What is Internal Medicine residency like?

[brady23]

Do you really work 70-80 hours per week, with a 24h call every 4-6 days, and only one day off per week but after residency, do the hours get better?

 

[ACHQ]

It depends on what rotation you're on (i.e. CTU/GIM vs sub-specialty) as well as how many patients you have to see and how big your team is

Typical CTU day for me: days start at 8 am (as an SMR more like 7 am) and goes until 5:00-5:30pm on a good day, 6:00-6:30pm on a bad day, with call every 4th day. At UofT we have a standard Mon,Fri,Sun, Thrus, Tues, Sat, Wed.... (with the cycle repeating again) call schedule for CTU. So for the Mon, Fri, Sun week you work  about 95-105 hours in that week. For Thursday week you work 48-50 hours (because your post call Monday and Friday). For the Tues, Sat week you work about 80 hours. And for the Wed week you work 56-60 hours.

There are some days where you leave at 4-430, but those are less common.

Mind you this includes things like handover, morning report/teaching, noon rounds, team teaching, running the list and of course rounding on your patients.

Typically on sub-specialty the hours are a bit better (but again depends on what sub-specialty and whether its purely a consult specialty or with inpatient responsibilities). Hours are 8/9am-5pm with call usually being more lenient about 3-5 call shifts in a 4 week block. 

This excludes ICU/CCU/Cardio. Which is usually 5-7 call shifts in a 4 week block. Hours are about the same as CTU.

[brady23]

11 minutes ago, ACHQ said:

It depends on what rotation you're on (i.e. CTU/GIM vs sub-specialty) as well as how many patients you have to see and how big your team is

Typical CTU day for me: days start at 8 am (as an SMR more like 7 am) and goes until 5:00-5:30pm on a good day, 6:00-6:30pm on a bad day, with call every 4th day. At UofT we have a standard Mon,Fri,Sun, Thrus, Tues, Sat, Wed.... (with the cycle repeating again) call schedule for CTU. So for the Mon, Fri, Sun week you work  about 95-105 hours in that week. For Thursday week you work 48-50 hours (because your post call Monday and Friday). For the Tues, Sat week you work about 80 hours. And for the Wed week you work 56-60 hours.

There are some days where you leave at 4-430, but those are less common.

Mind you this includes things like handover, morning report/teaching, noon rounds, team teaching, running the list and of course rounding on your patients.

Typically on sub-specialty the hours are a bit better (but again depends on what sub-specialty and whether its purely a consult specialty or with inpatient responsibilities). Hours are 8/9am-5pm with call usually being more lenient about 3-5 call shifts in a 4 week block. 

This excludes ICU/CCU/Cardio. Which is usually 5-7 call shifts in a 4 week block. Hours are about the same as CTU.

 

Thank you for this detailed response.

I really can't imagine having an 80 hour work week for 3 years of residency...working almost everyday including weekends, having to do 24h call at least weekly, only getting 1 day of per week - I have to imagine that the quality of someone's personal/non-professional life diminishes when they only have a day per week for themselves, which is probably spent on catching up on sleep.

 

[midi]

It's dreadful. You have to be a special breed of masochist to even consider it in my opinion. You'll find out real quick if that's you on your IM rotation in MS3.

[brady23]

7 minutes ago, midi said:

It's dreadful. You have to be a special breed of masochist to even consider it in my opinion. You'll find out real quick if that's you on your IM rotation in MS3.

I don't think I'm bred for it - my personal life is too important to me, and I'd go crazy if IM became my life even for just 3 years on the sacrifice of personal relationships. I'm just amazed at how popular IM really is, despite this significant trade-off. IM does seem interesting but not at that expense if I'm equally happy in another more chill residency like FM or Psych.

But kudos to those who can go through it, tremendous respect for them.

[bearded frog]

I think very few people want to be general interests, everyone is shooting for their specialty of interest, so all the IM residents are hating their life trying to get that sub specialty match. As opposed to other specialties where you generally do what you sign up for off the bat, at least after off-service heavy years.

[ralk]

Depends a bit on the residency program too. Western's IM residents, at least in PGY-1, seemed to be on call around 1-in-5 rather than 1-in-4, as clerks took some of the call shifts and off-service IM residents occasionally came in to cover a shift.

I agree with bearded frog too, a lot of IM residents don't enjoy CTU any more than the rest of us did. They put up with it to get to a subspecialty.

CTU in clerkship is a good test. You don't have to love it to go into IM, but if you do love it - and there's more than a few who earnestly do - maybe consider becoming an internist?

[ACHQ]

19 hours ago, brady23 said:

 

Thank you for this detailed response.

I really can't imagine having an 80 hour work week for 3 years of residency...working almost everyday including weekends, having to do 24h call at least weekly, only getting 1 day of per week - I have to imagine that the quality of someone's personal/non-professional life diminishes when they only have a day per week for themselves, which is probably spent on catching up on sleep.

 

Well it also depends on your perspective. CTU (and ICU, CCU/Cardio) is definitely the busiest, but aside from those you usually have only 1 weekend call (sat or sun), and the rest of the weekends off (when you are on subspecialty). Even with CTU or ICU/CCU you have 2 weekends off. That being said a lot of us are reading around cases/studying to some degree given our IM exam is in PGY-3 now. But we still manage to keep my personal relationships and life going, more on some rotations than others. Its all about time management. Also those 80+ hour work weeks include the hours for call.

Its true many of us don't want to be GIM, but I still think a lot do and most would be happy with GIM if they didn't get their subspecialty of choice. Even though we may work more than other more "chill" specialties, we all genuinely like internal medicine so are OK with some short term trade offs. Also its only really the first 2 years that are brutal. PGY-3 is much less so (especially if you don't want to do ICU or cardio). Other residencies like FM and Psych have to put up with a lot of off service which lasts 1 year usually (and often working similar hours to IM residents).

I would say surgery residency is probably more brutal in terms of hours, and they don't take there post call days often, and that usually spans for the full 5 years.

IM has its draws in terms of problem solving, intellectual stimulation and a mix of in-patient, consultation, and outpatient services (which you don't see much in early residency and medical school, and those are the more life style friendly subspecialties)

[psychiatry2017]

I echo with ACHQ. Family Medicine residency is mostly off-service rotations, you spend majority of time in Gen surg, Internal Medicine, OBS & GYN, pediatrics. The hours off-service rotations are round the same hours as PGY-1 in CTU in Internal. 

Also as an off-service resident rotating in Gen surg & obsy-gyn & NICU, you end up doing scut work and a lot of paperwork (i.e: ward, discharge, etc) , you usually put into 80 hours or more per week. Also, you get the less ''exciting'' cases, as interesting patients go to specialty residents, even in CTU. 

The good thing is that residency is 2 years, and you become an independent staff after 2 years rotating off-service. The job market is great, so no need to be extremely competitive as in IM residency, where everyone has to constantly read around their cases and the most RCTs to impress their staff physician for a stellar LOR for 2nd round of carms.

[brady23]

That gives me a lot of respect for geriatricians who slave away doing a 3 year residency in IM, and then go on to do geriatrics - which seems like it could be taught as a separate specialty or one more related to Family medicine instead. 

[rmorelan]

4 hours ago, brady23 said:

That gives me a lot of respect for geriatricians who slave away doing a 3 year residency in IM, and then go on to do geriatrics - which seems like it could be taught as a separate specialty or one more related to Family medicine instead. 

I don't know - dealing with the million drug combinations those geriatricians deal sounds like a lot. Their patients have multiple interacting problems, and are often actively sick. I almost feel if anyone needs to be an internal med trained doc it would be them. 

[Mithril]

5 hours ago, psychiatry2017 said:

I echo with ACHQ. Family Medicine residency is mostly off-service rotations, you spend majority of time in Gen surg, Internal Medicine, OBS & GYN, pediatrics.

I don't know about other family residency programs, but my family program was not mostly off-service rotations.

My first year of residency:

4 weeks of FM.

4 weeks of general surgery.

4 weeks of FM.

4 weeks of psych

4 weeks of FM

4 weeks of obs with FPs.

2 weeks of peds.

4 weeks of peds-EM.

2 weeks of ortho.

4 weeks of EM with CCFP-EMs.

4 weeks of FM.

6 weeks of IM.

4 weeks of hospitalist.

2 weeks of radiology.

That's 28 weeks doing FM rotations vs. 22 weeks of doing off-service.

Then in second year residency:

3 weeks of sports med.

4 weeks of peds.

4 weeks of FM.

4 weeks of EM with CCFP-EMs.

16 weeks of rural FM.

4 weeks of EM with CCFP-EMs.

4 weeks of palliative.

3 weeks of FM.

4 weeks of EM with CCFP-EMs.

4 weeks of FM.

46 weeks of just FM rotations and 4 weeks of off-service.

 

[goleafsgochris]

13 hours ago, rmorelan said:

I don't know - dealing with the million drug combinations those geriatricians deal sounds like a lot. Their patients have multiple interacting problems, and are often actively sick. I almost feel if anyone needs to be an internal med trained doc it would be them. 

This is a whole other topic haha, but the problem with this is that most geriatricians don't really get referred acutely sick older people--they get referrals for "geriatric problems" which is usually what is the cause of their confusion, do they have dementia, etc.  They really don't end up using a TON of the IM skills.

That being said, its a really laid back career, and I always find that the IM residents that go into it are partly just sick of IM when they go through residency because the field is SO unlike GIM.  Like a lot of it is fairly close to psychiatry.  Not that its not interesting.

[duke101]

If you want to know more about internal med residency - check out the Youtube Channel ViolinMD ... she is a PGY1 internal at mcmaster. Just thought Id share since I find the videos useful to get a good understanding about what residency is like in internal and her energy is awesome so its fun to watch. 

[Birdy]

On 2018-01-13 at 3:34 PM, psychiatry2017 said:

 

I echo with ACHQ. Family Medicine residency is mostly off-service rotations, you spend majority of time in Gen surg, Internal Medicine, OBS & GYN, pediatrics. The hours off-service rotations are round the same hours as PGY-1 in CTU in Internal. 

 

 

I’d disagree with that. I have summary sheets from the FM programs I have interviewed at and they’re not primarily off-service. Many are integrated or partially integrated so you’re never fully off-service, and for the block ones many of the non-FM blocks are with FPs who have a special interest. Ottawa, for instance, integrates FM and OB for most of their streams. Even non-integrated programs usually have half day back + AHD so you spend at least one day a week in FM.

Also, many don’t have CTU at all. You do FM hospitalist. I was surprised to encounter some programs that don’t include a surgery block either. 

[frenchpress]

On 1/13/2018 at 5:48 PM, Mithril said:

I don't know about other family residency programs, but my family program was not mostly off-service rotations.

My first year of residency:

4 weeks of FM.

4 weeks of general surgery.

4 weeks of FM.

4 weeks of psych

4 weeks of FM

4 weeks of obs with FPs.

2 weeks of peds.

4 weeks of peds-EM.

2 weeks of ortho.

4 weeks of EM with CCFP-EMs.

4 weeks of FM.

6 weeks of IM.

4 weeks of hospitalist.

2 weeks of radiology.

That's 28 weeks doing FM rotations vs. 22 weeks of doing off-service.

Then in second year residency:

3 weeks of sports med.

4 weeks of peds.

4 weeks of FM.

4 weeks of EM with CCFP-EMs.

16 weeks of rural FM.

4 weeks of EM with CCFP-EMs.

4 weeks of palliative.

3 weeks of FM.

4 weeks of EM with CCFP-EMs.

4 weeks of FM.

46 weeks of just FM rotations and 4 weeks of off-service.

 

This is getting off topic and I’m sure you’ve answered this elsewhere, but where did you do your FM residency? 

[Mithril]

2 minutes ago, frenchpress said:

This is getting off topic and I’m sure you’ve answered this elsewhere, but where did you do your FM residency? 

UBC coastal program.

[hamham]

On 1/13/2018 at 1:34 PM, psychiatry2017 said:

I echo with ACHQ. Family Medicine residency is mostly off-service rotations, you spend majority of time in Gen surg, Internal Medicine, OBS & GYN, pediatrics. The hours off-service rotations are round the same hours as PGY-1 in CTU in Internal. 

Also as an off-service resident rotating in Gen surg & obsy-gyn & NICU, you end up doing scut work and a lot of paperwork (i.e: ward, discharge, etc) , you usually put into 80 hours or more per week. Also, you get the less ''exciting'' cases, as interesting patients go to specialty residents, even in CTU. 

The good thing is that residency is 2 years, and you become an independent staff after 2 years rotating off-service. The job market is great, so no need to be extremely competitive as in IM residency, where everyone has to constantly read around their cases and the most RCTs to impress their staff physician for a stellar LOR for 2nd round of carms.

Most FM residency programs that I know are also NOT mostly off-service. Do you go to Toronto? Their model is still pretty traditional, and they work you like a slave by making you do off-service calls. From my experience, most off-service calls are not very relevant to FM, unless you are thinking of OBS or hospitalist or care of the elderly. 

[hamham]

If you are considering IM, make sure you go all the way and become a sub-specialist. In my opinion, to go through all that training just to become a general internist is not worth it. You are better off applying to FM, and then do hospitalist if you still interested in caring for inpatients. FM residency is shorter in duration, guarantees you a job and gives you more flexibility in terms of WHERE and WHEN you want to work.  

[Medaholic93]

On 1/28/2018 at 4:53 PM, hamham said:

If you are considering IM, make sure you go all the way and become a sub-specialist. In my opinion, to go through all that training just to become a general internist is not worth it. You are better off applying to FM, and then do hospitalist if you still interested in caring for inpatients. FM residency is shorter in duration, guarantees you a job and gives you more flexibility in terms of WHERE and WHEN you want to work.  

[ACHQ]

On 1/28/2018 at 11:47 PM, Medaholic93 said:

 

This has been my dilemma. So far, I am strongly interested in one IM subspecialty in particular, and dislike GIM and the endless rounding that comes with that in general. That said, I am willing to trudge along three years of core IM to hopefully get my subspecialty. However, the thought of going unmatched in my preferred subspecialty and being streamed into GIM has crossed my mind, and I feel I would be miserable if that was to come. Any advice on whether this was a concern for you or any others, and how they approached this?

If you reallly want a subspecialty and are willing to go all in (research, electives etc...) and willing to go anywhere and apply broadly you will almost certainly get matched somewhere.

[A-Stark]

On 2018-01-13 at 4:14 PM, brady23 said:

That gives me a lot of respect for geriatricians who slave away doing a 3 year residency in IM, and then go on to do geriatrics - which seems like it could be taught as a separate specialty or one more related to Family medicine instead. 

Not really - geriatrics is fairly "generalist" insofar as IM subspecialties goes, despite a lot of focus on neurology and pharmacology.

On 2018-01-14 at 10:00 AM, goleafsgochris said:

This is a whole other topic haha, but the problem with this is that most geriatricians don't really get referred acutely sick older people--they get referrals for "geriatric problems" which is usually what is the cause of their confusion, do they have dementia, etc.  They really don't end up using a TON of the IM skills.

That being said, its a really laid back career, and I always find that the IM residents that go into it are partly just sick of IM when they go through residency because the field is SO unlike GIM.  Like a lot of it is fairly close to psychiatry.  Not that its not interesting.

It all depends on where they practice. Most geriatricians end up doing varying amounts of medicine coverage, even though they have no GIM outpatient coverage. 

And quite frankly endless CTU rotations are not at all reflective of GIM practice. I'd go as far to say that most academic general internists aren't all that representative either. In community GTA hospitals, for example, staff cover call themselves (and bill accordingly). At TEGH, for example, they admit to just about any service over night. On my locums so far - albeit in smaller centres - I've spent most of my time admitting ACS patient or dealing with the ICU, doing my own lines and intubations (except for when we took one guy to the OR with the surgeon in the room!). Not that most geriatricians would enjoy that much "hands-on" stuff, but GIM is variable enough that there's really no shortage of interesting work that scarcely resembles slogging away on an academic CTU as a PGY1. 

[psychiatry2017]

On 1/28/2018 at 6:45 PM, hamham said:

Most FM residency programs that I know are also NOT mostly off-service. Do you go to Toronto? Their model is still pretty traditional, and they work you like a slave by making you do off-service calls. From my experience, most off-service calls are not very relevant to FM, unless you are thinking of OBS or hospitalist or care of the elderly. 

Hey Hamham, yeah doing FM residency at UofT. I think when we rotate off-service, the seniors tend to give us consults most relevant to FM learners.

I do have to say when you do FM residency at academic hospital, they tend to treat you as a glorified CC4 , perhaps community & rural hospital experience is much different. 

[Edict]

On 1/28/2018 at 6:53 PM, hamham said:

If you are considering IM, make sure you go all the way and become a sub-specialist. In my opinion, to go through all that training just to become a general internist is not worth it. You are better off applying to FM, and then do hospitalist if you still interested in caring for inpatients. FM residency is shorter in duration, guarantees you a job and gives you more flexibility in terms of WHERE and WHEN you want to work.  

While true, I do think GIM offers opportunities hospitalists do not get. GIM staff generally are the ones responsible for the academic part of IM, including running CTUs, teaching students, doing GIM research and many will participate in medical school education. In addition, GIM has the lock on interesting cases while in academic hospitalst hospitalists are mainly there to take care of ALC patients, of course you could work in community hospitals and see all kinds of patients. 

Imo, if you are interested more in community, do FM and hospitalist, you save 3 years. If you are more interested in academics/interesting cases/research, then you should do GIM and do the 5 years. 

 

[hamham]

1 hour ago, Edict said:

While true, I do think GIM offers opportunities hospitalists do not get. GIM staff generally are the ones responsible for the academic part of IM, including running CTUs, teaching students, doing GIM research and many will participate in medical school education. In addition, GIM has the lock on interesting cases while in academic hospitalst hospitalists are mainly there to take care of ALC patients, of course you could work in community hospitals and see all kinds of patients. 

Imo, if you are interested more in community, do FM and hospitalist, you save 3 years. If you are more interested in academics/interesting cases/research, then you should do GIM and do the 5 years. 

 

Every word you said is entirely true.

But in my opinion (and I want to emphasize it's ENTIRELY MY OPINION), the extra work you have to put in (I'm referring to the endless extra hours you have to put in for CTU calls as a junior and a senior) in order to HOPEFULLY get a chance to be involved in academics/teaching/research/interesting cases is not worth it.

"HOPEFULLY" b/c academic jobs are now limited and there is no guarantee that you would be able to get an academic job after you finish your GIM fellowship. The extra hours, coupled with the huge job insecurity (I am quite inflexible and can't see myself living outside of major urban centres like Toronto, Vancouver, Calgary, Montreal), are the factors that turned me off from IM, despite the fact that I love medicine.