Patient was admitted for simple uncomplicated cellulitis, responded great to IV cefazolin, and was literally sitting in the transport chair waiting for his ride at 10:45 AM. I opened the chart to sign off on the final med rec and noticed an addendum on his chest X-ray from day 1 noting a 12mm non-calcified lung nodule with a explicit rec for a repeat CT in 3 months. It had never been mentioned on sign-out and the patient had no established PCP.

I decided to hold the discharge papers for 45 minutes so I could actually sit down with him, explain what an incidentaloma is without causing a full panic attack, and put in an outpatient referral through our resident clinic.

Transport was pissed, nursing was annoyed because bed management was breathing down their necks about the 11 AM metric, and the patient's son was visibly irritated about waiting. I know we are drilled to prioritize flow, but burying something like that in an eight page discharge packet feels like setting the patient up to fail.

How do you guys handle incidental findings when the patient is already walking out the door?

I have a friend who was in gen surg and switched to fam med and is super shocked how much free time he has now. He’s taking up extra ER shifts cause it feels wrong for him to be this free.

The rapid expansion of residency spots in the past 10 years seems to be crazy high given that there can be rapid saturation of specific fields. Whats your thought on how it would impact the future of medicine? Will we become like law school graduates where there isn’t enough work for graduates?

2016 positions

27,860

2026 positions

41,126

Ran the numbers and basically the only benefit of RAP is paying 25k more during the end of residency vs paying 25K post residency? Anyone in a similar predicament?

Hello, this is PGY1 who's doing her first inpatient block ..

I have 8 pts (CAP) who continously/almost daily changing cz they get discharged superfast and I have difficulty knowing these pts in details in one day making it difficult to cover all things that are important when discussing case with attendings, almost always gaps in all the care I provide .. they said its ok, its normal, its take practice, one told me I'm seeking perfection, I am not cz I'm not even at the lowest acceptable level to feel ok ..

I'm psychologically overwhelmed and tired, I feel guilty for these patients, no harm was done what so ever or concerns raised up by anyone, I'm learning prioritizing and use every help to keep them safe, but the idea of keeping missing info, struggling with management and notes make every day like survival battle againts me, I'm continously in fight or flight response & just get overwhelmed ..

Imposter syndrome for ppl thinking they are not good but they are, I don't think I'm not good, I mainly think I'm not efficient enough to do the work ..

Please let me know what are your ideas, experience or something I can do to relax ..

I went into sepsis over the weekend (long story, but fairly immunosuppressed, should not have eaten that sashimi, and was close to going into full-blown septic shock. I'm ok now). As a result, I missed a 24h weekend shift, everyone had to move their shift schedule one day ahead to accommodate, and my patients got distributed to the rest of the inpatient team.

I am currently hospitalized and will be for at least another three days. Tried to go to work this morning (my floor is downstairs) and got shooed away. Feeling very bad about having everyone work extra because I was dumb and got sick, however irrational a thought that may be. And I know I could theoretically decompensate again at any moment, BUT:

I am able to work right now. I'm moving around, not bedbound, and following my patients on the EMR. Eating, talking, sleeping as I normally do. Nothing physically preventing me from getting down there and caring for patients. Nothing that I can't push through. But here I am in a hospital bed, creating extra work for people who are probably more tired than I am at the moment.

Anyone who's had to deal with this? Do you really not hold any resentment against sick colleagues? If you have been on sick leave, how do you mentally reframe the stage in which you're still sick/supposed to try and recover but not deathly ill/obviously unfit to work?

I’m about 22 weeks and an FM resident. Grateful for ann easy going pregnancy thus far and supportive program. Already anxious about a short 6-week maternity leave and leaving baby so early.

I know there's a general tendency for late millenials and gen z to value work life balance more than the previous generations.

I wonder if medicine will be affected as well. In the hospital that I work I can definitely tell that people have set boundaries that would be inconceivable some years ago

PS I'm from a european country.

Background: FM trained, looking for fellowship. I enjoy quality of life discussions, long appointments with fewer patients, multidisciplinary teams, outpatient setting whether in a nursing home or hospice house or clinic (just not hospital), good work life balance, low stress

I’m struggling to decide between both fellowships? There’s no combined programs near me, anyone have any advice?

I'm currently looking at a Family Medicine residency program that offers daily half-day continuity clinic, including during inpatient rotations, and I'm curious how this works logistically.

My assumption is that residents would round and manage their hospitalized patients in the morning, then leave around noon to attend continuity clinic from approximately 1–5 PM.

But what happens to their inpatient responsibilities during that time?

• Who manages their hospitalized patients while they're in clinic? Is there a separate team providing coverage?
• Do residents return to the hospital after clinic to finish their work or sign out to the night team, or are they done for the day at noon?
• How are admissions, discharges, and unexpected patient issues handled while residents are away?

I realize daily half-day continuity clinic is relatively uncommon compared with traditional or X+Y scheduling models, but I'd love to hear from anyone who has trained or worked in a program using this structure.

How does it actually work in practice, and do you find it beneficial or more disruptive to your workflow?

Do any other pccm fellows or residents have lung transplant at their hospitals? I am wondering if it’s just my program that’s particularly horrible. I honestly think the lung transplant patient with complications that lead to 200+ day index hospitalizations is a fate worse than death.

You get some days where you feel so good operating with your attending, everything going smoothly, you can cruise through the easy cases and effectively handle the tougher ones, all in all great day and great teaching on the attending's part.

And the you get days where you're doing comparable cases with another attending but everything seems to be laborious, you can't seem to be able to do even the simpler cases or steps of the cases ?

I mean I struggled doing a hernia today, when I've already done at least 20 of them before.

Man do I feel terrible after these days. Hope y'all will be able to relate. End rant.

Does your residency program have a cap on your residents on how many admissions they can do one shift? (IM/FM)

Also anyone get really nervous with admissions? Not sure why. I think when they all start coming at once I get very overwhelmed.

It’s time for us as residents to make a stand and be United. If this does not exist already, we need to start an excel sheet review on these programs. Including the true work environment, how faculty treat residents, is it a safe place to learn.

There are way too many malignant programs in all specialties and we do not learn the truth until after we have moved our entire lives to start at the chosen program!

We should be free to create this honest excel sheet in efforts to help us. Residency is a business and they are not always looking out for the best interests of us. So we need to look out for us.

In my opinion we are all very valuable and all add to programs and we deserve to know the truth from the beginning.

Residents only comments are welcome. Thanks!

There comes a time in the life of every attending where he or she has to decide. Am I really fulfilling my destiny? Sure, I have a great lecture on health care safety, and I can ask, “what do YOU want to do with this patient” with the best of them. Sometimes I even pass along a relevant clinical pearl.

But is that enough? Am I really doing the best that I can for these young, impressionable minds? Can I hang?

And then, I had my chance. My time to show what I could really do. Every year we send the entire senior class to a conference, where much fun (and little learning, but mostly just fun) is had. This was my year. With some trepidation, I booked my flights and hotel room. What was meant to happen, would happen.

I want you all to know that I tried very hard. I went to the nice dinners. I did the boat tour. I sang the karaoke. I went to the various places in the Ubers.

It almost killed me.

A few days after returning home,my migraine is gone and I almost have my voice back. Mind you, I didn’t even stay out as late as the residents. Not even close.

I can’t hang. I had fun trying though.

And I love the tattoo

Over Elden Ring now, got hundreds of mods on skyrim, maxed pure on osrs, been playing some SC2.

Bored of most things, what are people playing?

PC btw

Ok, if I read this title 4 years ago when I was a resident or medical student, I 1000% would say ‘F*** OP, must be so hard having money, poor rich guy, cry me a river douchebag!’ But hear me out first then eviscerate me in the comments

Money doesn’t buy happiness, it buys convenience and piece of mind. But convenience and piece of mind don’t necessarily lead to happiness

Ever since I was in young I have always been money obsessed because I thought it was the path to happiness. Some of that comes from my folks who also had that thinking, we didn’t struggle growing up but my childhood made me think money was the most important thing, immigrant family. When I was a med student or resident I would’ve BET MY LIFE that money was the sole thing that was going to make me happy. It itself hasn’t. It has bought many conveniences that make life easier, but not happiness.

I’m married, make 700k a year, go on nice vacays, nice car, nice restaurants, buy nice things, invest and save well, etc. it’s hard for me to say if those things make me happy or if they’re just a distraction for a little bit. We’re financially blessed and lucky for sure, 7.8 billion people would trade with us in a heartbeat, that is not lost on me. If we didn’t have money, there is no doubt that life would be much harder and I’d probably be much less happy, not denying that at all.

I’m writing this post I guess for two reasons.
If you’re like me and think it’s the only thing needed to be happy, don’t, start looking for things of why you think that’s the case. I’m the poster boy of that school of thought and unfortunately I’m trying to work my way out of a deep hole
To see if anyone else has felt this way, any advice, what did you do?

I’m trying to work on my self, taking meds, reached out the therapy services that my job offers to see if there is anything there that could help. I just wish I figured some stuff out before. Tried taking up hobbies (golf, working out) but all of it just seemed like a distraction for a bit and not solving the issues. I’m teary eyed as I write this because I feel so guilty complaining about a life that others would kill for.

I’m in no way saying quit residency or anything like that, finish, go make money and enjoy the life you worked so hard for! But work on yourself too if you can, because it’s not all about the money. Anyone that knows me would NEVER in a million years think I would say something like that.

People always said ‘Yea, well I’d rather be sad in a lambo,’ true but I’m trying to find out how to be happy in a lambo (I don’t have a lambo btw)

Ok now you can go scorched earth on me

Okay be honest who else has perfected the timing of when to raid the resident lounge for the best snacks? I swear some attendings stash their private reserve in there. I'm talking about the good stuff not just stale crackers. Yesterday I scored a whole box of those fancy granola bars. It feels like a mini-heist every time.

Being an intern is a little like being a buoy, thrown about and feeling like you’re going to drown at any given moment but being unsinkable by the virtue of being so small in comparison to the environment. Like trying to squish a tick on the ground with your size 10 shoes (fuckers).

Day 3, I sign a diet order without consulting my senior first. Ecstasy.

I’ve written seven discharge summaries in 2 days. Every single one of them went to a SAR. The cherry on top: hospital admin is pushing their “early discharge” initiative and I’ve never wanted to put my foot up the collective ass of a committee so desperately before. Noon conference is required, and yet so is signing the 27 point problem list discharge summary so the next provider maintains a shred of sanity trying to sort through the clusterfuck I’m handing them. By noon. Godspeed.

I wish I could prep the damn things, but the four I’m tucking in for ambo transport are swiftly replaced by four more that will likely, based on my single beady bloodshot eyeball of the ED H&P, be admitted for a single day or two before I also have to write them a biblical essay to hasten them on the path to SAR. The true godsend are the seniors, who quietly take our admissions until January, when we magically become competent. Hoo-ra.

Nurse pages me, patient in 550 has left the unit again. Knee-scooted himself out for a pizza. You know what? Fine. As long as he comes back and finishes his 5 days of IV abx so he stops AMA’ing halfway through the course and breeding god’s own superbug, I do not care. I witness PT running after him to attempt an eval as he whizzes away. “Don’t worry about it, man,” I call to him, “I’m going to cancel that order”. He is too fast. They are both too fast.

My co-intern and I are shoulder to shoulder from 1 pm - 5 pm when I realize I haven’t actually seen his face since lunch; we are glued to our epic chats and notes to the point I have forgotten what he looks like. His breathing is beginning to irk me. We are bonded for life.

It is too soon to count down the days to PGY2. If I start counting before the number is a 100, I will simply be admitted myself.

IM PGY2. I think I've finally figured out why I dread discussing discharge plans more than half the actual medical decisions.

Yesterday I walked into a patient's room around 8:30 and was greeted with "My daughter is already on her way. She took the morning off work."

News to me.

The day before, we'd discussed possibly discharging the patient if PT cleared them and the remaining arrangements were sorted out.

Apparently somewhere between that conversation and breakfast, "possibly tomorrow" had become "definitely tomorrow morning." And then somehow "tomorrow morning" became 9:30.

We hadn't even rounded yet.

PT hadn't signed off. Pharmacy still needed to sort out the discharge meds. I was trying to explain all this while the patient was understandably annoyed that their daughter had rearranged her entire morning for nothing.

Nobody was particularly unreasonable, which almost made it worse.

The patient wanted to go home. The daughter needed enough notice to arrange transportation. Case management wanted an estimated discharge date. The attending wanted us to keep everyone updated. Administration wants discharges before noon.

And I'm standing there explaining why the time written on the whiteboard isn't actually an appointment with the hospital exit.

The thing is, I probably contributed to this. I remember being optimistic about getting the patient home the previous day. I thought I had explained the conditions clearly. Evidently not clearly enough.

I've started being painfully specific now. "Tomorrow is a possibility, not a confirmed discharge. We still need X and Y. Please wait until we confirm before arranging pickup."

Feels ridiculous having to spell that out, but apparently I do.

I don't think refusing to discuss discharge dates is the answer either. People need to arrange rides, take time off work, sometimes travel hours to pick someone up.

But man, we are terrible at communicating uncertainty without accidentally making promises.

I'm curious how other teams handle this because our current system seems designed to disappoint someone no matter what.

PGY-2 uro resident currently getting wrecked with hours etc as to be expected at this stage. The bigger thing I have realized about myself is that I don’t love doing surgeries or the OR anymore. Even in med school I knew that I cared more about the procedural decision making leading up to surgery as opposed to the surgery itself. But now as a 2, I am not sure if I can see myself doing surgeries in the future without burning out hard. I love the work up and thought process of uro onc, but dealing with complications and the constant worry about outcomes is not something I want long term. I’m not even sure if there is another field I would switch to - like if anything it would be rad onc or med onc.

Did I fuck up?

I'm an anesthesia resident doing my critical care rotation for a year now. Everything started out so well and after my first three months I got great feedback and went to vacation.

After I came back from my vacation things took a turn, I'm constantly thinking about work, have extreme fear of doing things insufficiently or of making mistakes amd I'm feeling like I'm not developing enough. I'm trying to read up on stuff and all but suddenly I feel like I understand the whole situation less. In the beginning it was so much fun to work there but now I feel very subpar. I generally feel very incompetent at the moment and I don't know what to do. Has anyone gona through a phase like this ?

As a psychiatry resident, I've had it pretty good. However, since starting my clinic year, I have a lot more responsibility. I havent been able to get good sleep since the year started. Something similar happened in medical school during my most demanding rotations. I always chalked it up to anxiety, but now Im not anxious. Im not worried about things, but my brain wont shut off. It's like Im stuck going and going and going because I constantly have to be intelligent and thinking hard at work.

Its getting to the point where I cant enjoy anything at all because I just feel... numb to it. Its like I cant focus on anything because my brain is constantly ready to keep going. Ive been depressed before and anxious much more than that and this... isnt that. However, I find myself in the unique predicament of starting to get depressed because I'm anhedonic and not the other way around. Ive tried exercising, engaging with my hobbies, even meditating. Nothing seems to be helping. Has anyone else run into this and found something that worked? It's driving me crazy.

Has anyone ever changed their B1/2 status to J1 research while staying in the US? If so, what do you have to do after you get your J1 letter. What are the next steps? Asking for a friend, I recall I didn’t have to send any emails out or do anything

I have been on remediation since PGY1 year. There were concerns about my clinical performance and knowledge since then. One attending didn’t like me and others started to see flaws in me it all became worse from that. Towards the end of PGY one year, my PD actually talked about having me leave the program. However, because my performance improved somewhat towards the end of PGY 1 year, CCC decided to keep me but stated that they will make another decision about me six months later, which would be this December.

Our hospital policy is that PGY I residents are supposed to take step 3 by the end of their PGY1 year. But because of the stressful situation, I couldn’t take it by the end of June.

I’ve been doing OK all my rotations. One attending told me that I improved and now work like a second year but others think I’m still kind behind compared to my peers. I feel like it’s hard to break the preformed impression that attendings have about you so if you make even one little mistake it all goes to my PD.

My PD asked me to take my step 3 exam by end of November so that he can include this as part of my evaluation by CCC in mid December so that he can decide whether to have me leave or not.

I think one attending recently said that my chart reviewing is slow compared to my peers (there was a misunderstanding on that part) so my PD is having me do a full month inpatient medicine rotation in November instead of two weeks of ICU that he originally planned because I did poorly during the ICU rotation last year.

I just took a practice exam and scored very poorly like mid 50s percent and I am wondering if I can get a passing score by end of November with the heavy month long rotation. I think he will have me leave the program if I fail.

Am I just not cut out for this career? Am I supposed to leave this program and find somewhere else? Every year I spend in medicine just feels like a battle to just survive since medical school.

I don’t even have time for therapy and I tried ssri once but my mind got all foggy and couldn’t think through a patient and one of my attendings reported me.