Honestly I've heard this almost 6 or 7 times now on my IM rotation. I'm between IM and 1 or 2 other (more specialized) specialties. A lot of IM residents I've talked to have told me that if there is any other specialty outside of medicine that I can see myself doing, then I should do the other specialty hands-down. I also heard similar things about Gen surgery on my Gen surg rotation, but probably not as strongly. Anyone else heard these kinds of statements?
if there is any field that you can think of doing besides IM, do it
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sounds like you go to a school with horrible residencies. It takes a lot for residents to discourage others from choosing their specialty. There is nothing inherently bad about IM or Gen Surg.
I've heard that as well on IM and other services but still chose IM. Interesting people always seem to say to do radiology or dermatology. Grass is always greener on the other side man. Do what you like best. But be sure to take into account how your life priorities may be different 5 years from now.
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This is what people who hate what they do say.
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Except for the terrible residencies and possible terrible lifestyle.
I always thought I was going into IM until I did my IM rotations. Then I dropped the idea. Watching lab values all day, placing calls for consults and doing rounding, admits and discharges is not for me. Not even for 3 years.
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I heard that an awful lot about Gen Surg (not from my residents, but from SDN), but not in relation to IM. I think IM with its expanded sub-specialty base (as opposed to Gen. Surg, which eliminates ortho/neurosurg as well as in the process of eliminating vascular/plastics/CT from the equation) allows for a lot more opportunities if you get sick of the same old.
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I think that asking residents about their specialty is a little like asking a budding Marine recruit about the Marines in the middle of boot camp: of course they're gonna say it's terrible.
Residency is by and large, terrible. It doesn't matter what you go into. You are the bottom of the totem pole, you get worked harder than a slave, everyone yells at you, your days are long and you taste none of that "prestige" you thought you would come with an M.D.
That being said residency is a small fraction of your career. For IM it's 3 years. Three out of 30 or 40 years that you will practice.
And being a budding IM resident myself let me take the time to give you a completely biased assessment of IM: there's no better specialty in Medicine. The variety of the disease you'll treat is endless...you will never be bored. The subspecialties offered after residency are unparalleled in all of Medicine...no other field gives you so many choices. When you're done with IM residency the career possibilities are myriad: you can work in a hospital, you can open your own practice, you can work for a corporation, you can go work for the Government or an NGO, you can practice in a refugee camp, etc.
And let's face it...Internists are the only real doctors in the hospital 🙂 Everyone else just assists us.
Residency is by and large, terrible. It doesn't matter what you go into. You are the bottom of the totem pole, you get worked harder than a slave, everyone yells at you, your days are long and you taste none of that "prestige" you thought you would come with an M.D.
That being said residency is a small fraction of your career. For IM it's 3 years. Three out of 30 or 40 years that you will practice.
And being a budding IM resident myself let me take the time to give you a completely biased assessment of IM: there's no better specialty in Medicine. The variety of the disease you'll treat is endless...you will never be bored. The subspecialties offered after residency are unparalleled in all of Medicine...no other field gives you so many choices. When you're done with IM residency the career possibilities are myriad: you can work in a hospital, you can open your own practice, you can work for a corporation, you can go work for the Government or an NGO, you can practice in a refugee camp, etc.
And let's face it...Internists are the only real doctors in the hospital 🙂 Everyone else just assists us.
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LOL. Careful. Might make some popcorn in preparation for this back and forth.
but... you're going to be doing those things in lots of fields. Surgeons round, look at lab values, call consults, admit, discharge, clinic, and OR. Granted in general their rounds are shorter but that's usually because there isn't a lot to do on some services outside of SICU. I'd say you can get out of those things in anesthesia, radiology, derm, rad onc, plastic surgery, and path but not necessarily a whole lot else.
Remember though that residency is different than real life on your own. In residency rounds are often for teaching purposes as well as patient care, so they are slow. In private practice you will go a whole lot faster because you know what you want to do and it is you and only you making the decisions.
Finally, I think as a M3 it's hard to appreciate the knowledge behind decisions in any field. I admit I didn't like surgery because I found the OR boring and tedious. Part of that is likely I really didn't understand why things were being done and didn't want to ask for fear of looking stupid. No one truly makes an informed decision about their field. That's why advice on the "best fit" field is usually very general.
A surgeon is an internist who chose to finish training.
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Pick a field you like, know that most residencies will suck when compared to any other job or your post-residency career and get ready to give even more time to your training than ever before. Being a physician is still one of the best professions out there and I'm glad I chose it and will put up with the day to day crap that happens to everyone to be able to complete my training.
IM is a lot of rounding, some basic procedures and paperwork admitting, working up and discharging patients. If you can get 'home call' you can be sitting on your couch watching TV while your laptop is hooked into your EMR to issue verbal orders.
Surgery is EARLY mornings, many hours doing progressively more complex procedures, rounds, then back to the OR for an urgent case that can't wait until the next day. If you're on call, there's a very good chance you'll need to come in to see the patient and possibly take them to the OR and have them under and open for your attending when he comes in to supervise the surgery.
They both involve a lot of scut, patience and daily studying for your cases, your boards and inservice exams, so do what you want to do, first and foremost.
IM is a lot of rounding, some basic procedures and paperwork admitting, working up and discharging patients. If you can get 'home call' you can be sitting on your couch watching TV while your laptop is hooked into your EMR to issue verbal orders.
Surgery is EARLY mornings, many hours doing progressively more complex procedures, rounds, then back to the OR for an urgent case that can't wait until the next day. If you're on call, there's a very good chance you'll need to come in to see the patient and possibly take them to the OR and have them under and open for your attending when he comes in to supervise the surgery.
They both involve a lot of scut, patience and daily studying for your cases, your boards and inservice exams, so do what you want to do, first and foremost.
surgeons are more technicians, good at their set of procedures, rather than real physicians. In general surgeons see a patient pre-op, do the operation, and see them post-op a couple times. That's usually it.
Good example: for GBM patients the neurosurgeon does the biopsy and surgery, monitors for complications, sees the pt in clinic maybe once (most likely it's just the NP who sees the patient...), and he's done unless the oncologist sends the patient back for a revaluation for a new growth. However the oncologist diagnosed the cancer and manages all aspects of that patient's care (chemo, radiation, social issues, etc) for years and years essentially until the patient needs palliative care and dies. Now you tell me who the real physician is and who the technician is?...... exactly.
That is just the nature of the surgical fields.
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That phrase is only to be used in Gen surg. You just have miserable IM residents.
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These days, it seems like every type of doctor is saying the same thing.
I'm NOT interested in any type of surgery OR anything that requires an internal medicine residency.
That rules out a lot of things, actually.
I'm NOT interested in any type of surgery OR anything that requires an internal medicine residency.
That rules out a lot of things, actually.
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ouch! someone call the burn unit
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PRS has inpatients and rounds on them just like any other surgical service. While I was rounding on my patients today, my friend rounded on her Latissimus Flap patient, another one for whom she did a component separation, another in the SICU s/p facial trauma and saw a consult for a decubitus ulcer. Even a purely aesthetic practice will still have patients in house over night who need to be rounded on.
I realize that you're an M-4 and a "victim" of your experience/exposure, but you're way off here. All surgeons I know that have a heavy oncologic practice not only follow those patients for several years, but also often make the diagnosis. Speaking from experience, I can tell you that in most cases I am the one doing the biopsy, making the diagnosis, reviewing treatment options with the patient (including non-surgical ones), ordering additional imaging, lab work, etc in addition to doing the surgery and following them for up to 5 or more years. WE are actually the source of the referrals to medical and radiation oncology in most cases. This is why surgeons doing oncologic procedures are sought after by hospitals and private groups - we drive the referrals, which bring in $$$$ (much more than the surgery). The medical oncologist does not "manage all aspects of that patient's care", and most certainly does not manage adjuvant radiation treatments.
Perhaps that was the case for the NSG practices you saw, but the vast majority of Surgical Oncologists, Colorectal Surgeons, and others who treat cancers follow the above model.
I'm a medical student going into Internal Medicine, but I just wanted to say that I'm pretty disappointed by your characterization of general surgeons. I don't know exactly what your experience has been with general surgery, but for me, to describe surgeons as mere "technicians" is pretty short-sighted, disrespectful and frankly, pointless.
When a patient comes into the ED and surgery is consulted to make a management decision on whether he needs to go to the OR emergently (and what exactly he'll have done when he gets there), I don't see that as surgeons being mere "technicians."
When a patient has unexpected complications in the OR and the case requires quick thinking to figure out what's going on anatomically, physiologically and pathologically to fix it, I don't see that as the job of mere "technicians."
And maybe sometimes it's an "easy" call when a tumor needs to be taken out and sometimes it's "obvious" that it's not surgically resectable -- but when there's a gray zone and it's unclear whether surgery (and if so, exactly what type of surgery) would be the best option for the patient? That's a conversation that a surgeon has with the patient -- certainly not something a mere "technician" does.
Surgery is not the field for me, but I respect the hell out of what they do. I might make a joke or jab at their expense every now and then, but at the end of the day, I know that I (and my patients) will need them (and vice-versa), so to talk about which of us are "real physicians"? Pointless, and often just for the point of stroking your own ego.
I'm going to try and briefly rephrase what I mean by "technician" as it is a term I apply more broadly than perhaps most people. I'm trying to get at the point that often times patients have many issues going on with them beyond the one "medical" or "surgical" issue that brings them to the hospital. For example, a patient may have a COPD exacerbation but also new onset class II CHF symptoms, depression that no one has ever asked them about, poorly controlled DM, etc etc. Now the term "technician" can apply to a physician in any field who just "fixes" that one problem that brought them in and then either completely ignores all the other issues or turfs to "outpatient" management without actually setting up the follow-up or informing the patient about any of these issues. I understand all these issues I mentioned in the example need good outpatient management but what I have seen time and again is essentially just not even addressing other issues therefore resulting someone (usually me as the student) telling the patient there are other issues and they need to see a PCP (I have trouble even convincing the resident to say anything about it because that means they are liable for the info and explaining why they didn't address the issue...). These issues may not necessarily need inpatient work-up but in my opinion they need to be addressed and in my opinion it is not good management to ignore them. The same thing could be happening in a patient with cholecystitis that needs surgery. In my experience, unless there is another purely blatantly obvious issue that affects their ability to operate, the surgeons only care about their one issue and nothing else. This all results in extremely disjointed care.
So I guess in the case of NSG that I mentioned I was merely referring to what I saw as a case of essentially the surgeon taking a peripheral role (outside of the operation of course). I don't know, I obviously don't understand everything that goes in to the complexity of GBM management but to me it seemed the surgeon, in this instance, did a technician like job. I am certain there are cases that are not the same. And I am certain not all fields of surgery are the same. Technician is probably not the word I should have used to describe that scenario because it really doesn't get off the point that I want to make.
I am not trying to say any field is better than another nor that surgeons are not "physicians". Surgery obviously requires a medical school education and it takes many years to learn the operations and be able to perform them safely and effectively. They are physicians who perform a necessary and good service to patients. But in that regard (and this applies to any subspecialist) the surgeon has a medical school education and can take a more comprehensive HPI/ROS, figure out other issues going on, and set up the patient for appropriate care. I would not expect a surgeon to treat a patient's depression. But I would hope the bare minimum would be to sit and talk to the patient for 15 minutes to figure out what is wrong and get that patient good follow-up with the appropriate individual. Again too often (not necessarily just surgery; I see it in EM, subspeciality IM services, etc) I see a total disregard for these things most often in the setting of just completely ignoring it, again unless it affects disposition.
I just think that whole attitude is wrong. Why go to medical school and learn all that stuff. Being a physician is more than just treating a "disease". It is treating a "person" and any person with a medical school education has that capability. In residency you learn your trade but medical school gives you that comprehensive study that is extremely important across all fields.
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Seriously. Not to mention you rarely catch someone when the're having a great day and love their job.
Seriously. Not to mention you rarely catch someone when the're having a great day and love their job.
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Honestly, I wouldn't expect a surgeon/EM doc/IM subspecialist to address someone's depression. 
I can see people ask about it in relation to the current case in hand(i.e. meds they take). But it seems like if a resident was to bring it up to an attending, they might get chewed up for reporting extra information.
I can see people ask about it in relation to the current case in hand(i.e. meds they take). But it seems like if a resident was to bring it up to an attending, they might get chewed up for reporting extra information.
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And then an internist to actually take care of them.
I think the analogy of a technician is appropriate but not just for surgery. Basically anyone in a technical field can become a technician, not just a surgeon. You often see the GI guys or the Cath guys who just do their procedures all day every day become essentially technicians.
Honestly, I wouldn't expect a surgeon/EM doc/IM subspecialist to address someone's depression.
I can see people ask about it in relation to the current case in hand(i.e. meds they take). But it seems like if a resident was to bring it up to an attending, they might get chewed up for reporting extra information.
I once brought depression up to a specialist attending (a very temperamental guy who makes life super stressful for everyone working with him) and he didn't give me any slack at all. Patient was young, in and out of the ICU and with a bad disease who looked teary and sad with a flat affect. Hell I didn't even talk to the patient... just listened to her story, went in and listened to the attending talk to her and afterwards asked him if she was seeing anyone for depression. Lo and behold she wasn't and we got her a good psych consult. Now that entire encounter convo with the attending took less than 2 minutes and was part of our normal day. It's not freaking rocket science. We didn't sit with her for 30 minutes or start SSRIs. But we did the right thing.
A senior cardiologist told me once that the best fellow he ever worked with was not the smartest or most knowledgable guy. What separated this fellow out in his mind as a physician he would take his family to was that the fellow was very dedicated with great compassion, caring about all aspects of his patients. He gave the example of the fellow staying late on a weekend in the CCU and disimpacting a patient because the nurses are beyond slow and only because the patient was in pain (otherwise stable medically). A cardiology fellow does not go around disimpacting patients...
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I've heard this statement from every single specialty I've rotated through. Ignore it and choose a specialty that interests you and where you think you'll fit in.
I had an OB/Gyn attending who had been practicing for 20 years tell me that it was the worst specialty in the world. I had a medicine attending fresh out of residency tell me that he was in the worst specialty and that I should go into radiology. I've had anesthesia and radiology attendings tell me how their specialty is the worst and that it's a miserable life. I've had surgical attendings tell me that they never get time to see their children or their spouses and that they regret ever choosing their career.
In every case, the vast majority of the other residents and attendings told me without reservation that they loved their jobs and that they had absolutely no regrets choosing their careers. To some people, the grass is always greener on the other side. I'm a freshly matched M4 going into IM and even I've occasionally wondered whether I made the absolute right choice (and usually end up reassured).
tl;dr choose a specialty that's right for you and not based on the feelings of miserable residents or attendings who feel it necessary to announce it to the world.
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I also have heard this from surgery residents than IM, but I can imagine residents feeling that way if they are at a malignant or workhorse program.
Personally, the person you need to value the opinion of more strongly is your attendings. Of course residents who are exhausted from working 80 hour weeks and 14 straight days are going to be a bit burnt out, but residencies are much shorter than the amount of time you will actually practice.
Personally, the person you need to value the opinion of more strongly is your attendings. Of course residents who are exhausted from working 80 hour weeks and 14 straight days are going to be a bit burnt out, but residencies are much shorter than the amount of time you will actually practice.
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