Loved the medicine and knowledge on IM, kind of hated the day to day

[Maybedoc1]

MS2 in my clinical year trying to figure out what I want to do with my life. Just got done my inpatient IM rotation and I had some mixed thoughts. I went in thinking I was going to like it, but I’m conflicted. I loved talking about the physiology of all these diseases, I loved how broad the knowledge was, etc. The knowledge base that they have is immense, but the day to day is kind of a drag.

Talking about hepatorenal syndrome, heart failure, pulmonary hypertension, sepsis, etc was my jam, but spending 85% of my day at a computer writing notes, putting in orders, calling consults was not. Everyone from the intern to the 3rd year just spent so much time in a windowless room on a computer being responsible for every little thing for the patient. When the patients were good to go medically then came the disposition issues and that was a whole separate thing.

I bet attending life or a medicine subspecialty can be pretty chill, but that’s still 3 years of residency plus maybe another 3 years of fellowship. (I also don’t think I see myself working as a hospitalist so there’s that)

any advice for someone who likes the medicine of internal medicine, but not the day to day?

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[Goro]

MS2 in my clinical year trying to figure out what I want to do with my life. Just got done my inpatient IM rotation and I had some mixed thoughts. I went in thinking I was going to like it, but I’m conflicted. I loved talking about the physiology of all these diseases, I loved how broad the knowledge was, etc. The knowledge base that they have is immense, but the day to day is kind of a drag.

Talking about hepatorenal syndrome, heart failure, pulmonary hypertension, sepsis, etc was my jam, but spending 85% of my day at a computer writing notes, putting in orders, calling consults was not. Everyone from the intern to the 3rd year just spent so much time in a windowless room on a computer being responsible for every little thing for the patient. When the patients were good to go medically then came the disposition issues and that was a whole separate thing.

I bet attending life or a medicine subspecialty can be pretty chill, but that’s still 3 years of residency plus maybe another 3 years of fellowship. (I also don’t think I see myself working as a hospitalist so there’s that)

any advice for someone who likes the medicine of internal medicine, but not the day to day?

Teach

 

[APA 32]

Consider anesthesiology with a critical care fellowship

 

[Doctor-S]

MS2 in my clinical year trying to figure out what I want to do with my life. Just got done my inpatient IM rotation and I had some mixed thoughts. I went in thinking I was going to like it, but I’m conflicted. I loved talking about the physiology of all these diseases, I loved how broad the knowledge was, etc. The knowledge base that they have is immense, but the day to day is kind of a drag.

Talking about hepatorenal syndrome, heart failure, pulmonary hypertension, sepsis, etc was my jam, but spending 85% of my day at a computer writing notes, putting in orders, calling consults was not. Everyone from the intern to the 3rd year just spent so much time in a windowless room on a computer being responsible for every little thing for the patient. When the patients were good to go medically then came the disposition issues and that was a whole separate thing.

I bet attending life or a medicine subspecialty can be pretty chill, but that’s still 3 years of residency plus maybe another 3 years of fellowship. (I also don’t think I see myself working as a hospitalist so there’s that)

any advice for someone who likes the medicine of internal medicine, but not the day to day?

Agree with @Goro.

You can apply to become a Clinical Professor at an AMC and provide part-time teaching services in addition to maintaining your private IM practice.

 

[AnonymousDoctorGuyPerson]

MS2 in my clinical year trying to figure out what I want to do with my life. Just got done my inpatient IM rotation and I had some mixed thoughts. I went in thinking I was going to like it, but I’m conflicted. I loved talking about the physiology of all these diseases, I loved how broad the knowledge was, etc. The knowledge base that they have is immense, but the day to day is kind of a drag.

Talking about hepatorenal syndrome, heart failure, pulmonary hypertension, sepsis, etc was my jam, but spending 85% of my day at a computer writing notes, putting in orders, calling consults was not. Everyone from the intern to the 3rd year just spent so much time in a windowless room on a computer being responsible for every little thing for the patient. When the patients were good to go medically then came the disposition issues and that was a whole separate thing.

I bet attending life or a medicine subspecialty can be pretty chill, but that’s still 3 years of residency plus maybe another 3 years of fellowship. (I also don’t think I see myself working as a hospitalist so there’s that)

any advice for someone who likes the medicine of internal medicine, but not the day to day?

Have you gotten to rotate in the MICU?

Also, as ya said, a lot of the stuff you seem to dislike the most is far heavier during residency rather than the vast majority of your career as an attending. The 15% you like is what my attending's 90%+ is like, the other 10% is other admin stuff they get put through.

 

[FalconSlice]

MS2 in my clinical year trying to figure out what I want to do with my life. Just got done my inpatient IM rotation and I had some mixed thoughts. I went in thinking I was going to like it, but I’m conflicted. I loved talking about the physiology of all these diseases, I loved how broad the knowledge was, etc. The knowledge base that they have is immense, but the day to day is kind of a drag.

Talking about hepatorenal syndrome, heart failure, pulmonary hypertension, sepsis, etc was my jam, but spending 85% of my day at a computer writing notes, putting in orders, calling consults was not. Everyone from the intern to the 3rd year just spent so much time in a windowless room on a computer being responsible for every little thing for the patient. When the patients were good to go medically then came the disposition issues and that was a whole separate thing.

I bet attending life or a medicine subspecialty can be pretty chill, but that’s still 3 years of residency plus maybe another 3 years of fellowship. (I also don’t think I see myself working as a hospitalist so there’s that)

any advice for someone who likes the medicine of internal medicine, but not the day to day?

Have you given surgical specialties any thought? You actually do tangible things as well as use lots of physiology (depending on which surgical specialties)

FS

 

[mrbreakfast]

My advice would be to try other clinical rotations. That may help solidify your interests.

If you like the cognitive aspects of medicine but not the extensive charting and social issues (which are generally more prominent during residency than after), you could consider:

-IM -> subspecialty - fewer social issues and dealing with "crap"
-IM (or anesthesia) -> CC - intense pathophysiology, have to leave your "windowless room" a lot, dispo is more simple (either transfer out of ICU or discharge to heaven)
-GS - also has a broad pathophysiology, but replace charting with OR time - you generally can also get someone else to help with dispo issues

You could also consider neuro -> neurohospitalist - cognitive work/complex cases, still have to know a lot about other organ systems, but less extensive charting (eg you spend time in ED, ICUs, etc) and no social issues - but if you like taking care of every problem, might not be for you.

 

[JP2740]

Don’t do IM unless you love a particular subspecialty

 

[GadRads]

I had a similar experience. The daily reality of IM didn’t match what I expected, so I went with radiology. No regrets. Downside is the rapid pace and volumes we have to read.

 

[ACSurgeon]

MS2 in my clinical year trying to figure out what I want to do with my life. Just got done my inpatient IM rotation and I had some mixed thoughts. I went in thinking I was going to like it, but I’m conflicted. I loved talking about the physiology of all these diseases, I loved how broad the knowledge was, etc. The knowledge base that they have is immense, but the day to day is kind of a drag.

Talking about hepatorenal syndrome, heart failure, pulmonary hypertension, sepsis, etc was my jam, but spending 85% of my day at a computer writing notes, putting in orders, calling consults was not. Everyone from the intern to the 3rd year just spent so much time in a windowless room on a computer being responsible for every little thing for the patient. When the patients were good to go medically then came the disposition issues and that was a whole separate thing.

I bet attending life or a medicine subspecialty can be pretty chill, but that’s still 3 years of residency plus maybe another 3 years of fellowship. (I also don’t think I see myself working as a hospitalist so there’s that)

any advice for someone who likes the medicine of internal medicine, but not the day to day?

Hospital based specialties usually involves a lot of time in a windowless environment. Patient rooms have windows but many physician work rooms don’t. Resident work rooms will almost never be somewhere with a window. Now, you should be able to go outside for a little bit every day or look outside from a hallway window or a patient’s room. Aside from that, a lot of your time will be in a windowless area. If that’s a deal breaker, look for a clinic based specialty.

Also, spending a lot of time is a big part of modern medicine. Less for surgical specialties but still need a couple hours a day to look at scans and charts and write or sign your notes.

 

[Styrene]

MS2 in my clinical year trying to figure out what I want to do with my life. Just got done my inpatient IM rotation and I had some mixed thoughts. I went in thinking I was going to like it, but I’m conflicted. I loved talking about the physiology of all these diseases, I loved how broad the knowledge was, etc. The knowledge base that they have is immense, but the day to day is kind of a drag.

Talking about hepatorenal syndrome, heart failure, pulmonary hypertension, sepsis, etc was my jam, but spending 85% of my day at a computer writing notes, putting in orders, calling consults was not. Everyone from the intern to the 3rd year just spent so much time in a windowless room on a computer being responsible for every little thing for the patient. When the patients were good to go medically then came the disposition issues and that was a whole separate thing.

I bet attending life or a medicine subspecialty can be pretty chill, but that’s still 3 years of residency plus maybe another 3 years of fellowship. (I also don’t think I see myself working as a hospitalist so there’s that)

any advice for someone who likes the medicine of internal medicine, but not the day to day?

Academic medicine, or EM if you also like procedures and emergencies. Critical care avoids the disposition issues but has other social situations that are much more taxing depending on inter- and intrapersonal fortitude and temperament.

 

[collegestud2013]

MS2 in my clinical year trying to figure out what I want to do with my life. Just got done my inpatient IM rotation and I had some mixed thoughts. I went in thinking I was going to like it, but I’m conflicted. I loved talking about the physiology of all these diseases, I loved how broad the knowledge was, etc. The knowledge base that they have is immense, but the day to day is kind of a drag.

Talking about hepatorenal syndrome, heart failure, pulmonary hypertension, sepsis, etc was my jam, but spending 85% of my day at a computer writing notes, putting in orders, calling consults was not. Everyone from the intern to the 3rd year just spent so much time in a windowless room on a computer being responsible for every little thing for the patient. When the patients were good to go medically then came the disposition issues and that was a whole separate thing.

I bet attending life or a medicine subspecialty can be pretty chill, but that’s still 3 years of residency plus maybe another 3 years of fellowship. (I also don’t think I see myself working as a hospitalist so there’s that)

any advice for someone who likes the medicine of internal medicine, but not the day to day?

Probably being a specialist hospitalist (and not having an outpatient practice) is the closest you can get in a clinical specialty to having to deal with just the medicine and less with the social and dispo issues. At most hospitals these services operate as a consult service and are usually not required to admit patients by themselves, and don't get too involved in the dipso and discharge process. For example, neurology hospitalists, ID hospitalists, cardiology hospitalists, heme/onc hospitalists will see and manage patients within the scope of their specialty while inpatient but won't have to deal with the headaches of long-term outpatient follow-up for the more chronic issues.

In just about any outpatient setting you'll have to deal with a lot more than just the medicine part regardless of whether you're a specialist or primary care (eg dealing with insurance companies for prior auths, or being on call for your patients after hours that leads to burnout).

Of course there's also radiology and pathology as well. These tend to suit people who enjoyed their pre-clinical years of med school more than their clinical years since most of their work is rooted in pathophysiology and more basic science knowledge.