lot of them. Link to comment Share on other sites More sharing options...
KMD16 Posted December 20, 2013 Share Posted December 20, 2013 general internists have no business covering an e.d. at which kids and pregnant vag bleeds present.Is it fair to say the same applies to an Urgentcare facility E? Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 20, 2013 Moderator Share Posted December 20, 2013 as prima mentioned em is much easier as an fp than as an internist. general internists have no business covering an e.d. at which kids and pregnant vag bleeds make up a large portion of the visits. one of my largest accomplishments as an em pa lead/asst. chief of dept. a decade ago or so was firing all of the moonlighting IM residents and replacing them with em pas. productivity went way up and costs went way down. the IM residents were averaging 1 pt/hr and asking the pas about all kids, trauma, and ob issues anyway while making twice our salary. canned the lot of them. love it!!!!!!!! now how about Geri NP's working in patient, or Peds NP working pain clinic, or anyone of 100 other examples where a nurse practitioner trained in one field competes for and takes a job away from my PA. Outside of her field. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2013 Moderator Share Posted December 21, 2013 Is it fair to say the same applies to an Urgentcare facility E? yes, if it is only a single provider setup. if you have multiple providers and someone else can do kids and pregos then an internist for just adults is fine. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2013 Moderator Share Posted December 21, 2013 love it!!!!!!!! now how about Geri NP's working in patient, or Peds NP working pain clinic, or anyone of 100 other examples where a nurse practitioner trained in one field competes for and takes a job away from my PA. Outside of her field. I did fire 3 NPs while there and replaced them with PAs. I did also hire 1 stellar np. Link to comment Share on other sites More sharing options...
KMD16 Posted December 21, 2013 Share Posted December 21, 2013 yes, if it is only a single provider setup. if you have multiple providers and someone else can do kids and pregos then an internist for just adults is fine. It's a single provider setup. The director/owner an internist. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2013 Moderator Share Posted December 21, 2013 It's a single provider setup. The director/owner an internist. an internist seeing kids or pregnant pts is acting outside his license and training as much as a pediatrician doing brain surgery.... Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted December 21, 2013 Share Posted December 21, 2013 I'd do IM just to avoid the kids and preggo's if I had to choose between those two. For me personally, I'd prefer something where I'm not the long-term provider, just the short-term fix.....without the ED/UC hours. Why couldn't my first ED doc have offered to share his ED income with the hospital when his contract renewal came up back in the mid-90's and I'd still be there working a 9-7, M-Th, no weekends/holidays schedule.....? Link to comment Share on other sites More sharing options...
mdebord Posted January 2, 2014 Share Posted January 2, 2014 To the OP: have you discussed your schedule/expectations with each practice? I do FM and have been seeing 24-28 patients a day recently (not my choice). The quick ones (2 yo OM, sports physical, etc) tend to be younger and balance out the rest (75 yo HTN, DM, COPD WITH a sinus infxn). If each practice expects the same of you, I would think IM would equate to a harder workload. If they're willing to give you more time with the patients, that's a different story. But definitely something to consider! Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 3, 2014 Moderator Share Posted January 3, 2014 an internist seeing kids or pregnant pts is acting outside his license and training as much as a pediatrician doing brain surgery.... not totally true have worked with some great Surgeons (past) who were ER attendings all three of the local ER Prompt care docs are Internists Once you are "boarded" you can work in the ER as an attending....... not that I agree with it though and not that it is good practice Yes outside of formal training, but not outside of license in the pure sense Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 3, 2014 Moderator Share Posted January 3, 2014 sure, any physician can do anything in medicine that they want...BUT...an internist would get grilled severely on the stand if he missed something in a kid resulting in a bad outcome(say intususception) that any pediatrician or er boarded doc would have caught. Link to comment Share on other sites More sharing options...
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