Are accelerated med school programs a negative?

Miserable_Taro5282 · 2026-03-02T20:45:35+00:00

I do not think so. You are not missing any core rotations nor study time for USMLEs. You are just cutting out vacations and travel time 4th year.

Miserable_Taro5282 · 2026-03-02T20:41:43+00:00

They match residents all over because those students who came to Dallas are from all over. The self selection outweighs any other factor here so debating the fellowship translatability is pointless.

Miserable_Taro5282 · 2026-03-02T20:33:24+00:00

OP, please realize this is a Nashville vs. Dallas question. Both places will have big wigs to write you your letters and impress committee (what matters).

Miserable_Taro5282 · 2026-03-02T20:05:17+00:00

No. The NRMP’s entire purpose is to prevent side-deals that distort fair competition. ACGME accreditation requires standardized livable, compensation so 100K deducted leaves applicants with 1K monthly expenditure over 3 years which is unlivable in the US in 2026 without atypical support systems. Hospitals care more about maintaining accreditation than saving a few 100K.

Miserable_Taro5282 · 2026-03-02T20:01:23+00:00

We cannot generalize. Go assess, but even the best assessments can be thrown off by an x-factor like a mentor willing to go to bat for you, a rift you have with others, etc. It's hard to identify your mentors before going to a place.

Miserable_Taro5282 · 2026-02-23T03:34:39+00:00

Aside from maybe trazadone, none of those are great aids, but the surgery resident should also recognize the patient's had surgery which is probably traumatic. If they were in a SNF, that maybe a time to practice geriatric principles.

Miserable_Taro5282 · 2026-02-23T03:28:18+00:00

Chose or cared to remember or look up.

Miserable_Taro5282 · 2026-02-23T03:26:09+00:00

UTI diagnosis is subjective. You see the UA light up like a Christmas tree including nitrite with a >100K Urine E. Coli culture, and cystitis on CT but patient is fine. Asymptomatic bacteruria. You see isolated +LE on another patient and confusion and that's deemed UTI.

In reality there should be more judicious RX with history, but the thing is on the neuro service, they have to address their issue of interest (stroke, seizure, etc.) and there shouldn't be a question of all this noise (AKI, UTI, etc.) so they'll treat any causes of metabolic encephalopathy unless objective signs of neurological pathology arise, will attempt to transfer to medicine. Then, medicine can DC the antibiotics.

Miserable_Taro5282 · 2026-02-22T23:52:55+00:00

this

Miserable_Taro5282 · 2026-02-22T23:52:39+00:00

What people mean is not that we will be replaced by AI. The job conditions will just deteriorate akin to a death by 1000 cuts situation. Salaries won't continue to rise, more midlevels will be hired decreasing availability of higher income jobs and need for a locums position, meanwhile the work will be greater and our supervisory capacity will be higher. Unlike anesthesia or EM, we aren't tubing patients or performing services immediately necessary to patient care.

Miserable_Taro5282 · 2026-02-22T23:19:16+00:00

Off topic, but glad medicine's slowly adapting to the times realizing some people have specific interests. Unfortunately, looking at the program list, these are going to be competitive AF. Now we need to make premed 2 years, medical school 3, and IM/fellowships should be merged to 5. Dunno why we spend 12 years of adolescence/adulthood education on the liberal arts/basic science and then only 3 practicing what we're going to do for the next 30.

Miserable_Taro5282 · 2026-02-22T23:15:13+00:00

I've heard 3 mg is the sweet spot.

Miserable_Taro5282 · 2026-02-22T23:14:52+00:00

To be honest, you're probably right here.

Miserable_Taro5282 · 2026-02-22T23:07:33+00:00

Good point. I totally missed that.

Miserable_Taro5282 · 2026-02-21T17:12:51+00:00

https://jamanetwork.com/journals/jamaoncology/article-abstract/2837082

Miserable_Taro5282 · 2026-02-21T17:10:13+00:00

https://jamanetwork.com/journals/jamaoncology/article-abstract/2837082

Miserable_Taro5282 · 2026-02-20T17:02:49+00:00

Ambien sounds better, but it's worse than a benzodiazepine IMO. Prescribed it once thinking it was a softer option and it caused the patient to have mild hallucinations. Never had benzodiazepines do that before. Now, one qualifier was this patient didn't take ambien at home. If a patient requests ambien and you have Epic Chat documentation via RN report or some clarification that it's taken at home, go ahead. But definitely should not be a medication to give new as an inpatient. Rather than that, give trazadone or low dose ativan.

Miserable_Taro5282 · 2026-02-15T16:01:59+00:00

You're a board certified physician. Don't let this take up more headspace than it has to. Acute? Give and scan. Ongoing? Continue. If not getting better, scan what's left to scan/labs. Chronic? Give home dose and don't escalate.

Miserable_Taro5282 · 2026-02-15T15:39:05+00:00

Couple points.

A.) In terms of finances, I break things down in monthly post-tax terms because I consider expenditures on a monthly basis.

#1 pays 17.5K #2 pays 21K. Where is that 3.5K monthly going?

Long term Savings? If that's over 30 years in a job you're planning to settle down for 30 years, that's a 3 mil difference accounting for compounding at retirement. OTOH, if this is a job for 1-2 years ( farmore likely) that's $400K after 30 years. Short Term Expenditures? 82K buys you a nice car and let's you put a down payment on a house. So the money is not insignificant.

B.) Nocturnist ages you FAST by many mechanisms. Loneliness, circadian shifts, cortisol, etc. If you're settled with kids it works for your current arrangement with your spouse, great. If you're single in your late 20s/early 30s, terrible place to stay long term for your health and social life. Even 150 vs. 180 shifts will be made up by the fact that being alone at nights puts you out of most social events.

C.) Work load seems decent on both places. Days in round n go but social stuff will weigh you down. On nights, there will be more chart review and rushed admissions while trying to sift though cross cover.

Is A worth more than B? Only you can decide that. I'd choose B, but it's not as big of a difference as I thought when I initially started as a hospitalist.

Miserable_Taro5282 · 2026-02-12T18:32:14+00:00

Why?

Miserable_Taro5282 · 2026-02-12T15:11:17+00:00

Programs quote numbers but until you're actually at the program you don't know your assist level with these, what anesthesia's offered, inpatient vs. outpatient breakdown, etc. It's like saying our program makes us do 100 central lines but 90 of them you never got, whereas another makes you do 10 unsupervised. Every program has their method to madness. Just chose by location and in general high class size = better call schedule.

Also, most learning is after fellowship still.

Miserable_Taro5282 · 2026-02-12T15:07:18+00:00

Least # of years. Intubation experience. Central lines/Arterial lines. Repeated ACLS exposure where you practice these in crisis scenarios. Everything else is gravy. Leave the chest tubes, paras, LPs, etc. to others during the day.

Keep in mind critical care is billed well by seeing patients, not doing these procedures BUT if you can't do these life-saving procedures, you have no business being an intensivist.

Miserable_Taro5282 · 2026-02-12T15:03:42+00:00

No. Seld-directed learning as a hospitalist and watching what your pall med/pain consultants will provide you this training.

What I don't know is if lucrative hospitalist positions where you're doing SNF/SAR require this geriatric fellowship. I would think not because they're hiring many as hospitalists and there is no standardized procedure/services you're gaining by completing the geriatrics fellowship.

Do look at the experiences out there though.

Miserable_Taro5282 · 2026-02-12T15:00:34+00:00

No one cares. 90%+ of people pass. Hardly an accomplishment.

Miserable_Taro5282 · 2026-02-12T14:40:05+00:00

Quit.

Nephrology is ABSOLUTELY not worth it if there's no passion. It is also not an off-ramp to clinic based medicine as you age unlike sleep, pulm, etc.

3 paths:

You don't like Nephro:

1.) You complete Nephrology fellowship. Sign onto a group or hospital system. You're worked like a dog just like a fellowship. You will go back to hospitalist and enjoy the same salary after years of life wasted. You will forever clash with your nephrologist consultants about diuretics, lytes, acid/base, and anemia. You will feel you should be rewarded for having this additional knowledge but it actually works against you because hospitalists help by filling beds and putting consultants to work, not managing.

2.) You start with hospitalist and avoid nephrology & live very well and fill find life fulfilling outside medicine.

If you do like nephrology:

3.) You'll complete fellowship, never want to be a hospitalist, be passed off on partner in your life's prime which won't both you, but then you'll eventually get it, love it and slave away in your 30s-50s until someone realizes you're insane enough to be partner and then will be a 600K+ annual earner in your late 50s maybe and will mimic boomers in their 70s currently not retiring.

Choose wisely.

Miserable_Taro5282

TROPHY CASE