Parents unhappy with my specialty choice. Wat do?

[jdh71]

What am I missing here @MOHS_01 ???

I'm clearly a bad, misguided person right??

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[DermViser]

I had no idea that dermatology treat more than just rashes. Tell me more about this

<insert willy wanka meme here>

Since you don't wish to have an actual real, mature discussion on the topic there's no point in trying to convince you. You're being just like instatewaiter.

 

[DermViser]

Ok let me make it more clear. I don't want to be scrubbed into a long surgery in any room on my feet all day long in one spot where I cannot move from or sit down for 5 seconds so I don't contaminate something.

Ok, so then you're ok with being on your feet all day, just not one patient for a very extended period of time.

 

[jdh71]

Ok let me make it more clear. I don't want to be scrubbed into a long surgery in any room on my feet all day long in one spot where I cannot move from or sit down for 5 seconds so I don't contaminate something.

GI will be a nice mix of non-sterile OR procedures and clinic.

Yes fellowship will be hard, especially the first year, which is the way it is everywhere but you'll find the mix you like as an attending.

 

[jdh71]

Since you don't wish to have an actual real, mature discussion on the topic there's no point in trying to convince you. You're being just like instatewaiter.

Lol. What is there is have a discussion about? Seriously?

What is it that you think I'm saying?

 

[JP2740]

Ok, so then you're ok with being on your feet all day, just not one patient for a very extended period of time.

Yep pretty much

 

[SouthernSurgeon]

You're kidding right? Have you actually worked a full month with a GI fellow?

Also, if you're not operating, you're not in the OR. I can do a skin punch biopsy in this room:

That doesn't mean I'm in the OR.

That looks like the set of a horror movie

 

[DermViser]

Lol. What is there is have a discussion about? Seriously?

What is it that you think I'm saying?

You're convinced that all dermatologists do, even those in AMCs, is treat "rashes". Hence nothing to discuss since you're thoroughly convinced of this.

 

[DermViser]

That looks like the set of a horror movie

Yeah, I tried to find one without actual surgeons in it, and didn't look so modern that an actual hospital doesn't have. The usual operating rooms in hospitals have that ugly bathroom tile look vs. this one:

 

[jdh71]

You're convinced that all dermatologists do, even those in AMCs, is treat "rashes". Hence nothing to discuss since you're thoroughly convinced of this.

Incorrect.

No wonder so many people think you are a troll.

I'm certain dermatologists do more than that!! Haha.

 

[DermViser]

That's what I figured. I still want a good salary and time to dedicate to hobbies and ****. Hopefully I didn't **** up there.

You can still have time for for **** no matter what specialty.

 

[jdh71]

That's what I figured. I still want a good salary and time to dedicate to hobbies and ****. Hopefully I didn't **** up there.

Nah. Between colonoscopies and EGDs, you'll sit.

 

[DermViser]

Incorrect.

No wonder so many people think you are a troll.

I'm certain dermatologists do more than that!! Haha.

With all due respect, you're the one who said it, and you've been doing nothing but trolling and being antagonizing in this thread on every aspect.

 

[jdh71]

So do yall think those are legit reasons for picking GI over a lifestyle glamorous specialty lol

Seems reasonable on paper. But you need to go with your gut. What you like to do.

 

[DermViser]

So do yall think those are legit reasons for picking GI over a lifestyle glamorous specialty lol

No. Mainly bc one of your major reasons is salary.

 

[jdh71]

With all due respect, you're the one who said it, and you've been doing nothing but trolling and being antagonizing in this thread on every aspect.

I've never had so many likes from one single threads before! Lol. A bit odd for someone who is just "trolling".

I think you're reading the entire thing from some odd skewed perspective. Try a little insight.

I've never said that the only thing derm does is treat rashes. Everyone has a role, an important role. All I've said is that some of us clearly take much more responsibility than others when it comes to patient care to which a few of you didn't like the implications.

 

[DermViser]

I've never had so many likes from one single threads before! Lol. A bit odd for someone who is just "trolling".

I think you're reading the entire thing from some odd skewed perspective. Try a little insight.

I've never said that the only thing derm does is treat rashes. Everyone has a role, an important role. All I've said is that some of us clearly take much more responsibility than others when it comes to patient care to which a few of you didn't like the implications.

The "Would you eat a poop hot dog thread to get into the medical school of your choice" thread also gets a lot of likes also. Equating number of likes to trolling doesn't really make sense.

The only thing you've mainly said in this thread is that IM isn't 80 hours a week (which is debatable since you're using outpatient electives to heavily bring down the average, FREIDA is accurate (again debatable, since it's well known how inaccurate it is), etc. You came initially talking about how much it sucked to be you even though you didn't know it (sarcasm I know). No one was even talking about that.

 

[DermViser]

Careful Derm, as he stated, we're doing "God's work". For real.

jdh71 said General Medicine is God's work. He's not doing general medicine. He's a Pulmonary/Critical Care specialist.

 

[DermViser]

It's hard to predict where a field is going to go with reimbursement in the future. Most specialties will be going down, yet no one knows how far down. I don't think lower salary will make me hate my choice, but making a decision today, yes salary is one of the reasons for my specialty - no matter what I ended up picking.

Yes, most specialties will be going down. No doubt. The federal govt. feels that doctors do way too many procedures (no matter how justified) and that we should not be reimbursing based on fee-for-service but based on actual patient outcomes. By the time you're well into practice, fee-for-service likely will no longer exist, something GI currently benefits from. Take that for what it is. No specialty will have all good and no bad. It's the good that you like, and bad that you are able to live with.

 

[Dral]

Saved her life.

You are titrating her cholesterol meds?

Nope. I leave that job to the *cough* real doctors.

I'll be she can't wait for her savior to manage her metoprolol one day. Maybe Moses will part the seas and bring her some Metformin eventually.

We can only hope...we can only hope. heheh.

I actually understand what you mean by 'real doctor'. I'm not really offended. I'm actually happy with treating warts, acne, and the occasional psoriasis. I mean, if Derm was the bread and butter of medicine, we would spend more than like 2 lectures on it in med school.

 

[MOHS_01]

What am I missing here @MOHS_01 ???

I'm clearly a bad, misguided person right??

The worst. Clearly.

 

[MOHS_01]

Saved her life.

You are titrating her cholesterol meds?

Well... to be fair... it does kinda help to have a *correct* diagnosis. Of course we could pontificate on the differential for an hour on rounds... then have the student page the "doctor" on call to find out WTF that weird rash is.

Heh.



(nevermind me, I'm just trolling while waiting in line for the after hours' access to my safety deposit box -- I have another wheelbarrow's worth to do something with from today).

 

[fancymylotus]

Well... to be fair... it does kinda help to have a *correct* diagnosis. Of course we could pontificate on the differential for an hour on rounds... then have the student page the "doctor" on call to find out WTF that weird rash is.

Heh.



(nevermind me, I'm just trolling while waiting in line for the after hours' access to my safety deposit box -- I have another wheelbarrow's worth to do something with from today).

All those gold doubloons...damn. Why on earth didn't Kaus do derm instead being so hellbent on surgery?! Argh

 

[jdh71]

The "Would you eat a poop hot dog thread to get into the medical school of your choice" thread also gets a lot of likes also. Equating number of likes to trolling doesn't really make sense.

The only thing you've mainly said in this thread is that IM isn't 80 hours a week (which is debatable since you're using outpatient electives to heavily bring down the average, FREIDA is accurate (again debatable, since it's well known how inaccurate it is), etc. You came initially talking about how much it sucked to be you even though you didn't know it (sarcasm I know). No one was even talking about that.

The number of likes by reasonable folks posting in a serious conversation does seem a bit different . . .

It's not a definitive sign but does corroborate my non troll claim.

 

[jdh71]

Nope. I leave that job to the *cough* real doctors.

I'll be she can't wait for her savior to manage her metoprolol one day. Maybe Moses will part the seas and bring her some Metformin eventually.

We can only hope...we can only hope. heheh.

I actually understand what you mean by 'real doctor'. I'm not really offended. I'm actually happy with treating warts, acne, and the occasional psoriasis. I mean, if Derm was the bread and butter of medicine, we would spend more than like 2 lectures on it in med school.

You guys don't have to take offense when none is intended. It's a free country though. But I'm glad to hear you understand what I meant.

 

[jdh71]

Well... to be fair... it does kinda help to have a *correct* diagnosis. Of course we could pontificate on the differential for an hour on rounds... then have the student page the "doctor" on call to find out WTF that weird rash is.

Heh.



(nevermind me, I'm just trolling while waiting in line for the after hours' access to my safety deposit box -- I have another wheelbarrow's worth to do something with from today).

My wife has been intercepting my wheelbarrow.

And restoration hardware is rip off junk. I hope you broke down and got some better stuff.

On another note I just got done with a nice long interesting conversation with one of our CV surgeons. Gotta be flush cash come contract negotiation time. It's a good thing they are paying me by the truck load!!

 

[Danbo1957]

jdh71 said General Medicine is God's work. He's not doing general medicine. He's a Pulmonary/Critical Care specialist.

Derm. Really? Frankly, it's been interesting reading jdh71's posts over the years and his route through it all. (That and his ability to keep from getting banned from this site, given the trigger-happy moderators around here.) I've worked in GIM for thirty years, it is God's Work (but so is pulling an appendix at three in the morning, or doing 24 hours straight in the ICU )... saving lives, son.

 

[DermViser]

Derm. Really? Frankly, it's been interesting reading jdh71's posts over the years and his route through it all. (That and his ability to keep from getting banned from this site, given the trigger-happy moderators around here.) I've worked in GIM for thirty years, it is God's Work (but so is pulling an appendix at three in the morning, or doing 24 hours straight in the ICU )... saving lives, son.

I didn't say it wasn't God's work. I'm just saying that jdh71 is not doing God's work as defined here, bc he's not a generalist. He's a specialist.

 

[Rocher]

The number of likes by reasonable folks posting in a serious conversation does seem a bit different . . .

It's not a definitive sign but does corroborate my non troll claim.

You are the man, always love reading your posts. I get tired of the IM bashing day in and day out so it's nice to hear an attending with a positive perspective.

 

[jdh71]

I didn't say it wasn't God's work. I'm just saying that jdh71 is not doing God's work as defined here, bc he's not a generalist. He's a specialist.

ICU is generalist work at the extreme ends of the physiology.

I am not a generalist in pulmonary clinic.

 

[MOHS_01]

My wife has been intercepting my wheelbarrow.

And restoration hardware is rip off junk. I hope you broke down and got some better stuff.

On another note I just got done with a nice long interesting conversation with one of our CV surgeons. Gotta be flush cash come contract negotiation time. It's a good thing they are paying me by the truck load!!

RH - just lighting.

 

[DermViser]

ICU is generalist work at the extreme ends of the physiology.

I am not a generalist in pulmonary clinic.

You're a Pulmonary/Critical Care specialist. In the ICU you are a specialist -- Critical Care (intensivist).

 

[jdh71]

RH - just lighting.

Man I got some bar stools from there because my wife got anxious. Which I still haven't seen yet. Paid too much for them. They have crap customer service.

 

[Priapism4tooLong]

You are the man, always love reading your posts. I get tired of the IM bashing day in and day out so it's nice to hear an attending with a positive perspective.

Lol you are so cocky, I guess that helps in ICU.

oh **** not you rocher, i meant @jdh71 stupid iPhone mobile app

 

[jdh71]

You're a Pulmonary/Critical Care specialist. In the ICU you are a specialist -- Critical Care (intensivist).

It's a general specialty I take care of all the organs - I manage all the consultants if I get them, honcho the procedures, make sure nutrition and PT have seen my patient and if I transfer out to the floor and the stay will be short I work like a hospitalist, arrange for discharge.

ICU is just a place to put patients who need nursing and life support.

 

[jdh71]

Lol you are so cocky, I guess that helps in ICU.

oh **** not you rocher, i meant @jdh71 stupid iPhone mobile app

I'm not cocky. I am confident in my own abilities and you need to be when you are the last house on the block for the super sick. I don't always know everything to the level I'd like and when I don't I ask for help or know how to figure it out. That's not cocky. It's just part of the job.

 

[Priapism4tooLong]

Yep. Not too long ago I was called on a consult for a rash on this 38 yo's body. She had it for about a month...really itchy. Within 30 seconds I was telling the consultant to get a lipid panel. They looked at me all confused. I said "just please do it".

Eruptive Xanthomas

I think her TGs were over 1400...could have very well saved her life...or least a bunch of morbidity.

are you honestly comparing this situation to an intensvists job?

haha, im not hating on derm but thats funny

 

[Priapism4tooLong]

I'm not cocky. I am confident in my own abilities and you need to be when you are the last house on the block for the super sick. I don't always know everything to the level I'd like and when I don't I ask for help or know how to figure it out. That's not cocky. It's just part of the job.

haha i wish i had that confidence in ICU, its coming slowly however.

 

[jdh71]

haha i wish i had that confidence in ICU, its coming slowly however.

It takes time.

 

[jdh71]

Derm. Really? Frankly, it's been interesting reading jdh71's posts over the years and his route through it all. (That and his ability to keep from getting banned from this site, given the trigger-happy moderators around here.) I've worked in GIM for thirty years, it is God's Work (but so is pulling an appendix at three in the morning, or doing 24 hours straight in the ICU )... saving lives, son.

The admins won't talk about administrative action by policy but I'd bet I'm the most post-held person posting on SDN who has not gotten banned. Which is mostly a miracle. I think that someone near the top had a soft spot for me even though I was often barely off the chain.

I think between bouts of getting in trouble it had always helped that I post a lot of helpful stuff.

Though I seem to have figured out a way not to get into any trouble these days which is good. It's been three years since I had a post hold and I don't think I'll ever get another.

 

[Nasrudin]

Exactly. I think its often not easy to depersonalize oneself and the experience in order to see the bigger picture.

And maybe all the more reason to get rid of just straight pre-lim positions, especially in surgery UNLESS the prelim is a surgical intern for a surgical sub-specialty like ortho, ENT, or urology.

So I'm happy with where we've left it personally. But there is something you're ignoring about the structure of your field and the need to pull in labor. It takes a senior to supervise twice as many interns. So you don't need twice as many seniors the next year.

There is just too much clerical labor to be done. So you guys subcontract it out.

I'm on one end of the spectrum for workload, it would seem. When work hours shrink to 60 hours who doesn't feel differently about their life. And more positive about what their involved in.

But just once I'd like you guys to months of interning in a completely unrelated field. And get scolded for not attending academics and conferences in child psychiatry or anesthesiology despite that it pushes a crappy day into the night without the room to get work done.

We're that the case. The army that is IM would be as vociferous as I am with their distaste. It's just so damned assumed that medicine is the center of the universe that it's impossible to relate to you what it's like to be your pissed on guest.

Most people hate psych. You'd guys would flip if this whole thing was switched.

And one more time for the record. I'm just as good at this stupid intern job as any categorical. And I'm not bragging when I say it. It's more of a sinking feeling. Like being good at doing your taxes.

The positive. I like the people I'm working with. This medicine program picks great people. That wraps up the positives.

 

[eastcoastdr]

I know this conversation has steered away from the original topic at hand, but I wanted to respond to the OP since I went through the exact same thing last year when I was applying for residency. I too am Asian (Indian to be exact), my parents supported me part of the way through med school, and we have a close relationship as well. I chose psychiatry and my parents were PISSED. We fought for months about this, my parents thought I was throwing my career away to be what they basically considered a "guidance counselor". They also thought I was lazy and was shying away from other fields like med and ob/gyn because I didn't want to "work hard". They also had a LOT of stigma towards mental health. But I stuck to my guns and I kept re-iterating to my parents that I had done my research into various specialities and busted my ass on each of my core rotations before deciding upon psychiatry. I calmy and clearly explained my reasons for wanting to do psych. I also explained to them what it is exactly, that a psychiatrst does. I showed them TED videos about the importance of mental health. Sent them articles written by Indian psychiatrists. Did everything I could to show that I was serious about my chosen field. Eventually they came around. By match day, my parents were actually happy for me. Every now and then they still make cracks about me going "crazy" in the future from dealing with all my patients but I think they are generally pretty proud. My advice to you OP, is to stick to your guns. Do not apply to a field that you wouldn't be happy in. Don't get into arguments with your parents, just keep your cool and keep educating them on why you choose IM. Eventually they will come around. Good luck OP

 

[JP2740]

I know this conversation has steered away from the original topic at hand, but I wanted to respond to the OP since I went through the exact same thing last year when I was applying for residency. In fact if you search under my name, I'm sure you'll find a nice, long dramatic post started by me around this time last year lol. I too am Asian (Indian to be exact), my parents supported me part of the way through med school, and we have a close relationship as well. I chose psychiatry and my parents were PISSED. We fought for months about this, my parents thought I was throwing my career away to be what they basically considered a "guidance counselor". They also thought I was lazy and was shying away from other fields like med and ob/gyn because I didn't want to "work hard". They also had a LOT of stigma towards mental health. But I stuck to my guns and I kept re-iterating to my parents that I had done my research into various specialities and busted my ass on each of my core rotations before deciding upon psychiatry. I calmy and clearly explained my reasons for wanting to do psych. I also explained to them what it is exactly, that a psychiatrst does. I showed them TED videos about the importance of mental health. Sent them articles written by Indian psychiatrists. Did everything I could to show that I was serious about my chosen field. Eventually they came around. I think what really changed is when my parents reached out a psych attending that was a friend of a friend. They spent some time talking to this psychiatrist on the phone and I think after hearing about how he had made quite a good life for himself, they really started to relax on the issue. Come match day, my parents were actually happy for me. Every now and then they still make cracks about me going "crazy" in the future from dealing with all my patients but I think they are generally pretty proud. My advice to you OP, is to stick to your guns. Do not apply to a field that you wouldn't be happy in. Ask your mom to reach out to established IM attendings, so she can get a better understanding of what they do. Don't get into arguments with your parents, just keep your cool and keep educating them on why you choose IM. Eventually they will come around. Good luck OP

Big block o txt. Srs this should be a new psych diagnosis. I'm naming it after myself.

 

[fancymylotus]

Since I cannot Botox myself in however many years I need to, I have deemed dermies acceptable

I want mohs monies

Also stop grouching at @jdh71 everyone. Now.

 

[jdh71]

So I'm happy with where we've left it personally. But there is something you're ignoring about the structure of your field and the need to pull in labor. It takes a senior to supervise twice as many interns. So you don't need twice as many seniors the next year.

There is just too much clerical labor to be done. So you guys subcontract it out.

I'm on one end of the spectrum for workload, it would seem. When work hours shrink to 60 hours who doesn't feel differently about their life. And more positive about what their involved in.

But just once I'd like you guys to months of interning in a completely unrelated field. And get scolded for not attending academics and conferences in child psychiatry or anesthesiology despite that it pushes a crappy day into the night without the room to get work done.

We're that the case. The army that is IM would be as vociferous as I am with their distaste. It's just so damned assumed that medicine is the center of the universe that it's impossible to relate to you what it's like to be your pissed on guest.

Most people hate psych. You'd guys would flip if this whole thing was switched.

And one more time for the record. I'm just as good at this stupid intern job as any categorical. And I'm not bragging when I say it. It's more of a sinking feeling. Like being good at doing your taxes.

The positive. I like the people I'm working with. This medicine program picks great people. That wraps up the positives.

You complain that medicine is the center of the hospital yet universe, yet there it is, actually at the center of the hospital universe. Medicine feeds everyone else unless the chief complaint is definitely one other services only. You might as well rail at the sky for its blueness.

Places without prelims don't usually run two intern medicine teams. One intern. One senior. They split the list.

You biggest complaint is really that your program allows you to be fed to the wolves. If you think your time would be better spent in clinic or the ED, I think that's what you should speak too. Though it may be that your system relies on a psych intern for all months for man power. Which again is more of an individual systemic problem than a problem with internal medicine itself.

 

[Dral]

are you honestly comparing this situation to an intensvists job?

haha, im not hating on derm but thats funny

I didn't say that, but since you bring it up, how is something like treating a cancer patient different than intubating someone? A life possibly saved is a life possibly saved regardless of time course.

Comparing a single case to a career is like comparing a case report to a valid meta analysis. I'm not quite sure how you drew your conclusion from my post (assuming your question was not rhetorical).

You're free to hate on Derm if you'd like. It's pretty commonplace around here. It doesn't bother me. I'm pretty secure with my career choices and love what I do...wouldn't do anything else.

 

[Dral]

Since I cannot Botox myself in however many years I need to.

You most certainly can. I know someone who does their own lips.

 

[fancymylotus]

You most certainly can. I know someone who does their own lips.

No. I have it all figured out. I have a dermie friend who is going to take care of those needs for me and in turn I will take care of his dental care.

 

[Dral]

Funny you say that. I was at my dentist a few weeks ago and we got on the topic of Botox. I was telling her how to get it started in her practice.

 

[Priapism4tooLong]

I didn't say that, but since you bring it up, how is something like treating a cancer patient different than intubating someone? A life possibly saved is a life possibly saved regardless of time course.

Comparing a single case to a career is like comparing a case report to a valid meta analysis. I'm not quite sure how you drew your conclusion from my post (assuming your question was not rhetorical).

You're free to hate on Derm if you'd like. It's pretty commonplace around here. It doesn't bother me. I'm pretty secure with my career choices and love what I do...wouldn't do anything else.

I just thought you were comparing who saves more lives, since you quoted jdh and the whole context of the convo.

And I agree a life saved is a life saved no matter how it's done.

And i will never hate on derm. A few of my family members were dermatologists. I know it's a lot of complex things involved. Also it got me lots of awesome toys growing up.