Life in IM

[chickenpoutine]

Hi everyone,

I'm a medical student currently completing electives for the summer. I've been debating which field I should go for and have been really enjoying my CTU elective (intellectual stimulation, team-based effort, responsibility of patients in-ward). However, the residents' attitude (seemingly burned out, always tired) as well as some of the staff makes me hesitant. I've also been hearing anecdotally that subspecialty matches are becoming increasingly more difficult and even as a graduate the norm is to do several locums if you don't want to live rurally. I know that residency is temporary and shouldn't play a major role in my decision but lifestyle doesn't seem to get much better as an attending. 

Can anyone share any insight on this? 

Thanks!

[LittleDaisy]

6 hours ago, chickenpoutine said:

Hi everyone,

I'm a medical student currently completing electives for the summer. I've been debating which field I should go for and have been really enjoying my CTU elective (intellectual stimulation, team-based effort, responsibility of patients in-ward). However, the residents' attitude (seemingly burned out, always tired) as well as some of the staff makes me hesitant. I've also been hearing anecdotally that subspecialty matches are becoming increasingly more difficult and even as a graduate the norm is to do several locums if you don't want to live rurally. I know that residency is temporary and shouldn't play a major role in my decision but lifestyle doesn't seem to get much better as an attending. 

Can anyone share any insight on this? 

Thanks!

Do you want to do GIM? or subspecialties? There are some GIM Subspecialties that are life friendly. 

They work you hard in IM residency, I am not surprised to see that the residents you work with are burned out. For staff attending, depends on how comfortable you are letting your residents running the show. If you are the type of attending who likes to see every patient on your own, double checks everything your senior resident, junior resident and medical student does, and double check all the documentations (admission, d-c summaries); or asking the senior resident to page you for major decisions overnight, you will end up working a lot and seem burned out as you never have much time to rest. I have seen a few more senior GIM staff attending, who feel very comfortable letting the senior resident running the show, and come in at 8 am, and leave right around 4-5 pm after handover (provided that exists only in academic setting). 

I believe that the job markets in geriatrics, endocrinology and rheumatology are great, as you can easily set up outpatient office (however, high overhead and you will need to have friends in FM who can vouch for you and recommend you to their colleagues). Those specialties have become slightly more competitive though in the past few years. 

The hospital jobs are harder to come by, I believe that some people like to stay in academics (despite the lower pay, and being clinical associates for the first few years, commitment to research /education). However, even though the overhead working in hospital is almost none or lower, you don't pick your receptionist or your nurses, and there is not much you can do about a grumpier receptionist or a nurse not enthusiastic to work for you. 

TLDR, the life of a staff attending really depends on which subspecialty you pick. I think that you should still do IM if that's your passion. Residency is tough and they work you hard everywhere, life of staff attending will be tough for the first few years as you are the one making all the important decisions fresh out of residency. 

[futureGP]

IM residency will vary from schools in terms of work life balance. There are relatively chill, well funded programs out there. But expect CTU blocks to be busy. But if you are busy doing what you like, is it really?

Back to the life afterwards. Remember that unless you are doing FM, Psych, you will guaranteed have a hard time finding a job around major cities. So unless you are planning on FM or psych, get rdy to locum after whatever specialty you do. 

For subspecialty matches, I would look at MFM stats on CaRMS and see the numbers for yourself. The match rate is not crazy. It’s a whole lot better than carms round 1. Most people get their specialty of interest from their top 3 locations.

Also you should know that an academic CTU is not reflective of how most internists work. There is no big team of residents/med students if you work at a community hospital and are rounding on your 20 inpatients (honestly for the better because as staff, residents/students seriously slow you down). Intellectual stimulation is a plus but as staff you don’t want that all the time either (those fall/hip# admissions start to look very appealing). Inpatient responsibility can get stressful as staff without a resident taking first call.

if you truly want to see if IM is for you, I recommend getting more experience in the community, and outpatient subspecialty clinics. CTU is, again, not a good reflection of your life as IM specialist/subspecialist

[brady23]

100% agree, internal seems very interesting, but looking at the residents - most of them admit that residency is the worst years of your life.

I'm sure it's worth it in the end, but don't know if 5 years of working hard and 80 hour weeks is worth it?

[daleader]

16 hours ago, brady23 said:

100% agree, internal seems very interesting, but looking at the residents - most of them admit that residency is the worst years of your life.

I'm sure it's worth it in the end, but don't know if 5 years of working hard and 80 hour weeks is worth it?

 

On 8/16/2019 at 2:17 AM, futureGP said:

IM residency will vary from schools in terms of work life balance. There are relatively chill, well funded programs out there. But expect CTU blocks to be busy. But if you are busy doing what you like, is it really?

Back to the life afterwards. Remember that unless you are doing FM, Psych, you will guaranteed have a hard time finding a job around major cities. So unless you are planning on FM or psych, get rdy to locum after whatever specialty you do. 

For subspecialty matches, I would look at MFM stats on CaRMS and see the numbers for yourself. The match rate is not crazy. It’s a whole lot better than carms round 1. Most people get their specialty of interest from their top 3 locations.

Also you should know that an academic CTU is not reflective of how most internists work. There is no big team of residents/med students if you work at a community hospital and are rounding on your 20 inpatients (honestly for the better because as staff, residents/students seriously slow you down). Intellectual stimulation is a plus but as staff you don’t want that all the time either (those fall/hip# admissions start to look very appealing). Inpatient responsibility can get stressful as staff without a resident taking first call.

if you truly want to see if IM is for you, I recommend getting more experience in the community, and outpatient subspecialty clinics. CTU is, again, not a good reflection of your life as IM specialist/subspecialist

 

I do agree that only a fraction of IM residents seem content with their life during residency and thats because they truly loved what they were doing and they were happy doing those 80-100 hours weeks. Those who chose IM for the wrong reasons either switch out or live a miserable life during the residency hoping it does get better at the end. From my experience, 8 out of 10 IM residents I encountered were miserable and burnt out.

 

Question for everyone; how does life in IM residency compare to Peds? Both similar in terms of length, CTU, ICU/NICU, and 1 in 4 call schedule. 

[hero147]

1 hour ago, daleader said:

 

 

I do agree that only a fraction of IM residents seem content with their life during residency and thats because they truly loved what they were doing and they were happy doing those 80-100 hours weeks. Those who chose IM for the wrong reasons either switch out or live a miserable life during the residency hoping it does get better at the end. From my experience, 8 out of 10 IM residents I encountered were miserable and burnt out.

 

Question for everyone; how does life in IM residency compare to Peds? Both similar in terms of length, CTU, ICU/NICU, and 1 in 4 call schedule. 

Much better I would assume. I'm in neither, but Peds CTU call was so much less busy than adult CTU as a clerk. Kids were relatively quiet throughout the night on the floor with few admissions from emerg while it seemed like adult CTU was non-stop.

[Maruo]

On 8/14/2019 at 10:01 AM, chickenpoutine said:

Hi everyone,

I'm a medical student currently completing electives for the summer. I've been debating which field I should go for and have been really enjoying my CTU elective (intellectual stimulation, team-based effort, responsibility of patients in-ward). However, the residents' attitude (seemingly burned out, always tired) as well as some of the staff makes me hesitant. I've also been hearing anecdotally that subspecialty matches are becoming increasingly more difficult and even as a graduate the norm is to do several locums if you don't want to live rurally. I know that residency is temporary and shouldn't play a major role in my decision but lifestyle doesn't seem to get much better as an attending. 

Can anyone share any insight on this? 

Thanks!

I would ask your residents and staff how they feel about the fatigue. Notably, CTU is 3-5 blocks of the year for residents, so it's not what they're doing ALL the time. I personally really enjoy CTU for the reasons you've listed- it's just very tiring because of the demands on your time. Just because your colleagues seem tired does not necessarily mean they regret doing IM!

[LittleDaisy]

21 hours ago, Maruo said:

I would ask your residents and staff how they feel about the fatigue. Notably, CTU is 3-5 blocks of the year for residents, so it's not what they're doing ALL the time. I personally really enjoy CTU for the reasons you've listed- it's just very tiring because of the demands on your time. Just because your colleagues seem tired does not necessarily mean they regret doing IM!

I think that some IM programs (at UofT) for example, they require to you do CTU calls while off service on sub-specialties to cover for CTU residents who are on leave, vacation; etc. Some programs don't ask for you to cover CTU calls while off-service for example. 

The GIM staff in community hospital seems to be burnt out --> mostly the young ones as they cover more overnight calls. At some point, they just want a quieter night without being paged for new consults. The intellectual stimulation to take care of sick challenging cases are very appealing, but when you are the only staff covering for 20 inpatients and covering ER consults, you really want a quiet night with easy hip # as someone had mentioned above. 

Academic GIM jobs are hard to get by and are very competitive, they make you work hard for it.