How to incorporate more procedures into IM?

[kellen914]

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Hello SDN, soon to be MS4 here:

I am currently looking to apply to IM. However, I really like procedures (reason I am not doing surgery is because I dislike the bread and butter OR stuff, but I digress)

I have an interest in sub-specializing to boost my procedure possibilities, but I was wondering if it is possible to incorporate more procedures into IM if I were to remain in just general IM. People make it seem like IM docs do virtually no procedures except for the occasional intubation.

Any strategies on how to make IM more procedure oriented without specializing? How to approach residency to gain more procedure experience? or is specializing the only way?

 

[aka_tigerj]

Hello SDN, soon to be MS4 here:

I am currently looking to apply to IM. However, I really like procedures (reason I am not doing surgery is because I dislike the bread and butter OR stuff, but I digress)

I have an interest in sub-specializing to boost my procedure possibilities, but I was wondering if it is possible to incorporate more procedures into IM if I were to remain in just general IM. People make it seem like IM docs do virtually no procedures except for the occasional intubation.

Any strategies on how to make IM more procedure oriented without specializing? How to approach residency to gain more procedure experience? or is specializing the only way?

From what I've seen, it's not that the general hospitalists don't want to do procedures, it's just that they don't have time. If you're working for a hospital, you might have 15-20 minutes to draw up a plan, write your note, etc... usually just consult specialist...

 

[The kitchen sink]

Your best bet is to subspecialize into Cardiology, GI or Pulm/CCM.

 

[gutonc]

If you want procedures during residency, you can get them. Rather than calling pulm to tap that effusion, grab the thoracentesis kit and do it yourself. Same for ascites, LPs, etc. My program designated a supervising attending to staff any and all procedures that the floor residents wanted to do (not sure if this is still in place) so that the work could go on while a procedure was being done.

Want to do outpatient procedures (mostly skin biopsies, anoscopy, GYN stuff and joint aspirations/injections)? Do subspecialty rotations and tell your attendings that's what you want to do. There's a big push to incorporate US into general IM training so if this is something that interests you, find a program that does this, recognizing that your ultimate job site may not actually credential you to do these for billing purposes, in which cas you'll spend the time on the procedure but not actually get to bill it.

If you're talking about post-residency (remember, you're talking about a 3 year training period vs a 30+ year career here) then choose your training accordingly.

If all you want to do as an attending is drop tubes and lines then no, you're not likely to get much of this in a typical outpatient IM job and you should do PCCM.

 

[Bostonredsox]

Go to a community shop with high volume, no opposing residencies and no fellows. I had over 450 procedures as a medicine resident and as a result have had a variety of nocurnist and heavy icu community jobs available to me as an attending. The procedures are there, you just need to actively pursue them and be available to do them at all times. I mean all times. I would come in at 545am on outpt rheumatology to put the swans in the bypass pts to get my numbers.

 

[rd31]

Go to a community shop with high volume, no opposing residencies and no fellows. I had over 450 procedures as a medicine resident and as a result have had a variety of nocurnist and heavy icu community jobs available to me as an attending. The procedures are there, you just need to actively pursue them and be available to do them at all times. I mean all times. I would come in at 545am on outpt rheumatology to put the swans in the bypass pts to get my numbers.

All of a sudden I feel tired.

 

[Bostonredsox]

All of a sudden I feel tired.

If it were easy everyone would do it.

 

[kellen914]

Very helpful all, thanks for the responses and insight.

 

[efex101]

doing procedures during residency can be done, specially at community hospitals (not fellow driven). NOW doing procedures as outpatient IM less and less one huge driving point is the litigious society we live in....