Is it unwise to pursue IM simply for fellowship?

[Drrrrrr. Celty]

Love inpatient. Hate outpatient but there's a caveat - I'm sure doing outpatient as an Attending is a lot better because you can set your own pace about managing patients instead of waiting to present to the Attending.

Gen IM Clinic also isn't hard if you just do 1 or 2 problems per visit either. Personally I think clinic is easy compared to the floor.

---

Members don't see this ad.

 

[Drrrrrr. Celty]

1000% only doing IM in order to do fellowship (GI). I know GI is a gamble but thats why I busted my ass on boards to do well knowing this going in. I wouldnt mind H/O either or A/I for the lifestyle so either way im good with any of those 3. I have too much debt from chiro school to be a GP and i would hate hospitalist work lol my personal opinion

The allure of butt gold.

 

[Osteoth]

The allure of butt gold.

$800 up there etc etc lmao

 

[Doctor_Strange]

Subspecialty clinic is basically the gem of IM. Also most subspecialties are still really outpatient intensive. Like 1-2 weeks a month is clinic for our general cardiologists here. You can be very heavily inpatient, but you're not going to be able to do that for >40 weeks a year.

Honestly you need to decide not whether you like inpatient medicine, but whether you enjoy what internal medicine is. Do you think that working up hyponatremia is akin to nails on chalkboard? Because you're going to be doing that more than you'll be putting in central lines and procedures or chest tubes. I mean it's hard to do IM if you're not interested in medicine and working up weird **** to ad nauseum. This is not like EM where it's diagnostic big picture.

Like I'm an internal medicine resident. I can tell you that I think inpatient kind of sucks, but I also think that it's horribly interesting and intellectually stimulating. Furthermore I'm at very much a community program, albeit one with a decent sized hospital system and a good academic environment, but our match rate for fellowships are very good. We have in house and we usually have a preference for our own graduates. So while we aren't quote on quote prestigious, there are a few applicants here who ranked bigger and more established programs because they probably have a better shot at matching a fellowship here.

That's actually something I realized I haven't been exposed to -- sub-specialty clinic. It's been all general outpatient. So I actually will retract my statement, I guess I can't say I hate outpatient since I haven't really done much outside of DM management follow up.

But your point is taken and truthfully I do like persevering over details -- the thought of discussing and figuring out the cause of someone's hyponatremia or hypercalcemia to me is the kind of diagnostic work up that I enjoy. I think that's what initially attracted me to EM, but it has taken me a long time to realize that they do less of figuring out the problem and more of identifying it. I also felt -- in all due respect to them -- that there was a ton of shotgun medicine which again I do not for a second question given the legal minefield and broad atypical patient presentations that are seen in the ED.

I'm excited for my upcoming PCCM rotation to finally get a feel for the specialty. I only did one week of ICU before being pulled due to COVID.

 

[Kaustikos]

Gen IM Clinic also isn't hard if you just do 1 or 2 problems per visit either. Personally I think clinic is easy compared to the floor.

Yup. Had a couple attendings that wanted me to bill for EVERYTHING under the sun. Sometimes it was ridiculous - here for follow up hypertension. Bill for.... Everything we assessed last month.
But I loved her clinic because I knew I could move fast and not waste time. I didn't need more than 3 minutes to read the chart. If there was an issue, I brought it up. But it was mostly follow up.
But other attendings moved at a snails pace and I just wanted to kill myself*


*no insult to those that move slow. Different people move at their own pace.

 

[Dwan]

I was a bit curt in my initial posts. The truth is I do enjoy inpatient medicine; I do not enjoy outpatient medicine whatsoever. That being said, if I were to match at a program that had multiple in-house fellowships, I likely would strive to match into a competitive specialty if the resources were available to me, specifically some of the more procedural specialties like Cardiology and PCCM.

Is it really a gamble if one can get into a reputable program w/ good fellowship match? I mean, I guess anything thing is a gamble in this world but I often hear that the number one reason is less about competitiveness and more about residents having a stronger desire to becoming an attending.

Fellowship isn't terribly competitive if you go to a reputable program and are ok with mid/low tier fellowship programs. Sometimes the home program can be tough if there are a lot of good internal candidates interested. You just can't be a flag resident. People do often switch out of fields like cards/GI, but moreso because those are very rigorous fellowships, people get tired after 3 yrs of IM, and learn they can make a lot as a hospitalist with a decent lifestyle.

 

[fldoctorgirl]

Honestly you need to decide not whether you like inpatient medicine, but whether you enjoy what internal medicine is. Do you think that working up hyponatremia is akin to nails on chalkboard? Because you're going to be doing that more than you'll be putting in central lines and procedures or chest tubes. I mean it's hard to do IM if you're not interested in medicine and working up weird **** to ad nauseum. This is not like EM where it's diagnostic big picture.

Me reading this like "hell yeah lemme work up that hyponatremia"...guess I know I'm picking the right field lol. I love IM workups. Also don't know if I can swing the subspecialist life. I'm on cards right now and although I find the pathology really interesting and I'm enjoying the thought process and overall climate way more than any other rotation thus far (haven't had IM yet), I hate how everything is like "ok primary is working this up not our problem". I feel like we just manage the same 3 conditions all day, there's none of that working up weird **** as you say. I wanna work up everything lol

 

[gutonc]

Me reading this like "hell yeah lemme work up that hyponatremia"...guess I know I'm picking the right field lol. I love IM workups. Also don't know if I can swing the subspecialist life. I'm on cards right now and although I find the pathology really interesting and I'm enjoying the thought process and overall climate way more than any other rotation thus far (haven't had IM yet), I hate how everything is like "ok primary is working this up not our problem". I feel like we just manage the same 3 conditions all day, there's none of that working up weird **** as you say. I wanna work up everything lol

You like it now but....

My favorite thing to write in a note is "defer to PCP for workup/treatment". I mean, I even made it a smartphrase.

 

[Drrrrrr. Celty]

Fellowship isn't terribly competitive if you go to a reputable program and are ok with mid/low tier fellowship programs. Sometimes the home program can be tough if there are a lot of good internal candidates interested. You just can't be a flag resident. People do often switch out of fields like cards/GI, but moreso because those are very rigorous fellowships, people get tired after 3 yrs of IM, and learn they can make a lot as a hospitalist with a decent lifestyle.

Idk, even good applicants don't match GI.

 

[Kaustikos]

You like it now but....

My favorite thing to write in a note is "defer to PCP for workup/treatment". I mean, I even made it a smartphrase.

Medical management as per primary team

or my favorite -
Re-consult as needed

 

[Drrrrrr. Celty]

That's actually something I realized I haven't been exposed to -- sub-specialty clinic. It's been all general outpatient. So I actually will retract my statement, I guess I can't say I hate outpatient since I haven't really done much outside of DM management follow up.

But your point is taken and truthfully I do like persevering over details -- the thought of discussing and figuring out the cause of someone's hyponatremia or hypercalcemia to me is the kind of diagnostic work up that I enjoy. I think that's what initially attracted me to EM, but it has taken me a long time to realize that they do less of figuring out the problem and more of identifying it. I also felt -- in all due respect to them -- that there was a ton of shotgun medicine which again I do not for a second question given the legal minefield and broad atypical patient presentations that are seen in the ED.

I'm excited for my upcoming PCCM rotation to finally get a feel for the specialty. I only did one week of ICU before being pulled due to COVID.

I think that's something I wish I had exposure to as a med student. I absolutely love subspecialty internal medicine clinics. I love being able to do something well and not focus on everything.

Yah I think you'd prefer IM.

Critical care is intense though. And right now it's not a good field. It's covid critical pulmonology and it's tough.

 

[Kaustikos]

Yah I think you'd prefer IM.

Critical care is intense though. And right now it's not a good field. It's covid critical pulmonology and it's tough.

Intense and there are only increasing numbers of applicants every year. It's entertaining if not exhausting sometimes.

 

[Chemist0157]

Me reading this like "hell yeah lemme work up that hyponatremia"...guess I know I'm picking the right field lol. I love IM workups. Also don't know if I can swing the subspecialist life. I'm on cards right now and although I find the pathology really interesting and I'm enjoying the thought process and overall climate way more than any other rotation thus far (haven't had IM yet), I hate how everything is like "ok primary is working this up not our problem". I feel like we just manage the same 3 conditions all day, there's none of that working up weird **** as you say. I wanna work up everything lol

You need some typical/mundane to make it through the day. I feel like I only need like 1-2 interesting things for the day to be satisfied. Once you get out in practice, you are going to be doing it for years so plenty of time to see all kinds of things.

But hey, when you're out in practice and feel like you have the capacity/training to do something, and nobody else is really dealing with it yet, you can do it.

 

[Drrrrrr. Celty]

You need some typical/mundane to make it through the day. I feel like I only need like 1-2 interesting things for the day to be satisfied. Once you get out in practice, you are going to be doing it for years so plenty of time to see all kinds of things.

But hey, when you're out in practice and feel like you have the capacity/training to do something, and nobody else is really dealing with it yet, you can do it.

I think there's no denying that we need some amount of auto mode. Besides there is plenty of satisfaction in putting in 40 of lasix bid and watching a chfer deflate.

 

[Osteoth]

Idk, even good applicants don't match GI.

GI is a freaking blood bath.

 

[HemeOncHopeful19]

GI is a freaking golden poopbath.

Fixed for ya!

 

[Espressso]

This has been a great thread to read as an IM applicant with hopes to match into fellowship down the line.

 

[blue.jay]

This has been a great thread to read as an IM applicant with hopes to match into fellowship down the line.

From my personal experience and observation (with bias) i will rank IM fellowships by satisfaction (by observing specialist in my work place/residency) and compensation.

GI > Oncology > Cardiology > Critical Care > Rheumatology > Endocrine > ID = Nephrology (some physicians in good private practice group were much happier, will rate them higher than rheum).

 

[Nespresso]

Fellowship isn't terribly competitive if you go to a reputable program and are ok with mid/low tier fellowship programs. Sometimes the home program can be tough if there are a lot of good internal candidates interested. You just can't be a flag resident. People do often switch out of fields like cards/GI, but moreso because those are very rigorous fellowships, people get tired after 3 yrs of IM, and learn they can make a lot as a hospitalist with a decent lifestyle.

GI is a different world of competition compared to the others, by match rate alone AND the Caliber of the applicant pool. DOs for instance can walk into fellowship generally but would be very lucky to even match any GI fellowship.

 

[blue.jay]

GI is a different world of competition compared to the others, by match rate alone AND the Caliber of the applicant pool. DOs for instance can walk into fellowship generally but would be very lucky to even match any GI fellowship.

I know plenty of IMGs from average (even below average) schools with average scores (240s) and few posters and 1-2 publication while on visa matching in some GI/cards program somewhere in the country. Is this a bias against DOs or is that they don't apply broadly? Shouldn't they be better than IMGs considering they don't have visa issues and their schooling is comparable to USMDs?

Though, the visa requiring IMGs I know in cards/GI are predominantly women. I have heard rumors that cards, gi, crit are trying to recruit more women to increase gender diversity.

 

[Dwan]

GI is a different world of competition compared to the others, by match rate alone AND the Caliber of the applicant pool. DOs for instance can walk into fellowship generally but would be very lucky to even match any GI fellowship.

I agree it is different for DO, but I do not agree it is a different world of competition. There are many GI fellowship spots that are not particularly competitive. If from a strong program, the only reason people do not match is some flag, or applying to too few places.

 

[Redpancreas]

1000% only doing IM in order to do fellowship (GI). I know GI is a gamble but thats why I busted my ass on boards to do well knowing this going in. I wouldnt mind H/O either or A/I for the lifestyle so either way im good with any of those 3. I have too much debt from chiro school to be a GP and i would hate hospitalist work lol my personal opinion

Board scores mean very little for GI applications when evaluated independently of your residency program.
---

In terms of the overall question, the reason why they make you do IM is to understand medicine in its context. There's a lot to learn and you can not be a good specialist without at least understand whether a presenting complaint is related to your field or not. Whether or not doing IM just to do GI/Cards is controversial. If you're determined to do it because you love it, you will end up where you want to be at the end of the day and should go for it. On the contrary, if you're just looking to the quickest non-surgical way to 300K a year an have kids/life plans, it's probably not a good fit. You have to like complex patients and pathophysiology to do IM and then fellowship is really just an extension of one of its branches.

 

[Redpancreas]

GI is a different world of competition compared to the others, by match rate alone AND the Caliber of the applicant pool. DOs for instance can walk into fellowship generally but would be very lucky to even match any GI fellowship.

When there's a will, there's a way. If it's what someone wants to do ad they're willing to put time into it, anything is possible. The competition is definitely there, but if you like something and you ca put in the work, it shouldn't be the reason you decide not to do it.

 

[Deecee2DO]

Board scores mean very little for GI applications when evaluated independently of your residency program.
---

In terms of the overall question, the reason why they make you do IM is to understand medicine in its context. There's a lot to learn and you can not be a good specialist without at least understand whether a presenting complaint is related to your field or not. Whether or not doing IM just to do GI/Cards is controversial. If you're determined to do it because you love it, you will end up where you want to be at the end of the day and should go for it. On the contrary, if you're just looking to the quickest non-surgical way to 300K a year an have kids/life plans, it's probably not a good fit. You have to like complex patients and pathophysiology to do IM and then fellowship is really just an extension of one of its branches.

They do matter indirectly because they open doors at the academic programs with in-house fellowships especially for DOs wanting GI. Doing well on Step 1 opens doors for me at the better academic IM programs. Where you do IM and whether or not they have good GI fellowship placement increases your chances of matching GI which is very competitive to begin with. So overall I disagree that they matter very little especially for DO students like i mentioned

 

[InternistDO]

From my personal experience and observation (with bias) i will rank IM fellowships by satisfaction (by observing specialist in my work place/residency) and compensation.

GI > Oncology > Cardiology > Critical Care > Rheumatology > Endocrine > ID = Nephrology (some physicians in good private practice group were much happier, will rate them higher than rheum).

Also anecdotally, but the ID attendings I’ve worked with all seem very satisfied with their jobs and the crit care ones always seem a bit frazzled. In terms of income there’s no comparison though.

 

[Deecee2DO]

Me reading this like "hell yeah lemme work up that hyponatremia"...guess I know I'm picking the right field lol. I love IM workups. Also don't know if I can swing the subspecialist life. I'm on cards right now and although I find the pathology really interesting and I'm enjoying the thought process and overall climate way more than any other rotation thus far (haven't had IM yet), I hate how everything is like "ok primary is working this up not our problem". I feel like we just manage the same 3 conditions all day, there's none of that working up weird **** as you say. I wanna work up everything lol

This is so me lmao

 

[Drrrrrr. Celty]

From my personal experience and observation (with bias) i will rank IM fellowships by satisfaction (by observing specialist in my work place/residency) and compensation.

GI > Oncology > Cardiology > Critical Care > Rheumatology > Endocrine > ID = Nephrology (some physicians in good private practice group were much happier, will rate them higher than rheum).

I think Cards is kind of overworked. I've never met a non-exhausted cardiologist. This not to even talk about interventionalists.

 

[Drrrrrr. Celty]

Also anecdotally, but the ID attendings I’ve worked with all seem very satisfied with their jobs and the crit care ones always seem a bit frazzled. In terms of income there’s no comparison though.

Crit care is where the frazzled go to play. You're not really doing critical care if you haven't blamed a subspecialist for not doing their job.

 

[Drrrrrr. Celty]

They do matter indirectly because they open doors at the academic programs with in-house fellowships especially for DOs wanting GI. Doing well on Step 1 opens doors for me at the better academic IM programs. Where you do IM and whether or not they have good GI fellowship placement increases your chances of matching GI which is very competitive to begin with. So overall I disagree that they matter very little especially for DO students like i mentioned

I think you missed his point. Once you're in your board scores aren't as important. Generally most IM graduates applying for fellowships and matching are already somewhere in the realm of 235/ 245 for step 1 and step 2 respectably. And when you're shooting for GI differentiating candidates isn't effective with that measure.

Simply put you can pretty much exclusively fill all the GI programs in the country with Mid tier university MD graduates and up.

 

[Deecee2DO]

I think you missed his point. Once you're in your board scores aren't as important. Generally most IM graduates applying for fellowships and matching are already somewhere in the realm of 235/ 245 for step 1 and step 2 respectably. And when you're shooting for GI differentiating candidates isn't effective with that measure.

Simply put you can pretty much exclusively fill all the GI programs in the country with Mid tier university MD graduates and up.

Well my point is that matching mid tier IM as a DO can be a huge advantage and many times destroying Step 1 will help you get there as a DO. A DO matching at a place like Brown or Gtown (which I would say are approaching mid-tier-ish) has a darn good chance matching GI compared to many of his/her DO peers shooting for a GI spot coming from low tier academic, community or AOA IM programs. But i see what he/she is saying that once youre in an IM program Step 1 doesnt matter as much however Step 1 can help open more doors if it can help you match well to begin with

 

[rokshana]

GI is a different world of competition compared to the others, by match rate alone AND the Caliber of the applicant pool. DOs for instance can walk into fellowship generally but would be very lucky to even match any GI fellowship.

not really...cards is pretty competitive and pull/cc is getting there...yes GI is competitive, but its not Derm or Urology...after all they are IM residents that are applying for the fellowships...and no, look at the NRMP data...even non competitive IM fellowships don't have a lot of DOs ...can DOs get fellowships, sure, but its misleading to make people think its a walk in the park for DOs.

 

[blue.jay]

Also anecdotally, but the ID attendings I’ve worked with all seem very satisfied with their jobs and the crit care ones always seem a bit frazzled. In terms of income there’s no comparison though.

I agree that ID guys enjoy what they do and majority of the critical care docs look burnt out at work. I am assuming they are taking that stress with higher pay to enjoy their week off from the hospital.

 

[Doctor_Strange]

I think Cards is kind of overworked. I've never met a non-exhausted cardiologist. This not to even talk about interventionalists.

The cardiologist I rotated with told me he couldn't remember the last time he did not come in to his clinic on a Saturday morning to catch up on notes or whatnot. He seemed extremely spent. When I asked him about the specialty he told me to go into EM lol although he did say he enjoyed his work outside of his otherwise unfriendly call schedule.

 

[Deecee2DO]

I think Cards is kind of overworked. I've never met a non-exhausted cardiologist. This not to even talk about interventionalists.

Agree 100%. When i did my elective in interventional every single one of these guys seemed miserable. They were running around the hospital stressed as **** and never looked happy. I couldnt wait until the rotation was over. Upside is they make bank lol still not for me

 

[Espressso]

Agree 100%. When i did my elective in interventional every single one of these guys seemed miserable. They were running around the hospital stressed as **** and never looked happy. I couldnt wait until the rotation was over. Upside is they make bank lol still not for me

FWIW I noticed the complete opposite with the non-interventionalists. They were chill and really enjoyed the work. The interventionalists were definitely miserable and constantly exhausted.

 

[Deecee2DO]

FWIW I noticed the complete opposite with the non-interventionalists. They were chill and really enjoyed the work. The interventionalists were definitely miserable and constantly exhausted.

Could totally see this

 

[Drrrrrr. Celty]

Well my point is that matching mid tier IM as a DO can be a huge advantage and many times destroying Step 1 will help you get there as a DO. A DO matching at a place like Brown or Gtown (which I would say are approaching mid-tier-ish) has a darn good chance matching GI compared to many of his/her DO peers shooting for a GI spot coming from low tier academic, community or AOA IM programs. But i see what he/she is saying that once youre in an IM program Step 1 doesnt matter as much however Step 1 can help open more doors if it can help you match well to begin with

I think someone whose applying to GI from a community program with in house GI will probably have a better shot at GI. I think there's nuance.

 

[Deecee2DO]

I think someone whose applying to GI from a community program with in house GI will probably have a better shot at GI. I think there's nuance.

I still disagree with that if you are at a mid tier program That also has in-house GI fellowship they’re still going to have a better shot just because of the program they’re coming from. Being at an academic mid tier as a DO gives you an advantage for any fellowship since youll have more resources aka academic faculty and research opportunities than an IM applicant coming from a community program regardless if they have inhouse fellowships or not

 

[rokshana]

I still disagree with that if you are at a mid tier program That also has in-house GI fellowship they’re still going to have a better shot just because of the program they’re coming from. Being at an academic mid tier as a DO gives you an advantage for any fellowship simply because youll have more resources aka academic faculty and research opportunities than a community program

You will be a known entity at the program that is in house...if they know you and like you, your best shot at a fellowship, no matter how competitive, is going to be where they know you.

 

[Deecee2DO]

You will be a known entity at the program that is in house...if they know you and like you, your best shot at a fellowship, no matter how competitive, is going to be where they know you.

Yeah but still being at an academic mid tier with in-house GI fellowship still gives you the upper hand no matter what If you’re comparing it to being at a community program wit inhouse fellowship. let’s say Neither applicant from either scenario matches in-house now the academic applicant has a better shot

 

[rokshana]

Yeah but still being at an academic mid tier with in-house GI fellowship still gives you the upper hand no matter what If you’re comparing it to being at a community program wit inhouse fellowship. let’s say Neither applicant from either scenario matches in-house now the academic applicant has a better shot

Well if you are going to put it that way...the USMD applicant will have a better shot than the DO...no matter where they come from.

you have to optimize your application as much as...the academic place may not take their own and look to get fresh blood...cleveland clinic for example rarely takes their own into fellowship...where as the uni affiliated or community programs will give their chiefs pick of fellowship, even GI...

 

[Deecee2DO]

Well if you are going to put it that way...the USMD applicant will have a better shot than the DO...no matter where they come from.

you have to optimize your application as much as...the academic place may not take their own and look to get fresh blood...cleveland clinic for example rarely takes their own into fellowship...where as the uni affiliated or community programs will give their chiefs pick of fellowship, even GI...

Yeah i agree the USMD will have a better shot but im talking about comparing DOs here

 

[Drrrrrr. Celty]

Yeah but still being at an academic mid tier with in-house GI fellowship still gives you the upper hand no matter what If you’re comparing it to being at a community program wit inhouse fellowship. let’s say Neither applicant from either scenario matches in-house now the academic applicant has a better shot

Being in a large program with 32 interns and 2 or 3 GI spots open and a lot more academic residents who want to subspecialize means your odds of matching there are far worse than at a program with 10 interns who are spread out in their interests with 2 GI spots open and match mainly from their program.

I think this is the nuance that is missed in many respects with applying.

 

[Siggy]

You are spot on - I used to think the same, that EM work seemed better than hospitalisit work because you're almost always doing something, an endless stream of patients at 2-3 per hour. Now as an attending hospitalist, eff that! I liked admitting only 6 patients and being able to rewatch Saving private ryan and mad max fury road at work yesterday night (as a nocturnist) and put in a couple hours of COD:MW. Sure I get 20% less hourly pay than the ER doc downstairs but I'm doing less than 50% of the work.

Also I don't think hospitalists with at least a tinge of experience bother prerounding before shift. Most of us just show up and pick up the list, open the chart and go at it.

I'm in my first post-fellowship job and I transitioned to being the nocturnist. My group picked up a few hospitals and is drastically understaffed unfortunately (1 attending during the day assuming no one wants to pick up extra shifts... which means anywhere from 25-40 patients over the past month with 3 NPs).

Since we don't have enough physicians we aren't required to provide 100% night coverage yet. So by going to nights I do much less work, get paid more per hour, and basically get to pick my own schedule. The number of hours I've put into Among Us or going to the hospital's gym has been amazing.

 

[Kaustikos]

This thread has been derailed...lol

 

[Deecee2DO]

Being in a large program with 32 interns and 2 or 3 GI spots open and a lot more academic residents who want to subspecialize means your odds of matching there are far worse than at a program with 10 interns who are spread out in their interests with 2 GI spots open and match mainly from their program.

I think this is the nuance that is missed in many respects with applying.

As a DO applicant Id rather attend a mid tier uni program regardless if I had the option to

 

[Doctor_Strange]

This thread has been derailed...lol

Still all enlightening for me as a fourth year med student.

I'm on a PCCM elective right now, and honestly, I've been enjoying it immensely. It's making me excited as a possible sub-specialty. The ICU can at times be depressing if the patient is gonna die no matter what we do otherwise the variety has been a welcome experience and I feel like patients actually care about your opinion. In contrast, when I have been in the ED I often desired a more meaningful relationship or even just conversations that were meaningful beyond "is your pain better?" or "we are gonna admit you overnight for observation". For example, today a patient with metastatic lung cancer wrote down everything the doc was explaining about his plan -- she was invested in her care. These interactions were something I didn't even realize I wanted until *after* doing several EM rotations.

 

[blue.jay]

Still all enlightening for me as a fourth year med student.

I'm on a PCCM elective right now, and honestly, I've been enjoying it immensely. It's making me excited as a possible sub-specialty. The ICU can at times be depressing if the patient is gonna die no matter what we do otherwise the variety has been a welcome experience and I feel like patients actually care about your opinion. In contrast, when I have been in the ED I often desired a more meaningful relationship or even just conversations that were meaningful beyond "is your pain better?" or "we are gonna admit you overnight for observation". For example, today a patient with metastatic lung cancer wrote down everything the doc was explaining about his plan -- she was invested in her care. These interactions were something I didn't even realize I wanted until *after* doing several EM rotations.

PCCM is like the ED among IM subspecialties. You actually don't get to know patients that well as most of them and their families are in the worst possible state. Based on what you experienced I would suggest trying an out-patient hem/once elective and that will be far more gratifying. Do not ask for in patient oncology or BMT that could be depressing.

 

[blue.jay]

I'm in my first post-fellowship job and I transitioned to being the nocturnist. My group picked up a few hospitals and is drastically understaffed unfortunately (1 attending during the day assuming no one wants to pick up extra shifts... which means anywhere from 25-40 patients over the past month with 3 NPs).

Since we don't have enough physicians we aren't required to provide 100% night coverage yet. So by going to nights I do much less work, get paid more per hour, and basically get to pick my own schedule. The number of hours I've put into Among Us or going to the hospital's gym has been amazing.

Not trying to de-rail from the actual thread. Nocturnist job does provide great flexibility. The large academic center where I work used to have Nocturnists who used to cover the whole weekend (48 hrs) and they do 2 such weekends a month and for the rest of their time they worked with GI attendings doing research. One guy I knew who did that only matched on this 3rd attempt (but he was a IMG on visa). It shouldn't be that hard for a DO or US-IMG who can get something productive done in 1 yr as a nocturnist

 

[Doctor_Strange]

It's seem timely to say seeing all the #MedTwitter posts about fellowship match made me think of all those that did not match. Saw a reddit comment by a resident that the PD for their fellowship wrote them a LOR and he didn't even rank there despite all the signals he/she would...