I'm Not Enjoying my Internal Medicine Rotation

[FIREitUP]

I can appreciate that a good foundation in medicine is necessary, and I respect the field very much, but I honestly cannot stand IM. I find internal medicine to be very tedious, frustrating, and inefficient. I don't enjoy taking H & P's or writing notes and in many instances internal medicine seems futile. A large number of patients I've seen I can't say really have had a definitive improvement after being in the hospital. I see a lot of sick people leave chronically sick and suffering. The lack of a solution annoys me.

Is it normal to feel this way? I'm a pretty no nonsense person who likes to get things done with a definitive answer, so probably something surgical is more right for me. But I can't help but feeling scared that I'll hate all of my rotations (medicine is my first) and I'll be left doing something I hate for the rest of my life.

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[somekindof]

Just power through it and see how you like surgery, or any of the other specialties. I'm on IM right now too and I'm personally loving it. I had FM right before, and although it wasn't horrible, I found myself very bored and felt it was tedious. IM, however, has been really enjoyable so far. It's very exhausting, but I never feel bored. IM is what I had my eyes set on to begin with, so I'm glad I like it. I'm sure you have a personality that doesn't mesh well with IM's style, so just sit tight and just try and learn what you can as this rotation provides a foundation for the rest of your rotations. I can understand what you mean by not seeing immediate changes and stuff as IM seems to be an intellectual exercise/"numbers game" most of the time rather than an active type of medicine. My IM rotation is 100% inpatient, by the way.

 

[jdh71]

Modern internal medicine is mostly managing chronic disease and any acute exacerbations of said chronic disease - basically keeping people alive who would have otherwise died decades ago. You rarely "fix" anything, and the days of the isolated, one system problem are really gone. You have to find your pleasure in knowing how to best deal with, manage, and optimize the underlying pathophysiology with the modalities available to you to hopefully provide as much quality of life back to the patient as possible (which admittedly is often a huge task to undertake, for what is arguably not much of a quality of life). So, if you can't find this personally interesting, it's not a personal fault by any stretch, but you probably will need to find another specialty for your future practice, and not to panic, there are still plenty to see.

 

[qwerty89]

There is a reason why, at least at my school, all the hospitalists are FMGs

I'm having similar feelings about IM.

Most people tolerate IM to get to Cards, GI, Heme/Onc, etc

 

[Substance]

Check out non-core rotations like ophtho, derm, rads, path, rad onc and gas.

Clerkship is like a liquor store; they keep the good stuff in the back, behind closed doors.

 

[PTPoeny]

Lots of people hate their IM rotations and end up very happy in other parts of medicine. Other people hate their first rotation and go on to hate all their rotations. The first is more common than the later though.

Some people in IM love to believe that their specialty is a special basis for all others, but they are wrong. Not liking IM is not liking one particular part of medicine that is no more central to the profession as a whole than any other. Also, FYI, I don't know that I've met anyone who likes writing up an H&P, it is an important skill to have, and something you have to do before doing anything inpatient, but it isn't fun and exciting. Focus on learning the broadly applicable skills like presenting a patient and developing a differential diagnosis. It is a bit early to be worried that you will hate all of medicine, unless you are basing that off of something other than your first rotation of third year.

 

[Kahreek]

in europe IM is a specialty on its own as it only leads to the hospitalist, critical care, general career, If you want cards or gastro you apply right from the beginning of residency. I wonder how things would change if that was the case in usa.

 

[tco]

I have a very good friend who is a neurosurgery resident. He hated IM with a passion. He loves his job now... There's still hope for you.

 

[Kahreek]

but neurosurgery has very little to do with im.

 

[tco]

but neurosurgery has very little to do with im.

That's kinda the point. Did you read the OP?

 

[evilbooyaa]

IM isn't for everyone. Hang in there.

 

[VisionaryTics]

I can appreciate that a good foundation in medicine is necessary, and I respect the field very much, but I honestly cannot stand IM. I find internal medicine to be very tedious, frustrating, and inefficient. I don't enjoy taking H & P's or writing notes and in many instances internal medicine seems futile. A large number of patients I've seen I can't say really have had a definitive improvement after being in the hospital. I see a lot of sick people leave chronically sick and suffering. The lack of a solution annoys me.

Is it normal to feel this way? I'm a pretty no nonsense person who likes to get things done with a definitive answer, so probably something surgical is more right for me. But I can't help but feeling scared that I'll hate all of my rotations (medicine is my first) and I'll be left doing something I hate for the rest of my life.

Those were pretty similar to my feelings during IM. Also, no one likes H&Ps and notes.

Sounds like something surgical would be up your alley. Gen surg and many of its subspecialties, ortho, ENT, urology, ophtho all have pretty good outcomes and are surgical. Neurosurg has horrific outcomes.

 

[SteinUmStein]

Those were pretty similar to my feelings during IM. Also, no one likes H&Ps and notes.

Sounds like something surgical would be up your alley. Gen surg and many of its subspecialties, ortho, ENT, urology, ophtho all have pretty good outcomes and are surgical. Neurosurg has horrific outcomes.

I see where you are coming from but I disagree. I've seen many people base their initial decision to head down the "surgery tree" on despising IM, and I don't think that's a good conclusion to make. There are so many areas of medicine that are not IM and not surgery. Some are listed above. Others include PM&R, psych, etc. I disliked many aspects of IM, disliked almost all of surgery, and loved many other areas of medicine. Ruling out IM and its subspecialties does not limit you to a surgical career. Just my $0.02, best of luck.

 

[VisionaryTics]

I see where you are coming from but I disagree. I've seen many people base their initial decision to head down the "surgery tree" on despising IM, and I don't think that's a good conclusion to make. There are so many areas of medicine that are not IM and not surgery. Some are listed above. Others include PM&R, psych, etc. I disliked many aspects of IM, disliked almost all of surgery, and loved many other areas of medicine. Ruling out IM and its subspecialties does not limit you to a surgical career. Just my $0.02, best of luck.

I agree, hatred of IM =/= surgery. But he wanted direct interventions with measurable results. I think surgery fits the bill. Of course, surgery and surgical subspecialties require a special kind of masochist to thrive in them, so I would advise OP to keep his mind open throughout 3rd year.

 

[FIREitUP]

I agree, hatred of IM =/= surgery. But he wanted direct interventions with measurable results. I think surgery fits the bill. Of course, surgery and surgical subspecialties require a special kind of masochist to thrive in them, so I would advise OP to keep his mind open throughout 3rd year.

honestly I feel like IM requires this kind of personality. to be able to tolerate your patients constantly suffering and complaining while you, in many instances are helpless to actually do anything appreciable about it, is one of the worst feelings I've encountered and wears me down emotionally. i imagine it must be really fulfilling to improve the quality of life of your patients...

 

[username456789]

i imagine it must be really fulfilling to improve the quality of life of your patients...

One of the reasons I love my job.

 

[Brain Bucket]

Lots of people hate their IM rotations and end up very happy in other parts of medicine. Other people hate their first rotation and go on to hate all their rotations.

Just...lol.

 

[Kahreek]

the problem of IM with students, is that they go to a some gomers department. If you focus on CC, outpatient and get to experience being the one to choose, commence, follow a treatment plan then discharge someone who came in sick. You will see the gratifying side of IM, during scattered rotations it is a bit hard to follow on pts.

 

[FIREitUP]

I just finished my IM rotation a couple days ago. I feel relieved but apprehensive and worried at the same time. After completing the rotation I have this gut feeling that I made a huge mistake and medicine is not the right field for me...

 

[imperturbable]

I just finished my IM rotation a couple days ago. I feel relieved but apprehensive and worried at the same time. After completing the rotation I have this gut feeling that I made a huge mistake and medicine is not the right field for me...

I think a lot of med students go through this at some point. What I have found to be true is that your experience in anything in life is determined by the conglomeration of the people around you. Even within the same group, my friends and I came away with completely different opinions of a rotation because we worked with different nurses, residents, and attendings and saw different patients. If you're referring to medicine as a whole, then I would echo the advice above; it's only your first rotation. You have plenty of time to not like medicine.

 

[FIREitUP]

I think a lot of med students go through this at some point. What I have found to be true is that your experience in anything in life is determined by the conglomeration of the people around you. Even within the same group, my friends and I came away with completely different opinions of a rotation because we worked with different nurses, residents, and attendings and saw different patients. If you're referring to medicine as a whole, then I would echo the advice above; it's only your first rotation. You have plenty of time to not like medicine.

haha, thanks. our IM rotation is split into 4 weeks at home and 4 weeks away. On my first half I was away at a hospital where the nurses are great and do their job and the residents are high quality. To be honest, I still had a lot of trouble; but it seemed more like it was growing pains. At the end of it I started getting the hang of it more and it became less of a chore. My second half was in house which is a total disaster of a hospital and patients were sicker/coding everywhere. I think that really made a bad impression on me and affected my psyche. I have a total of 8 more weeks that I'll have to be in house for rotations so that will be tough, but hopefully as I go on to more functional hospitals and doing things that are more in line with my personality it'll get better.

 

[happygilmore]

I think a lot of med students go through this at some point. What I have found to be true is that your experience in anything in life is determined by the conglomeration of the people around you. Even within the same group, my friends and I came away with completely different opinions of a rotation because we worked with different nurses, residents, and attendings and saw different patients. If you're referring to medicine as a whole, then I would echo the advice above; it's only your first rotation. You have plenty of time to not like medicine.

Agree 100%. I was about to write "it's the people not the medicine".

I've found the culture, attitudes and individuals you work with make or break rotations. We develop generalizations about specialties because of the tendency of certain people/personalities to go into those fields (e.g. surgeons, IM docs, Obgyn docs, etc.). Even with that, if an exceptional doc that you click with was working in IM with you, you would probably love it.

 

[RiFFRaFF]

I absolutely hated life during my IM rotation. I would fantasize about getting clipped by a truck on my walk to the hospital just so I could miss a day. I feel like I would have appreciated it a lot more if I had a lighter first rotation, like family medicine, before IM.

I think the hate was from a combination of lack of knowledge, jitters, and general sense of not knowing what the hell was going on.

I think my IM rotation was set up in the best way, too. Great preceptors

 

[D elegans]

I had Surgery first followed by IM now which I'm wrapping up. While I loathed it, I'm glad I had Surgery first because I think it made me get used to long hours and craziness which made IM seem much better by comparison.

 

[alpinism]

There's a ton of BS in medicine today, and IM is the biggest turd of em all.

It's prob a good thing that you hated your rotation.

Start looking into a surgical subspecialty or maybe rads/gas/em...

 

[235009]

There's a ton of BS in medicine today, and IM is the biggest turd of em all.

It's prob a good thing that you hated your rotation.

Start looking into a surgical subspecialty or maybe rads/gas/em...

ummmm...what? please explain.....this should be good

as for the other specialties you named.....rads and gas are in a bad way right now in terms of job market and compensation

EM.... have fun seeing 10 drunks, druggies, hypochondriacs, or medication refills for every 1 real case. EM sounds great theoretically but is completely different in practice as long as our healthcare system is set up the way it currently is (no, obamacare isn't really going to change anything)

 

[KinasePro]

IM blows in many ways, especially general IM, but it's not all terrible. The subspecialties aren't so bad.

Honestly, from what I've seen as a 3rd year I'd say IM hospitalist or sub-specialist is much preferable to EM in terms of sheer BS to deal with per dollar earned.

Rads and gas are still pretty sweet gigs tho. Sure, you may have to chase a job into the midwest, but once there it's not a bad life at all. Working harder now than ever, but they're still getting paid pretty damn well for it.

 

[e30ftw]

EM.... have fun seeing 10 drunks, druggies, hypochondriacs, or medication refills for every 1 real case. EM sounds great theoretically but is completely different in practice as long as our healthcare system is set up the way it currently is (no, obamacare isn't really going to change anything)

Definitely true that you spend a lot of time talking to d-bags in EM, but it also has a significant amount of sick pts w/ instant gratification that follows from fixing them.

last night i intubated a chf'er with no physiologic reserve, played anesthesiologist during a 45 min deep sedation, paced new onset 3rd degree block, diagnosed a toxidrome in an AMS pt based on PE, coded a pt and got her back.. etc

all in one shift. fast track midlvls filter out a fair amount of BS leaving us the sickies.

couple of druggies/psych pts of course but i don't mind that if something cool happens on shift.

 

[anbuitachi]

haha, thanks. our IM rotation is split into 4 weeks at home and 4 weeks away. On my first half I was away at a hospital where the nurses are great and do their job and the residents are high quality. To be honest, I still had a lot of trouble; but it seemed more like it was growing pains. At the end of it I started getting the hang of it more and it became less of a chore. My second half was in house which is a total disaster of a hospital and patients were sicker/coding everywhere. I think that really made a bad impression on me and affected my psyche. I have a total of 8 more weeks that I'll have to be in house for rotations so that will be tough, but hopefully as I go on to more functional hospitals and doing things that are more in line with my personality it'll get better.

thought you are going into a surgical field anyway. i just finished obgyn, and i must say, the docs there prob feel like they accomplish a lot cause most of them end in 'happy' endings

 

[alpinism]

ummmm...what? please explain.....this should be good

as for the other specialties you named.....rads and gas are in a bad way right now in terms of job market and compensation

EM.... have fun seeing 10 drunks, druggies, hypochondriacs, or medication refills for every 1 real case. EM sounds great theoretically but is completely different in practice as long as our healthcare system is set up the way it currently is (no, obamacare isn't really going to change anything)

Per rads/gas, true the job market sucks now. I was only referring to doing procedures and making an immediate impact on patients.

EM has its good and bad (just like everything in medicine). If the OP is mainly frustrated about babysitting gomers, dealing with chronic self-inflicted diseases, and not fixing most patient problems (I felt the same way on IM) then EM is a viable option. Sure its 90% BS, but like e30ftw said you'll get a few pts each shift that you can "fix" (suturing lacs, reducing dislocations, STEMIs, asthma attacks&#8230😉.

 

[tiedyeddog]

After completing the rotation I have this gut feeling that I made a huge mistake and medicine is not the right field for me...

As a fellow third year on my second rotation, I feel so you hard on this sentiment. I have done FM and am more than half-way through peds. I have pretty much hated both rotations so far and often times at the end of the day I have wondered if I should just...quit. The days are so unfulfilling to me. It's not the amount of work, during FM I routinely worked 13-14 hours a day because I was with a rural practitioner who also did inpatient medicine. It's just the nature of what I have seen. Tons of sitting behind a computer, not actually touching patients physically except for listening to them for 5 seconds with a stethoscope, trying to placate inconsolable patients for most of visits and not doing a whole lot of "medicine" (or at least medicine as I preconceived it before M3), the mental masturbation that is rounds kills me after 5 hours.... it just doesn't deliver me a ton of gratification nor does imagining my life in any of my resident's shoes. Don't get me wrong, I am enjoying 3rd year way more than m1 or 2 but so far much of my 3rd year has sucked except for brief instances.

The only thing that hasn't stopped me from dropping out is the brief instances when I get to help pull a femoral line, being part of the team during codes, and other procedural work. I think you and I are similar in that there are specific things we need to be happy in our working lives. Maybe you haven't found yours yet or haven't seen it on the wards yet, but I know mine, and that is doing procedures. I feel like everyone eventually finds what they need to be happy in medicine, whether it be rounding, reading images, looking at pathology slides, or doing surgeries, just some people don't find it even until 4th year.

and just to make it clear, I am NOT trying to **** on fields that don't do procedural work. I just know it isn't for me.

/end semi-comprehensible rant

 

[calvnandhobbs68]

As a fellow third year on my second rotation, I feel so you hard on this sentiment. I have done FM and am more than half-way through peds. I have pretty much hated both rotations so far and often times at the end of the day I have wondered if I should just...quit. The days are so unfulfilling to me. It's not the amount of work, during FM I routinely worked 13-14 hours a day because I was with a rural practitioner who also did inpatient medicine. It's just the nature of what I have seen. Tons of sitting behind a computer, not actually touching patients physically except for listening to them for 5 seconds with a stethoscope, trying to placate inconsolable patients for most of visits and not doing a whole lot of "medicine" (or at least medicine as I preconceived it before M3), the mental masturbation that is rounds kills me after 5 hours.... it just doesn't deliver me a ton of gratification nor does imagining my life in any of my resident's shoes. Don't get me wrong, I am enjoying 3rd year way more than m1 or 2 but so far much of my 3rd year has sucked except for brief instances.

The only thing that hasn't stopped me from dropping out is the brief instances when I get to help pull a femoral line, being part of the team during codes, and other procedural work. I think you and I are similar in that there are specific things we need to be happy in our working lives. Maybe you haven't found yours yet or haven't seen it on the wards yet, but I know mine, and that is doing procedures. I feel like everyone eventually finds what they need to be happy in medicine, whether it be rounding, reading images, looking at pathology slides, or doing surgeries, just some people don't find it even until 4th year.

and just to make it clear, I am NOT trying to **** on fields that don't do procedural work. I just know it isn't for me.

/end semi-comprehensible rant

Good god 100x this. The poor IM residents spend 75% of their time sitting in front of a computer putting in orders, writing up progress notes/H+Ps, phoning back consults or the 100th page from some floor nurse, writing discharge instructions, etc.

 

[yehhhboiii]

Good god 100x this. The poor IM residents spend 75% of their time sitting in front of a computer putting in orders, writing up progress notes/H+Ps, phoning back consults or the 100th page from some floor nurse, writing discharge instructions, etc.

man im sounds terrible
i wonder if 3 years of that is worth it for cardiology/gi

 

[calvnandhobbs68]

Per rads/gas, true the job market sucks now. I was only referring to doing procedures and making an immediate impact on patients.

EM has its good and bad (just like everything in medicine). If the OP is mainly frustrated about babysitting gomers, dealing with chronic self-inflicted diseases, and not fixing most patient problems (I felt the same way on IM) then EM is a viable option. Sure its 90% BS, but like e30ftw said you'll get a few pts each shift that you can "fix" (suturing lacs, reducing dislocations, STEMIs, asthma attacks&#8230😉.

Oh please...the job market "sucks" for rads/gas is "Coming out of residency I might only getting paid 300K instead of 350K and I might have to live somewhere not on the coasts OH NOESS". Yeah there's some anecdotal worse stories but data means more than a couple SDN anecdotes and the median starting salary data is still about that range.

 

[235009]

i'm going to refrain from trash talking other specialties but realize that the documentation/paperwork isn't unique to IM. For instance in anesthesia, for a straightforward case (which is the vast majority), outside of the first 10 minutes and last 10 minutes of the case you're basically documenting non-stop. At least in IM, much like in peds and FM, you get to know your patients and connect with them on a human level. You also get to delve into the patient's condition. Sure you have to deal with the brunt of the social issues but as someone mentioned earlier each specialty has it's own downsides. When deciding what you want to go into you should weigh all these factors. Also be careful of some rotations that try to shield med students from the boring/difficult/annoying aspects of the specialty ....you need to keep your eyes open and see what the residents and attendings have to deal with to get the real picture.

 

[yehhhboiii]

Oh please...the job market "sucks" for rads/gas is "Coming out of residency I might only getting paid 300K instead of 350K and I might have to live somewhere not on the coasts OH NOESS". Yeah there's some anecdotal worse stories but data means more than a couple SDN anecdotes and the median starting salary data is still about that range.

it's the trend that matters and the outlook is bleak

 

[alpinism]

As a fellow third year on my second rotation, I feel so you hard on this sentiment. I have done FM and am more than half-way through peds. I have pretty much hated both rotations so far and often times at the end of the day I have wondered if I should just...quit. The days are so unfulfilling to me. It's not the amount of work, during FM I routinely worked 13-14 hours a day because I was with a rural practitioner who also did inpatient medicine. It's just the nature of what I have seen. Tons of sitting behind a computer, not actually touching patients physically except for listening to them for 5 seconds with a stethoscope, trying to placate inconsolable patients for most of visits and not doing a whole lot of "medicine" (or at least medicine as I preconceived it before M3), the mental masturbation that is rounds kills me after 5 hours.... it just doesn't deliver me a ton of gratification nor does imagining my life in any of my resident's shoes. Don't get me wrong, I am enjoying 3rd year way more than m1 or 2 but so far much of my 3rd year has sucked except for brief instances.

The only thing that hasn't stopped me from dropping out is the brief instances when I get to help pull a femoral line, being part of the team during codes, and other procedural work. I think you and I are similar in that there are specific things we need to be happy in our working lives. Maybe you haven't found yours yet or haven't seen it on the wards yet, but I know mine, and that is doing procedures. I feel like everyone eventually finds what they need to be happy in medicine, whether it be rounding, reading images, looking at pathology slides, or doing surgeries, just some people don't find it even until 4th year.

and just to make it clear, I am NOT trying to **** on fields that don't do procedural work. I just know it isn't for me.

/end semi-comprehensible rant

Even in "procedural fields" the amount of time practicing "medicine" is still minimal... The most surprising thing about my GS rotation was how much paperwork was involved and how little OR time there was. Most of the time was spent in front of the computer writing/dictating notes and rounding.

20 min procedure = 1hr paperwork
10 min f/u in clinic = 30min paperwork

 

[DrBowtie]

it's the trend that matters and the outlook is bleak

Please elaborate

 

[tiedyeddog]

Even in "procedural fields" the amount of time practicing "medicine" is still minimal... The most surprising thing about my GS rotation was how much paperwork was involved and how little OR time there was. Most of the time was spent in front of the computer writing/dictating notes and rounding.

20 min procedure = 1hr paperwork
10 min f/u in clinic = 30min paperwork

I definitely agree with what you're saying here. Writing H&Ps and notes is an essential part of medicine and understandably so.

 

[calvnandhobbs68]

Please elaborate

Yes please do.

 

[235009]

it's the trend that matters and the outlook is bleak

Please elaborate

Yes please do.

go over to the anesthesia board and you'll find a bunch of attendings lamenting about how the specialty is in trouble. basically unlike in the primary care specialties where PAs and NPs work together with physicians and help increase the number of patients a physician sees and bills for, in anesthesia the CRNAs are basically eliminating anesthesiologist jobs since the number of surgeries/procedures is limited by the number of surgeons whereas in primary care there is no shortage of demand. i've heard that on the anesthesia interview trail they try to address this by saying that critical care is the next big thing in anesthesiology but of course that's a pipe dream.... pulm/cc and surgeons aren't going to just let anesthesiologists take their jobs in the MICU/SICU

radiology isn't really in trouble as much as it is just going to be a less sweet gig as more technology gets implemented and many small community hospitals opt for teleradiology instead of having someone in-house. that means having to live in less desirable locations and getting paid less but unlike anesthesia the jobs aren't going to just disappear, in fact our dependence on scans will only keep increasing.

 

[yehhhboiii]

Please elaborate

well i don't know about radiology except that there was a hospital that tried to cut the funding for radiology residents recently. but for anesthesia, crnas are everywhere and their schools are pumping them out like nobody's business. the va just changed their rules to allow crnas to practice independently which many may not. who would want to shoulder responsibility when they can work their 40 hours and have the md be responsible for their mistakes? but the option is there and represents a shift in thinking that leads people to have a sense of a false equivalence between a nurse anesthetist and an anesthesiologist. the job market is getting tighter and salaries are falling off a roof. it used to be that you could join a group, spend some time paying your dues and then you get to profit share as a partner but nowadays there's a ton of uncertainty with the implementation of obamacare. private practice groups are cashing in by selling out to anesthesia management companies left and right. a lot of groups are willing to screw over people by telling them that they are on a partnership track so that they can string them along and replace them with someone cheaper when they're about to finish. signing bonuses are a thing of the past. a recent grad here just said that he joined a group with a one year partner track only to have them sell out to an amc when he was a few months in. people in medical school now have an employee model to look forward to, either as a part of an anesthesia management company or as a direct hospital employee. that means that there will be more people, who probably don't know a thing about medicine, trying to tell doctors how they should practice. there are crna groups taking over contracts that anesthesiologists had because hospitals want to keep more money and targeting anesthesia subsidies is an easy way to do it. it's getting to be that you will have to practice in the middle of nowhere or finish a fellowship in pain, peds, maybe critical care or cardiac, if ct surgery doesn't disappear, to be a viable candidate for jobs.

is that enough or do you have some popcorn left

 

[happygilmore]

well i don't know about radiology except that there was a hospital that tried to cut the funding for radiology residents recently. but for anesthesia, crnas are everywhere and their schools are pumping them out like nobody's business. the va just changed their rules to allow crnas to practice independently which many may not. who would want to shoulder responsibility when they can work their 40 hours and have the md be responsible for their mistakes? but the option is there and represents a shift in thinking that leads people to have a sense of a false equivalence between a nurse anesthetist and an anesthesiologist. the job market is getting tighter and salaries are falling off a roof. it used to be that you could join a group, spend some time paying your dues and then you get to profit share as a partner but nowadays there's a ton of uncertainty with the implementation of obamacare. private practice groups are cashing in by selling out to anesthesia management companies left and right. a lot of groups are willing to screw over people by telling them that they are on a partnership track so that they can string them along and replace them with someone cheaper when they're about to finish. signing bonuses are a thing of the past. a recent grad here just said that he joined a group with a one year partner track only to have them sell out to an amc when he was a few months in. people in medical school now have an employee model to look forward to, either as a part of an anesthesia management company or as a direct hospital employee. that means that there will be more people, who probably don't know a thing about medicine, trying to tell doctors how they should practice. there are crna groups taking over contracts that anesthesiologists had because hospitals want to keep more money and targeting anesthesia subsidies is an easy way to do it. it's getting to be that you will have to practice in the middle of nowhere or finish a fellowship in pain, peds, maybe critical care or cardiac, if ct surgery doesn't disappear, to be a viable candidate for jobs.

is that enough or do you have some popcorn left

all of medicine is screwed. Don't leave out the other specialties.

 

[calvnandhobbs68]

all of medicine is screwed. Don't leave out the other specialties.

Yes, a lot from that paragraph can be applied to most medical specialties.

 

[xenotype]

Outpt cash only IM/FM has a huge future because obamacare is going to ruin most people's access to care. High deductibles and ever increasing copays will only drive more people to cash pay. Middle/upper class people are also going to be turned off by being forced to see NP/PA for primary care instead of a real doctor, so they will pay a bit more for the real thing.

 

[KnuxNole]

Outpt cash only IM/FM has a huge future because obamacare is going to ruin most people's access to care. High deductibles and ever increasing copays will only drive more people to cash pay. Middle/upper class people are also going to be turned off by being forced to see NP/PA for primary care instead of a real doctor, so they will pay a bit more for the real thing.

Unless the NP/PA was sweet and nice while the "MD was a big fat meanie!", then they'll stick to their Dr. NP. Cause after all, the general population doesn't care how smart/well trained you are if they don't like you haha

 

[DrBowtie]

well i don't know about radiology except that there was a hospital that tried to cut the funding for radiology residents recently. but for anesthesia, crnas are everywhere and their schools are pumping them out like nobody's business. the va just changed their rules to allow crnas to practice independently which many may not. who would want to shoulder responsibility when they can work their 40 hours and have the md be responsible for their mistakes? but the option is there and represents a shift in thinking that leads people to have a sense of a false equivalence between a nurse anesthetist and an anesthesiologist. the job market is getting tighter and salaries are falling off a roof. it used to be that you could join a group, spend some time paying your dues and then you get to profit share as a partner but nowadays there's a ton of uncertainty with the implementation of obamacare. private practice groups are cashing in by selling out to anesthesia management companies left and right. a lot of groups are willing to screw over people by telling them that they are on a partnership track so that they can string them along and replace them with someone cheaper when they're about to finish. signing bonuses are a thing of the past. a recent grad here just said that he joined a group with a one year partner track only to have them sell out to an amc when he was a few months in. people in medical school now have an employee model to look forward to, either as a part of an anesthesia management company or as a direct hospital employee. that means that there will be more people, who probably don't know a thing about medicine, trying to tell doctors how they should practice. there are crna groups taking over contracts that anesthesiologists had because hospitals want to keep more money and targeting anesthesia subsidies is an easy way to do it. it's getting to be that you will have to practice in the middle of nowhere or finish a fellowship in pain, peds, maybe critical care or cardiac, if ct surgery doesn't disappear, to be a viable candidate for jobs.

is that enough or do you have some popcorn left

My main interest was in your rads comments, so it looks like you don't have much to say about that.

But agree with others, all of medicine is trending down.

 

[qwerty89]

IF more of radiology is done via tele rads...wouldn't that increase the # of jobs in desirable locations? All you need are multiple state medical licences. Then you can live in coastal california and read scans that originated in Nebraska right?

 

[235009]

IF more of radiology is done via tele rads...wouldn't that increase the # of jobs in desirable locations? All you need are multiple state medical licences. Then you can live in coastal california and read scans that originated in Nebraska right?

renting you a space to work is more expensive in california, as is electricity and other services.....not to mention taxes. so the overhead would be much cheaper in nebraska and the films would flow from expensive areas of the country to cheaper locations.

 

[jerseytrash]

i'm going to refrain from trash talking other specialties but realize that the documentation/paperwork isn't unique to IM. For instance in anesthesia, for a straightforward case (which is the vast majority), outside of the first 10 minutes and last 10 minutes of the case you're basically documenting non-stop. At least in IM, much like in peds and FM, you get to know your patients and connect with them on a human level. You also get to delve into the patient's condition. Sure you have to deal with the brunt of the social issues but as someone mentioned earlier each specialty has it's own downsides. When deciding what you want to go into you should weigh all these factors. Also be careful of some rotations that try to shield med students from the boring/difficult/annoying aspects of the specialty ....you need to keep your eyes open and see what the residents and attendings have to deal with to get the real picture.

This x1000

What people don't see on most of their gen surg/anesthesia/ENT/whatever rotations is the crapton of paperwork, BS, and social work fielding that a lot of the gen surg residents AND attendings have to do. Just as is the case in IM. People don't just go to work, operate, and leave unless they're attendings at Mayo clinic. They go in early, round on their patients, write notes, then go and operate, spend time after OR dictating/writing notes, rounding on more patients in between cases, going to clinic and writing notes/rounding/doing the billing and coding stuff, etc. It's a few hours of fun work with a few hours of dull work mixed in, *just like everything else in life*.