Day to day of IM residents throughout the years?

[lp92]

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Hi, trying to get a sense of how the day-to-day changes in IM from intern year to PGY2 and 3?

I get that interns spend a lot of time rounding, writing notes, calling families and managing social issues, which isn't very appealing to me, but I want to know if the burden of this eases up as you graduate to higher years?

 

[chessknt]

They sit down and stare at the ceiling pondering the mysteries of medicine.....

Seriously what about IM appeals to you? Everything you described is a core component of IM (except the social issues which usually is someone else's problem like CM/SW), If it doesnt appeal to you find a different field.

 

[M&L]

Hi, trying to get a sense of how the day-to-day changes in IM from intern year to PGY2 and 3?

I get that interns spend a lot of time rounding, writing notes, calling families and managing social issues, which isn't very appealing to me, but I want to know if the burden of this eases up as you graduate to higher years?

i am M2 here, but one of my family members is a 1st year fellow, just finished IM residency this summer. So he told me that it depends on the place, - community vs university affiliated and how high the ranking is. His residency was in an urban community hospital (lower ranking), and he said that in the place like theirs they had relatively less supervision than some other places. They started doing procedures much earlier than his friends in other places, and got a lot more independence. But he also said that he was working A LOT. 1 day off a week, crazy hours, a stress of a busy urban community hospital. but he said that he'd never learn as much in more prestigious place that is not as hands on.

Important to note, - he was never interested in research, he always wanted to be busy with pts.

 

[disorder]

Hi, trying to get a sense of how the day-to-day changes in IM from intern year to PGY2 and 3?

I get that interns spend a lot of time rounding, writing notes, calling families and managing social issues, which isn't very appealing to me, but I want to know if the burden of this eases up as you graduate to higher years?

Why does this matter?

Guess what, once you leave residency, you deal with ALL of it. And, you're liable.

 

[lp92]

Why does this matter?

Guess what, once you leave residency, you deal with ALL of it. And, you're liable.

Wow how about some answers that aren't imbued with contempt?

 

[lp92]

i am M2 here, but one of my family members is a 1st year fellow, just finished IM residency this summer. So he told me that it depends on the place, - community vs university affiliated and how high the ranking is. His residency was in an urban community hospital (lower ranking), and he said that in the place like theirs they had relatively less supervision than some other places. They started doing procedures much earlier than his friends in other places, and got a lot more independence. But he also said that he was working A LOT. 1 day off a week, crazy hours, a stress of a busy urban community hospital. but he said that he'd never learn as much in more prestigious place that is not as hands on.

Important to note, - he was never interested in research, he always wanted to be busy with pts.

Thanks for the insight! Only serious answer so far

 

[Crayola227]

Wow how about some answers that aren't imbued with contempt?

The reason is that IM is HARD and even as an attending...

well, a lot of hospitalists say they feel like overglorified residents....

you can go outpatient instead, but 1) IM residency is hit or miss for making you feel super prepared for that, but if that's your goal and depending on the program you can make it happen but that leads to 2) output IM is much like FM except typically more complex sicker patients....

The point is, what you see is pretty much what you get. It's a life of rounding, admits, discharges, and lots and lots and lots of notes. Lots of bread and butter, bounce backs, etc.

It's not like some specialties like say ENT where life shifts dramatically out of residency.

You didn't come in the thread sounding like someone that enjoys IM, rounding, or writing notes. That doesn't bode super well, and no one here can make it sound like it does.

Interns have the greatest note burden in some ways as far as length, but upper levels write plenty of notes, typically the transfer and d/c summaries. If you're an attending with no residents you write plenty of notes, you just learn to write ugly short blurbs. If you're an academic attending, you read lots of notes and write short blurbs. The rounding remains the same for all.

The higher up you go the more time with patients inpt, to a point. The amount of time with patients is sacrificed for volume and notes, this is true for all.

Clinic, the higher up you go the more and shorter your appts, so less time per patient.

 

[Redpancreas]

You invited that contempt with "interns spend a lot of time rounding, writing notes, calling families and managing social issues, which isn't very appealing to me, but I want to know if the burden of this eases up as you graduate to higher years". What you're asking pretty much epitomizes the worst qualities of an IM senior resident.

Also, your "only serious answer" so far comes as a second hand account, doesn't directly answer the question you asked, and has a cliche answer often used to argue why community programs are awesome. Whether or not your workload decreases year to year doesn't really correlate with community vs. academic. It's more about the individual culture of the program. Regardless, I am an IM resident who has seen the progression from intern to PGY-3.

Does the burden decrease as you go from PGY-1 -> PGY-3?
Yes. The physical labor/work decreases, but the responsibility (at least at good programs that still teach IM) increases. If it didn't, all fields that do a prelim IM year would be qualified to work as hospitalists or apply to IM fellowships if they underwent the most rigorous part of residency. As an intern, you're writing every patient's data down, writing every progress note, writing discharge summaries, examining every patient in the morning, etc. As you get more senior, you're not expected to do as much of this, but you're held accountable for it. You're expected to actually be correct in your assessments, aware of and accountable for everything your intern does, and when a family is upset or an attending doesn't agree with the wording of the discharge summary your intern wrote, you are the one the attending will call with concerns. Sadly some people carry the attitude that intern year is just scut you have to go through and if something goes wrong it's the interns fault and you are just there to occupy space while working on your research. Some less attentive programs enable that culture.

EDIT: Crayola hits the nail on the head. Things that you mention (my mistake, you did not say this) Things that traditionally an intern's role (discharge planning) etc. are things that the best IM attendings sometimes have to get involved with to ensure the best care so you asking if this is no longer a responsibility after intern year comes off as either uninformed or tone deaf.

Hope this helped!

 

[gutonc]

Hi, trying to get a sense of how the day-to-day changes in IM from intern year to PGY2 and 3?

I get that interns spend a lot of time rounding, writing notes, calling families and managing social issues, which isn't very appealing to me, but I want to know if the burden of this eases up as you graduate to higher years?

Yes, things change as you move from intern to R2 to R3. Then again if you're a fellow. And again if you're an attending.

Decide what you want to do with your life and choose the path that gets you there. Don't choose what you do with your life based solely on the path it takes to get there.

 

[lp92]

You invited that contempt with "interns spend a lot of time rounding, writing notes, calling families and managing social issues, which isn't very appealing to me, but I want to know if the burden of this eases up as you graduate to higher years". What you're asking pretty much epitomizes the worst qualities of an IM senior resident.

When most people post a thread on here, and at least in my case, they're not asking with the intent of inviting contempt. As someone who has not yet had the experience of residency, why does a curiosity for the structure and balance of workload as you progress form intern year to PG3 have to be met with so much defensiveness? I'm not trying to attack anyone, but it sure as hell seems like you are.

Also, your "only serious answer" so far comes as a second hand account, doesn't even answer the question you asked, and has a one-sided opinion of a commonly debated university vs. community program topic. Regardless, I am an IM resident who has seen the progression from intern to PGY-3.

I don't think any reasonable person who wasn't trying to shut me down right off the bat would disagree with the fact that at the time I posted this, this was the only answer that was posted with the actual intent of answering my question, regardless of whether it fully answered it.

Does the burden decrease as you go from PGY-1 -> PGY-3?
Yes. The physical labor/work decreases, but the responsibility (at least at good programs that still teach IM) increases. As an intern, you're writing every patient's data down, writing every progress note, writing discharge summaries, examining every patient in the morning, etc. As you get more senior, you're not expected to do as much of this, but you're held accountable for it. You're expected to actually be correct in your assessments and don't get effort points for trying (even if the intern gives you the wrong data), aware of and accountable for everything your intern does, and when a family is upset or an attending doesn't agree with the wording of the discharge summary your intern wrote, you are the one the attending will call with concerns. Sadly some people carry the attitude that intern year is just scut yu have to go through and if something goes wrong it's the interns fault and you are just there to occupy space while working on your research. Some less attentive programs enable that culture.

Thanks, this part is actually helpful. Things like this are not obvious to those of us who haven't gone through residency.

Things that you mention (i.e. discharge planning) etc. are things that the best IM attendings sometimes have to get involved with to ensure the best care so you asking if this is no longer a responsibility after intern year comes off as either uninformed or tone deaf.

Never in my question did I ask if discharge planning is never a responsibility as an attending...I was simply asking if the tasks of note writing and things of that nature stay constant in volume throughout the 3 years of RESIDENCY or not. Do you meet everyone including patients with this much defensiveness and assumption or is it just because this is an online forum and you feel like you can?

 

[M&L]

You invited that contempt with "interns spend a lot of time rounding, writing notes, calling families and managing social issues, which isn't very appealing to me, but I want to know if the burden of this eases up as you graduate to higher years". What you're asking pretty much epitomizes the worst qualities of an IM senior resident.

Also, your "only serious answer" so far comes as a second hand account, doesn't directly answer the question you asked, and has a cliche answer often used to argue why community programs are awesome. Whether or not your workload decreases year to year doesn't really correlate with community vs. academic. It's more about the individual culture of the program. Regardless, I am an IM resident who has seen the progression from intern to PGY-3.

Does the burden decrease as you go from PGY-1 -> PGY-3?
Yes. The physical labor/work decreases, but the responsibility (at least at good programs that still teach IM) increases. If it didn't, all fields that do a prelim IM year would be qualified to work as hospitalists or apply to IM fellowships if they underwent the most rigorous part of residency. As an intern, you're writing every patient's data down, writing every progress note, writing discharge summaries, examining every patient in the morning, etc. As you get more senior, you're not expected to do as much of this, but you're held accountable for it. You're expected to actually be correct in your assessments, aware of and accountable for everything your intern does, and when a family is upset or an attending doesn't agree with the wording of the discharge summary your intern wrote, you are the one the attending will call with concerns. Sadly some people carry the attitude that intern year is just scut you have to go through and if something goes wrong it's the interns fault and you are just there to occupy space while working on your research. Some less attentive programs enable that culture.

EDIT: Crayola hits the nail on the head. Things that you mention (i.e. discharge planning) etc. are things that the best IM attendings sometimes have to get involved with to ensure the best care so you asking if this is no longer a responsibility after intern year comes off as either uninformed or tone deaf.

Hope this helped!

I am not giving you "cliche answer". I gave you an honest feedback that my relative gave me. And i didnt say that community programs are "awesome", - my relative doesnt say that either. He explained to me his perceived difference in the programs. He said that everything depends on what you are looking for. He hates research, wants nothing to do with it at all, and he wants to be busy, and very hands on. So for him this program is a good option. BUt he also complains about crazy hours, and burnout. And he told me to consider not going into IM if i have other options (he didnt).

Personally, i like paperwork, i like working with families, social workers, and be busy. So things that the OP is listing dont actually sound like bad things to me at all. But i wanted to tell the OP what i know from my relative (even though i dont agree with OP), so that they can hear what i know, and maybe consider that information.

 

[Redpancreas]

When most people post a thread on here, and at least in my case, they're not asking with the intent of inviting contempt. As someone who has not yet had the experience of residency, why does a curiosity for the structure and balance of workload as you progress form intern year to PG3 have to be met with so much defensiveness? I'm not trying to attack anyone, but it sure as hell seems like you are.


I don't think any reasonable person who wasn't trying to shut me down right off the bat would disagree with the fact that at the time I posted this, this was the only answer that was posted with the actual intent of answering my question, regardless of whether it fully answered it.


Thanks, this part is actually helpful. Things like this are not obvious to those of us who haven't gone through residency.


Never in my question did I ask if discharge planning is never a responsibility as an attending...I was simply asking if the tasks of note writing and things of that nature stay constant in volume throughout the 3 years of RESIDENCY or not. Do you meet everyone including patients with this much defensiveness and assumption or is it just because this is an online forum and you feel like you can?

I don't think you posted with the intention of inviting contempt. That would be a troll post I would have refrained from posting a paragraph to. I'm saying when I read your post it led to an eyeroll and you seemed to be oblivious as to why you were getting the responses you got so I explained the sentiment from my perspective. It came off at least to me as if you were asking if PGY-2/3s could coast when in my experience, it is the opposite.

I do apologize for falsely attributing the discharge planning thing to what you said. In my head I jumped from notes to discharge summary to planning. Lastly, my post was intended to be honest and unlike you, I am not asking patronizing rhetorical questions aimed at your character. I'm not telling you what you did was wrong or asking you to apologize. I'm just giving you my perspective. That said, reflecting back I can see how it upset you and will keep that in mind, because I ultimately post here trying to help.

 

[Drrrrrr. Celty]

Rounding is the backbone of IM. It's important for not only your continued education, but also it forms a basis and evaluation of your mentorship. If your interns are clueless it means you haven't done your job well as a senior.

So yes, you write less notes as you go up the totem pole on ward rotations. But it's substituted with added responsibilities of being a senior, added responsibility of needing to work on your own projects, and the responsibility of balancing that with studying for ABIM.

As a whole go into IM because you like the science of medicine and because you like seeing it directly help people. In the end IM isn't just simply training for a job, it's training to be a good mentor for future doctors and to work in fellowship environments if you so desire.

 

[BorntobeDO?]

The scut goes down but the responsibility and expectations goes up as you progress.

 

[disorder]

Wow how about some answers that aren't imbued with contempt?

No contempt. But why does it matter? It's fine if you're curious, but your initial post isn't worded as such. You said the intern scut work isn't appealing to you, but I'm telling you... if that's what turns you off then avoid internal medicine, or at least general internal medicine. Sub specialties are somewhat protected from this.

As an attending, I write notes on all my patients, I talk to families, I talk to insurance companies, I fill out constant paper work because X,Y,Z med needs approval, I talk to case managers, I talk to social workers, I spend extra time out of my day answering pointless patient questions through "messaging", I double my clinic load by spending time on the phone with patients, etc. So, like I said, if that intern scut work really turns you off from a specialty, maybe medicine won't be for you.

But, reading your post, you really weren't asking about medicine as a field. You were asking about residency...

 

[Kaustikos]

No contempt. But why does it matter? It's fine if you're curious, but your initial post isn't worded as such. You said the intern scut work isn't appealing to you, but I'm telling you... if that's what turns you off then avoid internal medicine, or at least general internal medicine. Sub specialties are somewhat protected from this.

As an attending, I write notes on all my patients, I talk to families, I talk to insurance companies, I fill out constant paper work because X,Y,Z med needs approval, I talk to case managers, I talk to social workers, I spend extra time out of my day answering pointless patient questions through "messaging", I double my clinic load by spending time on the phone with patients, etc. So, like I said, if that intern scut work really turns you off from a specialty, maybe medicine won't be for you.

But, reading your post, you really weren't asking about medicine as a field. You were asking about residency...

Very true, which is why I decided to pursue fellowship. Props to hospitalist who don't mind the social aspects of the job, but I absolutely abhor it. Well, maybe not abhor, but it's a real inconvenience to what I want. Maybe I'm jaded or cynical. The hospital I work at primarily deals with nursing/adult home patients wherein a LOT of the patients are just futile care because they're so old, or trach'd/peg'd for years on end...or, the worst, 30-40 year old patients with cerebal palsy who are COMPLETELY contracted with multiple pressure ulcers. The worst being a patient with ulcers so bad you could LITERALLY see the femur protruding/exposed. And family members refused to come to grips with the reality of their situation. Or, worse yet, just dumped them at these places and were done dealing with them.
"Yes, hello, I'm calling about your father. He's in the ICU, septic shock on 3 pressors for a week now. No response to antibiotics. Intubated for a week. Calling to discuss goals of care" - 15 minutes later of practically explaining there is no chance of survival - full code still.
After ALL that; I'm done. Maybe in the future, at another hospital, I'll do my specialty and hospitalist part time. With the exception being I'm not at a hospital surrounded by nursing/adult homes.


For what's worth.

Anywho; props to you for being okay/enjoying that aspect.

 

[lp92]

Very true, which is why I decided to pursue fellowship. Props to hospitalist who don't mind the social aspects of the job, but I absolutely abhor it. Well, maybe not abhor, but it's a real inconvenience to what I want. Maybe I'm jaded or cynical. The hospital I work at primarily deals with nursing/adult home patients wherein a LOT of the patients are just futile care because they're so old, or trach'd/peg'd for years on end...or, the worst, 30-40 year old patients with cerebal palsy who are COMPLETELY contracted with multiple pressure ulcers. The worst being a patient with ulcers so bad you could LITERALLY see the femur protruding/exposed. And family members refused to come to grips with the reality of their situation. Or, worse yet, just dumped them at these places and were done dealing with them.
"Yes, hello, I'm calling about your father. He's in the ICU, septic shock on 3 pressors for a week now. No response to antibiotics. Intubated for a week. Calling to discuss goals of care" - 15 minutes later of practically explaining there is no chance of survival - full code still.
After ALL that; I'm done. Maybe in the future, at another hospital, I'll do my specialty and hospitalist part time. With the exception being I'm not at a hospital surrounded by nursing/adult homes.


For what's worth.

Anywho; props to you for being okay/enjoying that aspect.

May I ask what fellowship did you decide to pursue?

 

[lp92]

Very true, which is why I decided to pursue fellowship. Props to hospitalist who don't mind the social aspects of the job, but I absolutely abhor it. Well, maybe not abhor, but it's a real inconvenience to what I want. Maybe I'm jaded or cynical. The hospital I work at primarily deals with nursing/adult home patients wherein a LOT of the patients are just futile care because they're so old, or trach'd/peg'd for years on end...or, the worst, 30-40 year old patients with cerebal palsy who are COMPLETELY contracted with multiple pressure ulcers. The worst being a patient with ulcers so bad you could LITERALLY see the femur protruding/exposed. And family members refused to come to grips with the reality of their situation. Or, worse yet, just dumped them at these places and were done dealing with them.
"Yes, hello, I'm calling about your father. He's in the ICU, septic shock on 3 pressors for a week now. No response to antibiotics. Intubated for a week. Calling to discuss goals of care" - 15 minutes later of practically explaining there is no chance of survival - full code still.
After ALL that; I'm done. Maybe in the future, at another hospital, I'll do my specialty and hospitalist part time. With the exception being I'm not at a hospital surrounded by nursing/adult homes.


For what's worth.

Anywho; props to you for being okay/enjoying that aspect.

Thanks for the insight

 

[disorder]

Very true, which is why I decided to pursue fellowship. Props to hospitalist who don't mind the social aspects of the job, but I absolutely abhor it. Well, maybe not abhor, but it's a real inconvenience to what I want. Maybe I'm jaded or cynical. The hospital I work at primarily deals with nursing/adult home patients wherein a LOT of the patients are just futile care because they're so old, or trach'd/peg'd for years on end...or, the worst, 30-40 year old patients with cerebal palsy who are COMPLETELY contracted with multiple pressure ulcers. The worst being a patient with ulcers so bad you could LITERALLY see the femur protruding/exposed. And family members refused to come to grips with the reality of their situation. Or, worse yet, just dumped them at these places and were done dealing with them.
"Yes, hello, I'm calling about your father. He's in the ICU, septic shock on 3 pressors for a week now. No response to antibiotics. Intubated for a week. Calling to discuss goals of care" - 15 minutes later of practically explaining there is no chance of survival - full code still.
After ALL that; I'm done. Maybe in the future, at another hospital, I'll do my specialty and hospitalist part time. With the exception being I'm not at a hospital surrounded by nursing/adult homes.


For what's worth.

Anywho; props to you for being okay/enjoying that aspect.

To clarify, I am a sub specialist (gen cards), but I do deal with it all to a lesser degree than a hospitalist or a general practitioner.

 

[Kaustikos]

May I ask what fellowship did you decide to pursue?

Infectious Disease

To clarify, I am a sub specialist (gen cards), but I do deal with it all to a lesser degree than a hospitalist or a general practitioner.

Not the first cardiologist I've seen do that. Props/respect/hugs and all the best. Maybe I just need a vacation from social medicine.