Leaving Internal Medicine

[Eyeballzz]

Hello everyone!

I'm at a lost, and I really need advise. I am graduating from IM residency in 2018. During the past 2 years in residency, I realized I am starting to grow more and more upset about my decision. For internal medicine, visits are usually longer. There is a lot of talking and asking patients about their symptoms. If the visits are short, I am afraid that I would miss something in their labs or paperwork.

Prior to medical school, I did a lot of ophthalmology research. I did not have any direct clinical experience. When I shadow ophthalmologist, I realized that I really like the quick decision making and short clinic visits. I like the procedures, and I wish I can work more with my hands. In IM, I am only able to talk to patients.

I chose to enter internal medicine as a naive medical student thinking that as a generalist I would be able to do all type of medicine. What I soon realized is that as a generalist, I was never able to do anything WELL.

My fiance who is an ophthalmologist told me that the grass is gray every where. Your love for your work is what you make of it; "you tell yourself you love it and it happens." He said that concierge medicine may be better than ophthalmology because you don't have to rush through visits. It sounds appealing, but at the end of the day, I'd still be a general internist. It would still mean long, drawn out initial clinic visits with a lot of talking. It is hard for me to like the subspecialities of IM: cardiology is impossible to match into and chest pain doesn't get my juices going, GI is a lot more poop (and talking about poop) than I cannot handle, Endo is looking at labs but no procedures, Rheum is interesting but a lot of talking, and Heme/Onc is very sad.

I have tried to tell myself I love Internal Medicine, but when something bad happens, my house of cards fall.

I guess my question is...when do you know when to quit? Are the things I dislike in internal medicine true about all of medicine as a whole? Is a job ultimately a job? Am I being naive about changing to another field after residency? Can you truly force yourself to like something?

Thanks for your help!

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[rokshana]

Hello everyone!

I'm at a lost, and I really need advise. I am graduating from IM residency in 2018. During the past 2 years in residency, I realized I am starting to grow more and more upset about my decision. For internal medicine, visits are usually longer. There is a lot of talking and asking patients about their symptoms. If the visits are short, I am afraid that I would miss something in their labs or paperwork.

Prior to medical school, I did a lot of ophthalmology research. I did not have any direct clinical experience. When I shadow ophthalmologist, I realized that I really like the quick decision making and short clinic visits. I like the procedures, and I wish I can work more with my hands. In IM, I am only able to talk to patients.

I chose to enter internal medicine as a naive medical student thinking that as a generalist I would be able to do all type of medicine. What I soon realized is that as a generalist, I was never able to do anything WELL.

My fiance who is an ophthalmologist told me that the grass is gray every where. Your love for your work is what you make of it; "you tell yourself you love it and it happens." He said that concierge medicine may be better than ophthalmology because you don't have to rush through visits. It sounds appealing, but at the end of the day, I'd still be a general internist. It would still mean long, drawn out initial clinic visits with a lot of talking. It is hard for me to like the subspecialities of IM: cardiology is impossible to match into, GI is a lot more poop than I can handle, Endo is looking at labs but no procedures, Rheum is interesting but a lot of talking, and Heme/Onc is very sad.

I have tried to tell myself I love Internal Medicine, but when something bad happens, my house of cards fall.

I guess my question is...when do you know when to quit? Are the things I dislike in internal medicine true about all of medicine as a whole? Is a job ultimately a job? Am I being naive about changing to another field after residency? Can you truly force yourself to like something?

Thanks for your help!

have you thought about CC? there are more procedures and the sick pts make you think...

the other is EM...you have to be quick and they have procedures.

of course you could be a hospitalist...if you are at a small place, then procedures would be part of your responsibilities and you have 12 hours a day to take care of things.

optho would be a long shot i think...your fiancé would probably have better insight, but were you a competitive applicant as a med student for optho? that may help, but you are 3 yrs out...and they are able to be picky...but hey! being IM trained already may give you a leg up...the time would be the same as a fellowship for you to repeat a residency.

 

[JLC]

I think that your expectations are simply not realistic. Medicine in general may not be for you. But that's ok because with a medical degree and IM training, you can do consulting, work at non profit, lobby group, etc. I will realistically say if you want to continue doing medicine, you will need to subspecialize. Only one specialty in particular does a significant amount of procedures in medicine which is GI. (cardiology does as well but only if you pursue EP and IC both of which will require additional 2yr specialty training before you do any significant amount of procedures; Pulm has some as well but again the indications and uses of bronchs are very low volume compared to cards and GI.) I would say don't be discouraged from pursuing something until you've tried. Cards is competitive, but there is also around close to 1000 spots. Nobody in Gi likes poop. I would also say though everyone in medicine deals with bodily fluid (urine for uro, mucous for ENT, gen surg and colorectal deal with stool as well.)

 

[DoubleBogey]

Hello everyone!

I'm at a lost, and I really need advise. I am graduating from IM residency in 2018. During the past 2 years in residency, I realized I am starting to grow more and more upset about my decision. For internal medicine, visits are usually longer. There is a lot of talking and asking patients about their symptoms. If the visits are short, I am afraid that I would miss something in their labs or paperwork.

Prior to medical school, I did a lot of ophthalmology research. I did not have any direct clinical experience. When I shadow ophthalmologist, I realized that I really like the quick decision making and short clinic visits. I like the procedures, and I wish I can work more with my hands. In IM, I am only able to talk to patients.

I chose to enter internal medicine as a naive medical student thinking that as a generalist I would be able to do all type of medicine. What I soon realized is that as a generalist, I was never able to do anything WELL.

My fiance who is an ophthalmologist told me that the grass is gray every where. Your love for your work is what you make of it; "you tell yourself you love it and it happens." He said that concierge medicine may be better than ophthalmology because you don't have to rush through visits. It sounds appealing, but at the end of the day, I'd still be a general internist. It would still mean long, drawn out initial clinic visits with a lot of talking. It is hard for me to like the subspecialities of IM: cardiology is impossible to match into, GI is a lot more poop than I can handle, Endo is looking at labs but no procedures, Rheum is interesting but a lot of talking, and Heme/Onc is very sad.

I have tried to tell myself I love Internal Medicine, but when something bad happens, my house of cards fall.

I guess my question is...when do you know when to quit? Are the things I dislike in internal medicine true about all of medicine as a whole? Is a job ultimately a job? Am I being naive about changing to another field after residency? Can you truly force yourself to like something?

Thanks for your help!

Money can do a lot things and force you to “suck it up” to pay loans etc (I’m sure your wife can help you out, but that will get old while you try to find your dream job. You haven’t seen what it’s like outside of residency, which it IS much better. If procedures are your thing - IM clinic has procedures, but you have to develop a pt base - lots of talking to devleop a base. Medicine is....Medicine, pros and cons, but if you want procedures and not talk to pts,


Critical care - half the time your patients are intubated/sedated, access issues and need central lines/RRT lines, perform thora/para/bronch/LP.

ED - you wouldn’t have to not staining for some areas in the country, although more and more places want EM trained physicians - but rural areas not so much.

Derm - does procedures, can certainly expand procedures that are elective and pay cash. However, if you don’t like talking to patients then this specialty may be a problem.

 

[NotAProgDirector]

If "Cardiology is too hard to match into", you're not going to get an Ophthalmology spot.

Some additional background would be helpful in advising you. Are you a US MD, US DO, or IMG? Are you training in a univ IM or community IM program? What were your USMLE scores (general range rounded to the nearest 10 would be fine)? Any other red flags / issues in your past?

 

[jrbirdy]

.

 

[Eyeballzz]

If "Cardiology is too hard to match into", you're not going to get an Ophthalmology spot.

Some additional background would be helpful in advising you. Are you a US MD, US DO, or IMG? Are you training in a univ IM or community IM program? What were your USMLE scores (general range rounded to the nearest 10 would be fine)? Any other red flags / issues in your past?

US MD, top 10 med school
University affiliated County Program
Step 1 225
Step 2 253
Step 3 245
Im doing ok in residency. I was offered a chief position, but I declined because I needed to figure out what I'll do for the rest of my life.
No red flags, aside from my own perception that I dont feel like I really fit IM.

Cardiology is hard because I have very little interest in the heart and have no research at all so Ill have to take a few years off to get in. GI is probably the same way and a lot of talking about poop. I feel like if I want to do fellowship for 3 years, I should do another residency.

I like clinic more than inpatient. I do like talking to patients just not constantly about their feelings and symptoms and not drawn out conversations on the whole system and reviewing a stack of medical records. I like the counseling part of clinical encounters, I dont like basing my testing decisions on mainly the interview portion with the patients.

Thanks for all the input so far...I really appreciate it

 

[Crayola227]

I'm not sure what the answer is on IM docs going into EM in rural areas.... seeing kids

Anyone know?

 

[Crayola227]

GI is also pretty competitive, if I understand correctly

 

[aafisahar]

US MD, top 10 med school
University affiliated County Program
Step 1 225
Step 2 253
Step 3 245
Im doing ok in residency. I was offered a chief position, but I declined because I needed to figure out what I'll do for the rest of my life.
No red flags, aside from my own perception that I dont feel like I really fit IM.

Cardiology is hard because I have very little interest in the heart and have no research at all so Ill have to take a few years off to get in. GI is probably the same way and a lot of talking about poop. I feel like if I want to do fellowship for 3 years, I should do another residency.

I like clinic more than inpatient. I do like talking to patients just not constantly about their feelings and symptoms and not drawn out conversations on the whole system and reviewing a stack of medical records. I like the counseling part of clinical encounters, I dont like basing my testing decisions on mainly the interview portion with the patients.

Thanks for all the input so far...I really appreciate it

chief year is perfect for you wtf are you thinking. it's literally a holding pattern to figure out what you want to do while boosting your resume. chief + start research today and you can match into anything you want

 

[rokshana]

chief year is perfect for you wtf are you thinking. it's literally a holding pattern to figure out what you want to do while boosting your resume. chief + start research today and you can match into anything you want

lol, i agree!! doing a chief year would have been the perfect solution...given you the time to figure out what you want to do, would have helped with getting a more competitive fellowship if you wanted or interview for another residency altogether! but what is done is done.

steps are kinda low for optho...are you AOA? the research in optho...papers published? are you 1st author? can your fiancé help?

 

[rokshana]

I'm not sure what the answer is on IM docs going into EM in rural areas.... seeing kids

Anyone know?

she would have to redo a residency in EM.

 

[NotAProgDirector]

Getting an Ophthal slot is very unlikely. You could certainly try. You'd need to start getting clinical ophthal experience, using whatever elective time you have left. Plus, after you graduate, you'd probably need to start working (to make an income) and then also be doing some ophthal work (which might be unpaid). You could then apply in next year's match (or it might take another year to gain enough experience). At that point, you'd only have the cost of applying and could see how it goes. With those step scores, and a univ affiliated program, and time since graduation, I think you'll get very few if any nibbles. Much will depend upon how much networking you can do.

So Ophthal is really a plan B. You need a plan A. Not sure what that is. Hospital medicine is an option, I would assume? You can (relatively) easily titrate how much work you want to do (vs home much income you need). I can't tell from your OP what you would really like. Most clinical ophthalmology can be quite routine and boring too. My advice to my residents is to find the worst part of any career, and see if you can find some joy in it. Else, that part tends to eat you alive. So, if you're doing GI, you need to find enjoyment in screening colonoscopies and managing IBS. For Rheum it's fibromyalgia. And for HM, it's admitting patients who are ER dumps ("I can't send them home, so you'll need to admit them") or who are certain to sign out AMA and otherwise be a PITA. if you can find some joy in that part of the job, everything else is a piece of cake.

 

[xoggyux]

Sorry to be a downer but it seems your problems are way deeper than you might have realized. Not only you seem to detest most (all?) possible subspecialties of the path you chose but you might be about to make the same exact mistake that presumably put you in the situation you are in right now.
You are saying that you don't necessarily get enough exposure in ophthalmology which brings me to my point, what makes you think that you might actually like it? What happens when after 3-4 years you realize is not right for you, just the same way you are finding now that IM is not for you?
If I were you, uncertain about specialty just out of residency I would try one or two temporary jobs before making rushed decisions. It seems that you probably won't necessarily enjoy outpatient medicine very much (you don't like talking to patients for long) so perhaps give it a shot a hospitalist for a while? Sometimes the specialty is not the problem but rather the setting. I would give it a shot at 2 or 3 different settings (aka outpatient vs inpatient, different hospitals, or even different states as medical/work philosophy can vary by location) before making such decision. Furthermore, this might allow for some time to see if any specialty grows on you (not that there is anything wrong with remain unspecialized if that is what you enjoy, in fact, that is my goal for myself at this point).
If you want, while you are working towards giving it a shot at the specialty you already choose, you can on the side research and try to find out of there is something else that you would rather do. But this time, make sure you do your due diligence so you don't make the same mistake.

 

[Eyeballzz]

Getting an Ophthal slot is very unlikely. You could certainly try. You'd need to start getting clinical ophthal experience, using whatever elective time you have left. Plus, after you graduate, you'd probably need to start working (to make an income) and then also be doing some ophthal work (which might be unpaid). You could then apply in next year's match (or it might take another year to gain enough experience). At that point, you'd only have the cost of applying and could see how it goes. With those step scores, and a univ affiliated program, and time since graduation, I think you'll get very few if any nibbles. Much will depend upon how much networking you can do.

So Ophthal is really a plan B. You need a plan A. Not sure what that is. Hospital medicine is an option, I would assume? You can (relatively) easily titrate how much work you want to do (vs home much income you need). I can't tell from your OP what you would really like. Most clinical ophthalmology can be quite routine and boring too. My advice to my residents is to find the worst part of any career, and see if you can find some joy in it. Else, that part tends to eat you alive. So, if you're doing GI, you need to find enjoyment in screening colonoscopies and managing IBS. For Rheum it's fibromyalgia. And for HM, it's admitting patients who are ER dumps ("I can't send them home, so you'll need to admit them") or who are certain to sign out AMA and otherwise be a PITA. if you can find some joy in that part of the job, everything else is a piece of cake.

It's funny because I feel like sdnet usually dissolves into what are my chances.

My question really is...when do I know when to quit something and look for something else?

I think I really like the advice to find the worst part in something and see if you can find joy. I think IM gets me down because 30% of my patient population is depressed, but its too routine to send to psych. I think clinic medicine is more for me than hospital medicine though because there is no joy on the wards. At least in General IM, there are long term relationships to build...

chief year is perfect for you wtf are you thinking. it's literally a holding pattern to figure out what you want to do while boosting your resume. chief + start research today and you can match into anything you want

Yeah, in some ways, yes. But what's done is done, I have little regrets because you really cannot live off a chief income while taking time off to do research...

 

[GastriqueGraffin]

This feels like it's pseduo-trolling. Like on the surface you have a real question but your attitude and lack of maturity to realize that nothing is perfect and the sense that you don't really want to accept any answer makes me think that you're trolling. Good luck either way.

 

[Dusn]

I'm an ophthalmologist and my wife is an internist and so I'll try to help. The positives to ophtho: 1) you can usually see the pathology on exam. 2) get to work with your hands 3) you really have to examine almost all patients.. that means there's much less unreimbursed work than in primary care because the patient has to come in for an office visit. You aren't spending that much unreimbursed time reviewing labs, reports, and images (unless you go into neuro-ophtho or uveitis).

The negatives to ophtho: 1) it's oversaturated and it's hard to find a job in many areas 2) employers often "eat their young" and starting salaries are much lower than you would think ($150K-220K in or near many cities, likely even lower in academics), 3) The residents often get very little supervision and I found ophtho residency more painful than intern year in many ways because you often felt like you were on your own and start out not knowing anything, 4) most ophtho practices are run like mills where the ophtho is seeing 40-80 patients a day... I find this to be painful and horrible patient care. 5) reimbursements for cataract surgery have been cut dramatically (I can actually make more in the clinic than the OR) 6) optometrists are encroaching on our scope of practice (they're really pushing to be allowed to do procedures in many states) even though they over diagnose and overtest patients as it is.

You said, "When I shadow ophthalmologist, I realized that I really like the quick decision making and short clinic visits. I like the procedures, and I wish I can work more with my hands."

I believe that you can do that with GI. Personally a GI fellowship is what I'd do if I did IM. I think GI has a lot of the same advantages as ophtho. If you really decide you want to do ophtho, I'd probably tell the programs that you're interested uveitis, as an IM residency could be useful to a uveitis specialist (prescribing IMT, biologics and working up systemic diseases). You may not like uveitis for the same reasons you don't like IM but it'll sound good on interviews.

 

[IM2GI]

The obvious answer is to do a fellowship. To start over in a different competitive field is a tough path. The grass is always greener.

Im biased but GI is pretty awesome.

 

[Gastrapathy]

I don't get the feeling OP would like IBS whereas I don't really mind it anymore. If he did do GI, I think hepatology would be the best fit...so that's 4 more years.

 

[LoudBark]

I am not sure why everyone is suggesting GI or cardiology. He / she has made it very clear (regardless of board scores or credentials) that they are not interested in GI or cardiology. Read again what this poster is saying repeatedly about "chest pain doesn't get my juices flowing" and "don't like poop" and "don't like inpatient". I mean really, does this person even have the maturity to push them in to cardiology or GI?

Like a poster above, questioning if this a pseudo troll post.

"I don't like IM. Every subspecialty has drawbacks. Optho sounds cool but I just don't know. I like clinic but don't like inpatient but don't like lots of problems and talking lots to patients. Tell me what I should do and when or if I should quit."

 

[LookForZebras]

Don't quit internal medicine! It's such a broad specialty, I think you just need to find your niche. Maybe that's choosing a fitting subspecialty, like some of the poster's suggested. But I feel you should continue to explore different practice or employment types. Not just concierge medicine, but how about something like a holistic, integrative, functional medicine, or wellness health center? Or telemedicine? There are also certain opportunities that may allow you more time with patients, like working as a corporate physician for a large company (essentially occupational medicine, though these positions often accept internal medicine docs as well).

 

[Dusn]

Another issue is that if you and your fiancé decide to have kids at some point. One of you might want or need to cut back to part-time or just take a hiatus from medicine altogether for a few years while the kids are young. If you don't like medicine, you might want to be the one to cut back. If you do go to part-time, it doesn't make sense for you to do another fellowship/residency in cards, GI or Ophtho, lose earning years, then become the higher earner and then cut back or stop working when you're finally getting paid.

 

[marsupial]

All of this advice is lame

Apply in the match. To both Ophtho and Anesthesia while working as a hospitalist. You'll get in for sure.