Which specialty allows you to have a more balanced life?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
People like to have all kinds of polarizing opinions about Emergency Medicine.

If you aren't wired for shift work and care about your circadian rhythm then it's probably not a "lifestyle" specialty for you. If you have to be at your kids recitals and soccer games 5 days a week at 6pm it probably isn't for you.

However for some people it's a great lifestyle. Every resident I've talked to at my program which is all of them much prefers EM schedule to the schedule of their off-service rotations.

I am not a 9-5 person and would rather work a shift schedule than anything outpatient/office etc.

The medicine is great and the job pays well. Like most people we like to bitch and moan about certain aspects of our jobs. Thus the complaints about circadian rhythm sleep disorder. However there are ways around it for decreased pay..

EM is not a lifestyle specialty per se but you can find about any lifestyle that you want in EM if you are willing to look at many different geographic areas. Wanna work 200 hrs a month and make 500k/yr? you can do it. Wanna work 7 24hr shifts a month, sleep at ~5 hours/night while on shift and make 300k/yr? you can do it. Wanna do locums and only take day-time weekday jobs, you can do it. I know people who do each one of these options. The vast majority of docs end up in 140hr/mo jobs working 3-4 nights/month for $180-200/hr due to convenience and location. Still though that is not a bad lifestyle. For me EM is definitely a great lifestyle and I make it a point never to complain about the hours around my surgical colleagues because even though my sleep rhythm is completely gone I still have half the month off to do whatever I want.

Also easy to take week vacations w/o losing shifts you just work around it.. jmo EM is an awesome specialty for a certain type of lifestyle. I mean, come on, go to work, grab the chaotic ED by the horns and save some lives, dispo some people, chill RNs and paramedics (ED staff by far the best in the hospital) work flies by, leave with $2k in your pocket, repeat two more times then have 4 days off. What's not to love?
Members don't see this ad.
 
  • Like
Reactions: 2 users
and because as an EM resident you come to enjoy working in the ED as part of a team with your attendings (who I consider friends now) and staff who you get to know well. When you're sitting around cracking jokes with people you know all day it doesn't matter how many rectal bleeding patients you have to see, it can be a good shift.

The only reason I wrote the statement about people I know enjoying working in Emergency Medicine is to counter the multiple prior posts by non-EM residents stating that they did not enjoy their ED experience. Well guess what sherlock I didn't enjoy my trauma ICU month being q2 call for 2.5 weeks having to watch 10 people fail extubations because the seniors were too aggressive, rounding on the same people every godforsaken day at 0500 with no hope of placement, and getting reprimanded by the senior for sedating a cracked out methhead after he pulled his tube multiple times and i had to emergently reintubate twice between 2200 and 0300 while on call with no inhouse direct supervision.

actually I'm just messing around, enjoyed my TICU month and all my off service months. hours sucked but it was fun.
 
  • Like
Reactions: 1 user
KinasePro said:
Sorry, but I don't think we're going to see eye to eye here. I just have a hard time mustering sympathy for a lifestyle consisting of 36 hour work weeks and shift work. EM is the newest lifestyle specialty, and many EM residents/attendings IRL will admit that readily.
Click to expand...
The 36 hours has a huge circadian rhythm disturbance to go along with it, since your shift times vary. Do this for years, if not decades, and you can really burnout, I would think. If that's not an issue for your sleep cycle, then you're probably ok. I'm always jealous of people who can not allow that to affect them.

Also no faculty member at a medical school will usually come right out and say "my specialty sucks!" to a med student, usually.
 
Members don't see this ad :)
charmiedermie said:
The 36 hours has a huge circadian rhythm disturbance to go along with it, since your shift times vary. Do this for years, if not decades, and you can really burnout, I would think. If that's not an issue for your sleep cycle, then you're probably ok. I'm always jealous of people who can not allow that to affect them.

Also no faculty member at a medical school will usually come right out and say "my specialty sucks!" to a med student, usually.
Click to expand...

When you work as an attending you will work 3-4 nights back to back to minimize the circadium disturbance. yes those 3 days are crappy but you get 18 days to do whatever you want to do. This is while making 300K. Also you don't have to stay in EM when you get older just work urgent care.
 
  • Like
Reactions: 1 users
Brigade4Radiant said:
When you work as an attending you will work 3-4 nights back to back to minimize the circadium disturbance. yes those 3 days are crappy but you get 18 days to do whatever you want to do. This is while making 300K. Also you don't have to stay in EM when you get older just work urgent care.
Click to expand...
Yes, I know you can do urgent care after completing EM anytime. I'm curious how much the next 18 days after that 3-4 days, are more to fully recover from that circadian disturbance, than to do other restful things like hobbies. Also there have to be some physical consequences to all that, right?

http://www.sciencedaily.com/releases/2009/10/091026225744.htm
 
charmiedermie said:
Yes, I know you can do urgent care after completing EM anytime. I'm curious how much the next 18 days after that 3-4 days, are more to fully recover from that circadian disturbance, than to do other restful things like hobbies. Also there have to be some physical consequences to all that, right?

http://www.sciencedaily.com/releases/2009/10/091026225744.htm
Click to expand...

Yes shift work shortens out your life. But with the free time you have you can work out and use it to prepare healthy food to try and balance it. If the shifts are too much you can do urgent care easily and never work another night again making 70-100 bucks an hour seeing level 4 patients. you can make the same as a psychiatrist with a good payer base
 
The correct answer to this question is Neurosurgery.
 
  • Like
Reactions: 1 user
Slack3r said:
"Average american" includes a pretty wide range of professions.

How about professionals? All the engineers, accountants, office workers, teachers, etc. I know start between 7-8, with most of them starting between 7-730. Even dermatology residents often have required didactics in the am (630-7 start time).
Click to expand...

My parents are both chemical engineers and they have always started their workday 0830 am or 0900am. Even when my siblings were little, my parents did not ever wake up before 0730. They always told their employers that they could not come earlier because they had to drop kids off at daycare or school, which was true. Shower night before, set out clothes you will wear, make your lunch at night for the next day, and set up your break fast cereal bowl. Then you need 15 minutes to get ready. Another 15 minutes to get the kids ready. 30 minutes to get to work.

My husbands parents have the same story.
If you have ever driven during rush hour in any big city, you will see that the majority of people are driving to work around 0830. That's why the roads are packed. In med school, I remember family med clinic starting at 0900, and having to drive in rush hr, which sucks
 
  • Like
Reactions: 2 users
indynshrty said:
I really enjoy being a pediatric hospitalist - when I'm on service I definitely work hard, but when I'm not on service I'm working from home doing academic work. Roughly on service about 20 weeks a year. Also, there are other sites within our group that work 12-14 shifts a month, and those are 12 hour shifts. The rest of the time...up to you. :)
Click to expand...

Sounds like a pretty sweet gig
 
PL198 said:
once a month? do you live a block away? when you say close, you mean like 10 blocks close or something if you only have to get gas 12 times a year. not to mention I have no idea how you do anything besides work if you only have to fill up 12 times a year......
Click to expand...

Perks of living in a city (I don't know where SouthernSurgeon is, just speaking from experience). I only used half a tank of gas in February despite driving to work each day and also weekly groceries and a couple times out with friends. And I drive an SUV. I could have easily walked to the hospital, it's only about 15 blocks or so, but not in sub zero temps when I can park in a garage for free.
 
Ismet said:
Perks of living in a city (I don't know where SouthernSurgeon is, just speaking from experience). I only used half a tank of gas in February despite driving to work each day and also weekly groceries and a couple times out with friends. And I drive an SUV. I could have easily walked to the hospital, it's only about 15 blocks or so, but not in sub zero temps when I can park in a garage for free.
Click to expand...

keep in mind some posters hate living in the city and prefer the rural areas (I'll take the city life thank you).
 
Members don't see this ad :)
First, too much saltiness on these message boards.
Second, could someone talk about the subspecialties of oncology? How many are there? What do you get to do in each one? Do all oncologists have their hands in research in some capacity?
Much thanks to those who respond to this post!
:banana:​
 
JDC21GWU said:
First, too much saltiness on these message boards.
Second, could someone talk about the subspecialties of oncology? How many are there? What do you get to do in each one? Do all oncologists have their hands in research in some capacity?
Much thanks to those who respond to this post!
:banana:​
Click to expand...

You started by scolding/judging, then went on to hijack the thread with a string of four monumentally broad unrelated n00b questions, accented with a dancing fruit. Exceptional allo debut.
 
  • Like
Reactions: 9 users
jeffk805dent said:
then there has to be a reason why med school graduates are not flocking to these rural areas. Unless if doctors really are stupid.
Click to expand...

There are probably factors other than money at play. For instance, family.
 
jeffk805dent said:
then there has to be a reason why med school graduates are not flocking to these rural areas. Unless if doctors really are stupid.
Click to expand...

A lot of docs do flock to rural areas. You get much bigger salary plus often loan repayment for working in health shortage area. For some people however it's a challenge especially if their spouse needs a job and jobs happen to be scarce in the area (not all rural areas, but some).
 
It works out really well if the doc is making a whole bunch and their spouse is cool with being a house wife/house husband. Or the spouse can always get a job at the hospital
 
drkristy85 said:
rural pays 2-3X more
Click to expand...

Rural pays more, but usually not THAT much more. A rural job with an outrageously high salary is usually an indicator of serious problems with the position which makes it hard to retain physicians. In other words, buyer beware. Plus there's no way you are likely to ever going to get off guarantee (or if you do, you'll have a huge drop in salary since you can't see enough patients to maintain that income).
 
  • Like
Reactions: 1 users
Smurfette said:
Rural pays more, but usually not THAT much more. A rural job with an outrageously high salary is usually an indicator of serious problems with the position which makes it hard to retain physicians. In other words, buyer beware. Plus there's no way you are likely to ever going to get off guarantee (or if you do, you'll have a huge drop in salary since you can't see enough patients to maintain that income).
Click to expand...

That's just not true. In rural medicine, you have way too many patients. You often have to turn people down, because you don't have enough hrs in your day to see them all. There are a shortage of doctors and not much competition. People often will travel 2-3 hrs to see you. The hospital/clinic is super nice to you because they need to keep you around. Patients are grateful for your service.

Most rural position ads I run across are paid per patient seen, not salary. So you decide how high you want to go with income. besides, like I said, the loans get paid off by Uncle Sam.
 
Also you have to factor in a much lower cost of living when calculating
 
drkristy85 said:
That's just not true. In rural medicine, you have way too many patients. You often have to turn people down, because you don't have enough hrs in your day to see them all. There are a shortage of doctors and not much competition. People often will travel 2-3 hrs to see you. The hospital/clinic is super nice to you because they need to keep you around. Patients are grateful for your service.

Most rural position ads I run across are paid per patient seen, not salary. So you decide how high you want to go with income. besides, like I said, the loans get paid off by Uncle Sam.
Click to expand...
Are you talking rural primary care? Because if you are in any sort of specialty, you need volume to maintain your collections. "Rural" as in true rural does not have the population basis to support a a subspecialty surgeon or even an IM sub specialist. Not everyone in a 500-700 population town is going to need a nephrologist, allergist, or an ENT.

Eg. Washington County PA has a population of 200,000 people over 861 square miles. That's barely 240 people per square mile. The largest city has 13,000 people in it. Most are tiny towns with at most 1000 residents each.

Primary care has the volume for sure, but not anything specialized. They need to be in a larger city (Pittsburgh) to derive the referral base needed to see enough patients to pay the bills. That's the big unfortunate secret of specialization. Yes you can make more money than primary care, but you have to live in an area that has the referral base so you have the luxury of limiting your practice. Not every area can sustain that.
 
  • Like
Reactions: 1 users
drkristy85 said:
That's just not true. In rural medicine, you have way too many patients. You often have to turn people down, because you don't have enough hrs in your day to see them all. There are a shortage of doctors and not much competition. People often will travel 2-3 hrs to see you. The hospital/clinic is super nice to you because they need to keep you around. Patients are grateful for your service.

Most rural position ads I run across are paid per patient seen, not salary. So you decide how high you want to go with income. besides, like I said, the loans get paid off by Uncle Sam.
Click to expand...

Maybe in peds, which looks to be your field (and also one of the lower paying specialties, which makes a salary of "2-3x more" a bit less outrageous than some other fields). That can't be extrapolated to all fields. What can generally be extrapolated more or less across all fields is 1. the bigger/more desirable the city, the lower the pay and 2. academics pays less. Most employed physician salaries are at least somewhat RVU based, so it is paid per the level of work per patient (so you get more credit for more time spent with a patient or for procedures) and not simply by number of patients alone (which gives you no incentive to spend any time with a patient who traveled hours to see you in a rural setting).

I do not do primary care. I've also calculated the wRVUs (for lack of other ways to compare, given variability in payor mix and reimbursement) required to hit some rural salary guarantees I've gotten in the mail and can assure you, it would be difficult to achieve without running yourself into the ground, which can be a big red flag since your employer may expect you to "earn your keep". The more desperate a place is to get someone, the higher the salary goes. But these salary guarantee advertisements are generally still well below 3x the average salary in my field.

In your case, if most rural places are offering 2x salary to work there, but one place is offering 3x (i.e. clearly an outlier), odds are very good that there is something very undesirable going on with that last place other than simply being rural. Additionally, most places (including rural) don't need to send out mailers nationwide to recruit physicians---so places that have resorted to this are usually more undesirable positions that have been unable to be filled permanently.
 
  • Like
Reactions: 2 users
Momma smurf dropping bombs
 
  • Like
Reactions: 1 users
maxxor said:
Are you talking rural primary care? Because if you are in any sort of specialty, you need volume to maintain your collections. "Rural" as in true rural does not have the population basis to support a a subspecialty surgeon or even an IM sub specialist. Not everyone in a 500-700 population town is going to need a nephrologist, allergist, or an ENT.

Eg. Washington County PA has a population of 200,000 people over 861 square miles. That's barely 240 people per square mile. The largest city has 13,000 people in it. Most are tiny towns with at most 1000 residents each.

Primary care has the volume for sure, but not anything specialized. They need to be in a larger city (Pittsburgh) to derive the referral base needed to see enough patients to pay the bills. That's the big unfortunate secret of specialization. Yes you can make more money than primary care, but you have to live in an area that has the referral base so you have the luxury of limiting your practice. Not every area can sustain that.
Click to expand...

That's not how it works for rural subspecialist care. The rural subspecialist typically sees a patient population in a 2-3 HOUR driving radius which is a relatively large population. And yes, when you get into the midwest and plains states, there are wide swaths of land where you can drive 5 hrs without seeing a city.
 
drkristy85 said:
That's not how it works for rural subspecialist care. The rural subspecialist typically sees a patient population in a 2-3 HOUR driving radius which is a relatively large population. And yes, when you get into the midwest and plains states, there are wide swaths of land where you can drive 5 hrs without seeing a city.
Click to expand...

Rural primary care usually sees people in a 1 hour driving radius
 
Smurfette said:
Maybe in peds, which looks to be your field (and also one of the lower paying specialties, which makes a salary of "2-3x more" a bit less outrageous than some other fields). That can't be extrapolated to all fields. What can generally be extrapolated more or less across all fields is 1. the bigger/more desirable the city, the lower the pay and 2. academics pays less. Most employed physician salaries are at least somewhat RVU based, so it is paid per the level of work per patient (so you get more credit for more time spent with a patient or for procedures) and not simply by number of patients alone (which gives you no incentive to spend any time with a patient who traveled hours to see you in a rural setting).

I do not do primary care. I've also calculated the wRVUs (for lack of other ways to compare, given variability in payor mix and reimbursement) required to hit some rural salary guarantees I've gotten in the mail and can assure you, it would be difficult to achieve without running yourself into the ground, which can be a big red flag since your employer may expect you to "earn your keep". The more desperate a place is to get someone, the higher the salary goes. But these salary guarantee advertisements are generally still well below 3x the average salary in my field.

In your case, if most rural places are offering 2x salary to work there, but one place is offering 3x (i.e. clearly an outlier), odds are very good that there is something very undesirable going on with that last place other than simply being rural. Additionally, most places (including rural) don't need to send out mailers nationwide to recruit physicians---so places that have resorted to this are usually more undesirable positions that have been unable to be filled permanently.
Click to expand...

I did mean RVU's when I said per pt seen, sorry to not clarify. What do you mean by guaranteed salary and you calculating the RVU's? If there is salary guarantee, does that mean the place still goes by RVU's? I wasn't aware of that....
 
drkristy85 said:
That's not how it works for rural subspecialist care. The rural subspecialist typically sees a patient population in a 2-3 HOUR driving radius which is a relatively large population. And yes, when you get into the midwest and plains states, there are wide swaths of land where you can drive 5 hrs without seeing a city.
Click to expand...
Yes so outside of the Great Plains states, what rural area is greater than a 3 hour drive from a major city? I can't find any place east of Mississippi River that meets such criteria.

You're talking out of both sides of your mouth here: the reason rural patients would want to come to a rural specialist is that they are closer than going to the big city. If they are going to drive 2-3 hours to see you, why not go 2 hours to Pittsburgh (to use my Washington County example)?
 
maxxor said:
Yes so outside of the Great Plains states, what rural area is greater than a 3 hour drive from a major city? I can't find any place east of Mississippi River that meets such criteria.

You're talking out of both sides of your mouth here: the reason rural patients would want to come to a rural specialist is that they are closer than going to the big city. If they are going to drive 2-3 hours to see you, why not go 2 hours to Pittsburgh (to use my Washington County example)?
Click to expand...

In fairness, this isn't just in the Great Plains. Think rural New England. Places like New Sweden, Maine or some of the villages in the White Mountains of New Hampshire or northern Vermont are nowhere near big cities.
 
  • Like
Reactions: 1 user
ok so looking a map of Pennsylvania, it is packed pretty dense. Washington county is right next to Pittsburgh. But even to take densely packed NE region of the US, lets say the patient works for the DNR & lives on Route 6 north of Elk State forest, to use your state of Pennsylvania. They are really far from any big city.

There's even rural areas in Cali. I keep getting ads from these folks. Western cali by the border with Nevada you are far from any city (unless southern border, then you're by Vegas). Also Nevada has huge expanses of rural land. If we take eastern states east of Mississippi, look at tri-state intersection of Ohio, west Virginia and Kentucky as an example. Far from any city.
 
charmiedermie said:
Maybe in your bubble, but it depends on the specific job, depends on how close they live to that job, but many "taxpaying" adults don't have the 530/600 arrive to work time. Pretty sure schoolteachers aren't waking up that early on a frequent, consistent basis.
Click to expand...
Anyone with children is going to be waking up at 5:30/6. And as you get older you're going to start sleeping less and waking up earlier.
 
  • Like
Reactions: 1 user
drkristy85 said:
ok so looking a map of Pennsylvania, it is packed pretty dense. Washington county is right next to Pittsburgh. But even to take densely packed NE region of the US, lets say the patient works for the DNR & lives on Route 6 north of Elk State forest, to use your state of Pennsylvania. They are really far from any big city.

There's even rural areas in Cali. I keep getting ads from these folks. Western cali by the border with Nevada you are far from any city (unless southern border, then you're by Vegas). Also Nevada has huge expanses of rural land. If we take eastern states east of Mississippi, look at tri-state intersection of Ohio, west Virginia and Kentucky as an example. Far from any city.
Click to expand...

That route 6 location is less than 3 hours away from Geisenger Health System, a MASSIVE health center serving central PA. It's also not all that far away from large health systems in Pittsburgh, Philly, Buffalo, and Syracuse.
 
Bigger metro cities are definitely key for me. I'm not looking to have kids for a very long time, so that part isn't an issue. Location is #1, and I can't see myself in a small place, I need the lifestyle of a large metro area.
 
KnuxNole said:
Bigger metro cities are definitely key for me. I'm not looking to have kids for a very long time, so that part isn't an issue. Location is #1, and I can't see myself in a small place, I need the lifestyle of a large metro area.
Click to expand...
Wrong thread =)
 
drkristy85 said:
ok so looking a map of Pennsylvania, it is packed pretty dense. Washington county is right next to Pittsburgh. But even to take densely packed NE region of the US, lets say the patient works for the DNR & lives on Route 6 north of Elk State forest, to use your state of Pennsylvania. They are really far from any big city.

There's even rural areas in Cali. I keep getting ads from these folks. Western cali by the border with Nevada you are far from any city (unless southern border, then you're by Vegas). Also Nevada has huge expanses of rural land. If we take eastern states east of Mississippi, look at tri-state intersection of Ohio, west Virginia and Kentucky as an example. Far from any city.
Click to expand...


I went to med school in Athens, OH. Even there we had pretty much every basic specialty (endo, ortho, ent, ophto, rheum, etc) Huntington, Charleston, Parkersburg, Marietta, Morgantown, Chillicothe, and Portsmouth all had hospitals with basic specialties. There aren't a ton of them but they are around and sometimes patients had to go to Columbus for larger procedures or sub specialists. The specialists around there did seem to do quite well though, and patients would drive in for 1 to 1.5 hours to see you, but you're never really that far from a large town in those parts. Doubt you could pay me enough to go back there, although living in a major city would be even less preferable.
 
drkristy85 said:
I did mean RVU's when I said per pt seen, sorry to not clarify. What do you mean by guaranteed salary and you calculating the RVU's? If there is salary guarantee, does that mean the place still goes by RVU's? I wasn't aware of that....
Click to expand...

Salary guarantees are almost always temporary, not permanent, until you fully establish a practice. The hospital/health system gives it to a new physician for "support" since starting out, you're not busy enough volume-wise to earn a competitive salary. As in, after the initial contract period is up with these practices (anywhere from 1-3 years based on specialty), your salary usually changes to RVU-based so if you are not generating enough RVUs to maintain your salary, it drops, often abruptly, to be "equal" to your production level. It's a big reason for turnover with certain employers (there are health systems who are notorious for giving extremely high guarantees that physicians can't realistically achieve with RVUs) and also is a big surprise to the uninformed "first job" physician who finds this out the hard way. Finding out the RVU levels/production of comparable physicians (or those who have left) is extremely helpful before signing a contract, but you need to know to ask if they don't provide the data automatically.
 
  • Like
Reactions: 1 user
PL198 said:
except if you're dedicated enough to get into med school, your undergrad is probably going to free and any grad program you do in engineering will literally pay you. not to mention, any loans they have, wouldn't have 7 % interest and wouldn't have the interest capitalizing immediately. there's about 100 more factors that favor the engineer in this scenario. compound interest is powerful.
Click to expand...
What are you talking about? You're saying that any med student in the country is so steaksauce that they most likely had free undergrad and would have been so competitive for engineering programs that it would be completely compensated? With regards to loans, afaik federal student loans are the same rates across the board.

There are very few fringe scenarios in which engineering is a more profitable career than medicine.
 
Last edited:
Slack3r said:
Ok, your admittedly wealthy friends aside, most people in their 20s are not "living it up" anymore than anyone in med school.

All my non-med friends are working jobs they kinda hate making like $50k. Sure, they go to the bar on Thursday, but then again, so did me and all my med school friends during the preclinical years. We've been on trips, gone out, generally "lived it up" while still being in med school.

Stop acting like medical school is some all-consuming, soul-crushing endeavor. It's not, and suggesting otherwise makes you look like a whiny, out-of-touch child.
Click to expand...
In contrast to real-world employment, med school workload always seems that much bigger largely because you're in the bubble. I would say that the vast majority of med students spend the bulk of their day doing med school stuff, worrying about med school stuff, or feeling guilty about not doing med school stuff. Even if the actual workload doesn't require 16 hours every day, it's still very easy to let this idea of "med school dominates my life" take root.

Of course, the fact that virtually everyone you talk to is going through the same thing further adds to the bubble effect.
 
talking about graduate (medicine) vs undergrad(engineer) loans. most graduate work you do as an engineering student is going to be tuition-free along with a stipend.

these situations are much too complex to take a hard line stance on either one having a better ROI, I'm just saying there are alternative careers where a good ROI can be had, contrary to most people's opinions where medicine is like the only thing they could make money.

Making 60k a year @ 22 with no student loan debt can result in surprising wealth if it is adequately saved and 6-8 % compound interest works its magic, meanwhile the medical student is still accruing debt.
 
  • Like
Reactions: 1 user
You must log in or register to reply here.
Next unread thread

Similar threads

P
Which specialties have the most global health opportunities?
Replies
19
Views
2K
mvenus929
mvenus929
M
Switching to more competitive specialty
Replies
24
Views
3K
mistafab
mistafab
D
Which specialties "require" research years?
Replies
12
Views
3K
collegestud2013
C
K
Can I be a CT surgeon and still have a life?
Replies
17
Views
2K
LucidSplash
LucidSplash
P
Which specialties that are best for people who like to stand?
Replies
30
Views
2K
Sriddymopboi
S
Top