In you opinion: What is the best Medical Specialty for Travel? Meaning, which specialty allows a physician to incorporate international travel into their career ?

In you opinion: What is the best Medical Specialty for Travel? Meaning, which specialty allows a physician to incorporate international travel into their career ?

This is a question I considered heavily before deciding what to do. The way I see it there are two different ways of thinking about it:

1) Do something that will give you a technical skill

I always hear about ENTs and opthalmologists doing trips to the developing world to fix cleft palates and treat river blindness. Getting trained in something at least in part surgical gives you the ability to transport that skill across borders and "do" something for a limited period of time. It's like going to the developing world and building a water filtration system or housing--there is a task that you do for a certain period of time and then you come back. You're happy, the kids whose cleft palates you fixed are happy, everyone's happy. I know several surgeons who have done mission trips to Mexico and just done vaginal hysterectomies for 2 weeks.

The down side, of course, is that modern day surgery is so technology dependent that it limits where you can go and to what extent you can exercise your skill. Surgeons need an operating theater, or at least sterile equipment and (usually) anesthesia. So you'd have to go with a group that was well established in whatever area you were going.

2) Do something that allows you flexibility in what you are doing

Primary care--i.e. peds, medicine, med/peds, or family. You can go and do something like set up a clinic or work for MSF, Medecins du monde, or ICRC and help take care of common stuff. From what I understand, you are often placed in places like refugee camps where supplies are scarce and your capacity to diagnose is dependent upon your physical exam and whatever laboratory resources are available to you. Treatment is also defined by the resources that are at your disposal. The issue, of course, is that primary care is much better suited to the treatment of chronic disease, health screening, and preventive medicine--certainly essential in international medicine.

One that I've heard a lot of interesting talk about is emergency medicine--as ER training becomes a more comprehensive curriculum, ER docs may be well suited to practice in an international setting. They can handle the acute stuff as well as more chronic illness. Probably better suited to work in places where acute issues trump pap smears--war zones, areas of conflict, refugee camps, etc.

You need to decide whether it's the "adrenaline" stuff you like or if you prefer a more long-term arrangement. You also need to think about whether you want to be involved in policymaking or with an NGO. As for me, I decided that internal medicine would provide the necessary fundamentals to diagnose and treat pretty much anything anywhere. We may not operate, but internists can handle the acute and the chronic pretty well. Personally, I won't feel terribly comfortable going to practice international medicine before I've become a highly competent doc at home--my feeling is that I should get really good at what I do first, and then go turn myself loose on the international health scene. But that's one man's opinion.

AMSA has a part of its website which lists international health residency programs--but it's a bit outdated. Even if programs don't offer an international health track, many offer international health experience. Penn, for example, staffs a teaching hospital in Botswana through which med students and residents from Penn may rotate. Pretty cool.

Ultimately, it's not hard to do in most any specialty--there is a lot of need in the world and numerous international and domestic organizations actively seek out physicians to come work with them.

Hope this helps!

DS

This is a question I considered heavily before deciding what to do. The way I see it there are two different ways of thinking about it:

1) Do something that will give you a technical skill

I always hear about ENTs and opthalmologists doing trips to the developing world to fix cleft palates and treat river blindness. Getting trained in something at least in part surgical gives you the ability to transport that skill across borders and "do" something for a limited period of time. It's like going to the developing world and building a water filtration system or housing--there is a task that you do for a certain period of time and then you come back. You're happy, the kids whose cleft palates you fixed are happy, everyone's happy. I know several surgeons who have done mission trips to Mexico and just done vaginal hysterectomies for 2 weeks.

The down side, of course, is that modern day surgery is so technology dependent that it limits where you can go and to what extent you can exercise your skill. Surgeons need an operating theater, or at least sterile equipment and (usually) anesthesia. So you'd have to go with a group that was well established in whatever area you were going.

2) Do something that allows you flexibility in what you are doing

Primary care--i.e. peds, medicine, med/peds, or family. You can go and do something like set up a clinic or work for MSF, Medecins du monde, or ICRC and help take care of common stuff. From what I understand, you are often placed in places like refugee camps where supplies are scarce and your capacity to diagnose is dependent upon your physical exam and whatever laboratory resources are available to you. Treatment is also defined by the resources that are at your disposal. The issue, of course, is that primary care is much better suited to the treatment of chronic disease, health screening, and preventive medicine--certainly essential in international medicine.

One that I've heard a lot of interesting talk about is emergency medicine--as ER training becomes a more comprehensive curriculum, ER docs may be well suited to practice in an international setting. They can handle the acute stuff as well as more chronic illness. Probably better suited to work in places where acute issues trump pap smears--war zones, areas of conflict, refugee camps, etc.

You need to decide whether it's the "adrenaline" stuff you like or if you prefer a more long-term arrangement. You also need to think about whether you want to be involved in policymaking or with an NGO. As for me, I decided that internal medicine would provide the necessary fundamentals to diagnose and treat pretty much anything anywhere. We may not operate, but internists can handle the acute and the chronic pretty well. Personally, I won't feel terribly comfortable going to practice international medicine before I've become a highly competent doc at home--my feeling is that I should get really good at what I do first, and then go turn myself loose on the international health scene. But that's one man's opinion.

AMSA has a part of its website which lists international health residency programs--but it's a bit outdated. Even if programs don't offer an international health track, many offer international health experience. Penn, for example, staffs a teaching hospital in Botswana through which med students and residents from Penn may rotate. Pretty cool.

Ultimately, it's not hard to do in most any specialty--there is a lot of need in the world and numerous international and domestic organizations actively seek out physicians to come work with them.

Hope this helps!

DS


Thank you. You're response was very thoughtful and informative. I'm more interested in the "adrenaline stuff" as you put it. Treating chronic problems has never appealed to me. I am thinking along the lines of EM or GS with a trauma fellowship. However Trauma surg is going through a rough time right now. More cases are non-operative, reimbursement on the decline etc...
I want a specialty that allows me to be the best physician I can and at the same time pursue outside interests (one of them being International Relief/Medicine). For example, I would have loved to have gone to Pakistan/India to contribute to the relief effort there. And would like to know which specialty would allow one to get up and go at a moments notice. I am rotating through the Kidney/liver Transplant service. And the hepatologits/nephrologists/surgeons here are chronically busy. I can’t see any of them just deciding to leave for 3 weeks to and help in say Pakistan or even New Orleans!

Perhaps EM is the best fit for my requirements. The shift work, being able to diagnose many pathologies, would be conducive to practicing medicine abroad. How is EM training becoming a more comprehensive curriculum?