For The Rare Few Who Want to Remain Unspecialized are You Planing to Do Outpatient or Inpatient

[wjs010]

Outpatient is the way to go. This is true for any specialty, not only general IM. The more removed you are from the hospital the better.

Even when you have to deal with the full spectrum of medicine x 20-30 patients and their neediness issues?


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[PlutoBoy]

Even when you have to deal with the full spectrum of medicine x 20-30 patients and their neediness issues?


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Yes. Needy patients don’t become “unneedy” in the hospital. You can’t escape this.

 

[TraderDoc]

I’d rather see 20 needy patients in the hospital than 10 unneedy patients in clinic . But that’s just me. Clinic just isn’t for me. Reason why none of the fellowships would work out, they all had clinic duties. But grateful that there are doctors who feel the opposite.

 

[deleted245683]

anybody here work in the Socal market, particularly riverside county?

Not Socal, but the Bay Area (Silicon Valley). Graduated from residency in Socal in 2016. I work outpatient IM only, with minimal weeknight/weekend home call, 4 days on/3 days off for one of the few Kaiser competitors. However, all Kaiser competitors in the area seemed comparable with schedule, salary, and work load outside of direct patient care when i was applying late 2017. Starting salary was $253k. The salaries are slightly increased in the Bay Area compared to the rest of CA due to the cost of living, but imagine Riverside would be comparable due to being outside LA and more inland. However, my friends going into outpatient IM in Socal said their starting salaries tended to be more in the $235-245 range, but this was mostly LA/OC.

 

[jdh71]

I’d rather see 20 needy patients in the hospital than 10 unneedy patients in clinic . But that’s just me. Clinic just isn’t for me. Reason why none of the fellowships would work out, they all had clinic duties. But grateful that there are doctors who feel the opposite.

It's normal to feel this way in training. It is harder to be good at being an outpatient doc as an internist the way we are trained. You lack the appropriate reflexes to make the job easy, so it has to be uncomfortable for awhile until your get your personal algorithms and triage systems down to make decisions quicker. The hospital is just easier because the patients are a captive audience allows you to be slower and plodding about it all. And once they are in you can sit on some stuff for a bit.

 

[s109442]

In my clinical practice I think it does bear out in real life with regards to complex problems especially as they increase in number.

It's a reflexes thing more than FM is no good.

I might be getting ready to get flamed tho. I hope it's clear I'm not crapping on FM.

Wait are you saying IM docs are better at outpatient because they had more ICU months and floors months than FM.?

 

[jdh71]

Wait are you saying IM docs are better at outpatient because they had more ICU months and floors months than FM.?

I don't know are you looking to pick an internet fight? I've already had a few this week.

Not sure if serious.

 

[VA Hopeful Dr]

Wait are you saying IM docs are better at outpatient because they had more ICU months and floors months than FM.?

That's what you got from that? Seriously?

For the record, I'm FM married to an internist and what he said is exactly what happened when she went from hospitalist to outpatient.

 

[VA Hopeful Dr]

I don't know are you looking to pick an internet fight? I've already had a few this week.

Not sure if serious.

Bring it!!!

 

[pgy0246]

I was just seeing 14 patients yesterday; (9am-5pm). About 5 of them of significant issues I need to address (new patient with lung mass (found 15 months ago), CKD (GFR of 25), and hematochezia with hx of polyps (repeatedly declined GI referral).

I was seeing 14 inpatients on a weekend by myself, and get everything done by 11:30am.
But I was then seeing 14 outpatient weekday clinics (9-5pm) and didn't finish until 5:45pm.

If you pick an outpatient job offer, make sure you focus on the ages of your panel, and their educational level. The amount of work in seeing a 85 years old >> seeing a 25 years old with sinusitis. And it can frustrating trying to tell a 55 yo with PVD and leg amputation to quit smoking.

 

[DoubleBogey]

My biggest gripe between my training and real world has been the isolation from drug reps - this isolation from new upcoming meds (at least with my training). I’m now using DM injectionables/GLP1 more, Xultrophy, Injectables for migraines and HLD/repatha- never got this in my IM clinic, would see in the speciality clinics we rotated through. For good or bad, the drug reps at least give some exposure to what’s coming in/new, and after speaking with colleagues and going for those free dinners (when you have the time), gives you a little more UTD info.