Need Advice : Quit Ophtho, want IM

[hieyedoc]

Hi there. I guess someone could give me any advice.
I am a first year ophthalmology resident. i felt that although this field is interesting,turns out I did not really enjoy it. I'm wondering that Internal Medicine may be a good fit for me. It involves with intensive patient care, it keeps you busy everyday, and it deals with complex diagnostic which is more challenging in my opinion.
I have asked many people and understand the cons of IM. but I am asking here, whats your two cents of my case?

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[rokshana]

Hi there. I guess someone could give me any advice.
I am a first year ophthalmology resident. i felt that although this field is interesting,turns out I did not really enjoy it. I'm wondering that Internal Medicine may be a good fit for me. It involves with intensive patient care, it keeps you busy everyday, and it deals with complex diagnostic which is more challenging in my opinion.
I have asked many people and understand the cons of IM. but I am asking here, whats your two cents of my case?

how much optho have you actually done during the 1st year...and what were your expectations?

 

[hieyedoc]

how much optho have you actually done during the 1st year...and what were your expectations?

Well, pretty much I had my chance to do some supervised cataract surgeries and an evisceration surgery,handle ward and emergency consult,handle crazy numbers of outpatient clinic and ward,and dealing with pre-op and post-op surgery. What I expect first is that I continue to interest with this field(at least in my first year) but I do start to think that the sole reason I choose this specialty is only out of curiosity. I don't imagine myself doing this in the long run. Any thought?

 

[deleted547339]

Hi there. I guess someone could give me any advice.
I am a first year ophthalmology resident. i felt that although this field is interesting,turns out I did not really enjoy it. I'm wondering that Internal Medicine may be a good fit for me. It involves with intensive patient care, it keeps you busy everyday, and it deals with complex diagnostic which is more challenging in my opinion.
I have asked many people and understand the cons of IM. but I am asking here, whats your two cents of my case?

Remember one thing: medicine is a job.

Ophtho is an incredible job. You get paid by the truckload to work mostly bankers hours and save people’s vision. You have a golden ticket, don’t give that up - at least not yet. You need to be 100% sure, as you’re not likely to get that chance back. Don’t forget that the grass is always greener....

 

[IMreshopeful]

Remember one thing: medicine is a job.

Ophtho is an incredible job. You get paid by the truckload to work mostly bankers hours and save people’s vision. You have a golden ticket, don’t give that up - at least not yet. You need to be 100% sure, as you’re not likely to get that chance back. Don’t forget that the grass is always greener....

Truckload might be an exaggeration. You can probably make a lot more as a gastroenterologist. In saturated areas and big cities ophtho doesn’t make a ton of cash

 

[CCM-MD]

Remember one thing: medicine is a job.

Ophtho is an incredible job. You get paid by the truckload to work mostly bankers hours and save people’s vision. You have a golden ticket, don’t give that up - at least not yet. You need to be 100% sure, as you’re not likely to get that chance back. Don’t forget that the grass is always greener....

Ophtho MGMA 2017 median is in the mid 300s. Doesn't pay as well as people like to think.

 

[bronx43]

Hi there. I guess someone could give me any advice.
I am a first year ophthalmology resident. i felt that although this field is interesting,turns out I did not really enjoy it. I'm wondering that Internal Medicine may be a good fit for me. It involves with intensive patient care, it keeps you busy everyday, and it deals with complex diagnostic which is more challenging in my opinion.
I have asked many people and understand the cons of IM. but I am asking here, whats your two cents of my case?

Lol, don't do it bro. Just don't.

 

[NewYorkDoctors]

To the OP:

Read the threads on nephrology on this forum and then come back here with your revised thoughts.

Hint: nephrology is a wonderful field composed of "Super-Internists" who have knowledge of the exquisite fluid, electrolyte, acid base balance and also have a hand in every field!

 

[deleted547339]

Truckload might be an exaggeration. You can probably make a lot more as a gastroenterologist. In saturated areas and big cities ophtho doesn’t make a ton of cash

In what world is >350k for M-F 8-4 (probably actually 4-4.5 days) not a truckload of money?!??!?? Not to mention, that’s median, not a ceiling. Live in a smaller city and expect that to go up. And you have the opportunity to subspecialize and have that go up significantly. It’s a golden ticket - if you don’t think so, you need to have some more friends outside of medicine.

 

[Moose A Moose]

You’re out of your mind, OP...


Maybe psych is your calling.

 

[IMreshopeful]

In what world is >350k for M-F 8-4 (probably actually 4-4.5 days) not a truckload of money?!??!?? Not to mention, that’s median, not a ceiling. Live in a smaller city and expect that to go up. And you have the opportunity to subspecialize and have that go up significantly. It’s a golden ticket - if you don’t think so, you need to have some more friends outside of medicine.

350k depends largely on location lol. My friends in NYC getting 200k for initial offers. General ophtho not subspecialty

Of course if you go to BFE you’ll get paid more. That’s the case with any specialty. But it’s not significantly more than, say, a hospitalist in the same city who’s has every other week off.

I have plenty of friends outside of medicine, many who live on 70k per year. But thanks

 

[chessknt]

It is a drastic change. How much exposure did you have to optho; any to internal med as a resident? Gauge your interest based on clinic time and OR experience. Optho doesnt really have inpatients so floor scut monkey work is not a good estimate of what your life will eventually be. Depending on how much autonomy you had on the floor with gen surg, that could approximate what internal medicine is like (eg advance diets, check labs, work up dyspnea, deal with pain and hyperglycemia).

 

[NewYorkDoctors]

Since we're on the topic of money, there is one thing general opthalmology may not be able to do that community GIM can do -
Run a 99213 mill.
That racks up the billings far faster than any hospital based job in the right situation.

 

[IMGASMD]

It is a drastic change. How much exposure did you have to optho; any to internal med as a resident? Gauge your interest based on clinic time and OR experience. Optho doesnt really have inpatients so floor scut monkey work is not a good estimate of what your life will eventually be. Depending on how much autonomy you had on the floor with gen surg, that could approximate what internal medicine is like (eg advance diets, check labs, work up dyspnea, deal with pain and hyperglycemia).

Can’t OP open up his own office after his medicine training? Why limit him/her self for IP work only?

To OP: I think as long as you’re sure/happy, you want to do IM, go for it. I think most of us will not understand why switch from a highly competitive speciality into IM. You don’t have to justify to us, as long as you can justify it to yourself, then you’re good in my book. I am afraid that you will regret this decision nor do I want the responsibility steer you one way or another. I think ultimately that’s what everyone is saying.

Most people switch from GS out to something else, can’t say I’ve heard moving from optho out, since after all you are on the ROAD to happiness. I’ve heard someone switch from a top 10 medical school radiology program to same hospital’s psychiatry program. That was probably the most drastic change I’ve witnessed. Go talk to your advisors, talk to someone you trust, talk to your PD, talk to IM PD at your hospital. Most likely you’re at an academic institution with a lot of academics who are certainly functioning at a much higher brain level than me.

Best of luck to you.

 

[bronx43]

Since we're on the topic of money, there is one thing general opthalmology may not be able to do that community GIM can do -
Run a 99213 mill.
That racks up the billings far faster than any hospital based job in the right situation.

Depends on your patient base. It's hard to get a full 30 pts/day practice of easy 99213.

 

[jdh71]

Hi there. I guess someone could give me any advice.
I am a first year ophthalmology resident. i felt that although this field is interesting,turns out I did not really enjoy it. I'm wondering that Internal Medicine may be a good fit for me. It involves with intensive patient care, it keeps you busy everyday, and it deals with complex diagnostic which is more challenging in my opinion.
I have asked many people and understand the cons of IM. but I am asking here, whats your two cents of my case?

Stick with the ophtho. You don't want IM when you are done being interested in being "excited". You want that (relatively speaking) low hours, low patient responsibility, low call job.

Hang in there.

 

[mszzeta]

I cannot imagine how everyone considers only money and lifestyle when they choose a lifelong career that they will spend probably most of their time in the rest of adult life on before retire.

I would not say give up optho, which certainly have significant advantage regarding salary and lifestyle over most IM specialty. And there are lots of disadvantage of IM (dealing with social crap, lots of conditions are managed by algorithm that a MD makes little difference than NP/PA) that you may not aware unless you have decent exposures. So I would suggest you to have exposures.

Also IM is a vast field, from procedure-heavy Cards/GI to stressful but rewarding intensivist to intelligent ID/endo/Rheum, each with some advantages and disadvantages. If you are willing to sacrifice money and lifestyle (or at least one of them. You may get money from Cards or lifestyle from Rheum but probably cannot get both) for something you think you may truly enjoy, it is not unreasonable to consider

Hi there. I guess someone could give me any advice.
I am a first year ophthalmology resident. i felt that although this field is interesting,turns out I did not really enjoy it. I'm wondering that Internal Medicine may be a good fit for me. It involves with intensive patient care, it keeps you busy everyday, and it deals with complex diagnostic which is more challenging in my opinion.
I have asked many people and understand the cons of IM. but I am asking here, whats your two cents of my case?

 

[NewYorkDoctors]

I cannot imagine how everyone considers only money and lifestyle when they choose a lifelong career that they will spend probably most of their time in the rest of adult life on before retire.

I would not say give up optho, which certainly have significant advantage regarding salary and lifestyle over most IM specialty. And there are lots of disadvantage of IM (dealing with social crap, lots of conditions are managed by algorithm that a MD makes little difference than NP/PA) that you may not aware unless you have decent exposures. So I would suggest you to have exposures.

Also IM is a vast field, from procedure-heavy Cards/GI to stressful but rewarding intensivist to intelligent ID/endo/Rheum, each with some advantages and disadvantages. If you are willing to sacrifice money and lifestyle (or at least one of them. You may get money from Cards or lifestyle from Rheum but probably cannot get both) for something you think you may truly enjoy, it is not unreasonable to consider

I like how nephrology was not mentioned in the bolded text .

 

[NotAProgDirector]

I'm not certain what you're asking.

If you're asking: I'm thinking of switching to IM, want people's opinions. If so, I'm not sure how helpful these responses will be. I agree that medicine is a job, but I'd argue that it's really important to enjoy your job if possible. You can have a great life / salary in any field of medicine. Ultimately, you need to choose what you'd like to do. My recommendation would be to do an IM rotation (or two) if possible, to see if you really like it.

If you're asking: I want to switch to IM, how do I do that? If you're in ophthal, chances are you've got great scores and grades. You'd want a letter from your PD saying that "motohills is doing fine in our program, we would happily promote them to the next PGY level, but they have had a change of heart". If your prelim year was IM, you could look for a PGY-2 spot, if it was GS or TY you'll need a PGY-1. You could talk to your home program and see if they have room / interest. Otherwise, you apply into the match again. (If looking for a PGY-2, you talk to the IM PD of your home program, they should be able to help you find one).

 

[hieyedoc]

I'm not certain what you're asking.

If you're asking: I'm thinking of switching to IM, want people's opinions. If so, I'm not sure how helpful these responses will be. I agree that medicine is a job, but I'd argue that it's really important to enjoy your job if possible. You can have a great life / salary in any field of medicine. Ultimately, you need to choose what you'd like to do. My recommendation would be to do an IM rotation (or two) if possible, to see if you really like it.

If you're asking: I want to switch to IM, how do I do that? If you're in ophthal, chances are you've got great scores and grades. You'd want a letter from your PD saying that "motohills is doing fine in our program, we would happily promote them to the next PGY level, but they have had a change of heart". If your prelim year was IM, you could look for a PGY-2 spot, if it was GS or TY you'll need a PGY-1. You could talk to your home program and see if they have room / interest. Otherwise, you apply into the match again. (If looking for a PGY-2, you talk to the IM PD of your home program, they should be able to help you find one).

I'm asking the first one.
So far the responses has been quite helpful, so thank you.
I would like to add one more question for anyone here that has been working years in IM field : what is the best and worst thing from IM ?

 

[IMreshopeful]

I'm asking the first one.
So far the responses has been quite helpful, so thank you.
I would like to add one more question for anyone here that has been working years in IM field : what is the best and worst thing from IM ?

Best - I get to manage disease in my area of interest. As a sub specialist I get to take care of and perform procedures on things I also enjoy. My work/life balance is probably going to be better than that of your average surgeon.

Worst - get crapped on by non medical specialties with a large ego, deal with issues that a doctor shouldn’t have to deal with (social etc) because it affects their health.

 

[CatFactorial]

I'm asking the first one.
So far the responses has been quite helpful, so thank you.
I would like to add one more question for anyone here that has been working years in IM field : what is the best and worst thing from IM ?

When I think of a prototypical physician, internal medicine is what comes to mind. IM is the only field in which you are the primary manager of patients who simultaneously have severe COPD, DM2, refractory HTN, CAD/PVD (I’ve had a few of that exact phenotype). My residency hospital was ginormous and had eight various ICUs. Invariably, the most well-managed patients were in the medical ICU (which also had the highest mortality rate in the hospital). Because of the familarity that comes with routinely managing complicated patients, getting dumped on is a reality. And often times it’s not even that other services are exploiting us; they legitimately cannot keep crumping patients alive. I recall quite a few medicine consults that were solely to rescue people from the apes who manage the SICU and transfer them to the medical service.

 

[drfunktacular]

I'm asking the first one.
So far the responses has been quite helpful, so thank you.
I would like to add one more question for anyone here that has been working years in IM field : what is the best and worst thing from IM ?

Best:

• lifestyle is better than many other specialties (rheumatologist)
• no true emergencies
• hardly ever have to go to the hospital
• interesting disease processes, lots of thinking about immunology
• intellectual satisfaction with interesting cases (although they are few & far between--still lots of back pain & fibro)
• see the most interesting bits of lots of other specialties like inflammatory eye disease, weird skin diseases, etc
• can make a tremendous difference in people's lives controlling bad RA, vasculitis, tophaceous gout, etc

Worst:

• income is worse than many other specialties (but still pretty good tbh)
• people want to tell me about EVERYTHING (most of my notes reference upwards of 8 separate complaints), even when it's entirely unrelated
• dealing with chronic noninflammatory pain that PCPs try to dump on me "because it's arthritis" when it's not
• dealing with the people who have lupus, Lyme disease, ankylosing spondylitis, Behcet's disease AND Still's disease according to WebMD and won't be convinced otherwise