IM residencies that aren't 80+ hours a week?

[Drrrrrr. Celty]

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So I've always been mildly interested in IM. But I've always found it really hard to bite the bullet and sign up for a hellish intern year and 2 more years of not having actual weekends.

How often do you at your program actually have a full weekend off? How often do you feel like you're managing to sleep an actual 8 hour shift or come home and not feel like you need to pass out immediately?

 

[epicandprivate]

My program is not "front loaded". Call is pretty much spread out evenly throughout three years. I'd even say that third year is more difficult than 1st here which I'm not crazy about, me being a third year. However I rarely work 80 hour work week and I think part of that is because of our night float system. I'm sure there are other programs that are similar in structure. On average I'd say I work on average 65-70 hr work week for wards. Clinic weeks are more like 40-50 hr. Consults are variable, ID and cardio can work closer to 70-80 and rheum and Endo 40-50. Average one day off a week with a variation of "lblack, gray and golden weekends. Residency is residency. You'll work hard work many weekends have little vacation but it will be over before you know it.

So I've always been mildly interested in IM. But I've always found it really hard to bite the bullet and sign up for a hellish intern year and 2 more years of not having actual weekends.

How often do you at your program actually have a full weekend off? How often do you feel like you're managing to sleep an actual 8 hour shift or come home and not feel like you need to pass out immediately?

 

[epicandprivate]

Also I think in most places you get a "golden" every weekend on consult months. Unfortunately not where I am.

My program is not "front loaded". Call is pretty much spread out evenly throughout three years. I'd even say that third year is more difficult than 1st here which I'm not crazy about, me being a third year. However I rarely work 80 hour work week and I think part of that is because of our night float system. I'm sure there are other programs that are similar in structure. On average I'd say I work on average 65-70 hr work week for wards. Clinic weeks are more like 40-50 hr. Consults are variable, ID and cardio can work closer to 70-80 and rheum and Endo 40-50. Average one day off a week with a variation of "lblack, gray and golden weekends. Residency is residency. You'll work hard work many weekends have little vacation but it will be over before you know it.

 

[epicandprivate]

Also I think in most places you get a "golden" every weekend on consult months. Unfortunately not where I am.

Just in case it's not clear a golden weekend means a full weekend.

 

[Redpancreas]

So I've always been mildly interested in IM. But I've always found it really hard to bite the bullet and sign up for a hellish intern year and 2 more years of not having actual weekends.

How often do you at your program actually have a full weekend off? How often do you feel like you're managing to sleep an actual 8 hour shift or come home and not feel like you need to pass out immediately?

UC northshore and Rutgers RWJ. The latter is actually a pretty good program IMO.

 

[jdh71]

I die inside a little every time I see a thread like this.

It's like saying you want to be a marine but don't want to do that crucible (or shoot a gun) (or do anything dangerous) (lawl insert pic of laughing Japanese kitten here)

Or you want to be a serious competitor in the crossfit games but don't want to learn how to snatch squat and double unders are hard to do. Any pathway to the games that doesn't involve hard physical activity?? (Insert pic of dog that appears to be saying "idunno" here)

Doing hard things is . . . Hard. Suck it up. Or go do something else.

 

[gutonc]

So I've always been mildly interested in IM. But I've always found it really hard to bite the bullet and sign up for a hellish intern year and 2 more years of not having actual weekends.

How often do you at your program actually have a full weekend off? How often do you feel like you're managing to sleep an actual 8 hour shift or come home and not feel like you need to pass out immediately?

So if you don't do IM (which you're only mildly interested in), what will you do? You do recognize that even the true lifestyle specialties (Derm, Rad Onc, Ophtho) are only that once you're an attending, and not generally during training, right?

 

[Drrrrrr. Celty]

I die inside a little every time I see a thread like this.

It's like saying you want to be a marine but don't want to do that crucible (or shoot a gun) (or do anything dangerous) (lawl insert pic of laughing Japanese kitten here)

Or you want to be a serious competitor in the crossfit games but don't want to learn how to snatch squat and double unders are hard to do. Any pathway to the games that doesn't involve hard physical activity?? (Insert pic of dog that appears to be saying "idunno" here)

Doing hard things is . . . Hard. Suck it up. Or go do something else.

hah. I'm not saying I don't want to work hard. It's more like can I go to a place that doesn't have you working without weekends 8 months of the year.

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[jdh71]

hah. I'm not saying I don't want to work hard. It's more like can I go to a place that doesn't have you working without weekends 8 months of the year.

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It is what you are saying.

Why do you think training is the way it is? Everyone just hates themselves. It's fun to drop heavy **** on our toes??? Yay! Something like that?

 

[Drrrrrr. Celty]

It is what you are saying.

Why do you think training is the way it is? Everyone just hates themselves. It's fun to drop heavy **** on our toes??? Yay! Something like that?

alright, let me rephrase. How often do IM residencies make you push 80 hours or work you without a weekend? How about how many vacation days do you normally get? I've seen some programs only offer 2 and other offer 4.

Is a community or communiversity program going to be as 80+ a week as a university?



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[epicandprivate]

alright, let me rephrase. How often do IM residencies make you push 80 hours or work you without a weekend? How about how many vacation days do you normally get? I've seen some programs only offer 2 and other offer 4.

Is a community or communiversity program going to be as 80+ a week as a university?



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Your questions don't have simple answer. The answer is it varies from program to program. Some University prohrams are really busy and others are cush, same goes for community. You don't pick (or not pick) a medical specialty based on the life style in training. Make an adult decision and you can find a program that is more cush if you so choose to pursue IM.

 

[Drrrrrr. Celty]

Your questions don't have simple answer. The answer is it varies from program to program. Some University prohrams are really busy and others are cush, same goes for community. You don't pick (or not pick) a medical specialty based on the life style in training. Make an adult decision and you can find a program that is more cush if you so choose to pursue IM.

of course. I'm just honestly seeing how the specialty is overall or what not. I'm honestly considering IM regionally however.

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[jdh71]

alright, let me rephrase. How often do IM residencies make you push 80 hours or work you without a weekend? How about how many vacation days do you normally get? I've seen some programs only offer 2 and other offer 4.

Is a community or communiversity program going to be as 80+ a week as a university?

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Probably not. But you want to see as much as you can and as much weird and mixed and varied stuff as you can in training so that when you are actually responsible for people on your own you don't kill anyone with incompetence. And when you are done with three years of training you are BARELY competent and will wish you has seen more when the stakes weren't so personally high for you. Most programs and residents you will work with will be protective of your time off because they want you to be protective of their time off.

You don't want to pick a program based on how much time they will promise to let you off compared to another program.

 

[Drrrrrr. Celty]

Probably not. But you want to see as much as you can and as much weird and mixed and varied stuff as you can in training so that when you are actually responsible for people on your own you don't kill anyone with incompetence. And when you are done with three years of training you are BARELY competent and will wish you has seen more when the stakes weren't so personally high for you. Most programs and residents you will work with will be protective of your time off because they want you to be protective of their time off.

You don't want to pick a program based on how much time they will promise to let you off compared to another program.

Fair enough. How overall happy are you with IM though? Like I feel like I enjoy IM months as they're usually very intriguing and I do like seeing variety and having my mental gears turning.

 

[NewYorkDoctors]

I die inside a little every time I see a thread like this.

It's like saying you want to be a marine but don't want to do that crucible (or shoot a gun) (or do anything dangerous) (lawl insert pic of laughing Japanese kitten here)

Or you want to be a serious competitor in the crossfit games but don't want to learn how to snatch squat and double unders are hard to do. Any pathway to the games that doesn't involve hard physical activity?? (Insert pic of dog that appears to be saying "idunno" here)

Doing hard things is . . . Hard. Suck it up. Or go do something else.

Meh. IMO only the eventual cardiologists and PCCMers are "the marines of medicine."

Maybe the OP just wants to be a quiet, introspective ID, endo, or PMD physician eventually? There's only so much ID, endocrine or outpatient medicine to be seen in inpatient medicine. Maybe a better question for OP is which programs have a track for more outpatient experiences?

Still agreed how one should want to work as hard as possible just as a principle.

Though from a practical perspective, for someone who is set on a 40 hour a week PMD gig, working as an ICU resident most of residency is probably not going to benefit this individual as much as using the time off to study up on things.

 

[jdh71]

Fair enough. How overall happy are you with IM though? Like I feel like I enjoy IM months as they're usually very intriguing and I do like seeing variety and having my mental gears turning.

Overall I'm satisfied. I'm PCCM, so I really signed up for long hours even after training and I usually like it. I have to watch out for cynicism and burn-out and remember why I do this. I still think my vocation is a calling and not a mere job.

 

[jdh71]

Maybe the OP just wants to be a quiet, introspective ID, endo, or PMD physician eventually? There's only so much ID, endocrine or outpatient medicine to be seen in inpatient medicine. Maybe a better question for OP is which programs have a track for more outpatient experiences?.

Irrelevant. You have to be a well trained internist FIRST.

 

[Drrrrrr. Celty]

Meh. IMO only the eventual cardiologists and PCCMers are "the marines of medicine."

Maybe the OP just wants to be a quiet, introspective ID, endo, or PMD physician eventually? There's only so much ID, endocrine or outpatient medicine to be seen in inpatient medicine. Maybe a better question for OP is which programs have a track for more outpatient experiences?

Still agreed how one should want to work as hard as possible just as a principle.

Though from a practical perspective, for someone who is set on a 40 hour a week PMD gig, working as an ICU resident most of residency is probably not going to benefit this individual as much as using the time off to study up on things.

I'm mainly thinking about Rheumatology or allergy/immunology if I do IM. I've never found Cardiology appealing. I like Critical care because I liked having a solid team working along with me, but I don't generally enjoy medicine that doesn't involve actually interacting with patients. I like hearing histories, I like knowing what's worked and how to manage diseases.

 

[Drrrrrr. Celty]

Irrelevant. You have to be a well trained internist FIRST.

I agree undoubtedly. But I guess that brings up the question if you're not actually horribly interested in being an internist or hospitalist as much as being in one of the outpatient or mixed specialties like endo or rhuematology, is IM really a good fit?

 

[IMreshopeful]

I agree undoubtedly. But I guess that brings up the question if you're not actually horribly interested in being an internist or hospitalist as much as being in one of the outpatient or mixed specialties like endo or rhuematology, is IM really a good fit?

I think having a strong basis in IM residency will prepare you for any specialty. However it’s key to go to a residency and do rotations which will prepare you for your chosen career. Primary care track might be a good fit for you. Also if you’ve decided early on to do just primary care and not a mainly outpatient specialty, family medicine also a consideration (and their residencies are typically much less intense).

 

[jdh71]

I agree undoubtedly. But I guess that brings up the question if you're not actually horribly interested in being an internist or hospitalist as much as being in one of the outpatient or mixed specialties like endo or rhuematology, is IM really a good fit?

I'm not sure I understand the question. Doing IM is the only way through.

 

[Drrrrrr. Celty]

I'm not sure I understand the question. Doing IM is the only way through.

I mean more like if you're less in love with what an internist does and prefer the job of a specialist is that a path to disappointment?

 

[Drrrrrr. Celty]

I think having a strong basis in IM residency will prepare you for any specialty. However it’s key to go to a residency and do rotations which will prepare you for your chosen career. Primary care track might be a good fit for you. Also if you’ve decided early on to do just primary care and not a mainly outpatient specialty, family medicine also a consideration (and their residencies are typically much less intense).

I wish I had a better perspective on family medicine or primary care. My FM rotation was honestly a miserable month and it kind of made me believe that a lot of FM doctors aren't happy human beings. But it does totally appeal to me at least theoretically, I love getting to know people and following through on their care and I like being involved and social medicine is really as much fun as actually treating diseases.

Also OB/Gyn & Peds are not tings I am interested in. I prefer mainly adult medicine.

 

[jdh71]

I mean more like if you're less in love with what an internist does and prefer the job of a specialist is that a path to disappointment?

No. But you need need to get through what you need to get through.

 

[rokshana]

Meh. IMO only the eventual cardiologists and PCCMers are "the marines of medicine."

Maybe the OP just wants to be a quiet, introspective ID, endo, or PMD physician eventually? There's only so much ID, endocrine or outpatient medicine to be seen in inpatient medicine. Maybe a better question for OP is which programs have a track for more outpatient experiences?

Still agreed how one should want to work as hard as possible just as a principle.

Though from a practical perspective, for someone who is set on a 40 hour a week PMD gig, working as an ICU resident most of residency is probably not going to benefit this individual as much as using the time off to study up on things.

seriously? you think there is very little inpatient medicine for ID?

 

[rokshana]

I agree undoubtedly. But I guess that brings up the question if you're not actually horribly interested in being an internist or hospitalist as much as being in one of the outpatient or mixed specialties like endo or rhuematology, is IM really a good fit?

if you are not interested in being an internist, you will not be happy being an endocrinologist.

seems like FM would be a better fit for you...get to see fairly healthy patients and mostly outpt.

 

[Drrrrrr. Celty]

if you are not interested in being an internist, you will not be happy being an endocrinologist.

seems like FM would be a better fit for you...get to see fairly healthy patients and mostly outpt.

I think I don't enjoy being a internist because I don't like that type of life, i.e 7 on 7 off, and doing a lot of everything. Not because I don't like acuity.

But I'll pay more consideration to family medicine for sure.

 

[mdjo]

I also dislike hospital medicine and particularly critical care medicine--but I still really enjoy learning about internal medicine and I had a lot of fun in residency. I went to a university program with a heavy primary care emphasis (although not a specific primary care track) and also a lot of emphasis on education and lots of exposure to subspecialties. A lot of people in my program's leadership are quiet, nerdy PCPs and ID docs and rheumatologists and that definitely influenced the program in a way that worked for me. I got a great education and I mostly work 60-70 hours a week on inpatient rotations and 40-50 hours a week on consults and elective. I traded away most of my ICU rotations to the cowboys in my program like jdh up there. You don't have to torture yourself in training to be a great internist (btw, internist means any internal medicine physician, but often refers to IM PCPs). Ask a lot of questions about the culture of programs when you interview, because I think you would like a program like mine but maybe not one like jdh's.

P.S. Regarding family medicine, if you're okay with only practicing on adults, I think you'll be a much better PCP with a background in IM than a background in family medicine. But that might be less true if you're looking at those old-school IM programs where you spend all your life stuck in the hospital and clinic is an afterthought.

 

[Drrrrrr. Celty]

I also dislike hospital medicine and particularly critical care medicine--but I still really enjoy learning about internal medicine and I had a lot of fun in residency. I went to a university program with a heavy primary care emphasis (although not a specific primary care track) and also a lot of emphasis on education and lots of exposure to subspecialties. A lot of people in my program's leadership are quiet, nerdy PCPs and ID docs and rheumatologists and that definitely influenced the program in a way that worked for me. I got a great education and I mostly work 60-70 hours a week on inpatient rotations and 40-50 hours a week on consults and elective. I traded away most of my ICU rotations to the cowboys in my program like jdh up there. You don't have to torture yourself in training to be a great internist (btw, internist means any internal medicine physician, but often refers to IM PCPs). Ask a lot of questions about the culture of programs when you interview, because I think you would like a program like mine but maybe not one like jdh's.

P.S. Regarding family medicine, if you're okay with only practicing on adults, I think you'll be a much better PCP with a background in IM than a background in family medicine. But that might be less true if you're looking at those old-school IM programs where you spend all your life stuck in the hospital and clinic is an afterthought.

I can't say that I dislike hospital medicine, it's more that I want to have more consult and work on one area that I can get really good at.

overall for me my big thing is that I've always been really into psych and ive been considering maybe what I want is just a specialty where I can talk to people enough, manage complicated illnesses, while also not destroying myself haha.



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[NewYorkDoctors]

seriously? you think there is very little inpatient medicine for ID?

There is plenty of inpatient cases for ID. Rather the point is if an IM resident wants to do ID and get the full breadth , there’s a case for that’s individual to get more elective time or to have more studying time as The inpatient IM resident experience for ID (short of the ID elective itself) is rather limited in scope. Pneumonia , UTI , meningitis , cellulitis , osteomyelitis , influenza , URI. Rinse and repeat ... medical ICU is expanded somewhat with fungal diseases and perhaps a tick borne like Babeosis now and then .. but the pathology in sicu , cticu , outpatient hiv clinic , transplant services , toxo clinic etc has a wider scope that the IM resident is not exposed to .

Analogy rokshana as I believe you are an endocrine doctor from past posts , inpatient endocrine is somewhat limited compared to what the outpatient has to offer right ? DM DM DM and some thyroid mostlyninpatient right ? At a certain point , all that micu time or floorbadmissions for AMS must have had diminishing returns right ?

Anyway I’m a proponent for getting superior training , working ones butt off in training , and using ones free time in training to study hard and get research done . After all I am going for four board certifications (see my prior posts)


But many would be lying to themselves if they didn’t think trainees these days don’t want to take an easier path if it made sense . I am merely commenting on this.

 

[rokshana]

Analogy rokshana as I believe you are an endocrine doctor from past posts , inpatient endocrine is somewhat limited compared to what the outpatient has to offer right ? DM DM DM and some thyroid mostlyninpatient right ? .

not really...it is the misconception that all Endocrine sees is sugars as inpatient.

 

[stillevolving]

To the OP:
I'm at a top academic program. My intern year, I had 10 inpatient months, and yes, it was rough, but that's how I became a competent internist. R2 year, 6 inpatient months (meaning 6 months with weekends). R3 year, only 4 inpatient months (8 whole months with weekends).

It gets better every year. I am very well trained at the end of it and wouldn't have picked a different program. PM me if you're interested in more.