Which field of medicine?

[Outdoors]

Hi everyone, I've been really lucky and thankful to discover this website as a med student, and thought I'd ask some questions about specialty choice.  Specifically, what do you wish you would have considered when choosing a specialty?

These are some of the fields I've been considering, starting my 3rd year.  I'd really appreciate any input or advice the readers have here.  Thanks in advance!

 

Rad Onc

Pros: I really enjoy the field - the oncology, pathology, the technology, and the patient care.  Very reasonable hours worked in residency and practice.   High incomes currently, but may decrease substantially with oversupply of Rad Onc physicians

Cons: Significant concerns in the field about oversupply of job market. It may be very difficult to find an ideal location to live.  Too many residency graduates means limited chances for partnerships (most are only offering employed positions), extremely high overhead costs if a partner.  Limited diversity of practice means potential for big losses in income if/when CMS makes cuts.

 

PM&R

Pros: potential for great longitudinal patient care, broader patient base than just cancer patients, potential to do many procedures (esp. with 5th year pain management fellowship), great lifestyle

Cons: Definitely lower income than the other fields here.

 

Dermatology

Pros: lifestyle, income, interesting procedures, great potential for cash based / cosmetic income.

Cons: The only downside is it's very difficult to match (my step 1 score is within the range, but definitely on the low end). Is it worth trying for this specialty with the high risk of not matching?

 

 

[janettebournes]

Derm. The correct answer is always derm.

[q-school]

Which field do you like best?
Many years ago when I was your situation they said the same thing. Too many rad onc. Never actually materialized. Too many anesthesiologists. Never really materialized.

The future is hard to predict.

[Drsan1]

I agree go with what you like to do. Unless you plan to be one of the early retire folks you could be doing it for 30 years. Lifestyle important but even with a great schedule if you hate the job itself then you still will want to check out early. Which one excites you?

[Outdoors]

At the moment, I think Rad Onc is the most interesting to me, although that could change after going through all my clerkships/electives.  Overall, I'm interested in all 3 of these fields and would probably enjoy the day to day practice of any. That's why I've narrowed down a lot of other fields I might not like as much.

[CM]

Go for the best lifestyle. Always.

[jpa]

I'm a 4th year student here....Keep an open mind for first half of your 3rd year to see if something is surprisingly exciting.  I sort of had that experience.  If you're wanting to match Derm, get those honors on all rotations as well.

However, I'm curious---is Derm really THAT great of a lifestyle? Seems to me like psych is definitely less hours/less patient load.  And hospitalists get 180 days off a year--yes they work often work 12 hour days, however, I think Derms are working 5/week 10-11 hour days as well, correct?

[VagabondMD]

janettebournes wrote:

Derm. The correct answer is always derm.

Click to expand...

CM wrote:

Go for the best lifestyle. Always.

Click to expand...

Unless you are surgically inclined, and then it is ortho.

[Outdoors]

q-school wrote:

Which field do you like best?
Many years ago when I was your situation they said the same thing. Too many rad onc. Never actually materialized. Too many anesthesiologists. Never really materialized.

The future is hard to predict.

Click to expand...

Rex wrote:

In regards to derm, the cosmetic side is greatly exaggerated.  You really have to like selling things if you want to do cosmetics.  So many of the simple cosmetic procedures are done by everyone (other specialties, mid levels, and dentists) now a days and unless you are the only show in town, you will at some level have to compete with that race to the price bottom.  Some of those simple procedures, its hard to claim you have a quality advantage.  The more expensive or invasive procedures such as some lasers have a lot more hype than reality so again you are selling.  I know a lot of folks who have also lost money trying to add it to their practice.  It is difficult to match and you have to be honest with yourself about it.  Fortunately its not like the old days when derm was a delayed match after the regular match.  There was no scramble if you didnt get a spot.  Now at least you can list it but also list backups.

 

As was sort of mentioned above, some of the claims about too many of any one specialty didnt last in the past.  There was a time when lets say anesthesia couldnt fill its match pool with the same quality but it lasted only a few years and reductions in incomes didnt last very long either.

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Thanks for the advice.  I've heard people say the exact same thing about derm and cosmetic procedures.  I guess I naively assumed that it would be easier with derm.

 

In regards to Rad Onc and jobs, I wonder were the past job market concerns for other fields "evidence-based" for lack of a better term?  Rad Onc has some of the academic literature from leaders in the field talking about serious concerns for the future of the specialty (Red Journal "The Radiation Oncology Job Market: The Economics and Policy of Workforce Regulation")

http://www.redjournal.org/article/S0360-3016(16)30289-9/fulltext

 

Granted, at the end of the day, these are just predictions.  But browsing through online job postings for Rad Onc compared to other fields shows that there are significantly fewer rad onc jobs posted in desirable areas compared to any other specialty I've seen. Current Residents have also told me anecdotally that it's pretty difficult in the job search process.

 

 

[Outdoors]

jpa wrote:

I’m a 4th year student here….Keep an open mind for first half of your 3rd year to see if something is surprisingly exciting.  I sort of had that experience.  If you’re wanting to match Derm, get those honors on all rotations as well.

However, I’m curious—is Derm really THAT great of a lifestyle? Seems to me like psych is definitely less hours/less patient load.  And hospitalists get 180 days off a year–yes they work often work 12 hour days, however, I think Derms are working 5/week 10-11 hour days as well, correct?

Click to expand...

I had psych already and was pleasantly surprised by the rotation.  I don't think it's for me long-term, but still an interesting field.   Out of curiosity, what specialty did you end up deciding on?

[Outdoors]

Vagabond MD wrote:

 

janettebournes wrote:

Derm. The correct answer is always derm.

Click to expand…

CM wrote:

Go for the best lifestyle. Always.

Click to expand…

Unless you are surgically inclined, and then it is ortho.

Click to expand...

I've got a friend who is dead-set on ortho!  I don't think I'd do well in a surgical residency.  But...if I end up loving my surgery rotation I'd consider it

[CM]

.

[RadDoc6876]

Radiology.

[thriftyyoungdoc]

Of your choices above, I haven't heard many docs complain that did PM&R. They always seem pretty happy and they get to help a lot of different people.

[antheus]

Pick something that you genuinely enjoy because medical school and residency are far too long and difficult to end up with a job that you hate. There is a ton of doom and gloom in radonc with regards to oversupply of residents and this isn't entirely untrue. On the flip side, I don't know anyone whose done a rotation and not enjoyed it and I don't know many residents/attendings who don't love the field either. The ones that don't typically went into it expecting to make 500k+ working 4 days a week in the city of their choice which is simply not the reality. You'll still make a really good living with amazing work life balance and if money is your sole objective then there are opportunities readily available to absolutely kill it. Derm is obviously derm. You make a ton of money with a good lifestyle but it's super hard to get into and, in my opinion, not particularly fulfilling. But hey, I don't know anyone that wishes they didn't go into derm either! Go into 3rd year with an open mind. You may be surprised by what you like/don't like.