* * Anonymous Doc

Thursday, August 19, 2010

People are beginning to talk about fellowship applications.

For anyone reading who's outside of this world-- internal medicine residency is 3 years, and a lot of people go on to 1-3 more years of training to specialize-- whether in cardiology, gastroenterology (GI), endocrinology, hematology/oncology, rheumatology, or a few others. The more competitive ones tend to be the ones where people can make the most money-- cardio, hem/onc, GI.

So people have to get recommendations, write an essay, decide where to apply. It's like residency applications all over again.

To be a primary care doctor, it's not necessary to do a fellowship-- next year I'd apply for jobs, and hope to find something that's a good fit. But I feel like you're definitely looked down upon if you don't want to specialize. Well, at least you're looked down upon by specialists.

My co-resident has been working on her applications all month. I've read her essay like six times. Not because she asked me to, but because it's on her computer screen all day and I'm bored and I can't resist taking a look. It's the typical essay you'd expect in any of these situations-- "my father had xyz disease, and watching him go through that made me realize I want to be an xyz doctor, and seeing patients with xyz this past year has only made me further committed to the idea of helping people with xyz and hopefully getting involved in the xyz community and making it my life's work." Fine, whatever, it makes enough sense.

But the reason why I have trouble seeing myself pursuing a specialty like that is because you end up being like a widget maker. If you're, say, an interventional cardiologist, you spend all day doing angiograms and cardiac ablations. They serve a function, absolutely-- but it's boring after a month-long rotation, let alone a lifetime.

Of course, on the flip side, being a primary doctor, you end up seeing the same five problems over and over again, and anything of any importance, you refer off to a specialist anyway. So maybe that's boring too.

Hospital work is draining because you never see anybody who's well. Private practice is boring because you never really deal with anything interesting. It all seems boring-- which is the frustrating part. The attendings who come through are all bored with patient care. They want to get back to their research, some of them spend as little as 6 weeks a year seeing any patients at all, they don't have their own practices. But if I wanted to do science research, I would have gotten a PhD instead of going to medical school. I feel like I rarely meet anyone who will actually admit they enjoy what they do. So it leaves me with no idea what the heck I ought to actually do with my life, and not really any time to give it real thought because I'm working 80 hours a week.

So I can (secretly) make fun of my co-resident for her fake enthusiasm about xyz disease-- because most of it has to be fake, it really does-- but at the same time at least she has a destination. I just have, I don't know, almost two hundred thousand dollars of debt and a sleep debt probably almost as big.


  1. You have to make the same decision that basically everybody makes at some point in their life. Do you want a happy life or an interesting life?

    Penelope Trunk has written some interesting posts on this subject:



  2. No matter what your profession is, your career is a choice between being overworked and total monotony. There is no in-between, except maybe if you advance to the point where you have minions to do the dirty work. Even then, usually you have other responsibilities that come with that position which add on new duties. If you want something to make you happy, find a good hobby. :)

  3. I think primary care though is helpful to weirdo patients like me. When the specialists aren't paying attention or when the whole thing is so convoluted in terms of systems involved, at least at the beginning stages, my primary care doctor has been the most help.

    So you will see the same thing over and over and then a weirdo like me will waltz in to keep you hopping.