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

[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.

[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.

[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.

[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?

[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.

[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.

[VagabondMD]

I did IR originally and took PP job doing IR and DR. When I finished training, most of my subspecialty work was peripheral vascular and dialysis work. Much if that work is now done by other specialties. Midway through my career, I was no longer doing what I was trained to do. In IR, there is an ebb and flow of procedures and niches, and by the end of my 21 year run, I no longer was interested in most of the procedural work. Q2 call for the entire time also took its toll, and like surgeons, the inevitable complications had a cumulative affect on my psyche that I could not shake.

I stayed a while longer doing DR (breast and general), and my observation was that over the years, the number of images that you processed grew and the time you had to process them contracted. I found the work to be mentally exhausting. I think that this is an underrated quality of radiology work is that your brain is working balls-to-the-wall for 9-12 hours per day, making countless perceptions and decisions on a conscious and subconscious level.

When I started residency, I truly loved the field of radiology and then IR. It was perfect for me at a time, and I would have gone into it again. Today, I think that the most attractive fields are ortho and derm. Knowing all that I know now, I think rad onc would be a good fit for me if I were starting the journey in 2021. It is imaging based, interventional (as long as you consider radiation treatment a procedure), and I have always been especially interested in cancer. Plus, it is extraordinarily rare to get awaken in the middle of the night to “push the button”.

[Otolith]

Specialty ENT mid 30s

I love my specialty. Really enjoyed residency. Community employed practice was an adjustment though. Competing with academic centers is a challenge

1. Helping patients who need it is truly rewarding and the pay is good for the work I do
2. My patients that complain the most have the least wrong (majority), while those with true issues (cancer) complain the least (minority).
3. My day is telling people "no you don't have fluid in your ear despite what the PA said, and no your "vertigo" when you stand rapidly and BP drops to 80/40 is not from your ear despite what PA said..."
4. My administration is great but I hate being held responsible for things I cant change and being reliant on an admin time for changes


Problem is that, #1 is about 5% of my day...

I think for my income level I wouldn't do another specialty, its just part of the job. I think my true passion is teaching and perhaps once I get enough FI maybe I will transition careers.

[Anne]

2. My patients that complain the most have the least wrong (majority), while those with true issues (cancer) complain the least (minority).

This is true in every specialty. My theory is that having something truly go wrong changes your perspective to focus on what really matters and be more grateful for what you have. Also, when the seriously ill complain it doesn’t register as complaining because we expect it and our mind is focused on what to do to help, which is what we want to do anyway. When the person with a minor issue won’t stop complaining despite our best efforts to fix it (and often it’s either unfixable or the only person who can fix it is the patient—i.e. lifestyle) it registers as a giant annoyance and takes up more of our mental energy than the person we can actually help.

[STATscans]

I did IR originally and took PP job doing IR and DR. When I finished training, most of my subspecialty work was peripheral vascular and dialysis work. Much if that work is now done by other specialties. Midway through my career, I was no longer doing what I was trained to do. In IR, there is an ebb and flow of procedures and niches, and by the end of my 21 year run, I no longer was interested in most of the procedural work. Q2 call for the entire time also took its toll, and like surgeons, the inevitable complications had a cumulative affect on my psyche that I could not shake.

I stayed a while longer doing DR (breast and general), and my observation was that over the years, the number of images that you processed grew and the time you had to process them contracted. I found the work to be mentally exhausting. I think that this is an underrated quality of radiology work is that your brain is working balls-to-the-wall for 9-12 hours per day, making countless perceptions and decisions on a conscious and subconscious level.

When I started residency, I truly loved the field of radiology and then IR. It was perfect for me at a time, and I would have gone into it again. Today, I think that the most attractive fields are ortho and derm. Knowing all that I know now, I think rad onc would be a good fit for me if I were starting the journey in 2021. It is imaging based, interventional (as long as you consider radiation treatment a procedure), and I have always been especially interested in cancer. Plus, it is extraordinarily rare to get awaken in the middle of the night to “push the button”.

It would be interesting to hear from non radiologist about how much imaging is being done.

Especially in the ED. we have so many non relevant studies being ordered and when we try to get more information, I feel like I am just in the way. Working the evening shift and weekend are just horrible. Non stop imaging from the ED. Now traumas are full body scans. The imaging speed is faster but looking for pathology hasn't gotten easier.

Is it necessary to look for 'mets' in the ED? do you feel like if you don't scan them, they would slip away? Also, seems like every branch of medicine sends their patients to the ED - no one wants to take responsibilities. Answering machines are 'if this is an emergency, hang up and dial 911 or go to the ED".

[afan]

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.

Not many jobs are set up to "easily read less."

There are costs to a practice to have someone on board. Thus, it is more efficient to have fewer people working hard, than more people, taking it easily. The people who want a full time + job usually end up in charge. We have some people who are peripheral to the practice who work occasionally when we need coverage. They have no say in how things work and have to keep up when they are with us

We do not take anything like that much time off. We do 5 weeks of vacation, although many people do not take it all. Plus a week for CME, although I easily get 100 hours of CME each year without leaving home.

[VagabondMD]

It would be interesting to hear from non radiologist about how much imaging is being done.

Especially in the ED. we have so many non relevant studies being ordered and when we try to get more information, I feel like I am just in the way. Working the evening shift and weekend are just horrible. Non stop imaging from the ED. Now traumas are full body scans. The imaging speed is faster but looking for pathology hasn't gotten easier.

Is it necessary to look for 'mets' in the ED? do you feel like if you don't scan them, they would slip away? Also, seems like every branch of medicine sends their patients to the ED - no one wants to take responsibilities. Answering machines are 'if this is an emergency, hang up and dial 911 or go to the ED".

Over the years, reading exams from the ED became an increasing source of professional dissatisfaction. Consider these not uncommon scenarios, based on actual cases that I have seen toward the end of my career in radiology:

1. Stone protocol CT A/P with history of "right flank pain, R/O kidney stone". You do not see any stone and you report such. The ED doc calls you because he thinks that there is a non-displaced L1 transverse process fracture, and why did you not report it. The doc then tells you the patient fell and hit his/her back/side on the bath tub and there was really no clinical concern for kidney stone.

2. Belly CT with history of "abdominal pain". There is an unusual bowel gas pattern and you spend 15 minutes trying to figure out if the dilated bowel loops are secondary to enteritis or something more sinister. You are not certain, and you call the ED doc. You are told that the patient's only symptom is heavy menstrual periods and was sent by the OB/GYN to the ER for further evaluation. There is no abdominal pain or concern for a bowel process.

3. CT scan from the ER to "r/o hernia". You see no hernia and report it as such. 6 months later the patient comes for a PET/CT scan to work up her Stage III cervical cancer. In retrospect, you see a mass in the cervix and probably could have called it 6 months earlier had you been clued in to it. You look in the EMR and the reason she was in the ER 6 months ago was pelvic pain and vaginal bleeding and no one bothered to do a pelvic exam or ultrasound. You feel terrible that you are involved in this chain of missteps that may have contributed to a poor outcome.

And on and on. The lack of relevant history contributes to diagnostic inaccuracies, some are trivial and some are significant. Combined with the crushing volume that you can see on some shifts, especially nights and weekends, and you often do not have the amount of time or energy to spend on each case that the patient deserves.

[Rando]

And on and on. The lack of relevant history contributes to diagnostic inaccuracies, some are trivial and some are significant.

It's more than lack of history, it looks like the wrong study was ordered in all three. Though with good history you would have possibly been in a better position to recommend the right one.

[Zaphod]

It's more than lack of history, it looks like the wrong study was ordered in all three. Though with good history you would have possibly been in a better position to recommend the right one.

This is terrible, but I think will only increase. Idk why as it seems that the studies could have been done with complaints offered (outside heavy periods come on).

It feels like people are ordering things they believe will get done, insurance, timing, etc...instead of whats appropriate. This is of course crazy.