Anyone having FOMO about matching into IM?

[Doctor_Strange]

I don't know why but over the past few weeks I have been feeling like I made a mistake applying to IM (with the goal of Cardio fellowship down the line). A lot of my friends matched into anesthesiology and they keep talking about the high pay/lots of procedures/ and generally the efficient day-to-day of attending life. I rarely hear IM-bound folks speak so enthusiastically about their specialty choice. Maybe its just me getting nervous, but I worry 8 months into intern year I will have realized I made a mistake about choosing IM. I chose IM because I envisioned the fun that Cardiologists had of being able to do so many cool things from image interpretation to cath lab to clinic. I know its a long road ahead, but damn I hope its worth it. Thankfully, as a DO, I matched into a university program with a ton of fellowships, but still does not make me any less anxious about the future...

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[chessknt]

By your friends you mean a bunch of ******* 4th years who haven’t worked a single day as an anesthesiologist or even know what rvus are? Those friends?

 

[wamcp]

I don't know why but over the past few weeks I have been feeling like I made a mistake applying to IM (with the goal of Cardio fellowship down the line). A lot of my friends matched into anesthesiology and they keep talking about the high pay/lots of procedures/ and generally the efficient day-to-day of attending life. I rarely hear IM-bound folks speak so enthusiastically about their specialty choice. Maybe its just me getting nervous, but I worry 8 months into intern year I will have realized I made a mistake about choosing IM. I chose IM because I envisioned the fun that Cardiologists had of being able to do so many cool things from image interpretation to cath lab to clinic. I know its a long road ahead, but damn I hope its worth it. Thankfully, as a DO, I matched into a university program with a ton of fellowships, but still does not make me any less anxious about the future...

Imagine FOMOing into the hot specialty before you even start residency. None of this is guaranteed or predictable. Look at EM, great rates through 2018, until the bubble burst and ER docs are unemployed today. Below is from 2017:

“If you are a smart locums you are.

I avg 510/hr last yr. Just went full locums and made as much in 6 shifts as I did 15 at W2.

I have never done a shift at rate and never will.”


“I get a contracted "travel bonus" but I have to give a minimum of 6 shifts. Technically a moderate "bonus" for each of those 6 shifts. For any shifts I pick up over that, I wait until they are offering an additional bonus of > $1500 per shift. Over Christmas for example, the shift bonus was $3000/shift.”

“Update: Year 4 of locums, and I'm still at my regular "part-time" job doing 100 hours per month. The base "exhorbitant" rate has stayed the same. The shortage of physicians has worsened, and we now have > 20 open shifts in March. $2000/shift bonuses generally being offered to pick up the unfilled shifts 1 month out. Life has never been better.”

Economics of outrageous Locum Tenens hourly rates

You say this now. I said it "then" as well. Its not do-able. The gulf from senior resident to attending is wide and deep. I have no experience of being an EM physician but before med school I volunteered at an ER, so I could imagine how tough it would be to work 20, 12-hr shifts a month...

forums.studentdoctor.net

 

[Doctor_Strange]

By your friends you mean a bunch of ******* 4th years who haven’t worked a single day as an anesthesiologist or even know what rvus are? Those friends?

Lol true, I guess my angst -- if I am being 100% honest -- is I feel like IM residency is gonna be a lot more scut work / BS than other specialties wade thru. For me, I kept telling myself that 3 years is a relatively short time to hopefully achieve my other career / professional goals. I definitely am having some cold feet about internship lol

 

[chessknt]

Lol true, I guess my angst -- if I am being 100% honest -- is I feel like IM residency is gonna be a lot more scut work / BS than other specialties wade thru. For me, I kept telling myself that 3 years is a relatively short time to hopefully achieve my other career / professional goals. I definitely am having some cold feet about internship lol

There is a mirror thread of yours in the anesthesia forum right now go take a look. You’ll be fine and IM has much better subspec options than anesthesia and some of those have far better earning potential while other have a vastly superior quality of life.

 

[cards67]

Ignore the noise and do you. I'd actually find it insufferable if people around me were talking like that. Ego, insecurity? 4th years really don't know anything anyway. Training sucks for most one way or another.

 

[HatTricks01]

Yes, you will likely have to deal with more scut, transfer dumps, and dispo issues because that is the nature of IM. However, for the majority if of your intern year, you won't know your head from your a** and everything will be a learning experience for you. Your second year, you'll actually learn to manage patients while being a team leader. It probably won't be until the end of your second year into your third year that you'll feel the majority of scut/dispo/BS ED admissions tearing at your soul because you'd have seen it so many times by then that you know it will provide little to no educational value for you. However, by that time, you'll be concentrating on applying to fellowship / interviewing and by the time you (hopefully) match, you'll only have another 6 months left.

But yes, 4th years don't know anything and your colleagues who have matched into other specialties will definitely be dealing with BS of their own because that is the nature of being a trainee.

 

[NITRAS]

I don't know why but over the past few weeks I have been feeling like I made a mistake applying to IM (with the goal of Cardio fellowship down the line). A lot of my friends matched into anesthesiology and they keep talking about the high pay/lots of procedures/ and generally the efficient day-to-day of attending life. I rarely hear IM-bound folks speak so enthusiastically about their specialty choice. Maybe its just me getting nervous, but I worry 8 months into intern year I will have realized I made a mistake about choosing IM. I chose IM because I envisioned the fun that Cardiologists had of being able to do so many cool things from image interpretation to cath lab to clinic. I know its a long road ahead, but damn I hope its worth it. Thankfully, as a DO, I matched into a university program with a ton of fellowships, but still does not make me any less anxious about the future...

I have like 4 friends that are anesthesiologist. Every single one of them takes call at nights. One had to comb to find a job without having to supervise CRNA’s. You also have never heard one complain because some hot-shot surgeon directed them to do something stupid.

Yes, anesthesiologist make more, on average than IM docs. Yes, IM docs take care of poeple that no one else wants to. I have started three IV’s in the last six years, and I have never had to draw my own medications. I’ve never had to tell a surgeon no, we shouldn’t risk this old patient‘s life with a few remaining alveoli or cardiac myocytes to repair non-strangulated hernia be. Room turnover isn’t my problem.

Point is, all of us have some problems. I’m happy with IM’s. Anesthesia isn’t all glitter and gold. I promise.

 

[Splenda88]

The 400k+ salaries you hear about in Anesthesia doesn't mention that average hours worked is ~55, involves call, being a CRNA supervisor and not knowing exactly what time you’ll get out everyday

True...

Many IM docs, especially hospitalists would make 400k+ if they work 55 hrs/wk. In fact, I just signed a hospitalist contract and if I work 55 hrs/wk, I should make 430k+/yr

 

[ShuperNewbie]

Many IM docs, especially hospitalists would make 400k+ if they work 55 hrs/wk. In fact, I just signed a hospitalist contract and if I work 55 hrs/wk, I should make 430k+/yr

Same. I could probably inch close to 400K+ in NYC if I chose to work every week by supplementing my salary with moonlighting and/or locums. Instead, I choose to make mid 200s while working a little more than a week every month and enjoying my life and exploring other passions. @Doctor_Strange, post IM life is great man. Since you're the bottleneck/gatekeeper to everything, you have so much flexibility to choose what you want to do. There are so many possibilities and so many opportunities out there and we can generally rest assured that we'll be needed/be able to find something to do no matter how the climate changes.

 

[Splenda88]

Same. I could probably inch close to 400K+ in NYC if I chose to work every week by supplementing my salary with moonlighting and/or locums. Instead, I choose to make mid 200s while working a little more than a week every month and enjoying my life and exploring other passions. @Doctor_Strange, post IM life is great man. Since you're the bottleneck/gatekeeper to everything, you have so much flexibility to choose what you want to do. There are so many possibilities and so many opportunities out there and we can generally rest assured that we'll be needed/be able to find something to do no matter how the climate changes.

What do you do on your week off?

 

[ShuperNewbie]

What do you do on your week off?

What do I do with my three weeks off every month?

Anything I want to . What a life.

 

[Splenda88]

What do I do with my three weeks off every month?

Anything I want to . What a life.

You work only a little more than 1 wk/month and make 250k/yr! Hospital medicine is great.


Why do people spend an extra 2-3 yrs doing fellowship?

 

[Prehealth1011]

Same. I could probably inch close to 400K+ in NYC if I chose to work every week by supplementing my salary with moonlighting and/or locums. Instead, I choose to make mid 200s while working a little more than a week every month and enjoying my life and exploring other passions. @Doctor_Strange, post IM life is great man. Since you're the bottleneck/gatekeeper to everything, you have so much flexibility to choose what you want to do. There are so many possibilities and so many opportunities out there and we can generally rest assured that we'll be needed/be able to find something to do no matter how the climate changes.

Little more than a week for mid 200s?! Are you W2 or work nights/14h shifts?

 

[deleted980918]

I’ll tell you the truth, IM residency sucks no matter how you see it. Endless bs, social work round, dispo...etc. BUT there is a light at the end

subspecialty like cardiology and GI pays more than anesthesia and probably more than most surgical specialties out there with better lifestyle

even if you don’t end up doing the above, you can do hospital med or PCP with amazing lifestyle

I have no regrets or FOMO

 

[Splenda88]

UNE alum is new chief of Hospitalist Service at Maine VA Medical Center

The new chief of the Hospitalist Service at the Maine Veterans Affairs (VA) Medical Center at Togus is a graduate of the University of New England’s Master of Science in Physician Assistant (M.S.P.A.) program, the only such program in Maine. He is also the first physician assistant in the Maine...

www.une.edu

PA chief hospitalist service. Great!

 

[wamcp]

UNE alum is new chief of Hospitalist Service at Maine VA Medical Center

The new chief of the Hospitalist Service at the Maine Veterans Affairs (VA) Medical Center at Togus is a graduate of the University of New England’s Master of Science in Physician Assistant (M.S.P.A.) program, the only such program in Maine. He is also the first physician assistant in the Maine...

www.une.edu

PA chief hospitalist service. Great!

Whoops, did'nt realize you posted this here already and I just made a separate thread. Did you post it on r/noctor? My bad

 

[BorntobeDO?]

Lol true, I guess my angst -- if I am being 100% honest -- is I feel like IM residency is gonna be a lot more scut work / BS than other specialties wade thru. For me, I kept telling myself that 3 years is a relatively short time to hopefully achieve my other career / professional goals. I definitely am having some cold feet about internship lol

It is a lot of scut, but it is also 3 years. Really one bad year depending on how it’s organized (intern). When you do cards, it will be anesthesia who is jealous when you run the show. Cards potential is higher than gas if you want to work similar hours.

 

[CCM-MD]

UNE alum is new chief of Hospitalist Service at Maine VA Medical Center

The new chief of the Hospitalist Service at the Maine Veterans Affairs (VA) Medical Center at Togus is a graduate of the University of New England’s Master of Science in Physician Assistant (M.S.P.A.) program, the only such program in Maine. He is also the first physician assistant in the Maine...

www.une.edu

PA chief hospitalist service. Great!

WTF?

 

[sunshinefl]

I would have had FOMO if I matched into anything BUT Internal Medicine

 

[emergentmd]

I don't think anyone should FOMO for Anesthesiology. I remember talking to a bottom 1/3 friend who matched into Rad Onc which I never heard before and thought it was just some IMG field. Fast forward 10 yrs and dude was racking in $$$ walking around in a low stress job. Fast forward 20 yrs and the field is becoming an IMG field. Truthfully, many fields will start to be invaded by IMGs soon.

Pick the field you like or can deal with on a daily basis. Bottom line it is a job, pays the bills, and if you love it great but I have found very few docs who actually loves it or is their calling. I still enjoy my job and look forward to going to work but I am not delusional to think that it is a calling. If someone pays me my salary to stay home, I can assure you I will not be going to work b/c I love it.

 

[rokshana]

I don't think anyone should FOMO for Anesthesiology. I remember talking to a bottom 1/3 friend who matched into Rad Onc which I never heard before and thought it was just some IMG field. Fast forward 10 yrs and dude was racking in $$$ walking around in a low stress job. Fast forward 20 yrs and the field is becoming an IMG field. Truthfully, many fields will start to be invaded by IMGs soon.

Pick the field you like or can deal with on a daily basis. Bottom line it is a job, pays the bills, and if you love it great but I have found very few docs who actually loves it or is their calling. I still enjoy my job and look forward to going to work but I am not delusional to think that it is a calling. If someone pays me my salary to stay home, I can assure you I will not be going to work b/c I love it.

Ummm...F/IMGs are not midlevels...
And sounds like someone may need to think about retirement...

 

[emergentmd]

I think I understand the difference b/t IMG and midlevels. With the current and future expansion of residencies, many of the fields will be invaded by IMGs.
Sounds like someone is delusional.

 

[Splenda88]

Whoops, did'nt realize you posted this here already and I just made a separate thread. Did you post it on r/noctor? My bad

No.

 

[rokshana]

I think I understand the difference b/t IMG and midlevels. With the current and future expansion of residencies, many of the fields will be invaded by IMGs.
Sounds like someone is delusional.

lol...my specialty is full of I/FMGs...we are fine.

if you think F/IMGs are the "invaders"...well...... (they don't have an emoji with a white one so this will have to do...)

 

[emergentmd]

I never said IMGs are inferior or invaders. The way the system is set up, the sought after fields are vastly restricted to AMGs but the way private equity/for profit entities are starting to open residencies, this will not be the case in the future. I see Derm/ortho being open to IMGs due to the sheer number of positions in the next 10 yrs.

 

[AussieAg]

I'm a cardiology fellow. As someone mentioned earlier, there is light at the end of the tunnel that is internal medicine residency. Cardiology is awesome.

 

[rokshana]

I never said IMGs are inferior or invaders. The way the system is set up, the sought after fields are vastly restricted to AMGs but the way private equity/for profit entities are starting to open residencies, this will not be the case in the future. I see Derm/ortho being open to IMGs due to the sheer number of positions in the next 10 yrs.

You said it ...twice.

 

[sotto]

I never said IMGs are inferior or invaders. The way the system is set up, the sought after fields are vastly restricted to AMGs but the way private equity/for profit entities are starting to open residencies, this will not be the case in the future. I see Derm/ortho being open to IMGs due to the sheer number of positions in the next 10 yrs.

I’m glad you openly showed your true feeling when owned up to the fact you feel IMGs are inferior to be in specialties like Derm/Ortho .
Is there something intrinsically wrong with an IMG doing derm/ortho?

 

[emergentmd]

I am not debating if IMGs are inferior. I am just pointing out the obvious fact that it is extremely difficult for IMGs to get into competitive fields. If you want to go Karen on me and twist my words then go ahead.

But in truth, YES. If you came from a Caribbean school you are looked down upon by the vast majority of residencies and program directors.

 

[Doctor_Strange]

I am not debating if IMGs are inferior. I am just pointing out the obvious fact that it is extremely difficult for IMGs to get into competitive fields. If you want to go Karen on me and twist my words then go ahead.

But in truth, YES. If you came from a Caribbean school you are looked down upon by the vast majority of residencies and program directors.

You didn't say anything wrong. That's the way the system is set up. Of course no one actually thinks IMGs are inferior to AMGs. A doctor is a doctor is a doctor.

 

[Hotshy]

You didn't say anything wrong. That's the way the system is set up. Of course no one actually thinks IMGs are inferior to AMGs. A doctor is a doctor is a doctor.

MD>DO>>>>Carib is nothing new.

 

[rokshana]

I am not debating if IMGs are inferior. I am just pointing out the obvious fact that it is extremely difficult for IMGs to get into competitive fields. If you want to go Karen on me and twist my words then go ahead.

But in truth, YES. If you came from a Caribbean school you are looked down upon by the vast majority of residencies and program directors.

Really? Since the vast majority of residencies have F/IMGs in their programs...you do realize that sgu , by its sheer numbers (one class is =6-8 US Med school classes) supplies the most Med students to residencies each year
@NotAProgDirector ...would you say that the majority of PDs look at F/IMGs as inferior?

and i don’t think the xenophobic nationalist can actually call out someone for being a Karen

 

[NotAProgDirector]

Let's not derail this thread into an MD/DO/IMG mess. There's plenty of those threads around.

To the OP, back on track: I'm a hospitalist and I love my job. I also did primary care for 10+ years and loved that. I think anesthesia looks boring.

Advice from an old guy: Do what you love. All medicine pays well. I'd rather get a somewhat lower salary and love what I do every day. Really interacting with patients is the best part of my job.

 

[emergentmd]

Really? Since the vast majority of residencies have F/IMGs in their programs...you do realize that sgu , by its sheer numbers (one class is =6-8 US Med school classes) supplies the most Med students to residencies each year
@NotAProgDirector ...would you say that the majority of PDs look at F/IMGs as inferior?

and i don’t think the xenophobic nationalist can actually call out someone for being a Karen

No one with any sense especially a program director would say that IMGs are equivalent to AMGs. That is just laughable. Using SGU providing the most docs compared to any AMGs is the epitome of numbers misrepresentation. Laughable rebuttal.

You will not get any program director to agree with you. But go ahead and keep telling yourself this.

 

[Osteoth]

This has already been said but IM is nice because it’s flexible.

Want to make $500k 3 years out? Work 2.0 FTE nocturnist

Want to be your own boss 3 years out? Primary care

Want to be a specialist and make $? Cards, GI, onc, crit

Want to be an office based specialist? Etc etc

Nice thing is you can do any combo of the above and work in industry, leadership etc to boot.

 

[Splenda88]

This has already been said but IM is nice because it’s flexible.

Want to make $500k 3 years out? Work 2.0 FTE nocturnist

Want to be your own boss 3 years out? Primary care

Want to be a specialist and make $? Cards, GI, onc, crit

Want to be an office based specialist? Etc etc

Nice thing is you can do any combo of the above and work in industry, leadership etc to boot.

500k/yr is not realistic for 95%+ jobs out there but 400k is very doable in many jobs.

 

[gutonc]

500k/yr is not realistic for 95%+ jobs out there but 400k is very doable in many jobs.

Dude...you literally said it was for that kind of a job.

Don't move the goalposts now.

 

[Nocturnist]

I don't know why but over the past few weeks I have been feeling like I made a mistake applying to IM (with the goal of Cardio fellowship down the line). A lot of my friends matched into anesthesiology and they keep talking about the high pay/lots of procedures/ and generally the efficient day-to-day of attending life. I rarely hear IM-bound folks speak so enthusiastically about their specialty choice. Maybe its just me getting nervous, but I worry 8 months into intern year I will have realized I made a mistake about choosing IM. I chose IM because I envisioned the fun that Cardiologists had of being able to do so many cool things from image interpretation to cath lab to clinic. I know its a long road ahead, but damn I hope its worth it. Thankfully, as a DO, I matched into a university program with a ton of fellowships, but still does not make me any less anxious about the future...

Tune out the noise and just do you.
You said it yourself: you went into IM because you envisioned the fun of being able to do so many cool things. We may not all be as vocal about it as the 'sthesia bros, but many of us went into IM for the very same reason.

I always tell students the beautiful thing about IM is it leaves the most doors open. Clinical, admin, teaching, consulting, specializing, days, nights, afternoons, admitting, rounding. Its whatever you want to make of it.

I personally love the problem solving and thought process of actual medicine- admitting, rapid responses, codes, and wanted to minimize the rest of the BS (followups, rounding, case managements, family discussions). Nocturnist medicine is a natural fit for me. There's much more likely to be a fit for you in IM than elsewhere because its constantly evolving and growing.

Also- 8 months into intern year is possibly the worst time in your career to reflect on making the wrong choice. You went overnight from being top dog in your medical school to lowest on the totem pole. It's winter, it's cold, it's dark. Youre working harder than you ever have. There's a reason why that 6-8 month period of intern year is some of the highest suicide rate for residents. If you find yourself there- just keep swimming (and ofcourse, find someone to talk to). 4 months from then you're leading a team, building up interns and watching them grow, gaining confidence in your skills. Life gets so much better from there.

5 years out of residency i work as much as I want, when I want. I make great money. I'm about to close on my second house. I travel every month. My job satisfaction is through the roof. Theres light at the end of the tunnel- just keep swimming.

 

[yakattack16]

Tune out the noise and just do you.
You said it yourself: you went into IM because you envisioned the fun of being able to do so many cool things. We may not all be as vocal about it as the 'sthesia bros, but many of us went into IM for the very same reason.

I always tell students the beautiful thing about IM is it leaves the most doors open. Clinical, admin, teaching, consulting, specializing, days, nights, afternoons, admitting, rounding. Its whatever you want to make of it.

I personally love the problem solving and thought process of actual medicine- admitting, rapid responses, codes, and wanted to minimize the rest of the BS (followups, rounding, case managements, family discussions). Nocturnist medicine is a natural fit for me. There's much more likely to be a fit for you in IM than elsewhere because its constantly evolving and growing.

Also- 8 months into intern year is possibly the worst time in your career to reflect on making the wrong choice. You went overnight from being top dog in your medical school to lowest on the totem pole. It's winter, it's cold, it's dark. Youre working harder than you ever have. There's a reason why that 6-8 month period of intern year is some of the highest suicide rate for residents. If you find yourself there- just keep swimming (and ofcourse, find someone to talk to). 4 months from then you're leading a team, building up interns and watching them grow, gaining confidence in your skills. Life gets so much better from there.

5 years out of residency i work as much as I want, when I want. I make great money. I'm about to close on my second house. I travel every month. My job satisfaction is through the roof. Theres light at the end of the tunnel- just keep swimming.

Curious if you have a family. I hear that nocturnist is a big lifestyle boost, but can't imagine doing it with a spouse and kids at home; I imagine being miserable on my recovery days and it not being sustainable long term (even though I function fairly well at night during residency).

 

[chessknt]

Curious if you have a family. I hear that nocturnist is a big lifestyle boost, but can't imagine doing it with a spouse and kids at home; I imagine being miserable on my recovery days and it not being sustainable long term (even though I function fairly well at night during residency).

Whoever told you it was a lifestyle boost is insane and any further advice from this person should generally assumed to be wrong. There are some reasons to work nights (predominantly money) and many to not work them. The lifestyle of being asleep while everyone else is awake is not a boost unless you are a miserable misanthrope and want to interact with as few people as possible for the rest of your life.

It is definitely very hard to do with kids but does buy you some after school time before work so not a total waste. Youre still subject to the usual missing weekend events and working holidays that all inpatient work is subject to.

 

[emergentmd]

Curious if you have a family. I hear that nocturnist is a big lifestyle boost, but can't imagine doing it with a spouse and kids at home; I imagine being miserable on my recovery days and it not being sustainable long term (even though I function fairly well at night during residency).

I am an EM doc that almost never did an overnight shift b/c our place always had nocturnists so the latest my shift ended was 2am so never did a true overnight.

I had a bright idea 10 yrs into attending that I wanted to spend more time with the kids in the summer so signed up for all night for 3 summer months. Rainbows and unicorns, and thought the 11p-6a shift would not be bad. Work 10 dys a month, come home and sleep until noon feeling refreshed and enjoying the whole day with the family until my next shift. Realize that our overnight EM shifts were only 7 hours.

That was the most miserable 3 months and my wife can attest to this. With 3 young kids, there was no sleeping 7 straight hours. Even if they left me alone in my dark media room, the body kept telling me to wake up in 3 hrs. I don't remember even having a straight 7hours sleep for the whole summer. I will say nocturnist really messes you up and with kids its a double whammy.

Anyhow, the two nocturnist did it for probably 10 yrs. One quit medicine and never heard from him again. The other had a psych break down and had to seek mental care.

I would tread very very lightly and have an exit plan for anyone wanting to be a nocturnist.

 

[CCM-MD]

I am an EM doc that almost never did an overnight shift b/c our place always had nocturnists so the latest my shift ended was 2am so never did a true overnight.

I had a bright idea 10 yrs into attending that I wanted to spend more time with the kids in the summer so signed up for all night for 3 summer months. Rainbows and unicorns, and thought the 11p-6a shift would not be bad. Work 14 dys a month, come home and sleep until noon feeling refreshed and enjoying the whole day with the family until my next shift. Realize that our overnight EM shifts were only 7 hours.

That was the most miserable 3 months and my wife can attest to this. With 3 young kids, there was no sleeping 7 straight hours. Even if they left me alone in my dark media room, the body kept telling me to wake up in 3 hrs. I don't remember even having a straight 7hours sleep for the whole summer. I will say nocturnist really messes you up and with kids its a double whammy.

Anyhow, the two nocturnist did it for probably 10 yrs. One quit medicine and never heard from him again. The other had a psych break down and had to seek mental care.

I would tread very very lightly and have an exit plan for anyone wanting to be a nocturnist.

SDN has a tendency to idolize upon “sweet gigs” based upon the raw $ to amount of work ratio and duration of training. This makes nocturnist popular on here. The negative factors that you have mentioned are absolutely real and need more consideration from those considering nocturnist careers. It might be the perfect job for a few but definitely not the case for the majority.

 

[chessknt]

I am an EM doc that almost never did an overnight shift b/c our place always had nocturnists so the latest my shift ended was 2am so never did a true overnight.

I had a bright idea 10 yrs into attending that I wanted to spend more time with the kids in the summer so signed up for all night for 3 summer months. Rainbows and unicorns, and thought the 11p-6a shift would not be bad. Work 14 dys a month, come home and sleep until noon feeling refreshed and enjoying the whole day with the family until my next shift. Realize that our overnight EM shifts were only 7 hours.

That was the most miserable 3 months and my wife can attest to this. With 3 young kids, there was no sleeping 7 straight hours. Even if they left me alone in my dark media room, the body kept telling me to wake up in 3 hrs. I don't remember even having a straight 7hours sleep for the whole summer. I will say nocturnist really messes you up and with kids its a double whammy.

Anyhow, the two nocturnist did it for probably 10 yrs. One quit medicine and never heard from him again. The other had a psych break down and had to seek mental care.

I would tread very very lightly and have an exit plan for anyone wanting to be a nocturnist.

But did you make $700 per hour out of residency clearing 750k/year only working 10 nights per month as has been presented in this thread? Because if not you didnt have the SDN median job

 

[emergentmd]

But did you make $700 per hour out of residency clearing 750k/year only working 10 nights per month as has been presented in this thread? Because if not you didnt have the SDN median job

No but my bright idea came with working 10 shift rather than my typical 14 shifts a month due to the increase pay. Still quite miserable. No way I could do 12 hr 7 on/off.

I remember when we were working on the nocturnist bonuses and I would have voted for whatever they wanted. Night people may think they handle it well but they don't realize what they don't know. Have you guys ever looked at before & after pics of our presidents? Those 4-8 yrs really take their toll on them. Same with Nocturnists.

Oh, did I mention that when the kids woke up in the am my poor wife had to keep a 2,4&6 yr old quiet so dad could try to get a decent sleep?

 

[Doctor_Strange]

Tune out the noise and just do you.
You said it yourself: you went into IM because you envisioned the fun of being able to do so many cool things. We may not all be as vocal about it as the 'sthesia bros, but many of us went into IM for the very same reason.

I always tell students the beautiful thing about IM is it leaves the most doors open. Clinical, admin, teaching, consulting, specializing, days, nights, afternoons, admitting, rounding. Its whatever you want to make of it.

I personally love the problem solving and thought process of actual medicine- admitting, rapid responses, codes, and wanted to minimize the rest of the BS (followups, rounding, case managements, family discussions). Nocturnist medicine is a natural fit for me. There's much more likely to be a fit for you in IM than elsewhere because its constantly evolving and growing.

Also- 8 months into intern year is possibly the worst time in your career to reflect on making the wrong choice. You went overnight from being top dog in your medical school to lowest on the totem pole. It's winter, it's cold, it's dark. Youre working harder than you ever have. There's a reason why that 6-8 month period of intern year is some of the highest suicide rate for residents. If you find yourself there- just keep swimming (and ofcourse, find someone to talk to). 4 months from then you're leading a team, building up interns and watching them grow, gaining confidence in your skills. Life gets so much better from there.

5 years out of residency i work as much as I want, when I want. I make great money. I'm about to close on my second house. I travel every month. My job satisfaction is through the roof. Theres light at the end of the tunnel- just keep swimming.

Appreciate this advice and insight! I'm not gonna lie -- when I posted this I must have been feeling all kinds of emotions. Everyone was so giddy about their specialty choice -- magnified by social media posts -- I likely felt uncertain that because I was not excited myself that perhaps my heart was not tuned to IM, but a month later since this post I realize that was a temporary feeling. I feel great about my specialty choice, and not even because of all the doors that are open -- I just like the whole diagnostic workup that entails all of Internal Medicine. I'm pretty excited, frankly, for residency to start!

 

[Nocturnist]

Curious if you have a family. I hear that nocturnist is a big lifestyle boost, but can't imagine doing it with a spouse and kids at home; I imagine being miserable on my recovery days and it not being sustainable long term (even though I function fairly well at night during residency).

You'll never see me outright claiming it's a lifestyle boost because it's the only attending position I've ever held. I can only describe my experience and observations, keep reminding people that its not for everyone, and that your mileage may vary. Some folks would rather get scoped without sedation than do a single night shift, some folks like myself go to work each night feeling like theyre getting away with something,, thanking the hospitalist gods there are people out there willing to work days. MORE days...for LESS money.

About 1/3 of the IM nocturnists I've worked with have kids. As it happens, 100% of our ER nocturnists have kids, and I know they specifically chose it for that reason.

It took me a couple years to figure out how to manage my recovery day. It's definitely a wasted day in the sense that I'll wake up in the afternoon and go back to sleep by midnight'ish- but I'll wake up the next morning and I'm back to a regular schedule.

Being a nocturnist has has allowed me in 5 years to make what others in IM might take 10-15 years to make. I'm not going to claim I've banked enough to retire on quite yet, but I'm well on my way. If/when I want, I can (with a few weeks notice) scale back to working 5 nights a month (0.5 FTE) and still bring in well into the 6 figures. This is easily enough to continue maxing out my retirement accounts and covering my expenses without dipping into savings. I wasn't personally ever looking for an exit plan because I can't see myself doing anything else, but there it is if I ever did need one. If making 6 figures while having 25 days off a month unsustainable, I dont know what is.

 

[Nocturnist]

Appreciate this advice and insight! I'm not gonna lie -- when I posted this I must have been feeling all kinds of emotions. Everyone was so giddy about their specialty choice -- magnified by social media posts -- I likely felt uncertain that because I was not excited myself that perhaps my heart was not tuned to IM, but a month later since this post I realize that was a temporary feeling. I feel great about my specialty choice, and not even because of all the doors that are open -- I just like the whole diagnostic workup that entails all of Internal Medicine. I'm pretty excited, frankly, for residency to start!

Anytime, glad to be able to help.
Keep in mind nobody on social media ever brags about their fears, anxieties, worries, doubts, or mistakes. It can give us a career dysmorphic disorder just as severe as BDD.
It's good to be excited about residency- and remember that feeling and why you went into it when you're going through the low points of internship in a few months. Dont forget that on your best day you are not as good as you think you are, and on your worst day you're not as bad as you think you are. That kept me humble and got me through some of the lows. Do lots of fun things in the next month, get lots of sleep, and best of luck to you. Residency is some of the longest days but shortest years, it'll be behind you before you know it.

 

[blue.jay]

Nocturnist lifestyle is not for everyone. I do 50% fte days (9 hr) and 50% nights (15 hr shift) which I feel is much worse than pure 7 on/ 7 off nights (12 hr). I like my day shifts better and just doing nights for the past 3 years (though it's only 5-6 shifts a month) seems like I'm aging faster. I used to be generally content and healthy but working nights changed it (not sure if that's the only factor I can blame). My present employer said giving up nights is not negotiable (unless I'm above 50 or have health condition which precludes me from working night).
I don't feel it's worth ruining my physical and mental health so I'm moving to pure day time job and I hope I get to feel better again. I'm sure if I do nocturnist work for 3 more years I'll probably kill myself.

At one point you will realize life is more than money and so far I haven't met a single person who is doing pure night work for >5 yrs and remain physically/mentally healthy.

 

[90sportsfan]

You may feel that way because IM is technically "Primary Care," and there is some infatuation with "Specializing." There is some fear from students that IM residency is the biggest grind and you will be dealing with patients from all walks of life (i.e. potential for lots of difficult patients), rather than the specialty patients (I guess EM is kind of similar in the regards). However, through IM fellowships, you'll still have the opportunity to "Specialize." Plus the novelty of specializing will wear-off quickly and lifestyle will be the most important thing.