The Insiders Scoop – Internal Medicine Residency

Name: Amit Pandey

Specialty/Interests: Internal Medicine (interests include cardiology, medical education, and mentorship)

Education: UCLA (undergraduate), UCSD (medical school and residency)

Current Position: Internal Medicine Resident

1 | What drew you to your specialty?

I love the cerebral aspect of Internal Medicine. To me, the consummate physician has always seemed the one who is master of a vast array of knowledge, well-versed in every organ system and its corresponding pathologies. Of course, to attain this mastery is extremely difficult and something an Internist will spend their whole career pursuing. But this is the ideal to which I aspire. I love that Internal Medicine provides the opportunity to have this broad and robust understanding of medicine. This then facilitates some of the true fun of medicine: being a diagnostic detective, piecing together medical information to formulate a diagnosis and treatment plan. At the same time, Internal Medicine provides the opportunity to use your hands on focused, bedside procedures (and often more depending on your specialty) to help patients. This provides great balance. Finally, Internal Medicine requires the art of effective communication and connection with the patient, as most medical specialties do. I appreciate all 3 aspects of Internal Medicine equally: medical knowledge, procedural proficiency, and communication/empathy. The balance is what truly draws me to the field.

2 | What is a typical day like for you? How many hours do you work per week?

I am currently a third-year resident at UCSD. As such, my schedule varies typically by month, as most of our rotations are 2-4 weeks long. There are two different settings in which I work, and they each have very different schedules: inpatient (in the hospital) versus outpatient (in the clinic). On inpatient, I typically work 6 days per week. The average day starts around 6:30 AM and typically ends between 5 PM and 9 PM. The average workday is around 12-13 hours (though sometimes more or less), making for a 70-75 hour workweek generally. There are times when we work 26-28 hour shifts, starting around 8 AM one day and finishing between 10 AM and noon the next day. At UCSD, we work these shifts in the ICU. Frequently these shifts are busy enough that I do not sleep at all overnight. They can be grueling but are also exciting and allow for great learning and growth as a physician. On outpatient, the schedule is much more forgiving. We work Monday through Friday, and a normal workday is from 8 AM to around 5-6PM. In addition to work, I try to exercise as much as I can, especially when I’m on outpatient. I run, go to the gym, and play basketball. Most residents also incorporate research projects, presentations, etc. into their daily schedule. I work on cardiology research in my spare time.

3 | How much sleep do you get every night? How many vacation days do you take per year?

I typically sleep 6 hours per night when working on inpatient and shoot for 7 hours per night when on outpatient. When particularly busy with work or research/side projects (such as exciting work with Med School Insiders in the past!), it has not been unusual for me to sleep 5 hours per night for short periods of time. Because I know this is not sustainable long-term, I try to prioritize rest and stay as close as possible to 7 hours per night. Weekends and days off do allow me to catch up as well. Most residency programs have one great component which is 4 weeks per year of built-in vacation. I get two 2-week blocks of vacation per year during my residency training. This summer, I traveled to Mexico during my time off. I try to maximize relaxation time with family and friends, as well as travel to a new city or country during my vacations.

4 | How do you maintain your work-life balance?

Everyone achieves this differently, but it is paramount to do so and to find what works for you. Work-life balance is always a work in progress for me, as it is no easy task during residency. A few things are key for me. First is exercise. I love basketball. It keeps me sane. I try to play as frequently as I can, even if only for 45 minutes to do a brief shooting workout. Combined with running and other exercise, staying active allows me to feel healthy and balanced. Second is time with friends and family. Hanging out with the people I love is one of the best ways to decompress for me. I have been fortunate to live nearby family and many close friends throughout my training, which truly helps my quality of life. Finally, I try to take time for myself whether it be to read, watch a basketball game, or briefly meditate. This can be challenging with a busy schedule, but doing so allows me to minimize stress and restore happiness and relaxation to my life.

5 | What has been your most fulfilling professional experience?

The most fulfilling experiences of my professional life thus far have been related to caring for seriously ill patients at times of particular vulnerability, both of the patient and his/her family. Guiding patients and their families through these difficult experiences have been the most challenging yet most rewarding times in my career. Positive outcomes in which a patient has improved significantly have been amazing. Unfortunately, not all such situations have resulted in the patient making it through. This is a difficult reality of life and an inevitable experience as a physician. Though challenging, these experiences can also be very fulfilling if you can find a way to help the patient achieve some comfort and peace in whatever time you care for them. Furthermore, supporting families and easing their pain and burden by even a fraction can provide profound fulfillment. The experiences and connections in some of these profound situations cannot really be put into words. They are the magic of medicine, the secret stuff that draws us all to this fascinating field.

6 | What was your biggest struggle throughout your medical training/practice to date?

The most difficult part of becoming a physician to me has been the sheer length of the process and the patience and fortitude it takes to push forward at each step and each challenge. I have certainly enjoyed the process because becoming a physician is all about growth, slow and deliberate through hard work and dedication to the craft. There is beauty in that process. But at the same time, it can be grueling to endure the 7+ years on the road to becoming an attending physician. It is no easy feat to deal with the challenges of medical school such as board exams or clinical rotations during third year, which are in essence a new job each month. It was at times hard to see the light at the end of the tunnel. But I can say clearly and with complete confidence now, the light is there. All the hard work and dedication is worth it in the end. Residency, though very challenging in its own right, provides the reward of finally being the direct provider of medical care to your patients. It allows for the satisfaction of finally mastering the skills you set out to learn. The gratification is great, and by pushing through the tough times, you will make the reward that much sweeter.

7 | What mentors have been particularly influential in your life?

I have had several great mentors throughout my life, but my most influential mentors are 2 physicians I have worked with over the last several years. The first was my first research mentor, a Cardiologist whose immense intellect was surpassed only by his dedication to his craft and his meticulous attention to detail. He taught me how to be thoughtful, thorough, and creative when answering scientific questions. He also extended me great kindness in his advice and mentorship, both about medicine and about life. The second physician was a Hospitalist who has served as a mentor to me since the beginning of medical school. I first met him when he led one of my problem-based learning courses, and we quickly became great friends. He was later my attending on medicine rotations and was a mentor throughout. He taught me how to be a consummate clinician with a deep dedication to mentoring and guiding the next generation of physicians. His example has been invaluable to me.

8 | Any tips for juggling research with clinical responsibilities?

The most feasible way to achieve this is to choose a research project which lends itself to piecemeal work. In other words, you want a project which you can work on in spurts and pick up wherever you previously left off without any issue. Typically, clinical research comprised of retrospective chart review and data analysis allows for this. It is much more difficult to perform basic science research while working clinically, as these experiments require hours in the lab and provide less flexibility. With that said, it is not impossible. I have peers who have accomplished basic science projects while working as a medical student and resident. If you are passionate about it, go for it and make it happen!