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

[TheTodd]

Urologist here, would absolutely choose this again.

I love the mix of clinic, clinic procedures, and OR (though some weeks wouldn’t mind an extra OR day and less clinic). I like the range from QOL issues like urinary symptoms to cancer and everything in between. On the whole I can really help my patients and most are appreciative. it’s not all rosy, residency was long and brutal at times, there are some unsatisfying patients that need psych or chronic pain more then me (psychogenic ED, chronic ball pain, chronic pelvic pain, etc), but on the whole it’s been great.

I ended up in a great gig with 4 day work week, partnership tract in multi specialty group. Pay is good, hours manageable, call manageable and well compensated. I haven’t taken vacation in a year (young kids plus covid) and don’t feel the lack or any burnout, though will be taking more soon. Definitely got lucky landing where I did, though I still think if I had a more typical job I’d like the field, just at slightly lower pay/hour ratio.

[Hatton]

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.

2. Heavy cycles to ER????? Why? Unless fainting.
3. If this patient had been examined with a speculum by someone and a Pap smear done this would be avoided. In my view cervical cancer is best diagnosed by a physical exam and a biopsy not imaging. Imaging only helps you stage it.

[Dusn]

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.

Retina is, in my opinion, the most interesting field in ophtho and one of the coolest fields in medicine.

Joining a retina only group was a great call on your part. I started out in a multi-specialty private practice and I couldn’t stand it. When we had meetings, all the refractive surgeons would talk about is how to improve their Yelp reviews and get referrals from optoms (we would volunteer to cover call for optom offices when they went on vacation just so they would send referrals). Like I said before, I also thought the high patient volume was not conducive to giving good quality patient care. I thought many of the patients seen by many of the doctors in private practice really didn’t need to be seen yearly anyway (for example, my opinion is that if you have a mild cataract just come back when you want it removed, not every year). Private equity taking over private practices was also a concern. The Intravitreal injection schedule required by many patients also made it hard to take over 2 weeks off without having other retina specialists in the group to cover for you and the prior-authorizations for injections are also frustrating.

So ultimately I switched back to academics. I enjoy having meetings discussing interesting cases way more than Yelp reviews and optom referrals. We’re also a dual physician family that spends very little, are near financial independence about 7 years out, and I realized early that we probably would never need a private practice partner income.

At the same time, I appreciate doctors in private practice — the high income of doctors in private practice gives doctors who are not in private practice some negotiating leverage. I have a lot of the same concerns about the future of retina/ophthalmology, with private equity taking over, as you do. So my goal has been to keep spending low and reach FI.

[ScubaV]

I love the practice of pathology and I love the relative freedom to schedule my day however I choose as long as the work gets done in a timely fashion. Like many I am concerned about consolidation, declining reimbursements, and overall commodification of medicine. I'm employed by a hospital network and even though I like the environment and my colleagues I will say I feel more like a (highly skilled and paid) employee than a physician. And of course I recognize that however much I am paid, the RVU's I generate are worth far more.

The problem with pathology is that it is a very small field and our leadership seems more concerned with the needs of mega labs and academic institutions rather than pathologists. Leadership and academic literature has been harping on the impending doom of massive pathologist shortages via retirement for decades and then recently it came out that actually the number of practicing pathologists has been undercounted by as much as 40%. The job market is okay, but if you have any geographic restrictions then you need a lot of luck or stellar connections to land something.

[NumberWhizMD]

I'll go against the grain and say I'm primary care and LOVE it! Granted, I think it is related to my current job.

In my first job, despite being PCP, I had a very transient patient population (think, people who live in the country maybe half the year at most, or patients who are constantly changing insurance or PCP without clear follow-up). I HATED that job and thought it was me hating my chosen path.

However, I'm currently in a practice where I can "really" be a PCP. I love having long-term relationships with my patients, getting to know them, and getting to actually see long-term improvements in their health. It isn't perfect, but no specialty is. I have variety every day, I learn something new often, and it keeps me challenged, while also giving me a consistent schedule that allows me to pursue things outside of work.

The only other thing I really "loved" was inpatient pediatrics. I couldn't have gotten through all the other rotations, though, and didn't like the variable schedules.