Specialty Help: Heart telling me 1 thing, Wallet telling me another

[Blazers_33]

Hey everyone, another confused MS3 getting close to needing to schedule my 4th year and im torn between a couple (few?) specialties and really need to decide. Mostly I am in between FM (sports medicine) and anesthesia, with PM&r a maybe still there as a third.

Go to a low-tier MD in midwest, interested in moving back west to AZ, TX, NM somewhere around there. Step 1 of 243, no red flags, honored all clerkships so far (just 2 left, expecting ill honor at least 1 more of them), 1 first author pub and some poster stuff,

Things most important to me: 1. lifestyle 2. time for family (I am a father/husband) 3. money to pay off my lovely debt (private school) and support family 4. location 5. interest in field

Things in medicine I like: pharmacology (specifically psychopharm), physiology, psych patients but not enough to do psychiatry, sports med, neuro stuff, babies


FM:
PROS: lots of psych which I like
huge variety
easy to get into for me I'm assuming, residency location is hugely important and lots of programs--> easier to match where I want
3 year residency, not too brutal from what I hear
see a little of everything
can live and get a job anywhere, don't mind going a little more rural to make more $$
sports med fellowship would be cool to do more MSK, injections, etc.
get to see babies, OB, geriatrics, pretty much anything
can work in lots of different places, urgent care, ER, outpatient, etc.
9-5, no weekends, call, etc. and highly variable

CONS: LOW PAY. I don't care about being rich, driving a Bentley, having a boat, etc. Just wanna live comfortably, support family, and pay off my debt fast which im worried about. seems like pay is around 225k??
mid levels but not too worried since that crap is everywhere
lots of charting/paperwork which is annoying but not a deal breaker
dealing with patients who dont wanna help themselves is frustrating

Anesthesia
PROS: More cash money! (like 100k+ more). Will be able to pay off debt faster and go on more cool vacations.
more vacation time
dope pharmacology/physiology
I find what they do with all the gizmos and gadgets fascinating and really cool
really cool procedures
might be interested in pain
I like being in the OR/hospital and seeing cool things but don't wanna be the one doing the procedure
time to chill when a procedure is relaxed


CONS: hours. less predictable and longer. more difficult with family
having to be on call. dealing with call when im like 60 wont be cool
CRNA's are annoying in my experience, less job opportunities?
dealing with d-bag surgeons. most have seemed great though
a little more competitive and I haven't really shown any interest in it during school yet. worried about matching to a good spot.
emergencies can be a little frightening to me at times. im hoping with more training this would go away



tlr My heart is telling me FM but my brain/wallet are telling me anesthesia. Can anyone persuade me one way or another? Thanks for reading

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[flapjack3d]

i'm biased. all i comment nowadays is that "you should check out PM&R", but really all the things you're looking are really suited to PM&R.
1. lifestyle yup
2. time for family (I am a father/husband) yup
3. money to pay off my lovely debt (private school) and support family yup
4. location matching isn't terribly competitive, you can likely match in whatever part of the country you want (barring california if youre not from california)
5. interest in field (based on below, yup)

Things in medicine I like: pharmacology (specifically psychopharm), physiology, psych patients but not enough to do psychiatry, sports med, neuro stuff, babies
PM&R has all the above except the babies, but you could do peds pm&r too

 

[DOcSto]

I 2nd PM&R. I don't know much because I haven't started med school yet, but I work in a PM&R office and see the doctors enjoying what you describe above. The mix of MSK and Neuro is a big draw for me personally, but the lifestyle and pay are pretty good.

 

[Mad Jack]

i'm biased. all i comment nowadays is that "you should check out PM&R", but really all the things you're looking are really suited to PM&R.
1. lifestyle yup
2. time for family (I am a father/husband) yup
3. money to pay off my lovely debt (private school) and support family yup
4. location matching isn't terribly competitive, you can likely match in whatever part of the country you want (barring california if youre not from california)
5. interest in field (based on below, yup)

Things in medicine I like: pharmacology (specifically psychopharm), physiology, psych patients but not enough to do psychiatry, sports med, neuro stuff, babies
PM&R has all the above except the babies, but you could do peds pm&r too

PM&R is more competitive than it used to be. I would say everything is a yes except location, as matching where you want can be much more challenging with the limited spots in each program. It is still one of the fields that has the lowest percentage of US MDs applying per spot so overall match chances, especially with those board scores, are quite high.

 

[VA Hopeful Dr]

I feel like I'm spending half my SDN time these days correcting false ideas about FM income potential.

I don't know what kind of numbers you've heard, but 300k in FM isn't all that hard to manage. 400k is doable if you're willing to hustle at work. Plus it's pretty easy to get loan repayment in primary care.

 

[Splenda88]

I feel like I'm spending half my SDN time these days correcting false ideas about FM income potential.

I don't know what kind of numbers you've heard, but 300k in FM isn't all that hard to manage. 400k is doable if you're willing to hustle at work. Plus it's pretty easy to get loan repayment in primary care.

It's amazing that people in SDN think FM docs have low income potential. If you are not making 300k+ both in FM/IM is because you choose to. In fact, you don't even have to work crazy hours ( > 55 hrs/wk) to make 400k+ in both FM/IM.

If I work surgeon hrs (60+ hrs/wk) as a hospitalist, I probably will make surgeon $$$ (500k+/yr).

 

[mrbreakfast]

PM&R is more competitive than it used to be.

FWIW, PM&R is competitive within its application pool, not overall. It has one of the lowest average Step 1 + Step 2 scores for any specialty. OP's Step 1 score is ~85th percentile for US MD/DO applicants to PM&R. Match rate in PM&R for US MDs who scored >230 on step 1 was 96%. They are on track to match wherever they want.

seems like pay is around 225k??

Something to always consider when looking into salaries is that you often don't see how much that person is working. A FM doc making $225k may be working 3.5 days a week.

Things in medicine I like: pharmacology (specifically psychopharm), physiology, psych patients but not enough to do psychiatry, sports med, neuro stuff, babies

You should at least look into sports neurology, which very strongly matches a number of your medical interests (except the babies). However, all in all I'd consider FM over any of the other specialties mentioned in this thread.

 

[Blazers_33]

I feel like I'm spending half my SDN time these days correcting false ideas about FM income potential.

I don't know what kind of numbers you've heard, but 300k in FM isn't all that hard to manage. 400k is doable if you're willing to hustle at work. Plus it's pretty easy to get loan repayment in primary care.

is this 300K just in like the midwest or all over depending on how hard you work?

 

[Blazers_33]

It's amazing that people in SDN think FM docs have low income potential. If you are not making 300k+ both in FM/IM is because you choose to. In fact, you don't even have to work crazy hours ( > 55 hrs/wk) to make 400k+ in both FM/IM.

If I work surgeon hrs (60+ hrs/wk) as a hospitalist, I probably will make surgeon $$$ (500k+/yr).

I guess im just going off of averages I see online and stuff and most seems around 225-250k. obviously this doesn't show hours worked or anything. My fam med preceptor was making cash tho working 3.5 days a week, though she was considered "rural".

I dont have any doctor friends or family or anything so I really don't know what salaries are like beyond what the internet and preceptors are willing to tell me

 

[Blazers_33]

PM&R is more competitive than it used to be. I would say everything is a yes except location, as matching where you want can be much more challenging with the limited spots in each program. It is still one of the fields that has the lowest percentage of US MDs applying per spot so overall match chances, especially with those board scores, are quite high.

would an away rotation be necessary in the area I want to match in for Pmr since its more of a smaller field

 

[Splenda88]

I guess im just going off of averages I see online and stuff and most seems around 225-250k. obviously this doesn't show hours worked or anything. My fam med preceptor was making cash tho working 3.5 days a week, though she was considered "rural".

I dont have any doctor friends or family or anything so I really don't know what salaries are like beyond what the internet and preceptors are willing to tell me

Docs in academia and a good # of part timers might affect the average. The market is not bad right now for FM/IM docs (especially hospital medicine). Not difficult to find a job in a good suburb in the southeast where you can make 300k/yr without killing yourself.

 

[IMGASMD]

Hey everyone, another confused MS3 getting close to needing to schedule my 4th year and im torn between a couple (few?) specialties and really need to decide. Mostly I am in between FM (sports medicine) and anesthesia, with PM&r a maybe still there as a third.

Go to a low-tier MD in midwest, interested in moving back west to AZ, TX, NM somewhere around there. Step 1 of 243, no red flags, honored all clerkships so far (just 2 left, expecting ill honor at least 1 more of them), 1 first author pub and some poster stuff,

Things most important to me: 1. lifestyle 2. time for family (I am a father/husband) 3. money to pay off my lovely debt (private school) and support family 4. location 5. interest in field

Things in medicine I like: pharmacology (specifically psychopharm), physiology, psych patients but not enough to do psychiatry, sports med, neuro stuff, babies


FM:
PROS: lots of psych which I like
huge variety
easy to get into for me I'm assuming, residency location is hugely important and lots of programs--> easier to match where I want
3 year residency, not too brutal from what I hear
see a little of everything
can live and get a job anywhere, don't mind going a little more rural to make more $$
sports med fellowship would be cool to do more MSK, injections, etc.
get to see babies, OB, geriatrics, pretty much anything
can work in lots of different places, urgent care, ER, outpatient, etc.
9-5, no weekends, call, etc. and highly variable

CONS: LOW PAY. I don't care about being rich, driving a Bentley, having a boat, etc. Just wanna live comfortably, support family, and pay off my debt fast which im worried about. seems like pay is around 225k??
mid levels but not too worried since that crap is everywhere
lots of charting/paperwork which is annoying but not a deal breaker
dealing with patients who dont wanna help themselves is frustrating

Anesthesia
PROS: More cash money! (like 100k+ more). Will be able to pay off debt faster and go on more cool vacations.
more vacation time
dope pharmacology/physiology
I find what they do with all the gizmos and gadgets fascinating and really cool
really cool procedures
might be interested in pain
I like being in the OR/hospital and seeing cool things but don't wanna be the one doing the procedure
time to chill when a procedure is relaxed


CONS: hours. less predictable and longer. more difficult with family
having to be on call. dealing with call when im like 60 wont be cool
CRNA's are annoying in my experience, less job opportunities?
dealing with d-bag surgeons. most have seemed great though
a little more competitive and I haven't really shown any interest in it during school yet. worried about matching to a good spot.
emergencies can be a little frightening to me at times. im hoping with more training this would go away



tlr My heart is telling me FM but my brain/wallet are telling me anesthesia. Can anyone persuade me one way or another? Thanks for reading

Don’t do it for the money.
You won’t starve even at 225K/yr. I don’t know what the interest is right now for student loans…. But it should be manageable. If you can survive residency with less than 1/3 of that, you will feel much better after graduation.

For anesthesia
1. Lifestyle: can be tough in residency, but you can find jobs that fits your lifestyle, just like any other fields.
2. Time for family: see 1
3. Money: see above. More you work, you should make more.
4. Location: some of those states you listed may have more md only practices than out East.
5. Interest: that’s up to you.

In general mommy/daddy track 7-3 no calls, 4 weeks vacation. Probably will land you close to 300. Sure there’s potential to make more, but if you prioritize your other considerations; I’d say 300 ain’t bad.

Pick something that you want to do…. For 20 years. Everything else is bonus.

Good luck.

 

[Mad Jack]

would an away rotation be necessary in the area I want to match in for Pmr since its more of a smaller field

Would be helpful if you come off well

 

[Chelsea FC]

I would do a rotation in all of them. FM I hated teasing diabetes in people. Anesthesia was way more intense than I expect and I hate working in the OR with surgeons at times. Rehab can be very very boring to some people.

 

[IWishIWasBuff]

It's amazing that people in SDN think FM docs have low income potential. If you are not making 300k+ both in FM/IM is because you choose to. In fact, you don't even have to work crazy hours ( > 55 hrs/wk) to make 400k+ in both FM/IM.

If I work surgeon hrs (60+ hrs/wk) as a hospitalist, I probably will make surgeon $$$ (500k+/yr).

How does this change in large coastal cities?

 

[flapjack3d]

FWIW, PM&R is competitive within its application pool, not overall. It has one of the lowest average Step 1 + Step 2 scores for any specialty. OP's Step 1 score is ~85th percentile for US MD/DO applicants to PM&R. Match rate in PM&R for US MDs who scored >230 on step 1 was 96%. They are on track to match wherever they want.



Something to always consider when looking into salaries is that you often don't see how much that person is working. A FM doc making $225k may be working 3.5 days a week.


You should at least look into sports neurology, which very strongly matches a number of your medical interests (except the babies). However, all in all I'd consider FM over any of the other specialties mentioned in this thread.

Step 1 isn’t THAT important for matching PM&R. I had a basically identical step 1 and an otherwise decent app including “top” md school and certainly didn’t match “anywhere I want”. There’s enough programs and diversity of selectiveness to match in whatever /region/ you’d like but with programs being so small, it’s much more about fit and demonstrated interest in the specialty.

 

[SurfingDoctor]

When you're 50 and you already have a nest egg... you'll be hating yourself for doing a job just cause it pays slightly better, which you don't actually need at that point anyway... (also making $200K+ in your early 30s is not "low pay"... just for some perspective)

Also... you should never presume that you will get to work in a location you want AND make money... unless you want to work in bumblef-ck nowhere... then you're golden.

 

[RangerBob]

PM&R is more competitive than it used to be. I would say everything is a yes except location, as matching where you want can be much more challenging with the limited spots in each program. It is still one of the fields that has the lowest percentage of US MDs applying per spot so overall match chances, especially with those board scores, are quite high.

You're correct about a low percentage of MDs applying per spot. But when you add in DO's applying, the two together make PM&R among the more competitive specialties when you look at #US seniors applying/positions. But our board scores are second lowest I believe, so we're just an odd specialty. The OP would have no trouble matching to a strong PM&R program.

OP: Life is only so long. Multiple studies have shown relationships with friends/family are what really drives happiness, so I'd actually say be one of those guys/girls who never leaves their hometown and get a dead end job, lol. Barring that, when it comes to career choices, I'd go with what you enjoy more since you'll be doing it for decades. You'll make plenty of money in FM.

Also, if you do FM you can literally practice anywhere. Once my son was born, my wife and I realized we really wanted to be closer to family, despite high COA and other drawbacks to the area. I was primarily interested in inpatient PM&R and didn't have too much interest in outpt. There was one actue rehab unit for a few hundred miles and fortunately it was right next to everyone, and as luck would have it I was able to get that job. Had I not been able to get that job I wouldn't have been able to find a job I liked close to family, and I would have regretted not going into pysch (my second choice) as that would have allowed me to practice anywhere, just like FM.

 

[Splenda88]

How does this change in large coastal cities?

Might be a little harder...

 

[Mad Jack]

You're correct about a low percentage of MDs applying per spot. But when you add in DO's applying, the two together make PM&R among the more competitive specialties when you look at #US seniors applying/positions. But our board scores are second lowest I believe, so we're just an odd specialty. The OP would have no trouble matching to a strong PM&R program.

OP: Life is only so long. Multiple studies have shown relationships with friends/family are what really drives happiness, so I'd actually say be one of those guys/girls who never leaves their hometown and get a dead end job, lol. Barring that, when it comes to career choices, I'd go with what you enjoy more since you'll be doing it for decades. You'll make plenty of money in FM.

Also, if you do FM you can literally practice anywhere. Once my son was born, my wife and I realized we really wanted to be closer to family, despite high COA and other drawbacks to the area. I was primarily interested in inpatient PM&R and didn't have too much interest in outpt. There was one actue rehab unit for a few hundred miles and fortunately it was right next to everyone, and as luck would have it I was able to get that job. Had I not been able to get that job I wouldn't have been able to find a job I liked close to family, and I would have regretted not going into pysch (my second choice) as that would have allowed me to practice anywhere, just like FM.

Yeah, that's something a lot of people don't factor in. One of the reasons I shied away from critical care was that getting a job within an hour of home basically would require one of the attendings to die to open up a spot. PM&R is the same around here, but there are FM and psych jobs everywhere.

 

[7331poas]

It's amazing that people in SDN think FM docs have low income potential. If you are not making 300k+ both in FM/IM is because you choose to. In fact, you don't even have to work crazy hours ( > 55 hrs/wk) to make 400k+ in both FM/IM.

If I work surgeon hrs (60+ hrs/wk) as a hospitalist, I probably will make surgeon $$$ (500k+/yr).

I mean yeah, work crazy hours in FM to make 400. Or work 1 on 2 off in radiology and make 500. If you want to clear 300 in FM you need to be in a group that offers equity, RVU bonus, or something of that nature.

FM does not compensate well for the monotony of the work.

 

[Splenda88]

I mean yeah, work crazy hours in FM to make 400. Or work 1 on 2 off in radiology and make 500. If you want to clear 300 in FM you need to be in a group that offers equity, RVU bonus, or something of that nature.

FM does not compensate well for the monotony of the work.

As far as inpatient, FM in my group can clear 400k/yr working 8x 11hrs every 2 weeks

 

[VA Hopeful Dr]

I mean yeah, work crazy hours in FM to make 400. Or work 1 on 2 off in radiology and make 500. If you want to clear 300 in FM you need to be in a group that offers equity, RVU bonus, or something of that nature.

FM does not compensate well for the monotony of the work.

I made over 400k last year working 36 hours per week with 6 weeks off. I could clear 300k working 3 days per week. Hospital employed.

Also have to factor in the opportunity cost of those 2 extra years of training for radiology. More if you do any fellowships.

And lifestyle. I do no weekends, no nights, home phone call once every 5-6 weeks.

Your last line is key though: don't pick a specialty if you don't like the work. I don't find FM to be monotonous at all while I would many/most other specialties less enjoyable in various ways.

 

[SurfingDoctor]

I made over 400k last year working 36 hours per week with 6 weeks off. I could clear 300k working 3 days per week. Hospital employed.

Also have to factor in the opportunity cost of those 2 extra years of training for radiology. More if you do any fellowships.

And lifestyle. I do no weekends, no nights, home phone call once every 5-6 weeks.

Your last line is key though: don't pick a specialty if you don't like the work. I don't find FM to be monotonous at all while I would many/most other specialties less enjoyable in various ways.

Ha… I need to leave pediatric critical care medicine apparently.

 

[IMGASMD]

Ha… I need to leave pediatric critical care medicine apparently.

You were never there for the money…… you knew that when you entered pediatric residency.

 

[SurfingDoctor]

You were never there for the money…… you knew that when you entered pediatric residency.

True. I was joking anyway, I like my job for the most part.

 

[Splenda88]

It does not matter financially to be honest. Every physician should be rich after they have been practicing medicine for 20+ yrs unless there are extenuating circumstances (divorces etc...) that have prevented them or they are stupid with money.

The surgeons, cardiologists, GI docs etc... might have a net worth of 5+ mil after 20+ yrs. Yours might be 3+ mil. Not sure how big of a difference in lifestyle that would be (3 mil vs. 5 mil).

You invest 5-6k month in the S&P500 (401k, roth IRA, 529 etc..), you will have 3+ mil after 20 yrs with the average of 8-10% return. Pick a career that you think will make you "not hate going to work." (see I did not use the word "happy" here).

Compound Interest Calculator | Investor.gov

Determine how much your money can grow using the power of compound interest.

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[Frazier]

Even the most exciting things about any specialty will get old after a few years. The shiny luster will wear off and it will be routine after performing the same task for the 5000th time.

But know what doesnt get old? The frustration or hatred you have for doing/dealing with XYZ. Whatever you dont like about a specialty, it isnt going to likely get better. You will always dislike that thing.

Pick a specialty with as few of the "dislikes" as possible given that the shine is going to dull regardless of what you choose. You will be left with a specialty that you are good at, enjoy, and have very little to be frustrated about (if you pick correctly). Big picture: that is a good trifecta to have in a career.

 

[Neopolymath]

Even the most exciting things about any specialty will get old after a few years. The shiny luster will wear off and it will be routine after performing the same task for the 5000th time.

But know what doesnt get old? The frustration or hatred you have for doing/dealing with XYZ. Whatever you dont like about a specialty, it isnt going to likely get better. You will always dislike that thing.

Pick a specialty with as few of the "dislikes" as possible given that the shine is going to dull regardless of what you choose. You will be left with a specialty that you are good at, enjoy, and have very little to be frustrated about (if you pick correctly). Big picture: that is a good trifecta to have in a career.

This goes against the toxic positivity of some areas of SDN/medicine but this is a large part of how I believe one should pick a specialtiy.

Students get lured in by a few highs on some rotations and are largely shielded from the negatives (except maybe IM and FM where it is glaring obvious). It leads to stupid decisions instead of pragmatic ones.

 

[i-doctor]

Even the most exciting things about any specialty will get old after a few years. The shiny luster will wear off and it will be routine after performing the same task for the 5000th time.

But know what doesnt get old? The frustration or hatred you have for doing/dealing with XYZ. Whatever you dont like about a specialty, it isnt going to likely get better. You will always dislike that thing.

Pick a specialty with as few of the "dislikes" as possible given that the shine is going to dull regardless of what you choose. You will be left with a specialty that you are good at, enjoy, and have very little to be frustrated about (if you pick correctly). Big picture: that is a good trifecta to have in a career.

Kind of like some relationships/marriages. I’ve given confidential advice to friends who are having a torrid affair and are contemplating getting divorced (commonplace situation with doctors) and marrying their new love.
My advice is related to the above post: I tell them that their newfound love will too become old. So then the question: Which will be better— their present old or their future old?

 

[Dr G Oogle]

It's amazing that people in SDN think FM docs have low income potential. If you are not making 300k+ both in FM/IM is because you choose to. In fact, you don't even have to work crazy hours ( > 55 hrs/wk) to make 400k+ in both FM/IM.

If I work surgeon hrs (60+ hrs/wk) as a hospitalist, I probably will make surgeon $$$ (500k+/yr).

I second this. You can make a lot of money in FM, particularly if rural and see 30ish patients per day. If you do procedures even better. If you want bankers hours you won’t make as much in any specialty. Anesthesia can have very predictable hours unless you’re on call or are only game in town. You can also have a “daddy/mommy track” and work less but also make less.

Don’t know as much as about PMR but with outpatient procedures probably more income potential than FM if matched by hours worked, but again if you don’t work as many hours you don’t get paid as much.

My best advice is choose the one you love the most and work a little more hours so you came make the income you want. I don’t think 325-350k in a more rural area is gojng to mean you’re working an 80 hour week.

FM in particular is in high demand. I’m doing this leadership training at my hospital system and they gave us some insight into what patients complain about the most. And other than things like long wait times to see a physician, the biggest complaint was seeing an NP or PA instead of a doctor, especially in the more rural hospitals that are part of our system

 

[IMGASMD]

FM in particular is in high demand. I’m doing this leadership training at my hospital system and they gave us some insight into what patients complain about the most. And other than things like long wait times to see a physician, the biggest complaint was seeing an NP or PA instead of a doctor, especially in the more rural hospitals that are part of our system

This is actually encouraging news. I wish all the patients can be as well informed and welling to speak up.

 

[Dr G Oogle]

This is at a tertiary and quaternary health system but includes regional and rural practices, the mid-levels work in offices and practices with docs so even patients who are not particularly savvy understand the difference. In PP there are mid-levels who have no docs in practice and can and do misrepresent themselves as equal, in those cases the patient may not know the difference but there does seem to be a turn in the tide.

I say this to stay on track of thread (is FM a good choice, emphatically yes and I sometimes dream of having done FM myself for the pros you listed.)

One thing that’s also left out of conversation of FM and primary care in general is that any specialist worth their salt will and should be bending over backwards to help them get their patients seen since that is where referrals come from. Almost every PCP that is around me has my cell and my undivided attention when they call for a curbside or want to get a patient in quickly. There is a lot of benefit in being a PCP. I’ve come to the conclusion that people who bash primary care do it from a place of their own insecurities.

 

[oldman]

Hey everyone, another confused MS3 getting close to needing to schedule my 4th year and im torn between a couple (few?) specialties and really need to decide. Mostly I am in between FM (sports medicine) and anesthesia, with PM&r a maybe still there as a third.

Go to a low-tier MD in midwest, interested in moving back west to AZ, TX, NM somewhere around there. Step 1 of 243, no red flags, honored all clerkships so far (just 2 left, expecting ill honor at least 1 more of them), 1 first author pub and some poster stuff,

Things most important to me: 1. lifestyle 2. time for family (I am a father/husband) 3. money to pay off my lovely debt (private school) and support family 4. location 5. interest in field

Things in medicine I like: pharmacology (specifically psychopharm), physiology, psych patients but not enough to do psychiatry, sports med, neuro stuff, babies


FM:
PROS: lots of psych which I like
huge variety
easy to get into for me I'm assuming, residency location is hugely important and lots of programs--> easier to match where I want
3 year residency, not too brutal from what I hear
see a little of everything
can live and get a job anywhere, don't mind going a little more rural to make more $$
sports med fellowship would be cool to do more MSK, injections, etc.
get to see babies, OB, geriatrics, pretty much anything
can work in lots of different places, urgent care, ER, outpatient, etc.
9-5, no weekends, call, etc. and highly variable

CONS: LOW PAY. I don't care about being rich, driving a Bentley, having a boat, etc. Just wanna live comfortably, support family, and pay off my debt fast which im worried about. seems like pay is around 225k??
mid levels but not too worried since that crap is everywhere
lots of charting/paperwork which is annoying but not a deal breaker
dealing with patients who dont wanna help themselves is frustrating

Anesthesia
PROS: More cash money! (like 100k+ more). Will be able to pay off debt faster and go on more cool vacations.
more vacation time
dope pharmacology/physiology
I find what they do with all the gizmos and gadgets fascinating and really cool
really cool procedures
might be interested in pain
I like being in the OR/hospital and seeing cool things but don't wanna be the one doing the procedure
time to chill when a procedure is relaxed


CONS: hours. less predictable and longer. more difficult with family
having to be on call. dealing with call when im like 60 wont be cool
CRNA's are annoying in my experience, less job opportunities?
dealing with d-bag surgeons. most have seemed great though
a little more competitive and I haven't really shown any interest in it during school yet. worried about matching to a good spot.
emergencies can be a little frightening to me at times. im hoping with more training this would go away



tlr My heart is telling me FM but my brain/wallet are telling me anesthesia. Can anyone persuade me one way or another? Thanks for reading

In medicine the most important thing is finding something that brings you happiness. If money does that great. If not I would choose FM. To help with Paying off loans I’d work at a nonprofit like part of a university system or a county hospital. You can get your loans forgiven and likely help an underserved population. I remember my family med rotation where one of the doctors had time to go eat lunch with his wife every day and fridays left early to coach baseball games.

 

[dabears505]

Do psych and call it a day. Pick the lowest stress specialty possible. Do not do anesthesia.

 

[nontradms2]

One of the most important questions isn't answered in your post. A huge factor is the type and amount of debt you have. Are all your loans federal/Graduate PLUS type, or did you have to take out some private loans? And are you talking $400K or $600K? Government-backed loans are all subject to income restrictions and forgiveness. Private loans aren't. There are docs with $600K in loans who make minimum payments of 10% of after-tax-and-deductions income and whose loans continue to grow rather than being paid down. After 20 years you get to simply stop paying and the rest is written off. Working aggressively to pay down your loan isn't always the best choice.

Also, I know several FM docs who make more than $750K annually, but they went VERY rural and they are self-employed. They also work much less than 40 hours per week. Your income is determined by the things you do and the risks you are willing to take. "Average" salaries as reported by the big aggregators are only a starting point. And you have to keep in mind: those numbers only include the docs who chose to participate in the survey.

 

[snooper]

"LOW PAY. I don't care about being rich, driving a Bentley, having a boat, etc. Just wanna live comfortably, support family, and pay off my debt fast which im worried about. seems like pay is around 225k??"
Well, 225K is a generous salary, so I'd say to go for what you love to do. Also, it may be "Low pay" is in comparison to other specialties, but it isn't low in comparison to, say, highly accomplished experts in other fields or even DHHS. For example, Francis S Collins, Md, PhD, Director of NIH, makes less than 225K.

 

[mvenus929]

CONS: LOW PAY. I don't care about being rich, driving a Bentley, having a boat, etc. Just wanna live comfortably, support family, and pay off my debt fast which im worried about. seems like pay is around 225k??

I'm all for physicians getting paid well for the sacrifices they make. But anyone who complains that $225K per year isn't a lot of money also rubs me the wrong way. Especially if you want to do work in Arizona, New Mexico, or Texas, which are all relatively low cost of living places (Texas with no state income tax), $225K per year will get you far as long as you're smart with your money. There are lots of loan repayment options out there, especially for FM (because it's remarkably easy to work in an underserved area as a FM), so you'll likely have some assistance for loan repayment or you'll be able to work harder for a few years to earn more money to pay off your loans faster.

You will 100% be able to meet your goals after choosing FM. There are also other fields that will help you achieve those goals. Pick the specialty that will give you a reasonable earning potential but you can stand doing the bread and butter of the field for 20+ years.

 

[psyspy]

I'm all for physicians getting paid well for the sacrifices they make. But anyone who complains that $225K per year isn't a lot of money also rubs me the wrong way. Especially if you want to do work in Arizona, New Mexico, or Texas, which are all relatively low cost of living places (Texas with no state income tax), $225K per year will get you far as long as you're smart with your money. There are lots of loan repayment options out there, especially for FM (because it's remarkably easy to work in an underserved area as a FM), so you'll likely have some assistance for loan repayment or you'll be able to work harder for a few years to earn more money to pay off your loans faster.

You will 100% be able to meet your goals after choosing FM. There are also other fields that will help you achieve those goals. Pick the specialty that will give you a reasonable earning potential but you can stand doing the bread and butter of the field for 20+ years.

Many of the FAANG techies are currently hitting 200k before turning 30 when you consider their stock ownership/dividends. Not to mention cumulative affects of inflation in the past few years.

A physician salary of 225k is also one where earning negative salary (or zero if they’re lucky) for several years, but hey, some people may still disagree

 

[Amed]

I want to tell you to do Anesthesiology because of the pay- I’d feel same way! However, going against your heart is always regretful. You can make up the extra money by investing intelligently. Most of the family doctors I know make around 300k in the suburbs of Detroit. Best of luck to you, man!! 😊💓

 

[Lawpy]

Many of the FAANG techies are currently hitting 200k before turning 30 when you consider their stock ownership/dividends. Not to mention cumulative affects of inflation in the past few years.

A physician salary of 225k is also one where earning negative salary (or zero if they’re lucky) for several years, but hey, some people may still disagree

It’s hard to get jobs at FAANG companies especially since those jobs recruit really heavily from top tier undergrads. I’ll never understand why SDN takes this elitist view and downplays six figure salaries even with factoring in debt.

 

[sylvester500]

It's amazing that people in SDN think FM docs have low income potential. If you are not making 300k+ both in FM/IM is because you choose to. In fact, you don't even have to work crazy hours ( > 55 hrs/wk) to make 400k+ in both FM/IM.

If I work surgeon hrs (60+ hrs/wk) as a hospitalist, I probably will make surgeon $$$ (500k+/yr).

Sorry, but how? (Not being facetious, just a naive first year med student).

 

[psyspy]

It’s hard to get jobs at FAANG companies especially since those jobs recruit really heavily from top tier undergrads. I’ll never understand why SDN takes this elitist view and downplays six figure salaries even with factoring in debt.

Not as of recent. Much recruitment has expanded to solid top-mid tier UG schools because the companies themselves have expanded substantially and are in need of talent. That said much of this pro-employee job market could end with the recession + future bubble burst later this year

 

[SlitLampExam]

I would not choose a specialty by the expected income because the difference in income is not that much in most cases. I am wary of specialties that are solely dependent on a hospital contract, like anesthesiology. Hospitals can be bullies. One hospital controlling a local market is happening more and more.

The best advice that I came across was to actually speak with people in the specialty that are in private practice and not employed by the medical school. If you find that several of them are discouraging you to go into their field, evaluate their advice.

 

[NITRAS]

I feel like I'm spending half my SDN time these days correcting false ideas about FM income potential.

I don't know what kind of numbers you've heard, but 300k in FM isn't all that hard to manage. 400k is doable if you're willing to hustle at work. Plus it's pretty easy to get loan repayment in primary care.

Next thing you hear is that people who went to medical school to help people. . . . You know as opposed to take some sub speciality care that avoids every other aspect of patient care because it is too lowly to have someone in your office fill out patient forms Or have to deal with lowly compensated chronic medical conditions.

 

[Blazers_33]

One of the most important questions isn't answered in your post. A huge factor is the type and amount of debt you have. Are all your loans federal/Graduate PLUS type, or did you have to take out some private loans? And are you talking $400K or $600K? Government-backed loans are all subject to income restrictions and forgiveness. Private loans aren't. There are docs with $600K in loans who make minimum payments of 10% of after-tax-and-deductions income and whose loans continue to grow rather than being paid down. After 20 years you get to simply stop paying and the rest is written off. Working aggressively to pay down your loan isn't always the best choice.

Also, I know several FM docs who make more than $750K annually, but they went VERY rural and they are self-employed. They also work much less than 40 hours per week. Your income is determined by the things you do and the risks you are willing to take. "Average" salaries as reported by the big aggregators are only a starting point. And you have to keep in mind: those numbers only include the docs who chose to participate in the survey.

all federal. Will be between 350-400k ish I assume once residency is done, haven't calculated it out exactly and obv dont know the continuing situation with loan interest freezes and stuff

 

[Blazers_33]

Do psych and call it a day. Pick the lowest stress specialty possible. Do not do anesthesia.

def have thought a lot about psych, but have had serious psychiatric issues myself that make me hesitant to enter the field for fear of worsening my own illness

 

[Splenda88]

Sorry, but how? (Not being facetious, just a naive first year med student).

I work 7 days on/off (7a-6pm) ... base salary is in the 330s. I got paid ~$ 2250/day for any extra days I work above my 7 days on. If I work 20 days/month (220 hrs or 55 hrs/wk average), I should make ~470k/yr based on my calculation.

 

[Shunsui]

I work 7 days on/off (7a-6pm) ... base salary is in the 330s. I got paid ~$ 2250/day for any extra days I work above my the 7 days on. If I work 20 days/month (220 hrs or 55 hrs/wk average), I should make ~470k/yr based on my calculation.

What region of the country is this; rural or suburban or city?

Your setup sounds cush but I feel the 7on7off hospitalist lifestyle isn't for everyone compared to the business hours of outpt primary care which I would assume is significantly less compensation and is more so the route OP wants to take (i think)

 

[Splenda88]

What region of the country is this; rural or suburban or city?

Your setup sounds cush but I feel the 7on7off hospitalist lifestyle isn't for everyone compared to the business hours of outpt primary care which I would assume is significantly less compensation and is more so the route OP wants to take (i think)

Small city of 60k.... closest major international airport is 1:45mins away.

Lifestyle is 'in the eyes of the beholder.' The few people who have been doing it for > 10 years at my shop think the M-F 8-5pm lifestyle is terrible and prefer the 7days on/off so they can travel a lot, or take extended vacations whenever they want to.

I have done M-F 8-5pm (not as a physician) and I am finding myself liking the 7 days on/off more. Then again I am new to this.