On medscape reports and other sources, IM is consistently at the bottom for overall job satisfaction. Also, most respondents to these surveys state they would choose a different speciality...the 2016 report says only 23% of IM docs would choose the same speciality if they had to do it over again.
Why do you think this is?
Have you done your IM rotation yet?
One thing I can tell you, is that many people go into IM for the wrong reasons. Getting to see exciting rare presentations? No No No. It's great if you want to be responsible for a huge knowledge base and you want to retain most of what you learned in med school, but that stuff won't be what you actually do most of the time, even though it's always in the back of your mind. You better love and get fulfillment from managing chronic illness. If you're looking to roam the hospital stamping out disease, you picked the wrong field.
Also, some go in only wanting fellowship, and hating IM. Some get stuck!
It also helps if you have a real heart for caring for the chronically ill, and you're not that judgemental how they got themselves to your door. Mother Teresa-like love of CHF, COPD, ESLD, ESKD, DM2, obesity, substance abuse, poverty, low health literacy/education, so much of which are lifestyle factors that either aren't gonna change or it's too late... is helpful IMHO, and frankly, I've found it hit or miss in internists. Even so, it's a lot of psychosocial factors of sadness and stress, and that takes a toll even on a big heart.
You frequently "tune up" people who are going to "bounce back." And not bounce back in the good way, bounce back to be readmitted to the hospital in short order.
Even docs that love the medical side of managing chronic illness, still find the social, financial, administrative barriers/tasks etc to be somewhat draining over time.
Whatever I would do over 2 weeks just trying to tweak the beta blocker and lasix dose to try to get euvolemia and avoid orthostatic hypotension in my CHF/CLD'er, would not be nearly as frustrating as the hoops and paperworks and discussions with SW just trying to get SNF placement.
You could say I signed up for both, but on some level one is what you actually *have* to do the manage the *patient* and the other, is made up busywork that doesn't exist in the rational mirror universe, or even bizarro land, Sweden, but is just a byproduct of our administrative medicolegal system of pure waste.
Those tasks are always trying to suck the marrow from your bones, and while they absolutely cannot be cut out of your day, it ends up that time with individual patients is the variable you can control and cut to make space for this bull****.
It didn't make me overly stressed having so many exciting things to click through in the EHR, notes to read on my patients. I loved going to see them, except that I hated going to see them, because of the notes hanging over my head to finish. The notes I sort of enjoyed writing when it was thoughtful, and each day was like an unfolding puzzle in numbers and words, however I sort of hated it when it was the #1 limiter of my time with patients or eating meals, and half the time it was this ridiculous copy pasta but I had to waste enough time being sure to make it look like it wasn't the bull**** that it is.
My example, we all help patients with less than exciting medical problems that fall in our sphere on the regular. However, the amount of paperwork or administrative task burden and sense of futility can be high in IM.
When you cut out all the kids under 12 (mostly everyone under 18), all the pregnant people, and you mostly relegate yourself to the hospital, and outpatient you got FM docs mostly doing the outpt stuff.... ultimately you've set yourself up to be the master of medical trainwrecks. Which is what you should want to be if you choose IM. You are not choosing the well. You are choosing the sick, as your patient population. Even if you go outpatient, you are likely to attract more complicated patients for all I said, and it's frankly a waste of your training if you're not. Then if you go outpatient you are facing all the challenges PCPs do, but with sicker people as your base.
This can all be fun mentally, but can have a sense of futility to your spirit unless you take pleasure in the "tune up" or ongoing management, and will carry with it so many stressors from outside the hospital that you can't control but control you and the patient, for better or mostly worse.
While it isn't the absolute bulk of your patients, probably the worst ones you'll get are the gomers, or just other old people that aren't too gone to feel suffering, but aren't really calling the medical decision-making shots anymore. You also have your other old or dying. Cancers. Everyone trapped in a bed of urine with bedsores for one reason or another (motorcycle accident, MS, ALS, MD, etc etc), trying to not to die from an infection of wind, water, wound.
So far, I only really addressed the patient population, most seen dx, the administrative BS and psychosocioeconomic determinants of health that one faces in IM.
I'm less familiar with all the things that attendings have experience with that might be particularly draining in IM, doing it for years, the financial, billing, malpractice, medicolegal aspects over time.
Many people laud the 7 on and 7 off schedule, but as I understand it, that week the attending is on, the hours are actually the same for a resident during an inpatient month, maybe worse with no work hour restrictions, only the attending's census can be twice as big, and they don't have the sort of caps on admits and all that residents do.
So working harder than a resident does every other week with a week off in between might not be the Promised Land 10-40 years in that people expect it to be, especially if they didn't go in really wanting what it is to be a general internist.
