Need help with Specialty choice. And recommendations

[A-poor-student]

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[M&L]

Interventional radiology . “Surgery like”, but much better lifestyle . If you apply for combined (diagnostic plus IR) residency you are double board certified and can do both , or either. Great lifestyle . Average salary 412k roughly, with much much much better hours . And you can balance out how much iou want to do direct pt stuff (procedures) vs how much you want to just isolate by doing diagnostic

 

[A-poor-student]

I thought about it but the fact that they don't own any patients. Maybe I have a wrong perception about the specialty. But I would like to talk to patients and follow up.

 

[M&L]

Ok what about physical medicine and rehabilitation ?

 

[A-poor-student]

Good Suggestion. I never gave it a thought. Will totally look into it.

Does PMR have any fellowship that they do procedures?

 

[srirachamayonnaise]

I thought about it but the fact that they don't own any patients. Maybe I have a wrong perception about the specialty. But I would like to talk to patients and follow up.

Why is "owning" patients a good thing??? You have to take responsibilities for owning patients and hence bad lifestyle....

 

[M&L]

Good Suggestion. I never gave it a thought. Will totally look into it.

Does PMR have any fellowship that they do procedures?

Not sure . But we had an amputee panel thing when the attending came with a few pts and we were asking questions, snd it sounds so wonderful and rewarding . Ppl come to you on the worst day of their life, snd you get them better . Seemed very emotionally and mentally healthy , long term pt relationship, great use of anatomy knowledge , amazing life work balance . Look into it more

 

[A-poor-student]

Why is "owning" patients a good thing??? You have to take responsibilities for owning patients and hence bad lifestyle....

Maybe I am scared about all the doom and gloom surrounding rads in these forums.

"Owing" patients make it easier to not depend on other physicians.

 

[srirachamayonnaise]

Maybe I am scared about all the doom and gloom surrounding rads in these forums.

"Owing" patients make it easier to not depend on other physicians.

Surgeons don't own their patients either. Patients all get referred. The thing is if you touch a patient, you basically own that person in the sense that anything that goes wrong with them is your problem now.

 

[aaronrodgers]

I thought about it but the fact that they don't own any patients. Maybe I have a wrong perception about the specialty. But I would like to talk to patients and follow up.

That is changing in IR apparently. There is a push for an identity shift in the field from being technicans to being clinicians. At my institution there is IR clinic for regular post-procedural patient follow-ups.

 

[spartan25]

Ophtho. Cool procedures, good lifestyle. And you 100% “own” your patients

 

[Redpancreas]

My contribution to these discussions has been pretty consistent lately so sorry if I'm a broken record but try not to reduce surgery to "bad lifestyle" or medicine as "social work".

1. Start with medicine vs. surgery as these are two innately separate competencies to the extent that in some cultures they are two separate training paths. If you have a strong affinity towards one, that makes life pretty easy as you rule out many things right off the back.

2. If that's indeterminate, ask yourself how many years you see yourself in-training and what kind of lifestyle you want. Some surgical fields are, not by default, terrible lifestyles after completion of training as they can all be customized. In addition, while nearly all general surgery programs will have you working harder than most IM programs, some places will be chiller than others.

3. Find out what's more important than other things. If you want to do something procedural and like kids, maybe Peds CT surgery sounds like an ideal choice, but when push comes to shove, you do not want to be PGY8-plus and you can sacrifice procedural affinity if you find kids to be a higher priority. Figure out what your essential needs are and differentiate them from your wishes and idealizations.

3. Consider what kind of physician you want to be in 10 years when all is said and done and what your goals are. There is a spectrum of pure academic to community clock in-out with several niches. Which field among the (likely multiple) candidates will carry you there?

4. One thing I don't advise you weigh heavily is your interest in a subject matter in medical school which is difficult to explain because it's sometimes a major factor traditional medical students have to go on. I'm not saying that if you were a micro major in undergrad and did research there, did a Ph.D. in Microbiology, and this is actually what convinced you to go to medical school that you should double guess that...chances are you're going to be an ID doctor. I'm saying that if you did a rotation in Nephrology and found it fascinating, I don't think it's helpful to anchor that heavily because as you learn the basics of ID or Oncology and perhaps Rheumatology/Hepatology, you might find those interesting as well. Also, on a minor tangent, surgery gets a bad rap for being less intellectual but just read some of the operative notes. There are a lot of interesting decisions with 3D space that integrate medical reasoning that drive decision making. It's actually quite fascinating.

5. Avoid compromising for the sake of it. I like procedures, but I also want a good lifestyle hence I want IR or IM subspecialty... I am not saying that it can't be an initial jumping point but it shouldn't be your entire reasoning.

6. If you find yourself struggling, consider exploring what's not been presented to you. Medical school does not traditionally represent the E-ROAD specialties to third years as M3 is more about the fundamentals but maybe one of these is a great option for you and you should consider doing an elective in one or two.

Overall, I used to think of field choices as a straight forward arrow-diagrammed algorithm and some of my posts reflect that but honestly it need a more thoughtful approach. Sorry if some of these viewpoints come off as a bit contrarian because I know at the end of the day you have to make a choice. I just don't think it's as straight forward as, for example, the statement in the second sentence of point #5.

At the end of the day, to come up with some sort of conclusion and not just leave you with what I've written above, I think Orthopedic Surgery with potentially a fellowship seems like a good option. You seem to have an affinity to surgery if you enjoyed your surgical rotation. While Orthopedic residency is very tough and is 5 years, it is temporary and you can carve your future practice to fit. With your scores and publications you should meet the initial screens for Ortho as well.

 

[Phloston]

Current MS3/4 in a low-tier medical school. I am taking a gap year because I am finishing my MBA.

I started medical school thinking surgery was the only specialty I wanted. Got Step 1 low 25X and low Step 25X. Top 15% in class but no AOA. Honors in everything except Surgery (HP). 3 papers in orthopedics, 2 papers in radiology/Head and Neck, couple of abstracts of radiology. Will be around 10-11 in the Presentation/publication/poster session in ERAS.

The problem is that although I really liked the rotation in surgery. It is not a lifestyle in which I see myself in my future. I tried to explore other surgical specialties but they all have a similar lifestyle. And I don't know what to do because even though I love surgery, I want a life outside of medicine. A life that I feel will not be possible if I go down this route.

I don't know what other specialty to consider. I thought about IM but thinking about the social work and all the long patient notes that they do, is not something I like.

Any recommendations?

Look at the Medscape physician reports. Those are hugely helpful. Will give you tons of info/stats.

If you want to live life outside of medicine, FM is the best way to go. But because that isn't prestigious and lucrative enough for most people here, that will get laughs.

GP I did my rotation under in MS3 was one of the most brilliant people I've met in life. Guy spent tons of time with family and did a lot of archaeology research.

 

[Dave1980]

I thought about it but the fact that they don't own any patients. Maybe I have a wrong perception about the specialty. But I would like to talk to patients and follow up.

I think this "owning" patients fear is something that is only seen among med students. If you are IR and do procedures that people need you will get referrals to do those procedures. I don't see the IR field being reduced any further than it already has been.

 

[Sea Otter]

Good Suggestion. I never gave it a thought. Will totally look into it.

Does PMR have any fellowship that they do procedures?

PM&R has multiple fellowship options. Of particular interest to you may be interventional pain fellowships, where you are trained to do interventional spine procedures amongst other things.

PM&R physicians can also do Botox injections for spasticity, peripheral joint injections, EMGs, and several other procedures without a fellowship.

 

[Chelsea FC]

Current MS3/4 in a low-tier medical school. I am taking a gap year because I am finishing my MBA.

I started medical school thinking surgery was the only specialty I wanted. Got Step 1 low 25X and low Step 25X. Top 15% in class but no AOA. Honors in everything except Surgery (HP). 3 papers in orthopedics, 2 papers in radiology/Head and Neck, couple of abstracts of radiology. Will be around 10-11 in the Presentation/publication/poster session in ERAS.

The problem is that although I really liked the rotation in surgery. It is not a lifestyle in which I see myself in my future. I tried to explore other surgical specialties but they all have a similar lifestyle. And I don't know what to do because even though I love surgery, I want a life outside of medicine. A life that I feel will not be possible if I go down this route.

I don't know what other specialty to consider. I thought about IM but thinking about the social work and all the long patient notes that they do, is not something I like.

Any recommendations?

Do anesthesia then go into pain medicine.

 

[Dral]

ENT and Ophtho still see OR time but can have pretty good lifestyles the way I understand it.

If you don't need to be in an OR and are ok with just superficial cutting, you can consider Mohs. Derm residency and Mohs fellowships are both really competitive, but it's something to consider. If you have no interest in skin (most people don't) it may be tough to get through a derm residency though.

The mohs folks at my institution have a few patients who they see for yearly checks, thus keeping a longitudinal relationship with them.

 

[Mass Effect]

Current MS3/4 in a low-tier medical school. I am taking a gap year because I am finishing my MBA.

I started medical school thinking surgery was the only specialty I wanted. Got Step 1 low 25X and low Step 25X. Top 15% in class but no AOA. Honors in everything except Surgery (HP). 3 papers in orthopedics, 2 papers in radiology/Head and Neck, couple of abstracts of radiology. Will be around 10-11 in the Presentation/publication/poster session in ERAS.

The problem is that although I really liked the rotation in surgery. It is not a lifestyle in which I see myself in my future. I tried to explore other surgical specialties but they all have a similar lifestyle. And I don't know what to do because even though I love surgery, I want a life outside of medicine. A life that I feel will not be possible if I go down this route.

I don't know what other specialty to consider. I thought about IM but thinking about the social work and all the long patient notes that they do, is not something I like.

Any recommendations?

When asking others what specialty you should go for, it would help to tell us more about what you like, not just scores. You like surgery. But why? Is it the cutting? Is it the acuity? Is is the procedures? Is it the "prestige"? Is it the short notes?

 

[Splenda88]

DR---->IR

500k+/yr and call it a day.

 

[Neopolymath]

Why do these threads consistently provide no information to help provide talking points or useful insights from prior experiences???

Given we have virtually no useful information, OP should go into ophthalmology. Truly one of the few specialties that checks every single box for the typical successful medical student who likes patients, procedures, money, lifestyle, appreciation and importance, having a niche etc etc.

Until OP provides more useful information we can't really narrow it down to actionable advice unfortunately.

 

[collegestud2013]

Why is "owning" patients a good thing??? You have to take responsibilities for owning patients and hence bad lifestyle....

Owning patients may come with more responsibilities, but it also ensures better job stability in the long run and can make you less dependent on a hospital or health system for employment and thus you often have more leverage against your employers as an employed physician. In contrast, shift-based specialties that don't own any patients (eg EM, hospitalist, diagnostic radiology, critical care, inpatient anesthesiology) are more likely to rely on a hospital for employment, have less negotiating power against employers, and their terms very dependent on supply and demand of physicians in their field

 

[collegestud2013]

Why do these threads consistently provide no information to help provide talking points or useful insights from prior experiences???

Given we have virtually no useful information, OP should go into ophthalmology. Truly one of the few specialties that checks every single box for the typical successful medical student who likes patients, procedures, money, lifestyle, appreciation and importance, having a niche etc etc.

Until OP provides more useful information we can't really narrow it down to actionable advice unfortunately.

Ok what about physical medicine and rehabilitation ?

Can be a good lifestyle and you can own your patients (or just do inpatients shifts in a hospital or rehab facility) but pay is generally on the slightly lower end (high $200k to low $300k) which is probably the main reason it's not nearly as competitive as some of the other specialties. Maybe OP is okay with that, but it may not be a financially good choice if OP has a significant amount of loans.

 

[Smurfette]

Look, the reality of medicine is that the vast majority of doctors do not work in a big academic center and do not keep schedules like residents. Most students only experience formal rotations and the environment those occur in and don't have the opportunity to see other practice models.

Once you're an attending, you can get more control over your schedule. For example: Have a kid who has soccer games on Weds all summer? Tell your staff to end office a little early those days so you can have time to get there. This applies to all fields, by the way. Some doctors I know (including surgeons) really take advantage of this, others tend to work a ton. The key is that you have to get through residency first.

If you really want to do surgery, there are jobs that are slower paced as well as fields that could work well for having time outside of work depending on what you are looking for (like an ACS model of week on/week off, or variations thereof depending on location and volume. Or fields with few emergencies and few crazy call nights--Endocrine. Breast. etc.). Frequency of call is an issue, but a week on at a time and rarely being called in (like a rural model or even some small suburban hospitals) is vastly different from q2-3 call working all night and different from q4 with rare "all nighters" with a free post call day for add ons. You can find a job with any of those models, but the pay and locations are going to vary. If you are not as busy, your compensation may be less, but it is a trade-off. I have a busy practice, but once I'm home, I generally only go back in at night if I need to take someone to the OR because it can't wait until morning. For everyone else (which is most of the things I get called for), I do the consults and/or H&P, and sometimes their surgery, the next day.

 

[A-poor-student]

Why do these threads consistently provide no information to help provide talking points or useful insights from prior experiences???

Given we have virtually no useful information, OP should go into ophthalmology. Truly one of the few specialties that checks every single box for the typical successful medical student who likes patients, procedures, money, lifestyle, appreciation and importance, having a niche etc etc.

Until OP provides more useful information we can't really narrow it down to actionable advice unfortunately.

First of all, thanks to all who have answered.

I will try to give more information that is useful since several have asked me for it. And I think that way you all can help me more.

Money is not one of my priorities, a salary around 270k-300k is more than enough since my wife will also be a physician. She wants neurology, dual physician household is more than enough money.

Lifestyle is a priority for me. I don't want to have to be on call Q2-3. I prefer something that is once a week max of call.


Prestige is not something I am looking for. I will not go into academics.

I enjoy surgery a lot, I love how I can make a remarkable impact after each surgery. I like to work with my hands. But it's not like it's the only thing I see myself. I know I could be happy if I don't choose it even though I know what I prefer. In the future, a good lifestyle beats any love you have for surgery.

About some surgical specialties that they have mentioned. As I am from a low-tier medical school and I am not AOA. I don't know how it is feasible to match ENT or ORTHO. which were some that I was considering.

 

[Colinoscopy]

First of all, thanks to all who have answered.

I will try to give more information that is useful since several have asked me for it. And I think that way you all can help me more.

Money is not one of my priorities, a salary around 270k-300k is more than enough since my wife will also be a physician. She wants neurology, dual physician household is more than enough money.

Lifestyle is a priority for me. I don't want to have to be on call Q2-3. I prefer something that is once a week max of call.


Prestige is not something I am looking for. I will not go into academics.

I enjoy surgery a lot, I love how I can make a remarkable impact after each surgery. I like to work with my hands. But it's not like it's the only thing I see myself. I know I could be happy if I don't choose it even though I know what I prefer. In the future, a good lifestyle beats any love you have for surgery.

About some surgical specialties that they have mentioned. As I am from a low-tier medical school and I am not AOA. I don't know how it is feasible to match ENT or ORTHO. which were some that I was considering.

Others can correct me if I'm wrong here but EM will give you a solid lifestyle, matches the salary you're after, allows you to do at least some procedural stuff/work with your hands.

 

[Lawpy]

Others can correct me if I'm wrong here but EM will give you a solid lifestyle, matches the salary you're after, allows you to do at least some procedural stuff/work with your hands.

EM lifestyle can really suck and the job market has pretty much collapsed

 

[Colinoscopy]

EM lifestyle can really suck and the job market has pretty much collapsed

What makes you say that about the lifestyle? The EM docs in my area work 10-12 eight hour shifts per month. Granted it has been hell with COVID. And yes good point about the job market.

 

[odyssey2]

What makes you say that about the lifestyle? The EM docs in my area work 10-12 eight hour shifts per month. Granted it has been hell with COVID. And yes good point about the job market.

It’s not so much the time spent working but the constant changes from night to day in scheduled shifts and the draining nature of the work itself. EM can be brutal.

 

[Colinoscopy]

It’s not so much the time spent working but the constant changes from night to day in scheduled shifts and the draining nature of the work itself. EM can be brutal.

Excellent points. Could OP consider part time anesthesia? Might be difficult to find a gig like this but it would let OP get back to the OR, excellent lifestyle, some ability to work with their hands and have fairly direct impact. As far as salary, I've met a couple anesthesia attendings working part time making ~250k.

 

[Chelsea FC]

Can be a good lifestyle and you can own your patients (or just do inpatients shifts in a hospital or rehab facility) but pay is generally on the slightly lower end (high $200k to low $300k) which is probably the main reason it's not nearly as competitive as some of the other specialties. Maybe OP is okay with that, but it may not be a financially good choice if OP has a significant amount of loans.

If OP cant pay off loans with high 200K-300K salary OP would have different issues to worry about and doubt 500K salary would make much difference.