Is IM really like this?

[DermViser]

Agree. The responsibilities of a CNA is VERY different than an attending internist. He's not doing any patient management. He's not doing any of the thinking. He's a CNA which is similar to a apprentice brick layer, whereas an IM doc is similar to an architect.

Yeah, an architect, switching around bricks on an ever dilapidated foundation.

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[Arkangeloid]

Yeah, an architect, switching around bricks on an ever dilapidated foundation.

From what I've seen in preceptorship, this is completely accurate. Most patients just don't give a fk about their health.

 

[DermViser]

From what I've seen in preceptorship, this is completely accurate. Most patients just don't give a fk about their health.

Of which you can do absolutely nothing about.

 

[Anastomoses]

It never actually makes sense to me that people whine about patients not caring about their own health. I don't seem to have any problem with this. I'm on their side. If they don't have the power to do what is required to help their own lives, so what?! I'm not their god, I'm not their owner...as a doctor I would be their guide. At worst I'd grin and say "you've been very naughty, Mr. Johnson...you really must cut the fatty foods/high sugar content from your diet...this is becoming a dangerous situation" and I'd say it with a smile. No, their non-compliance would not get to me after 10 years. It's not personal!! That's the beauty of our work.

 

[HopefulReapp]

That thread is definitely a PCP bashing thread... Which one is worst? IM or FM! These docs seem to do the same thing in the region that I live now.

I wasn't bashing anyone. I just asked if what I saw was actually representative of the field or if I am missing something.

 

[HopefulReapp]

Also, OP reminded me of this.

That is usually the reaction. One of my patients a month back had physician orders to stand her up to get her to pee on chux placed on the floor so we wouldn't have to straight cath her (it was the only way she would pee). Found out after a few days later that her new blood tests actually showed klebsiella. Gross!

 

[DrBowtie]

It never actually makes sense to me that people whine about patients not caring about their own health. I don't seem to have any problem with this. I'm on their side. If they don't have the power to do what is required to help their own lives, so what?! I'm not their god, I'm not their owner...as a doctor I would be their guide. At worst I'd grin and say "you've been very naughty, Mr. Johnson...you really must cut the fatty foods/high sugar content from your diet...this is becoming a dangerous situation" and I'd say it with a smile. No, their non-compliance would not get to me after 10 years. It's not personal!! That's the beauty of our work.

Except now they are trying to tie things related to compliance like A1c and readmission rates for CHF to payments.

 

[SouthernSurgeon]

It never actually makes sense to me that people whine about patients not caring about their own health. I don't seem to have any problem with this. I'm on their side. If they don't have the power to do what is required to help their own lives, so what?! I'm not their god, I'm not their owner...as a doctor I would be their guide. At worst I'd grin and say "you've been very naughty, Mr. Johnson...you really must cut the fatty foods/high sugar content from your diet...this is becoming a dangerous situation" and I'd say it with a smile. No, their non-compliance would not get to me after 10 years. It's not personal!! That's the beauty of our work.

Unless you have literally zero emotional investment in your work, it will bother you eventually.

 

[DermViser]

It never actually makes sense to me that people whine about patients not caring about their own health. I don't seem to have any problem with this. I'm on their side. If they don't have the power to do what is required to help their own lives, so what?! I'm not their god, I'm not their owner...as a doctor I would be their guide. At worst I'd grin and say "you've been very naughty, Mr. Johnson...you really must cut the fatty foods/high sugar content from your diet...this is becoming a dangerous situation" and I'd say it with a smile. No, their non-compliance would not get to me after 10 years. It's not personal!! That's the beauty of our work.

#1 - It will bother you when the same patient comes again and again frustrated that things aren't working and then blames you. Unless you are a mindless robot with no emotions, you will care, as most of us choose the specialty we like bc we enjoy the specialty that eventually helps people.

#2 - with healthcare reform and P4P, their non-compliance will directly affect your reimbursement as penalties will be instituted against you for certain "quality" measures (i.e. Cholesterol levels, HgA1C, etc.)

But please, continue living in your flowery, utopia that you are just a "guide". Sometimes I wonder if you're really in medical school, or in high school.

 

[DermViser]

I wasn't bashing anyone. I just asked if what I saw was actually representative of the field or if I am missing something.

Nope you weren't missing something. It's quite accurate. You're smart enough to catch this early, rather when it's too late in MS-3.

 

[Instatewaiter]

There are a bunch of IM residents who came into IM to specialize.

I went into IM specifically to specialize. As long as you go to a half decent IM program and perform well, you're going to have a high likelihood of matching.

IM spans quite a large spectrum. In patient medicine at an inner city hospital is quite different than outpatient medicine or even inpatient medicine in an affluent area.

 

[Instatewaiter]

This is a half-baked analysis though. Back then, being any type of physician was "prestigious" and practically anyone could get into medical school compared to the competition these days. Sure, there is a definite link between physician pay and competitiveness of the specialty, but it's clearly not the entire story.

Actually, back in the day, IM attracted the best and the brightest from medical school. Things have changed as patient compliance and demographics changed. It used to be that people wore a suit and tie to see the doctor. That kind of respect is gone. Now general IM has become painful, and this is coming from a board certified internist (who fled general IM).

If you look at it like a job, hospitalist is a pretty sweet gig. 250K to work half the year...

If it was exclusively about money, then there wouldn't be a huge shortage of pain specialists, which pays well but can be miserable.

There's a shortage of pain specialists because many IM and FM refuse to take care of chronic pain patients nowadays because it is such a hastle. Add to that the fact that there have been a large swath of pain guys who have been indicted by the DEA and you have the shortage you'd expect.

#2 - with healthcare reform and P4P, their non-compliance will directly affect your reimbursement as penalties will be instituted against you for certain "quality" measures (i.e. Cholesterol levels, HgA1C, etc.).

And that's why you fire those patients.

 

[Instatewaiter]

Except now they are trying to tie things related to compliance like A1c and readmission rates for CHF to payments.

The readmission for CHF is one of the stupidest initiatives medicare because it is mindless and doesn't take into account patient compliance. Quite frankly, that extra loss in reimbursement should come from the patient's pocket if it's non-compliance.

 

[KinasePro]

Actually, back in the day, IM attracted the best and the brightest from medical school. Things have changed as patient compliance and demographics changed. It used to be that people wore a suit and tie to see the doctor. That kind of respect is gone. Now general IM has become painful, and this is coming from a board certified internist (who fled general IM).

That's essentially my point. The changes that have occurred since those days makes the comparison essentially irrelevant, especially in support of the notion that it's all exclusively about the money.

Re: attracting the best and brightest, that is even debatable and arguably irrelevant in this discussion due to the difference in residency selection back then. I met an older physician who was a Mass General IM graduate of the 50's era. To get his spot in the residency class, he scheduled a meeting with the program director and asked/demanded a spot in their residency program. And sure enough, he got a spot right then and there. The entire evaluation of him as an applicant was a simple 5 minute conversation without consideration of his LORs, grades, anything else at all. He admitted he was a middle-of-the-pack student from a middle-of-the-pack medical school, and said basically all he had to do was ask and the spot was his. Best and brightest? Definitely not. Now compare that to the stories from todays IM applicants, where students from middle-of-the-pack medical schools are lucky to even get an interview at Mass Gen w/ 95th percentile scores on step 1/step 2, AOA, and some first author publications. The competition isn't even comparable. Young doctors are just a different breed these days. On average they are more competitive, more pedigreed, and higher achieving.

There's a shortage of pain specialists because many IM and FM refuse to take care of chronic pain patients nowadays because it is such a hastle. Add to that the fact that there have been a large swath of pain guys who have been indicted by the DEA and you have the shortage you'd expect.

Right, and the cool $350-450k salaries you see posted for pain specialists doesn't seem to be helping the shortage. I'm just saying it's not only about the money.

 

[CassieBagley]

I imagine non-invasive cardiologists have to deal with a lot of this non-compliance with respect to obesity/cholesterol/HTN/angina/CHF stuff.

 

[D elegans]

Going through medical school and now being toward the end of third year I've found that the diagnostic part of medicine is what really interests me, I care less about patient compliance and forming long-term relationships and all that. Hospitalist IM appeals to me for that reason. Yeah I know that 90% of what you see will be CHF, DM, COPD, liver failure etc but you'll also have the interesting diagnostic challenges that most people think of when they idealize IM. Admittedly, I'd like the ratio of interesting-to-boring to be as high as possible which is why I plan on specializing in ID, but I still think that general IM is a great specialty.

 

[Bryan O’Blivion]

#1 - It will bother you when the same patient comes again and again frustrated that things aren't working and then blames you. Unless you are a mindless robot with no emotions, you will care, as most of us choose the specialty we like bc we enjoy the specialty that eventually helps people.

#2 - with healthcare reform and P4P, their non-compliance will directly affect your reimbursement as penalties will be instituted against you for certain "quality" measures (i.e. Cholesterol levels, HgA1C, etc.)

The interplay between these two points is exactly what drove me away from primary care, sad to say. I could really see these aggravating me over the long term. There are probably ways to adapt and work around these situations and still derive great satisfaction from your work, but when I tried to peer into the future as best I could, I saw myself fighting the inertia of a reimbursement process that is based of a 10 minute patient interaction and a set of metrics largely dependent on external factors, essentially what you describe here.

It never actually makes sense to me that people whine about patients not caring about their own health. I don't seem to have any problem with this. I'm on their side. If they don't have the power to do what is required to help their own lives, so what?! I'm not their god, I'm not their owner...as a doctor I would be their guide. At worst I'd grin and say "you've been very naughty, Mr. Johnson...you really must cut the fatty foods/high sugar content from your diet...this is becoming a dangerous situation" and I'd say it with a smile. No, their non-compliance would not get to me after 10 years. It's not personal!! That's the beauty of our work.

With all due respect, I would find that kind of interaction sort of soul crushing after a while, since it seems glib to me. I am not trying to demean you, if that kind of distancing is effective for you, more power to you, I think that it will probably help you flourish, particularly in the practice model described above. Not me.

 

[DrBowtie]

Going through medical school and now being toward the end of third year I've found that the diagnostic part of medicine is what really interests me, I care less about patient compliance and forming long-term relationships and all that. Hospitalist IM appeals to me for that reason. Yeah I know that 90% of what you see will be CHF, DM, COPD, liver failure etc but you'll also have the interesting diagnostic challenges that most people think of when they idealize IM. Admittedly, I'd like the ratio of interesting-to-boring to be as high as possible which is why I plan on specializing in ID, but I still think that general IM is a great specialty.

If you enjoy the diagnostic part of medicine, consider radiology.

 

[Brigade4Radiant]

Going through medical school and now being toward the end of third year I've found that the diagnostic part of medicine is what really interests me, I care less about patient compliance and forming long-term relationships and all that. Hospitalist IM appeals to me for that reason. Yeah I know that 90% of what you see will be CHF, DM, COPD, liver failure etc but you'll also have the interesting diagnostic challenges that most people think of when they idealize IM. Admittedly, I'd like the ratio of interesting-to-boring to be as high as possible which is why I plan on specializing in ID, but I still think that general IM is a great specialty.

I would consider a radiology elective in fourth year.

Also IM has some people who really never wanted to do it in the first place people apply to IM as a back up for Rads, Derm, ER, etc. That's what I did also they seem to have an unusually low level of satisfaction see the report below only 19% of general internists would choose the same career again. Sure Medscape polls tend to be filled out by people that are not satisfied but internal medicine is way lower than average for other specialties. We are not saying internal is a horrible field and no one should go into it we are saying if you like internal medicine do it but going into internal medicine just to go into a competitive fellowship like GI is not the best idea unless you are a pretty strong candidate in general.

http://www.medscape.com/features/slideshow/compensation/2013/internal-medicine

 

[D elegans]

Thanks for the advice above guys. While I said I don't care about forming the longterm patient relationships, I still do like interacting with them and formulating treatment, I just don't care as much about monitoring HTN or DM for years and years in an individual patient. Also looking at images in the dark all day sounds awful. But you make good points.

 

[Kaputt]

Going through medical school and now being toward the end of third year I've found that the diagnostic part of medicine is what really interests me, I care less about patient compliance and forming long-term relationships and all that. Hospitalist IM appeals to me for that reason. Yeah I know that 90% of what you see will be CHF, DM, COPD, liver failure etc but you'll also have the interesting diagnostic challenges that most people think of when they idealize IM. Admittedly, I'd like the ratio of interesting-to-boring to be as high as possible which is why I plan on specializing in ID, but I still think that general IM is a great specialty.

In my experience in IM, there is very little diagnosing in hospitalist medicine. The vast majority of the admitted patients have already been worked up and are just having flare-ups of their chronic diseases. It's all just management and pushing patients out the door. I agree that ID is more interesting, and I feel they are more likely to get cool diagnostic cases but they still get tons of boring management they have to deal with, like the gross diabetic/PVD foot.

Thanks for the advice above guys. While I said I don't care about forming the longterm patient relationships, I still do like interacting with them and formulating treatment, I just don't care as much about monitoring HTN or DM for years and years in an individual patient. Also looking at images in the dark all day sounds awful. But you make good points.

I still think you should at least consider radiology, given what you've said. These days radiology is a lot less hiding in the dark and a lot more engagement of referring physicians and doing procedures that involve patient interaction. On top of the diagnostic aspect, you get to discuss management quite a lot. Out in the real world, it's often what the radiologist says that determines a lot of management, especially in the ED. The great thing is that you just don't have to be the one who actually does it.

 

[colbgw02]

I still think you should at least consider radiology, given what you've said. These days radiology is a lot less hiding in the dark and a lot more engagement of referring physicians and doing procedures that involve patient interaction. On top of the diagnostic aspect, you get to discuss management quite a lot. Out in the real world, it's often what the radiologist says that determines a lot of management, especially in the ED. The great thing is that you just don't have to be the one who actually does it.

The bolded is the only part I definitely agree with.

Engaging referring physicians less and less common, thanks to the widespread installation of PACS, VRS, and EMR. These permit everyone to see the images and read the report from virtually anywhere - including at home - in increasingly short order from when the imaging study was performed. If you're accustomed to having the team stop by the reading room, that's largely a function of being at an academic center.

Regarding hiding in the dark, that's kind of +/-. On one hand, radiology is (and always has been) a lot more than just sitting in the reading room all day. Even non-interventionalist radiologists can have their day broken up by various procedures, ranging from something as simple as an upper GI series to a diagnostic cerebral angiogram (in the case of a neuroradiologist). Still, radiologists are busier than ever, due to the overall increase in medical image and an desire to maintain salaries in the face of declining reimbursements. There can be tremendous pressure in private practice to "produce", so it's not too hard to fall into a bad job where you're just churning out studies all day in the proverbial dark.

 

[Kaputt]

The bolded is the only part I definitely agree with.

Engaging referring physicians less and less common, thanks to the widespread installation of PACS, VRS, and EMR. These permit everyone to see the images and read the report from virtually anywhere - including at home - in increasingly short order from when the imaging study was performed. If you're accustomed to having the team stop by the reading room, that's largely a function of being at an academic center.

Regarding hiding in the dark, that's kind of +/-. On one hand, radiology is (and always has been) a lot more than just sitting in the reading room all day. Even non-interventionalist radiologists can have their day broken up by various procedures, ranging from something as simple as an upper GI series to a diagnostic cerebral angiogram (in the case of a neuroradiologist). Still, radiologists are busier than ever, due to the overall increase in medical image and an desire to maintain salaries in the face of declining reimbursements. There can be tremendous pressure in private practice to "produce", so it's not too hard to fall into a bad job where you're just churning out studies all day in the proverbial dark.

Agree, but ideally radiologists will engage more with clinicians in the future. The current sweatshop that is PP kind of inhibits that, though. What radiology needs is an influx of new young people who don't want to hide in the dark from patients and clinicians, so the specialty can be less of a report generating machine and more of a clinical service. This is all wishful thinking, though.

 

[Siggy]

It never actually makes sense to me that people whine about patients not caring about their own health. I don't seem to have any problem with this. I'm on their side. If they don't have the power to do what is required to help their own lives, so what?! I'm not their god, I'm not their owner...as a doctor I would be their guide. At worst I'd grin and say "you've been very naughty, Mr. Johnson...you really must cut the fatty foods/high sugar content from your diet...this is becoming a dangerous situation" and I'd say it with a smile. No, their non-compliance would not get to me after 10 years. It's not personal!! That's the beauty of our work.

I think the bigger problem is "Mr. Johnson, you really shouldn't drink a 6 pack of beer a day along with a 2 liter bottle of soda. You know, with your ESRD and CHF. We can't keep readmitting you to the hospital for acute on chronic heart failure, especially since medicare isn't paying for readmissions anymore." Repeat for the DKA'ers who seem to come in once every other week for an ICU admission because their gap is in the 20s due to non-compliance.

Want to smoke, drink, eat high fatty foods? Sure, because most of those non-compliance issues doesn't really affect the hospital. Readmitting the same person to the ICU within a week because he doesn't want to take his insulin? Another question entirely (especially when ICU beds are a scarce commodity).

 

[Nasrudin]

I'm wondering, as one of those interested in the academics of general medicine, what IM could do to shorten its rounds. It seems like residents are squeezed between managing all the patients issues and social work needs and spending too much of each day bringing an attending up to speed so they can leave by early afternoon.

I know the attendings input is vital to proper management. But IM rounds are one the deal breakers for many people who like certain aspects of it.

Is it done other ways or is epic IM rounds the way it goes everywhere?

 

[colbgw02]

As usual, follow the money. Engaging clinicians falls squarely under non-RVU generating activities. Clinicians used to have to engage radiologists, because the films were physically located in the department and a literal wet read took an hour. Those days are gone. The good news is that there has been some blowback against nationwide teleradiology firms, as hospitals have started to understand the benefit of having a radiologist in the building. And - as you mentioned - younger radiologists seem to understand that this is now a 24/7/365 field.

 

[padastra]

IM is still extremely competitive, especially at top-tier programs. It probably has the widest distribution of competitiveness--e.g. FM and Psych are categorically uncompetitive, Derm and Oto are categorically competitive, and IM covers both ends of the spectrum. In these top programs as many as 80% of residents end up specializing.

In terms of reimbursement, basic economics simply will never allow primary care to be reimbursed at a "reasonable" rate.

1) On the supply side of things, I think a competent physician makes a real difference in the 5% of the sickest patients, where someone really needs to get a handle on all the person's medications and different recommendations from different specialists. But in 95% of patients, telling them that they're now 50 and in need of a colonoscopy, or that their A1C is high enough to start metformin, just does not require very much skill and could be done by a PA, RN, NP, or frankly a relatively simple computer program. And these 95% of patients are going to drive reimbursement rates. If you compare this to a neurosurgical procedure, well, 100% of their time (instead of 5%) is spent doing something that requires a ton of training.

2) On the demand side of things, making a difference in a medical patient may require a dozen visits and oftentimes the result is that you've prevented a bad outcome. This is very different from e.g. neurosurgery where a few visits can turn a horrible outcome into a bad one. Mathematically preventing something instead of fixing something is equally important, but that just is not how human brains work (and also much much harder to prove). Thus on a per visit basis patients and insurance companies will be much more willing to pay large fees for the latter than the former.

I think several fields will begin to experience contraction in reimbursement faster than others, and Derm may be one of them. A competent IM physician could easily biopsy and then read the pathologist's recommendation to administer a steroid.

To clarify, I'm in IM. I don't think I could do practice full-time for many of the same reasons previous posters have addressed, but of all the specialties IM has the broadest array of career options (primary care, hospitalist, specialist, academic medicine, administration, public health, etc). But if you choose it for this reason, you have to be honest with yourself about your other skills: most people would not be competitive in e.g. a healthcare investment boutique. If you're like 90% of medical students (e.g. risk-averse good students with cursory research and volunteering who want to be respected and have a decent lifestyle--despite what 99% of people say in the interview), the safest path is probably a surgical subspecialty.

 

[anbuitachi]

PM&R has an excellent lifestyle and pay (with the right procedure-rich fellowship) and Psych as a complete outpatient specialty can have a great lifestyle.

Their pay is pretty low compared to other 4 yr residencies... they can do pain but pain is competitive coming from PMR. if im not mistaken, pain and spine also took cuts recently.

 

[Cirrus83]

IM is still extremely competitive, especially at top-tier programs. It probably has the widest distribution of competitiveness

I have to say that I was actually surprised to find this out myself, I thought I had a pretty good board score for my program until I actually talked to a few people and realized that a lot of the people here have ridiculously high board scores for IM (like...over 20 points over the published average)

 

[DrBowtie]

I have to say that I was actually surprised to find this out myself, I thought I had a pretty good board score for my program until I actually talked to a few people and realized that a lot of the people here have ridiculously high board scores for IM (like...over 20 points over the published average)

But the % of sub specialization from these top programs is high. They aren't doing IM to be an internist. It's merely a stop on the way to cards, GI, HO.

 

[username456789]

A competent IM physician could easily biopsy and then read the pathologist's recommendation to administer a steroid.

It's almost terrifying (but hilariously telling) that IM people think this is what happens.

No wonder I get so many ridiculous consults from you guys.

 

[padastra]

It's almost terrifying (but hilariously telling) that IM people think this is what happens.

No wonder I get so many ridiculous consults from you guys.

It was a joke dude.

 

[username456789]

It was a joke dude.

No way bro.

 

[padastra]

No way bro.

True story broski. I thought it would be funny with DermViser offering his sage views in this thread.

 

[CassieBagley]

If this is how IM is, how much better are the specialties (cards, GI, heme/onc, allergy)? I'm interested in cardiology because of the interesting disease processes, the physiology, and the procedures, but the least attractive aspect of the job is (annoying) patient interaction. Obviously if all my future patients were athletic Mensa members I wouldn't mind as much. Wondering if I should just pursue a surgical field or radiology.

 

[JBOB]

If this is how IM is, how much better are the specialties (cards, GI, heme/onc, allergy)? I'm interested in cardiology because of the interesting disease processes, the physiology, and the procedures, but the least attractive aspect of the job is (annoying) patient interaction. Obviously if all my future patients were athletic Mensa members I wouldn't mind as much. Wondering if I should just pursue a surgical field or radiology.

Have you ever met a Mensa member? I don't think you could a more annoying group of people.

 

[CassieBagley]

Have you ever met a Mensa member? I don't think you could a more annoying group of people.

Yes, I have and I agree, but just trying to say that an ideal patient is one who understands stuff and takes care of him/herself.

Still interested in some input on my post though...

 

[DermViser]

And that's why you fire those patients.

Exactly. The unintended consequences of doing Pay for Performance on certain measures for patients, esp. with internists, is the firing of those non-compliant patients.

 

[boogaloo]

Yes, I have and I agree, but just trying to say that an ideal patient is one who understands stuff and takes care of him/herself.

Still interested in some input on my post though...

Someone once told me about why they went into hematology/oncology instead of cardiology. He said something along the lines of, "Your patients in cardiology are usually there because of their own bad decisions. Your patients in hematology/oncology are usually just unlucky." I've liked every single heme/onc attending that I've worked with. They're just a higher class of people in my experience.

 

[DermViser]

Thanks for the advice above guys. While I said I don't care about forming the longterm patient relationships, I still do like interacting with them and formulating treatment, I just don't care as much about monitoring HTN or DM for years and years in an individual patient. Also looking at images in the dark all day sounds awful. But you make good points.

In general internal medicine, there is very little "diagnosing" per say. It's more a flare up/exacerbation of a chronic medical condition. If you truly enjoy the diagnosing in medicine, I suggest radiology, and if you like patients then Interventional Radiology.

 

[DermViser]

IM is still extremely competitive, especially at top-tier programs. It probably has the widest distribution of competitiveness--e.g. FM and Psych are categorically uncompetitive, Derm and Oto are categorically competitive, and IM covers both ends of the spectrum. In these top programs as many as 80% of residents end up specializing.

In terms of reimbursement, basic economics simply will never allow primary care to be reimbursed at a "reasonable" rate.

1) On the supply side of things, I think a competent physician makes a real difference in the 5% of the sickest patients, where someone really needs to get a handle on all the person's medications and different recommendations from different specialists. But in 95% of patients, telling them that they're now 50 and in need of a colonoscopy, or that their A1C is high enough to start metformin, just does not require very much skill and could be done by a PA, RN, NP, or frankly a relatively simple computer program. And these 95% of patients are going to drive reimbursement rates. If you compare this to a neurosurgical procedure, well, 100% of their time (instead of 5%) is spent doing something that requires a ton of training.

You do know that that that is just OUTPATIENT internal medicine right?

 

[DermViser]

Their pay is pretty low compared to other 4 yr residencies... they can do pain but pain is competitive coming from PMR. if im not mistaken, pain and spine also took cuts recently.

It's only 3 years after an internship and they can do a lot of procedures.

 

[sylvanthus]

In general internal medicine, there is very little "diagnosing" per say. It's more a flare up/exacerbation of a chronic medical condition. If you truly enjoy the diagnosing in medicine, I suggest radiology, and if you like patients then Interventional Radiology.

Very little diagnosing in IM, are you serious?

 

[DermViser]

I have to say that I was actually surprised to find this out myself, I thought I had a pretty good board score for my program until I actually talked to a few people and realized that a lot of the people here have ridiculously high board scores for IM (like...over 20 points over the published average)

This will be like this for ANY specialty at a top-tier institution. MGH, Brigham, etc. always get the pick of the litter. Almost all of these residents' goal is to specialize esp. in the competitive subspecialties like GI and Cardiology.

 

[DermViser]

It's almost terrifying (but hilariously telling) that IM people think this is what happens.

No wonder I get so many ridiculous consults from you guys.

Just what we need, a bunch of skin biopsies done by IM docs. Everyone will be looking like swiss cheese. I could completely see these docs biopsying an erythrodermic psoriasis patient. and hoping the Dermatopathologist will completely save the day, bc Dermpath is always so "straightforward".

 

[DermViser]

Someone once told me about why they went into hematology/oncology instead of cardiology. He said something along the lines of, "Your patients in cardiology are usually there because of their own bad decisions. Your patients in hematology/oncology are usually just unlucky." I've liked every single heme/onc attending that I've worked with. They're just a higher class of people in my experience.

It's also a very mentally and emotionally taxing field both on the patient and the Heme/Onc doctor.

 

[DermViser]

True story broski. I thought it would be funny with DermViser offering his sage views in this thread.

I admit I laughed. Mainly bc it's always funny to me how Internal Medicine believes it's still somehow revered and on the pedestal of the House of Medicine. I admit it gives me quite the high that no matter how smart IM docs are (and putting down Dermatology), when they see a skin condition on the wards in which they have not even the most basic clue about (even though there is a whole section in Harrisons - Ch. 51-56) , they always end up consulting Dermatology. Actions speak much louder than words.

By the way, Dermpath reports don't have treatment/management recommendations. They do however, describe the histology. Hope you like basic science.

 

[DermViser]

If this is how IM is, how much better are the specialties (cards, GI, heme/onc, allergy)? I'm interested in cardiology because of the interesting disease processes, the physiology, and the procedures, but the least attractive aspect of the job is (annoying) patient interaction. Obviously if all my future patients were athletic Mensa members I wouldn't mind as much. Wondering if I should just pursue a surgical field or radiology.

If this is true for you, then IM and Cards will be an absolute nightmare. Radiology is definitely the one you should pick. You're welcome.

 

[anbuitachi]

It's only 3 years after an internship and they can do a lot of procedures.

But their salary is still low compared to other 4 yr residencies (or 3 +1 ) like neuro, anesthesia, em, etc.

 

[DermViser]

But their salary is still low compared to other 4 yr residencies (or 3 +1 ) like neuro, anesthesia, em, etc.

Yes, and they have the concomitant better lifestyle, both in terms of hours as well as acuity of disease unlike Neuro/Anesthesia/EM.