I was wondering if it makes a diffenence whether I have an internal medicine vs family medicine doctor for primary care?
My longtime doctor (internal medicine) recently retired and while the clinic has assigned a new doctor to his patients I was thinking of looking for a new doctor closer to where I live. Adding family medicine to the search would roughly double the possible pool although so far I haven’t found a doctor of either type accepting new patients in the area clinics in which I’ve looked.
My understanding is internal medicine doctors get hospital-based training taking care of patients and family medicine training is largely done in outpatient clinics. But these days I’m not sure how much that matters for a serious illness since clinics use hospitalists that see you instead of your own doctor. And while I’ve been fortunate so far not to need a lot of medical attention it seems like when a serious issue comes up people get referred to a specialist instead of being treated by their own primary care doctor.
I’m hoping to get opinions from people inside medicine on whether the type matters when choosing a primary care doctor. The abilities of the actual doctor matter the most but I’ll have no way of judging that except perhaps a hint from where they did their residency (figuring more prestigious hospitals made an attempt to choose the more promising med-school grads).
It is true that Internal Medicine residents spend a greater percentage of their 3 year residencies in the hospital setting vs. the clinic setting, and Family Medicine residents spend a greater percentage of their 3 year residencies in the clinic setting vs. the hospital setting. But each spends plenty of time in each setting, so I wouldn’t worry about it.
I would not take the perceived prestige of the residency name into account when you pick a doctor. At least around here, the strongest students actually tended to pursue residencies at the public county hospital. It was often the more lazy residents who ended up at the fancy name brand hospital for residency (pay was better, hours were shorter, less responsibility, less challenging patients.)
I think one thing I would add to the decision process is where they have hospital privileges.
The hospital will have a great impact on the outcomes of a serious condition. I’d be looking for a Magnet hospital.
IM residency always include in-patient training, but IM residents also have clinic (out patient) rotations too. Not every IM trained physician will be hospital based during their career.
FM residency always includes some hospital rotations, though how much and at what level of intensity depends on the program. Some FM program are notorious for being intense, spending as much time doing in-patient and night float rotations as IM programs. I know of at least one program where the FM residents even are required to do an ICU rotation during each year of their training.
My last 2 PCPs, both IM trained general internists, never saw a single in-hospital patient once they finished residency. Not even the one who had a side job of being the staff physician for a nursing home. If one their patients needed hospital-level care–those patients were cared for by hospitalists, intensivists, EM physicians or whatever other specialty was appropriate.
(figuring more prestigious hospitals made an attempt to choose the more promising med-school grads).
Sometimes yes; sometimes no. IM is one of those specialties that perpetually never fills all its residency slots. About 1/3 (or more) of categorical IM slots are filled by IMGs. (International medical grads) In 2024, there were 10,261 internal medicine residency positions available. Only 95% of those positions filled during the Match and SOAP. The rest went unfilled. (And residency program directors hate that since it means everyone at the program has to pick up extra work to cover for those unfilled positions.)
Of those matching into IM, 35% were USMD seniors; 17.4% were USDO seniors; 1.3% were USMD grads; 0.6% were USDO grads; 10.6% were US IMGs; 30.3% were non-US IMGs)
Senior means med student who graduates this year.
Grad means they graduated in previous years (typically this means they couldn’t get a residency position the year they graduated due to any kind of a factor, from applying to too many reach-y places or to a different specialty to having major red flags on their application–like standardized exam or coursework failures, professionalism issues, or being creepy during interviews)
US IMG --these are usually individuals who couldn’t get accepted by a US med school for any of variety of reasons, ranging from the benign (like a low MCAT score) to serious and concerning (like a criminal conviction for a violent crime or a DUI where someone was killed)
*non US IMGs – foreign trained physicians
So IM is one of the least competitive specialties around and even “prestigious” hospitals often have trouble filling all their positions.
Add to the question mix: When would a geriatric specialist be recommended? Only for patients with a variety of overlapping issues, or for anyone over the age of 65?
When my MD of 25 years left to go concierge, I had a terrible time finding anyone taking new patients. The only options were usually recent graduates or recent transplants (who would not yet be familiar with recommended specialists if needed). I wondered if a geriatric specialist might be worthwhile going forward.
Geriatricians are trained to work with patients age 65 and older. Typically, however they mostly deal with frailer, older-than-65 patients unless the patient has multiple medical issues that require ongoing management and monitoring.
One of my PCP told me if I had a choice–to pick a younger physician, even a recent residency grad, because they were more current on treatments, patient management and technology (And less likely to be burned out.) He told me he thought the sweet spot was 5 years out of residency.
I just moved (like literally moved across the country this week!) so I am look for all new medical providers. I need to find an ophthalmologist, a PCP, an endocrinologist and dentist in the next 3-6 months. I feel your pain.
I asked my daughter (who is doctor) for recommendations and basically she told me that any doctor at a large multi-specialties practice will usually be fine unless I had something really unusual. (Which I don’t.) She told me to make an appointment with one ] and see if our personalities suit each other. If we mesh fine; if not ask to see a different doctor at the group next time.
My PCP retired a few years ago, thankfully the practice found 2 new doctors to join.
For me the biggest factor was finding someone who I clicked with. I went to one of the new doctors, we didn’t click. The second was a good fit.
So instead of speciality, I would look for fit. They are all doctors and some are better than others.
Saying this, my sil did an internal medicine residency. Most of his resident friends who were higher performing, applied for fellowships. Those who didn’t get their preferred fellowship, became hospitalists and reapplied for fellowships. I think that’s pretty common in internal medicine.
Some medical groups have physician profiles on their web sites. A primary care physician with a particular interest in something that is more likely to apply to you may be a point in their favor.
Not sure what value there is in chasing prestige of physicians’ residencies and medical schools. All US medical schools are elite in admission, and all US residencies are elite in admission for graduates of non-US medical schools.
Not sure what value there is in chasing prestige of physicians’ residencies and medical schools
Much of IM tends to be repetitive in that common conditions are just that–common. Physicians see a lot of those during residency no matter where they trained.
ABIM set standards for all residency programs in the volume and types of cases residents are exposed to. Programs that don’t meet those standards get shut down.
That’s because they have some of the lowest reimbursements based on RVS codes. Most people who finished a general IM residency are subspecializing because of higher reimbursement.
Keep in mind that your PCP can also be a Nurse Practitioner or a PA. With PCP shortages in many places (big shortage in MA for example), I think you just get whomever you find who takes your insurance and is accepting new patients. I feel like primary care today is mostly annual exams (check blood and urine test) and providing specialist referrals. Many people go to Urgent Care places now for that infection or injury instead of our PCP.
Same here. We go to urgent care for referrals, too because pcps are booked 3-4 months out. Can’t wait that long with an ear that feels like it is filled with water.
There is no difference for outpatient primary care if tehy are family med or internal medicine. The most important criteria should be that they are an MD or a DO. I prefer a doctor who does have urgent care availability also although that is often hard to find.
Internal medicine is focused on adult care, while family practice has some pediatrics training, and some obstetrics. I feel that internal medicine “specializes” in adult care, while FP has taken the role of general practitioner. I personally choose an IM doc for my own care, just as I chose to see a pediatrician for my children, and an OB-GYN for my reproductive care, because their entire residency was devoted specifically to that care.
I’ve read that there are very few new GP’s these days. I would think a primary care doc could be equally fine with a background in internal medicine or family medicine.
Full Disclosure - My H is a physician and don’t have a PCP. If I were to though, age would be very important to me. I’d prefer younger not because they might be more up-to-date but rather I’d want the care provider to be around for the long haul. Selecting someone close to my age likely means they’ll be retiring soon.
Internists have not only spent more time in the hospital setting, they have spent more time on adult specialty rotations that are outpatient (think GI, Endocrine, geriatrics,pulmonary). This is because family medicine is 3 yrs on the wholefamily: they do rotations in pediatrics and ob/gyn and adult med. internists do 3 yrs all on adult medicine. Just as pediatricians do 3 yrs all on children. Internal medicine docs are “specialists for adults”: they are more likely to be able to provide care for many outpatient problems and not refer to specialists for everything. Internal med is just more thorough adult training . That either matters to you or it doesn’t. Almost my doc friends see internal med for ourselves. We are all peds though, so it may be more likely that we understand the gaps in covering 3 major medical fields in 3 yrs vs the depth of training in one field for 3 yrs (this is of course after 4 yrs of med school for all).
Same here. We go to urgent care for referrals, too because pcps are booked 3-4 months out. Can’t wait that long with an ear that feels like it is filled with water.