How bad is residency?

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truly9

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I have been reading online at the American College of Physicians site about how internal medicine is losing its ability to attract students, how burnout is high, so the residency is very grueling...

As a third year med student considering IM, what should I know about the difficulty of IM residency? Everyone always says that it is very taxing. Is this true across the board, or are there good programs that are also more tolerable?

Do you love IM? Or do you wish you had chosen something else?
Do most people use it as a springboard for subspecialties?

Thanks.
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Its a thorny, bloodied springboard, littered with the bodies of those who fell by the wayside.....and opted for anaesthesiology and radiology....
 
Hi

Certainly IM is not easy, particularly for those who are going to a subspecialty. In this case, everything else seems painfull: primary care, etc.

Initially you are hit with an enormous amount of info that you need to master as fast as you can, to perform well during call. But once your initial 2-3 months are done with, you get a lot better at it.

My internship was very painfull during the initial 6 months. Lots of call, little to no sleep, and having to suddenly know everything about a bunch of patients. But you get used to it and the learning curve is very steep.

So internship is difficult for most people. I think surgery is even worse (or was). I say this b/c the hours now are about the same given the work-hours restrictions. But when I started the surgical residents worked a lot more, like 120h/w.

I really like IM, but I am going into Hematology/Oncology. I think I couldn't do primary care forever. I want to focus on specific problems.

good luck
 
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.................why so?
 
Medicine sucks the big "A".

1) You are the draincatcher for the hospital. If any service doesn't want a patient, guess where they end up? Yeah! "Every patient has a medical problem, so it'd be pretty silly for them to get rejected from Medicine", as one (bleep bleep) attending once told me. A woman comes in with a hip fx and Ortho wants to be a consult service? Hellooooo, Medicine! I do believe she has a one-year history of well-controlled outpatient-managed diabetes!

2) You have no power. Doctors talk all big about being all warm and cozy with each other, but they actually hate each others' guts. Don't believe me? Try to follow the political goings-on in a hospital some day - it's like 'Days of Our Lives', but a lot more homely. IM is the bottom of the totem pole because they make NO money (and sometimes lose a lot) due to all of their indigent, homeless patients. Score! And don't forget the huge Medicare reimbursements you get for preventative care or primary care. I think it's like two cents for an office visit. (Note: FP may be lower on the pole, but they're usually in their own unopposed hospitals.) This is part of the reason IM has to "take it" from any other specialty (like the ED, those bastards).

3) You have no prestige. There are "sexy" specialties and then there is IM. And don't act like you don't know what I mean. This is the public perception of your specialty. Cardiology: sexin' it up 24/7. Endocrinology: lookin' like a 50-year-old hooker in the Bronx. ED (yes, I have to admit this even though I hate them - but it's only because of that farce of a show 'ER'): fairly sexy. Rheumatology: the homelier cousin of Endo. You want to see a blank look? Tell a person on the street that you are an "internist". What? What the hell is that? You have even less name recognition than an FP.

4) You have no money. You get paid so much that you're right up there with Pediatrics and Psychiatry. Oh yeah! I can't spend money that fast! Slow down with the paychecks! For comparison, pool together money with 4 other internists and feel what it's like to be a general surgeon. Or throw a party for 20 of your closest internist friends and you'll be approaching a Dermatologist. Yeah, I know - we're all in this for the betterment of humanity. Riiiiight. Anyways, "daddy still gots ta gets paid!"

5) Your patients rock. Another back pain looking for workman's comp? Bring it on, baby! The woman in room 4 is a noncompliant diabetic in DKA for the third time in a month? Awww, yeah! You love it. The patient who won't show up for an appointment for the past six months calls you at home demanding disability (happened to me!)? Hang on, I'm too busy loving life! And don't bother with all the zebras, you go-getters. Ain't nobody comin' in with back pain who really has Pott's disease. And you're not even doing mental masturbation right when your differential always includes "neoplasm, AIDS/HIV, miscellaneous rheumatic conditions, and idiopathic (this is the only one I ever get)".

You disagree with me? OK, then how many of you are staying general internists? And now, how many of YOU are general internists because you wanted to be one, not because you couldn't get into Cardiology or GI?
 
The above post is funny, but not very accurate.
IM is a good field, and apart from being extremely cerebral, you get a lot of satisfaction doing what you do.
I'm applying for pulm/critical, but would definietely work as a hospitalist, or PCC.
I have friends going into it, and they are working in small towns, making upwards of 175K.

Even a VA Internal Medicine docor makes 100K, and the figures posted above are wrong
 
Funny stuff !
 
The exodus from IM is real - at least for the time being. I am concerned this will, more than anything else, impact the level of "public health" going forward. My personal feeling is that the greatest single driver of medical students choosing not to do IM long-term (ie., choosing a fellowship afterwards) is the rising cost of medical school tuition. If medical schools are serious about IM and primary care, they need to get it under control.

Judd
 
Above post by kinetic is absolutely money. Those ortho bastards wanted to place a lady who had come to the ED with a hip fx onto our medicine service. My medicine attending bitched ortho out, and the pt went on their service. However, we(medicine) still have to come every AM to consult for the pt's diabetes and HTN. The ortho guy says, " I don't know how to manage diabetes and HTM. I don't even know what drugs to give." Amazing...
 
Residency is slavery. Period. It's dangerous, and it should be outlawed.

Nurses crap on you thinking that they can do what you do, and resent taking orders from you. They somehow think you're getting paid big bucks NOW as a resident, and they have no concept of what it's like to actually stay overnight at a hospital.

Hospitals expect you to give away the best years of your youth to them without scarcely a complaint.

Primary care gets all the pain and suffering and none of the respect and even less of the pay.

Run, run, run if you can while there's still time.
 
Kinetic! Bravo, that post was ON POINT. Its very sad, but Internal Medicine is going to the ****ter. These people are on the front lines, and all the best students are running away as fast as they can! And with good reason. I actually had an interest in medicine before my third year started and 1 week into my medicine rotation, I knew I would never put myself thru the crap that is internal medicine. You are a glorified social worker, get no respect. The residents were as unhappy as the families visiting their dying parents. Im going to a lifestyle specialty like most sane people!
 
bravo for kinetic!! your comments are right-on-target!
 
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Sure, I get back-pats here in SDN, but I made those observations during residency and got my butt landed on the streets. Heh heh. Guess I need a little lesson in "tact".

(The attendings really don't like it when you give them observation #5, by the way.)
 
Al Pacino said:
Above post by kinetic is absolutely money. Those ortho bastards wanted to place a lady who had come to the ED with a hip fx onto our medicine service. My medicine attending bitched ortho out, and the pt went on their service. However, we(medicine) still have to come every AM to consult for the pt's diabetes and HTN. The ortho guy says, " I don't know how to manage diabetes and HTM. I don't even know what drugs to give." Amazing...
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HaHaHa....I love ortho. If I had to do it over again. I would put this quote in my personal statement for orthopaedics.
 
My favorite quote from an ortho resident to the nurse:

"The patient is having chest pain? Oh, I guess we better call cardiology 'cuz the heart is not my organ...."

Nuff said.
 
I'd shoot myself if I had to do medicine for more than one year. Chronic illness sucks.
 
My favorite word to describe IM - Gomerology
 
gioia said:
What is Gomerology?
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correct me someone if i'm wrong --

Gomerology - study and tx of gomers

G.o.m.e.r - (as is "get out of my emergency room") refers to difficult/ungrateful/frequent patients. I think the term's been around forever but was made popular by or one of those doctor books that describe the hell of residency (house of god, intern blues, etc. can't remember which one)
 
Ahhh... thank you for the clarification!
 
St. James said:
correct me someone if i'm wrong --

Gomerology - study and tx of gomers

G.o.m.e.r - (as is "get out of my emergency room") refers to difficult/ungrateful/frequent patients. I think the term's been around forever but was made popular by or one of those doctor books that describe the hell of residency (house of god, intern blues, etc. can't remember which one)
Click to expand...

i want narcotics so i'm gonna make up some bull$hit condition that puts me in immense [fake] pain.

you mean i actually have to manage my diabetes or else i'll lose my foot? your the doc, you take care of it.

ungrateful a$$holes.

wow sir, after spending five seconds with you i understand why you got shot. it's only a shame they can't aim for $hit.
 
:laugh: LOL

for more examples check out the 'things i learn from my pts' thread in the ER forum. hilarious stuff to read but hellacrappy to encounter.
 
Kinetic hit it on the head. I'm a soon-to-be third year medicine resident who is headed for anesthesiology.

Run while you still can!
 
Is IM really that bad? Or is the $ compensation just not commiserate with the amount of work involved?
 
There is alot of interesting stuff to learn, but the day to day practice sucks. Too much social work. Too much paper work. Not enough pay. And being everyones bitch sucks too.
 
juddson said:
The exodus from IM is real - at least for the time being. I am concerned this will, more than anything else, impact the level of "public health" going forward. My personal feeling is that the greatest single driver of medical students choosing not to do IM long-term (ie., choosing a fellowship afterwards) is the rising cost of medical school tuition. If medical schools are serious about IM and primary care, they need to get it under control.

Judd
Click to expand...


The most those people against IM said they'd go into PC or IM at their medical school interviews.
 
NE_Cornhusker1 said:
i want narcotics so i'm gonna make up some bull$hit condition that puts me in immense [fake] pain.

you mean i actually have to manage my diabetes or else i'll lose my foot? your the doc, you take care of it.

ungrateful a$$holes.

wow sir, after spending five seconds with you i understand why you got shot. it's only a shame they can't aim for $hit.
Click to expand...

You know your clinic will be fun when you see "fibromyalgia" or "low back pain" on the list. Fibromyalgia people are great to examine. If you cough the wrong way, they scream in pain and writhe on the ground, clutching their bodies and moaning for a good ten minutes.

I wouldn't mind IM if not for the fact that you can't just tell people the truth. NO! Heaven forfend!! You can't just say, "your fibromyalgia occurs because your life sucks ass and your tiny pin-head has created a pain syndrome, which causes you to annoy the hell out of me for the rest of your natural life. Which is actually pretty amazing, because I would have never guessed that your miniscule brain had enough power to do that, seeing as you're on welfare and disability." You have to side-step it like so: "This is a very difficult clinical condition to manage ...you know, studies have shown that, actually, anti-depressants can help diminish the pain very effectively ..."


Side-note: There's actually a book in the "Dummies" series called "Fibromyalgia for Dummies". I laughed for a few minutes when I saw that in the local bookstore. So true.


Or when some guy comes in with pancreatitis AGAIN because of their heavy drinking. And the LAST TIME you discharged them you told them that continued heavy drinking would cause MORE pancreatitis. These jack-offs have experienced it so much that THEY know how to treat it. But you can't slap them across their open-mouthed, halitosis-emitting, stubble-covered, toothless faces. Oh, no! Just treat them and discharge them and expect them to be back in a few months. Yeah!
 
kinetic said:
You know You can't just say, "your fibromyalgia occurs because your life sucks ass and your tiny pin-head has created a pain syndrome, which causes you to annoy the hell out of me for the rest of your natural life. Which is actually pretty amazing, because I would have never guessed that your miniscule brain had enough power to do that, seeing as you're on welfare and disability."

These jack-offs have experienced [pancreatitis] so much that THEY know how to treat it. But you can't slap them across their open-mouthed, halitosis-emitting, stubble-covered, toothless faces. Oh, no! Just treat them and discharge them and expect them to be back in a few months. Yeah!
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Kinetic, you should just go into research. That way you won't have to deal with people. I guess you didn't get into medicine to help people. (Its the patient's fault that they are sick)
God forbid, seeing you on a psych posting!!!
If you do, one day, go into research, then maybe you should research fibromyalgia and learn a little about it before going nutso about it.

"In 1987, the American Medical Association (AMA) acknowledged fibromyalgia as a true illness and a potential cause of disability. Fibromyalgia is accepted as a legitimate clinical entity by many well-respected organizations, such as the AMA, National Institutes of Health (NIH), and the World Health Organization (WHO) "
http://www.emedicine.com/pmr/topic47.htm
 
Yeah, Mustafa! You are soooo right. Everyone who is disgusted at patients who are non-compliant or who are frequent fliers should go into research. It's clear these people don't care about people. I agree. Not like you. I'm sorry I haven't swallowed the lame "don't judge -- NEVER judge (unless you're judging someone who's judging, then it's OK to judge them)" line that they feed you in medical school.

P.S. Psych classifies everything as a disease. Everything is an axis in DSM. I also don't agree that alcoholism is a disease. *gasp* I guess I better go into research.
 
Am I right in assuming that most of these IM stories are related from a hospital setting and not private practice?

As I understood it, I thought where you set up practice following residency/fellowship is just as important as what your specialty is. Wouldn't derm., in a po-dunk town of 20,000 regularly tick infested people be dif. than a glamorous practice in Beverly Hills? Wouldn't the same principle apply to IM?
 
gioia said:
Am I right in assuming that most of these IM stories are related from a hospital setting and not private practice?
Click to expand...

Yes.

gioia said:
Wouldn't derm., in a po-dunk town of 20,000 regularly tick infested people be dif. than a glamorous practice in Beverly Hills?
Click to expand...

No. You're still prescribing either eucerin cream or topical steroids. (P.S. People with tick-borne illnesses present to IM or FP, not to Dermatologists.)
 
Take a lot of the comments posted on this thread with a grain of salt -- most people here who posted really negative comments about IM are actually going into other specialties (like anesthesia, radiology, etc).

Keep in mind that every specialty has their own population of painful patients, but everyone's different as to which painful patient group they'd rather deal with. In IM, the biggest painful group are the Gomers, however they are just a minority of the patients we treat. Plus, some people actually do have something to contribute to the care of this specific patient population, especially in the realm of end-of-life care.

IM can be a very rewarding specialty. You treat a very wide variety of patient disease, and have the ability to effectively treat very complicated patients, as well as being the primary advocate for the patient. It is also one of the few specialties out there where you can develop long-term relationships with your patients, which is rewarding in itself.

As far as concerns for patients with "fake" diseases or complaints, this is not seen as much in the clinic setting as it is in, say, the ER. In my clinic for example, I only have 2 or 3 patients who are drug-seeking, and they've pretty much stopped coming to me because I won't give them what they want. They go to various ER's instead, because they have a much better chance of getting a shot of narcotics there than they do with me or another PMD.

Bottom line is that there are a lot of rewarding aspects to IM, but you just have to be willing to put up with the periodic BS. That said, I myself am not going to go into general IM -- I'm planning on subspecializing. But I have a lot of respect for people who choose to do general IM.
 
kinetic said:
(P.S. People with tick-borne illnesses present to IM or FP, not to Dermatologists.)
Click to expand...

You're right, Kinetic. :)

I was using a dramatic description of the unglamorous and less profitable scabby kind of issues that present themselves to derms in regions where Botox might be misunderstood as something you wear to a funeral and where Phototherapy is what you get at a wedding.
 
LOL, this may just be me, but something tells me Derm people don't work in "underserved" areas. Those schmoes work in large urban and suburban areas. Not enough $$$ in other places for their tastes. :rolleyes:
 
Heaven help me, I hope real life isn't as bad as residency! Although all the IM docs in private practice who still do hospital rounds say it is. At least they don't have nurses demanding central lines because three nurses have stuck the patient 5 times and haven't been able to get a line, only to discover two hours later that the patient has a hepwelled picc line! :mad: :mad: :mad:

As for me not caring about patients, why else would I stay until 8-9 pm when I am technically off at 5? Why else would I spend an hour talking to an upset, belligerent family? Why do I spend time trying to convince patients trying to leave ama to stay? I'd like to tell you to F off, but that kind of language isn't permitted on SDN. :smuggrin:

Kinetic has IM pegged.
 
I've been thinking of going into FP or IM, with more leaning towards FP - and these posts seem to be saying that FP is the right track. Before I go to the FP forum, what experience do you have with FP that you can compare with IM? The good, the bad and the ugly.
 
BACMEDIC said:
I've been thinking of going into FP or IM, with more leaning towards FP - and these posts seem to be saying that FP is the right track. Before I go to the FP forum, what experience do you have with FP that you can compare with IM? The good, the bad and the ugly.
Click to expand...


If you want to do primary care, see kids, pregnant woman and do adult medicine as well, FP is good. I'd avoid IM for primary care, unless you see yourself in academics. If you have any inkling that you would like to specialize, or gain advanced training and be able to actually use it (an increasing problem for FP folks), then consider IM. If you like kids and adults and you may want subspecialty training, then consider Med-Peds. Which ever you choose, with some good financial planning, you will make a comfortable living...although maybe not the half mil cardiologists and GI folks in the private sector are bilking the nation and their patients for.
 
AJM said:
Take a lot of the comments posted on this thread with a grain of salt -- most people here who posted really negative comments about IM are actually going into other specialties (like anesthesia, radiology, etc).

Keep in mind that every specialty has their own population of painful patients, but everyone's different as to which painful patient group they'd rather deal with. In IM, the biggest painful group are the Gomers, however they are just a minority of the patients we treat. Plus, some people actually do have something to contribute to the care of this specific patient population, especially in the realm of end-of-life care.

IM can be a very rewarding specialty. You treat a very wide variety of patient disease, and have the ability to effectively treat very complicated patients, as well as being the primary advocate for the patient. It is also one of the few specialties out there where you can develop long-term relationships with your patients, which is rewarding in itself.

As far as concerns for patients with "fake" diseases or complaints, this is not seen as much in the clinic setting as it is in, say, the ER. In my clinic for example, I only have 2 or 3 patients who are drug-seeking, and they've pretty much stopped coming to me because I won't give them what they want. They go to various ER's instead, because they have a much better chance of getting a shot of narcotics there than they do with me or another PMD.

Bottom line is that there are a lot of rewarding aspects to IM, but you just have to be willing to put up with the periodic BS. That said, I myself am not going to go into general IM -- I'm planning on subspecializing. But I have a lot of respect for people who choose to do general IM.
Click to expand...

Very well spoken!!!
 
A few weeks ago I talked to one of my classmates Dad, who is a gastroenterologist. He was telling me that during my 4th year I should do a rotation with him to get a real look at what internal medicine is like. He said he absolutely loves internal medicine and out in private practice it's much different than what you experience in medical school and residency.
 
It?s amazing the way money can dictate how people think. Add 100k to the internists?salary and all this conversation would be totally different. IM would all of a sudden be glamourous, interesting, and yes, very sexy. Perhaps even more so than Dermatology (the science behind pimple management).
 
Discobolus said:
A few weeks ago I talked to one of my classmates Dad, who is a gastroenterologist. He was telling me that during my 4th year I should do a rotation with him to get a real look at what internal medicine is like. He said he absolutely loves internal medicine and out in private practice it's much different than what you experience in medical school and residency.
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No, he doesn't love internal medicine. He loves gastroenterology. If he loved internal medicine so much, he wouldn't have sub-specialized. Now, all he has to deal with are people with GI complaints. And, as a private practitioner, he probably spends most of the day just doing procedures (colonoscopies), which are lucrative. Yes, he has to deal with IBD and IBS patients, who literally are a pain in the ass, but he can choose not to take those patients on should he want. And it is quite unlikely he deals with any indigent patients in private practice. Like I said in my original post: if you love internal medicine so much -- dealing with fibromyalgia, back pain, AIDS/HIV, TB, patients who come in with one-day non-productive coughs who demand antibiotics, etc. -- then stay a generalist. The only people who remain generalists these days are people who were unable to get into a subspecialty.
 
I would be interested in hearing from more categorical IM residents (we all know prelims don't really want to be doing medicine anyway, and we are all less than happy when we aren't doing what we love/want to do)......

Thanks for info AJM..... !
 
kinetic said:
P.S. Psych classifies everything as a disease. Everything is an axis in DSM. I also don't agree that alcoholism is a disease. *gasp* I guess I better go into research.
Click to expand...

Kinetic-

I have followed your posts for sometime, and I am proud to admit that I actually agree with you this time. I think they classified FM as a disease is because you can't bill medi-scare if you don't have a diagnosis.

On a similar note- impotence was ignored until they came up with $10 pills for "Erectile Dysfunction.
 
Theoreticaly: IM is one of the most interesting feilds in medicine.

Practicaly: IM is "Nursing home medicine".

If you can tolerate the smell of feces, and can say DM, HTN, CHF, Metastatic Ca, PEG, decubitus ulcer many times without getting bored, then IM is for you.

However, the same also applies for General Surgery.

Practicaly, General Surgery is "Nursing home surgery". :rolleyes:
 
Hey Leuko,

In a sense, won't every specialty be riddled w/ aging folk in the next 10 years?
 
I just want to say for the record that impotence has never been ignored, especially by patients. I worked in private practice offices for years before going to medical school, and if a patient called with an "emergency" that he couldn't discuss with the receptionist it was either erectile dysfunction or fear of having contracted an STD. It just wasn't popular (or worthy of television commercials) in the pre-Viagra days to discuss surgically implanted penile inflation devices.
 
By the way, I plan to be an internist in a small podunk town with a lot of geriatric patients and limited resources.
 
Thank god I went into rads. Most of IM will be foriegn grads from India and such in the future.

I actually helped out the IM folks as much as I can when I used to take call, mainly because their job was a pile of ****.

I figure most do it these days to go into a subspecialty.
 
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