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Internal Medicine residents! Which subspecialty are you planning on going for and why? (self.medicine)

submitted ago by mulletworm

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Hello, I'm currently a resident in a Canadian training program and will be applying for subspecialty fellowship in the next few months and would like to get some thoughts as to what fields redditor residents are interested in and the reasons behind it. Please state where you are from as well!

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[–]imitationcheese 8 points9 points ago

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Not subspecializing medically. My focus is on healthcare delivery improvement and gen med is good for that. There are too many subspecialists anyway.

[–]vometcomit 3 points4 points ago

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upvote for being awesome

[–]Respectable_GliomaMD - Neurosurgery - NYC 0 points1 point ago

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Agreed. Can't upvote this enough.

[–]Acutepancreatitis 1 point2 points ago

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my hero

[–]OlmecsGate 1 point2 points ago

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I'll be starting residency in the US July 1st but since no one else has responded I'll start the discussion. Pulmonary and Critical Care seems like a good field to me. I like the broad range of illness seen in the medical ICU. To me it feels like a more intense version of Internal Medicine. The Pulmonary component is also welcome for fear of burnout. Depending on how your hospital operates its unit you could work in the MICU for a full week and then take more of a break doing the Pulmonary component the next week. Again, I can only base these on my medical school observations, but this is where I see myself long term. I'll have to follow up in a few years. You're already in residency so you may have some better insight into the field if you care to share. Good luck with your search though.

[–][deleted] 0 points1 point ago

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My MD coworker suggests I go into pulmonary. He's a cardiologist and says people enjoy pulmonary.

[–]nybgrusMS4 0 points1 point ago

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I am still in 3rd year of med, but my thoughts are basically inline with yours.

[–]criticalemergency 0 points1 point ago

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US IM/EM resident entering my last year of residency this July. Going to be applying for a Pulmonary/Critical Care fellowship. I feel the most comfortable in the ICU and I love the medicine I get to practice there. Also my dual training in emergency and internal medicine makes it a great fit for me. I considered doing just a 2 year CC fellowship, but I like the idea of being able to do Pulmonary after 20 years of ER and ICU shifts.

[–]x_plorer2 0 points1 point ago

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Non-American here - I was wondering if you could give some more details about this (dual?) IM/EM residency? Sounds interesting.

[–]criticalemergency 2 points3 points ago

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Not alot of detail to give really. Traditional/categorial internal medicine residency is 3 years. Emergency medicine categorical residency is 3-4 years. We do a combined residency in both specialties and finish in 5 years. There are only 11 such programs in the country, most with 2 residency slots each year; two have 3 slots and one has 4 slots.

I happened to go to medical school at one of the hospitals that sponsors this combined residency which is how I became exposed to it. Most medical students in the country aren't even aware that such an option exists. My experience with the residents from the IM/EM program while I was a med student was that they were uniquely trained to take care of the sickest patients in the hospital. They combination of training you get with ER, wards, ICU, clinic, pediatrics, trauma, OB/Gyn, and the various medical specialties give you a unique skill set to take to a variety of places.

Some of us have a goal to work in international medicine, others are working towards a critical care fellowship, others are just looking to have the unique combination of procedural skills that you gain in an EM residency and the depth of medical knowledge possible from an IM residency.

There are several other combined residencies, the most popular being the 4 year IM-pediatrics known colloquially as med-peds. I think there are about 50+ such programs in the country, most have 4 spots per year. There are a couple of peds-EM programs, one family-EM program, and some combined psych-neuro programs.

[–]x_plorer2 0 points1 point ago

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Thanks for the reply - sounds amazing!

[–]Laughingman120 0 points1 point ago

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Gastroenterology. As a person who had his spleen, gallbladder, and appendix out by about thirteen, chronic stomachaches and GERD all my life, I feel like I could empathize, sympathize, and effectively treat patients in an area that has given myself so much trouble.

[–]imitationcheese 0 points1 point ago

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Except 99.99% of the cases you see won't be GERD or vague stomach aches. Those are primary care issues. And your surgeries are part of general surgery, not internal medicine... 1st or 2nd year med student?

[–]Laughingman120 0 points1 point ago

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Oh I understand, rereading what I posted I see it was pretty vague and misleading. I meant that the surgeries and what not were what originally got me interested. Who would want to see GERD or vague stomach ache patients anyways, apologies for the insinuation. Anyways, it was a GI doc that actually properly screened, diagnosed and referred me for necessary surgery when the primary was unsure of really even where to begin. I just meant as someone with general stomach problems from an early age(all be it mild) I took a special interest in the digestive system that has yet to die.

[–]cataphoresis -1 points0 points ago

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Critical Care. Yeah, you get stuck doing Pulm too, but I live and breathe ICU. Inpatient medicine all the way for me.

[–]nybgrusMS4 0 points1 point ago

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You don't have to do the pulm part. I am pretty sure you can just do a 2 year CC fellowship. Or if you are still a med student you can get to CC via surgery, anesthesia, or most recent, EM.

[–]cataphoresis -1 points0 points ago

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You can, yes. But no practice will hire you without pulm these days unless you're Surgical CC.

[–]nybgrusMS4 0 points1 point ago

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A hospital wouldn't be interested in having a dedicated inpatient intensivist? My understanding was that the pulm part was primarily for outpatient stuff...

[–]cataphoresis 0 points1 point ago

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Honestly, no. Pulmonologists can do procedures which the hospital can bill for and make money. That or sleep studies. Even large, urban safety-net hospitals tend to have Pulm/CC doctors (again except in the Surgical/Trauma ICUs) instead of straight CC.

To be fair, the vast majority of critical care doctors in the US are part of subcontracted groups and not employees of the hospital, and that refers back to my prior point about wanting the additional training.

[–]nybgrusMS4 0 points1 point ago

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Gotcha. Well, that works for me because I want to do CC and pulm anyways :-D

[–]criticalemergency 0 points1 point ago

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That's not entirely true. I know plenty of people trained in both Pulm/CC and just CC alone who are currently practicing solely as intensivists and are not doing any pulmonary or sleep as part of their practice. There is a smaller job market out there for them and I agree that if you're coming from the IM side, you're better off doing the 3 year pulm/CC instead of just straight CC. But it can be done in both teaching and non-teaching hospitals.