Specialties with Low levels of uncertainty

[koochkooch]

MS3 from NZ. I realise the nature of our profession is that it is inherently filled with uncertainty and that we should learn to cope with uncertainty, but this is something I really struggle with. I don't expect uncertainty to ever disappear, but I also want a job where I can predict what kinds of problems will be walking through the door, and that I will have control over the outcomes. Being certain about my work gives me peace of mind. Which specialties provide a relatively higher degree of certainty with regard to the scope of problems being dealt with (i.e. what walks through the door is predictable) and can be managed in a controlled manner with predictable outcomes?

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[OnePunchBiopsy]

I'm only an M3, but when I think of consistent, day-to-day medicine I think of Primary Care (Family Medicine, General Internal Medicine, Pediatrics), but even these specialties may have the occasional weird/crazy case that walks through the door. It also depends on your practice environment. For example, expect more consistency if you are a family doc working for a large health system or large group practice, but if you were rural (the only doc for miles) or working in the ER there would be much more variety and less consistency.

 

[bashwell]

MS3 from NZ. I realise the nature of our profession is that it is inherently filled with uncertainty and that we should learn to cope with uncertainty, but this is something I really struggle with. I don't expect uncertainty to ever disappear, but I also want a job where I can predict what kinds of problems will be walking through the door, and that I will have control over the outcomes. Being certain about my work gives me peace of mind. Which specialties provide a relatively higher degree of certainty with regard to the scope of problems being dealt with (i.e. what walks through the door is predictable) and can be managed in a controlled manner with predictable outcomes?

Of course, different healthcare systems and practice environments between NZ and US. So if you're looking for only NZ I'm not sure if you'll necessarily receive the answers you're looking for here in the U.S. forums? Well, unless people familiar with NZ's healthcare environment public and private and so on can comment. You might try asking in the Australia and NZ forums?

 

[Giovanotto]

Pathology?

 

[Winged Scapula]

Pathology?

I venture anything where diagnostic medicine is part of the specialty there's going to be some uncertainty. I'm fairly sure that pathologists would not include themselves as an appropriate choice for someone looking for a guarantee.

Perhaps something like medical genetics is more up her alley. Mostly counseling, running tests, and then more counseling.

 

[ACSurgeon]

Surgery. We are wrong sometimes, but never in doubt.

 

[BigRedBeta]

I mean if you're looking for a consistent day to day experience, then clinical pathology (ie doing something like running the laboratory or blood bank) is probably the field where there is the least variation and most "certainty". PM&R might also be more straightforward option as well that has more patient contact.

Regarding the idea that primary care is "more certain", as a peds intensivist, I'd definitely say that outpatient pediatrics is the opposite of certainty...an outpatient pediatrician has to be the one who can figure out what is different in the one kid with viral myocarditis versus the 250 other kids who just have a simple cold they'll see in the preceding 2 weeks - it's a situation that if you really think about it, is quite frightening. They don't have to take care of them, but they are the front line. The same is true in other primary care fields, getting too caught up in the routine will mean you'll miss the severe stuff that masquerades as "not so bad" for a period of time.

 

[WinslowPringle]

There is no field of medicine I know of that you'll ever know 100% what's walking through the door and be able to completely guarantee the outcome based on your work alone.

Some fields with maybe a modicum more of 'predictability', though...

Sports medicine? Generally healthy people, generally good outcomes.

Private practice opthalmology doing high volume cataract surgery and not much else?

Boutique dermatology (i.e., lots of Botox and resurfacing and not a general derm practice)

Hospice work (you know what is coming and the outcome is guaranteed....eventually)

 

[Psai]

There is no field of medicine I know of that you'll ever know 100% what's walking through the door and be able to completely guarantee the outcome based on your work alone.

Some fields with maybe a modicum more of 'predictability', though...

Sports medicine? Generally healthy people, generally good outcomes.

Private practice opthalmology doing high volume cataract surgery and not much else?

Boutique dermatology (i.e., lots of Botox and resurfacing and not a general derm practice)

Hospice work (you know what is coming and the outcome is guaranteed....eventually)

H

Heres the h you dropped

 

[Siggy]

PMR
Rad onc (the patient has cancer, the question you have is "do I nuke it or not, and if so, how?")
Legitimate pain management (the pain management service I rotated with normally had MRIs before seeing back pain patients. Break the pain contract? Good bye)

 

[DubVille]

PMR
Rad onc (the patient has cancer, the question you have is "do I nuke it or not, and if so, how?")
Legitimate pain management (the pain management service I rotated with normally had MRIs before seeing back pain patients. Break the pain contract? Good bye)

I agree there aren't usually any huge surprises in PM&R. However, I don't think the specialty really "exists" in NZ, making it very unpredictable.

 

[ScubaV]

Pathology?

Pathology is very predictable in terms of day-to-day schedule and lifestyle. In terms of work, though, it depends. In a private practice or hybrid setting, the vast majority of your caseload is going to be biopsies and the majority of those are going to be GI biopsies with a small handful of probable diagnoses before you even look at the slide (ex. the GI sampler: esophagus r/o EOE, Barrett's; stomach r/o H. pylori; small bowel r/o celiac; colon r/o IBD, microscopic colitis, polyps, etc). The rest, however, is going to be a wide variety of stuff and while most of the time it's straightforward there are always going to be weirdo cases that don't read the book and can even challenge national experts that you might consult. That said, the process for dealing with these is pretty standard: look through your reference books/online resources -> show to colleagues <-> order ancillary tests -> send it for outside consult.

In a subspecialized academic setting the scope of stuff you see is much narrower, but it also means you get a higher concentration of weirdo stuff in the form of consults.

If anyone is thinking about pathology, though, don't pick it because you don't like patients or because you like CSI and want to do forensics. Pick it because you did an elective and enjoyed it. Medical school doesn't teach you about what pathologists actually do.

 

[Giovanotto]

Pathology is very predictable in terms of day-to-day schedule and lifestyle. In terms of work, though, it depends. In a private practice or hybrid setting, the vast majority of your caseload is going to be biopsies and the majority of those are going to be GI biopsies with a small handful of probable diagnoses before you even look at the slide (ex. the GI sampler: esophagus r/o EOE, Barrett's; stomach r/o H. pylori; small bowel r/o celiac; colon r/o IBD, microscopic colitis, polyps, etc). The rest, however, is going to be a wide variety of stuff and while most of the time it's straightforward there are always going to be weirdo cases that don't read the book and can even challenge national experts that you might consult. That said, the process for dealing with these is pretty standard: look through your reference books/online resources -> show to colleagues <-> order ancillary tests -> send it for outside consult.

In a subspecialized academic setting the scope of stuff you see is much narrower, but it also means you get a higher concentration of weirdo stuff in the form of consults.

If anyone is thinking about pathology, though, don't pick it because you don't like patients or because you like CSI and want to do forensics. Pick it because you did an elective and enjoyed it. Medical school doesn't teach you about what pathologists actually do.

Having worked in clinical pathology, this is very accurate.

 

[Pinkertinkle]

Private practice ophthalmology would be mostly the same few diagnoses.

 

[koochkooch]

Pathology is very predictable in terms of day-to-day schedule and lifestyle. In terms of work, though, it depends. In a private practice or hybrid setting, the vast majority of your caseload is going to be biopsies and the majority of those are going to be GI biopsies with a small handful of probable diagnoses before you even look at the slide (ex. the GI sampler: esophagus r/o EOE, Barrett's; stomach r/o H. pylori; small bowel r/o celiac; colon r/o IBD, microscopic colitis, polyps, etc). The rest, however, is going to be a wide variety of stuff and while most of the time it's straightforward there are always going to be weirdo cases that don't read the book and can even challenge national experts that you might consult. That said, the process for dealing with these is pretty standard: look through your reference books/online resources -> show to colleagues <-> order ancillary tests -> send it for outside consult.

In a subspecialized academic setting the scope of stuff you see is much narrower, but it also means you get a higher concentration of weirdo stuff in the form of consults.

If anyone is thinking about pathology, though, don't pick it because you don't like patients or because you like CSI and want to do forensics. Pick it because you did an elective and enjoyed it. Medical school doesn't teach you about what pathologists actually do.

Thanks, this is the sort of detail I wanted. Do you know as much about other specialties? Optho, family medicine?

 

[ScubaV]

Thanks, this is the sort of detail I wanted. Do you know as much about other specialties? Optho, family medicine?

Sorry. I'm a pathology resident, so I know the details there. I only did family medicine as a medical student rotation and never had any experience with ophthalmology.

 

[Giovanotto]

Sorry. I'm a pathology resident, so I know the details there. I only did family medicine as a medical student rotation and never had any experience with ophthalmology.

DO or MD resident? I'm considering pathology or if by miracle I can do dermatopathology as a DO.

 

[ScubaV]

DO or MD resident? I'm considering pathology or if by miracle I can do dermatopathology as a DO.

Caribbean MD. Once you get a residency, your medical school doesn't matter too much, but it does influence what kind of residency you can get. At least for pathology, DOs seem to be on a similar tier as Caribbean MDs in that you will be limited to low/middle tier programs barring you being an exceptional candidate or having a connection of some kind.

If you want dermpath you can go through dermatology (obviously very difficult) or pathology. Which route you go also influences what your work environment is like. I believe dermatologists going into dermpath basically want to be able to look at their own stuff and keep all the revenue. Most pathologists going into dermpath still have to sign out other types of cases, although there are definitely some positions where they only do dermpath.

Dermpath is quite competitive as a fellowship and really requires you to start pursuing it early in your residency in terms of doing research, attending meetings, doing dermpath rotations. Two people in my program are going for it and they've said that you really benefit from being in a program that has an in-house fellowship (something we don't have) and takes internal candidates.