What are the cons of an internal medicine residency/career? Why is not very competitive?
Just asking as I am mostly thinking about pursuing IM.
Residency - long ward months? lots of order writing for other services? everyone sends pts to the IM service?
Outpt Internist - Turf war with the nurses? No respect? Compensation?
Hospitalist - burn out? low compensation? big city saturation?
thanks all.
(good luck to everyone on match day today)
As one poster stated above, the pros for one person are the cons for another.
In medicine:
- You will deal with many medical topics and will require a broad, integrated knowledge base, as opposed to a focused knowledge base.
- You will need to read (a lot) because the field is constantly changing.
- You will not get to treat children.
- Most of your patients will be older, with more advanced and/or chronic disease.
- You will treat most of your patients through medications rather than through procedures.
Hope this helps.
You also have to consider that some of these things affect you differently as a resident vs. when you have a job.
e.g., babysitting ortho/uro/nsg patients on a medicine service AS A RESIDENT is unbelievably frustrating, because you will likely lose every time you try to refuse a dump (not everywhere, but at most medicine programs) and you end up wasting your time writing progress notes on someone you're not really learning anything from. And on top of that, in general, you get no appreciation from the service who dumps on you. (when was the last time nsg said "hey thanks for taking that lady with a peg/trach/chronic foley/uti/vegetative state/seizures etc because of her ICH!"?). In most academic hospitals IM is the great dumping ground, even for people with surgical/psych/neuro issues when the respective subspecialists don't want to deal with it. For instance, patients in the ER with surgical issues who the surgeons don't want to operate on, but the ER docs don't feel comfortable sending out for self-protection reasons-->medicine admit, and then you have to spend a week figuring out how to dispo the patient out without them getting the definitive management they actually need and you can't provide. AS AN ATTENDING, though, it can be pretty sweet because you make $$$, you don't have to do much for them, at most private hospitals patients have insurance and can go to an LTAC, you have good social work support, AND you actually get props from the surgeons who don't want to/don't know how to manage people with HTN/DM/whatever else they don't want to bother with.
Outpatient IM can be pretty good in most mid-size cities and even some larger ones depending on your salary expectations and willingness to cover the hospital service (if there is one). And w/r/t nurse turf wars, there is some of that, but the more you work with NPs you will see that while there are some things they can manage on their own, for the most part they just don't know as much as an MD and don't know enough to function independently. In that sense, you're better off thinking of them as an aide to you in seeing more patients in your practice--they can do all the routine BP checks, tweaking of DM meds, etc while you see new patients (which bill better) and see your more interesting patients.
As far as hospital medicine, I personally am not very interested in this and pretty much agree with your assessment: long hours, grinding through LOTS of patients, not taking the time to think about anything in your management (chest pain->call cards, GERD->call GI, knee pain->call rheum, temp of 100.5->call ID, on warfarin->call heme, etc) and for all that work and patient acuity you are still compensated fairly poorly compared with the specialists who don't work as hard as you do--$200k is nothing to sneeze at but it's a lot easier to make that as a GI with no or little call and no admitting responsibilities.
Regarding subspecialty IM, there is a huge range, there is the opportunity for good compensation, you can pretty much pick your lifestyle, and in some fields you still have the opportunity to do some general medical management while having subspecialty knowledge and procedure opportunities. This obviously is the way that IM is trending more and more every day (I think something like >85% of residents in my program do fellowships). Consider the range of differences between something like outpatient rheum/endo/AI vs. interventional cards/PCCM--you don't have the opportunity to do such a wide variety of things in any field other than IM.
Remember, residency in almost anything is going to suck. IM is better than some but worse than a lot. But you have a lot of control over your post-residency life vs. something like Gen surg or nsg, where life post-residency will still be pretty crappy.
