GS vs. IM residency: any differences aside from obvious length and OR?

[FreeWeezy]

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Hi all,

I'm in the somewhat unique position of being fairly certain of the specific area of medicine I want to practice (Bariatrics: It was my undergrad research and really lifelong interest and reason for going to medical school so I'm not likely to change my mind), but having multiple options of residencies in order to pursue this interest. Surgical weight loss seems more evidence based, but I never thought of myself before as a surgeon. After observing many cases in the OR, however, I think I can do it with enough training. It also seems to be getting more and more prone to a mostly office practice 10 years out (when I'll be finished residency and fellowship) with SILS and trans-oral approaches to surgery. I've also worked with medical bariatricians and while options are more limited (and drug pipeline not as promising), it can certainly be done. The best approach seems IM with or without Endo/GI fellowships after.

My main question is how does a 5 year surgery residency compare to a 3 year IM residency in terms of hour, call, physical demand, etc. I know it varies by program but are there some general differences hours and lifestyle wise aside from the obvious 2 extra years?

Also, whether it's a weight loss dug or surgical intervention, BOTH are really just "tools" and behavior intervention and diet and exercise are key. I know it doesn't pay as well, but I really like this part. My thinking is that since bariatric surgery is much more established than bariatric medicine and that surgeons can obviously also write perspescriptions and work in multidisciplinary teams, surgery would give me one additional "tool" (as well as a much more clear pathway) I wouldn't have if I went the medical way. Does anyone have any thoughts on this? Specifically, is it misguided to think a few extra years of residency would be worth it to gain a very powerful additional skillset to help my patients? I know not many baiatric surgeons want to counsel and do much followup because of the economics, but suppose I'm willing to sacrifice higher pay. Is it realistic to be in OR one day a week, do 10 surgical cases for those pts who need surgery, and spend the other days following up and working medically with patients who don't need surgery? Would I know enough after med school and a GS residency to also medically manage patients?

Thank you very much for any insight on either general IM vs. GS surgery or bariatrics specifically!

 

[smq123]

Moving to allopathic.

 

[danzman]

Hi all,

I'm in the somewhat unique position of being fairly certain of the specific area of medicine I want to practice (Bariatrics: It was my undergrad research and really lifelong interest and reason for going to medical school so I'm not likely to change my mind), but having multiple options of residencies in order to pursue this interest. Surgical weight loss seems more evidence based, but I never thought of myself before as a surgeon. After observing many cases in the OR, however, I think I can do it with enough training. It also seems to be getting more and more prone to a mostly office practice 10 years out (when I'll be finished residency and fellowship) with SILS and trans-oral approaches to surgery. I've also worked with medical bariatricians and while options are more limited (and drug pipeline not as promising), it can certainly be done. The best approach seems IM with or without Endo/GI fellowships after.

My main question is how does a 5 year surgery residency compare to a 3 year IM residency in terms of hour, call, physical demand, etc. I know it varies by program but are there some general differences hours and lifestyle wise aside from the obvious 2 extra years?

Also, whether it's a weight loss dug or surgical intervention, BOTH are really just "tools" and behavior intervention and diet and exercise are key. I know it doesn't pay as well, but I really like this part. My thinking is that since bariatric surgery is much more established than bariatric medicine and that surgeons can obviously also write perspescriptions and work in multidisciplinary teams, surgery would give me one additional "tool" (as well as a much more clear pathway) I wouldn't have if I went the medical way. Does anyone have any thoughts on this? Specifically, is it misguided to think a few extra years of residency would be worth it to gain a very powerful additional skillset to help my patients? I know not many baiatric surgeons want to counsel and do much followup because of the economics, but suppose I'm willing to sacrifice higher pay. Is it realistic to be in OR one day a week, do 10 surgical cases for those pts who need surgery, and spend the other days following up and working medically with patients who don't need surgery? Would I know enough after med school and a GS residency to also medically manage patients?

Thank you very much for any insight on either general IM vs. GS surgery or bariatrics specifically!

I am not an expert in any of this, but in talking to some gen surg guys who have trained in bariatrics it seems that there may be some possibility that GI guys could do some of these procedures in the office in the near future. I know that some of the newer hernia repairs are being done by both surgeons and GI's, but its only a select subset if I remember correctly.

FWY, all the bariatrics surgeons I have met did a fellowship (+2yrs)

 

[Hurricane95]

Where are you so far in school. I would venture to say first or second year, right?

By the time you go through third year and rotate through each internal medicine and surgery rotations, you would have already answered your own question. Surgery and medicine are apple and oranges - 2 VERY different specialties and residencies.

For your goals as generally described, I would imagine that a better route would be to go general surgery + bariatrics fellowship (5+2+possibly research years). Keep in mind that bariatric and weight loss surgery inherently has a lot of clinical follow up involved. Once these surgeons operate on these patients, the patients essentially become theirs for life (they require lots of following up and no one else will usually want to touch them from a surgical standpoint). The medical route for caring for patients with obesity and metabolic disturbances would be to do an endocrine fellowship after a medicine residency. (3+3 years). Though of course, this always leaves you limited because you would never operate on anyone.

There are tremendous differences between medicine and surgery residencies besides only the length of 3 vs 5 years. Intern years may be the only year where there is slight similarity, because most of intern year is bitch work - doing floorwork, writing orders, following patients, making phone calls for XYZ reasons, social work BS, scheduling things, etc. However you are dealing on the one hand with patients who are being treated for medical problems by medicine teams and specialties vs. treating patients who have surgical problems of different types. Year 2 and beyond the divergence takes off. In medicine you get leadership responsibilities and lead teams starting in year 2, as well as lots of clinic, medical ICU and rotate through the specialties. Most of internal medicine is hands off, although you do some procedures on occasion like LP's, central lines, biopsies, etc. especially when rotating through ICU's or doing subspecialties. In certain medicine specialties like GI or cardiology they do LOTS of procedures, but exposure to this as a resident is more limited. Surgery from year 2 onwards is mostly time in the operating room doing surgery, with increasing responsibility as a team leader with each passing year.

WHERE you do your training can make a huge difference too. As a general rule of thumb, you get different personality types in these 2 fields. Stereotypically surgeons are very alpha, goal-driven, aggressive, OCPD and to-the-point. Medicine people stereotypically are nicer, and the field is more cerebral and people talk a lot more. About everything.

Take rounds for instance. On internal medicine, a team may be handling let's say 8-20 patients at a given time. Rounds may be done in a conference room and the team sits there for 3 hours talking about each person, and talking in depth about their medical problems including presenting articles and asking a lot of why questions to get discussion going. Then they may go around seeing each individual patient and making treatment/diagnostic plans for each for another couple of hours. Rounds are the focus of the day, and floorwork (getting things done, like writing orders, admitting patients, etc. ) follows. ROunds alone may take 3-5 hours in some cases and involve lots of blah blah, usually in a friendly environment.

"Rounds" in surgery are seen as a necessary thing that has to get done early and out of the way so the team can go to the operating room and do the cases for the day. It's a necessary evil that has to get done to make plans and follow-up on patients who the team has already operated on or is being consulted on. It is possible to "round" on 20 patients in half an hour on a surgery service. There is no "academic discussion" or blah blah on exploring 10 reasons WHY the potassium could be elevated. The potassium is high? Ok, get and EKG and fix it. Done. Next. Everything is very efficient and goal driven. Surgeons have a reputation for being *******s sometimes. This is sometimes true, but in some cases is a result of the nature of the work. There is simply a ton of work to do and not much wiggle room to waste time. After rounds, generally the intern will go do floorwork and the rest of the team will go operate for X hours on Y number of patients.

Surgery is usually more arduous training and more stressful, independent of the length of training. Surgeons have the reputation of beating on you and demanding perfection to such a level that it causes stress. Medicine is extremely busy in terms of hours too, but supposedly more cordial. Although this varies tremendously on where you train and how malignant the programs are (malignant means a program basically makes your life hell and treats its residents harshly). There are some hospitals where the medicine program is actually more malignant than the surgery program. Stereotypes are also not always true. Not all surgeons are *******s and not all medicine people are bubbly talkative nice people who like to teach. I've met internists who are bigger *******s than the worst surgeons.

Once you go through at least 3rd year it will all make sense and you will find where you fit best.

 

[Hurricane95]

Also another point to consider is that results in medicine are not always clearly visible from the get-go whereas everything in surgery is more concrete. To really enjoy internal medicine, you have to derive satisfaction from knowing that you may not get immediate results form your work. Mrs. Smith has high blood pressure? Ok, you optimize her medication regimen so her numbers get under control in the hopes that this is one of your many interventions that will prevent her from having a future complication like an MI or end-stage renal disease. You got her under 120/80? Strong work, pat yourself on the back. How is her A1C, does her diabetes plan need adjusting, etc

In surgery things are very concrete. There is a problem, and you must fix it through surgery. The guy has acute cholecystitis. You go in there, yank out his gallbladder, and he is now fixed. Done. Babysit him for a couple of days and make sure he tolerates food and starts peeing and pooping and his pain is under control, and he's good to go. You fixed the problem. You get immediate gratification for you work.

 

[danzman]

I think at the end of the day, you should figure out what it is you want to do for the rest of your life, surgery or medicine. Never the two shall mix (almost..).

 

[SocialistMD]

Two points to clarify.
1. Bariatric (MIS) fellowships are only one year, not two.
2. I don't know of any "hernias" being repaired by gastroenterologists, but there are some endoluminal options developing for weight loss assistance. There are endoluminal fundoplications that claim reduction of a hiatal hernia, but they do not repair the hernia.

 

[FreeWeezy]

Two points to clarify.
1. Bariatric (MIS) fellowships are only one year, not two.
2. I don't know of any "hernias" being repaired by gastroenterologists, but there are some endoluminal options developing for weight loss assistance. There are endoluminal fundoplications that claim reduction of a hiatal hernia, but they do not repair the hernia.

Yes, both are correct. MIS is 1 year everywhere I know.
Also, Endo is a 2 year fellowship at least at my institution. And not essential for Medical Bariatrics. I was recommended by head of Medical Bariatrics (who actually did FM) to do IM, see if any specific fellowships are available by then which very well may be, and depending on success of getting right into Bariatrics keep options open for GI or Endo Fellowships. Peds is also an option but more limiting.

I'm curious though, I'm very aware of transluminal/transoral approaches (TOGA, balloon, etc.), but these are all being done now by bariatric surgeons under general anesthesia. I actually thought at first GI had a monopoly on scopes. If they catch on 10 years from now, will they be done by GI also, GI along with GS/Bariatrics, or a mix of both? Would that be a turf battle?

Also, is there general consensus that the hours in IM and GS are essentially the same but vary more by program than by specialty? I seem to like spending 10 hours in OR because time goes very quickly but in clinic, etc., 10 hours goes very very slowly. What is normal schedule, call, etc. like in both?

 

[FreeWeezy]

I think at the end of the day, you should figure out what it is you want to do for the rest of your life, surgery or medicine. Never the two shall mix (almost..).

I want to help people lose weight. It's going to be diet and exercise, with help possibly from bands or scripts (phentermine, wellburtin, topamax, adderrall, whatever if anything new comes to market in 10 years).

I don't really care if it's a script or band (or any other procedure) that helps patients lose weight since either way followup and compliance to diet is huge predictor of success.

I still don't understand why two are so different after residency. We are already talking about GI doing some of these procedures and bariatric surgeons often write scripts if surgery was not enough. I know the idea is foreign, but I don't really want to be a surgeon or an internist. I want to learn as much psych, nutrition, medicine, and possibly surgery to have every tool at my disposal. I'm just thinking since IM can't do surgery but GS are fully certified to do medicine and surgery, GS may be better option?

But main question really is aside from differences by institution, how does IM and GS differ in terms of hours and call?

 

[danzman]

Two points to clarify.
1. Bariatric (MIS) fellowships are only one year, not two.
2. I don't know of any "hernias" being repaired by gastroenterologists, but there are some endoluminal options developing for weight loss assistance. There are endoluminal fundoplications that claim reduction of a hiatal hernia, but they do not repair the hernia.

http://my.clevelandclinic.org/endoc...aparoscopic_bariatric_surgery_fellowship.aspx

2yrs, more like the OP is discussing.

The discussion I had with the surgeon was that now GIs can do endoluminal fundos, but in the near future they may be able to perform weight loss procedures. I cant remember the name of the procedure now though....

Again, only based on a discussion I had with 2 surgeons, in no other way knowledgeable about the subject.

 

[45408]

Surgical weight loss seems more evidence based, but I never thought of myself before as a surgeon. After observing many cases in the OR, however, I think I can do it with enough training. It also seems to be getting more and more prone to a mostly office practice 10 years out (when I'll be finished residency and fellowship) with SILS and trans-oral approaches to surgery.

SILS may have some promise, but NOTES isn't really taking off for anything bariatric, nor do I expect it to. Bariatric surgery is not at all going to feel like an office practice, and you will be managing your post-operative complications. You have to be able to handle quite a bit of general surgery in order to do this. Also, depending where you work, you'll be taking general surgery call at night anyway.

My main question is how does a 5 year surgery residency compare to a 3 year IM residency in terms of hour, call, physical demand, etc. I know it varies by program but are there some general differences hours and lifestyle wise aside from the obvious 2 extra years?

Well, since I know the IM residents at my program, I can say that we (the surgery residents) work much longer hours than they do, which they freely admit to us. We take an average of Q4 call for around 48 of the 60 months of residency, and we're on the hook for weekend call for all five years. Of course, like everyone else, our new interns can't take call the first year. The medicine residents are only on wards or ICU rotations for 5-6 months of the year. The rest of the time, they're not on call much, and if they are, it's for things that are very unlikely to result in them coming in.

My thinking is that since bariatric surgery is much more established than bariatric medicine and that surgeons can obviously also write perspescriptions and work in multidisciplinary teams, surgery would give me one additional "tool" (as well as a much more clear pathway) I wouldn't have if I went the medical way.

It's a lot more than just an additional tool. More like a way of life.

Is it realistic to be in OR one day a week, do 10 surgical cases for those pts who need surgery, and spend the other days following up and working medically with patients who don't need surgery? Would I know enough after med school and a GS residency to also medically manage patients?

Ten gastric bypasses per week is a pretty busy week, and there's no way in hell that's any less than two full days in the OR, except in a rare setting with unbelievably high volume. Those places exist (or so I've heard), but they're veritable factories. Here, it would be more like 3 days worth of cases.

And as a general/bariatric surgeon, you are responsible for the medical management of your surgical patients. We rarely consult anyone for that as an inpatient, but we also never handle their diabetes and hypertension as an outpatient.

 

[45408]

I still don't understand why two are so different after residency. We are already talking about GI doing some of these procedures and bariatric surgeons often write scripts if surgery was not enough.

I don't think we're going to see much more GI involvement in this field. I'm biased, of course. Writing a script takes a few seconds, and it doesn't turn a surgeon into an internist.

But main question really is aside from differences by institution, how does IM and GS differ in terms of hours and call?

More of both for surgeons. None of the internists here take call. The hospitalists just work in shifts. If you haven't done clinical rotations, that's really what you need to do before you make this decision. It seems that you don't see the apples to oranges debate going on here.

 

[FreeWeezy]

Well, since I know the IM residents at my program, I can say that we (the surgery residents) work much longer hours than they do, which they freely admit to us. We take an average of Q4 call for around 48 of the 60 months of residency, and we're on the hook for weekend call for all five years. Of course, like everyone else, our new interns can't take call the first year. The medicine residents are only on wards or ICU rotations for 5-6 months of the year. The rest of the time, they're not on call much, and if they are, it's for things that are very unlikely to result in them coming in.

Thanks so much for the response!

Sorry, I meant 10 bands. I've seen a surgeon do 8 (simple band cases literally take at most 10 mins to wrap around and stitch to stomach not counting of course pe-op and post-op work, anesthesia, etc.) and 2 revisions with some complex hernias in a day.

So please excuse my ignorance: What is the difference between q4 call and weekend call? And does call mean actually being physically present at hospital or being close by for an emergency case?

I talked to a new intern and she arrives at 6AM and leaves around 8PM. Also, the 5th year resident seems to have every weekend off but seems to stay late. Since interns you said interns can't take q4 call (bc they don't have license yet?), does that mean they actually work less first year with no call? Is the schedule something like this:

PGY1
Day 1:6AM-8PM
Day 2:6AM-8PM
Day 3:6AM-8PM
Day 4:6AM-8PM
Day 5:6AM-8PM
Day 6:6AM-4PM
Day 7:rest (80 hours in 7 days)
Day 8:6AM-8PM

PGY2-5:
Day 1:6AM-8PM
Day 2:6AM-8PM
Day 3:6AM-overnight
Day 4😳vernight-6PM
Day 5:rest
Day 6:6AM-8PM
Day 7:6AM-8PM (80 hours in 7 days)
Day 8:6AM-overnight

Excuse my ignorance again, but if you could lay it out it would be extremely helpful! Also, broadly, how would it differ in IM? I'm thinking of approaching the surgeon I've been working with to do research, but want to know what I'm getting into!

 

[FreeWeezy]

Also, is at least one or two days off a week where you just rest (no call, etc.) off standard in ether GS or IM?

 

[45408]

So please excuse my ignorance: What is the difference between q4 call and weekend call? And does call mean actually being physically present at hospital or being close by for an emergency case?

You should talk to the upper classmen more at your school, but in brief, Q4 means every 4th night. Residents are now limited to a 28 hour shift, so that's from 6am Monday to 10am Tuesday. Interns can't take call because the ACGME decided so this past year. It's idiotic. Now they're like fifth year med students.

Being on call for something like dermatology means fielding phone calls, coming in for the very rare consult. Being on call for surgery means seeing a fair number of consults and probably doing cases like appendectomies or a Hartmann's procedure.

Weekend call is what we do when we're on elective rotations and we need to be present every week day, so we're on call on Friday or Saturday night only.

does that mean they actually work less first year with no call?

Yep, so we (PGY2+) work more.

PGY2-5:
Day 1:6AM-8PM
Day 2:6AM-8PM
Day 3:6AM-overnight
Day 4: overnight-6PM
Day 5:rest
Day 6:6AM-8PM
Day 7:6AM-8PM (80 hours in 7 days)
Day 8:6AM-overnight

Can't stay that late after being on call, plus your math is off. That's 92 hours in 7 days. You only have to average 80 hours, so you can go over sometimes.

Sometimes I'll be on call Sunday, Wednesday and Saturday, like earlier this month. I hit 100 hours in 7 days - awake, working, in the hospital.

Excuse my ignorance again, but if you could lay it out it would be extremely helpful! Also, broadly, how would it differ in IM? I'm thinking of approaching the surgeon I've been working with to do research, but want to know what I'm getting into!

As an attending? Most of them don't take call. The hospitalists cover all inpatients. As a resident, at least here, it means that they're on call for 5-6 months out of the year, and I'm on Q4 call (including weekends) for 7-12 months out of the year, and I cover 3-4 weekends every month.

Also, is at least one or two days off a week where you just rest (no call, etc.) off standard in ether GS or IM?

On average, you have to have 1 day off per week over 4 weeks. Usually you get one Saturday, one Sunday, one full weekend off and then work one whole weekend. Sometimes, though, you'll get two Saturday calls in a row, which means from July 11th to July 29th with no days off. You do go home post-call after 28 hours though, so Sunday will be like a half-day off once you take a nap.

 

[Mattchiavelli]

Per new ACGME rules, interns can only work max 16 hours at a time w/8 hours minimum off between, and 80hrs/week averaged over 4 weeks with 1 day off for every 6 on also averaged. It's not unheard of for surgery residents to go over hour restrictions and have to underreport their hours (all residencies make you log hours as proof they are ACGME compliant).

Call for genreal surgery means you are definitely in-house, and things you get called for are situations like "Patient's colon just ruptured and needs surgery NOW." IM has its tough spots and some calls and schedules can be a little taxing, but I don't think anyone would say IM residency is tougher than GS residency, unless they are completely and utterly divorced from reality.

In either residency, stuff relating to bariatrics will be a small portion so you will have to decide which residency has non-bariatric stuff that piques your interest more- IM with the CHF, hyperparathyroidism, rheumatoid arthritis, end stage renal disease, etc VS gen surg with the appendectomies, colectomies, cholecystectomies, mastectomies, and hernias of all shapes sizes and locations. Personally, I think IM would give you better clinical experience to do things like help develop exercise regimens that would work based on current meds/diseases, med management, etc. GSurgeons can prescribe medications, but they usually realize that their training did not focus enough on complex medication management, and they refer as appropriate. Similarly, if you are working in a clinic with patients as an internist, nothing is stopping you from referring patients to some bariatric surgeons you trust to eval and intervene if appropriate. In this day and age, you can't do everything, unless you want to do a crappy job at it.

 

[ArcGurren]

OP - everything said here is pretty much true with regards to the differences between medicine and surgery.

There are some surgical subspecialties which have quite a lot of "medicine" in them, such as urology and ophthalmology. They tend to have shorter surgeries and a lot of medical management in between.

 

[inspirationmd]

Where are you so far in school. I would venture to say first or second year, right?

By the time you go through third year and rotate through each internal medicine and surgery rotations, you would have already answered your own question. Surgery and medicine are apple and oranges - 2 VERY different specialties and residencies.

For your goals as generally described, I would imagine that a better route would be to go general surgery + bariatrics fellowship (5+2+possibly research years). Keep in mind that bariatric and weight loss surgery inherently has a lot of clinical follow up involved. Once these surgeons operate on these patients, the patients essentially become theirs for life (they require lots of following up and no one else will usually want to touch them from a surgical standpoint). The medical route for caring for patients with obesity and metabolic disturbances would be to do an endocrine fellowship after a medicine residency. (3+3 years). Though of course, this always leaves you limited because you would never operate on anyone.

There are tremendous differences between medicine and surgery residencies besides only the length of 3 vs 5 years. Intern years may be the only year where there is slight similarity, because most of intern year is bitch work - doing floorwork, writing orders, following patients, making phone calls for XYZ reasons, social work BS, scheduling things, etc. However you are dealing on the one hand with patients who are being treated for medical problems by medicine teams and specialties vs. treating patients who have surgical problems of different types. Year 2 and beyond the divergence takes off. In medicine you get leadership responsibilities and lead teams starting in year 2, as well as lots of clinic, medical ICU and rotate through the specialties. Most of internal medicine is hands off, although you do some procedures on occasion like LP's, central lines, biopsies, etc. especially when rotating through ICU's or doing subspecialties. In certain medicine specialties like GI or cardiology they do LOTS of procedures, but exposure to this as a resident is more limited. Surgery from year 2 onwards is mostly time in the operating room doing surgery, with increasing responsibility as a team leader with each passing year.

WHERE you do your training can make a huge difference too. As a general rule of thumb, you get different personality types in these 2 fields. Stereotypically surgeons are very alpha, goal-driven, aggressive, OCPD and to-the-point. Medicine people stereotypically are nicer, and the field is more cerebral and people talk a lot more. About everything.

Take rounds for instance. On internal medicine, a team may be handling let's say 8-20 patients at a given time. Rounds may be done in a conference room and the team sits there for 3 hours talking about each person, and talking in depth about their medical problems including presenting articles and asking a lot of why questions to get discussion going. Then they may go around seeing each individual patient and making treatment/diagnostic plans for each for another couple of hours. Rounds are the focus of the day, and floorwork (getting things done, like writing orders, admitting patients, etc. ) follows. ROunds alone may take 3-5 hours in some cases and involve lots of blah blah, usually in a friendly environment.

"Rounds" in surgery are seen as a necessary thing that has to get done early and out of the way so the team can go to the operating room and do the cases for the day. It's a necessary evil that has to get done to make plans and follow-up on patients who the team has already operated on or is being consulted on. It is possible to "round" on 20 patients in half an hour on a surgery service. There is no "academic discussion" or blah blah on exploring 10 reasons WHY the potassium could be elevated. The potassium is high? Ok, get and EKG and fix it. Done. Next. Everything is very efficient and goal driven. Surgeons have a reputation for being *******s sometimes. This is sometimes true, but in some cases is a result of the nature of the work. There is simply a ton of work to do and not much wiggle room to waste time. After rounds, generally the intern will go do floorwork and the rest of the team will go operate for X hours on Y number of patients.

Surgery is usually more arduous training and more stressful, independent of the length of training. Surgeons have the reputation of beating on you and demanding perfection to such a level that it causes stress. Medicine is extremely busy in terms of hours too, but supposedly more cordial. Although this varies tremendously on where you train and how malignant the programs are (malignant means a program basically makes your life hell and treats its residents harshly). There are some hospitals where the medicine program is actually more malignant than the surgery program. Stereotypes are also not always true. Not all surgeons are *******s and not all medicine people are bubbly talkative nice people who like to teach. I've met internists who are bigger *******s than the worst surgeons.

Once you go through at least 3rd year it will all make sense and you will find where you fit best.

Hands down one of the best breakdowns of Surgery vs IM lifestyle and mindsets, at least in academia. Read this and take note!