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Best and worst part of your specialty

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  • Best and worst part of your specialty

    Teeing off of the "derailed" foley thread   and because I think this forum skews toward those who enjoy their jobs I want to hear what people like most and least about their specialty. Who knows if this will take off but I think it could be fun and generate good discussion.

    Field: EM

    Years in practice 6:

    Best part of job: being trained to be able to handle basically anything at least in the short term, creating order from chaos, being able to fix some things (e.g. lacerations, some fracture care)

    Worst part of job: night shifts, surges in patient volume, mismatch in patient expectations between what they want and what an ED can actually provide

    Favorite condition/procedure: respiratory failure, fracture management

    Least favorite condition/procedure: "weakness"

    Do it again? (if not what else): 100% yes

  • #2
    Field: general dentist

    Years in practice: 6

    Best part of job: schedule, autonomy, ownership. I often get bored and envision the grass being greener as a physician (I think I would love ortho) but then I remember I have total control of my schedule and practice and work 31 hours a week.

    Worst part of job: managing the practice I do not work at. Although there is a wide variety of procedures and people, the job can get monotonous.

    Favorite condition/procedure: surgical placement of implants

    Least favorite condition/procedure: dentures

    Do it again? (if not what else): most likely, as stated above, I would think hard about going to med school, but I think lifestyle would win out and I would do dentistry again. I do not really feel like my job is a big part of my identity so I think I could be happy doing a lot of different things.


    • #3

      15 years

      Best: long term relationships with people; getting to know their deepest secrets; using every psychotherapy skill I have to manage difficult patients; the miracle cures that come when ‘the relationship heals’; the spiritual and emotional growth I enjoy by allowing myself to make a human connection with those who are suffering. I also enjoy medical psychiatry and the interface with medicine and neurology and am sought out for those skills, so I get to see less common cases and make unusual diagnoses (for a shrink) including (recently) central venous thrombosis, autoimmune/paraneoplastic encephalopathy, occult malignancy, and lupus cerebritis.

      Worst: How many psychiatrists does it take to change a light bulb? Only one, but the light bulb has to want to change. there are some patients invested in being ill. Because I am not in private practice I do not turn away patients. I see all comers. Successful suicides are very, very painful.

      Favorite complaint/diagnosis: I love seeing patients who were diagnosed with refractory neuroticism (depression, anxiety) and being able to tease out subtle previously unrecognized and hence untreated psychosis

      least favorite complaint/diagnosis: probably OCD. Largely intractable, we don’t have any skilled CBT providers locally, patients are often non-compliant.

      Do it again: wouldn’t do anything else!



      • #4
        Field: Ob/gyn

        Years in practice 3

        Best part of job: Delivering babies is pretty awesome. I like a lot of gyn things too, especially since a decent amount of gyn problems are fixable

        Worst part of job: Fetal demise. Especially at term.

        Favorite condition/procedure: Several- ruptured ectopics (as long as it's an easy one)- it's the only surgery I do where they wake up immediately feeling better, stat c-sections- nobody hopes to do them but I do kinda feel like a badass going from skin to baby out in 1 minute, LEEPs- nothing special about the procedure, but I know that for every 3 LEEPs I do I've prevented 1 case of cervical cancer so that's pretty awesome.

        Least favorite condition/procedure: Aside from losses, when people blame all sorts of problems on "my hormones" and have no clinical signs whatsoever that their HPO axis is malfunctioning, yet want me to "check hormone levels" (which btw fluctuate every single day of a normal cycle) and miraculously fix their weight gain or whatever

        Do it again? (if not what else): Absolutely


        • #5

          Field: Urology

          Years in practice 10

          Best part of job: improving quality of life- incontinence or ED is not something everyone discusses with friends or spouses

          Worst part of job: diagnosing high grade cancer. Low grade prostate and bladder patients do well.

          Favorite condition/procedure/complaint/diagnosis: Botox for OAB. works well, done in 20 mins and lasts 6 mos. These patients are the happiest.

          Least favorite condition/procedure: imagined hypogonadism. The trend is for 20-somethings to request Testosterone injections. Or the patients who state they can only get erections with their girlfriends and not their wives.

          Do it again? (if not what else): yes, but my timeline is 8 more years until I retire. I haven't decided what my next adventure will be.


          • #6
            Field: EM

            Years in practice 6:

            Best part of job: the camaraderie, the varied pathology as well as varied ages and complaints, plays well to my ADD, working night shifts(yes you read that right, I'm a nocturnist!!), shift work allows a good work life balance,

            Worst part of job: having to tell people their family members are dead, worst of the worst, telling parents their children have died, also sucks to find cancer; also families dumping patients and not giving a ************************ about their loved ones

            Favorite condition/procedure: LOVE shoulder dislocations (and other dislocations), also love bedside ultrasound (did a fellowship)

            Least favorite condition/procedure: chronic patients who think I can fix them (chronic patients, fibromyalgia, chronic pain, chronic GI stuff, etc)

            Do it again? (if not what else): Definitely.  Went to med school to do EM


            • #7
              Field:  Ob/Gyn now Gyn only.

              years:  26 OB/ 4 Gyn only

              best part: long term relationships with patients.  I liked Ob when I did it also

              worst part: without a doubt it is telling someone that their baby is dead.  Delivering dead babies is terrible also. I decided I had had these conversations enough times in my life.

              favorite procedure. Adrenaline rushes..ruptured ectopics and stat csections. Mastery..vaginal hysterectomy of large fibroids.

              least favorite.  Patients who want to blame their hormones on weight gain, fatigue, marriage problems etc.


              do it again ?????



              • #8
                Field: Anesthesiology

                Years in practice: 2

                Best part of job: checking up on a patient in PACU 10 minutes after a nerve block; the variety of cases I see on a daily basis; the other docs in my group; the work/life balance; when I go home, I don't carry a pager.

                Worst part of job: trying to run the OR board while also taking care of patients; dealing with (certain) unpleasant surgeons

                Favorite condition/procedure: the weird/challenging stuff that forces you to problem solve and do the "MacGyver Anesthesia" that can't be found in any textbook; 3D interrogation of the mitral valve for repair vs replacement

                Least favorite condition/procedure: labor epidural for BMI > 50 (usually screaming in pain, usually at 3:00 AM)

                Do it again? (if not what else): ************************ yes


                • #9
                  Great idea @MPMD this thread is awesome.




                  • #10
                    Field: Fam Med (will be going rural midwest)

                    Years in practice 2.5 (still in residency)

                    Best part of job: Sheer variety. Like MPMD said, I like learning a moderate amount about everything. Especially with going rural, I am being trained for inpatient care, outpatient, ER/Trauma, and even OB (although I have decided against doing OB when I start my big boy job). Continuity is a big plus.

                    Worst part of job: Can't really complain right now. Not having my own staff makes clinic and daily tasks burdensome if you don't stay on top of it (our office only has 1 MA per 2 docs and they are limited to just clinic duties. We often deal with our own prior auths and billing snafu's). When I graduate, I'll have 1 in 4 combined clinic and ER call to look forward to (but I realize that I've done it to myself by going rural).

                    Favorite condition/procedure: Fractures, lacerations, skin biopsies. Dropping someone's A1C from 9.5 to 6.9 is a great feeling as well.

                    Least favorite condition/procedure: Chronic pain. Trying to determine who is sincere and who is just fueling a habit is enough to make me want to turn in my DEA license sometimes.

                    Do it again? (if not what else): Medicine:100%, I think I would still do family medicine due to the variety, but I do love ER/Trauma.


                    • #11
                      Field: GI

                      Years in practice: ~ 0.5 

                      Best part of job: preventing colon cancer, getting a mix of procedures and not having to spend 40 hours in clinic

                      Worst part of job: patient with nausea on 15+ medications, abdominal or pelvic pain for 5+ years coming for 3rd opinion, chronic pancreatitis

                      Favorite condition/procedure: inflammatory bowel disease as one can greatly improve these patients' QOL, early decompensated cirrhosis (can, again, improve QOL at least for the short term), banding esophageal varices, routine screening colonoscopy on a healthy 50 year-old patient

                      Least favorite condition/procedure: end-stage cirrhosis, colonoscopy on a 75+ year-old with multiple previous abdominal surgeries, colonoscopic decompression on a patient with adynamic ileus

                      Do it again? (if not what else): absolutely


                      • #12
                        Field: General Dentistry

                        Years in practice: 3

                        Best part of job: Office owner in a small town, so I have basically absolute freedom over the cases I see and what I refer out. I practice in my hometown, so I know a lot of my patients from when I was young, however, there are days I'd actually put that in the con section as well. I also love restoring someone's confidence and self-esteem by fixing their smile, although I admittedly don't get a lot of cosmetic cases in my area.

                        Worst part of job: WCI constantly belittling my profession  :P (Just kidding! I actually really enjoyed that pediatrician blog post that seemed to piss so many dentists off) Really, probably no different from the physicians - insurance reimbursement rates, dealing with lazy staff, difficult patients, etc. Probably my least favorite aspect though is the increase of dentistry as a "customer service" industry. For example, I recently went to my dermatologist, where I waited 2 hours to be seen for probably about 30 seconds by the doc, and then got charged over $100 to do so, at what was basically a recall appointment where nothing new happened. He is one of the most respected dermatologists in this region. But if I make a patient wait for all of 10 minutes, I get bitched at by them and then can expect a bad Google or Facebook review (or both) and could potentially lose an entire family and referral source. I don't know, I just feel like this entitled attitude of patients has affected dentistry more than medicine, but I'm sure you docs deal with this as well. Just my observations I guess.

                        Favorite procedure: Crown and bridge

                        Least favorite procedure: Dentures, just like RMD. Honestly, I think you'd have a hard time finding a GP that didn't hate dentures. Stressful, difficult, and the patient is rarely happy with the end result.

                        Do it again? Hard to say. I got into both medical and dental school, but chose dentistry for the lifestyle, and granted I can't really beat that. I make really good money working 32 hours a week and own my own business, which I love. But sometimes I get that itch that I regret not taking the other road occasionally. Honestly, as far as dentistry goes, it's really just a job for me - I don't love it, but I don't hate it, and I'm decent enough at it. And it pays the bills. All in all, I'd probably go the same route, but that answer could honestly change depending on the day you catch me.


                        • #13

                          Medicine:100%, I think I would still do family medicine due to the variety, but I do love ER/Trauma.
                          Click to expand...

                          Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.


                          • #14
                            Nice idea MPMD!

                            Field: Internal Medicine/Hospitalist

                            Years in practice 6

                            Best part of job: The flexible schedule.  Makes it really easy to travel and have important days off.  I also like being able to pick up extra shifts as needed.  The job itself isn't too bad most of the time and the pay is good for what I do.  It can be satisfying to see people make a quick, good recovery in the acute care setting.

                            Worst part of job: When the census gets too high and we're seeing too many patients each day.  That is by far the worst part of the job.  The work load can be unreasonable at times and very difficult to manage.  Angry or unreasonable family members. Getting constantly interrupted when trying to do your work.  We tend to get dumped on a lot.  Dealing with opioid addicts or other difficult patients with unreasonable demands/expectations.  The 24/7 responsibility when I'm on a block of rounding days (technically my ****************** is on the line even when I'm sleeping, though I have a partner covering for me).  That's a heavy burden to carry, which is why I've come to prefer shift work (admitting shifts).  I hope to be able to eliminate rounding completely in the near future and just do admitting shifts prn.

                            Favorite condition/procedure: I will not answer this one because I'm superstitious about it.  When I was a medical student I had a very well respected, old-school internal medicine doctor/program director tell us to never choose a favorite disease/diagnosis because there have been so many classic cases of docs contracting the very illness that were their favorites or for which they were considered experts.

                            Least favorite condition/procedure: Any acute neurologic issue.  I also hate getting called about tachycardia or hypotension.  There are probably others I'm not thinking about now

                            Do it again? (if not what else): 100% No.  I've learned a lot about myself in the past few years that has made me realize that I really chose the wrong career.  Though I'm not regretful about it, because regret is a negative emotion and I don't want to be that way.  Plus, there are tons of positive things that I can say about my time as a physician, etc.  But, knowing what I know now, I am certain I'd be a lot happier in a career where my introvertism was not being constantly tested everyday.  Where I could do something that I actually find intellectually interesting and challenging.  Where I could focus really intently on one difficult problem at a time and come up with creative solutions or design more efficient ways of solving them.  Where my natural strengths/abilities were able to be fully utilized.  Having a position where I could work at my own pace without constant interruptions and forced social interaction.  I think I would have enjoyed being an engineer, although I'm not sure I could handle the math.  Or, a biologist doing something in the ecology field or with marine biology.  It's hard to say, but I do know that I don't like medicine.  I'm 35, going on 36 and seriously contemplating going back to school for something else before I'm too old.  But, it's really hard to leave a career that pays so well and gives me so much time off, especially when I still have 98k of student loans to deal with and we've grown accustomed to a pretty comfortable lifestyle and we get to travel a lot.  I'm very optimistic about the future though and I'm excited about the possibility of finding something new someday.


                            • #15
                              Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.