Welcome to Moving Ahead in Medicine, a new podcast for early- and mid-career physicians working to navigate clinical practice and professional growth. Each episode will dig into career transitions and challenges, lessons learned in patient care and prescribing, and finally, what physicians have changed their minds about since moving from medical school to medical practice.
Our host is Michelle Lee, MD, a resident physician at a New York City hospital, public speaker, author, and community advocate.
In Episode 1, Dr. Lee speaks with Jiyeon “Monica” Jeong, MD, a board-certified internal medicine physician who's worked in primary care and hospital settings, including at UCLA Hospital in California. Dr. Jeong attended Weill Cornell Medical College, and trained in internal medicine at UCLA, where she served as chief resident. She's a YouTube content creator of Medicine with Monica, where she provides clinical pearls for medical trainees.
Find out how early feelings of burnout convinced Dr. Jeong to move from private clinic practice back to hospitalist medicine where she initially trained, and how childhood “Whodunit mysteries” led her to pursue a career in medicine.
Listen to the conversation here or read the edited transcript.
Deciding to Enter Medicine
Dr. Lee: I love listening to the educational content you have posted on YouTube and I'd like to talk about some of the things that have changed for you since attending medical school. What made you decide to go into internal medicine originally?
Dr. Jeong: I've had a few jobs in internal medicine, including primary care and nocturnist, and currently, I'm moving into a daytime hospitalist role. I've also done rotations as a teaching hospitalist. So, you could say I've even had four different roles in internal medicine. And it's funny because I started medical school dead-set on obstetrics and gynecology.
But that all changed when I did my internal medicine clerkship, which ended up being my first clerkship of third year. It was terrifying but amazing. I would come home after a 12-hour day and instead of feeling exhausted, I would feel energized and ready to go back the next day.
So I was like, okay, I think this is it. This is the field I want to go into. And since I went into internal medicine, I've done some thinking regarding what I love about this field. I boiled it down to two things.
When I was growing up, I would read a lot of mysteries, and specifically, “Whodunit.” Those were my favorite books to read along with Nancy Drew and Encyclopedia Brown. And I feel like that love for solving mysteries translated well into medicine because every time I see a patient, there's a puzzle to solve. What's the diagnosis? What clues can I get?
That whole clinical reasoning process is fascinating.
The second thing I like about internal medicine is the humanistic side of it. We're usually the first line of providers that patients will see about a problem, whether you're in primary care, or if you're admitting a patient in the hospital. So, you tend to be that first person on the patient's health journey, and you're there with them through the most difficult and vulnerable times. And in being there for them during those times, you develop some pretty deep and meaningful connections.
So both the intellectual side of medicine and the humanist side made me love the field.
Finding that First Job, and Realizing It’s Not the Right Fit
Dr. Lee: That's an amazing background story. And how did you search for a job?
Dr. Jeong: I was lucky because I knew what I wanted to go into early on. I started intern year wanting to go into hospital medicine. So, I developed relationships with people in that department at my institution, UCLA. And the other lucky part is that I knew I wanted to stay at UCLA. So, I didn't have to do a huge job search to look at other institutions.
I developed a lot of strong relationships with people in the department and approached mentors looking for job openings. I actually got approached by one of my mentors who had openings in her Extensivist Clinic, which is kind of like primary care, but for very high-need patients with complex medical conditions or a lot of psychosocial needs or both. And she convinced me to switch from what I thought I wanted to do with hospitalist medicine to extensivist medicine. And that’s how I got my first job.
Dr. Lee: As you mentioned, you've served in a couple of different roles since medical school graduation. How did your approach to care change in these different settings?
Dr. Jeong: Well, I went into hospitalist medicine not knowing much about it. In medical school and even in residency, depending on where you work, you might not get a ton of outpatient experience. Or, even if you do, you might not get the full experience as far as calling patients or the administrative aspects. I was not familiar with how the clinic worked but I was open to trying it out.
That's when I realized, Wow, clinic medicine is really, really hard because you're seeing a patient every 15 to 30 minutes. It’s a very inflexible schedule. It's just boom, patient after patient. And on top of that, there are a lot of administrative tasks that go into clinic medicine, which includes managing your in-basket, calling patients, signing forms, all kinds of things.
You're not just there from 8 AM to 5 PM because you have all these other administrative tasks. It's that constant 10 to 12 hours, five days a week. And I realized I didn't have time for other interests, specifically medical education and growing my YouTube channel. I wanted to have a more flexible schedule and that pushed me back into hospital medicine, which was my original interest.
Success After Switching Roles
Dr. Lee: Do you miss any aspects of the former one?
Dr. Jeong: In switching jobs, I was lucky in that I had a very supportive boss within my clinic. I viewed her as a mentor and felt very comfortable approaching her and being honest about my feelings and the fact that I wanted to switch. At the same time, I reached out to the hospitalist department, which I still have connections with because of my time during residency and my chief resident year.
And it was a pretty seamless switch – luckily there was a job available. It was a nocturnist job, which was not my initial choice. I had wanted to be a daytime hospitalist, but that wasn’t open. So I took the nocturnist role and started the next academic year.
Dr. Lee: So now, when you are off from work, are you really off or does charting still extend beyond your shift?
Dr. Jeong: For a hospitalist, that's one of the big pros of the job. The fact that you're off, you're really off. And what that means is, depending on where you work, you might alternate between clinical time and administrative time. So, you could do 7 days on and then 7 days off, 7 days on, 7 days off. That's probably the most common schedule. And that off time is called administrative time.
You can also use that time for your other interests, work-related interests, or some people travel or do whatever they want for those 7 days. It's nice to be able to do other things, recharge, and be ready for that next stint of work.
Lessons Learned
Dr. Lee: Let’s dive into the pros of working in a primary care setting. Say you're an internal medicine resident right now and you're choosing between the hospital route and the clinic route. What should residents consider?
Dr. Jeong: Lots of pros! There are definitely things I miss about the clinic job. Most people go into primary care for the longitudinal relationship that you build with patients. You're not going to really get that as much in the hospital setting. You're admitting a patient, you're with them during their hospitalization, then they're discharged, and you might not ever see them again.
Whereas in clinic, you have your patient panel. These are patients that view you as their doctor, their go-to medical person. And you see them regularly and build relationships with them over time. And that relationship is really meaningful because you become the person that they come to every time they have a problem.
In primary care, you're also the coordinator of their medical care. They need to see specialists so there are multiple aspects of the relationship. The other thing about clinic work is that some people do like having a very predictable schedule. With the lack of flexibility, you have predictability through set clinic hours.
Whereas in the hospitalist role, you could have a patient become hypotensive literally 1 minute before you're supposed to sign out. And it's your responsibility to stay there and help stabilize the patient.
Dr. Lee: All good things to consider. Do you have any last words you'd like to share for those considering their first job in medicine or thinking about a career transition?
Dr. Jeong: My advice would be to just be honest with yourself about what you enjoy. At the end of your workday, ask yourself, Do I feel happy, satisfied, and energized? Or, Do I feel burned out and sad day after day? The day before you start your next stint of work, are you sick with dread or have the “Sunday scaries”? These are things to reflect on so you can figure out what role fits you best. And just know that even if you take a job and realize it's not for you, just as I did, you can switch.
The beauty of internal medicine is the variety of roles within the field. So if you need to switch, get out there and see, because nothing is written in stone.
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