Farewell AMA - Pulm/CC fellow

[tiedyeddog]

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I just want the deets on the SDN drama. What forum was it in? Allo? The ones I frequent don't seem to have this kind of drama routinely in them. I won't go into Pre-Allo b/c I value my mental health.

lol I also would like to obtain this information

 

[Lawpy]

Boards studying should be review. You can't review what you haven't learned. I would recommend starting around January of your second year. Until the learn the material as it's taught and focus on doing well in classes. That's how I did it and ended up with a ~250 even though I didn't do particularly well with regards to grades (slightly above average). The review books and questions are only a snapshot. Step 1 will have many questions that you'll only be able to answer if you took the time to study for your classes and are nowhere to be found in the review books/questions.
Don't be one of those people who complains that the doctoring class is a waste of time. It's why you're in med school. If you think you're going to show up on day one of 3rd year and be a wizard on the wards without practicing on a whole bunch of standardized patients first you're wrong and need to check your ego.

Thanks! And I'm surprised this wasn't asked before, but what do you think makes a great medical student for clinical years? Especially for someone who is interested in pursuing IM?

 

[Psai]

Since crossposting is against the rules, the thread may or may not have the title "Can a PA be Board Certified" which has a nonzero probability of being located in the emergency medicine forum

Apparently being a paramedic is equivalent to being an emergency medicine physician, you know sorta like how being a pa makes you basically a physician

 

[LutGholein]

Since crossposting is against the rules, the thread may or may not have the title "Can a PA be Board Certified" which has a nonzero probability of being located in the emergency medicine forum

Apparently being a paramedic is equivalent to being an emergency medicine physician, you know sorta like how being a pa makes you basically a physician

Thank you for this gift. Hahahahahaha!

 

[tiedyeddog]

Since crossposting is against the rules, the thread may or may not have the title "Can a PA be Board Certified" which has a nonzero probability of being located in the emergency medicine forum

Apparently being a paramedic is equivalent to being an emergency medicine physician, you know sorta like how being a pa makes you basically a physician

I bet that guy has hurt people before. Seriously.

 

[evilbooyaa]

Since crossposting is against the rules, the thread may or may not have the title "Can a PA be Board Certified" which has a nonzero probability of being located in the emergency medicine forum

Apparently being a paramedic is equivalent to being an emergency medicine physician, you know sorta like how being a pa makes you basically a physician

I read most of that one before. Just went back for the juciest last page. What's the one with OP's drama?!?!

 

[xClashx]

What is considered competitive for pulm/critical care in terms of step 1.

 

[Ho0v-man]

Could you tell us what you liked/didn't like about the other IM sub specialities?

Is there any reason (financially) to pursue a subspecialty like rheum/endo? It seems like a lot of work to make the same pay as an internist. Or is it a situation where you make "X" with a crazy hospitalist schedule whereas you make the same with a more relaxed lifestyle?

Thank you for your contributions.

 

[tiedyeddog]

I read most of that one before. Just went back for the juciest last page. What's the one with OP's drama?!?!

That was pretty epic, highly recommended.

 

[235009]

Thanks for the advice.

Is hospitalist/primary care that bad? I know the pc answer is that "no its great primary care is awesome and we need the best and the brightest in that field". I don't agree with that BUT hospitalist/primary care also doesn't seem THAT bad to me. I shadowed primary care docs that have done cool procedures, see a wide variety of pts, make pretty good money (~200k), and work reasonable hours. In fact one of my favorite mentors was a semi retired IM doc that started an awesome free clinic where he was able to make a tremendous difference in a large Mid-west city. Even with the frustrations, it seems like a decent gig to me.

Out of curiosity if, in some horrible bizzaro world, you were an average DO what would you choose? psych?

I love the way you posed your question.

I'm obviously at least somewhat biased because I didn't choose to do either of those but obviously the fact that I went through IM residency I've thought extensively about both and know folks who are now doing both as a career.

I would've actually considered hospitalist. Inpatient medicine is the reason the majority of us go into IM (instead of say FM, though avoiding pregnant women and children is another biggie). You are basically tasked with fixing a person in a discrete amount of time while at the same time you can form a relationship, albeit brief, with the patient. There are downside: it can get quite repetitive with the majority of your patients comprising 10 or fewer diagnoses and the hospital has become a sort of revolving door for certain patients like the mentally ill, homeless, folks addicted to various substances as well as a cadre of patients who are chronically ill. Also the schedule can be kinda brutal. Most entry level hospitalist jobs require you to work lots of weekends...usually two per month. Not to mention holidays.

Primary care is a different story... While I wholeheartedly applaud anyone who finds it to be their calling and is doing it as a career I can't stand it. Again keep in mind that I did this during residency for 3 years so it's not like I'm speaking theoretically. I think the structure of the healthcare system, insurance companies and patient expectations have formed a perfect storm of awfulness with regard to primary care. You spend an inordinate amount of time glorified secretary filling out all kinds of paperwork for disability etc...and if that wasn't awful enough you have to redo some of these forms every 6 months or year. Insurance companies try to obstruct your efforts to help the patient. Prior authorizations is a big one. I had one patient who refused to be on insulin unless she got the pen and her insurance wouldn't cover it until she tried regular needles first and "patient preference" is not a reason for a prior auth. At the same time they're grading you based on some ridiculous formula they've made up that doesn't properly account for how sick or non-compliant the patient is. Finally we've "empowered" patients to the point that they basically think going to the doctor is the same as going to walmart. They expect you to be their drug dealer for narcotics no questions asked. If they have knee pain you better heal it....clearly modern medicine has defeated normal aging. Then when you don't give then what they want because it's not appropriate they'll shop around or threaten to sue you. The system is completely warped, soul crushing and unsustainable. The first time I got to say "talk to your primary care doctor about that" in pulmonary clinic it felt AMAZING.

Your top 3 pointers for

1. Third year rotations

2. Dealing with the rampant passive-aggressiveness.

Thanks.

I agree, this site is easily butt-hurt about a lot of things.

Thanks! And I'm surprised this wasn't asked before, but what do you think makes a great medical student for clinical years? Especially for someone who is interested in pursuing IM?

For third year when you say you're going to do something do it...and in a timely fashion. It's not too different than my advice for being a good resident: be reliable. So many times I'd have a med student say they'd do something for one of their patients only to go off and write their notes, then go to lecture, then lunch and it isn't done by afternoon rounds. Completely unacceptable. Residents don't expect you to know everything but they do expect you to be prepared and if you don't know something to look it up promptly. If you know you admitted a patient with X the afternoon before and you didn't spend at least half an hour reading all about it and then weave what you learned into your presentation the next day then you're doing third year wrong. Same advice goes for your subI.

Not sure what passive-aggressiveness you're talking about but you'll definitely encounter lots of different personalities be it attendings, residents, nurses. Just be humble and nice to everyone.

Can you share what was the IA, and how you overcame it, if it indeed hindered your chances at application time? ie, were you ill advised over a pot possession or a DUI vs, say, theft or cheating?

It's the last one. I can PM you the details.

Could you tell us what you liked/didn't like about the other IM sub specialities?

Is there any reason (financially) to pursue a subspecialty like rheum/endo? It seems like a lot of work to make the same pay as an internist. Or is it a situation where you make "X" with a crazy hospitalist schedule whereas you make the same with a more relaxed lifestyle?

Thank you for your contributions.

The only other ones I seriously considered were ID, cardiology and GI.
GI - too much poop. hyper-competitive because of $$$ and thus attracts some unsavory personalities. not sure it'll be worth it in the long run with virtual colonoscopies and other non-invasive tests for colon cancer becoming more of a thing.
Cards - realized i wasn't all that good at reading ekgs or listening to hearts. cardiologist personality is way too similar to surgeons.
ID - essentially primary care for HIV patients, too much thinking with virtually no doing, a bit too formulaic. the research is awesome but the clinical practice is totally not (in my view).
endo - never seriously considered this but i find it interesting
rheum and heme/onc - was never good at either so never considered them. can't deal with fibromyalgia
renal - nope

A lot of folks who do some of the primarily outpaient specialties (rheum/endo/ID) do it for the lifestyle. It is way better to be a subspecialist than a PCP even if the bottom line isn't different. You can usually still work as a hospitalist or attend on the wards if you're at a place with residents if you're into that.

 

[Rekt]

1: Unbiased if possible, but what's your outlook on the competitiveness of Pulm/CC in the next few years?
2: What's your plan, academic vs. private practice?
3: What kind of lifestyle would be considered average for an attending? I imagine it can vary if more heavily weighted on clinic vs. ICU.
4: What's a ballpark compensation you're expecting? (You can PM)
5: Would it be a terrible decision to go into IM ONLY wanting Pulm/CC (or any 1 subspeciality for that matter)?

 

[Yadster101]

I love the way you posed your question.

I'm obviously at least somewhat biased because I didn't choose to do either of those but obviously the fact that I went through IM residency I've thought extensively about both and know folks who are now doing both as a career.

I would've actually considered hospitalist. Inpatient medicine is the reason the majority of us go into IM (instead of say FM, though avoiding pregnant women and children is another biggie). You are basically tasked with fixing a person in a discrete amount of time while at the same time you can form a relationship, albeit brief, with the patient. There are downside: it can get quite repetitive with the majority of your patients comprising 10 or fewer diagnoses and the hospital has become a sort of revolving door for certain patients like the mentally ill, homeless, folks addicted to various substances as well as a cadre of patients who are chronically ill. Also the schedule can be kinda brutal. Most entry level hospitalist jobs require you to work lots of weekends...usually two per month. Not to mention holidays.

Primary care is a different story... While I wholeheartedly applaud anyone who finds it to be their calling and is doing it as a career I can't stand it. Again keep in mind that I did this during residency for 3 years so it's not like I'm speaking theoretically. I think the structure of the healthcare system, insurance companies and patient expectations have formed a perfect storm of awfulness with regard to primary care. You spend an inordinate amount of time glorified secretary filling out all kinds of paperwork for disability etc...and if that wasn't awful enough you have to redo some of these forms every 6 months or year. Insurance companies try to obstruct your efforts to help the patient. Prior authorizations is a big one. I had one patient who refused to be on insulin unless she got the pen and her insurance wouldn't cover it until she tried regular needles first and "patient preference" is not a reason for a prior auth. At the same time they're grading you based on some ridiculous formula they've made up that doesn't properly account for how sick or non-compliant the patient is. Finally we've "empowered" patients to the point that they basically think going to the doctor is the same as going to walmart. They expect you to be their drug dealer for narcotics no questions asked. If they have knee pain you better heal it....clearly modern medicine has defeated normal aging. Then when you don't give then what they want because it's not appropriate they'll shop around or threaten to sue you. The system is completely warped, soul crushing and unsustainable. The first time I got to say "talk to your primary care doctor about that" in pulmonary clinic it felt AMAZING.





For third year when you say you're going to do something do it...and in a timely fashion. It's not too different than my advice for being a good resident: be reliable. So many times I'd have a med student say they'd do something for one of their patients only to go off and write their notes, then go to lecture, then lunch and it isn't done by afternoon rounds. Completely unacceptable. Residents don't expect you to know everything but they do expect you to be prepared and if you don't know something to look it up promptly. If you know you admitted a patient with X the afternoon before and you didn't spend at least half an hour reading all about it and then weave what you learned into your presentation the next day then you're doing third year wrong. Same advice goes for your subI.

Not sure what passive-aggressiveness you're talking about but you'll definitely encounter lots of different personalities be it attendings, residents, nurses. Just be humble and nice to everyone.



It's the last one. I can PM you the details.



The only other ones I seriously considered were ID, cardiology and GI.
GI - too much poop. hyper-competitive because of $$$ and thus attracts some unsavory personalities. not sure it'll be worth it in the long run with virtual colonoscopies and other non-invasive tests for colon cancer becoming more of a thing.
Cards - realized i wasn't all that good at reading ekgs or listening to hearts. cardiologist personality is way too similar to surgeons.
ID - essentially primary care for HIV patients, too much thinking with virtually no doing, a bit too formulaic. the research is awesome but the clinical practice is totally not (in my view).
endo - never seriously considered this but i find it interesting
rheum and heme/onc - was never good at either so never considered them. can't deal with fibromyalgia
renal - nope

A lot of folks who do some of the primarily outpaient specialties (rheum/endo/ID) do it for the lifestyle. It is way better to be a subspecialist than a PCP even if the bottom line isn't different. You can usually still work as a hospitalist or attend on the wards if you're at a place with residents if you're into that.

So if you were an avg DO student would you most likely go into psych?

 

[Bounce!]

Long time lurker here, sad to see you go. =\ Still, thanks for doing this AMA.
What are your hours like? I've heard that pulm/cc gets like one entire week off a month after three weeks of work? How chill (or not chill) are pulm/cc folk?

 

[yoyoni]

I love the way you posed your question.

Primary care is a different story... While I wholeheartedly applaud anyone who finds it to be their calling and is doing it as a career I can't stand it. Again keep in mind that I did this during residency for 3 years so it's not like I'm speaking theoretically. I think the structure of the healthcare system, insurance companies and patient expectations have formed a perfect storm of awfulness with regard to primary care. You spend an inordinate amount of time glorified secretary filling out all kinds of paperwork for disability etc...and if that wasn't awful enough you have to redo some of these forms every 6 months or year. Insurance companies try to obstruct your efforts to help the patient. Prior authorizations is a big one. I had one patient who refused to be on insulin unless she got the pen and her insurance wouldn't cover it until she tried regular needles first and "patient preference" is not a reason for a prior auth. At the same time they're grading you based on some ridiculous formula they've made up that doesn't properly account for how sick or non-compliant the patient is. Finally we've "empowered" patients to the point that they basically think going to the doctor is the same as going to walmart. They expect you to be their drug dealer for narcotics no questions asked. If they have knee pain you better heal it....clearly modern medicine has defeated normal aging. Then when you don't give then what they want because it's not appropriate they'll shop around or threaten to sue you. The system is completely warped, soul crushing and unsustainable. The first time I got to say "talk to your primary care doctor about that" in pulmonary clinic it felt AMAZING.

The only other ones I seriously considered were ID, cardiology and GI.
GI - too much poop. hyper-competitive because of $$$ and thus attracts some unsavory personalities. not sure it'll be worth it in the long run with virtual colonoscopies and other non-invasive tests for colon cancer becoming more of a thing.
Cards - realized i wasn't all that good at reading ekgs or listening to hearts. cardiologist personality is way too similar to surgeons.
ID - essentially primary care for HIV patients, too much thinking with virtually no doing, a bit too formulaic. the research is awesome but the clinical practice is totally not (in my view).
endo - never seriously considered this but i find it interesting
rheum and heme/onc - was never good at either so never considered them. can't deal with fibromyalgia
renal - nope

Greatly appreciate this real talk on specialties. I'm an incoming M1 and agree knowing your specialty early on is helpful in several ways, and I myself was considering anesthesia, cards, among others (and note what you said about anesthesia, and accept it might not be for me after all—I thought I'd really enjoy it because of the physiology/pharmacology and procedures but worried about it being too much supervising and repetitive, which is exactly what you said). What is your real talk on dermatology, trauma orthopedic surgery, ENT, and radiation oncology (all academic)? Any thoughts on how interesting/repetitive the medical basis and day-to-day is, frequent personality types encountered, etc.?

Thanks so much for doing this.

 

[raiderette]

If we keep asking questions, will you stay longer?
Seriously, can you talk about building your reputation and consults? Do you work for a physicians group, and do you essentially get your referrals from the wards?

 

[Frazier]

 

[sliceofbread136]

Where can I find thread that made you quit? It is for important research project

 

[TheaterOfTheme]

Looks like he's gone...


Sent from my iPhone using SDN mobile

 

[Gurby]

Looks like he's gone...


Sent from my iPhone using SDN mobile

 

[Astra]

doot doot doot another one bites the dust

 

[Ho0v-man]

doot doot doot another one bites the dust

It's a sad day indeed.

How do ya think we're gonna get along without him when he's gone?

 

[libertyyne]

doot doot doot another one bites the dust

No thanks mr.skeletal.

 

[Astra]

It's a sad day indeed.

How do ya think we're gonna get along without him when he's gone?

its ok. Soon we will all be banned for perceived microaggressions.

 

[235009]

Looks like he's gone...

If we keep asking questions, will you stay longer?

I'm still "here". Just weaning myself off the site so not going to be as quick to reply. I will do my best to answer as many questions as I can because I know you guys have put some thought into them and would hate to leave you hanging. Would be a bit silly to abandon this thread less than a week after creating it. I have however stopped participating anywhere else on this site. So feel free to keep the questions coming. I won't ghost without warning.

1: Unbiased if possible, but what's your outlook on the competitiveness of Pulm/CC in the next few years?
2: What's your plan, academic vs. private practice?
3: What kind of lifestyle would be considered average for an attending? I imagine it can vary if more heavily weighted on clinic vs. ICU.
4: What's a ballpark compensation you're expecting? (You can PM)
5: Would it be a terrible decision to go into IM ONLY wanting Pulm/CC (or any 1 subspeciality for that matter)?

@MeatTornado Not to be a leech off of rekt, but to be a leech, I pretty much have the same questions (have been hellbent on peds till recently). Also would be grateful for a PM if that works better for you, Meatasaurus!

1. overall competitiveness in internal medicine is has been going up over the last few years which will in turn make the more popular subspecialties more competitive. I think there was a small blip in competitiveness for pulm/cc specifically recently but has sortof plateaued. I think the eness of the IM subspecialties will continue to remain the same with GI and cards being most competitive and pulm/cc and heme/onc being moderately competitive for the foreseeable future unless something drastic happens with regard to compensation or scientific discovery.

2. Academic for now but depends on how successful my research is and whatever peripheral life factors happen in the next few years

3. As I mentioned before lifestyle is highly variable, especially for a combined specialty with both inpatient and outpatient components. I've seen attendings who do tons of ICU and work 36 hours straight while others do only outpatient pulm.

4. Very hard to say....starting salary ranges very widely from low 100k at some academic places to 300k for private practice. It's really so hard to say in such a heterogeneous specialty and there's naturally a big rift between academic and pp.

5. Anyone who goes into IM should be comfortable practicing IM without a subspecialty. Whether it's a terrible decision to go into i just to do a subspecialty depends on where you go for residency. If you are at a top or middle tier residency then you're much more likely to end up in your desired specialty. But if you're at a low-tier or community program you need to be more cautious. Of course if you want to do ID or renal there's nothing stopping you regardless of where you are.

So if you were an avg DO student would you most likely go into psych?

I would've done IM and been a hospitalist.
That said I did only apply to US MD schools and was not even planning on reapplying if I did not get in the first round.
Was a big mistake to tell one of my med school interviewers that last part....apparently not the right answer if they ask you what you'd do if you aren't accepted this cycle.

What are your hours like? I've heard that pulm/cc gets like one entire week off a month after three weeks of work? How chill (or not chill) are pulm/cc folk?

I'm a fellow so can't answer the first part about hours and schedule since I'm assuming you're talking about attending schedule.
I think pulm/cc folk are quite chill personality-wise. Bottom line though is that you have to find your people, the group you fit in with specialty-wise. You'll find that there is a prevailing personality in every specialty and it takes some self-reflection and self-awareness to realize which group you fit in with.

Greatly appreciate this real talk on specialties. I'm an incoming M1 and agree knowing your specialty early on is helpful in several ways, and I myself was considering anesthesia, cards, among others (and note what you said about anesthesia, and accept it might not be for me after all—I thought I'd really enjoy it because of the physiology/pharmacology and procedures but worried about it being too much supervising and repetitive, which is exactly what you said). What is your real talk on dermatology, trauma orthopedic surgery, ENT, and radiation oncology (all academic)? Any thoughts on how interesting/repetitive the medical basis and day-to-day is, frequent personality types encountered, etc.?

Thanks so much for doing this.

Wish I could've gotten excited about derm...that would've been a sweet lifestyle but i found it sooooo boring and impossible to identify one rash from the other. Also seemed like you just put steroids on it and hope it works half the time.
Never thought about rad onc but essentially there's so much physics and I'm bad at it so that was out.
Of all the surgical specialties I would've only done ortho but I couldn't stand the overall culture in surgery so eliminated the specialty as a whole. The ENT folks I've encountered have been chill though while trauma surgeons tend to be borderline masochistic because your schedule doesn't get any better when you're an attending since you're on call a lot.

Essentially when choosing a specialty you first decide on surgery vs. not surgery. That's really the essential split. Some folks who want surgery but don't want that lifestyle end up in anesthesia or EM while some of the not surgery folks end up in one of those two specialties too.
One ridiculous thing I've seen here, particularly in the DO forums, is folks who want surgery, realize it's out of reach and then try and convince themselves that FM is close enough because you get to do minor procedures. In my view FM nothing like surgery.

Seriously, can you talk about building your reputation and consults? Do you work for a physicians group, and do you essentially get your referrals from the wards?

Again, as above, I'm a fellow and your question is geared toward an attending. Maybe @jdh71 might be able to answer this and the other question about attending schedule.
I also just realized I forgot to give him a shout out in the first post! I'm such an idiot!

 

[Vyzzle]

The dermatology thing made me laugh out loud. "Put steroids on it and hope it works" has always been how I imagined it.

Also very informative post, especially about subs.

Also have my own question, which IM subspec would you rate as requiring the most problem solving skills? I imagine Pulm CC is up there or at the top.

Sent from my SM-G930V using SDN mobile

 

[ridethecliche]

The dermatology thing made me laugh out loud. "Put steroids on it and hope it works" has always been how I imagined it.

Also very informative post, especially about subs.

Also have my own question, which IM subspec would you rate as requiring the most problem solving skills? I imagine Pulm CC is up there or at the top.

Sent from my SM-G930V using SDN mobile

It's quite remarkable how many different diagnoses one can treat with steroids and hydrolated petrolatum.

 

[Brorthopedic]

It's unfortunate that you're leaving, your knowledge will be missed.

Personally I think this is all a bit theatrical. If your end goal is to really help pre-meds, which I think it is and that you do, the bullsh*t can be ignored. You know, for those pre-med's sake.

 

[yoyoni]

Wish I could've gotten excited about derm...that would've been a sweet lifestyle but i found it sooooo boring and impossible to identify one rash from the other. Also seemed like you just put steroids on it and hope it works half the time.
Never thought about rad onc but essentially there's so much physics and I'm bad at it so that was out.
Of all the surgical specialties I would've only done ortho but I couldn't stand the overall culture in surgery so eliminated the specialty as a whole. The ENT folks I've encountered have been chill though while trauma surgeons tend to be borderline masochistic because your schedule doesn't get any better when you're an attending since you're on call a lot.

Essentially when choosing a specialty you first decide on surgery vs. not surgery. That's really the essential split. Some folks who want surgery but don't want that lifestyle end up in anesthesia or EM while some of the not surgery folks end up in one of those two specialties too. One ridiculous thing I've seen here, particularly in the DO forums, is folks who want surgery, realize it's out of reach and then try and convince themselves that FM is close enough because you get to do minor procedures. In my view FM nothing like surgery.

Yeah, I have a friend shadowing a dermatologist now and she said it's kinda boring. But it's PP and I want to do academic medicine. In academics is it still a lot of steroids on rashes? I would presume academics would have more variety, with more serious conditions? Derm is perfect for me (mixed patient population, Mohs allows for the surgical aspect, lots of autonomy, immediate results and gratification, etc.) EXCEPT FOR the medical basis! I have no idea if I'll end up loving skin enough to focus my future career on the organ system skin...

...and same for ENT. I don't know how interesting I'll find the areas of the body ENT's operate on, but something to explore. I loved being in the OR, and hate the idea of never being in the OR again/all clinic time, but I also really, truly don't know if I'll be willing to grind out the required hours as an attending. I want to work hard, I'm actually somewhat masochistic and enjoy working really hard, but at some point I also need to take a breath. That combined with the fact that if I were to actually do an 8 hour surgery I would legit have to scrub out for a snack break make me question my ability to do surgery. As I mentioned I gave consideration to Anes., but now am no longer considering it.

I guess options now are Derm—>Mohs, Ortho, CT, NSG, or ENT (almost all of the surgical specialities lol). What is this "culture" you speak of in surgery? I shadowed an academic CT and he was very kind and hilarious, which kinda dispelled my preconceived notions about surgeons.

 

[ridethecliche]

It's unfortunate that you're leaving, your knowledge will be missed.

Personally I think this is all a bit theatrical. If your end goal is to really help pre-meds, which I think it is and that you do, the bullsh*t can be ignored. You know, for those pre-med's sake.

If this place was more realistic, the pre-meds and med students would think twice before hurling insults and challenging residents/fellows/attendings on here, especially when it comes to the field itself. None of the things the OP describes would ever happen in real life because it would be like committing academic suicide.

The anonymous nature of this site lets pre-meds/med students/whathaveyou think that they're on equal footing as folks that have a ton more experience. I can see it getting pretty olf for folks to deal with that. They legitimately don't have to, especially from moderating staff. I haven't had any bad experiences with the mods, but I can see how/why it would get old quick.

 

[Lawpy]

If this place was more realistic, the pre-meds and med students would think twice before hurling insults and challenging residents/fellows/attendings on here, especially when it comes to the field itself. None of the things the OP describes would ever happen in real life because it would be like committing academic suicide.

The anonymous nature of this site lets pre-meds/med students/whathaveyou think that they're on equal footing as folks that have a ton more experience. I can see it getting pretty olf for folks to deal with that. They legitimately don't have to, especially from moderating staff. I haven't had any bad experiences with the mods, but I can see how/why it would get old quick.

There is an implicit hierarchy on SDN as premeds posting threads in med student and higher level forums get moved to premed forums. A similar hierarchy should be present for professional behavior. Respect for those senior in training is important but is often sadly lost in the forums because anonymity.

 

[Brorthopedic]

If this place was more realistic, the pre-meds and med students would think twice before hurling insults and challenging residents/fellows/attendings on here, especially when it comes to the field itself. None of the things the OP describes would ever happen in real life because it would be like committing academic suicide.

The anonymous nature of this site lets pre-meds/med students/whathaveyou think that they're on equal footing as folks that have a ton more experience. I can see it getting pretty olf for folks to deal with that. They legitimately don't have to, especially from moderating staff. I haven't had any bad experiences with the mods, but I can see how/why it would get old quick.

The anonymity and lack of a hierarchical system is what makes places like SDN great

 

[Promethean]

The anonymity and lack of a hierarchical system is what makes places like SDN great

I agree with this. Hierarchy serves certain useful roles... but it also comes at a cost. Having a forum where it doesn't apply as strictly opens up opportunities for communication to flow in ways that it cannot in the real world.

Having that work effectively and not devolve into a ****show requires that there be some form of effective moderation. Some folks will reach the end of their patience with that and move along, and that is too bad, but it is probably an unavoidable side effect of the same mechanisms that produce those aspects of the forum that make it worthwhile.

Sad to see you go, MT. SDN will likely still be around should you feel differently about it in the future. Good luck in all your future endeavors.

 

[bashwell]

As with everyone else, sad to see you go, @MeatTornado, you're one of the lights on SDN! Any chance of reconsidering? Or at least coming back someday under a different guise? 😉

Just curious, you mentioned pulm/cc is full of chill people, what's your take on the "personalities" of all the other medicine subspecialties? I have my sense of each, but I always appreciate your insight.

In any case, I wish you all the best man! 🙂

 

[username456789]

The dermatology thing made me laugh out loud. "Put steroids on it and hope it works" has always been how I imagined it.

And this is exactly how most non-Dermatologists approach just about anything on the skin.

 

[Light at end of tunnel]

@Lucca abruptly closed @Psai 's farewell thread because people went off topic (I think), although I suspect the fact that it represented a 'disgruntled' SDN user there may have been some alternative motivation.

Let's not give mods justification to do the same here.

 

[sliceofbread136]

If this place was more realistic, the pre-meds and med students would think twice before hurling insults and challenging residents/fellows/attendings on here, especially when it comes to the field itself. None of the things the OP describes would ever happen in real life because it would be like committing academic suicide.

The anonymous nature of this site lets pre-meds/med students/whathaveyou think that they're on equal footing as folks that have a ton more experience. I can see it getting pretty olf for folks to deal with that. They legitimately don't have to, especially from moderating staff. I haven't had any bad experiences with the mods, but I can see how/why it would get old quick.

Whole heartedly disagree just as others have pointed out. Being able to communicate freely here is what makes the board great. Medical students should not simply be accepting what you say as fact due to your experience. You should be able to use the knowledge you have gained from that experience to show them why you are right and they are incorrect. The exchange of ideas then becomes much more valuable for both sides.

I do agree that insults are inexcusable, but that applies to both sides. I also agree that some of the mods can be immature/power abusive at times, but overall I think they do a fairly good job

 

[3characterslong]

If this place was more realistic, the pre-meds and med students would think twice before hurling insults and challenging residents/fellows/attendings on here, especially when it comes to the field itself. None of the things the OP describes would ever happen in real life because it would be like committing academic suicide.

The anonymous nature of this site lets pre-meds/med students/whathaveyou think that they're on equal footing as folks that have a ton more experience. I can see it getting pretty olf for folks to deal with that. They legitimately don't have to, especially from moderating staff. I haven't had any bad experiences with the mods, but I can see how/why it would get old quick.

Thats why people post on anonymous internet forums to begin with.

I would also challenge you to find a even single more hierarchical anonymous internet forum than this (pre-allo doesn't count).

 

[cbrons]

Special achievement:

50G - Meat Tornado

• (Gain acceptance to a U.S. medical school despite having an institutional action on your record) - in honor of retirement of @MeatTornado

 

[235009]

Also have my own question, which IM subspec would you rate as requiring the most problem solving skills? I imagine Pulm CC is up there or at the top.

Internal medicine is inherently about problem solving and so are all the subspecialties. that's what sets aside medicine from surgery. I don't think you can really rank them in that respect.

Personally I think this is all a bit theatrical. If your end goal is to really help pre-meds, which I think it is and that you do, the bullsh*t can be ignored. You know, for those pre-med's sake.

My "goal"? I found this site useful mostly for the interview feedback section way back when I was interviewing for med school and sharing experiences with folks who were going through residency match at the same time. To give back I would answer questions occasionally because there are so few actual physicians on SDN. I haven't gotten anything substantial out of this website in years now (the pulm/cc forum is dead on arrival). So no I'm not going to put up with bullsh*t for the benefit of random strangers on the internet.

What is this "culture" you speak of in surgery? I shadowed an academic CT and he was very kind and hilarious, which kinda dispelled my preconceived notions about surgeons.

Unfortunately that person is the exception. Surgeons are still under the impression that you should work yourself to death while the rest of the medical community has come to terms with the importance of work-life balance. Also the god complex is very strong. The hierarchy is super rigid. Also they put so much importance on the actual surgery and not enough on what happens afterwards (in practice, the surgery rotation shelf is all about the latter). It just wasn't for me. It's a bit hard to explain and of course a surgeon may not feel this way at all. My notions were reinforced when I did SICU as a fellow too.

If this place was more realistic, the pre-meds and med students would think twice before hurling insults and challenging residents/fellows/attendings on here, especially when it comes to the field itself. None of the things the OP describes would ever happen in real life because it would be like committing academic suicide.

The anonymous nature of this site lets pre-meds/med students/whathaveyou think that they're on equal footing as folks that have a ton more experience. I can see it getting pretty olf for folks to deal with that. They legitimately don't have to, especially from moderating staff. I haven't had any bad experiences with the mods, but I can see how/why it would get old quick.

There is an implicit hierarchy on SDN as premeds posting threads in med student and higher level forums get moved to premed forums. A similar hierarchy should be present for professional behavior. Respect for those senior in training is important but is often sadly lost in the forums because anonymity.

The anonymity and lack of a hierarchical system is what makes places like SDN great

I agree with this. Hierarchy serves certain useful roles... but it also comes at a cost. Having a forum where it doesn't apply as strictly opens up opportunities for communication to flow in ways that it cannot in the real world.

Having that work effectively and not devolve into a ****show requires that there be some form of effective moderation. Some folks will reach the end of their patience with that and move along, and that is too bad, but it is probably an unavoidable side effect of the same mechanisms that produce those aspects of the forum that make it worthwhile.

Sad to see you go, MT. SDN will likely still be around should you feel differently about it in the future. Good luck in all your future endeavors.

I've very rarely seen the free-for-all nature of this website actually be beneficial. Most of the time you just have folks who don't know what they're talking about either incorrectly regurgitating things they've read on SDN (it's like playing a game of telephone) or giving "advice" that's completely wrong. Again the physicians mostly don't get anything out of this website. The more advanced forums are all basically dead or flooded with a few repetitive topics (like folks getting kicked out of residency and pretending like it wasn't their fault at all). What you all are wrong about is calling this an anonymous forum. The SDN admin has decided that it is worthwhile to check posters' credentials and display them on the site. In return they offer those posters an ad-free page (maybe, I use adblock so never saw ad) and unlimited PMs... woop dee doo. It's also one thing to be disrespected by some snot nose premed 10 years younger than me who doesn't know any better but another thing to have the SDN admin allow essentially dispensable members to blatantly disrespect senior members without whom this forum would be complete BS. Enjoy your open discourse but without input from the folks who have been through the journey already (not @Goro or @LizzyM, both of whom aren't physicians) then SDN basically turns into your college pre-med club and no actual information is being passed along, just conjecture.

As with everyone else, sad to see you go, @MeatTornado, you're one of the lights on SDN! Any chance of reconsidering? Or at least coming back someday under a different guise? 😉

Just curious, you mentioned pulm/cc is full of chill people, what's your take on the "personalities" of all the other medicine subspecialties? I have my sense of each, but I always appreciate your insight.

In any case, I wish you all the best man! 🙂

Sorry but this isn't a charade. This was fun for a while but now it just feels tedious. Doesn't help that after you've made thousand of posts mostly helping other members and elevating the discourse on the website, some pre-med admonishes you and puts you on "probation"....no thanks...i'll spend my time doing something else.

Cardiology - most like surgeons
renal and ID - huge nerds haha
GI - a good portion are gunners
heme/onc - tend to be very compassionate


EDIT: I would come back under one circumstance....if SDN shared some of that sweet Caribbean school $$$ they take in from the ads ;-)

 

[sullen-burger]

You mentioned patients threatening to sue somewhere earlier in the thread so my question is if that happens, how do you respond in that scenario? Do you say anything? What do you say?

Thanks for doing the AMA, sorry you see you decide to leave.

 

[NontradCA]

Married? How'd the process affect your relationships?

 

[ortnakas]

What made you decide to keep training in pulm/crit vs stopping after residency and being a hospitalist?

I'm a third year DO student and I'm currently leaning toward the latter, honestly for personal reasons more than academic limitations (I do recognize this as a real thing I'd likely face in fellowship apps), but I'm curious what your thought process was in deciding.

 

[ridethecliche]

There is an implicit hierarchy on SDN as premeds posting threads in med student and higher level forums get moved to premed forums. A similar hierarchy should be present for professional behavior. Respect for those senior in training is important but is often sadly lost in the forums because anonymity.

The anonymity and lack of a hierarchical system is what makes places like SDN great

I agree with this. Hierarchy serves certain useful roles... but it also comes at a cost. Having a forum where it doesn't apply as strictly opens up opportunities for communication to flow in ways that it cannot in the real world.

Having that work effectively and not devolve into a ****show requires that there be some form of effective moderation. Some folks will reach the end of their patience with that and move along, and that is too bad, but it is probably an unavoidable side effect of the same mechanisms that produce those aspects of the forum that make it worthwhile.

Sad to see you go, MT. SDN will likely still be around should you feel differently about it in the future. Good luck in all your future endeavors.

Whole heartedly disagree just as others have pointed out. Being able to communicate freely here is what makes the board great. Medical students should not simply be accepting what you say as fact due to your experience. You should be able to use the knowledge you have gained from that experience to show them why you are right and they are incorrect. The exchange of ideas then becomes much more valuable for both sides.

I do agree that insults are inexcusable, but that applies to both sides. I also agree that some of the mods can be immature/power abusive at times, but overall I think they do a fairly good job

Thats why people post on anonymous internet forums to begin with.

I would also challenge you to find a even single more hierarchical anonymous internet forum than this (pre-allo doesn't count).

I never said anything about not being able to converse freely. You should always have the freedom to challenge those in a position of authority. It should also be done with a modicum of respect given the fact that they have far more to teach and you have far more to learn. This obviously goes out the door when it comes to P&R ish stuff, but I have definitely seen posts where premeds and med students use the veil of anonymity to be blatantly dismissive and disrespectful.

I've certainly challenged my fair share of members on here, but have tried to do it semi-respectfully...even when I was being an ass 😛

Sometimes folks post on here to shoot the sh1t. Other times they post here because they have experience that more junior members can learn and draw from. They don't deserve to be subjected to blatant disrespect. That was all there was to my point.

 

[IsWhat]

So MT got an IA for cheating? I thought that was basically a death sentence?

@Goro

 

[Goro]

So MT got an IA for cheating? I thought that was basically a death sentence?

@Goro

Meat explained to me what happened, via pM. There's cheating, and then there's CHEATING. His was not as serious as the latter, and his case illustrates that time does heal wounds, even self-inflicted ones.

 

[cellsaver]

Sometimes folks post on here to shoot the sh1t. Other times they post here because they have experience that more junior members can learn and draw from. /QUOTE]

"If I have seen further, it is by standing on the shoulders of Giants."
Isaac Newton (1643-1727)

Some of us post here because we know in our hearts that others have made it possible for us to be where we are today. We are merely sharing what others have taught us

 

[Shams al Deen]

Let's say one is going after GI or Cardiology, obviously where you end up for residency matters a lot. But is it generally pretty easy get GI or Cards if you are lucky enough to land a top tier IM residency (like Duke, UTSW)? And how about if you land a good IM program that's like top 30ish (such as BU or UNC or UAB)?

Also is there any data available as to how many people go unmatched for cards fellowship at certain residency programs? I have seen the fellowship matches on different program websites, but they are just trying to show off their program and not including the data from people who tried but failed to match.

 

[HelpPleaseMD]

Let's say one is going after GI or Cardiology, obviously where you end up for residency matters a lot. But is it generally pretty easy get GI or Cards if you are lucky enough to land a top tier IM residency (like Duke, UTSW)? And how about if you land a good IM program that's like top 30ish (such as BU or UNC or UAB)?

Also is there any data available as to how many people go unmatched for cards fellowship at certain residency programs? I have seen the fellowship matches on different program websites, but they are just trying to show off their program and not including the data from people who tried but failed to match.

If you are at a mid-tier program or better the likelihood of you matching GI or Cards is very high. No one in my residency has failed to match any subspecialty within the last 5 years at least and we aren't top tier. Generally IMO if you show up and do your job / join a few research projects you will be set. The projects don't even need to be high quality.

 

[235009]

You mentioned patients threatening to sue somewhere earlier in the thread so my question is if that happens, how do you respond in that scenario? Do you say anything? What do you say?

Depends on the context. Outpatient you know the patient a lot more and can get a better understanding why they're upset and work it out. Though sometimes just saying "i'm sorry you feel that way" and offering them a different doctor is the best action. Inpatient there are usually patient patient advocates that will take the time to hear the patient's concerns. If you made a mistake and a patient threatens to sue you say as little as possible and go directly to the hospital legal department.

Most of the time the patient isn't actually serious about it and/or has absolutely no case.

Married? How'd the process affect your relationships?

Not married. Moving every few years is a double edged sword. You get to start over but it's also harder to settle down. I've generally dated within medicine so they've been quite understanding and/or were in the same situation.

What made you decide to keep training in pulm/crit vs stopping after residency and being a hospitalist?

I'm a third year DO student and I'm currently leaning toward the latter, honestly for personal reasons more than academic limitations (I do recognize this as a real thing I'd likely face in fellowship apps), but I'm curious what your thought process was in deciding.

I want a career with a large non-clinical component. Whether that's research or something else is still unclear but I certainly didn't want to take a 100% clinical job straight out of residency.

So MT got an IA for cheating? I thought that was basically a death sentence?

@Goro

Meat explained to me what happened, via pM. There's cheating, and then there's CHEATING. His was not as serious as the latter, and his case illustrates that time does heal wounds, even self-inflicted ones.

@Goro's answer is a bit of an exaggeration. I applied only 2 years after the incident. Quite different than the "take 3 decades off and then maybe you can consider applying" advice you get on SDN.

Let's say one is going after GI or Cardiology, obviously where you end up for residency matters a lot. But is it generally pretty easy get GI or Cards if you are lucky enough to land a top tier IM residency (like Duke, UTSW)? And how about if you land a good IM program that's like top 30ish (such as BU or UNC or UAB)?

Also is there any data available as to how many people go unmatched for cards fellowship at certain residency programs? I have seen the fellowship matches on different program websites, but they are just trying to show off their program and not including the data from people who tried but failed to match.

If you are at a mid-tier program or better the likelihood of you matching GI or Cards is very high. No one in my residency has failed to match any subspecialty within the last 5 years at least and we aren't top tier. Generally IMO if you show up and do your job / join a few research projects you will be set. The projects don't even need to be high quality.

This response is spot on. The only caveat is if you have extenuating circumstances (usually geographic limitations or couples match) which could leave you unmatched. But if you are applying broadly enough, did a good job in your residency program (showed up to work, cared, took care of patients, learned appropriately) then you'll match.

 

[cellsaver]

@Goro's answer is a bit of an exaggeration. I applied only 2 years after the incident. Quite different than the "take 3 decades off and then maybe you can consider applying" advice you get on SDN.

cue The Beatles - Long and Winding Road

Here's your hat, what's your hurry?