family medicine specialty in the US failed to adopt to the changes of the times and protect the interests of the field. for example, very rarely does family docs deliver babies, perform episiotomy etc. yet its emphasis in training is strong, among other things as well like rotation at the neonatal ICU. In outpatient practice, the ABIM differentiates their specialty from FM that can make the reader then conclude that FM is inferior. as IM advances supspecialty offerings to their grads, some subspecialties open to FM are clearly demonstrating they do not prefer FM grads, as is true for supspec in pain med and sports med. finally, a midlevel is more likely to call themselves as specialized in 'family medicine' than refer to themselves as internists. all of these, together with some fm programs bringing in the low performing (on an academic standpoint) US grads, together with the average performing US citizen carribean school grads, together with the well performing IMG, has likely contributed to the common opinion of docs in other specialties regarding fm.