Internal Medicine Hours

[emeka]

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What are the hours/lifestyle like for Internal medicine residents compared to non-residents.
I've just started med school but I'm begining to think of specialties to pursue

 

[vitaminj]

What are the hours/lifestyle like for Internal medicine residents compared to non-residents.
I've just started med school but I'm begining to think of specialties to pursue

I'm at a major university center and I think that what happened to Hopkins last year put the fear of God in most programs. As an intern I have been under 80 hours every week except for two--once during my very first week and then another random week. For Medicine and theortically every residency 80 hours SHOULD be the worst it is. At my hospital though I have heard through the grapevine that the surgery residents are traditionally over 80 with an isolated story of one resident pulling 127 hours in one week on transplant!

 

[emeka]

Thanks vitaminj

Does anyone know what the hours are like after one is done residency, and practicing as a general internist??

 

[BayesianDoc]

Does anyone know what the hours are like after one is done residency, and practicing as a general internist??

Hospitalist or Outpatient.
A few friends of mine are internists. The hospitalist works 7-5/6 with call from home every4th weekend. The outpatient internist is about 8-5/6. The outpatient doc does not see his patients in the hospital b/c the hospitalist and the outpatient doc are both in the same group that is owned by the hospital.

 

[pufftissue]

What are the hours/lifestyle like for Internal medicine residents compared to non-residents.
I've just started med school but I'm begining to think of specialties to pursue

Emeka,

Just do me a favor and file this one away in your brain:
SPECIALIZE.

That's it.

The reason? Medicine is more unattractive than it has ever been. Like every specialty, the pendulum will probably swing back towards IM's favor because at this rate, there simply will not be enough docs willing to do IM in I don't know, say 10-15 years. The only reason left to do IM is if you truly love it, that's it. In every other way, it stinks. 1. You get dumped on by every other conceivable specialty. If your patient is fecally impacted, its yours. If your patient is in intractable pain, its yours. If your patient is having an MI, its yours. If your patient is just anxious, its yours. If your patient has hemorrhoids, its yours. You can consult specialists, but you have to deal with every single problem first. Becuase as IM, you're supposed to know about everything. 2. Your pay is half what everyone elses is. Simply put, you do all the scut work and set your friendly specialist up for the $1000 procedure. 3. Paperwork: you're doing more of that than seeing your patients. Dictations, managing 10 chronic meds per patient, filling out disability forms, and other scut that a specialist never sees. 4. No patient is ever truly well. I.E., if you have a patient who comes into your office for a checkup, you've got a bunch of stuff to do: Schedule colonoscopy, check lipids, rectal, PSA, breast exam, PAP smear, DEXA scan, etc, etc, etc. That same patient goes into a nephrologists' office or an optho or a dermatologist's office, it's: fix the kidney problem, that's it, get intraocular pressure measured and glaucoma eyedrops, or get clindamycin for acne and get a mole removed for $400. And the specialist rare needs to see them again but in that one visit has made more than you will in 5 visits. And for any other problems, the specialist will say: go to your primary care doctor for that. But you can't say that as a general IM doctor.

SO, in a word: SPECIALIZE. You will never meet me, but UNLESS you truly have a heart of gold, IM is truly not worth it.

My two cents, but trust me, SPECIALIZE. I know I have a reward in Heaven for the good I have just done you 🙂

 

[Cardiovert]

Emeka,

Just do me a favor and file this one away in your brain:
SPECIALIZE.

That's it.

The reason? Medicine is more unattractive than it has ever been. Like every specialty, the pendulum will probably swing back towards IM's favor because at this rate, there simply will not be enough docs willing to do IM in I don't know, say 10-15 years. The only reason left to do IM is if you truly love it, that's it. In every other way, it stinks. 1. You get dumped on by every other conceivable specialty. If your patient is fecally impacted, its yours. If your patient is in intractable pain, its yours. If your patient is having an MI, its yours. If your patient is just anxious, its yours. If your patient has hemorrhoids, its yours. You can consult specialists, but you have to deal with every single problem first. Becuase as IM, you're supposed to know about everything. 2. Your pay is half what everyone elses is. Simply put, you do all the scut work and set your friendly specialist up for the $1000 procedure. 3. Paperwork: you're doing more of that than seeing your patients. Dictations, managing 10 chronic meds per patient, filling out disability forms, and other scut that a specialist never sees. 4. No patient is ever truly well. I.E., if you have a patient who comes into your office for a checkup, you've got a bunch of stuff to do: Schedule colonoscopy, check lipids, rectal, PSA, breast exam, PAP smear, DEXA scan, etc, etc, etc. That same patient goes into a nephrologists' office or an optho or a dermatologist's office, it's: fix the kidney problem, that's it, get intraocular pressure measured and glaucoma eyedrops, or get clindamycin for acne and get a mole removed for $400. And the specialist rare needs to see them again but in that one visit has made more than you will in 5 visits. And for any other problems, the specialist will say: go to your primary care doctor for that. But you can't say that as a general IM doctor.

SO, in a word: SPECIALIZE. You will never meet me, but UNLESS you truly have a heart of gold, IM is truly not worth it.

My two cents, but trust me, SPECIALIZE. I know I have a reward in Heaven for the good I have just done you 🙂

Well said. Pufftissue has indeed given you a clinical pearl. 👍

General IM blows and anyone who tells you otherwise is delusional. Go into any field other than general IM unless you like being the secretary, social worker, grunt, peon, garbage collector, ER b_tch, Surgery b_tch, Psych b_tch, Gyn b_tch of the medical community.

 

[Stormreaver]

I love IM and I'd love to be able to practice as a general internist. But I have to agree with the above posters. Unfortunately, IM has become less and less attractive, and I'll be specializing. That certainly seems to be the way to go.

 

[Jattdoc]

pufftissue......AMEN


thanks for the words of wisdom in both of the threads?


👍

 

[Henle]

....his summary is a 100% correct- I know because I went through IM residency. My only hope: people will vote with their feet, however there will be still many FMG willing to do it...

 

[abu barney]

....his summary is a 100% correct- I know because I went through IM residency. My only hope: people will vote with their feet, however there will be still many FMG willing to do it...

Ditto that, IM has become the pits of all specialties. In terms of lifestyle, most of the IM subspecialties also suck, maybe except allergy, rheum, endo, and GI. Cards makes you a killing, but that's if you wanna spend your life in the clinic. I agree that compensation for hospitalists are going to rise, and I can imagine in the near future that there will be a large demand for internists joining groups that do peri-op work for orthopods and other surgeons who lack the expertise needed for incredibly brainy tasks like following PTTs and writing for beta blockers. <Sigh> The future looks increasingly bleak.

 

[Neville Sarkari]

I don't think that IM is quite as bad as it is being made out here. I have been in private IM practice for 5 yrs and I enjoy it. You can see 25-30 patients a day in the clinic, 5-10 a day in the hospital and make 130-180k depending on your expenses, patient mix, etc.

I will agree that there is disparity with the income of some specialists, but they are also taking risks that I don't have to assume. With risk comes reward, but sometimes the risk bites you hard.

General IM can be rewarding both in practice and financially. A lot of us are starting to capture some of the ancillary services (lab, dexa scan, echo, ct, etc) and get those revenues. Most General IM already do stress tests, joint injections, LP's, etc. Since we usually direct the patient to those services we can control who does them.

I think the disparities in practice income will get resolved, specialists will make a lot less in the next few years. We will all probably make less, and I expect govt to control more and more of our lives. I think that we will all be working for the govt in 15-20 yrs...

Neville Sarkari M.D.

 

[uclabruins47]

what's the malprac these days for gen. IM? and also is the 130-180k gross salary before taxes and expenses?

 

[Neville Sarkari]

what's the malprac these days for gen. IM? and also is the 130-180k gross salary before taxes and expenses?

Well, malpractice depends greatly on which state you live in because different states have different malpractice laws and climates. However, about 10-20k is probably a good estimate.

130-180k gross salary is before income taxes. It is after deducting all other expenses, including malpractice. Most people would want to deduct another 40k from the gross and put it into a retirement fund (but you don't have to.)

Neville Sarkari MD
Private Practice IM

 

[Gil B]

Much of the above referenced frustrations would disappear if so many services were not expected to be done for free. To this end I recently drafted the following for use in my private practice.

Preamble to
Old Style Personal Service Agreement


Whereas the world has become a less friendly place, and
Whereas it is harder today to get things done than it used to ?

I offer you the option of a personal service agreement. To make things easier for you, I will provide services so as to make office visits less necessary. These services include:

telephone appointments for items that do not reasonably require your appearance in the office, such as recurrent sinusitis, uncomplicated bladder infections and medication changes. It includes email service. It includes overcoming insurance company refusals to pay for your medicines. It includes resolving pharmacy problems that prevent you from picking up your prescriptions. It includes dealing with mail-in pharmacies if you use them.

These services are not covered by the large majority of insurances nor Medicare. I propose a straight hourly rate. The usual cost for medical service is far greater than $200/hour. $180/hour will make it so I can do this for you. Because many of the services can be done quickly, the cost would not be substantial. Your total cost for personal service would not exceed $50 without your notification. Typically this amount would represent from two to five such services.


XXXXX XXXXX, MD
Family and General Medicine
1600 Creekside Dr.
Folsom, CA 95630
voice (916) 983-0000
fax (916) 983-0000
October 2004






____________________ __________
sign me up (patient signature) date


Preamble to
Old Style Personal Service Agreemen

Whereas the world has become a less friendly place, and
Whereas it is harder today to get things done than it used to ?

I offer you the option of a personal service agreement. To make things easier for you, I will provide services so as to make office visits less necessary. These services include:

telephone appointments for items that do not reasonably require your appearance in the office, such as recurrent sinusitis, uncomplicated bladder infections and medication changes. It includes email service. It includes overcoming insurance company refusals to pay for your medicines. It includes resolving pharmacy problems that prevent you from picking up your prescriptions. It includes dealing with mail-in pharmacies if you use them.
These services are not covered by the large majority of insurances nor Medicare. I propose a straight hourly rate. The usual cost for medical service is far greater than $200/hour. $180/hour will make it so I can do this for you. Because many of the services can be done quickly, the cost would not be substantial. Your total cost for personal service would not exceed $50 without your notification. Typically this amount would represent from two to five such services.

Gil Carter, MD
Family and General Medicine
1600 Creekside Dr., Suite 3300 Folsom, CA 95630
voice (916) 983-7200 fax (916) 983-8591
October 2004




_________________________ ____________
sign me up (patient signature) date

 

[mahylo]

Emeka,

Just do me a favor and file this one away in your brain:
SPECIALIZE.

That's it.

The reason? Medicine is more unattractive than it has ever been. Like every specialty, the pendulum will probably swing back towards IM's favor because at this rate, there simply will not be enough docs willing to do IM in I don't know, say 10-15 years. The only reason left to do IM is if you truly love it, that's it. In every other way, it stinks. 1. You get dumped on by every other conceivable specialty. If your patient is fecally impacted, its yours. If your patient is in intractable pain, its yours. If your patient is having an MI, its yours. If your patient is just anxious, its yours. If your patient has hemorrhoids, its yours. You can consult specialists, but you have to deal with every single problem first. Becuase as IM, you're supposed to know about everything. 2. Your pay is half what everyone elses is. Simply put, you do all the scut work and set your friendly specialist up for the $1000 procedure. 3. Paperwork: you're doing more of that than seeing your patients. Dictations, managing 10 chronic meds per patient, filling out disability forms, and other scut that a specialist never sees. 4. No patient is ever truly well. I.E., if you have a patient who comes into your office for a checkup, you've got a bunch of stuff to do: Schedule colonoscopy, check lipids, rectal, PSA, breast exam, PAP smear, DEXA scan, etc, etc, etc. That same patient goes into a nephrologists' office or an optho or a dermatologist's office, it's: fix the kidney problem, that's it, get intraocular pressure measured and glaucoma eyedrops, or get clindamycin for acne and get a mole removed for $400. And the specialist rare needs to see them again but in that one visit has made more than you will in 5 visits. And for any other problems, the specialist will say: go to your primary care doctor for that. But you can't say that as a general IM doctor.

SO, in a word: SPECIALIZE. You will never meet me, but UNLESS you truly have a heart of gold, IM is truly not worth it.

My two cents, but trust me, SPECIALIZE. I know I have a reward in Heaven for the good I have just done you 🙂

I Love it!! AMEN!!!!!!