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  • Specialty Choice Advice for MS3

    My question is, what field would you advise an MS3 to go into if that student cared most about having a good lifestyle, higher compensation and fulfilling work? Are there specific gigs / niches in medicine that might be less widely known that I should be looking into (e.g. REI, anesthesia pain, etc.)?

    I had a career in finance before deciding to blow it all up and going to medical school. Choosing something sustainable is important to me as I burned out in my prior career. I was hardcore on the FIRE train before, but now want to have a long, fulfilling career in medicine. I'm on the older side (will be in my early 30's when I finish medical school), I plan to have kids in residency and I want to be present as much as I can for my wife and for them. I think all specialty options should be on the table for me based on my boards (>99% percentile step 1). Will continue to work hard and try to do my best throughout the remainder of third year and on Step 2.

    It's hard at this point in 3rd year to know what I'd really enjoy doing for the length of a career in medicine. What I think I know at this point: nights and call will probably be toughest for me burnout-wise, I don't need patient interaction but I do prefer longer term / continuity in patient care, I'd prefer to be self-employed/private practice/small group and would be especially interested in a field geared towards entrepreneurship, longer training is a minus for me just given my age.

    Folks have been encouraging me to do derm. I'm also thinking about ophtho and radiology. Of those three I think I'd find radiology the most intellectually interesting, but I'm a bit averse to 6 years of training given my later start. Derm I might have to take a research year just to be assured I'd match which would be kind of a bummer to me.

    Any help would truly be greatly appreciated. Thanks in advance.





  • #2
    You went from one career with a high burnout rate to one with maybe an even higher burnout rate. What made you burn out in your prior career? I bet a lot of those same elements will be present in your medical career.

    I'm not in any of those fields that you mentioned but derm and ophtho may be your best bets out of the ones you mentioned. Regardless, I wish you the best of luck.

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    • #3
      If you like surgery, ortho. If you do not like surgery, derm. I am retired rad (IR and DR) and I think DR is great if you are an introvert, like working at a computer, and make quick decisions.

      Moreover, pick something that you can see yourself doing for a very long time. You might get a more realistic view of the various fields you are considering in your fourth year, which is often too late for applying to residency.

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      • #4
        Originally posted by VagabondMD View Post
        If you like surgery, ortho. If you do not like surgery, derm. I am retired rad (IR and DR) and I think DR is great if you are an introvert, like working at a computer, and make quick decisions.

        Moreover, pick something that you can see yourself doing for a very long time. You might get a more realistic view of the various fields you are considering in your fourth year, which is often too late for applying to residency.
        Thanks for your reply. I can't quite see myself doing surgery...just frankly don't think I have the skills with my hands. Can you elaborate on what you'd find attractive about derm?

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        • #5
          Originally posted by thriftymedstudent View Post

          Thanks for your reply. I can't quite see myself doing surgery...just frankly don't think I have the skills with my hands. Can you elaborate on what you'd find attractive about derm?
          Basically banker's hours with non-existent emergencies and minimal, if any, call. PE firms have really gotten their hands into the field recently so who knows what entrepreneurial activities in derm will look like in 5-10 years.

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          • #6
            Originally posted by CordMcNally View Post

            Basically banker's hours with non-existent emergencies and minimal, if any, call. PE firms have really gotten their hands into the field recently so who knows what entrepreneurial activities in derm will look like in 5-10 years.
            How real in your opinion is the mid-level threat in derm?

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            • #7
              My pick is urology.

              mix of cases. Mix of hospital and office base procedures. Mix of procedures and clinic. Mix of pathology (bph to cancer). No one dying during your procedures. Not hospital dependent. Call can be frequent but not difficult. Pay cab reach 7 figures. Important to a location but not moving the needle in big ways (like ortho or cards) which brings more scrutiny

              Second choice is ENT for much of the same above

              My advice:

              1. don’t want to be dependent on hospitals
              2. no heavy call burden (coming in for legit emergencies)
              3. you’re not killing people or having people die in front of you (vascular surgery, cardiology, etc)
              4. not completely office based (fp, Im)

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              • #8
                Derm is highly recommended. It is super competitive for a reason!

                PMR with pain / injection fellowship could be up your alley, though not sure they make more than radiology.

                I don't expect weekends or call with either of the above.

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                • #9
                  under-rated lifestyle fields

                  (caveat: i am not saying these fields are easy or that they have a perfect lifestyle, but i think they have a favorable training/payoff ratio if you are looking at this purely in terms of family time and salary)

                  1. psych
                  2. PMR
                  3. allergy

                  2 bonuses for psych and pmr
                  1. you really help people
                  2. they are both relatively noncompetitive so US allo students w/o major academic issues can often pick their residency or close to it

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                  • #10
                    Originally posted by thriftymedstudent View Post

                    How real in your opinion is the mid-level threat in derm?
                    I'm derm/dermpath. Mid-level expansion, private equity and an increased number of residency spots are real threats to the specialty. It has become harder for our residents to find good job opportunities in the last several years. There are lots of pros, as have already been mentioned (good hours, few emergencies, limited to no call, relatively high compensation, mix of procedures, some entrepreneurial opportunities).

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                    • #11
                      Originally posted by ttc99 View Post

                      I'm derm/dermpath. Mid-level expansion, private equity and an increased number of residency spots are real threats to the specialty. It has become harder for our residents to find good job opportunities in the last several years. There are lots of pros, as have already been mentioned (good hours, few emergencies, limited to no call, relatively high compensation, mix of procedures, some entrepreneurial opportunities).
                      Agree. Those are all very valid threats to the current work climate. I still shake my head when Elston retracted the beautifully written paper that exposed how PE runs up the bill. I imagine there are still some advantages to living in MCOL to LCOL areas where the market isn't as saturated with PE groups and midlevels.

                      - path/dermpath

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                      • #12
                        Originally posted by thriftymedstudent View Post
                        good lifestyle, higher compensation and fulfilling work
                        You realize that this can be virtually any specialty right? Do what you think is the most interesting and fun.





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                        • #13
                          I don't know if you're going to find a lifestyle specialty in residency. They all have bad months.

                          The exception is probably derm. I lived with a derm resident. He had a pretty great residency life.

                          I wouldn't do a research year to do derm.

                          What makes some specialties better is the call and the actual obligations on call. Patient "neediness" can also be stressful depending on your personality type.

                          I'd still pick radiology 9 out of 10 times. The 10th would be ortho.

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                          • #14
                            Pathology is the clear answer here. Do a rotation in path for sure!

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                            • #15
                              Do not do path unless you want roll the dice for a good income; most path gigs are academic or corporate or require stumbling upon a gem in the middle-of-nowhere/rural.
                              hours are good, call is zero, weekends are free, pay is livable but often mostly siphoned off by academic dept, hospital, or benevolent physician employers (derm, urology, gastro) that pay you "well" for the privilege of financing their 7 figure income.

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