Internist vs Family Practice

When considering a new primary care provider in the US, are there any advantages or disadvantages to choosing an internist vs a general practitioner/family medicine MD or LPN?

Quite a few things to take into consideration. Do you have kids and would like one doctor for the whole family? Family practice docs are trained to care for children... internists are not. Do you live in a populated or rural locale. In rural area family practitioners might even do deliveries. Are there adults who have a greater burden of illness or more complex problems like congestive heart failure or advanced chronic lung disease. If so, an internist might better serve your needs. Just a few of the things to consider.

I work for a family practice, practitioners have to know all ages because we are seeing 3 generations of families in some case. Internist doesn't have that broad range. It really is a personal preference. I assume you mean NP, because an LPN can't be the provider of record. NPs will sometimes be a better bet for information on managing conditions and for linkages that others won't ask about. But I've had some great ones, and some awful ones, so it's not a guarantee.

We’ve had some serious medical issues in our family and have used an internist for 25 years. Our kids, however, still went to a family practice until they left home. Our interists have been our medical quarterbacks, identifying issues that a specialist is better qualified to handle. They don’t pretend or try to do it all. They are tied into all medical decisions and have the “whole picture”. Prior to retiring, they were connected to teaching hospitals (Univ. Colorado and UTSW). We’ve had the best state of the art medical care. Our small town internists has ties to a teaching hospital and has referred us there for specialized tests and procedures.

Everyone’s needs are different so it’s not one size fits all.

I'm a family medicine resident in the US. The biggest differences in the training and practice between IM and FM are:

Internal medicine: adults only, primarily inpatient trained with more avenues for subspecialization (i.e., may have more elective experience during residency in cardiology, GI, hematology, etc.) so may be a good fit if you have frequent hospitalizations and require a lot of specialist care, but no training in OB and may only perform very limited GYN care since they don't receive much training there. IM is a great option for those without kids or those with more extensive specialist involvement.

Family medicine: all ages from cradle to grave, primarily outpatient trained, trained in OB and can deliver babies (some FM can even do c-sections with extra training) and is the ONLY specialty that can do continuity OB (i.e. doing all prenatal care, delivering the baby, then taking over pospartum care of the mom and pediatric care of the baby), more likely to be comfortable with routine GYN care as well including IUDs, also trained in minor procedures such as vasectomies. FM is a one stop shop for the whole family and a great option for people who need less involvement by specialists.

Per my recent comment above, this is referring to scope of practice for physicians in those specialties. PAs and NPs in each have different roles and scopes dependent on the practice they work with.

So @IRLDrB an 80 year old would be better served by an internist? What if that 80 year old hasn't really shown any serious issues that often come with being an 80 year old and goes for regular screenings with a cardiologist, a urologist, and a dermatologist?

Thanks.

@easy123 no, not necessarily. Geriatric medicine is a subspecialty of family medicine. When I said people who need a lot of specialists, I don't mean for screenings. I mean people with frequent hospitalizations for complex conditions like kidney disease or heart failure.

In the US there are almost no GPs, no insurance company will reimburse them.

Family medicine is a jack of all trades. They have a 3 year residency with a little bit of everything thrown in. Whereas internal medicine has little to no surgical or pediatric components generally focussing on adult medicine and related specialties, (cardiology, endocrinology, nephrology, psychiatry etc) I personally don't have great experience with family medicine and generally see them referring a lot. There are of course exceptions. As someone who ran a pediatrics office we saw a lot of family medicine mistakes. FM along with physician extenders is realitvily new and fits into the crappy health care model that started under the Clinton administration. I think FM is a good specialty for very rural area that can't support multiple physicians.

Internal medicine will usually see 21 to death. Geriatrics is a sub specialty of either family or internal medicine. While family medicine can see all ages many will not do neonates and infants, usually seeing them from 2 years and up.

To directly answer the OP's question, my recommendation is to find internal medicine for yourself if you can, they are uncommon in the out patient setting these days and a pediatrician for your kids. That will get you both the highest level of care.

Rarely you will find someone who is double boarded in Internal medicine and Pediatrics.

@masterkinkster

Internal medicine is NOT a "higher level of care" than family medicine. Especially when we're talking a clinic setting when internal medicine is better equipped for inpatient and receives much less training in outpatient. In the same vein, Med-Peds is not a higher level of care than FM either as the focus there is also inpatient and not outpatient.

@masterkinkster there is a generation of FM that tends to refer out more, but that is NOT how younger FM generations are trained. We're trained specifically not to refer out unless you need to.

@masterkinkster you're willing to shit on a whole specialty because you saw some mistakes. I see mistakes from IM and pediatricians frequently too because every specialty has mistakes they're more prone to make. Additionally, FM physicians are not equivalent to APPs, and you cannot take the mistakes of a PA or NP and say that family medicine physicians are the problem. You can take your stigmatizing BS out from the team sport that is medicine.

I think most people see family physicians in the US unless they need specialized care. I've known women that use their gynecologist as their only doctor, as unwise as that is. There are a few physicians that took the Med-Peds route, though it is something that I don't think is a common residency program. It is essentially a certification in both internal medicine and pediatrics. If I'm not mistaken, they take two years of residency in internal medicine and then take two in pediatrics (the order could be reversed). From what I understand, they are not so familiar with gynecology or obstetrics, but are highly regarded for their "skill set". I know the residency programs are becoming more common in Texas, though I don't know about the rest of the US. It does seem that family medicine is the default choice. As for general practitioner, if I'm not mistaken that is a designation after someone has completed the first year of internship in a residency. They can then practice medicine, but they usually can't accept insurance and they tend to work primarily for themselves or they work in fields besides patient care. I've known a few people that had their MD and PhD program, but finished the one year internship in order to obtain a license to practice medicine. Heck, I think it depends on the state whether or not you can even get licensed to practice after the 1 year period. However, you're going to encounter a lot more nurse practitioners in the wild than general practitioners. If you go to those urgent care clinics that are seemingly on every corner in the US, you're most likely going to encounter nurses, not doctors.

We pick our PCP docs on who we trust and communicate well with, pretty much regardless of their specialty. We had a FM for 20 years who we were extremely happy with. When we moved to Dallas we initially saw a FM highly recommended by a friend who we didn’t clique with. Ended up seeing a IM doc who we did connect with. Both were good doctors, we just communicated better with and were more comfortable with the IM doc, not because she was IM. When we retired and moved to Oregon we found a PCP who is an IM whose specialty is nephrology even though we don’t have any kidney issues. We’re comfortable communicating any problems with her and have had excellent care for 10 years. We also had a urologist who was great, but left the practice. We were referred to another who was also very good, but we didn’t hit it off and switched. Could be our problem we don’t like some docs, but it’s a personality, comfort and communication issue vs whether they are FM or IM or whatever

@IRLDrB

First I am not shitting on a whole specialty, family medicine has a place.

Your implication that family medicine is an equal level of care is absurd on its face.

FM residency is 3 years and does short rotations in many disciplines. A Peds residency for instance is almost exclusively pediatrics.

There is no way you can argue that FM has the same education or experience as a pediatrician, nor can they provide the same level of care as they lack the knowledge and experience.

And geriatrics is a specialty open to both FM and IM not only FM.

@masterkinkster

It sounds like you have zero idea how residency works. IM and peds are both 3 year programs with short rotations in a variety of subspecialties that most of them don't practice long term. The majority of my residency is inpatient IM which we practice at the same level as IM residents. What specialist are you that you have such insecure and inaccurate views of FM?

@Quietly123 you are technically independently licensed after intern year, but you can't get hired anywhere or get board certified without residency completion. The only place you can really work as a GP in the US is in the military if you do a GMO tour after intern year prior to finishing residency. The Navy especially still utilizes a lot of GMOs.

@IRLDrB I have no insecurities, quite familiar with how residency works, I simply don't think that FM is equal to IM or Peds. Your claim is you can provide the same level of care with three years of training that would more likely be 6 years when you start including the surgery and gyn.

Like it or not you are a jack of all trades, expert in none. Try knowing your limits people's lives depend on it. No place for overconfident cowboys in medicine and that's what you sound like trying to claim FM is the same as meds peds plus gyn and some surgery, it's not, especially not pediatrics.

Our main doctor is a ARNP. We get along very well with her and can easily discuss our health issues with her. She was sub's Moms provider and left a positive experience for us.

She has been a much better source of information with many of our issues (sub's neuropathy, CHF, and during my initial broken arm issues.). She easily explains what the cardiologist, kidney doctor, and impatient surgeons are not good at telling us. Giving us information to make a better decisions.

When issues arise we get a referral from her for a specialist, but she will consult the others on less urgent issues so that treatments do not clash and unneeded visits are avoided.

ARNP = advanced registered nurse practitioner I knew what NP meant but not what the ar meant.

Our doctor is a GP but does everything. She does peds on certain days, OB/GYN on certain days, etc. I always ask her where she gets her energy. I am serious. She could be called in to deliver a baby and be in the office later. Her staff will call and let you know if she is in delivery and that there is a delay. They will bump your scheduled appointment to the expected time. She is never in a hurry. If one of her patients is in an MVA (Motor Vehicle Accident) and admitted to the hospital she will come and visit. If a child is going to have their tonsils removed she will be there and then back in the office. To the best of my knowledge and from what I have seen she works from 4:00 am until she is done for the day. She is young. My old doctor who delivered us and took care of me and my sister found her for me when I moved down here for college. For me, it is a no-brainer. If I am sick I can call her and tell her. She will call in a prescription. But that is because I am a nurse. We also get one bill to our insurance. It's not like getting a bill from an OB/GYN and a GP or whatever. I said I don't know where she gets her energy because she does all of that plus she is married with children.

@masterkinkster

I love how you imply that general internists and general peds are master experts and FM isn't because they're too general. Do you not understand that subspecialists lose most of their knowledge of general primary care and that primary care IM have to refer to other specialists? General (and especially outpatient primary care) IM are not doing the job of a cardiologist, gastroenterologist, etc. General internists are not subspecialty experts in subspecialties either.

Outpatient primary care IM actually does LESS than FM. They do the same adult primary care, but they don't do peds or OB. IM is notorious for paralysis at the thought of prescribing BP meds in pregnancy.

I posted this thread about six months ago because I was frustrated with the family practice I was seeing. In this case (and this case only), I felt that the provider I was seeing was superficial at best, and too quick to refer me to a specialist - and apparently unwilling to do an exam and make a diagnosis. In no way was this intended to lump all Family Medicine Practitioners into one homogeneous group. At that point, I had had no experience with an internal medicine doctor as my primary care provider.

That being said - I did end up leaving my family practice provider and opted for an internal medicine provider as my primary care provider - and I couldn't be happier.

Long story short:

1st appointment was 90% interview & history. Physical exam scheduled a month later.

2nd interaction - get labs done one week before the physical exam.

3rd interaction - a 30 minute physical exam that was closer to 45 minutes. It began with an EENT exam where the ear exam alone was more thorough than the entire exam done by the previous provider.

Yes, the IM doc did refer me to a specialist for an issue, but only after doing a physical exam on that issue to Mahe an informed decision to make a referral. Previous FP provider would have simply referred me to a specialist after a brief Q&A and without any physical investigation.

So in my case, the IM doc I selected as my PCP is light years better than the FP provider I was seeing.

Masks your own evaluation of this - it's a very limited sample size.