What job do you think is the best?

[Toshi]

RadDoc wrote:

I would do radiology again in a heart beat. I still think medicine is still one of the best ways to guarantee a high income especially if you pick a specialty.

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Agreed. I quite like my radiology lifestyle. 8a-5p, 4 weekends per year, actual sick days if one needs them. It's like... a normal job! Imagine that.

[Zaphod]

I think medicine is one of the better security wise high income profession. Its the loans and all around hassle/stress that take away from it.

Finance, obviously is another one. You dont even have to stick around all that long to live comfortably, especially since you know a thing about finances and hopefully have saved. Dental stuff isnt bad mostly due to lack of residency and lower stress, more control. If I could do medicine over again, though I like my field...I would in a heartbeat trade it for a shorter residency or one that had hours allowing moonlighting other income (EM, Rads, derm). Long residency and a fellowship delayed earnings and allowed loan compounding that its just hard to justify.

Starting some side business is great. Go for it, especially when young. Basically earning starting younger just makes a whole lot of sense, even if the nominal salary isnt as much.

[Joseph]

I really wasn't expecting all of the comments of "my job is the best".  That is awesome that so many of you truly enjoy the niche you are filling.

Zaphod, I feel you... more along the lines of our household dinner conversations.  

[shishka32]

As a medical student, I kind of wonder if many of the practice setups/lifestyles are even realistic for this generation of med students. I am only about halfway through my clinical year, but I have found no "calling" or "passion", so the specialties I am looking into are ones with: goodish hours, at least decent pay, and a good job market. Procedures are a plus. I initially thought something surgical but the lifestyle might be too much of a negative factor.

 

Pathology: job market is horrendous

Radiology: job market still pretty bad (many jobs are nights only, no partnership), too many residency spots

 

Let's not forget the others:

Anesthesia: good income, job market ok, future with CRNA's and lack of respect make it difficult to get excited about

Derm: next to impossible to match into unless you're AOA with 250 step 1

Neurosurg/Ortho/Gen Surg/CT surg/OB: work a bazillion hours a week, on call all the time, neuro/ortho hard to match into

ENT/Uro/Ophtho: very difficult to match into, otherwise good fields, not the most interesting anatomy to me but good fields

Peds/IM: low pay unless you're in adult cards or adult GI, job market depends on subspecialty

FM/primary care: low pay, good job market, NP/PA encroachment, no respect, boring, not for me

Psych: low pay, good job market, but not for me

 

So I am leaning towards EM. I believe it has everything I want including a halfway decent lifestyle. I've like the rotations I've done in EM. But it is disheartening - many of the attendings at my school say things like, "Oh do radiology (or anesthesia or pathology or... etc.), make your 400k with no call or weekends, and enjoy life".... as if that exists any more.

 

Not sure what I am getting at here, just wondering if any of the physicians in this thread went through a similar state of mind in med school. Is living a decent life with decent hours and good pay even possible in medicine nowadays?

[Joseph]

That was quite the response, shishka.  I don't even know where to start except to say "good luck".

[shishka32]

Sorry for the rant. Appreciate it, thanks!

[docnews]

Shishka32, I would try to do some rotations in my community settings to get a real feel for different specialties. It is not the hours or pay - it is how you feel on the worst days.

I'm in EM: when on shift there are times when I get my butt kicked but when I go home completely exhausted I still feel like I have pride in what I do.

When rotating with surgery or internal medicine: I "work" way more hours but many of which are a lot slower paced and feel often unproductive to me which can eat away at my soul. I don't live for my next chance to stand in the OR for hours on end. I don't live for pondering one person's case for hours, digging through the data, to diagnose the zebra. I respect both, but both are not me.

Don't choose EM or another field based on perceived lifestyle. One resident confided in me recently that they didn't realize how stressful being an ED doc really is. You are sheltered as a med student in all fields really. Ponder the following...

In the ER, will you enjoy "running the show" or cower as everyone tries to get your attention all at once.

In the OR, will you enjoy "being the fixer" or cower as someone's innards lay mangled before you.

On the wards, will you enjoy "being the problem solver" or cower as all the data mining gives you a headache.

In the clinic, will you enjoy "solving the real problems" or cower as you have to deal with another family's seemingly unending social quagmire.

[DoubleMDs]

I will repeat what I did in the comments section after the wci blog on this. I will highly discourage my children from becoming a physician. The time, effort and ridiculous amount of money just to get there is not worth the end game of unappreciative patients, endless charting and high likelihood reimbursement and physician autonomy will only continue to decline (and I'm in one of the highest paying surgical subspecialties). Be an entrepreneur. Invent an app. Be an implant rep (they make as much or more then us surgeons and have zero malpractice or liability). Just don't go to medical school. The golden age of medicine is long gone. Very glad so many on this thread enjoy where they are. But I would bet most in that position have been in practice 10+ years or are in cush fields (derm, radiology, path). Find me a young surgeon, fp doc, peds, IM who is happy with practice and their finances/debt and maybe they can make a better argument if they still would do all again.

[The White Coat Investor]

shishka32 wrote:

As a medical student, I kind of wonder if many of the practice setups/lifestyles are even realistic for this generation of med students. I am only about halfway through my clinical year, but I have found no “calling” or “passion”, so the specialties I am looking into are ones with: goodish hours, at least decent pay, and a good job market. Procedures are a plus. I initially thought something surgical but the lifestyle might be too much of a negative factor.

 

Pathology: job market is horrendous

Radiology: job market still pretty bad (many jobs are nights only, no partnership), too many residency spots

 

Let’s not forget the others:

Anesthesia: good income, job market ok, future with CRNA’s and lack of respect make it difficult to get excited about

Derm: next to impossible to match into unless you’re AOA with 250 step 1

Neurosurg/Ortho/Gen Surg/CT surg/OB: work a bazillion hours a week, on call all the time, neuro/ortho hard to match into

ENT/Uro/Ophtho: very difficult to match into, otherwise good fields, not the most interesting anatomy to me but good fields

Peds/IM: low pay unless you’re in adult cards or adult GI, job market depends on subspecialty

FM/primary care: low pay, good job market, NP/PA encroachment, no respect, boring, not for me

Psych: low pay, good job market, but not for me

 

So I am leaning towards EM. I believe it has everything I want including a halfway decent lifestyle. I’ve like the rotations I’ve done in EM. But it is disheartening – many of the attendings at my school say things like, “Oh do radiology (or anesthesia or pathology or… etc.), make your 400k with no call or weekends, and enjoy life”…. as if that exists any more.

 

Not sure what I am getting at here, just wondering if any of the physicians in this thread went through a similar state of mind in med school. Is living a decent life with decent hours and good pay even possible in medicine nowadays?

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Lots of EM docs found they kind of liked everything. You sound like you kind of hate everything! Don't worry too much though. You've got at least 6 months to make a decision, and probably closer to 9. And if you interview in two specialties, more than a year. There are a lot of rotations left to like.

I wouldn't spend a lot of time worrying about APP encroachment. I don't think it's as big a deal as most pre-meds and even med students worry. That worry was there 20 years ago and guess what? Still not a big deal.

I wouldn't avoid a field because you think it's too competitive or the job market is bad or whatever. By the time you come out of training in 5-8 years, things will have changed. I mean, if you're the bottom of the class, don't go for derm, but in reality, in most fields it's about board scores, your rotation grade in your chosen specialty, and your letters. Most of that is still ahead of you. You're not ruled out of anything yet barring a terrible Step 1.

EM is a lifestyle specialty in some ways, but not others. Bear in mind that 90% of your working hours in EM are outside of banker's hours. That will matter a lot more to you at 40-50 than it does at 25-30.

[RadDoc]

Radiology market is opening up also. It all depends on where you want to live. I live in the south and have a great job. I work 3.5 days a week with 12 weeks vacation. Volume is totally manageable based on my training and pay is great. Partnership track was only 1 year. I live in a major city and drive 25 minutes to work.

I interviewed at 5 other jobs very similiar to this one in the south but liked the people here the best. I have friends that took jobs in the north and other coveted areas with longer partnership tracks, less pay, and less vacation just to be a in a specific area.

Its all about where you are willing to be.

[Toshi]

I agree. The radiology jobs exist, but not exactly where you want to be for most people. (On the other hand, I'm very satisfied with my location. One of my co-fellows ended up in the wilderness, quite literally, though!)

[jz]

Aside from lifestyle, income, and interest, I'll mention the satisfaction of actually knowing clinical medicine.   After 30+ years of emergency medicine, I derive satisfaction in identifying  the full scope of disease. I'm sometimes gobsmacked at other doctors'  limitation in basic clinical medicine.

[shishka32]

Thanks everyone for your comments.

i think for me personally there is no perfect specialty. I love the OR and would love surgery but I hate the hours. Radiology was fascinating but I couldn't do that all day every day (I also did two days in IR and didn't like it much). I love kids but it pays pretty low. etc etc

Combine this with all the fear spewed out by residents, fellows, and attendings about their respective specialty (usually non-surgical) makes for a difficult career decision.

It would be much easier if I simply had a passion for derm or rads or pathology or anesthesia. Sweet lifestyle + love going to work? Fantastic. It seems the decision for me will be choosing one or the other, and it's tough to decide on a 30-40 year career at this stage of my clinical experience.

[s2km]

Have you considered PM&R? Definitely a good lifestyle.  Might be too boring for you based on your other posts though.

[asmallchild]

shishka32 wrote:

Thanks everyone for your comments.

i think for me personally there is no perfect specialty. I love the OR and would love surgery but I hate the hours. Radiology was fascinating but I couldn’t do that all day every day (I also did two days in IR and didn’t like it much). I love kids but it pays pretty low. etc etc

Combine this with all the fear spewed out by residents, fellows, and attendings about their respective specialty (usually non-surgical) makes for a difficult career decision.

It would be much easier if I simply had a passion for derm or rads or pathology or anesthesia. Sweet lifestyle + love going to work? Fantastic. It seems the decision for me will be choosing one or the other, and it’s tough to decide on a 30-40 year career at this stage of my clinical experience.

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I'll nominate derm again. (Matching, of course, is a whole other issue)

You like surgery and decent hours? Try Mohs

You like pattern recognition or seeing clinic patients til your throat hurts? Try general derm

You like kids? Try pediatric derm (no way to get around the lower reimbursement though)

You hate people in general and want to be in a quiet room by yourself? Try dermpath

You like talking to some of the most psychotic people ever (I'm kidding. Kinda)? Try cosmetic dermatology