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Is Internal Medicine Really That Bad?

Discussion in 'Internal Medicine and IM Subspecialties' started by EMDO2018, May 15, 2014.

  1. EMDO2018

    EMDO2018 Banned Banned

    Oct 8, 2013
    I don't know
    I shadowed two internist and like the variety of cases, but inpatient appealed to me more. Why do internist have the lowest satisfaction of any specialty, even lower than FM? Only 27% say they would choose IM again.

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  3. EMDO2018

    EMDO2018 Banned Banned

    Oct 8, 2013
    I don't know
  4. ChrisGriffen

    ChrisGriffen Banned Banned 2+ Year Member

    Aug 29, 2013
  5. jdh71

    jdh71 epiphany at nine thousand six hundred feet Physician 10+ Year Member

    Dec 14, 2006
    FEMA Camp, USA
    Gotta do what you like, though most people in IM don't stay in pure IM, they do a specialty. I wonder how the survey asked the question. Lots of people who go straight to work later often wish they had done a fellowship, but once you get going it's very hard to go back.
  6. DIce3

    DIce3 5+ Year Member

    Apr 4, 2011
    not currently in Quebec
    Here is the answer: If all physicians had the same earnings, had the same level of prestige, and worked the same number of hours, traditional general internal medicine (defined as: inpt + outpt) would be a competitive specialty. General IM is the ultimate, unless you want to live in the OR, because the diversity and complexity of the specialty is awesome. That said, the first three statements listed above are definitely not true, and as a result, general internal medicine sits near fast food worker in degree of competitiveness. Essentially no one is currently going from medical school into traditional general internal medicine. This is a tragedy. I LOVE traditional general IM but even I am constantly pissed off by how unequal the first three things are compared to other specialties. Every year we have more paperwork to fill out for free, more hoops, more nonsense, and less money all the while dermatologists make twice as much, working half as much. Any issues? just send the patient back to the internist. Paperwork? send back to the internist. Preauth? Send back to the internist. We are considered equal to the online-trained PA/ARNP now so I think it is ok for us to be replaced as we clearly have no value. It is total nonsense and I think the 27% relates to this topic exactly: we sitting with the rotting trash and are tired of it.
    DermViser, Kahreek and anbuitachi like this.
  7. padastra


    Mar 20, 2014
    While true that IM is easy to get into, it is not true that any IM program is easy to get into--the distribution of competitiveness is probably the widest of any field: residents accepted to the very top programs (e.g. UCSF, MGH) were generally very competitive for any specialty at any program, and residents accepted to e.g. mid-tier IM programs were probably barely competitive for surgical subspecialties, and some residents accepted to ****ty community programs probably shouldn't be doctors.

    The thing that drove me into IM is the flexibility. Even with just residency completed, clinical jobs range from primary care (business hours + lots of follow-up and off-hour work) to hospitalist work (shiftwork, one week heavy one week off, nice salary). You can easily pursue academia and teach, do basic science research, do clinical research, or do public health research. You can subspecialize into something that's very outpatient such as Endocrine or something that is inpatient and procedure-heavy like Critical Care. If you look around your medical school and hospital, you might find that a large proportion of the high-up administration were originally from medicine, and I don't think that is a coincidence. For myself personally, I have a business / entrepreneurial background, so taking a field with a short residency, still adding a ton of value to myself to e.g. a healthcare investment boutique, and being able to pursue part-time clinical work just made the most sense.

    I think any field will get boring--at least, I get bored easily and have never done anything for 40 years. Medicine offers the most diversification of my career. Lastly, the world is changing at a rapid pace, and who knows what e.g. Radiology will look like in 20 years? Or Pathology? Or Dermatology? --or Internal Medicine, but with the diversity of the field you're protected a little bit.

    It is absolutely true that general medicine faces some very difficult challenges. We saddle medical students with $200k in debt and 8 years of additional schooling (+ residency) and then ask them to prioritize patient care over their own ability to pay off that debt. Sure you can argue that $150k is more than enough even then, but how can I fault anyone for pursuing fields with a significantly higher $/work-hr ratio? At the same time, the reimbursements are lower and the qualifications to get that reimbursement (documentation, patient satisfaction will be upcoming, etc.) are higher. I think a lot of general practice people feel unfairly targeted: and it's true, but the thing is that general practice represents such a large slice of the pie that a 1% cut there is so much more total savings than a 1% cut to e.g. dermatology. That's why there's so much focus.

    Lastly, unlike procedure-oriented fields general medicine is a field which is most dependent on a patient's personal insight and decision-making--something that primary care physicians are expected to improve, but how do they do it? Nobody really knows except to modify reimbursements as seen above (even though there is very minimal evidence that incentivizing PROVIDERS will result in better PATIENTS, in fact there are a couple studies that show this not to be true). And frankly if we figured out how to improve people's insight and decision-making we'd corner the market in all education, not just health education. Like seriously. If you can get people to discipline themselves everyday and make good long-term decisions, you could ****ing eliminate poverty.

    So is it that bad? No I think it's wonderful. But at the same time, there's enough **** going on that I don't think it a personally and financially sound decision to go into primary care without diversifying your career. Even though it's arguably what society needs the most. But --- primary care is NOT equal to internal medicine.

    Addendum: HIV / ID is one of the higher ones up there. Clearly there are a lot of factors involved besides the $ / work-time ratio.
    Last edited: May 15, 2014
  8. visari

    visari 2+ Year Member

    Sep 14, 2013
    Speaking to some PCPs, a lot of them complain about the amount of paper work and documentation they need to do. This has increased dramatically in the last few years and is getting at their nerves. They can't prescribe a medication without a preauth form to fill out, a phone call to the insurer, a doc-to-doc talk...etc. useless core measures and check boxes for each and every diagnosis that are designed for billing purposes rather than true patient care.
    Having said that, those who are genuinely interested in general IM still like their jobs and find joy in what they do. While those whom general IM was their only option because they couldn't get into fellowship are usually miserable.

    Generally speaking, unless you do your IM residency in a crappy place or have some big red flags on your CV you shouldn't have a problem getting your desired fellowship. So thinking of IM as a bridge to your other career goals is not unreasonable. I don't know why some people try to paint it all black but the general rule is that you still CAN get into fellowship if you want to and show some interest. And it's not like the "good" residents go for fellowships while he "not so good" ones do general IM. for example, some of the smartest people in my class are actually going for general IM (inpt and outpt) and they were definitely better residents than those going for cardiology or GI this year.

    Also, I don't agree with the tone that general IM is a bad field because it's less competitive than other specialties. competitiveness reflects money and prestige more than any thing else. for ex GI is not a better specialty than nephrology by any means. it's not more complex nor more interesting, but it currently brings more $$ and has more job openings. That's (and only that) is why GI is 10 times more competitive than nephro currently. Also, compare the number of spots for IM with that of ENT or neurosurgery, it wouldn't make sense for them to be of the same level of competitiveness.
    bashwell and Houmd like this.
  9. Gastrapathy

    Gastrapathy no longer apathetic Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Feb 27, 2007
    Hey look, more GI bashing in the IM forum.

    Sent from my iPhone 6 using Tapatalk
    MordFustang and DermViser like this.
  10. dozitgetchahi

    dozitgetchahi 7+ Year Member

    Oct 20, 2008
    Nothing he said is untrue.

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