NYC IM Programs

[DermViser]

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Speak for yourself.

It's like when someone claims that there is no one who could possibly be interested in Derm for any reason except the lifestyle. You may say based on your extensive IM experience (i.e. a prelim year you likely tried to finish with the bare minimum of effort it took to graduate on time) that you personally wouldn't want to do it long-term, but there's thousands of others every year who are more than happy to do IM. And I'll eat my phone if it's just because of the $$$.

No one's talking about IM. We're talking about Hospitalist Medicine, which is a completely different case (vs. outpatient general Internal Medicine).

 

[Raryn]

No one's talking about IM. We're talking about Hospitalist Medicine, which is a completely different case (vs. outpatient general Internal Medicine).

So am I.

I have plenty of friends from residency that either just went into hospitalist medicine or are planning on it, most of which enjoy their wards experience and aren't primarily motivated by money. In fact, I know plenty of internists from before medical school, including some that have been doing hospital medicine exclusively since the early 90s (before Wachter even coined the term "hospitalist") that certainly enjoy their work, though they may bitch about stuff like occ night calls.

It is no less ridiculous that many IM graduates actually enjoy hospitalist medicine and find it somewhat intellectually stimulating than the fact that many graduates actually enjoy dermatology in the same circumstances. Alternatively, all dermatologists just want an easy lifestyle that consists of coming in and making things wet if dry, dry if wet, or attempting steroids +/- antifungals w/ an optional biopsy where the pathologist tells you what it actually is that you're treating.

 

[DermViser]

So am I.

I have plenty of friends from residency that either just went into hospitalist medicine or are planning on it, most of which enjoy their wards experience and aren't primarily motivated by money. In fact, I know plenty of internists from before medical school, including some that have been doing hospital medicine exclusively since the early 90s (before Wachter even coined the term "hospitalist") that certainly enjoy their work, though they may bitch about stuff like occ night calls.

It is no less ridiculous that many IM graduates actually enjoy hospitalist medicine and find it somewhat intellectually stimulating than the fact that many graduates actually enjoy dermatology in the same circumstances. Alternatively, all dermatologists just want an easy lifestyle that consists of coming in and making things wet if dry, dry if wet, or attempting steroids +/- antifungals w/ an optional biopsy where the pathologist tells you what it actually is that you're treating.

Then why do Hospitalists have such a high burnout rate, esp. after 5 years? These are very valid concerns. You don't see elderly hospitalists for a very good reason.

You know that Dermatologists get residency training in reading Dermpath, right?

 

[qwerty89]

Then why do Hospitalists have such a high burnout rate, esp. after 5 years? These are very valid concerns. You don't see elderly hospitalists for a very good reason.

You know that Dermatologists get residency training in reading Dermpath, right?

I would imagine the high burnout rate is at least somewhat related to these 2 factors 1. its less competitive and 2. getting into fellowship is harder than getting into residency.

1. less competitive means some people will use this as a backup in the match. Obviously anyone who gets into their #2 specialty will be disappointed. ANyone who gets into Derm, Urology, Ortho, ENT, etc clearly wanted those specialties. You can't "fall" into them.

2. IMO med students have little clue how competitive fellowships really are. LORs in residency, research and connections are more nebulous than looking at Step 1 scores. Anyone applying to a competitive field straight outta med school knows exactly whats important (Step 1, clinical grades, etc) which leads to realistic expectations. Its easier as a med student with mediocre scores going to a mediocre IM program to think that they are going to get into GI fellowship than it is to think they are getting into Derm, ENT, etc. And on a side note, considering how little premeds understand about how much self selection goes on in med school (as far as who applies to what and how that affects the match statistics) I would think that med students have an equally poor understanding of the self selection process that goes on in IM residency when it comes to who applies for GI, Cards, etc. I look at the GI match statistics and see 700ish applicants for 400ish spots (give or take) but I have no idea what that really means. How many FMGs applied? Whats the match rate from top 10 programs vs top 50 vs crap programs? How many potential applicants never apply because they were discouraged by their PDs? Personally I don't have the slightest clue

 

[Raryn]

Then why do Hospitalists have such a high burnout rate, esp. after 5 years? These are very valid concerns. You don't see elderly hospitalists for a very good reason.

You know that Dermatologists get residency training in reading Dermpath, right?

There are few elderly hospitalists because the option to do hospital based medicine as a career has only been around ~20 years. 25 on the absolute outside. That said, there are definitely middle-aged hospitalists, which is exactly what you'd expect.

Regarding the burnout rate, I'd have to pull the actual papers, but every time they've studied it the majority (60-70% at least) report being quite satisfied with their work, which isn't too far from doctors in general. Hospitalists are a little different in that they actually have options if they "burn out", because they are also trained to do PC or can do a fellowship. If they were emergency providers, who burn out at a higher rate, they'd have no alternatives but to do administration or "early retirement".

And I doubt any dermatologist not mohs or dermpath trained is staking their license on doing all their own path in house.

 

[SouthernSurgeon]

There are few elderly hospitalists because the option to do hospital based medicine as a career has only been around ~20 years. 25 on the absolute outside. That said, there are definitely middle-aged hospitalists, which is exactly what you'd expect.

Regarding the burnout rate, I'd have to pull the actual papers, but every time they've studied it the majority (60-70% at least) report being quite satisfied with their work, which isn't too far from doctors in general. Hospitalists are a little different in that they actually have options if they "burn out", because they are also trained to do PC or can do a fellowship. If they were emergency providers, who burn out at a higher rate, they'd have no alternatives but to do administration or "early retirement".

And I doubt any dermatologist not mohs or dermpath trained is staking their license on doing all their own path in house.

I'd be interested to know how much the "burnout" numbers are skewed by young grads who only ever planned on doing hospitalist medicine for a year or two.

I know a ton of recent grads who for whatever reason do it one to two years - often to line up their training with a spouse, often to have time to build a competitive fellowship app.

I don't think it's fair to call it "burnout" when someone like that leaves since that was their plan from day oneone

 

[atomi]

The 5 worst fields in medicine:

1. Internal medicine (competitive)
2. General surgery (very competitive)
3. OB/Gyn
4. Emergency medicine (competitive)
5. Tie: Neurology/General pediatrics

Yet probably >50% of US grads choose to go into these awful, and yet paradoxically usually competitive, fields. Might it have something to do with them comprising the bulk of M3 when students make up their mind which specialty to consider? Maybeeeeee...

 

[DermViser]

I'd be interested to know how much the "burnout" numbers are skewed by young grads who only ever planned on doing hospitalist medicine for a year or two.

I know a ton of recent grads who for whatever reason do it one to two years - often to line up their training with a spouse, often to have time to build a competitive fellowship app.

I don't think it's fair to call it "burnout" when someone like that leaves since that was their plan from day oneone

I believe the burnout is at the 5 year mark - long after you really can't apply for fellowship anymore. At least not Cards, GI, or Heme/Onc.

 

[DermViser]

The 5 worst fields in medicine:

1. Internal medicine (competitive)
2. General surgery (very competitive)
3. OB/Gyn
4. Emergency medicine (competitive)
5. Tie: Neurology/General pediatrics

Yet probably >50% of US grads choose to go into these awful, and yet paradoxically usually competitive, fields. Might it have something to do with them comprising the bulk of M3 when students make up their mind which specialty to consider? Maybeeeeee...

That's bc most of those U.S. grads in 1 and 2 want to specialize.

 

[Nasrudin]

The 5 worst fields in medicine:

1. Internal medicine (competitive)
2. General surgery (very competitive)
3. OB/Gyn
4. Emergency medicine (competitive)
5. Tie: Neurology/General pediatrics

Yet probably >50% of US grads choose to go into these awful, and yet paradoxically usually competitive, fields. Might it have something to do with them comprising the bulk of M3 when students make up their mind which specialty to consider? Maybeeeeee...

I disagree about neurology. But otherwise I share your sense of intrigue. Like wtf is going on here. Do people get sucked into some twilight zone when they choose a career?

It's like a Steven Seagal movie. Somebody thinks it's awesome, but its so awful you just can't believe it got made, much less watched by millions.

He's got a f'n ponytail. A ponytail...??!!

 

[SouthernSurgeon]

The 5 worst fields in medicine:

1. Internal medicine (competitive)
2. General surgery (very competitive)
3. OB/Gyn
4. Emergency medicine (competitive)
5. Tie: Neurology/General pediatrics

Yet probably >50% of US grads choose to go into these awful, and yet paradoxically usually competitive, fields. Might it have something to do with them comprising the bulk of M3 when students make up their mind which specialty to consider? Maybeeeeee...

Wooo we're not #1!!!

And we are "very" competitive!!!!


Winning!!!!!

 

[L8Bloomer]

Any shot at an interview at any of the top IM programs in NYC?
DO
top 20% of class
Step 1: 239
Step 2: 250

 

[evilbooyaa]

I believe the burnout is at the 5 year mark - long after you really can't apply for fellowship anymore. At least not Cards, GI, or Heme/Onc.

Checking something at the 5 year mark means within 5 years of becoming a hospitalist... which would include those who stopped being a hospitalist after 1-2 years to put together resources for a fellowship.

 

[DermViser]

IM is stupid competitive, and it boggles my mind. It's basically med school part 2 at university programs. You are in a class of 30 or so people, and you are competing with your peers for the fellowship match. Why anybody would want to subject themselves to med school again but harder, longer, and with more responsibility, and especially subject themselves to the worst part of med school, medicine wards, is beyond me. 6 days a week of 14-16 hour days of social work, rounding, paper pushing, and body fluids? Yeah, that's a reasonable and healthy way to live. Then you get out and you get that sweet hospitalist job you coveted and spend your week off recovering then kill yourself all over again. It's basically being waterboarded for the rest of your career and thinking "if only I can get through this week..." over and over again.

Medicine wards sucks the life out of you. I can't imagine it doing it as a career. I wouldn't do it for $500k. I wouldn't do it for $1m. I would do it for $5m. I could suck up three years of residency and two years of work and retire. 5 years of my life in my 30s is worth no less than 10 million dollars. Yet we got people lining up to do it for $200k/year? Think about it. There is a reason your attendings are only on the wards a month or so a year. There is a reason hospitalists work 7-7s. In other professions, people do the same job throughout the year. Why do IM docs only do ward medicine part of the year? To anybody else, this would be suspicious. But not to med students. To them, it's a perk.

 

[Serous Demilune]

Any shot at an interview at any of the top IM programs in NYC?
DO
top 20% of class
Step 1: 239
Step 2: 250

Stop trying to derail this thread!

 

[Psai]

Any shot at an interview at any of the top IM programs in NYC?
DO
top 20% of class
Step 1: 239
Step 2: 250

Probably not

 

[PL198]

IM is stupid competitive, and it boggles my mind. It's basically med school part 2 at university programs. You are in a class of 30 or so people, and you are competing with your peers for the fellowship match. Why anybody would want to subject themselves to med school again but harder, longer, and with more responsibility, and especially subject themselves to the worst part of med school, medicine wards, is beyond me. 6 days a week of 14-16 hour days of social work, rounding, paper pushing, and body fluids? Yeah, that's a reasonable and healthy way to live. Then you get out and you get that sweet hospitalist job you coveted and spend your week off recovering then kill yourself all over again. It's basically being waterboarded for the rest of your career and thinking "if only I can get through this week..." over and over again.

Medicine wards sucks the life out of you. I can't imagine it doing it as a career. I wouldn't do it for $500k. I wouldn't do it for $1m. I would do it for $5m. I could suck up three years of residency and two years of work and retire. 5 years of my life in my 30s is worth no less than 10 million dollars. Yet we got people lining up to do it for $200k/year? Think about it. There is a reason your attendings are only on the wards a month or so a year. There is a reason hospitalists work 7-7s. In other professions, people do the same job throughout the year. Why do IM docs only do ward medicine part of the year? To anybody else, this would be suspicious. But not to med students. To them, it's a perk.

because medical students are d*mb as ****. memorizing facts doesn't mean intelligence, and in my opinion it kills intelligence.

 

[Serous Demilune]

because medical students are d*mb as ****. memorizing facts doesn't mean intelligence, and in my opinion it kills intelligence.

I laughed but I don't think Raryn would agree with you

 

[notbobtrustme]

because medical students are d*mb as ****. memorizing facts doesn't mean intelligence, and in my opinion it kills intelligence.

People don't want to admit it but the profession has basically devolved into us being UpToDate interpreters. It's ****ing statistical warfare out there with every attending lobbing random studies to justify their care or discrediting others' studies for the same reason.

 

[PL198]

Seriously. Medical school admissions is like the hunger games. And a select few emerge from the hunger games, covered in blood. A bit of these select few choose to re-enter the games and participate in the quarter quell(IM), in which many of them die as well. Those remaining alive will pledge their lives towards long hours while the others stay dead.

yeah I'll pass. I'll never understand how the IM system is set up. It's literally like applying to medical school all over again. I don't understand how the districts(the students) don't rebel and overthrow the system. Between this and radiology requiring intern year, I have no idea how this **** is tolerated. It's just so illogical.

 

[PL198]

People don't want to admit it but the profession has basically devolved into us being UpToDate interpreters. It's ******* statistical warfare out there with every attending lobbing random studies to justify their care or discrediting others' studies for the same reason.

With all the legal interventions that happen any time something bad happens, the profession is just going to be more and more about memorizing a textbook. Anything that actually requires thinking could have mistakes, because people aren't perfect, and thus it's eliminated. Medicine is literally the perfect profession to remove intelligence from the equation, because you can always use patient safety to justify it.

 

[KnuxNole]

People don't want to admit it but the profession has basically devolved into us being UpToDate interpreters. It's ******* statistical warfare out there with every attending lobbing random studies to justify their care or discrediting others' studies for the same reason.

True. UptoDate is the main source of reading/literature search for residents everywhere!