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Hey guys - your opinion - which medical specialty has the most problem solving in it?
Hey guys - your opinion - which medical specialty has the most problem solving in it?
Also - Do you notice how the pay scale goes inversely proportional to this list (more or less). That is truly a sad state of affairs.
I wonder if we'll ever see a system where good internists are paid more for keeping their patients healthier? (adhering to recommended screenings, better controlling patients' blood pressures, getting A1c's and lipids to goal, etc.)
Yes, this is already happening. But the system is that you are paid normal amounts for keeping patients healthy, and deducted reimbursements for not having patients at goal.
So you are penalized for doing a bad job, not rewarded for doing a good one.
Here's what I think:
Nephrology
ID
Critical Care
Heme/Onc
Rheum
Cards
GI
I didn't include general IM...I think in many ways gen med can be the most challenging.
Also - Do you notice how the pay scale goes inversely proportional to this list (more or less). That is truly a sad state of affairs.
If you don't think cards has to do any problem solving, try being in the cath lab with a STEMI that is crashing and in cardiogenic shock and coding...
We seems to have some consensus of the most "problem solving" specialties within internal medicine. Let's cross-compare the specialties between surgery and medicine.
How much problem solving are there in more clinical surgeries such as ENT and Urology compared to specialties like Heme/Onc and Cardiology?
How about specialties like Dermatology, Radiology, Psychiatry, or Rad Onc compared to Internal Medicine?
I want to know because I am definitely someone who gravitates towards the problem solving ones, but I have not had the chance to assess all of these other subspecialties. Compare as many as you feel comfortable comparing in the above mentioned specialties...thanks!
We seem to be back to talking about internal medicine subspecialties. Any insight into the surgical and other specialties I mentioned above?
Wait...talking about IM subspecialties? In the IM forum? What's wrong with us?
Oh...right...it's you.
That statement achieved just about nothing. You must not be too bright. yada yada yada nonsense... etc
the CLINICAL cardiologist (whose priority is seeing complex cardiology patients not placing stents in 70% lesions) is at the top, as described nicely by goldengate98.
This is exactly true. It's very easy to stand on the outside and say things like: "Rheum is easy, you just put everybody on steroids" or "cards is easy, you just throw stents in everybody." But that's just because you are largely shielded from the high-level decision-making and thought processes that occur in every specialty. I just finished a case in the cath lab where we paused for awhile after shooting the coronaries to pull up the echo, the stress test and the previous RHC numbers, to try to sort out whether an intervention would be worthwhile for this particular patient. But all the referring physician will know is that either a stent was deployed or not.I think everyone though, thinks that their specialty of choice is one of the most complex just because they get to see the intricacies of the specialty.
This is exactly true. It's very easy to stand on the outside and say things like: "Rheum is easy, you just put everybody on steroids" or "cards is easy, you just throw stents in everybody." But that's just because you are largely shielded from the high-level decision-making and thought processes that occur in every specialty. I just finished a case in the cath lab where we paused for awhile after shooting the coronaries to pull up the echo, the stress test and the previous RHC numbers, to try to sort out whether an intervention would be worthwhile for this particular patient. But all the referring physician will know is that either a stent was deployed or not.
It was not. But that attitude basically makes my point.Let me guess...the stent was deployed.
It was not. But that attitude basically makes my point.
Believe me, I wish we still lived in an era where there was a substantial financial incentive to drop stents. I'd gladly wrestle with my conscience on a daily basis.How did you guys feel about that? Sounds like tough stuff. Did anyone need extra counseling?
And how much longer before you guys were blaming the dyspnea on the lungs?
Pulmonology/Critical Care is being way overrated on this thread. Just because the pts in the MICU are closer to death doesn't mean the problem solving is more complex. In fact, in some ways it is simpler and more algorithm driven.
Having everyone rank endocrinology so low is shocking the heck out of me.
This is exactly true. It's very easy to stand on the outside and say things like: "Rheum is easy, you just put everybody on steroids" or "cards is easy, you just throw stents in everybody." But that's just because you are largely shielded from the high-level decision-making and thought processes that occur in every specialty. I just finished a case in the cath lab where we paused for awhile after shooting the coronaries to pull up the echo, the stress test and the previous RHC numbers, to try to sort out whether an intervention would be worthwhile for this particular patient. But all the referring physician will know is that either a stent was deployed or not.
There was a notion that his dyspnea was an anginal equivalent. Whether or not he had other good reasons for dyspnea was therefore relevant.Rhc numbers affected your decision on stent placement? How?
Probably also why they rank rheum low. Lower $.
nephro is about even with critical care. for #1.
it's why I want to do both... a PD I met on the interview trail has both certifications. is it possible still? I think it is if you do nephro then do one year of CC.
Yes. Very possible. Two years nephro + 1 critical care afterwards
Very possible, but you'll have to find the right CCM program. Not all of them are down with the 1 year clinical fellows.
But, with work hour changes and CCM fellows often having to cover the ICU while their interns take their Q45min naps, many places will look to fill the gaps with more CCM fellows while not having to dilute the bronch pool.