Which type of doctor would you choose to be of these 3?

[NP545]

I have an interest in primary care. Recently, I was talking with a couple of my resident friends and when i told them I was considering internal med, they started laughing and told me I should consider changing my mind. Is there not a good balance of lifestyle, residency rigor, salary, and satisfaction in primary care?

I've also noticed that primary care gets "picked on" a lot. Why is this? Are their residencies 'worse' than say a surgery residency? Why do people make fun of primary care aspirations?

(I usually ignore their hate, but I'm curious as to why this hate is so prevalent)

---

Members don't see this ad.

 

[Ismet]

Different strokes for different folks.

Lots of specialties get picked on. Inpatient specialties pick on EM. Derm gets picked on. FM gets picked on. Figure out what you like to do, talk to people in that field to get a sense of the lifestyle and rigor, and don't think as much about what your resident friends say. Unless they are internal med residents. If that's the case, then ask them what they mean by telling you to change your mind.

Also, PEDS

 

[Catalystik]

PEDS

Yep!

 

[mcloaf]

I voted IM, but only for the fellowship-trained subspecialties you can pursue afterwards. Straight up IM is a tough gig.

 

[Cyberdyne 101]

Isn't there a combined peds/IM option?

 

[NP545]

Straight up IM is a tough gig.

Why do you say that?

 

[gyngyn]

Isn't there a combined peds/IM option?

Yes. A relatively small number of positions, though.

 

[Cyberdyne 101]

Yes. A relatively small number of positions, though.

If attainable, is this even a practical pathway?

 

[ProudMD]

Why do you say that?

Good question. I also want to know.

 

[gyngyn]

If attainable, is this even a practical pathway?

There were about 340 filled positions in Med/peds last year. It's a niche sort of specialty in which applicants have "back-up" plans for either IM or Peds. When I ask my students why they have chosen this specialty it is more likely to be the force of personality of a faculty member in this small community.

 

[ProudMD]

@gyngyn

Could you explain why some consider pure internal medicine (no fellowship afterwards) a difficult/less desirable job?

 

[gyngyn]

@gyngyn

Could you explain why some consider pure internal medicine (no fellowship afterwards) a difficult/less desirable job?

Internal Medicine is at the front line of the lifestyle diseases that affect and kill a majority of Americans.
It's a little like being a Marine. You do a lot of the important heavy lifting, but Special Forces gets all the glory.

 

[Cyberdyne 101]

There were about 340 filled positions in Med/peds last year. It's a niche sort of specialty in which applicants have "back-up" plans for either IM or Peds. When I ask my students why they have chosen this specialty it is more likely to be the force of personality of a faculty member in this small community.

The backup plan makes perfect sense. So are the faculty in this community looking to increase the number of spots? Or do they want to keep it exclusive?

 

[gyngyn]

The backup plan makes perfect sense. So are the faculty in this community looking to increase the number of spots? Or do they want to keep it exclusive?

At the moment is looks like it will stay a niche specialty.

 

[Cyberdyne 101]

Internal Medicine is at the front line of the lifestyle diseases that affect and kill a majority of Americans.
It's a little like being a Marine. You do a lot of the important heavy lifting, but Special Forces gets all the glory.

Wow, that's a powerful analogy. There must a great deal of frustration in this field.

Edit: A few IM doctors that I've spoken to confirmed this. Kudos to everyone who is eager to enter IM.

 

[gyngyn]

Wow, that's a powerful analogy. There must a great deal of frustration in this field.

I love these guys. There is no other specialty I consult more. A good internist is priceless. I don't know how they do it; a boatload of topics to stay abreast of and static reimbursement for their opinion...

 

[mcloaf]

Why do you say that?

Good question. I also want to know.

Gyngyn basically summed it up and obviously has a lot more experience in this area than I do. However based on IM docs that I've interacted with it seems like a high stress job with a lot of very sick patients and rough lifestyle. The inpatient IM doc I know here works hours that don't seem all that different from some surgeons at times, albeit for a lot less pay and with a lot more rounding. Being a generalist is also less appealing to me than being an expert in a particular area.

Then again I'm still in the preclinical years, so I'll defer to the attendings/residents/clinical med students around here.

 

[Tappinfool66]

Also, PEDS

Couldn't have written it better myself. Peds all the way

 

[allantois]

I don't like kids and I would rather have an option to specialize.

 

[sliceofbread136]

If it were up to me we would only have pediatricians. Once you pass 20 you've lived long enough

 

[Catalystik]

I don't like kids and I would rather have an option to specialize.

Subspecialties in Pediatrics:
Adolescent Medicine
Child Abuse Pediatrics
Developmental-Behavioral Pediatrics
Hospice and Palliative Medicine
Medical Toxicology
Neonatal-Perinatal Medicine
Neurodevelopmental Disabilities
Pediatric Cardiology
Pediatric Critical Care Medicine
Pediatric Emergency Medicine
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Hematology-Oncology
Pediatric Infectious Diseases
Pediatric Nephrology
Pediatric Pulmonology
Pediatric Rheumatology
Pediatric Transplant Hepatology
Sleep Medicine
Sports Medicine

 

[allantois]

Subspecialties in Pediatrics:
Adolescent Medicine
Child Abuse Pediatrics
Developmental-Behavioral Pediatrics
Hospice and Palliative Medicine
Medical Toxicology
Neonatal-Perinatal Medicine
Neurodevelopmental Disabilities
Pediatric Cardiology
Pediatric Critical Care Medicine
Pediatric Emergency Medicine
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Hematology-Oncology
Pediatric Infectious Diseases
Pediatric Nephrology
Pediatric Pulmonology
Pediatric Rheumatology
Pediatric Transplant Hepatology
Sleep Medicine
Sports Medicine

My specialization comment referred to family medicine


PS I know there are a few specialties within family medicine.

 

[HinduHammer]

Yes. A relatively small number of positions, though.

If attainable, is this even a practical pathway?

There were about 340 filled positions in Med/peds last year. It's a niche sort of specialty in which applicants have "back-up" plans for either IM or Peds. When I ask my students why they have chosen this specialty it is more likely to be the force of personality of a faculty member in this small community.

My good friend is a Med/Peds resident down in Houston. He tried to match into ENT via the couples match, but apparently the programs in Houston had a quote of Baylor grads and he just happened to be the one left out. Anyway, his wife matched into Surg there so he scrambled into a Med/Peds residency and he LOVES it. He's not sure what he's going to do afterwards, probably leaning towards adults. But he really feels like he is getting a much more well-rounded, comprehensive training. Perhaps he's making lemonade out of lemons, but he really enjoys what he's doing now and is looking forward to subspecializing. He is leaning towards Critical Care and will either do Peds CC or Adult CC. Just thought I'd throw my n=1 story in here =)

 

[Cyberdyne 101]

Subspecialties in Pediatrics:
Adolescent Medicine
Child Abuse Pediatrics
Developmental-Behavioral Pediatrics
Hospice and Palliative Medicine
Medical Toxicology
Neonatal-Perinatal Medicine
Neurodevelopmental Disabilities
Pediatric Cardiology
Pediatric Critical Care Medicine
Pediatric Emergency Medicine
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Hematology-Oncology
Pediatric Infectious Diseases
Pediatric Nephrology
Pediatric Pulmonology
Pediatric Rheumatology
Pediatric Transplant Hepatology
Sleep Medicine
Sports Medicine

Peds PM&R is another great field. Obviously, it's through a different pathway, but I figured it was worth mentioning

 

[Catalystik]

Peds PM&R is another great field. Obviously, it's through a different pathway, but I figured it was worth mentioning

Pediatric Allergy and Immunology has another pathway, too.

 

[Tappinfool66]

Pediatric Allergy and Immunology has another pathway, too.

I'm currently interested in this. It seems like a really interesting specialty with the option, depending on where you do fellowship, to be very clinical (more on the allergy side) or academic (more on the immunology side). That being said, I'm not even in medical school yet (accepted and starting next August, though!) so I'm sure I'll change my mind a thousand times.

 

[JPA178]

Isn't there a combined peds/IM option?

Also, Med/Peds is great if you want to treat chronic conditions that span from childhood to adulthood. For instance, you could do a pulmonology fellowship and specialize in patients with cystic fibrosis from childhood through adulthood, or endocrinology and work with type 1 diabetics, etc.

 

[gyngyn]

My good friend is a Med/Peds resident down in Houston. He tried to match into ENT via the couples match, but apparently the programs in Houston had a quote of Baylor grads and he just happened to be the one left out. Anyway, his wife matched into Surg there so he scrambled into a Med/Peds residency and he LOVES it. He's not sure what he's going to do afterwards, probably leaning towards adults. But he really feels like he is getting a much more well-rounded, comprehensive training. Perhaps he's making lemonade out of lemons, but he really enjoys what he's doing now and is looking forward to subspecializing. He is leaning towards Critical Care and will either do Peds CC or Adult CC. Just thought I'd throw my n=1 story in here =)

For sure. My students who go into it seem to love it. That's how they keep filling the residency slots!

 

[aalamruad]

I'm currently interested in this. It seems like a really interesting specialty with the option, depending on where you do fellowship, to be very clinical (more on the allergy side) or academic (more on the allergy side). That being said, I'm not even in medical school yet (accepted and starting next August, though!) so I'm sure I'll change my mind a thousand times.

 

[ratman7]

Don't all three types you listed make the same salary, plus or minus 5K?

 

[gyngyn]

Don't all three types you listed make the same salary, plus or minus 5K?

Their work and training is very different.

 

[IlDestriero]

Wow, that's a powerful analogy. There must a great deal of frustration in this field.

Edit: A few IM doctors that I've spoken to confirmed this. Kudos to everyone who is eager to enter IM.

Lots of people are eager to enter IM and be on the front lines of primary care managing complex patients... until they match. Then it's all about the specialization and jockeying for fellowships.

 

[IlDestriero]

I don't like kids and I would rather have an option to specialize.

There are fellowships in peds to specialize in anything you want, but you'd have to like kids.

 

[Tappinfool66]

Whoops, fixed it! I realized that what I was saying sounded confusing and/or wrong. I didn't mean that allergy can't be academic or that immunology is all research with no clinical aspect. What I wanted to say was that it seems like an appealing specialty because it gives you the opportunity to work in an outpatient setting with patients who are generally well as an allergist or in an inpatient setting with sicker patients as an immunologist. This probably isn't specific to this specialty, though. I think I'm just trying to justify my reasons for liking it lol

 

[Cyberdyne 101]

Lots of people are eager to enter IM and be on the front lines of primary care managing complex patients... until they match. Then it's all about the specialization and jockeying for fellowships.

I was actually referring to the ones that do not seek fellowship training.
But you're right, there is more eagerness among those that do specialize.

 

[RTC19]

Peds hands down. I love kids.

 

[Ismet]

I don't like kids and I would rather have an option to specialize.

Easy! Family Medicine --> Geriatrics. Guaranteed no kids!

How can you not love kids tho

 

[allantois]

Easy! Family Medicine --> Geriatrics. Guaranteed no kids!

How can you not love kids tho

I am actually interested in Geriatrics (Although I mostly think of subspecialties within IM that deal with seniors).

Hopefully adcoms would be delighted to hear that

I'm planning to back up my claims by volunteering at a nursing home
And I like kids who are old enough to talk up until they reach middle school

 

[ratman7]

Their work and training is very different.

which would you say is the most lifestyle-friendly of the three?

 

[IlDestriero]

Best lifestyle and low stress is probably PM&R.

 

[Instatewaiter]

Don't all three types you listed make the same salary, plus or minus 5K?

No they don't.

 

[gyngyn]

which would you say is the most lifestyle-friendly of the three?

I see physicians delighted with their life in all these specialties. I've them miserable as well. The quality of your life in this profession comes from choosing a field that you are so good at that everyone recognizes it.
It 's a lot easier to be exceptionally good at something that provides intrinsic reward.

 

[NontradCA]

I picked Peds. I like kids, not so much the elderly. Although, part of me wants to work for the elderly for that reason. I find that in general, we don't care a lot about our seniors in this culture.

FM seems as though it's the most grinding and difficult specialty in medicine. You have to wear so many different hats. They are laid back as a specialty, but usually stressed out from what I've seen.

 

[lisi326]

My experience of IM (and one I've heard from a lot of our residents) is that it's intrinsically a career where you aren't actually "fixing" your patients. Most people go into medicine because they want to find a problem, diagnose the problem, then solve it. General IM (and neuro, which is what I'm doing) is not a specialty where you can do that, most of the time. The most common diagnoses you treat are ones that are chronic and treatable but not fixable. I refer to our inpatient medicine service (at large urban hospital that essentially acts as our city's public hospital) as a bandaid service - your patients come in with their uncontrolled hypertension, decompensated heart failure, chronic liver failure, chronic renal failure, and you "tune" them up as best you can (stick a bandaid on it) and send them out, knowing without a doubt that almost all of them will be back within the next few months.

In gen peds, it's mostly the opposite - your kids come in with their acute illnesses that, no matter how bad they might be, they'll almost always recover from without issue - and you feel good about the fact that you're actually helping. IM feels like endlessly spinning your wheels in the mud that is chronic disease care in the US.

That being sad, I'd still def do IM over peds or family. I don't mind not being able to fix my patients.

 

[EvenStevens]

PEDS, even though i've heard they are the worst payed MDs. *shrugs*