The Most Intellectually Challenging Specialty

[Leukocyte]

Any Ideas?

Thanks

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[Seaglass]

Nuclear Physics

 

[St. James]

IMO Neurosurgery -- aspects of other fields can come close, but neurosurg takes the cake when you factor in that you're often sleep deprived and messing with someone's brain.

 

[Leukocyte]

Nuclear Physics

Yes, Yes. Sorry, I meant ........in "Medicine/Surgery" in general.

 

[Leukocyte]

IMO Neurosurgery -- aspects of other fields can come close, but neurosurg takes the cake when you factor in that you're often sleep deprived and messing with someone's brain.

Is that Technically challenging or intellectually/Cognitively challenging?

Technical/Mechanical stuff aside, wouldn't Neurology be more challenging?

 

[doepug]

Gotta go with pathology or rads... both are very intellectually challenging fields.

 

[Leukocyte]

Why Pathology? Research Pathology? or Everyday clinical/anatomic pathology? Is everyday pathology practice really more intellectually challenging than other specialties?

Why Radiology? How intellectually challenging is it for a radiologist to recieve a "study" with an order that already has "R/0 _______" from the ordering clinician telling him/her what to look for (which I consider a technical, rather than cognitive, challenge)?

 

[BPKurtz]

Nephrology.

Damned if I'll ever *really* understand the kidney.

You could make an argument for Cardiology.
Someday Neurology will surpass both those.
Rad Onc is pretty crazy with all that physics too.
Take your pick, I go with nephro.

bpkurtz

 

[Lonestar]

beauty is in the eye of the beholder.

 

[Whisker Barrel Cortex]

Why Pathology? Research Pathology? or Everyday clinical/anatomic pathology? Is everyday pathology practice really more intellectually challenging than other specialties?

Why Radiology? How intellectually challenging is it for a radiologist to recieve a "study" with an order that already has "R/0 _______" from the ordering clinician telling him/her what to look for (which I consider a technical, rather than cognitive, challenge)?

Firstly, the percentage of time whatever the clinician wants to rule out is actually the diagnosis is pretty low. Oftentimes the clinician doesn't know exactly what he/she is looking for (r/o pathology/disease is on way too many requisitions).

Secondly, it is not in the routine abcess check CTs, head CTs for headaches, daily chest x-rays that provides the challenge. It is the more unusual cases that are intellectual. We are required to know the diagnoses of every specialty and the differentials for different findings from the brain to the muscle on plain film, nuclear studies, MRI, CT, and US. Not only differentials, but what makes which diagnosis in the list more or less likely to be the answer. There are so many benign findings that clinicians don't even know about that we have to know because they could be mistaken for true pathology. We are tested in physics, followed by a written exam, followed by an oral examination (full day, 9 sections, multiple cases per section).

The amount of reading and studying required to do well in radiology and pass the boards is tremendous. So yes, it is intellectual, just not on the majority of cases.

 

[Retinamark]

My vote (biased as it is) would be for neuro-ophthalmology. It's a fascinating watershed zone including bits of neurology, ophthalmology & neurosurgery. Read the "Clinical Challenges" section in Survey of Ophthalmology for fascinating case studies.

 

[MustafaMond]

Internal medicine. ( and any of its specialties)
Period.

Radiology a close second

 

[tofurious]

Chiropractic.

Oh wait, you said "intellectually challenging", not "intellectually challenged". I need to see a neuro-ophtho.

 

[Amy]

Chiropractic.

Oh wait, you said "intellectually challenging", not "intellectually challenged". I need to see a neuro-ophtho.

 

[Neuron]

Nephro and Neuro.

Hands down.

Neurosurg (especially skull base and vascular neurosurg) is probably the most technically challenging field, but no surgical field is especially intellectually demanding (compared to other medical fields).

 

[Neuron]

My vote (biased as it is) would be for neuro-ophthalmology. It's a fascinating watershed zone including bits of neurology, ophthalmology & neurosurgery.

That opinion appears to be shared by others. A Mass General neurosurgeon once told me he thought neuro-ophthos are the smartest neuro docs around. I can kind of see this, although I think the most challenging intellectual work in any of the neuro fields is often done by the least appreciated individual - the general neurologist confronted with an undifferentiated neurological nightmare.

 

[Leukocyte]

So far:

3 vote for Nephrology/IM

3 vote for Radiology

1 vote for Neurosurgery

1 vote for Neurology

1 vote for Neuro-Ophthalmology

1 vote for Pathology

Please do not be biased. If I was a Dermatologist, I would not deny that dermatology is, well, .....................

Thanks for posting.

 

[bobbyseal]

I'd pick Nephrology as one of the most intellectually demanding fields of medicine. Someone once told me, "The dumbest kidney is still smarter than a genius house officer."

After that, I really want to say a General Surgeon who finished residency circa 1967-70. I think these dinosaurs have a better understanding of human physiology than most other doctors out there. In addition, these General Surgeons are adept at not only surgery, but also, medical management of a patient. I love getting gray hair guidance from these old guys.

 

[DrQuinn]

Maternal-Fetal-Medicine.

Those are some smart mofos.

Q, DO

 

[tofurious]

Maternal-Fetal-Medicine.
Those are some smart mofos.

Smart or not, it is questionable whether they solve more problems than they create.

 

[Docxter]

1. Radiology and pathology because of the sheer volume of stuff and disease entities you need to know in almost every body system. Also each has it's own stuff like new molecular stuff in pathology and physics and ultrarapid technology changes in radiology that people need to be uptodate on.

2. Neurology, nephrology. Limited and focused in terms of body systems covered, but quite complex in their own right if you want to be good.

3. Despite what some people may think, staying uptodate and good in general fields such as general IM and FP can be quite challenging too if you're not one of those that refers to a specialist for every minimally complex case.


P.S. Quinn NSU, that thing about maternal-fetal medicine was a joke, right?

 

[basementbeastie]

rheum...messin' with the immune system and all....

 

[DoctorDoom]

Rural/Remote Medicine.

... but no surgical field is especially intellectually demanding (compared to other medical fields).

Not true, when you are talking about the old school general surgeon. The breadth and depth of knowledge, as well as technical skills required, can be staggering.

 

[Neuron]

Rural/Remote Medicine.

Not true, when you are talking about the old school general surgeon. The breadth and depth of knowledge, as well as technical skills required, can be staggering.

Incorrect.

We are obviously approaching this from different perspectives. Your vote goes to rural docs. I think rural docs have to do a very challenging job, because the breadth of basic information they need to know, and the skills they need to have, is considerable. However, I don?t think the purely intellectual/cognitive work that they do on the average day compares to that done by some of the other specialists mentioned above. This in no way implies that rural PCPs have it easy.

About surgeons, the question was not about technical skill, it was ?which specialty is the most intellectually challenging?? The practice of the surgical fields, compared to some of the specialties mentioned above, is simply not as intellectually demanding. This does not mean that there aren?t some extremely intelligent surgeons around ? of course there are.

 

[Neuron]

Great Avatar, by the way.

 

[DoctorDoom]

Incorrect.

We are obviously approaching this from different perspectives. Your vote goes to rural docs. I think rural docs have to do a very challenging job, because the breadth of basic information they need to know, and the skills they need to have, is considerable. However, I don?t think the purely intellectual/cognitive work that they do on the average day compares to that done by some of the other specialists mentioned above. This in no way implies that rural PCPs have it easy.

About surgeons, the question was not about technical skill, it was ?which specialty is the most intellectually challenging?? The practice of the surgical fields, compared to some of the specialties mentioned above, is simply not as intellectually demanding. This does not mean that there aren?t some extremely intelligent surgeons around ? of course there are.

LOL... "incorrect?" A bit arrogant of you. Sure you want to talk that way to the Lord of the RingWraiths?

I addressed intellectual demands and not just technical skill in my post also. The challenge of diagnosis and the vast fund of knowledge required in rural medicine without the benefits of modern equipment and the range of obscure knowledge required is why I gave it to them. All they have is their brainpower, talk about undifferentiated! That's also what I meant by "true general surgery" in the days of yore. I think they more than rival the daily intellectual demands of neurology and nephrology, or the other top finisher for me, endocrine.

I have no doubt that some of the more subspecialized Neuro fields are far more intellectually demanding in terms of academic research, but general practice... well that's another thing all together. Although the knowledge base can be overwhleming, clinical practice of Neurology is currently limited and generally "straightforward" like most specialties. No doubt though that the average GS guy isn't challenged intellectually like the average neurologist. As can be noted, the vast majority of the contenders in my list are medical fields as well.

Seems like we may be viewing things from the different angles of breadth of knowledge as opposed to depth of knowledge required in the mental gymnastics required in each field. Rather than declaiming from on high that you are "incorrect," mere living shadows corrupted to the will of The Dark Lord like myself will just say I disagree.

 

[Neuron]

LOL... "incorrect?" A bit arrogant of you. Sure you want to talk that way to the Lord of the RingWraiths?

Hehe. That was somewhat purposeful, actually. Inspired by your mercilessly cutting, brutal, vicious ?Not true?. Yeah yeah, petty, I know.

I addressed intellectual demands and not just technical skill in my post also. The challenge of diagnosis and the vast fund of knowledge required in rural medicine without the benefits of modern equipment and the range of obscure knowledge required is why I gave it to them. All they have is their brainpower, talk about undifferentiated! That's also what I meant by "true general surgery" in the days of yore. I think they more than rival the daily intellectual demands of neurology and nephrology, or the other top finisher for me, endocrine.

I have no doubt that some of the more subspecialized Neuro fields are far more intellectually demanding in terms of academic research, but general practice... well that's another thing all together. Although the knowledge base can be overwhleming, clinical practice of Neurology is currently limited and generally "straightforward" like most specialties. No doubt though that the average GS guy isn't challenged intellectually like the average neurologist. As can be noted, the vast majority of the contenders in my list are medical fields as well.

Seems like we may be viewing things from the different angles of breadth of knowledge as opposed to depth of knowledge required in the mental gymnastics required in each field. Rather than declaiming from on high that you are "incorrect," mere living shadows corrupted to the will of The Dark Lord like myself will just say I disagree.

I agree with most of what you say (it is really not much different than what I posted above - except this bit about general neurologists, with which I disagree). Any doc who really knows the clinical method (besides his regular ****) and practices without needing to order every image or test known to man has my highest respect, whatever his specialty and wherever he practices. I have simply not thought of rural docs this way because those I have worked with (n<3) seem to work with two options: ?reassurance? when things have not completely degenerated into a disaster, and ?urgent referral? once they have!

Threads like this are really not very ?useful?. Most people post in favour of their specialty. This is not intrinsically bad, but I think it just reflects the limited experience most of us have in other fields of medicine (most of us have just had med school + a variable amount of residency training in one specialty). Trying to keep an open mind, you can see though where Docster, for instance, is coming from. Radiologists often have quite a bit of ?cognitive activity? on their plate, perhaps more so these days when so many docs would rather put their cock in a coalbag rather than forego that precious 12th MRI to tell them what they need to do with a patient. Ditto pathologists. Personally I?ve always felt nephros are generally really smart.

 

[Leukocyte]

Threads like this are really not very ?useful?. Most people post in favour of their specialty.

True.

However, given that >1000 people viewed this thread (in 2 days), and asuming that the few people who took the time and energy to post (a measure of the level of interest in cognitive specialties) are future or current Neurologists, Radiologists, Nephrologists, and Pathologists, it can be argured that these fields are indeed the most intellectually demanding since these people are interested in the subject of intellectual specialties (since they posted).

After >1000 views in a General Residency forum, we did not hear from current/future General Surgeons (new, not old dudes), dermatologists, orthopedists, ENT, ect......

Maybe they are not interested in "Cognitive specialities", and this is why they are in/going into Surgery, Dermatology, ENT, Orthopedics...........?????

 

[cancer_doc]

Radiation Oncology

You have written boards in Biophysics, Radiobiology, AND Clinical. Then, if you pass, you have the oral boards to look forward to.

Because therapeutic radiation isn't something you can reverse or neutralize after you prescribe it, you have to validate everything you do- which means you have to know and detail every important clinical trial that ever existed.


However, I sure like to gauge which is the most intellectually AND physically demanding field in medicine (definitely not Rad Onc).

 

[DrQuinn]

1. Radiology and pathology because of the sheer volume of stuff and disease entities you need to know in almost every body system. Also each has it's own stuff like new molecular stuff in pathology and physics and ultrarapid technology changes in radiology that people need to be uptodate on.
3. Despite what some people may think, staying uptodate and good in general fields such as general IM and FP can be quite challenging too if you're not one of those that refers to a specialist for every minimally complex case.


P.S. Quinn NSU, that thing about maternal-fetal medicine was a joke, right?

I wasn't joking about MFM. I think the smartest attending I have ever met in my 5 years was an MFM attending at Univ of FL. And I wasn't the only student that thought that, either.

Sher volume/disease entities? And your comment about styaing up to date in general fields? That could also make Emergency Medicine intellectually challenging, although I wouldn't agree with that and most wouldn't either. We see ALL patients (transplant, cancer, pediatrics, obstetrics, nursing home, blah blah), order the initial labs, do a quick differential, and evaluate our own imaging (to a moderate extent).

I would never put EM as the most intellectually challenging, however.

I would agree with a cerebral like specialty that is hard to PHYSICALLY diagnose... like nephrology or rad onc or neuro-optho. I wouldn't consider pathology... IMHO if you know what all the different types of cells they are, you just need to recognize them. Most, if not all, is bread and butter... and if something is tough, they often send it out (I've had that happen quite a few times... very frustrating when you're waiting for an answer!).

Q, DO

 

[Lumberg]

Just wanted to weigh in...
Put me down for Neuro and Nephro as the most intellectually challenging.

 

[Docxter]

I wasn't joking about MFM. I think the smartest attending I have ever met in my 5 years was an MFM attending at Univ of FL. And I wasn't the only student that thought that, either.

Q, DO

OK. In other words, that specific MFM doc was the smartest doc you've ever seen. I thought we were talking about various intellectual fields in medicine, not specific supersmart people we've all met. Thanks for clarifying.

 

[DrQuinn]

OK. In other words, that specific MFM doc was the smartest doc you've ever seen. I thought we were talking about various intellectual fields in medicine, not specific supersmart people we've all met. Thanks for clarifying.

Actually most of the MFMs I know are pretty dang smart. I do thing they are one of the smarter fellowships but honestly they lose sight of the rest of, well, medicine. (Same can be said for any specialty, though).

Q, DO

 

[augmel]

I'm with Quinn. I watched a MFM doc manage a 500lb 40 year old with hx of hodgkins and radiation induced aortic stenosis. The lady went into premature labor and crumped every timer her uterus contracted and delivered all that blood back to her heart. The MFM folks had to manage a complex medical ICU patient and at the same time keep her fetus viable. Did it all themselves.

 

[PrinceLazar]

Internal medicine (without a doubt)

(only field where ALL of medicine is integrated). yes I KNOW family Practice ALSO integrates ALOT, but the drive is entirely directed towards funneling someone towards either referrals or prescriptions, while talking to their pimps, sorry HMO's on the phone every 5th second.

But I would also say that I personally consider all oncological subspecialties the MOST intellectually challenging of it ALL. Lotsa hardcore scientists there.

 

[DoctorDoom]

However, given that >1000 people viewed this thread (in 2 days), and asuming that the few people who took the time and energy to post (a measure of the level of interest in cognitive specialties) are future or current Neurologists, Radiologists, Nephrologists, and Pathologists, it can be argured that these fields are indeed the most intellectually demanding since these people are interested in the subject of intellectual specialties (since they posted).

After >1000 views in a General Residency forum, we did not hear from current/future General Surgeons (new, not old dudes), dermatologists, orthopedists, ENT, ect......

Maybe they are not interested in "Cognitive specialities", and this is why they are in/going into Surgery, Dermatology, ENT, Orthopedics...........?????

That is some pretty specious reasoning. Better pay close attention in biostatistics!

 

[fourthyear]

Okay, if nobody else will speak up for surgeons, I will.

I guess anyone not in surgery has no idea how much you have to think to be a good surgeon. We have to know the medical basis behind every disease we treat surgically in order to properly diagnose things, decide who would benifit from a surgery and weigh the risks and benefits in each patient based on other medical problems, as well as to talk intelligently to people who consult us and ask us to evaluate someone for surgery, and how to take care of any complications that may arise. It's not like a medicine doctor tells us what a patient has, we cut it out, then send them back to them on post-op day 1 to take care of them!

And who takes care of the most critically ill patients in the hospital? - general surgeons often do. We are trained in residency to handle anything a medicine-trained critical care specialist can handle, and I bet people think those medicine critical care guys are smart.

Surgery residents I know spend much more time reading and studying than residents of many other specialties because we have to. Every time we go to the OR we are expected to know the disease process, how we diagnosed it, alternative treatments to surgery, multiple surgical approaches to treat the same thing and how to decide which to use, plus all the detailed anatomy that many other specialists don't need to know too well beyond their anatomy class in med school. That stuff doesn't just get learned on the job -you have to open books and spend time reviewing it.

Yes, surgeons generally spend a lot less time sitting around on rounds discussing all of the above knowlege than medicine docs do. So I guess people think they don't know it just because they don't spend all day talking about it like medicine docs do.

If you really somehow just can't beleive that general surgeons are intellectual, then how about some of the specialties:
- ENT - anyone think head and neck anatomy is easy?
- Cardiogthoracic surgeons - these guys stop the heart, cut it open and fix it, then start it beating again - sure, any dummy could do that!
- Neurosurgery - "it doesn't take a brain surgeon" is a common phrase that proves the average american thinks of a brain surgeon as smart as a "rocket scientist"

 

[DoctorDoom]

Okay, if nobody else will speak up for surgeons, I will.

Feh, I tried, no one would listen...

 

[flighterdoc]

Feh, I tried, no one would listen...

He said FOR surgeons, not TO surgeons.....

 

[Fermata]

The answer is obvious: dermatology.

Atleast....that's where the smartest students end up(Ironic, isn't it?).

 

[DoctorDoom]

He said FOR surgeons, not TO surgeons.....

Huh? you lost me there... Why would I speak up to myself?

 

[CSI Miami]

Any Ideas?

Thanks

Would have to be neurosurgery. Life & death decisions. Intimate knowledge of anatomy required.

 

[Harps]

Internal medicine. ( and any of its specialties)
Period.

From my limited reservoir of knowledge, doesn't IM have the highest case complexity index?

-Harps

 

[fourthyear]

Internal med tends to get a lot of consults to have others figure out the complex stuff for them. So unless they are really motivated to try to probe into doing complex workups on their own, it's not neccesarily the most complex thing out there.

 

[AlphaKi]

I would say Neurology is the most difficult intelectually to grasp followed by Neurosurgery.

But here's one no one thought about PSYCHIATRY.

Look, if that field were as easy as the other fields we'd be a heck of a lot further in understanding that area than we are in Oncology, Radiology, Anesthesiology etc. Those areas are tough but there's also simple to understand what goes right and wrong.

Yet, in Psychiatry, you have a delicate blend of environment, biology/neurochemistry and emotions all mixing together. It's a heck of a lot easier identifying that you have to direct certain particles at a tumor ( just plug it into a formula ) but mental illness is the least understood, less than cancer and internal medicine.

IMO, the EASIEST to understand is Pediatrics. Definitely not the easiest to necessary call knowledge of some obscure childhood 'thing' at 4 in the morning ( my mother actually called my poor doc once ) but...

 

[yaah]

Stop it all of you! All fields of medicine are intellectually challenging. There really are no degrees. Some require a heavier knowledge base, to be sure, but that doesn't necessarily mean it is "intellectually superior." Others require more technical skills, decisionmaking, studying, researching, thinking on your feet, considering many alternatives, etc.

"Intellectually challenging" depends on the individual physician. Some people will be in a specialty and not challenge themselves intellectually, falling into a routine, etc. This can happen in almost any specialty. Others will take whatever they have picked for their career and challenge themselves daily to improve their knowledge base or their way of practicing medicine. Even the "most lowly" general practitioner (I am being facetious) can find a career and practice that is vastly more intellectual and detailed than the most prestigious academic neurosurgeon. A lot of it depends on the individual. To be sure, some specialties to provide more of an opportunity to use your brain, but there are really no specialties (dermatology? ) that limit it.

Thus, I am going into path. I think path is the superior specialty and it challenges me. But that's all for me. Others might find it tedious and repetitive. I find radiology repetitive and tedious.

 

[makoo88]

It all ends with the pathologist.

Q.E.D.

 

[Trogghunter]

Pulm/ccm Think, ~40% of ILDz is still idiopathic, you're in the middle of the heart-lung-renal circuit: rt heart failure, pulm HTN, ards, hepatopulm-syndrome as pulm. As ccm you deal with the end result of every failing system in the body from surgical, neonatal, pediatric, CV/vasc platforms. You don't exactly use run of the mill meds, you manage vents, and your patients are almost always complicated with comorbidities. DKA is consistently the easiest/fastest ICU admission-discharge. Pulm/Ccm (especially in a closed unit) requires full on understanding of every system and requires procedural skills under the worst circumstances. In top of it all, you're the one answering to family/loves ones in their worst hour. Boom.

 

[Thama]

Radiology is first because of the physics and the sheer breadth of differentials. Neurology probably second.

 

[gutonc]

It all ends with the pathologist.

Q.E.D.

I hate you for necro-bumping this inane and previously dead thread.