Seriously Questioning My Choice of Specialty

[BillBill1219]

I am seven months into intern year of IM residency and am seriously questioning whether I have made the right choice. I chose IM because I like physiology, pathophysiology, diagnostic problem solving, and working directly with patients. I had not fancied myself a "procedure guy" in medical school so IM seemed like a good fit for these reasons.

Fast forward to intern year...the job is not at all matching up to what I had envisioned. First of all, the work is extremely tedious. I cannot tolerate spending hours upon hours sitting at a computer teasing through a patient's chart to find out what home medications he takes, when his last colonoscopy was, what the last echo showed etc. After the initial intake, I see patients for 5 minutes daily on rounds and spend the rest of the day at the computer. The most physical thing I do is place a stethoscope on the patient's chest so I am not really learning any hands-on skills and this bothers me (procedures are hard to come by at my facility.) I am much more of a "doer" than I had taken myself to be.

I hate the fact that you are not just dealing with the acute presentation on inpatient medicine. All of the patient's problems, social or otherwise become your problem. This feels like I am a glorified clerk/babysitter on the medicine floors. I am tired of the mental-masturbation that goes into formulating a broad differential diagnosis only to call a consultant and/or discharge the patient anyway. It seems like I am academically responsible for a lot of information that I will never use clinically and this is a distraction from the things I do have to do.

I had done an ED rotation early this year (as an intern) and loved it. I felt energized at the end of each shift. My mind seems to work much better when confronted with a problem to solve in the here and now. I loved seeing patients get better right in front of me and even when we couldn't totally solve their problem, we at least directed them to where they can go for help. I cannot tolerate the dreaded clinic "follow up visit" because there is nothing to do other than make sure the patient has an adequate supply of Crestor. I felt so strongly about this, that I actually re-entered the match this year and applied to Emergency Medicine. I had a handful of interviews. This is a major decision and I just wanted to know if anyone else has felt this way and if so, did you switch specialties or find something in IM that you did enjoy and stuck with it? By the way, I am not interested in fellowship because I am in my mid thirties and do not want to spend that much extra time training (so critical care is out.) Thank you for any replies.

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[bobow98]

Intern year sucks in every speciality. You are the grunt and are at the bottom. Ask any private in the army how it feels.
Once you are a resident, you'll have time to think and plan. As you progress, you will zoom out and see more of the big picture. It gets better, and rapidly so, once you are done with intern year.

This is coming from a guy who almost didn't go into IM solely because he hated the idea of rounding and couldn't figure out what internal medicine was even about. Just keep moving a day/week at a time, it will be over before you know it.

Also know you can't solve every problem. Solve the ones that are keeping the patient in the hospital and ask for help from the other staff on things that help keep the patient out of the hospital (social).

Life is totally different as an attending with actual time off too. And when you are a subspeciality attending, you can say things like "talk to your PCP/insert other specialist about that, I'm a humble ___ologist." And the patients will respect that.

 

[chessknt]

I am seven months into intern year of IM residency and am seriously questioning whether I have made the right choice. I chose IM because I like physiology, pathophysiology, diagnostic problem solving, and working directly with patients. I had not fancied myself a "procedure guy" in medical school so IM seemed like a good fit for these reasons.

Fast forward to intern year...the job is not at all matching up to what I had envisioned. First of all, the work is extremely tedious. I cannot tolerate spending hours upon hours sitting at a computer teasing through a patient's chart to find out what home medications he takes, when his last colonoscopy was, what the last echo showed etc. After the initial intake, I see patients for 5 minutes daily on rounds and spend the rest of the day at the computer. The most physical thing I do is place a stethoscope on the patient's chest so I am not really learning any hands-on skills and this bothers me (procedures are hard to come by at my facility.) I am much more of a "doer" than I had taken myself to be.

I hate the fact that you are not just dealing with the acute presentation on inpatient medicine. All of the patient's problems, social or otherwise become your problem. This feels like I am a glorified clerk/babysitter on the medicine floors. I am tired of the mental-masturbation that goes into formulating a broad differential diagnosis only to call a consultant and/or discharge the patient anyway. It seems like I am academically responsible for a lot of information that I will never use clinically and this is a distraction from the things I do have to do.

I had done an ED rotation early this year (as an intern) and loved it. I felt energized at the end of each shift. My mind seems to work much better when confronted with a problem to solve in the here and now. I loved seeing patients get better right in front of me and even when we couldn't totally solve their problem, we at least directed them to where they can go for help. I cannot tolerate the dreaded clinic "follow up visit" because there is nothing to do other than make sure the patient has an adequate supply of Crestor. I felt so strongly about this, that I actually re-entered the match this year and applied to Emergency Medicine. I had a handful of interviews. This is a major decision and I just wanted to know if anyone else has felt this way and if so, did you switch specialties or find something in IM that you did enjoy and stuck with it? By the way, I am not interested in fellowship because I am in my mid thirties and do not want to spend that much extra time training (so critical care is out.) Thank you for any replies.

I mean you already acted on it so what are you looking for? I assume you've spoken to your PD about this since you're in the match again and your concerns were not allayed.

 

[BillBill1219]

I mean you already acted on it so what are you looking for? I assume you've spoken to your PD about this since you're in the match again and your concerns were not allayed.

I have acted on it, but match day isn’t until March and my decision is not final. Thank you for your comment.

 

[BillBill1219]

Intern year sucks in every speciality. You are the grunt and are at the bottom. Ask any private in the army how it feels.
Once you are a resident, you'll have time to think and plan. As you progress, you will zoom out and see more of the big picture. It gets better, and rapidly so, once you are done with intern year.

This is coming from a guy who almost didn't go into IM solely because he hated the idea of rounding and couldn't figure out what internal medicine was even about. Just keep moving a day/week at a time, it will be over before you know it.

Also know you can't solve every problem. Solve the ones that are keeping the patient in the hospital and ask for help from the other staff on things that help keep the patient out of the hospital (social).

Life is totally different as an attending with actual time off too. And when you are a subspeciality attending, you can say things like "talk to your PCP/insert other specialist about that, I'm a humble ___ologist." And the patients will respect that.

Thanks for the reply. My senior residents assured me that it does get better, but I see what they do and they spend as much time on the computer as me. They just have more of a supervisory role while I am the glorified scribe. I understand that intern year sucks in every specialty and that is why it is so hard to tease out if it’s just intern year problems or if I’m really in the wrong field.

 

[Meerkatology]

I am seven months into intern year of IM residency and am seriously questioning whether I have made the right choice. I chose IM because I like physiology, pathophysiology, diagnostic problem solving, and working directly with patients. I had not fancied myself a "procedure guy" in medical school so IM seemed like a good fit for these reasons.

Fast forward to intern year...the job is not at all matching up to what I had envisioned. First of all, the work is extremely tedious. I cannot tolerate spending hours upon hours sitting at a computer teasing through a patient's chart to find out what home medications he takes, when his last colonoscopy was, what the last echo showed etc. After the initial intake, I see patients for 5 minutes daily on rounds and spend the rest of the day at the computer. The most physical thing I do is place a stethoscope on the patient's chest so I am not really learning any hands-on skills and this bothers me (procedures are hard to come by at my facility.) I am much more of a "doer" than I had taken myself to be.

I hate the fact that you are not just dealing with the acute presentation on inpatient medicine. All of the patient's problems, social or otherwise become your problem. This feels like I am a glorified clerk/babysitter on the medicine floors. I am tired of the mental-masturbation that goes into formulating a broad differential diagnosis only to call a consultant and/or discharge the patient anyway. It seems like I am academically responsible for a lot of information that I will never use clinically and this is a distraction from the things I do have to do.

I had done an ED rotation early this year (as an intern) and loved it. I felt energized at the end of each shift. My mind seems to work much better when confronted with a problem to solve in the here and now. I loved seeing patients get better right in front of me and even when we couldn't totally solve their problem, we at least directed them to where they can go for help. I cannot tolerate the dreaded clinic "follow up visit" because there is nothing to do other than make sure the patient has an adequate supply of Crestor. I felt so strongly about this, that I actually re-entered the match this year and applied to Emergency Medicine. I had a handful of interviews. This is a major decision and I just wanted to know if anyone else has felt this way and if so, did you switch specialties or find something in IM that you did enjoy and stuck with it? By the way, I am not interested in fellowship because I am in my mid thirties and do not want to spend that much extra time training (so critical care is out.) Thank you for any replies.

as an IM attending i spend < 5minutes chart reviewing on an admission except for the occasional very complex person thats been in the hospital for a month recently. for med rec, some hospitals have pharmacists that do it for you, some don't. it is a big up when they do, all u have to do is check to continue it or not.

ER work is more active, but after a while of dealing with drunks, druggies , BS visits, and people coming in just wanting dilaudid (you can always dump those on IM at least ). it might get tedious too. but sometimes you'll really save someones life when u code them back or something.
-when i did ER rotation, they didn't give me any of those "BS" patients to see, so im not sure if ur rotation is entirely representative of what you will actually do as an attending

at the end of the day medicine is just a job that puts food on the table, sometimes you'll have a memorable experience with a patient. but 90% of ur day is going to be tedious work that u dont like. thats just the definition of work IMO

 

[NewYorkDoctors]

I am seven months into intern year of IM residency and am seriously questioning whether I have made the right choice. I chose IM because I like physiology, pathophysiology, diagnostic problem solving, and working directly with patients. I had not fancied myself a "procedure guy" in medical school so IM seemed like a good fit for these reasons.

Fast forward to intern year...the job is not at all matching up to what I had envisioned. First of all, the work is extremely tedious. I cannot tolerate spending hours upon hours sitting at a computer teasing through a patient's chart to find out what home medications he takes, when his last colonoscopy was, what the last echo showed etc. After the initial intake, I see patients for 5 minutes daily on rounds and spend the rest of the day at the computer. The most physical thing I do is place a stethoscope on the patient's chest so I am not really learning any hands-on skills and this bothers me (procedures are hard to come by at my facility.) I am much more of a "doer" than I had taken myself to be.

I hate the fact that you are not just dealing with the acute presentation on inpatient medicine. All of the patient's problems, social or otherwise become your problem. This feels like I am a glorified clerk/babysitter on the medicine floors. I am tired of the mental-masturbation that goes into formulating a broad differential diagnosis only to call a consultant and/or discharge the patient anyway. It seems like I am academically responsible for a lot of information that I will never use clinically and this is a distraction from the things I do have to do.

I had done an ED rotation early this year (as an intern) and loved it. I felt energized at the end of each shift. My mind seems to work much better when confronted with a problem to solve in the here and now. I loved seeing patients get better right in front of me and even when we couldn't totally solve their problem, we at least directed them to where they can go for help. I cannot tolerate the dreaded clinic "follow up visit" because there is nothing to do other than make sure the patient has an adequate supply of Crestor. I felt so strongly about this, that I actually re-entered the match this year and applied to Emergency Medicine. I had a handful of interviews. This is a major decision and I just wanted to know if anyone else has felt this way and if so, did you switch specialties or find something in IM that you did enjoy and stuck with it? By the way, I am not interested in fellowship because I am in my mid thirties and do not want to spend that much extra time training (so critical care is out.) Thank you for any replies.

I think I have diagnosed your problem. I had this problem too.

Basically you will be much happier if you do a fellowship (or two) and subspecialize. You will be able to engage in the positive aspects of IM.
"I chose IM because I like physiology, pathophysiology, diagnostic problem solving, and working directly with patients"
Of course, you are limited to that subspecialty. However, nothing is stopping you from subspecializing and also going some GIM later on.

Definitely subspecialize into something. It may not have to be something super hard and procedural like Interventional Cardiology, but just do some subspecialty so you can focus more on the actual medical/science and "hard disease" rather than all the social stuff and what I like to call "diseases of decay and neglect."

 

[chessknt]

I have acted on it, but match day isn’t until March and my decision is not final. Thank you for your comment.

You didn't submit a rank list yet? I think if you did then your decision is indeed final (if you match) since that was a legally binding agreement.

You should be soliciting feedback from people in your program (attendings, 3rd year residents, your pd) not people on a forum if it is in the open since that advice will be way more useful.

I think others have pointed out that being ineffecient and knowing what to focus on and spending too much time on xyz is normal at your phase and not a sign of what the job is actually like. I think it is silly to shut out specialization because you are in your 30s especially because you're already willing to burn 1-2 years by switching in to em which could net you a subspec in IM. The job prospects in EM are dismal right now but who knows what the future holds.

 

[BillBill1219]

You didn't submit a rank list yet? I think if you did then your decision is indeed final (if you match) since that was a legally binding agreement.

You should be soliciting feedback from people in your program (attendings, 3rd year residents, your pd) not people on a forum if it is in the open since that advice will be way more useful.

I think others have pointed out that being ineffecient and knowing what to focus on and spending too much time on xyz is normal at your phase and not a sign of what the job is actually like. I think it is silly to shut out specialization because you are in your 30s especially because you're already willing to burn 1-2 years by switching in to em which could net you a subspec in IM. The job prospects in EM are dismal right now but who knows what the future holds.

I have been keeping quiet about my plans to switch into EM. I’m training at a very small, very gossipy community center right now and I don’t really want the news out in the open. That is why I am not so forthcoming with people in my program. Also, my program does not place people into specialties like cardiology, pulm/crit, G.I.etc. I also do not want to kill myself even more trying to be competitive for such a subspecialty. My program seems to exist for one reason and one reason only which is to turn out community based hospitalists. Occasionally people to go into lower competitive specialties like geriatrics or endocrine. I can’t say I’m particularly interested in pursuing a a sub specialty in IM right now, but will remain open minded throughout the rest of my training. I am willing to sacrifice the additional year switching into EM if it means doing work that I enjoy.

 

[rokshana]

I have been keeping quiet about my plans to switch into EM. I’m training at a very small, very gossipy community center right now and I don’t really want the news out in the open. That is why I am not so forthcoming with people in my program. Also, my program does not place people into specialties like cardiology, pulm/crit, G.I.etc. I also do not want to kill myself even more trying to be competitive for such a subspecialty. My program seems to exist for one reason and one reason only which is to turn out community based hospitalists. Occasionally people to go into lower competitive specialties like geriatrics or endocrine. I can’t say I’m particularly interested in pursuing a a sub specialty in IM right now, but will remain open minded throughout the rest of my training. I am willing to sacrifice the additional year switching into EM if it means doing work that I enjoy.

So…you didn’t tell you PD??it’s one thing to not tell gossipy people , but the EM programs would have wanted to talk to your current PD.

Of course the match rate for EM has been pretty abysmal, so you would prolly match.

 

[collegestud2013]

I am seven months into intern year of IM residency and am seriously questioning whether I have made the right choice. I chose IM because I like physiology, pathophysiology, diagnostic problem solving, and working directly with patients. I had not fancied myself a "procedure guy" in medical school so IM seemed like a good fit for these reasons.

Fast forward to intern year...the job is not at all matching up to what I had envisioned. First of all, the work is extremely tedious. I cannot tolerate spending hours upon hours sitting at a computer teasing through a patient's chart to find out what home medications he takes, when his last colonoscopy was, what the last echo showed etc. After the initial intake, I see patients for 5 minutes daily on rounds and spend the rest of the day at the computer. The most physical thing I do is place a stethoscope on the patient's chest so I am not really learning any hands-on skills and this bothers me (procedures are hard to come by at my facility.) I am much more of a "doer" than I had taken myself to be.

I hate the fact that you are not just dealing with the acute presentation on inpatient medicine. All of the patient's problems, social or otherwise become your problem. This feels like I am a glorified clerk/babysitter on the medicine floors. I am tired of the mental-masturbation that goes into formulating a broad differential diagnosis only to call a consultant and/or discharge the patient anyway. It seems like I am academically responsible for a lot of information that I will never use clinically and this is a distraction from the things I do have to do.

I had done an ED rotation early this year (as an intern) and loved it. I felt energized at the end of each shift. My mind seems to work much better when confronted with a problem to solve in the here and now. I loved seeing patients get better right in front of me and even when we couldn't totally solve their problem, we at least directed them to where they can go for help. I cannot tolerate the dreaded clinic "follow up visit" because there is nothing to do other than make sure the patient has an adequate supply of Crestor. I felt so strongly about this, that I actually re-entered the match this year and applied to Emergency Medicine. I had a handful of interviews. This is a major decision and I just wanted to know if anyone else has felt this way and if so, did you switch specialties or find something in IM that you did enjoy and stuck with it? By the way, I am not interested in fellowship because I am in my mid thirties and do not want to spend that much extra time training (so critical care is out.) Thank you for any replies.

As others have said intern year in any specialty is going to suck to some extent and is not representative of attending life. In community hospitalist practice, you round on your own and won't have to go through mental masturbation on every single patient.

Also, I don't think switching to EM will solve many the big issues you have with IM. In practice, EM is largely about triaging and pushing patients through the system and you will almost never spend much time with any one patient to have any type of continuity at all (it's either admit if you can't fix them, or triage and discharge/refer to outpatient). In med school or in a non-EM residency, you may be get a biased view when rotating on EM as you may only be asked to see the more interesting cases. In attending EM practice, the reality is that you have will have RVU targets to meet, and to meet those you will have to see all types of patients, including the annoying ones liked drug seekers that don't have really have any true acute emergency going on. You will also be expected to work a good share of nights, and nowadays see patients at a fast pace (commonly 2-3 per hour unless you're at very slow ER like at a VA or rural ED). And malpractice liability in EM is notoriously high as well. All of this, and consistently being on the frontline leads to EM consistently having one the highest burnout rates of any specialty in medicine; it's not uncommon at all to see EM attendings switch to part time ER shift work even just a few years out of training, and very few will work full time ED shifts for full 30+ year career.

In the past one of the main benefits of EM (and dealing with all the issues as above that comes with working in the ED) would have been a high hourly pay rate (typically higher than doing daytime hospitalist medicine shifts, and as high as many subspecialists that require longer training), but nowadays with EM being saturated and poor job market for new grads, you'll likely end up working harder just to make a similar hourly rate as a hospitalist. There's a reason EM was abnormally easy to match into during the 2022 match.

As others have said, based on what you don't like about general IM, being an IM subspecialist will solve a lot of the issues you have. If you just want to manage a patient's medical problems while avoiding as much of the logistics and social issues that come with direct patient care, the closest you could come to that (besides switching to a non-patient oriented specialty like pathology or radiology) is being a specialist hospitalist and (not have any outpatient responsibilities). For example, it's common for hospitals to have neurology or ID hospitalists who just operate as consult service and aren't expected to admit their own patients. But if doing fellowship to subspecialize isn't a realistic option due to your age and competitiveness, I suspect you may be happier doing IM hospitalist than switching to EM.

 

[BillBill1219]

So…you didn’t tell you PD??it’s one thing to not tell gossipy people , but the EM programs would have wanted to talk to your current PD.

Of course the match rate for EM has been pretty abysmal, so you would prolly match.

I did speak privately with the PD. He wrote me a letter of recommendation in fact. The only other people who know are the DIO and the program coordinator.

 

[Clean7795]

Fast forward to intern year...the job is not at all matching up to what I had envisioned. First of all, the work is extremely tedious. I cannot tolerate spending hours upon hours sitting at a computer teasing through a patient's chart to find out what home medications he takes, when his last colonoscopy was, what the last echo showed etc. After the initial intake, I see patients for 5 minutes daily on rounds and spend the rest of the day at the computer. The most physical thing I do is place a stethoscope on the patient's chest so I am not really learning any hands-on skills and this bothers me (procedures are hard to come by at my facility.) I am much more of a "doer" than I had taken myself to be.

I hate the fact that you are not just dealing with the acute presentation on inpatient medicine. All of the patient's problems, social or otherwise become your problem. This feels like I am a glorified clerk/babysitter on the medicine floors. I am tired of the mental-masturbation that goes into formulating a broad differential diagnosis only to call a consultant and/or discharge the patient anyway. It seems like I am academically responsible for a lot of information that I will never use clinically and this is a distraction from the things I do have to do.

Just curious, what did you expect IM to be like? Most medical students have at least several weeks of exposure to IM, usually much more than that. You're describing pretty much the typical IM experience as a trainee.

Anyway as an attending you don't have to spend nearly as much time chart reviewing. Most of what you do now is because you don't want to miss something small that the attending catches—looks bad. In the community people care as much as they are able to, within medicolegal bounds. So in that sense it gets better. But a lot of the issues you raise won't go away, like being responsible for most of the common chronic conditions during admission. If you don't like that, then you need to specialize to focus your scope.

Changing to EM may help, but it has it's own set of problems.

 

[BillBill1219]

Just curious, what did you expect IM to be like? Most medical students have at least several weeks of exposure to IM, usually much more than that. You're describing pretty much the typical IM experience as a trainee.

Anyway as an attending you don't have to spend nearly as much time chart reviewing. Most of what you do now is because you don't want to miss something small that the attending catches—looks bad. In the community people care as much as they are able to, within medicolegal bounds. So in that sense it gets better. But a lot of the issues you raise won't go away, like being responsible for most of the common chronic conditions during admission. If you don't like that, then you need to specialize to focus your scope.

Changing to EM may help, but it has it's own set of problems.

Thanks for all the replies. Once I had made my mind up about IM as a student, I kind of just focused on looking good on rounds, and never really gave it a second thought or considered what the day-to-day work is actually like from a resident perspective. In hindsight, I should’ve been more open minded to other specialties, and not limited myself to IM because I assumed I would like it.

I really don’t think the BS patient visits would bother me all that much. I scribed in the ED before med school, so I’m familiar with the high volume of low acuity patients. They give a kind of a mental break if anything. I did see a bunch of those as an intern as well, and I was glad to help those people whether they truly needed emergent care or not (not that I think abuse of EDs is a good thing.) I should mention as a caveat that I’ve also acquired the idea that pretty much all of medicine sucks and most specialties have glaring problems with them. I am trying to pick a specialty that I won’t hate doing for the next several decades and if I can accomplish that, I’d be happy.

 

[NotAProgDirector]

There's no right or wrong answer. I completely agree that it's worth a bit more time now to end up with a job you like. My advice to residents and students trying to pick their career: choose something that, whatever the worst part of the job is, you can gain some satisfaction from it. In Hospital Medicine it's often the social issues and discharge planning. In outpatient GIM it's the crazy patients you can't fix. In EM it's the super low acuity patients who are certain they are dying, or those addicted to and seeking narcotics. Etc.

Already mentioned are some of the negatives in EM that you may not be fully aware of. You say you're aware of them, but here you are in IM and you seem to have missed them. There's some chance the same is true for EM.

Since EM will extend your training by 1 year, critical care is only one year more than that. But you've already mentioned that your program doesn't do a great job of getting residents into fellowships, so you'd need to be prepared if that didn't work out.

For anyone questioning the match timing, the OP has until March 1 to either certify a list, or withdraw from the match.

 

[FutureInternist]

I am seven months into intern year of IM residency and am seriously questioning whether I have made the right choice. I chose IM because I like physiology, pathophysiology, diagnostic problem solving, and working directly with patients. I had not fancied myself a "procedure guy" in medical school so IM seemed like a good fit for these reasons.

Fast forward to intern year...the job is not at all matching up to what I had envisioned. First of all, the work is extremely tedious. I cannot tolerate spending hours upon hours sitting at a computer teasing through a patient's chart to find out what home medications he takes, when his last colonoscopy was, what the last echo showed etc. After the initial intake, I see patients for 5 minutes daily on rounds and spend the rest of the day at the computer. The most physical thing I do is place a stethoscope on the patient's chest so I am not really learning any hands-on skills and this bothers me (procedures are hard to come by at my facility.) I am much more of a "doer" than I had taken myself to be.

I hate the fact that you are not just dealing with the acute presentation on inpatient medicine. All of the patient's problems, social or otherwise become your problem. This feels like I am a glorified clerk/babysitter on the medicine floors. I am tired of the mental-masturbation that goes into formulating a broad differential diagnosis only to call a consultant and/or discharge the patient anyway. It seems like I am academically responsible for a lot of information that I will never use clinically and this is a distraction from the things I do have to do.

I had done an ED rotation early this year (as an intern) and loved it. I felt energized at the end of each shift. My mind seems to work much better when confronted with a problem to solve in the here and now. I loved seeing patients get better right in front of me and even when we couldn't totally solve their problem, we at least directed them to where they can go for help. I cannot tolerate the dreaded clinic "follow up visit" because there is nothing to do other than make sure the patient has an adequate supply of Crestor. I felt so strongly about this, that I actually re-entered the match this year and applied to Emergency Medicine. I had a handful of interviews. This is a major decision and I just wanted to know if anyone else has felt this way and if so, did you switch specialties or find something in IM that you did enjoy and stuck with it? By the way, I am not interested in fellowship because I am in my mid thirties and do not want to spend that much extra time training (so critical care is out.) Thank you for any replies.

Just imagine doing a lot of the same work, except med rec is done by pharmacy and there is way less “it could be this or that”, when we know what it is, for 10X the pay and much better hours…
Hospitalist FTW !!!! 😏

 

[Redpancreas]

OP, you already acted on this decision so I don't understand what the aim of your post is. If I was in your spot, I would absolutely not have done what you did. I personally think you made a mistake, but if you're looking for validation for your EM choice, visit the EM forums maybe? Right now you're young and you want to save the world and perceived your IM intern year as a waste of time. IM fields do offer more than what you experienced. Also, you realize that hospitalists do make pretty substantial triage decisions and even as a senior/attending, you're making a lot more important decisions than you did as an intern? I just hope you aren't posting in 6 months about how most patients in ED don't belong there and there's only a code (i.e. dead person who you may resuscitate only to die again in a month or so) but most of the time feel like a glorified bouncer in training under the supervision of the ED attending. I suppose you saved yourself two years, but you could have done pulm/crit and had a much more flexible job with the same upsides.

 

[BillBill1219]

OP, you already acted on this decision so I don't understand what the aim of your post is. If I was in your spot, I would absolutely not have done what you did. I personally think you made a mistake, but if you're looking for validation for your EM choice, visit the EM forums maybe? Right now you're young and you want to save the world and perceived your IM intern year as a waste of time. IM fields do offer more than what you experienced. Also, you realize that hospitalists do make pretty substantial triage decisions and even as a senior/attending, you're making a lot more important decisions than you did as an intern? I just hope you aren't posting in 6 months about how most patients in ED don't belong there and there's only a code (i.e. dead person who you may resuscitate only to die again in a month or so) but most of the time feel like a glorified bouncer in training under the supervision of the ED attending. I suppose you saved yourself two years, but you could have done pulm/crit and had a much more flexible job with the same upsides.

I am not that young. I definitely do not want to save the world nor do I perceive IM intern year as a "waste of time". As stated earlier, my decision is not final. As stated earlier, I am not interested in pulm/crit for reasons described above. You stated that you think I have made a mistake and "would absolutely not done what you did" without explaining why.

Please read through the forum more and post more thoughtfully before opining. Thank you.

 

[bronx43]

wait so you’re an intern and want to re enter the match to do another 3 years in EM (which btw is a dead end job if there’s any definition of such in medicine). They’re pumping out unprecedented numbers of EM grads and the market will very likely oversaturate by the time you finish.

After you complete EM, you would have spent 4 years total. That’s only 2 less than if you pursued GI, and 1 less if you did CC without pulmonary.

As someone who hates medicine and regrets pursing it in the first place, I don’t recommend jumping ship from IM for the Em path. You’ve already sacrificed a lot and it is only a few more years to become a specialist and have much more leverage in this game. It sucks but it does get better…

 

[NewYorkDoctors]

I am not that young. I definitely do not want to save the world nor do I perceive IM intern year as a "waste of time". As stated earlier, my decision is not final. As stated earlier, I am not interested in pulm/crit for reasons described above. You stated that you think I have made a mistake and "would absolutely not done what you did" without explaining why.

Please read through the forum more and post more thoughtfully before opining. Thank you.

Geez sensitive much ? Did you come here for honest input or just to enter an echochamber? If it’s the latter go to Reddit or twitter .

Go do EM then and have a nice life . We all respect whatever decision you ultimately make as it is your life and your choices. Would you like a participation trophy now ? Mods give this poster a participation trophy 🏆

Or maybe do derm and ask the Ichthyosis patients about their thicker skin .

 

[FCMike11]

Very very very standard intern year experience

I think you’d enjoy outpatient medicine

Much of what you described is very much bread and butter hospitalist medicine. You will improve in time with the tedious tasks though such that it doesn’t take lots of brain power or time of your day.

I don’t think you’d enjoy EM. You should see the 5 level 4 or 5s they deal with for every actual medicine patient that comes in

 

[sloh]

You should spend some time reading the EM forums. Don't switch to EM

 

[Clean7795]

Thanks for all the replies. Once I had made my mind up about IM as a student, I kind of just focused on looking good on rounds, and never really gave it a second thought or considered what the day-to-day work is actually like from a resident perspective. In hindsight, I should’ve been more open minded to other specialties, and not limited myself to IM because I assumed I would like it.

I really don’t think the BS patient visits would bother me all that much. I scribed in the ED before med school, so I’m familiar with the high volume of low acuity patients. They give a kind of a mental break if anything. I did see a bunch of those as an intern as well, and I was glad to help those people whether they truly needed emergent care or not (not that I think abuse of EDs is a good thing.) I should mention as a caveat that I’ve also acquired the idea that pretty much all of medicine sucks and most specialties have glaring problems with them. I am trying to pick a specialty that I won’t hate doing for the next several decades and if I can accomplish that, I’d be happy.

ER needs a more specific kind of personality to enjoy it long term. The majority of medical students enjoy ER after rotating through it... as counterintuitive as it sounds, the decision shouldn't be made about the general feeling about the rotation. It should be about whether or not you would enjoy that sort of workflow, BS, and patient population 10-20 years down the road.

For me personally, I enjoyed the ER rotation but would never choose it as a career.
- Shift work is less pleasant the older you are, especially into the 40s/50s
- Low flexibility (there are very few clinical subspecializations you could practice full-time with a ER background)
- Low control over work volumes
- Personality of patient population
- Depending on where you work, the personality of the consultants/admitting physicians

As you know, our priorities change over time in life. The things I enjoy now, differs from the 10 years before that. Therefore I strongly value the ability to shift into other areas of practice, which in itself lets me control my work volumes/patient population. Many ER docs don't realize that entering the specialty, and as a result get burnt out from systemic issues beyond their control... again you need a specific personality to keep on enjoying it.

My advice is to do some introspection on what you want your life to look like and will enjoy long term—you already made the mistake once of not doing so.

 

[AlbinoHawk DO]

Everyone i knew loved EM intern year and swore they'd do more than one rotation. Then they all finished the rotation, and they never wanted to do it again. EM is fun intern year because you know nothing, and the specialty makes you feel useful. IM feels tedious because you don't know everything. Eventually, you'll know enough to play and do well in IM, and something like EM will seem boring and incompetent. Then again, who knows? You might be better off in EM due to your personality

 

[anonperson]

I am seven months into intern year of IM residency and am seriously questioning whether I have made the right choice. I chose IM because I like physiology, pathophysiology, diagnostic problem solving, and working directly with patients. I had not fancied myself a "procedure guy" in medical school so IM seemed like a good fit for these reasons.

Fast forward to intern year...the job is not at all matching up to what I had envisioned. First of all, the work is extremely tedious. I cannot tolerate spending hours upon hours sitting at a computer teasing through a patient's chart to find out what home medications he takes, when his last colonoscopy was, what the last echo showed etc. After the initial intake, I see patients for 5 minutes daily on rounds and spend the rest of the day at the computer. The most physical thing I do is place a stethoscope on the patient's chest so I am not really learning any hands-on skills and this bothers me (procedures are hard to come by at my facility.) I am much more of a "doer" than I had taken myself to be.

I hate the fact that you are not just dealing with the acute presentation on inpatient medicine. All of the patient's problems, social or otherwise become your problem. This feels like I am a glorified clerk/babysitter on the medicine floors. I am tired of the mental-masturbation that goes into formulating a broad differential diagnosis only to call a consultant and/or discharge the patient anyway. It seems like I am academically responsible for a lot of information that I will never use clinically and this is a distraction from the things I do have to do.

I had done an ED rotation early this year (as an intern) and loved it. I felt energized at the end of each shift. My mind seems to work much better when confronted with a problem to solve in the here and now. I loved seeing patients get better right in front of me and even when we couldn't totally solve their problem, we at least directed them to where they can go for help. I cannot tolerate the dreaded clinic "follow up visit" because there is nothing to do other than make sure the patient has an adequate supply of Crestor. I felt so strongly about this, that I actually re-entered the match this year and applied to Emergency Medicine. I had a handful of interviews. This is a major decision and I just wanted to know if anyone else has felt this way and if so, did you switch specialties or find something in IM that you did enjoy and stuck with it? By the way, I am not interested in fellowship because I am in my mid thirties and do not want to spend that much extra time training (so critical care is out.) Thank you for any replies.

EM job market is going to continue to get worse. The residency market is getting saturated and there will be an oversupply of EM physicians.

Doesn't matter how great a specialty is if you can't get a decent job.

I'm not here to crap on EM as a specialty but you seem to make it out as EM doesn't have it's issues.

You will be on your computer putting in orders and documenting constantly.

You will be calling consultants on a regular basis.

You will have the ability to do procedures.

You will be tied to the hospital. This is not good.

Ask anyone who is working currently, it's best to avoid specialties that are beholden to the hospital. You will eventually get taken advantage of.

IM allows a good deal of flexibility with inpatient and outpatient work. And the fact that one can technically open up their own shop if desired is a plus.

Edited:
You want a specialty that doesn't depend on the hospital.
Few things are true in life:
Death, taxes, incompetent hospital administration

 

[wysdoc]

Moderator note:
Several intemperate comments have been removed and the primary mudslingers warned to keep posts more professional.

 

[BillBill1219]

Thank you for all for the replies. To clarify, the reason why I acted on it as hastily as I did was because I came to this decision midway through application season, and I had to be very aggressive contacting program directors asking for interviews. It wasn’t until several weeks into this process that I began to realize the grim future of emergency medicine and this certainly plays into my decision. It certainly seems like the job market is tenuous at best and one would be taking a major risk following this path. I’m contrast, internal medicine is certainly safer and offers many more practice options.

 

[chessknt]

Thank you for all for the replies. To clarify, the reason why I acted on it as hastily as I did was because I came to this decision midway through application season, and I had to be very aggressive contacting program directors asking for interviews. It wasn’t until several weeks into this process that I began to realize the grim future of emergency medicine and this certainly plays into my decision. It certainly seems like the job market is tenuous at best and one would be taking a major risk following this path. I’m contrast, internal medicine is certainly safer and offers many more practice options.

You seem to be making multiple hasty decisions--I am glad you are stopping to reflect before you submit your rank list but the only person who can answer if you will be happy doing XYZ is you. You need to really look beyond how you feel right now and look at the work you would do as an attending and ask yourself if that is what you want to do. More importantly don't look at how your attending work, look at how attendings work in the setting you are interested in practicing in (small community hospital, big city private hospital etc).

I think saying you won't subspecialize because of your age is myopic and another hasty decision--not being able to because of where you matched to begin with is another issue entirely but not one that is impossible to surmount if you really want to. The subspecialization choices within medicine vastly outclass EM so in many ways it is much more customizable than EM.

 

[BillBill1219]

You want a specialty that doesn't depend on the hospital.
Few things are true in life:
Death, taxes, incompetent hospital administration

Wouldn't hospitalist/nocturnist fall under this category as well? I wonder how safe hospital medicine is in the future; who says they won't be replaced my midlevels either?

 

[dozitgetchahi]

I have been keeping quiet about my plans to switch into EM. I’m training at a very small, very gossipy community center right now and I don’t really want the news out in the open. That is why I am not so forthcoming with people in my program. Also, my program does not place people into specialties like cardiology, pulm/crit, G.I.etc. I also do not want to kill myself even more trying to be competitive for such a subspecialty. My program seems to exist for one reason and one reason only which is to turn out community based hospitalists. Occasionally people to go into lower competitive specialties like geriatrics or endocrine. I can’t say I’m particularly interested in pursuing a a sub specialty in IM right now, but will remain open minded throughout the rest of my training. I am willing to sacrifice the additional year switching into EM if it means doing work that I enjoy.

If you like the pathophysiology, diagnostic thinking, etc of IM, you should probably look into rheumatology. I get to focus on these things in my visits and not deal with the social horse****. It’s much of the “good” in IM, without a lot of the “bad”.

 

[anonperson]

Wouldn't hospitalist/nocturnist fall under this category as well? I wonder how safe hospital medicine is in the future; who says they won't be replaced my midlevels either?

Yes. Hospitalists are tied to the hip with the hospital. Not an ideal situation. You can read various people in this forum question the long term prospects of hospitalist medicine and the potential changes that may occur.

Main thing is you can always refuse to play the hospitalist game and do outpatient only.

Plus the number of subspecialties for IM gives you a huge amount of flexibility. Those opportunities for EM are very limited. Toxicology etc are fairly rare and academic with little change in your long term job situation. You can do CC or pain but not the norm.

 

[Splenda88]

wait so you’re an intern and want to re enter the match to do another 3 years in EM (which btw is a dead end job if there’s any definition of such in medicine). They’re pumping out unprecedented numbers of EM grads and the market will very likely oversaturate by the time you finish.

After you complete EM, you would have spent 4 years total. That’s only 2 less than if you pursued GI, and 1 less if you did CC without pulmonary.

As someone who hates medicine and regrets pursing it in the first place, I don’t recommend jumping ship from IM for the Em path. You’ve already sacrificed a lot and it is only a few more years to become a specialist and have much more leverage in this game. It sucks but it does get better…

Why do you hate medicine?

hospital medicine is an ok job that pays the bills and more...

 

[dozitgetchahi]

EM job market is going to continue to get worse. The residency market is getting saturated and there will be an oversupply of EM physicians.

Doesn't matter how great a specialty is if you can't get a decent job.

I'm not here to crap on EM as a specialty but you seem to make it out as EM doesn't have it's issues.

You will be on your computer putting in orders and documenting constantly.

You will be calling consultants on a regular basis.

You will have the ability to do procedures.

You will be tied to the hospital. This is not good.

Ask anyone who is working currently, it's best to avoid specialties that are beholden to the hospital. You will eventually get taken advantage of.

IM allows a good deal of flexibility with inpatient and outpatient work. And the fact that one can technically open up their own shop if desired is a plus.

Edited:
You want a specialty that doesn't depend on the hospital.
Few things are true in life:
Death, taxes, incompetent hospital administration

This is one area in which rheumatology shines as an IM subspecialty. I am 100% outpatient at a multispecialty private practice. For that reason, I am one of the very few docs in my practice who isn’t credentialed with the local hospital - which is constantly embroiled in bitter fighting with my private practice. My practice suggested I consider credentialing with the hospital when I started, but I made it clear that I didn’t want to round (at all) and furthermore, I had no desire to be caught up in the constant political horse trading and BS between them and the hospital system. Their response: “sounds good, can’t blame ya, and you’ll be really busy in clinic anyway”.

I agree that you don’t want to have to be boxed into dealing with a hospital system as a physician. In IM, there are several specialties where you can be 100% outpatient - PCP, rheumatology, allergy/immunology, and perhaps endo? Otherwise, largely, you need the hospital for consults and/or procedures. In EM, you’re locked into the hospital system unless you want to go build your own urgent care somewhere.

 

[hotsaws]

I'm married to an EM doc and lots of my close friends chose it as a field. I would echo much of what has been said about EM vs IM in here. The worst parts of EM are not as apparent as a trainee or even as a younger adult (depending on where you're at in life). EM during residency, and maybe early career, is appealing because of the shift nature of it, culture, short residency, decent money out the gate, transportability of the job, etc. If you are young and single, the shift work nature of it is doable or maybe even desirable. Once you get more settled, you realize that family and the rest of the settled people in the world don't work nights/weekends/holidays. The culture certainly varies from hospital to hospital. There can be toxic admin and consultants and poor support staff. Although, my wifes current gig has nocturnists and relatively friendly admin and consultants. Night and day from the last job. It is a plus that she can easily move across town or across the country and get another job that basically pays the same. The outlooks for the field are not great. The amount of CMG-sponsored ****ty residency programs are blowing up. Go look at the EM residency spot expansion numbers -- they are just churning out bodies. Hospital admins won't care if you trained at a top notch program or some ****ty little community program. The income has pretty much declined over the years and has a pretty definite ceiling (aside from some SDG gigs or maybe some rural spots that offer high hourly) based on hours worked. I know countless EM docs that are looking for side hustles or otherwise complete escapes from EM.

Hospitalist work is probably even worse and many similar negatives. Couldn't pay me to do it.

If you're already stuck in IM, I don't think going into EM is any kind of escape. I actually think you are further limiting options and enslaving yourself to the system. I could see maybe a transfer to something like Psych or Anesthesia. I've heard those stories and I think there's a better case to be made for those. If you are not happy in IM, your best option is to subspecialize. If you're scrambling into one of these low end, newer EM programs, I would take that into consideration as well. As the EM job market becomes flooded, there will need to be some way to separate applicants. The admins may not care which warm body staffs the ED but the medical directors might.

 

[bronx43]

Why do you hate medicine?

hospital medicine is an ok job that pays the bills and more...

I hate clinical medicine mostly because I hate customer service and having to pander to patients on a daily basis. And from the perspective of customer service and having slews of referrals with mostly psychosomatic complaints, rheumatology was a poor fit for me. Psychosomatic complaints are much worse in major metropolitan areas, so if you want to live in a "desirable location," be ready for generalized arthralgia, fatigue, malaise in the setting of a positive ANA or borderline ESR.
I've said many times, but I should have done radiology 100x.

 

[Splenda88]

I hate clinical medicine mostly because I hate customer service and having to pander to patients on a daily basis. And from the perspective of customer service and having slews of referrals with mostly psychosomatic complaints, rheumatology was a poor fit for me. Psychosomatic complaints are much worse in major metropolitan areas, so if you want to live in a "desirable location," be ready for generalized arthralgia, fatigue, malaise in the setting of a positive ANA or borderline ESR.
I've said many times, but I should have done radiology 100x.

I agree about radiology. Patient interaction is overrated.

 

[bronx43]

I agree about radiology. Patient interaction is overrated.

I would say the lack of patient interaction is severely underrated.

 

[Drrrrrr. Celty]

I hate clinical medicine mostly because I hate customer service and having to pander to patients on a daily basis. And from the perspective of customer service and having slews of referrals with mostly psychosomatic complaints, rheumatology was a poor fit for me. Psychosomatic complaints are much worse in major metropolitan areas, so if you want to live in a "desirable location," be ready for generalized arthralgia, fatigue, malaise in the setting of a positive ANA or borderline ESR.
I've said many times, but I should have done radiology 100x.

Does Rheum have rheum hospitalist routes? I feel like that itself is a whole world of insanity admittedly.

You also are ABIM certified. You can go back into Hospital medicine and not do outpt.

And that's just keeping in bounds of IM. You can go work in government, cooperate, be a pharm rep etc.

 

[Drrrrrr. Celty]

This is one area in which rheumatology shines as an IM subspecialty. I am 100% outpatient at a multispecialty private practice. For that reason, I am one of the very few docs in my practice who isn’t credentialed with the local hospital - which is constantly embroiled in bitter fighting with my private practice. My practice suggested I consider credentialing with the hospital when I started, but I made it clear that I didn’t want to round (at all) and furthermore, I had no desire to be caught up in the constant political horse trading and BS between them and the hospital system. Their response: “sounds good, can’t blame ya, and you’ll be really busy in clinic anyway”.

I agree that you don’t want to have to be boxed into dealing with a hospital system as a physician. In IM, there are several specialties where you can be 100% outpatient - PCP, rheumatology, allergy/immunology, and perhaps endo? Otherwise, largely, you need the hospital for consults and/or procedures. In EM, you’re locked into the hospital system unless you want to go build your own urgent care somewhere.

Endo you can be outpt entirely too. It's just not that hard to cover inpatient at local community hospitals.

Honestly with Endo you're in such demand you really can do whatever you want and still maintain a job. The only issue is that the pay hasn't caught up with say Rheum. Endo is somewhere between Rheum and PCP. That being said even in Endo you can get procedural training if you want and augment your income.

 

[bronx43]

Does Rheum have rheum hospitalist routes? I feel like that itself is a whole world of insanity admittedly.

You also are ABIM certified. You can go back into Hospital medicine and not do outpt.

And that's just keeping in bounds of IM. You can go work in government, cooperate, be a pharm rep etc.

There aren't many options for inpatient "hospitalist" route for rheum, since only large academic institutions have enough "weird" cases for rheumatology consults. Furthermore, academic faculty usually cover their own inpatient consult services. But academia or "fakedemia" is a whole other can of worms.

I can go back to hospitalist, and have floated the idea. So far, practicing rheum in a semi-rural setting has been a good compromise - far less psychosomatic complaints and generally friendlier people. Radiology, on the other hand, does not have such issues. They can live in a major metro, while having none of the customer service headaches us clinicians have. They also make a lot more than non-procedural, so it's win win win.

 

[Splenda88]

There aren't many options for inpatient "hospitalist" route for rheum, since only large academic institutions have enough "weird" cases for rheumatology consults. Furthermore, academic faculty usually cover their own inpatient consult services. But academia or "fakedemia" is a whole other can of worms.

I can go back to hospitalist, and have floated the idea. So far, practicing rheum in a semi-rural setting has been a good compromise - far less psychosomatic complaints and generally friendlier people. Radiology, on the other hand, does not have such issues. They can live in a major metro, while having none of the customer service headaches us clinicians have. They also make a lot more than non-procedural, so it's win win win.

I am afraid to even tell patients they need to lose weight these days since I have gotten a few pushbacks. I am in year 2 as an attending and I wonder if medicine was like that 20+ yrs ago.

It's sad that a huge component of medicine is customer service.

 

[bronx43]

I am afraid to even tell patients they need to lose weight these days since I have gotten a few pushbacks. I am in year 2 as an attending and I wonder if medicine was like that 20+ yrs ago.

It's sad that a huge component of medicine is customer service.

I never tell patients they need to lose weight. What’s the point? They clearly won’t do it and there’s an unreasonably high probability you will get terrible patient satisfaction scores if not outright complaints.
Incentives matter… whodathought?

 

[Splenda88]

I never tell patients they need to lose weight. What’s the point? They clearly won’t do it and there’s an unreasonably high probability you will get terrible patient satisfaction scores if not outright complaints.
Incentives matter… whodathought?

You are right because I got fired by patient for telling her she needs to lose weight. "I am not a compassionate physician."Lol. That was the complaint. I am starting to know how to choose my battle as a new attending.

 

[hotsaws]

I enjoy the small talk and I’m lucky that my avg A/I patient is basically a normal to high functioning person. It helps that I’m in a nice, but not wealthy, suburb of a city. I genuinely enjoy the vast majority of my patient encounters.

With that said, I cannot overstate the value of limited patient interaction fields like rads, path, or anesthesia. I would steer someone towards rads these days, especially with the the world moving in the direction of work from home settings and it is seems technologically feasible to work from home (or wherever) as a radiologist.

Despite liking my job, I am also beholden to the customer service aspect. This is especially true when seeing established patients of other docs in the practice. Some clearly baby and cater to patients, especially those with functional illnesses. I tend to nip those cases in the bud right off the bat and politely and throughly explain why I don’t think I can help them.

 

[sloh]

I hate clinical medicine mostly because I hate customer service and having to pander to patients on a daily basis. And from the perspective of customer service and having slews of referrals with mostly psychosomatic complaints, rheumatology was a poor fit for me.

I never tell patients they need to lose weight. What’s the point? They clearly won’t do it and there’s an unreasonably high probability you will get terrible patient satisfaction scores if not outright complaints.
Incentives matter… whodathought?

You are right because I got fired by patient for telling her she needs to lose weight. "I am not a compassionate physician."Lol. That was the complaint. I am starting to know how to choose my battle as a new attending.

As PM&R, this is why I love my SNF gig way more than my first outpatient job seeing chronic-pain-lite every day.

 

[dozitgetchahi]

I enjoy the small talk and I’m lucky that my avg A/I patient is basically a normal to high functioning person. It helps that I’m in a nice, but not wealthy, suburb of a city. I genuinely enjoy the vast majority of my patient encounters.

With that said, I cannot overstate the value of limited patient interaction fields like rads, path, or anesthesia. I would steer someone towards rads these days, especially with the the world moving in the direction of work from home settings and it is seems technologically feasible to work from home (or wherever) as a radiologist.

Despite liking my job, I am also beholden to the customer service aspect. This is especially true when seeing established patients of other docs in the practice. Some clearly baby and cater to patients, especially those with functional illnesses. I tend to nip those cases in the bud right off the bat and politely and throughly explain why I don’t think I can help them.

As a rheumatologist, I also enjoy the encounters and have been fortunate enough to work for institutions where the significance of “patient satisfaction” scores have been kept within reason.

I considered rads in the beginning, and ultimately decided against it as I didn’t want to spend my career in a darkroom acting as a human slide reader. Also, in terms of the economics of the specialty, the grass isn’t necessarily greener. Yes, you can make money, but you’re gonna have to work your ass to do it. The stress levels are by no means lower either. Go read the rads forums if you don’t believe me. The competitiveness of the specialty was dropping when I applied for residency.

Also, from the POV of being messed with by hospitals or other big institutions, rads is NOT necessarily the right idea either. At the end of the day, rads is actually another one of these “any warm body”, “interchangeable cog” specialties (like EM, hospitalists, anesthesia, etc etc) that tend to be the first to get ****ed with by administrators. Any time they can drop your ass like it’s hot and pull someone else in for the next shift, you know you’re going to be dealing with some big BS from admin sooner or later. And the radiologists I know all agree with this.

 

[hotsaws]

Yeah, those are good points and well taken. I have to remember not to fall victim to the grass is greener cynicism that sometimes brews within me. You make an excellent distinction regarding the warm body specialties vs those of us with significant face time that build sort of a "brand" for ourselves. I won't speak for other fields but a successful A/I practice is dependent on the quality of the doctor in terms of bedside manner, likability, charisma, quality of care, etc. Our referral base wants their patients happy and happy patients themselves provide very important word of mouth advertising. There's an incentive to treat people really well and the reward isn't just financial -- those happy patients make the job very fulfilling. Plus, an A/I doc with thousands of happy patients isn't an easily replaceable commodity that can just be exchanged for a new grad.

 

[BillBill1219]

I'm married to an EM doc and lots of my close friends chose it as a field. I would echo much of what has been said about EM vs IM in here. The worst parts of EM are not as apparent as a trainee or even as a younger adult (depending on where you're at in life). EM during residency, and maybe early career, is appealing because of the shift nature of it, culture, short residency, decent money out the gate, transportability of the job, etc. If you are young and single, the shift work nature of it is doable or maybe even desirable. Once you get more settled, you realize that family and the rest of the settled people in the world don't work nights/weekends/holidays. The culture certainly varies from hospital to hospital. There can be toxic admin and consultants and poor support staff. Although, my wifes current gig has nocturnists and relatively friendly admin and consultants. Night and day from the last job. It is a plus that she can easily move across town or across the country and get another job that basically pays the same. The outlooks for the field are not great. The amount of CMG-sponsored ****ty residency programs are blowing up. Go look at the EM residency spot expansion numbers -- they are just churning out bodies. Hospital admins won't care if you trained at a top notch program or some ****ty little community program. The income has pretty much declined over the years and has a pretty definite ceiling (aside from some SDG gigs or maybe some rural spots that offer high hourly) based on hours worked. I know countless EM docs that are looking for side hustles or otherwise complete escapes from EM.

Hospitalist work is probably even worse and many similar negatives. Couldn't pay me to do it.

If you're already stuck in IM, I don't think going into EM is any kind of escape. I actually think you are further limiting options and enslaving yourself to the system. I could see maybe a transfer to something like Psych or Anesthesia. I've heard those stories and I think there's a better case to be made for those. If you are not happy in IM, your best option is to subspecialize. If you're scrambling into one of these low end, newer EM programs, I would take that into consideration as well. As the EM job market becomes flooded, there will need to be some way to separate applicants. The admins may not care which warm body staffs the ED but the medical directors might.

Thanks for the reply. Hospital medicine comes with enormous, heaping mounds of bullish*t and that is why I want to stay away from it if I can too. I never really bought into the 7 on 7 off schedule as any kind of great bargain either. I really don't want to devote an extra second to training more than I have to. Even the extra year in if I switch to EM makes be cringe but I am trying to think long-term. I am going to be in my late 30s by the time I graduate. I have a young family. I feel like I am economically pigeonholed into hospital medicine (if I stay in IM) because it pays so much more than outpatient (even outpatient subspecialties.) Even if I wanted to subspecialize, I feel I cannot sacrifice the extra 2-3 years for less or the same pay as PCP internal medicine. Let's face it cards, GI, pulm/crit are not exactly there for the taking. So when people tell me "why not do GI or pull/crit" a) I am really not that enthusiastic about those fields and b)they are a reach considering I am a DO with no research training at a small community program. It seems if this ER thing doesn't work out then hospital medicine is my only choice at least for the first several years out of training.

 

[CCM-MD]

Thanks for the reply. Hospital medicine comes with enormous, heaping mounds of bullish*t and that is why I want to stay away from it if I can too. I never really bought into the 7 on 7 off schedule as any kind of great bargain either. I really don't want to devote an extra second to training more than I have to. Even the extra year in if I switch to EM makes be cringe but I am trying to think long-term. I am going to be in my late 30s by the time I graduate. I have a young family. I feel like I am economically pigeonholed into hospital medicine (if I stay in IM) because it pays so much more than outpatient (even outpatient subspecialties.) Even if I wanted to subspecialize, I feel I cannot sacrifice the extra 2-3 years for less or the same pay as PCP internal medicine. Let's face it cards, GI, pulm/crit are not exactly there for the taking. So when people tell me "why not do GI or pull/crit" a) I am really not that enthusiastic about those fields and b)they are a reach considering I am a DO with no research training at a small community program. It seems if this ER thing doesn't work out then hospital medicine is my only choice at least for the first several years out of training.

You are mistaken about about the outpatient focused fields not paying well. I have friends that are fresh out of training working as PCPs making close to 300k working 4 days a week bankers hours, no call, all weekends and holidays off, plus vacation. Rheum and endo have similar/better opportunities and shouldn’t be challenging to match if you put some effort. Switching to EM to avoid dealing with BS is hilarious.

 

[BillBill1219]

You are mistaken about about the outpatient focused fields not paying well. I have friends that are fresh out of training working as PCPs making close to 300k working 4 days a week bankers hours, no call, all weekends and holidays off, plus vacation. Rheum and endo have similar/better opportunities and shouldn’t be challenging to match if you put some effort. Switching to EM to avoid dealing with BS is hilarious.

Well that is certainly positive to hear. Can you say where they are getting these jobs?