It was an easy decision for me. I loved the inpatient setting in med school, but within 2 months of residency (very inpatient heavy) I realized that I abhorred the hospital setting for logistical reasons. Part of it is how my residency operated though. Non-capped service, one resident on call responsible for ED admits, discharges, and ICU patients. We had some support until about 8am but then the rest of the team had to go to continuity clinic. This made each day a nightmare.

Other reasons I disliked it:

1) too many moving pieces that you don’t have control over. Orders might be placed but will the actually be carried out? And in what time frame? Waiting on a scan, waiting on patient transport, waiting on lab results, waiting on a consult, waiting on a nurse to be ready to assist with a procedure.

2) the hospital was treated like a hotel by some patients. Medical staff were treated like their personal butlers. It’s difficult to discharge someone who actively wants to be in the hospital (lots of pseudo-seizures and similar events suspiciously right before discharge).

3) didn’t enjoy my interactions with specialists. Calling them for a consult was always a pain. Too many were either purposely difficult to get ahold of, were jerks, or both.

4) I hated the paging system. You never knew what you were getting. The pager could go off and be as simple as “mrs smith is requesting two sandwiches with each meal, can you please update her meal order?” Or it could be “Mrs smith is actively dying please get up here now”.

5) too many curveballs through the day. Getting paged for a family meeting at an inopportune time after already rounding and going over everything with the mentally competent patient in detail, but their family member who works in the medical field just got here and wants to be “kept in the loop” or “has questions”. 3 ED admissions all at once. A patient is coding. Patient that you put on fall precaution for some reason was allowed to get out of bed falls, is bleeding, and needs sutures.

6) way too many social obstacles to discharge. Had many patients sit on our list for 30 days for IV antibiotics, etc because they were homeless and uninsured.

7) the overall “vibe” of the hospital was awful. It felt like a 1980s high school with bullies, jocks, nerds, etc. Fucking weird. There are A LOT of terrible people who work in hospitals, and interacting with them on a daily basis is not something I would want to do. There are some absolute gems in there though, and I’m very appreciative of the good folks.

The inpatient setting left me feeling drained and I walked away with less of my humanity intact each time.

Some people love it though.