Posted by: notdeaddinosaur | September 29, 2011

What’s in a Listing?

I get mail, this from a healthy 20-something reader who’s just moved to a new city:

What’s the difference between doctors listed as Family Practice, Internal Medicine, and General Practice?  Also, what are some things I should consider (that I might not already be considering) when finding a primary care physician?

That’s a bit of a loaded question, not because of any bias of mine (perish the thought!) but because each of those terms is used in different ways, by different people, at different times, for different purposes. So here’s the rundown on each of them in turn.

Family Practice

What it’s supposed to mean: Designates a physician who has completed a three-year postgraduate training program in Family Medicine, trained to provide primary care to patients of all ages, presenting with conditions of any organ system, including care of acute conditions and ongoing management of chronic diseases.

What doctors hope people think it means: Some doctors think having themselves listed as “Family Practice” is good marketing. This irks me. (Trust me: an irked dinosaur is not a pretty sight. You wouldn’t like me when I’m irked.)

What it really means: As long as you check for Board certification, pretty much what it’s supposed to. (And remember: no news is NOT good news. No mention at all means no certification. Just like no mention of any marital status on a dating website means “Married”.) Otherwise it means someone trying to horn in on what I do because they think the term is inclusive.

Internal Medicine

What it’s supposed to mean: Indicates that a physician has completed a three-year postgraduate training program in General Internal Medicine. Bear in mind that the vast majority of graduates of those programs goes on to further specialty fellowship training. Precious few of them actually go out at that point and hang up a shingle, opening their doors to a practice specializing in the care of patients with multiple complex diseases

What doctors hope people think it means: In this new day and age of enhanced prestige marketing appeal of primary care, plenty of specialists with sagging revenues and appointment slots to spare believe that a listing under “Internal Medicine” will lure more patients. They have no problem with this double-dipping, but I do.

What it really means: Technically, it could indicate someone who couldn’t get accepted into any fellowship program. Most likely it’s a specialist trying to get listed twice in the directory. As a practical matter for a generally healthy adult, it’s a perfectly acceptable option for a primary care physician.

General Practice

What it’s supposed to mean: In the olden days, physicians hung out a General Practice shingle after one year of internship. Specialists were the only ones who went on for more advanced residency training. After everyone started doing residencies, it was osteopathic physicians who used the term General Practice, while MDs went on to fine-tune the training and certification that became Family Medicine (which now welcomes osteopathic graduates).

What it really means: Either an older MD who only did a one-year internship, or a younger DO who did a three-year residency. By now, though, even this is a little dated, so I’m surprised that there are physicians listed at General Practice. What it really means is that you need to carefully explore training and certification.

What else to look for:

Given that the reader failed to specify what he was already considering in terms of his physician search (presumably such vital indicators as Board certification, convenience of office hours, and courtesy of staff, among other things) the main thing I would do is provide reassurance that it is okay to go with one’s gut. Pick a doctor you like. More importantly, don’t be afraid to STOP going to a doctor you decide you do not like. Trust me; the doctor is not going to care. There are plenty of other patients out there.

Think in terms of finding a doctor who “gets” you. Someone you’d feel comfortable going to when you’re uncomfortable. Someone you can trust. That’s really the bottom line, whatever section of the directory they’re listed in.

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Responses

  1. I’m sad that this is what goes on in Internal Medicine in your neck of the woods. As a resident headed for IM primary care, at first I admit I was a bit miffed reading your post. But I stopped and thought about it, and you make some valid points. The vast majority of my colleagues are headed for fellowship (or becoming hospitalists). And I suspect that outside of my academic institution bubble, there are places where older specialists are double-dipping. But I do still feel a bit put off by the concept (even if it is sometimes true) that Internists in primary care are only those who a) failed to get a fellowship or b) are specialists trying to play both sides of the fence. We are, admittedly, a relatively small percentage of the whole, and possibly even more rare where you are rather than here in the Midwest, but depending on where your new reader has moved, Internists in primary care might be just as dedicated as the Family Practitioners.

  2. Good explanation. In my area (Greater Boston) most of the experienced MDs )that you hear about from other people’s good experiences are not taking new patients. The ones with open practices are usually fresh out of school or are the ones that ALWAYS have openings cause people don’t stay with them (for good reasons). So, people end up picking a group but not the doc in it that they really want to have. What’s the process/etiquette for asking a different doc in a group to become your primary doc, once you are in a group?

  3. I love this post because I also happen to be a 20-something yo in NYC looking for a primary doctor. Should I go familiy medicine route, or internists? But truth be told, I was doing some research and all the doctors have internists designation; not family medicine. Also, what should I go to the doctor for? Surely not when I have a cold or flu right?

  4. I’m quite disappointed with what you’ve written. My cousin did a residency in IM and did get accepted to fellowships, but after giving it serious thought, he decided that he would be unhappy spending the rest of his career on just one body part or body system. He needed more variety. So he joined an IM practice. He uses the term Internal Medicine because a) that’s what he’s trained in; and b) he does not treat children.

    As for General Practice, this is an easier term for most people to understand than Family Practice, so some doctors trained in Family Medicine and Internal Medicine use it. People could easily think that “Family Practice” means the members of the practice are all from the same family. Or that they’re family therapists. “Internal Medicine” can make people think they can’t treat stuff that’s external, such as a rash.

    My cousin’s practice, for example, is thinking about changing their name to General Practitioners because of the confusion and the fact that some doctors in the practice are trained in Family Medicine and others in Internal Medicine.

    As for selecting a doctor, I’ve relied on the wisdom of others about what doctors to select and what doctors to avoid. If the recommended doctors are not taking new patients, I have them recommend someone else.

  5. I think you missed out on detailing the difference between FM and Internal Medicine.

    IM is focused on complex management of organ systems, and in most residencies is primarily inpatient.

    FM is more generalist — in that they have significant training in OB/GYN, Dermatology, Psychiatry, etc.

  6. So whats the process for picking a chiropractor? My lower backs been sore for months but I’m not sure where to go. DO they have different specializations just like doctors? Do you have to have a primary chiropractor? LOL Sorry, I’m a bit new to this. I’m only 20 and I’ve never really had a primary care provider ever so I’m not sure where to start at all. As a kid I basically went to a doctor when I was sick and that was all. It was just a walk in clinic and I don’t think I ever saw the same doctor twice except maybe as an infant. I got vaccinated in those free health fair things and such, you know where they get the kids in line like a cattle than call them up one by one to their doom… I mean vaccine. All this looking up certifications and such sure seems like a lot of work. Should I see a chiropractor first or a regular doctor? And if it’s a regular doctor will they only look at my back or will they have like a check-up thingy too? And as a broke college kid, perhaps most importantly, will it cost a fortune? How do you make sure the doctor accepts your insurance? =/

  7. Trisha, I don’t know if you’ll see this or not, but my first suggestion (since your a “broke college kid” would be to see a local community health center at http://bphc.hrsa.gov/ or most four year colleges have a student health center with a primary care physician available for free.

    They can lead you to an environment where they provide primary care (which includes initial evaluation of back pain), and provide referrals as needed. CHC’s have a sliding fee based on income, and most have significant other resources to pull upon to provide free or reduced cost care including preventative care, annual physicals, etc.

    Chiropractor’s should not be confused with physicians. Their training unlike physicians is not based upon science, etc. Pay for a good massage.

    One other thing that should have been mentioned is DO’s (Doctor of Osteopathy). DO’s in the United States are medical doctor’s with nearly identical training as MD’s, the same prescribing rights, do the same residencies, can perform surgeries and (sub) specialize, etc. The differences are how the professions evolved historically, but they have mostly wound up in the same place.


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