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Would you choose the same specialty today? -medical student seeking some advice

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  • #16
    So I started in OB/GYN and hated it.  I worked as a GP for a few years in a public health clinic while my husband finished his residency.  Then I went back and completed a peds residency.  Glad I ended up where I did with peds.  I wish I been less sure of myself and willing to consider other options than OB/GYN while I was in med school.  Good that you are thinking about lifestyle which is what I counsel my son and his s.o. to think about.  In the end, if you choose poorly like I did, you can change your mind.


    • #17
      I think I might change to something shorter in residency and that allowed locums or increased ability to make money on your terms/schedule.


      • #18
        Choose the specialty that you like and enjoy the most.  Lifestyle will have a role in how much you like and enjoy the job, of course, but agree with MPMD that it's overrated.

        I'm in orthopaedics, and I would choose it 100% again. And no one would say, "Go into ortho because those surgeons have a great lifestlye." But guess what? I have a great lifestyle and many other orthopaedic surgeons do too. I have to work a few evenings a month and one weekend every 8 weeks, but that's not difficult.  And I control my schedule. So when my daughter has a preschool program at 11am. My scheduler just blocks out my schedule for that time.

        If someone asks you why you chose a particular specialty and the first thing that comes to mind is "a great lifestyle" (which is often times code for saying that you get to do the things outside of work that you enjoy) then you might be in trouble.

        Any and every specialty can have a great lifestyle.



        • #19
          I chose path for many reasons.  I liked the relative efficiency of my day.  My clinical rotations seemed to be at the mercy of more moving parts than the lab.  I felt that I was pretty good at clinical and had great training at my med school.  Several faculty really urged me to do IM, but I got emotionally burnt out with my patients, the system, etc.  I liked the diversity of cases although that can change if you super specialize.  The puzzle solving nature of path was a big draw.  I've yet to experience the lifestyle aspects as I'm just now in my first of two fellowships, but that isn't as big a deal to me as being happy with my colleagues one day.  I can say that I would pick it again.  I had some rough days where I wouldn't pick the same residency program but still path.  You can always do transfusion/blood bank or cytology if you want patient interaction.


          • #20
            I feel the answers should also involve how long you’ve worked full time in it and how far you anticipate retirement from being.


            • #21
              I'm a physiatrist aka PM&R and I would absolutely choose it again.  7 years now.  I did not learn much about it in med school and thought I was going to be a surgeon.  I stumbled upon it during a tour as a Navy GMO/flight surgeon in Iraq after first assisting on a case where one of my guys had his leg blown up.  The orthopedic surgeon let me do much of the case (I had been a surgical intern and he knew I was interested)--it was just trauma stabilization/placement of an ex fix so he could be sent on to Germany for definitive treatment.  I had been having doubts during my intern year about pursuing surgery--I found myself looking forward to clinic and rounding more than the OR.  The leg looked pretty bad and I was sure he was going to lose it despite our efforts so after that I started reading about amputee care and stumbled upon the world of PM&R which combined pretty much everything I was interested in (btw, he ended up keeping his leg, continued in the Marine Corps until retirement, and is doing well).

              PM&R generally has a good lifestyle, but that's not why I chose it.  Every once and a while I'll have a resident who I can tell chose physiatry primarily for the perceived lifestyle.  They generally seem kind of miserable, and are miserable to work with.  Luckily most physiatrists choose it because they truly love it.  Pros:  broad field, lots of options for practice type, often patients are medically complex with interesting problems, patients often come to you who have failed everything else and you have freedom to think outside the box with their treatment plan (this can also be a negative, as PM&R can be a dumping ground for other services--you just have to not mind that).  Cons: nobody knows what you do (including other doctors).   I think some of the people who refer to me think I spend my day exercising with patients.  My patients get what I do though--I like to say that nobody understand a what a physiatrist does until they need one, and then they understand pretty quickly.

              I treat a lot of chronic pain, although I don't do interventional spine injections--I personally do not find them all that interesting.  Treating chronic pain can be emotionally draining, so if you are going to go into it you have to be able to deal with that.  I would not go into pain management just because you enjoy certain procedures--the pain world is going to evolve and you don't know how much of those procedures you are going to be doing in 10 years, procedures are generally an adjunct and for effective treatment you generally need a comprehensive approach, which often means a lot of time spent with patients.  I write long notes not for insurance purposes, but because my patients are complex and I want to make sure their information is all laid out in a well synthesized manner, for the referring physician, for my own treatment planning and follow up, for the rest of the treatment team, and for other doctors who see them down the road.   And because, obviously, I like to write.

              My recs for choosing a specialty:

              1.  Choose what you are truly interested and want to learn the most about.  You can make plenty of money to live a good life in any specialty of medicine.

              2.  If you realize in internship or residency that you truly made the wrong choice, don't be afraid to switch.  When I was in med school I had this belief that switching in internship or residency was this awful thing and you had to make the right choice as an MS4.  I have known numerous people now who gave switched in internship or even after a few years of residency.  Life worked out great for them.  Nobody cares.  Their program director and coworkers did not cast an evil spell on them.

              3.  At some point however you just have to be happy with what you choose.  The grass is always greener until you jump the fence.

              I have no idea when I will retire, but when I do it will be because life is short and I have other interests, not because I want to leave my specialty.  I hope that I will eventually be able to transition to a flexible schedule with regular sabbaticals to do the other things I want to do...if I can manage that I might work as long as my brain allows.



              • #22
                I very seriously considered EM and did my internship at a hospital with a well known EM program; they asked me if I wanted to switch and I talked it out a bit but decided to stay with psych. I’m very happy in my work. There are of course THOSE DAYS but they exist in any field. I am very busy but prefer to work hard/play hard and I have more than 150 days off per year.

                Psych can pay well these days if you are efficient and, ironically, if you do therapy. We can now bill two separate codes for med management and psychotherapy, which means your 30 minute visit just got 50-100% more lucrative. I always practiced a combined meds/therapy practice, now I’m just getting paid for it - I think it’s fair, and leads to better care of patients.

                I sometimes miss doing a little more medicine but I don’t miss having to read in my field constantly. Psych evolves more slowly, a lot of the literature is trash, and some of the most important reading is in psychology, philosophy, and religion, which I enjoy. I’m able to incorporate my interests in behavioral finance, nutrition, exercise, and neurology with my practice. As long as I skim the major journals, do my CME, read up on new drugs, and subscribe to a service like JournalWatch, I am covering my bases. The fact that yet another article was published showing that 3 people responded to a brand new psychotherapy over 3 weeks is irrelevant, and I can skip that nonsense. I could never do oncology, IM, FP, or any other field which required reading huge amounts of journal articles every day or week.

                Psych is also a very diverse specialty. I have a mix of inpatient and outpatient. I do medical consults and I do long term psychotherapy. I see heroin addicts and schizophrenics and anorexics, sometimes back to back to back. I have colleagues who do only IP, only therapy and have never even prescribed Prozac, straight med management, pure prison work, pure forensic psych, eating disorders only, pure Suboxone in volume, psychoanalysis, research, ED/crisis stabilization, and wild combinations of some or all of the above.

                I love the long term relationships. The deaths (natural and unnatural), heartaches, and self destruction can be painful but I treasure the journey and feel my patients lead richer and more meaningful lives because of my work. That’s hard to come by in any career, including most fields of medicine.

                I need another 12 hours in every day. I’d keep doing what I do for a long time if I only I had another 12 hours to do the other things I love.



                • #23
                  I am a hospitalist. Compared to either outpatient medicine or other sub-specialties I am happy with my decision and wouldn't have done much differently. Compensation in our group is pretty good (a rare private democratic group). Like that I will be in a good position to back off a bit when FI (similar to ER and anesthesia). Biggest downside is the nights/weekends. Would have considered RadOnc if knew about it earlier than 4th year of med school but thats ok. There are a few of those specialties that are off most people's radar that would have been nice to know about earlier in school.


                  • #24
                    Radiology is a good career, but far from chill in PP.  Extremely fast paced, and you need to be able to make decisions very quickly and accurately, for 10 hours with little break.  Not everyone's brains operate like that.  Academics is more chill.


                    • #25
                      I would choose EM again. Most days I like the job, some days are better than others. I really love the flexibility I was able to work more shifts, earn money and aggressively pay off loans/invest. There are always extra shifts, whether it be at your hospital or through moonlighting/locums. It’s also fairly easy to go part time when and if you want to. It pays pretty well, seemingly pretty high demand for the foreseeable future. As mentioned previously, one of the easiest careers in medicine to ramp up and ramp down the amount you work.


                      • #26
                        I would 100% choose pathology again!  Going into 4th year, I was between pathology, radiology, and dermatology (even had a dermatology PD ask me to join her program when I published with her early 4th year of med school).  I guess you could say the common theme is that I enjoy visual "pattern recognition".  I enjoy looking at something and knowing right away what it is.  I enjoy the science of medicine and knowing that I really help patients out, just not by doing histories, physicals, placing orders in EMRs, or dealing with insurance companies I ended up going with pathology bc after I considered everything, that is just what I liked most.

                        If someone is interested in diagnostic radiology in med school, I would at least give pathology some thought.  The vast majority of work in community pathology is interpreting biopsies/surgical resections, with a minor component of laboratory management tossed in.  Compared to radiology, the average private practice pathologist probably has a bit more chill schedule with shorter days and non-existent overnight or weekend work.  Most PP pathologists I know are making over 400k.

                        I do think it is cool, though, when I hear of some radiologists working from home.  I do also think that radiology has an edge over pathology when thinking of what the future may hold.


                        • #27
                          My advice to medical students would be to not go into Family Medicine.  Though there's been plenty of talk about the importance of primary care over the decades, it has not translated into better reimbursement.  I will say with the advent of hospitalists the lifestyle has considerably improved over where it was 10-20 years ago.


                          It looks to me like the future of FM is mostly with NPs/PAs, and if someone really wants to go into primary care they may well be better off going to PA school.  You still get decent pay but with less debt, less headaches and a better lifestyle at an age where you often have young children.


                          So would I do it again - things have turned out fine but knowing what I do now I would not have chosen FP.


                          • #28
                            Mid career diag.rad.  Like others have said, very tough to concentrate for 9-12 hrs straight with little downtime and constant interruptions. THousands and thousands of images where perfection is expected and all your oversights are there forever!  Very heavy emphasis on production these days.  Lots of evenings and weekends since radiology is 24-7.   Not chill at all.  You’ll be fried after each shift.  If your a perfectionist ocd type then stay away.  It’s a specialty where speed is highly valued (quality less so in my opinion).

                            If you decide to live somewhere desirable, you may not get a good job and be underpaid as those areas tend to be corporate employed heavy, but this may be true for other specialties.  There is some probability of AI hurting your career at some point in the coming decades.  Trend for more reads for the same or less money.  But given all that, it may be one of the better ones in medicine if you can tolerate the work.


                            • #29
                              Rad onc is awesome. You will be busy clinically but ultimately you never work over night and emergency radiation is not common. Also you get to cure cancer and truly palliate symptoms affecting QoL. We routinely melt peoples malignant pain away to the point they can come off opioids. Very successful stopping slow bleeding causing symptomatic anemia. OTOH about 50% of volume is patients you’re going for cure. You could follow prostate, anal, head and neck, etc patients you cure with radiation alone for 15 years if you wanted but mostly we discharge from clinic when they’re out of the woods. Also if you’re into tech we have some of the coolest toys in medicine.

                              Downside is jobs are more limited and you may not get to pick your geographic location. Also it sounds like there may be more patient facing time than the OP would like.


                              • #30
                                Q for the psychiatrists here. I've heard that more and more psychiatrists are starting practices that are cash only. What do you have to do to move to that model? Does it sound better than it actually is? Not a psychiatrist but it seems like not dealing with insurance would be awesome.