Hi everyone,

I hope all is well for everyone in the forum. Here is my situation:

I am currently a 3rd yr IM at a "top ranked" IM program and need some advice. I have always been one of those "smart people" my entire life and have done well in most of my endeavors and am young for my residency class-- I will finish my residency 1-2 years younger than most-- and had solid board scores on step 1 (~220), step 2 ck 230s, and step 3 240 and am a little confused as to how to spend the rest of my life....

Before I started medical school and during medical school I always wanted to be a surgeon-- that was my life's dream, but when I did the rotation during medical school I realized that I am unable to persue a surgical specialty due to an inability to perform tasks requiring manual dexterity. This essentially eliminated all surgical and most procedural type specialties and essentially took away my "dream specialty."

As a result, I chose to persue internal medicine because I did not know what I really wanted to do w/ my life. I knew when I started my residency that it was going to be brutal (ie lots of call, tough calls, etc) and here I am in my third year and somehow I do not know what I want to do w/ my life... The thing is that I enjoy learning and reading medicine, but I am beginning to realize that practicing medicine is really probably not for me. The more I see of it, I am beginning to become frustrated with seemingly endless paperwork, "dumps" on the medicine service, disrespect from other physician colleagues and patients, and their families. I don't know whether I am just disillusioned with medicine because I am a resident as everyone keeps saying that "things get better ," but people told me that when I was an intern and things haven't gotten too much better.

I have thought of persuing a specialty that is "not so people based" (ie rads), but am being told that I may come across some funding issues from CMS and the REALITY of having to grind through another four years of residency. The other option is to continue on in internal medicine and try to subspecialize in something-- the problem is that the only specialty that has an option to do something that is not as people based is cardiology with an echo fellowship, but that would likely require several more years of training.

Regardless, I should be completing my IM residency this year and fell confused as the other option would be to either work as a hospitalist or even leave medicine for a year or two and then come back to do a fellowship? I do not know if it is just me who feels so disillusioned about medicine as a whole, but is this commmon (or am I just a resident with the "blues" that will soon pass)? In addition, getting back to the title of my original post, what else can someone w/ little experience who is board certified in IM do that is not clinic/hospital medicine per se?

Sorry for the rambling post, but I would also appreciate it if anyone else could share their experience with any similar feelings during their residency and their possible career options? Thanks in advance.

Hi everyone,

I hope all is well for everyone in the forum. Here is my situation:

I am currently a 3rd yr IM at a "top ranked" IM program and need some advice. I have always been one of those "smart people" my entire life and have done well in most of my endeavors and am young for my residency class-- I will finish my residency 1-2 years younger than most-- and had solid board scores on step 1 (~220), step 2 ck 230s, and step 3 240 and am a little confused as to how to spend the rest of my life....

Before I started medical school and during medical school I always wanted to be a surgeon-- that was my life's dream, but when I did the rotation during medical school I realized that I am unable to persue a surgical specialty due to an inability to perform tasks requiring manual dexterity. This essentially eliminated all surgical and most procedural type specialties and essentially took away my "dream specialty."

As a result, I chose to persue internal medicine because I did not know what I really wanted to do w/ my life. I knew when I started my residency that it was going to be brutal (ie lots of call, tough calls, etc) and here I am in my third year and somehow I do not know what I want to do w/ my life... The thing is that I enjoy learning and reading medicine, but I am beginning to realize that practicing medicine is really probably not for me. The more I see of it, I am beginning to become frustrated with seemingly endless paperwork, "dumps" on the medicine service, disrespect from other physician colleagues and patients, and their families. I don't know whether I am just disillusioned with medicine because I am a resident as everyone keeps saying that "things get better ," but people told me that when I was an intern and things haven't gotten too much better.

I have thought of persuing a specialty that is "not so people based" (ie rads), but am being told that I may come across some funding issues from CMS and the REALITY of having to grind through another four years of residency. The other option is to continue on in internal medicine and try to subspecialize in something-- the problem is that the only specialty that has an option to do something that is not as people based is cardiology with an echo fellowship, but that would likely require several more years of training.

Regardless, I should be completing my IM residency this year and fell confused as the other option would be to either work as a hospitalist or even leave medicine for a year or two and then come back to do a fellowship? I do not know if it is just me who feels so disillusioned about medicine as a whole, but is this commmon (or am I just a resident with the "blues" that will soon pass)? In addition, getting back to the title of my original post, what else can someone w/ little experience who is board certified in IM do that is not clinic/hospital medicine per se?

Sorry for the rambling post, but I would also appreciate it if anyone else could share their experience with any similar feelings during their residency and their possible career options? Thanks in advance.

cant you do consulting or something, like in pharma? I'm sure there are some MD's in that sector. Also you could go for an MPH and do something epidemiological if you like that kind of stuff. Or,if you have a science background from undergrad, you could always go into research if you like that. There is tons of biomedical research going on out there.

However, i'm surprised at your experience in your medicine program. Things are definitely not the way you mentioned at mine. Maybe it's just the environment at your particular hospital that has colored IM in a bad light for you. So, i'd agree with people who told you "things get better." It really depends on the culture of your hospital, the people you work with, and the type of job within IM you have. I've seen some fellow residents go on to amazing, cush primary care jobs and and terrible, burning-out primary care jobs. Some hospitalist jobs are sweet, some aren't. You just have to pick wisely.

My medicine residency experience was not too unlike yours.

Yes, I do think some of your feelings are just residency burnout. Remember, people treat you better when you are an "attending". Also, some nonacademic hospitals are better to work at...not as much conflict between nurses and docs, and not as many curveball patients (these tend to get turfed to the academic hospital). If you find a cushier hospital there might also be less of the patients-who-can't-pay-but-expect-the-red-carpet-treatment/you to kiss ass.

There actually are nonclinical jobs you could get. I just saw an ad in JAMA for the food/drug administration...they are having a big hiring push now to hire more people. You may want to check it out for future reference. My understanding is they hire docs to do more than drug reviews, etc. They also monitor food safety and medical devices (I guess the cardiac and surgical devices). I am sure there are other government jobs to be had also (highway traffic safety administration, etc.). I'm not sure you'll even need an MPH for most of those jobs. I know that the CDC also has some sort of 2 year fellowship thing you can sign up to do...it's something with disease/epidemic monitoring.

I have seen weight loss clinics hiring doctors as well. Not sure what your duties would be.

You could look into business/consulting jobs also...I'm not sure how many MD's they hire but there are probably some that might hire you.

If not sure you want to do a fellowship, you could take off a year and just do locum tenens (only work 1/2 the time and you'll still make much more than you are making now).

I guess if I were in your situation I might try and think about what geographic region I wanted to live in, then plan to move there after residency. You could talk to folks at your residency too, not telling them you don't like clinical medicine but that you are interested in "exploring some other opportunities/nontraditional careers in medicine" and see if they have any leads/ideas. Just be careful you don't burn bridges there in case you later want to do a fellowship.

Word of advice: I'd go ahead and sign up this winter to take the Internal medicine board exam next summer/fall as soon as you finish residency. Technically one can practice w/just USMLE and your state license, but effectively most insurance companies and employers want you to be "Board Certified". It seems like a waste of $1500 when you sign up for the test, but it's really necessary.