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How to pick a medical specialty - finances vs interest vs lifestyle

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  • How to pick a medical specialty - finances vs interest vs lifestyle

    Hi everyone,

    I'm a med student currently in a research year (after MS3) trying to decide what the heck to do with my life specialty-wise. I have competitive grades, board scores, and research so I think I can swing most any specialty, but no particular specialty has stuck out for me despite rotating in pretty much every field at some point or another. Not afraid to work hard but I do have a family so lifestyle factors in somewhat too.

    Looking back, how would you rate the importance of salary, interest, and lifestyle for someone who literally hasn't found a field they are passionate about? For instance, I think I would like ortho, they make a bazillion dollars so I could save/give more, but I don't love it and it's a tough life with a lot of call. Another example - I think radiology is interesting, could have a good lifestyle depending on the job, but I'm worried about working in a dark room long-term (yes I have rotated in these specialties). I have ruled out many specialties including anesthesia, FM, IM, psych, OB, derm, ophtho, path, rad onc.... but can't get much further than that. Peds, EM, ENT, rads or IR, ortho, urology I think I could do but, again, I don't wake up beaming going into any of these rotations. Some people choose work hours over all else, others say interest is all that matters even if you work stupid hours, others say pick a high salary. Ugh.

    I'm rambling at this point. I hope my question makes sense, thanks.

  • #2
    Interest > lifestyle > salary IMO

    It took all that effort to get into medical school and assuming you apply for something competitive, it will take a ton of time and money to get into the residency of your choice. Why not try and make it something you are interested in?

    Assuming nothing draws your interest, I would go with lifestyle. You can always increase your earning potential by working more in a lifestyle friendly field. There are other fields out there (surgical ones come to mind) where there may not be an option to scale your work.

    I'd leave salary or income potential last. Yes, it's important. But it also changes very quickly based on factors we often cannot control. Assuming you find a field that you like and is lifestyle friendly, I can't imagine being too unhappy or even being destitute (especially if you are already reading these forums as a student). Conversely, the most miserable people in medicine are often driven by money and locked into a demanding field that they hate.


    tl;dr = pick derm. win all 3.


    • #3
      I think its really important. As you get older you wont care about being passionate about things and realize everyone does something that you'd probably be just as happy or bored with doing as well. I wish I would have chosen a specialty with a shorter residency and more opportunity for shift/locums/extra money.

      I always fell asleep in rads but now would be great. Call, what you make it, you could be ortho and have a niche practice its not that hard. I know lots of people in my specialty getting killed on call and hours at their academic practices, while I do none of the sort. They act as if anything else is impossible, its not.

      The other thing you dont think of as a young strapping person is the surgical specialties are inherently very physical and thats just another issue and risk as you age.

      Nothings perfect, and I think you'll find later on it was more stressful than necessary.


      • #4
        I was in a similar place, lots of interests but nothing grabbing me hard. For me I also was older with a family in tow... There is a book called  "choosing a medical specialty" which I found and made myself read all the way through even though I had some ideas.  Made me consider anesthesia (hadn't even thought about it before) and it turned out to be my best match in terms of temperament and skills...check the book out and read it all the way through.


        • #5
          First off ortho doesn't make a "bazillion" dollars. More then peds, yes, but don't believe it will immediately be raining millions because you can do a knee scope. If that's what you want there are a lot of other fields that make a lot more money then medicine. I suggest you consider whatever else that route might be for you, although you may be committed with three plus years down already. Second, if you "think" you like ortho or any other surgical sub specialty it's probably not for you. The residencies are long, arduous, physically demanding and just generally painful and if there isn't something involved that you know you actually like doing it will be pretty tough to get through.

          Fwiw most people I've known that "like most everything" but don't love anything typically go into anesthesia, EM or radiology because lifestyle, ease and overall variety end up winning out most. That sounds like the boat you may be in but it's up to you to decide what you value most. Good luck.


          • #6
            Without a doubt, lifestyle/hours/call is the most important factor. From what I'm told, derm is the most competitive residency now. There is a good reason for that.
            Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.


            • #7
              You may want to listen to this podcast called "doc outside the box". It's a doc named Darko and he interviews docs that do things outside of medicine. WCI was on there also. Some of the people on his podcast talk about home no areas in traditional medicine fit them so they found their niche in other things. There may be a reason no specialty stands out for you.


              • #8
                How to prioritize  interest/income/lifestyle:

                1st 10 years: chose what interests you.

                2nd 10 years:  chose highest  paying specialty

                3rd 10 years:  chose the best lifestyle.


                • #9
                  I think your primary goal is to find something in medicine that you are passionate about.  If you are not passionate about any specialty, then I would pick a specialty with a good lifestyle that makes a decent salary (Derm and Radiology may top the list).  While you are working in that coveted specialty after residency, you can figure out what your REAL life passions are (which may be way outside of medicine) and gradually transition to that as you gain financial independence.  Good luck!


                  • #10
                    You are spending a year in research right now. What field of research are you in? Do you see yourself doing research throughout your career? If you do, I'd try to match your field to your research interests.

                    I find your list of fields you have ruled out a bit all over the place. What specifically has been the reason you've ruled out each of those? I'd sit down and write this out so that you can step back and look at themes. More importantly, write out what is most important to you from a career standpoint - amount of direct patient care, procedures (surgical or non-surgical), lifestyle, etc and start to rank these things based on how much you value that particular aspect. Rather than go from 1-10 on the scale, you should assign values to each item so that you total makes 100 so that you can better visualize how important each factor is to you. For example, if lifestyle/time with family is by far the most important thing to you with amount of procedures a distance second, you can assign lifestyle something like a 45 and procedures a 20 to indicate the degree of difference between the two and then divide up the remaining points from there. Only you can determine what is most important to you in the realm of interest vs lifestyle vs pay - each person has their own metric that works for him/her.

                    Once you have a list of your values, you should use the remaining time of your research year to research the different fields and set up meetings with people (attendings, ideally the residency program director) in the different fields that are appealing to you to ask good questions about the field and how that matches your interests. Not only will it be a good way to learn even more about the field, it is a good way to show genuine interest in the field prior to moving to the application process. You should hopefully be armed with great insightful questions after doing your own self-reflection and then research into the field before the meetings.

                    After you have it narrowed down a little more (2-3 fields max), set up sub-Is in your fields of interest during the summer and immerse yourself into it, soliciting as much advice from residents/fellows and attendings about the field and where it is going. Find out what the recent graduates of the program are doing and see if they can give you some connections of alumni that went into private practice to get information about that side of it since you'll only be seeing academics during your rotation.

                    Good luck!


                    • #11
                      I also had no strong preference after my third year.  I enjoyed all of my rotations, though did not want to do anyone of them forever.  I ultimately picked emergency medicine for the variety and lifestyle.  We see a little bit of everything and our full time docs work 12 shifts a month.  Before my kids school, we went out of town for a week every month.  We have cut that down to times they are out of school.  The pay is pretty good and there continues to be a labor supply/demand mismatch pushing wages up for those of us who are employed.

                      The obvious downside is the nights, weekends and holidays we work are a drag.  There is also a burnout factor, though if you are smart with your money, burnout may translate to early retirement and there is nothing wrong with that!  


                      • #12
                        This is one of the most important decisions you'll ever make. You've ruled out a lot of specialties which is fine as long as you've got good reasons. You might want to reconsider anesthesia  8-)

                        I wrote a piece on this. The infographics / flowcharts linked at the end are worth your time, if nothing else. Happiness is the ultimate goal.




                        • #13
                          Unfortunately its impossible to really know what day to day doctoring life is really like from a rotation, its such a skewed vantage point that you dont get the reality feel of it. A more thorough rotation makes sense but isnt logistically possible. Even residency is hardly reflective of the vast possibility of practices except hard core academics. You wont really know until youre doing it, but of course thats nearly too late.


                          • #14
                            For me, I excluded certain specialties based on income and lifestyle, mostly peds and FM. Not that there aren't well compensated physicians in those specialties, it just seemed that the work and hassle need to achieve that pay weren't worth it when I could do something else. Then I probably choose pathology based on what interested me.

                            I would caution you about making decisions based purely on a single rotation. There are such a diverse array of practice setups even within each field. Really focus on what the attending is doing and see if you'd enjoy doing that. For example, if during a path rotation, you're stuck shadowing a bad resident and stare into a microscope watching someone else drive for 12 straight hours like I did a couple brutal months, I'd have never chosen path, but I love my job now. Not that this is a plug for path, but maybe reevaluate some of those you ruled out and find out why.


                            • #15
                              My take:

                              1. You're either an OR guy or your not. If you don't love the OR I would be very hesitant to go that route. Hard to punch the clock there unless you really live for it IMO.

                              2. Unless you love FM or peds I would stay away due to low incomes - more so in peds as some FM guys can still get to 300k+

                              3. Call, call, call - the single thing that defines lifestyle - seems like u understand that.

                              4. I tell people yes IM sucks but it still gives u options if you haven't fully decided. U can take the 26 weeks off Hospitalist shift work route, shoot for income with proceduralist route or get yourself a lot of different job set ups (outpt only with no call, mixed inpt/outpt), even ER though that is changing quickly.

                              5. Agree- don't let one rotation completely rule things out

                              Tough call as most in medicine have a pretty clear idea of what they want to do. Good luck in sorting it out.