Bored Internal Medicine intern here...

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AnotherDork

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... to answer all your questions about med school and residency while on a (rare) slow overnight. Limited time offer!
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what's the most important thing about med school (that should factor in when you're deciding which schools to apply to) or residency that you never thought about as a premed?
 
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Ok so I've read all the old threads on this, and I've asked about 10 current med school students, but I always get wishy-washy answers (which is fine, that may just be how this is).

What is a *good* residency? (Not residency field, I'm talking about matching in hospital A vs hospital B. Lets talk only internal medicine as a hypothetical, to keep it simple).

Now, I usually get an answer like "Its the feeling you get when you walk in there, do you see yourself there for four years? Can you work with those people? You'll just get a good feeling."

Secondly, one could go simply by NIH funding numbers. That's a pretty big generalization (obviously, I'm sure nobody's arguing that its not). That list that comes up in google shows about 50 internal medicine residencies - pretty sure there's a lot more also, so not much help...

Obviously, a good residency is located where you want to be located. So lets take location out of the picture. What's left? Is it just prestige and your "gut feeling"?
 
First thought... would you do it all over again? Yes, in a heartbeat.

"what's the most important thing about med school (that should factor in when you're deciding which schools to apply to) or residency that you never thought about as a premed?" Look at the students/residents. Are they happy? Do they answer questions honestly? Could you get along with them or are they total tools? Spend a lot of time talking to them. Get their emails and ask them questions after your interview day. Because this honestly is going to make the biggest difference in your day-to-day life, not the call schedule or whether you have 2 vs. 3 elective blocks your first year.

theWUbear: I can't answer your question. Sorry if this is wishy-washy, but I think your question is too personal. A good residency may be a community hospital in the neighborhood one grew up in, or a research powerhouse to different people. I chose a large urban academic program because I wanted to keep my options open (don't know if or what I want to subspecialize in) and I like teaching so I want to make that a part of my career. But that may not be what you want. And if you want to be a primary care doc, that community hospital may have a VERY good program for that.
 
Oh great wizard,

are you more attractive to females now that you are a doctor?

:luck:
 
theWUbear said:
Ok so I've read all the old threads on this, and I've asked about 10 current med school students, but I always get wishy-washy answers (which is fine, that may just be how this is).

What is a *good* residency? (Not residency field, I'm talking about matching in hospital A vs hospital B. Lets talk only internal medicine as a hypothetical, to keep it simple).

Now, I usually get an answer like "Its the feeling you get when you walk in there, do you see yourself there for four years? Can you work with those people? You'll just get a good feeling."

Secondly, one could go simply by NIH funding numbers. That's a pretty big generalization (obviously, I'm sure nobody's arguing that its not). That list that comes up in google shows about 50 internal medicine residencies - pretty sure there's a lot more also, so not much help...

Obviously, a good residency is located where you want to be located. So lets take location out of the picture. What's left? Is it just prestige and your "gut feeling"?
Click to expand...

As someone who will be starting IM residency in a couple months, hopefully I can tackle your question.

When I came up with my list of programs to apply to, there were several factors that I took into consideration... first off, will the program that I go to provide me with solid clinical training so when I leave residency I know that I can handle anything out there pretty much or know when I need help, does the program have a good reputation so if I do decide to do fellowship, do the programs that I apply for in fellowship have a good feeling about the applicants coming from a certain program, location (which you will find out when you are applying plays a very large role in where you want to be because I didn't apply to places like Hopkins, Wash U even though they are top IM programs because I really don't want to be in those cities), clinical setting where you are practicing (for medicine I feel you need to have a VA to learn your bread and butter medicine and a county/university hospital where you see the WTF cases).

Now for IM, there is a pretty well established list of what are the top programs for residency i.e. Hopkins, MGH, Udub, Michigan, BWH etc etc etc and pretty much all of those top programs will provide you with awesome clinical training and provide you with the necessary research opportunities if you intend on fellowing so for each applicant, where do they want to be for the next 3 years which does take into account things like do you feel like you fit into that program, do you want to be in a particular city, do you like the camraderie of the program etc
 
What advice would you offer to students beginning medical school, whether its academic or otherwise?
 
How much time will you actually spend with patients, versus time spent filling out paperwork or chasing after tests?

Was everyone in your class pleased with their match results? I never hear bitter stories, but I'm not sure if they just don't get focus. Along that vein, how many of your peers are satisfied with their current careers/prospects? (Maybe too rough and subjective to answer)
 
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ocotillo said:
How much time will you actually spend with patients, versus time spent filling out paperwork or chasing after tests?

Was everyone in your class pleased with their match results? I never hear bitter stories, but I'm not sure if they just don't get focus. Along that vein, how many of your peers are satisfied with their current careers/prospects? (Maybe too rough and subjective to answer)
Click to expand...

I'm interested in this too.
 
"What advice would you offer to students beginning medical school, whether its academic or otherwise?" The most important piece of advice is just "relax." Especially if you've already been accepted. The odds are overwhelming that you're going to do fine. Don't study the summer before med school starts, don't take any science classes or do any crazy volunteer work. Just relax. Sit on a beach or travel or something. You will learn everything you need to know (and a helluva lot of stuff you really don't need to know) once you start med school.

"How much time will you actually spend with patients, versus time spent filling out paperwork or chasing after tests?" There's definitely a lot of time doing a bunch of BS, especially as an intern in an inpatient setting. Some days you only see each patient for like 5 minutes (though the amount of behind-the-scenes work you do for them can be many times that). One thing many premeds don't get is that lots of times patients don't want a doctor sitting there for an hour asking *****ic questions about their childhood or pets. If you return in the PM and spend another 5 minutes with them, they're usually pretty happy, unless they're tired and tell you to go away.

"Was everyone in your class pleased with their match results? etc" Seems like most people were happy. A few I know weren't. But once you start your new position usually you hit your stride and make the best of it. Hope this helps.
 
future IM hopeful here...

do you plan to specialize?
 
What's the coolest thing you've seen since intern year started?
 
FYI, there's a quote and multi-quote function.
 
FloatOn said:
FYI, there's a quote and multi-quote function.
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COOL!!! I never knew how people were able to do this!

FloatOn said:
What's the coolest thing you've seen since intern year started?
Click to expand...
Narcan administration. That stuff works quick!

Hoody said:
future IM hopeful here...

do you plan to specialize?
Click to expand...
Probably at some point. Even if I don't do a "real" subspecialty (Cards, GI, Renal, etc, none of which sound super appealing) I might do a Gen Med fellowship in order to focus on medical education or something, but I'm nerdy like that.
 
When did you decide on IM?

Also, would you say there is a mix of people from different med schools at the hospital you work at, or are most of them from the same general area?
 
LuciusVorenus said:
When did you decide on IM?

Also, would you say there is a mix of people from different med schools at the hospital you work at, or are most of them from the same general area?
Click to expand...

I was always thinking about it because I like the variety, but I definitively decided after my IM clerkship 3rd year.

I'd say the plurality of people are from the Northeast (My program's in the Northeast), but there are people from everywhere, including at least 6 other countries I can think of off the top of my head.
 
Has it been difficult for you to maintain social/romantic relationship(s) so far during your internship? How about in med school?
 
oh thanks!
two other things if you have the time

what percentage of your fellow residents in IM would you say are choosing academic medicine over private practice?

...and are attendings really that mean :(
 
I would like to add that it's nice to see you so calm and helpful. Most of the time I see residents posting they are very moody and grouchy.
 
If you're interested in a particular IM subspecialty, do people end up gunning for it from the start of residency, or even earlier, or do most of you just sort that out during residency?
 
Are you really close with your fellow interns? I ask this because I hope I end up at a program where colleagues go out together on the weekend or go to each other's bday parties and stuff. I don't think all programs are conducive to friendships.
 
What is your opinion and the opinion of the other residents and doctors you work with on health care reform and the future of medicine? I am applying next year, but don't want to take on the journey of becoming a doctor if I will be hundreds of thousands in debt when I finish and make as much as a McDonald's worker. I am not very knowledgeable about the bill, and I feel it is too early to predict what the outcome of the medical field will be in the next 5-10 years, however I am curious as to what are your thoughts. Thanks!
 
Looks like the intern had to go save some lives. Doesn't he know we have pressing questions here!?
 
In case he ever comes back:

Are you able to make time for hobbies? Do you have hobbies?! How do you maintain your sanity?
 
Also why does medicare/medicaid, indirectly, pay residents, what's the rationale behind this?
 
1 question: what program are you at that gives you so much free time?

;)

:p
 
mwalker394 said:
Has it been difficult for you to maintain social/romantic relationship(s) so far during your internship? How about in med school?
Click to expand...

I'll take a stab at a couple of his unanswered questions.

If you already have someone, the relationship is strong, and they have their own friends, job, interests to keep them entertained while you are not around, you will do fine. If not, not so much. This is true whether you are talking about med school or residency. In terms of dating, there is time in the first two and last year of med school to date, start a relationship. Third year gets tough because of the hours in certain rotations. Internship is worse hours than third year. You will be in the hospital up to 80 hours/week, so unless you meet someone there or someone who is cool only seeing you once every couple of weeks when you pop up for air, it may not be the best year to get things started. You have to realize that you generally get only 4 days off a month as "weekends", and some of those days may be spent sleeping or studying for things like Step 3 or working on a presentation they wanted you to give at morning meeting etc.

You won't be lonely intern year -- you will be in the hospital all the time surrounded by people, and frequently when you do get to go home you will fall right to sleep even if it's still early. But it would be a very hard year to cultivate anything romantic. It would take meeting a very special individual who needs nearly no attention.
 
Dr McSexy said:
I would like to add that it's nice to see you so calm and helpful. Most of the time I see residents posting they are very moody and grouchy.
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Comes with the territory. As an intern you are everybody's bitch. The attendings, the senior residents. The nurses will try to browbeat you into writing orders for things they think are right because they think you don't know what you are doing yet (which is sometimes true, but still fees wrong). And the patients often don't treat you great either when they aren't trying to die on you.
 
ocotillo said:
If you're interested in a particular IM subspecialty, do people end up gunning for it from the start of residency, or even earlier, or do most of you just sort that out during residency?
Click to expand...

I'll let the other guy answer this, but in general there will be folks who spend more time studying for the in-service tests than others based on goals. I wouldn't call it "gunning" per se because unlike med school where you are graded against your classmates, the real competition is going to be external to your program.
 
FloatOn said:
Are you really close with your fellow interns? I ask this because I hope I end up at a program where colleagues go out together on the weekend or go to each other's bday parties and stuff. I don't think all programs are conducive to friendships.
Click to expand...

When you work with folks for 80 hours per week, you end up being at least somewhat friendly with most of them, and you all need each other from time to time to help you with things, cover for you, etc. You can't be a total loner. However, if you have a spouse, family, SO, etc, you probably will want to spend the limited time you have outside the hospital with them rather than your co-interns. That's just normal. So the single interns tend to hit the happy hours when they are off and the rest see the folks they have been neglecting while doing crazy hours. That's true most places. I don't think it's so much a function of friendly vs nonfriendly as it is a function of single vs non-single folks.
 
Markobenin said:
What is your opinion and the opinion of the other residents and doctors you work with on health care reform and the future of medicine? I am applying next year, but don't want to take on the journey of becoming a doctor if I will be hundreds of thousands in debt when I finish and make as much as a McDonald's worker. I am not very knowledgeable about the bill, and I feel it is too early to predict what the outcome of the medical field will be in the next 5-10 years, however I am curious as to what are your thoughts. Thanks!
Click to expand...

You won't have much time to think of things or follow politics as a resident, and are too far down the rabbit hole to turn around now regardless of what they decide to do.
 
metallica81788 said:
Does your program actually follow the 80hr/week rule for residents? How many actually do?
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Most programs are making an earnest effort to give you a schedule that theoretically keeps you within the 80 hour work week (averaged over 4 weeks) rule. Things happen, you can't always leave to sign out in the middle of that Code Blue, etc and inevitably there will be times that the envelope gets pushed farther than it should under the rules. I'd say a lot of residents find they are working in the ballpark of 70-75 hours/week most weeks, with a few weeks here and there breaking the 80 hour mark and a few "easy" electives where your hours dip into the 60s. Do all programs strictly stay within this duty hour limit? No. Do they all now have schedules that suggest you theoretically should be within the limit? Yes. Do they want your time cards to reflect that you are staying within that limit?...
 
MisterVeil said:
In case he ever comes back:

Are you able to make time for hobbies? Do you have hobbies?! How do you maintain your sanity?
Click to expand...

Hobbies? Dude, you are going to be working 80 hours/week and then coming home and spending whatever time you have with friends/family before you go to sleep at some ridiculously early time each night. But sure, if you collect stamps, baseball cards, I'm sure these things will appreciate during residency. You have 3 weeks of vacation each year. Most people travel, spend them on a beach someplace and the like. But if you want to spend them doing a hobby, you can.

In terms of maintaining sanity, I think the premed notion of needing time to unwind is something you will leave by the wayside along this trail. You get up, go to work, come home, sleep. Maybe eat and see friends/family here and there. Unwinding isn't really going to be a priority. You won't go insane from residency. Might be a bad place to be if you are already insane, but it won't cause it.
 
Bernoull said:
Also why does medicare/medicaid, indirectly, pay residents, what's the rationale behind this?
Click to expand...

How else are you going to get (largely) public hospitals to train individuals? The money you make from the work residents do during their crazy hours is nice, but doesn't really cover the expenses of insurance, training, benefits and salary of these individuals. Paying each hospital $100k per resident sweetens the pot enough to ensure that all of the 20,000 residents each year get the training they need.
 
ishchayill said:
1 question: what program are you at that gives you so much free time?

;)

:p
Click to expand...

You will have down-time on some shifts at every program. Patients stable, nothing to do until the day team shows up. You probably are sitting in a call room unable to sleep but waiting for that next page. You can't go home until the shift ends. Most call rooms have a computer but not always a TV.
 
Law2Doc said:
How else are you going to get (largely) public hospitals to train individuals? The money you make from the work residents do during their crazy hours is nice, but doesn't really cover the expenses of insurance, training, benefits and salary of these individuals. Paying each hospital $100k per resident sweetens the pot enough to ensure that all of the 20,000 residents each year get the training they need.
Click to expand...
I'm not currently a resident but this strikes me wrong.

I'd bet overall that having residents is a very profitable activity for a hospital. Otherwise, why would they do it?

I'd estimate it costs around $75K in total (all benefits and costs covered) to have a resident, and that would be covered with something like $300/day in collected fees. It must surely average much more than that over the course of a residency, with great variability depending on the specialty? Tell me if I'm wrong on this, maybe so, But if not, with the $100K support in addition, having residents then adds up to a much more profitable "business" for hospitals than many other things they do.
 
Musclemass said:
I'm not currently a resident but this strikes me wrong.

I'd bet overall that having residents is a very profitable activity for a hospital. Otherwise, why would they do it?

I'd estimate it costs around $75K in total (all benefits and costs covered) to have a resident, and that would be covered with something like $300/day in collected fees. It must surely average much more than that over the course of a residency, with great variability depending on the specialty? Tell me if I'm wrong on this, maybe so, But if not, with the $100K support in addition, having residents then adds up to a much more profitable "business" for hospitals than many other things they do.
Click to expand...

Getting $100k plus the work generated is profitable for hospitals. The work itself minus the training, insurance, salary and costs is not. The reason I know? There are quite a few unfunded spots that are eternally unfilled, but funded spots are more or less all filled each year. The reason, that $100k makes it profitable. Without it, the outlay of costs, the risk of liability, and training effort make it not worth it. Believe me, if it were worth it to hospitals to sign on the cheap labor these unfunded spots would be internally funded. But they aren't and that should tell you they, without the funding, are unprofitable. You have to realize that the costs per resident are not trivial. You have to pay around $45k in salary to start with, then on top of that you have medmal insurance (which for someone new and unlicensed is not a small figure), health & disability insurance and benefits, you have to give book funds, and supply white coats, and maintain call rooms, and give meal tickets. Plus attendings have to take time out of their day to actually train people. All totalled, the costs are going to far exceed the $75k figure you floated, I suspect it's more like twice that. While residents do generate value from their work, a LOT of what residents do is not significantly billable. They may spend hours rounding and writing notes, all of which gets swept into a daily amount for having seen the patient each day. Most of the things they do with an attending or senior present get billed to the patient as a single procedure done by the more senior person. You don't get to bill patients for dictations, dictation summaries, transfer notes, sign-outs/hand-offs and the like, all of which are important for the functioning of the hospital and a big part of your day, but none of which are "value added" activities. So the real contribution of residents, billings-wise, is to allow attendings to manage a greater number of patients. And maybe order more tests than a more senior person might. This is beneficial to the hospital, but hard to quantify in terms of a "should we fund an additional residency slot out of our own pocket" kind of analysis. For the most part, to entice these hospitals to hire residents they need the $100k medicare kicker to seal the deal.
 
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