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

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  • #16
    Thank you everyone for the very helpful replies. It is good to get viewpoints from a third party. I will take the advice about rating the importance of each aspect of what I want and see what I come up with. I'll check out that podcast too. Thanks again.

    One of my frustrations is also that we don't get hardly any exposure to private practice where I will likely end up. I doubt the IM docs in community are doing rounds from 8-11 and then signing charts and heading home.

    I agree that the specialties I have crossed so far and still considering are all over the place. I like variety, procedures, good lifestyle, working with kids over adults. I dislike crazy hours/call (i.e. gen surg/neurosurg/CT surg), long rounds, chronic medical conditions that really can't be helped (neuro).

    Briefly, I ruled out FM, psych, OB, ophtho, path, derm, neuro due to very low interest in those fields.  IM out mainly because I am not attracted to chronic medical problems, the long rounding, etc. Cards, GI, critical care would be cool but I would just rather do radiology for that amount of training.

    I really like working with kids which is why I am still considering peds despite the low salary. I think whatever field I choose will likely be peds oriented whether it be peds itself, peds rads, peds ENT, so on. It's too bad there are well-child visits and low salary in peds as those are downsides to me. I have been working in the ED once a week for the past several months and have enjoyed it so its still on the list. ENT/ortho/urology might be out simply because I don't live and breathe for the OR. I think it is awesome - not sure I would think it's awesome to miss family events consistently which I know some surgeons do. I think I will reconsider anesthesia. My main concern honestly is the future of the field. CRNAs continue to get more and more privileges which is scary looking at a career spanning multiple decades.

    I think I could manage my way through most of these specialties I have not ruled out... I guess the question comes what else is important to me and that is probably just a personal choice.


    • #17
      Remember if you want to specialize in peds that will often lock you in academia or at least limit your job search geographically if that means anything to you.


      • #18

        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.
        Click to expand...

        Would you mind including a link to the specific text you're referencing? There are quite a few, at wildly different price points, on Amazon and the internet.


        • #19
          Let me make it easy for you:

          Do you like surgery, pick ortho? If not, derm.

          (JK, of course)

          i have not read all of the responses, but do not discount the fact that fields change over time (including their relative compensation and lifestyle). Radiology was once a great field, extremely competitive, extremely well-reimbursed, and very enjoyable. Now, not so much in any of those areas. I understand that ophthalmology has suffered similarly. Derm and ortho may be great now, but who knows what it will look like 5-10 years from now when you get done and another 10 years after that. I know of people who picked radiology as a field when it was on top of the world and by the time they got out of training, jobs were hard to find, pay was down, work environment had deteriorated, etc.

          Which goes back to trying to find something that interests you, being flexible in your expectations, and building a life outside medicine that brings you joy.


          • #20
            1. Don't go into a surgical specialty unless you love to operate, you will burn out and be miserable.

            2. Decide if seeing patients is important. If it is you can exclude radiology, pathology, etc.

            3. When in doubt pick dermatology.


            In all seriousness though, try and pick something you love and that you suspect you will not burn out from. But if you don't really love anything, pick something that makes good money. Had I chosen peds instead of radiology and burned out 5 years into practice my life would be very different right now. Being in a high paying sub-specialty gave me the luxury of cutting back on work when I burned out. It gave my family the luxury of my wife being able to choose to work or not.

            If you love what you do though, it doesn't really matter how much you make. You will live a very comfortable life as a physician, especially if you take the financial advice WCI teaches.


            • #21
              Everyone here (myself included) has suggested that derm is one of the top choices, for lifestyle, for salary, for interesting work, etc. One of my good friends from med school, a 23 year dermatologist, is burned out and cannot wait to retire. I think that he chose an employment model that did not suit him, and now he hates it.

              Which brings up the point that you can create a great life for yourself in any field, and you can take the most outwardly attractive fields and be miserable doing them (arguably, I am a poster child for the latter). A lot depends on the model of your practice, your temperament and suitability for that practice, and how you and the field BOTH change over time (because you BOTH will change over time).


              • #22
                He's probably referring to Iserson's Getting Into A Residency, which is now in its 8th edition:



                • #23
                  So picu?


                  • #24
                    Lots of great advice already given. My personal opinion is that interest>lifestyle>income potential. If you pick derm despite rashes making you want to vomit, going to clinic every day is going to be punching the clock, and life is too short for that. Income potential can and will change. Lifestyle is negotiable, I know FP's working 70 hour weeks and general surgeons taking call 1x/month.

                    You said you ruled out IM, keep in mind if you want to do GI, cards, pulm, etc you need to do IM first before a fellowship.

                    Based on what you have shared as your interests, I would strongly consider peds ENT if you are a strong enough student to get into ENT. Work with kids, good mix of office and surgery, good pay, many more elective surgeries with significantly less potential for "8 hours in the OR on a Saturday night" call then other surgical specialties.


                    • #25
                      Thank you all again. To the above two posters, I actually have a couple of days in ENT and PICU set up over the next couple of weeks with faculty. Maybe they will pull me in or push me away and keep whittling my list down.


                      • #26
                        I was thinking of Peds and then read the book I mentioned above, and realized Anesthesia was my tribe. Peds Anes is always an option and shorter training than Peds-based specialties (4 yrs +1 for Peds Anes vs 3 yrs +3 for Peds specialties). I chose Anes recognizing I could always do Peds Anes if I wanted to keep with kids. And re: the CRNA problem, less of an issue if you have specialty (i.e. Peds Anes) training in the field. I just wish I knew how much other peoples' saliva grosses me out before I chose this path as I deal with it every day. ICK. I didn't end up doing a peds Anes fellowship, btw, bc I wanted to join a certain practice that didn't need any more pedi people.


                        • #27
                          Interest > income > lifestyle

                          If you don't have the interest, you'll either burn out or you will hate your life no matter how much you make or how much free time you have. You mention multiple times that you don't like call and you don't like long hours. I suggest thinking about it long and hard before you consider a surgical specialty. At the very least your training (between 5 and 10 years depending on specialty/subspecialty) will have a lot of both. Your life as an attending may as well but can also have very little call and good hours if you choose the right job and set your practice up that way.

                          Which brings me to my next point: in my opinion, in the right job, income and lifestyle can both be tailored to whatever you want (especially in a private practice surgical specialty), and are somewhat inversely proportional. I know surgeons who are happy with their 300-400k income and work 3.5 days a week, and I know some that work 7am-8pm every day and bring in 2M. Some in each of those two extremes take no call and some choose to take a lot of call. In the right practice you can work really hard and make a lot of money when you're young and care more about income, and work less and make less when you're at a point where lifestyle matters more.

                          From what I've seen, EM has a great balance of decent hours, a lot of time off, no call, and good pay. Anesthesia can have good hours, good pay, and variable call. Derm may have great pay and great hours but I would rather work construction than do dermatology. And to make everything more complicated, with the healthcare environment we live in none of the above is guaranteed. There are a lot of variables but make sure it's something you like and you can hopefully figure the rest out as you move along within whatever specialty you choose.


                          • #28
                            I just want to weigh in as one of the impoverished pediatricians.

                            There are any number of things I find frustrating about my job and medicine in general (see my comment in the other thread about job satisfaction) but my pay actually isn't one of them.

                            I'm a peds hospitalist who lives in a HCOL area with a stay at home husband and 2 kids and I find my pediatrician pay has worked out just fine. I was a bit spendy until recently and just started getting more serious about savings but none of that had anything to do with my salary. I'm sure I just would have spent more if I had made more!

                            I make a little under $300K a year. I work all nights which gives me a little pay boost compared to my other colleagues but even my day time colleagues make around $250K.

                            I know that in the grand scheme of doctor pay, we are at the bottom. But $250K with the lifestyle of a hospitalist is not bad at all. We work about 12 shifts a month and when we leave the hospital, we leave work behind which I love. No call! As hospitalists, we also have the flexibility to work more or less. Some people in my group work 0.75 FTE and work 8 days a month and others moonlight at community hospitals or urgent care clinics to boost pay because we have so much extra time available around our shifts.  The down side is weekends and holidays (and nights for those of my colleagues who hate those but that's not a problem for me). But nights and weekends and holidays are tough for most physicians to avoid.

                            There's a lot of different things to do in peds hospital medicine too. You could be at an academic center with residents and fellows. You could be at a community hospital going to deliveries and seeing newborns. Or you could even do sedation in certain programs. Lots of flexibility.

                            The only warning I would give about peds hospital medicine is that now that it is on it's way to being a board certified subspecialty, at some point in the near future you will need to do the a 2 year fellowship which is a time and money suck with no extra pay off. Fortunately for the old timers, none of us who got in years ago have to worry about that and will be grandfathered in if we take the exam once it exists. But definitely something to consider for young docs going forward.



                            • #29
                              So this is now SDN ? Ok.


                              • #30

                                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.
                                Click to expand…

                                Would you mind including a link to the specific text you’re referencing? There are quite a few, at widely different price points, on Amazon and the internet.
                                Click to expand...