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

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  • jhwkr542
    replied
    So picu?

    Leave a comment:


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

    https://www.amazon.com/Isersons-Getting-Into-Residency-Students/dp/1883620368/

    Leave a comment:


  • VagabondMD
    replied
    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).

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  • TheHappyPhilosopher
    replied
    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.

    Leave a comment:


  • VagabondMD
    replied
    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.

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  • MochaDoc
    replied




    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.

    Leave a comment:


  • SValleyMD
    replied
    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.

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  • shishka32
    replied
    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.

    Leave a comment:


  • SValleyMD
    replied
    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.

    Leave a comment:


  • jhwkr542
    replied
    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.

    Leave a comment:


  • Zaphod
    replied
    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.

    Leave a comment:


  • PhysicianOnFIRE
    replied
    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.

    Cheers!

    -PoF

    Leave a comment:


  • GXA
    replied
    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!  

    Leave a comment:


  • shantster
    replied
    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!

    Leave a comment:


  • Live Free MD
    replied
    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!

    Leave a comment:

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