Hospital Medicine VS Specializing (How To Choose)

How do you choose between staying in general internal medicine vs specializing? What are some of the pros and cons? I'll tell you about how I decided to make my choice in this video!

0:00 Introduction
1:10 Starting work earlier
2:29 Control of location
3:24 Ending the rat race
3:43 The problem with subspecialty pay
4:37 Teaching
5:06 Medical knowledge
5:36 Being a "doctor"
6:13 Impact
6:48 Lifestyle
8:15 Prestige
9:24 Hospital medicine is not easy
9:45 Broad knowledge and being out of your comfort zone
10:56 Reddit opinions
13:58 Conclusion

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[angelonicolascaputizuniga]

I'm an IMG and I completely agree with you, that's why I'll just do IM, the biggest reason is because I don't want to continue in the rat race. I want to make FIRE as soon as possible, avoiding burnout and looking for happiness

[Neilliam]

It’s clear that you like teaching because you’re so good at it! I love your videos

[tokki]

Every med student needs to watch this video <3

[ItWillRainXO]

Thank you SO much!!! This is an excellent and super valuable video as I’ve always wanted to do general IM for a lot of these same reasons but people are so discouraging about it lmao, I don’t mind getting paid a bit less than my colleagues. Internists/hospitalists are by no means struggling to get by. I like having the big picture view as well, not wanting to forget all the stuff in med school that we worked so hard to learn. I think it is very intellectually gratifying to build knowledge to be able to have really thorough differentials and not miss “zebras” etc. It’s great to hear from someone who is already in the residency process of how a life of general IM can be!

[stevehawke]

Great reasons for being an IM generalist! I totally agree. I'd add:

1. Check out White Coat Investor. It's financially better to do IM than subspecialize. Especially if you want to FIRE. There are some exceptions, of course, but one can only speak generally. Think of it this way. Hospitalist & PCP each make around $300k per year (base), give or take. Residents and fellows get paid maybe $60k per year. So you're effectively losing ~$240k per year for 2-3 years (or longer for some super fellowships like in cardiology) depending on fellowship. That's not only in terms of opportunity costs but other significant costs too. You could pay off your loans sooner which has huge ramifications. You could have less interest accruing on your loans which again is significant. You could invest that money elsewhere. Etc. Anyway you're not losing out merely on opportunity costs but much more too.

2. Ultimately it's just a job. Don't get me wrong. I love the job but it's still a job. I love medicine but I love my family and friends more. So I'd rather have more time to spend with them early on. You went into this in your video far better than I have here. I'm just reiterating it because I think it's often underated by physicians.

3. Just an aside but anesthesiology isn't a lifestyle specialty from what I've seen from friends and colleagues in anesthesiology. And even for the mommy track anesthesia jobs that are more lifestyle friendly, you're still dealing with "easy" cases that could go wrong very quickly! Just being in the OR is being in a high risk environment. There are no real easy cases, not exactly, you still always have to be vigilant even on easy cases. Or do it seems to me. And the future of anesthesiology is likely supervising CRNAs to one degree or another. Some don't mind it, but most seem to be less than happy about it. So that's a consideration for anesthesiology. And CRNAs can be militant unlike their counterparts in other specialties of medicine.

[nathanleavitt]

This was very helpful, I’m an intern in IM, appreciate your thought process!

[Soriyou]

Current MS4 at US MD school. Thought so much about this throughout my time at medical school.
I considered all sorts of non-surgical specialties as I do not enjoy the OR or unattractive work-life balance.
Radiology, anesthesiology, IM, cardio, GI, hemonc, rheum, psych, neurology, PMR, and FM.
The more I went through the process, the more I realized how important preventive medicine is in our healthcare system.
So in the end, I decided to apply FM for the upcoming cycle.
I would have done IM if I were interested in hospital medicine, but outpatient medicine is where my heart lies.
My stats are competitive enough to apply to any specialty I considered, but I decided to find and stick to my happy place.
Unless you are truly content or interested in work that a certain field does, trying to get a position in a certain field for prestige is a pretty bad idea.
I have seen many residents and even attendings hating their lives because they pursued the wrong field for the wrong reasons.
Thank you Dr. Liu for making this video and please keep up with making educational videos for med students/residents.
Hopefully, more students watch this video to realize that prestige is overrated.

[JonathanCirillo]

Thank you for being open your career choice. I'm between hospitalist and pulm-crit now

[joshpuma]

Thank you for this. This video was the sign I needed

[andywang]

I agree with a lot in this video :). I think many people don't enjoy the social aspect, likening a hospitalist to being a secretary that just coordinates consults. I found it funny when the reddit comment had it in reverse; the hospitalist was calling the consulting physicians trained monkeys. Just shows that theres different strokes for different folks. Perspective makes such a huge difference.

I'm stuck between pursuing hem/onc vs. general IM. I've been interested in cancer since 8th grade. I have spent tons of hours completing cancer research throughout undergrad and medical school and feel like it would all be a waste if I did not pursue hem/onc. I also hate the rat race and I know hem/onc is one of the rattiest with research/publication pressure 😩

[detailed]

this is my dream. what is a Typical cv to match into internal medicine?

[detailed]

what should an img do to match into internal medicine? I'm really passionate about this

[GMDMD]

opportunity costs. I joke with residents on the fence to do a 1 year cash fellowship. We have a new grad in our hospitalist group taking “live like a resident” literally, pulling 25 shifts a month making serious bank. Buying the dip big-time. You can make close to specialist money if you want to work surgeon hours.

[kritika]

The 7 on is killer though . The first two off you’re burned out.

[mytube]

Hi Dr. Liu: which year did you graduate from SKMC? My son is in SKMC now class of 2025.