Very uneasy about specialty choice

[labrat21]

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[TypeADissection]

No right answer but you should do rads. Think about all of the pages from nurses that you are not going to get when in rads. No one is calling you about blood pressure, high/low sugars, low O2 sats, etc. My personal favorite, "Hi, yeah, um, the family is here and demanding to talk to the doctor right now." This will of course happen while you're in the ED seeing your 7th CHF exacerbation of the day or 11th chest pain rule out. You may or may not have pooped by this point in the day/night. But make no mistake. Radiology is not easy. It is a mental sweat shop from the moment you sit down to when you leave. I love our radiologists and am always impressed with their ability to see things that just don't occur to many of us. In the end, you have to do what makes you happy because every specialty is hard and you have to love it or it's all futile. Good luck. Cheers.

 

[Lya]

Things I like about IM
-This is a big one: feeling like a real doctor. Everything on my med school personal statement applies to IM.
-I like interacting with nurses and feeling like part of a team

Things I dislike about IM:
-I enjoy seeing patients but not for 8-10 hours nonstop, as I am kind of introverted. Working in an outpatient office where I'm expected to see 20-25 patients per day sounds miserable.
-I hate rounding and get very nervous giving patient presentations.
-I'm not a great teacher. Sometimes I can have trouble articulating my own thoughts and I feel like this is not a great thing for explaining diseases to patients. Although I'm sure this is something that can improve with practice.
-The constant interruptions and being able to know about so many patients at one time is very draining and stressful to me. Even as a med student carrying 3-4 patients I find it overwhelming to be fielding multiple phone calls and conversations at once where you're expected to know everything about your patient. I'm not a multitasker. I like to do one thing with minimal interruptions and then move onto the next. Yes, you get interrupted in rads too but I don't find it as stressful for some reason.

Things I like about rads:
-Also diversity of pathology, the idea of having to know OB, Peds, Surg, and IM is awesome to me
-I enjoy learning about radiology, I find it easier to study radiology than internal medicine, and I'm interested in it. I like physics.
-I like the idea of being a "doctors doctor" or a consultant for doctors. I don't NEED patient interaction if there was significant interaction with colleagues. I just wish it was more than a 30 second phone call a few times per day.
-I think the future of medicine is in radiology. Radiologists are making more and more of the diagnoses and I'm excited to see what the technology will look like in the future
-The days are not as draining. I feel less fulfilled after a day of rads than a day of IM, but I also have way more energy. I can come home to my girlfriend excited to see her and talk about our days, exercise, etc. When I get home after a day in IM all I want to do is sit in front of netflix with some food. I'm nasty to my girlfriend and I generally hate how I act but I just have no social energy left after talking to people all day long.

Thing I dislike about rads:
-By going into rads I feel like I'm throwing away this idea I had of myself as a clinician. I feel like I would miss feeling like a "real doctor"
-I sometimes feel lonely sitting in the reading room all day watching the attendings read. I find myself hoping that the clinicians will come in and interrupt so that we can talk about a patient. This rarely happens in my hospital (outside of peds radio). A phone call just doesn't do it for me in terms of interaction with colleagues
-Job market isn't great although it has been improving. I live in a major coastal metropolis and would really like to stay here as my family and girlfriend are here.

Just by reading your post, I get the feeling that after your prelim year, you will probably tell yourself, "I've had enough of 'being a real doctor' and I'm so happy to start my radiology residency soon."

I think that it just comes down to:
1) Great job market and feeling fulfilled, but stressful, draining, and miserable during the day and come home and watch netflix with some food -> IM
2) Not great, but improving job market, and feeling less fulfilled but have way more energy and come home and talk about your days and exercise -> rad

You might not be able to end up at major cities as a radiologist, but even if you live in a city as a hospitalist, I don't think it will matter to you much since you will feel draining and stressful and come home and just watch netflix with some food.

If I were you, I would do rads.

 

[anbuitachi]

Clearly Rads.
IM is not for you.
Only med students care about being a 'real doctor'. We are all real doctors, just with different roles.

 

[labrat21]

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[bashwell]

Getting near application season and I have narrowed my specialty choices to IM or radiology. I recently decided to focus my energies on radiology because I felt like I needed to make a decision already, but I am having serious feelings of unease as the summer progresses. I find that I have this constant feeling that I am making a mistake, but then when I open up the forums, do some research, etc., I end up reassured that radiology is the right specialty for me. The feeling of contentment only lasts a few hours or days before it comes back though.

Things I like about IM
-3 year residency, I could see myself stopping at that point to work as a hospitalist. I could also see myself in a subspecialty but I don't have anything specifically in mind
-Great job market
-Ability to tailor my career how I want. Who knows what I will want to do in 10 years, I'll be a completely different person by then. I feel like IM gives me so much flexibility.
-Diversity of pathology
-This is a big one: feeling like a real doctor. Everything on my med school personal statement applies to IM.
-I like interacting with nurses and feeling like part of a team

Things I dislike about IM:
-I enjoy seeing patients but not for 8-10 hours nonstop, as I am kind of introverted. Working in an outpatient office where I'm expected to see 20-25 patients per day sounds miserable.
-I hate rounding and get very nervous giving patient presentations.
-I'm not a great teacher. Sometimes I can have trouble articulating my own thoughts and I feel like this is not a great thing for explaining diseases to patients. Although I'm sure this is something that can improve with practice.
-The constant interruptions and being able to know about so many patients at one time is very draining and stressful to me. Even as a med student carrying 3-4 patients I find it overwhelming to be fielding multiple phone calls and conversations at once where you're expected to know everything about your patient. I'm not a multitasker. I like to do one thing with minimal interruptions and then move onto the next. Yes, you get interrupted in rads too but I don't find it as stressful for some reason.

Things I like about rads:
-Also diversity of pathology, the idea of having to know OB, Peds, Surg, and IM is awesome to me
-I enjoy learning about radiology, I find it easier to study radiology than internal medicine, and I'm interested in it. I like physics.
-I like the idea of being a "doctors doctor" or a consultant for doctors. I don't NEED patient interaction if there was significant interaction with colleagues. I just wish it was more than a 30 second phone call a few times per day.
-I think the future of medicine is in radiology. Radiologists are making more and more of the diagnoses and I'm excited to see what the technology will look like in the future
-The days are not as draining. I feel less fulfilled after a day of rads than a day of IM, but I also have way more energy. I can come home to my girlfriend excited to see her and talk about our days, exercise, etc. When I get home after a day in IM all I want to do is sit in front of netflix with some food. I'm nasty to my girlfriend and I generally hate how I act but I just have no social energy left after talking to people all day long.

Thing I dislike about rads:
-By going into rads I feel like I'm throwing away this idea I had of myself as a clinician. I feel like I would miss feeling like a "real doctor"
-I sometimes feel lonely sitting in the reading room all day watching the attendings read. I find myself hoping that the clinicians will come in and interrupt so that we can talk about a patient. This rarely happens in my hospital (outside of peds radio). A phone call just doesn't do it for me in terms of interaction with colleagues
-Job market isn't great although it has been improving. I live in a major coastal metropolis and would really like to stay here as my family and girlfriend are here.

What should I do? My 4th year schedule is already filled up with radiology. Do I continue on this path? Finish my prelim year and reevaluate at that point?

Rads:

1) It's probably easier to go from rads to IM than to go from IM to rads (even if rads is less competitive now). Rads has to do an intern year so do a medical intern year. If you do it and find you don't like it, then you'll be happy you matched rads. If you find you like it, then you could ask to switch to IM. However, if you do IM, then it's probably going to be harder for you to switch into rads if you don't like your intern year.

2) Why can't you keep up your clinical skills as a radiologist if you really wanted to feel like a "real doctor"? If you really want to go and see a patient, to make a better clinical correlation, then I don't see why you couldn't go to the floor, take a history, examine the patient, etc.? The main reason I can see is you're pressed for time and have to get through a list, but during residency these should be less of an issue.

3) Don't worry about the job market for rads because it'll be 6 years (with fellowship) before you finish and the job market could change a lot. Besides, you could probably still find "something" in your "major coastal metropolis" if you sacrifice lifestyle and/or income.

4) What's nice about rads is that when you are done with your work, you are done, and you can go home. You don't have to carry a pager and worry about patients, following up with them, keep checking Epic, etc. You get a ridiculous amount of vacation per year too (I believe somewhere between 8-12 weeks per year). It's much harder to take a month off as a doctor with patients, dependent on referrals, and so on.

IM:

1) To be fair, a lot of your complaints about IM could improve as well if you do an IM residency. For example, you'll likely get better at expressing yourself and teaching as a resident as you continue to teach med students as an intern, interns as a resident, and so forth. You'll find carrying 3-4 patients a lot less overwhelming and can even do more with more practice. You ll find a lot of the multi-tasking isn't so bad. Intern year might be very difficult for you, but you could come out surprising yourself at what you can do vs what you think you can't do now. I know because I'm an introvert and most of what you say is exactly the same for me, but I'm not like this anymore.

2) Also, you might not like rounding in an academic university setting which can take hours. But as an attending in private practice, rounds can be as fast or as slow as you make them. You also don't have to teach at all as an attending in private practice if you don't want. You can see as few or little outpatients as you want as an attending in private practice if you find the right group. You could just focus on inpatients as a hospitalist. In other words, you don't have to do a lot of what you do in academic IM. In other words, I wouldn't judge IM by what you see in a university hospital, but rather judge it by what you see in private practice.

3) Yes, you could definitely change a lot in 10 years. A lot of the issues that you think you have now (e.g., introverted personality, unable to teach, rounding) could easily change with time. I'm not saying an introvert is suddenly going to become a completely outgoing and extroverted person, but you'll find very few introverts (and extroverts) are truly 100% introverted (or 100% extroverted), and that maturity and having certain experiences can definitely change you to be less introverted for example, more resilient in carrying multiple patients, etc. These are things that residency will do for you. Residency is meant to teach you how to do all these things well. You can't expect to be an attending overnight.

4) IM does give tons of great options. If you are a US allopathic student, every fellowship should be within reach too, including competitive ones like GI and cards. If you find you really want to do imaging, you could do cards and cardiac imaging. For example, I know a cardiac imager making >$600K after 3 years out as an attending in city over 1 million population out West, although he works about 60 hours per week. If you want to make less, you could work less. That's the beauty of patient-facing specialties in private practice -- once you have built and established your practice, you can see as many or as few patients as you want. You are the boss. You dictate how many patients to see or not see, when to see them, etc.

 

[sirenitaa]

I am having pretty much the same issue but with pediatrics vs radiology. A lot of the things you said resonate with me, especially the part about the idea of being a"real doctor." Here are some other things I am struggling with that may or may not be relevant to you:

- I want to be a mom one day and be able to spend time with my kids. I know pediatrics is supposed to be family-friendly, but I rarely hear pediatric attendings talk about their own children and have NEVER seen a pregnant pediatric resident. On the contrary, the radiology attendings I've worked with always talk about coaching their children's soccer teams, taking their kids camping, etc and a lot of the residents are either pregnant or already have kids. I LOVE children, but I don't want to feel like taking care of other people's kids takes away from my ability to take care of my own kids. And maybe having my own children will be more than enough to satisfy my need to be around kids.

- I feel selfish and guilty about considering choosing radiology instead of peds. I have this idea stuck in my head that taking care of sick kids is a noble, humble role. Which is stupid because I don't think of radiologists as selfish people at all; I think I just tend to idealize and heroicize (if that's a word) pediatricians.

- In radiology, your patients will never know your name and will never think of you as their doctor. This one bothers me a lot.

- If there is an emergency on a plane (or wherever), no one is gonna say "oh thank god, we have a radiologist here"

I was completely taken off-guard by how much I like radiology. I always knew I was visually oriented but I didn't realize that I (apparently, according to my attendings) have exceptional spatial perception. I didn't expect to find it so intellectually engaging, and have enjoyed this rotation more than other medical students who actually want to go into radiology. I actually only took this elective to have a "break" after completing a grueling but rewarding acting internship in peds last month. And now I'm extremely confused, and only have a couple weeks left to make a decision.

I think my scores and grades are okay (>240 step 1, 50/50 honors/high pass on clerkships), but at this point all of my letters are based on pediatrics, and 2/3 are written by pediatricians. I have one publication (second author) that happens to be about imaging techniques in a pediatric population, but no other meaningful research.

Any advice would be greatly appreciated!

 

[labrat21]

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[sunealoneal]

I am having pretty much the same issue but with pediatrics vs radiology. A lot of the things you said resonate with me, especially the part about the idea of being a"real doctor." Here are some other things I am struggling with that may or may not be relevant to you:

- I want to be a mom one day and be able to spend time with my kids. I know pediatrics is supposed to be family-friendly, but I rarely hear pediatric attendings talk about their own children and have NEVER seen a pregnant pediatric resident. On the contrary, the radiology attendings I've worked with always talk about coaching their children's soccer teams, taking their kids camping, etc and a lot of the residents are either pregnant or already have kids. I LOVE children, but I don't want to feel like taking care of other people's kids takes away from my ability to take care of my own kids. And maybe having my own children will be more than enough to satisfy my need to be around kids.

- I feel selfish and guilty about considering choosing radiology instead of peds. I have this idea stuck in my head that taking care of sick kids is a noble, humble role. Which is stupid because I don't think of radiologists as selfish people at all; I think I just tend to idealize and heroicize (if that's a word) pediatricians.

- In radiology, your patients will never know your name and will never think of you as their doctor. This one bothers me a lot.

- If there is an emergency on a plane (or wherever), no one is gonna say "oh thank god, we have a radiologist here"

I was completely taken off-guard by how much I like radiology. I always knew I was visually oriented but I didn't realize that I (apparently, according to my attendings) have exceptional spatial perception. I didn't expect to find it so intellectually engaging, and have enjoyed this rotation more than other medical students who actually want to go into radiology. I actually only took this elective to have a "break" after completing a grueling but rewarding acting internship in peds last month. And now I'm extremely confused, and only have a couple weeks left to make a decision.

I think my scores and grades are okay (>240 step 1, 50/50 honors/high pass on clerkships), but at this point all of my letters are based on pediatrics, and 2/3 are written by pediatricians. I have one publication (second author) that happens to be about imaging techniques in a pediatric population, but no other meaningful research.

Any advice would be greatly appreciated!

I personally think you'll get over that "real doctor" stuff pretty quickly. You obviously posted with radiology on your mind, but I'm not really reading anything that speaks to a huge desire for pediatrics other than the fact that you've been mentally on the pediatric track for some time.

You can get letters from your radiology rotation and research I assume, but from what I remember you really don't need a letter from radiology when applying, since it's hard for a med student to contribute as much to a team as one does on a Peds Sub-I, for example.

 

[bashwell]

I am having pretty much the same issue but with pediatrics vs radiology. A lot of the things you said resonate with me, especially the part about the idea of being a"real doctor." Here are some other things I am struggling with that may or may not be relevant to you:

- I want to be a mom one day and be able to spend time with my kids. I know pediatrics is supposed to be family-friendly, but I rarely hear pediatric attendings talk about their own children and have NEVER seen a pregnant pediatric resident. On the contrary, the radiology attendings I've worked with always talk about coaching their children's soccer teams, taking their kids camping, etc and a lot of the residents are either pregnant or already have kids. I LOVE children, but I don't want to feel like taking care of other people's kids takes away from my ability to take care of my own kids. And maybe having my own children will be more than enough to satisfy my need to be around kids.

- I feel selfish and guilty about considering choosing radiology instead of peds. I have this idea stuck in my head that taking care of sick kids is a noble, humble role. Which is stupid because I don't think of radiologists as selfish people at all; I think I just tend to idealize and heroicize (if that's a word) pediatricians.

- In radiology, your patients will never know your name and will never think of you as their doctor. This one bothers me a lot.

- If there is an emergency on a plane (or wherever), no one is gonna say "oh thank god, we have a radiologist here"

I was completely taken off-guard by how much I like radiology. I always knew I was visually oriented but I didn't realize that I (apparently, according to my attendings) have exceptional spatial perception. I didn't expect to find it so intellectually engaging, and have enjoyed this rotation more than other medical students who actually want to go into radiology. I actually only took this elective to have a "break" after completing a grueling but rewarding acting internship in peds last month. And now I'm extremely confused, and only have a couple weeks left to make a decision.

I think my scores and grades are okay (>240 step 1, 50/50 honors/high pass on clerkships), but at this point all of my letters are based on pediatrics, and 2/3 are written by pediatricians. I have one publication (second author) that happens to be about imaging techniques in a pediatric population, but no other meaningful research.

Any advice would be greatly appreciated!

Radiology, then pediatric fellowship? Radiology can have a great lifestyle so you can spend more time with your kids. You can even do teleradiology from home and still earn a great salary. Also, it's nice to have a clear separation between home and work.

As far as not feeling like a "real" doctor, no one says you can't keep up your clinical skills during residency. Sure, it's hard, but I've seen radiologists round on patients they're interested in or otherwise want to see for themselves for whatever reason(s). As far as the emergency, life-saving stuff, I think most of that is just BLS, knowing how to use a defibrillator, that's about all you can really do on most planes anyway. It's not like most doctors can do much without the more advanced equipment that you see in the ED or ICU, which obviously you wouldn't expect to see on a plane.

That said, I know pediatricians who work part-time. Apparently the culture of pediatrics is more open to part-time work. I also know a full-time pediatrician who lives in quite a nice part of Texas who makes $350k/year working a great schedule (e.g., 40 hours per week). According to him, this isn't uncommon at all. Pediatricians are in demand in most parts of the country, whereas radiologists might have a tougher time, but then again a lot could change by the time you finish a radiology residency. In pediatrics, you're your own boss, where you can decide when you start and when you leave work, if you need to take a longer lunch to run to do something, then you can, if a patient arrives late then you can reschedule them if you want, basically you're more in charge of your own schedule. PP radiology seems less flexible in having control over your own schedule, but I could be wrong about this.

And consider it's probably easier to switch from rads to peds than to switch from peds to rads if you change your mind during residency.

 

[masaraksh]

Ortho

 

[Mad Jack]

Getting near application season and I have narrowed my specialty choices to IM or radiology. I recently decided to focus my energies on radiology because I felt like I needed to make a decision already, but I am having serious feelings of unease as the summer progresses. I find that I have this constant feeling that I am making a mistake, but then when I open up the forums, do some research, etc., I end up reassured that radiology is the right specialty for me. The feeling of contentment only lasts a few hours or days before it comes back though.

Things I like about IM
-3 year residency, I could see myself stopping at that point to work as a hospitalist. I could also see myself in a subspecialty but I don't have anything specifically in mind
-Great job market
-Ability to tailor my career how I want. Who knows what I will want to do in 10 years, I'll be a completely different person by then. I feel like IM gives me so much flexibility.
-Diversity of pathology
-This is a big one: feeling like a real doctor. Everything on my med school personal statement applies to IM.
-I like interacting with nurses and feeling like part of a team

Things I dislike about IM:
-I enjoy seeing patients but not for 8-10 hours nonstop, as I am kind of introverted. Working in an outpatient office where I'm expected to see 20-25 patients per day sounds miserable.
-I hate rounding and get very nervous giving patient presentations.
-I'm not a great teacher. Sometimes I can have trouble articulating my own thoughts and I feel like this is not a great thing for explaining diseases to patients. Although I'm sure this is something that can improve with practice.
-The constant interruptions and being able to know about so many patients at one time is very draining and stressful to me. Even as a med student carrying 3-4 patients I find it overwhelming to be fielding multiple phone calls and conversations at once where you're expected to know everything about your patient. I'm not a multitasker. I like to do one thing with minimal interruptions and then move onto the next. Yes, you get interrupted in rads too but I don't find it as stressful for some reason.

Things I like about rads:
-Also diversity of pathology, the idea of having to know OB, Peds, Surg, and IM is awesome to me
-I enjoy learning about radiology, I find it easier to study radiology than internal medicine, and I'm interested in it. I like physics.
-I like the idea of being a "doctors doctor" or a consultant for doctors. I don't NEED patient interaction if there was significant interaction with colleagues. I just wish it was more than a 30 second phone call a few times per day.
-I think the future of medicine is in radiology. Radiologists are making more and more of the diagnoses and I'm excited to see what the technology will look like in the future
-The days are not as draining. I feel less fulfilled after a day of rads than a day of IM, but I also have way more energy. I can come home to my girlfriend excited to see her and talk about our days, exercise, etc. When I get home after a day in IM all I want to do is sit in front of netflix with some food. I'm nasty to my girlfriend and I generally hate how I act but I just have no social energy left after talking to people all day long.

Thing I dislike about rads:
-By going into rads I feel like I'm throwing away this idea I had of myself as a clinician. I feel like I would miss feeling like a "real doctor"
-I sometimes feel lonely sitting in the reading room all day watching the attendings read. I find myself hoping that the clinicians will come in and interrupt so that we can talk about a patient. This rarely happens in my hospital (outside of peds radio). A phone call just doesn't do it for me in terms of interaction with colleagues
-Job market isn't great although it has been improving. I live in a major coastal metropolis and would really like to stay here as my family and girlfriend are here.

What should I do? My 4th year schedule is already filled up with radiology. Do I continue on this path? Finish my prelim year and reevaluate at that point?

Radiologists also do procedures, so it's not like it's reads all day every day. That gets you some interaction with other people.

 

[Mad Jack]

Ortho

He didn't mention his big 3 total. Until I see that I'd hold off.

 

[cellsaver]

He didn't mention his big 3 total. Until I see that I'd hold off.

and then there is this:

- Great job market
-Ability to tailor my career how I want.​

I think all recent USA MD graduates (last 10 years?) should file a class action law suit against their medical schools, LCME and AAMC for failing to educate them about the current state of medical business practices. These new physicians are like sheep standing in line readying themselves for the sheering....butt naked.

The "great job market" is indeed great for Third Party Payers, licking their chops as they see freshly minted MDs signing contracts for reimbursement schedules, hospital admins "hiring" physicians and CEOs of medical groups laughing all the way to the bank. As for physicians "ability to tailor" their own career.....I just shake my head and think, "poor sheep".

While Goro goes on and on about Caribbean medical schools preying on desperate wannabe medical students, where is the outcry of medical schools failing to educate students about the real practice of medicine in America?

 

[Mad Jack]

and then there is this:

- Great job market
-Ability to tailor my career how I want.​

I think all recent USA MD graduates (last 10 years?) should file a class action law suit against their medical schools, LCME and AAMC for failing to educate them about the current state of medical business practices. These new physicians are like sheep standing in line readying themselves for the sheering....butt naked.

The "great job market" is indeed great for Third Party Payers, licking their chops as they see freshly minted MDs signing contracts for reimbursement schedules, hospital admins "hiring" physicians and CEOs of medical groups laughing all the way to the bank. As for physicians "ability to tailor" their own career.....I just shake my head and think, "poor sheep".

While Goro goes on and on about Caribbean medical schools preying on desperate wannabe medical students, where is the outcry of medical schools failing to educate students about the real practice of medicine in America?

Millennials want to be employees to be fleeced. It's sad, but we had a business lecture for the residents and medical students, and when he asked who had any interest in business I was one of only two people to raise my hand. Doctors don't view the business of medicine as a business, unfortunately, which leaves them open for exploitation.

 

[Mad Jack]

So true lol. It's taboo to even say the word money, how the hell do you expect them to express interest in business?

I wonder how many of them actually have an interest, but weren't willing to say so for fear of the judgment of their peers. Or how many physicians, residents, and medical students actually had an interest in business but basically conditioned themselves out of it through years of feigned altruism.

 

[DrfluffyMD]

I am having pretty much the same issue but with pediatrics vs radiology. A lot of the things you said resonate with me, especially the part about the idea of being a"real doctor." Here are some other things I am struggling with that may or may not be relevant to you:

- I want to be a mom one day and be able to spend time with my kids. I know pediatrics is supposed to be family-friendly, but I rarely hear pediatric attendings talk about their own children and have NEVER seen a pregnant pediatric resident. On the contrary, the radiology attendings I've worked with always talk about coaching their children's soccer teams, taking their kids camping, etc and a lot of the residents are either pregnant or already have kids. I LOVE children, but I don't want to feel like taking care of other people's kids takes away from my ability to take care of my own kids. And maybe having my own children will be more than enough to satisfy my need to be around kids.

- I feel selfish and guilty about considering choosing radiology instead of peds. I have this idea stuck in my head that taking care of sick kids is a noble, humble role. Which is stupid because I don't think of radiologists as selfish people at all; I think I just tend to idealize and heroicize (if that's a word) pediatricians.

- In radiology, your patients will never know your name and will never think of you as their doctor. This one bothers me a lot.

- If there is an emergency on a plane (or wherever), no one is gonna say "oh thank god, we have a radiologist here"

I was completely taken off-guard by how much I like radiology. I always knew I was visually oriented but I didn't realize that I (apparently, according to my attendings) have exceptional spatial perception. I didn't expect to find it so intellectually engaging, and have enjoyed this rotation more than other medical students who actually want to go into radiology. I actually only took this elective to have a "break" after completing a grueling but rewarding acting internship in peds last month. And now I'm extremely confused, and only have a couple weeks left to make a decision.

I think my scores and grades are okay (>240 step 1, 50/50 honors/high pass on clerkships), but at this point all of my letters are based on pediatrics, and 2/3 are written by pediatricians. I have one publication (second author) that happens to be about imaging techniques in a pediatric population, but no other meaningful research.

Any advice would be greatly appreciated!

Its rare but u can do peds prelim for rads. I looked into this

 

[appalachian_man]

I wonder how many of them actually have an interest, but weren't willing to say so for fear of the judgment of their peers. Or how many physicians, residents, and medical students actually had an interest in business but basically conditioned themselves out of it through years of feigned altruism.

Or they're like me, and have never liked business, finance, or administration. It's definitely possible to like making money and not like business.

To stay on topic: OP, have you considered IR? It sounds like it might be worth checking out for you.

 

[Mad Jack]

Or they're like me, and have never liked business, finance, or administration. It's definitely possible to like making money and not like business.

To stay on topic: OP, have you considered IR? It sounds like it might be worth checking out for you.

You can't earn real money without an interest in those things.

Agree about IR, but is OP competitive for it?

 

[appalachian_man]

You can't earn real money without an interest in those things.

Agree about IR, but is OP competitive for it?

The definition of "real money" is super relative, I guess. Anything 6 figures is real money to me, but I also come from a very rural area.

You would probably be better equipped to answer that than me, I'm just a lowly M1

 

[Mad Jack]

The definition of "real money" is super relative, I guess. Anything 6 figures is real money to me, but I also come from a very rural area.

You would probably be better equipped to answer that than me, I'm just a lowly M1

I grew up poor and rural as well, but I've become quite good with finance over my many years prior to medical school. The difference between owning your own practice and investing versus just being an employee that goes into the eployer retirement plan can be literally 200%+++, depending on how good you are at business and finance. If you want to do well for yourself, you could be an employee. If you want to build an empire that could support your family in perpetuity, well, that's something that requires some business knowledge or solid investments.

OP, have you considered integrated IR, or is it too procedural?

 

[Jabbed]

I don't think that millennials are any "less interested in business" than their predecessors. Nothing in our education has ever been geared towards training us to own and operate a business. I think the overall practice setting has just changed. Whereas the new grads of yesteryear would be swindled into 'partnership tracks' with ****ty contracts, the new grads of today are swindled into ****ty CMG contacts. Reimbursements have decreased across the board and the barrier to entry for hanging a shingle is higher than ever.

 

[hunterjumper14]

I am having pretty much the same issue but with pediatrics vs radiology. A lot of the things you said resonate with me, especially the part about the idea of being a"real doctor." Here are some other things I am struggling with that may or may not be relevant to you:

- I want to be a mom one day and be able to spend time with my kids. I know pediatrics is supposed to be family-friendly, but I rarely hear pediatric attendings talk about their own children and have NEVER seen a pregnant pediatric resident. On the contrary, the radiology attendings I've worked with always talk about coaching their children's soccer teams, taking their kids camping, etc and a lot of the residents are either pregnant or already have kids. I LOVE children, but I don't want to feel like taking care of other people's kids takes away from my ability to take care of my own kids. And maybe having my own children will be more than enough to satisfy my need to be around kids.

Not the case at my institution, it seemed like almost every peds resident was planning on having kids, was pregnant, or had kids already. They even count the resident's care of their child as a newborn rotation... They are second only to OBYGN in terms of number of residents pregnant at one time!

 

[cellsaver]

Doctors don't view the business of medicine as a business, unfortunately, which leaves them open for exploitation.

The floggings will continue until they view, nay, embrace medicine for what it is: business.
Dr Pearl is a role model in this regard.

New Physicians Will Need Business School Skills
Dr Robert M. Pearl, MD, MBA
July 6, 2017
NEJM

“Most medical schools in the United States have adapted their curricula to include team-based approaches. However, graduating students still lack the fundamental business and leadership training needed to effect the changes required and simultaneously maximize quality and reduce cost in clinical practice. Regardless of whether future physicians decide to work in a large health care system or solo practice, they will need fundamental knowledge and skills in three key business disciplines: leadership, teamwork, and data analytics.”​

 

[xClashx]

Just do anesthesiology.

 

[fetorius]

What is the climate these days for Rads interested in building their own practice and contracting with hospitals? I was under the impression that many PPs are being bought out by larger groups/hospitals. I can imagine it being difficult as a Radiologist to either start a new PP from scratch, particularly in an urban setting.

 

[JJArms22]

Holy crap, OP are you me? I feel EXACTLY the same way. I've been agonizing over this for the last several weeks. Sometimes I feel content with rads then I get this feeling of doubt that I could never sit down all day reading images. Then I think of all the BS I'd deal with on IM and I again feel better...but then I think of how I'm abandoning that vision I had for myself working with patients and being a part of their lives. Idk man, it's so hard. I know myself, and I know that IM might eventually burn me out. I think doing an IM prelim year will be best. We'll both know halfway through if going into rads was the right decision.

 

[DrfluffyMD]

What is the climate these days for Rads interested in building their own practice and contracting with hospitals? I was under the impression that many PPs are being bought out by larger groups/hospitals. I can imagine it being difficult as a Radiologist to either start a new PP from scratch, particularly in an urban setting.

Not really possible unless you have over 5 millions of capital to start, at which point investing those money into a new practice is a good way to lose them.

 

[Osteoth]

Not really possible unless you have over 5 millions of capital to start, at which point investing those money into a new practice is a good way to lose them.

How the hell do you need 5 million to open a rads practice? Don't you just need a couple of computers and some hospital to feed you referrals?

 

[bashwell]

How the hell do you need 5 million to open a rads practice? Don't you just need a couple of computers and some hospital to feed you referrals?

PACS isn't only just a couple of computers.

Also, you're going to need machines for CTs, MRIs, PETs, etc.

 

[IslandStyle808]

I wonder how many of them actually have an interest, but weren't willing to say so for fear of the judgment of their peers. Or how many physicians, residents, and medical students actually had an interest in business but basically conditioned themselves out of it through years of feigned altruism.

I doubt they were conditioned out, rather I believe they were weeded out from the get go by academic doctors. As soon as you start any sort of talk involving money with them they go on altruistic rant about how its wrong to deny patients who cannot pay. It can be a touchy topic, but the reality is if you don't have "enough "patients who can pay, you can't keep a sustainable practice.

 

[Mad Jack]

I doubt they were conditioned out, rather I believe they were weeded out from the get go by academic doctors. As soon as you start any sort of talk involving money with them they go on altruistic rant about how its wrong to deny patients who cannot pay. It can be a touchy topic, but the reality is if you don't have "enough "patients who can pay, you can't keep a sustainable practice.

I dunno, I've spoken with many a resident and fourth year that dropped the act after some careful questioning and admitted they'd just been lying to themselves on some level about why, exactly, they choose to enter medicine in the first place.

 

[IslandStyle808]

I dunno, I've spoken with many a resident and fourth year that dropped the act after some careful questioning and admitted they'd just been lying to themselves on some level about why, exactly, they choose to enter medicine in the first place.

I should probably be questioning the residents and when my class hits third to fourth year. The classmates that were in it for the money to a large degree were pretty upfront when I spoke with them. I can't seem to pry the super altruistic ones, they seem to be living in another dimension or something before medical school.

 

[rafa 22]

dude do rads.

 

[Hakuna Matata]

I am having pretty much the same issue but with pediatrics vs radiology. A lot of the things you said resonate with me, especially the part about the idea of being a"real doctor." Here are some other things I am struggling with that may or may not be relevant to you:

- I want to be a mom one day and be able to spend time with my kids. I know pediatrics is supposed to be family-friendly, but I rarely hear pediatric attendings talk about their own children and have NEVER seen a pregnant pediatric resident. On the contrary, the radiology attendings I've worked with always talk about coaching their children's soccer teams, taking their kids camping, etc and a lot of the residents are either pregnant or already have kids. I LOVE children, but I don't want to feel like taking care of other people's kids takes away from my ability to take care of my own kids. And maybe having my own children will be more than enough to satisfy my need to be around kids.

- I feel selfish and guilty about considering choosing radiology instead of peds. I have this idea stuck in my head that taking care of sick kids is a noble, humble role. Which is stupid because I don't think of radiologists as selfish people at all; I think I just tend to idealize and heroicize (if that's a word) pediatricians.

- In radiology, your patients will never know your name and will never think of you as their doctor. This one bothers me a lot.

- If there is an emergency on a plane (or wherever), no one is gonna say "oh thank god, we have a radiologist here"

I was completely taken off-guard by how much I like radiology. I always knew I was visually oriented but I didn't realize that I (apparently, according to my attendings) have exceptional spatial perception. I didn't expect to find it so intellectually engaging, and have enjoyed this rotation more than other medical students who actually want to go into radiology. I actually only took this elective to have a "break" after completing a grueling but rewarding acting internship in peds last month. And now I'm extremely confused, and only have a couple weeks left to make a decision.

I think my scores and grades are okay (>240 step 1, 50/50 honors/high pass on clerkships), but at this point all of my letters are based on pediatrics, and 2/3 are written by pediatricians. I have one publication (second author) that happens to be about imaging techniques in a pediatric population, but no other meaningful research.

Any advice would be greatly appreciated!

Just one comment- Peds is a very family friendly specialty. I know many people in peds residency that are pregnant or had babies. I would say Peds and FM are likely the two friendliest specialties to have babies during residency, IMO.


Sent from my iPhone using SDN mobile

 

[Anicetus]

Getting near application season and I have narrowed my specialty choices to IM or radiology. I recently decided to focus my energies on radiology because I felt like I needed to make a decision already, but I am having serious feelings of unease as the summer progresses. I find that I have this constant feeling that I am making a mistake, but then when I open up the forums, do some research, etc., I end up reassured that radiology is the right specialty for me. The feeling of contentment only lasts a few hours or days before it comes back though.

Things I like about IM
-3 year residency, I could see myself stopping at that point to work as a hospitalist. I could also see myself in a subspecialty but I don't have anything specifically in mind
-Great job market
-Ability to tailor my career how I want. Who knows what I will want to do in 10 years, I'll be a completely different person by then. I feel like IM gives me so much flexibility.
-Diversity of pathology
-This is a big one: feeling like a real doctor. Everything on my med school personal statement applies to IM.
-I like interacting with nurses and feeling like part of a team

Things I dislike about IM:
-I enjoy seeing patients but not for 8-10 hours nonstop, as I am kind of introverted. Working in an outpatient office where I'm expected to see 20-25 patients per day sounds miserable.
-I hate rounding and get very nervous giving patient presentations.
-I'm not a great teacher. Sometimes I can have trouble articulating my own thoughts and I feel like this is not a great thing for explaining diseases to patients. Although I'm sure this is something that can improve with practice.
-The constant interruptions and being able to know about so many patients at one time is very draining and stressful to me. Even as a med student carrying 3-4 patients I find it overwhelming to be fielding multiple phone calls and conversations at once where you're expected to know everything about your patient. I'm not a multitasker. I like to do one thing with minimal interruptions and then move onto the next. Yes, you get interrupted in rads too but I don't find it as stressful for some reason.

Things I like about rads:
-Also diversity of pathology, the idea of having to know OB, Peds, Surg, and IM is awesome to me
-I enjoy learning about radiology, I find it easier to study radiology than internal medicine, and I'm interested in it. I like physics.
-I like the idea of being a "doctors doctor" or a consultant for doctors. I don't NEED patient interaction if there was significant interaction with colleagues. I just wish it was more than a 30 second phone call a few times per day.
-I think the future of medicine is in radiology. Radiologists are making more and more of the diagnoses and I'm excited to see what the technology will look like in the future
-The days are not as draining. I feel less fulfilled after a day of rads than a day of IM, but I also have way more energy. I can come home to my girlfriend excited to see her and talk about our days, exercise, etc. When I get home after a day in IM all I want to do is sit in front of netflix with some food. I'm nasty to my girlfriend and I generally hate how I act but I just have no social energy left after talking to people all day long.

Thing I dislike about rads:
-By going into rads I feel like I'm throwing away this idea I had of myself as a clinician. I feel like I would miss feeling like a "real doctor"
-I sometimes feel lonely sitting in the reading room all day watching the attendings read. I find myself hoping that the clinicians will come in and interrupt so that we can talk about a patient. This rarely happens in my hospital (outside of peds radio). A phone call just doesn't do it for me in terms of interaction with colleagues
-Job market isn't great although it has been improving. I live in a major coastal metropolis and would really like to stay here as my family and girlfriend are here.

What should I do? My 4th year schedule is already filled up with radiology. Do I continue on this path? Finish my prelim year and reevaluate at that point?

I saw your comment on the coastal city thing for rads. It's very hard to find jobs in some of those very desirable cities if you don't go to an upper tier residency. This was major for me because I absolutely didn't think rads was worth it if I had to end up in like western NY, but if you have great stats etc this aspect won't be an issue for you.

 

[cellsaver]

I dunno, I've spoken with many a resident and fourth year that dropped the act after some careful questioning and admitted they'd just been lying to themselves on some level about why, exactly, they choose to enter medicine in the first place.

Back in the 1990s /2000s, when employees drove the market, employers were in the back seat of job negotiations. Since the economic crash of 2008, the employers have run the work place setting.

A recent Letter to the Editor in the American College of Physicians Internist publication (excerpt follows below my text) was authored by a PD of an IM Program in Kentucky. He couldn't have been more blunt as to the desperation PDs in IM programs feel in recruiting IM Resident with an interest in the outpatient IM setting. If this sentiment is accurate, then there are many more business opportunities available to IM Residents if they knew how to play their cards. Medical students and Residents need to jump on the business learning curve pronto. As we say in business, "negotiate your salary/benefits on your way going in".

In 2014 and 2015, program administrators surveyed residents about one to five years post-residency and found that many reported being underprepared to understand the business of medicine, quality metrics, and incentive-based care.
Source: Prepping IM residents for primary care, American College of Physicians, May 2017​

Specialization in medical education
A letter to the editor addresses the primary care shortage in medical education.

I am now the program director of the internal medicine residency program at Lake Cumberland Regional Hospital in rural Kentucky. I practiced as an “old school” general inpatient/outpatient internist for nearly 30 years before beginning my current position. One of the most challenging things about my current job is finding general internists to teach and proctor the 130 continuity clinic sessions required by the Accreditation Council for Graduate Medical Education (ACGME).​

All of us currently filling this role are aging rapidly, and trying to find anyone at all graduating from an internal medicine training program who is interested in the outpatient arena is difficult at best. I am sure these graduates exist, but they are certainly few and far between. The clear reality currently is that the combination of demand for hospitalists nationwide and the associated current pay scale for the same, along with the frequent time off while working this schedule, are colliding with professional school debt owed by most graduates to form the perfect storm against the practice of outpatient general internal medicine.

This is particularly true in rural areas, where more and more complex primary care is being delivered by nurse practitioners, many of whom are proctored by physicians in name only. If ACGME and ACP are serious about making the management of complex outpatient medical issues the continued purview of the internist, and not the family physician or physician extender, then they must recognize the reality of these market forces.​

 

[Mad Jack]

Back in the 1990s /2000s, when employees drove the market, employers were in the back seat of job negotiations. Since the economic crash of 2008, the employers have run the work place setting.

A recent Letter to the Editor in the American College of Physicians Internist publication (excerpt follows below my text) was authored by a PD of an IM Program in Kentucky. He couldn't have been more blunt as to the desperation PDs in IM programs feel in recruiting IM Resident with an interest in the outpatient IM setting. If this sentiment is accurate, then there are many more business opportunities available to IM Residents if they knew how to play their cards. Medical students and Residents need to jump on the business learning curve pronto. As we say in business, "negotiate your salary/benefits on your way going in".

In 2014 and 2015, program administrators surveyed residents about one to five years post-residency and found that many reported being underprepared to understand the business of medicine, quality metrics, and incentive-based care.
Source: Prepping IM residents for primary care, American College of Physicians, May 2017​

Specialization in medical education
A letter to the editor addresses the primary care shortage in medical education.

I am now the program director of the internal medicine residency program at Lake Cumberland Regional Hospital in rural Kentucky. I practiced as an “old school” general inpatient/outpatient internist for nearly 30 years before beginning my current position. One of the most challenging things about my current job is finding general internists to teach and proctor the 130 continuity clinic sessions required by the Accreditation Council for Graduate Medical Education (ACGME).​

All of us currently filling this role are aging rapidly, and trying to find anyone at all graduating from an internal medicine training program who is interested in the outpatient arena is difficult at best. I am sure these graduates exist, but they are certainly few and far between. The clear reality currently is that the combination of demand for hospitalists nationwide and the associated current pay scale for the same, along with the frequent time off while working this schedule, are colliding with professional school debt owed by most graduates to form the perfect storm against the practice of outpatient general internal medicine.

This is particularly true in rural areas, where more and more complex primary care is being delivered by nurse practitioners, many of whom are proctored by physicians in name only. If ACGME and ACP are serious about making the management of complex outpatient medical issues the continued purview of the internist, and not the family physician or physician extender, then they must recognize the reality of these market forces.​

I think it'll be a self-resolving issue as the hospitalist market saturates. Hospitalist postings have gone down for the first time in years at most recruiters due to inpatient saturation, which will ultimately drive hospitalist wages down and internists into the outpatient setting (where wages will likely also go down, unfortunately, due to heavy competition).

 

[mehc012]

I grew up poor and rural as well, but I've become quite good with finance over my many years prior to medical school. The difference between owning your own practice and investing versus just being an employee that goes into the eployer retirement plan can be literally 200%+++, depending on how good you are at business and finance. If you want to do well for yourself, you could be an employee. If you want to build an empire that could support your family in perpetuity, well, that's something that requires some business knowledge or solid investments.

OP, have you considered integrated IR, or is it too procedural?

I'm happy being an employee just so that I do not have to think about the business end of things. I simply don't care, don't want to learn about it, and don't want to have to think about it. If that means I make a few hundred k less than my max, I'm actually OK with that...there's a reason people can make business into an entire education and career all of its own, and that reason is that it's a lot of work. I'd rather spend my energies elsewhere; my kids will be better off without a trust fund anyway.

 

[cellsaver]

...which will ultimately drive hospitalist wages down and internists into the outpatient setting (where wages will likely also go down, unfortunately, due to heavy competition).

Not so. As I stated earlier, "negotiate your salary/benefits on your way in". In other words, if they are desperate at the Letter to the Editor articulated, they will not be in the driver's seat when it comes to salary negotiations. An IM Resident armed with a savvy employment attorney can write a sweet business contract where the IM Resident can effectively take over the Program. When you smell the scent of blood as a recent graduate from a Residency Program, that is your chance to strike for gold. Don't even hesitate. Your job description will get it out of you.

 

[cellsaver]

I'm happy being an employee just so that I do not have to think about the business end of things. I simply don't care, don't want to learn about it, and don't want to have to think about it. If that means I make a few hundred k less than my max, I'm actually OK with that...there's a reason people can make business into an entire education and career all of its own, and that reason is that it's a lot of work. I'd rather spend my energies elsewhere; my kids will be better off without a trust fund anyway.

You might be too young to remember the famous quote from the film Apocalypse Now by Lt Kilgore (Robert DeNiro): "I love the small of napalm in the morning".

That scene applies to the job market for IM Residents considering these IM Programs are desperate to have newly minted IM doctors in the outpatient setting.

Arming yourself with business knowledge will position you that much more strongly AND you stand a better chance of running the program on your terms. Thus you will be the physician you dreamt of being and dictating your work environment, mission statement and influencing patients and the practice of medicine as you see fit. This is more than possible and at a very young age. this is potentially better than Wall Street.

If you can do medical school, you can learn business and excel at both.

 

[vm26]

I saw your comment on the coastal city thing for rads. It's very hard to find jobs in some of those very desirable cities if you don't go to an upper tier residency. This was major for me because I absolutely didn't think rads was worth it if I had to end up in like western NY, but if you have great stats etc this aspect won't be an issue for you.

Upper tier residency and fellowship may be relevant for academics but not so much for private practice (we care mainly about efficiency, versatility, and your ability to work well with others). Things will certainly be more competitive in larger metro areas but larger issue is that you will likely get a suboptimal deal compared to practices in other locations (e.g. lower income, no partnership or longer partnership track, more malignant personalities etc)...

 

[mehc012]

You might be too young to remember the famous quote from the film Apocalypse Now by Lt Kilgore (Robert DeNiro): "I love the small of napalm in the morning".

That scene applies to the job market for IM Residents considering these IM Programs are desperate to have newly minted IM doctors in the outpatient setting.

Arming yourself with business knowledge will position you that much more strongly AND you stand a better chance of running the program on your terms. Thus you will be the physician you dreamt of being and dictating your work environment, mission statement and influencing patients and the practice of medicine as you see fit. This is more than possible and at a very young age. this is potentially better than Wall Street.

If you can do medical school, you can learn business and excel at both.

I know I can, and if the sh¡t hits the fan and I need to, I will. But I don't want to, and right now I don't have to, so I feel no need to.
I don't want to run the program. I don't want to dictate my work environment. That sounds like mind-numbing boredom, and SO not worth the extra dough to me. I'm more than happy being an employee, doing the job I actually like doing, and just b¡tching about any workplace policies I think are stupid over a beer with my friends later.

 

[Mad Jack]

Not so. As I stated earlier, "negotiate your salary/benefits on your way in". In other words, if they are desperate at the Letter to the Editor articulated, they will not be in the driver's seat when it comes to salary negotiations. An IM Resident armed with a savvy employment attorney can write a sweet business contract where the IM Resident can effectively take over the Program. When you smell the scent of blood as a recent graduate from a Residency Program, that is your chance to strike for gold. Don't even hesitate. Your job description will get it out of you.

They will be in control now, but I was putting toward ten years from now.

 

[Osteoth]

I think it'll be a self-resolving issue as the hospitalist market saturates. Hospitalist postings have gone down for the first time in years at most recruiters due to inpatient saturation, which will ultimately drive hospitalist wages down and internists into the outpatient setting (where wages will likely also go down, unfortunately, due to heavy competition).

What is the difference in compensation between outpatient & inpatient (hospitalist) internists?

You might be too young to remember the famous quote from the film Apocalypse Now by Lt Kilgore (Robert DeNiro): "I love the small of napalm in the morning".

That scene applies to the job market for IM Residents considering these IM Programs are desperate to have newly minted IM doctors in the outpatient setting.

Arming yourself with business knowledge will position you that much more strongly AND you stand a better chance of running the program on your terms. Thus you will be the physician you dreamt of being and dictating your work environment, mission statement and influencing patients and the practice of medicine as you see fit. This is more than possible and at a very young age. this is potentially better than Wall Street.

If you can do medical school, you can learn business and excel at both.

Hard to say. Being in business school rn one of the most interesting things for me is that when you read case reports about companies who succeeded/failed in various ventures, two organizations can do the exact same thing, follow the exact same protocol, but one will fail and the other succeed.

And when various entities go back and look at the situations surrounding either organization, they try to extrapolate reasons why various components of their organization or project succeeded, but largely everyone shakes their heads, reads the book the successful company's CEO will undoubtably write, and tries their damnest to forget the loser CEO who was was in the wrong place at the wrong time.

Business is often a quagmire, without a scientific process for discovery and regimentation/accumulation of knowledge. I think you can succeed in both, as I hope to when I graduate, but at the same time it is a very different from medicine/science in general, and I would not say that every physician/scientist can stomach the kinds of logical leaps and lack of codified rationale behind many common practices that "just work" in business.

 

[Mad Jack]

What is the difference in compensation between outpatient & inpatient (hospitalist) internists?



Hard to say. Being in business school rn one of the most interesting things for me is that when you read case reports about companies who succeeded/failed in various ventures, two organizations can do the exact same thing, follow the exact same protocol, but one will fail and the other succeed.

And when various entities go back and look at the situations surrounding either organization, they try to extrapolate reasons why various components of their organization or project succeeded, but largely everyone shakes their heads, reads the book the successful company's CEO will undoubtably write, and tries their damnest to forget the loser CEO who was was in the wrong place at the wrong time.

Business is often a quagmire, without a scientific process for discovery and regimentation/accumulation of knowledge. I think you can succeed in both, as I hope to when I graduate, but at the same time it is a very different from medicine/science in general, and I would not say that every physician/scientist can stomach the kinds of logical leaps and lack of codified rationale behind many common practices that "just work" in business.

30-80k, depending on the area.

 

[VA Hopeful Dr]

and then there is this:

- Great job market
-Ability to tailor my career how I want.​

I think all recent USA MD graduates (last 10 years?) should file a class action law suit against their medical schools, LCME and AAMC for failing to educate them about the current state of medical business practices. These new physicians are like sheep standing in line readying themselves for the sheering....butt naked.

The "great job market" is indeed great for Third Party Payers, licking their chops as they see freshly minted MDs signing contracts for reimbursement schedules, hospital admins "hiring" physicians and CEOs of medical groups laughing all the way to the bank. As for physicians "ability to tailor" their own career.....I just shake my head and think, "poor sheep".

While Goro goes on and on about Caribbean medical schools preying on desperate wannabe medical students, where is the outcry of medical schools failing to educate students about the real practice of medicine in America?

You're correct about all the people profiting off of our labor, but the job market for most MDs is still quite good even accounting for that. This is especially true for things like IM and FM.

 

[IslandStyle808]

Hard to say. Being in business school rn one of the most interesting things for me is that when you read case reports about companies who succeeded/failed in various ventures, two organizations can do the exact same thing, follow the exact same protocol, but one will fail and the other succeed.

And when various entities go back and look at the situations surrounding either organization, they try to extrapolate reasons why various components of their organization or project succeeded, but largely everyone shakes their heads, reads the book the successful company's CEO will undoubtably write, and tries their damnest to forget the loser CEO who was was in the wrong place at the wrong time.

Business is often a quagmire, without a scientific process for discovery and regimentation/accumulation of knowledge. I think you can succeed in both, as I hope to when I graduate, but at the same time it is a very different from medicine/science in general, and I would not say that every physician/scientist can stomach the kinds of logical leaps and lack of codified rationale behind many common practices that "just work" in business.

Reminded me of an example a woman I spoke to a year back said to me. She had a son who was wanted to set up a restaurant in the Philippines and when he did he failed. He later tried again a few years later and his approach did not change what so ever. He was then successful and I think he has then setup another restaurant later on. It goes to show that there are factors that we don't know about very well, like the factor of 'taste' we learn in business and economics. You can try to analyze the game and hedge your bets, but you can still fail even with the best business plan.

 

[PTPoeny]

I am having pretty much the same issue but with pediatrics vs radiology. A lot of the things you said resonate with me, especially the part about the idea of being a"real doctor." Here are some other things I am struggling with that may or may not be relevant to you:

- I want to be a mom one day and be able to spend time with my kids. I know pediatrics is supposed to be family-friendly, but I rarely hear pediatric attendings talk about their own children and have NEVER seen a pregnant pediatric resident. On the contrary, the radiology attendings I've worked with always talk about coaching their children's soccer teams, taking their kids camping, etc and a lot of the residents are either pregnant or already have kids. I LOVE children, but I don't want to feel like taking care of other people's kids takes away from my ability to take care of my own kids. And maybe having my own children will be more than enough to satisfy my need to be around kids.

- I feel selfish and guilty about considering choosing radiology instead of peds. I have this idea stuck in my head that taking care of sick kids is a noble, humble role. Which is stupid because I don't think of radiologists as selfish people at all; I think I just tend to idealize and heroicize (if that's a word) pediatricians.

- In radiology, your patients will never know your name and will never think of you as their doctor. This one bothers me a lot.

- If there is an emergency on a plane (or wherever), no one is gonna say "oh thank god, we have a radiologist here"

I was completely taken off-guard by how much I like radiology. I always knew I was visually oriented but I didn't realize that I (apparently, according to my attendings) have exceptional spatial perception. I didn't expect to find it so intellectually engaging, and have enjoyed this rotation more than other medical students who actually want to go into radiology. I actually only took this elective to have a "break" after completing a grueling but rewarding acting internship in peds last month. And now I'm extremely confused, and only have a couple weeks left to make a decision.

I think my scores and grades are okay (>240 step 1, 50/50 honors/high pass on clerkships), but at this point all of my letters are based on pediatrics, and 2/3 are written by pediatricians. I have one publication (second author) that happens to be about imaging techniques in a pediatric population, but no other meaningful research.

Any advice would be greatly appreciated!

You can do a peds prelim year before your radiology residency to really hedge your bets (or just not to hate your prelim year). If you do well during that year and want to change to do peds the program may be able to find you a spot. My program had several residents do this. This would be a way to delay your decision by a year and give you a chance to get more experience in both fields.

Peds is probably one of the more family friendly specialties out there. Every single residency interview I went on included a presentation of the program's maternity leave policy because so many peds residents have babies during residency. I think the only residents I have seen pregnant more often are OB residents. During residency I knew most of my attending's kids personally and faculty/resident kids (and dogs to be inclusive) were included at every single residency get together that was at someone's house.

Although, having said all that your only downsides to radiology are in regards to how other people see you. Can you do more radiology ASAP? A peds radiology rotation will look good on your application to both specialties!