PD's view of the Fellowship Match 2013

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rokshana said:
no IM SHOULD be dealing with much of diabetes and simple hypothyroidism…but the number of consults i get from the Gen Med service and the PCPs out there for referral to the diabetes or the endo clinic say they either don't want to or are uncomfortable with doing so…always a bit awe struck when a i get a call from the inpatient gen med or hospitalists services for DM management...
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Haha. This reminds me of COPD, asthma, and cough.

Some docs notice the patient has lungs and them refer.

But I'm not sure I blame too many of them to be honest. Of course an internist, if he/she had time could sit down and work their way through the problem come up with the appropriate treatment plan and then painstakingly explain it to their patient, OR just refer them to the specialist to do that thinking for them. God bless and thank-ye. Problem taken care of.
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I think most PCP's don't want to deal with some of it and I guess I can't blame them. The time they put in to taking care of all of their patient's problems doesn't reimburse them well enough. Thats the feedback I get from them anyway.
 
rokshana said:
always a bit awe struck when a i get a call from the inpatient gen med or hospitalists services for DM management...
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You must still be in fellowship. Outside of large academic medical centers, endocrine does not do inpatient work. In the community, hospitalists or general surgeons or critical care docs or whoever admits the patient manages all of the endocrine issues. Really have no idea why an endocrinologist would do inpatient work outside of academics. If you get your rare call for an inpatient consult, it would really disrupt the day to have to come in for just one patient (who might not even be insured). Better to just fill up those outpatient appointment slots.
 
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LoudBark said:
You must still be in fellowship. Outside of large academic medical centers, endocrine does not do inpatient work. In the community, hospitalists or general surgeons or critical care docs or whoever admits the patient manages all of the endocrine issues. Really have no idea why an endocrinologist would do inpatient work outside of academics. If you get your rare call for an inpatient consult, it would really disrupt the day to have to come in for just one patient (who might not even be insured). Better to just fill up those outpatient appointment slots.
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yep…it says so in my status…but i was a hospitalist between residency and fellowship and have seen it at the smaller hospitals i worked as as well as the academic centers as well…and the general surgeons seem to consult the hospitalist for anything remotely resembling a medical problem…they are certainly not managing htn or dm on THEIR services...
 
Instatewaiter said:
Gonna be honest this kinda befuddles me. Realistically there's not a whole lot of endo that a half decent internist can't take care of. And what's left probably wouldn't be enough to make a living off of. I guess internists now adays don't want to be bothered with diabetes and thyroid issues.

Rheum is like the black box of medicine. Cards and GI have their procedures that take training to learn. Onc changes so much and we don't get a lot of training during gen IM residency that I can see the need. But endo? **** 50% of IM residency is dealing with endo issues.
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I guess ID faces basically the same situation as endo (i.e., generalists can do most of it), which I think sucks because I like ID a lot as well.

Btw, why does the popularity of GI continue to climb? I thought CMS had zoomed in on scopes as a major focus of cost cutting...and once scope reimbursements are slashed (and you *know* that will eventually happen with Obamacare in action) I suspect IM graduates will drop that specialty like a hot potato. As someone else has said around here before, there's nothing intrinsically sexy about GI and frankly most people who are 'interested' in it seem to be chasing the money. Without big reimbursement from scoping, I suspect GI would be about as popular as nephro.
 
I sat and had a long weird talk with one of the god's of GI as a resident . . . and what he bemoaned about GI was that the specialty had become a field for proceduralists and that GI has largely lost the art of medicine - working up and treating pain syndromes or loose stools or even UC or Chron's. Maybe the cuts in reimbursement with help this, but I doubt it. I think the specialty, regardless of compensation, will still appeal to people who like the procedural aspect. Scopes are kind of cool.
 
dozitgetchahi said:
I guess ID faces basically the same situation as endo (i.e., generalists can do most of it), which I think sucks because I like ID a lot as well.

Btw, why does the popularity of GI continue to climb? I thought CMS had zoomed in on scopes as a major focus of cost cutting...and once scope reimbursements are slashed (and you *know* that will eventually happen with Obamacare in action) I suspect IM graduates will drop that specialty like a hot potato. As someone else has said around here before, there's nothing intrinsically sexy about GI and frankly most people who are 'interested' in it seem to be chasing the money. Without big reimbursement from scoping, I suspect GI would be about as popular as nephro.
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How do you know what CMS is focussing on or has zoomed on colonoscopy cuts?
Cardiology cuts came without warning 3 years ago.....
ACG has been fighting cuts in GI since 2010 and has been doing a good job as far as that is concerned....go to ACG website in news archives section.......they proudly announce how they kept the reimbursement for scope stable by fighting CMS.
Personally, I also agree that the one trick pony that GI Is , will fall to fats after colonoscopy cuts (ERCP and hybrid don't contribute to the paycheck as colo-no-scopy does)
I know a Private practice gastroenterologist, who is making a million a year, doing a hour of colonoscopy in 20 min,
His erstwhile practice used to have 3 GI physicians, now he works alone with a NP.
 
"Again, I haven't said anything negative towards cardiologists and gastroenterologists, you just suck at reading comprehension - there is a context here and if you could slow down and put some cream on your hurt ass you might be able to see the point I'm trying to make. Do I have to spell it out for you? Are you so dense it makes it that hard to see? I thought cards only took the best?? Lol."

You're a good poster and I like to read what you write, and no one is in the wrong here in this thread, but:

Internetargument.jpg


I would have use the Special Olympics one, but a pediatrician might stumble upon this thread
 
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jdh71 said:
I think we can all agree, if you can't draw blood on a hard stick, you don't get to have an opinion.
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I ended up drawing it after some more effort. Thanks for your (i/u)nvaluable insight on that thread.

330

Anyway, I'm just a lowly starter doctor so I'll say I am wrong so you can go to bed. Good night.
 
Though I would say, making snipey comments from the sidelines is rather beta. If you have something to say to me, say it.

There NEVER was an argument before, that was the point. I was never arguing with anyone, so to then post a comment like, "haha, look at the stupid internet argument" is clearly demonstrating someone who has some serious issues with reading comprehension.

And someone who can't take a joke.
 
jdh71 said:
Though I would say, making snipey comments from the sidelines is rather beta. If you have something to say to me, say it.

There NEVER was an argument before, that was the point. I was never arguing with anyone, so to then post a comment like, "haha, look at the stupid internet argument" is clearly demonstrating someone who has some serious issues with reading comprehension.

And someone who can't take a joke.
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Why is this still going on? I don't feel like going through the thread to make my point but who cares anyway. Everyone has their opinion....now let's move on.
 
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IMDoc607 said:
Why is this still going on? I don't feel like going through the thread to make my point but who cares anyway. Everyone has their opinion....now let's move on.
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You NEVER had a point except to protest how hurt your ass was. I NEVER made any comments about cardiology of gastroenterology. Do you still need to apply cream to your wounds? Or perhaps, as others pointed out, I wasn't making any comments about cardiology or gastroenterology, and you simply can't comprehend the english language.

Why don't you PLEASE for the love of everything good and holy, go "through the thread" and give me your ****ing point. I want to know it.
 
jdh71 said:
You NEVER had a point except to protest how hurt your ass was. I NEVER made any comments about cardiology of gastroenterology. Do you still need to apply cream to your wounds? Or perhaps, as others pointed out, I wasn't making any comments about cardiology or gastroenterology, and you simply can't comprehend the english language.

Why don't you PLEASE for the love of everything good and holy, go "through the thread" and give me your ******* point. I want to know it.
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Don't care enough...have a good day
 
IMDoc607 said:
Believe what you want if it makes you feel better.
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There isn't anything to "believe" or "feel better" about - you called the interaction wrong earlier in the thread - it was obvious to anyone who has a couple of brain cells to rub together. However, I thought you "didn't care". So either "care," man up, and say your ****ing peace, or GTFO. What the hell is wrong with you?
 
Two questions:

1) What the fu(k just happened?

2) What were we actually talking about?
 
So... again the thread degenerates into a circle jerk among the same 3 veteran posters.
Nice to see that some things never do change here.
 
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Deferoxamine said:
So... again the thread degenerates into a circle jerk among the same 3 veteran posters.
Nice to see that some things never do change here.
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What also doesn't change is your comments from the sidelines without ever a single helpful post in the forum.

It's your own personal little circle jerk of one.

The irony would be kind of funny if it wasnt so sad.
 
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jdh71 said:
What also doesn't change is your comments from the sidelines without ever a single helpful post in the forum.

It's your own personal little circle jerk of one.

The irony would be kind of funny if it wasnt so sad.
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I don't even know where to begin. :laugh:
I've been on and off here for almost 5 years. When have you ever known me to be serious about things other than standardized tests and the occasional random anxious Type A stuff?
The fact that you got so offended about this is the biggest surprise of all.
 
Deferoxamine said:
I don't even know where to begin. :laugh:
I've been on and off here for almost 5 years. When have you ever known me to be serious about things other than standardized tests and the occasional random anxious Type A stuff?
The fact that you got so offended about this is the biggest surprise of all.
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Offended?! No. Just pointing out that your commentary is about as stupid as what you're commenting on. Which makes probably actually makes you the bigger idiot.

I mean if you're such a cool guy - you know, like, WAY above all of this, then why even bother? All you do is show up in here a couple times a year and bitch about it. You want the forum to be better, then do something about it yourself instead of just waiting around for it to happen for you. It's your attitude that is the problem in the world today.

Do I get into arguments regular enough? Especially when I think someone's being a *****/fool/idiot? Yup. That's just me. Will always be me. If you don't like it put me on ignore. But what I also do is stick around here and do my best help some of these young jedi on their way up. Some schools are woefully unable to give those apply to medicine any advice. Is my advice golden? Or better? Hardly. It's one man's opinion, but at least I'm giving a ****, where no one else seems to be. I aint no hero, I'm not saying that but do my best for the peeps, and I have earned my seat here in the forum and my occasional tirade. Those of you who don't like it, can go outside and play hide and go **** yourselves.
 
Gastrapathy said:
Fleas....

None of our gigs is that competitive. But how anyone could want to be an endocrinologist will forever be a mystery to me
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But what's more wonderful than treating type 2 diabetes all day everyday.
 
Deferoxamine said:
So... again the thread degenerates into a circle jerk among the same 3 veteran posters.
Nice to see that some things never do change here.
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Sounds like someone feels left out.. It could be a a circle rhombus if you wanted it to be...
 
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