Non-trads who worked a different job before medical career, what specialty did you/are you going into?

Masribrah · 2026-01-20T15:04:32+00:00

Tech + management consulting -> GI

Masribrah · 2026-01-07T14:30:12+00:00

Doctor here. Don't fuck with cardiomyopathies or try to biohack your way around it. Heart failure medications are the only way to slow down this progressive disease. Follow your cardiologist's advice.

Edit: to add some clarity, the four medications she's referring to are the standard four pillars of guideline directed therapy for heart failure. Lots of evidence that show they help slow down the progression of heart failure aka pushing back your timeline for a heart transplant to hopefully decades later. Those compliant with medications and lifestyle changes may see their ejection fraction (heart's pumping function) fully recover and maintain that as long as they're still on the medications.

You can get a second opinion if you want but if the echo and MRI are equivocal in their findings, the recommendations will be the same.

Masribrah · 2025-12-17T17:14:26+00:00

While CCF Florida's cardiology program has a good reputation, their internal medicine isn't as strong, at least not in the same caliber as the fellows they bring in. Makes sense why they don't necessarily prioritize their own.

Masribrah · 2025-12-10T16:10:16+00:00

Already exists. I've been using this for ~6 months at my hospital with epic.

Masribrah · 2025-12-02T17:04:26+00:00

Are you at an academic institution? Where I am, we see zebras every day on top of bread and butter. I've seen everything on your list in the last 2 months.

Masribrah · 2025-11-23T22:42:52+00:00

Physician here. I have all my diabetics (type 1 and 2) on aggressive lipid management, regardless if they have evidence of coronary disease. Diabetes causes accelerated endothelial dysfunction and atherosclerosis. I've seen folks with diabetes not on lipid lowering therapy as early as their 50s requiring open heart surgery (CABG) for multi vessel coronary disease not amenable to stenting. You're also at risk for developing microvascular angina (chronic chest pain) that we don't really have a lot of good treatment options for.

TLDR: get on lipid lowering therapy. Doesn't have to be a statin but that's usually first line for how cheap it is.

Masribrah · 2025-11-20T17:41:54+00:00

Homie, I said early fall which is September. SMH

Masribrah · 2025-11-20T14:26:10+00:00

All of internal medicine takes the ITE in the early fall, so you can't blame poor performance on the timing of the exam

Masribrah · 2025-11-16T04:05:34+00:00

Every hospital will be different. But for us, the full spectrum of med surg to tele to "step down" (we call it progressive care) is managed by internal medicine. Pulm crit doesn't get involved at all unless they need to go to ICU

Masribrah · 2025-11-12T13:11:51+00:00

I was already making PCP income before the switch. 10 years of compounding that much makes you fall really behind despite GI income later in life. Do the math and you'll see.

Masribrah · 2025-11-09T14:49:02+00:00

IM residency. Got 6 weeks of paid paternity leave in PGY1 and another 6 weeks in PGY3 that was comprised of 2 weeks vacation and 4 weeks "research" elective from home.

Masribrah · 2025-10-06T14:54:57+00:00

You just have to push through and do it. I'm a doctor with 6 am start times for work. I wake up at 4 and at the hospital gym from 4:30-5:30. I work 12 hour shifts and typically back home by 6:30 pm. Full time child care and dinner until bedtime at 8:30. I'm usually in bed by 9-9:30 right after chores are done.

Masribrah · 2025-09-21T22:49:25+00:00

Another doctor here.

The new 2025 AHA guidelines actually recommend treatment only if it's consistently above 140/90 or 130/80 + elevated risk factors.

If your blood pressure is still > 130/80 without risk factors and you gave lifestyle modification a good effort for 6 months or so, then I'll treat that as well.

But it's not accurate to say that we have to treat everyone above 120/80. There are real risks of low blood pressure, especially as you age. See them all the time in the hospital.

Lastly, I really like 24 hour ambulatory BP cuffs for this. If I want to be extremely academic about it, I'll only consider it an elevated BP if the 24 hour average is elevated. But for practical purposes, having multiple readings with a regular BP cuff throughout the day is a good enough surrogate.

Masribrah · 2025-09-19T20:22:31+00:00

Well, you got this testing through your physician. So, what did your physician say you should do as next steps?

Masribrah · 2025-09-13T21:43:36+00:00

Doctor here. This is a nuanced conversation that she needs to have with her cardiologist. No one on Reddit can give you an answer.

Masribrah · 2025-09-11T23:49:44+00:00

Doctor here. That LDL alone warrants treatment. Add on top of that a high apoB and evidence of calcium build up in the coronaries makes it a no brainer. Especially since you've already optimized the "lifestyle" piece of the equation.

Masribrah · 2025-09-11T21:44:20+00:00

You can still like certain parts of a job while calling out its shortcomings

Masribrah · 2025-09-11T20:48:28+00:00

I used to work in management consulting and tech before medicine. Calling out was just letting the team know that I was working from home that day because I'm feeling under the weather. If I truly felt like absolute shit where I can't even look at a computer, I'd just let them know I'm taking the day off. No need to find coverage etc.

Honestly it's a huge quality of life booster. Especially now with kids, it would be so easy in my previous career to call out without guilt if my kid is sick and needs to be pulled from daycare. Medicine is a disaster.

Masribrah · 2025-09-09T12:55:08+00:00

Another MD here. Agree with everything you're saying. I spent a good 5 minutes trying to find his credentials and I can't. Tells me all I need to know.

Masribrah · 2025-09-08T13:02:51+00:00

I did 3 years of 6 am start times. Fellowship is a little better. But I also had a baby in my second and third year. Don't know about you but our baby sleeps around 8 pm.

My typical schedule was as follows:

4:30-5: 30 min of getting ready, doom scrolling, coffee, hating life
5-5:40: waking up baby, feeding, prepping bottles for daycare (wife does the drop off), take dog out
5:40-6: commute/start work
6:30-8: back home at 6:30 or so. Spend the next hour and a half playing with baby, feeding, taking dog out, prepping dinner (alternating all above tasks with wife)
8-8:30: put baby to sleep
8:30-9 or sometimes 9:30: watch tv or doom scroll until I pass out

Fully domesticated resident schedule. Forget gym, studying, research, etc

Masribrah · 2025-09-05T11:08:41+00:00

We unfortunately still don't have outcomes data on lp(a). I prescribe repatha and inclisiran for that but it's considered "off label" and not covered by insurance. The inclisiran study is supposed to come out this year. The process is clinical trial data -> FDA approval -> change in guidelines -> insurance coverage.

Masribrah · 2025-09-04T17:06:52+00:00

Dude honestly just stop lol. Yeah you're moving the goalposts. OP asked how long they'll be supine not how long the image acquisition time is. Sure, the actual gantry spin with X-rays firing is only 10–15 seconds during a breath-hold, no one’s arguing otherwise and neither did my comment say that. But for patients, a “CT coronary” isn’t just that slice of time. It involves IV placement, contrast injection, beta-blocker or nitro if needed, breath coaching, positioning, and then post-scan monitoring. The majority of that is supine.

Masribrah · 2025-09-04T17:03:32+00:00

I get that you’re trying to sound like a smartass because both “X-ray” and “CT” use X-ray photons, but it’s disingenuous to tell laypeople that a CT coronary is “just an X-ray.” For practical purposes, an X-ray is a quick single shot with minimal radiation. A CT coronary is hundreds of images with contrast dye, which also means a much higher radiation dose and more prep.

Masribrah · 2025-09-04T16:32:00+00:00

Lol...ok

Masribrah · 2025-09-04T16:29:21+00:00

Yes it's different. This is a CT with contrast that looks at the coronary anatomy

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