For a primary care doctor, I don’t think it matters much between IM and FM. Both will be capable in an outpatient setting. I would base your decision on appointment availability. Some PCPs are booked out 3-6 months in advance.
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My current doctor is an IM and my previous doctor of 17 years was FM. I see very little difference between the two from the patient perspective. Both seem to refer out to specialists in similar ways. I’m also in the camp of going with whomever has good reviews and you can get into see in a timely way.
IMO, it’s more important to see the hospital affiliations. I love when all the specialists and the primary care doc are at the same system so everyone can see the same clinical records and pull up tests/results/images.
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When I moved to a very rural part of PA there weren’t too many specialists. The FP docs were very popular and saw patients throughout the lifespan. They still did OB there, delivered babies, and then were also the docs that saw those babies in the nursery. They also did routine GYN care, and staffed the ER where I worked as an RN many years ago.
Now where I live FP docs barely do routine GYN care anymore, nevermind OB. Not sure if that’s because the practices tend to refer out or if the patients prefer specialists. I imagine the big malpractice issues that happened with the OB specialty several years ago also hit the FP docs hard, too, so many decided to not practice in that role anymore.
I always had great experiences with FP providers and had great respect for the ones who stuck to the extreme rural communities where no one else wanted to practice. They did amazing work for those communities.
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Primary care physicians must be broadly knowledgeable, because a patient may have anything. Even if they refer to a specialist, they need to refer to the correct kind of specialist.
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My current PCP is an IM doc, prior to her I have always had FM docs. I see no difference in practice except fewer children in the waiting room. My PCP is also nearing retirement and I hate the thought of getting a new one. But I do also hate that when I get sick I’m not able to see her, but have to go to Urgent Care.
The best care I have ever had was from Kaiser (Southern California) when I was 48 and they called me and said “You haven’t had a well-women check in several years and we will have female providers doing those in your area next week when can we schedule you?” My PCP was male and I’d been putting it off. She was fine but she said, “Are your breasts always lumpy? Why don’t you go down to the mammo clinic on the first floor, they take walk-ins.” Less than two weeks later my cancer was diagnosed and I was scheduled for surgery. They made appointments for me with specialists, and when I really didn’t like one, I called the breast cancer guide person and she got me another one based on what I said and what she knew about the oncologists. I remember thinking “If single-payer health care were like this, I would totally be in support.” No frills, but efficient standard of care practice.
Now, however, I don’t even know if that would happen so smoothly in the Kaiser system. And their system where we currently live isn’t well thought of. So, if I got a serious diagnosis again, I would be scrambling to be seen, to find specialists, to get in to them in a timely way. It’s exhausting to think about.
IM vs. FM is the least of my concerns.
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When my dad was in medical school in the mid-50’s in our predominantly rural state, a preceptorship in a rural/lacking doctor area was required. The idea was to encourage med students to want to locate in those truly rural areas when they graduated.
My dad was assigned to a general practitioner who served three counties. He saw approximately 70-80 patients a day. He delivered babies in people’s homes. My dad said that the notion that this experience would lure recent med school graduates to rural areas was completely misplaced. It had the exact opposite effect.
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I’ve had both. I loved my FP doctor and back in those days she delivered babies. Since living in my present area I’ve had quite a few IM providers. Most of them were young but for a few reasons closed their practices. The last two are now practicing “wellness functional medicine” and don’t take insurance. I met a new one a few weeks ago. I would have loved to make the choice with more information but in reality I made the choice due to availability. I liked her and I will see her again later this year. If I decide I don’t care for her I’ve got an appointment in late April with another IM Dr that came recommended by several people. Late April was her earliest available appointment and I booked that in June.
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These days, most primary care physicians accepting new patients are female. So if you are specifically looking for a female primary care physician, one should not be too hard to find.
That’s because GP as a specialty does not exist. There’s no board exam for General Practice/General Medicine. Insurers often wont reimburse unless a physicians is BE or BC.
There are only a few places where an individual can practice without completing a full medical residency as a GP. Those places include: cash-only private practices, BIA and the federal prison system. Or occasionally under the aegis of a large medical group which bills as a company/corporation, not as individual doctors.
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It definitely was not for the faint of heart! They had to be ready to treat anything and everything until they could get them to a specialist or higher level of care many miles away.
I have a relative who is a specialist in a rural area.
He’s nearing retirement and can not find an associate for long. When he finds someone (and recruiting is an expensive thing to do), that person will leave in a few years.
Not because he’s hard to get along with. Not because he doesn’t have a great staff. Some is the hospital system isn’t the easiest to work with. And the money made is more than an urban area.
But mostly because wives (edited to say spouses or partners of both sexes) hate living in a small town. They have careers and family. Moving to a small town isn’t what they want. Or works for their career.
My daughter is married to a physician. They live in an urban area, she wants a career, she worked hard for her degrees. They have many physician friends. Many are married to physicians, it’s easier for both to find a position in an urban area. Even if that means making less money.
I wont go into that many of their friends are of different races and the racism is still prevalent. They aren’t looking for jobs in certain states either.
It’s difficult. I don’t what the answer is.
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^^This, but I would change wives to spouses…
D1 rotated in a very small, rural hospital while in med school. The director of medical services offered her a job while she was still a 3rd year med student. The offer included a guaranteed promotion after 3 years with a huge salary bump if she would come work for them after residency. She liked the challenges the region provided and fully intended to move there and take the job until…she got married to an academic scientist and they suddenly had the “Two Body Problem” with 2 working professionals who both needed professional level jobs that the rural location simply couldn’t accommodate.
D2 interviewed with the BIA and loved the job they offered her. (Lower salary than she would make in an urban area, but lots of time off and located in some of the most beautiful country you can image [think Monument Valley area]) But she had a husband who was attending professional school so she couldn’t accept because she was newly married and didn’t want to spend the first 3 years of her marriage living separately. Every now and then they contact her to see if she’s changed her mind. Her husband will finish school this year and the BIA offered to hire both of them–but they’ve bought a house and are starting a family which makes the idea of moving there much less attractive.
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You are completely correct.
I would edit my post except that it would make yours seem incorrect. More women in medical school now so lots of spouses and partners of both genders.
Absolutely spouses and it’s a problem for both genders. I knew that too! 
My daughter’s sister in law is a physician who recently made a job change. Great for her, but problematic for her husband.
Boo on me! 
edited my post to reflect that.
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A relative of mine also needed a new PCP due to retirement. Someone recommended a clinic in their area that only treats women over the age of 65. It is a comprehensive, team-centered approach primarily staffed with PA’s / NP’s, but also a few MD’s. Covered by Medicare. If/when specialists are needed they are referred. I also think seniors often need a different point of view, even if they don’t have a long-list of issues.
Alas, nothing similar where I live, or I would definitely try that approach. If successful, perhaps it will become more popular elsewhere.
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I would love this.
BIA? Business improvement area?
I’m thinking bureau of Indian affairs
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The Indian Health Service (a division of the Bureau of Indian Affairs) staffs all medical centers on Native American reservations plus various urban Indian healthcare centers in the US.
D2 did a clinical rotation at Chinle and loved her experience there. Her job offer was at the Shiprock/Northern Navajo Medical Center.
One of BFFs from high school now practices medicine on the Pueblo of Isleta. The clinic there isn’t run by the IHS/BIA but is operated by the Pueblo itself. (Which is a sovereign nation under treaties with the United States.)
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There are NO GPs, have not been for many years. My post said that family practitioners have essentially assumed the role that USED to be played by GPs - they have training in adult med, pediatrics med, and OB/GYN care. They spend less time on adult med training than do IM docs, and far less time on peds or OB/GYN training than do pediatricians or GYNs. To me, that says that if available, IM/peds/GYN are a better choice for care, than FP, if that option is available. FP is better than no MD in rural areas, or underserved areas.
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Which means that she will initially and possibly exclusively be seen by practitioners with one tenth the training of an MD, who entered medicine via a far less selective process. PAs and NPs don’t function like residents in training - they practice largely with little oversight by MDs.
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