Hey guys, an MS3 here. Not sure if there is a recent thread on the topic but anyway, what made you decide to pick on IM finally as you applied for residency? Did you know you wanted to do it even before your MS3 rotation, or after? or did you apply to something else as your no.1 and IM was your backup? Or did you do something else for a year then transfer over? Did you always want to do something post IM and it was a stepping stone? Interested to read your responses as my application year is this year! Seems scary to pick something to do for the rest of your life (arguably...) but I suppose we all have to make that decision one day.
So tell me, why did you pick IM?
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I knew the area of medicine/science I wanted to work in based on my research interests, but could have gone in multiple directions to get there. During 3rd yr, I looked into them all and IM was ultimately the area that I liked the most and could see myself doing in general (the personalities and the way people thought about things fit me the best). Ultimately, you just have to try to go into everything with an open mind and follow your gut.
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I like the variety of cases in IM, the personality and culture, and the educational aspect of it. Also I wanted to do cardiology as a career so there's that.
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Ms4 here. Story time, so get ready (this is LONG).
For the majority of my life as a kid up until high school I wanted to do something completely different. Medicine was out of the question. But throughout school I'd always had an interest in biology (just because), and I found that I enjoyed studying it. My dad, an interventional cardiologist, always wanted me to become a doctor too (never forced anything though). I just didn't feel like it was for me. One day, he took me out with him to see him do a procedure. I'd no clue what was going on (I was like 15 at the time), but I remember seeing him walk into the cath lab like an absolute boss, get all scrubbed up, and proceed to effortlessly insert the catheter into the pt's groin and masterfully thread it up to the coronaries.
On the other side of the lab, I saw the computer screen light up, with contrast filling the coronaries and the heart itself. It literally left me awestruck. That grainy video of the heart bobbing up and down was the single most f**king coolest and fascinating thing I'd ever seen in my short life. He then proceeded to put the stent in, and that was it. All done in 30 minutes. The fact that one could put a wire into another human being and "fix" their heart (and pain) just like that, was absolutely astounding to me. That moment is when I decided that I should atleast give medicine a chance.
So that's how I decided to go to medical school after undergrad. Throughout school I knew I wanted to do "medicine," but I wasn't sure which field exactly. To be honest, there were times during undergrad (and med school) I felt absolutely helpless and drained for various reasons, and reconsidered my choice of career (any premeds/meds reading this: It is NORMAL to sometimes feel unsure about your decision). But I grew a pair and continued on.
I developed an interest in internal medicine during our school's pathophysiology course in M2 (especially the cardiovascular module). It just made so much sense to me (and was pretty logical too), and I actually enjoyed studying for both the Step 1 and my course exams. So I went into M3 almost 50% decided I wanted IM, while keeping an open mind for other specialities too. I did FM, Psych, Peds and Ob/Gyn before my IM rotation. While they were all fine and dandy and I learnt a lot, I never really felt "at home" in any of these rotations. I was always looking for ways to get out of the hospital (after doing my duties, obvs) and go home to study for the shelf.
But my IM rotation was fantastic. Sure, the hours were ugly, but man it was amazing! For the first month I rounded with this badass legend of an attending who knew pretty much all of medicine. Our rounds were 8a-2p or 3pm mostly. Loooong, but absolutely PACKED with teaching (especially the physical exam) and pimping. I'd barely have 15 mintues to grab a quick lunch before heading off to lecture, and I'd often come back after lecture to check up on my pts or to read about them. IM was the first time I truly felt "at home." I would arrive at the hospital at 5:30am, and before I knew it was already 3pm. The hours didn't matter at all. I loved talking to my patients, and learning more about them. I liked to think I was their friend. I would routinely stay later to read up and go home just to eat and sleep.
What draws me to IM?
1)The doctor-patient relationship in IM is a major draw for me. I want to have meaningful and long term longitudinal relationships with my patients.
I once took care of this older woman with DM, HTN, CHF, AKI and tons of comorbs for 3 weeks. She was almost always delirious so she couldn't talk much, plus I didn't speak her language very well. I saw her multiple times a day every day, trying to talk to her and doing whatever I could to make her feel comfortable, and advocating for her during rounds. Even as an M3, I was essentially an intern when it came to managing her (encouraged and supervised by the rest of my team). I became her and her family's primary point of contact. I gladly endured several episodes of being shouted at when her family was frustrated at having to deal with a medical student instead of having 24/7 access to an attending. When my rotation with the team ended, her daughters were very grateful and basically insisted I stay on. I find this kind of work extremely rewarding and fulfilling.
2) I love the logical, detective work it takes to come to a diagnosis in IM, and find the breadth and depth of IM to be staggering.
IM docs have to know a **** ton of stuff, despite having specialities to consult. The immense depth and breadth of knowledge and topics in IM was also a big draw for me, and I didn't personally feel that way in my other rotations. There's always so much more to learn! I found it intriguing and challenging to learn how to use all the available data (Hx, phys exam, labs/imaging and what to order next, etc) to figuring out what a patient has and how to manage her best.
Edit: I'm probably headed into cardiology after IM, but I feel I'll enjoy IM just as much for the above mentioned reasons.
So there you have it. Sorry for the long post.
Now I just hope I don't become jaded after 3 years of residency due to all the red tape and other BS.
For the majority of my life as a kid up until high school I wanted to do something completely different. Medicine was out of the question. But throughout school I'd always had an interest in biology (just because), and I found that I enjoyed studying it. My dad, an interventional cardiologist, always wanted me to become a doctor too (never forced anything though). I just didn't feel like it was for me. One day, he took me out with him to see him do a procedure. I'd no clue what was going on (I was like 15 at the time), but I remember seeing him walk into the cath lab like an absolute boss, get all scrubbed up, and proceed to effortlessly insert the catheter into the pt's groin and masterfully thread it up to the coronaries.
On the other side of the lab, I saw the computer screen light up, with contrast filling the coronaries and the heart itself. It literally left me awestruck. That grainy video of the heart bobbing up and down was the single most f**king coolest and fascinating thing I'd ever seen in my short life. He then proceeded to put the stent in, and that was it. All done in 30 minutes. The fact that one could put a wire into another human being and "fix" their heart (and pain) just like that, was absolutely astounding to me. That moment is when I decided that I should atleast give medicine a chance.
So that's how I decided to go to medical school after undergrad. Throughout school I knew I wanted to do "medicine," but I wasn't sure which field exactly. To be honest, there were times during undergrad (and med school) I felt absolutely helpless and drained for various reasons, and reconsidered my choice of career (any premeds/meds reading this: It is NORMAL to sometimes feel unsure about your decision). But I grew a pair and continued on.
I developed an interest in internal medicine during our school's pathophysiology course in M2 (especially the cardiovascular module). It just made so much sense to me (and was pretty logical too), and I actually enjoyed studying for both the Step 1 and my course exams. So I went into M3 almost 50% decided I wanted IM, while keeping an open mind for other specialities too. I did FM, Psych, Peds and Ob/Gyn before my IM rotation. While they were all fine and dandy and I learnt a lot, I never really felt "at home" in any of these rotations. I was always looking for ways to get out of the hospital (after doing my duties, obvs) and go home to study for the shelf.
But my IM rotation was fantastic. Sure, the hours were ugly, but man it was amazing! For the first month I rounded with this badass legend of an attending who knew pretty much all of medicine. Our rounds were 8a-2p or 3pm mostly. Loooong, but absolutely PACKED with teaching (especially the physical exam) and pimping. I'd barely have 15 mintues to grab a quick lunch before heading off to lecture, and I'd often come back after lecture to check up on my pts or to read about them. IM was the first time I truly felt "at home." I would arrive at the hospital at 5:30am, and before I knew it was already 3pm. The hours didn't matter at all. I loved talking to my patients, and learning more about them. I liked to think I was their friend. I would routinely stay later to read up and go home just to eat and sleep.
What draws me to IM?
1)The doctor-patient relationship in IM is a major draw for me. I want to have meaningful and long term longitudinal relationships with my patients.
I once took care of this older woman with DM, HTN, CHF, AKI and tons of comorbs for 3 weeks. She was almost always delirious so she couldn't talk much, plus I didn't speak her language very well. I saw her multiple times a day every day, trying to talk to her and doing whatever I could to make her feel comfortable, and advocating for her during rounds. Even as an M3, I was essentially an intern when it came to managing her (encouraged and supervised by the rest of my team). I became her and her family's primary point of contact. I gladly endured several episodes of being shouted at when her family was frustrated at having to deal with a medical student instead of having 24/7 access to an attending. When my rotation with the team ended, her daughters were very grateful and basically insisted I stay on. I find this kind of work extremely rewarding and fulfilling.
2) I love the logical, detective work it takes to come to a diagnosis in IM, and find the breadth and depth of IM to be staggering.
IM docs have to know a **** ton of stuff, despite having specialities to consult. The immense depth and breadth of knowledge and topics in IM was also a big draw for me, and I didn't personally feel that way in my other rotations. There's always so much more to learn! I found it intriguing and challenging to learn how to use all the available data (Hx, phys exam, labs/imaging and what to order next, etc) to figuring out what a patient has and how to manage her best.
Edit: I'm probably headed into cardiology after IM, but I feel I'll enjoy IM just as much for the above mentioned reasons.
So there you have it. Sorry for the long post.
Now I just hope I don't become jaded after 3 years of residency due to all the red tape and other BS.
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I think I always knew IM was for me, even though I tried to talk myself out of that fact throughout most of medical school, mainly because of people talking about how much of a dumping ground it is and how much social work is involved. We do sometimes get dumped on by other specialties and deal with social issues, but it's really not that bad. IM is the core of medicine, so naturally we are going to be the default specialty for specialists to admit patients to and dealing with social issues is just part of being the primary physician. I was a little ambivalent before I started residency but now that I'm in it I have no regrets and am having (mostly) a great time.
Those are things that can be said about any specialty... Admittedly, that doesn't really matter. It is also the same two things everyone writes about in their PS
The best bed-side manner and patient-doctor relationships I have seen were from a surgeon.
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You're absolutely right. Every specialty has these two things. Yet people end up choosing one over the others. It may be typical PS material, but it was 100% true for me irl.
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I'm really fond of typing and the sound of typing. I also enjoy the on-hold phone music my hospital uses. Increasingly it is fun to politely be like WTF to an ED attending who wants to admit a costochondritis patient for stress echo, but still end up admitting him anyway.
It just seemed to fit my personality best. I like diagnosis, variety, learning/teaching and being "my doctor" for patients. Strongly considered EM as well but I wanted to be more definitively involved in the care of my patients.
IM is my first choice. I'm a good test taker which in America means you get your pick of the litter. Every mentor said to pick what you loved and not what had the best pay/lifestyle. I took them at their word.
IM is my first choice. I'm a good test taker which in America means you get your pick of the litter. Every mentor said to pick what you loved and not what had the best pay/lifestyle. I took them at their word.
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Basically agreed. Chicks (and dudes, depending on your gender/orientation) love a nerdy man who can treat some renal failure.
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The reason why I chose IM was a serendipity. Initially, I thought I wanted to become a surgeon until I figured out that surgery is boring as sh!* and the lifestyle is simply inhumane. After overcoming that frustration I ended up finding a lot of pleasure sorting out some clinical conundrums à la Sir Arthur Conan Doyle in an IM interest group that I've joined purely because there were some nice chicks.
Bottom line is blub1212 speaks the truth by saying that chicks are the major driving force behind this choice.
Bottom line is blub1212 speaks the truth by saying that chicks are the major driving force behind this choice.
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Basically because I wanted to stay in the New York area at an academic program but wasn't a good enough applicant for competitive residencies. I hate IM but I think I can tolerate some of the subspecialties.
Do yourself a favor, seriously, and be competitive for derm, ophtho, anesthesia, rads, ortho, ENT, urology, etc. at a good program. You will be much happier than dealing with the chronic bull**** of internal medicine.
Do yourself a favor, seriously, and be competitive for derm, ophtho, anesthesia, rads, ortho, ENT, urology, etc. at a good program. You will be much happier than dealing with the chronic bull**** of internal medicine.
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Unless you actually like internal medicine. I would go crazy doing any of the above specialties except maybe derm. I think IM is awesome.
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Wow, I envy the super lucky IM program that ends up with you...
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I'm miserable and I hate myself
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You sound like someone your co residents find a delightful person to work with
IM is everything I thought of when I thought of doing medicine in college. It's cerebrally challenging on an intellectual level but also challenging in other areas - talking to family members, understanding the psychological nature of your patient. This combined with the awesome, well-rounded residents I worked with made it a no brainer for me. Very excited to start residency next year.
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It's odd that you would consider derm = ophtho = anesthesia = surgical subspecialties - given that those are drastically different. Sounds like you are more interested in money & depending on which of those, not having a lot of free time.
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Well IM does have some pros, namely that it's flexible and it's relatively easy to get into a good residency program. But why is it easy? Most medical students realize there are other options with better pay, better prestige, many with better hours, and better opportunity to make a difference, and less social work/ bull****/ scut. So naturally these are superior fields, but if you just like IM or you're in a situation where it makes sense for you do it. But if you have options to do those others in my mind you would regret later in life not taking the golden ticket.
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I think believing these other specialties are a golden ticket is a little naive. Just take a look at the Medscape compensation surveys, many people in those very fields you mention would've chosen a different specialty if they could go back. Beyond that, IM gives you access to some of the specialties with the highest money and satisfaction, so I am still not believing that in general those other fields are "golden tickets" (except maybe derm, those guys have it pretty good).
Thanks everyone for their responses!
Seems like people genuinely enjoy the curiosity and intellectual stimulation that IM provides.
Another question, how do you look past all the paperwork, notes, specialists sort of dumping everything on you etc. to focus on the actual medicine. If I ever got into IM, I would be truly looking forward to reading Harrison's cover to cover because it is just so cool, but I wonder if people become jaded over "work" issues.
Seems like people genuinely enjoy the curiosity and intellectual stimulation that IM provides.
Another question, how do you look past all the paperwork, notes, specialists sort of dumping everything on you etc. to focus on the actual medicine. If I ever got into IM, I would be truly looking forward to reading Harrison's cover to cover because it is just so cool, but I wonder if people become jaded over "work" issues.
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I smell epic troll here
I had good enough grades and scores to do many of the lifestyle fields as did many people on this forum. We didn't all just pick IM because we were scared of applying to other specialties. I am very happy with my choice and likely would not pick another field.
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All specialties have paperwork and require time and input that's non clinical. You get paid good money as a hospitalist and you work basically half the year to admit subspecialized patients. That's plenty incentive to look past.
Also if you don't like it, subspecialize in IM.
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IM rox
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I really LOL'd at this. Great summary
I knew there was a great divide in the hospital. Someone was needed. Anyone. To coordinate social work, surgery, and all the other medicine subspecialties. One man to connect all these people to the patient. That man is an internal medicine trained Doctor. Never did I feel how truly important I was until I was able to reach new specialties when I admitted a dental abscess and could consult OMFS.
IM = Commander in Chief.
Other specialties = special forces/ units like navy seal, air force, ect...
Commander in Chief does NOT need to know how to fly an F22 but he/she sure know how to achieve the mission at hand and can DECIDE when to call in for an air strike. He/She can also pick and choose which special unit officer to go to which mission. The a*hole officers get scrap or nothing. (aka a*hole specialists with attitude get no referral LOL)
Other specialties = special forces/ units like navy seal, air force, ect...
Commander in Chief does NOT need to know how to fly an F22 but he/she sure know how to achieve the mission at hand and can DECIDE when to call in for an air strike. He/She can also pick and choose which special unit officer to go to which mission. The a*hole officers get scrap or nothing. (aka a*hole specialists with attitude get no referral LOL)
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For sure, IM attracts the hard-core nerds and wonks.
+ shyness
+ nebbish
++ awkward
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Ok Cox lol
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Disclaimer: I chose med-peds.
I chose IM (and peds) because of the variety. You get the full spectrum of patients, racially, ethnically, socioeconomically, and educationally. Oh, and age-wise, of course!
If I have to work with only middle class white women for the rest of my life, I will be unhappy.
If I have to work with only heroin addicts for the rest of my life, I will be unhappy.
If I have to work with only healthy patients in clinic for the rest of my life, I will be unhappy.
If I have to spend every appointment explaining that vaccines don't cause autism, I will be unhappy.
Med-peds just gives you everything, and while some of the social situations and patient attitudes and annoying problems that could probably be dealt with as an outpatient but we admitted them anyway totally piss me off, I will always have something different in the next room. And I even get to switch hospitals!
I chose IM (and peds) because of the variety. You get the full spectrum of patients, racially, ethnically, socioeconomically, and educationally. Oh, and age-wise, of course!
If I have to work with only middle class white women for the rest of my life, I will be unhappy.
If I have to work with only heroin addicts for the rest of my life, I will be unhappy.
If I have to work with only healthy patients in clinic for the rest of my life, I will be unhappy.
If I have to spend every appointment explaining that vaccines don't cause autism, I will be unhappy.
Med-peds just gives you everything, and while some of the social situations and patient attitudes and annoying problems that could probably be dealt with as an outpatient but we admitted them anyway totally piss me off, I will always have something different in the next room. And I even get to switch hospitals!
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3 questions
After finishing the Internal Medicine Residency and becoming hospitalists, can hospitalists open their own clinics and do their own practice as internists after working in the hospital for a while? Also, can a physician be working as a hospitalist and an internist at the same time? Lastly, can internists still work in their own clinics after they retire? Thanks!
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It's not common but there are primary care physicians who admit and round on their patients in the hospital. It's not conducive to a good lifestyle though. As for doing a 7 on/7 off hospitalist gig where on the week off you run your own clinic, that's basically a recipe for heavy burnout.
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Hospitalists are internists. So yes, if they choose not to be a hospitalist anymore, they can be an outpatient internist. The likelihood of successfully opening your own clinic is getting lower and lower though.
Again, hospitalists ARE internists. If you mean can they be a PCP and do inpatient work, yes. It's called "traditional primary care" where you admit and follow your own patients in the hospital. Some people like this, most people don't. Jobs like this exist but are becoming less common.
No. If you've retired, you are, by definition, not working. If you mean, "can you quit hospital work and go do outpatient work?", then yes. It's going to be a re-learning curve but there's no reason you couldn't do so.
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Got rejected from what I actually wanted to do and rocketed to the very bottom of my rank list to the only IM program I applied to. I hate about 90% of what I do - the time we spend in the ER or the ICU have been the only bright spots of the year but it's a paycheck every two weeks while I try to climb out of this hole and into second residency.
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If you like the ED and ICU, then you could do IM then pulm/CC or CCM only after IM. That's a great way to go.
Or possibly do a second residency in EM, though that might be harder.
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That's the exact conclusion I arrived at. If I can do a second residency and just bail on IM then that is preferable. I hate clinic and I hate wards. Precious little of IM is not clinic or not wards.
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what did you expect being an FMG with sub par step scores...you should be happy that you matched...
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So then why the hell was your backup IM?
I understand that it's not fun for you. However if this was actually a specialty you applied for and not just SOAPed into then you yourself brought it on. It's just that I know residents like you who had IM as a "backup" and were miserable, and made it abundantly clear. Not really helpful.
Maybe they didn't have a choice.
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Everyone has a choice. Don't apply to IM if you don't want to do it. There are other specialties that IMG's can get into, so why pick a specialty you won't be happy with? If you don't want to go into any of the specialties, you can go into industry. You can stay in your own country and pursue a different career in medicine. I understand all of these options aren't available to everyone, but everyone has SOME choice.
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I disagree - I know people who applied for anesthesia, path, psych, variety of things as backup. Plenty of other options.
I can't even begin to reiterate how frustrating it is as a senior resident having interns who really hate what they're doing (only has happened a couple times but still) - it's bad for morale everywhere and just makes everyone miserable.
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Reminds me of a conversation in another thread about how it doesn't help to have people who are 'forced' to take up "primary care specialties".
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It just didn't think I could fail. I was told I was guaranteed an interview in IM at my home program, if I wanted it, so I plunked down the hundred bucks for a practice interview. I put them at the bottom of the rank list as an afterthought. It didn't even occur to me given my stats and the number of interviews I had that I'd end up here.
I just go to work, do what I'm paid to do, work on my research and all that. It could be worse. I've got a paycheck every two weeks and the opportunity to put my name on some papers, make some contacts and the like. I figure this is just a bump in the road and I have at least a shot at bigger and better things further on down the line.
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Because you can't be a cardiologist without doing IM first.
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I'm kind of tired of this answer. IM has become the new "Pre-Cards/GI," nearly as deplorable of an educational notion as Pre-Med.
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