What do I do after I graduate or what to consider?

[Drrrrrr. Celty]

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Hi I originally planned on going for Adult Psychiatry, but ended up soaping into Internal Medicine at a 250 bed community hospital with in house options for fellowships in cards and a few other specialties and in a solid health network thats been around for over 30 years. I wanted to know what I really have to expect in terms of a job after I finish residency aside from being a hospitalist?

I'm willing to work hard during residency and I'm going to work my hardest to make sure I am the most well trained I can be. But where do I go from there and what can or should I envision myself doing afterward? I don't like the idea of being a hospitalist and I think that the career where I can have a more reasonable lifestyle 9 to 5 or having a lot of freedom in setting my schedule is what I really want. I don't want to be the attending who has a roster of 20 patients who he needs to pick up for 7 days on.

I've been interested in doing Rheumatology. But what do I do to improve my odds in obtaining a fellowship or preparing for such? It's been looking like it might be very competitive. What about endocrinology? What or how do I go about getting involved in research or does it matter what kind of research at that?

What about primary care?

I know these questions sound absurd. But I really don't know much of what I'm getting into with this all and I hope I can you can help me figure it out a bit.

 

[chessknt]

Get through intern year and you'll have a more formed idea about what you'll be able and want to do. Residency isn't medical school--you don't have to have your entire pathway mapped out before you walk in the door.

 

[lulu09]

1. Lots of jobs in IM - fellowships, hospitalist, primary care, academic general internal medicine, concierge medicine...etc. Heck, you can even go into tech or consulting. No one is forcing you to be a hospitalist.

2. Hospitalist schedule is not just 7 on/7 off. You can structure very flexible schedules, especially at smaller hospitals.

3. Best prep for fellowship is to be good at clinical medicine (be a good intern and stand out in your program) and do research. Once you feel somewhat confident intern year, try to look for mentors (do your rheum elective early if that's what you're interested in so you can get connections). Rheum is more competitive than endo, but decide after you had a chance to do the relevant electives. It's silly to choose specialties simply based on competitiveness.

4. First step of getting involved in research is to do the clinical elective so you can meet attendings in the specialty at your hospital who may have research projects or can connect you to research faculty at an academic affiliate. The vast majority of residents do clinical research (retrospective analyses, case reports, clinical reviews, meta-analyses...etc.) You can work in a wet lab if you're really into it but I wouldn't advise due to the time commitment involved and steep learning curve, especially without previous lab experience.

5. You will have plenty of primary care training in the form of ambulatory clinic in your residency. You can decide after you've done a few blocks of it whether you like primary care or not.

I know that this is not your intended specialty, but IM is honestly one of the most forgiving in the sense of what you're expected to pick up from the beginning and on the lighter side of general "intensity" compared across all residencies. Once you start internship, just take it one day at a time and you should develop a sense of what you like to do. Come back past intern year and you'll see a lot of these questions would have been answered simply based on your experiences during intern year.

 

[jdh71]

Hi I originally planned on going for Adult Psychiatry, but ended up soaping into Internal Medicine at a 250 bed community hospital with in house options for fellowships in cards and a few other specialties and in a solid health network thats been around for over 30 years. I wanted to know what I really have to expect in terms of a job after I finish residency aside from being a hospitalist?

I'm willing to work hard during residency and I'm going to work my hardest to make sure I am the most well trained I can be. But where do I go from there and what can or should I envision myself doing afterward? I don't like the idea of being a hospitalist and I think that the career where I can have a more reasonable lifestyle 9 to 5 or having a lot of freedom in setting my schedule is what I really want. I don't want to be the attending who has a roster of 20 patients who he needs to pick up for 7 days on.

I've been interested in doing Rheumatology. But what do I do to improve my odds in obtaining a fellowship or preparing for such? It's been looking like it might be very competitive. What about endocrinology? What or how do I go about getting involved in research or does it matter what kind of research at that?

What about primary care?

I know these questions sound absurd. But I really don't know much of what I'm getting into with this all and I hope I can you can help me figure it out a bit.

Primary care you can do right out of residency and you will have your own clinic for three years, so you'll get a good sense of if that is what you want to do. Rheum and Endocrine shouldn't be that hard to get into if you like the specialties. There may not be a lot of "research" where you are going based on your description. It is what it is. Really the best thing you can do at this point is simply be an excellent first year resident, get the lay of the land at your program, rotate through some things you are interested in (most programs will give you a clinical "elective" [you end up going through them all anyway] in a subspecialty your first year - ask for an exposure to rheum or end first year [these also tend to be easier rotations AND as such sought by higher level residents]), and don't plan on making any decisions about anything for 18 months. You now have three months to relax a bit, so do that. Post here less. Stress about it less.