Which IM subspecialty has the least amount of procedures?

[tb_or_not_tb]

Especially if they are predominantly inpatient and cerebral.

Few specialties come to mind: med onc, endo (both have too much outpatient focus though), hematology (only bone marrow biopsies, but they are pretty minor), ID, nephro.

Any other suggestions?

[bearded frog]

The Venn diagram of "primarily inpatient" and "no procedures" is pretty small, depending on where you practice etc. some GIM docs will pretty much only consult when they need a procedure or medication they can't do themselves. Lets go one by one:

• Cardio - You aren't doing caths unless you want to. You might do some echos on your own but I don't know if you qualify that as a "procedure".
• ICU - lol
• Endo - No procedures that I can think of
• Gastro - scopes so yes
• Geriatrics - I don't think so
• Heme/onc - Biopsies and LPs
• ID - No procedures
• Nephrology - Biopsies
• Resp - Bronchs
• Rheum - Joint taps/injection
• Allergy/immunology - Not much

I think the most inpatient specialty without procedures is probably ID

[ameltingbanana]

Would agree with the above. Procedures to add:

• Cardio - you'll be expected to do central lines (Cordis) to float temporary pacers through. Pericardiocentesis comes to mind too - some GIM and most ICU docs can do this but outside of a code blue scenario it's almost always cardiology. I would also consider urgent overnight TTEs/TEEs a "procedure"
• Nephrology - temporary dialysis lines in addition to kidney biopsies (though IR does a lot of kidney biopsies depending on where you train). In some centers, Nephro functions as an MRP service and you are sort of expected to have GIM competencies for your inpatients as well (i.e. comfort with thoras, paras, etc.)
• Resp - would add thoracentesis and chest tube insertion (usually pigtails)

Agree with beardedfrog that if you want inpatient + no procedures, you are looking at ID vs geriatrics (geri at a lot of centers is starting to have a lot of inpatient presence given how elderly and frail our inpatient population is getting). Probably more so ID to be honest.

[gangliocytoma]

Neurology isn't a an IM subspecialty (although it used to be). Can imagine that is fairly low on the procedure side of things. You may need to do LPs occasionally. Also it is literally cerebral

[shikimate]

you guys forgot palliative care, this match OP's description perfectly

also occupation med, no inpatient but zero procedure, unless you count paper shuffling.

also med biochem, no inpatient but zero procedures.

 

[blah1234]

43 minutes ago, shikimate said:

you guys forgot palliative care, this match OP's description perfectly

also occupation med, no inpatient but zero procedure, unless you count paper shuffling.

also med biochem, no inpatient but zero procedures.

 

I would say ward based palliative care could be a good fit but there are a lot of social issues, family meetings, discharge planning that may not be for everyone. It's also in my opinion not the most cerebral medicine/science problem solving field based on my previous rotation experience.

Occupation med could also be a good fit but there's a lot of paperwork that may also not be for everyone.

Personally I didn't expect to enjoy palliative care during my rotation but I ended up liking it a lot. Very rewarding work and the lifestyle is pretty good.

[JohnGrisham]

2 hours ago, shikimate said:

you guys forgot palliative care, this match OP's description perfectly

also occupation med, no inpatient but zero procedure, unless you count paper shuffling.

also med biochem, no inpatient but zero procedures.

 

Generally the Palliative docs i know still do para's if you count that as a procedure (malignant ascites etc), some have done thoras as well for supportive management, but definitely not much more than that.

[JohnGrisham]

1 hour ago, blah1234 said:

I would say ward based palliative care could be a good fit but there are a lot of social issues, family meetings, discharge planning that may not be for everyone. It's also in my opinion not the most cerebral medicine/science problem solving field based on my previous rotation experience.

Occupation med could also be a good fit but there's a lot of paperwork that may also not be for everyone.

Personally I didn't expect to enjoy palliative care during my rotation but I ended up liking it a lot. Very rewarding work and the lifestyle is pretty good.

It's a hidden secret i think - but also, not relatively common for non-FM docs to go into it. I've seen a few GIM, and EM docs do extra palliative to work in the field; but mostly to either get a "break" from their main field, or to supplement lack of jobs (nephro and cardio fellows who have done palliative training to get extra work).

[shikimate]

Lol if you don't wanna do para you can just let IR do those for you. 

OP can also consider ID/Med micro route.  med micro has no procedures, except maybe picking up the occasional petri dish if your center doesn't use MALDI-TOF. No inpatients though, unless you count little bugs living comfy in your petri dishes as inpatients.