Internal Medicine Specialty

[ImAVet]

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hi!

I've been accepted and will be attending Mizzou vet school starting in August! I know it is too early and all and I may change my mind in the future, but I am really considering specializing in internal medicine. I LOVE the whole idea of veterinary internists being known as the ones "solving the puzzle". Can anyone tell me more about this specialty (e.i how many years of internship/residency, how a typical day looks like for an internist, the pros and cons etc.)?

Any information would be greatly appreciated!!!

 

[twelvetigers]

hi!

I've been accepted and will be attending Mizzou vet school starting in August! I know it is too early and all and I may change my mind in the future, but I am really considering specializing in internal medicine. I LOVE the whole idea of veterinary internists being known as the ones "solving the puzzle". Can anyone tell me more about this specialty (e.i how many years of internship/residency, how a typical day looks like for an internist, the pros and cons etc.)?

Any information would be greatly appreciated!!!

One year internship and then three years residency, plus passing the boards. Someone else will have to speak on the others, though the extra four years of schooling and the very low pay associated with internship and residency positions (and the extra time student loans spend in deferment as a result) will certainly be one of the biggest cons.

 

[jmo1012]

hi!

I've been accepted and will be attending Mizzou vet school starting in August! I know it is too early and all and I may change my mind in the future, but I am really considering specializing in internal medicine. I LOVE the whole idea of veterinary internists being known as the ones "solving the puzzle". Can anyone tell me more about this specialty (e.i how many years of internship/residency, how a typical day looks like for an internist, the pros and cons etc.)?

Any information would be greatly appreciated!!!

I promise you that any vet in any form of clinical practice is "solving the puzzle" everyday. Internists are typically working with a subset of patients that require advanced diagnostics that are often not found at a general practice, such as ultrasound, endoscopy/rhinoscopy, advanced imaging, etc. Their appointment books are typically filled with complaints like chronic weight loss, chronic vomiting/diarrhea, unresponsive nasal discharge/sneezing, chronic coughing, elevated liver enzymes, and complicated cases of diabetes, cushings, etc. Essentially, sick patients that are not critically ill. There are general practitioners who refer a lot more than others, depending on their comfort level with these cases, available diagnostics (there are definitely clinics out there with competent ultrasonography, endoscopy), and client wishes.

internal medicine in school is going to be significantly different than real world IM. when i was on clinics, IM had some of the sickest, most complex cases in the hospital. however, where i'm at for my internship is a private practice. these cases typically end up with the critical care service, while the less sick patients typically transfer to medicine. IM works hand in hand with the other services here, with surgery and oncology being the biggest ones. we make lots of cancer diagnoses on medicine, things that need either surgical resection, surgical biopsies, or chemotherapy. in academia, you are probably looking at sicker and more complex cases since thats why people end up at the academic institution, but those are hard residencies to acquire, and even harder post-residency jobs to acquire.

i think over the next few years, it will be important for you to spend time shadowing both GPs and internists to get a sense of what it really means to be an internist. i promise you there are tons of GPs out there managing and diagnosing complex cases every day, so that's not really a good reason to specialize. those of us who specialize do it because its the only way for us to be happy and feel satisfied. trust me. if i could be happy without pursuing an extra 4 (though for many it is 5-7 extra years) years of training for grueling hours and minimal pay, i would ditch this path in a heartbeat. but i'm stuck, its not what makes me feel satisfied and complete, so a a residency/masters program for me it is!

 

[cowgirla]

I promise you that any vet in any form of clinical practice is "solving the puzzle" everyday. Internists are typically working with a subset of patients that require advanced diagnostics that are often not found at a general practice, such as ultrasound, endoscopy/rhinoscopy, advanced imaging, etc. Their appointment books are typically filled with complaints like chronic weight loss, chronic vomiting/diarrhea, unresponsive nasal discharge/sneezing, chronic coughing, elevated liver enzymes, and complicated cases of diabetes, cushings, etc. Essentially, sick patients that are not critically ill. There are general practitioners who refer a lot more than others, depending on their comfort level with these cases, available diagnostics (there are definitely clinics out there with competent ultrasonography, endoscopy), and client wishes.

!

This.

Most of the cases I refer to our internal med gurus are patients that have multiple chronic illnesses, and especially if they have multiple endocrine abnormalities. unregulated diabetes + cushingoid + other mystery disease causing neuro signs was my most recent referral.

The one before that was a dog that went from high level performance sports to unable to eat/chronic diarrhea/significant weight loss in less than three weeks. With that sudden decline we wanted her somewhere with the capabilities to get everything done NOW rather than waiting for this labwork one day and then that imaging the next day and then the other labwork a few days later.

 

[LetItSnow]

internal medicine in school is going to be significantly different than real world IM. when i was on clinics, IM had some of the sickest, most complex cases in the hospital. however, where i'm at for my internship is a private practice. these cases typically end up with the critical care service, while the less sick patients typically transfer to medicine.

I think that may be generally the case, but I work side by side with IntMed docs (our ER practice shares space with a referral practice at two locations) and they take plenty of what I would call "critical" cases - even with criticalists on their staff.

So there probably is a variety within that speciality, even outside academia.


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[jmo1012]

I think that may be generally the case, but I work side by side with IntMed docs (our ER practice shares space with a referral practice at two locations) and they take plenty of what I would call "critical" cases - even with criticalists on their staff.

So there probably is a variety within that speciality, even outside academia.


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There is definitely variety, our internists are the only ones taking critical cases at the hospitals where we don't have critical care

 

[ImAVet]

Thank you everyone for your advice! The thing is I don't see myself being happy with graduating from vet school then going into a practice as a general medicine vet. I shadowed one for 3 years and actually grew quit bored of it as it seemed to be the same things over and over. I need something more exciting, mysterious where I have to really put the pieces to the puzzle together. I like to break things down that are difficult to comprehend. I'm looking to see a variety of cases most days not the same old same old each day. If this makes sense at all. I have been researching different specialties and found internal medicine to be what attracted me the most because it seems to be exactly what I'm looking for. I thought dermatology would be a good fit for me as I love, as people say "looking/exploring the nasty things on skin". But what I noticed is I know many times things going wrong in the body will give you a sign on the skin, and finding out what is going on is what interests me the most. Are there other specialities that may include my interests?

 

[jmo1012]

Thank you everyone for your advice! The thing is I don't see myself being happy with graduating from vet school then going into a practice as a general medicine vet. I shadowed one for 3 years and actually grew quit bored of it as it seemed to be the same things over and over. I need something more exciting, mysterious where I have to really put the pieces to the puzzle together. I like to break things down that are difficult to comprehend. I'm looking to see a variety of cases most days not the same old same old each day. If this makes sense at all. I have been researching different specialties and found internal medicine to be what attracted me the most because it seems to be exactly what I'm looking for. I thought dermatology would be a good fit for me as I love, as people say "looking/exploring the nasty things on skin". But what I noticed is I know many times things going wrong in the body will give you a sign on the skin, and finding out what is going on is what interests me the most. Are there other specialities that may include my interests?

you actually may like ECC a lot better, the things you listed above are actually all reasons i find IM bland and boring. yes you are solving complex puzzles, but usually over time, and you are seeing the same variation of appointments every day. again, i think it ultimately comes down to getting a lot of experience in the field to help you decide. and also spending time with other specialties to get some experience there. one thing IM will likely get you that ER/CC will not is good QOL. you can work a few days a week during day hours and set the number of appointments you see. yes you may be there late some days, but the internists i've worked with have all had reasonable lives outside of work.

 

[Minnerbelle]

Thank you everyone for your advice! The thing is I don't see myself being happy with graduating from vet school then going into a practice as a general medicine vet. I shadowed one for 3 years and actually grew quit bored of it as it seemed to be the same things over and over. I need something more exciting, mysterious where I have to really put the pieces to the puzzle together. I like to break things down that are difficult to comprehend. I'm looking to see a variety of cases most days not the same old same old each day. If this makes sense at all. I have been researching different specialties and found internal medicine to be what attracted me the most because it seems to be exactly what I'm looking for. I thought dermatology would be a good fit for me as I love, as people say "looking/exploring the nasty things on skin". But what I noticed is I know many times things going wrong in the body will give you a sign on the skin, and finding out what is going on is what interests me the most. Are there other specialities that may include my interests?

From the above post it sounds like you don't really have a good understanding of what actual doctors specialized (the ones you've described) or not do. It would probably be in your best interest to really investigate before you start making up your mind.

Honestly, specialists are more likely to see the "same ole same ole" daily than a GP or ER vet. Particularly derm... Each specialty tends to have their bread and butter stuff they see over and over like it's groundhog's day, and scattered in there are the actually rare interesting things. It's more that they tend to have special modalities with advanced diagnostics or treatment that aren't done in GP settings (some can be, but it's hard for someone to get good at unless you do it all the time, which wouldn't happen without referrals).

I've been toying with the idea of specializing in something like dentistry as of late for the exact opposite reason. I personally take it hard when I feel like I'm not doing a GREAT job on things, and the reality is that as a GP I feel spread too thin and I feel really guilty when I have certain types of cases (ophtho especially) where I don't think I'm awesome at it. In a way, I like the fact that my day is always unpredictable. But when I have a string of cases where I'm feeling inadequate, I wonder if being the "best" or at least more of an authority figure at a limited scope of things would make me feel better.

Some people definitely do better as specialists, and others do better as generalists. And you could certainly fall into either category, but based on your comments I don't think you know enough to evaluate that for yourself. There's nothing wrong with that! So don't pigeonhole yourself too early and keep an open mind.

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[ImAVet]

From the above post it sounds like you don't really have a good understanding of what actual doctors specialized (the ones you've described) or not do. It would probably be in your best interest to really investigate before you start making up your mind.

Honestly, specialists are more likely to see the "same ole same ole" daily than a GP or ER vet. Particularly derm... Each specialty tends to have their bread and butter stuff they see over and over like it's groundhog's day, and scattered in there are the actually rare interesting things. It's more that they tend to have special modalities with advanced diagnostics or treatment that aren't done in GP settings (some can be, but it's hard for someone to get good at unless you do it all the time, which wouldn't happen without referrals).

I've been toying with the idea of specializing in something like dentistry as of late for the exact opposite reason. I personally take it hard when I feel like I'm not doing a GREAT job on things, and the reality is that as a GP I feel spread too thin and I feel really guilty when I have certain types of cases (ophtho especially) where I don't think I'm awesome at it. In a way, I like the fact that my day is always unpredictable. But when I have a string of cases where I'm feeling inadequate, I wonder if being the "best" or at least more of an authority figure at a limited scope of things would make me feel better.

Some people definitely do better as specialists, and others do better as generalists. And you could certainly fall into either category, but based on your comments I don't think you know enough to evaluate that for yourself. There's nothing wrong with that! So don't pigeonhole yourself too early and keep an open mind.

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I am feeling a little lost but that's OK. I still have a long way to go! I guess my best bet would be just to explore everything. I want something I will be passionate about. I will just have to explore my options and take advantage of everything Mizzou offers. I'm not quite sure if I am aware of all the specialties that exists. Maybe one will come up when I least expect it and I will fall in love with that. Who knows. But thank you and to everyone else for their advice. I definitely want a life outside of vet med so maybe ECC wouldn't be my choice. I'll keep exploring! 🙂

 

[jmo1012]

I am feeling a little lost but that's OK. I still have a long way to go! I guess my best bet would be just to explore everything. I want something I will be passionate about. I will just have to explore my options and take advantage of everything Mizzou offers. I'm not quite sure if I am aware of all the specialties that exists. Maybe one will come up when I least expect it and I will fall in love with that. Who knows. But thank you and to everyone else for their advice. I definitely want a life outside of vet med so maybe ECC wouldn't be my choice. I'll keep exploring! 🙂

I think the best thing to do in vet school is to always keep an open mind, try out as much as you can, and take advantage of as many of the once in a lifetime opportunities as you can. its game over for a lot of the neat things once you have a license, have to work a real job, have those responsibilities. also, in addition to the opportunities you have at the university, try to get some experience in private practice (specialty) because it is a different game.

dont fret, you have lots of time to decide what you want to do with the rest of your life 🙂 people get residencies when they've just made up their minds during internship year (i know a few).

 

[ImAVet]

I think the best thing to do in vet school is to always keep an open mind, try out as much as you can, and take advantage of as many of the once in a lifetime opportunities as you can. its game over for a lot of the neat things once you have a license, have to work a real job, have those responsibilities. also, in addition to the opportunities you have at the university, try to get some experience in private practice (specialty) because it is a different game.

dont fret, you have lots of time to decide what you want to do with the rest of your life 🙂 people get residencies when they've just made up their minds during internship year (i know a few).

Thank you so much for your advice! I've never experienced a private practice. I'll put that on my to do list! 🙂 I'll take advantage of every opportunity (I'll be paying too much to not do so! Haha) 🙂

 

[Braki]

You can honestly probably find good quality of life in any specialty if you make it a priority - for example, the criticalist at my vet school worked 8-5 and just helped oversee cases during the day, and wasn't on call, so the quality of life there was pretty great because of how it was structured. Conversely, I've definitely seen many internists work very long hours and not have a good quality of life. Certainly some specialties are better known for quality of life than others (e.g. radiology, derm) but for the others you can make it work if you have the right set-up.

When I first got into vet school I was also thinking about specializing in IM up until probably late in my third year when I started to have doubts. I ended up pursuing a different path because every time I talked to people for advice, I encountered an unsettling number of internists and IM residents who warned me against it and said that they had regretted going into it. So now I'm going to do a cardiology residency starting this year (coincidentally, also at Mizzou) which definitely was 100% the right choice for me but not something I realized until I was able to get more exposure to it. You have lots of time though to see the different specialties the decide what you want to do. If there's any opportunities to work in the hospital and get to know the different specialties I would definitely recommend it so you get an idea of what their daily life is like.