What job do you think is the best?

[PNWskindoc]

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.

Click to expand...

OP,

I was in the same position as you and actually even applied to a surgical subspecialty before pulling out of the match because I realized I didn't want a surgeon's lifestyle. I took a year off and tried to get as much experience in as many different specialities as possible and I ended up in dermatology. Admittedly, dermatology wasn't something I felt I was "called to do" or something I was even remotely "passionate" about it but I realized I'm just not wired that way and I could probably be happy doing a lot of different things, as long as it had pretty good pay, hours and some patient interaction. I also came to the conclusion that you tend to like things that you're good at, so even if the idea of dermatology might not excite you once you develop some level of mastery, you learn to enjoy it much more. I'm now 6 months from graduating a derm residency and I couldn't be happier. Job market is GREAT (as long as you don't want to do Mohs or dermatopathology), pay is very generous and and the hours are hard to beat. Just my 2 cents.

 

[canadianoutlaw]

This thread has really turned into more about what medical specialty people get the most net satisfaction from.

 

I'll put in a plug for Radiation Oncology. This specialty is highly satisfying/fulfilling, working with and helping (often curing) cancer patients. Intellectually challenging and stimulating and get to work in a multidisciplinary setting as part of the cancer team. Technical expertise is important, so skill/experience is rewarded with outcomes. Can be procedural (OR)-heavy if one choses. Usually clinic-heavy. Also can follow patients longitudinally so develop strong fulfilling relationships with patients over time.

 

Practical considerations include high reimbursement, acceptable job market, largely outpatient. It is highly competitive to match, perhaps the most competitive, and residency is hard work and challenging, but the specialty is extremely rewarding.

[jz]

It is useful to consider where you lie on the introvert------------->extrovert spectrum.   These terms are defined by how you are energized, or depleted of energy. These are NOT a function of social skills.

Example:   if you are a hopeless extrovert, annoyingly so to others around you,  you will de-energize toiling in the fields without patient contact.

Example:  if you are a natural  introvert, face-to-face contact with 30+ patients daily will drain you.

[shishka32]

Thanks all for the advice. I really appreciate it.

Is radiation oncology really procedure-heavy if one chooses? I thought they didn't do any procedures except the occasional brachytherapy.

I'll give derm a real chance. I'm also considering EM, rads (+procedures), peds ICU/NICU.

[BeamOn]

Shishka, RadOnc can be relatively procedure-heavy with brachytherapy, but that's not the norm. There has been somewhat of a shift away from brachytherapy in many sites due to a combination of better reimbursement for external beam and the scheduling hassles that can come with procedures. Alternatively, you're pretty valuable to many groups if you want to be the 'procedure guy.'  Some(many) RadOnc guys do little to no brachytherapy, some do maybe a couple dozen cases per month, but nobody is doing a dozen cases a day. Depending on your perspective though, you can think of every case (including external beam plans) as a procedure; you just get to sit down in normal clothes at a computer to do it. They're basically billed as such.

All that aside, Derm/RadOnc, NICU, and EM are on polar opposite sides of the MD spectrum. A bit of shadowing time in each should help narrow it down. Best of luck.

[7Rays]

I'm 5 years into my radiology career (post residency and fellowship) and love it. $ is good, can be great. Vaca is above average. Stress is low (as long as you can work fast and are competent). Jobs are opening up in the last 1-2 yrs. Just do a desirable fellowship (changes over time).  Partnerships can still be found in all sized cities and locations if you are good, but it may take several years to get where you want (often purely based on when people are retiring from their groups). I'm not suggesting you go into radiology wanting to do teleradiology but many people end up doing this for various reasons and you can basically live anywhere you want (just need internet).

You can find jobs with no patient contact if that's something you want. Others, like myself, prefer the patient contact and do many procedures on a daily basis (as a diagnostic rad). The job is fairly versatile.

[Hatton]

Shiska, I gather from your posts that you would not like what I have done.  I am OB/GYN.  I am solo (weekend call sharing).  I have been doing just gyn for 1.5 years.  The schedule has been stressful at times.  The money does not really compensate for the risks.  I can honestly say that I have enjoyed delivering multiple babies for a couple then doing a hysterectomy etc.  Their is satisfaction that comes from continuity.  I really doubt small practices will survive all the changes in healthcare.  If I had it all to do over again I would  consider lifestyle more in the decision tree.

[shishka32]

Thanks all for sharing. I realize my interests probably seem all over the place and as this year continues I hope to whittle it down. At this point all I know I want is a manageable lifestyle with at least a decent income. I do enjoy procedures. Hatton1, I did enjoy my OB/GYN rotation but as you said the lifestyle may be a deal breaker.

I can't figure out how to PM, so I will just post this here: 7Rays what type of procedures do you do?

Thank you again.

[JK]

I have to put a plug in for derm... I'm a current PGY-2 and while it was ridiculous to get into, I'm really glad I made the effort. It's certainly an uphill battle and complete commitment to successfully match (made more difficult when several of your classmates aren't working nearly as hard in medical school or going out to bars while you're at home studying)...but it is absolutely worth it. I'm only 6 months into my actual derm training and while the amount of book studying is unbelievable, I really do enjoy what I do and learning each and every day. And most importantly, most/all of my attendings seem pretty happy and enjoy what they do.

Dermpath, General derm, peds, Mohs, cosmetics... you can also go a number of routes depending on your interests. Just be willing to make the sacrifices during med school and be willing to go anywhere for residency (which I'm sure is the same for most competitive specialties).

[7Rays]

shishka32,

 

Basic procedures for diagnostic rads includes:

 

Biopsies of bone, breast, soft tissue masses, thyroid, solid organ,  etc using US, CT, stereotactic xray

Fluoroscopic procedures such as upper GI series, esophogram, swallow study, small bowel series, BE, joint injections/aspirations, pain management such as epidurals, selective nerve root injection, facet injections, SI injections

Ultrasound guided pain injections really catching on now to skip the whole radiation under fluoro, plus really fun to do if you have a modern US machine

US guided paracentesis and thoracentesis

And that's just the basic stuff... if you do Interventional Rad, the sky is the limit. Our guys do typical IR stuff and a bunch of basic cosmetic procedural stuff and run a successful outpatient IR clinic

If set up correctly, you can have meaningful patient contact in rads. In some ways, it's the perfect amount. Typical day for me is 10-25% procedures, and the rest is reading joint MRIs. It's fantastic.

[YSH]

I agree that there's no ONE specialty that will fit the bill. Also, agree with the point that it depends on your personality (introverted vs. extroverted).

Regarding future considerations:

1. are you married, is your spouse also in a time demanding field, how does your spouse (significant other) feel about your current work commitment, or your idea of work commitment in the next 5 years?

2. do you have kids, do you see kids in your future, will you know how being a parent may change your mindset or ideas regarding your career?

Of course, it is not possible to know now how all these things will affect you.

I think that why the idea of money management, avoiding debt and all the good gist at WCI is so important. Being financially above the water gives you (and your family) more options.  If you are not locked into your situation, either financially or whatever, you have more freedom to choose.  I would also say, keep your expectation realistic in terms of lifestyle, money, how much your family can tolerate in terms of your aspirations, etc.  We all only have 24hrs a day and no amount of career or financial achievement can ever outweigh a great marriage and a loving home.

I am in GenSurg, and spouse has equally time demanding career (at one point in life, a investment banker).  We married right out of college, when we were dirt poor, young, naive, in our pre-attending and pre-banker selves .  GenSurg can be the pits in terms of lifestyle, but I love what I do and when I chose the specialty and chose not to subspec, I knew that it won't be easy.  Calls can take its tolls and best done when young(er).  But sometimes, when you do something that is more generalized, it also keeps many doors open.  The more specific the field, the smaller the niche.  Also, once our children were born, the concept of career changed, both for the male and female counterpart (although, most would say it changes for the woman more than the man, but I know a few fathers that beg to differ).  We are at the stage where both partners have scaled back in our respective careers, in order to invest in our family. Who knows, once the kids are set, we might go back full throttle.

Good luck.

 

[ktehc]

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.

Click to expand...

Hey shishka32,

I'm in the same boat as you (almost). Current MS2 with interest in ortho, neurosurg, EM, and radonc. Though my experience is pre-clerkships and based mostly on prior work experience, shadowing, and research projects, I am starting to more heavily consider the lifestyleay ratio as a determining factor in what I attempt to pursue most seriously. I know it's premature, as I don't even take Step until early April, but it seems like we're forced to choose earlier and earlier to have the best chances at matching. I keep hearing "choose what you love and pay/hours won't matter," but I don't love any one field enough to not consider pay/hours.

The answers provided here are helpful though, so thanks all!

[shishka32]

Y SH wrote:

I agree that there’s no ONE specialty that will fit the bill. Also, agree with the point that it depends on your personality (introverted vs. extroverted).

Regarding future considerations:

1. are you married, is your spouse also in a time demanding field, how does your spouse (significant other) feel about your current work commitment, or your idea of work commitment in the next 5 years?

2. do you have kids, do you see kids in your future, will you know how being a parent may change your mindset or ideas regarding your career?

Of course, it is not possible to know now how all these things will affect you.

I think that why the idea of money management, avoiding debt and all the good gist at WCI is so important. Being financially above the water gives you (and your family) more options.  If you are not locked into your situation, either financially or whatever, you have more freedom to choose.  I would also say, keep your expectation realistic in terms of lifestyle, money, how much your family can tolerate in terms of your aspirations, etc.  We all only have 24hrs a day and no amount of career or financial achievement can ever outweigh a great marriage and a loving home.

I am in GenSurg, and spouse has equally time demanding career (at one point in life, a investment banker).  We married right out of college, when we were dirt poor, young, naive, in our pre-attending and pre-banker selves .  GenSurg can be the pits in terms of lifestyle, but I love what I do and when I chose the specialty and chose not to subspec, I knew that it won’t be easy.  Calls can take its tolls and best done when young(er).  But sometimes, when you do something that is more generalized, it also keeps many doors open.  The more specific the field, the smaller the niche.  Also, once our children were born, the concept of career changed, both for the male and female counterpart (although, most would say it changes for the woman more than the man, but I know a few fathers that beg to differ).  We are at the stage where both partners have scaled back in our respective careers, in order to invest in our family. Who knows, once the kids are set, we might go back full throttle.

Good luck.

 

Click to expand...

 

Thanks for the advice. I am married, no kids but plan on them in the future. The wife supports me no matter what specialty I choose (we got married right after college dirt poor as well). She has a career but it is easily transferable and she plans to stay at home with the kids while they are young. The lifestyle factor is mainly coming from myself as we look towards starting a family and wanting to be home. I am glad to hear you make it work in general surgery. I'll PM you.

[shishka32]

ktehc wrote:

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.

Click to expand…

Hey shishka32,

I’m in the same boat as you (almost). Current MS2 with interest in ortho, neurosurg, EM, and radonc. Though my experience is pre-clerkships and based mostly on prior work experience, shadowing, and research projects, I am starting to more heavily consider the lifestyleay ratio as a determining factor in what I attempt to pursue most seriously. I know it’s premature, as I don’t even take Step until early April, but it seems like we’re forced to choose earlier and earlier to have the best chances at matching. I keep hearing “choose what you love and pay/hours won’t matter,” but I don’t love any one field enough to not consider pay/hours.

The answers provided here are helpful though, so thanks all!

Click to expand...

Hey,

It is difficult to figure out a specialty. It's one of the biggest decisions we will ever make. I will say the clinical year really opens up your eyes in terms of what you like and what you don't. Unfortunately, as you say it seems fields are getting more and more competitive. ENT has a 248 step 1 average and multiple publications are essentially a prerequisite. I'm not sure how one could even think about matching into a specialty like that without knowing in M1/M2 or taking a year off. But somehow we'll figure it out and make it work. Best of luck.

[Antares]

I'm thinking about the "Would you do it again?" question. I'm a 57 yo psychiatrist in private practice. What I really wanted most -- when deciding and now -- was my time, for reading, learning, writing, intellectual interests. But my alternative career, a professorship in academia (not as a doc) seemed not lucrative enough to support financial security. The other option was something in finance that would offer a very high income and early retirement, but utterly without interest to me. My compromise was a job that afforded control over my time and a less than full-time schedule, satisfying pt contact and intellectual stimulation. I got all that.

I work my preferred schedule, noon to 8 PM, four days a week. I take home ~350K per year after expenses, no insurance just fee for service, no Medicare, no staff. My wife works a little less in the same field and takes home ~250K. I like my work, but when I no longer need the income will definitely stop.

However, I think if magically I were 21 again, I'd take a little more risk. I might well try something that could yield financial freedom earlier, and turn to medicine if it didn't look like that were going to work. Maybe I'd bite the bullet and go for a high-end finance job for a decade or two. Or try something entrepreneurial. At least have a chance at getting control over my time sooner.

On the other hand, I recall a conversation I had as a college freshman, when I naively said "I'm going to be a surgeon, work very hard and retire at 45". My friends said "If that's your reason and you drop dead at 44, your whole life will have been a waste." There's something to that.