Two Minute Drill

Your Opinions Will Vary

Haterade is welcome but please have a point.

Internal Medicine

The backbone of medicine. You will know a lot about everything upon completion of residency, so much that you will frighten those around you, especially when you generate a three page differential diagnosis from obscure symptoms, every item of which is reasonable and makes sense. I genuflect to IM residents for whom I have the deepest respect.

Rounding. Rounding. Round some more. If you don’t like it, don’t even think about it.

Unpopular specialty with American medical students except those hoping to subspecialize because, well, primary care is unpopular at this time. Many, many fellowships in anything from Infectious Diseases to Hematology-Oncology. Nephrologists are so smart they make other doctors submissively urinate. Very easy to get a residency position somewhere although there are many programs which are individually extremely competitive. Somewhat more difficult to land a good fellowship so you are not done with writing personal statements and begging for a job just yet.


I am not mature enough to be a urologist because most of the jokes I know involve testicles and penes. (The plural of “penis”) One week in medical school was enough. I am just not interested in men’s sexual dysfunction and I don’t want to pry into their sex lives which is what a good urologist needs to do. I suppose you can get used to anything but I just don’t know.

Very competitive specialty, by the way. Well paying and the residency hours are not bad for a surgical specialty. Heck, the hours are pretty good compared to any residency. I can’t imagine call is too intense. Are there really that many urologic emergencies?

Of course, the ideal urologist would be named Richard Johnson, Dick Wiener, or Dong Hung Lo. I understand they give you extra points for the match if you have a descriptive name.

Seriously, though, a very cool surgical specialty which is broad enough to encompass clinic work and a variety of surgical procedures but focused enough where you are not worrying about every little thing. From talking to residents, I understand that they have tremendous job satisfaction primarily because of patient gratitude. You hate the guy who gives you blood pressure medications. You love the guy who gives you Viagra.

Family Medicine

See my many post on this subject. “Family” Medicine. Not manly. Not manly at all. “Family” anything is just not sexy. Too non-threatening. Trauma Surgery is the dangerous-looking thug dating and impregnating your daughter before dumping her for a Bolivian hooker with a wooden leg. Family Medicine is the decent, slightly pudgy guy named “Walter” who really loves your daughter for her personality and will live with the shame of being the step-father to the dangerous guy’s kid. And even though he beat her, your daughter still prefers the thug to her husband.

But that’s just me. It is a decent specialty but hugely unpopular like most of primary care. Despite pages of AMCAS personal statements now in the dustbin of application history, most people grow to find chronic management of patients somewhat unappealing. Sure, I liked some of my patients and was very happy to see them but you’re pretty much stuck with them all.

Family Medicine’s scope is too broad as it encompasses pediatrics, internal medicine, and Obstetrics and Gynecology (OB/Gyn). Let’s give it the benefit of the doubt and say intern year is interchangeble between these specialties. (it isn’t, you understand but let’s be charitable) You are still left with 2 years of FM to learn 2 year worth of peds, two years worth of internal medicine, and four years of OB/Gyn. That’s eight years of knowledge to cram into two years of FM after intern year.

Now, Family Physicians don’t claim to be pediatricians or internists but why take your kid to the FP whent there is a pediatrician in town? Also, most FPs don’t do a lick of OB secondary to the inabilty to get priveleges and liabilty so why bother getting the training other than the basic intern training that I believe every intern in every specialty should have?

Tremendous fear among family physicians and residents that they will be replaced eventually by Physician Assistants and Nurse Practioners who operate as primary care providors in many states almost free from physician supervision. Maybe not replaced but salary parity would make going to medical school and residency, seven years total, seem like a bad investment when a two or three years master’s degree gets the same pay.

If that weren’t bad enough, the fellowship offerings for those who wish to subspecialize are mighty slim pickings and few lead to accredidation in the new specialty. Sports Medicine is one good fellowship and much sought after. You can do an OB fellowship and (I believe) an Emergency Medicicne fellowship but neither lead to board certification and may or may not be career enhancing. Plenty of government jobs if you have the hankering to get a Masters of Public Health or work as the liason to some quasi-governmental group pushing hard for socialized medicine so the nanny-state can get us to eat our vegetables and lose weight.

General Surgery

Some surgery residency programs brag (well, sort of) that they have a 100 percent divorce rate among their residents. Work hour limitations or not, surgery is a very demanding residency. You have to be very dedicated to surgery to survive. Emergency Medicine, family medicine, anesthesia, and many other specialties are littered with ex-surgery residents who looked around and said, “It’s not worth it.” And not just interns, either.

Very demanding schedule. Not only will you operate but you will also have clinic duties which most surgeons dislike as it keeps them from the OR. Expect early mornings and late evenings with plenty of call.

The tradeoff is that surgery is very cool. It requires skill and precision and ideally will yield concrete results. Patients love their surgeons. Again, the internist can have worked with the patient for ten years managing a plethora of potentially deadly and complex medical conditions but take out his gall bladder and you are his hero for life.

General surgery is mostly abdominal and digestive tract surgery. Colectomies, gall bladders, and the like. Hernia repairs. A lot of wound management. Many opportunities to sub-specialize. Cardiothoracic surgery is a separate specialty and residency as is neurosurgery.

I liked trauma surgery but it and another month of general surgery during medical school was enough for me. I endured rather than enjoyed my two surgery rotations as an intern at Duke.

Pretty competitive, too.

Obsterics and Gynecolgy

After you get over your natural revulsion at looking at vagina as a career, it is a very intersting specialty which is, like urology, broad enough for plenty of variety but not so broad that you spend your career chasing every little thing. For those who don’t know, it is both a surgical and a clinic-based specialty. Mostly pelvic surgeries of course. Hysterectomies, obviously. But all kinds of other things including “slings” to repair prolapsed bladders and cancer surgery. Also primary care for women, annual exams, pap smears, and other bread-and-butter stuff.

Babies too. Managing pregnancy and delivery. A lot better than pediatrics because once the umbilical chord is cut you never have to deal with the child again…ever….a big plus in my book.

Scroll down for description of a typical day for an intern on an OB servive.

Do I like delivering babies? I don’t dislike it but it is not on my top twenty list of things I enjoy. Can men do OB? Of course, but the specialty is female dominated and getting more so under the general and absolutely wrong-headed assumption that patients should be treated by Doctors who “look like them.” My internist is a chick. I don’t begrudge her the yearly prostate exam.

Probably the most clique-ish of any residency. Relatively cool towards outsiders and rotators. I also think that OB residents are the most malignant towards medical students and interns, not surgeons as is commonly believed. You can get along with a surgeon. I cannot, easily, grow a vagina so it is an uphill struggle.

I have tremendous respect for the specialty, however.


Perhaps the most boring clinic known to man. Most kids are healthy, thank God, but they are still brought to the doctor with distressing regularity for “well child checks,” colds, eczema, diarrhea, and other usually minor complaints.

“Well Child Checks.” Pointless but you have to concentrate because every now and then you will pick up something that will have lifetime consequences if not treated. Can someone please computerize the growth charts? I get eye strain looking at them.

Pediatric wards, however, are very cool. Sick kids usually get well when skillfully managed (and even unskillfully managed) which is very gratifying. Pediatric residents are the equal of internal medicine residents when it comes to medical knowlede. Pedatrics is internal medicine for children when you think about it. Every adult sub-specialty has it’s pediatric equivalent. Pediatric Nephrology, Pediatric Gastroenterology etc. so there are many opportunities for fellowships.

A very challenging but at the same time non-malignant residency, I have been told. Come on. These people talk to kids all day. It takes a true psycopath to talk sweetly to a four-year-old and then turn to his confused intern and call him a “waste of sperm.” It’s just not like that.

General pediatrics suffers from low salaries in practice but the specialty is still popular and is probably the one field which is a “calling” to most of it’s participants. I am a cynical dog and something of a misanthropist but I love our children’s pediatrician.

Emergency Medicine

What’s there not to like, especially in residency? Regular and predictable hours as it is shift-work. Incredible variety of patients, everything from chronic stable back pain that all of a sudden became an emergency at three in the morning to major, extremely sloppy trauma. Gynecological exam for an STD and five minutes later pushing thrombolytics for a massive pulmonary embolus. Plus you are safe from those “two dudes” are causing all of that mayhem out there.

It’s the only specialty where SOCMOB (Standing on Corner, Minding Own Business) is a legitmate abbreviation, as in “Patient was SOCMOB when he was attacked by two dudes. Also a good specialty to meet fellow christians as everybody was either sitting on their porch at 2 AM reading their bible or coming home from bible study when they were attacked.

The residency hours are pretty decent too, although you will be on a vampire schedule much of the time. It is a stealth “lifestyle” specialty as most people don’t realize the advantage of working four days in a row and then getting three days off. It pays very well, too, as there is currently a shortage of board certified Emergency Physicians. It is definitely the best paying three-year specialty.

Best jokes and most laid-back colleagues of any residency. EM residents need to cultivate affability and calmness. Other specialties might throw a hissy fit but we feel your pain even if we are killing you with admits. You need to like multi-tasking and managing many patients simultaneously. Prioritizing is important. The triage nurse stacks them in the order of severity and you also have to decide who needs the attention like right now and who can simmer a bit.

You also need to develop the ability to make decisions with limited information. If a patient has no chart and can’t communicate there’s not too much history to ellicit except what the paramedics tell you.

6 thoughts on “Two Minute Drill

  1. While I appreciate your sarcastic with a sprinkle of truth in your comments on family practice, I do not agree with your take on it. FP seems to be unattractive, unpopular, “unmanly”, low-pay, lot of work, yet FP brings a satisfaction no $$ nor prestige can buy. I can say the same thing for ER, from personal experience, 50% of the ER docs seem to have mis-diagnosed problems.
    My point is, you should have a balanced view on all specialties, offer the pros and cons, instead of 90% cons and 10% on family medicine. your unfortunate personal experience cannot be helped, perhaps you’re bitter still, but I do hope you can offer a more unbiased view on your blog. it’s not so hard to start a blog and have pissin contests on their specialties based on their own personal experiences…

  2. I’m not bitter. As soon as I matched into Emergency Medicine the bitterness and angst over what I thought, until that time, had been the biggest mistake of my life (scrambling into Family Practice) melted away like the spring snow.

    And it is my blog. I appreciate your reading it but there is no requirement that I offer both sides of every subject or that I provide balance. I deeply appreciate all of my readers and I try to give you a lot of quality content (108 articles and growing) but I am not providing a public service for which balance is required. I am giving my opinion on a few subjects with which I have a passing familiarity and since it is my opinion, balance is not even possible. I can’t write what I don’t believe and in this case, I don’t really believe in a lot of the things that are articles of faith in the academic family practice community.

    Look, there are thousands of blogs on the internet, most with more traffic than mine, on which you can find the conventional wisdom and the party line. Even the ones that pretend to complain about things buy into the premise, if you understand my meaning. In a way, my blog and Brother Hoover’s over at Medschoolhell are the balance, a place where people who want to get a different perspective and one which they have never really heard, can come to learn part of the full picture.

    Everything on my blog is true. Even the satire has a truth in it which is what makes satire funny. I didn’t like Family Medicine. Most people don’t even if everybody except me, apparently, pays lip service to it. They vote with their feet, so to speak, and while Emergency Medicine easily fills all of its available spots in the match, Family Medicine goes begging.

  3. panda, you didn’t talk about psyche or path. does this make you pathologically pscychotic? sorry, couldn’t resist.

    i have a friend who left a top ortho program for path and is happy and have met two ‘normal’ psychiatrists in my life. interested in your thoughts.

  4. I am thoroughly disappointed that the plural of penis isn’t penii.

    I discovered the true nature of humans to BS the most obvious of situations during emergencies while I was an EMT. “Sir, how did you manage to find yourself propelled up into the air and smashing through your closed window? Oh, you tripped? You were so distraught at your clumsiness that you busted your own face in, too? Sure, I do that all the time.”

  5. FYI there are a lot of urologic emergencies. Radiologists and Urologists frequently mingle at night. Septic obstruction seems to occur way too often when I am on call. Foleys can’t be passed… Uncontrolled urinary bleeding…

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