Grass is always greener.....are you happy with your choice of specialty?

[Eye3md]

you are a retina surgeon, correct?

i'd be curious to hear your response to the OP... are you happy with your choice of speciality?



i am early career retina surgeon also (3rd year attending, in private practice), and i could not be happier so far with my current speciality and perhaps more importantly my job. medium sized retina only group in small/rural semi-coastal town, not particularly desirable/competitive area, but good for me and my husband. physician run practice, two of the partners make all the business decisions but they are very fair and frankly very good at running a business. we take very good care of patients, but things are maximized for physicians benefit (i.e. great work life balance). 4 days of work per week. work very hard when in clinic, seeing 50-70 patients per day, usually work from 8 to 4 or 5. one weekend of call every month, but not bad at all. income 500-700k per year so far... fingers crossed for partnership in a year, and hopefully decent increase in income then.

i think i just got really luck with this job. just dumb luck. being an attending has been much more enjoyable than i expected. i am a pretty negative/pessimistic/worrying person, and i was (and still am!) very worried about our group getting bought out by PE or a hospital (even though all signs point to that not being an issue). i wish i could just relax and enjoy my current set up without stressing for the future.

in training i was pretty pragmatic when picking ophtho then retina... i liked surgery a fair bit, i liked clinic a fair bit, preferred outpatient... found ophtho and retina to be fairly interesting, seemed like good work-life balance and stable field... now i'm finding myself genuinely surprised how much i like this stuff. it's cool being a specialist in a relatively obscure but necessary field, where what i say pretty much goes.

i worry that i walked into a pretty ideal setup right away, and if things were to become less ideal (like most other physician and retina jobs), i would be pretty unhappy.

fingers crossed but so far so good.

You sound like you are in a good situation. I left my first practice situation, after a year or so, because I could see I was not going to make partner but only keep making money for the partners. My current job, I’ve been with for almost 20 years and I have great, very fair and honest partners. That certainly matters a lot with regards to how much you enjoy your work.

[pulmdoc]

I would not do anything else. This past year has been beyond stressful for me and my family due to the crush of critically ill COVID, but I have always had a "run toward the sounds of chaos" mentality so I think if I was on the sidelines it would have chafed at me to be unable to help.

I love that pulm/CC has a very wide variety of practice breakdowns, everywhere from 100% critical care to 100% pulmonary and every mix inbetween. I am currently about 70/30 CCM/pulm but now that I am FI 10 years out of fellowship I am doing more clinic and less CCM.

[Turf Doc]

Volume/person is related to the desire to make money of the individual rads. Could easily read less and make less. Most rads don't want to do that.

The amount of vacation in PP rads is frankly ridiculous compared to essentially all other specialties and employment situations. There are people literally getting 12-18 weeks off. I have never heard of a job where you get 1/3 of the year off with no call and reading an extremely narrow modality such as mammography in another specialty besides rads. It would be like if you were a general surgeon who only did appys all day and literally nothing else.

I love rads subject matter and the job FWIW just the employment paradigms especially in private practice make no sense to me and I don't really see them repeated anywhere else in any other field of medicine. Would rather have a little less time off and not have calls be absolutely miserable where you are doing 3x FTE work. Again this is something I haven't really heard of in any other field and am not sure why it's a thing in radiology, I guess because PACS enables it? Not sure how it's legally defensible, it seems pretty clear to me you could look at normal business hours volumes and establish that as a normal volume and then if you have a mistake during a time where you are literally doing an integer multiple of that, it would look pretty bad.

Kaiser and/or VA jobs should get you closer to something more normal day-to-day with less time off right? Or maybe a tele eat-what-you-kill job provided you're not planning on eating much. Guessing the PP you signed with is more lifestyle-friendly?

[Hatton]

Hatton You underestimate the "trust factor" on the husband and the relationship that is created. Many fathers are grateful for your care and attention to the people most important to them. You forgot one additional factor. How did you feel when the child you brought into this world became a patient? Not common, but anecdotally I can say this happens (he practiced 42 years). Of course my daughter ended up needed to find a new OB/GYN. I am sure you have a legion of fans that greatly miss you, not just patients, the fathers and the children.

Sure Tim I felt like a number of "husbands" were my patients as well. In fact I delivered several babies same dad different mother.

[Hatton]

I am fearful of the almost unavoidable poor outcomes and high risk of litigation. If/when I get sued, that might be a decision point to see if I want to continue doing OB. Sad but true. One of the reasons I am so thankful for the WCI and this forum- to have an out before age 65yo if needed.

Any advice about how to weather this storm (poor outcome and/or litigation) and still want to keep practicing? Is it possible?

I would recommend following the WCI guidelines to become FI at a younger age. Litigation risk/fear is simply a part of OB. Sad but true. I quit OB at 56 and completely retired at 62.

[ObgynMD]

you are a retina surgeon, correct?

i'd be curious to hear your response to the OP... are you happy with your choice of speciality?



i am early career retina surgeon also (3rd year attending, in private practice), and i could not be happier so far with my current speciality and perhaps more importantly my job. medium sized retina only group in small/rural semi-coastal town, not particularly desirable/competitive area, but good for me and my husband. physician run practice, two of the partners make all the business decisions but they are very fair and frankly very good at running a business. we take very good care of patients, but things are maximized for physicians benefit (i.e. great work life balance). 4 days of work per week. work very hard when in clinic, seeing 50-70 patients per day, usually work from 8 to 4 or 5. one weekend of call every month, but not bad at all. income 500-700k per year so far... fingers crossed for partnership in a year, and hopefully decent increase in income then.

i think i just got really luck with this job. just dumb luck. being an attending has been much more enjoyable than i expected. i am a pretty negative/pessimistic/worrying person, and i was (and still am!) very worried about our group getting bought out by PE or a hospital (even though all signs point to that not being an issue). i wish i could just relax and enjoy my current set up without stressing for the future.

in training i was pretty pragmatic when picking ophtho then retina... i liked surgery a fair bit, i liked clinic a fair bit, preferred outpatient... found ophtho and retina to be fairly interesting, seemed like good work-life balance and stable field... now i'm finding myself genuinely surprised how much i like this stuff. it's cool being a specialist in a relatively obscure but necessary field, where what i say pretty much goes.

i worry that i walked into a pretty ideal setup right away, and if things were to become less ideal (like most other physician and retina jobs), i would be pretty unhappy.

fingers crossed but so far so good.

I think starting off right is such a huge help. It’s like fertile soil that allows ones roots to take hold. Glad you found some good soil.

Granted there could be a huge forest fire that wipes everyone out (PE firm anyone?) but even in a forest fire, the trees with the deepest roots have the greatest chance of survival. That, and having a financial out if needed.

40-50 people in clinic is a lot of patients. Sheesh. I had no idea that’s what it was like for ophthalmology/retina. I thought they had a cush life cos they were a ‘ROAD’ specialty.

[pitt1166]

I agree completely. I know ophthos who see 100 patients a day and they’re definitely missing stuff — they just might be working too fast to realize it. I think the patient volumes is a growing problem across medicine.

That being said, I agree that the problem might be the worst in radiology and the number of missed critical findings in the radiology reports I see really seems to reflect the rushed way they were read. They don’t even seem to be reading the reason for the study. For family members, I don’t care what the read says any longer. I always ask for a copy of the images on a CD and ask a competent radiologist friend or family member to look at it.

Sorry to sound like I’m bashing radiology. I think this issue of too many patients —> poor quality of care is universal across medicine, not just rads.

you are a retina surgeon, correct?

i'd be curious to hear your response to the OP... are you happy with your choice of speciality?



i am early career retina surgeon also (3rd year attending, in private practice), and i could not be happier so far with my current speciality and perhaps more importantly my job. medium sized retina only group in small/rural semi-coastal town, not particularly desirable/competitive area, but good for me and my husband. physician run practice, two of the partners make all the business decisions but they are very fair and frankly very good at running a business. we take very good care of patients, but things are maximized for physicians benefit (i.e. great work life balance). 4 days of work per week. work very hard when in clinic, seeing 50-70 patients per day, usually work from 8 to 4 or 5. one weekend of call every month, but not bad at all. income 500-700k per year so far... fingers crossed for partnership in a year, and hopefully decent increase in income then.

i think i just got really luck with this job. just dumb luck. being an attending has been much more enjoyable than i expected. i am a pretty negative/pessimistic/worrying person, and i was (and still am!) very worried about our group getting bought out by PE or a hospital (even though all signs point to that not being an issue). i wish i could just relax and enjoy my current set up without stressing for the future.

in training i was pretty pragmatic when picking ophtho then retina... i liked surgery a fair bit, i liked clinic a fair bit, preferred outpatient... found ophtho and retina to be fairly interesting, seemed like good work-life balance and stable field... now i'm finding myself genuinely surprised how much i like this stuff. it's cool being a specialist in a relatively obscure but necessary field, where what i say pretty much goes.

i worry that i walked into a pretty ideal setup right away, and if things were to become less ideal (like most other physician and retina jobs), i would be pretty unhappy.

fingers crossed but so far so good.

[STATscans]

Volume/person is related to the desire to make money of the individual rads. Could easily read less and make less. Most rads don't want to do that.

The amount of vacation in PP rads is frankly ridiculous compared to essentially all other specialties and employment situations. There are people literally getting 12-18 weeks off. I have never heard of a job where you get 1/3 of the year off with no call and reading an extremely narrow modality such as mammography in another specialty besides rads. It would be like if you were a general surgeon who only did appys all day and literally nothing else.

I love rads subject matter and the job FWIW just the employment paradigms especially in private practice make no sense to me and I don't really see them repeated anywhere else in any other field of medicine. Would rather have a little less time off and not have calls be absolutely miserable where you are doing 3x FTE work. Again this is something I haven't really heard of in any other field and am not sure why it's a thing in radiology, I guess because PACS enables it? Not sure how it's legally defensible, it seems pretty clear to me you could look at normal business hours volumes and establish that as a normal volume and then if you have a mistake during a time where you are literally doing an integer multiple of that, it would look pretty bad.

as for the volume. I think in PP and in small community hospitals, you can read pretty quick without making mistakes (too often).

most of the studies are not necessary and you have a high chance of being negative. as long as you do your search pattern and stick to it, I think you can read fast and be accurate.

CTs of the heads are ordered ALOT and they are the easiest study to read. DVT studies are another thing. Many out patient orthopedic follow up studies are straight forward. For the complicated ones, you take your time and dictate a good report. But on the stone cold normal ones, use a template. I mean how many ways is there say 'the lungs are clear, the heart is normal. there is no ptx."? if normal, just say, "powerscribe negative chest 2 views' and move on.

And if the patients come in multiple times how many times do you have to describe the multiple levels of disk space narrowing or the multiple diverticula they have? It was already mentioned before.

So yes it can be done.

If you work at a large hospital with complicated cases, ah, then dictations can go on. But you get the name recognition of working for a 'top hospital' as opposed to being called a 'small time radiologist'.

[Antares]

I’ve always thought I wouldn’t want to be in medicine if I weren’t a psychiatrist, but I guess I could have made it work. I prioritize the independence, autonomy, control of schedule, control of which patients I choose to work with, lack of EMR, no insurance to deal with in private practice. But more than all that, the work is just interesting and satisfying. I talk to people about their deepest concerns. I am called upon to be my best self. Then again, there is a risk of romanticizing work.

[Tim]

Retired OB here. If I could have a do-over I would of picked something more lifestyle friendly. The call bothered me a lot more as I aged. Certainly you save lives in OB/GYN as a regular occurence. You will likely have some unexpected unexplained fetal deaths along the way. It happens. It makes OB/GYN take an emotional toll. I got sued and even went to trial. This is horrible beyond words. I found the biggest plus of OB was the long term patient relationships. You start seeing a patient as a teenager for contraception, you do several deliveries, and finally a hysterectomy. The complete female life cycle so to speak.

Hatton You underestimate the "trust factor" on the husband and the relationship that is created. Many fathers are grateful for your care and attention to the people most important to them. You forgot one additional factor. How did you feel when the child you brought into this world became a patient? Not common, but anecdotally I can say this happens (he practiced 42 years). Of course my daughter ended up needed to find a new OB/GYN. I am sure you have a legion of fans that greatly miss you, not just patients, the fathers and the children.

[ObgynMD]

Retired OB here. If I could have a do-over I would of picked something more lifestyle friendly. The call bothered me a lot more as I aged. Certainly you save lives in OB/GYN as a regular occurence. You will likely have some unexpected unexplained fetal deaths along the way. It happens. It makes OB/GYN take an emotional toll. I got sued and even went to trial. This is horrible beyond words. I found the biggest plus of OB was the long term patient relationships. You start seeing a patient as a teenager for contraception, you do several deliveries, and finally a hysterectomy. The complete female life cycle so to speak.

I am fearful of the almost unavoidable poor outcomes and high risk of litigation. If/when I get sued, that might be a decision point to see if I want to continue doing OB. Sad but true. One of the reasons I am so thankful for the WCI and this forum- to have an out before age 65yo if needed.

Any advice about how to weather this storm (poor outcome and/or litigation) and still want to keep practicing? Is it possible?

[GoBlueMD]

It’s funny because it seems everyone says they are recruiting yet the job market is overall pretty neutral. Personally I think many PP rads are out of touch with what perspective job candidates desire(said as someone who recently accepted a PP position). Hence why tele is proliferating. PP has failed to innovate and respond to the market as a whole, hence they’re losing the battle.

I think there are more candidates that want a narrow focus in private practice. This is very difficult in PP where “general call” encompasses almost every body part. Our call is broken into subspecialty imaging modalities somewhat. But, there’s no MSK only call or body only call.

Weekday shifts have more room for subspecialty reading. But, if you can only staff one specialty, that’s undesirable and it will make coverage tricky when planning off days.

Mammo has morphed into another specialty basically. In the last 5+ years, I have been the only rad that reads almost everything +mammo. Almost all mammo rads interested in our practice have not wanted to read other specialties. Rads without mammo fellowship and saying no to mammo. And they can in this climate. Mammo is relatively easy compared to other rad specialties. Plus you interact with patients and perform low risk procedures!

In summary, staffing a medium sized PP (20-30 rads) can be very difficult. For long term viability of the practice, the rad hired has to read out of their fellowship subspecialty, with the exception of mammo these days.

[Hatton]

I’m satisfied with my career, but am realistic that there are pros and cons:

pros:
- I have the best patients. For real. They are smart, funny, bad*ss, tough. I haven’t attracted too many crazy ones, but maybe haven’t been around long enough to yet? The best thing about my job is getting to make a real difference in the lives of my patients, some of whom have been with me my whole (short) career
- it’s the perfect mix of challenging, but I can handle it. Technically, I feel like I am constantly learning but also good at what I do. Intellectually, I can know what I need to know. Not gonna lie: understanding hyponatremia was never my jam. I’ve learned it and forgotten it several times now.
- I have saved lives. That’s a pretty cool thing to say. It’s meaningful to me.
- I love my partners. Landed in a group that mentors young doctors and doesn’t eat them. I chose an employed position to finish
childbearing, build my practice, not have to worry about overhead so didn’t have too much expectation. I feel like I’ve found a hidden ruby in a pile of seaweed.
- even though it is an employed position, I have a lot of control over my schedule and 6 weeks off a year + holidays. Not bad. I know I could probably make more $ elsewhere but because our financial house is in order, I don’t need to.


cons:
- unpredictable hours. Getting up for deliveries in the middle of the night is physically tough for me. Wipes me out 48hrs later. Ironically the next day is not so bad, it’s the day after that I feel like death. I can do this for a while longer, but no way can I do it until 65yo.
- it’s stressful. I haven’t had a bad outcome yet, but I’m not kidding myself. It’s because I am at the beginning of my career. If I’m the norm, a lawsuit or three will come my way. Even worse is the thought of a unexpected maternal or fetal death. *shudder*
- the EMR. Ugh.

For now the pros way outweigh the cons. Would rather do this any day than have a desk job like the hubs. But super jealous that the hubs gets to sleep every night and never takes weekend call.

We are kidding ourselves if we expect the perfect job. There is good and bad to everything.

Retired OB here. If I could have a do-over I would of picked something more lifestyle friendly. The call bothered me a lot more as I aged. Certainly you save lives in OB/GYN as a regular occurence. You will likely have some unexpected unexplained fetal deaths along the way. It happens. It makes OB/GYN take an emotional toll. I got sued and even went to trial. This is horrible beyond words. I found the biggest plus of OB was the long term patient relationships. You start seeing a patient as a teenager for contraception, you do several deliveries, and finally a hysterectomy. The complete female life cycle so to speak.

[Eye3md]

I know ophthos who see 100 patients a day and they’re definitely missing stuff — they just might be working too fast to realize it. I think the patient volumes is a growing problem across medicine.
. I think this issue of too many patients —> poor quality of care is universal across medicine, not just rads.

I agree with this. I don’t see 100 pts per day but I’ll sometimes see 70+. Yes, I’m paid VERY VERY well but I HATE it. I can’t just go and cut my pt volume in half because these pts would have no where else to go (they’d have to drive hours away to see another retina doc). All of my partners are very busy like this too. Problem is, we’ve been trying to recruit another doc for 3-4 years now, and cannot get anyone. There are too many retina jobs and not enough retina candidates. I like what I do but wish it wasn’t so darn busy day to day.

[ObgynMD]

I’m satisfied with my career, but am realistic that there are pros and cons:

pros:
- I have the best patients. For real. They are smart, funny, bad*ss, tough. I haven’t attracted too many crazy ones, but maybe haven’t been around long enough to yet? The best thing about my job is getting to make a real difference in the lives of my patients, some of whom have been with me my whole (short) career
- it’s the perfect mix of challenging, but I can handle it. Technically, I feel like I am constantly learning but also good at what I do. Intellectually, I can know what I need to know. Not gonna lie: understanding hyponatremia was never my jam. I’ve learned it and forgotten it several times now.
- I have saved lives. That’s a pretty cool thing to say. It’s meaningful to me.
- I love my partners. Landed in a group that mentors young doctors and doesn’t eat them. I chose an employed position to finish
childbearing, build my practice, not have to worry about overhead so didn’t have too much expectation. I feel like I’ve found a hidden ruby in a pile of seaweed.
- even though it is an employed position, I have a lot of control over my schedule and 6 weeks off a year + holidays. Not bad. I know I could probably make more $ elsewhere but because our financial house is in order, I don’t need to.


cons:
- unpredictable hours. Getting up for deliveries in the middle of the night is physically tough for me. Wipes me out 48hrs later. Ironically the next day is not so bad, it’s the day after that I feel like death. I can do this for a while longer, but no way can I do it until 65yo.
- it’s stressful. I haven’t had a bad outcome yet, but I’m not kidding myself. It’s because I am at the beginning of my career. If I’m the norm, a lawsuit or three will come my way. Even worse is the thought of a unexpected maternal or fetal death. *shudder*
- the EMR. Ugh.

For now the pros way outweigh the cons. Would rather do this any day than have a desk job like the hubs. But super jealous that the hubs gets to sleep every night and never takes weekend call.

We are kidding ourselves if we expect the perfect job. There is good and bad to everything.