IM-esque specialties for people who like the medicine in IM, but not necessarily the practice?

[Maybedoc1]

3rd year student (post core clerkship) trying to decide what to do with my life. One thing I’ve realized throughout medical school is that I really love the knowledge base that IM gives you, but I oscillate between mildly disliking and outright detesting the day to day of most IM practice that I’ve seen. I love talking to smart internists who seemingly know everything across all organ systems. I love thinking about physiology and pathophysiology and pharmacology. How entresto works. How orthodromic AVRT works. How hepatorenal syndrome works. Infectious disease. Wanna talk about high anion gap metabolic acidosis? I’d love to. LFTs? Why yes.

However the day to day of IM I find tough. The sitting at a computer for 90% of your day (unless your rounding of course). The notes. The discharge summaries. Titrating GDMT over a few days. Outpatient clinic. The lack of acuity (as far as I’ve seen at least). The hours of rounding. The new admission that you go see in 3 hours cause there’s nothing super acute and they can wait for a while. You went and saw the patient and now it’s time for a long note. Etc. I fully recognize that I haven’t seen all that IM has to offer with my 2-3 months of rotating. This has just been my experience.

So what are some IM-lite specialties that approach the knowledge of an internist as much as reasonable, but have a bit more..spunk? Excitement? I’ve considered doing IM and then fellowship, but I’m not sure how happy I’d be in an IM residency and 3 years isn’t a short amount of time.

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[mrbreakfast]

The answer is IM -> critical care. There's going to be nothing else that truly has what you want (acuity + whole-body pathophysiology knowledge), other than perhaps crit care surgery.

Since you are asking for other specialties, though:
-Anesthesia -> crit care: still has a good amount of pathophysiology and high acuity stuff, however much of residency (OR stuff, etc) may not be your cup of tea.
-Neuro -> neurohospitalist (or vascular): in terms of acuity and esoteric knowledge, neuro is IM on steroids, and a neurohospitalist's day is much more active than a medicine hospitalist's (at least in terms of moving around). However, whenever you focus on depth of knowledge, you lose breadth, and you certainly won't be treating the whole body here.
-EM may or may not be for you, but if you primarily enjoy diagnosis and stabilization before "passing along" a patient, it may be.

Keep in mind your knowledge base is yours, not your specialty's. You can learn and master whatever you want. It's not like you go into a specialty and lose your general knowledge. For example, as a medicine prelim I did ~38 weeks of medicine wards and ICU alone; you don't just forget that. There are plenty of specialties out there where being a good doctor means understanding many organ systems.

 

[Tenk]

The answer is IM -> critical care. There's going to be nothing else that truly has what you want (acuity + whole-body pathophysiology knowledge), other than perhaps crit care surgery.

Since you are asking for other specialties, though:
-Anesthesia -> crit care: still has a good amount of pathophysiology and high acuity stuff, however much of residency (OR stuff, etc) may not be your cup of tea.
-Neuro -> neurohospitalist (or vascular): in terms of acuity and esoteric knowledge, neuro is IM on steroids, and a neurohospitalist's day is much more active than a medicine hospitalist's (at least in terms of moving around). However, whenever you focus on depth of knowledge, you lose breadth, and you certainly won't be treating the whole body here.
-EM may or may not be for you, but if you primarily enjoy diagnosis and stabilization before "passing along" a patient, it may be.

Keep in mind your knowledge base is yours, not your specialty's. You can learn and master whatever you want. It's not like you go into a specialty and lose your general knowledge. For example, as a medicine prelim I did ~38 weeks of medicine wards and ICU alone; you don't just forget that. There are plenty of specialties out there where being a good doctor means understanding many organ systems.

I think you’re right on crit care for this and just wanted to say that op would probably not enjoy EM. Medicine wise, I love pathophysiology and intellectual discussions with my hospitalists and intensivists but working in the ED, I probably do this on 1-3% of all the cases I see and that’s probably an overestimate. You just have to wade through so much boring crap and social garbage to find one interesting case sometimes. I’d prolly leave EM post Covid if it wasn’t for the money and days off.

 

[IlDestriero]

Anesthesia, anesthesia/critical care, pul/critical care

 

[Styrene]

If you have any predisposition towards psychiatry, CL psychiatry at a tertiary center, (and also integrated psychiatry) requires IM knowledge and is very detail-oriented. The rabbit hole is as deep as you want to go in that regard. But, of course, it's "just" psychiatry at base.

 

[esob]

If you have any predisposition towards psychiatry, CL psychiatry at a tertiary center, (and also integrated psychiatry) requires IM knowledge and is very detail-oriented. The rabbit hole is as deep as you want to go in that regard. But, of course, it's "just" psychiatry at base.

I was going to recommend this as well. You could also do a med-psych residency and you likely would get a good CL job w/o needing the C/L fellowship.