Warning about going into Medicine from a Resident

[emry123]

For those of you who are thinking about internal medicine you should really think twice about this. I am a resident at a very strong program and want to give you my two cents. In theory, medicine is a wonderful area to go into but but in reality it is so far from this. As a sub I you really do not get to experience IM and see it for what it really is. Medicine is the dumping ground of all the specialties. You will be dumped on for 3 years. Now think about this.... day in and day out you are constantly thrown cases that often have little learning value. You are woken up at 3 am for a social admit and you can not stop any of it. The ER will dump all their cases on you and you have little or NO choice in taking it. You have a small bowel obstruction and surgery will consult on it!!! You will be a part time social worker, part time physical therapist, part time nurse and oh yes, part time physician. IM docs talk all day long and they don't do s... You micromanage patients on a daily bases... you tinker a little bit one day and then tinker some more. You will theorize all day long and in the end this will not change your clinical outcomes. Wait until you get to the ICU. You will sit there with a critically ill patient and essentially (attending dependent) the medicine people will perform futile care until their is no life left in that person. Many have no concept of futile care and they just pound things into the ground. There is a reason no one is going into medicine and you should understand why??? You will never see the frustration of the residents when you interview or do sub I's. I can't tell you the number of unhappy medicine residents there are all over the county. I have friends at most of the prestigious programs and they are going through the same misery. When you get out and do not go into a specialty the reimbursement is horrible. You will not be able to get your patients out on time and your service always gets backed up. These are just a few things out of many that you need to realize before you make a mistake. Good luck to all of you I wish you the best and hope I havce given you some insight into IM.

---

Members don't see this ad.

 

[dharmabum7]

sigh, one jaded soul should not be enough to derail everyone else's ambition...while there are definately negative aspects in medical residency, i still think there can be fulfillment in medicine....ultimately i think this post simply reminds us all, be careful where you choose to go for residency, because prestige does not equal happiness....

 

[docjr]

Thanks for your two cents. Forgive the presumption, but it sounds like you either chose the wrong specialty, the wrong program, or both. I think many of us have a pretty good idea of what internal medicine entails, and want to do it anyway.

Your characterization wasn?t particularly inaccurate, just bitter. Many of us want to subspecialize, and those who don?t might enjoy some of the psychosocial aspects of the job ? or at least not hate it as much as you do. Things might be a little more collegial somewhere other than a top ranked program, or in private practice vs. academic medicine.

That?s not to say you aren?t going to get dumped on, or the ER docs aren?t going to piss you off. But hell, that?s life. Also, I?m not sure that I would operate under the assumption that what you do in residency will, in any way, resemble what you?ll be doing for the rest of your career after residency.

I?d still rather wake up at 3am and admit the guy with the diabetic foot ulcer that ?couldn?t wait until morning?, than I would scrub in on a 14 hour kidney/pancreas transplant or a 12 hour aneurysm clipping. Hopefully it?s not too late for you to switch to anesthesiology, or something you might find more enjoyable. At the very least, I hope you have some vacation time coming up.

 

[ckent]

Your complaints have more to do with your specific program rather then IM as a whole. I imagine that every IM program out there experiences some amount of "dumping" from surgery or the ER, but other programs are much better at giving IM residents the authority to say no and refuse patients. I'm going to have disagree with you on those social admits though, because as annoying as they can be to get at 3 in the morning, sometimes it's the patient's only option in terms of getting medical care versus dying out on the street. Remember that after residency, as an attending, you will have the authority to say no to the ER and the surgeons, and actually, most surgical cases can't even share their cases with IM physicians simply because they get a set fee per case (surgery and hospital stay), so if they did want an IM physician to watch over their patient's postsurgical status, then they would have to split some of their moola. Also, my understanding was that partial small bowel obstruction was that medical therapy is the first line of therapy, so I don't think that it was completely inappropriate for that patient to admitted to your service and having surgery consult on them. I can empathize with the surgeons too, they oftentimes have very large patient lists and they have to split their time between working in the OR and taking care of floor work and rounding. My surgery rounds were always much longer then my medicine rounds, mainly because of the volume of patients that were on my surgical services I think.

 

[AJM]

Emry,
No offense, but it sounds like you are very burned out, and may want to consider changing out of IM, as it doesn't sound like it's the right field for you. I would disagree that a large number of IM residents share your feelings about the specialty. While there are times I may feel as you do, (usually only during particularly bad call nights), I overall really enjoy the field and get a lot of satisfaction out of taking care of medicine patients. Most of the residents in my program are also very happy and enjoy what they do. My program is a strong program as well, although I fail to see what that really has to do with overall happiness with the field of IM.

A lot of the issues you mention are very program dependent, and that may be part of the problem, as ckent mentioned. Yes, there are times where you get dumped on, but every specialty has their own dumps as well -- it's not unique to IM. I've found that it's best to look at these so-called dumps from the patient's perspective. Basically someone needs to take care of these patients, and medicine is the specialty that best takes care of the patients where it's not entirely clear what's wrong with them. Sure, there's often not a lot of learning with dumps, but that doesn't mean these patients don't need help. Also, some of the most interesting cases I've had initially looked like dumps or weak admissions and turned into something more than that. That taught me to keep a good differential diagnosis in mind for every case -- even the ones that seem simple or boring.

I also think that sub-I's do get a pretty good idea of what IM residency is like (although nothing really compares with doing the residency yourself). Sub-I's are with the residents on their team all the time. Residents don't just change their personality or attitude every time their sub-I steps into the room. Yes, interviews tend to be very sugar-coated, but it is incredibly difficult to sugar coat things to a sub-I that you're working with for a month straight.

I'm sorry you've been so frustrated, and I hope you find a good solution to your dissatisfaction.

 

[avendesora]

Please don't feed the troll.

If the OP is serious, I really feel for you. IM is not for everyone, and you obviously chose based on the wrong reasons, or your program sucks (Emory?)

Some people enjoy taking care of PATIENTS as opposed to problems.

I could duplicate that post for any specialty and fill in the blanks differently to make it come out in a bad light. Anyone on here still making up your mind, take this as a warning to choose WISELY!.

 

[Surfer75]

I'm a R1 from a very respectable program and agree with the fact that IM can be a huge dumping ground, and yes you'll have your psycho-social admits and micromanagement here and there, but there will be a lot of valuable learning cases as well which make it all worth it. I want to specialize and by no means did I ever fall head over heals in love with general IM, but realize that everyone has to go through his/her 3 yrs to get to their fellowship. That's life. Fortunately we only do 4 months general IM in year 1, 3 in year 2, and 3 in year 3, the rest are specialties, CCU, and ICU.

- JT

 

[Crypt Abscess]

Only four months of general wards as a PGY-1 in IM? I thought the RRC REQUIRED at least 7 months of general IM wards as a PGY-1.

 

[Foxxy Cleopatra]

emry,

This is interesting because I am a surgical resident who has been thinking about switching into IM- guess the grass is always greener...

I have been experiencing many of the same frusterations; we are a dumping ground for ortho, neurosurg, and plastics- most of what I do is social work, discharge planning, follow-up arrangement, and writing the home scripts the ortho team wants.

I have logged 4 cases in the last 3 months; I can do my whole job with a pen and a telephone. I feel that my knowledge base is worsening because all I do is scut. I feel your pain because I dread going into work every day and have thought about switching into medicine because at least it (from the periphery) seems like they have teaching rounds and think.

On the other hand, I have not yet done a general surgery month, so I cannot say that I really do not like surgery- I have barely done any! It is very difficult to separate whether we are just in a temporarily bad situation or if the field after residency itself really stinks.

Just wanted to say I hear your disgust- it is very hard to keep an open mind. I had a blast during my surgery rotations as a 3rd and 4th year student yet now I have a hard time finding 1 good thing to say about residency. I wish I was in love with radiology or anesthesia because I'd switch. Oh well. Good luck.

 

[Square Pants]

Agree with you emry123, but you don't go far enough. The same can be said for every primary care career (and most specialty residencies). I have thought of this a lot and I am totally prepared to be a secretary/social worker/transcriber. With the remaining 2% of my time I *hope I can do some medicine, but who the freak knows.

The problems which you speak of are inherent to our system. It's what you get when ~75% of our admissions are due primarily to correctable social problems (smoking, obesity, sedentary lifestyle). If people took better care of themselves we could spend less time on social work and more time on medicine. But alas...

I also agree that primary care is mostly about letting the patient heal him/herself, and then charting this progress ad-nauseum so we can feel good about how we spent 90 hours last week.

Anyway emry123, just wanted to let you know I agree with you.

 

[bartholomew]

It appears to me that there are a couple people on this thread who would have done better by pursuing a career outside of medicine...

 

[Mike2]

Reading all of the angst above makes me think we're all in this misery together and gives me strength. I can and will finish my intern year! (in medicine) I especially laughed out loud when I saw the quote above about being able to do your entire job with a pen and paper. That quote ROCKS! I totally agree, although I have learned a lot this year and do feel competent to manage basic problems that come up all the time in the hospital as well as outpt. I'm at Penn and was also worried for a while but now realize that we take our good days and bad days together. It's a waiting game... just get me to the next year, that's all I ask. Overall, we have some really good people with us, and it helps to talk about our frustrations, which we often do. Here's to subspecialization!