primary care - IM or FP?

[brooklynbrawler83]

assuming that you are not interested in any fellowships................can somebody please elaborate and explain the difference between IM and FP in terms of primary care practice?

ie:

fp can do procedures? im can not?

how is billing done?

which is better if all you want to do is primary care? which one can you make more money in?

[brooklynbrawler83]

and what 'procedures' can IM NOT do?

[Compassion MD]

I would personally do IM because you and do more fellowships...

[RussianJoo]

If you don't want to do a fellowship like you said and just want primary care think both are pretty equal in terms of procedures and scope of practice. You might have a better chance at getting a job at hospital if you're a general IM than FP but i am not 100% sure on that. There might be small differences like FP is more geared towards spending more time with the patient and taking care of them as a whole, or might be able to do OB stuff from FP and not from IM.

However, i know multiple physicians who practice in rural settings where there are no specists and they spend the day doing colonoscopies and other procedures. I know of IM docs working in ICUs who didn't get a Critical care fellowship, this is of course in places where there are doctor shortages. Technically speaking once you get your license you can do whatever you want. Heck you can even preform surgery as an IM or FP doc, it's your license and the insurance company might not pay you for it but if the patient is paying out of pocket then that doesn't matter. In rural parts of the country generalists do many more procedures, something that specialists would do. for example they'll do stress tests, colonoscopies, endoscopies, minor biopsies, LPs, suture a patients cut, some FP's deliver babies. it just depends where you work and what you're comfortable doing.

[thethom]

If you don't want to do a fellowship then they are very similar in private practice, HOWEVER, family medicine includes pediatrics. An IM practice will be adult only. As for the hospitalist setting, from what I've seen, getting a job is fairly easy for both groups (IM and FM both get inpatient training and ICU training in residency), however FMs working the ER can do adult and pediatric emergencies, however a hospital hiring an IM to work the ER will also need to hire a pediatrician for the kids that come in...

That being said, historically the majority that go into IM go into fellowships afterwards.

[RussianJoo]

and what 'procedures' can IM NOT do?

legally as a licensed MD you can do whatever procedure you want no matter what kind of training you have. for example it's very common for an IM doc to do colonscopies on a daily basis in the mid-west where the closest GI specialist is 200 miles away. Or an IM doc might even do minor surgical procedures. Heck you can even do major surgery as an im doc the only problem is your malpractice insurance won't cover your butt when you do stuff like this and the insurance company won't pay because technically you're not "trained" to do this. but legally you can do whatever you want, you're a doctor and have a license to practice both medicine and surgery. So if you find someone who's willing to have their gallbladder taken out by you and you're an IM doc and is willing to pay cash then if you're comfortable doing that legally you can.


plenty of people take botox injection courses and then get a little certificate to hang on their wall, and start injecting botox into their patients, this is because botox injections aren't covered by insurance and the patient pays cash for them and they're pretty simple to do. Heck I even know an Intesevist who is botox certified. he says on the weekends one day he'll start having botox parties. He got certified in Florida while on vacation for a week.

[Scientific]

Actually, in terms of procedure, FP does more. This is because FP includes OB and small surgical procedures. There are different laws as to what they can do depending on the state you live in. The surgical procedures that I know of that can be done by a FP are Tubal ligations and C-sections, & I believe D&Cs as well, maybe Vasectomies?. There are probably more, but I don't know off the top of my head. There are also smaller in-office procedures like PAP smears, Colposcopies, etc. IM can't do these because they are not trained in OB (or surgery). If you are interested in fellowships, IM is definately the better choice for you. If not, I'd say go with FP. It's a lot more flexible. You can have your own practice, work as a hospitalist, or work as an ER doc (which I believe IM can't do). It's really up to you and what you want to do. Generally speaking, they make roughly the same so money shouldn't drive your decision. If you are interested in OB or Peds definately go with FP. If you only want to do adult medicine and definately not OB, then do IM.

[thethom]

IM typically has more trouble landing a job with ED work because of the lack of training in pediatrics. Many will say there is a movement towards only BC/BE ER docs working in EDs, however most hospitals in the nation will take ER docs as well as FMs. Right now and for many years to come, it will only be the larger level 1 and level 2 trauma centers that take only BE/BC ED docs.

As for procedures, the ones you mentioned including vasectomies, plus joint injections, trigger points, casting/splinting, removal of superficial masses and other derm procedures, stress tests, etc etc etc...I could go on for days.

[RussianJoo]

can you not get BC if you did an FM residency and then an EM fellowship?

[thethom]

As far as I know, the EM fellowship does NOT lead to ABEM board certification (Unlike the Sports Medicine and Geriatrics fellowships which lead to their own board certifications).

There is a separate board certification that EM fellowship trained docs can do, here is a description of one: Emergency Medicine Fellowship



-Dr. T.