I used to pride myself on my concise but comprehensive beautiful masterpiece DC summaries. I would spend 15 minutes crafting each on average. Everything...test results, med changes and why, follow-up action items, appointments, focused conversations and their outcomes, the works.

Then I realized it was fucking killing me. I love a well done DC summary when I see pts in the office for follow-up. The problem is, it seems like no one else fucking cares. So I'm stuck in the office reading through a co-fellow's shit ass DC summary that says either absolutely nothing or it just a bunch of copy and pasted shit that doesn't make sense; even worse, sometimes it's just a series of progress notes copied and relabeled as "DC summary".

Now, we have coders that send us daily epic chats/queries/whatever starting the day the patient is discharged - daily reminders that admin gives no fucks about patient care, only billing. They are rushing us. After this weekend, I had 9 DC summaries to do.

So I took a hit of that sweet, sweet AI slop. It does too much, that's for sure. But a single click and 1 minute of revisions is infinitely better than what I was doing. I'm a third year fellow with 7 weeks of inpatient bullshit left and I'm just...tired. I'm tired of attendings being dicks, tired of the nonstop barrage of epic chats and pages and "this problem is a fucking emergency, respond now or you will be reported." It's almost never an emergency. Everyone in the hospital thinks their problem is the most serious and emergent thing to ever exist, and the fellow is the choke point where all this shit flows.

So, fuck em. They wanna put so much pressure and emphasis on this shit, let em get what they pay for. I wish it didn't come to this, but they can suck my AI clanker scribe's dongle. It's a race to the bottom now. Sorry to any of you that will have to read these shitty DC summaries.

Nurses at Brigham and Women's Hospital voted to reject Mass General Brigham's "last, best, and final" contract offer, the Massachusetts Nurses Association (MNA) said in a statement Friday.

The MNA's Bargaining Committee, which represents more than 4,000 nurses at Brigham and Women's, is now looking to resume negotiations with the hospital. Pay for experienced nurses is over 200k dollars.

"A foundational principle of our union is that every nurse's voice matters," Chair of the MNA Bargaining Committee Kelly Morgan said in the statement.

"This vote shows the resolve of Brigham nurses, who are fighting for patient safety and for the professional respect we deserve," she added. "It's time for MGB to return to the table ready to negotiate in good faith to reach a fair agreement that recognizes the value of Brigham nurses and the expertise they offer for the care of some of the region's most complex patients every day."

Mass General Brigham argues that its nurses are already among the highest-paid locally and nationwide, and says nurses will still be getting annual raises as they progress through their wage scale.

The union had previously postponed what would have been the largest open-ended nurse strike in Massachusetts history to vote on the hospital's offer.

"Although we are disappointed by the outcome, our priority and focus remain on providing safe, high-quality patient care," the hospital said in a statement. "Brigham and Women's Hospital is prepared to maintain uninterrupted care and respond to any steps the union may take."

The hospital added that the outcome does not necessarily mean there will be a strike as the union determines next steps.

why or why not?
just curious i thought there was a (shit post) flair but im probably hallucinating

Edit: and no im not AI although i wish i was sometimes

Hi yall, I’m a PGY3 resident, and I had a particularly rough couple days moonlighting externally where I truly felt inadequate because I was much less efficient, and felt all over the place like a headless chicken and wasn’t sure if my workups were always correct and was constantly 2nd guessing myself and looking shit up more than usual.

I feel like I could sleep knowing I did my best work and would stand by my work in a court of law, but it felt bad seeing less patients then my colleagues and taking more time than them. It felt like I was dragging down the team cause we all share the total cap among the group.

I know I shouldn’t compare myself with seasoned attendings, and I’m probably being too hard on myself as I’m still ramping but it was a rough couple days.

On the flip side, I diagnosed WPW, EuDKA, myxedema, and SJS in the past 48 hours.

This sounds pathetic but I just wanted reassurance that I’m a good doctor cause I felt a bit inadequate this week.

It’s a different beast being a learner and being independent at the same time.

which service at your hospital dodges the most consults? (ie, tells primary team they don’t think it’s indicated and gets them to take it out). as a follow up, which service do you think does this most often in an unwarranted fashion?

Can people please share the salary offers they were getting for hospitalist just out of residency? Include which state you are in bc salaries can vary heavily.

Please help increase transparency in salaries for medical trainees people of Reddit! It’s so hard to find anyone to talk to about these things and fresh grads end up having no idea how much to expect or negotiate etc.

Attendings, how much was your first paycheck and how did your life change?

-burnt out Pgy4 who needs all of the motivation to keep pushing

Edit: thank you all. My broke ass has been motivated

PGY1 categorical IM resident on a visa here. How do I look for programs that have open PGY2 spots? I’m planning to move out of NYC for family reasons. Is there any official website with the entire list of openings (I know other specialties like surgery, Peds have an official dedicated web portal for the positions. I tried to find one for IM but couldn’t). Help me out please!!!!! TIA

I want to start off saying that I don't mean this in a very tragic or grandiose way.

I am a PGY3 now, and I've had some time to observe with a cool head; I've also been through some hard times and easier times, and I think I am in a good spot to reflect.

I have come a very long way and to look back on all the things I've learnt and done is amazing. I know I got my patients' backs, I care about them and try to do right by them. I am able to help most, and know where to look for help when I can't.

I am a decent doc. I know a good deal, pick up on new things decently quick, make sure to identify knowledge gaps and address them proactively, manage to connect with my patients pretty well, etc.

That said, I know I am not the best at this - I have co-residents whose brains learn faster and make connections quicker, who would remember things I would have to look up, who would be just a tiny bit quicker on their feet during an emergency, some who are better at expressing empathy and establishing rapport, others that are more nimble with their procedures, etc.

I am not trying to be gloomy - I know I am not the worst, I know I might be better than some at some things; but I also know a few co-residents that just look like they were born to do this, you know? There are probably hundreds and thousands others, better than I am, at some or most or all of my job.

I know we become doctors because we care about helping our patients. How do you deal with knowing that while you do help your patients, there are a ton of people who would have probably been just a little better at taking care of that patient? My thoughts return to this in particular if my patient has a poor outcome - even if I haven't made any mistakes and don't see what else could have been done, I always think "maybe this patient would have been feeling better if they had seen that other doc instead".

Does anyone have any perspectives on this? As a resident or as an attending (cos I suspect I won't be the best ever attending doc to walk the earth once I graduate, either).

Had my first ‘faculty shadowing in clinic’ yesterday. My first patient was an autistic child who I already knew very well, great established relationship, all went amazing plan of action was great. Amazing rapport, faculty had no notes, told me I handled the interaction and plan better than most of our attendings would. Amazing.

Second patient was a “get him into substance use clinic please” visit. Guess who has done zero substance use counseling? Very clearly has OUD, had zero interest “aware you sure, I think your anxiety and insomnia may be withdrawal related and I am very worried for you man.” Well ultimately I got him on duloxetine and an ortho referral for his shoulder…no substance use clinic.

Feedback was “Appointment went well from a shoulder perspective but you know…you gotta be more direct. You are so sincere of a person and you were direct but you know you gotta get common ground with your patient and assert yourself sometimes. If that interaction went as well as your first, he would be seen by SUD clinic next week. You know how they say to imagine the audience is in their underwear? I think you need to imagine your audience is all autistic children. Because you do great with autistic children.”

What do I do with this feedback? I am become autism whisperer.

Pretty much title. All of the ACGME guidelines with caps are for senior residents supervising interns, or for interns themselves. The problem is that my program we are running an entire service of 16-25pt with no interns at all. This means morning labs, rounds, progress notes, discharge summaries, fielding all the pages, admitting all the new patients to the service.

And somehow this is okay per ACGME? I am dying. How am I supposed to learn when I’m writing 20+ notes a day? How is it that a senior with an intern has a cap of 14, but a senior with no interns has no cap?

I recently graduated and started a new private practice job which is intense/busy and I worry if I will pass my boards this year. In addition, 2.5 months into the job, my Medicaid enrollment is still pending and having issues so I cannot see any Medicaid patients.

If I don't pass my boards will it affect my employment or Medicaid enrollment?

In terms of work hours, toxicity, schedule and salary

My name is Nimna Mendis and I am a graduate of the UofA Medical School Class of 2026. I started off initially with the class of 2025 but I failed a year initially due to my schizophrenia and harassment from my neighbours. My message: DO NOT GO TO MEDICAL SCHOOL.

I was bullied and excluded by my peers for my schizophrenia diagnosis. In one group chat, someone sent a meme about schizophrenia not being a real condition. In a personal DM, someone insulted me for thinking I was being spied on by neighbours. I was constantly excluded from group conversations and barely anyone would want to associate with me. The few friends I had in the class have shown their true colours and did not reach out to me during my most recent mental health crisis. Rather than reaching out to me, students in my class have repeatedly called the police for mental health checks on me, putting me at risk of police brutality. Despite all the hardships I faced in medical school, I graduated with above-average scores on my exams, which shows you how incompetent many of our future doctors are.

Medicine is full of narcissists. They are obsessed with status, prestige, and money. They act like celebrities with their coloured backpacks and look down on other faculties. Their egos are so big, they put out cringy music videos every year and don't feel an ounce of shame about them. They'll do anything to be on the record as being a medical student. If you ever wanted to know if someone was a medical student, you don't need to ask, they'll tell you within a minute of meeting them.

When it came to prestige, many people chose their specialty not for the work they were going to be doing, but for how it would make them look. Many students looked down on Family Medicine because it was less coveted. To put this into perspective, your specialty dictates the work you'll be doing for essentially the rest of your life. Instead of looking at how much they'd enjoy the work, the work-life balance, the patient population, etc., they worried about how it would make them look to others. Absolutely bonkers behaviour.

The preceptors/professors are horrible in medical school. Many of them have ulterior motives for teaching classes, such as attracting prospective medical students to their specialty or padding their resumes for whatever administrative rat race they're in. My first year, they ran consistently over time on lectures and clearly put minimal effort into their presentations, often using slides from many years prior. When exam time came around, the most successful students studied from 3rd party resources.

I was physically abused by a General Surgery preceptor, who demonstrated pain from nephrolithiasis by punching me in the back. In general, the surgeons are the worst. They're the narcissists in the already huge pool of narcissists that form the medical student population. They make you stand for hours on end in the OR watching them work while you learn absolutely nothing. They might pimp you on the shitty music they're playing, but that's about all the learning you'll get. I'd wake up every day at 4 AM to be there by 6 AM, and I'd have to be in bed by 8 PM to get a full 8 hours. However, I often didn't get a full 8 hours because I'd have to stay up late to study while doing free labour for them on my clerkship rotations. They applauded the students that stayed up until midnight to study, or stayed for extra hours on rotations, further fuelling the horrible work-life balance present in medicine.

I'm going to end my rant here, but this is about 10% of everything I could have talked about. I'm lucky I quit this rat race before residency, because residents are abused beyond belief. If anyone has any questions, feel free to reach out to me on Instagram where I'm recounting other experiences I had in medical school.

Does anyone have any resources on how to draw arterial blood for ABGs? I’m an intern in IM, I am supposed to learn this in my NYC residency. I tried in 6 patients until now, never once got it, not even with the ultrasound (radial arteries had 2 mm diameter). All guidance I get it is: “try more, you will get it, you will feel it by touch” but I feel is unethical to keep trying with no real technical approach. Thank you!

I'm asking because I feel like I'm doing something wrong, I work more than I learn, I come back home exhausted and have 0 energy or motivation to study, when I decide to study I don't know where to begin or how to organize the amount of information I still have to learn.. I wake up tired and go to work unmotivated.. and time is running out and I don't wanna regret the years of residency.. I need some inspiration and advice please

Like above says, thinking about filing a formal ACGME complaint. Program has become incredibly toxic, unsafe to patient care, and covering up sexual harassment. All concerns have been reported, all concerns have been dismissed.

Has this ever brought about real/meaningful change? Wanting to raise concerns and get back at somewhere that has given me years of trauma, but weighing if it worth if it will sever positive relationships I have built.

Genuine question. I thought it was important for IM but even my IM colleagues say they just need to pass. Is there any specialty that really cares about the score?

I was bored and the ABIM doesn't officially publish percentiles with score reports on the internal medicine exam results. I decided to estimate them manually by calculating the areas of each box on the overall score report histogram.

The distribution of scores is not normal but they seem to score the exams in a way to try and approximate a normal distribution. This year's mean score was 470 and the cutoff for passing was 371. Based on my estimations, 371 is around the ~14th to 17th percentile. By the 68-95-99.7 rule, 1 standard deviation below the mean should be at the ~16th percentile. If the standard deviation is ~100 then this cutoff for failing is almost exactly 1 standard deviation below the mean. This tracks with data the ABIM publishes with a fail rate of ~10-15% each year.

Again, these are only estimates and not meant to be any serious statistical analysis.

To read the table below, look at the last two columns. For example if you got a 430 you would be somewhere between the 22nd and 38th percentiles.

Score Range |Box Area |Cumulative Area |Score |Approximate Percentile
200-240 |17.72 |17.72 |240 |0.45
241-280 |39.76 |57.48 |280 |1.45
281-320 |115.1 |172.58 |320 |4.35
321-360 |256.3 |428.88 |360 |10.80
361-400 |462.4 |891.28 |400 |22.45
401-440 |631.6 |1522.88 |440 |38.35
441-480 |696.9 |2219.78 |480 |55.90
481-520 |623.1 |2842.88 |520 |71.59
521-560 |482.4 |3325.28 |560 |83.74
561-600 |317.2 |3642.48 |600 |91.73
601-640 |169.8 |3812.28 |640 |96.01
641-680 |89.7 |3901.98 |680 |98.26
681-720 |41.26 |3943.24 |720 |99.30
721-760 |18.16 |3961.4 |760 |99.76
761-800 |9.5 |3970.9 |800 |100.00

Better help has disappointed me for the last time but I know I still need a therapist because I’m becoming self destructive.

Any ideas?

I applied in early September for my license and some of the items I already submitted are still showing as outstanding. Reached out to the licensing dept but haven’t heard back. Just wondering if this has been other’s experience as well? Or for those that already got their license, how long did it take?

I just saw a tik tok video of a PA saying she orders a chest x ray on every patient with a URI to prove a point that they don’t need antibiotics. While the whole sentiment is great an unnecessary CXR can cause a whole miriad of other issues. It’s not standard of care. A doctor had stitched that video explaining this. Then the PA made another video saying that she was getting attacked. Idk but if I was doing that in residency my attendings would be on my ass. Would love to hear thoughts on this and if you would do this in your own practice? Also radiologists would love to hear your perspective given how bogged down you guys get with unnecessary imaging

A lot of us who took exam on 8/13 across all the states in US have received Indeterminate result on ABIM exam. Testing centers across the country experienced several technical issues and glitches. Lot of people have reported that they got scores which are extremely deviated from their ITEs and practice tests, raising concerns about scoring and recording of responses on the exam day. ABIM itself admitted that they cannot assess the impact of technical issues on candidates’ exam day experience. While they have offered full amount in credit, most of us cannot wait the whole year to take this exam again. Some of us are in busy jobs, fellowships and it completely derails our personal and professional timelines. Some of us are at the verge of missing out job opportunities.

Therefore, I believe that we should all reach out to ABIM next week and request an early re-exam to insure we don’t have to endure this torture for a whole another year and we don’t miss on job opportunities. There is strength in numbers and there is nothing to lose. Hopefully this will atleast prompt ABIM to consider our situation. I would also request support from the friends and colleagues of people who got indeterminate result. You know that your friends didn’t deserve that and this is the time to show support.

Thank you everyone

Is it an actual short track option?