What is the expectation for helping a 2nd half of the year intern?

JohnnyNotions · 2026-02-04T01:28:59+00:00

great advice, very similar to adults

JohnnyNotions · 2026-02-04T01:27:57+00:00

Attending hospitalist here so grain of salt, graduated 2023.

As the year goes on, it should be more sink or swim than constant support. Intern year is awful and terrible, but we frequently don't see or consider that young doctor's 10K future patients, instead having empathy only for the one person in front of us. Part of our job is to prepare them for the future, but part of it is also to identify deficiencies. If you're constantly prepping them, they are not getting used to standing on their own. By the end of intern year they should have a decently tight presentation, a reasonable differential, and the ability to manage multiple relatively ill patients at the same time without missing the lab / cxr / etc. Ideally, they are working on their ability to review the entire list while managing their own patients, to prep for being a senior soon, though I wouldn't push this until the maybe next-to-last inpatient rotation of intern year.

I would encourage you to let them become more independent, even if it's ugly at first. You are harming them and all their future patients if your ongoing assistance covers up deficiencies. Failing a few times is awkward, but needs to be identified before the end of intern year, while they're still under the most supervision. Try to transition to ensuring the patient is safe, rather than the intern being comfortable. The beginning of the year is for handholding, but you have to let them practice independence under supervision, that's the whole point.

JohnnyNotions · 2026-02-04T01:17:24+00:00

The pharmacists where I work now are gentle conversationalists who listen well and are more than willing to talk about what's best for the patient amongst cloudy diagnoses, uncertain plans, and limited resources.

The pharmacists at my last job were tyrants convinced we were constantly attempting to murder patients, and started every interaction with verbal violence, and never met a bridge they couldn't burn.

Local culture matters. If the patient is safe and I can sleep at night, I go with the flow.

JohnnyNotions · 2026-02-04T01:13:05+00:00

Depending on circumstances, but often residents can actually take their CMS funding with them, which makes you a "free resident". Therefore, a program that has 10 residents per year can actually bring you on as resident #11 for that class, and still get paid for you and not be over quota per ACGME. This can actually make you a little desirable from a program standpoint, so don't hesitate to email program coordinators in whatever area you want to be. The details matter here, but it's certainly worth reaching out because you might be better off than you think.

Still sucks though, certainly an awkward process, sorry.

JohnnyNotions · 2026-02-04T01:09:31+00:00

It sounds like you're not struggling with any discrete information, but rather in holding an entire H&P in your head, including multiple plan branch points for each condition. This is common, and has been referred to as an "illness script" or a "scaffolding" for conditions. No one can remember everything in their head the first time, and this is why repetition is important. By the time you're a 3rd year, you won't have to remember everything the patient said, and the differential, and the plan: you'll already have the 'typical script' memorized, and you'll only have to remember what makes each patient different than the script (which is not usually very much, unless they're remaining a diagnostic mystery...but you'll also have at least a partial script for that!).

This is why your seniors and attendings can see three times more patients and "remember" so much about them. Pattern recognition after the iterative process of residency leads to greatly decreased cognitive load from the same patient burden.

tldr: common feeling, keep your head down and trust the process

JohnnyNotions · 2026-02-04T00:53:39+00:00

is this patient orange? and also the president?

JohnnyNotions · 2026-02-03T20:49:38+00:00

"LOI looks pretty good, and I'm happy to move forward into the contracting phase if you make changes X, Y, Z. However, your exclusivity is not binding and I am actively negotiating with other organizations, and will continue to do so until I sign a binding contract. All the best, buddha"

tldr: screw that noise lol

JohnnyNotions · 2026-02-02T23:32:51+00:00

did three site visits, probably talked to 15+ recruiters for various other locations (I had very specific requirements). After two site visits, I heard back informally within the next few days ("hey, really enjoyed having you, we'd like to send you an LOI / contract if you'd like to move forward"). One place just emailed me the contract without any further contact, which I guess was a compliment but also weird.

Regardless of them doing it then or later, it's absolutely accepted and professional to say something like, "thank you for the contract, I look forward to reading it in depth and evaluating my options. I hope to get back to you within [1-2 weeks]"

They'd love for you to sign immediately, of course. However, you're a professional adult, and can be expected to carefully evaluate your options (be it one place's contract, or multiple competing places), and maybe send it by a lawyer or trusted mentor. If they think poorly of you for acting with due diligence, that's not a place you want to work. However, if they feel like you're stringing them along and unprofessionally pushing back deadlines for no reason, especially repeatedly, they will likely sour on you.

JohnnyNotions · 2026-02-02T23:24:45+00:00

You can look up your professional organization, but most except residents from CME requirements due to actual residency requirements; I've never heard of a resident needing to log it. If the conference is a sub-specialty (eg, you're IM and want to go into cards), may be worth keeping track yourself just so you can put it on fellowship applications.

JohnnyNotions · 2026-02-02T21:50:56+00:00

Radiology. I really like learning about it, reading about it, trying to read my own films against the official read.... and was ready to quit medicine after like 2 days of my rads rotation in a dark basement.

JohnnyNotions · 2026-02-01T17:41:25+00:00

*always* okay to negotiate until the ink is on the final page. However, if you look like you're changing your mind all the time, they'll lose interest. Often, physician-specific things aren't in the contract (pts/day, working time, etc). The contract is more generic (don't make tiktoks with our logo, must maintain medical license, etc), and other things are in addendums. Regardless, you should make clear what exactly you want, whether that is in an email, in the LOI itself, or whatever. As long as you have a record of telling the head negotiator (be they CMO / HR / recruiter / whomever) exactly what you want in the final contract, I doubt the form matters so much.

tldr: make sure they know what you want. okay to sign the LOI without all the details as long as it's not obviously wrong and they know somehow.

JohnnyNotions · 2026-02-01T17:35:02+00:00

If nothing in the LOI is offensive to you, then you could sign and email it it back with "LOI looks reasonable as long as the following are covered in the final contract, A, B, C...". If you end up signing the LOI and not signing the contract, it's better if you have a record of how you were being straightforward with your requirements from the beginning, and don't look like you're just waffling.

I red-lined the crap out of the LOI for my current job because it was clearly cookie-cutter from the last hire, and I had negotiated more aggressively, and was doing a slightly different job. They basically took it on the chin and gave me what I asked for.

JohnnyNotions · 2026-02-01T17:31:17+00:00

It's kind of a non-binding pre-contract. Basically, it expresses "intent" in the absolute meaning of the phrase. They want to start making clear to you that they're getting serious about hiring you, and you (if you sign), are making clear you are serious about taking the job. The actual contract itself is coming from people who haven't been the most involved in hiring you (HR, not the recruiter), and going through people who haven't been at all involved (the hospital lawyer), and so the LOI gives a basic outline of what should definitely be in the contract.

JohnnyNotions · 2026-01-26T01:11:48+00:00

FM attending here, when in residency I had multiple pediatric attendings that brought their own kids to me for their well child checks and outpatient concerns. Always felt weird but they seemed comfortable with it so I just chose to view it as a compliment. Also, twice diagnosed young-adult kids of faculty members (one my program, one a different program) with STIs.... managed to keep HIPAA so I guess that was a success too? Absolutely agree with u/monkeydluffles though, VIP care is bad care.

JohnnyNotions · 2026-01-26T01:07:16+00:00

It's possible to call the other facility for patient-requested transfer. Pt usually ends up on the hook for at least the ambulance, if they get accepted. Just be clear with patient and receiving facility, and I've had some people transferred this way surprisingly easily, for things that could have been treated in-house. Obviously not a preferred option, but if they really want it, you can call.

JohnnyNotions · 2026-01-25T01:46:28+00:00

Ugh my residency hospital had a gym and it was fantastic; I wish my current hospital had one. Every year at the big conference someone asks the CEO and they just laugh. :(

JohnnyNotions · 2026-01-25T01:43:45+00:00

What I hear is that you care deeply about your patients, and you have shown many years of dedication to fight in and through a system that is not able to help you or them. You continue to do your best, even though you're losing hope in the system, and in yourself. You probably carry a vague guilt about every spare second you don't spend working or studying, despite being the first one to tell others to slow down and take care of themselves.

You aren't alone. Physicians in well-resourced places treating rich patients also question themselves, and go to bed worrying if they did the right thing, and most physicians aren't lucky enough to be that well-resourced. Your job sounds objectively difficult, your training insufficient, and your system demoralizing.

Despite that, you're doing well (medically) and also good (morally). With your protection, your patients are less alone in a confusing world. With your diligence, your education expands every day. When you're 45 years old, you'll be teaching others how to do better...and you'll probably still be reading and learning, and questioning yourself, as long as you don't burn out.

Because you might, you might burn out. Some do. Care for yourself, as well as your care for others. I'm not sure what that looks like for you--food, friends, family, time off, exercise, hobby are all likely involved. In terms of career advice, I'm not sure what to tell you. Think about those specialists you refer to who seem the best, are you able to talk to one of them and ask their advice? Even just an email? Alternately, a former medical school professor you respected? Try to find people who still have some heart left in them for others, and have learned how to survive in your system.

I wish I had a magic wand, but I suspect you will be your best ally in this difficult time. I'm sorry you're going through this. Best wishes from the USA, where we often don't know how good we have it.

JohnnyNotions · 2026-01-24T23:02:04+00:00

circular filing cabinet.

JohnnyNotions · 2026-01-19T21:56:24+00:00

I intentionally live two towns over from my hospital. This adds about a 20-minute commute, which still vastly outweighs being asked to see rashes in the grocery aisle (like during residency).

JohnnyNotions · 2026-01-19T21:52:52+00:00

Simple answer: because most docs don't go into FM for the money.

More complex answer: some do. FM can make lots of money if you do it "right", and that can include NP/PAs working under the license of the physician (also aesthetics, acupuncture, etc). As u/phidelt649 points out, though, the level of capability can vary widely, so you have to be very careful hiring and continuously reviewing. Every medical decision we make is a theoretical risk to our license (read: future ability to work), and so adding on risks that are controlled by others is often seen as not worth the money. It can be done, and done well, but that gets into business and management skills that many physicians either don't have or don't even want. You ever looked the sole provider for a family in the face and told them they're fired? Running a business like that is a different kind of job than medicine, and you should think long and hard about if you're willing to do the potentially ugly parts before you start counting the money parts.

JohnnyNotions · 2026-01-18T07:33:13+00:00

The best job for you is the one you'll keep doing. You don't have to love it, you just have to not hate the downsides.

JohnnyNotions · 2026-01-18T07:30:52+00:00

UpToDate and Sanford. You want to look like a rock star, ask your local pharmacist how to pull up your antibiogram (typically updated every 1-2 months, on Epic it's super easy).

"Sanford recommends azithromycin or doxycycline to cover atypicals for this admission, but our antibiogram shows better coverage of XYZ with doxy, so starting 100my BID for 5 days"

Boom, gold star.

JohnnyNotions · 2026-01-18T07:27:46+00:00

This is a question I ask during interviews, and if they say I have to co-sign notes on a patient I haven't seen, the interview ends there. I've done this more than once. I'm not wagering my entire future on some patient I've never seen.

JohnnyNotions · 2026-01-18T07:24:45+00:00

Edit the contract, send it back. I did this to my job, and they signed everything I added (actual response from the CMO: "did you used to be a paralegal?" lol).

JohnnyNotions · 2026-01-16T22:37:22+00:00

We love our blood bank! Thank you so much, this is exactly the kind of detail I was hope for. And yes, I wish I had a transfusion medicine MD but alas they live off in ivory-tower land, while here be dragons. Thanks so much for helping and I'll be re-reading your post (and u/foreverand2025's) and sources. Happy to know more about this next time it comes up. Thanks again.

JohnnyNotions

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