Best and worst part of your specialty

[Sajimone]

Field: HemOnc

Years in practice: 7

Best part of job: Clinical trials, using new immunotherapeutics to treat malignancy.  I primarily focus on cutaneous/connective/gastrointestinal malignancies and I enjoy the multi-disciplinary approach of treating patients.  Im part of a big institution, lots of resources and I interact with most other specialties periodically.  The absolute best part of my job is to see a patient with metastatic disease completely respond to therapy and to eventually come off all treatments and pain meds.  We are in a new era of oncology!

Worst part of job: inpatient service.. I have to do two months of inpt service with the housestaff.. enjoy the teaching but the patient load and acuity picks up...

Favorite condition/procedure:  I don't normally do a lot of procedures, but some of the newer clinical trials are using genetically modified viruses or other injectable proinflammatory or immune stimulating agents.   That's fun for the short term, but Im quick to pass off to the surgeons or interventionalist if complicated or if Im uncomfortable.

Least favorite condition/procedure: bone marrow biopsies.. I did my time.  luckily I have fellows who are eager to do these and if not.. then we have trained NPs or PAs.   Last resort is IR.   Rarely.. do I these anymore.

Do it again? (if not what else): Absolutely!  I actually majored in computer science during my undergrad and I came very close to sticking with the engineering track but I stuck to my gut instinct to stay with pre-medicine.  I enjoy learning new things and immuno-oncology has really taken off these past years.   I sincerely hope chemotherapy will be the last thing we do and perhaps a thing of past!   Plus.. I do so much more with paid teaching, expert witness, real estate, hoping to write a book soon.

[OlyFizz]

Field: General PM&R

Years in Practice: 4

Best Part of Job: getting to see a variable patient base, forming relationships with patients, getting people who have been having problems for years back on track, working 4.5 days a week with limited call responsibilities.

Worst Part of Job: no-shows, dealing with insurance denials for prescribed meds, insurance companies that only allow 12 therapy visits per year no matter what the diagnosis; can get monotonous.

Favorite condition/ procedure: Hypermobility, specifically SI dysfunction you can easily get them back in place, do a little injection or steroid pack and a little PT and they go on to do pretty well. I also like trigger point injections because they give people a lot of relief and it is often immediate gratification. A straightforward carpal tunnel EMG/ nerve conduction is also nice. Botox for cervical dystonia/ spasticity.

Least favorite condition/procedure: anoxic brain injury; chronic pain patients who just want narcotics and never to do any therapy or proactive treatment; supermorbidly obese people with muscular back pain who are upset I can't fix that problem with medication.

Do it again? probably. I never felt called to do anything else and I do enjoy my job most of the time.

[Millenial Doc]

Field: Pathology

Years in practice 5

Best part of job:  Great lifestyle and pay.  Path has to be one of the best fields for amount you can earn in a 40 hour work week with no weekends or call.  Minimal/no patient interaction (great for me, maybe not others).  Clinicians, in general, I find a lot more reasonable to interact with than patients.

Worst part of job: Messy specimens (i.e. colons, placentas) that need grossed in.

Favorite condition/procedure: No procedures, but my favorite specimens to look at are GI and derm.


Least favorite condition/procedure: Autopsies, radical prostatectomies, questions about clinical chemistry or microbiology from clinicians.

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

[Wudoc111]

Great topic and love the format started!

Field: Internal Medicine/Hospitalist

Years in practice: 3/22

Best part of job:  You get to do everything!  Always learning since often we have to act as the specialist.  Coming up with solutions and even cures when others have given up.

Worst part of job: Sometimes having to do everything! Especially procedures or starting therapy that should be performed by a specialist. Nonstop phone calls to coordinate care. Having to adjust to healthcare incentives (they mean well but did the policy makers really think things through). No placement/disposition options for increasing group of patients. Being told I am doing too much for patients and that is no longer how things are done. Being told by the ER that the specialists will consult and that the hospitalist should admit but the specialists no shows through the next morning and having to call again and often the next day.....

Favorite condition/procedure: All complex internal medicine cases with clear indications for admission


Least favorite condition/procedure: "OBSERVATION versus ADMIT/INPATIENT"   Focused sub specialist issues that can be served with just that one sub specialty involved. Cumbersome EMR systems more focused on capturing costs rather then patient care and safety. Speaking to Clinical Review Utilization and Coding

Do it again? (if not what else): Probably not. First 18 years was great.  Perhaps growing older one becomes set in one's ways but the recent trend in hospitalist work seems abusive.  Perhaps it is still a great field for fresh young doctors who have not seen what it was like in the past.

What else? LOL, I should have become a sub specialist?? I suspect I would then complain about how the hospitalist ruin everything. : )

[BurnedoutDoc]

Field: Emergency Medicine

Years in practice: 13

Best part of job: The schedule.  Being able to work as many or few hours as you want. Never bored, the shifts usually pass quickly (sometimes too quickly! no time to eat or go to bathroom) The teamwork, comradery, finding humor in very dark situations.

Worst part of job: The schedule. Nights, weekends and holidays forever.  This gets harder the older you get. Having to scarf down your lunch or dinner in 15 minutes and not being able to leave the dept in case a sick patient arrives.

Favorite condition: Anything life threatening that can be fixed and the patient will be dc from hospital (STEMI, ruptured ectopic, PE, etc)

Least favorite condition:  Nosebleeds (I can handle blood from everywhere else).  Invasive procedures on very old patients without DNRs or patients with a terminal condition.  Drunks (99% are just drunk, 1% have a life threatening condition--good luck picking the 1% out)

Do it again?  Not if I had to do full-time.  It is brutal, especially with young children.  0.5 time is much better, half the weekends, half the overnights.  The pay has increased a lot while I have been practicing.  By making the job so difficult, you guarantee job security because no one can do it for more than 20 years and many of them decrease hours after the first few years out of residency.  I am the second oldest attending in my department, including administration.  I don't know where the older EM physicians go--hopefully there are retired!

 

[timpanda]

Field: Medical Genetics

Years in practice 2

Best part of job: Seeing patients with rare conditions. Reviewing the medical literature on nearly every patient. Counseling patients and their families about genetic diseases and sometimes preventing adverse outcomes in family members. Normal business hours. On call but rarely get paged because genetic emergencies are few and far between.

Worst part of job: delivering devastating diagnoses. Those who are convinced they have something genetic but don't.

Favorite condition/procedure: anything I'm able to diagnose clinically and substantiate with molecular testing. Piecing together complex symptomatology into a unified genetic diagnosis

Least favorite condition/procedure: neurodegenerative conditions in the young

Do it again? (if not what else): definitely, though I wish the pay was better

[Ghetto]

Entertaining thread!

Field: Dermatology/Mohs Surgery (Solo)

Years in practice: 15

Best part of job: Clinical/Pathologic correlation - Love clinical examination of cutaneous tumors and then correlating the exam with what I’m seeing microscopically. Chasing a perineural squamous cell carcinoma into the facial musculature can be satisfying when you get clear margins!  A nice facial flap that heals beautifully is rewarding. Talking anxious patients through a procedure. I enjoying consulting with the colleagues I work with the most: often I’ll review biopsies with a dermatopathologist and work closely with oculoplastic surgeons to clear ocular/orbital tumors prior to their reconstruction. Seeing a patient that I diagnosed and treated for melanoma ten years ago back healthy as ever. Also, call is a cinch.

Worst part of job: Staff and office duties and overhead are killers for solo practitioners. I employ what seems to be an army of people including lab techs, MAs, nurses, front office people and I have a large building with a lab and surgery center so the overhead, maintenance, accreditation, and HR concerns are never ending. Mine is almost purely a referral only specialty so I’m constantly wondering if some other guy in town is picking off my referral sources. Always behind in my EMR charting and endless referral letters. Any procedural specialty has its complications and I agonize over mine to the point of poor sleep at night when they occur.

Favorite condition/procedure: Clearing a skin tumor with Mohs that has recurred after their dermatologist and plastic surgeon have both had a whack at it. Performing a nice repair that heals great. Derms love taking pics of interesting skin lesions to present at conferences!

Least favorite condition/procedure: Any surgical procedure on a young woman’s upper chest. Chance of hypertrophic scarring is high. Any procedure on unrealistic patients. I don’t do any Botox or cosmetic procedures. I got ribbed in medical school/residency about going into Derm to do cosmetic work. Interesting now to see Ob-GYNs, FPs, heck even the Vascular surgeons in my town falling all over themselves to get in cosmetic procedures. No thanks, I can do without the vanity and body dysmorphic disorder thank you very much.

Do it again? (if not what else): Yes, although sometimes I get tired of dealing with people and wish I was a pathologist reading slides or radiologist reading scans in a basement somewhere! Looking forward to slowing down once my kids finish college....

[Vee Tee]

Field: neurology
Years: 7
Best part:
During hospital work, I loved teaching residents I miss that the most. Call me crazy but I loved working in the inner city hospitals the most because the patients were most appreciative. My absolute favorite gig was in one the roughest parts of the city. I took the subway home at night. I was cautious and knew my limits but still loved it. I loved working on patients in the ICU coordinating care with all the other specialists I miss that part. It was also a kick advising neurosurgeons on neurological management. That was always fun especially when I was brand new. Most of them were really nice. Being the last person called because everyone’s run out of ideas I always felt like the encephalopathy guru. I loved localizing seeing the MRI and getting it right especially brainstem lesions. Out-patient: I love evaluating and helping complicated patients. I love it when someone tells me no one has ever done such a thorough exam on me. It’s second nature but makes me feel this was what I was meant to be doing outside of having my family. I love when a patient looks me in my eye and shakes my hand and says thank you to me after I dig a little deeper trying to get to the root of the disease. I love looking up literature when patients ask me intelligent questions they tried to look on the internet such as what is the latest on stem cell research on such and such. I love carrying my doctors bag with all my instruments. Also, seeing patients who could have had a nearly fatal or devastating outcome and looking like a million bucks I.e. someone’s whose spinal cord compression was treated in the nick of time I get actual goosebumps. Being a second opinion and actually getting a handle on it instead of thinking I can refer to so and so. Or, seeing a patient who was comatose and is walking into your office. Also, when residents still call me for advice and thank me for passing the neuro part of the boards. Also, when I ask a medical resident to localize they say lacunar infarct in the posterior limb of the internal capsule on the right and the MRI shows exactly that! Doing a spinal tap when a primary team couldn’t handle it including attending and hearing that pop! Then dribble dribble.

Worst: Hospital: the hardest is talking to the family of someone who had a cardiac arrest, seeing a patient with mild symptoms 30 minutes later comatose and you find a large intracranial hemorrhage with brainstem herniation, going to the hospital in a cab at 2am for tpa. Out-patient: dealing with opiate seekers, barbiturate seekers. You try your best some still not happy with you and it doesn’t matter how well-intentioned you may be.


Favorite diagnosis: I wouldn’t wish it on anyone maybe I’d say most interesting diagnoses ....whenever I make a rare diagnosis by myself such as paraneoplastic syndrome, olivopontocerebellar atrophy, transverse myelitis due to both multiple sclerosis and CNS vasculitis, progressive supranuclear palsy

Least favorite: in the hospital: alcohol withdrawal seizures just because I feel they are preventable

Would I do again: just looking at the best parts outweighing the bad parts I would say absolutely!!!

[The Physician Philosopher]

Field: Anesthesiology

Years in practice 1.5

Best part of job:  Being an expert that is leaned heavily upon when it "hits the fan."  I really enjoy the thrill and challenge of taking care of people at their sickest.  Also, I like the part of the job where you get to introduce yourself to a patient and convince them over the next 5 minutes why you are trustworthy enough to take them as close to death as they will get before they meet their Maker.

Worst part of job: ungrateful/whiny surgeons that stampede when anyone causes a delay (but certainly don't mind showing up late themself or forgiving that 1000th "toughest joint I have ever replaced..." you'd think they would run out of the toughest case they've ever seen at some point).

Favorite condition/procedure: Favorite procedure = a combined spinal epidural (CSE) on OB.  I don't do this a lot anymore, but man was it gratifying watching someone in horrendous pain get comfortable quickly.  I also liked the "performing under pressure" that came with that procedure.

Least favorite condition/procedure: I hate placing triple lumen central lines.  I'd much rather just put a giant double lumen MAC introducer for central access, but alas sometimes the triple lumen is the right one to do the job.  Lease favorite condition is the unrecognized difficult airway = Not fun.

Do it again? (if not what else): Absolutely.  I love what I do.

[NaOH]

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[Dreamgiver]

NaOH wrote:

The Physician Philosopher wrote:

Also, I like the part of the job where you get to introduce yourself to a patient and convince them over the next 5 minutes why you are trustworthy enough to take them as close to death as they will get before they meet their Maker.

 

Click to expand…

The last time I was put under general anesthesia, I vaguely remember that when the anesthesiologist came to introduce himself I told him I was a pharmacy student and was interested in what meds I would be getting during the procedure. Of course I can’t remember what he actually told me, but I think it made his day that I asked.

Click to expand...

I love it when patients ask me technical questions

[SerrateAndDominate]

Field:  Pathology

Years in practice:  3.5 (fair to count residency)

Best part of job:  Lifestyle and work: pay.  Diversity of cases.  I like going from a benign skin rash to a rare pancreas tumor in a short time.  It's mentally stimulating, and I like seeing a stack of trays at the end of the day to somewhat quantify everything I've done for the day.  I also have an overall strong group of residents who are great team players.  I am going to miss that part of my training.

Worst part of job: Subspecialty sign-out is mixed.  I like learning from experts about certain things, but I think several faculty use it as a crutch to get out of handling other cases.  I wish some pathologists would be as technically competent as they expect of their trainees.

Favorite condition/procedure: I don't mind doing the autopsies (hate the paperwork).  I like doing FNAs so I can help give clinicians and patients a rapid idea of what's going on and how to plan the next step.  It's just enough patient interaction for me.  For some reason, I enjoy pancreatic lesions.

Least favorite condition/procedure: Paperwork for autopsies; anything clinical path (chem, heme, micro); validation;  I also dislike some of the "splitting" we do in the field, especially in dermpath.  I think we get too caught up in small details that don't move things along.

Do it again? (if not what else): Definitely.  It's one of my favorite fields in medicine although I had some great teachers who prepared me to do just about anything.  Outside of medicine, I would love to have a woodworking shop, but I know I would never want to sell my stuff.