Is IM really like this?

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HopefulReapp

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Incoming ms1 here. I've been working full time as a patient aid on a med surg floor and it has certainly been rewarding and a great learning experience, but it has also shown me a lot of negative aspects of medicine. I don't see much improvement in my patients from day to day. The majority of illnesses are suicidal ideations, uncontrolled diabetes, dementia, hypertension, etc. Many of them refuse to help themselves, are frequent patients, or are waiting months to be placed.

I'm just wondering if my perspective is incredibly skewed by being an aid as opposed to the physician. I get kicked, screamed at, pooped and peed on, and a bunch of other things daily.

Is all of IM like this? Is it any more exciting as a med student or physician? I've shadowed specialists in out patient settings and enjoyed it much more (more alert/healthier patients.) Does this mean that I shouldn't consider IM in the future?

Thanks everyone


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Incoming ms1 here. I've been working full time as a patient aid on a med surg floor and it has certainly been rewarding and a great learning experience, but it has also shown me a lot of negative aspects of medicine. I don't see much improvement in my patients from day to day. The majority of illnesses are suicidal ideations, uncontrolled diabetes, dementia, hypertension, etc. Many of them refuse to help themselves, are frequent patients, or are waiting months to be placed.

I'm just wondering if my perspective is incredibly skewed by being an aid as opposed to the physician. I get kicked, screamed at, pooped and peed on, and a bunch of other things daily.

Is all of IM like this? Is it any more exciting as a med student or physician? I've shadowed specialists in out patient settings and enjoyed it much more (more alert/healthier patients.) Does this mean that I shouldn't consider IM in the future?

Thanks everyone


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From my experience in healthcare, a lot of the IM bread and butter cases are self-inflicted to some degree. Diabetes, HTN, COPD, CHF, etc. Those will make up a good chunk of a medicine floor.
 
I didn't find my inpatient GenMed rotations very interesting or exciting. You learn a lot, but during my subI in particular, I felt like discharge and social work issues tended to require more attention than the actual medicine aspect of patient care.
 
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Incoming ms1 here. I've been working full time as a patient aid on a med surg floor and it has certainly been rewarding and a great learning experience, but it has also shown me a lot of negative aspects of medicine. I don't see much improvement in my patients from day to day. The majority of illnesses are suicidal ideations, uncontrolled diabetes, dementia, hypertension, etc. Many of them refuse to help themselves, are frequent patients, or are waiting months to be placed.

I'm just wondering if my perspective is incredibly skewed by being an aid as opposed to the physician. I get kicked, screamed at, pooped and peed on, and a bunch of other things daily.

Is all of IM like this? Is it any more exciting as a med student or physician? I've shadowed specialists in out patient settings and enjoyed it much more (more alert/healthier patients.) Does this mean that I shouldn't consider IM in the future?

Thanks everyone


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Yes, Internal Medicine is like this. Now you know why IM is not competitive.
 
You don't know what you will like/dislike in the future. It changes with a lot of people. Do your best first two years and see what you enjoy later =)
 
You don't know what you will like/dislike in the future. It changes with a lot of people. Do your best first two years and see what you enjoy later =)
If he/she already doesn't like IM now, he's hardly likely to "like" it in the future.
 
If he/she already doesn't like IM now, he's hardly likely to "like" it in the future.

yeah maybe, but maybe they will like something IM related and will have to go into IM anyway


Anything is Possible in this beautiful world of Medicine!
 
yeah maybe, but maybe they will like something IM related and will have to go into IM anyway

Anything is Possible in this beautiful world of Medicine!
:rolleyes:
Going into a field bc you THINK you might get a coveted fellowship, is a bad idea, as depending how competitive it is, you may not get it and be stuck doing general IM.
 
:rolleyes:
Going into a field bc you THINK you might get a coveted fellowship, is a bad idea, as depending how competitive it is, you may not get it and be stuck doing general IM.

Also true, but lots of people do it. I have met a fair few Cardio/GI docs who didn't like IM so much.
 
Also true, but lots of people do it. I have met a fair few Cardio/GI docs who didn't like IM so much.

Cardiology and GI are one of the most competitive fellowships. You're not going to meet those (or at least those who will admit) who pursued a Cards/GI fellowship and failed to match to it. You'll only be exposed to the success stories, hence the selection bias.
 
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Cardiology and GI are one of the most competitive fellowships. You're not going to meet those (or at least those who will admit) who pursued a Cards/GI fellowship and failed to match to it. You'll only be exposed to the success stories, hence the selection bias.
Make them lowest paying specialties and then they won't be competitive. BTW cards is already feeling the crunch and GI may feel it soon.
 
Incoming ms1 here. I've been working full time as a patient aid on a med surg floor and it has certainly been rewarding and a great learning experience, but it has also shown me a lot of negative aspects of medicine. I don't see much improvement in my patients from day to day. The majority of illnesses are suicidal ideations, uncontrolled diabetes, dementia, hypertension, etc. Many of them refuse to help themselves, are frequent patients, or are waiting months to be placed.

I'm just wondering if my perspective is incredibly skewed by being an aid as opposed to the physician. I get kicked, screamed at, pooped and peed on, and a bunch of other things daily.

Is all of IM like this? Is it any more exciting as a med student or physician? I've shadowed specialists in out patient settings and enjoyed it much more (more alert/healthier patients.) Does this mean that I shouldn't consider IM in the future?

Thanks everyone


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Make it the top paying specialty and people will find it very interesting and exciting.
 
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Cardiology and GI are one of the most competitive fellowships. You're not going to meet those (or at least those who will admit) who pursued a Cards/GI fellowship and failed to match to it. You'll only be exposed to the success stories, hence the selection bias.

All i'm saying is he might want to do it later. I know its tough to get into those specialities but its not impossible. There are a bunch of IM residents who came into IM to specialize.
 
Make it the top paying specialty and then it'll competitive.

A) It's not a top paying specialty for a reason (vs. Surgical specialties which carry A LOT more risk) and B) Even if you made it the top paying specialty, people wouldn't do it bc of the lifestyle and the mundane problems you have to deal with.
 
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All i'm saying is he might want to do it later. I know its tough to get into those specialities but its not impossible. There are a bunch of IM residents who came into IM to specialize.

Yes, and not every resident that wants to specialize after IM can specialize. You will be fighting for those spots amongst your class.
 
A) It's not a top paying specialty for a reason (vs. Surgical specialties which carry A LOT more risk) and B) Even if you made it the top paying specialty, people wouldn't do it bc of the lifestyle and the mundane problems you have to deal with.
Too bad history doesn't support what you say. Back in the '60s to mid '80s when everyone's pay was about the same the two most prestigious specialties were general internal medicine and general surgery.
 
If he/she already doesn't like IM now, he's hardly likely to "like" it in the future.

I disagree. His experience is extremely skewed. Which IM doc do you know who gets kicked, pooped and peed on daily? He's not dealing with IM issues. He's essentially a sitter, it sounds like. That doesn't give you a perspective of medicine.
 
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Pay for IM is not going to go up. If anything it's a race to the bottom for nearly all specialties. A specialty like IM where you just get crapped on all day long will never be as competitive as derm or the top dog surgical subspecialties.

IM used to be competitive when the IM docs were given loads of respect and status. They don't get that anymore.
 
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I disagree. His experience is extremely skewed. Which IM doc do you know who gets kicked, pooped and peed on daily? He's not dealing with IM issues. He's essentially a sitter, it sounds like. That doesn't give you a perspective of medicine.
Agree. The responsibilities of a CNA is VERY different than an attending internist. He's not doing any patient management. He's not doing any of the thinking. He's a CNA which is similar to a apprentice brick layer, whereas an IM doc is similar to an architect.
 
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Too bad history doesn't support what you say. Back in the '60s to mid '80s when everyone's pay was about the same the two most prestigious specialties were general internal medicine and general surgery.

This is a half-baked analysis though. Back then, being any type of physician was "prestigious" and practically anyone could get into medical school compared to the competition these days. Sure, there is a definite link between physician pay and competitiveness of the specialty, but it's clearly not the entire story.

If it was exclusively about money, then there wouldn't be a huge shortage of pain specialists, which pays well but can be miserable. Also, ortho/nsurg spine would be the most competitive fields in medicine. Instead, fellowships go unfilled in ortho spine, and nsurg spine has an excellent job market due to shortage. Neurosurgeon residents at my institution uniformly hate spine, and would rather be clipping aneurysms at 4 am on Christmas morning for 1/2 the compensation. Anesthesia and radiology should be more competitive than derm by your logic, as well. I think in actuality, people go after their desired combination of optimal lifestyle, mulah, and medical interest.
 
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This is a half-baked analysis though. Back then, being any type of physician was "prestigious" and practically anyone could get into medical school compared to the competition these days. Sure, there is a definite link between physician pay and competitiveness of the specialty, but it's clearly not the entire story.

If it was exclusively about money, then there wouldn't be a huge shortage of pain specialists, which pays well but can be miserable. Also, ortho/nsurg spine would be the most competitive fields in medicine. Instead, fellowships go unfilled in ortho spine, and nsurg spine has an excellent job market due to shortage. Neurosurgeon residents at my institution uniformly hate spine, and would rather be clipping aneurysms at 4 am on Christmas morning for 1/2 the compensation. Anesthesia and radiology should be more competitive than derm by your logic, as well. I think in actuality, people go after their desired combination of optimal lifestyle, mulah, and medical interest.
Don't flatter yourself.
 
While being an attending internist will undoubtedly lead to less foreign urine on your clothes, you still have to deal with the same patient population and disease processes as described above. If it's just the former that bothers, the OP, then it's good he's going to medical, and not nursing, school If it's the latter, then it sounds like the OP has learned a lesson that it takes many of us years into clinical medicine to figure out.
 
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While being an attending internist will undoubtedly lead to less foreign urine on your clothes, you still have to deal with the same patient population and disease processes as described above. If it's just the former that bothers, the OP, then it's good he's going to medical, and not nursing, school If it's the latter, then it sounds like the OP has learned a lesson that it takes many of us years into clinical medicine to figure out.

DM, hypertension, and dementia? That's not exclusive to IM. You have to deal with that patient population in any specialty that deals with patients. Even in surgery, your patient interaction may be slightly limited, but your patients will still have all those co-morbities you need to watch on the floor.
 
Too bad history doesn't support what you say. Back in the '60s to mid '80s when everyone's pay was about the same the two most prestigious specialties were general internal medicine and general surgery.

The "prestige" of medicine and surgery back in the day was rooted in something far different.

First of all, the pay structure was radically different for all doctors, and pretty much all doctors had little to no student loan debt, so (stereotyping broadly) most doctors were living large, regardless of their specific field.

Second of all, the nature of intern year was different back then and really required going through the gateways of medicine and surgery. There was no such thing as a EM intern year to apply to like you can today, and even for fields like psych you traditionally did a year of medicine first then applied for your psych spot. And when you force people into those fields to start with, more people are going to stay in them due to simple inertia or lack of alternate options.

Third, more importantly, the FIELDS were radically different than they are now. General surgeons did everything, because "everything" wasn't really all that much. Now there are myriad more procedures, more varieties of ways to do the procedures, and most importantly, careful monitoring of morbidity/mortality rates and increased standardization/expectations of very good outcomes.

Medicine has changed even more drastically due to the changes in the nature of inpatient/hospital based care, as well as the increased frequency of diseases like obesity and diabetes, as well as the increased ability of us to keep pretty much anything alive in an ICU for a prolonged period of time, leading to drastically out of touch patient expectations.

And these drastic changes in the nature of the work have come about over time, parallel to a dramatic:
- rise in litigation
-rise in debt
-drop in reimbursements
-rise in hospital/insurer/employer meddling in the day-to-day ability to practice.

Even if you somehow magically increased the salary for general medicine by 100K (which you can't, since they do nothing that merits higher reimbursement, and as dermviser mentioned their risk/liability is substantially lower than the higher paid fields), you wouldn't see a flood of people running to apply.
 
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While being an attending internist will undoubtedly lead to less foreign urine on your clothes, you still have to deal with the same patient population and disease processes as described above. If it's just the former that bothers, the OP, then it's good he's going to medical, and not nursing, school If it's the latter, then it sounds like the OP has learned a lesson that it takes many of us years into clinical medicine to figure out.
The position has given me a tremendous amount of respect for the nurses that I will work alongside in the future and is something that I know I would not have nearly enough patience for.

edited the rest out, too emotional of a reply
 
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DM, hypertension, and dementia? That's not exclusive to IM. You have to deal with that patient population in any specialty that deals with patients. Even in surgery, your patient interaction may be slightly limited, but your patients will still have all those co-morbities you need to watch on the floor.

Ummm...that's probably why I said "clinical medicine". I never mentioned IM to the exclusion of other fields or at all, for that matter.
 
Ummm...that's probably why I said "clinical medicine". I never mentioned IM to the exclusion of other fields or at all, for that matter.

Actually, you did. Your first sentence specifically mentions IM.

While being an attending internist will undoubtedly lead to less foreign urine on your clothes, you still have to deal with the same patient population and disease processes as described above.
 
Okay, you got me; I said "internist". I think it was pretty clear that there was nothing about my original post that suggested these issues are unique to internal medicine.

Obviously, not to me, which is why I replied. Moving on...
 
Too bad history doesn't support what you say. Back in the '60s to mid '80s when everyone's pay was about the same the two most prestigious specialties were general internal medicine and general surgery.

You just proved my point. Back in the 60s - 80s when everyone's pay was about the same, people chose the specialty they liked based on whether they liked the subject matter, since as you said, "everyone's pay was about the same". Fast forward to now, where lifestyle concerns are very important to the millenial medical student.
 
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Don't flatter yourself.
Truth hurts. But yes, let's just make the reasoning black-and-white, without any nuance. Bc that's exactly how real life works. :rolleyes:
 
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I was interested in IM, and still am, but many IM and IM-subspecialty physicians I know seem burnt out and annoyed all the time. It worries me.
 
I was interested in IM, and still am, but many IM and IM-subspecialty physicians I know seem burnt out and annoyed all the time. It worries me.
That's bc IM as a specialty sucks esp. from a lifestyle standpoint. Everyone likes the theoretical learning and knowledge of IM. The actual practice of it? Not so much.
 
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I was interested in IM, and still am, but many IM and IM-subspecialty physicians I know seem burnt out and annoyed all the time. It worries me.

Might want to meet some of the ones in allergy, endocrine, and rheum. They don't seem burnt out or annoyed.
 
Might want to meet some of the ones in allergy, endocrine, and rheum. They don't seem burnt out or annoyed.

How many of those folks have to supplement their outpatient practice with general internal med, though?

Allergy is awesome, though. It's like the derm of IM, but highly competitive. It would be a poor idea to go into IM with the express interest to go into allergy in case the fellowship match didn't work out too hot.
 
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That thread is definitely a PCP bashing thread... Which one is worst? IM or FM! These docs seem to do the same thing in the region that I live now.
 
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How many of those folks have to supplement their outpatient practice with general internal med, though?

Depends on where you are. I wouldn't imagine any of them would have to if they're in a major city.
 
How many of those folks have to supplement their outpatient practice with general internal med, though?

Allergy is awesome, though. It's like the derm of IM, but highly competitive. It would be a poor idea to go into IM with the express interest to go into allergy in case the fellowship match didn't work out too hot.

Yeah, I know a few allergists and they seem to be quite happy with what they're doing.

You just proved my point. Back in the 60s - 80s when everyone's pay was about the same, people chose the specialty they liked based on whether they liked the subject matter, since as you said, "everyone's pay was about the same". Fast forward to now, where lifestyle concerns are very important to the millenial medical student.

Lifestyle is the most important thing to me, as it is to most of my friends. Of course, you get the occasional dude who wants nothing more than to go into an academic surgical subspecialty and work all the time. He's welcome to his misery, especially when the reimbursement to his field gets shattered.

For less-than-stellar students like me, we don't have too many lifestyle options though, Psych and PMR are the big ones I think.
 
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That thread is definitely a PCP bashing thread... Which one is worst? IM or FM! These docs seem to do the same thing in the region that I live now.

Might want to step down off your soapbox, premed. Oh, I'm sorry, MS-0. Most med students who fork out 6 figures salaries don't want to compete against NPs.
 
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Might want to step down off your soapbox, premed. Oh, I'm sorry, MS-0. Most med students who fork out 6 figures salaries don't want to compete against NPs.

I'm not going to lie, I would be fine going into FM if it weren't for this DNP nonsense.
 
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That thread is definitely a PCP bashing thread... Which one is worst? IM or FM! These docs seem to do the same thing in the region that I live now.

You have no idea what you're talking about Mr. Class of 2018.
 
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Also, OP reminded me of this.

 
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Yeah, I know a few allergists and they seem to be quite happy with what they're doing.

Lifestyle is the most important thing to me, as it is to most of my friends. Of course, you get the occasional dude who wants nothing more than to go into an academic surgical subspecialty and work all the time. He's welcome to his misery, especially when the reimbursement to his field gets shattered.

For less-than-stellar students like me, we don't have too many lifestyle options though, Psych and PMR are the big ones I think.

PM&R has an excellent lifestyle and pay (with the right procedure-rich fellowship) and Psych as a complete outpatient specialty can have a great lifestyle.
 
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Make it the top paying specialty and people will find it very interesting and exciting.

You couldn't pay me 500K to do inpatient internal medicine, ESPECIALLY an academic-focused residency :(
 
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Make it the top paying specialty and people will find it very interesting and exciting.

Yes, look at those swaths of medical students applying for Neurosurgery....oh wait....
 
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