What specialty is the best kept secret in medicine?

[r90t]

Remember that the landscape of radiology will be completely different 30 years from now. You don't know if radiology will pay well and not have "crap hours" in 3 decades.

This is why making decisions based upon transient factors is a recipe for failure. Find a specialty you are passionate about, $ and lifestyle can change at any moment. I would agree if you are equally enthusiastic about multiple specialties then chose the one with better peripheral factors but don't let those drive your choice.

When I was applying for school in the late 90s, radiology had approx a 1:1 ratio. A radiology friend of mine told me a story where a girl in his class was crying because she had to scramble into rads instead of IM. that was 15 years ago when Bill and Hiliary were going to push the PCMs to the forefront of your medical care. Fast foward to 2002 and the competition had increased and less students thought primary care was sexy.

What will it be like in the 2020s?? I have no idea, but I expect reimbursements to continue to drop in all areas, except maybe PC, 'cause they can't drop much lower.

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[Rollo]

Being self reliant, getting by independently, by not relying on a monopoly, I can see being pretty satisfying. Direct voluntary exchange at least ensures one's service is appreciated in direct proportion to his income.

Then I suppose we have two different definitions of what personal satisfaction with one's career means.

 

[Lagunatic]

Coming from a scientist in the cardiovascular device industry, I believe that interventional radiology is an awesome field to get into. The technology is constantly evolving with positive clinical data in bioresorbable scaffolds, RF ablation, and drug coated balloons. Also the patients who are treated, generally feel immediate relief and can resume living the life they knew before they had cardiovascular issues.

The demand for these specialists will only increase in the coming years since the leading of death over 65 is heart disease (National Center for Health Statistics). Unfortunately, with the changes in health care and high costs associated with these interventions, there will probably be changes on the horizon. Maybe the shift will be towards preventative care and economic diagnostic tools to treat the disease before a major adverse event happens. However, it's a great field and I would totally recommend it.

 

[Coldsoldier]

Interventional Cardiology. You get to play with toys and in America, heart problems are as common as day and night, so you'll always be in demand. The pay is one of the highest, but you have to put in a lot of hard work. It pays off if you love what you do though. Its an amazing field.

 

[badasshairday]

Interventional Cardiology. You get to play with toys and in America, heart problems are as common as day and night, so you'll always be in demand. The pay is one of the highest, but you have to put in a lot of hard work. It pays off if you love what you do though. Its an amazing field.

whoa whoa whoa. Cardiology is the least secret specialty out there. lol.

 

[ushush]

Pure lifestyle question. Keep in mind that I'll weigh other factors as I go along in my training. It may happen that I hate work in certain specialties and love others, which will be important for me. But so far, I know that IM allows you to work as a hospitalist or try to make it into less competitive specialties(endo) or more competitive (gi, cardio). After ER, you are most likely going to work in ER without spending any more time on fellowship training. So here is the question:
If the best IM program u could match was a place like Santa Barbara IM. And the best ER was in the middle of nowhere. What would you choose? Let's say in santa barbara you'd be playing beach volleyball all 3yrs and then you would work as a hospitalist. Would it make for a better lifestyle/salary if you instead spent 3yrs in ER in the middle of nowhere and then moved to santa barbara (or some other cool place) for work?
Keep in mind that specialist salaries may approach primary care salaries in the future(at least for some specialties).

 

[GroovyMed]

.

 

[ushush]

EM baby. You can't beat 36 hour work weeks and being well compensated for that time, dood. How could you compare that with some hospitalist gig

But I looked at some job ads and it is now possible to get hospitalist 7on/7off days-only on california coast and make $250k/yr. Sure an ER attending working 14shifts per month can make more (perhaps $400k/yr) but some of his shifts might be 7am-7pm and some 7pm-7am. If ER wants 7on/7off and days-only i think they take a significant pay cut (or work at a level-4 ER and make the same as hospitalists). Also I wonder how much it would suck to do a 3yr residency in some undesirable location/hospital(if I am unable to match ER residency of my choice)?

 

[D elegans]

Rheumatology

 

[Klokke]

http://www.abim.org/exam/certification/sleep-medicine.aspx

It's not a fact and you are wrong

http://www.abim.org/pdf/cert-related/Sleep-Medicine-Certification-FAQ.pdf

Once again, Sleep Medicine is NOT a self-standing specialty for which one can train right out of med school. It has recently been given ABSM status for certification as a fellowship subspecialty under 6 different actual specialties.

It's not a specialty.

 

[upright]

crna

 

[Klokke]

Facts? Awww. Better check back with the ACGME and the ABPN and ABIM etc. Sorry.

Thanks for playing...please deposit 0.25$ to play again.

It's an official specialty to any who are truly interested.

Once again, Sleep Medicine is NOT a self-standing specialty for which one can train right out of med school. It has recently been given ABSM status for certification as a fellowship subspecialty under 6 different actual specialties.

It's not a specialty. Look it up.

 

[Klokke]

.

 

[Klokke]

But I looked at some job ads and it is now possible to get hospitalist 7on/7off days-only on california coast and make $250k/yr. Sure an ER attending working 14shifts per month can make more (perhaps $400k/yr) but some of his shifts might be 7am-7pm and some 7pm-7am. If ER wants 7on/7off and days-only i think they take a significant pay cut (or work at a level-4 ER and make the same as hospitalists). Also I wonder how much it would suck to do a 3yr residency in some undesirable location/hospital(if I am unable to match ER residency of my choice)?

Great points.

 

[muhali3]

http://www.abms.org/who_we_help/physicians/specialties.aspx

Saying Sleep Medicine is not a specialty because you can't train in it right out of med school is like saying Cardiology is not a specialty because you can't train in it right out of med school.

Look beside Internal Medicine in the above link.

 

[muhali3]

crna

r u sideways reincarnated?

 

[danielmd06]

Once again, Sleep Medicine is NOT a self-standing specialty for which one can train right out of med school. It has recently been given ABSM status for certification as a fellowship subspecialty under 6 different actual specialties.

It's not a specialty. Look it up.

I think I see what you are trying to convey. My original take on your comment was that there was no professional recognition by the ABSM of sleep medicine as a recognized field of medicine - much like the UCNS fellowships available to graduating neurology residents. Formal sleep medicine fellowships are recognized by the ACGME. Have others not been mentioning fellowships as valid options or medical career "secrets" in this conversation?

The idea of the thread here as I understood it was to suggest areas of medicine that offer high compensation and excellent lifestyle and yet were often relatively unknown to applicants (whether out of medical school or out of residency). The semantic differentiation of a sub-specialty versus a specialty, and a residency versus a fellowship were not my concerns.

As you discovered yourself, sleep medicine is not recognized independently under the American Board of Medical Specialties (many, many, many "sub" specialties are not) but the examination process as of 2011 is and will be overseen by the ABMS through various disciplines including anesthesiology, neurology, psychiatry, internal medicine, otolaryngology, and family medicine.

In summary, you are quite correct that one cannot apply to a sleep medicine "residency" any more than you can apply to a cardiology "residency" directly out of medical school. However cardiology, rheumatology, gastroenterology ect are all "specialites" or "sub-specialties" of medicine that can be practiced full time after completion of a fellowhip training period - exactly like sleep medicine. Thus, in keeping with my understanding of what the purpose of this thread was about, I believe sleep medicine warrants inclusion in the discussion as a specialty whether you consider it semantically appropriate to do so or not.

 

[upright]

r u sideways reincarnated?

I don't understand your question.

 

[muhali3]

your avatar and username are quite like a member named sideways who was banned a while back.

 

[upright]

your avatar and username are quite like a member named sideways who was banned a while back.

Nah, must be a coincidence. Plus it's a TOS violation to be banned and come back. If I were banned, I wouldn't come back. I follow the rules. I'm a med student, not a hooligan.

 

[JackShephard MD]

I think I see what you are trying to convey. My original take on your comment was that there was no professional recognition by the ABSM of sleep medicine as a recognized field of medicine - much like the UCNS fellowships available to graduating neurology residents. Formal sleep medicine fellowships are recognized by the ACGME. Have others not been mentioning fellowships as valid options or medical career "secrets" in this conversation?

The idea of the thread here as I understood it was to suggest areas of medicine that offer high compensation and excellent lifestyle and yet were often relatively unknown to applicants (whether out of medical school or out of residency). The semantic differentiation of a sub-specialty versus a specialty, and a residency versus a fellowship were not my concerns.

As you discovered yourself, sleep medicine is not recognized independently under the American Board of Medical Specialties (many, many, many "sub" specialties are not) but the examination process as of 2011 is and will be overseen by the ABMS through various disciplines including anesthesiology, neurology, psychiatry, internal medicine, otolaryngology, and family medicine.

In summary, you are quite correct that one cannot apply to a sleep medicine "residency" any more than you can apply to a cardiology "residency" directly out of medical school. However cardiology, rheumatology, gastroenterology ect are all "specialites" or "sub-specialties" of medicine that can be practiced full time after completion of a fellowhip training period - exactly like sleep medicine. Thus, in keeping with my understanding of what the purpose of this thread was about, I believe sleep medicine warrants inclusion in the discussion as a specialty whether you consider it semantically appropriate to do so or not.

FYI, NRMP does track sleep medicine fellowship matching data as of 2012:
http://www.nrmp.org/fellow/index.html

Pediatric Surgery (1992)
Primary Care Sports Medicine (1994)
Radiology
Interventional Radiology (2002)
Neuroradiology (2001)
Sleep Medicine (2012) <New
Surgical Critical Care (2004)
Thoracic Surgery (1988)
Vascular Surgery (1988)

 

[D elegans]

Rheumatology

+1. Fascinating diseases, great patient interaction, good lifestyle, and few know about it upon entering med school

 

[OneTyme]

crna

Best post EVER.

 

[michaelrack]

Once again, Sleep Medicine is NOT a self-standing specialty for which one can train right out of med school. It has recently been given ABSM status for certification as a fellowship subspecialty under 6 different actual specialties.

It's not a specialty. Look it up.

Do you mean "ABMS"?? The ABSM is the American Board of Sleep Medicine- the old "rogue" sleep board that no longer certifies physicians- it now certifies sleep psychologists and technicians.

 

[Payback]

I do not know about you but back in my days, qualification depended mostly on humble perseverance and lot of hard works. People like you makes me sick!
Getting a passing grade on a subject is not good enough, you have to get an A, or know/re-correct your mistakes: because when you are in practice, you only get to try it ONCE!!
Yeah, that for not re-take that course that you flunked or barely passed because your professor is mediocre. I mean it have happened. I heard so many of people like you who went to jail or lost their licenses to practice because of the way you behave. Hahahaha.

 

[shaggy alfresco]

Well, I think the most 'objective' (as objective as you can be at least) would be satisfaction of physicians with their specialty, modified by how hard it is to get that specialty. So Dermatology may have high satisfaction but it's also hard to get and so it's not a secret.

So which specialties are relatively easy to get but have high satisfaction rates?

http://www.semmelweis.org/ref/8c2.pdf

The top five in satisfaction (by ratio of very satisfied are): Geriatrics, Neonatal, Infectious DIseases, Dermatology, and Pediatrics. Dermatology is very competitive but the others aren't. Very interesting that four of the top five aren't competitive (I'm sure its changed in the last decade but I'd be surprised if it was completely different). I think it shows that what medical students view as being a 'great specialty' and the things that make them happy may not always match with what their future self in 20 years considers the things that makes them happy. Which makes sense. When I was in my 20s, my outlook was quite warped in favor of money. I'm glad I'm older when I started medical school and (I hope) have a more 'seasoned' outlook on what I think I'll be happy with.

I am not blaming kids in their 20s but it's very hard to know what you'll consider important in your 40s or 50s, or even 30s - I certainly didn't. People are going to go for 'sexy' specialties or those with greater monetary rewards and I've no problem with that. I'm a capitalist - it's great, do what you want and make your decisions on whatever criteria you personally feel to be most important but I would only caution that you don't make the choice a one variable exercise (or give too much weight to only one variable) because your criteria will certainly change as you age (and that variable may no longer be important to you, or be less important, or the specialty itself could change and that variable which happened to be true for that specialty when you picked it may not be true 20 years from now).

 

[sirenomelia]

+1. Fascinating diseases, great patient interaction, good lifestyle, and few know about it upon entering med school

Mostly Lupus patients and others with very complicated chronic, smoldering miserable problems that are very difficult to manage.

 

[jeh315]

Would FM be a best kept secret if one is willing to work a rural setting?

- Higher than peer salary
- student loan reimbursement
- Ability to moonlight in urgent care or ER for more $

 

[Doublecortin]

+1. Fascinating diseases, great patient interaction, good lifestyle, and few know about it upon entering med school

what sort of $$$ can a rheum make in private practice?

 

[Doublecortin]

Well, I think the most 'objective' (as objective as you can be at least) would be satisfaction of physicians with their specialty, modified by how hard it is to get that specialty. So Dermatology may have high satisfaction but it's also hard to get and so it's not a secret.

So which specialties are relatively easy to get but have high satisfaction rates?

http://www.semmelweis.org/ref/8c2.pdf

The top five in satisfaction (by ratio of very satisfied are): Geriatrics, Neonatal, Infectious DIseases, Dermatology, and Pediatrics. Dermatology is very competitive but the others aren't. Very interesting that four of the top five aren't competitive (I'm sure its changed in the last decade but I'd be surprised if it was completely different). I think it shows that what medical students view as being a 'great specialty' and the things that make them happy may not always match with what their future self in 20 years considers the things that makes them happy. Which makes sense. When I was in my 20s, my outlook was quite warped in favor of money. I'm glad I'm older when I started medical school and (I hope) have a more 'seasoned' outlook on what I think I'll be happy with.

I am not blaming kids in their 20s but it's very hard to know what you'll consider important in your 40s or 50s, or even 30s - I certainly didn't. People are going to go for 'sexy' specialties or those with greater monetary rewards and I've no problem with that. I'm a capitalist - it's great, do what you want and make your decisions on whatever criteria you personally feel to be most important but I would only caution that you don't make the choice a one variable exercise (or give too much weight to only one variable) because your criteria will certainly change as you age (and that variable may no longer be important to you, or be less important, or the specialty itself could change and that variable which happened to be true for that specialty when you picked it may not be true 20 years from now).

I don't think it's quite as hard as you think. For MOST people it will probably be: 1) ability to spend time with kids/family/hobbies = lifestyle, 2) the amount of $$$ you get compensated when you do work, .... 227) what you actually do in terms of specialty

 

[Lokhtar]

I don't think it's quite as hard as you think. For MOST people it will probably be: 1) ability to spend time with kids/family/hobbies = lifestyle, 2) the amount of $$$ you get compensated when you do work, .... 227) what you actually do in terms of specialty

I disagree. People quickly realize its not worth compensated well and "having time" if you don't like where you spend 70% of your waking life. As a non trad, I quickly realized that.

But hey, go for it. More spots for me in the "undesirable" specialities .

 

[D elegans]

what sort of $$$ can a rheum make in private practice?

It depends on the reference, but I've seen from the 200-300ish range, obviously with exceptions making more. It's not so much a specialty of the big bucks.

 

[GroovyMed]

.

 

[thomprya]

At the end of the day it's really about what makes you happy, to me the dream is 250-300k go to work at 8, come home at 5. 6wks paid vacation per year doing something I love sounds like a dream. Its really possible to pull 1mil in any medical specality if you are business savvy ( I know a fam doc that pulls that kind of money easy) but eh, I'd rather have the free time. I will let the surgeons and workaholics pull 500 to 1mil on 80+ hours a week. They can have the 3 cars 2 houses and 1 ex-wife, im happy with less stuff I actually get to use. No offense meant, just my opinion....

 

[Dral]

Rheumatology

I'd wager Allergy/Immuno...similar type of practice, don't have to deal with the fibromyalgia pts.

 

[rorod]

At the end of the day it's really about what makes you happy, to me the dream is 250-300k go to work at 8, come home at 5. 6wks paid vacation per year doing something I love sounds like a dream. Its really possible to pull 1mil in any medical specality if you are business savvy ( I know a fam doc that pulls that kind of money easy) but eh, I'd rather have the free time. I will let the surgeons and workaholics pull 500 to 1mil on 80+ hours a week. They can have the 3 cars 2 houses and 1 ex-wife, im happy with less stuff I actually get to use. No offense meant, just my opinion....

What specialties do you know of that have your dream characteristics?

 

[That Wisco Kid]

Quick question, perhaps a little off subject, but since PM&R has been mentioned as a possible best kept secret thought I’d throw it in.

Is there any difference between PM&R and Non-Surgical Orthopedics? There’s a doc at my local hospital that lists Non-Surgical Orthopedics as his specialty but all his residency/fellowship training is listed as PM&R related. Different specialties, or different names for the same specialty (essentially)?

 

[sirenomelia]

Adding another one, maternal fetal medicine. Great patient relationship, procedures, interesting science, and surgery. I'm not sure how good the pay is and at times the hours can be rough, but seems like most in the field are pretty happy with the gig.

high maintenance/demanding patients with high liability

 

[Antynamikal]

Quick question, perhaps a little off subject, but since PM&R has been mentioned as a possible best kept secret thought I’d throw it in.

Is there any difference between PM&R and Non-Surgical Orthopedics? There’s a doc at my local hospital that lists Non-Surgical Orthopedics as his specialty but all his residency/fellowship training is listed as PM&R related. Different specialties, or different names for the same specialty (essentially)?

I'm interested to know in this as well.

 

[Warderino92]

Best kept secret is cruise medicine... Where your entire career consists of cruising around the world, sipping pina coladas, hitting on hot babes, and mostly dealing with scrapes and upset stomachs.

And the occasional old person who died mid cruise.

 

[exsanguination]

Quick question, perhaps a little off subject, but since PM&R has been mentioned as a possible best kept secret thought I’d throw it in.

Is there any difference between PM&R and Non-Surgical Orthopedics? There’s a doc at my local hospital that lists Non-Surgical Orthopedics as his specialty but all his residency/fellowship training is listed as PM&R related. Different specialties, or different names for the same specialty (essentially)?

This doctor smells of somebody who did not match into orthopaedics, but still wanted to feel the weight of the title. However, I'd go to him for any kind of orthopaedic related problem first long before I'd consider going to an orthopaedic surgeon since I believe surgery should be last resort unless there is a clear indication to cut. The PM&R trained physician would likely have a much broader and deeper understanding of non-operative options and modalities. Surgeons do what surgeons do best - cut.

 

[VA Hopeful Dr]

This doctor smells of somebody who did not match into orthopaedics, but still wanted to feel the weight of the title. However, I'd go to him for any kind of orthopaedic related problem first long before I'd consider going to an orthopaedic surgeon since I believe surgery should be last resort unless there is a clear indication to cut. The PM&R trained physician would likely have a much broader and deeper understanding of non-operative options and modalities. Surgeons do what surgeons do best - cut.

Umm, that's not as true as you think it is. Ortho especially these days tries everything before surgery since surgery on joints is rarely a 100% patient satisfied endeavor.

 

[TooMuchResearch]

This doctor smells of somebody who did not match into orthopaedics, but still wanted to feel the weight of the title. However, I'd go to him for any kind of orthopaedic related problem first long before I'd consider going to an orthopaedic surgeon since I believe surgery should be last resort unless there is a clear indication to cut. The PM&R trained physician would likely have a much broader and deeper understanding of non-operative options and modalities. Surgeons do what surgeons do best - cut.

Depending on the clinic, sports medicine trained people might be listed as non-operative orthopedics. It makes more sense to some in the general public than sports medicine.

 

[ncide]

Best kept secret is cruise medicine... Where your entire career consists of cruising around the world, sipping pina coladas, hitting on hot babes, and mostly dealing with scrapes and upset stomachs.

Except since you are on call you are not allowed to drink. That's a lawsuit waiting to happen if a patient were to smell alcohol on your breath and charge you with malpractice if something was misdiagnosed or mismanaged.

 

[DocFarnsworth]

Best kept secret is cruise medicine... Where your entire career consists of cruising around the world, sipping pina coladas, hitting on hot babes, and mostly dealing with scrapes and upset stomachs.

Except when **** loads of passengers get norovirus and then you're the doc stuck taking care of all them


Sent from my iPhone using SDN mobile app

 

[Daimon Michiko Doctor X]

Medical Microbiology (Canada) amazing salary no work

 

[starstarie]

I'd say for procedural inclined people: anesthesiology and urology.

Uro is competitive, but mostly bc it's so small! Most ppl write it off bc of the genitalia, bad idea folks.

 

[Psai]

I'd say for procedural inclined people: anesthesiology and urology.

Uro is competitive, but mostly bc it's so small! Most ppl write it off bc of the genitalia, bad idea folks.

Hey it's not that small okay?

 

[NWwildcat2013]

Outpatient neurology? The residency can suck and you often need to do a fellowship resulting in 5 years of training but afterwards its low stress. You might have very ill patients (e.g. MG, ALS, HD, PD) but they won't be acutely dying on you. The pathology is interesting. Compensation is decent (mid 200s). You will always be in demand. In fact, I read somewhere that neurologist have some of the highest wait times for appointments. More treatments are available and the "diagnose and adios" stereotype is no longer as true.

 

[muhali3]

Outpatient neurology? The residency can suck and you often need to do a fellowship resulting in 5 years of training but afterwards its low stress. You might have very ill patients (e.g. MG, ALS, HD, PD) but they won't be acutely dying on you. The pathology is interesting. Compensation is decent (mid 200s). You will always be in demand. In fact, I read somewhere that neurologist have some of the highest wait times for appointments. More treatments are available and the "diagnose and adios" stereotype is no longer as true.

Agree with most of your post although I'm not sure where you're getting that they need to do a fellowship from. The only fields I know where doing fellowship is expected is radio and path.