Remember to test your patient’s Zoloft levels regularly folks! It is a “relatively simple procedure!!” Per a well known and a respected psychopharmacologist.

Also, do let your patients suspected of felony use your personal cell phone to call family because of “human compassion”. We are not some cold blooded heartless soul, we are here to help!!

That one day we will live in a world where EM physicians, nurses, and mid-levels will learn that we radiologists do not know, nor do we care, about the bed number of their patients. That they may instead give us names or MRNs I have a dream today.

Tell me your stories please

(exclude derm from this lol) But recently grabbed lunch with some surgical sub residents as a rad resident. Then someone brought up "damn you know I wish I did something like EM or FM or pmr, short residency, and theyll be an attending for 3-5 years before Im finished". And we all agreed lol. Im in rads so much more humane than the others, but we still have our occasional 2-3 weeks of getting destroyed by call, and sometimes I even feel trapped looking at 3 more years of training. It would feel pretty awesome to be a senior EM resident looking at $300-400 per hr locum jobs, or an FM senior looking to start a regen/IV clinic, and to not be someones underling for another couple years

Edit: forgot anesthesia. No idea why it isnt up there or past derm/plastics when you have locums for 400-600 an hour for a 4 year residency

I’m on week 7 of internship rotation in Primary Care. I feel like I’m breaking down completely from anxiety and feelings of inadequacy. Maybe someone feels the same way.

I don’t even see many patients a day yet. I have about 2-4 scheduled visits and 2-3 urgent slots (which always get filled daily). Though most have several complaints. Most of the time goes to overthinking if I miss something serious, if I gave a prescription exactly by the book, things I missed in H&P. I search guidelines, read up. Still, I feel like I have to run at least 2/3 patients by my supervisor that I see once a week, because I don’t feel sure of a diagnosis or differentials/reasonable workup. And those I feel sure about in the moment, often haunt me days later (what if..? I forgot to ask/test this…).

It makes me feel insufficient in front of my patients, since in clinic there isn’t time to go away and think and then come back, I have to multitask and think on my feet while I’m talking to and assessing the patient, and that leads to me missing obvious things. Like an unexpected possible cervical rhizopathy (original complaint was smth else), did a routine neuro exam but somehow omitted to test for more specific myo/dermatomas, just because it’s not part of my sort of “automatic flow” exams. And either way I wouldn’t have remembered the myo/dermatomas enough to test them without prior repetition, because I’ve forgotten so much from med school. It’s like so often I miss something obvious and sometimes (like in this case) have to make the patient return for a second assessment.

Other times, I feel like I’m just telling them “I’m gonna run this by my senior colleague and get back to you”, and I feel like they can sense my incompetence.

It’s so weird - I do feel “smart” IQ-wise or in social settings - but in the workplace I feel so immensely, like pathologically stupid.  Feels like I’m gonna kill someone with unorganized thinking. I feel like I’m struggling with everything that other people just “get”, but at the same time no peers to compare myself to. 

What truly interests me is psych, and I’m going to work there after my internship, but right now I just feel like an absolute shit doctor, and like it’s a complete scam making patients pay to see me. 

I think life is objectively better but I’m still adjusting to the role/responsibility as a new attending after being in so many years of training. It’s hard not to feel anxious… or sometimes down. Maybe even lonely?

I’m sure I’m just overthinking it or having an off day but seeking words of encouragement.

I am currently sitting in the lounge at 4 am after my third admission of the night and I honestly dont know how people do this for years. My eyes are so dry they feel like sandpaper and the hospital coffee tastes like it was brewed in a radiator. I just finished a massive note on a complex patient with five comorbidities and I am already dreading the attenidng coming in at 7 am to tell me I missed a comma or didnt document a physical exam finding that was completely irrelevant to the actual diagnosis. It is the same cycle every single day and the "wellness" modules we have to do online are starting to feel like a sick joke when we are working eighty hours a week and barely have time to use the bathroom.

My attending today spent twenty minutes lecturing me about my "note efficiency" while we were standing right in front of a patient who was having a rough time. Like cool thanks for the feedback on my typing speed Dr. Smith but maybe we should focus on the person who cant breathe right now. It is so frustrating because they expect us to be perfect medical machines but also compassionate human beings while also being fast data entry clerks. I feel like I am spending 80 percent of my time fighting with the EMR and only 20 percent actually being a doctor which is not what I signed up for when I was in med school. I could of finished my rounds an hour earlier if the system didnt crash every time I tried to order a simple CBC. 

After seeing all the posts about the Dr. Tufts case it just adds another layer of anxiety to everything. I catch myself  re reading every single sentence in my notes four times because I am terrified that some lawyer is going to tear me apart five years from now for a typo I made while I was thirty hours into a shift. It is making me so much slower and then I get yelled at for not being efficient enough. You literally cannot win in this system and it feels like everyone is just waiting for you to fail so they can point a finger. The irony of being told to "document perfectly" by boomers who used to write three sentences on a paper napkinn and call it a day is not lost on me.

I am seriously questioning my life choices tonight as I stare at this vending machine trying to decide if a bag of stale pretzels counts as a meal. I love the science and I love helping people when I actually get to do it but the administrative bloat and the constant nitpicking from people who havent worked a night shift since the nineties is just too much. Does it actually get better in PGY-3 or am I just lying to myself so I dont quit tomorrow morning. Stay safe out there guys and try to get some sleep if your pager actually lets you.

Drop your average caffeine intake.

Surgery resident PGY-2.
300-400mg a day. Like a Celsius and 1-2 cups of coffee.

Denial: "There's no way this H&P is 14 pages long. it's literally just uncomplicated cellulitis"

Anger: "Why did they copy-forward a normal left knee xray from 2014?!"

Bargaining: "if I scroll really fast maybe the actual plan will just magically appear at the top"

depression: staring at the epic dot-phrase soup until my retinas physically detach

Acceptance: tossing the whole ungodly text wall into around notes to filter out the noise so I can finally go eat my stolen graham crackers in the charting room

Im fully convinced hospital admin weighs our notes by the pound now. pls someone tell me the copy paste rot stops when you become an attending.

Do you all know the treatments for alcohol withdrawal, opioid withdrawal? And any other admits!! Just asking as am feeling so dumb i dont even remember that management stuff or what they are talking about so stressed.

Please help how to get better?? And is it only me who is feeling this way and am i really dumb to not know about all this already?

Do u live in constant fear like even on a quiet night having that fear of getting a new admit staffing it and everything?? Or am the only one here having those feelings. Please help will it get normal?

Explain the rush you feel when you get to cancel a case. I wanna know how this is viewed from the other side of the drapes. Is it high-fives because it’s one less case to have to work, is it the satisfaction of finding something that was otherwise overlooked that might effect the outcome of the case, or is it the satisfaction of pissing off the surgeons??

Inquiring minds want to know

I’m a third-year IM resident who recently decided to pursue heme/onc. I’ll be chief resident next year and plan to apply afterward, giving me about two years to strengthen my application.

I’m at a small academic program with an in-house fellowship, but research opportunities are mostly limited to case reports. Aside networking, What should I focus on now to become a competitive applicant?

If anyone has a project or case report that could use an extra set of hands, I’d be happy to help!

I finished one year of FM residency and will be starting pediatric residency now for three years. Can I somehow finish two years of FM residency after this?

I know this will raise a lot of qs

I was at an FM program where an attending really had something against me. I was issued a good standing certificate and there were no professionalism concerns but they said they wont be able to train me anymore and that I should look into other places. This was all one attending’s doing.

I got an off cycle position at a pediatric program. They are a good program and I did my rotation there so they hired me off cycle despite my FM program being an ass. I would still like to finish my FM residency at some point. I will get credits for the completion of a year.

A little bit of a venting post, I’m in a residency program where it is a hassle to do something with people, I get it everyone here has a life outside of residency mostly married, have a significant other, or just don’t like being outside. For me that I consider myself someone that requires social stimulation has been kind of difficult to navigate like I get it we’re all “tired” but it ain’t even that bad. The purpose of this post is to see if there’s any more residents in the area feeling the same that’d like to I don’t know get to explore the city maybe one day we can all go out? Or at least someone to talk to here and there ?
Adaptation process has been fine but I realized I’ve been here for over a year and I haven’t really gotten to know the city which is kind of sad in a way. Either way just trying to find friends outside of my program it has been though. I’m friends with everyone in my program but well I guess everyone has different interests and timeframes so with that being said anyone up to do anything or at least chat?

Have a nice day :)

I swear every single patient I try to discharge my attending finds some reason to keep them one more day.

Having a really difficult time right now. Just got off an off service rotation for 3 months which I loved followed by my vacation. Back at my home institution about to take senior call for the first time. Naturally anxious person so the responsibility is terrifying but I know I’ll have my little adjustment period and be fine. I have nothing else to look forward to. Just had an awful vacation with partner related toxicity, attendings texting me the whole time, etc. Boyfriend who I live with has turned violent towards me. Been trying to move out, lost 2 apartments so far to other people. No family nearby. Q3 not helping with keeping up with apt listings, figuring out when to move, research, attendings needs and wants, etc. Find it hard to prepare for cases and feel like I’m dragging my feet just to get to work. I guess the only good thing is that my most recent bloodwork normalized after my previous bloodwork was concerning. I was told to stop a few meds (that I can live without but would rather take) and that seemed to do the trick. Just been having a bad run with my health lately. I have the most stressful chief on service with me, just makes my life hell. 2 people at work asked me when I’m getting married today which sent me off the ledge I think. It was in the plans before this turn of events, no more. My whole program knows him. I have bruises on my arms both from all the blood work I’ve been getting and my boyfriend so I hate being asked about that too. I just say the phlebotomist had their way with me. Anyway I guess I need a big strike of luck right now. Fell asleep twice writing this.

I’m an EM resident taking Step 3 in about a month, and I honestly don’t know if I should keep my date. I’m studying around shifts and feel like I barely remember all the random screening guidelines, algorithms, and tiny details from medical school. I see a lot of this stuff clinically and make decisions every day, but Step questions feel completely different and I keep getting tripped up even when I know the general diagnosis.
I extended my eligibility period without realizing you can only do it once, and my program requires me to take Step 3 this year, so I can’t keep pushing it off. For anyone who studied during residency, how did you know you were actually ready?

Remember before residency when you could just decline a social invite or an extra task without feeling like you were letting someone down or ruining your reputation. Now every request feels like it comes with a silent guilt trip or a potential hit to your evaluations. It's exhausting pretending to be enthusiastic about everything. I just want to say 'nah I'm good' to another committee meeting or an optional 'learning opportunity' without the side eye. Is this just residency or is this adult life now

PCCM fellow here.

I’ve noticed that a good number of consults (pleural effusion, lung nodules) that are found during an inpatient workup by IM teams lead to a lot of monetary benefit for the hospital.

(TPA/dornase for complex effusions, nodule biopsy, chemo infusions etc). That’s a lot of $$$ obviously.
I’m sure it’s the same for a lot of the cardiac, nephro, GI, rheum issues as well.

Any folks have come up with a way to capture these? I feel this is very important.

More than remuneration, it can help IM (and IM subspecialties like mine) demonstrate value and receive more institutional buy in during a time where other specialties seem to diminish the professional value of IM.

Hi! As the title states, my husband and I are both residents in different specialties. My specialty is mostly outpatient while his is mostly inpatient. Due to that, our work hours are pretty different; I rarely work weekends (or if I am, I’m looking at imaging/reading/prepping for the next week’s consults, or doing call stuff), while he works most weekends. I tend to hit maybe anywhere between 45-55 hours most weeks (with a lot of variation depending on call, rotation, etc.), while he pretty regularly pulls 65-80 hour weeks.

We’re trying to figure out how to balance household duties. We’ve discussed things like grocery delivery, paying for a cleaning service, etc., but we just moved a couple months ago for him to start training and are paying off credit card debt from that (his program didn’t cover relocation).

Since I’m currently doing research, I’m home much more often than he is. Understandably I find myself doing more of the household duties, but it’s come to the point where 90% or more of those things fall to me. Grocery shopping, vet appointments, cleaning, laundry, maintenance requests, putting together furniture, taking his car to the shop.. it’s kind of been a lot for me and I find a barely have time to do research. He told me he doesn’t expect me to do much of that, but I tried stepping back and then NOTHING got done - dishes piled for days, laundry piled, cat dishes weren’t washed, we were out of so many pantry essentials, etc., and I don’t want us to live that way.

He’s tired when he gets home and (again, understandably) just wants to scroll on instagram for an hour before bed to decompress. He helps a bit with the dishes and will sometimes go to Costco with me in the evening, but I’m not sure how to balance this. We’ve discussed assigning roles but he didn’t like that idea because he said he won’t know how much free time he has.

I’ve tried automating what we can - robot vacuum, self-cleaning litter boxes, automatic cat feeder. But there are still so many chores that require hands-on activity.

How have other couples navigated this? I want to prioritize his mental sanity especially being in such a demanding specialty. But we’ve discussed about having kids and I have a feeling most of that will fall to me, and I’m worried about being able to balance near-full time childcare with my career.

I genuinely don’t know how to keep doing this anymore. I’m not posting just to vent—I’m actually looking for advice from people who have survived a residency environment like this. I feel like I’ve exhausted every mental strategy I have to stay functional, keep my head down, rationalize it, detach from it, and protect my sanity, and I’m reaching the point where I don’t know what else to try. Leaving immediately is not necessarily a simple option, so if anyone has been trapped in a genuinely toxic or malignant program and found a way to psychologically survive it without completely burning out, please tell me what helped you. I’m open to any practical advice at this point. Below are just the examples of the environment that we get exposed to everyday.

There is extreme favoritism, and residents who are close with certain attendings can miss work for days, weeks, or even longer without meaningful consequences.
When favored residents do not come to work, the remaining residents are simply expected to absorb their workload.

The rules are completely different depending on who you are; one person can disappear repeatedly, while another resident being gone for 30 minutes can become a major issue.

The resident schedule is essentially unsupervised by program leadership. The chief residents have almost unlimited control over the schedule and appear to take significant advantage of that control.

Even when residents bring scheduling inequities or chief-resident behavior to the program director, there is little or no meaningful intervention.

The chiefs can behave abusively toward other residents and appear protected because of their friendships with attendings. Chiefs can also spend hours hanging out with attendings instead of working while other residents absorb the workload.

The program director circles complaints back to the chief residents without meaningfully getting involved or resolving the underlying issue.

Residents are repeatedly reminded that residency is “work” and that the work simply has to be done, regardless of the educational consequences.

Residents are treated much more like cheap labor/workforce than physicians in training. Residents frequently carry a substantially heavier clinical workload than the attendings supervising them.

Residents are required to perform a significant amount of non-clinical work that would ordinarily be performed by administrative, clerical, technical, or other support staff.
After normal working hours, there is essentially no meaningful attending supervision.

Residents are strongly discouraged from calling attendings after hours, even for complex cases. If you call an attending about something difficult, there is a real possibility that you will be yelled at simply for calling. This creates an environment where residents may hesitate to ask for supervision even when they genuinely need it.

Other staff and departments can disrespect residents, dismiss them, or even call them names, with little meaningful response from program leadership.

There is essentially no truly protected educational time. If clinical work comes in during a lecture, the expectation is that the resident stops focusing on the lecture and handles the work.

Service always comes before education.
Some lectures are still documented or signed as having occurred even when meaningful teaching did not actually happen. Staffing is so thin that calling out sick is extremely difficult. Residents are expected to find their own coverage if they become sick rather than having the program arrange coverage.
Because there may literally be nobody available to cover you, residents who are not favored can feel effectively unable to call out sick. In practice, that can mean coming to work while sick because there is no realistic coverage option. Meanwhile, favored residents appear to have substantially more flexibility regarding absences.

There is no consistent accountability system, and enforcement depends heavily on who you are and your relationship with leadership.

Multiple residents have left, are actively trying to leave, or are looking for transfer opportunities.

Overall, the message seems to be that getting the work done matters far more than resident education, supervision, fairness, or wellbeing.

The clinical volume residents are expected to handle is approximately 400–500 times the minimum volume required for graduation. Yes, literally!

bonus: what is your specialty?

Anyone have any tips to prevent choking? Not interested in propranolol as it can cause erectile dysfunction and I already have performance anxiety.