Why are IM rounds inefficient?

[GadRads]

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Why do internists spend sooooo much time rounding? Rounds that could take 2 hrs tops drag on to almost 4 hrs. It's quite draining. I love the medicine, but the rounding sucks at times.

 

[22031 Alum]

Why do internists spend sooooo much time rounding? Rounds that could take 2 hrs tops drag on to almost 4 hrs. It's quite draining. I love the medicine, but the rounding sucks at times.

In medical school, you aren't seeing rounds that are meant to be efficient. I guarantee a hospitalist in some random hospital without students/residents is rounding on their service in less than 2 hours. In a teaching environment, there's a lot to pontificate on for the sake of learning.

 

[bashwell]

Why do internists spend sooooo much time rounding? Rounds that could take 2 hrs tops drag on to almost 4 hrs. It's quite draining. I love the medicine, but the rounding sucks at times.

It's mainly for teaching in teaching hospitals, not so much in private practice.

 

[VisionaryTics]

 

[Kaustikos]

Why do internists spend sooooo much time rounding? Rounds that could take 2 hrs tops drag on to almost 4 hrs. It's quite draining. I love the medicine, but the rounding sucks at times.

Because you have to pimp, then pimp and then some idealistic lecture about patients.
Followed shortly by actual medicine

 

[GadRads]

The rounding is dissuading me from IM. My initial goal was cardio, but Rads or Anesthesia look better now. Although I would probably do intern year in medicine before entering the latter two fields.

 

[bashwell]

The rounding is dissuading me from IM. My initial goal was cardio, but Rads or Anesthesia look better now. Although I would probably do intern year in medicine before entering the latter two fields.

Rads and anesthesia face their own difficulties. They're both still good fields for the right person. But I'm just saying make sure you're that person before you pick either. Do a rotation in each, ask not just residents, but attendings too, and attendings who have been attendings for a long time what they think are the positives and negatives including foreseeable challenges of their respective field, etc. For rads, check out posts by people like @tco and @Gadofosveset and maybe @shark2000. For anesthesia, check out posts by people like @FFP and @BLADEMDA. Just ask around a lot. Read a book like Felson's for rads or Anesthesia Secrets for anesthesia.

Also, if you like cardiology, then I'm guessing you'd probably fit in better with anesthesiology (you can later do a fellowship in cardiothoracic anesthesia too) than with radiology (although maybe interventional rads would suit you).

 

[22031 Alum]

The rounding is dissuading me from IM. My initial goal was cardio, but Rads or Anesthesia look better now. Although I would probably do intern year in medicine before entering the latter two fields.

Remember that it's possible that after 3 years, your day-to-day life could bear very little resemblance to residency, if you chose.

 

[alpinism]

IM rounds at my med school were fine, took 2-3hrs tops.

Usually done by 11am, noon at the latest if we had a huge census or multiple complex patients.

Peds rounds on the other hand...

Family centered rounds plus waiting for all the nurses, social workers, pharmacists, and nutritionists to put their 2 cents into the plan, commonly dragged on for 4-6 hours. Some days we weren't done till 2 or 3pm with no lunch break.

 

[GadRads]

IM rounds at my med school were fine, took 2-3hrs tops.

Usually done by 11am, noon at the latest if we had a huge census or multiple complex patients.

Peds rounds on the other hand...

Family centered rounds plus waiting for all the nurses, social workers, pharmacists, and nutritionists to put their 2 cents into the plan, commonly dragged on for 4-6 hours. Some days we weren't done till 2 or 3pm with no lunch break.

What school is this with efficient IM rounds? PM me.

Yeah, that kind of Peds round would have driven me completely insane. Didn't care for peds, but rounds were 8-10/11 AM most days. Made it tolerable.

 

[GadRads]

Rads and anesthesia face their own difficulties. They're both still good fields for the right person. But I'm just saying make sure you're that person before you pick either. Do a rotation in each, ask not just residents, but attendings too, and attendings who have been attendings for a long time what they think are the positives and negatives including foreseeable challenges of their respective field, etc. For rads, check out posts by people like @tco and @Gadofosveset and maybe @shark2000. For anesthesia, check out posts by people like @FFP and @BLADEMDA. Just ask around a lot. Read a book like Felson's for rads or Anesthesia Secrets for anesthesia.

Also, if you like cardiology, then I'm guessing you'd probably fit in better with anesthesiology (you can later do a fellowship in cardiothoracic anesthesia too) than with radiology (although maybe interventional rads would suit you).

I am a cerebral guy who loves solving puzzles. That is what drew me to IM/cardio, but the inefficient IM rounding just wear me out. Surgery rounds were sweet/efficient. If I pursue rads, I will be hoping to do vascular and interventional rads, and cardiac anesthesia if I pursue anesthesia. Main worry is rads job market/CRNA issue in anesthesia. Also hoping to have a research career eventually in either academia or industry.

 

[bashwell]

I am a cerebral guy who loves solving puzzles.

If you're alluding to the diagnostic process, then I'd say this fits much better with radiology (diagnostic) than anesthesiology. In anesthesiology, you'll already know tons about your patient including various diseases and co-morbidities prior to surgery. You have to in order to make sure they make it through surgery! Not that diagnosis can't happen in the OR, but obviously the diagnostic process is central to radiology in a way that it's not in anesthesiology.

You might also consider pathology. Although pathology arguably faces even bigger challenges (e.g. worse job market, needing to do at least one and often two fellowships).

That is what drew me to IM/cardio, but the inefficient IM rounding just wear me out. Surgery rounds were sweet/efficient.

Personally, I wouldn't give up on IM if it's only or mostly about the rounding. I hate rounding too, but I'd look beyond residency/fellowship, and see what it's like in private practice.

Also I think there's a lot more to consider besides just rounding. For example, one good thing about IM and most IM subspecialties is (generally speaking) you are in better control of when you see patients. Not always, but again I'm just speaking in general and in comparison to anesthesia and radiology. If you're a cardiologist or oncologist, and a patient is very late, it's possible to reschedule.

In anesthesia, if a surgeon is late, or a surgeon wants to do an add-on case, and you're on, then you'll be staying late, working weekends, etc. You have a lot less control over your schedule in this regard.

In radiology, if you're not reading as many as other radiologists, you may be regarded as slow, and so you have to pick up the pace.

Also consider not all "call" is created equal. It's in general much better to take call from home than having in-house call which happens a lot in anesthesiology even as an attending. In IM you may or may not have to come in, even if you're on call, depending on the subspecialty, your group, etc.

Just a couple of other things to consider among many other things.

If I pursue rads, I will be hoping to do vascular and interventional rads, and cardiac anesthesia if I pursue ansthesia.

Again keep in mind other things as well. For instance, interventional rads is hard to match and you'll be working very hard. Similar with cardiac anesthesia, which in addition involves working with (in my experience) some of the most arrogant surgeons on the planet. In anesthesia you have to not mind sometimes being treated like hired help or something along those lines. You're a service to facilitate surgery, which has its pros and cons.

Main worry is rads job market/CRNA issue in anesthesia.

Although these are legitimate concerns, I don't actually think these are the main concerns for each of the specialties. There's too much to type about but again just do a rotation if you haven't already, talk to lots of people at various stages of training and experience, etc.

If you go over to the rads forum, it sounds like the job market may be picking up. You'll still most likely have to do a fellowship at least, whether interventional or something else, but that's probably due less to the job market than the fact that there's so much to learn in radiology. Just make sure you're the type of person who also enjoys reading and reading and then reading some more during residency (which is different than what many procedurally oriented people tend to like doing). Lots of studying involved in radiology. For some that's good, for others that's not. Just make sure you have the personality to get through it.

With anesthesia, the CRNA issue is a problem, and most likely the future will most of the time involve supervising 2 or 3 or more CRNAs at a time rather than doing your own cases, since the ACT model is here to stay. This involves taking on medico-legal risks or liability. If something happens, let's hope your CRNA (s) calls you when you asked them to call you rather than thinking they know best, that they're just as good as you are, etc. But CRNA issues aside, the bigger issue is loss of autonomy and independence. Fewer and fewer private practices. Less money, often more hours. You'll most likely be an employee of a hospital or AMC.

Also hoping to have a research career eventually in either academia or industry.

If you're into research, then radiology is probably better. But you can have a research career in both. Although IM again is good too.

Hope that helps a bit, but again just ask lots of people, do rotations, spend some time on the rads and anesthesia forums, etc. Different people may tell you different things, since we're all limited by our own experiences and perspectives. But you'll find common patterns and trends in every specialty which you can pick up on and follow to see if how it all fits with you and your goals in life. Also know what you enjoy may or may not be what you are good at. But you need to be able to have both to some extent to make it through residency, etc.

Personally I think for many if not most people there are several specialties people could be happy in and excel in. But we all can't be stem cells forever. 🙂

 

[GadRads]

@bashwell helpful post. Yes, by cerebral I meant diagnosing and figuring out the problem, especially in complex cases. Rotating in Rads and Anesthesia soon. Talking to many others in both fields as well. Last thing - why do you think rads might be more research friendly?

 

[jdh71]

Probably been said already medicine rounds in medical school are so painful because of teaching medical students and residents. And also making sure the residents aren't killing the patient that you are going to barely see so you need to make sure things are sufficiently covered.

When you're working in the real world you do your own rounds. See patient. Write note. Rinse. Repeat. Until you are done. Then leave. Unless you're admitting then you hang out until it's time to go home. Or admit obviously.

 

[bashwell]

@bashwell helpful post. Yes, by cerebral I meant diagnosing and figuring out the problem, especially in complex cases. Rotating in Rads and Anesthesia soon. Talking to many others in both fields as well. Last thing - why do you think rads might be more research friendly?

Just a few things:

1) You can do research in most or maybe all fields.

2) It also depends on what type of research you want to do. Do you want bench or lab-based, clinical, or "translational"? Are you looking to publish case reports or a case series? Hoping to work on a RCT with an established group or team (or far more ambitiously set up your own)? Do you want to write a systematic review or meta-analysis? Is it going to be retrospective or prospective? And so on. The answer will vary depending on what type of research you're looking for. It would be "easier" to do some of these in some fields vs. other fields.

3) Of course, you'll be driven by your interests. Your interests should probably be prioritized over whether it's easy or hard to do research in a particular field, or whether one is more or less research friendly, because you could probably get involved in research somewhere if you really are interested in something. What I mean is if for example your research interests are all surgically-related, then even if it's easier to do research in rads, it'd be generally better to do research in anesthesia than rads (unless we're talking interventional rads).

4) Given all this, I should note I was just speaking generally about radiology being "better" for research. It really depends. But some of the benefits of rads are that you're exposed to almost all the fields, not just like adults or kids or only cardiology or gastroenterology, but practically everything. You also have permanent records or data of the images of all the patients you read on. The "culture" of rads tends to be more research oriented whereas surgeons and anesthesiologists in general don't care as much, although of course there are a lot of exceptions. But a lot of this could also apply to IM to be fair. Again, it just depends on what you're interested in, what you're looking for, etc.

 

[KnuxNole]

Rounds in residency lasted for 1 hour. Much better than 3 hours of hell in med school IM/peds..

 

[seminoma]

Why do internists spend sooooo much time rounding? Rounds that could take 2 hrs tops drag on to almost 4 hrs. It's quite draining. I love the medicine, but the rounding sucks at times.

Because there are MS3s droning on with inefficient presentations. I'm guilty of this, sorry.

 

[username456789]

I am a cerebral guy who loves solving puzzles.

I'm much more of a cerebellar guy.

My patients are just impressed that I can maintain my balance while talking at the same time. Anything beyond that is just gravy.

 

[bc65]

Be careful not to draw incorrect conclusions from what you see in medical school or residency about specialties or practice situations. Residency is different than being a student, and being in practice is different than residency. Inpatient is very different than outpatient, and in almost all specialties, what you see in med school and residency is primarily inpatient.

I changed specialties in medical school after doing a 4th year elective with a very busy attending in his office. He ran around non-stop, never stopped for lunch, drove from hospital to hospital. I hated it. I later realized that it wasn't the specialty I didn't like, it was just that this particular practice was very busy and the doctor liked to work too hard.

 

[charmiedermie]

Why do internists spend sooooo much time rounding? Rounds that could take 2 hrs tops drag on to almost 4 hrs. It's quite draining. I love the medicine, but the rounding sucks at times.

Internal Medicine is a cognitive thinking specialty. Part of the way to learn the thinking behind the assessment and plan is to present your entire thinking process from chief complaint on down. The reason why it takes longer than usual is because the interns and residents have to smile and nod on the outside, while MS-3s slowly present their H&P on rounds since they are "learning", when we really want to do this:

 

[Nasrudin]

I never agreed that this pedagogy of presenting formally was an efficient learning tool. But maybe this pay off varies per learner. I think IM rounds is only marginally efficient at funneling a 24 hour slice of patient information towards a lazy academic attending who prefers this coasting style of work to doing things themselves. That and they like the sound of their own voice.

You know what would be fast learning. Rolling with a fast attending one on one and trying to be marginally useful, like presenting their o/n's right before you go see them together and then getting a to do list with a brief explanation of why. Or basically residency at a community hospital.

Some good curricular academics at lunch and you're good to go.

Rounding and formal presentations are stupid.

With regards to who does rounds the best--hands down ortho. And the notes....like beautifully ******ed haikus. F'n amazing. They all sound like they're written by Channing Tatum's character on 21 Jump Street. And I love that f'n guy. He's about doing stuff.

 

[Kaustikos]

With regards to who does rounds the best--hands down ortho. And the notes....like beautifully ******ed haikus. F'n amazing. They all sound like they're written by Channing Tatum's character on 21 Jump Street. And I love that f'n guy. He's about doing stuff.

Channing Tatum was hands down the best in 21 and 22 Jump Street.
I really really really wished they'd do the "alluded" 23 Jump Street. They basically said they were done with 22 but 23 would've been hysterical for our crowd.

But yeah,
Ortho actually puts words. The ED is just literally nothing except the doctors name and where the patient is going lol not all Ed docs but sometimes I feel ED docs take full advantage of the emr. Like, the nurses had more information in their notes.

 

[CherryRedDracul]

At my school, it depended on the attending. The all the attendings I had, luckily, preferred rounds to last for 2 hours MAX. Our IM program director was one of my attendings explicitly stated, "I get bored if rounds go beyond 2 hours, so keep it succinct." Thus, as students, we had to learn how to present only the pertinent stuff which I thought was a great learning experience.