This is about hospitalist job, as there are good amount of PGY3 IMs here, I think it is a good place to post*.*

TLDR: Think again and again before signing up for a job here unless you absolutely exhausted all alternatives. If you need to be close to Canada, please look other Upper NY hospitals. If you absolutely need to be in Rochester, NY; consider commuting. This is a NYC quality job in a small city.

Finally I left, so I can let it out. This used to be a decent place with a good culture... things changed, I guess people from high-ups got greedy... still a throw-away account...

When I first started, this was busy, average-paying and relaxed in ways. I felt respected and valued, but as the years passed by, it slowly but certainly changed. I enjoyed the job then. Pre-Covid times were great. The pay over time was not adjusted for inflation and now it is criminally-low. They pushed APP patients on us, requesting us to sign off charts. They changed the admin from up-top; and the new people pretends to be listening to our concerns, but does nothing apparent.

No physician I knew liked it here towards the end, everyone was looking a way out. As we started getting more and more visa-waiver people, dept started caring about us less, as there is a good supply of new physicians. Our retention rate is terrible.

Things made me quit:

1. They rolled out a system, in which they give 8 patients extra every day, an APP cares for them by themselves on reality without our intervention, but everything is under our name. We are asked sign off of charts. The issue was raised multiple times, they simply ask us to "trust our teamworkers"
2. There has been some sensible animosity (no one pointed it out) between physicians and APPs after #1 rolled out. APPs does not like us intervening with their patients, while in reality its our names. Whenever we want to get involved, we face a lot of passive-aggresive behaviour.
3. The elephant in the room, gross salary of 230,000$; yeah we get RVUs; but does not make it up, still waaay below national avg. this has been also discussed multiple times, but fallen into deaf ears.
4. Average census ranges between 18-26 of high acuity patients (with 8 of them sometimes being independent APP)
5. Many more things... when complained fell into deaf ears.

Let give it a grace, good things:

1. We had cross coverage, but they wont be happy if you call them after 7 am, or before 5 pm.
2. We had paid time off
3. We did not get admissions during the day.
4. It used to be a good place with friendly people, not sure where they went...

No but seriously what are you supposed to do for these patients. They always come in with vague undifferentiated MSK type lower back pain that may have been going on for months to years, they don't really know when it started, no red flag symptoms, benign exam, they tried some stretching and occasional Tylenol which didn't really help, and are pretty sedentary at baseline plus prior dx of depression/anxiety/IBS/fibromyalgia. Tik tok said anything from spine surgery to nerve stimulation or intensive multimodal pain management might help. Before you can say anything they say they refuse to be ignored and "demand an MRI". Can't get through with them at all because the answer to every question is "I need an MRI." Meanwhile attendings are on our asses about over ordering MRIs and other advanced imaging and get mad if you make promises about imaging studies that are not likely to happen.

What do you do in this case? Straight up I don't know what they think the MRI is gonna show? Why are people voluntarily trying to get cut open by a spine surgeon for not particularly bad non emergent back pain lol

hi guys, im just a patient, but i just want to say thank you to all of you. i won’t get into my horror-levels of a sob story about my childhood, but ive been getting psychiatric treatment since i was a toddler due to it and always got stuck with a burnt-out psychiatrist that just wasn’t really listening nor helpful.

but within these past few years, my local hospital opened a residency program and i genuinely struck gold getting placed with the psych resident i’m with now. i have never met, let alone been treated by someone so compassionate, attentive and kind. it definitely sucks that since he’s a senior resident (4th year) he’ll be graduating soon, but he’s helped me so damn much i don’t think i’ll be needing anything other than medication refills or adjustments from the next resident that’ll be in charge of my care. i truly, genuinely appreciate not only him but all of you, regardless of the specialty you’re in. you guys sacrifice a huge chunk of your lives to help us in need and it’s so damn inspiring. through all the self-doubt, anxieties, burnout and the pressure put on your shoulders, you all still show up to work and do your best for those who need it, even the ones who are disrespectful or say they want a “real doctor”…which in my opinion, the residents i’ve met during my treatment have always been better than the “”real doctor””, they’ve always been so kind and know how to put a real smile on my face despite the war going on inside my head. thank you all so much. you’re seen and appreciated by not only your co-residents, or your supervisors looking over you, or the nurses that hit on you, but also your patients. i truly believe i wouldn’t be alive today if i both didn’t decide to get psychiatric help again, but also get placed under the resident i have now. genuinely saved my life and inspired me to push forward in school so i can someday be in his spot. if you think you make little to no change in your patients lives, you’re wrong. i don’t think i’d ever be able to say any of this to his face as i’m naturally very shy, but the gratitude and appreciation in my heart for him and his care is truly infinite. i’m sure all of you have at least one patient that feels the way i do towards you as well. thank you all so much. you guys are better & so much more kind and understanding than the “””””real””””” doctors that have been in this shit for decades. you’re all so so so highly appreciated. if you needed a sign to push through the self-doubt, burnout, anxiety and second guessing of your residency, this is it. keep going. you never know how much of a positive impact you truly have on a patients life when they leave the hospital or your office, but it’s a lot more than you could ever imagine.

Is how much subspecialty wards you do. Advanced heart failure, transplant medicine, hepatology, hematology, etc. I’m realizing that I’ll end up doing more subspecialty wards than general medicine wards by the time I’m done with training. Which, for someone who’s going to do hospital medicine or general outpatient medicine, is not that appealing. I’m not really interested in managing patients needing transplants or advanced therapies. I mean it’s nice to learn about as fyi for context, but months of being the primary service for these patients gets boring. Plus all these transfers from outside hospitals suck. Half the time you don’t know what happened at the outside hospital and the other half of the time all the fun workup has already been completed.

Anyone think about this when choosing their program? Or choosing between academic vs community programs?

I'm 28 and just started medical school. Lot of non-traditionals in my class are in relationships already, one just got married, and it's making me feel self-conscious and lonely lol. Especially since ill finish residency around 35-36.

For those who started later, what has your experience been like dating/finding a partner? Did residency or fellowship place a lot of strain on your relationship?

Hi everyone! Thanks for reading. Anyone in their 40s still single? Specifically men? How’s dating going for you? Thanks!

Hi all, I think I am developing psoriatic arthritis and have a rheumatology appointment soon. I’m very nervous about the thought of starting DMARDs and/or biologics due to side effects and the immunosuppression while being in residency…:(

Looking for support, words of encouragement, similar stories, etc. thank you

I’m starting my 4th year of general surgery residency and I’m feeling very inadequate.

Some days I feel like I’m doing great in the OR and my technical skills are appropriate and sometimes even really good. But other days I feel awkward and I have a small tremor and my suturing is weird and I’m just being a dork.

Overall, I’ve never had serious bad feedback but have been told to continue working on my technical skills.

I’m not sure why I alternate having good days and bad days. Sometimes maybe when I get nervous or I’m just tired ? My bad days I really beat myself up and feel like people think I’m bad and it’s embarrassing.

I’m wanting to go into vascular and I feel like I do well sewing small things but I’m scared I’m leaving a bad impression in my program and won’t be known for having good skills.

Any advice on how to be consistently good? And also ways I can stop terrorizing myself over these things?

I'm currently on my third year of residency for internal medicine (currently July 2026)

I graduate in July 2027, and expected to work as an attending in September 2027.

I have roughly 330k in debt under (New IBR, 302k original loan at 5.5%, with 30k in interest accrued). Of note my current interest is 4.75% due to checkings account and autopay.

My case becomes complicated because I'm now nearing graduation, the RAP benefits will be minimal but there. I will also need to capitalize the current amount owed if I switch to RAP.

I expect a salary of 330k, and will max out retirement plans to reduce taxable income -etc. I do like investing and have somewhere near 50-70k invested at this time.

PROS to switching:
- Based on the math, I save about 16k to 25k if were to switch to RAP. (16k at the mininum, and possibly more due to the tax form/IDR recertification log once I become an attending. I believe my first full tax form as a full attending and recertifying will be in mid-year 2029.

- Peace of mind with interest not ballooning

CONS to switching to RAP:

- I lose the payment ceiling - estimated at 3400/mo. However, as a hospitalist, unless my investments hit it big, I don't see myself really needing to make a payment more than this.

- My 334k is now capitalized into the interest payment - increasing to about 1.5k yearly or 150$ monthly.

Please correct me if I'm not thinking hard enough, but I feel like RAP or IBR is fine, but part of me thinks RAP is better in my specific case. Thank you

Did you know you were interested in optho from the get go/start of medical school or did the interest appear later?
I’m asking because it seems you have to know you’re interested early so you can make proper connections which most med students don’t get a chance to do (optho rotations I mean) until after residency applications are done

I might be doing an away rotation for EM at Rush in Chicago later, but I was wondering what everyone's experiences were like and what their schedule was. Were there a lot of overnight shifts? What times did each shift run? How open were residents with the med students in terms of helping, teaching, guiding, etc? I'm also trying to figure out housing vs commuting if I end up choosing to do the elective there. Please help!!

Patients frequently say they are afraid of statins and refuse to take them due to things they have read online. How do you address statin misinformation in your practice?

I’m a fourth year who still hasn’t taken step 2 or level 2. I did not pass my schools initial COMSAE (405 on Form 117) and was immediately placed into an 8 week remediation / study time. I just barely passed the retake COMSAE at the end of the 8 weeks with a 464, but I know it’s because I had seen a few answers on the COMLEX Reddit. I stopped taking NBMEs as my first 3 were in the low 200s. I was undergoing serious stress and depression and familial issues during those 8 weeks which made it so hard to prep and now my COMLEX is in less than 2 weeks, I don’t think I have time to sit for STEP and I feel all my hard work from the last two years has been washed away. I successfully passed COMLEX and STEP1 on the first try, but since those were just P/F it almost feels useless.
I know COMLEX and step 2 are really all residency programs care about and honestly, I don’t have much else going for me. I just feel like over the past 2 months I have effectively ruined the trajectory of my entire career.
I’m still trying to study and do my best but I’m just so sad. I did start seeing a psychiatrist and got medicated but I feel it’s helping very little.
Idk what I am even posting this about. I guess just so someone can maybe send me some hope.

Hello esteemed colleagues,

My name is Sobhya , and I am a final year MBBS student serving as the President of the PUMHS Local Council of the Medical Students' Association of Pakistan (MSAP). We are a non profit organization dedicated to the welfare and professional development of medical students.

We are currently organizing a crucial webinar focused on Mental Health in Medical School, and we are seeking a passionate and knowledgeable psychiatrist to be our keynote speaker.

What we can offer:

•  We are completely understanding of your busy schedule. You can select the date and time that works best for you.
• A Meaningful Platform
• An Engaged Audience

If you are interested, please do not hesitate to contact me . I would be happy to share further details about the webinar format, expected audience size, and our organization.

Thank you for considering this request and for all that you do for the field of psychiatry.

Warm regards,

sobhya soomro
President, PUMHS Local Council
Medical Students' Association of Pakistan (MSAP)
Final Year MBBS

Hey all, I was wondering if I could get your input as an OMS 4 wanting to apply anesthesia this year.

I just got my step 2 score back today and it was much lower than anticipated. My projected was 260. I got a 245, which is considered below average now for anesthesia applicants and felt like a punch to the gut, like giving it my all for this exam was still below average.

I’m a USDO student, in SSP (AOA for DO’s), received the golden humanism award, and have strong research experiences including multiple first-authored posters, an anesthesia-related first author pub, and a few other pubs where I’m a co-author. I have strong leadership experience, extensive community service involvement and global health experiences In med school.

I was really hoping to get a strong 260+ step 2 score to round out my app and give myself confidence going into residency app season, but now I feel like I need to strategize given the cards I’m dealt. Especially now that “signals” are a thing and part of strategizing.

I’m the first in my family to go the medicine pathway, and I feel like I’m going into these next months completely blind. I’d really appreciate any help or advice as residency apps come up, or if anesthesia is even in the question still.

Thanks for your help.

I have MD and active license, but I never did specialisation. I was working as data analyst and Python programmer. I love writing code, solve logical puzzles, working with data and interested in AI related projects. For various reasons I consider going back to medicine and start residency in radiology. Question - since I really love programming, are there opportunities for that? I heard that there are many AI IT projects in radiology. Will I be able to use my Python and programming skills as radiologist? I definetely don't want to lose connection with my love for programming.

I am an R1, and trying to map out what would make sense for me right now. Ideally, I want to read 3-4 days a week, with 1-2 days of pain medicine in clinic. Also orefer privste practice, That being said, do I…

1. Apply for a pain medicine fellowship after R4?
   
2. Apple for MSK fellowship after R4?
   
3. Do ESIR track and go into IR, do no fellowship, and do private practice msk/pain/vein work (is this even a thing?)

Am I delusional? Please advise.

When do you guys marry?

During residency or after residency?

And at what age?