career satisfaction

[reds_maniac]

Hi everyone,
I'm trying to decide between internal medicine and others field right now. I enjoy the differential diagnosis process and the art of medicine found in internal medicine, but many of the R3s and recent medicine graduates I've come across seem to be burnt out and bitter. Is there very high level of dissatisfaction in internal medicine? What's the key to maintaining satisfaction during and after residency?

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[C5toC9]

what are you comparing it against? i think unlike smaller fields, there is really a great variety of satisfaction ratings in IM

 

[path or no path]

Hi everyone,
I'm trying to decide between internal medicine and others field right now. I enjoy the differential diagnosis process and the art of medicine found in internal medicine, but many of the R3s and recent medicine graduates I've come across seem to be burnt out and bitter. Is there very high level of dissatisfaction in internal medicine? What's the key to maintaining satisfaction during and after residency?

I am also curious whether it's the residency that universally sucks, or the field itself? I've heard that level of satisfaction once you are an attending goes way up?

 

[dragonfly99]

I don't know guys...I know an awful lot of unhappy primary care attendings who graduated in the past few years. Office work can be a grind along with the reams of paperwork, plus recent influx of patient emails (since CMS and other accreditation bodies, hospital systems, etc. think it is a great thing to give patients unlimited email access to their doctors). Specialists like GI and allergists seem to be fairly happy.

 

[VJWDO]

I think everyone gets burnt out by the end of residency but it is not the field doing it to them it is residency. Being an attending is awesome. Making your own decisions and not having to justify it to everyone around you (though sometimes you still have to) is refreshing.

As stated above the paperwork and social work aspects around IM can be exhausting but if you have a good system and office staff to support you in the outpatient setting it is manageable. In the hospital it is important to choose a job that has good ancillary staff and top notch discharge planning as that will frequently be the source of many headaches.

I did end up going into specialty training but I still really like IM and worked as a hospitalist for a year and loved it, but the place I worked at was great so I think that is really the important issue.

Get a good education/residency experience, find a job that has all the features above and you should be fine. Obviously this is an ideal situation and probably easier said than done.

 

[staup]

I think everyone gets burnt out by the end of residency but it is not the field doing it to them it is residency. Being an attending is awesome. Making your own decisions and not having to justify it to everyone around you (though sometimes you still have to) is refreshing.

As stated above the paperwork and social work aspects around IM can be exhausting but if you have a good system and office staff to support you in the outpatient setting it is manageable. In the hospital it is important to choose a job that has good ancillary staff and top notch discharge planning as that will frequently be the source of many headaches.

I did end up going into specialty training but I still really like IM and worked as a hospitalist for a year and loved it, but the place I worked at was great so I think that is really the important issue.

Get a good education/residency experience, find a job that has all the features above and you should be fine. Obviously this is an ideal situation and probably easier said than done.

Don't kid yourself to think that office work in primary care is that much different than office work in a specialty. The difference with a specialty is that you are dealing with a specific organ system as opposed to general medical issues (meaning first line for anything). The time and paperwork can be very similar. The difference is also pay with certain specialties, for now.

I agree that the ancillary staff make all of the difference.

 

[DIce3]

Most of the general internists I know are happy and maybe even very happy with their practice. Forget about PGY-3 bad attitude disorder, as it will be cured in a few more years.

As a board certified internist and internal medicine subspecialist, I can say I prefer the general medicine part more. I agree with staup that office work in primary care is not that much different than office work in a specialty. In fact, as a subspecialist you have to smooze all the PCPs, write nice consult letters, and see the 9 PM consult to keep the PCP happy. As a generalist, you just have to make it home in time for dinner.

 

[dragonfly99]

A lot of docs are in integrated hospital systems like VA, Kaiser, etc. now. The subspecialists don't have to kiss up to the primary docs to get referrals in that situation. It looks to me like primary care still gets crapped on the most by everyone else. However, if they do outpatient-only then they have a call-free life...