Why are people so against doing medicine residencies???

[dnt107]

On another thread, people were dissing medicince residency and it seems like a lot of students are doing everything they can to avoid doing a medicine residency. Why is that? Tell me about the medicine residency...I'm interested in it and am wondering why everyone hates it.

Thanks a bunch.
MS1

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[godfather]

more people go to into IM than sometimes all of the other fields combined. people will always critisize the field or fields that they didn't choose ( that's why they are not choosing them in the first place). No field is perfect they all have aspects that aren't appealing to even the people that choose those fields. Having said this, IM plays a critical role in medicine because whatever you end up in you need to know IM to some degree,whereas if you're a physiatrist you don't need to know any thing about opthamology or other speicialties but you need to know your IM to some degree. the same can be said for virtually any other field. Even in most of the procedure oriented fields your only doing procedures like 10 to 20 percent of the time. the rest of the time your practicing IM whether you believe it or not.

 

[rad]

Here are a few of the reasons I chose to avoid a general medicine residency:

(1) long hours with heavy call schedule at most places
(2) it seems like you rarely actually treat patients without a specialist telling you what to do
(3) not enough procedures
(4) a lot of times you feel like you are trying to save sinking ships with the predominance of debilitated elderly seen on a typical medical service
(5) frustrating at times being responsible for ALL medical and social issues that a patient has. You feel like a secretary keeping track of all the specialists and studies
(6) Annoying dealing with difficult patients and their families especially in medicine because you are responsible for dealing with all issues
(7) the predominance of social issues. Like post-hospital placement, dealing with dnr/dni issues patient versus family desires, etc.
(8) The paperwork!
(9) Spending half of your day on the phone for instance making sure patients are sent for studies, why this specialist has not seen the patient, getting consents from family members,
etc..
(10) Dealing with lazy ancillary staff who do not do their job (nurses, radiology techs, respiratory techs, etc.)
(11) Poor job prospects for a general internist right now in good locations
(12) Do not like gi, cards, nephro, heme/onc and feel other subspecialties are hard to practice 100% in desirable (crowded) locations.

I better stop now

 

[docab]

I'm nearing the end of my IM residency and I'm glad I went into this field. While I agree that there are long hours w/ heavy call schedules in many places, I disagree w/ 'rad's statement about rarely treating pts w/o a specialist telling you what to do. I consider this a naive statement and I don't think you'll find any practicing internist who feels this way. If any IM physician relies heavily on specialists, then they didn't receive good training. Specailist referrals are made most often when procedures are needed (e.g. GI referral for colonoscopy).

In my experience, IM & surgical residents (and medical students going into surgery/IM) are at odds w/ one another. Surgical residents think IM refer to specialists for everything and just follow other people's advice. IM residents laugh at the sheer panic of many surgical residents when they call for an IM consult for a pt w/ BP of 180/90 and glucose of 210. Ironically, there's tremendous respect (at least at my hospital) between the surgical and internal med attendings. Overall, I agree that it's quite common of medical students and residents to 'rip' on other residency specialties.

Go for what interests you and don't worry about what others post. When making a decision about what field to enter, I suggest you talk to physicians in that field to get the most accurate pros/cons of the career choice.

 

[jkchou]

 

[UHS2002]

Originally posted by jkchou:
•I want to go into IM because:

3) I will be a "real" doctor; in the sense that IM will enable me to treat medical emergencies if they should happen to my family and friends. (just to pick on some specialties, would a radiologist/anesthesisologist/dermatologist/opthalamologist/otolargyngologist be able to remember what medication to give during a sudden onset of supraventricular tachycardia?)

4) I will be a "real doctor" when specilists call me up wondering if their patient with a serum blood glucose level ~400 is abnormal or not.

5) I will be challenged by the broad spectrum of diseases, and learn as much as I can.

6) I will always see something "new" instead of seeing/doing the same things over and over again.

7) I will enjoy specialists competing over me for my referrals (anyone want to get a referral for an angioplasty/angiogram evaluation, a CT/MRI scan, or a referal for hip fracture repair?). Believe it or not, specialists earn quite a large percent of their income from IM referrals.

8) It one of the few "true medicine" careers that are out there.

I can go on and on about my personal reasons for choosing IM. But its up to you to see if its what you want.•••

Addressing some of your points:
3)The "real doc" in such an emergency is probably not to be you, but the ER doc you are going to send your friends or relatives to. I never met an Internist who had Adenosine in office or who had and could give Amiodarone IV in office. If the pt was unstable, believe me, any doc with a lifepak in office would know how to use it, that is why everybody takes ACLS, not just Internists...

4) You don't have to be an Internist to know that a BS of 400 is abnormal. A third year medical student can do that. You will not get many consults from specialists because they do not know what to do with a patient, if you are a general Internist. You will get consults from psych because they don't know how to deal with most medical stuff (sorry psych folks, but by the end of residency you are very rusty on a lot of medicine), and you will get consults from other specialist because they don't have "the time to bother". A surgeon makes better use of his time in the OR than managing Mrs. Smith's DM or HTN. It is not that he doesn't know how to do it, he simply doesn't care to do it because it is tedious and time consuming, and usually very unrewarding.

5) and 6) You really don't know what you are talking about here. As a general internist you will see mostly run of the mill stuff. DM, HTN, high cholesterol, atherosclerosis, COPD, pneumonia, and all the common ills of the aging population. Unless you work at an academic medical center, you will not get to see much variety at all. And if you work at an academic medical center, unless you are a sub specialist, you will continue to see HTN, DM, COPD and high cholesterol.

7) Yep, specialists will court you for your referrals, but remember that there are plenty of general internists to be courted out there. Specialists court all kinds of primary care physicians plus ED physicians, not exclusively internists.

8) I can't even begin to understand what you mean by this.

I think IM is a great field to go into for some people, but I don't necessarly agree with the reasons you have given. I think you have a very misleading picture of what IM is or isn't and, when time comes, I am sure you will have found it out and if still going into IM, choosen it based on more realistic considerations

 

[rad]

The question asked about medicine RESIDENCY!


In response to some of your claims

(3) Every doctor who graduates from med. school is a real doctor. Your family members will have their own doctor and hospital that they will go to with SVT. You should not treat your family members. Also as many of the specialists will be lacking basic general medicine skills you will of course be lacking many of the skills they possess.

(5) While you are learning and being challenged by unfamiliar diseases the specialist will actually be treating and helping people with the "few" diseases that he "sees over and over again"

(6) Whenever you see something "new" you will be sending the patient to the specialist who can handle it.

There is a reason so many people switch out of medicine into anesthesia, rads, etc. but rarely switch into medicine. Lets talk some more as you approach the beggining of your fourth year of med. school, I guarantee you will have a different perspective on things

 

[jkchou]

 

[rad]

Here we go again, although I do love your naivete!


(3) On a long roadtrip in the middle of now-where your background in IM will not allow you to do much for the majority of medical emergencies. What are you going to do for an MI except CPR if necessary. What are you going to do for a CVA, PE, DVT, etc. My point is that any doctor will recognize a medical emergency and tell the person to go to the nearest ER. You do not need to be an internist for that.

(4) Yes other specialists do not have some of the skills of an internist. But dont mess with surgeons, they are pretty sharp clinicians most of the time (I am going into rad)

(5) But was the primary MD actually treating these people or simply following up after the specialist consultation.?

(6) Critical thinking and experimentation are good in the research lab. In medicine if you are not sure about the treatment of a disease or dont feel comfortable then refer to someone who does. Patients expect quick effective treatment and not experimentation. Also in this medicolegal environment you have to be careful.

keep it coming my naive friend

 

[Mango]

Hey rad, so the guy really likes IM. Why try and talk him out of it? Somebody's gotta do it. I for one am glad that there are people cut out for IM, because we'd all be pretty screwed without them. I too would rather be anything BUT an IM doc, for many of the reasons discussed above. But again - I'm glad others like it.

 

[jkchou]

You know. I didn't believe it when I saw the title of this thread "why are people so against doing medicine residency". And it seems that it is so. BTW, the doctor who I worked for was was TREATING and DIAGNOSING those rare cases. He has been an incredible mentor and I hope I can be as knowledgeble as he is.

As for other specialties, you don't see me dissing about them in the other threads. I respect whatever motivation others might have, as long as they are altruistic. I can also come up with quite a few bad points about each of the specialties people want to go in (mind posting your motivation of going into RAD?). There is no perfect specialty, but as long as you like it, you should do it. The truth is that we all have our own reasons of why a certain career interests us. The person wanted to know why people want to go into IM. Not why people don't want to go into IM. And I did just that, a list of why I am going into IM. If you don't like my reasons, tough.

Just as last point, I hate to say this, but judging from some of my classamtes who are against IM as much as some of the post on this thread, money, prestige, and lifestyle are sometimes the subconcious motivation of why certain people diss IM, a relatively less glorifying and more work intensive career. If today IM slots suddenly get slashed and 10 years from now there is a competition and shortage of IM doctors and their salaries suddenly ballon up, would interst in IM swell as well?

 

[UHS2002]

jkchou,

the point you are choosing to miss here is that NOBODY is putting IM down as a specialty choice. What we are riding on here is what RAD appropriately called your "naivete". It is sooooooo evident that you are a pre-clinical student and have little idea of what IM really entails, much less what an IM residency entails.

I would suggest that you print your initial post and tuck it away somewhere and just take it out a few years from now, let's say a month before your graduation. I am convinced that, if you have any sense of humor, you will laugh at yourself for the things you wrote. It has happened to all of us.

 

[UHS2002]

Originally posted by jkchou:
•
For 5), True, 80-90% of cases I have seen in the primary care setting are HTN, DM, CHD, arteriosclerosis...etc. But, maybe I got lucky, I have also seen cases of lepromatous TB, scleroderma, Leiden V deficiency, petite mal seizures,...etc. And this was in a private clinic, in a town with only 160,000. I would think that there would be even more variety in IM when I practice in cities like LA or NYC.
•••

Oh, BTW:

Scleroderma is very common, petit mal seizures are almost a "dime a dozen" as pathology is concerned. Now, "lepromatous TB", ah that is a rarity, . Sorry, so rare in fact that you and your preceptor would have come across the first case ever!

I am not going to be an internist, so I might not fall into the category of someone who is going to practice "real medicine", as you imagine "real medicine" to be at this stage of your education, but there is not such a thing as lepromatous TB! What there is is lepromatous leprosy.

Let's see: M. tuberculosis and M. bovis cause tuberculosis. M. leprae causes leprosy and "lepromatous leprosy" is one kind of leprosy (the other being "tuberculoid leprosy"). Now, all together, internists wannabes: THERE IS NO SUCH A THING AS LEPROMATOUS TB!!!

 

[rad]

agree with UHS2002

 

[Sabreman]

OK, two points.

1) You guys are just mean.

2) Meanness aside, take a step back and remember why we started this. No one goes to med school wanting to be a radiologist or anesthesiologist (yes, I'm sure YOU the alert reader are the one person to whom this statement is untrue so please don't waste our time responding to this one generalization). We choose those specialties because 1) we learn during med school that they are kinda interesting, and 2) because they have a great life. But we all started out wanting to save lives and change the world. Take my case...

I am top of my class, 262 Step I, junior AOA, MD/PhD, etc. I always wanted to do IM, even liked my rotations. I did, however, see that it was hard work, had lots of annoying aspects, and paid squat compared to lots of other fields. Hence, I decided to do dermatology. I even applied and had interviews at top programs like NYU and UCSF. At the last minute, however, I interviewed on a whim (or a gut instinct) at Johns Hopkins and the Harvard IM programs. I was stunned at how many brilliant people went into IM and LOVED it! These folks could easily be doing derm or optho or rads anywhere, but chose instead to devote themselves to becoming leaders in a field that is unappreciated by most of the rest of medicine. Now I know these programs are different in some ways from your average IM program, but they have the same (or worse) crappy hours and hard work and see the same COPD and CAD pts, just have better housestaff and faculty. I was blown away and had to remember why I went into medicine in the first place. I changed my mind, dropped out of derm wannabe-ness, and have never been so happy about my choice. Internal medicine rocks, and don't you forget it! It takes a special kind of person to do it, so I can only tell our aspiring internist to hang in there, we need all of you we can get.

 

[rad]

you will regret your decision later, trust me

 

[jkchou]

Amazing how many people are reading these threads and only two would bash on IM. I just have a one word reply to you "W-H-A-T-E-V-E-R." I will do what I want to do out of my own reasons and you will do what you want to do. Lets hope we never see each other in real life.

 

[deleted4401]

Why are you guys so mean??

The guy likes a field, and the heading does seem to give reason to bash the field... but think of what they are really asking?

"Why are people so against doing IM?" ... Well, the reasons you guys have stated are the same reasons that existed for 50 years, since American medicine started coming into it's own. It's just currently that IM is on a down-cycle. And that's what it is. Because just 25 years ago, it was considered a very cognitive, high-reaching field. You guys make it sound like freakin' babysitting. It's just different. It is taking care of sick adults whatever their problems can be. We can all make generalizations ("All you'll see in Peds in runny noses" "All you'll do in Gen Surgery is _____"). Sure they'll be a lot of hypertension or whatever, but they'll be doing what they like.

Here's reasons that get more to the heart of things, I think ...

1) "ER" and the glorification of procedures. Nobody thinks that diagnosis of strep[throat/HTN/cancer is as cool as putting in a trach or trauma surgery. Just not as much sex appeal. Thank you Drs. Carter, Green, Benton!

2) Lifestyle seems to matter a lot more, and a dedicated IM may not have the best one. No Exeter for his kids. No Bentley, just an Avalon. No 3 month vacations, just a few weeks off like most normal folks. Maybe in a few years this lifestyle thing will go away, and people will continue to choose fields they are actually interested in.

3) Not as much elective procedures and all of that, so a lot of dealing with uninsured, underinsured, and Medicare/Medicaid. That's just not fun stuff. A lot of people would just rather accept cash payments for boob jobs and Lasiks.

I don't know what's the point to hate on someone's field of choice. Fine, yours is better, and you'll see great patients and drive a nicer car. But, the dude who wants to do IM might like what he does every day. Sure it will be a pain and sometimes seem like drudgery, but what job doesn't sometimes?

My reason for not even considering IM is because adults generally suck. They cause their own misery (poor health, war, arguments about which field of medicine is better). That's the major reason. I think it would be decently interesting if adults weren't such *****s.

Simul

 

[rad]

As UHS2002 and I have pointed out, there is nothing wrong with going into internal medicine. We were simply pointing out to jkchou that his reasons for going into the field were not based on reality and reflect his clinical inexperience.

Highpowermed: people who go to medical school do not do so to become hand surgeons, radiation oncologists, physiatrists, etc. as well but does that make these doctors any less important as you implied? Also regarding your statement "I was blown away and had to remember why I went into medicine in the first place" why did you go into medicine in the first place? Was it to help people or save lives? Do you think that anesthesiologists, ophthalmologists, and radiologists do not save or improve the quality of peoples'lives every day? <img src="confused.gif" border="0">

 

[jkchou]

Strange... you two keep on saying that you just wanted to point out my misconception of IM, while everyone else seems to think that you two are bashing IM.

 

[Whisker Barrel Cortex]

JKCHOU,

I think your responses are extremely hypocritical. If you go back and read this thread from the beginning, you'll notice that there were initially some honest responses on why people did not like internal medicine. Then you came in on your high horse and used terms like "real doctor" and "true medicine" as descriptions of internal medicine. This obviously implies that everyone else is not a real doctor. This is the attitude that many of the posters responded to.

Then throughout the rest of your posts you critisized the motivation of people in other fields. Of course this is going to foster hostility towards you and start the IM bashing.

So go ahead and become an IM doc and next time one of your patients has a surgical problem, do the operation yourself since surgeons aren't real docs. You can run the anesthesia and treat any complications with your true medicine. When your patient comes in with a brain tumor, you can read the MRI and figure out what it is, since radiologists obviously aren't qualified. Then, go ahead and take the tumor out.

Sorry for the tirade, but you must realize that every specialty is needed and every specialty plays a crucial role in maintaining peoples health.

From a "real doc" radiologist to be.

 

[Sabreman]

Rad,

I was not implying that other fields don't help people's lives, I was stating that MY reasons for choosing derm were selfish and contrary to MY original desire to practice medicine. Sorry if it come out otherwise. The best lifestyle in the world will slowly kill you if you hate what you are doing, so we all try to find the field where we fit best.

BTW everyone, most people who go into IM sub-specialize (cards, GI, Heme/Onc) and make just as much money as the "lifestyle" fields. Don't let money stop you if you are interested in IM.

 

[jkchou]

Yes, there were some truly honest responses at the begining. And maybe I came off as being on a high horse. But I *never* said IM is the "only" real medical specialty. I said its "one of the few real/true medicine CAREERS (I said nothing about medical SPECIALTY)" out there. On a different bullet, I also said "I will be practicing real medicine". But I *never* discounted that there are other doctors out there who are also practing "real medicine". Not everyone involved in medical CAREERS is practicing " real medicine" in the sense that most techs only know the "what" but not the "how" and other medically related positions don't have nearly the same intellectual stimulation as when you are the doctor dx and rx a patient. I also specifically pointed out that what I meant by "real medicine" is only when I am in some remote place and there is no ER in site and my IM background would help me, specifically in that situation alone where I am challenged to think and treat whoever on the spot instead of relying on diagnostic procedures/tests...etc.

If you read my post and saw "I will be practicing one of the few true medicine careers" as meaning "I will be practicing the specialty of IM, which is the only real medical specialty out there," I can't help but wonder why you would jump to make that inference. Never would I be so presumptious as to say that IM is "the only" real medicine out there.

I can't help it if people in certain specialties are ticked off by their own interpretations of what I said (judging from how people misinterpret my list post, I promise I will stay away from shot list forms from now on). And now it seems, from a very small representative of people on this thread, certain specialties seem to be sensitive and over-react to the term "real medicine" for no reason at all. If everyone aas you say misinterpreted what I said as "IM is the only real medicine out there" would people not interested in IM still start to defend it?

Also, did I bash on any specialty? No. Did I say such and such specialty is not "real medicine"? No. Did I discount the importance of any specialty? No. Are most of them needed for "real medicine" Yes.

Also, I think I hit some of the more sensitive reasons why some people will never openly admit to when they decided not to go into medicine. And I think that hit some sensitive nerves around here and maybe that is where the hostility truly comes from.

Why would people automatically think "real medicine" doesn't apply to their speciality is beyond me.

At last, I feel that I need to get this off of my chest. It is pretty obvious now that no one likes the field of their choice being attacked. But quite frankly, people bash IM all the time and we IM people are just supposed to take it (isn't it curious how there is a thread of why people are against IM but no other thread on anything else?)? But, this is a forum where people exchange our views. You don't necessarily have to like mine. I don't neccessarily have to like yours. And its always best when we get along. But this doesn't always happen. I tolerate it and respect it when people start to post things on whats so not desirable about IM that they don't want to go into it. And I merely pointed out why I liked IM. Maybe they will change. Maybe not.

 

[rad]

jkchou,

you are way off in all your remarks and extremely hypocritical. Good luck to you as you pursue your medical career, because you will need it my friend!

 

[jkchou]

There, I have deleted the first post and took away some of the more "emotional" posts now that I know why people are ticked off by what I wrote. Hope this reduces some hostility around here.

 

[Leotigers]

"Why are people so against doing medicine residencies???"

Some of the best people to get answers to your question would be from IM residents:

<a href="http://www.studentdoctor.net/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic&f=11&t=000849" target="_blank">http://www.studentdoctor.net/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic&f=11&t=000849</a>

<a href="http://www.studentdoctor.net/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic&f=11&t=000897" target="_blank">http://www.studentdoctor.net/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic&f=11&t=000897</a>

 

[jkchou]

Thank you, ER, for the link.

 

[Leotigers]

Originally posted by HighpowerdMed:
•
BTW everyone, most people who go into IM sub-specialize (cards, GI, Heme/Onc) and make just as much money as the "lifestyle" fields. Don't let money stop you if you are interested in IM.•••

HPM,

You are absolutely right. Every medicine resident I met at UC Davis and UCSF wanted to subspecialize (mostly in Cards or GI). The problem is that it is people like you and residents at top programs who will get all the choice Cards and GI fellowships. There are close to 5000 categorical spots in medicine every year but only a couple of hundred fellowship spots. Everyone may want to do a fellowship but few will have the opportunity to do so.

 

[jkchou]

Now, after I have explained again and again ad naseum that people are misinterpreting my original post (even I am begining to feel nauxious from repeating myself so many times). It seems certain people are taking my original post out of context and pasting it around. What is the purpose of those few people now after I found out people are misinterpeting my post and I have deleted my original post?

Any idea why I am so disspointed by some of my peers on the other thread?

Would it help you if I reposted the original post and change the words around and cut out "real medicine". Do you think it will sound different? Or, do you think it will still be an attack on every speciality there are except for IM?

In the concern that I will be crucified again for just posting "why I like IM" in the same list form (notice "I", as in me, and no one else, not my friends, not my parents, not my girlfreind, not my teachers, not my mailman, not my aunts and uncles, and ultimately NOT YOU). I am going to re-post the original post and simply change "real medicine" into a more elaborate explanation-I only used "real medicine" becuase I was prepping for a test and thought to save some time by using it as a short cut to get to the point. Now I regret doing so because when I was writing it, in the back of my mind, I susupected that people will misinterpret it. But did I listen to myself? sadly, no. Now since the original post is gone, I am doing it from memory, a few words will be different but same idea.

1) even before I started medical school, I always knew that I want to do something like GI, Card, ICU, pulm, or geriatrics. They are all IM fellowships and I was surprised when I found out that out.

2) so many career choices after IM

3) Since I will be an IM doctor, when there is an emergency comes up and there is no ER, I will be able to treat my family members and loved ones (ER doctors can do this too).

4) By being a IM doctor, I will be in the heart of medicine when specialist call me up for my knowledge and we need to come up with a DX or RX for the patient.

5) I remember something about referrals. Now I think that one sounds a little selfish-so I am not going to touch that one.

6) as an IM doctor, I will see a variety of diseases and be challenged to learn as much as I can.

7) as an IM doctor, I will always do something new, instead of doing the same things over and over again

8) I will be in the career of internal medicine, which is one of the few "True Medicine" careers there is.

Maybe these are not the best reasons to go into IM. But these are what I like about IM at this point. Like I said before, if you don't like what I like about IM, tough.

Now, thats EXACTLY THE SAME POST ONLY WITH THE WORDS "REAL MEDICINE" CUT OUT. Do they sound so different? Its the same idea. And if you are going to misinterpret my post again, maybe you should get together with some neurologists, some neurosurgeons, some radiologists, and some internist to practice "REAL MEDICINE" and figure out what the h*ll is wrong with your Wernicke's area.

If you asked my what I love about my girlfriend and I say "she has the brightest smile, the loveliest cheeks, the bluest eyes, the most out-going/adventurous personality, the most understanding nature, and the most talented ability in cooking. She is simply one of the few real women out there". Am I just being infactuated with my girfriend? Or am I saying your significant other is the laziest, ugliest, most boring, least talented cook, and ultimately, that your girlfriend is a b!tch since only my girlfriend is a "real women"? Then, if you knew my girlfriend, are you going to tell me "no, your girlfriend is not a real women because her cheeks is too high, her eyes are too wide, her eyes are way too freakish blue, she likes to have fun too much, she is a push over because she is too understaning, and her cooking is actually not very good?"

If you see other people going around posting my poorly worded original post, please just tell them to come back to this thread and see for themselves what was going on. Let them decide for themselves, instead of getting bits and pieces of mis-used information.

 

[EidolonSix]

Have heart IM folks....UHS and Rad obviously are too busy examining the finer aspects of their colons with their heads.

IM is the most diverse specialty (although family practice may also apply) in the broad field of medicine in that it serves to diagnose and in some cases treat/cure the broad range of diseases and conditions that afflicts the human populations.

In the "real" world, internists are often the first doctors to see a patient for a given problem. A well trained interest knows how to diagnose 90% of these problems and is likely able to treat a good portion of those. Doctors receiving referred patients often lose sight of this since they are unaware of the other patients a general internist has seen and treated w/o referral. Surgeons are often guilty here.

Their is a good reason so many specialties depend on internal medicine as a spring board to fellowship or further training....because it espouses the principles of methodical diagnosis with considerable evidence based treatment modalities. Radiology, dermatology, anaesthesiology, radiation oncology etc.....all require a prelim/traditional year, with medicine as a component.

As for emergencies, it is entirely dependent upon the setting. Very ill patients often come to clinic....not always straight to the ER. Hospital codes are often run by attending hospitalists (internists). Many ERs still employ experienced internists to handle ER patients.

Variety...people with HTN, DM, CAD get other diseases too. You are just as likely to get a zebra in a small town, seeing 20 pts per day as you are a large city seeing 20 pts per day.

As for fellowships....cardiology, GI, renal, heme/onc, etc.....all must maintain board certification in internal medicine to continue practice....

The rather silly viewpoints by its aformentioned detractors are just that. An IM practice is what you make it....you cannot argue with wide variety of specialty options or practice options.

Not that all of IM is rosey, but come on guys...their is something noble about taking care of people with both known and unknown problems, both chronic and acute and having the knowledge of how to diagnose, how to treat and when to refer. This is what a real doctor is...and this is what "true medicine" is. Without memory or respect of this, you are not a "true physician" no matter what title is attached to the end of your name.

I suggest reading Osler's "Internal Medicine as a Vocation" in Aequanimitas with Other Addresses if you want to understand the concept.

 

[rad]

What you say almost sounds romantic. Once you actually practice medicine you will quickly realize that much of what eidolonsix wrote will not matter. You will be bitter and frustrated especially as a resident for the reasons mentioned in my original post. However the original question posed was why people avoid medicine RESIDENCY so much and the criticism was directed towards jchow for his blissful ignorance.

 

[EidolonSix]

Can't handle the heat....stay out of the kitchen. The very fact that it does matter makes the job worth doing.

Its not the right job for everyone...and I'm not saying that it doesn't have its headaches which thwarts many people from pursuing the field.

However, to counter Jchou's overly optimistic statemtents, rad and UHS used inaccurate pessimism. If you want to do IM, do the rotations, take the initiative to take care of your own patients and see if it works...if not then move on, but for godsakes stop this purile "why medicine sucks and other specialties are better" argument...

Oh, and by the way....tuberculoid leprosy is a clinical entity.

 

[rad]

I do not think that I ever said that my chosen specialty was better than IM. I simply pointed out why I chose not to do an internal medicine residency and why I though jkchou was wrong in his thinking.

That being said, I think it is very difficult as a medical student to select a field. You get mininal exposure to most specialties and mostly in academic medical centers which are not representative of the real world.

 

[UHS2002]

Originally posted by EidolonSix:
•
Oh, and by the way....tuberculoid leprosy is a clinical entity.•••

EidolonSix, although you might have thought mightly amusing to refer to RAD and myself as someone who is examining their colons with their heads, I would like to re direct you to my prior post, where I am trying to educate our future Internist that
1) there is no such thing as LEPROMATOUS TB, as he stated
2) and where I STATE that there are 2 KINDS OF LEPROSY: LEPROMATOUS AND TUBERCULOID. I am quoting myself here buddy!

We might be examining our colons with our heads, but at least WE CAN READ! No wonder some of the folks here did so poorly on the reading comprehension part of the MCAT. It amazes me that supposedly educated people CANNOT read and , as such, end up making some asinine comments.

Unfortunately, this is also the reason why this inane subjects just keeps on going. Nobody is bashing IM, NOBODY IS BASHING IM, oh, did I mention that N-O-B-O-D-Y I-S B-A-S-H-I-N-G I-M ???!!!

RADS point and mine (throwing pearls to the oinkers, as it seems) was that jkchou's ideas about IM are, to put it mildly, on the naive side. Not that I really should give a rat's posterior about it. If someone wants to make a fool out of him/herself, they should be free to do so, it is a free country and millions make fools of themselves everyday in it, so what is new?! It was more of a kindness to try to point out that jkchou has a rather pollyanish idea of "real medicine".

 

[EidolonSix]

I'm afraid that countering excessive, erroneous optimism with equally uninformed pessimism does not bring this argument back to a happy medium.

Admittedly, chou makes some rather overly optimistic arguments for why one would go into IM. Truth be known, however, that he does have some handle on the scope of the specialty and the specialties that rely on it as a prerequisite. Most other specialties do not have this scope and in the event of an acute medical condition, I would count on an well-trained internist to handle it as much as a well-trained ER doc. Personal opinion here, not to be confused with any stated fact.

Medical school gives you a title....it does not make a real doctor. ACLS gives you a certificate...it does not make you an expert. ETC. Telling yourself you are a real doctor...does not make you a real doctor. They call chiropractors doctors....So please.....define for me what you guys think make a real doctor, then we can argue the finer points of this.

UHS...I have managed to do my time in medical school, being able to read and objectively evaluate the specialties and pros and cons....not to say that a 3 month clerkship is necessarily ideal for making such a decision. I also have managed to read...successfully. I am not sure, but have you been to a morning report...where even the attending is challenged by a diagnosis. Have you thumbed through Harrison's to see the breadth of diseases that are categorized a problems faced by internist? Chou was not wrong in saying that he wants to be challenged by seeing a variety of things and occasionally challenged by a zebra. And yes, there is a sea of horses to wade through. But zebras happen and internists are often the ones who get em.

UHS....I'm sorry I missed the last line of your diatribe about the clinical forms of M. leprae. I have managed to make it through medical school successfully. I fully assure you, I can read fine. I hope you are more constructive as a resident, if you choose to go that far.

I don't want to tick anyone off here, but it is easy for non-internists and non-surgeons to point out all the negatives of the general specialties without acknowledging the fact that the foundations of the entire field are built upon those fundamental principles that bother general medicine and surgery have honed for centuries. People are "so against" doing these residencies...for myriad reasons, the tedium, unperceived rewards, bad hours, bad pay. Unfortunately, some are more vocal and unrealistic about it. Again...an opinion....not to be interpreted as fact.

 

[UHS2002]

Originally posted by EidolonSix:
•UHS....I'm sorry I missed the last line of your diatribe about the clinical forms of M. leprae. I have managed to make it through medical school successfully. I fully assure you, I can read fine. I hope you are more constructive as a resident, if you choose to go that far.•••

Hmmmm, I see darrrrrrling, so you make "arguments", however, when others are right on a point (on something purely objective, mind you, not the "touchy feely" discussions that have characterized this site of late), then it is a "diatribe"...

Don't worry bud, I am actually in the midst of applying for residency. I have no concerns about being "constructive". BTW, being "constructive" doesn't mean agreeing with whatever delusions people might have about something. And, I did not find your comment about spending time examining my colon with my head very contructive either, but I am sure you thought it was constructive since it originate from you...if it had been written by someone else I am sure you would have been the first to find it "uncostructive".

I would like to direct you to an excellent book "Iserson's Getting Into a Residency". In it you will find a table with % of practitioners who said that their respective specialty met their expectation (pg 110). You will find that 62.9 % of general internists say that IM met their expectations and, on a scale from 1-5 for satisfaction with their current position, the given rating was 3.3 .This was the lowest of any of the primary care specialties. Why?! It is not because there is anything inherently wrong with IM (as you and jkchou keep wanting rad and I to say, to no avail I might add). I venture to say that it is because many people entered this specialty with unrealistic expectations. They think that they will see all the zebras in Harrison's...News flash: most internists will see as many zebras in their career as any primary care provider, unless they are employed by a academic tertiary medical center (which most general internists are not). As a matter of fact, FPs will probably see more zebras than internists, both being in practice in the general community, since FPs can at least hope to see some pediatric zebras on top of their adult ones...

 

[OT_Still]

Just an observation from an unbiased individual:

It seems as though this thread has become rad & UHS vs. the masses - Each trying to defend the title for the "most witty dialogue"

Just a thought - This post was a *loaded question*, any time a question is asked to defend a particular position, you'll get two factions: the defenders and attackers, and rarely will they meet in the middle.

"Can't we all just get along ?"