urology vs internal medicine

[C5toC9]

Anybody going through or have gone through similar decision process?

IM
very interesting, see diverse pathology, develop strong foundation of knowledge in medicine, exposure to all fields of medicine, many fellowship options, many practice options, inpatient + outpatient, 90%+ match rate, 3 years + 0-3yr fellowship, manageable hours, super smart people in field

risk of not matching into desired fellowship, "dumping" ground in hospital, lot of chronic diseases without good treatment, declining reimbursement

Urology
experts in GU pathology, lot of up and coming technology, good treatments for many of the diseases, laidback surgeons, good mix of surgery and clinic, high reimbursement, 5 years

risk of not matching into specialty (70%+ match rate), good hours among surgery residents but still worse than medicine, tough residency, only see GU


This is what I can come up with on the top of my head. Thoughts and advice?

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[armybound]

They're pretty much complete opposites in your daily routine.

Do you like to round for hours or do you not?

 

[jcu]

They're pretty much complete opposites in your daily routine.

This.

I will never comprehend the confusion behind some of these specialty vs. specialty threads.

 

[ArcGurren]

They're pretty much complete opposites in your daily routine.

Do you like to round for hours or do you not?

Sigh.

Just so people know... in real internal medicine practice, whether you're a hospitalist, a sub-specialist, or in your outpatient practice, you do NOT round for hours unless you're in an academic setting and you're the kind of person who likes to hear themself talk to death.

With the exception of those people, NOBODY likes to round for hours without getting their work done. Most people go into medicine because they 1) really like primary care or 2) really like some subspecialty. I've never, ever, ever met another fellow student who likes to round that long, and most people I know going into medicine, myself included, hate long rounds.

/rant

 

[ArcGurren]

Anybody going through or have gone through similar decision process?

IM
very interesting, see diverse pathology, develop strong foundation of knowledge in medicine, exposure to all fields of medicine, many fellowship options, many practice options, inpatient + outpatient, 90%+ match rate, 3 years + 0-3yr fellowship, manageable hours, super smart people in field

risk of not matching into desired fellowship, "dumping" ground in hospital, lot of chronic diseases without good treatment, declining reimbursement

Urology
experts in GU pathology, lot of up and coming technology, good treatments for many of the diseases, laidback surgeons, good mix of surgery and clinic, high reimbursement, 5 years

risk of not matching into specialty (70%+ match rate), good hours among surgery residents but still worse than medicine, tough residency, only see GU


This is what I can come up with on the top of my head. Thoughts and advice?

OP, most of what you listed is true, but I would make it pretty clear that the two specialties are VERY different. I don't know if you've rotated through the two specialties, but it becomes very evident very fast that urology is first and foremost a surgical specialty - at least during residency training. I don't know where this nonsensical belief comes from that urology is a good medicine/surgery or clinic/surgery mix comes from - the clinic consists mostly of prescribing erectile dysfunction drugs, doing DREs, pulling drains (just like any other surgical clinic) postoperatively, and following progression of prostate cancer. The only unique thing I would say about uro as a surgical subspecialty are the things you listed, and the fact that you can do a lot of smaller procedures with uro (urodynamics, biopsies, screening cysto, etc) if you so choose.

From what your list sounds like, it sounds as though you're learning more towards medicine.

 

[remote]

this should not even be a decision....please do NOT do internal medicine (unless you can't get into uro). here are some reasons why:

1. rounding - as you will quickly notice, most of your residency will be rounding for hours on end after which you will have to write long-ass notes on each patient and then you get to round again...then you go home. trust me, there is no way someone can tell me that they actually enjoy rounding for hours every day. also a significant portion of your residency will be spent standing and talking about the differential diagnosis of x, y, and z...you will actually be doing nothing.

2. dump service - as you mentioned above, yes, medicine is the dump service of the entire hospital and every other service knows that and dumps everything they can on medicine. you may think "oh, it can't be that bad" but you're going to start hating when you have to admit another hip fracture or kidney stone patient because the patient has a history of constipation (a bit of an exaggeration, but you get my point)...also, it's going to become very annoying and frustrating when there will be nothing you can do to block these dumps because the hospital will back the surgeons b/c they know that surgeries/procedures are what make money for the hospital and thus they will want to keep those surgeons busy doing their surgeries and not having to worry about patients on teh floor....

3. "Variety" - i love how pple going into medicine always claim as one of their reasons for going into medicine that they want to know about "everything" and be able to treat "everything." oh please, give me a break...98% of what you will do will be COPD/CHF exacerbation, cellulitis, urosepsis, and electrolyte abnormalities. oh wow, look at that variety....for most other things, you will become very good at calling consults and getting the specialist's opinion and thus will just have follow orders.

4. competition in residency - since 99% of the pple going into medicine want to do cards/GI/another fellowship, there will continue to be a lot of competition in residency among residents to out-perform each other, get research projects, impress attendings, etc...that's going to suck.

5. non-competitive residency - why do you think medicine is not so competitive? all the smart kids in med school realize how much it sucks and thus don't want to do it...so be smart and don't do it.


Now, why you should do Urology:

1. Specialist - you will be a specialist, and thus do not have to worry about every single medical problem the patient has. but rather just deal with the GU issue, write a quick note, and leave. along these lines, you will mostly be a consult service and thus don't have to deal with the social issues of patients and finding things like nursing services, etc.

2. Surgery/Medicine - uro has one of the best mixes of medicine and surgery and thus allow one to tailor his/her practice to whatever fits their life. younger urologists do more surgeries whereas older urologists can taper down how much surgery they do and focus more on smaller procedures and office work/procedures. this aspect is huge in my opinion because we all will become older and what we could do at age 33 (i.e. a 6 hour surgery) is not as doable at age 53...so keep that in mind. it seems like too many students don't think about this when picking fields.

3. Decent lifestyle - uro def. has one of the best lifestyles among surgeons given the fact that there are relatively few GU emergencies. again, this is a nice aspect especially as you get older in your career.

4. High compensation - at least for now, urologists are some of the highest paid physicians.

5. Variety - GU issues encompass everything from benign diseases, malignant diseases, anatomic defects, infections, trauma, reconstructive, etc. additionally, urologists treat men, women, and kids of all ages. i think GU has the best variety of any surgical specialty.

6. Very competitive - there is a reason why it is competitive...it's worth doing.

 

[todds]

this should not even be a decision....please do NOT do internal medicine (unless you can't get into uro). here are some reasons why:

1. rounding - as you will quickly notice, most of your residency will be rounding for hours on end after which you will have to write long-ass notes on each patient and then you get to round again...then you go home. trust me, there is no way someone can tell me that they actually enjoy rounding for hours every day. also a significant portion of your residency will be spent standing and talking about the differential diagnosis of x, y, and z...you will actually be doing nothing.

I think this is based on medical student experience, however not all services round for that long and you do not have to write a long ass progress note for each patient. When I was on medicine, I just wrote a quick note either on prerounds or during rounds. You have to write whats relevant and the HPI if you type fast its not a big deal

They are big on differential because unlike surgeons, IM thinks. Furthermore rounding is only on academic services, not as an attending

2. dump service - as you mentioned above, yes, medicine is the dump service of the entire hospital and every other service knows that and dumps everything they can on medicine. you may think "oh, it can't be that bad" but you're going to start hating when you have to admit another hip fracture or kidney stone patient because the patient has a history of constipation (a bit of an exaggeration, but you get my point)...also, it's going to become very annoying and frustrating when there will be nothing you can do to block these dumps because the hospital will back the surgeons b/c they know that surgeries/procedures are what make money for the hospital and thus they will want to keep those surgeons busy doing their surgeries and not having to worry about patients on teh floor....

This is true - this is definitely one of the drawbacks..HOWEVER, you will be on a service like this for 7 months out of 3 years at many good programs. The rest of the time you will be on specialty rotations and wont deal with this problem, and if you dont become a hospitalist, never deal with it again after. Some programs may have more months as primary service which would suck.

3. "Variety" - i love how pple going into medicine always claim as one of their reasons for going into medicine that they want to know about "everything" and be able to treat "everything." oh please, give me a break...98% of what you will do will be COPD/CHF exacerbation, cellulitis, urosepsis, and electrolyte abnormalities. oh wow, look at that variety....for most other things, you will become very good at calling consults and getting the specialist's opinion and thus will just have follow orders.

Again, I think this may be your medical student experience. You don't have to call consults for everything and you DO NOT have to follow anybody orders. Consultants give their opinion, doesnt mean you follow it if you dont want to. There is a variety of pathology at most big academic centers, but I imagine what you say to be the case at smaller community programs. Furthermore you will be seeing a whole bunch of stuff on specialty rotations which should be at least 2/3 of your residency

4. competition in residency - since 99% of the pple going into medicine want to do cards/GI/another fellowship, there will continue to be a lot of competition in residency among residents to out-perform each other, get research projects, impress attendings, etc...that's going to suck.

If you're competitive enough to be considering Urology, you will be in good spot to get a top notch IM program and you should be able to basically get what you want so I don't think that its too much of a deal.

5. non-competitive residency - why do you think medicine is not so competitive? all the smart kids in med school realize how much it sucks and thus don't want to do it...so be smart and don't do it.

Its not competitive on AVERAGE, but the top programs you bet you need a 250+ step 1 plus honors in clerkships + research. The problem there is so much variation and there are a lot of bad community and academic programs out there so IM get a bad rep. Again if you're competitive for Urology, you'll be competitive for a top IM program and you will have lots more options.

GI, Cards definitely earn more and sometimes Heme/Onco or Pulm/CC/Sleep can bring in more money that Urology depending on where you practice, even though money shouldnt be the main motivator for you


.

^

 

[colbgw02]

"They are big on differential because unlike surgeons, IM thinks."

Yes, that's definitely the reason why IM is big on differential [sic].

 

[Freakfarm0]

"They are big on differential because unlike surgeons, IM thinks."

Yes, that's definitely the reason why IM is big on differential [sic].

I'm digging The House of God signature!

 

[colbgw02]

I'm digging The House of God signature!

Thanks.

There are a lot of things about that book that are minimally or no longer applicable, but I think laws 8 and 13 will always be true.

 

[C5toC9]

Would it be too late at this time of the year (third year MS) to go the urology route?

These decisions are killing me

 

[officedepot]

.

 

[DrBowtie]

Would it be too late at this time of the year (third year MS) to go the urology route?

These decisions are killing me

Not too late. The good thing is that since Uro is the early match and IM is the late match, you could actually apply and interview for both. If you don't match Uro, you can still match an IM program.

 

[C5toC9]

Good points. I think you generally need at least 1 away in uro and with home uro rotation and medicine sub-i/away, it would be difficult to do both. Do attendings/programs take it well if you apply to 2 things? I take it they would find out one way or another, even just by looking at your fourth year schedule.

 

[ArcGurren]

Good points. I think you generally need at least 1 away in uro and with home uro rotation and medicine sub-i/away, it would be difficult to do both. Do attendings/programs take it well if you apply to 2 things? I take it they would find out one way or another, even just by looking at your fourth year schedule.

I don't think it's as big a deal for urology since its an early match.

 

[Law2Doc]

Also bear in mind that if you know urology is what you really want, you could always do a research year between 3rd and fourth year where you could work on a urology related project while during the year squeeze in an away and home rotation. You " lose " a year, but come out much more competitive for this specialty as compared to those with nothing urology related on their CV (which for an early match specialty is going to be many people).

 

[peterkronenberg]

Well, I know this is an old post, I'm not working in the US, but in Europe, but anyway, here it goes:
I faced a similar decision with the difference of being already a resident in Internal Medicine. I always loved internal medicine, and it's true that sometimes it's hard, others try to dump their patients on us and so on. But I still liked it. However I always felt the need for a more practical/manual/surgical side that was lacking in Internal medicine.
And urology seemed for me another good option where that surgical need could be satisfied. Beside it's (very limited) medical side I must admit, urology was one of the specialties that appeared to have many other interesting stuff and aspects. And 8 years ago I had the chance to apply for an urology residency. And I'm very happy I did so, it was the best decision of my life.
Urologists perform at least 4 types of different surgical approaches, including open surgery, laparoscopic, endoscopic or percutaneous surgery (and i'm not even considering robotics). The surgeries are sometimes challenging, but it's not like some other potentially stressful specialties, or at least I imagine them as being stressful, such as open heart surgery or vascular surgery (where you probably wonder hmmm, will he die now? will his heart beat again? is this suture strong enough or will he bleed to death in 2 minutes after I scrubbed down?). There are many non-surgical techniques that are also fun and done multiple times daily, such as ultrasound, cystoscopies, urodynamic studies, prostate biopsies and so on. For those who love technology, urology has plenty of it, not only in the OR but also outside of it. Concerning your fellow colleagues, people in urology seem to be more relaxed, funny and have better interpersonal relations, but of course this is very subjective, but nonetheless my sincere impression, and also one that contributed for me to choose urology. And concerning scientific commitment and advances, urology has some of the finest and best organized congresses worldwide concerning content, practical courses, hands-on courses, wide possibilities of poster, podium and video presentations for residents or others who wish to (if it's high quality research), annually reviewed guidelines, magnificent fellowships throughout the world, and so on. Even as a resident you might become enthusiastic about a certain field, become involved in it, perhaps doing some research in it, and who knows discover things that will change how things are done throughout the world. Believe it's not impossible nor so unlikely if you dedicate yourself.
The bottom-line is, if you identify yourself with the lines I wrote above, you should REALLY consider urology as a possibility.
I hope this somehow helps those that were in the same situation as I was.

 

[FootballFoot]

What do you all think about the radiation and cancer risk from use of fluoroscopy in the OR all the time for urologists? Isn't that a big downside for urology? What about having to perform DREs every day? And having urine splashed on you?

 

[Haybrant]

Would not recommend urology. Mostly bc urologists are dicks. I only say that in part jest. Also be careful, it is not easy to get a job in a location that you may want, although that goes with many specialties but in medicine that is not a problem.

Uro residency is worse than medicine hands down. They want to keep their numbers down so you will be stuck with terrible consults and you will get very mean/jaded. Those residency years are your glory years, dont waste it slaving away over someones hematuria. Also as prostate surgeries continue to fall bc patients are getting smarter the competition for $ in urology is going to skyrocket. I would be very careful about getting into urology right now

PM me, always happy to discuss any issues.

 

[mcloaf]

Would not recommend urology. Mostly bc urologists are dicks. I only say that in part jest. Also be careful, it is not easy to get a job in a location that you may want, although that goes with many specialties but in medicine that is not a problem.

Uro residency is worse than medicine hands down. They want to keep their numbers down so you will be stuck with terrible consults and you will get very mean/jaded. Those residency years are your glory years, dont waste it slaving away over someones hematuria. Also as prostate surgeries continue to fall bc patients are getting smarter the competition for $ in urology is going to skyrocket. I would be very careful about getting into urology right now

PM me, always happy to discuss any issues.

It's a little shady for you to offer the above opinion without qualifying it by mentioning that you're a radonc attending who sees prostate cancer patients.

 

[Haybrant]

It's a little shady for you to offer the above opinion without qualifying it by mentioning that you're a radonc attending who sees prostate cancer patients.

oh sorry, im rad onc, i see prostate like 85% of other rad oncs. You can take advice from other med students or from someone who has about 10 friends that are urology attendings. I have no incentive to come here and lie to you. Too many people want things sugar coated in medicine and I can tell you many young attendings I know are in situations they didnt expect or didnt want to be in bc they werent told the truth up front.

 

[mcloaf]

oh sorry, im rad onc, i see prostate like 85% of other rad oncs. You can take advice from other med students or from someone who has about 10 friends that are urology attendings. I have no incentive to come here and lie to you.

I didn't say you were lying, but your opinion of urology isn't unbiased either.

 

[just another mojo maker]

oh sorry, im rad onc, i see prostate like 85% of other rad oncs. You can take advice from other med students or from someone who has about 10 friends that are urology attendings. I have no incentive to come here and lie to you. Too many people want things sugar coated in medicine and I can tell you many young attendings I know are in situations they didnt expect or didnt want to be in bc they werent told the truth up front.

Sorry to side track this thread, but it'd be great to hear your opinion about your field. If you were a med student now, would you choose hem onc via IM or rad onc? I ask mainly because there are some location and job concerns for rad onc now. I'm not particularly attached a location but would prefer NE/Mid-Atlantic region long-term.

 

[GadRads]

Many people put up with internal medicine so they can get to GI, cards, etc. Once in a while you will see an interesting case that actually makes you think, but by and large, you will manage COPD exacerbation, diabetes/HHS, hypertension, hypertensive urgency, alcohol/drug intoxication, pneumonia, sepsis, UTI, urosepsis, pancreatitis, pain seekers, cellulitis, osteomyelitis, dehydration, gastroenteritis, and so on. You deal with medically non-adherent patients and occasional patient belligerence. The ICU is a bit more interesting as you get to use your brain a little more.

Overall, general IM is important but it is challenging due to the social issues you have to deal with. There is also the issue of risk. My friend once admitted a patient who had bedbugs crawling on him. Had to dump her clothes into the washer as soon as she got into her apt, even though she used contact precautions, and she always gets only as close as needed for physical exams. Props to the nurses and infestation personnel who took care of the issue.

You also have lots of documentation and paper work. You spend more time doing paper/social work than actual medicine. And don’t even get me started on the eternal and inefficient rounds. If you don’t mind all these issues, maybe medicine is for you. There are people who love it. If I were a categorical IM resident, I would be doing it to get to my fellowship.

 

[Haybrant]

.

 

[masaraksh]

I can't tell which one of these two is worse they're both beyond undesirable for me.

 

[FootballFoot]

Many people put up with internal medicine so they can get to GI, cards, etc. Once in a while you will see an interesting case that actually makes you think, but by and large, you will manage COPD exacerbation, diabetes/HHS, hypertension, hypertensive urgency, alcohol/drug intoxication, pneumonia, sepsis, UTI, urosepsis, pancreatitis, pain seekers, cellulitis, osteomyelitis, dehydration, gastroenteritis, and so on. You deal with medically non-adherent patients and occasional patient belligerence. The ICU is a bit more interesting as you get to use your brain a little more.

Overall, general IM is important but it is challenging due to the social issues you have to deal with. There is also the issue of risk. My friend once admitted a patient who had bedbugs crawling on him. Had to dump her clothes into the washer as soon as she got into her apt, even though she used contact precautions, and she always gets only as close as needed for physical exams. Props to the nurses and infestation personnel who took care of the issue.

You also have lots of documentation and paper work. You spend more time doing paper/social work than actual medicine. And don’t even get me started on the eternal and inefficient rounds. If you don’t mind all these issues, maybe medicine is for you. There are people who love it. If I were a categorical IM resident, I would be doing it to get to my fellowship.

Do you think these issues are also present in EM? Social issues, no intellectual thinking, personal risk?

 

[Psai]

Do you think these issues are also present in EM? Social issues, no intellectual thinking, personal risk?

Hell no
Social issues are dealt with by the social worker or admitted to medicine. You're dealing with the undifferentiated patient. It's as close to pure medicine as it should be practiced as you can get in this medicolegal environment. Personal risk, yes you have a lot of drunks, drug use, people covered in lice, etc. but that comes with the job.

 

[nufang]

.

Haybrant, would like to send you a PM, however it doesn't appear you allow for that (no "start a conversation" option when I click your name, error message when I start a convo manually).