Just some food for though on this whole post:
If we are defining ROAD as "the hours worked are more reasonable than most and the pay is better than most, with potential for one to be very good" then we have one conversation. If we are defining BOTH hours worked or amount earned as being "very favorable" then we have an extremely different conversation (the conversation starts and ends with me telling you "youre kidding yourself") To do a quick summary: Radiology - great hours, reasonable-to-no in hospital call, good pay. Exceptional pay if youre interventional but that is a VERY hard thing to get. Ophtho - This right here is everything its cracked up to be. Barring a change in medicare payments, this one is *the* field you discuss when you discuss "road". Anesthesia - The hours are NOT as good as you have been lead to believe and call is a very real thing. But the pay is comically large. Assuming CNRA's dont steal the field it looks to stay exceptionally well paid. Derm - every derm I know states that its a field where what you make is how hard you hustle. Its profit margin "per hour spent hustling" is good, but I know poor dermatologists. And they dont suck, they just dont feel like getting their hands dirty with running medical spas or doing cosmetic procedures. Without having a robust cosmetics business it pay is not there. And obviously the hours (if you hustle when you are working) are among the best.
BUT with all of that said. None of the four above can be said to have a "downside" at either pay or hours worked (which no other field can say). Hell I'd say they are the 4 best "hours + pay" fields. But they are not uniformly "good for lifestyle". 3 of the 4 of them have an area where they are average among the two aspects. "lifestyle fields" dont really exist, outside of ophtho; get that silly thought that they do out of everyone's head and we can talk a bit.
So now to touch on Emergency Medicine. 1) You need to have the right personality for emergency medicine. I could talk for ages about it, but its true. Though you need a certain personality quirk to want to work on orbital trauma as well... so ophtho sort of understands the 'we collect a certain kind of person' mentality. 2) No field works less than EM... so woohoo. It scores big time on the hours worked metric. It must be super lifestlye right? 3) most other fields out there eventually stop working crappy shifts like holidays and overnights. "Call" and "home call" dont exist in EM. You cant be the attending who phones it in to the resident or nurse on christmas day. The price of entry for the fewest hours per week is that you dont get to decide WHEN those hours are. 4) The pay for EM isnt quite what people think it is. Its above the mean. Definitely above the mean. You're dealing with minimum salaries of 200K, but absolute maximums are about 350K. Technically many people are paid per hour and *could* earn many K more, but study after study of incomes shows that no one ever does for any sustained period of time. Pretty much all EM docs end up at about 225-275K and very few exist within the extremes of that pay range. Thats fantastic per hour, but a pittance compared to what Derm (potentially), optho and anesthesiology make. And also pennies compared to what surgeons make. Its a field where there is a income roof.
So if you want to put emergency medicine in there since it gets paid well (but FAR from great by physician standards) and works very little, then go ahead. I hesitate away from doing that, but I can see the logic in it.
Onto PM&R. I know TONS of PM&R docs and they all qualify their work the exact same way. They must get paid the most money for the least work of any field. BUT working more than the 'required' amount does not yeild more income (obviously major exceptions apply, but im generalizing here and its how they usually phrase it). PM&R docs can definitely be 'entrepreneurs' and make money through non-classical methods... but we need to stick to the bread-and-butter stuff here. I cant anticipate you being a good businessman, only a competent physician. Lets lay this out there: PM&R DOCTORS DO NOT MAKE A LOT OF MONEY (by physician standards). But what they do have is a job where there is a set amount of 'stuff' to do per day and once its done they can call it a day and leave barring one of the post-stroke patients re-infarcting. For the amount of work they do, they get paid exceptionally well. But if youre looking at the paycheck at the end of the month? They are not a particularly dazzling field for flat out income. Now what do you do with all that extra time? Apparently PM&R private practice outpatient stuff isnt all that lucrative. Its necessary, but not that lucrative. Most do that for a little boost. But im sure plenty do lots of 'non-classical' tangents of PM&R to really boost the income. I would definitely *not* put PM&R into the ROAD group. I would say that it is a great option for those that like short days (or at least, potentially short days) and neurology.
Endocrinology: I have no idea why you threw this out. Endo is one of the most poorly paid specialties out there and they are generally overwhelmed with patients. Endo belongs no where in this conversation. If you love endo, good for you. Do it. God bless you. May all of your patients have highly-billable disorders. But don't count on it. hypercalcemia managment for years pays less (combined!) than a 30 minute parathyroidectomy.
Psych I have no real commentary on. All I know is that my psych resident friends tell me that inpatient psych pays terribly and outpatient psych pays wonderfully. They actually comment that this is why inpatient psych physicians tend to be so clueless about general medicine (as always, exceptions apply), because the smarter psych graduates have the ability to go outpatient. No clue about the lifestyle dynamics to either.
Jumping back to anesthesia: You called gas easy at one point. Anesthesia and EM are about the same for competitiveness, I would say. Both have some easy to get into programs which makes the whole field "seem" easier, but generally speaking youre talking about needing a 240 on one of your usmle's to stand a legit chance at a mid-level program or better. I think calling anesthesia easy to get into is incorrect, but it does have a good number of small programs with more variable acceptance standards. Theyre also both similar in that I wouldnt suggest going AOA for either of them. I know controversial comment. But I know in EM there are basically four AOA programs really worth their salt and the rest vary from "a bit lacking" to "how the hell is that still accredited". I hear in anesthesia that number is basically one program that is comperable to ACGME. Its why I didnt mention the comlex above, because if youre thinking gas or emergency, you should be thinking USMLE. I know I'm gonna get hell for this, but I have heard pretty much unanimous commentary from DO residents in both gas and emergency that the AOA world is horribly lacking for these fields except for super limited examples of strong programs (including commentary from DO residents in AOA programs in these fields).
Hospitalists: You can make a crap ton of money, but 4 out of 5 people dont. Generally speaing hospitalists are getting the shaft with potential income and BIG TIME getting the shaft with hours required. But.... they get vacation time galore, so when they are off they are truly off. Also about 20% (thus the 4 out of 5) are basically hospital mercenaries. If you are willing to travel a lot and go where the jobs are, there is some IMMENSE money to be made in locums tenens. But this is *horrific* for lifestyle when youre on service. Its nice to work 2 or 3 weeks and then have a month or more off and make a boatload of money for it, but it is hard to pack up and move to north dakota, central PA, or Maine every other month to get that boatload of money. Living out of hotels gets tiring very quickly.
Urgent Care: If youre not *owning* or *running* the urgent care, then youre making peanuts and some other physician is profiting off of you. Working in urgent care as a physician is failing unless youre the one at or near the top of the food chain.
Rheum: Dont know a ton about it.
Neuro: All neuro fields pay horribly. There is an evolving field of interventional neurology that might go the way of IR and IC. But as of right now, its super niche and not showing signs of expanding yet. Its basically one big innovation away from blowing up. But until it does, neuro pays pretty terribly and asks a lot of time from you.
Peds: know what pays worse than sick patients? Healthy ones. Peds is notoriously the lowest paying 'major' field of medicine. Again, dont know how this field snuck into the convo.
FM: People give FM too much of a hard time. If you hustle and are a businessman, you'll make more money than you know what to do with in FM. But you need to be a *very good* business man. Most of us arent.
Pain medicine: This is an amazing fellowship. I have nothing negative to say. If youre in Anesthesia, PM&R or (as of Friday. literally two days ago) Emergency Medicine this is a hell of a field. Now it is *exceptionally* hard to get, but if you get it, you'll have a nice life as long as you get past the huge number of malingering patients.
