Is it worth specializing in SA Internal Med?

[ChaosArcher]

So I'm at a dilemma, and I'm not sure where to go from here.

I've always assumed I would leave vet school and go into general practice right away- it's the pragmatic choice, after all, and I've always been a pragmatic thinker. Diving straight in would mean I could start getting a good salary right away and start working on building a real life for myself, finally free of schools and grades and living off student loans.

However... two problems, with the GP path. The first problem, and perhaps the largest, I hate surgery. I mean I really, really hate surgery. I can do it, have done it- we did three surgeries this semester (2nd semester, 2nd year). The first was traumatic because I felt wholly overwhelmed by the atmosphere, despite assisting in many surgeries during my years shadowing, the second was fine, the third was also fine though I had at least 3 minor, silent panic attacks as the jejunal arteries I was tying off kept slipping and bleeding as I was trying to do my resection/anastomosis in the small bowel. So I really, really, really hate surgery, it's a different kind of stress for me and clearly the wrong sort for me to feel comfortable with, and the thought of being expected to do them for the rest of my life kind of makes me want to dissolve into the floor right now and give up.

Second problem, which is less of a problem, but- I love internal medicine. Love it, especially urology, oh it's so fun. We finally took our first urology course this semester, and I'm having a blast. In our AIMs courses (big case-based courses where we're given full cases to workup and apply the knowledge from our lectures) I'm always the one to dive straight into the CBC/chems/UA, gleefully sinking my teeth into infectious panels and tearing apart histories and physical exam findings like it's Christmas morning. I love internal medicine, and if you told me that was job from now till the end of time, I'd be happy with that.

But internal med specializing requires another year of internship, 3 more years of residency, and primary research which I tried out back in undergrad to crashing, burning failure (a research biologist I am not...). All of that comes with more uncertainty, more moving around, more being unsettled and longer before I can have a salary to count on, with the added stress of student loans coming due as I would no longer be in school.

Basically, is an internal medicine speciality worth it to avoid surgery altogether, especially given I love the field so much? And if it is, how do people make it work, with the stress of student loans and the financial demands of just trying to exist and live on a resident's pay? Or are there other options for those of us in vet med who love internal, greatly dislike surgery, but would still like to be able to practice primary medicine without having to go into speciality or referral clinics?

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[WildZoo]

Well, you can definitely practice in GP without doing surgery if that is what you want. It just takes finding the right clinic, and it may mean a longer job search for you. Depends on what the market is going to look like when you're looking for a job too - right now clinics are really hurting for doctors, that doesn't mean they will be at that same level in a couple of years. But generally presenting yourself as someone who is really interested in medicine and wants to see those complicated cases and do workups is an attractive sell.

I'd also consider that...you've done three surgeries. It may very well still be something that you can get more comfortable with, with more experience. That's not me saying your feelings about it aren't valid, just that doing a procedure for the first time is stressful for pretty much everyone, and while you may never love it, you may find that you're more comfortable with it with more experience.

Specializing is one of those things that I wouldn't do unless you are absolutely sure it is the path you want to take. You don't have to specialize to do medicine workups. There may be a point where your resources are tapped out or a case is so complex that you want to refer, but if you have the desire and knowledge you can keep and manage most of your medical cases yourself in GP. A lot of times you're kind of forced to because people simply can't afford the referral.

I think you also have to ask yourself if you only ever want to see sick animals, usually on a referral basis, or if you are at all interested in the other things that GP has to offer as well - wellness appointments, less complicated sick patients, long-term relationships with clients and their animals, higher salary upon graduation, theoretically better work-life balance.

All that being said, you have plenty of time to think about it still! Maybe talk to the internists at your school about their day to day lives, what their internship and residency experiences were like, and why they chose internal medicine over GP.

 

[VIN-Foundation]

Specializing in internal medicine to avoid surgery. Terrible reason.

There are plenty of GPs these days who do little if any surgery. And anyway, 2nd year is too early to give up on surgery.

Specializing in internal medicine because you love internal medicine. Good reason.

However, it's important to realize that loving internal medicine doesn't necessarily mean you will love being an internist. But it's a good first step.

Regarding the financial challenges of internship/residency, the most important thing is do NOT defer student loans. Instead, get into an income-driven repayment (IDR). For more details, please see VIN Foundation's Student Debt Center

 

[JaynaAli]

I agree that going into any specialty because you hate xyz is not the right approach and will probably only lead to burnout. But if you do love the specialty and that type of patient, that absolutely is a reason to consider pursuing it.

A residents pay is low, but most residents get by without major difficulty. Salaries are slowly improving. They could certainly be better but you won’t be destitute. Most residents will go into income based repayment and owe nothing or very little on your loans during residency. I think my payments were $0 for internship and my first year of residency, then after that they were like $100-150/mo which wasn’t difficult to afford. Usually, the specialist salary post-residency will ‘make up’ for any delay in paying off loans during your training since your earning potential is usually higher than in GP. This isn’t true for all specialties but probably is for IM. The training years can even count towards PSLF if you’re in academia and stay there or get employed by some other nonprofit.

And usually the research requirement for acvim specialties is (or can be) a more clinical based research project, rather than bench science. I also do not enjoy research but I didn’t mind my little residency project. I won’t be doing more research but it isn’t too bad, imo. Often the faculty will have ideas based upon their own interests and little projects they need help doing and can help you figure out something that is publishable in order to meet residency requirements.

 

[Petdr2022]

Specializing in IM is definitely a good plan if you love it. Being an IM resident though id have to say that its a lot more than just "3 years", its constant learning and ridiculous long hours even after residency is finished.

Earning potential is definitely there. I know internists who take home 500-600k a year on Pro Sal.

Also if you love urology im sure you'd love the interventional studies which you can do as an internist. Not exactly surgery but just as fulfilling!
Hope this helps

 

[Musicandhorses]

I’m in GP and I don’t love soft tissue or ortho surgery but love dentistry. So we exist! You might find you like dentistry instead.