Moderator EMEDPA Posted January 20, 2015 Moderator Share Posted January 20, 2015 How can anyone enjoy practicing medicine like this? (honest question, as I've only ever done inpatient). But with those time constraints and multi- system problems of IM it seems impossible to the point I can't believe providers (especially PA/NP) are willing to work this way as opposed to selling out to sub specialty medicine some folks wonder how an internist can spend an hour doing an admit and see only 8 pts/shift...what do you talk about after 15 minutes? :) Link to comment Share on other sites More sharing options...
Ridiculopathy Posted January 20, 2015 Share Posted January 20, 2015 How can anyone enjoy practicing medicine like this? (honest question, as I've only ever done inpatient). But with those time constraints and multi- system problems of IM it seems impossible to the point I can't believe providers (especially PA/NP) are willing to work this way as opposed to selling out to sub specialty medicine it's rough. been doing this 9 years. has caused mental stress. and apparently IM/FM is not changing for the better with all the healthcare changes and regulations. but in the end, i do love what i do; im exposed to various disease states and never get bored - just exhausted. just hoping to find a a less stressful practice in the future. Link to comment Share on other sites More sharing options...
treejay Posted January 20, 2015 Share Posted January 20, 2015 General IM: 15 mins to address new complaints, preops, physicals, hospital follow ups,all while managing multiple comorbidities and keeping medication/problem/diagnoses lists up to date. Massive adminstrative work without given time to do it. Sounds like my job. Although we were given 20 minutes, I pushed back a bit and advocated for the new grad PAs and NPs I work with (including myself), and we'll be given 30 minutes for the foreseeable future. a little breathing room to look up everything I am unsure about which is a lot at this point (but noticeably diminishing weekly) Link to comment Share on other sites More sharing options...
Ridiculopathy Posted January 20, 2015 Share Posted January 20, 2015 Sounds like my job. Although we were given 20 minutes, I pushed back a bit and advocated for the new grad PAs and NPs I work with (including myself), and we'll be given 30 minutes for the foreseeable future. a little breathing room to look up everything I am unsure about which is a lot at this point (but noticeably diminishing weekly) awesome and congrats. i will be pushing for more time with complicated patient at our upcoming meeting. unfortunately IM offices are expecting us to practice IM at an urgent care pace. Link to comment Share on other sites More sharing options...
KMD16 Posted January 20, 2015 Share Posted January 20, 2015 50% UC, 30%FM, 5% Admin is my ideal work environment. Occasionally, I provide coverage in the main ED (15%). Doing 100% IM/FM, no thank you. I've done it in the past. Never again. Link to comment Share on other sites More sharing options...
SocialMedicine Posted January 20, 2015 Share Posted January 20, 2015 I have actually never worked full time in IM. From the beginning of my career I always had at least 15 or more % doing teaching or continuing my education. Could not imagine 20 patients a day 5 days a week. Link to comment Share on other sites More sharing options...
KMD16 Posted January 20, 2015 Share Posted January 20, 2015 Keeping it mix....keeps me sane. Link to comment Share on other sites More sharing options...
whoRyou Posted January 24, 2015 Share Posted January 24, 2015 I don't know all the answers, just where to find them! IMHO, I think that is half the battle in medicine Link to comment Share on other sites More sharing options...
Guest Paula Posted January 24, 2015 Share Posted January 24, 2015 some folks wonder how an internist can spend an hour doing an admit and see only 8 pts/shift...what do you talk about after 15 minutes? :) Here's what they say: Hey, patient have you seen the most recent pictures of the 16 pointer I shot with my bow last October? Here let me show you as they whip out their iphone and regale you with their exploits. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 24, 2015 Moderator Share Posted January 24, 2015 Keeping it mix....keeps me sane. yup. that's why I have 3 jobs: busy job pays the bills and provides benefits rural dual coverage job let's me work with folks I can learn from and see high acuity solo coverage rural job let's me apply what I learn in job #2 and run the show with no one to second guess me Link to comment Share on other sites More sharing options...
Derbingle Posted January 25, 2015 Share Posted January 25, 2015 Had an experience today and realized something, having docs that totally back you when you have a difficult patient, (or any hard situation when you make a decision and need it to stay in place) makes all the difference. So I think any job is tolerable as long everyone is working hard, your docs back you up and you dont get dumped on regularly. We had a team yesterday and today where everyone was hustling, two docs two PAs, the momentum got going, its was so busy and had this energy. But on Other days 1or 2 of them sit and try to do very little, nursing staff breaths down the necks of the ones seeing patients bc they are on the floor and availble, and then I hate my job on those days as the sitting docs try to micromanage and use you an extension of their own hand, literally. Link to comment Share on other sites More sharing options...
problem child Posted January 28, 2015 Share Posted January 28, 2015 I would think clinically, ICU or solo ED would be the most challenging for a PA since the volume of knowledge needed is immense and you'd have to make a lot of quick, sometimes critical decisions. Lifestyle-wise, it doesn't get any worse than a hardcore surgery practice. Endless responsibilities, long and unpredictable hours, and a stressful work environment. word Link to comment Share on other sites More sharing options...
problem child Posted January 28, 2015 Share Posted January 28, 2015 General IM: 15 mins to address new complaints, preops, physicals, hospital follow ups,all while managing multiple comorbidities and keeping medication/problem/diagnoses lists up to date. Massive adminstrative work without given time to do it. makes me want to stick a fork in my eye just thinking about it! Link to comment Share on other sites More sharing options...
problem child Posted January 28, 2015 Share Posted January 28, 2015 here's a new one....I was reading through this thread and "liking" many comments, when all of a sudden THIS pops up: "You have reached your quota of positive votes for the day" WTF??? I didn't know this was a republikan website, nyuk nyuk nyuk Link to comment Share on other sites More sharing options...
lov2xlr8 Posted January 28, 2015 Share Posted January 28, 2015 Just got back from being stuck out on Long Island for 2 days thanks to the snowstorm, do per-diem IM (gen med and cardiac stepdown) at a small community hospital. Ended up staying with a few Urology PA's in there.... gasp.... hospital payed for apartment across the street. Both were doing their 24h shift (in addition to their one other 12h shift for the week). They hung out at the apartment for a majority of the day, slept, fielded a few consults from the apartment and managed them from there, went out to eat with us, went in to the hospital for 4-5 hours... Case in point, I need to specialize! I know this is likely not typical but still, doing IM for the last 3 years, don't know if I ever would have had a long enough break from a barrage of pages to even walk across the street. Was cool to see, they were awesome. Link to comment Share on other sites More sharing options...
problem child Posted January 29, 2015 Share Posted January 29, 2015 once again... "You have reached your quota of positive votes for the day" sheesh Link to comment Share on other sites More sharing options...
andersenpa Posted January 29, 2015 Share Posted January 29, 2015 For the folks playing at home, this is a trick question There IS no Most Difficult Specialty. The best answers are the one you hate or the one where you are not supported. Link to comment Share on other sites More sharing options...
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