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

[STATscans]

10 years in private practice FM.

I wouldn't do it again. FM is so broad and practice creep with mid-levels. The financial liability isn't worth the financial rewards.

Even in the first 10 years in practice I have seen less respect, less autonomy, more paperwork, and less revenue per hour in practice. And most days I still love my job because I see a difference by helping my patients become healthier or guide them through a complex disease.

If I did it again maybe I would have done ENT or dermatology.

do you think eventually FM, EM and the basic primary care stuff can AND should be handled by 'mid-levels' ??

And physicians will all be specialist or even sub specialist?

[STATscans]

It's tough to generalize a local situation to a whole specialty, but some of what you said is true in some practices. All Radiologists miss findings on occasion. We try to make it as rare as possible. I'm in a large group and there are a couple of my partners who miss a bit more than average, I wish it were different but that's the reality. As in all fields of medicine some docs are better than others.

The thing with Radiology that's unique is that every one of our mistakes is forever out there on the image. That's not true in most of medicine. The missed heart murmur, or the palpable breast mass that didn't get palpated is never revealed to others like the missed breast cancer on a mammogram.

The other somewhat unique thing in Radiology is that everyone (some hyperbole there) thinks they can read the image as well as the Radiologist. Its much easier to find "Waldo" once you already know where he is from reading our report. Its all part of the life. I take the good with the bad. The grass is always greener.....

hear hear hear, here here here here...

The only person who doesn't miss a case is someone who doesn't look at them regularly. Even the best of them miss something. And as was stated, images are saved forever and in hindsight anyone can 'see' a lesion.

Can you imagine if a camera hovered over a surgical room and recorded every cut, stitch and wipe? I bet many surgeons would have 'error rates' comparable to radiologist.

How about a camera recording every ER visit?

[K82]

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.

It's tough to generalize a local situation to a whole specialty, but some of what you said is true in some practices. All Radiologists miss findings on occasion. We try to make it as rare as possible. I'm in a large group and there are a couple of my partners who miss a bit more than average, I wish it were different but that's the reality. As in all fields of medicine some docs are better than others.

The thing with Radiology that's unique is that every one of our mistakes is forever out there on the image. That's not true in most of medicine. The missed heart murmur, or the palpable breast mass that didn't get palpated is never revealed to others like the missed breast cancer on a mammogram.

The other somewhat unique thing in Radiology is that everyone (some hyperbole there) thinks they can read the image as well as the Radiologist. Its much easier to find "Waldo" once you already know where he is from reading our report. Its all part of the life. I take the good with the bad. The grass is always greener.....

[zlandar]

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.

Do you count weekends/holidays for time off? I looked at the numbers for my own group and each rad works 32 weekend/holidays days a year. Counting 5 days as a "week off" that's over 6 weeks of call. As a rad you know call is often worse than a regular daytime shift.

We aim for 10-12 weeks off (not including the above weekend/holiday numbers) but any time we take a new contract that impacts time off for months. If you want to hire a new fellow he/she can't start until July. Hiring a rad already out in practice still takes 3-6 months to get credentialed. That's not counting the time to find/interview a good rad. If you hire too many and/or lose a contract you are left either with a lower salary or lowering payroll i.e. letting rads go. I don't like doing the second option at all so that means being more conservative on hiring.

Our productivity expectations are what we set for ourselves. Rads are people and as long as they fit into an acceptable range of productivity it's fine. That's why I find private equity owned rad groups troubling- there are owners who are completely dissociated from the work generating the income. It's easy to tell the docs to work longer and faster when you don't have to pull on the chain.

Actually having to hire, create/manage a schedule, and do payroll for a group gives you a different perspective.

[dayman]

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.

You are a resident right? Real world PP is more complicated than that, you will see.

You'll be one voice in a group with many other radiologists. Or worse, you're in an employment scenario where your boss is not one of your partners and couldn't care less how you feel on call. Different people are obviously going to have differing opinions on the money vs lifestyle spectrum.

Even when the group agrees, it's not so simple. My group is currently aggressively hiring. With volumes exploding everywhere there are more jobs than radiologists right now. It's not easy to get good people, and when you do get them signed it's not like they are going to start tomorrow. It takes time and our patients need their studies read in the meantime.

And when we are recruiting, what do most new grads look at? It's location and then how much pay, how much time off, how often do I have to work on the weekend. So the group that chooses a better lifestyle and lower volumes will often be at a competitive disadvantage. It's hard for a new rad to understand "sure that job pays 100K more but you will want to quit at the end of every weekend shift" until you've been there.

[Zaphod]

All of this is an issue with the linearity of pay in medicine. Unless you own a practice, take a cut from other docs/midlevels, etc...you're paid essentially like an hourly worker. See pt get x, always. never more, sometimes less.

Its even less than that ofc as you top out the marginal tax rate, which is the part I dont get as much. Why crush yourself too far into the marginal rate (if it requires extra hours/work in said specialty) if you're getting much less but of course your risk is not capped at all.

[Random1]

Out patient IM, 20+ years. Started out traditional Outpt/InPt then transitioned to OP only.

I'm satisfied with the way my career, but I dont think I would do it again if I knew ahead of time what it was really like. For the most part , days are generally pleasant. As commented above you feel like you are the dumping ground for everything in medicine from forms , to referrals , to anything no one else wants to do or see. But the worse part is the patients who have become more demanding through the years. I used to have a few demanding patients. Now it seems that everyone is.

Though the years I have tailored my practice, I have someone else do the forms and all the other "garbage". No nights weekends or holidays, and still make enough to become FI at 53. A lot of practicing is what you make of it, especially in IM. So life is good, but I guess it could be greener some where else.

[Dusn]

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.

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.

[Panscan]

dayman, I think I get where you are coming from with this remark about the perceived lifestyle field of radiology and what the job really entails. When you are off, it’s all good, but when you are at work, it’s overwhelming many times, because of the volume of work. I have a friend, who is in radiology in the southwest, and I’m amazed at how many scans he has to read through when he’s at work.

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.

[engerland66]

Private practice GI. Few years in. Democratic group. Partner. Own ASC. Would not do anything else. Great mix of office and procedures (not too long). ERCPs sometimes stressful, but no other significant anxieties or worries. This was my goal from 2nd year of med school and thankfully it worked out despite naysayers saying “private practice is dead”.

[Eye3md]

I'm a radiologist, no regrets. It's not perfect but I'd pick it again.

Radiology is weird as a so-called "lifestyle" field though. We do have great time off, both in amount of vacation and ability to completely unplug from medicine while off. But radiology is 24/7/365 now and our night and weekend shifts (almost always understaffed, covering multiple hospitals) can be brutally busy in a way that I don't think most non-radiologists realize.

dayman, I think I get where you are coming from with this remark about the perceived lifestyle field of radiology and what the job really entails. When you are off, it’s all good, but when you are at work, it’s overwhelming many times, because of the volume of work. I have a friend, who is in radiology in the southwest, and I’m amazed at how many scans he has to read through when he’s at work.

[PedsCCM]

Pediatric critical care is a fantastic field. Very little scope creep, kids are fun to work with and largely get better. Maybe more importantly, they want to get better. Nothing in the world like seeing a 4 year old who is intubated dance along with Baby Shark. We also don't have the fractioning of specialization that you see in the adult world. I get to care for neuro, cardiac, medical and surgical pathologies. The bad days are REALLY bad though. Thankfully those are infrequent.

[HikingDO]

10 years in private practice FM.

I wouldn't do it again. FM is so broad and practice creep with mid-levels. The financial liability isn't worth the financial rewards.

Even in the first 10 years in practice I have seen less respect, less autonomy, more paperwork, and less revenue per hour in practice. And most days I still love my job because I see a difference by helping my patients become healthier or guide them through a complex disease.

If I did it again maybe I would have done ENT or dermatology.

I’m FM and have been doing it for 20 years. I literally don’t know 1 FM doc who loves their job, for the reasons you stated above and more. Not sure what I would have specialized in if I could go back in time, I don’t remember hiking or mountain biking residencies back then, but if they existed that would have been the way to go!

[dayman]

I'm a radiologist, no regrets. It's not perfect but I'd pick it again.

Radiology is weird as a so-called "lifestyle" field though. We do have great time off, both in amount of vacation and ability to completely unplug from medicine while off. But radiology is 24/7/365 now and our night and weekend shifts (almost always understaffed, covering multiple hospitals) can be brutally busy in a way that I don't think most non-radiologists realize.

[runfast00]

10 years in private practice FM.

I wouldn't do it again. FM is so broad and practice creep with mid-levels. The financial liability isn't worth the financial rewards.

Even in the first 10 years in practice I have seen less respect, less autonomy, more paperwork, and less revenue per hour in practice. And most days I still love my job because I see a difference by helping my patients become healthier or guide them through a complex disease.

If I did it again maybe I would have done ENT or dermatology.