Why would anyone choose to go into internal medicine?

[Trajan]

So I'm almost done with week one of my medicine AI. It's a very good learning experience at a hospital that has fourth years truly function as an intern (except you have to get your orders cosigned--bloody nuisance).

That being said, why the hell would anyone choose to do this for a career? You run around like a chicken with your head cut off, managing a patient's 23 medications only for him/her to leave and stop taking them. Not that I blame them, I'm 26 with a rather high IQ and I can't remember to put rogaine foam on that small bald spot on the back of my head every night. How can an 82 year old with a prior CVA and an 8th grade education take 35 pills a day at the appropriate times?

An anecdote: yesterday a patient about to be discharged walks over to the nursing station to chat with the attending who was scribbling away at some stupid note. The attending keeps his head down as the talkative patient apologizes for being rude to the staff while he was in pain and profusely thanks the doctor. The attending scribbles, nods, makes no eye contact, and states, "I've got to go, I need to find a computer." He dashes away.

Inpatient medicine is the worst job in the entire medical field. I think that it takes people's souls away.

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[Thaitanium]

Take your "rather high IQ" and dont go into internal medicine.

You sound like you got something stuck up you arse.

 

[IceMan0824]

He does sound like he has a stick up his arse, but he does makes some good point also

Beside, IM isn't for everyone. That is why there are other aspect of medicine. Some people prefer the general knowledge and uncertainty that IM brings, while some of us are just in for 'surprise surprise' the specialties.

Either way, you sound like one of the many people I would rather not have as a co-worker or mate. Hope you enjoy your Dermatology or Surgical residency(if you make it in).

 

[drbruce]

He probably did one of those phony internet IQ tests - everybody comes out with above 130. What a joke!

If you can't handle internal medicine then you should probably give up being a doctor because it is clearly not for you. IM is at the heart of doctoring.

 

[drbruce]

He probably did one of those phony internet IQ tests - everybody comes out with above 130. What a joke!

If you can't handle internal medicine then you should probably give up being a doctor because it is clearly not for you. IM is at the heart of what being a doctor is all about.

 

[Trajan]

Take your "rather high IQ" and dont go into internal medicine.

You sound like you got something stuck up you arse.

Of all of the doctors that I have encountered -- and I doubt that I am alone in this -- the ones with the largest sticks up their arses were in internal medicine. Perhaps that's why they are well suited for their field.

As for the IQ comment, everyone in medical school is very bright when compared to the general population. Even you probably have a rather high IQ. Somehow, however, we assume that, as I have previously said, 82 year olds with limited education, vision, and memory can take 35 pills a day as directed.

No one ever said that high intelligence correlates with common sense.

 

[deleted87716]

why the hell would anyone choose to do this for a career?

Most of us look at fields that we're not interested in this way. Believe it or not, some people actually enjoy managing complicated medical patients, just as some people enjoy surgery or anything else. It's a mistake to denigrate a field just because you don't like it.

Besides, it sounds like you dislike hospital medicine more than internal medicine in general. You don't have to be a hospitalist, or even do any hospital medicine unless you want to.

 

[turkleton]

what's with med students/physicians insecurity about their intelligence? everyone is smart... we get it.

In defense of IM, it has its drawbacks as most will admit, attributable to their patient load. However, internists, I think see the validity and humanity in cases where others write off. I'm not quite sure why an 82 year old who suffers a CVA is undue the same care and respect as others- yea chalk it up to corny, hackneyed bs, i could care less- but you'd be singing a different tune if it was your grandfather. It maybe a pain in the ass to deal with the complex patients where you're not going to make a huge medical difference, but we enjoy it. It sucks being sick, it sucks being in the hospital, and it sucks being paraded around in some stupid ass gown while everyone runs crazy tests on you, treats you like a 5 year old even though you're old enough to be their fathers father- give them some credit. I've had the misfortune (maybe fortune) to see an elderly man ,who suffered, die in front of me on an ICU stint. His wife of 55 years wasn't doing exactly doing cartwheels because he was old.

Aside from which the cardiologist popping open a coronary on a 55 yo, an oncologist treating a 50 year old breast ca pt, a GI doc treating a 25 year old IBD (not exactly uncommon diseases) I think commands plenty of respectability.

If you don't want to do IM because you don't like it/it's not for you, fine it's not for everyone. But don't go around bashing internists- you're just displaying your ignorance, high IQ and all.

 

[king_lizard]

so Trajan what are you going into?

So I'm almost done with week one of my medicine AI. It's a very good learning experience at a hospital that has fourth years truly function as an intern (except you have to get your orders cosigned--bloody nuisance).

That being said, why the hell would anyone choose to do this for a career? You run around like a chicken with your head cut off, managing a patient's 23 medications only for him/her to leave and stop taking them. Not that I blame them, I'm 26 with a rather high IQ and I can't remember to put rogaine foam on that small bald spot on the back of my head every night. How can an 82 year old with a prior CVA and an 8th grade education take 35 pills a day at the appropriate times?

An anecdote: yesterday a patient about to be discharged walks over to the nursing station to chat with the attending who was scribbling away at some stupid note. The attending keeps his head down as the talkative patient apologizes for being rude to the staff while he was in pain and profusely thanks the doctor. The attending scribbles, nods, makes no eye contact, and states, "I've got to go, I need to find a computer." He dashes away.

Inpatient medicine is the worst job in the entire medical field. I think that it takes people's souls away.

 

[chicamedica]

I LIKE inpatient medicine. It doesn't take my soul away; on the contrary, the things i have seen, and the experiences i've had on the floors and in the unit have enriched my soul. I've been really lucky to have worked with some inspiring housestaff and attendings though, so maybe that's why. The attending you were exposed to sounds like a jerk, so that may be why you have the perspective that you have. The reason I'm not currently going into IM is actually the OUTPATIENT aspect, mostly for the issue you touched upon--people's noncompliance makes making a difference in their well being much harder, and is just not as rewarding to me. In the hospital at least you can make sure they get their proper meds and see their improvement.

I fully agree with whoever said IM is at the heart of any specialty of medicine. Tell that to some of the attendings i've had, who've dared to tell me i dont have to know certain things for anesthesiology. Arrrgh, that makes me SO MAD!!😡 Just teach! I'll choose what i need/want to know.

 

[Hernandez]

Inpatient medicine is the worst job in the entire medical field. I think that it takes people's souls away.

I love inpt medicine and can't stand clinic. I get so sick of listening to middle age overweight women coming in for their refills of Prozac. Give me someone who is actually sick and possibly be helped. I enjoy the challenge of figuring out all the little details and zebras.

 

[Trajan]

This is actually quite interesting to me. Some of you have helped answer the original question well, even eloquently. My problem with what I'm seeing of the work that one does in a medicine residency is that it creates tremendous frustration. Largely, this is, I think, secondary to excessive workload. Kind of hard to be that ideal Norman Rockwell physician when you are admitting ten patients in the evening.

No one thinks that the 82 year old doesn't deserve respect. Nor do I suggest that we should not prescribe medication to him or her, even if that means 17 scripts. That doesn't mean it's ideal, in fact it's pretty ridiculous and sad for the patient, but that's a reality for many people, especially the elderly.

I'm glad that some of you enjoy this important work. I'm also pleased that some of you can reply to the rhetorical, tongue-in-cheek question "why would anyone choose to go into internal medicine?" without thrashing about so much as to give oneself a wedgie.

What am I going into? Not 100% sure, honestly. A transitional year for now--to get a good background in, gasp, managing hospitalized patients. But eventually physiatry, pediatrics, or perhaps pediatric physiatry. Actually I enjoy working with patients with very serious medical problems. However, I like finding practical solutions --medical, physical, and psychosocial--to improve quality of life, rather than just managing medications. Perhaps that's not the most intellecual work in medicine, but it takes all types.

Good luck to all of you.

 

[turkleton]

This is actually quite interesting to me. Some of you have helped answer the original question well, even eloquently. My problem with what I'm seeing of the work that one does in a medicine residency is that it creates tremendous frustration. Largely, this is, I think, secondary to excessive workload. Kind of hard to be that ideal Norman Rockwell physician when you are admitting ten patients in the evening.

No one thinks that the 82 year old doesn't deserve respect. Nor do I suggest that we should not prescribe medication to him or her, even if that means 17 scripts. That doesn't mean it's ideal, in fact it's pretty ridiculous and sad for the patient, but that's a reality for many people, especially the elderly.

I'm glad that some of you enjoy this important work. I'm also pleased that some of you can reply to the rhetorical, tongue-in-cheek question "why would anyone choose to go into internal medicine?" without thrashing about so much as to give oneself a wedgie.

What am I going into? Not 100% sure, honestly. A transitional year for now--to get a good background in, gasp, managing hospitalized patients. But eventually physiatry, pediatrics, or perhaps pediatric physiatry. Actually I enjoy working with patients with very serious medical problems. However, I like finding practical solutions --medical, physical, and psychosocial--to improve quality of life, rather than just managing medications. Perhaps that's not the most intellecual work in medicine, but it takes all types.

Good luck to all of you.

You're a better man than I. I like discussing ARF in the setting of CHF a lot more than handling complicated psychosocial issues. But like you said, it takes all types. Interesting choice of careers- best of luck in one of them.

 

[orientedtoself]

good luck with finding solutions in physiatry

 

[glorytaker]

He probably did one of those phony internet IQ tests - everybody comes out with above 130. What a joke!

If you can't handle internal medicine then you should probably give up being a doctor because it is clearly not for you. IM is at the heart of what being a doctor is all about.

That's weird 'cuz my IQ on an Internet test was 122. ?

 

[mcindoe]

i can speak from both sides...as someone who initially asked myself "why would anyone choose to go into IM" and went into surgery, only to end up asking myself "why would anyone choose to go into surgery?" and applying for a spot in IM this year. i saw enough things on my medicine rotations that made me think i'd slit my wrists if i had to endure any more months of talking about potassium on rounds, or getting flustered with managing all those meds (especially if it involved trying to explain to an 82 year old man how to do a prednisone taper, let alone how to write a prescription for it!). i got annoyed with the late night unnecessary admissions, the lasix dosing, the "paralysis by analysis" discussions, the note writing, the obscure and excessive (and often inconclusive) tests and imaging, the cavalcade of consultants lining up to chime in on your team's treatment plan, you name it. i thought this was all ridiculous and i didn't want to do another week of it, and especially not three years of it in residency.

rather than tell you all the things i ended up hating about surgery, i'll cut to the chase and tell you exactly why i'm choosing to go into internal medicine after swearing i'd never do it...something that i only learned from perspective. i missed getting to spend time with patients. i missed the doctor-patient relationship. i missed getting to spend that time explaining to the old man how to do a prednisone taper, and despite my frustration, i was always reminded of why i got into this business to begin with...to take care of patients. and patients are so grateful when you spend time with them and they recognize the effort and compassion you put into treating them. it's that sort of interaction that you might not appreciate when you're tired, overworked, overwhelmed, or preoccupied. but it's the very thing that makes you feel there's a reason to come back the next day...because there are patients that get to know you and are relieved to see your familiar face the next morning, and are comforted by your presence. when they get better, they feel better, and you feel better knowing that they left the hospital in better shape than when they came in because you took good care of them.

there's stuff to complain about in any specialty, career, workplace, whatever. internal medicine has its own fair share of nuisances, but after practicing in a field of medicine where your doctor-patient interaction involves a patient who is mostly anesthetized or snowed on narcotics post-operatively, i can't wait to go back to being able to have those relationships with patients, practicing medicine but also practicing empathy and compassion, and no matter how big of a jerk some attending or colleague might be, nothing will get in the way of the interaction you get to have with your patients, and the ability to use your knowledge to help people and your bedside manner to comfort them, along with the gratitude you will receive in return from them (and in abundance), all will answer your question will brilliant clarity. as will simply asking yourself: why did you want to become a doctor? answer that honestly and you'll probably be able to answer your own question.

 

[nutcancer]

awesome reply. i'm an ms 3 who hasn't had IM but is scared to death about how boring it appears and how others have complained about it. of course, i'm probably going to choose it for speciality reasons.

i think its easy for the hospitalists responding to this thread to say the OP is ignorant. but i think its a very fair question the OP posed. i've talked to plenty of med residents and they flat out admit they are in it for the speciality (this is MOST med residents in academic institutions). residents in the field recognize its boring but they want to reap the rewards of a speciality.

i have a feeling i'm going to get harrassed for my post. but to the OP, the answer to your question is 'to get into an exciting specialty.'

 

[sistermike]

awesome reply. i'm an ms 3 who hasn't had IM but is scared to death about how boring it appears and how others have complained about it. of course, i'm probably going to choose it for speciality reasons.

i think its easy for the hospitalists responding to this thread to say the OP is ignorant. but i think its a very fair question the OP posed. i've talked to plenty of med residents and they flat out admit they are in it for the speciality (this is MOST med residents in academic institutions). residents in the field recognize its boring but they want to reap the rewards of a speciality.

i have a feeling i'm going to get harrassed for my post. but to the OP, the answer to your question is 'to get into an exciting specialty.'

I was going to post the same answer -- many of the IM folks are looking to land a fellowship. However, if you look at the amount of IM's in our country compared to specialists, it is obvious that we have a far greater amount of IM docs. It probably has a great deal with someone not being able to land a fellowship, or perhaps them deciding to not pursue the fellowship afterall and to start work ASAP.

My roommate works in the IT field and he currently works for a large international transcription company, which in return is owned by an IM doc. I've spoken with the IM doc on numerous occassions and he stated that he was looking to go into IM with the intention of specializing afterword. However, he found that after his intern year, he actually began to enjoy his work and decided that IM was probably the best choice for him afterall.

 

[mcindoe]

a residency in IM can do a lot more than serve as a pathway to getting a fellowship, and i should have added in my earlier post that IM residency is the gateway to a wide array of pathways, many of which aren't even in clinical medicine. you can either stop after 3 years and then start to practice general IM, doing outpatient clinical work or becoming a hospitalist, or you have the option of going onward to do fellowship training in all sorts of specialties. but it doesn't end there.

maybe you find that after the short three years (which is a small amount of time to invest, as compared to many other fields like surgery) you don't see yourself practicing clinical medicine after all. or for your own personal reasons, you want a career with a higher salary or you have other interests and talents that you wish to pursue outside the arena of medicine. fortunately, three years of general IM training doesn't corner you into practicing medicine and limit what you can do afterwards--you can take your unique background and credentials and enter the business field, maybe even get an MBA, become a writer (novels, film/TV, or columnist), journalist (in print or on TV), or do consulting for pharma or biotech companies. you can become an analyst for an investment banking firm, and with all these business career paths you can play an instrumental role in providing a company or firm with the insight and perspective of a trained physician, and because there's only a limited number of qualified physicians out there that are fully trained and willing and able to give up clinical medicine entirely and do this full-time, you will be in high demand and will be compensated accordingly.

(as an aside, while it's possible to do some of the above-described business endeavors right out of med school and use your M.D. credentials to get those jobs, a company hiring someone for technically being a doctor (i.e. having "M.D." after one's name on a resume) without having any post-graduate clinical training in my opinion is like buying a new $90,000 BMW with a 4-cylinder engine...might look good from the outside but when you start to drive it you find out quickly that it's pretty weak and can't perform the way you thought it would. companies don't always understand how little we actually know just because we completed med school and are technically doctors...they don't realize that it's the residency training that teaches us how to put everything we've learned to practical use....and to use the BMW analogy again, become the 8- or 12-cylinder engine that they thought they were getting in the first place.)

the bottom line is that there are choices....many of them, in fact. and they go beyond the scope of fellowships and medicine in general. you have the ability to decide what career you want, and the oppoprtunities are abundant. not all require that you do a residency, but it can only help you and keep doors open, and residency is not the type of thing you can decide you want to do in 10-15 years and just go back. possible, but among other things, you're not likely going to quit a job 10 years down the road so that you can work three times as many hours for 1/3 the pay for the next three years, you know? and let's say you leave clinical medicine for the business world--if you've completed your residency and have a change of heart somewhere down the line, you'll still be a trained physician (and hopefully board certified too), so you can always come back.

so to further answer the OP's question, the opportunities for people who do training in IM make it a very appealing choice--it's relatively short in duration, very broad in scope, and there are many things you can do (clinical or anything but) after you've completed your training.

hope this helps.

 

[mcindoe]

i have a feeling i'm going to get harrassed for my post.

no, but i'd like to harrass you about your screen name. LOL

nutcancer? 😕

 

[nutcancer]

there is no explanation for my name. none!

i didn't fully understand ur analogy. is it like joining the army? to most people, it seems kind of thankless and even dangerous. but in the end you learn discipline, sacrifice, and other intangible things?

 

[salmonella]

a residency in IM can do a lot more than serve as a pathway to getting a fellowship, and i should have added in my earlier post that IM residency is the gateway to a wide array of pathways, many of which aren't even in clinical medicine. you can either stop after 3 years and then start to practice general IM, doing outpatient clinical work or becoming a hospitalist, or you have the option of going onward to do fellowship training in all sorts of specialties. but it doesn't end there.

maybe you find that after the short three years (which is a small amount of time to invest, as compared to many other fields like surgery) you don't see yourself practicing clinical medicine after all. or for your own personal reasons, you want a career with a higher salary or you have other interests and talents that you wish to pursue outside the arena of medicine. fortunately, three years of general IM training doesn't corner you into practicing medicine and limit what you can do afterwards--you can take your unique background and credentials and enter the business field, maybe even get an MBA, become a writer (novels, film/TV, or columnist), journalist (in print or on TV), or do consulting for pharma or biotech companies. you can become an analyst for an investment banking firm, and with all these business career paths you can play an instrumental role in providing a company or firm with the insight and perspective of a trained physician, and because there's only a limited number of qualified physicians out there that are fully trained and willing and able to give up clinical medicine entirely and do this full-time, you will be in high demand and will be compensated accordingly.

(as an aside, while it's possible to do some of the above-described business endeavors right out of med school and use your M.D. credentials to get those jobs, a company hiring someone for technically being a doctor (i.e. having "M.D." after one's name on a resume) without having any post-graduate clinical training in my opinion is like buying a new $90,000 BMW with a 4-cylinder engine...might look good from the outside but when you start to drive it you find out quickly that it's pretty weak and can't perform the way you thought it would. companies don't always understand how little we actually know just because we completed med school and are technically doctors...they don't realize that it's the residency training that teaches us how to put everything we've learned to practical use....and to use the BMW analogy again, become the 8- or 12-cylinder engine that they thought they were getting in the first place.)

the bottom line is that there are choices....many of them, in fact. and they go beyond the scope of fellowships and medicine in general. you have the ability to decide what career you want, and the oppoprtunities are abundant. not all require that you do a residency, but it can only help you and keep doors open, and residency is not the type of thing you can decide you want to do in 10-15 years and just go back. possible, but among other things, you're not likely going to quit a job 10 years down the road so that you can work three times as many hours for 1/3 the pay for the next three years, you know? and let's say you leave clinical medicine for the business world--if you've completed your residency and have a change of heart somewhere down the line, you'll still be a trained physician (and hopefully board certified too), so you can always come back.

so to further answer the OP's question, the opportunities for people who do training in IM make it a very appealing choice--it's relatively short in duration, very broad in scope, and there are many things you can do (clinical or anything but) after you've completed your training.

hope this helps.

You can actually do everything you mentioned in your post with a residency training in other areas (not necessarily in internal medicine). For example, with a surgery residency under your belt, you would be valuable for medical/surgical device companies, consulting on animal trials, device ergonomics, etc. A radiologist, neurologist, ophthalmologist, PM&R, would all be valuable to their respective research fields. Companies probably pay these subspecialists more than an IM physician.

 

[mcindoe]

You can actually do everything you mentioned in your post with a residency training in other areas (not necessarily in internal medicine). For example, with a surgery residency under your belt, you would be valuable for medical/surgical device companies, consulting on animal trials, device ergonomics, etc. A radiologist, neurologist, ophthalmologist, PM&R, would all be valuable to their respective research fields. Companies probably pay these subspecialists more than an IM physician.

Yes, but surgery is an extra two years of training than IM. Two arduous years of being paid ~$50,000 to work 80+ hours a week is nothing to downplay. If you think you're likely to do something non-clinical post-residency, why spend any more time than three years to complete your training?

Your statement about companies paying subspecialists more than an IM physician is just conjecture...it sounds more like something you just made up rather than a fact. and if the subspecialists get paid more for a few specialized positions, all the power to them...those people have put in a lot of extra time training at low wages to be in that position. but the business world is completely different than the medical field...someone much less qualified than you can end up with a much better, high-paying job if they market themselves right. either way, any physician going into a non-clinical pathway after residency won't have much trouble finding a job, and it doesn't really matter who gets more money or what training background you come from. my original point was that these pathways exist, that's all.

 

[DrNick2006]

One reason why medicine gets a bum rap and one reason only. It is relatively low compensation for a large amount of responsibility. If medicare pay structure were redistributed so that the average admission H and P (takes 1-2 hours to do) paid the same as a lap choly, then people would be flocking to IM. The fact is, however, that IM patients are the most complex, and therefore require a large amount of time per pt at low compensation, so unlike say, dermatology, where its no trouble to see 15 patients in a morning, there is no way to do this well as an internist, and so your wage goes down, and with lower wages goes less truly genuinely interested in the real idologic basis for medicine physicians.

 

[kungfufishing]

i dont know if this is the only reason, but it probably matters more than it should. I'm even an EM resident ("the bad guy") but objectively speaking a good internist is who I want my parents' doctor to be. There should be more money in it. This coming from a guy who absolutely loves EM and might not want to be in medicine if I had to do something else.