View Full Version : Com Med vs Fam Med
02-17-2005, 05:19 PM
I'm debating between applying for Family Medicine or Community Medicine (I still have some time before I need to decide). I would eventually like to be working in international health and/or inner-city care (mobile clinics, school-based clinics, women's preventive health, etc) in combination with doing some academic research work in these areas. I know this would normally suggest going through the community medicine route, however I already have a Master's in Public Health and have spent sometime managing and researching inner-city health programs so I am wondering if I may be able to still achieve my goals with a Family Medicine residency, rather than going through the 18 month academic coursework and placement (much, though not all, of which may be repetition for me) and longer Comm Medicine residency, and still get to where I want to be. I am a mature student so would appreciate the shorter residency but would endure a longer residency if it was necessary.
02-17-2005, 08:47 PM
Let me say up front I'm no expert, but maybe I can provide some insight which will help.
Having the MPH + Family Medicine should be enough to get you into the areas you mentioned. However, some jobs might require you to have an actual community medicine residency (such as a medical officer of health, not that you mentioned it, but just an example).
Doing the MHSc (as part of the comm med residency) would have some repetition, but maybe you could target a different area than your MPH and gain new/more experience. I'm sure that the placements in the comm. med. residency would give you a wider range of knowledge, and give you experience that could land you a more senior position.
Have you talked to anyone in/running the community medicine residency about your options? There may be some flexibility to tailor it to your needs.
02-17-2005, 11:49 PM
Thanks for the response. Like I said before, I still have some time before I need to make a decision but I'm trying to toss out ideas right now (i'm sort of a long-term thinker . . . though my life never truly works out the way i plan it, I usually try to have something to focus on). I know a couple of people who have started IM and PEDS rotations in community medicine but they're still in the early stages. I had previously thought of UofT as being a top choice for a community residency because a) it would help me work more in the inner-city field which I was previously in whereas some of the other comm med programs focus more on rural meds and b) I've looked at the UofT Public Health prog and believe that it may provide more options than some of the other schools. However, I was told that UofT doesn't guarantee you a position in community medicine and it is something you apply for during the residency. I still feel like I shouldn't have a problem qualifying but it started the ball rolling as to whether or not I should be considering other options. In any case, thanks for your help.
Also does anyone know any medical students/residents or is anyone themselves considering working in academia in the field of public health and community medicine? I worked in the States with many physicians who while practicing were also teaching and coordinating community programs. Unfortunately since i've moved back to Canada I haven't spoken to too many medical students interested in teaching and research alongside practicing. I know many of the physicians I worked with only became involved in academia further down in their careers but I'm wondering if there are any other students already considering academia as a possibility and what their plans are and experiences have been.
Thanks again for your help.
02-18-2005, 06:54 AM
Some schools have combined community and family med residencies.
02-19-2005, 11:27 AM
Community medicine is something I was considering for a while. Canadian community med residency programs give you 2 yrs of family medicine training (and all allow you to get your CCFP, with the exception of UBC I think--unless they've changed that recently), plus 3 yrs of community medicine research & placements, so that by the end of residency, you usually have a Master's degree in Health Sciences/Public Health/Epi (depending on the program, they're called different things), plus your CCFP and your RCPSC credentials. This should prepare you to combine clinical work with public health work/research.
However, talking to some community med folks, I've heard it's very difficult to do both very well, since you're essentially trying to keep up with developments in 2 specialties....most have said they focus mainly on either the clinical medicine part or the public health part. but there are people who do it. The issue is finding a position that will allow you to divide your time between the two.
mountainsbeyondmountains, it's great that you already have an MPH....because you have that part already, I think you definitely could do the type of work you describe doing a family medicine residency, without doing the 5 yr. community medicine residency.
That being said, like a previous poster mentioned, if you ever did want a Medical Officer of Health job, they usually ask for Community Medicine RSCPC-qualified candidates. and if you wanted to do the full Community Med training, you could do your Master's in a different area to broaden your expertise.
I think that there are a lot more opportunities in the US to do the kind of work you're interested....not that it's impossible to do here, but there are less resources available, and i think just fewer people in the field (just given the differences in population size between Canada and the US, it's not surprising).
In my experiences, all the program directors of Community Medicine residency programs across Canada are more than willing to answer any questions you have. Their contact info can be accessed at www.carms.ca under 'program descriptions'. In particlar, Bart Harvey at U of T is especially friendly and approachable, so you should talk to him if you haven't already. (BTW, I was a little confused about your comment about U of T not guaranteeing you a spot in community medicine? Do you mean from med school, or from residency? You apply directly to community medicine residency separately from family medicine residency...).
p.s. i take it from your login name you're a Paul Farmer fan? He's an exceptional person who has managed to do a lot of great policy research & advocacy work as well as clinical work....if only we all could be like him!
02-19-2005, 11:32 AM
Oh, I get it now...
Correct me if i'm wrong, but did you mean that U of T's Dept. of Public Health doesn't guarantee you a spot in the Master's degree program if you're in the Community Medicine residency. i think that may be because not everyone chooses to do a Master's (the full grad degree isn't a requirement of the residency program, if i understand correctly)....and from the sounds of it, with your background you shouldn't have any problems getting accepted to do a grad degree if you were a com med resident.
02-20-2005, 03:50 PM
Thanks for all your help everyone! I actually finished my MPH in the States and worked in New York for some time before returning to Canada. There are definitely more opportunities for this type of work in the States, mainly because there's more funding and there are more international ties if you want to do international work. But all said and done, my home's in Canada and this is where I would rather be so i'm trying to make the best of it.
Yes, I am a Paul Farmer fan . . . have been pretty blown away by his work.
I'm going to keep doing my research but i've begun to consider the option of family medicine (2 yr) plus 1 yr either in academic medicine or hospital medicine (i know it's a little off track)- possibly at U of T. I just think that one of these combinations might make me more well rounded. Plus the more i think about it the more i find myself leaning towards academia. I have had experience in the community setting and found that many programs are often affiliated with an academic medical center and plus there are so many problems that exist within the hospital as well as in the community that having a hospital position could help me stay a bit involved in everything and give me some leverage when trying to negotiate with hospital admin for support. Lofty ideas I know . .. but I want to keep my doors open and like i said before .. . i'm a Paul Farmer fan .. . aim for the sky and reach the mountains.
02-21-2005, 08:02 PM
wow...I am so happy to have found someone in the same boat as me with the same questions! :D
I too have a Master's in Epidemiology and am interested in community medicine.
Have you been in contact with program advisors as to whether you can use your previous degree as credit towards a community medicine residency?
01-04-2006, 08:05 PM
Well I e-mailed Bart Harvey, the PD for U of T's program today with that question. He replied that if the previous Master's training is deemed equivalent to what would be expected as part of the regular residency, you may:
- apply for a year's credit and complete the residency in 4 years, or
- pursue an alternative graduate program, including a PhD, or
- use the 12 months to pursue additional field placements, or
- a combination of the last two
Also, many US and UK Master's programs would be acceptable (possibly others, I only asked about those two).
A very nice gentleman as mentioned in one of the previous posts here, so I'm sure he'd be happy to answer any other questions you might have.
01-09-2006, 12:14 AM
I know one individual who was previously a family doctor and has now completed community medicine. During his residency, he refused to give up his clinical work at a downtown clinic and this caused him a lot of grief. One thing you have to be weary of is that in general, if you go into academic community medicine or work for a health authority, your clinical work will be restricted and you'll focus more on research & administration.
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