We (residents) take home-call on nights and weekends for a bunch of nursing homes around the hospital. Per “protocol,” nursing home staff have to call and report everything to the physician on-call. It’s just a liability sponge and our hospital is surely well-compensated for it. However, I may jump into the ocean with a cinderblock if I have to do this another night. Typical weeknight calls when working a 14-hour shift the next day:

8PM: 87-year-old female with an itchy mouth for 3 weeks, deciding to call right now

8:30PM: non-bleeding skin tear appropriately bandaged, had to report per protocol

11PM: patient felt nauseous, just gave some previously ordered PRN zofran

1AM: 96-year-old refused his bedtime atorvastatin

2AM: Cramping leg, any suggestions doc?

4AM: Patient sat down on the ground. No pain. Just felt like sitting. Had to let you know since it’s protocol!

I have not read the protocols, but goodness do I know they don’t need to be calling in the middle of the night with these issues instead of waiting to report them in the morning.

Anyway, anytime I get a call like this, I’m asking for vitals. Full set. Freshly obtained, please. Sometimes I get pushback. They ask, “you want me to go get vitals? I’m just letting you know they refused meds. Why do you want vitals?”

“Protocol,” I answer.

If you guys are on a 24h shift, I often feel the need to shower before trying to crawl into bed even if it’s for 1-2h of sleep. The shower is available but it’s a shared bathroom between everyone overnight in that unit (aka attending, fellow, resident and APP) so 3-4 people share that bathroom. But there is a shower in there. Is it weird if I shower on my 24? I just feel so gross by 8-9PM and want to wash my body.. especially if I’m trying to sleep a few hours here…

Edit: I feel my cooch gets a ‘vagina’ smell more prominently if I don’t shower. So when I show up to a rapid response at 430AM (~24h after I last washed her) I feel my cooch lights up the room lolol

Program Coordinator here. I see what you go through every day (and night). It's so hard, the path you're on.

Thank you for becoming a Physician. It's only because of you that my family and I have the health and quality of physical ability we do.

Thank you for tolerating the endless "constructive" criticism you get. I know it is often (but not always) very useful feedback, because it makes you an even more effective Physician, but thank you so much for being strong enough to face those interactions and your willingness to be introspective.

Thank you for finding ways to get through the ridiculous bureaucracy of GME requirements. It's absurd that I am required to make you do that pathetic module on Infection Control every damn year. But thank you for hanging in there and doing the stupid module, because checking that box gets you one step closer to being done with the absurdity of GME requirements.

Thank you for all you teach me. I watch you, year after year, and I learn so much about dedication, about going out of one's way to help ease another's pain, and about perseverance.

I am in awe of you. Most people have no idea what it takes to become a Physician. Thank you for being willing to go through this.

We have a new guy here, smells like shit, I’m just gonna say it. What the hell does he eat, MEATBALL PARM SANDWICHES 24/7? I’m not even talking about his farts. This is literally his fucking sit-down air that he’s polluting near me at my desk! PSA FOR ALL, WASH YOUR ASS BEFORE SHIFT!

I’m in my mid-30s and a neurology subspecialty fellow. Throughout college, med school, and residency I found one thing about myself that is a major weakness. I’m definitely not the type to initiate unprofessional behavior but I am the type to return unprofessional behavior to the person who starts it. I am very patient in almost all situations except someone who starts acting rudely and inappropriately. As a PGY-4 I snapped at an attending who was yelling at me during rounds for not testing reflexes on a patient who was there for DHE for a migraine. This attending had a track record of always yelling at residents and as an adult in my mid-30s who was close to be an attending I felt the need to stand my ground and not be yelled at like a child. That attending backed down and never did that again but looking back it was a terrible idea.

Currently doing fellowship at a different institution and really go into it with a nurse practitioner on a service who needed a consult from us. I saw the patient and told her our recommendations and she disagreed with them (unprofessionally) despite me patiently explaining it over and over. So I calmly just spoke with her attending and never heard from her again. Two years ago I would have snapped back pretty hard.

DR resident on IR rotation. I actually like IR. I previously did surgical specialty sub-Is and hated it compared to DR, but overall think it's a good personality fit if I did IR. However, DR is the absolute best job in medicine and no other field comes close to the amount of control you get over your workflow.

Feel like a lot of faculty on the IR rotation have mixed thoughts on DR. They especially hate people reading from home lol.

I would have expected a higher degree of collegiality to be honest.

Do your seniors jump in while you are presenting to attending while on nights?? Or only my seniors are super enthusiastic? Please help how to politely tell them to shut their mouth. And if i really do miss something my attending will ask me and then i will have a chance to explain it more. I really hate how seniors are intruding in between before i even complete the presentation.

Is it the same everywhere?

Serious answers only.

I feel like there's been an increasing uptick of people mentioning this complaint and I have no idea where to start with it. Just got otherwise healthy 40-60 year olds saying they have brain fog but aren't able to describe any tangible symptoms other than not functioning at work as well as they used to or being a bit drowsy during the day. And no, they generally aren't talking about ADD symptoms, as if we need any more tenuous ADD diagnoses in people with no prior history.

I just don't have any idea where to start when this gets brought up and it's happening more and more these days.

Edit: Appreciate all the input and different avenues to consider. It is somewhat amusing that the vast variety of possible concerns reinforces the idea that the complaint could literally be anything.

I'm a 2nd year IM resident. My mom (who is also a physician, though not in an IM-adjacent subspecialty) developed an infection and needed to be admitted to the hospital. I'm frustrated with her because she is convincing her team to do things that I really don't think are indicated.

Her infection is one that is generally treated with several days of IV abx followed by longer course of oral antibiotics once the patient has improved clinically. One of her old friends who is an ID doc in another country convinced her that she needs multiple weeks of IV despite this going against IDSA guidelines (she is also improved clinically, can take PO now) and she somehow convinced the ID doc at her hospital to place a PICC line for a multiple week course of IV.

She developed aFib that resolved with fluids and a small bolus of metoprolol. Despite TTE not showing any structural issue and the hospitalist recommending outpatient follow up, she demanded a cardiology consult inpatient who just recommended outpatient ziopatch and follow up as expected.

Her LFTs have been elevated in the setting of infection but downtrending. She asked for a RUQUS which was normal so is now asking if she can have a CT to make sure. I tried to tell her that follow up labs in a month should be a good starting point but she basically said "i'm not waiting that long, I need to know".

This is clearly coming from a place of intense health anxiety as this is a major infection in an otherwise healthy person that came out of left field. I've been trying to figure out why I'm feeling so frustrated towards her. Maybe it's because I tried at first to reason with her about more conservative management and I became defensive when it became clear she didn't want to hear what I was saying. Maybe it's because I have a lot of discussions with patients like her who want aggressive management/workup when it's not indicated and I am a bit horrified to know she is one of those people who can act entitled and demanding.

I feel really guilty because I love her and I understand where this is coming from. I also wonder if I'm being too critical and maybe what she's asking for is reasonable. It's just been frustrating to watch and at this point I'm just saying "sure, sounds good" when she says she wants something else worked up that's probably unnecessary. Anyone else struggle with family members or friends like this?

Towards the tail end of my residency here and I find myself experiencing a kind of weird sadness that I didn’t leave much of an impression. Like I flew under the radar too much.

I know I’ve come a long way from where I started - not just personally and mentally, it was a tough environment that came with its fair share of academic and professional curveballs, and tested me physically and emotionally. I pulled through. People liked me. I dealt with interesting and rewarding cases, did procedures, and made amazing friends.

There could’ve been so much more though. So much wasted opportunity to… really dig in, explore and challenge myself - especially with research - and make more of my time outside the hospital. Wasted potential and all. I guess I wish retrospect could be more forgiving, but it’s making me restless and morose.

I want to be able to celebrate the growth and progress I experienced in my individual capacity but it seems to be overshadowed by this bleakness that I’m not leaving a mark, which is funny and maybe just a vain and self-pitying way of manifesting validation.

Very long rant ahead!!!
I’m so fucking tired of this system. I have ADHD and work in an extremely cognitively demanding specialty and somehow one of the most exhausting parts of my month is accessing the medication I’ve been prescribed for years. I have been on a medication for a long time before moving states for residency but after switching insurance, I had to switch to the generic because the brand wasn’t covered. Fine. Except now the generic is constantly unavailable, on backorder, or only in stock at some random pharmacy over an hour away. So every month, I get to play this stupid fucking game of calling pharmacies, figuring out who has what in stock, hoping they still have it by the time my prescriber sends the prescription, and then praying that insurance actually covers it. And because it’s a controlled substance, there are additional restrictions and hoops to jump through at practically every step. if the generic isn’t available? Well, the brand is excluded from my formulary. I ended up paying over $700 out of pocket for two months of medication because I literally could not get the alternative my insurance supposedly covers.

When I called insurance to explain this, I was basically told there was nothing they could do. Oh, and apparently I could just ask my doctor to switch me to a different medication. Because that’s how medicine works, right? Just randomly switch medications that someone has been stable on because an insurance company decided it doesn’t want to pay for them. The irony of being a physician and having to explain this to a health insurance company is genuinely fucking insane.
I’m already working ridiculous hours, constantly switching between days and nights, studying outside of work, and trying to function on whatever sleep I can get. I work in an environment where I feel like every single shift is an evaluation, every decision is being scrutinized, and every mistake could potentially be used as evidence that I’m not meeting expectations. You’re expected to show up and perform at 100% every single day. You’re expected to be efficient, confident, knowledgeable, emotionally regulated, professional, and somehow immune to exhaustion.

Having a bad day? Better hope nobody notices.
Struggling? Better not let it affect your performance.
Need time to take care of your own health? Good fucking luck.
Meanwhile, I’m spending what little free time I have calling pharmacies and insurance companies, trying to appeal coverage decisions, coordinating prescriptions, and figuring out whether I’ll even be able to get my medication next month. And here’s the part that makes the whole situation especially ridiculous: ADHD affects executive functioning. So I’m expected to use the very executive functioning I struggle with to navigate an unnecessarily complicated system just to obtain the medication that helps me manage it. I also don’t have a partner or family member who can take over these tasks for me. There’s nobody I can ask to call five pharmacies while I’m at work or spend hours fighting with insurance. It’s all on me, on top of everything else.
And throughout all of this, I’m still expected to show up to work, take care of people, make sound clinical decisions, and never let any of it affect me. I’m just so fucking tired of being expected to function like a machine while being treated like my own health and well-being are an inconvenience.

Anyway, that’s my problem but needed to just let it all out somewhere.

Wondering how everyone else who takes stimulant medication schedules it around call shifts and post-call days.

IM PGY1 here and I have been taking my Vyvanse at 7:00AM as usual the morning of my call shifts, which usually gets me through til 5pm on a regular day, but obviously doesn't last overnight and I really struggle to organize my thoughts for late night consults and morning handover. And then I go home and sleep for three hours and then struggle to wake up and be productive and not doom scroll/continue to sleep until the evening. And then I mess up my sleep schedule for the next day, rinse and repeat until the sleep debt accrues.

Are y'all taking a bonus dose the afternoon of your call shift? Or another full dose closer to handover? Or when you get home before falling asleep?

Genuinely, how do you do handoff for patients that are not yours? I am an IM intern.

On my long call days when another intern signs out to me and leaves, I fumble so hard to sign out their patients to the night team. I know my patients very well so those are easy, but when I get to a co interns patient, I have no idea what to say besides a one-liner and any explicit tasks that they told me to tell night team to follow up on. I can feel the night team waiting for more history/plan that I just don't have.

Do I need to read up on their patients before sign-off? I feel like I have no time for that between the afternoon admits/answering nursing messages/ putting out fires. Do I just pay more attention during rounds to everyone's presentations? Please help

My wife and I are currently living in New York City. She is in J-1 status and works as a research associate at a medical center, and I am in J-2 status.

We are trying to extend our health insurance coverage for one additional month. Unfortunately, we have had difficulty finding a suitable insurance plan because several providers do not accept applicants who are already living in the United States, particularly in New York.

My main concern is that we might have a two-day gap in our health insurance coverage while arranging a new policy.

My questions are:

1. If our insurance expires, what are the potential consequences of the two-day gap?

2. Could such a short gap lead to termination of our J-1/J-2 exchange visitor programs or affect our immigration status?

3. Could this affect my wife’s employment at her institution?

4. Are there any other insurance providers that accept J-1/J-2 holders who are already living in New York and need only one additional month of coverage?

I would really appreciate hearing from anyone who has experienced a similar situation or has knowledge of the regulations.

Four months into residency and I need to get this off my chest.

I’ve honestly had a great experience with almost every senior I’ve worked with. They teach, they have your back, they make the long days easier. But there are two who I just don’t get. All they do is talk about other people. Every single shift it’s who messed up, who’s lazy, who doesn’t know anything. And somehow they have a problem with 18 out of 20 residents. At some point you have to ask yourself if the problem is everyone else or if it’s you.

The worst part is it never stops. Every question turns into “well, if I were you I would have done it this way.” Every conversation turns into tearing someone down. I’ve been thrown under the bus more than once, and I know the second I walk out of the room I’m the next topic.

Be the senior people actually want to learn from. Teach. Correct people to their face, not behind their back. That’s it. That’s the whole job.

I really try not to tell docs I’m a resident bc I don’t want them coming in with assumptions. That being said I’m pretty sure it’s on my chart because they all know. Anywho PLEASE FOR THE LOVE OF GOD STOP ASKING ME WHAT I WANT TO DO JUST TELL ME. I am at your office because I DONT KNOWWWWWW. Literally hate when they’re like well what do you think. Girl I don’t wanna think right now. If I had an opinion I would bring it up. Let me be a patienttttt.

I want some practice with cases before starting call. Casestacks seems pretty expensive but I heard it is highly recommended. Does anyone have a referral code? Or should I go with navigating radiology?

Am an atheist but patient asked me to pray with him. Faked it but it meant a lot to him. Am a terrible person.

IM intern here,
I struggled a lot with IM
I worked with ton of colleagues, by far im the worst, even other rotators/prelim ( I mean even people who dont like medicine are doing better). I hate being heavy on my team or to put extra load on my senior/attending, i feel embarrassed every single day. Especially when i got asked about one of the patient and i dont know the answer while my senior knows.

My biggest problems are attention and memory, i forget major things immediately after i read them which consume my time. I also found myself feeling down and stressed

For people who went to the same problem, what did you do ? Did you quit ? What happens ?

I will update my post to provide further details:

I was a diagnostic radiology resident at an ACGME-accredited program, and my contract was not renewed before my final year of training. It's a complicated situation, but I'll try to summarize what happened and why I believe the decision was unfair.

The program cited deficiencies in several ACGME competency areas, including Medical Knowledge, Practice-Based Learning, Systems-Based Practice, and Professionalism. They alleged issues with my clinical performance, efficiency, productivity, responsiveness to feedback, educational participation, and compliance with departmental expectations.

I acknowledge that the program had raised concerns about my performance previously and that I had been placed on remediation plans. However, I strongly dispute several of the allegations used to justify the final non-renewal decision, particularly because I believe some are contradicted by documentation.

My main concerns are:

1. Inadequate evaluations and feedback: Throughout my training, I was not consistently provided with formal CCC assessments or milestone evaluations for review. During a substantial portion of my final year at the program, I also did not receive timely written evaluations documenting my performance. I believe this made it difficult to understand exactly where I stood and what specific improvements were expected.
2. Inconsistencies regarding my training progression: At one point, the program decided I needed to repeat a year of training. However, the initial communication regarding this decision was unclear, and there were inconsistencies between my official training classification, rotation assignments, and how the program subsequently treated my progression. I also have concerns about whether appropriate written notice was provided.
3. Disputed productivity and clinical performance allegations: The program raised concerns about my workflow, efficiency, and reporting turnaround times. However, based on the available records, my clinical productivity was comparable to, and sometimes exceeded, that of other residents. I was also routinely assigned substantial senior-level clinical responsibilities, which I believe raises questions about how the program characterized my overall performance.
4. Professionalism allegations and inconsistent enforcement: Some of the allegations involved departmental practices, including workstation usage and participation in educational activities. I dispute several of these claims and believe certain expectations were not applied consistently among residents. I also have documentation that I believe contradicts some of the allegations.
5. Concerns about the remediation process: Although I underwent remediation, I believe the process lacked clear, consistently communicated, and objectively measurable expectations. In my view, I was not given a sufficiently transparent opportunity to understand how my improvement was being assessed before the decision to end my training was made.

Eventually, the program issued a formal non-renewal notice. I challenged the decision through the institutional grievance process, presenting my concerns about the evaluations, procedural inconsistencies, and factual inaccuracies. Unfortunately, my grievance was denied.

Despite the non-renewal, I subsequently obtained an official letter from my program director confirming that I had successfully completed my documented training through the preceding postgraduate level. I also have a completed preliminary year in internal medicine and have passed all three USMLE Steps on my first attempt.

What makes this particularly frustrating is that I was extremely close to completing residency, yet the decision effectively prevented me from pursuing board certification through the usual pathway.

I understand that residency programs have considerable discretion in evaluating residents, and I'm not claiming that every concern raised about my performance was baseless. However, I believe the final decision relied partly on disputed allegations, inconsistent expectations, and a process that lacked sufficient transparency and timely feedback.

My main goal isn't financial compensation. I simply want an opportunity to complete my remaining year of residency and become board-certified.

I've already explored the internal grievance process and consulted legal counsel, but I'm now trying to determine whether pursuing litigation or negotiating reinstatement would be realistic.

I'd especially appreciate hearing from anyone who has dealt with residency non-renewal, successfully challenged a similar decision, or has experience with attorneys handling these cases.

Recently finished a week of nights and am stunned by the phone call volumes and constant interruptions. It’s honestly unsafe how frequently we get interrupted and most certainly leads to missed findings, report errors, and delayed reads. I’ve started to ask people to call me back especially if it’s for a wet read, but often this isn’t enough. I’ll just get another phone call in 2 minutes from a tech or someone else who needs a wet read.

Next night float I’ve been considering just not answering the phone until I’m finished reading the current study I’m working on. It really just doesn’t feel safe to be interrupted constantly and I don’t understand how it’s normalized for us to be phone monkeys while trying to make critical findings. The team will come in person to us for cases like trauma which of course we drop what we’re doing and prioritize.

I can't help but compare myself to my co-intern. She's so smart, efficient, and always on top of her patients. Attendings and seniors are always praising her while I'm just there lol. I feel like I'm barely surviving each shift and trying to get my orders in, while she makes everything look so easy.

I'm genuinely happy for her, but it makes me feel like I'm so behind. I know I shouldn't compare myself to others but it's hard not to. Anyone else feel this way during intern year? Any advice?

Reposting here for more exposure -

Now that I’m a physician, I’m very aware of the fact that my phone number and address can be easily found online. After hearing about that pediatric intensivist that was recently killed because someone broke into his house in the middle of the night, I’m trying to get my info off the internet so my patients can’t find it. Has anyone done this before? Did you do it through paid services and if so which ones? Thanks!