Why does everyone say IM Sucks?

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GOINGDUMB

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M4 Applying Psych and IM.

I liked them both and I feel there is quite a bit of overlap.

Everyone (IM Attendings, Rads Attendings, IM Prelims on my Core IM Rotation, Rads residents, random people on the internet, data from medscape compensation reports, Leigh et al physician satisfaction papers) tells me IM sucks and not to go into it.


I'm really a curious kind of guy who likes to ask "why" a lot a kind of an armchair intellectual wannabe. I had fun running around on IM and helping with scut, The PD was a nephrologist and was super cerebral which was fun. So I applied and have been looking coming out as a nocturnist (Easy IM stuff at night with differential pay, less rounding?) or a subspecialist - Nephro, Critical Care, ID, Cards, GI, Addiction, Sleep, I like all of them) or do some sort of Research (like Peter Agre or Phillip Polgreen (just google coolest jobs and popular mechanics for the latter)).


So Idk why exactly why it sucks?

Can someone please elaborate?

Success stories? Horror Stories?

Thanks!!


p.s. No intent to troll. I just wanna know for real what I'm getting myself into here
 
GOINGDUMB said:
M4 Applying Psych and IM.

I liked them both and I feel there is quite a bit of overlap.

Everyone (IM Attendings, Rads Attendings, IM Prelims on my Core IM Rotation, Rads residents, random people on the internet, data from medscape compensation reports, Leigh et al physician satisfaction papers) tells me IM sucks and not to go into it.


I'm really a curious kind of guy who likes to ask "why" a lot a kind of an armchair intellectual wannabe. I had fun running around on IM and helping with scut, The PD was a nephrologist and was super cerebral which was fun. So I applied and have been looking coming out as a nocturnist (Easy IM stuff at night with differential pay, less rounding?) or a subspecialist - Nephro, Critical Care, ID, Cards, GI, Addiction, Sleep, I like all of them) or do some sort of Research (like Peter Agre or Phillip Polgreen (just google coolest jobs and popular mechanics for the latter)).


So Idk why exactly why it sucks?

Can someone please elaborate?

Success stories? Horror Stories?

Thanks!!


p.s. No intent to troll. I just wanna know for real what I'm getting myself into here
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You should probably ask the IM attendings you know why they dislike it. Likely it's a mix of frustration of hours, pay and futility of trying to help certain noncompliant and incurable patient groups. I wouldn't put much stock in the views of people in other specialties or in prelim interns -- they already picked something else so to them every other field is worse.
 
Law2Doc said:
You should probably ask the IM attendings you know why they dislike it. Likely it's a mix of frustration of hours, pay and futility of trying to help certain noncompliant and incurable patient groups. I wouldn't put much stock in the views of people in other specialties or in prelim interns -- they already picked something else so to them every other field is worse.
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Yeah I asked said attendings. They weren't being too clear or univocal as to about why exactly...


Speaking of which Law2Doc - You sound like you've did something else before medicine? Lawyer? With that kind of insight what did you choose?
 
Not everyone says that IM sucks.

People complain about medicine in general (all specialties), IM isn't really any worse or better than medicine as a whole, particularly if you include subspecialties.
 
Everybody dumps on IM.

If an orthopod has a pt with HTN and doesn't want to bother with the admit process, they say "Admit to IM for management." Then they get out of all the scut and can just jump in and fix the fracture.

IM has to round and round, all day. And then to get away from rounding, they go to "clinic" all the time. It takes 2-3 weeks to see the results of therapy change, instead of seeing immediate results like we do in anesthesiology.

ER docs dump stuff on IM.

That is some of why IM sucks.
 
As a psych intern who has been on medicine for a while now (so I have worked both psych and IM) I can say with confidence that I am a happier, less stressed person on psychiatry. IM has a tremendous volume of work associated with it. I show up at six, leave around nine or ten on admitting days and on my "off" day (they alternate) leave four or five. I work six days a week. Almost that entire time I work at what is for me breakneck speed, and it all needs to be done accurately. I barely make it by without violating work hours, and as you admit up to five patients per day you have to deal with endless pages about your current patients and all of the discharges that are pending (for which, by the way, you need to do a med rec, discharge plan, discharge order, and discharge summary on TODAY; and by the way, it's your professional duty to get out within your hours!). And in the morning, seeing all this coming, you still have to stand and listen to all of the presentations on rounds knowing the clock is ticking on multiple time sensitive issues. You get to think and solve puzzles all day, for sure, but you have to do it quickly and under pressure.

Psychiatry is just more relaxed. Your patients are typically less acute (minus the occasional actively agitated patient needing to be restrained or other unusual circumstances) and you can take a more leisurely pace, getting to talk with and know them better and taking more time to think. You can also have much more of a life outside of work.

All that said, IM is a cool specialty. It keeps you engaged and you make a tremendous difference in patient's lives. You can also go into subspecialties that allow much better work life balance, and as an attending you can have more control over your working style. It doesn't suck. But know beforehand that the pressure is turned up significantly in IM intern year compared to as a student, and what is fun at low volumes is not fun for some at much higher volumes.
 
Bartelby said:
As a psych intern who has been on medicine for a while now (so I have worked both psych and IM) I can say with confidence that I am a happier, less stressed person on psychiatry. IM has a tremendous volume of work associated with it. I show up at six, leave around nine or ten on admitting days and on my "off" day (they alternate) leave four or five. I work six days a week. Almost that entire time I work at what is for me breakneck speed, and it all needs to be done accurately. I barely make it by without violating work hours, and as you admit up to five patients per day you have to deal with endless pages about your current patients and all of the discharges that are pending (for which, by the way, you need to do a med rec, discharge plan, discharge order, and discharge summary on TODAY; and by the way, it's your professional duty to get out within your hours!). And in the morning, seeing all this coming, you still have to stand and listen to all of the presentations on rounds knowing the clock is ticking on multiple time sensitive issues. You get to think and solve puzzles all day, for sure, but you have to do it quickly and under pressure.

Psychiatry is just more relaxed. Your patients are typically less acute (minus the occasional actively agitated patient needing to be restrained or other unusual circumstances) and you can take a more leisurely pace, getting to talk with and know them better and taking more time to think. You can also have much more of a life outside of work.

All that said, IM is a cool specialty. It keeps you engaged and you make a tremendous difference in patient's lives. You can also go into subspecialties that allow much better work life balance, and as an attending you can have more control over your working style. It doesn't suck. But know beforehand that the pressure is turned up significantly in IM intern year compared to as a student, and what is fun at low volumes is not fun for some at much higher volumes.
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Thank you! That is quite a bit of insight! I've been thinking that might be my downfall taking on the volume... Hmmm.

Follow up question, since you are a psychiatrist - Do the IM PGY2's and 3's seem miserable? Exhausted? Burnt Out? Happy?
 
GOINGDUMB said:
Thank you! That is quite a bit of insight! I've been thinking that might be my downfall taking on the volume... Hmmm.

Follow up question, since you are a psychiatrist - Do the IM PGY2's and 3's seem miserable? Exhausted? Burnt Out? Happy?
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your hours as an intern will be tough because you are still new at everything. However, from what I have noticed there is simply a lot of things that could get done quicker but the intern is just inefficient at doing it (especially new ones). Also your hours vary by aspects such as how difficult a call day is, what specific rotation you are on, how helpful your team is, how long it takes your attending to round, etc.

I think the thing that you have to realize is that a lot of these issues will be gone when you are done with training. You'll have help such as NPs/PAs and working in an environment where other healthcare workers such as nurses actually do their jobs reasonably well. You'll never get away from the notes, discharges, etc no matter what field you're in. But a lot of busy and scut work can be done by midlevels.

Just pursue the field you enjoy the most and what fits your personality the best. In my experience psych residents have fundamentally different personalities than IM. The same is true of IM vs surg vs peds vs etc.

It's fine to apply to both or med-psych programs, but be careful with applying to two fields within the same institution. I think it's ok if you do med-psych and psych but I would avoid doing IM and psych. Also, I will add that from what I have heard med-psych is a path meant more for people looking to get into leadership roles somewhere. Not sure if that is true though.
 
Bartelby said:
As a psych intern who has been on medicine for a while now (so I have worked both psych and IM) I can say with confidence that I am a happier, less stressed person on psychiatry. IM has a tremendous volume of work associated with it. I show up at six, leave around nine or ten on admitting days and on my "off" day (they alternate) leave four or five. I work six days a week. Almost that entire time I work at what is for me breakneck speed, and it all needs to be done accurately. I barely make it by without violating work hours, and as you admit up to five patients per day you have to deal with endless pages about your current patients and all of the discharges that are pending (for which, by the way, you need to do a med rec, discharge plan, discharge order, and discharge summary on TODAY; and by the way, it's your professional duty to get out within your hours!). And in the morning, seeing all this coming, you still have to stand and listen to all of the presentations on rounds knowing the clock is ticking on multiple time sensitive issues. You get to think and solve puzzles all day, for sure, but you have to do it quickly and under pressure.

Psychiatry is just more relaxed. Your patients are typically less acute (minus the occasional actively agitated patient needing to be restrained or other unusual circumstances) and you can take a more leisurely pace, getting to talk with and know them better and taking more time to think. You can also have much more of a life outside of work.

All that said, IM is a cool specialty. It keeps you engaged and you make a tremendous difference in patient's lives. You can also go into subspecialties that allow much better work life balance, and as an attending you can have more control over your working style. It doesn't suck. But know beforehand that the pressure is turned up significantly in IM intern year compared to as a student, and what is fun at low volumes is not fun for some at much higher volumes.
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This is definitely what I noticed while on my Sub-I's. Also, it seems like there is inherently a lot of social work involved in IM. You have to make lots of phone calls, set up appointments, deal with placement issues. I don't know if that's true at every institution, or just at the ones where I rotated. Some people love it, but I think for a lot of people it isn't exactly what they thought it was going to be, which is why they are miserable.
 
Dejavu said:
Everybody dumps on IM.

If an orthopod has a pt with HTN and doesn't want to bother with the admit process, they say "Admit to IM for management." Then they get out of all the scut and can just jump in and fix the fracture.

IM has to round and round, all day. And then to get away from rounding, they go to "clinic" all the time. It takes 2-3 weeks to see the results of therapy change, instead of seeing immediate results like we do in anesthesiology.

ER docs dump stuff on IM.

That is some of why IM sucks.
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This actually depends on the institution. Where I am, there is zero chance in hell ortho (or any surgical specialty) would be able to dump a patient on any IM service, where they would just get consulted for surgery. That's pretty much what GS services are for...
 
Dejavu said:
Everybody dumps on IM.

If an orthopod has a pt with HTN and doesn't want to bother with the admit process, they say "Admit to IM for management." Then they get out of all the scut and can just jump in and fix the fracture.

IM has to round and round, all day. And then to get away from rounding, they go to "clinic" all the time. It takes 2-3 weeks to see the results of therapy change, instead of seeing immediate results like we do in anesthesiology.

ER docs dump stuff on IM.

That is some of why IM sucks.
Click to expand...

This
 
Generally speaking:

Everyone dumps on IM, little support when doing social work stuff (so the resident often does a lot of it themselves), poor efficiency (do not need 3-4 hour rounds, 1 hour table rounds and then go see the sickest pts together, no need to see EVERY pt together). A lot of the "cool" stuff like procedures, IM often shy away from. Furthermore, if you get stuck with poor IM resident/team, they will consult anytime something interesting comes instead of thinking on their own

People from other specialties who get exposed to this above will obviously come away with a poor image of IM - much of it is true at MANY institutions. HOWEVER - it can be very different at other institutions, often top programs.

It depends on the hospital. Some places care a lot about education so they set up services such as a separarte hospitalist team with PAs/NPs who take care of more scut for the residents, or take on the baby sitting transfers, or admissions with very little learning value.

Some places don't round for that long, so that people read/think for themselves. Some people have a dedicated social worker so they take care of a lot of the nonsense that comes a resident's way.

IMO, very few IM programs overall care about resident education in this way, and often try to use residents for scut work because its free to the hospital. So you need to be careful about where you apply if you decide IM - most of the top programs I felt had less of the negative aspects and had more positive aspects associated with them, but thats my IMO
 
GOINGDUMB said:
Thank you! That is quite a bit of insight! I've been thinking that might be my downfall taking on the volume... Hmmm.

Follow up question, since you are a psychiatrist - Do the IM PGY2's and 3's seem miserable? Exhausted? Burnt Out? Happy?
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At most programs PGY-II is a little tougher than it used to be given the new work hour rules. That means more overnight and longer days PGY-II because us PGY-Is cannot do 24 hour calls. I think where I am it depended on the resident, but I saw a couple of mildly burnt out ones. PGY-III is generally outpatient, and it becomes about like a 9-5 job (along with your fair share of no shows that allow for coffee breaks and work catch-up!). Most PGY-III and IV psychiatry residents are pretty darn happy, and if not it probably isn't because of the job. Consider, though, that there will be some program to program variation in intensity.

Overall the psychiatry residents at my program are a pretty happy bunch. If you enjoy working with the patient population and love reading and learning about psychiatry it can be the kind of job you actually look forward to getting up in the morning to do!
 
It is sad to hear that people think that IM sucks - I just completed three years of internal medicine and recently started GI fellowship.

The GI staff at my program as well as my fellow colleagues and I are probably the most satisfied and happy group of people that I know 🙂
 
smartreader said:
It is sad to hear that people think that IM sucks - I just completed three years of internal medicine and recently started GI fellowship.

The GI staff at my program as well as my fellow colleagues and I are probably the most satisfied and happy group of people that I know 🙂
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....because you're doing GI now, not general IM.
 
smartreader said:
It is sad to hear that people think that IM sucks - I just completed three years of internal medicine and recently started GI fellowship.

The GI staff at my program as well as my fellow colleagues and I are probably the most satisfied and happy group of people that I know 🙂
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Also, the specific question was "why" people think IM sucks. I'd bet many of the above responders love IM, but can recognize the downsides that cause many to dislike it.
 
DoctwoB said:
Also, the specific question was "why" people think IM sucks. I'd bet many of the above responders love IM, but can recognize the downsides that cause many to dislike it.
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For sure! I don't intend to troll anyone or any field - I just want some insight, some elaboration on the "why?"
 
Bartelby said:
Most PGY-III and IV psychiatry residents are pretty darn happy, and if not it probably isn't because of the job. Consider, though, that there will be some program to program variation in intensity.

Overall the psychiatry residents at my program are a pretty happy bunch. If you enjoy working with the patient population and love reading and learning about psychiatry it can be the kind of job you actually look forward to getting up in the morning to do!
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I dig. No doubt psychiatry is a winner in terms of happy people. But I had a gas on IM - I'm worried I'll miss the drama, middle of the night action, tubes, platelet dilemmas, wet biodynamics/physio/pathodynamics, (not that Psych doesn't have it but IM has it daily at noon conference). But philosophically and in terms of where my heart is, its Psych.

Such a dilemma.


Funny conversation on radiology:

Me: Yeah, I don't think Rads is for me - I'm debating IM vs Psych. I need dynamics, action, things moving, etc

Rads Attending: I agree. "You are too smart for internal medicine. Do psych"

Me: ?????????
 
GOINGDUMB said:
I dig. No doubt psychiatry is a winner in terms of happy people. But I had a gas on IM - I'm worried I'll miss the drama, middle of the night action, tubes, platelet dilemmas, wet biodynamics/physio/pathodynamics, (not that Psych doesn't have it but IM has it daily at noon conference). But philosophically and in terms of where my heart is, its Psych.

Such a dilemma.


Funny conversation on radiology:

Me: Yeah, I don't think Rads is for me - I'm debating IM vs Psych. I need dynamics, action, things moving, etc

Rads Attending: I agree. "You are too smart for internal medicine. Do psych"

Me: ?????????
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This is because radiologists are lazy doctor wannabe haters. Don't confuse them with real physicians. :meanie:
 
jdh71 said:
This is because radiologists are lazy doctor wannabe haters. Don't confuse them with real physicians. :meanie:
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Haha...

Many radiologists were torn between radiology and IM. They're both pretty cerebral, just a lot less BS in radiology.

Not generalist obviously, but I was thinking seriously about cardiology or heme/onc.

Psychiatry is nothing but BS.
 
johnnydrama said:
Haha...

Many radiologists were torn between radiology and IM. They're both pretty cerebral, just a lot less BS in radiology.
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Radiology is cerebral? Can you elaborate? - I can't seem to appreciate that - It just seemed mostly like a bunch of pattern recognition and anatomy? I've heard this said before about radiology - Can somebody give me an example?
 
GOINGDUMB said:
Radiology is cerebral? Can you elaborate? - I can't seem to appreciate that - It just seemed mostly like a bunch of pattern recognition and anatomy? I've heard this said before about radiology - Can somebody give me an example?
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A great radiologist will give you 10 things in the DDx for a particular radiographic finding that you've never even heard of, in addition to the 15 you were already thinking about. The best of them will correctly call a particular malignant pathology (e.g. neuroendocrine vs. adenocarcinoma). Unfortunately, those radiologists are few and far between (and centered at academic institutions).

A good radiologist will confirm what you were already thinking, and maybe help you figure out a subtle finding every now and then. This is the vast majority of them (and are about half of what you see out in community practice).

A crap radiologist will give you the "clinical correlation required, recommend some other study I'm going to get paid even more to read" thing. These folks are evenly split between academics and the community.
 
gutonc said:
A great radiologist will give you 10 things in the DDx for a particular radiographic finding that you've never even heard of, in addition to the 15 you were already thinking about. The best of them will correctly call a particular malignant pathology (e.g. neuroendocrine vs. adenocarcinoma). Unfortunately, those radiologists are few and far between (and centered at academic institutions).

A good radiologist will confirm what you were already thinking, and maybe help you figure out a subtle finding every now and then. This is the vast majority of them (and are about half of what you see out in community practice).

A crap radiologist will give you the "clinical correlation required, recommend some other study I'm going to get paid even more to read" thing. These folks are evenly split between academics and the community.
Click to expand...

Huh, so that means I've never read a report by a great radiologist.
 
GOINGDUMB said:
lol
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My point, and I hope you saw it, was that many people are going to talk crap about other specialties. It's very easy to generalize and stereotype and then make comments towards that end about any specialty.

For the most part people went into radiology because they LIKED it and people went in Psych because they LIKED it and people went into IM because they LIKED it.

Being a general internist is probably one of the HARDEST jobs anywhere in the medical world - these people (the good ones anyway) are literally worth their weight in gold - and it's easy to get discouraged when an already difficult jobs get harder, and you seem to see a certain amount of disrespect from some of your specialist colleagues.

Every specialty has it's con points, and with the golden age gone, don't expect things to get more awesome, but probably smolder in the vicinity of tolerable until you're done working. Pick something you like to do, and if your heart is in psych then go for it, we need good psychiatrists - or do Med/Psych - they do have combined programs.

Good luck.
 
jdh71 said:
My point, and I hope you saw it, was that many people are going to talk crap about other specialties. It's very easy to generalize and stereotype and then make comments towards that end about any specialty.

For the most part people went into radiology because they LIKED it and people went in Psych because they LIKED it and people went into IM because they LIKED it.

Being a general internist is probably one of the HARDEST jobs anywhere in the medical world - these people (the good ones anyway) are literally worth their weight in gold - and it's easy to get discouraged when an already difficult jobs get harder, and you seem to see a certain amount of disrespect from some of your specialist colleagues.

Every specialty has it's con points, and with the golden age gone, don't expect things to get more awesome, but probably smolder in the vicinity of tolerable until you're done working. Pick something you like to do, and if your heart is in psych then go for it, we need good psychiatrists - or do Med/Psych - they do have combined programs.

Good luck.
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I dig. Thanks for the insight.

Idk, I guess I'll have to see where I sit when I rank my programs lol.

I just don't wanna be miserable.

I just don't wanna look back and feel I wasted my 20's lol.

As for the LIKED part though, I respectfully disagree. I honestly feel that is heavily though not exclusively influenced by the income, lifestyle, etc.

But, I personally feel income the distribution across the specialties under a collapsing single pool of money/production is all gonna implode toward a relatively equal and $hitty income relative to work amongst the specialties, that's why I'm going after what I REALLY like.
 
gutonc said:
A great radiologist will give you 10 things in the DDx for a particular radiographic finding that you've never even heard of, in addition to the 15 you were already thinking about.
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I think we value different domains of cerebralness.

A radiologist who gives 20 differentials for something they see, that sounds like step 1 review class. Like a Rain Man kind of cerebral I guess. I wish I could elaborate more on what I mean by that. So yeah I guess that is cerebral, if that's the flavor of cerebral that gives you a buzz.

I'm talking cerebral in that Dr. Dre in the studio, Peter Agre discovering Aquaporins, Calling the subprime mortgage crisis in 2005 and buying credit default swaps type cerebral. Fluidic, Encompassing, Dynamic, Complex.

But to each his own. I'm just yappin on a sunday afternoon.
 
GOINGDUMB said:
I think we value different domains of cerebralness.

A radiologist who gives 20 differentials for something they see, that sounds like step 1 review class. Like a Rain Man kind of cerebral I guess. I wish I could elaborate more on what I mean by that. So yeah I guess that is cerebral, if that's the flavor of cerebral that gives you a buzz.

I'm talking cerebral in that Dr. Dre in the studio, Peter Agre discovering Aquaporins, Calling the subprime mortgage crisis in 2005 and buying credit default swaps type cerebral. Fluidic, Encompassing, Dynamic, Complex.

But to each his own. I'm just yappin on a sunday afternoon.
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Nothing in medicine is like that. Unless you're a researcher, and "clinical research" generally isn't that cerebral either.

For that look to genomics, microfluidics, nanotechnology, other cool **** that will change all of our lives but barely get taught in medical school.

The truth is we're all just plumbers, except some of us are paid a bit more per hour (but definitely not all)...
 
Dejavu said:
Everybody dumps on IM.

If an orthopod has a pt with HTN and doesn't want to bother with the admit process, they say "Admit to IM for management." Then they get out of all the scut and can just jump in and fix the fracture.

ER docs dump stuff on IM.

That is some of why IM sucks.
Click to expand...


Sorry to revive the thread, but I keep thinking about THIS^

Dumping.

Isn't this good? - You can get reimbursed for doing easy work - Just start them on an ACE-I fill out some forms, EMR with a Macro, and profit, right (I feel I'm missing something here)?

I get it as a resident this can suck. But as an attending, this sounds like a nice daily bonus ($50 for 30 minutes of work?)... or not?

Again, not trolling. I have a long drive everyday so I think a lot about this stuff.
 
GOINGDUMB said:
Sorry to revive the thread, but I keep thinking about THIS^

Dumping.

Isn't this good? - You can get reimbursed for doing easy work - Just start them on an ACE-I fill out some forms, EMR with a Macro, and profit, right (I feel I'm missing something here)?

I get it as a resident this can suck. But as an attending, this sounds like a nice daily bonus ($50 for 30 minutes of work?)... or not?

Again, not trolling. I have a long drive everyday so I think a lot about this stuff.
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You are correct that this sucks when you're a resident. And a good program won't let these come to the teaching service.

Once you're a hospitalist, grinding RVUs to make bank, they can be somewhat less crappy for the reason you point out...fat bank for minimal work (although the money's not really that good...I make almost $100/h sitting on my butt and looking at ridiculous FYI pages while moonlighting...last week I had to do work a little over 3 out of my scheduled 12 hours so I made almost $400/h of actual work...but that's neither here nor there).

But it's a rare hospitalist that doesn't want some sort of intellectual stimulation and admitting the broken hip for "medical management" just because ortho is too dumb to figure out how to write for an insulin sliding scale and continue home HTN meds will lead to rapid burnout.
 
gutonc said:
You are correct that this sucks when you're a resident. And a good program won't let these come to the teaching service.

Once you're a hospitalist, grinding RVUs to make bank, they can be somewhat less crappy for the reason you point out...fat bank for minimal work (although the money's not really that good...I make almost $100/h sitting on my butt and looking at ridiculous FYI pages while moonlighting...last week I had to do work a little over 3 out of my scheduled 12 hours so I made almost $400/h of actual work...but that's neither here nor there).

But it's a rare hospitalist that doesn't want some sort of intellectual stimulation and admitting the broken hip for "medical management" just because ortho is too dumb to figure out how to write for an insulin sliding scale and continue home HTN meds will lead to rapid burnout.
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This might be shifting this thread off topic (it's a dumb topic anyway) but could you explain a bit about moonlight? I know the basic principle of it but how exactly are you paid? By hour + admissions?
 
ArcGurren said:
This might be shifting this thread off topic (it's a dumb topic anyway) but could you explain a bit about moonlight? I know the basic principle of it but how exactly are you paid? By hour + admissions?
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Me personally? Hourly. This is one of 3 moonlighting jobs I've had and all have been hourly (FWIW, I've never heard of any other mechanism for paying moonlighters in any specialty although I'm sure they exist). So the less I do, the better I feel about the time I put in. Which is not to say that I don't do everything that needs to be done...some nights I get lucky and don't have to do much (I once did a 12h shift with no admits and only 6 pages...I got paid almost $200/page), other nights I'm up all night getting my ass handed to me...you pays your money and you takes your chances.
 
gutonc said:
Me personally? Hourly. This is one of 3 moonlighting jobs I've had and all have been hourly (FWIW, I've never heard of any other mechanism for paying moonlighters in any specialty although I'm sure they exist). So the less I do, the better I feel about the time I put in. Which is not to say that I don't do everything that needs to be done...some nights I get lucky and don't have to do much (I once did a 12h shift with no admits and only 6 pages...I got paid almost $200/page), other nights I'm up all night getting my ass handed to me...you pays your money and you takes your chances.
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Man I kinda hope I match at a program which allows this... I know I could totally use the extra money when I'm a resident lol.
 
gutonc said:
I did it as a fellow. Some residents were allowed do it as R3s, but only the stellar ones.
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Our program allows R2s to moonlight in-house. They have different pay scales, but it usually 600-800. Before, some nights were an easy 600 with no admits. But since we expanded, it seems that all the residents are getting slammed on their shifts.
 
gutonc said:
A great radiologist will give you 10 things in the DDx for a particular radiographic finding that you've never even heard of, in addition to the 15 you were already thinking about. The best of them will correctly call a particular malignant pathology (e.g. neuroendocrine vs. adenocarcinoma). Unfortunately, those radiologists are few and far between (and centered at academic institutions).

A good radiologist will confirm what you were already thinking, and maybe help you figure out a subtle finding every now and then. This is the vast majority of them (and are about half of what you see out in community practice).

A crap radiologist will give you the "clinical correlation required, recommend some other study I'm going to get paid even more to read" thing. These folks are evenly split between academics and the community.
Click to expand...

This.

I definitely *loved* radiology for many of these reasons. A truly great radiologist is damn impressive to see in action. At the end of the day, however, I just didn't feel like I was going to enjoy a medical desk job as much as I would enjoy IM. Hopefully this was the correct decision.

Furthermore, I get the impression that a lot of people just tolerate IM residency because they want access to the subspecialties. In fact, this is a trend I noticed through a number of specialties - there are people tolerating ob/gyn just to be able to do reproductive endo, for instance. I loved the idea of doing medical tox, but ultimately I wasn't sure if I could stomach EM enough to be able to do the subspecialty.

And as far as research being 'more cerebral' etc than medicine - perhaps, but you need to remember what proportion of those people actually get to have the full experience directing their own research as a fully tenured professor etc. I too thought of doing a PhD and going into research, but for me the (very real) risk of doing all that training and still coming out a broke-ass, overworked community college 'instructor' who does no research and hates his life was simply not worth whatever shot you might have at becoming some big-name researcher. Most people who get PhDs and try to get decent research jobs come out empty-handed, and the job options available at that point really suck. I think medicine is a much more satisfying option for most people on the fence between the two careers.
 
dozitgetchahi said:
And as far as research being 'more cerebral' etc than medicine - perhaps, but you need to remember what proportion of those people actually get to have the full experience directing their own research as a fully tenured professor etc. I too thought of doing a PhD and going into research, but for me the (very real) risk of doing all that training and still coming out a broke-ass, overworked community college 'instructor' who does no research and hates his life was simply not worth whatever shot you might have at becoming some big-name researcher. Most people who get PhDs and try to get decent research jobs come out empty-handed, and the job options available at that point really suck. I think medicine is a much more satisfying option for most people on the fence between the two careers.
Click to expand...

Oh absolutely. Even if you want to do research, I would still go MD.

Being a PhD requires far too much effort for far too little guaranteed return. I would be fine earning a lower salary as a PhD, but the lack of decent job prospects was horrifying.

MDs can do anything a PhD can, the reverse is not true. MDs can often get better funding too.

MD/PhD is just for bragging rights + free tuition, doesn't matter much.
 
johnnydrama said:
Oh absolutely. Even if you want to do research, I would still go MD.

Being a PhD requires far too much effort for far too little guaranteed return. I would be fine earning a lower salary as a PhD, but the lack of decent job prospects was horrifying.

MDs can do anything a PhD can, the reverse is not true. MDs can often get better funding too.

MD/PhD is just for bragging rights + free tuition, doesn't matter much.
Click to expand...

Ugh I dunno man I could totally have gone for this
 
Obviously you're going to get biased opinions asking people in an IM thread why many say it sucks. The thing I've asked myself over and over is can I do this job for the next 30-35 years and be satisfied? The number one deciding factor for me is redundancy, not pay. Sure, Urology pays really well, but seriously how many TURP procedures can you do before you want to rip your eyes out (about 3 for me)? I feel that doing an IM residency is going to be tough and know that it has many downsides, but the fact that you get to deal with such a wide variety of pathology is what intrigues me. I enjoy the patient interactions (not all of course), and the fact that you have such a wide breadth of knowledge to master and challenge yourself with.
 
I like the comment above pertaining to seeing immediate results in anesthesiology. You mean when a patient is bradycardic and you give them atropine and see their heart rate increase? Wow, now that's exciting stuff. Or maybe you meant that alongside seeing immediate and exciting results on the operating table you mastered words with friends, yeah pretty neat stuff.
 
in defense of IM, it has the hottest chicks just by sheer probability. That has to mattter in your selection process right? :naughty:
 
Azipropofol said:
in defense of IM, it has the hottest chicks just by sheer probability. That has to mattter in your selection process right? :naughty:
Click to expand...

i think u are in one of the exceptional IM program. Enjoy it bro. This is the world's order :
Derm chicks > Ophtho chicks > FM chicks > Peds chicks > PM&R chicks > IM chicks = ER chicks > Neuro chicks > Psych chicks > Anes chicks > Gen Surg. chicks > Ortho chicks :scared:
 
Noegrus said:
Sorry, but peds chicks are hands down the best.
Click to expand...

wow not feeling the im girl hate but omg dude true about peds. I seriously fell head over heels for this peds resident last year. easily the most beautiful gal Ive seen in my life. 😛

Gspan you forgot nsurg to bottom out that list lol
 
Azipropofol said:
wow not feeling the im girl hate but omg dude true about peds. I seriously fell head over heels for this peds resident last year. easily the most beautiful gal Ive seen in my life. 😛

Gspan you forgot nsurg to bottom out that list lol
Click to expand...

they're all robots. Robots don't count
 
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