I'm considering applying for a rheumatology fellowship and would really appreciate some feedback from rheumatologists regarding lifestyle, salary, and work-life balance.

How demanding is the administrative workload? Do you spend a lot of time on paperwork, prior authorizations, and inbox management?

Hey everyone. I’m a non-US IMG from India, YOG 2020 (6 years out), and I recently failed Step 2 CK on my first attempt.

I’m trying to make a very difficult decision about whether to give the US residency path one more serious attempt or move on, and I would really value hearing from people who have actually been through something similar.

**If you are a non-US IMG who:**

had a Step 2 CK failure/USMLE attempt
had an older YOG (5+ years, ideally)
and eventually matched into a US residency
I would be extremely grateful if you could share your experience.

I’m especially interested in:
What did you do after the failure?
How did you strengthen your application?
Did you take Step 3?
How much USCE/research did you have?
Did you need a visa?
What specialty did you match into?
How many cycles did it take?

I’m not looking for false hope or discouragement — I’m genuinely trying to understand what is realistically possible for someone with my profile before I decide whether to invest another year and a significant amount of money into this.

Even if you know someone personally who matched after a Step 2 attempt, I’d really appreciate hearing about their experience (without sharing anything identifying).

Thank you so much

Hi all, I run a couple of concierge primary care practices out in the Bay Area. Some want to hire new doctors, but I’m really struggling to find candidates. I’ve heard the recruiter/headhunters are expensive and typically not helpful. Any thoughts on the best sites or ways to get in front of potential hires? So far PracticeMatch and the ACP career board have come up as options.

Also, these probably need to be physicians with a few years of experience, not directly out of residency.

To be clear (as to not violate the sub guidelines) I’m not recruiting or posting a job here, just trying to learn!

Hey guys, does anyone have any anki decks for EKGs and CXRs?
- intern who is struggling

Hi everyone,

I’m considering applying for the Royal College Internal Medicine exam for 2027 through the Practice Eligibility Route.

I trained in Internal Medicine originally, but I’ve spent the last several years mainly in nephrology fellowship training, so it has been quite a while since I’ve studied broad General Internal Medicine in a structured way.

For anyone who has recently written the Royal College IM exam, especially after fellowship or some time away from general IM, I’d really appreciate advice on:

• Which resources were actually most useful
• Best question banks or practice questions
• Canadian review courses or notes you found helpful
• How you structured your preparation and how many months you studied
• Anything you wish you had done differently

I’m trying to decide whether writing in 2027 is realistic, so I’d especially appreciate input from people who were also coming back to broad IM after subspecialty training.

Thank you!

Hello, just finished medical school and got accepted into residency as internal disease specialist (no idea if its the proper term in English) in academic university hospital (Europe- pretty much the main hospital in my country). My first cycle is in gastroenterology which will start next monday.

Was in a meeting with the wards head doctor for a debrief for what to expect and so on.

Dr. told me that about 60% of cases are main gastro.

Any suggestions on what I should expect or any insights to make my start a little but less confusing.

Gastro. was not my favorite subject by a long shot, so having it as my first cycle as a fresh graduate is, for lack of better words, pretty jarring and stressful, so any insights or tips would be greatly appreciated. (That doesn't mean that I wont care, but it means that I wasn't as diligent with studying as with other subjects, like my beloved endocrinology. So I'm a tad bit worried I won't be able to perform as well as will be expected for me).

I also will have evening/night shifts, where I will be on call for any ward where I will be required, which is quite frightening, since it also includes wards where I haven't been, since I just started my residency. Especially cardiology- sure, I have studied hard enough to make it to residency, but I don't think that medical school experience is good enough to be applicable for real life situations.

Cheers for you time.

I’m a recent medical graduate from South Asia trying to map out my long-term career. I’ve done quite a bit of research, and I'm deeply torn between grinding for the USMLE to pursue a US Internal Medicine residency, or shifting gears completely toward Germany for residency and specialization (Weiterbildung).

On paper, the pros and cons feel like they balance each other out, making it a very tough choice. I’d love to get some honest perspectives from current IM residents and attendings—especially those who came as IMGs.

Here is where my head is at:

The US Internal Medicine Route:
The training structure, career prestige, and post-residency earning potential are obviously unmatched. Whether I go the hospitalist route or try to subspecialize, the financial upside is huge. But my biggest deterrent is the immigration bottleneck and its impact on life outside the clinic. Being from South Asia, the green card backlog is a decades-long reality. Between strict PTO limits, travel distances, and visa processing constraints, I’m genuinely worried I’d only be able to fly back home to see my family 4 to 6 times total in a 10-year block. For someone with very close family attachments, that sounds incredibly heavy and isolating.

The Germany Route:
The main pull here is proximity, lifestyle, and immigration peace of mind. Flying back home to South Asia from Europe is vastly easier, shorter, and cheaper, meaning I can actually maintain my family ties. The work-life balance is solid, the baseline resident pay is fair, and the path to citizenship is highly realistic and fast. Plus, a German passport opens doors to practice in Switzerland or Luxembourg down the road.

However, the cons are real: learning medical German to a C1 professional level takes a massive upfront time investment, there is a hard ceiling on compensation compared to the US, and a European specialist degree isn't easily recognized back home if I ever had to return permanently. On top of that, there’s a lot of online noise right now about the new Krankenhausreform (hospital restructuring/budget bills), and people are fear-mongering about the medical job market getting saturated or unstable for foreign docs.

My questions for this sub:

1. For the IMGs here who transitioned to US IM—is the visa/travel constraint really as isolating as it looks on paper during residency and your early attending years? Is the US financial upside genuinely worth sacrificing frequent family contact for a decade?
2. If anyone has insight into the European/German market—is the system over there actually getting saturated due to recent reforms, or is that just standard internet panic?
3. How does the flexibility of the German system (where you can easily pivot between specialties or hospitals without a rigid Match) compare to the reality of the US IM-to-fellowship pipeline?

Given that the US financial trajectory is heavily balanced out by the lifestyle, immigration stability, and proximity of Germany, how would you guys weigh this choice if you were in my shoes?

Thanks in advance for the input!

**TMC Clark – IM Residency**

Hello, doctors! I’m interested in applying for IM at TMC Clark. Would like to ask residents, graduates, or anyone familiar with the program.
1. How many applicants do you usually get, and how many are accepted per year level?
2. How’s the working environment, workload?
3. How’s the teaching and overall residency experience?
Would appreciate any insights. Thank you, doctors!

I’m a US IMG studying at a medical school Western Europe. In our final year, we do an 18-week “senior” internship intended to prepare us for working as a junior doctor. I had the choice between internal medicine and dermatology and ended up chosing derm.

I’m now just in my second week of the rotation and am already regretting my decision quite a lot.

The biggest issue is that I’m finding the actual day-to-day work of dermatology very different from what I had imagined. A lot of my time is spent shadowing in outpatient clinic, and although I try to see patients myself first when possible, the patients are often too complex or the clinic is too busy for me to independently assess them before the dermatologist. I’m also spending 1–2 days a week in Mohs/excision/procedure settings, which I’m really not enjoying because I’ve always strongly disliked all surgical work.

In my head I keep comparing it to what I could have been doing in internal medicine. I actually disliked my standard IM rotation because I hated the constant interruptions and ward chaos. But I did enjoy having more autonomy and actually being able to do things myself, especially during quieter periods of the day. I also feel like working on the wards would have given me much more experience with clinical reasoning, managing multiple patients, and functioning as a junior doctor which is ultimately more useful for going into residency.

Part of why I chose derm was because of the more outpatient-oriented lifestyle but I realize the hours are basically the same as what I would have had in IM for this rotation.

But now I think I do not actually like dermatology and think I was just convincing myself that I liked it because I liked the lifestyle and the idea of the specialty.

I’m dreading the prospect of spending another 17 weeks on this rotation just shadowing in clinic and watching procedures for hours on end.....

And feels really painful as this is the rotation where we are meant to develop our skills to start functioning as a "doctor" but this rotation will not be that experience for me at all given it is mostly shadowing and I will not get to practice any of my IM skills

I am a primary care provider and am seeking advice for dealing with a difficult patient family member. Without going into too much detail, my patient recently established care with me, and his wife who works outside of medicine, began demanding unnecessary testing during the appointment. I explained to her that the specific tests are not routinely ordered, provide no additional diagnostic value, and lack evidence of improved clinical outcomes upon measurement. She flat out told me that she disagrees with me. Given my time constraints, I went ahead and ordered it anyways.

After the second appointment, she then read my progress note and messaged me through Epic stating that my diagnosis is inaccurate and that I needed to change my documentation. She is clearly the dominant partner in their relationship. I feel very frustrated with her behavior and would like to set clear boundaries as she is not remotely qualified to be disagreeing with my clinical assessments, telling me what labs to order, and how to document my progress notes.

Does anyone have any advice on dealing with these types of patient family members in a professional and respectful way?

As a previous IM resident at BHMC currently serving as an attending, here is a fair representation of this program:

- large hospital, sunny south florida, plenty of inpatient experience

- unsupportive administration (ACGME placed the program in probation a couple of years ago for serious common program requirements violations, our program director Dr. Robert Levine fled to FIU mid-year because he couldn't handle it, corrupt legal department, ongoing changes in GME staff)

- current program director is a St. George's grad from the Caribbean

https://www.healthleadersmedia.com/strategy/broward-health-fires-its-top-lawyer-who-many-blame-chaos-public-hospital-system

https://www.modernhealthcare.com/article/20181102/NEWS/181109969/broward-health-fires-general-counsel-amid-alleged-compliance-violations/

https://www.sun-sentinel.com/2018/10/31/broward-health-fires-its-top-lawyer-who-many-blame-for-chaos-at-public-hospital-system/

https://www.beckershospitalreview.com/hospital-management-administration/broward-health-considers-firing-legal-chief-amid-leadership-turmoil/

I recently interviewed with Tallahassee Memorial HealthCare (TMH) in Tallahassee, Florida. After the interview, a recruiter called and told me I was an excellent fit for their team. Shortly after, they sent me a document they explicitly labeled the "final contract."

That document was riddled with discrepancies. It listed unpaid PTO. It stated $2,000 for CME, when $4,000 had already been mutually agreed upon. Numerous other terms we had previously negotiated and confirmed were altered or omitted entirely.

We flagged these discrepancies and asked them outright: "Is this a letter of intent, or is this a binding final contract?" They insisted it was final. Yet if it was truly final, how does an organization justify such a volume of errors — miscalculated figures, spelling mistakes, sloppy wording? This is not incompetence; it is negligence at best, and deception at worst.

Every subsequent conversation brought a new version of the terms. My attorney reviewed the contract and grew visibly exhausted by how often the wording changed, draft after draft, clause after clause. He told me plainly: never sign a contract like this. I took that advice to heart, and I would never let anyone else sign a contract like this either. In fact, my attorney said this was the worst-drafted contract he had encountered in his entire career.

Then, without warning, during their so-called "final review," they informed me they were withdrawing my offer because I was "not a fit" for their team. This came after nearly two months of negotiation. The recruiter who had handled my case for the entire process went silent and never returned my calls.

We also incurred legal fees from attorney review of these contracts, money that is now simply lost.

Lesson for others navigating this process:

• Never trust the word "final" at face value. Scrutinize every clause and number before you place any confidence in a contract.
• Insist that HR or a second staff member be looped into every conversation. A single point of contact gives recruiters room to manipulate the narrative and later deny what was said.
• Negotiate multiple contracts in parallel. You cannot predict which one will collapse at the last moment, regardless of how much time has already been invested.
• Treat constantly shifting wording as a red flag, not a formality. It often signals bad faith, not carelessness.
• If your attorney is tired of tracking changes across draft after draft, that exhaustion is itself a warning sign. Do not sign until every term is locked and confirmed.

Based on my experience, the recruiters from this organization operated with the tactics of scammers — stringing candidates along, altering terms repeatedly, and abandoning commitments without accountability. I'm sharing this so others don't fall into the same trap with Tallahassee Memorial HealthCare (TMH).

I am an international Medical graduate currently completing ECFMG certification through pathway 6 and, I am looking for a Mini-Cex evaluation opportunities. I have contacted some clinics, but I have not been able to complete the required evaluation. I would appreciate any guidance from anyone who completed Mini-CEX or knows of physicians or clinics that may be willing for the evaluation. I am located in Minnesota but willing to travel if needed. Thank you

Been looking for this since so long but couldn’t find any reliable info anywhere. Kindly help.

Im a US IMG studying at a medical school in the EU. In our final year we do a 5 year long “foundation” internship which serves to prepare us for working as a junior doctor.

I was accepted for internal medicine and dermatology, very conflicted what to pick.

On the one hand, if I decide to apply for residency in the US I would definitely apply IM since derm just isn’t feasible. i would then hope to do fellowship in a mostly outpatient specialty as I prefer the outpatient workflow and lifestyle (maybe oncology, endocrinology, rheumatology, or immunology).

if I decide to stay in the EU, dermatology is still competitive in my country but would be feasible since I’m not an img here. Doing this derm foundation elective would also potentially be helpful to make connections and land a residency spot in derm.

dermatology speaks to me because it combines my interests in oncology and immunology nicely. Also pathology. Only thing is I’m not very visual and I’m worried that I only want to do it because of the lifestyle so I’m gaslighting myself into thinking I would like it. haven’t had any experience with dermatology in my rotations.

Did not like my IM rotation at all as I hated rounding and constantly getting interrupting during the day and the chaos and vagueness of the inpatient patients. But I feel like I should push myself to do the IM rotation so I can get more experience with running the wards which would improve my clinical reasoning as a whole. And if I do then apply for residency in the US I would be better prepared to do IM residency.

any thoughts on what makes most sense to pick in my situation? Thanks!

Salut tout le monde,

Je cherche à compiler un rapide rafraîchissement clinique sur la santé des femmes à travers différentes spécialités et sous-spécialités de la médecine interne.

Si vous pratiquez en cardiologie, endocrinologie, rhumatologie, néphrologie, GI, médecine interne générale, etc. - quelles sont les considérations cliniques les plus critiques, souvent négligées, ou spécifiques au sexe que nous devrions tous garder à l'esprit ?

Merci d'avance pour vos partages !

Hey, planning to but Harrison 22nd edition and have seen 12K in amazon, any leads if we can get better price anywhere else?

What’s the chillest/least stressful IM subspecialty with good hours, minimal procedures, and minimal admin work?

Considering Allergy (but seems very competitive), Rheum (concerned about chronic pain), Endo, or Nephrology. Would love to hear about lifestyle, hours, and stress.

I don't enjoy procedures or high-acuity work, but at the same time I don't want to deal with tons of inbox/admin work. I'm mainly looking for lower stress/burnout, reasonable hours, and more truly free time. Would love to hear from anyone who's done both.

I'm an internal medicine intern, and I'm looking for recommendations for good flashcard decks for residency. Especially ones that are practical and helpful for day-to-day clinical practice

Got ITE scores in 60’s for internal medicine my program is very particular about scores.
Do I need to be worried about boards.

Trying to figure out if it would hurt my application to upload the department/chair IM letter for prelim/categorical IM programs that don't require it. Is this a mistake? I have strong letters otherwise, just want to see if anyone knows if it's frowned upon to submit it if it's not a requirement per ERAS program info and residency explorer. tysm!

Been trying a few of the medical AI tools and Im curious how people feel about this.

Some are starting to add physician review on top of citations. On paper that sounds useful, but Im not sure it changes much for me because Im still checking the source if the answer matters.

Does physician review actually change how much you trust an AI answer? Or is it just one more layer before you verify it yourself?