Thread: internal medicine vs family practice

any knowledgeable people on this comparison of primary care specialities ? What are the differences between internal and family practice ?

I know that family practice people treat very young children < 5 yrs where as internits do not , but aside from that ..what are the pros and cons of each ? While they are both primary care , internists seem to be better compensated . Also , can family practioners work as hospitalists ?

anyone who can answer these questions . please post so that more people can be informed .

thanks

my personal experience...
i've seen 4 gastroenterologists in the last 3 years, and one very astute IM doc has done more for me than any these specialists. i can sleep again. i have a lot of IBS symptoms, and this doc has done it for me. this doc seemed more interested in asking me questions, and really listening to what all my symptoms are... unlike some of these specialists only prescribing supposed solutions. i really think IM is for me as well.

I dont think the numbers you quote are realistic.Most physicians would totally burn out seeing 40 primary care visits a day, 12 hours a day,every day.While there may be some who can do this,most physicians would not last long.Perhaps with a nurse practitioner or PA(s) this could be done.Secondly there are few FPs who will have 200 patients a week paying $50 per visit out of pocket.Most FPs rely on HMOs, Medicare etc (sometimes capitated= not fee for service) to fill up much of their practice and the fees are often less than $50 per visit for a simple office vist.. and very few office visits are that simple ..often patients come in with multiple complaints and can't be rushed for the next one.People want to specialize because... with their procedures Cardiologists and GI can make several times an FP income for the same amount of time spent at work.I do know of FPs with large offices who make several hundred thousand a year,they are businessmen as much as physicians and work very hard.you will need to hire ancillary staff and really keep on top of things.Many are just not cut out to be entrepeneurs and end up working for a group practice at lower salaries,few people open up solo primary care practices from scratch these days.

as for the other question...Yes there are agood number of IMGs in various fellowships including cardiology,oncolgy etc.. in the US.If you do well in your residency ..strong recommendations and performance can outweigh IMG status.Also if you are flexible in terms of geography..and will go to rural Texas,Michgan,smaller midwest cities etc many fellowships are possible.California and Florida on not likely.The problem as an IMG is getting a strong university internal medicine program in the first place ..if you do you have fellowship possibilities.

I'm an internist. I see about 30 people a day. I bill more then $50 for the typical office visit. It takes me on average 15 minutes per patient. 30 minutes for a new patient.

These are the average medicare reimbursements for various office visits. Level 2 visits are rare. It would be something like a 20 year old who comes in so you could look at their (barely) burned finger or something. Most of my visits are level 3. A fair number are level 4. you get a diabetic with a history of MI, and a little short of breath you have a level 4. Happens all the time.


Established Patient Office Visits
99211 Level 1 (Nurse/Medical Assistant Only) 22.00
99212 Level 2 (brief) 36.42
99213 Level 3 (intermediate) 51.13
99214 Level 4 (extended) 79.82
99215 Level 5 (comprehensive) 116.98

G

Doc,

Personal question. I know u just started working as an IM. Are you staying IM...or shooting for some fellowship somewhere??

Staying IM. I love it. People think that we are just referral machines, but there is an awful lot of stuff I treat without referring to a specialist. I used to think i wanted to do a fellowship, but since I enjoyed IM, and couldn't think of any field i liked enough to put in a few more years at minimum wage, I chose not to. Specialists make more than me (for many not a lot more, if you look at the salaries), but those salaries generally come with a price. I work 40 hours a week, I eat dinner everynight with my family, and I am home for the vast majority of my weekends. I wouldn't trade that for double my salary. G

Dr. G. It was after reading a post from yourself many months ago that I decided to apply to Saba & AUC. I have a wife and kids and as much as I would love to be a physician, I will not trade my familly for it. They come first and foremost. Reading your post made me realize that working 100 hrs per week as an attending is a choice that a person makes. I choose not to make it. I understand that during internship and residency I will work long hours, I can deal with that for a couple of years, we have a great & stronge marriage. But after that, I want a normal life. In my case, IM and FP look really appealing.

Anyways, thanks for the advice, it made a big difference for me to hear it from someone in the trenches!

WantMD :-)

Glad I could help. That's why I post. Family most definitely comes first. G

Doc,
Thanks for the honest perspective. I will keep it in mind.

question for everyone ... ,:
thanks 4 all the replies so far but there is a lingering question :
which primary care specialty is more respected ? Family Practice or Internal Medicine ? Which doctor typically sees more patients ? Iknow some say fp but these weer fp docs speaking .. so which ones do see more patients ? Ho wmany patients per day ?
Which specialty is deemed more knowledgeable and which one is the public generally more confident in ?

please respond ..doesnt matter if u are a med student or a doctor ..
lets share our ideas.
Thanks,