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brady23

Why or why not internal medicine?

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Just curious what other people's reasons were for doing or not doing IM!

Things I like
- cerebralness of internal medicine: you really have to think critically 
- team-based: frequently going over cases with your colleagues 
- procedural & hands-on: you can do many procedures like lines, intubating patients, ultrasounds 

Things I don't like

- lifestyle: being on call/paged frequently can interfere with your personal life
- freedom/flexibility: if you want to go on vacation, it'll depend on the hospital's schedule  
- long histories: you probably end up seeing 10-12 patients per day for 0.5 - 1 hours which is draining 
- acuity: you're mainly going to be seeing sick patients
- high stress - I imagine it's stressful seeing crashing patients all the time, especially when you're the only one covering the floor at night!
- salary: for outpatient subspecialties with a good lifestyle (geriatrics, allergy, rheum, endocrine), you slave away doing 3 years of GIM and end up making a similar amount to FP, with less job prospects potentially

Also, curious if anyone would consider GIM or hospital-based internal specialties a lifestyle specialty (I know outpatient ones are more lifestyle like allergy, endo, geriatrics, rheum)?  Based on what I wrote above, I don't, but I'd love another perspective!

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Internal medicine is know for being very cerebral, but honestly most specialties require cerebralness in their own domain. Don't get me wrong, I'm always in awe by the knowledge of IM physicians. Their differentials are more elaborate than other specialties and their knowledge is probably the most well rounded and in depth of all the specialties. However, ask an internal medicine physician anything about peds or obstetrics/gynecology and they won't know much (which of course is perfectly normal given the scope of IM). I just point this out because IM physicians often shit on family meds for being incompetent when the nature of family medicine makes it that you can't be an expert in everything. FMs are trained in 2 years to know the basics of psych, obstetrics/gyn, pediatrics, IM and prevention. Whereas IM trains 4-5 years only in IM..

The things I dislike about internal medicine:

- patient population = mostly older adults, multiple chronic disease comorbidities (often towards the end of evolution). Often it feels like you're just putting a band-aid on the acute problem and you know the patient will end up back in the hospital sooner rather than later.

- never seeing pediatrics or obstetrics again

- tediousness of inpatient medicine e.g. infinite note writing, little change day-to-day 

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What you wrote sounds more like the clerkship/resident experience of IM... which I liked, but I found that I could focus more on the enjoyable aspects of thinking/problem solving, discussing cases with colleagues, and doing occasional procedures in other fields without having to deal with as much documentation/paperwork and other challenges such as family dynamics in inpatient medicine.

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11 minutes ago, Lactic Folly said:

What you wrote sounds more like the clerkship/resident experience of IM... which I liked, but I found that I could focus more on the enjoyable aspects of thinking/problem solving, discussing cases with colleagues, and doing occasional procedures in other fields without having to deal with as much documentation/paperwork and other challenges such as family dynamics in inpatient medicine.

Interesting. In what ways do you think IM post-residency is different? I would think you'd still have to deal with call, being the solo doctor on night shifts and seeing crashing/high acuity patients regularly?

Unless you choose a lifestyle IM subspecialty

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1 hour ago, brady23 said:

Just curious what other people's reasons were for doing or not doing IM!

Things I like
- cerebralness of internal medicine: you really have to think critically 
- team-based: frequently going over cases with your colleagues 
- procedural & hands-on: you can do many procedures like lines, intubating patients, ultrasounds 

Things I don't like

- lifestyle: being on call/paged frequently can interfere with your personal life
- freedom/flexibility: if you want to go on vacation, it'll depend on the hospital's schedule  
- long histories: you probably end up seeing 10-12 patients per day for 0.5 - 1 hours which is draining 
- acuity: you're mainly going to be seeing sick patients
- high stress - I imagine it's stressful seeing crashing patients all the time, especially when you're the only one covering the floor at night!
- subspecialties are competitive (other than geriatrics perhaps but slaving away for 3 years doing GIM isn't worth it in my opinion)

Also, curious if anyone would consider GIM or hospital-based internal specialties a lifestyle specialty (I know outpatient ones are more lifestyle like allergy, endo, geriatrics, rheum)?  Based on what I wrote above, I don't, but I'd love another perspective!

Just a few points

-You describe really an internal residency, or a GIM physician.  Most Internal residents subspecialize (or attempt to).  Things like team-based nature, cerebralness, lifestyle, etc don't necessarily apply to all those fields

-I wouldn't consider Internal to be "procedure heavy" per-se.  I 100% would not choose internal because I liked procedures.

-again, most of internal is NOT team-based.  Academic clinical teaching units are team based.  Otherwise, not so much.  

-No one would consider GIM or hospital based IM subspecialties lifestyle specialties.  Do ONE ctu call shift and you will see why.  Geriatrics and rheum are lifestyle, but those are barely hospital based if at all.

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Internal is a big tent specialty. You can find a niche in something in internal. The one thing I find that makes someone good for "internal", is they typically really love learning and love medicine, they enjoy being MRP and interacting with patients and they don't love pediatrics. Otherwise you can end up doing inpatient or outpatient or a mix, big city or small city, procedure heavy or no procedures at all, no life or lifestyle, part time or full time, teaching or research or community etc. 

 

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There's definitely an internal medicine-type personality out there that seems to thrive in the specialty. Very detail oriented, doesn't mind that it might take 25 minutes to present a patient properly because they are so complex and have that many problems... your attending might also interrupt you after 18 minutes to correct you on a small detail and ask for clarification on a  point you made 6 minutes ago... "so what did their echocardiogram in 2012 show again?"

You must also enjoy looking things up in Uptodate at 9:30 am after you've been on duty for 25.5 hours, because your attending decides that this is an excellent time for a teaching session on glomerulonephritis, and while you're at it, why don't you demonstrate a textbook quality neurological exam for the team? Oh and internists are some of the most well dressed people in the hospital... even when on call.

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IM really appeals to me, with the only drawback being the long hours and being on call so frequently. I don't mind putting in 80h/week for a few years during training (or so I think), but I doubt I'd be able to keep up this lifestyle for an entire career. Once you make it past residency, how much flexibility is there (I don't mind making less money if that means I get a better lifestyle) if I want to keep doing hospital-based, GIM-style work? Alternatively, is it possible to sub-specialize in an outpatient-centric field like endo, while still doing some GIM inpatient work from time to time?

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15 minutes ago, shematoma said:

There's definitely an internal medicine-type personality out there that seems to thrive in the specialty. Very detail oriented, doesn't mind that it might take 25 minutes to present a patient properly because they are so complex and have that many problems... your attending might also interrupt you after 18 minutes to correct you on a small detail and ask for clarification on a  point you made 6 minutes ago... "so what did their echocardiogram in 2012 show again?"

 You must also enjoy looking things up in Uptodate at 9:30 am after you've been on duty for 25.5 hours, because your attending decides that this is an excellent time for a teaching session on glomerulonephritis, and while you're at it, why don't you demonstrate a textbook quality neurological exam for the team? Oh and internists are some of the most well dressed people in the hospital... even when on call.

Haha this is such a good anecdote. I definitely agree - there's a specific personality for IM! I really wish I did like IM better haha 

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2 minutes ago, MedP111 said:

IM really appeals to me, with the only drawback being the long hours and being on call so frequently. I don't mind putting in 80h/week for a few years during training (or so I think), but I doubt I'd be able to keep up this lifestyle for an entire career. Once you make it past residency, how much flexibility is there (I don't mind making less money if that means I get a better lifestyle) if I want to keep doing hospital-based, GIM-style work? Alternatively, is it possible to sub-specialize in an outpatient-centric field like endo, while still doing some GIM inpatient work from time to time?

Yes definitely, most IM docs have a good lifestyle afterwards. There are lots of lifestyle specialties and even GIM can be made to be more lifestyle if you want it to be. Even something like Cardio or GI could become lifestyle if you did not do CCU, Scope or Interventional. Technically, all you need to do is be a cardio staff part time for the first few years, build up a patient base and then you could move to outpatient full time. You could also do echo for income. 

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14 hours ago, brady23 said:

Just curious what other people's reasons were for doing or not doing IM!

Things I like
- cerebralness of internal medicine: you really have to think critically 
- team-based: frequently going over cases with your colleagues 
- procedural & hands-on: you can do many procedures like lines, intubating patients, ultrasounds 

Things I don't like

- lifestyle: being on call/paged frequently can interfere with your personal life
- freedom/flexibility: if you want to go on vacation, it'll depend on the hospital's schedule  
- long histories: you probably end up seeing 10-12 patients per day for 0.5 - 1 hours which is draining 
- acuity: you're mainly going to be seeing sick patients
- high stress - I imagine it's stressful seeing crashing patients all the time, especially when you're the only one covering the floor at night!
- salary: for outpatient subspecialties with a good lifestyle (geriatrics, allergy, rheum, endocrine), you slave away doing 3 years of GIM and end up making a similar amount to FP, with less job prospects potentially

Also, curious if anyone would consider GIM or hospital-based internal specialties a lifestyle specialty (I know outpatient ones are more lifestyle like allergy, endo, geriatrics, rheum)?  Based on what I wrote above, I don't, but I'd love another perspective!

You should think about anesthesia. It has all the things you listed in your "Things I like" category and does not have most of the things in your "Things I dont like" category.

Obviously with the caveat that almost any specialty can/will be high stress at times and that most hospital based specialties will provide limited flexibility and freedom for booking vacation.  This will depend entirely on how big the the hospital is where you end up and how many staff are available to cover for you.

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23 hours ago, brady23 said:

Just curious what other people's reasons were for doing or not doing IM!

Things I like
- cerebralness of internal medicine: you really have to think critically 
- team-based: frequently going over cases with your colleagues 
- procedural & hands-on: you can do many procedures like lines, intubating patients, ultrasounds 

Things I don't like

- lifestyle: being on call/paged frequently can interfere with your personal life
- freedom/flexibility: if you want to go on vacation, it'll depend on the hospital's schedule  
- long histories: you probably end up seeing 10-12 patients per day for 0.5 - 1 hours which is draining 
- acuity: you're mainly going to be seeing sick patients
- high stress - I imagine it's stressful seeing crashing patients all the time, especially when you're the only one covering the floor at night!
- salary: for outpatient subspecialties with a good lifestyle (geriatrics, allergy, rheum, endocrine), you slave away doing 3 years of GIM and end up making a similar amount to FP, with less job prospects potentially

Also, curious if anyone would consider GIM or hospital-based internal specialties a lifestyle specialty (I know outpatient ones are more lifestyle like allergy, endo, geriatrics, rheum)?  Based on what I wrote above, I don't, but I'd love another perspective!

I won't consider GIM hospital-based as lifestyle specialty, unless you work in academic hospitals, where your residents cover consults for you overnight+ deal with ward patients overnight during the week, but you still need to come in during the weekends to assess the new patients+ help out your residents with morning rounds.

When you work in community hospital as GIM-hospital based as MRP,  life is very busy, and depends on the size of your GIM group, you might do calls as often as 1 in 4 or less. Having one acutely sick pre-icu patient in the ward really takes a big chunk of your day, with 15-20 patients to round...

If you love acute, sick, adult medicine, you should definitely consider GIM!

For outpatient lifestyle internal sub-specialties, you are right that endocrinologists & rheumatologists make roughly the same as GPs...However, they bill much higher for consults  & follow-up, if you are being very efficient, you could definitely make more than GPs...Most of them don't, because people who pick endo & rheum & geriatrics usually prefer a lighter work schedule and end up not working as much as a GIM. 

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32 minutes ago, LittleDaisy said:

I won't consider GIM hospital-based as lifestyle specialty, unless you work in academic hospitals, where your residents cover consults for you overnight+ deal with ward patients overnight during the week, but you still need to come in during the weekends to assess the new patients+ help out your residents with morning rounds.

When you work in community hospital as GIM-hospital based as MRP,  life is very busy, and depends on the size of your GIM group, you might do calls as often as 1 in 4 or less. Having one acutely sick pre-icu patient in the ward really takes a big chunk of your day, with 15-20 patients to round...

If you love acute, sick, adult medicine, you should definitely consider GIM!

For outpatient lifestyle internal sub-specialties, you are right that endocrinologists & rheumatologists make roughly the same as GPs...However, they bill much higher for consults  & follow-up, if you are being very efficient, you could definitely make more than GPs...Most of them don't, because people who pick endo & rheum & geriatrics usually prefer a lighter work schedule and end up not working as much as a GIM. 

How competitive are GIM jobs in academic hospitals (specifically in Quebec if you know)? I know some of the competitive subspecialties in IM often require PhD's now, is it the same for GIM?

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9 minutes ago, MedP111 said:

How competitive are GIM jobs in academic hospitals (specifically in Quebec if you know)? I know some of the competitive subspecialties in IM often require PhD's now, is it the same for GIM?

I think fairly competitive no matter where, Quebec or BC or Ontario! Only a few openings per year or sometimes less, if you are committed for academic GIM staff position, the best is to talk to all the important people who can vouch for you. Start to do a masters in research vs medical education, and build a strong C.V on medical education & Q.I or heavily on research. 

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So unless you do outpatient IM specialties like geriatrics, rheum, endo, and allergy, you can expect call or weekend work if you work as a GIM in a community/academic hospital, or as an IM hospital-based subspecialty?

Call is a big factor in my opinion in choosing a career so just curious.

 

 

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15 minutes ago, brady23 said:

So unless you do outpatient IM specialties like geriatrics, rheum, endo, and allergy, you can expect call or weekend work if you work as a GIM in a community/academic hospital, or as an IM hospital-based subspecialty?

Call is a big factor in my opinion in choosing a career so just curious.

 

 

Yes.....unless you pick IM hospital-based subspecialty where you only do outpatient clinical work (having an office in the hospital like endo, allergy, rheumatology), and choose not to be involved in consult services. I am sure that as you gain more seniority, you could opt to do less calls or focus primarily on outpatient work (but would be difficult at beginning of career)

If you pick GIM hospitalist in the community for example, you need to come in during the weekend to round on your ward patients, doing consults overnight+ weekends; and will get paged by nurses overnight for ward patients issues and come work in the next morning . You could also opt to do GIM outpatient work exclusively: i.e: outpatient referrals by GP, or pre-op referrals,  but would be difficult at beginning of career IMO. 

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1 hour ago, MedP111 said:

How competitive are GIM jobs in academic hospitals (specifically in Quebec if you know)? I know some of the competitive subspecialties in IM often require PhD's now, is it the same for GIM?

Who told you that? Even ortho, by far the worst specialty in terms of jobs, doesn't require a PhD for academic jobs. I had a bunch of preceptors who have been attendings for under 5 years in various specialties (nephro/neurology/cardiology/pneumology/etc) and none of them even had a master's degree. The norm seems to be a 2-year fellowship (and 2-year + master's for ortho/ridiculously saturated specialties).

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23 minutes ago, Snowmen said:

Who told you that? Even ortho, by far the worst specialty in terms of jobs, doesn't require a PhD for academic jobs. I had a bunch of preceptors who have been attendings for under 5 years in various specialties (nephro/neurology/cardiology/pneumology/etc) and none of them even had a master's degree. The norm seems to be a 2-year fellowship (and 2-year + master's for ortho/ridiculously saturated specialties).

I read about this in some of the threads on this forum while browsing a while back. From memory, I recall nephrology specifically being mentioned. Something about how so many candidates get PhD's nowadays that not having one will make it hard for you to get an academic position. Hopefully I'm wrong though, it's reassuring to hear your experience shows otherwise.

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53 minutes ago, LittleDaisy said:

Yes.....unless you pick IM hospital-based subspecialty where you only do outpatient clinical work (having an office in the hospital like endo, allergy, rheumatology), and choose not to be involved in consult services. I am sure that as you gain more seniority, you could opt to do less calls or focus primarily on outpatient work (but would be difficult at beginning of career)

 If you pick GIM hospitalist in the community for example, you need to come in during the weekend to round on your ward patients, doing consults overnight+ weekends; and will get paged by nurses overnight for ward patients issues and come work in the next morning . You could also opt to do GIM outpatient work exclusively: i.e: outpatient referrals by GP, or pre-op referrals,  but would be difficult at beginning of career IMO. 

Thank you. Was just curious - would these outpatient hospital-based specialties also pay overhead?

On one hand, I think yes - but on the other hand, it's from a hospital - so they could just be salary based?

Don't really want to do overnights or be on call or weekends too frequently, so this was helpful.

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51 minutes ago, MedP111 said:

I read about this in some of the threads on this forum while browsing a while back. From memory, I recall nephrology specifically being mentioned. Something about how so many candidates get PhD's nowadays that not having one will make it hard for you to get an academic position. Hopefully I'm wrong though, it's reassuring to hear your experience shows otherwise.

Well my nephrology tutor had been an attending for about 2 years and had only done a 2-year fellowship. No PhD, not even an MSc.

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1 hour ago, brady23 said:

Thank you. Was just curious - would these outpatient hospital-based specialties also pay overhead?

On one hand, I think yes - but on the other hand, it's from a hospital - so they could just be salary based?

Don't really want to do overnights or be on call or weekends too frequently, so this was helpful.

I am not sure....but unless you want to do endocrinology, rheumatology, allergy or geriatrics with no inpatient consultation services or inpatient bed, you will have to do calls in internal medicine as a young staff physician. 

If you prefer a lifestyle with absolutely no calls or minimal calls, I would suggest pick a specialty with mostly outpatient services: psychiatry, family medicine, etc. 

Not many specialties in medicine have good lifestyle unfortunately. But the important thing is to pick what you love, otherwise, you will still be miserable in a good lifestyle specialty in which you hate, and have to drag yourself out of bed to go to work at 8 am :) 

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On 4/22/2018 at 5:57 PM, brady23 said:

Just curious what other people's reasons were for doing or not doing IM!

Things I like
- cerebralness of internal medicine: you really have to think critically 
- team-based: frequently going over cases with your colleagues 
- procedural & hands-on: you can do many procedures like lines, intubating patients, ultrasounds 

Things I don't like

- lifestyle: being on call/paged frequently can interfere with your personal life
- freedom/flexibility: if you want to go on vacation, it'll depend on the hospital's schedule  
- long histories: you probably end up seeing 10-12 patients per day for 0.5 - 1 hours which is draining 
- acuity: you're mainly going to be seeing sick patients
- high stress - I imagine it's stressful seeing crashing patients all the time, especially when you're the only one covering the floor at night!
- salary: for outpatient subspecialties with a good lifestyle (geriatrics, allergy, rheum, endocrine), you slave away doing 3 years of GIM and end up making a similar amount to FP, with less job prospects potentially

Also, curious if anyone would consider GIM or hospital-based internal specialties a lifestyle specialty (I know outpatient ones are more lifestyle like allergy, endo, geriatrics, rheum)?  Based on what I wrote above, I don't, but I'd love another perspective!

I think you're inferring a lot from your experience as a learner. Staff don't take an hour to see a patient. I certainly don't. It's about taking a "complete" history. The time requirement really hits with documentation (though dictations are 5-10 min each) and, especially, admission paperwork. "Lifestyle" specialties may not make much more than busy GPs, but they'll have better work/life balance and won't need to see nearly the same volume as them. The amount of GIM coverage required will vary by hospital and practice setup. 

20 hours ago, shematoma said:

There's definitely an internal medicine-type personality out there that seems to thrive in the specialty. Very detail oriented, doesn't mind that it might take 25 minutes to present a patient properly because they are so complex and have that many problems... your attending might also interrupt you after 18 minutes to correct you on a small detail and ask for clarification on a  point you made 6 minutes ago... "so what did their echocardiogram in 2012 show again?"

You must also enjoy looking things up in Uptodate at 9:30 am after you've been on duty for 25.5 hours, because your attending decides that this is an excellent time for a teaching session on glomerulonephritis, and while you're at it, why don't you demonstrate a textbook quality neurological exam for the team? Oh and internists are some of the most well dressed people in the hospital... even when on call.

Learners often don't get what the most pertinent details are. I tend to be thinking ahead of whatever they're saying, particularly since when reviewing I've usually already gotten a sense of the issues and diagnosis well before then. I wish I could say I was well dressed...

19 hours ago, MedP111 said:

IM really appeals to me, with the only drawback being the long hours and being on call so frequently. I don't mind putting in 80h/week for a few years during training (or so I think), but I doubt I'd be able to keep up this lifestyle for an entire career. Once you make it past residency, how much flexibility is there (I don't mind making less money if that means I get a better lifestyle) if I want to keep doing hospital-based, GIM-style work? Alternatively, is it possible to sub-specialize in an outpatient-centric field like endo, while still doing some GIM inpatient work from time to time?

Staff don't work 80h/week outside of interventional cardiologists when they're on call. Most centres will either require you or be very happy to accept involvement in a GIM call schedule. Remember the amount of call you do will depend on the size of your group, so once you get to 7-10+ you might only have one call per week (or less) and a weekend every other month. I'll have more (soon enough!!) because ICU coverage but so it goes. 

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Hey does anybody have advice on what I should do? I want to do a major in life science at McMaster as like premed but I’m not sure if I can do it. My sister didn’t make it into med school and my whole family isn’t supporting me in wanting to go. If I see that I can’t get at least a 3.6 gpa in life science first and second year and that my mcat score will be too low should I just go into an accelerated nursing program and later on become a np? Cause I want to have a backup plan if I can’t make it into med school or pa school and I know I won’t be able to do anything with a degree in life science. I would do a four year nursing degree but nursing is super hard and I def wouldn’t get a high enough gpa to get into med school. I really know that I want to go to med school so bad and being a nurse wouldn’t cut it for me. What major should I do that in ur opinion would be easier to get a high gpa in ? Kin life science or nutrition even I don’t know 

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