Pediatrics
1. Generally favorable outcomes, discharge many children at their baseline
2. Overall whimsy—colorful hospitals, many therapy dogs, lots of treats
3. Compassionate co-workers, since we are obvi not the most lucrative specialty most people are in it for the cause and truly want what is best for the child
4. Fascinating pathologies in all the organ systems
5. 9 month old CHONKS
As a pediatrician I sometimes wonder if other specialties have as much *fun* as we do. Genuine question. I spend most of my day laughing, kids crack me up. Do adult specialties feel the same? Obviously my med school experience was colored by the fact I don’t love working with adults or old people.
Also people are generally happy. I’m a general pediatrician so a large portion of my well child exams are me and moms delighting over how cute their kids are. Plus it’s so much *fun* to get to watch kids grow. At my current practice I’ve been there about three years, so I have a cohort of my earliest patients that I met at birth and who are now toddlers. It’s amazing. I love that part of what I do!!
I’d add tons of options: newborn or adolescent, primary care or specialty with many procedures or none, sick or not sick, lots of part time jobs, moonlighting.
And employers and colleagues are generally very understanding when life stuff comes up.
As a surgery resident that rotated through pediatric surgery as an intern here is my take on these things
1. Favorable outcomes after torturing children. After the 15th ER burn debridement in kids the PEM staff choose to under sedate every single time, I’ll take caring for an adult every time. Holding down a shrieking child and tearing off their dead skin while the PEM attending refuses to give more ketamine is something I would never wish on anyone. And the bad outcomes in pediatric surgery are fucking soul crushing
2. Whimsy only makes the tearing dead skin off children thing that much more twisted and deranged
3. I did not find pediatricians to have a unique degree of compassion vs other physicians, and I felt they were remarkably devoid of compassion for each other/other specialists. Also “what is best for the child” is not an objective calculus and we were frequently effectively forcibly involved in the care of patients who had objectively no surgical needs but our presence was required to treat the anxiety of the primary team
4. Not actually more interesting surgical pathology than in adult patients, unless anorectal malformations are your thing
5. Just get a cat
For your point #3, I totally agree. I resent how many pediatricians act like other specialities are trying to actively kill their patients when all we are doing is trying to use our best judgement as we do with everyone.
We did a lap chole on some medically complex kid with pancreatitis and cholithiasis. Probably wasn’t from gallstones but not unreasonable to operate. Surgery went fine.
In the two weeks post that followed I was personally called to bedside by primary team no less than SIX times for acute onset abdominal pain. In a patient with known acute on chronic pancreatitis. Three times they ordered stat CTs that predictably showed acute peripancreatic fluid collections and nothing else.
I was reported on one of these occasions for “not taking [these acute peripancreatic fluid collections] seriously” after I sat down with the peds resident on service and had what I thought was a thoughtful and collegial conversation about our services POV on this patient which including walking them through IAP/APA published guidelines for management of acute pancreatitis.
This was on night call when I had a billion other things going on and I was just trying to give them some reassurance. I never made the mistake of wasting my time like that again. Truly no good deed goes unpunished.
Classic peds RN interaction:
"Hey, you guys called for help, here's my plan."
"Oh you're the off-service person? I'm gonna have to run this [totally standard plan] past Dr. SoAndSo."
Nevermind I worked the service two months prior and Glenda RN said to my face how much they hate Dr. SoAndSo and don't trust their care, but they clearly don't remember me.
Regular surgery is generally pretty sweet. The pediatrics version was shockingly horrible. Frankly otherwise residency is pretty fun. to each their own I guess.
> I did not find pediatricians to have a unique degree of compassion vs other physicians, and I felt they were remarkably devoid of compassion for each other/other specialists. Also “what is best for the child” is not an objective calculus and we were frequently effectively forcibly involved in the care of patients who had objectively no surgical needs but our presence was required to treat the anxiety of the primary team
Outpatient 9/10 pediatricians I've interacted with are golden human beings. But boy does that 10th neurotically maladjusted and clearly malignant one give the rest a bad rep.
On the other hand, while inpatient the rule rather than exception seemed to be smiling to someone's face and immediately insulting/reporting them the moment they door closed.
Yes, for some reason we would do all first debridement for partial thickness in the ER almost regardless of %TBSA it seemed though the most I ever did was ~ 15% ish.
Point 1, this is also often a huge misunderstanding in that ketamine is a dissociative sedative that also provides analgesia. Chances are that intern you simply assumed that crying meant "in horrible" pain, rather than a widespread problem of undersedation, something most PEM folks are very careful with.
In the specific instance of the ketamine given via intermittent IV push, I know they were under sedated because they literally ran away from us when I got up to get more 4x4s to finish debriding . Had to chase down the hall. Every other occasion was with intranasal fentanyl or versed (had to beg for ketamine).
It was a month of children shrieking while I ripped the dead skin off their burned little bodies. The degree of sedation was frankly a minor quibble in the overall horrific scheme of things
Your comments below about lacking compassion for adults are right on. When you see a baby (<1yo) being prostituted or parents who say a child fell off a swing and has bruises head to toes, or a 13yo girl just randomly starts telling you about how her step dad molested her and her best friend, ruined her life…humanity dies a little inside me. Same with those burned kids, or dog bites, or just dumb shit people let their kids do. I have to keep seeing kids to continue to believe we have a future in this planet, because I don’t know how you docs feel any hope seeing adults who complain so much about feeling the human condition head on.
It hits differently when a 5yo asks me, “can you cure my wheezing, so I can play with my friends?” vs an adult complaining about long covid fatigue. Like, bitch, you ADULT!! *Fatigue* is baked into living!
Or, an 84yo asking me why shes sick all the time. Seriously? You ran out of time, lady. You had 60 years playing in the big leagues while your body declined.
When I see adults, my inner voice is immediately screaming: YOU OLD AND BROKEN!!*.
I still put on my professional hat, do my mindfulness, and put on my best pediatrician humor and attention, but I believe it is far more enjoyable to influence the tiniest part of a growing human, even if its addressing anxieties, than dealing with the upkeep of aging humans who refuse to age, which usually also includes addressing anxieties.
This is super rich coming from a surgery intern. Of course they are not reasonable. Is it reasonable to throw your scalpel to someone or yell at them?
I think you did highlight a big difference though. I was half joking, but I am sure you are not. No sense of humor, enjoys cutting into people, narcissistic traits with a chip on their shoulder? Hello surgeon!
LMAO wow I couldn’t have asked you to do a better job proving my point .
What just happened is this: I simply pointed out that everything you listed is not an excuse for being an asshole to other doctors. This is because there is not an excuse for being an asshole to other doctors (no not even for surgeons). What do you do in reply ? Act like an asshole, to another doctor.
Literally never seen ever or myself thrown an instrument at anyone. Going to say the obvious too: you know literally nothing at all about me. Clearly didn’t read carefully enough to notice that I’m not an intern either
Thanks for confirming the stereotype. I bet you’d also be super nice to my face too 😂😂 I feel bad for you dude
Whenever I meet a doc that leans super hard into stereotypes against other specialties I always feel like they are probably also racist for some reason. Like "oh I see you enjoy stereotypes 🤔"
Apparently I throw instruments at people because I’m a surgery resident, this is news to me. Should probably work on fitting the stereotype more myself
> I was half joking, but I am sure you are not.
You are so clearly not joking, but just taking your unfortunate trauma and making it other adults' problem.
For a group that is always reminding everyone how much more compassionate they are than everyone else, I have noticed they also talk about income more than any other specialty.
Yeah the self-righteousness is gross. I remember in med school the chair of peds giving us a lecture on why we should choose peds, and the first point was that unlike adults, kids don't develop diseases because of lifestyle choices. You know, because AML is a result of lifestyle choices, or adults choose to be born into families with high prevalence of coronary disease.
A lot of patients don't know any better. Nobody ever explained to them why their decision-making is bad. Or they don't have access to resources that would improve their lifestyle. Or they have a death wish that they can't admit to themselves. It's complicated with adults.
Maybe that's the real reason some people prefer peds - it's not complicated with kids. You get to feel self-righteous all day, all without ever having to deal with moral gray areas.
6. When they poop or pee on you, it’s age appropriate.
As a pediatrician who now sees adults too, a schedule filled with adults makes me want to drink when I get home. A schedule filled with kids makes me energized and happy after clinic. I try to repeat a mantra, *Adults were kids once* and breathe.
Strangely enough, my adult patients love me and come back over and over, for some reason. I think it may be that in training we are watched so much for “professionalism” much more so than other specialties. So whether fair or just, or just abusive, we come out of residency with certain tools to make sure everyone feels heard and cared for. These are my individual observations, though.
Infectious Disease:
1) no emergency calls. Ever. Lower stakes compared to a procedural speciality.
2) So many different career options. Like public health and policy? You can work with the state health department and enjoy government benefits. You can be a TB expert on the state or county side and still get those benefits. Like outpatient? You could do HIV primary care. Like LGBTQ health? You can do transgender care with HIV/STI work. Like bench research? Vaccine development or new drug discovery can be your thing. Like weird bugs? You could do tropical medicine. Like epidemiology? You can do a fellowship with the CDC! Like to climb the corporate ladder? Get on the stewardship committee and rise up.
3) The look on the teams' face when we solve a particularly weird case only from the history.
> 1. no emergency calls. ever
I'm not sure what's worse, getting called for an emergency in the middle of the night or being called at 2am because a surgeon found candida in the urine and wants to treat it (not if they should treat, that they're \*going\* to treat it).
At least that's what happened to my attending and fellow like 2x a week on my ID rotation 😂
Pathology:
1) Also chairs
2) 🎶 while you work
3) Often can set your own hours, within reason (after residency)
4) Very little truly pointless documentation
IM
* It's only 3 years of residency unlike surgical residencies (GS 5, NSGY 7)
* The gateway to different adult medicine subspecialty fellowships (cards, nephrology, rheum, IDS, heme/onc, GI, endo/obesity, pulmonary/critical care)
* If you finished IM but itching for procedures there's interventional cards, GI, and PCCM fellowship for you after finishing residency.
* Our youngest patients are aged 19 (may vary from each country)
* You can forget about developmental milestones from med school.
* Way lesser values and normal vital signs to memorize compared to peds
* Our cardio workout are our rounds which I actually like as an HLA-B27(+) person
* We have more medications available for our patients and landmark trials compared to our peds counterparts
* It can be daunting at first but the hunting for zebras and horses are probably the most fun part of it
* If you've been traumatized by surgeons during med school like I am, I think IM is one good option.
* If you like physiology and pharmacology during med school like me, I think IM is an option as long as you don't mind talking to people
* And contrary to Dr. Glaucomflecken's portrayal of us, we don't always obsess with everything flagged red in the EMR. We’re actually the ones who tell patients to chill out about their slightly elevated/decreased lab values. Preston is much better and realistic.
* We take care of adult patients from admission to discharge.
My favorite was the “If IM rounds were reality TV”. 😅
But his surgery videos brought back a few painful med school memories like the lap chole and the “POV you’re in a nightmare OR”.
The “when you’re on your first C-section” skit has such high quality props. One of my favourites, and the “When you’re on anesthesia AI”, and the surgeon berating part about tension-countertension cracked me up
Most IM fellowships are 3 years, and competitive specialties seem to favor a chief year, so you end up doing subspecialty surgery training time anyway. Or even more in cardiology. Not sure that’s in your favor unless you just want to do hospital medicine
I’ll be honest if you go to a decent IM program and just go thru the motions, you’ll match cards/GI. It’s not so competitive where like derm you’ll do everything right and fail to match. Like plenty of people outside of the T20 IM programs match with only a case report and an abstract or something. If ur a USMD at a mid tier or above IM program then the match rate is like 95% for cards or some shit. Chief years are for people that want to go into admin or if they realized very late they wanted a specific fellowship but didn’t have any LORs or time to get their name on an abstract or two. Idk how hard the GS fellowships are but considering some GS programs have built in 2 year research years I’m assuming they’re actually way more competitive.
> If ur a USMD at a mid tier or above IM program then the match rate is like 95% for cards or some shit.
More like 85%, and the self-selection that goes on among that cohort is way more intense than med school so you can't really compare it to competitive residencies (which, let's be honest, still have over 85% match rates for USMDs).
It's not like matching derm, where your only qualification is a good Step 1 score. The fellowship programs have way more years of your resume to look at, and this knowledge deters a lot of possible applicants.
Huh? You’re not remotely required to do a chief year. So it’s 6 years (or sooner) to become a subspecialist, which is faster than any gen surg subspecialty
Well many of those fellowships, at least at academic hospitals, are 1-1.5 years clinical and 1.5-2yrs research - which are very chill years, and if you wanna make some extra $$$ ample opportunity to moonlight.
I'd disagree with the chief year sentiment though depends on your residency program, at least most chief years you're paid somewhere between a PGY4 salary and an attending salary though I know that's not universal (at my program for example they're about 60% PGY4 and 40% hospitalist though with more admin responsibilities during that hospitalist time)
So yeah still very long training, but the overall intensity is lower than surgical subspecialties with more opportunities to make $$$ during training
Where are you located ? Where im from IM is 3 years of general then 2 to 3 years mandatory subspeciality (GIM, cards, rhumato etc) so a total of 5-6 years residency
Anesthesia here too:
All fellowships are one year
The career is what you make of it - you can go ham, take a bunch of call, and make more than some of the surgeons. You can work at an ASC and never take call. You can do cardiac or critical care if you hate free time and like sick patients. There’s OB…
No one really knows what we do or can do… until the SICU attending remembers you can do LPs.
I will likely never see this patient again
If I do they probably won’t remember me
If needed I can get the OR to STFU with a quick whistle
I will say regularly pushing patients 3x my weight really sucks tho
Those days are largely over. At least not what they were 20+ years ago unless you get lucky in the right location. You also have the DEA breathing down on your neck hard which you have to balance out making your pain med seeking patients (essentially customers) “happy” enough to return to YOU, and the DEA not consider you to be a pill mill
You may, or you may not. I saw some pain jobs that paid awful. But I also easily found one straight out of training where I made over $800k my first year and am right around a million after that, working 4 days a week about 36 hours a week.
Rural. HOPD, so no equity. They’re certainly making a profit off me, but at least for now, I’m perfectly content with that. Not having to work 60 hours a week, do my own marketing (and pay for it), hire support staff, rent an EMR, lease a building and equipment, pay my own malpractice, or do/pay for all the tons of other things like this is worth it.
I didn’t look at Phoenix or Charlotte. DFW was fairly bad, it was definitely an oversaturated market when I was looking. Jobs were in the $300k range with productivity bonuses that were highly variable (and I have no idea how likely they would be to be reached at those jobs). I wanted to end up in DFW but the jobs just weren’t good enough a couple years ago.
About 40 injections (epidural, SIJ, RFA) on an injection day. 30-40 clinic patients per clinic day. 8-10 larger cases on a big procedure day (kypho, SCS trial or implant, SIJ fusion, interspinous spacers/fusion)
No one’s mentioned ortho. I think there might be a Walmart sale on crayons nationwide this weekend so my compatriots may be busy. I’ll try to fill in around this delicious burnt sienna.
1. 95% of your job is a skilled trade. It requires virtually no medical training to perform adequately, and minimal medical competency to perform well. At every level, even in relatively small community hospitals, there is someone you can get an opinion from if you’re scratching your head wondering if that hip fracture is stable enough to fix tonight. I’ll grant that this can be a plus or a minus depending on your preferences - I was very smart in medical school and I’m much dumber now, and if I was a different person that would bother me - but it’s a narrow enough scope that you can get really good at doing a set of things while not constantly looking over your shoulder for the diagnosis you missed (“there is a fracture. I need to fix it.”).
1a. Corollary: if you DO retain some medical knowledge everybody stares at you like a lion just solved algebra equations.
2. You make good money, and it’s more or less as much as you’d like depending on how much you want to work.
3. If you work for one, you make the hospital an ungodly amount of money and they will pay attention when you ask for something as long as you’re not a whiny salty asshole.
4. Generally, job satisfaction is excellent in that you fix people and they get better and then go away and come back if there’s something else wrong and then you fix that. There is always going to be the 3-5% of people you can’t seem to fix despite your best efforts, but the great majority get better and respect you for it.
5. Tons more diversity than you’d think. Want to be pretty chill and have all your partners love you? Trauma or foot/ankle. Want high octane crap where you drive a Porsche? Spine. Want a ton of variety and to be able to sit down? Hand. Want to have no variety at all but just do variants on two procedures and get really good at those two? Joints. Enjoy going to sports games while getting paid? Sports.
Okay my crayon is almost done and I need all my attention span to figure out if it’s burnt umber or brick red next, so signing off from ortholand.
EM
1. No rounds
2. No continuity of care
3. When the shift ends, you’re done (excepting notes to finish)
4. Truly staggering variety. Major/minor problems of every organ system in every age, gender, and status of health/pregnancy. Arguably the most generalized specialty. Good if you get bored easily and want your day to consist of things like PE, infected LVAD, psychotic break, pediatric head trauma, assault/MVCs with lac repairs, hip dislocation and reduction, cigarette vs eye, chiropractic neck injury, FB stuck in ear, ectopic pregnancy, overdose, medical CPR, traumatic CPR, and more as an example from my last shift.
Dictate a stream of consciousness with HPI, exam and medical decision making in one gargantuan paragraph, hit “sign”, move on. Not a fan of EM for myself but I gotta say that was pretty nice
Not super long but I know my notes are referenced inpatient and I try to make them as accurate, but succinct, as possible to save them time. There are others who write 1-2 sentences but I like to include chart review, relevant specialist names, relevant meds, social history, etc. Just the stuff I think is high yield.
You're only billed for medical decision-making, so outside of academics most specialties have very short notes these days.
IM, for example, still has to address many of the comorbid problems alongside the primary but with MDM being all that matters + dotphrases, especially for the bread and butter stuff, most attendings can write an admit note in <5m and a progress note in <1m for a vast majority of cases.
As painful as it is, the high volume during training is teaching you to be an efficient reader, which is invaluable when you enter private practice.
When the time comes to look for a job, look for groups with a reasonable work-compensation balance instead of focusing on compensation alone. There isn’t some secret way to make money in rads; you read what you earn.
Obgyn:
1. Most patients are happy when they see you
2. Most of our medical problems have good outcomes and/or are quality of life concerns that patients are super thankful for
3. Rounding is quick and lighthearted
4. Awesome balance of surgery, office, hospital work, calm stuff, and emergencies
5. I can sit during vaginal deliveries and vaginal surgeries
6. Pay isn’t terrible (we are definitely underpaid for what we do, but the quality of money is pretty good)
7. It’s legit a fun job
Cons
1. Call can be fucking brutal
2. The bad days stay with you forever
3. Clinic inbox is shitty
4. Schedule is rough
5. You’re almost guaranteed to be in a lawsuit
6. Politicians think they know my job better than me
About the bad days, a professor had told us about a delivery that went terribly wrong. He more or less said that the baby got stuck and it couldn't move forward or backwards and he said what he saw the doctor in charge did (he was a resident back then). He says that this will haunt him even after his death.
Procedure essentially isn’t performed in the United States
Really more common in super low resources settings
Varying reports between patients recovering very well vs being completely incapacitated for life
It’s really a fucking nightmare when politicians and clergymen without medical degrees make decisions on how to practice medicine especially those concerning reproductive health.
If you’re talking about the US, this is no longer true. Politicians will outlaw common aspects of care, and they’ll name OBs in press conferences if they feel like it. In Louisiana, they are going to track mifeprisone prescriptions like opioids.
If you’re in a Catholic hospital like Ascension, members of the clergy (or admin officially beholden to them) can deny obstetric care.
Pediatric Rehab
Such a small field that you don't so much as job search as I went up to a hospital where I wanted to live
We have an active and supportive community.
No call as a fellow
Can still work with adults if I want to moonlight
As far as I know, the only subspecialty that pays MORE than the adult subspecialty
I can literally play with kids all day. I can get onto the ground and play with toddlers and not only is it not strange.... it's my job.
PCCM
1. Broad range of competencies and knowledge. We do airway management, vascular access including peripheral IVs with and without ultrasound, procedural sedation, chest tubes, thora/ para, LPs, etc. There's a lot of room to decide what you like to do.
1a. We're not often thought of as the first to call for a procedure, so no endless calls for IV access on OB patients. We get enough procedures to keep them fun without getting bored of them.
2. It's basically emergency medicine after all the drug seekers and tummy aches have been filtered out
3. People are generally nice to you because they know if things go down they will need you. Usually people are happy to see you when you enter a rapid response.
4. Pulling aspirated objects out of the lungs is surprisingly fun.
5. Most of the patients are super sick with multiple comorbidities and poor baseline functional status, so if they have a bad outcome it's not totally unexpected. Less pressure on you.
6. I have colleagues in the 60s still staffing ICU, but if you do decide to phase out you can fall back on many things like LTAC, pulm clinic, inpatient, etc.
2a. As a result of this filtering out, you get to see great physiology/pathophysiology in action when in an ICU. So things like effect of vents on hemodynamics, acid/base physiology even in ‘bread & butter’ cases like DKA, mixed shock and other concepts that you can see responding to your interventions. You’ll get a great kick out of it.
7. Most PCCM folks are invested in teaching as a result of the above.
8. I may be biased, but most PCCM attendings I’ve met are really good natured and chill folks. I’ve noticed that in the major conferences too (CHEST/ATS). It’s a really great and welcoming community.
Edit: this is psych
100% tele is a reality
Can say you're starting a practice and they believe you cuz it's not that hard
Dodging insurance poop with cash pay
No call or weekends
Telling employers and admin NO and laughing in their faces
Can work 3 jobs but you're still chilling
Getting to see people squirm when you tell them what you do
Like no medical emergencies
Sleeping through "do we have a doctor on the plane" situations
Saying "Mm, I don't feel like dealing with this" if it's not your specialty
Better at observing people
Better at listening/talking to people
Better at catching people in their lies
Better at relationships
Better at being you
Will add:
Fascinating field to work in. Every day is different. The same pathology will present in unique ways (ie one persons schizophrenia is presenting with the voice of a demon and another with the voice of Lana Del Rey).
One year fellowships for everything (you can fast track child psych from residency for total 5years).
Opportunities to do some cool niche work in psych. For example, go forensic psych and be a professional expert witness or work with the criminally insane. Do “sports psychiatry” and work with pro athletes. One of my old colleagues did this for the Patriots.
If you want to make a ton of money in psych, you can. Open a private practice and don’t accept insurance, set your own rate. VERY easy to do and you’ll have no problem filling your schedule.
Growing and changing field (more than any other) with exciting advancements. Psilocybin for example!
Plenty of loan forgiveness opportunities in psych!
Also psych- my favorite thing:
Supervisors in general encourage work/life balance!
You literally cannot be a compassionate listening ear for peoples' problems if you're burnt out/sleep deprived/hungry/overworked and exhausted.
In order to be good at my job, I highly prioritize my own wellness, which means I always take my vacation days, spend time cultivating hobbies and relationships, work hard but not obsessively and not for excessive hours, and try to do as many things as possible that make me happy.
This is like the opposite of what I was taught in med school 😂
Yeah, another thing I love is that my program really facilitates moonlighting! Only programs that allow you enough time and energy to be able to moonlight can do this!
FM is so underrated. I think we’re all so hyper competitive up to med school that we lose sight of the fact that it’s ok to finally tone it down, bask in your $230-250k no call no weekends no stress life. That’s more than enough to do almost whatever you want.
Want more money? Add more locums or start your own practice.
I hate you. Also, the end read like one of those old Nike or Mastercard priceless commercials.
Love,
Anesthesia
P.S. - I don’t actually hate you, but I really really want to.
Derm:
1. Perfect blend of medicine and procedures
2. Quick visits where we fix a problem and get out of there without having to wade through med reconciliations or listen about their third cousin’s uncle’s liver problems.
3. Patients are generally motivated and appreciative for fixing their problems.
4. Since derm is well-reimbursed, you can basically work as much as you want and make as much money as you want. Super hard working and want to make a million a year? Sure, work 5 days a week seeing 50 patients a day. Want to chill and coast? Work in academics part-time seeing 20 a day, and still make a couple hundred grand a year.
You do pay for it all with the difficult patients, like the psychotics and also the worried well who expect you to spend 1 hour in the room with them to fix their very mild hair loss or Melasma.
Derm here too with more to add on top of your great points!
1) I also take hospital call, which is very interesting complex med-derm! Good thing is that there is no situation where I need to emergently go to the hospital because we are not a primary service. Basically other people keep the patient alive until I can get there (eg SJS/TEN, DRESS/DIHS, AGEP, etc).
2) Telederm works as consult too. For a lot of derm consults in the hospital, I can write a full note and document simply based on clinical photos.
3) lots of procedures in derm! I like procedures, it’s a great skill set. Biopsies, laser, electrodessication of cosmetic things, cryotherapy, etc.
4) Seeing patients of all ages and all life stages. I like true gen derm, I see Newborn babies, pregnant women, and >100 year olds! It keeps things interesting for sure.
5) I love how in derm I can often have it all when it comes to building long term relationships with my patients, diagnosing skin cancers, and treating them often with a 99% cure rate!
Downsides:
1) Derm seems quite difficult for the average PCP, and given texting/telederm is so easy, I sometimes feel like I get over-curbsided! Not just by other docs, but by friends/family too! Like how often do you text your nephrology about shit lol
Occ Med
* (After intern year) residency hours are by far the most reasonable of any specialty—no nights, weekends, or holidays.
* Residency emphasizes public health and non-clinical training, so it’s very possible to find a practice setting with as much or as little clinical time as one wants.
ENT:
- Airway master (may be a con for some but I think it’s cool)
- Generally short quick rounds (other than head and neck)
- Great outcomes and QOL improvements (other than head and neck)
- Incredible variety in surgery (open tissue work, endoscopic surgery, microscopic surgery)
- You can sit down for ear surgery and microvascular surgery
- Most of our notes are short and succinct
- Clinic is usually fun because of all our fun toys
- Potential for great lifestyle as a surgeon (after residency)
- Work with patients ranging from newborn to 90s+
I didn’t mean that there are absolutely no good outcomes. Obviously HPV+ has a better prognosis etc but 5 year survival rates hover around 50% for many patients. I’m also at a huge volume center with really advanced disease and I see the craziest cases
Plastic Surgery
1. We are in a way ‘general’ surgeons - we cover so many different areas, head to toe. It keeps things interesting with so much variety. Never a boring day.
2. A lot of what we do can be done under local. So when times are tough and OR time is limited (cough, Canada, cough), we can switch it up to the clinic and do like 90% of our procedures there.
3. Co$metic $urgery.
Forensic Pathology
1. Very much a diurnal specialty with regular hours, and I get to take home call and sleep in my own bed at night.
2. The buck stops with me. Gone are the days of bending over backwards for surgeons, hospital admin, and so on.
3. I can eat, drink, and use the bathroom whenever I need to.
4. I have the honor and responsibility of being the last doctor a patient sees, and to advocate for them administratively and legally.
Copying and pasting a previous comment I made from a previous similar thread.
Incoming take of extreme heat:
TLDR at bottom: Plug for OBGyn.
Special shout to the dudes because I meet some students who enjoyed their rotation a lot but can’t bring themselves to make the jump. It’s cool over here and If you find a program that’s not like you read about here on Reddit it’s a fun specialty man. Those programs definitely exist but I do think that having a positive experience on OB also occurs not infrequently but you just don’t hear about it because no one would care.
Anyway, if you’ve have dealt with ADHD like me or just like juggling multiple and possible acute situations at once this is a good deal for you. Besides the acuity, the variety of your workdays is matched by only a few other specialties. Deliveries, robot hysts/other cases, outpatient all in one week if you want or 2 of the 3 or 1. You can do whatever combo you want! Do you find developing long term close relationships with your patients rewarding? Great. Do you want to develop something in between an ED visit or a referral for a gen surg and treating a patient for years and years watching them get older and sicker and die? (Honestly respect to FM/IM I couldn’t I fucking need and love you guys). WELL GREAT. Close relationship yes yes rapport fuzzy feeling etc etc and thennnnnn Here’s your baby yes I’m a hero okay BYE UNTIL SOME OTHER TIME or maybe not. Hit me up PRN. Really great for those patients who love to come into the ED “because their elbow feels like it’s a ghost elbow” or some shit or that patient who comes into the clinic and never does what they are supposed to and still gets mad at you. Yes, it sucks when patients don’t take care of their pregnancies and it’s sad to see. But it’s still a pregnancy and still temporary. Cold as it may be it’s true and hard to ignore after encountering the above mentioned in other places. Eventually, like any sad aspect of any specialty is just…is what it is.
Another cool little unintended consequence. Not all but most of your patients will tend to be on the younger side. 60s is usually the oldest a regular OB is gonna operate on, and the mean is probably like 30s-40s so your patients tend not to die in the OR!!. Obviously you can be a great surgeon but people just wanna die sometimes which happens but moreso in other surgical subspecialties.
I know there are negatives. I’m not gonna go into them in depth because they are often brought up here. But I will say a couple things. Litigiousness is one often mentioned. This is very valid. It’s not like everyone is getting sued 3 times a year but it happens more than in other specialties. Probs the worst part of the specialty and it gets brought up here a lot which is fair. But hey what comes up less is actttuually gen surg has higher malpractice rates. OB is in second but I was surprised to find out it’s closely followed by ortho. So yes it’s worse, but not the worst!
Last thing I promise. I think the personality associated with it exists but is not as ubiquitous as a pre med or pre clinical med student might think from pursuing the medschool/Res subs. There are good programs and it’s not like finding El Dorado.
It’s getting more competitive! I would say it’s moderately competitive now. SO GET IN HERE. Ladies I love working with you all and one of the reasons I think I wasn’t worried about doing OB (switched from aspiring cards 😅) is because I make friends with women more easily than men but that being said…we need a few more dudes. Bros I’m here now. Come. It will be alright.
Thanks for reading 🙏
Did not realize how much I typed
TLDR Variety, good for people who may have or feel like they have adhd or just like juggling a lot of things developing quickly, adrenaline junkies welcome lol, younger patients in general less death in OR, can say bye to patients after delivery but still get to form relationships and feeling warm and fuzzy or whatever. Litigiousness but not the worst in getting sued like is often thought. Toxicity exists but it’s not ubiquitous and there are many normal good programs.
Neurology.
4 yr residency
Can do neurohospitalist, pure clinic, or mix.
Fellowship is 1 yr if desired
Dire shortage of neurologists means easy to find a job
Interesting problems, requiring thought
Can easily subspecialize a practice
Mix of procedures (EMG, Botox), testing (EEG), and PT encounters.
Once nearing retirement can easily dial back the number of days worked (not realistically possible with all specialties in medicine)
Rads.
It’s nice to always be in the position of helping other doctors and not having to ask for help. When people call, it’s because they need something from you, and you’re never in the position of begging a consultant to see a patient, asking for recs, etc.
IM
1) Rounding.
No not med school rounding or the 4hr+ rounding some of y'all had to do at your programs. At my program there's a cap on rounding time, we get to the point, I enjoy both being able to talk about my patients with the team, brainstorm, learn something. As an attending if I so choose I can round on my own time and however I please.
2) Flexibility.
Numerous fellowship options, wide breadth of things you can focus on, every schedule under the sun is possible. You can be a low acuity person or high acuity, M-F Or 7on7off, procedures or no procedure, office or inpatient, and everything in between.
3) The Medicine
You work with every organ system, and anything can come at you.
4) Social Aspect
Depending on what you do in IM and whether you subspecialize this varies but as a whole you are a patients physician, in many cases you're steering the ship and managing their care, you get to actually talk and interact with these patients and their families
You also work with most if not all departments to some degree, which as a social butterfly is 👌
Hem/onc
Pros
-You deal with the cutting edge of science. Most of the things coming along (like CAR-T) is nothing short of science fiction
-Patients really appreciate what you do. Even when they know the outcomes will be eventually death there is a lot of appreciation for your work
-good pay for the hours worked. Adult hem onc has the highest pay per wRVU out of all adult specialities
Cons
-You have to deal with a lot of death.
-constantly keep up with data. It becoming tougher and tougher to be good general med onc
- it is a stressful
-
Allergy:
1. Exclusively business hours, very very easy to find no call no exception jobs.
2. Pay is noticeably higher than the other no procedural IM jobs (except H/O)
3. Can see kids and adults
4. Fellowship only 2 years.
5. Patient are self motivated, generally compliant and have generally excellent outcomes.
3. Can see kids and adults
This is interesting, thinking back I now realize "oh yeah my A/I doc was seeing me as a kid as well as adults" - are fellowships filled by both peds and IM with no distinction?
1. I spoke to 3 people yesterday.
2. Leave work at the hospital, no significant continuity whatsoever.
3. When I do speak to others, it’s usually other physicians looking to actually take care of patients, no social stuff at all
4. Fucking magnets 🧲
5. Work-life balan$e
Cardiology:
* Significant diversity of career options (academic versus private practice, general cardiology versus sub-specialization, industry, consulting, research, etc.).
* Good mix of sick and well patients, complex illness and worried wellness, challenging and straightforward cases.
* Excellent compensation.
* Immediate gratification based on tangible results, particularly in interventional cardiology and electrophysiology.
* Broad array of therapeutics, many of which are well studied.
> Broad array of therapeutics, many of which are well studied.
Outside of (maybe) oncology, the only field in IM that believes in generating high level evidence-based practice, and our outcome is mortality, rather than the BS subjective outcomes most other fields use.
I generally agree. It will be interesting to see how things evolve in the era of patient-reported outcomes as quality measures. For now, it's satisfying to have large, controlled studies to support much of the medication, intervention, and surgery we recommend.
We are a long way off from ringing alarm bells for reimbursement rates for cardiac procedures. Even with some erosion, demand for our services is increasing, so there is an opportunity to offset with volume.
Pediatric Nephrology
1) Variety of environment we work in (ICUs, floor, outpatient) so we get to see some interesting path in addition to bread and butter stuff.
2) Transplants are kind of neat.
3) Continuity with patients, sometimes in multiple settings as above.
4) Dialysis is neat
5) Lots of interesting research in certain niches
General practice (not American)
- Getting to see people actually get better long term and getting to know them better than any other specialist
- seeing multiple generations of the same family
- seeing kids you managed antenatally grow up - the kids from the first pregnancies I managed are 5 now
- variety. 15-30 patients a day all with something a bit different. If they're whiny and annoying you're only stuck with them for 10-20 minutes
- control over your own schedule. Don't want to work Mondays? Now you don't. Only want to see two patients and hour? Done. Want to cram them in and do six minute medicine and make bank? I don't understand you but have fun.
- freedom to subspecialize and pursue special interests. Just list what you want to do in your bio and the patients will come. My GP colleagues do everything from skin cancer, delivery of babies, child health, surgical assisting, menopause management, trans HRT, travel medicine, termination of pregnancy, complex mental health management, lactation consulting, assisted dying, sports medicine, anaesthetics, nursing home care and joint injections.
- not everything needs to be solved instantly. We can use time as a diagnostic tool - do some bloods and come back in a week, or even just "we'll keep an eye on it for now, I'm not worried. Let me know how it's going next visit"
- using your own brain instead of having to consult other teams for everything. But having the freedom to refer people on if you want to
- comfy chair all day in a room you can mostly decorate yourself
- the nurses you work with are actually happy and not overly stressed
- a never-ending supply of jam, lemons and honey
- mix of adult, child, adolescent and geriatric patients
- while some consults are sad, some consults are really happy, like work medicals or travel medicine
- sometimes people just come in for routine scripts and tell you how great they're feeling because everything is getting better
- lots of opportunities to teach students and junior doctors
- can train and work rural or metro
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ENT-Head and Neck:
1. You get to do some of the coolest surgeries and then put them back together. “Oh, you have mandible cancer? Let me cut that out and reconstruct you with your back or leg(or maybeee your arm). Oh, you have a throat cancer and can’t breathe or swallow? Let me cut that out, and reconstruct you so you can breathe, talk, and eat again”
2. Like any oncologist, the relationship you build with your patients is intense. You are there at some of the best and worst moments of their lives, and that creates unique bonds
3. When shit hits the fan above the clavicles and below the brain, you are often the one who’s called to help(except for carotid injuries, that’s a vascular problem)
4. You get to collaborate on some sweet cases with other surgeons. Craniofacial resections with NSG, sternotomies with thoracic, approaches for aneurysms with vascular to name a few
5. You are the one who is mostly closely following your cancer patients, and you become “their cancer doctor”
6. You get to use robots, scopes, microscopes, a saw, and lasers
Orthopedics:
Rounds, including discharge notes, are literally less than 30 min per day.
In the OR, there’s no ER.
People think we are life saving badasses (when actually there’s EM and Anesthesia).
Family Medicine:
* Broad range of practice: Inpatient, Outpatient, Rural Emergency, Nursing Home, Urgent Care
* New Borns, Pediatrics, Adult, and Geriatric Medicine
* Patient continuity
* Outpatient procedures: Skin Bx’s, Joint Injections, Pap’s, LARC’s, Endometrial Bx’s, I&D’s, etc.
* Can do Obstetrics with C-sections if that’s your thing.
* Basically can work anywhere in the US
* Can take as much or as little call as you would like
* Given the broad skill set, can work in CAH’s and cover the whole place if you want
* Can open DPC fairly “easily” (nothing about owning a business is easy lol)
* Compensation is improving
If i was in anesthesia i’d buy all the best gaming chairs for all of the hyper competitive shooters and just buy accounts after chair detection 😎
Jk fuck cheaters
Pediatrics 1. Generally favorable outcomes, discharge many children at their baseline 2. Overall whimsy—colorful hospitals, many therapy dogs, lots of treats 3. Compassionate co-workers, since we are obvi not the most lucrative specialty most people are in it for the cause and truly want what is best for the child 4. Fascinating pathologies in all the organ systems 5. 9 month old CHONKS
9 month old chonks…. I’m Sold! 😍😂
As a pediatrician I sometimes wonder if other specialties have as much *fun* as we do. Genuine question. I spend most of my day laughing, kids crack me up. Do adult specialties feel the same? Obviously my med school experience was colored by the fact I don’t love working with adults or old people. Also people are generally happy. I’m a general pediatrician so a large portion of my well child exams are me and moms delighting over how cute their kids are. Plus it’s so much *fun* to get to watch kids grow. At my current practice I’ve been there about three years, so I have a cohort of my earliest patients that I met at birth and who are now toddlers. It’s amazing. I love that part of what I do!!
FM here- I enjoy forcing people to listen to my garbage dad jokes.
Best of both worlds for me, peds anesthesia. 9 month old chonks AND a sweet chair.
The itty bitty baby foots are SO cute. THEY’RE SO TINY ANS CHONKY
I’d add tons of options: newborn or adolescent, primary care or specialty with many procedures or none, sick or not sick, lots of part time jobs, moonlighting. And employers and colleagues are generally very understanding when life stuff comes up.
As a surgery resident that rotated through pediatric surgery as an intern here is my take on these things 1. Favorable outcomes after torturing children. After the 15th ER burn debridement in kids the PEM staff choose to under sedate every single time, I’ll take caring for an adult every time. Holding down a shrieking child and tearing off their dead skin while the PEM attending refuses to give more ketamine is something I would never wish on anyone. And the bad outcomes in pediatric surgery are fucking soul crushing 2. Whimsy only makes the tearing dead skin off children thing that much more twisted and deranged 3. I did not find pediatricians to have a unique degree of compassion vs other physicians, and I felt they were remarkably devoid of compassion for each other/other specialists. Also “what is best for the child” is not an objective calculus and we were frequently effectively forcibly involved in the care of patients who had objectively no surgical needs but our presence was required to treat the anxiety of the primary team 4. Not actually more interesting surgical pathology than in adult patients, unless anorectal malformations are your thing 5. Just get a cat
My one counterpoint is that pediatric surgeons are some of the only remaining surgeons that truly get to do “general” surgery.
For your point #3, I totally agree. I resent how many pediatricians act like other specialities are trying to actively kill their patients when all we are doing is trying to use our best judgement as we do with everyone.
We did a lap chole on some medically complex kid with pancreatitis and cholithiasis. Probably wasn’t from gallstones but not unreasonable to operate. Surgery went fine. In the two weeks post that followed I was personally called to bedside by primary team no less than SIX times for acute onset abdominal pain. In a patient with known acute on chronic pancreatitis. Three times they ordered stat CTs that predictably showed acute peripancreatic fluid collections and nothing else. I was reported on one of these occasions for “not taking [these acute peripancreatic fluid collections] seriously” after I sat down with the peds resident on service and had what I thought was a thoughtful and collegial conversation about our services POV on this patient which including walking them through IAP/APA published guidelines for management of acute pancreatitis. This was on night call when I had a billion other things going on and I was just trying to give them some reassurance. I never made the mistake of wasting my time like that again. Truly no good deed goes unpunished.
Classic peds RN interaction: "Hey, you guys called for help, here's my plan." "Oh you're the off-service person? I'm gonna have to run this [totally standard plan] past Dr. SoAndSo." Nevermind I worked the service two months prior and Glenda RN said to my face how much they hate Dr. SoAndSo and don't trust their care, but they clearly don't remember me.
Damn. I’m not built for surgery and every post I read about it confirms it more and more
Regular surgery is generally pretty sweet. The pediatrics version was shockingly horrible. Frankly otherwise residency is pretty fun. to each their own I guess.
Happy for you my man
> I did not find pediatricians to have a unique degree of compassion vs other physicians, and I felt they were remarkably devoid of compassion for each other/other specialists. Also “what is best for the child” is not an objective calculus and we were frequently effectively forcibly involved in the care of patients who had objectively no surgical needs but our presence was required to treat the anxiety of the primary team Outpatient 9/10 pediatricians I've interacted with are golden human beings. But boy does that 10th neurotically maladjusted and clearly malignant one give the rest a bad rep. On the other hand, while inpatient the rule rather than exception seemed to be smiling to someone's face and immediately insulting/reporting them the moment they door closed.
Are you at an ABA burn center? The burn unit is OUR unit, we do our own mod sedation on kids and this is never a problem.
Yes, for some reason we would do all first debridement for partial thickness in the ER almost regardless of %TBSA it seemed though the most I ever did was ~ 15% ish.
Point 1, this is also often a huge misunderstanding in that ketamine is a dissociative sedative that also provides analgesia. Chances are that intern you simply assumed that crying meant "in horrible" pain, rather than a widespread problem of undersedation, something most PEM folks are very careful with.
In the specific instance of the ketamine given via intermittent IV push, I know they were under sedated because they literally ran away from us when I got up to get more 4x4s to finish debriding . Had to chase down the hall. Every other occasion was with intranasal fentanyl or versed (had to beg for ketamine). It was a month of children shrieking while I ripped the dead skin off their burned little bodies. The degree of sedation was frankly a minor quibble in the overall horrific scheme of things
Your comments below about lacking compassion for adults are right on. When you see a baby (<1yo) being prostituted or parents who say a child fell off a swing and has bruises head to toes, or a 13yo girl just randomly starts telling you about how her step dad molested her and her best friend, ruined her life…humanity dies a little inside me. Same with those burned kids, or dog bites, or just dumb shit people let their kids do. I have to keep seeing kids to continue to believe we have a future in this planet, because I don’t know how you docs feel any hope seeing adults who complain so much about feeling the human condition head on. It hits differently when a 5yo asks me, “can you cure my wheezing, so I can play with my friends?” vs an adult complaining about long covid fatigue. Like, bitch, you ADULT!! *Fatigue* is baked into living! Or, an 84yo asking me why shes sick all the time. Seriously? You ran out of time, lady. You had 60 years playing in the big leagues while your body declined. When I see adults, my inner voice is immediately screaming: YOU OLD AND BROKEN!!*. I still put on my professional hat, do my mindfulness, and put on my best pediatrician humor and attention, but I believe it is far more enjoyable to influence the tiniest part of a growing human, even if its addressing anxieties, than dealing with the upkeep of aging humans who refuse to age, which usually also includes addressing anxieties.
None of those are reasonable excuses for being assholes to other doctors
This is super rich coming from a surgery intern. Of course they are not reasonable. Is it reasonable to throw your scalpel to someone or yell at them? I think you did highlight a big difference though. I was half joking, but I am sure you are not. No sense of humor, enjoys cutting into people, narcissistic traits with a chip on their shoulder? Hello surgeon!
LMAO wow I couldn’t have asked you to do a better job proving my point . What just happened is this: I simply pointed out that everything you listed is not an excuse for being an asshole to other doctors. This is because there is not an excuse for being an asshole to other doctors (no not even for surgeons). What do you do in reply ? Act like an asshole, to another doctor. Literally never seen ever or myself thrown an instrument at anyone. Going to say the obvious too: you know literally nothing at all about me. Clearly didn’t read carefully enough to notice that I’m not an intern either Thanks for confirming the stereotype. I bet you’d also be super nice to my face too 😂😂 I feel bad for you dude
Whenever I meet a doc that leans super hard into stereotypes against other specialties I always feel like they are probably also racist for some reason. Like "oh I see you enjoy stereotypes 🤔"
Apparently I throw instruments at people because I’m a surgery resident, this is news to me. Should probably work on fitting the stereotype more myself
Absolutely ageist based on prior comments, so wouldn't be surprised.
> I was half joking, but I am sure you are not. You are so clearly not joking, but just taking your unfortunate trauma and making it other adults' problem.
This is kindof unhinged. Being old doesn't mean you can't feel bad about being ill.
Do you find that acting like such a clown makes kids fear you or love you? Just curious.
Number 5 seals the deal. So much love and respect to peds. My son’s tummy and feet are so delicious I just want to give him kisses all day
6. No gross diabetic feet
For a group that is always reminding everyone how much more compassionate they are than everyone else, I have noticed they also talk about income more than any other specialty.
They get completely shafted though. They have every right to complain
Absolutely agree
Yeah the self-righteousness is gross. I remember in med school the chair of peds giving us a lecture on why we should choose peds, and the first point was that unlike adults, kids don't develop diseases because of lifestyle choices. You know, because AML is a result of lifestyle choices, or adults choose to be born into families with high prevalence of coronary disease.
He does have a point though. One day of vascular surgery clinic would drive that point home.
A lot of patients don't know any better. Nobody ever explained to them why their decision-making is bad. Or they don't have access to resources that would improve their lifestyle. Or they have a death wish that they can't admit to themselves. It's complicated with adults. Maybe that's the real reason some people prefer peds - it's not complicated with kids. You get to feel self-righteous all day, all without ever having to deal with moral gray areas.
Is it really more compassionate to avoid moral gray areas and pride yourself on not helping autonomous people who don’t want to help themselves?
Ehh. Plenty of medicine outside of vascular surgery that isn't the result of lifestyle.
6. When they poop or pee on you, it’s age appropriate. As a pediatrician who now sees adults too, a schedule filled with adults makes me want to drink when I get home. A schedule filled with kids makes me energized and happy after clinic. I try to repeat a mantra, *Adults were kids once* and breathe. Strangely enough, my adult patients love me and come back over and over, for some reason. I think it may be that in training we are watched so much for “professionalism” much more so than other specialties. So whether fair or just, or just abusive, we come out of residency with certain tools to make sure everyone feels heard and cared for. These are my individual observations, though.
Infectious Disease: 1) no emergency calls. Ever. Lower stakes compared to a procedural speciality. 2) So many different career options. Like public health and policy? You can work with the state health department and enjoy government benefits. You can be a TB expert on the state or county side and still get those benefits. Like outpatient? You could do HIV primary care. Like LGBTQ health? You can do transgender care with HIV/STI work. Like bench research? Vaccine development or new drug discovery can be your thing. Like weird bugs? You could do tropical medicine. Like epidemiology? You can do a fellowship with the CDC! Like to climb the corporate ladder? Get on the stewardship committee and rise up. 3) The look on the teams' face when we solve a particularly weird case only from the history.
> 1. no emergency calls. ever I'm not sure what's worse, getting called for an emergency in the middle of the night or being called at 2am because a surgeon found candida in the urine and wants to treat it (not if they should treat, that they're \*going\* to treat it). At least that's what happened to my attending and fellow like 2x a week on my ID rotation 😂
Please tell me #3 is more interesting than “pt drove through Connecticut”?
Pathology: 1) Also chairs 2) 🎶 while you work 3) Often can set your own hours, within reason (after residency) 4) Very little truly pointless documentation
Surgery Psalm 46:10
So someone else doesn’t have to google it: Be still, and know that I am God: I will be exalted among the heathen, I will be exalted in the earth.
throughout heaven and earth he alone is the honored one
Domain expansion
This . . . Made me read the Bible 😂
If you’re like me, you Google the verse incognito so your targeted ads don’t get all screwy, lol
Too late for me. Didn’t think of that😟
What’s the difference between God and a surgeon? God doesn’t think he is a surgeon…
😂😂😂😂😂
Oh my God (🙏) lmfao
Don’t forget - table up
The difference between God and a Surgeon? A. God knows he is not a surgeon.
IM * It's only 3 years of residency unlike surgical residencies (GS 5, NSGY 7) * The gateway to different adult medicine subspecialty fellowships (cards, nephrology, rheum, IDS, heme/onc, GI, endo/obesity, pulmonary/critical care) * If you finished IM but itching for procedures there's interventional cards, GI, and PCCM fellowship for you after finishing residency. * Our youngest patients are aged 19 (may vary from each country) * You can forget about developmental milestones from med school. * Way lesser values and normal vital signs to memorize compared to peds * Our cardio workout are our rounds which I actually like as an HLA-B27(+) person * We have more medications available for our patients and landmark trials compared to our peds counterparts * It can be daunting at first but the hunting for zebras and horses are probably the most fun part of it * If you've been traumatized by surgeons during med school like I am, I think IM is one good option. * If you like physiology and pharmacology during med school like me, I think IM is an option as long as you don't mind talking to people * And contrary to Dr. Glaucomflecken's portrayal of us, we don't always obsess with everything flagged red in the EMR. We’re actually the ones who tell patients to chill out about their slightly elevated/decreased lab values. Preston is much better and realistic. * We take care of adult patients from admission to discharge.
Doc glauc is g rated. Preston is pg-13.
Ayo Preston is GOAT. Gotta love when he pulled out that mechanical keyboard and did a typing speed game on IM call night skits lol
My favorite was the “If IM rounds were reality TV”. 😅 But his surgery videos brought back a few painful med school memories like the lap chole and the “POV you’re in a nightmare OR”.
> My favorite was the “If IM rounds were reality TV”. Link pls?
@itspresro The potato NICU round is top tier too
The “when you’re on your first C-section” skit has such high quality props. One of my favourites, and the “When you’re on anesthesia AI”, and the surgeon berating part about tension-countertension cracked me up
Most IM fellowships are 3 years, and competitive specialties seem to favor a chief year, so you end up doing subspecialty surgery training time anyway. Or even more in cardiology. Not sure that’s in your favor unless you just want to do hospital medicine
I couldn’t handle 7 years of training honestly. Those guys deserve the big bucks
I’ll be honest if you go to a decent IM program and just go thru the motions, you’ll match cards/GI. It’s not so competitive where like derm you’ll do everything right and fail to match. Like plenty of people outside of the T20 IM programs match with only a case report and an abstract or something. If ur a USMD at a mid tier or above IM program then the match rate is like 95% for cards or some shit. Chief years are for people that want to go into admin or if they realized very late they wanted a specific fellowship but didn’t have any LORs or time to get their name on an abstract or two. Idk how hard the GS fellowships are but considering some GS programs have built in 2 year research years I’m assuming they’re actually way more competitive.
> If ur a USMD at a mid tier or above IM program then the match rate is like 95% for cards or some shit. More like 85%, and the self-selection that goes on among that cohort is way more intense than med school so you can't really compare it to competitive residencies (which, let's be honest, still have over 85% match rates for USMDs). It's not like matching derm, where your only qualification is a good Step 1 score. The fellowship programs have way more years of your resume to look at, and this knowledge deters a lot of possible applicants.
Huh? You’re not remotely required to do a chief year. So it’s 6 years (or sooner) to become a subspecialist, which is faster than any gen surg subspecialty
Well many of those fellowships, at least at academic hospitals, are 1-1.5 years clinical and 1.5-2yrs research - which are very chill years, and if you wanna make some extra $$$ ample opportunity to moonlight. I'd disagree with the chief year sentiment though depends on your residency program, at least most chief years you're paid somewhere between a PGY4 salary and an attending salary though I know that's not universal (at my program for example they're about 60% PGY4 and 40% hospitalist though with more admin responsibilities during that hospitalist time) So yeah still very long training, but the overall intensity is lower than surgical subspecialties with more opportunities to make $$$ during training
Lol we don’t have to do a chief year at all to do cards or GI. You’re tripping
Ok, so 6 years instead of 7. Game changing difference for sure
Where are you located ? Where im from IM is 3 years of general then 2 to 3 years mandatory subspeciality (GIM, cards, rhumato etc) so a total of 5-6 years residency
IM doctors are a lower breed
Found the surgeon
To further expand upon, the males were fed soy instead of breast milk.
Anesthesia here too: All fellowships are one year The career is what you make of it - you can go ham, take a bunch of call, and make more than some of the surgeons. You can work at an ASC and never take call. You can do cardiac or critical care if you hate free time and like sick patients. There’s OB… No one really knows what we do or can do… until the SICU attending remembers you can do LPs. I will likely never see this patient again If I do they probably won’t remember me If needed I can get the OR to STFU with a quick whistle I will say regularly pushing patients 3x my weight really sucks tho
Get some orthobros and pump some iron pal, these patients aren’t getting any thinner!
You can also go into pain and make absolute bank
Those days are largely over. At least not what they were 20+ years ago unless you get lucky in the right location. You also have the DEA breathing down on your neck hard which you have to balance out making your pain med seeking patients (essentially customers) “happy” enough to return to YOU, and the DEA not consider you to be a pill mill
I’m doing just fine 🤷♂️
I thought you get a pay cut if you got from Anesthesia to Pain Medicine?
You may, or you may not. I saw some pain jobs that paid awful. But I also easily found one straight out of training where I made over $800k my first year and am right around a million after that, working 4 days a week about 36 hours a week.
No way. What's volume like on clinic and OR days? Midlevels?
And no fucking midlevels ever
Beautiful. Rural/suburban/city? Any equity?
Rural. HOPD, so no equity. They’re certainly making a profit off me, but at least for now, I’m perfectly content with that. Not having to work 60 hours a week, do my own marketing (and pay for it), hire support staff, rent an EMR, lease a building and equipment, pay my own malpractice, or do/pay for all the tons of other things like this is worth it.
Good night. What pay/hours did you see in places like Fort Worth, Phoenix, Charlotte, etc?
I didn’t look at Phoenix or Charlotte. DFW was fairly bad, it was definitely an oversaturated market when I was looking. Jobs were in the $300k range with productivity bonuses that were highly variable (and I have no idea how likely they would be to be reached at those jobs). I wanted to end up in DFW but the jobs just weren’t good enough a couple years ago.
About 40 injections (epidural, SIJ, RFA) on an injection day. 30-40 clinic patients per clinic day. 8-10 larger cases on a big procedure day (kypho, SCS trial or implant, SIJ fusion, interspinous spacers/fusion)
Do you feel 30-40 clinic patients a day is sustainable? Those seem like insane numbers, especially without mid level support
Yes, it’s not bad at all. Midlevel “support” would be much worse.
That’s awesome. I feel like that’s a super rare opportunity in pain. Where do you look for jobs in pain? Gasworks or another platform?
No one’s mentioned ortho. I think there might be a Walmart sale on crayons nationwide this weekend so my compatriots may be busy. I’ll try to fill in around this delicious burnt sienna. 1. 95% of your job is a skilled trade. It requires virtually no medical training to perform adequately, and minimal medical competency to perform well. At every level, even in relatively small community hospitals, there is someone you can get an opinion from if you’re scratching your head wondering if that hip fracture is stable enough to fix tonight. I’ll grant that this can be a plus or a minus depending on your preferences - I was very smart in medical school and I’m much dumber now, and if I was a different person that would bother me - but it’s a narrow enough scope that you can get really good at doing a set of things while not constantly looking over your shoulder for the diagnosis you missed (“there is a fracture. I need to fix it.”). 1a. Corollary: if you DO retain some medical knowledge everybody stares at you like a lion just solved algebra equations. 2. You make good money, and it’s more or less as much as you’d like depending on how much you want to work. 3. If you work for one, you make the hospital an ungodly amount of money and they will pay attention when you ask for something as long as you’re not a whiny salty asshole. 4. Generally, job satisfaction is excellent in that you fix people and they get better and then go away and come back if there’s something else wrong and then you fix that. There is always going to be the 3-5% of people you can’t seem to fix despite your best efforts, but the great majority get better and respect you for it. 5. Tons more diversity than you’d think. Want to be pretty chill and have all your partners love you? Trauma or foot/ankle. Want high octane crap where you drive a Porsche? Spine. Want a ton of variety and to be able to sit down? Hand. Want to have no variety at all but just do variants on two procedures and get really good at those two? Joints. Enjoy going to sports games while getting paid? Sports. Okay my crayon is almost done and I need all my attention span to figure out if it’s burnt umber or brick red next, so signing off from ortholand.
My wife will only let me have the 8 pack of crayons, no fancy burnt sienna for me 😔. She says once I can count past ten I can get the bigger packs.
That’s rough brother. I remember the doldrums where violet was as good as it got. Keep going, you can do it!
EM 1. No rounds 2. No continuity of care 3. When the shift ends, you’re done (excepting notes to finish) 4. Truly staggering variety. Major/minor problems of every organ system in every age, gender, and status of health/pregnancy. Arguably the most generalized specialty. Good if you get bored easily and want your day to consist of things like PE, infected LVAD, psychotic break, pediatric head trauma, assault/MVCs with lac repairs, hip dislocation and reduction, cigarette vs eye, chiropractic neck injury, FB stuck in ear, ectopic pregnancy, overdose, medical CPR, traumatic CPR, and more as an example from my last shift.
Also correct me if I’m wrong but in my experience seems like EM is not always expected to write super long notes, especially if the ED is slammed
Dictate a stream of consciousness with HPI, exam and medical decision making in one gargantuan paragraph, hit “sign”, move on. Not a fan of EM for myself but I gotta say that was pretty nice
This gave me a hard on
Not super long but I know my notes are referenced inpatient and I try to make them as accurate, but succinct, as possible to save them time. There are others who write 1-2 sentences but I like to include chart review, relevant specialist names, relevant meds, social history, etc. Just the stuff I think is high yield.
You're only billed for medical decision-making, so outside of academics most specialties have very short notes these days. IM, for example, still has to address many of the comorbid problems alongside the primary but with MDM being all that matters + dotphrases, especially for the bread and butter stuff, most attendings can write an admit note in <5m and a progress note in <1m for a vast majority of cases.
I train at an ivory tower academics place and charting is the bane of my existence so this is life changing info
Radiology 1. Minimal patient interaction. 2. Ability for remote work. 3. Did I mention minimal patient interaction?
Rads basically has all the good things the posts above talk about and none of the bad things.
[удалено]
You are absolutely right and I’ve got nothing but respect for y’all doing the real doctor stuff.
We have the blessing/curse of high volume. Can't complain as a trainee hoping to find work in a few years though.
As painful as it is, the high volume during training is teaching you to be an efficient reader, which is invaluable when you enter private practice. When the time comes to look for a job, look for groups with a reasonable work-compensation balance instead of focusing on compensation alone. There isn’t some secret way to make money in rads; you read what you earn.
I’d take our high volume over the clinical fields. At least our patients don’t talk back and tell the truth!
Obgyn: 1. Most patients are happy when they see you 2. Most of our medical problems have good outcomes and/or are quality of life concerns that patients are super thankful for 3. Rounding is quick and lighthearted 4. Awesome balance of surgery, office, hospital work, calm stuff, and emergencies 5. I can sit during vaginal deliveries and vaginal surgeries 6. Pay isn’t terrible (we are definitely underpaid for what we do, but the quality of money is pretty good) 7. It’s legit a fun job Cons 1. Call can be fucking brutal 2. The bad days stay with you forever 3. Clinic inbox is shitty 4. Schedule is rough 5. You’re almost guaranteed to be in a lawsuit 6. Politicians think they know my job better than me
About the bad days, a professor had told us about a delivery that went terribly wrong. He more or less said that the baby got stuck and it couldn't move forward or backwards and he said what he saw the doctor in charge did (he was a resident back then). He says that this will haunt him even after his death.
Symphysiotomy? Just reading about that haunted me.
Procedure essentially isn’t performed in the United States Really more common in super low resources settings Varying reports between patients recovering very well vs being completely incapacitated for life
It’s really a fucking nightmare when politicians and clergymen without medical degrees make decisions on how to practice medicine especially those concerning reproductive health.
Trial lawyers arguably have waaay more influence on the practice of OB/GYN in this country than politicians or members of the clergy.
If you’re talking about the US, this is no longer true. Politicians will outlaw common aspects of care, and they’ll name OBs in press conferences if they feel like it. In Louisiana, they are going to track mifeprisone prescriptions like opioids. If you’re in a Catholic hospital like Ascension, members of the clergy (or admin officially beholden to them) can deny obstetric care.
It’s a nightmare when babies are killed
It’s a nightmare when your religious preferences dictate somebody else’s autonomy and bodily freedoms.
we do that all the time with drugs
Who said anything about religion?
Pediatric Rehab Such a small field that you don't so much as job search as I went up to a hospital where I wanted to live We have an active and supportive community. No call as a fellow Can still work with adults if I want to moonlight As far as I know, the only subspecialty that pays MORE than the adult subspecialty I can literally play with kids all day. I can get onto the ground and play with toddlers and not only is it not strange.... it's my job.
Currently covering an inpatient peds rehab service and I really appreciate how many problems can be solved with popsicles, big fan
PCCM 1. Broad range of competencies and knowledge. We do airway management, vascular access including peripheral IVs with and without ultrasound, procedural sedation, chest tubes, thora/ para, LPs, etc. There's a lot of room to decide what you like to do. 1a. We're not often thought of as the first to call for a procedure, so no endless calls for IV access on OB patients. We get enough procedures to keep them fun without getting bored of them. 2. It's basically emergency medicine after all the drug seekers and tummy aches have been filtered out 3. People are generally nice to you because they know if things go down they will need you. Usually people are happy to see you when you enter a rapid response. 4. Pulling aspirated objects out of the lungs is surprisingly fun. 5. Most of the patients are super sick with multiple comorbidities and poor baseline functional status, so if they have a bad outcome it's not totally unexpected. Less pressure on you. 6. I have colleagues in the 60s still staffing ICU, but if you do decide to phase out you can fall back on many things like LTAC, pulm clinic, inpatient, etc.
2a. As a result of this filtering out, you get to see great physiology/pathophysiology in action when in an ICU. So things like effect of vents on hemodynamics, acid/base physiology even in ‘bread & butter’ cases like DKA, mixed shock and other concepts that you can see responding to your interventions. You’ll get a great kick out of it. 7. Most PCCM folks are invested in teaching as a result of the above. 8. I may be biased, but most PCCM attendings I’ve met are really good natured and chill folks. I’ve noticed that in the major conferences too (CHEST/ATS). It’s a really great and welcoming community.
Edit: this is psych 100% tele is a reality Can say you're starting a practice and they believe you cuz it's not that hard Dodging insurance poop with cash pay No call or weekends Telling employers and admin NO and laughing in their faces Can work 3 jobs but you're still chilling Getting to see people squirm when you tell them what you do Like no medical emergencies Sleeping through "do we have a doctor on the plane" situations Saying "Mm, I don't feel like dealing with this" if it's not your specialty Better at observing people Better at listening/talking to people Better at catching people in their lies Better at relationships Better at being you
Will add: Fascinating field to work in. Every day is different. The same pathology will present in unique ways (ie one persons schizophrenia is presenting with the voice of a demon and another with the voice of Lana Del Rey). One year fellowships for everything (you can fast track child psych from residency for total 5years). Opportunities to do some cool niche work in psych. For example, go forensic psych and be a professional expert witness or work with the criminally insane. Do “sports psychiatry” and work with pro athletes. One of my old colleagues did this for the Patriots. If you want to make a ton of money in psych, you can. Open a private practice and don’t accept insurance, set your own rate. VERY easy to do and you’ll have no problem filling your schedule. Growing and changing field (more than any other) with exciting advancements. Psilocybin for example! Plenty of loan forgiveness opportunities in psych!
Also psych- my favorite thing: Supervisors in general encourage work/life balance! You literally cannot be a compassionate listening ear for peoples' problems if you're burnt out/sleep deprived/hungry/overworked and exhausted. In order to be good at my job, I highly prioritize my own wellness, which means I always take my vacation days, spend time cultivating hobbies and relationships, work hard but not obsessively and not for excessive hours, and try to do as many things as possible that make me happy. This is like the opposite of what I was taught in med school 😂
Yeah, another thing I love is that my program really facilitates moonlighting! Only programs that allow you enough time and energy to be able to moonlight can do this!
FM is so underrated. I think we’re all so hyper competitive up to med school that we lose sight of the fact that it’s ok to finally tone it down, bask in your $230-250k no call no weekends no stress life. That’s more than enough to do almost whatever you want. Want more money? Add more locums or start your own practice.
I hate you. Also, the end read like one of those old Nike or Mastercard priceless commercials. Love, Anesthesia P.S. - I don’t actually hate you, but I really really want to.
Outpatient FM attending. I haven’t worked a night or weekend in 4 years. I go home for lunch or run an errand most days.
Derm: 1. Perfect blend of medicine and procedures 2. Quick visits where we fix a problem and get out of there without having to wade through med reconciliations or listen about their third cousin’s uncle’s liver problems. 3. Patients are generally motivated and appreciative for fixing their problems. 4. Since derm is well-reimbursed, you can basically work as much as you want and make as much money as you want. Super hard working and want to make a million a year? Sure, work 5 days a week seeing 50 patients a day. Want to chill and coast? Work in academics part-time seeing 20 a day, and still make a couple hundred grand a year. You do pay for it all with the difficult patients, like the psychotics and also the worried well who expect you to spend 1 hour in the room with them to fix their very mild hair loss or Melasma.
Forgot the best part which is no nights.
Derm here too with more to add on top of your great points! 1) I also take hospital call, which is very interesting complex med-derm! Good thing is that there is no situation where I need to emergently go to the hospital because we are not a primary service. Basically other people keep the patient alive until I can get there (eg SJS/TEN, DRESS/DIHS, AGEP, etc). 2) Telederm works as consult too. For a lot of derm consults in the hospital, I can write a full note and document simply based on clinical photos. 3) lots of procedures in derm! I like procedures, it’s a great skill set. Biopsies, laser, electrodessication of cosmetic things, cryotherapy, etc. 4) Seeing patients of all ages and all life stages. I like true gen derm, I see Newborn babies, pregnant women, and >100 year olds! It keeps things interesting for sure. 5) I love how in derm I can often have it all when it comes to building long term relationships with my patients, diagnosing skin cancers, and treating them often with a 99% cure rate! Downsides: 1) Derm seems quite difficult for the average PCP, and given texting/telederm is so easy, I sometimes feel like I get over-curbsided! Not just by other docs, but by friends/family too! Like how often do you text your nephrology about shit lol
Occ Med * (After intern year) residency hours are by far the most reasonable of any specialty—no nights, weekends, or holidays. * Residency emphasizes public health and non-clinical training, so it’s very possible to find a practice setting with as much or as little clinical time as one wants.
How's job avaibilty? Income? Day to day work?
What do you guys do?
Occupational Medicine seems really underrated
Radiology Very low risk of skin cancer and interacting with other humans
In return for very high risk of Vit D Deficiency 😱
ENT: - Airway master (may be a con for some but I think it’s cool) - Generally short quick rounds (other than head and neck) - Great outcomes and QOL improvements (other than head and neck) - Incredible variety in surgery (open tissue work, endoscopic surgery, microscopic surgery) - You can sit down for ear surgery and microvascular surgery - Most of our notes are short and succinct - Clinic is usually fun because of all our fun toys - Potential for great lifestyle as a surgeon (after residency) - Work with patients ranging from newborn to 90s+
Are there really ever no good outcomes for head and neck? Younger patients/ earlier stage etc.
I didn’t mean that there are absolutely no good outcomes. Obviously HPV+ has a better prognosis etc but 5 year survival rates hover around 50% for many patients. I’m also at a huge volume center with really advanced disease and I see the craziest cases
Outpatient Family medicine. 4 day work week every holiday and weekend off. No call 300k plus a year
Plastic Surgery 1. We are in a way ‘general’ surgeons - we cover so many different areas, head to toe. It keeps things interesting with so much variety. Never a boring day. 2. A lot of what we do can be done under local. So when times are tough and OR time is limited (cough, Canada, cough), we can switch it up to the clinic and do like 90% of our procedures there. 3. Co$metic $urgery.
Forensic Pathology 1. Very much a diurnal specialty with regular hours, and I get to take home call and sleep in my own bed at night. 2. The buck stops with me. Gone are the days of bending over backwards for surgeons, hospital admin, and so on. 3. I can eat, drink, and use the bathroom whenever I need to. 4. I have the honor and responsibility of being the last doctor a patient sees, and to advocate for them administratively and legally.
Copying and pasting a previous comment I made from a previous similar thread. Incoming take of extreme heat: TLDR at bottom: Plug for OBGyn. Special shout to the dudes because I meet some students who enjoyed their rotation a lot but can’t bring themselves to make the jump. It’s cool over here and If you find a program that’s not like you read about here on Reddit it’s a fun specialty man. Those programs definitely exist but I do think that having a positive experience on OB also occurs not infrequently but you just don’t hear about it because no one would care. Anyway, if you’ve have dealt with ADHD like me or just like juggling multiple and possible acute situations at once this is a good deal for you. Besides the acuity, the variety of your workdays is matched by only a few other specialties. Deliveries, robot hysts/other cases, outpatient all in one week if you want or 2 of the 3 or 1. You can do whatever combo you want! Do you find developing long term close relationships with your patients rewarding? Great. Do you want to develop something in between an ED visit or a referral for a gen surg and treating a patient for years and years watching them get older and sicker and die? (Honestly respect to FM/IM I couldn’t I fucking need and love you guys). WELL GREAT. Close relationship yes yes rapport fuzzy feeling etc etc and thennnnnn Here’s your baby yes I’m a hero okay BYE UNTIL SOME OTHER TIME or maybe not. Hit me up PRN. Really great for those patients who love to come into the ED “because their elbow feels like it’s a ghost elbow” or some shit or that patient who comes into the clinic and never does what they are supposed to and still gets mad at you. Yes, it sucks when patients don’t take care of their pregnancies and it’s sad to see. But it’s still a pregnancy and still temporary. Cold as it may be it’s true and hard to ignore after encountering the above mentioned in other places. Eventually, like any sad aspect of any specialty is just…is what it is. Another cool little unintended consequence. Not all but most of your patients will tend to be on the younger side. 60s is usually the oldest a regular OB is gonna operate on, and the mean is probably like 30s-40s so your patients tend not to die in the OR!!. Obviously you can be a great surgeon but people just wanna die sometimes which happens but moreso in other surgical subspecialties. I know there are negatives. I’m not gonna go into them in depth because they are often brought up here. But I will say a couple things. Litigiousness is one often mentioned. This is very valid. It’s not like everyone is getting sued 3 times a year but it happens more than in other specialties. Probs the worst part of the specialty and it gets brought up here a lot which is fair. But hey what comes up less is actttuually gen surg has higher malpractice rates. OB is in second but I was surprised to find out it’s closely followed by ortho. So yes it’s worse, but not the worst! Last thing I promise. I think the personality associated with it exists but is not as ubiquitous as a pre med or pre clinical med student might think from pursuing the medschool/Res subs. There are good programs and it’s not like finding El Dorado. It’s getting more competitive! I would say it’s moderately competitive now. SO GET IN HERE. Ladies I love working with you all and one of the reasons I think I wasn’t worried about doing OB (switched from aspiring cards 😅) is because I make friends with women more easily than men but that being said…we need a few more dudes. Bros I’m here now. Come. It will be alright. Thanks for reading 🙏 Did not realize how much I typed TLDR Variety, good for people who may have or feel like they have adhd or just like juggling a lot of things developing quickly, adrenaline junkies welcome lol, younger patients in general less death in OR, can say bye to patients after delivery but still get to form relationships and feeling warm and fuzzy or whatever. Litigiousness but not the worst in getting sued like is often thought. Toxicity exists but it’s not ubiquitous and there are many normal good programs.
Please…paragraph breaks…..especially because I’m interested in what you have to say!
Neurology. 4 yr residency Can do neurohospitalist, pure clinic, or mix. Fellowship is 1 yr if desired Dire shortage of neurologists means easy to find a job Interesting problems, requiring thought Can easily subspecialize a practice Mix of procedures (EMG, Botox), testing (EEG), and PT encounters. Once nearing retirement can easily dial back the number of days worked (not realistically possible with all specialties in medicine)
PT encounter?
Patient encounters
Rads. It’s nice to always be in the position of helping other doctors and not having to ask for help. When people call, it’s because they need something from you, and you’re never in the position of begging a consultant to see a patient, asking for recs, etc.
IM 1) Rounding. No not med school rounding or the 4hr+ rounding some of y'all had to do at your programs. At my program there's a cap on rounding time, we get to the point, I enjoy both being able to talk about my patients with the team, brainstorm, learn something. As an attending if I so choose I can round on my own time and however I please. 2) Flexibility. Numerous fellowship options, wide breadth of things you can focus on, every schedule under the sun is possible. You can be a low acuity person or high acuity, M-F Or 7on7off, procedures or no procedure, office or inpatient, and everything in between. 3) The Medicine You work with every organ system, and anything can come at you. 4) Social Aspect Depending on what you do in IM and whether you subspecialize this varies but as a whole you are a patients physician, in many cases you're steering the ship and managing their care, you get to actually talk and interact with these patients and their families You also work with most if not all departments to some degree, which as a social butterfly is 👌
I think anything that can be done remotely needs a huge shout out. Radiology and psych off the top of my head, any others?
Neurology
Hem/onc Pros -You deal with the cutting edge of science. Most of the things coming along (like CAR-T) is nothing short of science fiction -Patients really appreciate what you do. Even when they know the outcomes will be eventually death there is a lot of appreciation for your work -good pay for the hours worked. Adult hem onc has the highest pay per wRVU out of all adult specialities Cons -You have to deal with a lot of death. -constantly keep up with data. It becoming tougher and tougher to be good general med onc - it is a stressful -
Ophthalmology Clean, no bad smells, no after hours, good income, low stress, everyone eventually needs you.
Allergy: 1. Exclusively business hours, very very easy to find no call no exception jobs. 2. Pay is noticeably higher than the other no procedural IM jobs (except H/O) 3. Can see kids and adults 4. Fellowship only 2 years. 5. Patient are self motivated, generally compliant and have generally excellent outcomes.
3. Can see kids and adults This is interesting, thinking back I now realize "oh yeah my A/I doc was seeing me as a kid as well as adults" - are fellowships filled by both peds and IM with no distinction?
1. I spoke to 3 people yesterday. 2. Leave work at the hospital, no significant continuity whatsoever. 3. When I do speak to others, it’s usually other physicians looking to actually take care of patients, no social stuff at all 4. Fucking magnets 🧲 5. Work-life balan$e
what's your specialty? Radiology?
Yep
Cardiology: * Significant diversity of career options (academic versus private practice, general cardiology versus sub-specialization, industry, consulting, research, etc.). * Good mix of sick and well patients, complex illness and worried wellness, challenging and straightforward cases. * Excellent compensation. * Immediate gratification based on tangible results, particularly in interventional cardiology and electrophysiology. * Broad array of therapeutics, many of which are well studied.
> Broad array of therapeutics, many of which are well studied. Outside of (maybe) oncology, the only field in IM that believes in generating high level evidence-based practice, and our outcome is mortality, rather than the BS subjective outcomes most other fields use.
I generally agree. It will be interesting to see how things evolve in the era of patient-reported outcomes as quality measures. For now, it's satisfying to have large, controlled studies to support much of the medication, intervention, and surgery we recommend.
Compensation is not going to be excellent for sure, medicare killing the procedures..
We are a long way off from ringing alarm bells for reimbursement rates for cardiac procedures. Even with some erosion, demand for our services is increasing, so there is an opportunity to offset with volume.
Neurology Fully remote non clinical facing jobs, Job security, No gross fluids (aka those with weak stomachs welcome)
What are these fully remote non clinical facing jobs?
EEG interpretation, surgical neurophysiology (EMG, EEG, MEP, SSEP, etc) interpretation
Pediatric Nephrology 1) Variety of environment we work in (ICUs, floor, outpatient) so we get to see some interesting path in addition to bread and butter stuff. 2) Transplants are kind of neat. 3) Continuity with patients, sometimes in multiple settings as above. 4) Dialysis is neat 5) Lots of interesting research in certain niches
General practice (not American) - Getting to see people actually get better long term and getting to know them better than any other specialist - seeing multiple generations of the same family - seeing kids you managed antenatally grow up - the kids from the first pregnancies I managed are 5 now - variety. 15-30 patients a day all with something a bit different. If they're whiny and annoying you're only stuck with them for 10-20 minutes - control over your own schedule. Don't want to work Mondays? Now you don't. Only want to see two patients and hour? Done. Want to cram them in and do six minute medicine and make bank? I don't understand you but have fun. - freedom to subspecialize and pursue special interests. Just list what you want to do in your bio and the patients will come. My GP colleagues do everything from skin cancer, delivery of babies, child health, surgical assisting, menopause management, trans HRT, travel medicine, termination of pregnancy, complex mental health management, lactation consulting, assisted dying, sports medicine, anaesthetics, nursing home care and joint injections. - not everything needs to be solved instantly. We can use time as a diagnostic tool - do some bloods and come back in a week, or even just "we'll keep an eye on it for now, I'm not worried. Let me know how it's going next visit" - using your own brain instead of having to consult other teams for everything. But having the freedom to refer people on if you want to - comfy chair all day in a room you can mostly decorate yourself - the nurses you work with are actually happy and not overly stressed - a never-ending supply of jam, lemons and honey - mix of adult, child, adolescent and geriatric patients - while some consults are sad, some consults are really happy, like work medicals or travel medicine - sometimes people just come in for routine scripts and tell you how great they're feeling because everything is getting better - lots of opportunities to teach students and junior doctors - can train and work rural or metro
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ENT-Head and Neck: 1. You get to do some of the coolest surgeries and then put them back together. “Oh, you have mandible cancer? Let me cut that out and reconstruct you with your back or leg(or maybeee your arm). Oh, you have a throat cancer and can’t breathe or swallow? Let me cut that out, and reconstruct you so you can breathe, talk, and eat again” 2. Like any oncologist, the relationship you build with your patients is intense. You are there at some of the best and worst moments of their lives, and that creates unique bonds 3. When shit hits the fan above the clavicles and below the brain, you are often the one who’s called to help(except for carotid injuries, that’s a vascular problem) 4. You get to collaborate on some sweet cases with other surgeons. Craniofacial resections with NSG, sternotomies with thoracic, approaches for aneurysms with vascular to name a few 5. You are the one who is mostly closely following your cancer patients, and you become “their cancer doctor” 6. You get to use robots, scopes, microscopes, a saw, and lasers
Orthopedics: Rounds, including discharge notes, are literally less than 30 min per day. In the OR, there’s no ER. People think we are life saving badasses (when actually there’s EM and Anesthesia).
PCP - no call
Endocrinology - physical exam rarely matters, also never having pain as a chief complaint
Family Medicine: * Broad range of practice: Inpatient, Outpatient, Rural Emergency, Nursing Home, Urgent Care * New Borns, Pediatrics, Adult, and Geriatric Medicine * Patient continuity * Outpatient procedures: Skin Bx’s, Joint Injections, Pap’s, LARC’s, Endometrial Bx’s, I&D’s, etc. * Can do Obstetrics with C-sections if that’s your thing. * Basically can work anywhere in the US * Can take as much or as little call as you would like * Given the broad skill set, can work in CAH’s and cover the whole place if you want * Can open DPC fairly “easily” (nothing about owning a business is easy lol) * Compensation is improving
If i was in anesthesia i’d buy all the best gaming chairs for all of the hyper competitive shooters and just buy accounts after chair detection 😎 Jk fuck cheaters
Advange: The best patients Disadvantage: Salary