I am so f'ing depressed about choosing IM.

[Doctor_Strange]

I just feel so sad and disappointed at being an IM intern. I have zero passion over the medicine I am practicing. I wish I went into a specialty that was more procedural to be honest, something like anesthesiology or even frankly Radiology. I already have sunk one year into this and will likely waste another year if I decide to reapply and at that point might as well finish residency...oh well...time go write another long ass note that is meant only for billing...

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[deleted367183]

I feel your pain. People who don’t hate residency worry me.

 

[anonperson]

I just feel so sad and disappointed at being an IM intern. I have zero passion over the medicine I am practicing. I wish I went into a specialty that was more procedural to be honest, something like anesthesiology or even frankly Radiology. I already have sunk one year into this and will likely waste another year if I decide to reapply and at that point might as well finish residency...oh well...time go write another long ass note that is meant only for billing...

Do a fellowship in Cardiology, GI, or Pulm/CCM. You will get all the procedures you want.

Other than IR which is a fairly small subset, how is general radiology procedural? You're just generating a report into a microphone.

 

[guytakingboards]

Do a fellowship in Cardiology, GI, or Pulm/CCM. You will get all the procedures you want.

Other than IR which is a fairly small subset, how is general radiology procedural? You're just generating a report into a microphone.

Radiologist here. That depends on how IR and General radiology are defined.

Some people refer to IR as this blackhole of where all radiology procedures get done, and whoever is the person doing said procedure is an interventional radiologist. I, as a radiologist, define an IR as an interventional radiology fellowship trained rad. Those are two very different things.

Generally every single radiology sub-specialty has their own specific procedures:
Neuroradiology: lumbar punctures, disc biopsy/aspiration, epidural blood patch/steroid injection.
MSK: large and small joint injection/aspiration (using fluoro/CT/ultrasound), extremity soft tissue biopsy/ablation, calcific tendonitis barbotage, etc
Body: organ biopsy using US/CT, paracentesis/thoracentesis.
Chest: debatably not different than body, but they could theoretically be doing all lung biopsies.
Mammo: stereotactic and US guided breast/lymph node biopsies

IR: venous access, arterial access, interventinal oncology, trauma embo's, PAD, stroke (though that could be considered neurointerventional), etc.... IR is also the dumping ground for all the tougher stuff that the above mentioned rads can't do.

That's not even inclusive of what I consider a procedural skillset in GI/GU fluoro.

In a general practice, where its a single rad on-site at a hospital or clinic, it'd be common to do the lower end stuff of all those categories. E.g. a typical general radiology day might include a few fluoro cases, a shoulder injection, a thyroid biopsy, a lumbar puncture, a mammo biopsy and/or (somewhat uncommonly given skill set) putting in a port or tunneled central catheter. None of that really needs a fellowship trained interventional radiologist.

The overwhelming number of lumbar punctures in community practice are done by a non-neuroradiology/non-interventional trained rad. I.e. a general rad.

(though i'm always somewhat amused/annoyed when the chart refers to the work i've done as 'IR did [XYZ] procedure'. No, I did it and i'm a neurorad)

 

[guytakingboards]

I just feel so sad and disappointed at being an IM intern. I have zero passion over the medicine I am practicing. I wish I went into a specialty that was more procedural to be honest, something like anesthesiology or even frankly Radiology. I already have sunk one year into this and will likely waste another year if I decide to reapply and at that point might as well finish residency...oh well...time go write another long ass note that is meant only for billing...

I said this in another thread to a similarly disgruntled surgery intern, but what you are feeling is normal and totally reasonable. Intern year is not meant to be fun or emotionally fulfilling. You are the scut monkey, with little input into anything. It's crap medicine; another way of looking at it is that it's a role we generally hire poorly trained/educated midlevels to fill.

That being said, it's there to set you up to be the [upper level] resident on service next year. Or to go do radiology or anesthesiology or whatever you desire.

Point being, don't look at it as representative of the kind of medicine you'll be practicing in 10 years. It's likely organic chemistry: you grit your teeth, finish the year and move the heck on.

 

[thumbz]

Ugh sadly it's going to get worse before it gets better my friend. Good luck!

 

[hallowmann]

I feel your pain. People who don’t hate residency worry me.

This. The longer you're in it the less tolerable the whole thing becomes. I like what I do (the actual medicine and treating patients part), but medical training is a pit. The inefficiencies and lies/hypocrisy of admin are laid bare, and all the f's are gone... there's just none left.

OP, this is the hardest time of year as an intern. It really is. Pretty much now through Feb sucks. You start to feel more confident and are trusted to do more on your own though, which feels good and carries you to next year.

It'll be alright. There are plenty of fellowships you can do after IM if you really hate it. Some of them are procedure heavy, some of specialty clinic heavy, some are competitive, but others not so much. There's a lot of versatility in it. You'll find something you like better than this.

 

[Doctor_Strange]

I chose IM strictly to pursue Cardiology. I like clinic. I like the cath lab. I don't mind a busy life as an attending. But jesus that dream may be far gone if I cannot start enjoying the medicine at least somewhat. I hate feeling like a typist all day and night.....

 

[j4pac]

If your stats are OK...you can try PM&R

 

[Drrrrrr. Celty]

This. The longer you're in it the less tolerable the whole thing becomes. I like what I do (the actual medicine and treating patients part), but medical training is a pit. The inefficiencies and lies/hypocrisy of admin are laid bare, and all the f's are gone... there's just none left.

OP, this is the hardest time of year as an intern. It really is. Pretty much now through Feb sucks. You start to feel more confident and are trusted to do more on your own though, which feels good and carries you to next year.

It'll be alright. There are plenty of fellowships you can do after IM if you really hate it. Some of them are procedure heavy, some of specialty clinic heavy, some are competitive, but others not so much. There's a lot of versatility in it. You'll find something you like better than this.

Honestly, this is the truth. I'm nearing the end and I've noticed that I and most of my cohort are genuinely just waiting for this tribulation to end. I don't even think I'm working that much anymore comparatively to last year or intern year where I was working on the clock far far more.

That being said I think you can find a lot of joy in medicine. I certainly feel like this year I've grown more passionate about what I actually enjoy because I'm getting closer to being in fellowship.

 

[Drrrrrr. Celty]

I just feel so sad and disappointed at being an IM intern. I have zero passion over the medicine I am practicing. I wish I went into a specialty that was more procedural to be honest, something like anesthesiology or even frankly Radiology. I already have sunk one year into this and will likely waste another year if I decide to reapply and at that point might as well finish residency...oh well...time go write another long ass note that is meant only for billing...

Feel free to message me and talk.

This is not an easy path. It's one where you need to quickly determine that you have to make your career and education work for you, not make yourself work for your education.

 

[Arch Guillotti]

Generally every single radiology sub-specialty has their own specific procedures:
Neuroradiology: lumbar punctures, disc biopsy/aspiration, epidural blood patch/steroid injection.

Anesthesiologist here. Who are you doing blood patches on?

 

[guytakingboards]

Anesthesiologist here. Who are you doing blood patches on?

In my group, neuroradiology is generally only doing blood patches on post-dural puncture headache patients which we did the LP/myelo on. It's not super common on either the OP or IP side (we use 22g's or smaller for LPs).

At the hospitals, anesthesiologists get all other blood patch referrals from ER/neurology/IM/etc.

We diagnostic neurorads rarely do non-target blood patches for intracranial hypotension. My interventional neurorad partners will do targeted blood patches for CSF leaks.

 

[Redpancreas]

I just feel so sad and disappointed at being an IM intern. I have zero passion over the medicine I am practicing. I wish I went into a specialty that was more procedural to be honest, something like anesthesiology or even frankly Radiology. I already have sunk one year into this and will likely waste another year if I decide to reapply and at that point might as well finish residency...oh well...time go write another long ass note that is meant only for billing...

I agree that IM residency is a lot of coordination moreso than intellectual work with reliance on specialties and that the service is a dumping ground because other specialties probably deep down feel that that's what you're there for even if they don't voice it that way. We then displace our frustration on our ER colleagues to block admissions. Just try to stay humble. Focus on the basics with the history, exam, and asssessment/plan. 90% of the time, the patient will tell you the diagnosis. It's your job to hear it. With the exam, don't skip it and realize that attention to detail will ultimately be rewarded. With the assessment/plan, the biggest frustration with many who choose IM is that they want there to be a logical answer. They want things to fit a mechanism or pattern they learnt like Macrocytic Anemia -> B12 deficiency -> IF -> Pernicious Anemia. Instead, the name of the game when ordering tests/imaging is to rule out what you don't want to miss and rule in what's most likely.

If your future is fellowship, understand the issues don't end there. There will be subspecialists above you and unique problems to being a specialist. If your future is within IM, your experience will grow and you will eventually carve a niche while being able to turf a lot of the liability to consultants.

 

[Giovanotto]

I just feel so sad and disappointed at being an IM intern. I have zero passion over the medicine I am practicing. I wish I went into a specialty that was more procedural to be honest, something like anesthesiology or even frankly Radiology. I already have sunk one year into this and will likely waste another year if I decide to reapply and at that point might as well finish residency...oh well...time go write another long ass note that is meant only for billing...

I think I still have minor PTSD from medicine prelim year (during covid). I honestly think I would of dropped out or switched specialty if I was forced to do another year. It was soul crushing. I also think that its affected my decision for fellowship and beyond. I'm forgoing a fellowship and thinking about finding locum gigs or just very low hour work. I know this is cliché to say, but damn our youth years are flying by us....

 

[Drrrrrr. Celty]

I think I still have minor PTSD from medicine prelim year (during covid). I honestly think I would of dropped out or switched specialty if I was forced to do another year. It was soul crushing. I also think that its affected my decision for fellowship and beyond. I'm forgoing a fellowship and thinking about finding locum gigs or just very low hour work. I know this is cliché to say, but damn our youth years are flying by us....

Idk, after intern year it's kind of a lot more chill. Where as I feel like for a lot of other specialties like EM or Surgery the pain is just beginning.

 

[NITRAS]

I feel like IM treats you like an adult way before manny other specialities. You should be largely independent within a few months of being a PGY2.

Also, people document way too much in residency.

 

[bingbongbink]

I feel your pain. People who don’t hate residency worry me.

Facts

 

[bingbongbink]

I feel like IM treats you like an adult way before manny other specialities. You should be largely independent within a few months of being a PGY2.

Also, people document way too much in residency.

That is EXTREMELY program dependent. Some do, some do not.

 

[j4pac]

How does PM&R view people who have completed a diff residency? Positively? Neutral? Negatively?

I have been around the field my whole life due to disabled family members but that’s as much “linking” to the field I have. I know it’s a field that really values dedication above all else..

Depends on the person. If you come off malcontent, then having another residency won’t help you. If you come off as someone passionate about our specialty that just learned about us too late, and after learning, you made the appropriate steps to show interest and get competitive…I suppose it could help you. There is a surprising amount of IM in certain PM&R programs. The IM cases in my PM&R residency was honestly as challenging as my internship. Bring strong at IM is a good thing.