Can you help recommend an IM residency?

[DO???]

I am a 4th yr DO student who has recently decided to switch into IM. I have talked to my IM advisor who recommends a community-based hospital based on my preferences. I am a self-starter, I learn best from my patients, learn better on my own, I do not enjoy consulting (I would like to work up the issues myself because I feel as though I learn more; this is a huge deal for me). I have no plans to do a fellowship. I would like to work in a small community hospital when finished as a hospitalist. I am asking because I have found that it is extremely difficult to find out how much autonomy is given and if a place does a lot of consulting or not.

Stats: 254 step 1, 742 comlex 1, 3.9x GPA, rank: 2/140+, no research or publications.

I would like to stay on the east coast more towards the south if possible. Can you recommend a program that is non-malignant, good autonomy starting right away, decent teaching? I kindly thank you in advance for taking the time to read this and providing any wisdom. It is much appreciated.

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[IMreshopeful]

I am a 4th yr DO student who has recently decided to switch into IM. I have talked to my IM advisor who recommends a community-based hospital based on my preferences. I am a self-starter, I learn best from my patients, learn better on my own, I do not enjoy consulting (I would like to work up the issues myself because I feel as though I learn more; this is a huge deal for me). I have no plans to do a fellowship. I would like to work in a small community hospital when finished as a hospitalist. I am asking because I have found that it is extremely difficult to find out how much autonomy is given and if a place does a lot of consulting or not.

Stats: 254 step 1, 742 comlex 1, 3.9x GPA, rank: 2/140+, no research or publications.

I would like to stay on the east coast more towards the south if possible. Can you recommend a program that is non-malignant, good autonomy starting right away, decent teaching? I kindly thank you in advance for taking the time to read this and providing any wisdom. It is much appreciated.

I can’t really speak to where are good places for you to apply as a DO due to lack of experience. But just because you want to do community IM doesn’t mean you have to train in a community setting. Most hospitalists graduating from university programs still go into the community for practice and are probably far better prepared to be frank. Your average community hospital is not going to have as sick a group of patients. Autonomy’s also something you earn as the residency goes on - you don’t get to start making all the plans on day one.

 

[Earl Simmons]

To echo what was said above, IM is unlike other fields (ex. surgical fields) in which a big dichotomy may exist between academic white-collar and community blue-collar programs with respect to hands-on experience. In IM, the top programs still offer every opportunity to make decisions (under guidance of course), work long hours, do procedures on rotations like MICU, and more. The difference is that such academic programs also likely value research and residents have an interest in pursuing academia more often than in a community program perhaps.

In summary, other than some programs here and there you shouldn't be worried about applying to academic IM programs because you will get phenomenal training at one!

 

[DO???]

I can’t really speak to where are good places for you to apply as a DO due to lack of experience. But just because you want to do community IM doesn’t mean you have to train in a community setting. Most hospitalists graduating from university programs still go into the community for practice and are probably far better prepared to be frank. Your average community hospital is not going to have as sick a group of patients. Autonomy’s also something you earn as the residency goes on - you don’t get to start making all the plans on day one.

My concern with the larger academic residencies is how much consulting is done. During my IM rotations, I worked with a dr from a large university trained institution and he consulted everything. I had about 5 consults on every patient which was not the norm for the other physicians. I went into auto pilot and was not engaged when we had all of these consults. That is my concern with the academic IM programs. Can you provide any advice as to whether my concerns are legit or overblown? Thank you in advance.

 

[IMGASMD]

You have a phenomenal step 1. You should look around and see if you may want to specialize in something else.

A few fronts you want to tackle. Staying in NE as a primary IM, doing hospitalist work and not calling consults is not the “norm”. There are simply too many doctors around NE. We all have learned to practice defensive medicine. What if something didn’t go right and the lawyer asks, there are 50 cardiologists on staff, why didn’t you call one of them? Maybe you’d get a little less in Vermont/Maine, maybe.

Secondly, like everyone else said, you want to do as much as possible and see more in residency. What if you called consult because your attending wants you to? You want to learn how to manage the most difficult patients from the specialist. You can always compare what they recommend to what you would do. Here’s a special surprise for you, you don’t need to follow what they say! Everything will come in due time. You don’t have to practice that way when you’re an attending.

Lastly, to tie everything together, you may want to practice eventually in a smaller town where may not have any consultants. Have you been to places that GI won’t come in during the weekends or there is one ID physician that may/may not accept consult? Two cardiologists who are so old and doesn’t want to be on call and no staff to manage cath labs at night? Also you are a bit early in your career to see, sometimes calling consults are more about politics than actual management of patients. It is a conscious decision that you make for yourself/group/family.

Don’t settle for a community program, it is time in your career that you should learn the most. Most academic attending doesn’t want to hear this, but they understand: when you’re training, you are practice on their license. You want to make mistakes on their dime so to speak. You may want to try something else different and work out the kinks in your own practice. Most big academic places will have better resources and more receptive to try non-conventional therapies. (Dangle with maybe I will write a case report, paper...)

With that score and drive, you may carve out what you want in any IM programs.

PS. You said east coast south.... don’t have any specific suggestions nor experience.

 

[fasteddie911]

I would add that heavy-handed consultations can depend on the program and their culture. I know some programs, big-name programs, can be consult heavy and their residents aren't as solid generalists as other programs.

 

[IMreshopeful]

My concern with the larger academic residencies is how much consulting is done. During my IM rotations, I worked with a dr from a large university trained institution and he consulted everything. I had about 5 consults on every patient which was not the norm for the other physicians. I went into auto pilot and was not engaged when we had all of these consults. That is my concern with the academic IM programs. Can you provide any advice as to whether my concerns are legit or overblown? Thank you in advance.

This depends a lot on what program you’re at. If anything there’s LESS reflexive consulting from academic programs... a lot of community shops basically are consult machines. Afib? Consult cardiology. Fever? Consult ID. Anemia? Consult heme. They often have a financial incentive to consult out because it increases revenue for subspecialists. In the academic institution consults from the medical service usually are more like... afib refractory to beta blockers, digoxin, amio? Consider dofetilide? Consult cardiology. Fever of unknown origin despite cultures, imaging, echo, hardware eval? Consult ID.

Even if you have consulting services that does NOT mean you can’t learn from them. You can always read up on how to manage your patients

 

[rokshana]

This depends a lot on what program you’re at. If anything there’s LESS reflexive consulting from academic programs... a lot of community shops basically are consult machines. Afib? Consult cardiology. Fever? Consult ID. Anemia? Consult heme. They often have a financial incentive to consult out because it increases revenue for subspecialists. In the academic institution consults from the medical service usually are more like... afib refractory to beta blockers, digoxin, amio? Consider dofetilide? Consult cardiology. Fever of unknown origin despite cultures, imaging, echo, hardware eval? Consult ID.

Even if you have consulting services that does NOT mean you can’t learn from them. You can always read up on how to manage your patients

i agree, this has been my experience as well.

 

[Trogghunter]

I am a 4th yr DO student who has recently decided to switch into IM. I have talked to my IM advisor who recommends a community-based hospital based on my preferences. I am a self-starter, I learn best from my patients, learn better on my own, I do not enjoy consulting (I would like to work up the issues myself because I feel as though I learn more; this is a huge deal for me). I have no plans to do a fellowship. I would like to work in a small community hospital when finished as a hospitalist. I am asking because I have found that it is extremely difficult to find out how much autonomy is given and if a place does a lot of consulting or not.

Stats: 254 step 1, 742 comlex 1, 3.9x GPA, rank: 2/140+, no research or publications.

I would like to stay on the east coast more towards the south if possible. Can you recommend a program that is non-malignant, good autonomy starting right away, decent teaching? I kindly thank you in advance for taking the time to read this and providing any wisdom. It is much appreciated.

Go to the best program possible, your interests may change and you want to set yourself for fellowship. You will get plenty of autonomy at a university program and you will be better trained, especially if you start working towards focusing on IM and not fellowship early. Many programs have tracks specific for hospitalist. There are many searches here about IM programs that take DOs. Some on the east/SE would be UF, FAU, uSC, maybe charleston, MCG, VCU, GW, ?Maryland, Christiana, VT-carillion. Apply broadly, but those are places that were DO friendly a few years ago for your stats. Don't bother with small community programs. If you do well on your step 2 you will get interviews at one of those and will match as long as you're not a weirdo on interview.

The consultant question really is irrelevant, in my experience of rwsidency. In residency it's actually kind of nice to have consultants involved and have the entire scope of specialists available because you learn from them, if you're motivated to ask about their management. You don't want to be driving patients into the ground and wondering why something isn't working when you really need EP or allergy or something not available in the community....you don't just learn through service, you need teaching.

If you really want autonomy, find a residency that has a relationship/rotations with a VA hospital.

 

[Earl Simmons]

I attend a medical school that has an academic IM program and there is hardly any consults at the large state-funded/VA hospital. The private hospital is another story. But it goes to show that an academic program does not automatically mean consulting is rampant. The training here and at other top academic places I know of and have friends at is exceptional. They come out as rockstar docs.

 

[DO???]

Thank you all very much for the great advice and fantastic insight, it is much appreciated. I have a lot to think about!

 

[Instatewaiter]

In my experience, commuinity hospitals are consult machines while consults are rare in academic centers. The fellows basically yell at any resident who calls a ridiculous consult in university center which helps to cut down on stupid consults.

In a community hospital, anything difficult to manage gets transfered to a tertiary care center. So you get much more exposure to rare pathology and difficult to manage pathology at a tertiary care center/university program during your training.

Next, you have access to advanced specialists for the rarer things which leads to more educations, research and elective opportunities.

The best hospitalists I have met were trained at academic centers because they are exposed to brighter co-trainees and attendings who have more experience with advanced care.

OP, I think you have it backwards where you would get your better educational opportunities.

 

[GastriqueGraffin]

Go to a tertiary care university hospital that is more focused on clinical training than research.

 

[doctorbeastmode]

Yeah I empathize and agree with your goals, but think you’re totally off on the expectations. Community hospitals are not better training. You’ll see tons of bread and butter and be less prepared when really sock people show up. The value of tertiary care is learning from the best in their fields so you DONT have to consult people as much later.

Look for top IM programs with a good reputation for autonomy. There are plenty out there. You’ll be more desirable on the community coming from one as well.

 

[Redpancreas]

Consider all midwestern state programs besides maybe UMich and WashU.