Would competitive specialties be competitive if everyone made the same?

[FIREshrink]

That could be a fun poll. If every specialty paid exactly the same (per hour, let's say), what would you choose?

Still would insist on a decent lifestyle/limited call. Think I'd still choose psych but probably inpatient only. Other options would be academic IM specialty like maybe endocrine, or Neuro.

[White.Beard.Doc]

Seems like most of the OBs I know all want to transition to office gynecology. Covering deliveries at all hours for decades gets pretty taxing on the body and mind as the years go by. Yes, some of the 70 year olds are still doing it, but they are getting tired.

[White.Beard.Doc]

And how about the Emergency Medicine match this year? EM was only 3 to 4 years, shift work at 36 hours a week, with plentiful jobs paying 350 to 400k. The med students were lining up to match in EM.

Then Covid happened and the ED volume tanked, the job market tanked for new grads, and the med students went running for the exits, all in the course of 1 year. 67 EM programs did not fill, hundreds of open spots.

So yes, compensation and jobs matter.

[medicoFIRE]

Why do you think Dermatology is “prestigious” in the US when it is not way in nearly all other countries. Hint- lifestyle and $$$ might be involved.

[Tim]

Why do you think Dermatology is “prestigious” in the US when it is not way in nearly all other countries. Hint- lifestyle and $$$ might be involved.

https://occameducation.com/what-are-...-us-and-the-uk
Part of the problem is that the education system has not really changed much or been re-engineered in a long long time. And fellowships have had an increasing importance, adding to education needs required.
Broad general education requirements add time and costs. The vocational training adds time and costs at every level.
Secondary->University->Medical School->Residency->Fellowship->Find a Job

Much has been made of the value of STEM vs Liberal Arts and recently social sciences education. From a vocational point of view there is a huge amount of waste. From a life balance point of view, a well rounded individual has a rich knowledge of the world, ethics and society.

The world has changed. The path is now geographically neutral for getting educated in the US. for a physician. Tech has broken the model. Medical education is still rooted in an inefficient general requirements model for GPA, not skills and achievement. Very inefficient use of time learning things that will never be used or provide benefits in one’s practice.

Counter point is valid, the self selection process actually takes time to make good decisions. Not enough information or flexibility to pivot if a narrow path model was adopted. Starting over would have a high failure rate.

Bottom line, money matters. But only to suffice, not optimize.

[MPMD]

And how about the Emergency Medicine match this year? EM was only 3 to 4 years, shift work at 36 hours a week, with plentiful jobs paying 350 to 400k. The med students were lining up to match in EM.

Then Covid happened and the ED volume tanked, the job market tanked for new grads, and the med students went running for the exits, all in the course of 1 year. 67 EM programs did not fill, hundreds of open spots.

So yes, compensation and jobs matter.

just FYI this is not fake news.

rough year for EM and a bit of an uncertain future.

not catastrophe, but changes for sure.

i think students are getting the message that a career in EM is not just adrenaline rushes followed by long periods of mountaineering for $400k

[MPMD]

Everybody in the world would like to make more money and work less.

high level points from when i talk to students about specialty selection (i do this a lot)

• have to decide if you have to operate, some do (notice this is "have to operate" not "want to operate," we all knew this person in med school)
• have to decide if you want to see adults, if not it's a very easy decision
• have to decide if you want to see sick people/have pts die on you, not as fun as it might seem up front to students, not for everyone
• have to decide if you want standing in your community as a doctor - neurosurgeons and obstetricians get it, EM and pathology do not.
• some things matter to everyone: money, weekends, nights, holidays, control of workload.

[Turf Doc]

high level points from when i talk to students about specialty selection (i do this a lot)

• have to decide if you have to operate, some do (notice this is "have to operate" not "want to operate," we all knew this person in med school)
• have to decide if you want to see adults, if not it's a very easy decision
• have to decide if you want to see sick people/have pts die on you, not as fun as it might seem up front to students, not for everyone
• have to decide if you want standing in your community as a doctor - neurosurgeons and obstetricians get it, EM and pathology do not.
• some things matter to everyone: money, weekends, nights, holidays, control of workload.

i find it kind of funny that people went their whole lives without operating, have never operated, but during their 3rd year of med school realize they "have to operate" or they won't be happy

[abds]

i find it kind of funny that people went their whole lives without operating, have never operated, but during their 3rd year of med school realize they "have to operate" or they won't be happy

these people wouldn’t be happy in medicine if not operating. There are probably other careers surgeons would be perfectly happy in. I might not have operated my whole life before med school but I fixed cars, help dad and uncles build and renovate houses, taught myself electrical and plumbing, etc. I would gladly do all those things as a career if I could readily make as much money as I do being a surgeon, before doing non-procedural medicine actually (in a fantasy world of all things like hours and income being equal).

I’m not sure it’s so much performing surgery but actually doing things with my hands. And/or directly and immediately fixing something.

[MPMD]

i find it kind of funny that people went their whole lives without operating, have never operated, but during their 3rd year of med school realize they "have to operate" or they won't be happy

eh, i don't know.

surgery is pretty cool.

i definitely had really good friends in medical school who i think just found the appeal of surgery basically overwhelming and now are pretty happy.

[FIREshrink]

Why do you think Dermatology is “prestigious” in the US when it is not way in nearly all other countries. Hint- lifestyle and $$$ might be involved.

I never thought of derm or any other specialty as more or less prestigious.

Lucrative, competitive, sure. But prestige, as in higher social standing or greater respect or admiration for their perceived achievements? Weird.

But obviously lots of people believe in that crap, along with money it basically make our world go round. Kind of sad, isn't it?

[Turf Doc]

I never thought of derm or any other specialty as more or less prestigious.

Lucrative, competitive, sure. But prestige, as in higher social standing or greater respect or admiration for their perceived achievements? Weird.

But obviously lots of people believe in that crap, along with money it basically make our world go round. Kind of sad, isn't it?

I think dermatology is prestigious among med students and those in-the-know, but in general I'd say surgery (especially something like neurosurgery) is more prestigious among lay-people.

Side-note, kind of funny that to my knowledge ive never seen a neurosurgeon posting on any financial forum, whether for docs or not. Radiology, anesthesiology, and EM on the other hand appear way overrepresented.

[Hatton]

Seems like most of the OBs I know all want to transition to office gynecology. Covering deliveries at all hours for decades gets pretty taxing on the body and mind as the years go by. Yes, some of the 70 year olds are still doing it, but they are getting tired.

I agree OB is hard to keep doing because of the lifestyle and drama as one ages. FI OBs go to GYN or retire.

[Hatton]

high level points from when i talk to students about specialty selection (i do this a lot)

• have to decide if you have to operate, some do (notice this is "have to operate" not "want to operate," we all knew this person in med school)
• have to decide if you want to see adults, if not it's a very easy decision
• have to decide if you want to see sick people/have pts die on you, not as fun as it might seem up front to students, not for everyone
• have to decide if you want standing in your community as a doctor - neurosurgeons and obstetricians get it, EM and pathology do not.
• some things matter to everyone: money, weekends, nights, holidays, control of workload.

Glad to know I had standing in my community. Not sure about this.

[bovie]

these people wouldn’t be happy in medicine if not operating. There are probably other careers surgeons would be perfectly happy in. I might not have operated my whole life before med school but I fixed cars, help dad and uncles build and renovate houses, taught myself electrical and plumbing, etc. I would gladly do all those things as a career if I could readily make as much money as I do being a surgeon, before doing non-procedural medicine actually (in a fantasy world of all things like hours and income being equal).

I’m not sure it’s so much performing surgery but actually doing things with my hands. And/or directly and immediately fixing something.

Yes. This.

Personally, I wouldn’t want to be in medicine at all outside of the OR. Wouldn’t even be a consideration.

Certainly not how most people feel and that’s fine, but we definitely exist and it has nothing to do with an “MS3 epiphany.”