Residents, What do you not like about your specialty?

[Leukocyte]

It is very rare to find a person who is 100% satisfied with EVERYTHING in his/her chosen specialty. So, what are the things that you do not like about your chosen specialty? Feel free to contribute anything that YOU PERSONALLY do not like about your specialty. This is your place to open up and vent.

This would be very helpful for us MS-3s/MS-4s who are still clueless as to what specialty to get into.

Thank you very much (in advance) for your helpful contribution.

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[lf777]

Hi

I am almost done with PGY-2 IM

What I do not like about it:
- Primary care (obviously I'll be a subspecialist)
- Being the (almost) dumpster of the hospital. Not being able to refuse patients to our service. If any pt comes and are deemed "medically complicated" (veeeery subjective), there are no questions asked: dump him/her in a Medical svc and other services "will follow" (yeah right)

But IM is very interesting that you do establish a lot of rapport with patients, and the mental part of it is great. No question that there are a lot of things that are not the greatest, but I'd do it again if I had to.

good luck to all !
lf

 

[Apollyon]

Finishing my EM-1 year.

What do I HATE? Off-service rotations, where I'm like the guy running in the race who finishes, but, like, 10 meters behind everyone else. I am NOT a neurologist, cardiologist, anesthesiologist, obstetrician, or surgeon, and this is amply reinforced without interruption (except for my EM months).

 

[prominence]

could any residents in pm&r, anesthesiology, or psychiatry please comment on this thread?

 

[Whisker Barrel Cortex]

I would say the part of radiology that bothers me the most is the rude behavior and adversarial attitude some clinicians have toward radiologists. We do our best to be helpful, and most clinicians are appreciative and have a good attitude. Some, however, lack the simple courtesy of treating a fellow physician with respect. When we ask for history, we are not doing it to try to get out of work, we are doing it to either provide you with a better study and better interpretation, or to best utilize the limited hospital resources. Treat your radiologists well and often they will go out of their way to help you. Treat them like crap, and you will get the same back.

 

[theD.O.C.]

Well somebody asked for a PM&R guy to answer this question....
This is kind of hard because there really is so much to like about this field if you're into biomechanics and more practical medicine. So here goes:
1. Residency sucks- more of a general complaint
2. Not having a specific pathology we can call "ours"- sounds silly but PM&R docs are "doctors of function" We improve a patient's ability to live, work and enjoy their lives in their environment after devastating injuries (stroke, spinal cord, brain damage) and not so devasting but still debilitating ones too (sports/ musculoskeletal injuries, chronic pain). As a result, we do alot of cross-disciplinary work. It's a little bit of neuro, a little of orthopedics, a little of infernal medicine, a little therapy, a little biomechanics etc. This can give you an overwhelming sense that we don't "belong" anywhere in the traditional spectrum of medicine.
3. Orthopedic inpatient rehab- these patients are generally routine and on an inpatient rehab can feel like babysitting and cleaning up messes especially since the powers that be want to ship almost all joint replacements to rehab post op day 2 even with fevers dropping crits and desats (oh it's just atelectasis don't worry......)
4. Not enough research in the field- this can be good and bad depending on how much one cares about research. In case some of you do...There are alot of very collaborative and cross-institutional efforts to fix this. One of these is the RMSTP mentorship program adminstered by the Association of Academic Physiatrists (website is physiatry.org). The RMSTP program is a group of academicians from programs all over the country who guide interested PM&R residents in finding research mentors and help with developing grant applications and academic/research postings post-residency.
5. and finally, residency in general sucks.

Hope this helps

 

[Foxxy Cleopatra]

Good question, let me think about this one...

For general surgery:

1. Needle sticks- you will get stuck, multiple times. HIV is of course the first thing that comes to mind, but there is an awful lot of Hep C out there. After taking care of transplant patients and watching what it's like to go through end stage liver disease and a transplant secondary to Hep C, I surely don't want it happening to me.

2. Litiginous issues, malpractice insurance (though this effects other fields of medicine to some extent.) I hate the way it's dictated the way we make decisions, where we can afford to practice, what tests we order, how it makes you feel like you need to be on guard around nearly everyone, need I go on?

3. How much non-operative, BS work you do. Yes, I realize that a part of this is because I am a lower level resident, but my attendings round with us daily on some services for up to 2 hours taking care of non-surgical issues (the endless supply of ortho patients dumped on the surgery service for us to find home health and rehab, filling out forms, pulling teeth to get even simple things done, etc.) This may get better when residency is over but it does not necessarily go away.

4. The sound of a pager going off every 8 minutes all day and night. Feeling absolutely beaten from being so damn tired and getting called again at 2 AM to go put orders in a computer for the nurse.

5. Rude, judgemental, condescending attitudes from other health professionals. Realizing that we're not all necessarily in this together.

6. The inefficient system- waiting hours for rooms to turn over, not being able to get some of the tools you need, tools not working, etc.

7. Hostile patients and families. Having your competancy questioned by them. Being treated like you are no better than a bag of sh#t.

8. Maybe some programs do the 80-hour week but where I come from, there is no way (male or female) you can have a remotely conventional life and do this. Bear in mind that life after residency isn't restricted to 80 hours. I'll get to the point and say there are a lot of very difficult and frustrating things about surgery; don't sign up for it unless you hold such a stong passion for it that you are willing to sacrifice everything (and I do mean everything) else in your life.

 

[IndyXRT]

(the endless supply of ortho patients dumped on the surgery service for us to find home health and rehab, filling out forms, pulling teeth to get even simple things done, etc.)

Interesting. In the hospitals I work in, ortho dumps on IM, not general surgery. Isn't part of being a good carpenter learning how to clean up after yourself?

Anyhow, after spending a year in IM, I'm also discouraged at what a dumping ground it is. It seems that all of the patients nobody else wants to deal with get put on the IM service. But I'm only preliminary medicine, so perhaps my viewpoint is skewed (i.e. it's hard to see the good points when you're doing something just because you have to). It seems to me, though, that IM docs put in an awful lot of work (not just residents, but the guys in academics and private practice as well), and are not adequately compensated (I'm not advocating paying specialists less, but IM guys do deserve more money). Just my two cents.

 

[DrQuinn]

I agree with Apollyon...

Finishing my EM PGY-1 year (almost done!!!!!!!!!!!!!)

And I absolutely abhor off-service months. I am doing neurosurgery now and its blatantly obvious that I am not a neurosurgery resident (although they are asking me to do their post-op checks on surgeries I can't even pronounce). I just want to be back in the ED shoveling through the charts.

Q, DO

 

[mdblue]

1. Turnover rate of in-pt unit
2. Recycling of D/A pts if you are working in a downtown hospital
3. Only stressing the med-mgt part and carrying the same attitude over in a real-world job
4. Amount of paperwork
5. Diagnosing everyone(all D/A) as bipolar so that they are eligible for SSI

 

[hans19]

I'm a rads resident doing an elective month in rads at a Private Hospital.

Unlike other fields there are no 'dumps' from ortho, there are minimal needle sticks unless you do interventional, not a whole lot of social work, No drug seekers, No GOMERS (just their films), No fibromyalgia patients.
You work hard, then go home.

If theres anything at all I dislike, its minor stuff.
IE being interrupted for a wet read in the middle of a dictation, and losing train of thought. But whatever, it comes with the territory.

Calls can be rough, believe it or not. You are up pretty much all night, non-stop reading films. Its hard to concentrate full-on for hours at a time. There isn't a whole lot of down time during call. My eyes get real dry and vision blurs sometimes.

Then there are the perceived threats to the field such as
Turf wars with cards or vascular surg for interventional rads and the fear of outsourcing.

In reality these private interventional rads guys are doing anything they are capable of doing. Its a free market out there, and if you are good at what you do and can provide good service, you won't be short of business. As for outsourcing, this group is huge and is still hiring. This group provides telerads coverage for remote parts of the state. No body is having problems putting food on the table.

But thats peanuts compared to the BENEFITS.

Most of the attendings I have worked with seem happy. (I say 'most' because I don't like generalize with 'ALL' or 'NEVER'.) But to rephrase, I have not seen an attending, unhappy with his/her job. I have HEARD of unhappy rads that are going through a nasty divorce, or that have had one too many malpractice suits. But this is the exception rather than the rule.

Rads really is intellectually challenging and diverse. These private guys are expected to read almost any kind of study.
These private interventional guys are doing a lot of cool procedures. And it always seems like theres an attending getting back from or going on vacation.

Of course, the 'best' field to go into is the one you are most interested in.
But if you really happen to be interested in rads, in my heavily biased opinion , it offers a lot more benefits and a lot less B.S.

It is one of the better of the 'bests'.

 

[amdap]

peds: negligent, disinterested parents who want their kids to be perfect but aren't willing to accept their own role in childcare

 

[amdap]

got that, Fab?

 

[Fabio]

Also for peds: little respect and lowest-paid - but we still love what we do! (or are about to do)

Got it, amdap.

 

[prominence]

1. Turnover rate of in-pt unit
2. Recycling of D/A pts if you are working in a downtown hospital
3. Only stressing the med-mgt part and carrying the same attitude over in a real-world job
4. Amount of paperwork
5. Diagnosing everyone(all D/A) as bipolar so that they are eligible for SSI

whats D/A? is it depression/anxiety?

whats SSI?

 

[edinOH]

Pissed-off consultants who don't like the fact they are on-call.

Along those lines, mediating turf wars between consultants who don't want to accept responsibility for the care of a particular pt.

Having every decision you make ultimately critiqued/criticized by your admiting colleagues.

Every other specialist thinks they can do your job better than you can, but none are willing to actually step up to the plate and take a swing.

The constant threat of litigation.

Nights and weekends. Just a fact of life in EM and most other fields for that matter. Still, I can see how this, especially nights, can become a big pain in your ass as your career progresses.

Despite all these things, I love EM and honestly wouldn't be happy doing anything else. My philosophy has become, "If you have to have a job, EM isn't a bad one to have".

Ultimately you just have to pick your poison. All fields have their share of BS, you just have to chose the flavor you prefer.

 

[edinOH]

whats SSI?

Sliding Scale Insulin of course!

 

[Leukocyte]

Sliding Scale Insulin of course!

Oh boy, and I always thought it was RISS (Regular Insulin Sliding Scale)

SSI = means on welfare/disability/social security assistance

By the way, To everyone who posted, THANK YOU.

 

[prominence]

are there any residents with any anesthesiology feedback for this thread?

 

[lf777]

A lot of these complaints are just about residency in general. Whatever you specialty is (or will soon be), there is a lot of crap that residents have to take. Pagers, bad nurses are just the beginning. I always thing of this as a temporary pain. Someone will be your intern or your on call resident eventually, so a lot of that pain will not follow you (most likely)...

I have 1 year, 14 days of IM left. Then off to fellowship, where the grass is (supposedly) greener.

lf

 

[mdblue]

whats D/A? is it depression/anxiety?
drug n alchohol= substance abuse/dependence (according to DSM)

whats SSI?

Disability...BTW that was funny edinOH

 

[ERMudPhud]

A lot of these complaints are just about residency in general.

This is especially true about the IM dumping ground complaint. I now work in a private hospital and the hospitalist admit all kinds of stuff that would have driven them crazy in residency. In fact the ortho service has preprinted admit order that only specificy orthopedic issues and then have a check box (which they usually check) that says "call hospitalist service" for preop clearance and all medical issues. Its good for the hospitalists since they get paid for each patient they see and its good for the patient since they have somebody who actually cares about and understands their medical issues managing the rest of their care. Its not just ortho either, many of the other surgical subs, and virtually all neuro admits go through the hospitalists.

 

[supercut]

General surgery

Talk about dumps...

The trauma service (and thus the general surgery residents) take care of all orthopedic and neurosurgery trauma pts (unless the pt has no medical issues and has either an isolated neuro or single orthopedic injury...otherwise they are "multiple trauma" and thus come to the trauma service

Any pt who has an interventional radiology diagnostic procedure (for vascualar diagnosis) gets dumped on the vascular surgery service (and thus is cared for my the general surgery residents). They have a check box type order system that basically only has on it two things...how long the pt is to remain supine and a box that says "resume all home meds". This despite the fact that we have a computerized order system and paper orders are invalid everywhere in the hospital except the interventional suite (Oh, to be able to do a procedure and bill for it and then have someone else write the orders, deal with any issues and discharge the pt for you!)

Transplant: everyone who has ever had a transplant who subsequenetly gets admitted to the hospital for any reason gets dumped on the transplant service! (and is thus taken care of by general surgery residents)

Other things I don't like about general surgery:

Long hours. My program does a pretty good job at keeping our hours limited to 80, though generally not as much for upper level as for lower level residents. Still, many other specialties you work less than 80 hours. Plus I have some clinical responsibility most weekends. Makes it hard to do things outside of work (not impossible, just hard)

The attitude of other specialties toward you: Most people think surgeons are stupid and all we want to do is cut. Of course we don't keep up with the latest in managine difficult HTN or DM. We are keeping up with the latest in our field. But at the same time I routinely see that other specialties do a poor job of initial workup of problems they think their pts have that might be surgical. And sometimes they think that they should just be able to tell us to operate on a pt and we should just comply with their wishes (eg a pt in the ICU with ARDS, worsening liver and kidney function, who has been unresponsive for weeks who suddenly develops toxic megacolon. We recommend conservative treatment and the MICU folks demand to know angrily why we wont' operate on this pt!!

The fact that it's a normal part of the culture that you rarely get to eat, and if you do it's ususally junk food from a machine scarfed down very quickly. (ie you barely finish morning rounds in time to get to the OR, then you are in the OR all day with your time between cases taken to make sure the next pt has all the appropriate paperwork...which was usually done in the office prior and is supposed to be faxed over but ususally isnt.)

The back pain that I usually have, worse according to how long I've been on my feet consecutively. No type of shoes, no OTC pain meds seems to make a difference.

The fact that nobody else seems to care if cases start on time. Everybody else in the OR is on shift work and have people to give them a break for lunch. (Anesthesia, scrub nurse, ciruclator....they all get breaks and get relieved at X time. So it doenst' matter to them if there are endless delays...such as paperwork not being ready or instruments not availble or not working, despite the fact that the surgeon has submitted multiple times a card listing in exact detail what instruments, suture, dressing etc. s/he will use for the case, something is often missing)

Attendings who don't care about resident education, who don't care if theres a resident with them or not. Those who think resident/PA/NP are all equivalent. Those who don't let the upper level residents do the case or take junior level residents though the case.

OR nurses/staff who spend more time policing the actions of residents rather than doing their job. (they are quick to report you for percieved infractions but they won't answer your pager during a case)

Since we also use the services of consultants, I too hate being yelled at by the resident on call for that service for calling.

Patients who refuse to participate in their own care. The ones refuse to get out of bed because they have 2/10 pain. Those who expect that post op they should be able to achieve 0/10 pain. Those who can't understand that that advancing diets slowly, leaving NG or foleys in is important for them to heal properly (I don't mind if they tell me they don't like these things...but I expect them to understand that sometimes we have to put up with unpleasant things for our own good)

Angry, hostile pts. (though I'm sure it's not specific to surgery, nearly any specialty would wind up dealing with these pts)

Otherwise, most of the things I hate are either specific to my PGY level (interns are treated the worst) or to my program. Generally, though we have pretty good ancillary services. Most of the things Foxxy complained about in terms of having to deal with social work issues I don't have to do. I just make sure the appropriate social worker knows about the pt and they take care of figuring out where the pt needs to go . Then all I need to do is fill out a short discharge form and dictate a summary.

And ultimately, despite these things, surgery is absolutely the coolest job in the world!!!

 

[Apollyon]

And ultimately, despite these things, surgery is absolutely the coolest job in the world!!!

I'm on trauma this block (as the junior, thank heavens - that intern stuff is the WORST!), and that's something I've noticed/wondered - being in the OR is the absolute end-all, be-all best for surgeons, but how do they tolerate surgical floor patients? If anything can be worse than multi-medically mangled medicine patients, it's post-op patients who've either had a good result (and are, therefore, incredibly boring), or are sick as hell, sometimes terminally, but not sick enough for the unit, can't be operated on, or had an intra- or post-op complication, and are just CTD.

 

[Big Lebowski]

Psychiatry

-I second MdBlue complaint about recycling D/A patients; particularly because they seek help secondary to running out of money and having no where else to stay. The typically admission would be "I used cocaine yesterday, now I'm suicidal....by the way, will I be able to go out and smoke, will I have my own room with a television, can I get double portions of meals?"

-On Call Consults: "assess for competency" which in actuality we cannot do without the court being involved. Half the time, the patient is just not "informed" of the procedure/treatment and the alternatives and therefore unable to make an "informed decision"

-On Call dumps: I'll give an example; 96 y/o women, can barely sit up in bed, no psych hx whatsoever. House was legitamately broken into about one month before I was seeing her (confirmed with son). Brought to ER for mental status changes including visual hallucinations. She is disoriented and clearly delirious; saying she is afraid someone is going to break in to her home. However, very cooperative and pleasent. Neuro calls and gives me their assessment that they believe she has "paranoid schizophrenia" and needs to be admitted to the inpatient psych service of the county hospital(with the other schizophrenics, substance abusers, and multiple county prisoners).

-Sometimes being treated as if I were a social worker.

 

[DrQuinn]

-On Call dumps: I'll give an example; 96 y/o women, can barely sit up in bed, no psych hx whatsoever. House was legitamately broken into about one month before I was seeing her (confirmed with son). Brought to ER for mental status changes including visual hallucinations. She is disoriented and clearly delirious; saying she is afraid someone is going to break in to her home. However, very cooperative and pleasent. Neuro calls and gives me their assessment that they believe she has "paranoid schizophrenia" and needs to be admitted to the inpatient psych service of the county hospital(with the other schizophrenics, substance abusers, and multiple county prisoners).

-Sometimes being treated as if I were a social worker.

Yeah dont' you hate those new onset 96 year old schizophrenics?!

Q, DO

 

[gaslady]

I'm on trauma this block (as the junior, thank heavens - that intern stuff is the WORST!), and that's something I've noticed/wondered - being in the OR is the absolute end-all, be-all best for surgeons, but how do they tolerate surgical floor patients? If anything can be worse than multi-medically mangled medicine patients, it's post-op patients who've either had a good result (and are, therefore, incredibly boring), or are sick as hell, sometimes terminally, but not sick enough for the unit, can't be operated on, or had an intra- or post-op complication, and are just CTD.

Post op patients who have done well may be boring but there's much worse than that, like when they do poorly and you feel horrible about it. I much prefer rounding on someone who asks when the staples will be out versus worrying about why their belly is still distended and could they be perforated.

 

[Winged Scapula]

Management of decubitus ulcers or the dreaded "non-healing wound under a large pannus./ ?candidate for panniculectomy" consult.

Oh, the glamour of it all!

 

[Foxxy Cleopatra]

Management of decubitus ulcers or the dreaded "non-healing wound under a large pannus./ ?candidate for panniculectomy" consult.

Oh, the glamour of it all!

Those (panniculectomy consults) are my favorites!

The best one was recently when we got called to work up an "abdominal mass" on a 600+ lb patient transferred in from a nursing home. Before seeing the patient, I was flipping through the chart and read the medicine resident's H&P. On the physical exam, it said, "large abdominal mass, catheter in place though unsure if it is a regular foley or suprapubic." I thought, "how could you NOT tell whether the catheter was in the phallus?"

Then I examined the patient; there was no CT (patient was too big, and as far as I know, no one had checked to see if the zoo would do it); the "abdominal mass" in question was a HUGE piece of pannus overhanging the groin area. So I gave it my greatest attempt to lift it to see if I could spot the origin of the catheter and I couldn't- I couldn't even lift it far enough to see the guy's privates.

I therefore called my chief, who was considerably larger and with more upper body strength than I and together we still couldn't lift the pannus far enough. Needless to say, the attending didn't even consider doing an elective panniculectomy.

The patient actually was a nice guy and I felt bad for him but it was hard to explain what we were trying to do with a straight face.

 

[Whisker Barrel Cortex]

Those (panniculectomy consults) are my favorites!

The best one was recently when we got called to work up an "abdominal mass" on a 600+ lb patient transferred in from a nursing home. Before seeing the patient, I was flipping through the chart and read the medicine resident's H&P. On the physical exam, it said, "large abdominal mass, catheter in place though unsure if it is a regular foley or suprapubic." I thought, "how could you NOT tell whether the catheter was in the phallus?"

Then I examined the patient; there was no CT (patient was too big, and as far as I know, no one had checked to see if the zoo would do it); the "abdominal mass" in question was a HUGE piece of pannus overhanging the groin area. So I gave it my greatest attempt to lift it to see if I could spot the origin of the catheter and I couldn't- I couldn't even lift it far enough to see the guy's privates.

I therefore called my chief, who was considerably larger and with more upper body strength than I and together we still couldn't lift the pannus far enough. Needless to say, the attending didn't even consider doing an elective panniculectomy.

The patient actually was a nice guy and I felt bad for him but it was hard to explain what we were trying to do with a straight face.

** Shudders with thought of panniculitis during internal medicine internship ****

I had a guy that I was cross covering on last year at the VA. This guy was 600lbs give or take 100lbs. He was well known to the entire staff. He had gained so much weight, that he was affecting his respiration. He couldn't breath with all that weight. He was hypercapneic and had to be on CPAP just to maintain his oxygenation. When he was signed out to me, he was full code and I was advised that he was very ill and might need ICU care by the end of the night. He was mostly just sleepy due to the hypercapnea. I got called to see him at 10pm because he wouldn't wake up. I tried as hard as I could to wake him, but couldn't. With the though of possible ICU transfer (open unit) and intubation, I called my senior, who promptly came up and somehow inflicted enough pain to wake him up.

So at midnight, I get paged again. The nurse says that his daughter had brought him a burger from the vending machine downstairs (disgusting burgers) and he was going to eat it, taking off his CPAP to do so. So I came up there and basically told him that I couldn't prevent him from eating, but that there was a risk he could die. I acknowledged his desire to eat, but asked him if he was willing to die for the crappy, disgusting burger from the vending machine downstairs. After a half hour discussion, I finally presuaded him not to eat it. That was one of my favorite success stories from internship: I persuaded a 600lb man NOT to eat!

 

[hans19]

Had a 'code brown' the other night.
Called to see an unresponsive patient in arrest. On my arrival, the room was smelling not-nice . Apparently the pt, an elderly lady in the 70's, s/p recent brain stem infarct, on vent, full code, had just had a BM, then became bradycardic, then lost pressures, then asystole. A few compressions, a little atropine and epi later, the pt regained pressures went back into the good 'ole normal sinus. I guess it was all vaso-vagal.
I wouldn't be surprised if she arrests again with her next BM. Pt is still full code .

Hans

 

[elkchaser]

Bente-

Where I'm from, "busting a nut" is not terminology that you would want to use when referring to the gross effort it took to lift a mans pannus to see his cancerous penis. If, in fact, you did almost "bust a nut," perhaps a visit to the psychiatrist is in order, as this is often used as an ejaculatory reference.

 

[tinnsjo]

In neurology clinic, the headache is 'tension', drug w/drawl and other non-pathological headaches.
In ortho rotation, the back patients got to me.
Peds, the parents...I think all the specialties have a dark side.
Urology...bust a nut? Sounds like trauma to me!

 

[Winged Scapula]

The best one was recently when we got called to work up an "abdominal mass" on a 600+ lb patient transferred in from a nursing home. Before seeing the patient, I was flipping through the chart and read the medicine resident's H&P. On the physical exam, it said, "large abdominal mass, catheter in place though unsure if it is a regular foley or suprapubic." I thought, "how could you NOT tell whether the catheter was in the phallus?"

Earlier this year I got a call from the Medicine team stating that they were having some trouble inserting a Foley into one of their ICU patients. Would I mind coming down and having a try?

I thought the same as you did - how can they screw that up? Well the poor gentleman had "pseudo-micropenis" due to the large accumulation of fat around his genitalia which obscured his urethral meatus as well as the rest of his manhood. With a mighty push down into his groins bilaterally, I managed to pop the darn thing out while our intern slid the Foley into this poor man's thang (which was pretty sore after multiple attempts by the nurses and medicine residents). I learned something new that day - but still hope I don't have to do it again.

 

[drusso]

Well somebody asked for a PM&R guy to answer this question....
This is kind of hard because there really is so much to like about this field if you're into biomechanics and more practical medicine. So here goes:
1. Residency sucks- more of a general complaint
2. Not having a specific pathology we can call "ours"- sounds silly but PM&R docs are "doctors of function" We improve a patient's ability to live, work and enjoy their lives in their environment after devastating injuries (stroke, spinal cord, brain damage) and not so devasting but still debilitating ones too (sports/ musculoskeletal injuries, chronic pain). As a result, we do alot of cross-disciplinary work. It's a little bit of neuro, a little of orthopedics, a little of infernal medicine, a little therapy, a little biomechanics etc. This can give you an overwhelming sense that we don't "belong" anywhere in the traditional spectrum of medicine.
3. Orthopedic inpatient rehab- these patients are generally routine and on an inpatient rehab can feel like babysitting and cleaning up messes especially since the powers that be want to ship almost all joint replacements to rehab post op day 2 even with fevers dropping crits and desats (oh it's just atelectasis don't worry......)
4. Not enough research in the field- this can be good and bad depending on how much one cares about research. In case some of you do...There are alot of very collaborative and cross-institutional efforts to fix this. One of these is the RMSTP mentorship program adminstered by the Association of Academic Physiatrists (website is physiatry.org). The RMSTP program is a group of academicians from programs all over the country who guide interested PM&R residents in finding research mentors and help with developing grant applications and academic/research postings post-residency.
5. and finally, residency in general sucks.

Hope this helps

Another thing to hate about PM&R residency are consults on debilitated little 90 year-old patients with "new onset gait difficulties" only to discover that the patient really hasn't walked since the Carter administration. This is certainly not "new."

 

[roja]

-Off service rotations. I am so glad someone else likes this stuff.

-This is more of a generalized comment: I can't stand watching people diss other fields. Nothing is more ridiculous than watching field a bit*h about field B, field b complain about field c, etc etc etc. Be nice people! if you are calling a consult its because its not your area of specialty. You need those people... for christ sake, be polite.

-i HATE having to call and put in 'soft' admissions. having said that, I absolutely let the admitting team know exactly what is goign on.

-CYA medicine.

-STAT labs that take an hour to get.

 

[JKP]

man, this is the funniest thread I've read so far on this website!

 

[soon2bdoc2003]

Just finished my prelim year in IM at a small community hospital, starting anesthesia next week. What I hate the most about IM... dirty thieving geriatricians who want to milk every penny from nursing home patients. Sending patients to different hospitals so they can repeat zillion dollar workups every other month, trying to sneak in every chronic infiltrate as a pneumonia, manipulating families and proxies into allowing unspeakable acts to be comitted on their loved ones. During my 2 months of geriatric hell I would tell people that I torture old ladies for a living so my attendings can have $300,000 watch collections and drive porsches to work. Cant wait to see what happens once these fools are done bleeding medicare dry.

 

[Justin4563]

Anesthesia:
good specialty, intellectual contrary to popular belief.. mostly theoretical...

I hate the fact that i cannot dictate my own schedule.. I am at the mercy of the surgeon.. IF he or she posts a case I have to do it.. I cant say as a surgeon does.. Ill do it tomorrow.. or in the morning....

Most of our expertise are used in the operating room. Most of the people in the hospital dont know how skillful we are at doing some stuff.. I think we are the best in the hospital at putting any line in a patient whether it be pa cathethers a lines blocks spinals etc.. SOme surgeons are very good as well.. if they do it often.. .

I fear malpractice litigation often

the stress is beyond belief at times...

But i like the fact that i dont have to step foot on the floors if i dont want to. ever except for intubations and codes which is a night ****ing mare cluster **** late at night..

I like the fact that i wont be discharging any patients ever.

 

[drboris]

EM residents, what things don't you like about your specialty

 

[roja]

EM residents, what things don't you like about your specialty

There are a ton of things I like about EM. Here are a few:

-shift work: this lets me have a definately life outside of my career. Even residency. My pager (when I can find it) doesn't go off all the time.
-no pager
-No call
-I like having patients come in 'clean' which no partial work up or idea of what is goign on. I like to be the first one who his trying to figure out what is going on.
-I like the fact that EM is still a field where you use your intuition. I may not know exactly why a patient has symptoms X or looks like crap but I can tell they need to be admitted.
-In EM, if you want to take a month to travel, you don't have to worry about covering your patients (just your shifts). I can take 6 mos off and still come back and work.
-I like procedures but don't want to be a surgeon. Suturing, LP's, intubations, etc.. all good.
-Knowing how to run a code.
-Patient diversity. Sometimes it sucks that all your patients aren't clean and wealthy and well behaved. but the ED sees everyone, regardless. Appeals to my idealistic side.
-EM has very interesting people. very diverse. People tend to be very relaxed... perhaps it has something to do with being able to do many things at once. it gives an inner calm.
-I like the pace. I like having many things at once to do. I get bored otherwise.
-I like to think quickily and act quickly. Nothing is more annoying to me to sit on rounds and talk about ordering some test for 40 minutes and then not do it. If you considered it for 40 MINUTES, you probably should just order it! Make a decision!!!!!!!!!!!
-I like the fact that it crosses all fields. I liked all of medical school... EM touches everything: urology, peds, ob/gyn, surgery, IM, optho, ortho, etc etc.

and yadda yadda yadda....

 

[Leukocyte]

There are a ton of things I like about EM. Here are a few:

-shift work: this lets me have a definately life outside of my career. Even residency. My pager (when I can find it) doesn't go off all the time.
-no pager
-No call
-I like having patients come in 'clean' which no partial work up or idea of what is goign on. I like to be the first one who his trying to figure out what is going on.
-I like the fact that EM is still a field where you use your intuition. I may not know exactly why a patient has symptoms X or looks like crap but I can tell they need to be admitted.
-In EM, if you want to take a month to travel, you don't have to worry about covering your patients (just your shifts). I can take 6 mos off and still come back and work.
-I like procedures but don't want to be a surgeon. Suturing, LP's, intubations, etc.. all good.
-Knowing how to run a code.
-Patient diversity. Sometimes it sucks that all your patients aren't clean and wealthy and well behaved. but the ED sees everyone, regardless. Appeals to my idealistic side.
-EM has very interesting people. very diverse. People tend to be very relaxed... perhaps it has something to do with being able to do many things at once. it gives an inner calm.
-I like the pace. I like having many things at once to do. I get bored otherwise.
-I like to think quickily and act quickly. Nothing is more annoying to me to sit on rounds and talk about ordering some test for 40 minutes and then not do it. If you considered it for 40 MINUTES, you probably should just order it! Make a decision!!!!!!!!!!!
-I like the fact that it crosses all fields. I liked all of medical school... EM touches everything: urology, peds, ob/gyn, surgery, IM, optho, ortho, etc etc.

and yadda yadda yadda....

Aaaaaaaa....Dear EM doc, the "patient" presented with a "cheif complaint" OPPOSITE to what you wrote on your "diagnosis list". AGAIN.

Your "friend", Internal Medicine doc.

(Joking, please do not get offended)

 

[!dr_nick!]

The post about all the needle sticks from the gen surg resident kind of scares me. What is the source of all the needle sticks (besides NEEDLES, duh)? Is it the suturing process?

 

[Foxxy Cleopatra]

Let me start out by saying I actually did have a heck of a lot of fun in the OR this week as I'm getting to do more and more.

What don't I like about my specialty (surgery)? I already gave a long answer but can pretty much sum it up with this:

It's July 3rd, great weather outside, 7:50 PM on a Saturday night and here I am playing on the internet as I am stuck waiting now over 1 hr and 15 minutes for a patient to get films (and they're still not done )

 

[roja]

Aaaaaaaa....Dear EM doc, the "patient" presented with a "cheif complaint" OPPOSITE to what you wrote on your "diagnosis list". AGAIN.

Your "friend", Internal Medicine doc.

(Joking, please do not get offended)

I have no idea what this means, so I can't get offended.

 

[Sessamoid]

I have no idea what this means, so I can't get offended.

I too found the intention in this presumably snide joke completely confounding.

 

[roja]

Well, you know. We're not known for being very bright in the ED.


And did you know we were lazy as well?

 

[Bugpie]

I have no idea what this means, so I can't get offended.

This was in reference to the OP's question and your response.

QUESTION: What do you NOT LIKE.....

YOUR ANSWER: What you liked.....

But, personally, I enjoyed reading your response...very informative!

Happy 4th of July!!!

 

[Sessamoid]

This was in reference to the OP's question and your response.

QUESTION: What do you NOT LIKE.....

YOUR ANSWER: What you liked.....

But, personally, I enjoyed reading your response...very informative!

Happy 4th of July!!!

I was going to answer, but I'm just too lazy. Think I'll go take a nap.

 

[roja]

This was in reference to the OP's question and your response.

QUESTION: What do you NOT LIKE.....

YOUR ANSWER: What you liked.....

But, personally, I enjoyed reading your response...very informative!

Happy 4th of July!!!

Please refer to post of Dr. Boris which said: 'EM docs, what DO you like about your specialty'... adn hence, my response. (unlike my response to the OP on a prior page which adressed what I didn't like)


Its important to read ALL of the chart, before jumping to conclusions.