Have the lucrative specialties changed?

[DMFA]

Ask again in two years. If it seems interesting, join the relevant club. When you rotate in it, consider getting in with a case report or research project, esp if in that specialty. You don't have to decide until it comes time to do ERAS. If you decide early, it can have a psychological effect on your attitude and performance on rotations irrelevant to your chosen specialty.

Just focus on grades, USMLE, and trying to build your CV with maybe a few posters or case reports. I don't think if you're published in an ortho journal that it's going to hurt you from matching into IM...

It's okay and positive to have an interest, but don't develop premature closure. I was ER all the way in med school, having worked ER in college, then rotated in it and couldn't stand it...and then was lost for personal statements and letters of recommendation. Oops.

[kingsnake]

The lucrative specialties have not changed....just a little less lucrative

[MichaelB]

Miss Bonnie MD wrote:

Derm pays well because most of us see a TON of pts. To make money doing cosmetics, you need high volume – the overhead is actually quite high, not to mention the high maintenance patients. So I rarely do cosmetics.

It’s a bad sign when derms are feeling burned out, and yes we are. Prior auths, insurance denials, and high maintenance patients….

Click to expand...

Agree with you mostly, especially on the cosmetics. Things I have done to avoid burnout and help me to still enjoy derm are:

1- work 4 days a week

2- hire PAs- they see all the stuff we don't want to see much any more- acne, warts, etc. It frees us up to see a lot of skin cancer patients and do more procedures which I enjoy.

3- have a good EMR system and office manager. I don't spend much time at all on administrative stuff, billing, etc

4- control your schedule. This is huge. I know exactly how many patients I can see per hour and stay busy without killing myself.

of course, these are difficult if you don't own your own practice, but they have helped me a lot.

[pistolpete]

MichaelB wrote:

Miss Bonnie MD wrote:

Derm pays well because most of us see a TON of pts. To make money doing cosmetics, you need high volume – the overhead is actually quite high, not to mention the high maintenance patients. So I rarely do cosmetics.

It’s a bad sign when derms are feeling burned out, and yes we are. Prior auths, insurance denials, and high maintenance patients….

Click to expand…

 

4- control your schedule. This is huge. I know exactly how many patients I can see per hour and stay busy without killing myself.

of course, these are difficult if you don’t own your own practice, but they have helped me a lot.

Click to expand...

This is huge!

[MichaelB]

Don't rule out derm if you like procedures. Become a Mohs surgeon and you can do almost 100% procedures and it is very highly compensated with excellent lifestyle. Of course as everyone has said you need to be at the top of your class, so work hard now.

[Dermonc]

I second the sentiment here - do well in classes especially step 1 first and foremost then figure out what you want to do after you find out what you can get in to. Keep in mind most people enter med school thinking they are going to be the top of their class because they were the top of their class in college, so you'll have to work harder than them if you want to get into a competitive specialty. I shadowed different fields maybe once a month first year to try to figure out what I wanted to do (I found the MGMA survey and eliminated the bottom half then shadowed the fields in the top half that didn't have terrible lifestyles). I ended on Derm because I found the work to be interesting and rewarding - though I realize many others don't find this to be the case (I also find most people who talk down Derm have zero exposure to the field). I bought into the doom and gloom mindset of SDN probably a little too much and figured Derm has the least to worry about of any of the ROAD specialties. Having a reliable schedule and weekends is a godsend and is worth a pretty penny unless you are planning on being single or childless for the rest of your life. Derm is great and has very little drawbacks compared to other fields and I encourage you to keep an open mind.

[The White Coat Investor]

Longevity probably matters more than pay. Better to be a pediatrician for 30 years than burn out of dermatology in 10.

[Miss Bonnie MD]

MichaelB wrote:

Miss Bonnie MD wrote:

Derm pays well because most of us see a TON of pts. To make money doing cosmetics, you need high volume – the overhead is actually quite high, not to mention the high maintenance patients. So I rarely do cosmetics.

It’s a bad sign when derms are feeling burned out, and yes we are. Prior auths, insurance denials, and high maintenance patients….

Click to expand…

Agree with you mostly, especially on the cosmetics. Things I have done to avoid burnout and help me to still enjoy derm are:

1- work 4 days a week

2- hire PAs- they see all the stuff we don’t want to see much any more- acne, warts, etc. It frees us up to see a lot of skin cancer patients and do more procedures which I enjoy.

3- have a good EMR system and office manager. I don’t spend much time at all on administrative stuff, billing, etc

4- control your schedule. This is huge. I know exactly how many patients I can see per hour and stay busy without killing myself.

of course, these are difficult if you don’t own your own practice, but they have helped me a lot.

Click to expand...

I wasn't talking about myself burning out, but I am seeing lots of colleagues burning out quickly. I am employed by a health system but I do get to control my schedule more than most. It'd be nice to see less patients though. I do work 4 days a week and right now my issue is my awful commute which will be changing not soon enough.

I'm looking forward to working 2.5-3 days a week

[Strider_91]

Thank you to all this wise docs who have come before me and have taken the time to post their 0.02 cents. I am taking all of the advice into account and realize I am jumping the gun a bit and even sound naive/ neurotic thinking of a specialty an an incoming m1.

Either way:

My plan is basically to eliminate the lowest paying specialties from previous MGMA data and then try to get more exposure to the normal/ high paying specialties while in school. I like the idea of shadowing a different specialty each month; that seems reasonable.

I am going to try my absolute hardest to crush all my classes and the USMLE obviously.

Lastly I will try not to let the doom and gloom of sdn (a pre med/ med forum) consume me. You are all way better to get advice from.

[Strider_91]

Also I don't want to give the impression I am going into medicine for the money. That's not the case , I would still go to medical school if I won the lottery, just may work once a week when I finish though...


I also would not choose a specialty based on compensation data alone but it is a factor.

Lastly, I'm prepared to move if I have too, but I'd be more comfortable doing that for a specialty that doesn't require building a practice like EM. I could be completely wrong but that just seems like a very portable field. It would terrify me to move across the country and then become stuck there, like if I built a reputation as an orthopedic surgeon in the area.. Idk how those of you who have done that made that leap of faith.

[ENT Doc]

Strider, don't forget that technology can change everything.  What is high paying now doesn't matter - what appears to be well positioned given external market forces does.  For example, radiology may seem lucrative now, but there are already companies selling AI software that has been shown to be better at reading x-rays.  Do we honestly think CT scans and MRIs aren't next?  And do we honestly think that company won't price diagnostic radiologists out of the market and that this price won't be too small to ignore from an administrator's perspective?  Interventional radiology will hold up longer, naturally, as will other procedural specialties as long as you stay a generalist.  More narrow the focus = less ability to manage idiosyncratic risk.

[Rotish]

What x Ray technology do you speak of?

I'm a radiologist and this is News to me. All the boldest claims about AI are coming from Silicon Valley seeking investors and academia seeking grants. It's certainly something to think about down the line, but the technology is nowhere close unless you like false positives approaching 100%.

Not to mention, this type of doom and gloom isn't limited to radiology (such as the robot that will take over the anesthesiologist).

[ENT Doc]

Rotish wrote:

What x Ray technology do you speak of?

I’m a radiologist and this is News to me. All the boldest claims about AI are coming from Silicon Valley seeking investors and academia seeking grants. It’s certainly something to think about down the line, but the technology is nowhere close unless you like false positives approaching 100%.

Not to mention, this type of doom and gloom isn’t limited to radiology (such as the robot that will take over the anesthesiologist).

Click to expand...

http://www.enlitic.com

While their study isn't disclosed in a standard journal that I know of (yet) it beat out a 3 expert panel of radiologists working together to identify malignancies on CXR imaging.  More accurate.  Better false negatives.  While I'm sure there is plenty to poke holes in here, the writing is on the wall.

[Strider_91]

ENtdoc,
Interesting thought about being a more generalized physician, I wouldn't have thought about that on my own. I think a "generalized specialist" is probably the best bet in terms of expertise yet still having maneuverability. I have read a post from you about a head and neck surgeon being done for if they cured a certain type of carcinoma that makes up about 90% of their practice.

It is my understanding that this is what happened to cardiac surgeons when interventional cardiologists started putting in stents.

It is counter intuitive to realize that being general can be better especially when you factor in the opportunity costs of some fellowships. I also remember reading about this in Dr. Dahle's book.

[Rotish]

I can have a false negative rate of 0 too if call every case positive, ya know. Just probably gonna piss off some referring docs along the way.

Color me skeptical when a 15 month old press release with earth shattering claims still hasn't managed to publish even preliminary data.

I have no doubt that AI will only continue to improve. But I actually see it more as making my workflow easier than I see it kicking me to the curb