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

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  • NumberWhizMD
    replied
    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.

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  • ScubaV
    replied
    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.

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  • Dusn
    replied
    Originally posted by pitt1166 View Post

    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.
    Last edited by Dusn; 06-14-2021, 10:23 AM.

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  • Hatton
    replied
    Originally posted by VagabondMD View Post

    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.

    Leave a comment:


  • TheTodd
    replied
    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.
    Last edited by TheTodd; 06-14-2021, 02:34 AM.

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  • Dontgetthejab
    replied
    Originally posted by VagabondMD View Post

    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.
    THIS!! we need to give the radiologist more history!! It’s a tough job for sure!

    Leave a comment:


  • ObgynMD
    replied
    Originally posted by VagabondMD View Post

    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.
    Omg. I will try to include better history when I order scans.

    Leave a comment:


  • zlandar
    replied
    Originally posted by Zaphod View Post

    (outside heavy periods come on).
    Unintentional humor only a radiologist could appreciate.

    Leave a comment:


  • Zaphod
    replied
    Originally posted by Rando View Post

    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.

    Leave a comment:


  • Rando
    replied
    Originally posted by VagabondMD View Post


    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.

    Leave a comment:


  • VagabondMD
    replied
    Originally posted by STATscans View Post

    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.

    Leave a comment:


  • afan
    replied
    Originally posted by Panscan View Post

    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.

    Leave a comment:


  • STATscans
    replied
    Originally posted by VagabondMD View Post
    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".





    Leave a comment:


  • Anne
    replied
    Originally posted by Otolith View Post
    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.

    Leave a comment:


  • Otolith
    replied
    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.


    Leave a comment:

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