[Residency] 4th year struggling to pick a specialty

[khichadi]

Venture over to the EM forum and do some reading.

How do I find EM (or specific specialty) forum? Do you have link?
Thanks.

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[Redpancreas]

How do I find EM (or specific specialty) forum? Do you have link?
Thanks.

Tl;dr the field's in trouble because their projected supply is eclipsing their demand even by conservative estimates and people are seeing the effects on that squeeze in salary. This was concluded by multiple official EM organizations and publicized by MedTwitter. Private Equity is buying the practices since it's a hospital department and shiftwork making it easy to corporatize and replace with midlevels/mass ordering. SDN's EM forum has been talking about it for a few years, but it's beaten to death so it's probably not the first thing on there because it's the elephant in the room everyone knows about now.

 

[Pshalt]

Hello! I'm new here and searching for some advice

I'm a 4th-year medical student and I cannot for the life of me pick a specialty!

My top priorities:

1. Working with both adults and kids
2. Procedures and medicine
3. Work-life balance and family time
4. Mostly inpatient work - some clinic is fine but do not want to spend the majority of my time in clinic (this is primarily the reason i'm not interested in family medicine)
5. Job opportunities - my fiancé and I are looking to be in a specific city to be close to our families
6. Done with residency and fellowship within 6 years

Background: Came into medical school only wanted to do OB. Still love the obstetric part of it but did not at all love the OR or the gynecology part of it so figured it didn't make sense to do a specialty where I only liked half of it. After this, I realized I enjoyed working with both adults and kids a lot so considered med peds. I like the idea of this field but from the digging that I've done it really seems like most people end up choosing to work with either adults or kids unless they do a combined fellowship or outpatient work. Combined fellowships just seem too long for me to handle and they seem to be specific in location. Thought EM for a while because I liked the fast pace and the ability to work with a variety of patients but could not for the life of me get the hang of the weird hours (i'm a very routine person) and wasn't sure about the lack of continuity of care. I didn't mind it for the 1 month I was on the rotation, but can see how it would be something missing for me later on. From EM, I realized my love of procedures so looked into anesthesia or interventional radiology. Peri-operative care just doesn't really interest me very much. I think interventional radiology would be really cool but I don't know too much about it yet or if, with all my particularities above, it's just a little too competitive or i've started looking into it too late.

Any advice is appreciated!! I really need to decide on something soon and every way I turn there is something that makes me shy away from the specialty. I know a common thing that people say is to look at the lows of the specialty and if you can deal with the lows adequately, that's the one you should pick. I understand this but at the end of the day, I just haven't found something that I can see myself doing for the rest of my life without missing an aspect of another specialty.

Take a hard look at general radiology. It fits your lifestyle needs and can have great but short patient interactions especially in small town practices. Lots of procedures even if not IR. I do 25 joint injections a week and talk to patients all the time. I thought it would be boring, but every radiologist I know is happy and watching and doing are very different. I work from home 75%, am raising 4 kids and make plenty of money.

 

[minimumwage]

Hello! I'm new here and searching for some advice

I'm a 4th-year medical student and I cannot for the life of me pick a specialty!

My top priorities:

1. Working with both adults and kids
2. Procedures and medicine
3. Work-life balance and family time
4. Mostly inpatient work - some clinic is fine but do not want to spend the majority of my time in clinic (this is primarily the reason i'm not interested in family medicine)
5. Job opportunities - my fiancé and I are looking to be in a specific city to be close to our families
6. Done with residency and fellowship within 6 years

Background: Came into medical school only wanted to do OB. Still love the obstetric part of it but did not at all love the OR or the gynecology part of it so figured it didn't make sense to do a specialty where I only liked half of it. After this, I realized I enjoyed working with both adults and kids a lot so considered med peds. I like the idea of this field but from the digging that I've done it really seems like most people end up choosing to work with either adults or kids unless they do a combined fellowship or outpatient work. Combined fellowships just seem too long for me to handle and they seem to be specific in location. Thought EM for a while because I liked the fast pace and the ability to work with a variety of patients but could not for the life of me get the hang of the weird hours (i'm a very routine person) and wasn't sure about the lack of continuity of care. I didn't mind it for the 1 month I was on the rotation, but can see how it would be something missing for me later on. From EM, I realized my love of procedures so looked into anesthesia or interventional radiology. Peri-operative care just doesn't really interest me very much. I think interventional radiology would be really cool but I don't know too much about it yet or if, with all my particularities above, it's just a little too competitive or i've started looking into it too late.

Any advice is appreciated!! I really need to decide on something soon and every way I turn there is something that makes me shy away from the specialty. I know a common thing that people say is to look at the lows of the specialty and if you can deal with the lows adequately, that's the one you should pick. I understand this but at the end of the day, I just haven't found something that I can see myself doing for the rest of my life without missing an aspect of another specialty.

Family Medicine

 

[coolkat712]

Hello! I'm new here and searching for some advice

I'm a 4th-year medical student and I cannot for the life of me pick a specialty!

My top priorities:

1. Working with both adults and kids
2. Procedures and medicine
3. Work-life balance and family time
4. Mostly inpatient work - some clinic is fine but do not want to spend the majority of my time in clinic (this is primarily the reason i'm not interested in family medicine)
5. Job opportunities - my fiancé and I are looking to be in a specific city to be close to our families
6. Done with residency and fellowship within 6 years

Background: Came into medical school only wanted to do OB. Still love the obstetric part of it but did not at all love the OR or the gynecology part of it so figured it didn't make sense to do a specialty where I only liked half of it. After this, I realized I enjoyed working with both adults and kids a lot so considered med peds. I like the idea of this field but from the digging that I've done it really seems like most people end up choosing to work with either adults or kids unless they do a combined fellowship or outpatient work. Combined fellowships just seem too long for me to handle and they seem to be specific in location. Thought EM for a while because I liked the fast pace and the ability to work with a variety of patients but could not for the life of me get the hang of the weird hours (i'm a very routine person) and wasn't sure about the lack of continuity of care. I didn't mind it for the 1 month I was on the rotation, but can see how it would be something missing for me later on. From EM, I realized my love of procedures so looked into anesthesia or interventional radiology. Peri-operative care just doesn't really interest me very much. I think interventional radiology would be really cool but I don't know too much about it yet or if, with all my particularities above, it's just a little too competitive or i've started looking into it too late.

Any advice is appreciated!! I really need to decide on something soon and every way I turn there is something that makes me shy away from the specialty. I know a common thing that people say is to look at the lows of the specialty and if you can deal with the lows adequately, that's the one you should pick. I understand this but at the end of the day, I just haven't found something that I can see myself doing for the rest of my life without missing an aspect of another specialty.

psychiatry had a HUGE demand, the majority of people that are sick have a sickness related to that field so that field has a need. That would only be good if you feel like you talk to people
Often because it involves that. If your the type to want isolation and just “do work” maybe a different field, of course your going to have to interact with people regardless but it also depends. My question to you is are you okay with speaking to people very often?

 

[Aspiringalways24]

All 6 of those things cant matter the same to you. Pick 3 and know that chances are you will settle to a speciality that ticks 2 of the 3 boxes. I had a long list of wants like you did but knew deep down that Life outside of work is the most important thing for me. Then that made my decision easier.

I’m curious what specialty you chose @Chelsea FC (I apologize if already mentioned and I missed!)

 

[guytakingboards]

Any advice is appreciated!! I really need to decide on something soon and every way I turn there is something that makes me shy away from the specialty. I know a common thing that people say is to look at the lows of the specialty and if you can deal with the lows adequately, that's the one you should pick. I understand this but at the end of the day, I just haven't found something that I can see myself doing for the rest of my life without missing an aspect of another specialty.

Not an uncommon scenario to be a med student finding that you liked features of a lot of different specialties. Given your wide spectrum of priorities, I'd just like to point out a few things:

- That priority list is going to change over time. Job opportunities and work-life balance are gonna shoot to the top of the list in a few years I'd imagine.
- You're at a point where you can say "I can [/can't] see myself doing XYZ specialty without missing something from another specialty". That is almost certainly going to change. Coming out of training (whatever training you end up picking), you may have a completely different set of preferences. You may find you don't actually like doing procedures, or doing the procedures of the particular specialty you picked. You may grow to hate inpatient work... or outpatient work.

I'm a radiologist who does nearly 100% neuroradiology. Are there days when I miss direct patient care? Sure. Are there days where I miss the cool procedures of general surgery? Yes. Heck, are there days where I miss doing general radiology and light IR procedures? Yes and yes. I still enjoy my job immensely and don't worry too much about not doing every possible thing I saw in medical school.

You may be an slightly imperfect fit for several specialties. That's okay. I'd say focus on making the best of and being happy with whatever you end up picking and not focusing on the things your chosen specialty doesn't end up providing.

 

[DrAWACS]

You seem thoughtful, sincere, and well-motivated with a number of valid priorities. As some have noted, a few of these conflict.
Not sure I have "the answer" (actually, I don't but let me offer a few thoughts and pieces of advice for consideration:

-Think hard about longevity. I know I was hell-on-wheels for intense specialties in my 3rd and 4th years. I am not so much anymore. Try to project yourself into the future and what that specialty or criterion will feel like after being an attending for 7 yrs. 15 yrs. Maybe even 4 yrs. Doing only a lot of intense, inpatient stuff may get old. You will get old(er). I say this coming back to inpatient after years away. I actually like the relevance and acuity, and procedure especially, but I also know I don't want to do it 12 hrs a day every day. You've already ID'ed not being stuck in clinic because of specialty (I'm the same).
My best inputs in this line came from having honest conversations with senior docs whom I respected. Some of their candid thoughts were very surprising.

- Flexibility. Can you do a different type of X w/o doing a 2nd residency or acting as a GP? If anesthesia, you will always to some extent be tied to systems and hospitals. You cannot hang out your own shingle. So also pathology, ED, and (often radiology).

- Can't do everything. I think that's a drawback of med/peds and a lot of broad clinical specialties, esp. with short residencies. If you want to work with adults/kids, both biological genders, a range of acuities, etc, you might to weight being a specialist more highly. E.g. ENT, optho, urology. Those three also offer a mix of operative/outpatient work. One thing I very much like about radiology is a broad mix of dx, pathology, and as much rx as you have stomach for (via IR or general procedures). As a subspecialist, I can have colleague-level discussions with neuro, neurosurg, ENT on complex cases.

- Do you really groove on the detective work? You said you like medicine. Do you mean the dx, the inpatient vibe, the discussions/explanations/EOL care? Some specialties offer a lot less deduction than others (sorry, ortho). Some are endlessly deep but have a very different style (neuro, can't change as much in most practices... though stroke critical care is great; not a lifestyle specialty though).

- Do you want multiple practice styles? Ie. part-time to pay the bills, travel/volunteer, etc? Certain specialties offer a lot more flex. I worked as a military reservist for 7 yrs and kept up GP skills while being a radiologist. Also went on some civilian volunteer trips; specialists and surgeons were super-valuable on those.

- Rhythm. Most radiology practices have a busy/grind/interruption based workflow, except when they become more efficient, then it becomes a quiet grind. Harder to get comp'ed for patient care and E&M work outside certain IR/practice environments. Good in some ways (productive) but the actual amount of concentration/thinking/worry time is higher than I'd guessed, and higher than a lot of other specialties that seemed more intense when I was a student.
My point is that the practical logistics and economics of a specialty end up influencing what it actually feels like to do (e.g. keeping the EHR alive instead of the patients, etc), so hence again the value of talking to practitioners. Esp. outside academia if at all possible.

- How comfortable are you being told what to do? Some specialties are far more under the thumb of administrators, contracts, etc. Some are also more affected by the stroke of a pen far away. OTOH some FPs have done well doing good work in independent practices. And some high-technical-revenue specialties (ortho) have more sway with hospitals and systems, so tend to be able to control their practices more.

Ha! Just refreshed the page and saw another neuroradiologist post thoughts. Small world.

Good luck!

 

[MilkmanAl]

Was going to say anesthesia as well. Could do a pediatric fellowship or ICU fellowship or both. You can still do OB and I'm sure future partners would love you if you took all the OB call.....From what I've seen it has a good mix of procedures and medicine. Job market is currently not bad. Also you can do mommy tracks and have good work life balance from those I've talked to, you just will make less money.

Here's another vote for anesthesia. The work schedule can be a bit unpredictable, but if you're willing to sacrifice some income, you can get a position at a surgicenter or small rural hospital that would provide the schedule you're looking for.

 

[EyeNerd2.0]

My 2 cents. Apply med-peds & don’t look back. That leaves the most doors open for you to make more specific decisions as you start practicing independently under supervision as a resident. My thoughts and perspectives shifted as I progressed through residency. You can later adjust your decisions on seeing more adults vs kids, doing more inpatient vs outpatient work, and whether to do fellowship training or no.

 

[mcat_taker]

@stemsoflife you said you liked OB going in to med school and still love the obstetric part of it but not the OR.

Just want to point out that many hospitals employ a laborist model where you can just focus on obstetrics after completing OBGYN residency. Think shift work OB and just delivering babies, with the occasional consult in ED. You wouldn't have to do any clinic or operative GYN. Just focus on delivering babies.

If you hate the OR/long procedures -- OBGYN also offers non surgical fellowships like REI and MFM that allow you to practice more "obstetric medicine" without having to do surgery.

Think consulting gig/clinic/reading USS for high risk pregnancies with MFM with procedures like amnios/CVS
Think fertility treatment procedures / clinic helping people get pregnant with REI

 

[voodoomagic]

Something where your education and training and degree counts for something (TO THE HOSPITAL).. any other specialty, even if you save dozens of lives.. you are a cost and tax to society Trust me.. you ain’t seen nothing yet homie! Good luck. In a perfect world, Anestheiology or ER. But these two specialties.. Administrators hate you. You’re not generating revenue you see.. you’re just helping the community.. doesn’t count.

 

[deleted1095841]

When you say you want to treat both children and adults, do you mean you specifically want to treat both of them? Or rather you want to see patients with varying ages (and resulting differences in physiology)? I'd imagine a newborn, 5 year-old child, and 17 year-old adolescent are quite different medically.

 

[Chelsea FC]

I’m curious what specialty you chose @Chelsea FC (I apologize if already mentioned and I missed!)

PM&R as stated above

 

[Tachymeter]

To the original poster. If you want it you can find it. In the PNW alot of family medicine doctors do inpatient medicine. Some of them do it exclusively without clinic, pediatrics and adult in the same hospital. In fact for years I did inpatient with peds and adults and my own clinic. Although I far and away prefer the latter. You probably need to work at a smaller hospital to get that set up or for a residency program.
Note that you can also do OB as a fm doctor. I know fm docs that do Ob, peds, adult, and newborn all as part of their normal hospital rounding and privileging. You just have to find what works for you.

 

[Aspiringalways24]

PM&R as stated above

Don’t know how I missed that. Sorry!

Is it impolite to ask about compensation for more family friendly specialties? I’m going to be an MS1 in August (I know this is super early), but I’ve been really interested in Psychiatry and one of the Anesthesiologists I worked with would always play up Anesthesia because of compensation and being able to pay student loans back.. but I’m under the impression that you should choose a specialty because it interests you and you enjoy it and not purely for the big $$$$$$.

 

[NicMouse64]

Don’t know how I missed that. Sorry!

Is it impolite to ask about compensation for more family friendly specialties? I’m going to be an MS1 in August (I know this is super early), but I’ve been really interested in Psychiatry and one of the Anesthesiologists I worked with would always play up Anesthesia because of compensation and being able to pay student loans back.. but I’m under the impression that you should choose a specialty because it interests you and you enjoy it and not purely for the big $$$$$$.

It might change. I am going into anesthesia because I like it, not because I expect to make big bucks. If I do then great, if I don't then it's ok. Don't pick a life just because of the money, although having it as a consideration is reasonable.

 

[voodoomagic]

If you want strictly compensation- do something interventional. Interventional cardiology, interventional radiology, interventional neurology, vascular surgery.. all make quite a bit. Anesthesia/ER/Radiology.. all hospital based.. you don't "bring money to the hospital".. very unstable, very political, very corporate. But yes, they make more $ than FP/Peds/IM etc.. if $, then orient yourself to the right specialty where you will be "valued".. Even IM.. you stick a bunch of scopes down there and up there.. salaries in the 600k range are pretty common.. unreal, I know.. compared to FP/Peds etc.. certainly more than Anesthesia/ER..

Consider the politics of the specialty very carefully. It's unfortunate, but that's the way it is.. right now. Look into the history of Anesthesia- NPs get their scope of practice via straight up Nepotism.. and it's going to keep happening. They call themselves Nurse Anesthesiologists now. They get a degree called "DNP", a "Doctorate" in Nursing practice, and call themselves "Doctors".. I wish I could say I was joking.. but at the VA, the previous undersecretary's wife was a CRNA-- he passed this memo which basically attempted to grant VA CRNAs independent practice. It all started with Bill Clinton who's Mom was a CRNA.. on his way out, he passed an "executive order" which granted CRNAs independent practice. Bush W immediately reversed it. In California, Arnold Schwazenegger wanted to get chiropractic manipulations using Anesthesia.. the evidence-based specialty that we are, Anesthesiologists there refused to engage.. he then "authored" California's "opt out" without consultation of the California Medical Board. Immediately thereafter, Minnesota's Governor, Jesse "the Body" Ventura, who apparently doesn't have the time to bleed underscoring his understanding of "the body"... Arnold's buddy (from the Predator movie) passed his executive order. Basically.. they've made a joke out of a profession.

Anesthesiologists deal with intra-op **** all day long, and political **** pretty much forever.. The intra-op stuff never burns you out .. but intra-op problem solving is fun and if you miss the call well, the outcome is hit or miss.. sometimes no one will ever know that someone missed something...
But Anesthesia.. I was surprised.. how much I had to know about every other specialty such as OB, Peds etc... I thought it was going to be easy but I distinctly remember a WTF moment when I realized how much I had to know.. about specialties I didn't think I'd ever have to deal with The visual optics of it..make it seem laid back, but it's not..YOU just have to be laid back.. which is why most Anesthesiologists look "chill" and the ones who don't .. don't.. well...

Anesthesia and ER are amazing specialties, that give you the breadth of patient exposure you seek, the thrill of the save, yes the boredom of what others perceive as routine and the surprises which demand you to step up to the plate in the clutch. All these things which are way more important to a community hospital than the Administrator wishes to acknowledge.. they know.. but they don't acknowledge.. DON'T FEEL TOO GUILTY ABOUT CHOOSING A SPECIALTY FOR $$ IF YOU CAN SEE YOURSELF LIVING (not necessarily loving) IT AND DOING IT.. TRUST ME... THE HOSPITALS, INSURANCE COMPANIES, POLITICIANS, PRIVATE EQUITY (BIG BIG DEAL IN MEDICINE RIGHT NOW) ETC. AIN'T THINKING ABOUT ANYTHING BUT $$$.. AND YOU/WE ARE A PAWN IN THE WHOLE THING. SO DON'T FEEL TOO GUILTY TO FUNCTION ON THE TRUTH OF THE SITUATION. The whole thing about patients.. they're basically voters.. who don't give a **** about what's going to hit them anyway.. that's why we have responsible Politicians..

But consider all the other issues.. make your call.

This is about as honest as it gets.. for ya.. you definitely work for your $.. in-house call, supervising multiple rooms with personnel who don't feel they should be supervised yet don't know enough to know what they don't know.. and it all falls on you.

All that said, I would still say do Anesthesia if you can hack the above issues, because, frankly, we need good Physicians who can represent the specialty well by being the content and procedural experts.. and leaders... I've seen too many "leaders" kowtow to CRNAs and Surgeons and well pretty much even the flies on the OR walls.. that's not what we need.. and in fact, in the generation(s) that are following mine, I see this trend reversing somewhat, fortunately.. the recent opportunistic moves by the CRNA lobby have riled many who would have otherwise been complacent.

 

[voodoomagic]

Don’t know how I missed that. Sorry!

Is it impolite to ask about compensation for more family friendly specialties? I’m going to be an MS1 in August (I know this is super early), but I’ve been really interested in Psychiatry and one of the Anesthesiologists I worked with would always play up Anesthesia because of compensation and being able to pay student loans back.. but I’m under the impression that you should choose a specialty because it interests you and you enjoy it and not purely for the big $$$$$$.

With all the mental health issues, which are only getting worse.. Psych is a pretty good choice.. you have your own office, your hours.. but the downside is.. you gotta listen to people with all sorts of problems.. all sorts of problems.. But you can have a boutique practice. I wouldn't do it though..

 

[mrbreakfast]

If I had a 12 yo I wanted assessed for a neurological disease, I would see a child neurologist, specifically.

You cannot both state this and recommend any medical specialty in which both children and adults are both seen, because that statement applies to any imaginable ailment - any pediatric specialist is going to provide better care than their adult equivalent. OP states they want to treat both adults and kids; in doing so they will inherently thus not be an expert in either. Neurology fits well, because if your 12 year old has a seizure and you want them to be seen by a child neurologist, you may have to decide between driving several hundred miles or waiting several months for a clinic appointment; you could also drive to your nearest ED and be seen by an adult neurologist, who will probably provide very similar recommendations, in 30 minutes.

Neurology is a field in which the average non-academic hospital may have a single (or zero) neurologists in-house at any given time, let alone a child neurologist. Of course everyone wants optimal care, but not everyone can proverbially be seen at Mayo.

This all goes back to my original post in this thread: if OP truly wants to treat both adults and children, they will have to make concessions elsewhere in specialty choice.

 

[stemsoflife]

@stemsoflife you said you liked OB going in to med school and still love the obstetric part of it but not the OR.

Just want to point out that many hospitals employ a laborist model where you can just focus on obstetrics after completing OBGYN residency. Think shift work OB and just delivering babies, with the occasional consult in ED. You wouldn't have to do any clinic or operative GYN. Just focus on delivering babies.

If you hate the OR/long procedures -- OBGYN also offers non surgical fellowships like REI and MFM that allow you to practice more "obstetric medicine" without having to do surgery.

Think consulting gig/clinic/reading USS for high risk pregnancies with MFM with procedures like amnios/CVS
Think fertility treatment procedures / clinic helping people get pregnant with REI

This thought definitely seems more and more appealing every day! I'm wondering where I can talk to someone who works as a laborist and get their thoughts.

 

[mcat_taker]

This thought definitely seems more and more appealing every day! I'm wondering where I can talk to someone who works as a laborist and get their thoughts.

Head over to the OBGYN board and try there. Talk to MFM and REI people at your hospital. If your hospital uses a laborist model talk to them.

OBGYN is a great field because there are fellowships for lots of different personalities. For those that love the OR: gyn-onc/uro-gyn/MIGS for those that hate it REI/MFM.

If you focus on OB you have a relatively healthy patient population (women of childbearing age). It's not a bad gig.

 

[drginawalton]

Hello! I'm new here and searching for some advice

I'm a 4th-year medical student and I cannot for the life of me pick a specialty!

My top priorities:

1. Working with both adults and kids
2. Procedures and medicine
3. Work-life balance and family time
4. Mostly inpatient work - some clinic is fine but do not want to spend the majority of my time in clinic (this is primarily the reason i'm not interested in family medicine)
5. Job opportunities - my fiancé and I are looking to be in a specific city to be close to our families
6. Done with residency and fellowship within 6 years

Background: Came into medical school only wanted to do OB. Still love the obstetric part of it but did not at all love the OR or the gynecology part of it so figured it didn't make sense to do a specialty where I only liked half of it. After this, I realized I enjoyed working with both adults and kids a lot so considered med peds. I like the idea of this field but from the digging that I've done it really seems like most people end up choosing to work with either adults or kids unless they do a combined fellowship or outpatient work. Combined fellowships just seem too long for me to handle and they seem to be specific in location. Thought EM for a while because I liked the fast pace and the ability to work with a variety of patients but could not for the life of me get the hang of the weird hours (i'm a very routine person) and wasn't sure about the lack of continuity of care. I didn't mind it for the 1 month I was on the rotation, but can see how it would be something missing for me later on. From EM, I realized my love of procedures so looked into anesthesia or interventional radiology. Peri-operative care just doesn't really interest me very much. I think interventional radiology would be really cool but I don't know too much about it yet or if, with all my particularities above, it's just a little too competitive or i've started looking into it too late.

Any advice is appreciated!! I really need to decide on something soon and every way I turn there is something that makes me shy away from the specialty. I know a common thing that people say is to look at the lows of the specialty and if you can deal with the lows adequately, that's the one you should pick. I understand this but at the end of the day, I just haven't found something that I can see myself doing for the rest of my life without missing an aspect of another specialty.

How about consider PM&R with a brain injury fellowship so you can do inpatient and have an outpatient clinic where you do Botox procedures for spasticity and maybe even baclofen pump refills (both of which can be done for spinal cord injury patients and Botox for stroke and MS spasticity). Good quality of life.

 

[Chelsea FC]

How about consider PM&R with a brain injury fellowship so you can do inpatient and have an outpatient clinic where you do Botox procedures for spasticity and maybe even baclofen pump refills (both of which can be done for spinal cord injury patients and Botox for stroke and MS spasticity). Good quality of life.

Chances are he won’t get the peds/adult mix because most peds cases would go to peds PM&R especially if he works in a big city

 

[calivianya]

I did not know this and agree if that's the case Neurology goes way farther than IM to ensure that both types of residents get training with the younger/older demographic. That being said, it seems like there is still an effective split between Child Neuro and Neuro (Adult IMO bc 4 mo. =/ competency) and one spending 4-8 months in residency in my mind is just the tip of the iceberg and the bolded part of your quote indicates the pediatric neuro and neuro (adult IMO) are effectively split. FM and IM PCPs are doing colonoscopies in areas that are not large metros. If I had a 12 yo I wanted assessed for a neurological disease, I would see a child neurologist, specifically. Additionally I'd imagine an attending's practice/competence is mostly their experience as an attending and not 4-8 months in residency. Sorry if I thread on some toes with that opinion and interested in hearing counterarguments.

Your post is a little older, but I just saw it and I have relevant experience with my third year site, so, here I am!

I think just about anyone would agree that if they had a child with a neurological disease, but they would rather see a child neurologist specifically. However, my third year clinical site is so remote that the nearest place where they actually have reputationally-great children’s services and a decent children’s hospital is over 90 miles away. The town my hospital is in is also extremely poor, with people often working multiple jobs to make ends meet. Per capita income here is lIke $17,000/year.

We’re talking about asking poor people, with potentially unreliable transportation, to make a nearly 200-mile round trip to take their kid to a single child neurologist appointment, let alone if the kid is going to need testing and they will have to make multiple trips, and that’s a really big ask when there’s a neurologist literally less than 2 miles from the hospital who sees kids. Is it ideal? No, but you can at least pick your kid up and take the kid to the neurologist on a lunch break (in theory) when the neurologist is two miles away. Some neurology care is better than no neurology care at all.

So it is very feasible to do both children and adults in a rural area, and it is highly, highly necessary to have people that are willing to do both.


I am starting to see the appeal of a rural practice across all specialties. I pretty much hate living in a rural area, but I am seeing relatively huge scopes of practice for every doctor I have been placed with since there are few subspecialists. The radiologist I am currently rotating with does every type of radiology imaginable - he does IR and DR, and we may spend all morning reading everything from XRs of pediatric fractures, newborn hip dysplasia ultrasounds, mammograms, and CTs of adult brain tumors, and intersperse that with occasionally heading to the procedure room to watch swallow studies, do paracenteses, breast biopsies, and place a drain for a biliary leak post cholecystectomy all in the same day. I think it would be difficult to find a gig with that type of breadth in a larger area.

 

[Viscernable]

I know absolutely nothing about human med specialities but because I was curious about med-peds I was looking for information on it and this paper is a very nice summary of the average med-ped physician’s work life and could be helpful. Obviously, caveat that it shows the mean or median of all surveyed and isn’t necessarily representative of the modal average e.g. the percentage of time spent working different specialties may be 40/60 on average but most med-ped physicians may spend most time on one or the other.

 

[kgamon8]

Really struggling with my fourth year course choices and relate to you in every way! What did you end up picking?