Are there less competitive ROAD-lifestyle specialties for the average student?

[DMC]

I'm in the middle of my second year now, and I'm not sure exactly what field of medicine I want to pursue. I know it's still kind of early, but I would like to have some idea of what I want to do one day. The only thing that I know for sure is that I want to have a structured lifestyle, not work 80 hour weeks the rest of my life, and have solid pay. (I know - we all want this...)

I also know the best lifestyle/pay fields at the moment are the ROAD specialties. We know they are some of the most difficult to match into though and you have to be at/close to the top in your class.

Personally, I'm just average in my class. Since chances for the ROADs will be realistically hard for me to match into, I was wondering if there are any other fields out there that can still offer a desirable lifestyle/pay yet be more realistic for the average medical student.

Are there any that offer a good lifestyle/pay for less competitive students? If so, which ones?

---

Members don't see this ad.

 

[Rollo]

Family Medicine and Emergency Medicine come to mind

 

[DrBowtie]

Pm&r

 

[Colbert]

You can go into most of the medical sub-specialties (cards, endo, GI, etc) and work as much or as little as you want depending on how much you want to make.

 

[JaggerPlate]

To me, it seems like the dynamics of 'ROAD' are currently changing. Seems like most fields in medicine follow a similar pattern: shortage -> good money for docs in that field -> students catch on -> it become competitive -> becomes a ROAD-esque type conquest (ie: a solid 5 'what are my chances at X field' SDN threads a day) -> people start catching on - insurance companies, midlevels, etc, -> slowly decays and other fields that weren't popular are now primed to be at this level.

I think this is why people usually say to pick something you're interested in and not worry about where it's at for the moment. Just look at the ROAD fields right now and where they have the potential to move:

Rads - just took a 16% cut in reimbursement across the board ... ouch
Anes - look at the issues with the CRNAs - a lot of headaches, a lot of uncertainty, and (for whatever reason) the field itself seems to be decreasing in competitiveness.
Ophthal - very, very low starting salaries (like 150k from what I've seen on SDN) which get better when you make partner - but this seems to take a lot of time, and many practices seem to pick up, milk dry, and throw away new docs before ever making them a partner (revolving door)
Derm - probably the safest simply because of the very low number of residency spots, but the militant NPs have their sites set on derm and one of the big money makers for a lot of guys - MOHS, was ripped in half (reimbursement wise) a few years ago by medicare.

Long story short ... I'd personally pick something you're interested in where you'd have decent hours. 10 years from now, it could all change.

 

[Cheshyre]

I've heard Pathology, but I've never looked into it.

 

[JaggerPlate]

I've heard Pathology, but I've never looked into it.

Research the job market ... ouchey.

 

[Brachyury]

Psychiatry

 

[DMC]

To me, it seems like the dynamics of 'ROAD' are currently changing. Seems like most fields in medicine follow a similar pattern: shortage -> good money for docs in that field -> students catch on -> it become competitive -> becomes a ROAD-esque type conquest (ie: a solid 5 'what are my chances at X field' SDN threads a day) -> people start catching on - insurance companies, midlevels, etc, -> slowly decays and other fields that weren't popular are now primed to be at this level.

I think this is why people usually say to pick something you're interested in and not worry about where it's at for the moment. Just look at the ROAD fields right now and where they have the potential to move:

Rads - just took a 16% cut in reimbursement across the board ... ouch
Anes - look at the issues with the CRNAs - a lot of headaches, a lot of uncertainty, and (for whatever reason) the field itself seems to be decreasing in competitiveness.
Ophthal - very, very low starting salaries (like 150k from what I've seen on SDN) which get better when you make partner - but this seems to take a lot of time, and many practices seem to pick up, milk dry, and throw away new docs before ever making them a partner (revolving door)
Derm - probably the safest simply because of the very low number of residency spots, but the militant NPs have their sites set on derm and one of the big money makers for a lot of guys - MOHS, was ripped in half (reimbursement wise) a few years ago by medicare.

Long story short ... I'd personally pick something you're interested in where you'd have decent hours. 10 years from now, it could all change.

Very good points JaggerPlate. I've never looked at it like that.

For the sake of the thread though, right now we have have:

EM, Path, Psych, PM&R, FM

Any others or does that about wrap it up?

 

[Instatewaiter]

Psychiatry

Unfortunately that involves being a psychiatrist.

Very good points JaggerPlate. I've never looked at it like that.

For the sake of the thread though, right now we have have:

EM, Path, Psych, PM&R, FM

Any others or does that about wrap it up?

I second PM&R

Path has a crappy job market

FM is frustrating

psych takes a special kind of person. I am too much like that geico commercial (http://www.youtube.com/watch?v=APwfZYO1di4) to be a psychiatrist but god bless 'em

EM has a very high rate of burn out.

Other options: peds and IM have similar problems with BS you have to go through although you can be an IM hospitalist. Other specialties that have good lifestyle include Neurology, Endocrine (i think DM all day would be boring), rheum, allergy. Allergy is probably the most like derm of any medicine specialty.

Cards and Pulm critical care tend to be 2 areas where 9-5 just doesn't fit in unless you are a outpatient pulmonologist. GI can be hit or miss.

 

[DMC]

Unfortunately that involves being a psychiatrist.



I second PM&R

Path has a crappy job market

FM is frustrating

psych takes a special kind of person. I am too much like that geico commercial (http://www.youtube.com/watch?v=APwfZYO1di4) to be a psychiatrist but god bless 'em

EM has a very high rate of burn out.

Other options: peds and IM have similar problems with BS you have to go through although you can be an IM hospitalist. Other specialties that have good lifestyle include Neurology, Endocrine (i think DM all day would be boring), rheum, allergy. Allergy is probably the most like derm of any medicine specialty.

Cards and Pulm critical care tend to be 2 areas where 9-5 just doesn't fit in unless you are a outpatient pulmonologist. GI can be hit or miss.

Thanks much for the insight! I will add those to the list:

EM, Path, Psych, PM&R, FM, IM Hospitalist, Neuro, Sleep, Endo, Rheum, Allergy

 

[Rollo]

Thanks much for the insight! I will add those to the list:

EM, Path, Psych, PM&R, FM, IM Hospitalist, Neuro, Endo, Rheum, Allergy

You do realize you're ranking pretty much all of the specialties other than competitive and Ob-Gyn?

 

[TexasPhysician]

Thanks much for the insight! I will add those to the list:

EM, Path, Psych, PM&R, FM, IM Hospitalist, Neuro, Endo, Rheum, Allergy

EM and Psych are GOOD options.

Path and PM&R have a difficult job market comparatively
Hospitalist, Endo, Rheum, Allergy all involve rigorous IM training for less pay than psych/em.
Neuro ain't bad.
Future of FM isn't as good with Obama Care

 

[patel2]

here is a great post from tremulousNeedle about EM from a few months ago, and why I think the specialty will only get more and more competitive in the future as people catch on...

It is NOT rare as long as the group you join operates at a set of hospitals with a good payer mix. In the greater metropolitan area where I am training, greater than 80% of the non-academic EM attending physicians make ~$250K or greater (this includes the groups that practice at the inner city ED’s).

You also have to remember that all of this is for 32-38 hours per week. I know for a fact that some groups practicing a couple hundred miles away offer programs where their doctors can greatly increase their pay. For example, if the physician elects to participate, they can enter a several week cycle where they bump up their hours to 45-50 per week (still close to, if not better than most specialties). During this period their salaries nearly double. There are some younger attending physicians (new grads) that work this many hours for nearly the whole year and bring in between $400K and $500K. And I haven't even begun to discuss Locum Tenens, where EM docs can make over a half million dollars(again, obviously at the expense of some of the lifestyle perks).

And remember this is all after a 3 year residency. As suggested, Derm and Ophtho are great fields. For Radiology, most places require that you do some form of a fellowship, either accredited or non-accredited; this turns radiology into, at best, a 6 year endeavor, which can easily translate into a $600K loss (depending on the lifestyle you are accustomed to, that can easily be a huge chunk of your retirement fund, a really nice house, vacations for the rest of your life, 10 awesome cars, 4 really awesome cars, need I go on?).

Finding the sweet path is a balance, but for starters you really should enjoy what you're going to do for the rest of your life.


…and by the way, ROAD usually DOES break $300K.
Radiology: “The annual salary for radiologists ranges from $386,755 to $600,000”
Ophtho: “The annual salary for ophthalmologists ranges from $150,000 - 351,000 for full-time medical school faculty”
Anesthesia: “The annual salary for anesthesiologists ranges from $311,600 to $446,994”
Derm: “The annual salary for dermatologists ranges from $287,832 to $385,953”

EM: “The annual salary for emergency medicine physicians ranges from $216,000 to $300,000”

This is all 2008 (probably collected in 2007) data posted on the AAMC website. The numbers that I discussed regarding EM in an earlier post and at the beginning of this post are more recent and come from EM specific sources, which is why there is a difference. EM is projected to steadily increase in pay over the next several years.

 

[DMC]

EM and Psych are GOOD options.

Path and PM&R have a difficult job market comparatively
Hospitalist, Endo, Rheum, Allergy all involve rigorous IM training for less pay than psych/em.
Neuro ain't bad.
Future of FM isn't as good with Obama Care

I wasn't aware than PM&R has a difficult market. That was one of my main interests.

Allergy is REALLY starting to interest me now as I have been reading up on it and liked immuno when we took it...

 

[Isoprop]

allergy is highly competitive because there's like 2 fellowship spots open per year.

okay not 2, but a very very small number of fellowship spots.

 

[MossPoh]

EM and Psych are GOOD options.

Path and PM&R have a difficult job market comparatively
Hospitalist, Endo, Rheum, Allergy all involve rigorous IM training for less pay than psych/em.
Neuro ain't bad.
Future of FM isn't as good with Obama Care

Any data to back that up? It was one of the few parts they actively tried to get more money to.

 

[peppy]

I'm a psych resident. Yes, IF you have the right personality for psych and are comfortable with the idea of working with people who are often stigmatized in society (the homeless, drug addicts, people in jail - because many seriously mentally ill people end up in at least one of those categories) I think it's a great field!

Most psych residencies are very benign and the hours are quite reasonable compared to most other specialties. In practice, you have a lot of flexibility in terms of where you want to work and what kind of work you want to do. It's comparatively easy to set up a private practice as a psychiatrist since you have lower overhead than many other specialties. You also have a pretty diverse range of subspecialties if you're willing to do a fellowship (for example, forensic psych is very different than psychosomatic medicine; you can even go into palliative care, sleep medicine, or pain medicine from psych, though I hear pain and sleep are kind of uphill battles).

I think the main reason psych is not more competitive is simply because of the stigma on the patients and the perception that psychiatrists aren't "real" doctors. However, the best psychiatrists are the ones who make an effort to maintain their medical knowledge, because you do need to be able to recognize when someone's psychiatric symptoms are from a genuine mental illness or when it might be a medical condition presenting in an unusual way. For example, I've seen a patient whose "schizophrenia" was actually post-ictal psychosis from seizure disorder as well as a patient whose psychotic behavior was actually a side effect of liver toxicity from depakote.

Psych will never be like derm, since there will always some people who just don't like dealing with psych patients, but if you are comfortable with psych patients, the lifestyle is definitely a bonus.

 

[TexasPhysician]

Any data to back that up? It was one of the few parts they actively tried to get more money to.

First, let me say that the ObamaCare thing is incredibly difficult to figure out, and I don't think anyone 100% understand it yet. Me included.

The fear that some have is that there are not enough FM docs to handle the issues out there if all of a sudden EVERYONE has crappy ObamaCare insurance and needs to see a FM doc. This is why Obama wants PA's and NP's to be able to practice FM without supervision. If this all eventually comes to fruition, why would a medical group pay an MD when a PA/NP can do the same thing?

Again, FM may be a great field to go into for the future. No one can predict. I'm not trying to start a FM flare war. I for one think FM is a very valuable field that the government doesn't give enough respect towards.

 

[TexasPhysician]

I wasn't aware than PM&R has a difficult market. That was one of my main interests.

Allergy is REALLY starting to interest me now as I have been reading up on it and liked immuno when we took it...

This may be a regional thing, but the Allergists I know have a hard time making ends meet while keeping a good lifestyle. To get enough patients, one doc I know goes to 4 different cities/month. Many FM docs can do a big portion of what allergists do these days.

The number of allergy/immuno spots are kept low because the demand just isn't there for it to increase. According to my IM buddies, allergy/immuno still isn't that competitive despite the small number of positions.

PM&R pain fellowshipped docs don't have trouble finding jobs on the other hand.

 

[fozzy40]

Physiatrists in general do not have problems getting jobs. The market is actually pretty good for both inpatient and outpatient.

 

[zac16125]

Lifestyle is also very important to me, and I have been doing some research on this, so I can comment on some of the things below.

If you don't mind working 12 hour days, EM and Hopitalist both seem like great fields. EM will pay you more (Avg 240's vs 200's), but you will also have more stress to deal with. Huge advantage is both have many days off and no call. Disadvantage is 12 hr work days leading to high burn out rates.

Pysch pays about what Hospitalists make (avg 200's) and has the advantage of a more "traditional" work week. The psychiatrists I know work more of a 9-5 schedule than other physicians I know. The downside is you likely will have to take call, and lots of people are turned off of psych for various reasons (not being a "real" doctor, not being able to deal with the pt population, etc).

Rheum is a good field if you want to do a ton of injections, be paid pretty well and not have to take call, it seems like a good option. I only know one rheumatologist, shes in private practice and takes no call, which is kind of sweet. However, I believe its a 3 year fellowship, which is a long time to train. Plus, IMO its pretty boring.

Endo is pointless IMO. Although I think its an interesting field, the fellowships are few and far between, and again I think its an additional 3 yrs. Seems like a lot of time to only make slighlty more than a general internist (high 210's vs 190's). Plus many primary docs are calling themselves "Diabetes Specialists" and the like, kind of stealing the thunder from those board certified endocrinologists. I don't really know how call works for it, I assume there aren't many endo emergencies, and most patients would probably have other primary care docs, so that could be an advantage.

FM, I know there are family docs out there making a KILLING by manipulating that medicare "full risk capitation" system. I doubt it will continue to reimburse as well, once they realize the system is being worked. Plus its called full risk for a reason, and I don't think its something I'd do, for a number of reasons. And if you decide to do more traditional reimbursement, it pays the least of any physician specialty (avg 175's), you have to take call, and I find it to be a pretty boring.

I don't know much about Path/PMnR/neuro/Allergist, so I cant' really comment on them aside from the fact that being a pathologist seems like some kind of punishment for misdeeds in a past life. I cringe at the thought.

I'm leaning toward psych based on lifestyle and general interest in the subject. Now if I can only come to terms with hanging up the stethoscope...

*All salary stats are averages taken from Merrit Hawkins 2010 physician salary survey.

 

[TexasPhysician]

The city you plan to practice in has a huge influence on pay as well

 

[Brachyury]

Lifestyle is also very important to me, and I have been doing some research on this, so I can comment on some of the things below.

If you don't mind working 12 hour days, EM and Hopitalist both seem like great fields. EM will pay you more (Avg 240's vs 200's), but you will also have more stress to deal with. Huge advantage is both have many days off and no call. Disadvantage is 12 hr work days leading to high burn out rates.

Pysch pays about what Hospitalists make (avg 200's) and has the advantage of a more "traditional" work week. The psychiatrists I know work more of a 9-5 schedule than other physicians I know. The downside is you likely will have to take call, and lots of people are turned off of psych for various reasons (not being a "real" doctor, not being able to deal with the pt population, etc).

Rheum is a good field if you want to do a ton of injections, be paid pretty well and not have to take call, it seems like a good option. I only know one rheumatologist, shes in private practice and takes no call, which is kind of sweet. However, I believe its a 3 year fellowship, which is a long time to train. Plus, IMO its pretty boring.

Endo is pointless IMO. Although I think its an interesting field, the fellowships are few and far between, and again I think its an additional 3 yrs. Seems like a lot of time to only make slighlty more than a general internist (high 210's vs 190's). Plus many primary docs are calling themselves "Diabetes Specialists" and the like, kind of stealing the thunder from those board certified endocrinologists. I don't really know how call works for it, I assume there aren't many endo emergencies, and most patients would probably have other primary care docs, so that could be an advantage.

FM, I know there are family docs out there making a KILLING by manipulating that medicare "full risk capitation" system. I doubt it will continue to reimburse as well, once they realize the system is being worked. Plus its called full risk for a reason, and I don't think its something I'd do, for a number of reasons. And if you decide to do more traditional reimbursement, it pays the least of any physician specialty (avg 175's), you have to take call, and I find it to be a pretty boring.

I don't know much about Path/PMnR/neuro/Allergist, so I cant' really comment on them aside from the fact that being a pathologist seems like some kind of punishment for misdeeds in a past life. I cringe at the thought.

I'm leaning toward psych based on lifestyle and general interest in the subject. Now if I can only come to terms with hanging up the stethoscope...

*All salary stats are averages taken from Merrit Hawkins 2010 physician salary survey.

Rheum and endo are both two years at most institutions; only the most research heavy universities have three year fellowships for rheum and endo. So, unless you want to go into academic medicine, they're both two years

Another option is to do heme without onc. The job market is kind of rough if you only do heme, but if you join a large enough practice, maybe it would be possible for you to become the heme person

 

[DMC]

Thanks for the informative posts guys! Keep them coming! Sorry I've been out of it for a couple of days. We just had our first endo test today.

You guys are a ton of help so far. I thank you for this. I didn't know you can do just heme without onc. Are there still residencies for that? Every residency I've seen thus far is heme-onc.

 

[Brachyury]

Thanks for the informative posts guys! Keep them coming! Sorry I've been out of it for a couple of days. We just had our first endo test today.

You guys are a ton of help so far. I thank you for this. I didn't know you can do just heme without onc. Are there still residencies for that? Every residency I've seen thus far is heme-onc.[/QUOTE]

According to FREIDA, there are five heme-only fellowships: USC, Stanford, Yale, NIH, and Buffalo. Again, I'm not sure what the job market for a heme-only doc is; you'll want to ask someone about that

 

[Everglide]

I second PM&R - great lifestyle with ok pay and not competitive.. or so I am told.

 

[Gabby]

Question for those of you knowledgeable about psych. Is there a way to do psych and still keep your medicine skills? I've heard psychiatrists say before that they've forgotten most of their clinical exam skills and their knowledge base.

My other question is about rural psych. Is there a good living in that or do you need to be in a big city to make decent pay.

 

[wannabeOBGYN]

Question for those of you knowledgeable about psych. Is there a way to do psych and still keep your medicine skills? I've heard psychiatrists say before that they've forgotten most of their clinical exam skills and their knowledge base.

My other question is about rural psych. Is there a good living in that or do you need to be in a big city to make decent pay.

1. On my psychiatry rotation the doctor forgot to check a patient's meds on entry to the acute psych unit. He continued all meds on admission even though she was diabetic and not eating. Long story short: she became comatose, had a glucose level in the 40s, almost coded, the doctor freaked and had to take "some personal time" to calm himself down for half an hour.

P.S. The glucose was only checked by a nurse by chance, nobody thought to do it regularly on a diabetic patient.
P.P.S. He didn't know how to transfer the patient back to the medical floor.
P.P.P.S. This is anecdotal and could be way off from the norm.

2. Do rural patients believe in psychiatry?

 

[fozzy40]

I think any specialist can maintain their medicine skills if they are diligent about staying up to date. I will say that your medicine knowledge can slip pretty quickly if you do not stay on top of it. Ultimately it comes down to what you are comfortable with.

In regards to psychiatry in a rural setting, from what I remember there actually is a huge need and you can make a very decent living. As you probably know, location is a huge factor when it comes to any specialty across the board; rural settings will always tend to make more compared to metropolitan areas.

 

[sideways]

1. On my psychiatry rotation the doctor forgot to check a patient's meds on entry to the acute psych unit. He continued all meds on admission even though she was diabetic and not eating. Long story short: she became comatose, had a glucose level in the 40s, almost coded, the doctor freaked and had to take "some personal time" to calm himself down for half an hour.

P.S. The glucose was only checked by a nurse by chance, nobody thought to do it regularly on a diabetic patient.
P.P.S. He didn't know how to transfer the patient back to the medical floor.
P.P.P.S. This is anecdotal and could be way off from the norm.

2. Do rural patients believe in psychiatry?

No bias here folks.

 

[MLT2MT2DO]

1. On my psychiatry rotation the doctor forgot to check a patient's meds on entry to the acute psych unit. He continued all meds on admission even though she was diabetic and not eating. Long story short: she became comatose, had a glucose level in the 40s, almost coded, the doctor freaked and had to take "some personal time" to calm himself down for half an hour.

P.S. The glucose was only checked by a nurse by chance, nobody thought to do it regularly on a diabetic patient.
P.P.S. He didn't know how to transfer the patient back to the medical floor.
P.P.P.S. This is anecdotal and could be way off from the norm.

2. Do rural patients believe in psychiatry?

There are bad physicians in every specialty it would be ridiculous to think this is a psych only thing. I could tell you horror stories in regards to OB/GYN, Surgery, and IM docs that I have worked with over the years...of course mine are all anecdotal too.

 

[st2205]

Check around on the psychiatry forum for a good answer on that. In short, there's a reason why psychiatrists complete medical school first and why psychiatry doesn't have its own separate professional schools. Consult psychiatry wouldbe another aspect of psych where obviously physical exam skills and medical knowledge is completely integrated, as well as emergency psychiatry despite the above story.

 

[TexasPhysician]

Question for those of you knowledgeable about psych. Is there a way to do psych and still keep your medicine skills? I've heard psychiatrists say before that they've forgotten most of their clinical exam skills and their knowledge base.

My other question is about rural psych. Is there a good living in that or do you need to be in a big city to make decent pay.

1. Unless you keep up with medicine skills yourself, you will lose those skills by specializing in anything. How often does a radiologist do physical exams? How often does derm faculty handle codes? Do ortho surgeons ever even want to leave the OR? If you are that worried, there are combined psych/fam and psych/IM residencies.

2. You can actually make better money sometimes in rural areas within psych.

 

[DMC]

1. Unless you keep up with medicine skills yourself, you will lose those skills by specializing in anything. How often does a radiologist do physical exams? How often does derm faculty handle codes? Do ortho surgeons ever even want to leave the OR? If you are that worried, there are combined psych/fam and psych/IM residencies.

2. You can actually make better money sometimes in rural areas within psych.

Good point.

Regarding the pay for rural psychiatrists, I spoke to our staff psychiatrist about that (our school is right outside of Knoxville, TN and it can get pretty rural around here). He said he knows one that literally is fresh out of residency with a first year salary of $245k. That also includes executive benefits (insurance covered by the hospital with weeks of vacation days too). He got such a great deal simply because it is a rural area. He will be the one of the only psychiatrists around, so they used those benefits to recruit I guess.

 

[Orthodoc40]

My roomie is a 3rd year psychiatry resident and she is often catching medical problems that the ER docs, hospitalists and internists miss.

So yes, it is very possible to keep those skills fresh. She might be (probably is?) unusual, but I'm guessing it depends on you & how much you learn in the first place, and then how much you decide to apply it or forget it later on.

 

[wannabeOBGYN]

There are bad physicians in every specialty it would be ridiculous to think this is a psych only thing. I could tell you horror stories in regards to OB/GYN, Surgery, and IM docs that I have worked with over the years...of course mine are all anecdotal too.

I completely agree, there are a handful of scarily bad physicians in all kinds of specialties. I said it was anecdotal. Honestly, I'm not sure how that guy got into/through med school in the first place, let alone residency.

 

[EssTwoThreeFour]

PMR - very DO friendly, you can go far.
EM - I personally hate EM but i know it will give u a pretty good life style.
Hospitalist - hard work, but shift work. This can give u a pretty good life style too if you don't care about $ too much.

HOSPITAL ADMIN - you gotta get an MBA (2 yrs max), making a very very good living. Its a totally different line of work which means lifestyle is different. I'm not really sure what its like, but I'd assume its better than Surgery. just a thought.

But remember.... If you do what you love, the money will come.
*barf

 

[JaggerPlate]

HOSPITAL ADMIN - you gotta get an MBA (2 yrs max), making a very very good living. Its a totally different line of work which means lifestyle is different. I'm not really sure what its like, but I'd assume its better than Surgery. just a thought.

You wouldn't need an MBA (practicing admin/business without a professional degree isn't like practicing medicine without a DO/MD), but many guys do have these or MHAs. However, I wouldn't write hospital admin off as bank/easy living. Most people start way, way lower in admin and probably make far less than the 'physician average' (if such thing exists). It takes a lot of skill, time, and politics to actually become the admin of a hospital, and there's no guarantees. Just my .02 ... admin/business is a good suggestion though, but I just wouldn't 'count' on being a hospital admin in the same sense that you can count on being a PM&R doc, for example, if you went through with the PMR residency.

 

[EssTwoThreeFour]

You wouldn't need an MBA (practicing admin/business without a professional degree isn't like practicing medicine without a DO/MD), but many guys do have these or MHAs. However, I wouldn't write hospital admin off as bank/easy living. Most people start way, way lower in admin and probably make far less than the 'physician average' (if such thing exists). It takes a lot of skill, time, and politics to actually become the admin of a hospital, and there's no guarantees. Just my .02 ... admin/business is a good suggestion though, but I just wouldn't 'count' on being a hospital admin in the same sense that you can count on being a PM&R doc, for example, if you went through with the PMR residency.

quite true. Well said. Nothing is easy in this life.

 

[zac16125]

1. On my psychiatry rotation the doctor forgot to check a patient's meds on entry to the acute psych unit. He continued all meds on admission even though she was diabetic and not eating. Long story short: she became comatose, had a glucose level in the 40s, almost coded, the doctor freaked and had to take "some personal time" to calm himself down for half an hour.

P.S. The glucose was only checked by a nurse by chance, nobody thought to do it regularly on a diabetic patient.
P.P.S. He didn't know how to transfer the patient back to the medical floor.
P.P.P.S. This is anecdotal and could be way off from the norm.

2. Do rural patients believe in psychiatry?

There is a difference between failure to stay up to date with your medical knowledge and complete incompetence.

 

[dozitgetchahi]

I second PM&R - great lifestyle with ok pay and not competitive.. or so I am told.

Around here, PM&R is said to stand for "Plenty of Money and Relaxation". Apparently some of the PM&R docs affiliated with us are really doing well. Of course, a lot of this depends on how excited you are about OMM and how you feel about integrating it tightly into your daily practice.

 

[DMC]

Around here, PM&R is said to stand for "Plenty of Money and Relaxation". Apparently some of the PM&R docs affiliated with us are really doing well. Of course, a lot of this depends on how excited you are about OMM and how you feel about integrating it tightly into your daily practice.

Very true. I had a long discussion with our PM&R physician here at school last night. He said between OMM and the additional musculoskeletal education that osteopaths get over allopaths allows us to be such successful PM&R docs. To me, that is very attractive as a osteopathic student.

He was saying there will be a HUGE shortage through at least 2025 as well because of all the baby boomers and because it's such an underadvertised speciality with minimal exposure in most medical school's programs. He said there's a high demand for physiatrists, and that's why the pay is very good for a non-surgical specialty.

 

[Just Joshin]

Very true. I had a long discussion with our PM&R physician here at school last night. He said between OMM and the additional musculoskeletal education that osteopaths get over allopaths allows us to be such successful PM&R docs. To me, that is very attractive as a osteopathic student.

He was saying there will be a HUGE shortage through at least 2025 as well because of all the baby boomers and because it's such an underadvertised speciality with minimal exposure in most medical school's programs. He said there's a high demand for physiatrists, and that's why the pay is very good for a non-surgical specialty.

Would PM&R be feasible in a rural location? I'm interested in it, but I haven't any exposure to it. After med school though, my wife and I want to settle down some place more rural instead of the big city life we've had the past few years.

 

[fozzy40]

Would PM&R be feasible in a rural location? I'm interested in it, but I haven't any exposure to it. After med school though, my wife and I want to settle down some place more rural instead of the big city life we've had the past few years.

Any hospital in a rural setting would probably LOVE to have a physiatrist on staff to help manage the patients. From an outpatient perspective, you could either join an ortho or spine to help with your referrals. However, you would need allied health therapists to refer to as well.

I have a friend who moved to a rural area in Idaho and is doing well with a good mix of inpatient and outpatient.

 

[Jamers]

Unfortunately that involves being a psychiatrist.



I second PM&R

Path has a crappy job market

FM is frustrating

psych takes a special kind of person. I am too much like that geico commercial (http://www.youtube.com/watch?v=APwfZYO1di4) to be a psychiatrist but god bless 'em

EM has a very high rate of burn out.

Other options: peds and IM have similar problems with BS you have to go through although you can be an IM hospitalist. Other specialties that have good lifestyle include Neurology, Endocrine (i think DM all day would be boring), rheum, allergy. Allergy is probably the most like derm of any medicine specialty.

Cards and Pulm critical care tend to be 2 areas where 9-5 just doesn't fit in unless you are a outpatient pulmonologist. GI can be hit or miss.

Please prove to me EM has a high burnout rate. The attendings I work with have been doing EM for 25 years or more. This phrase is mentioned so many times without any sort of back up and its just laughable.

 

[MJB]

Please prove to me EM has a high burnout rate. The attendings I work with have been doing EM for 25 years or more. This phrase is mentioned so many times without any sort of back up and its just laughable.

All I have to go off of is my experience....I've done somewhere around 10 of these glorious "shifts" in the past few weeks, and while I thought I had a special kind of hate for being a shift worker hospitalist, this EM stuff has taken the cake. 10 Shifts or so has felt longer than the 2 months of hell I served on inpatient medicine during IM.

While I could see myself one day picking up a few shifts just to make a little extra cash, I honestly don't see how people make a career out of it. I would be utterly miserable dealing with the EM "clientele" and schedule the rest of my life. That, to me, is why I would imagine there is high burnout...maybe not to the point of quitting (because if you're BC in EM, what else you gonna do?), but to the point of being "burnt out" and miserable.



To the OP, I considered many, many, many fields before deciding on FM. I plan to do a residency, possibly a fellowship, and get my MBA (integrated program). This should allow me to obtain a position in any number of settings.

If you so choose, it is possible to work an "8-5" M-F schedule with no nights, weekends, call, etc...Or, you can do the hospitalist thing...or work in the ER, etc...

My hope is that I may end up being on faculty or getting into the hospital admin realm if things in practice go south or aren't as enjoyable as I'm hoping. I have previous experience in the pharma world as well, so that's a possibility.

I just wanted something with variety and flexibility, while having decent hours. We'll see how it turns out for me. I just know I'm not a fan of shift work...at all.


I also strongly considered Urology and Derm...I think both would be very cool fields..with a decent life. I hope to incorporate some Derm into my practice one day, as I was exposed to it a little too late to consider it much for residency. Figured I'd hate it, but ended up really loving it.

 

[namethatsmell]

All I have to go off of is my experience....I've done somewhere around 10 of these glorious "shifts" in the past few weeks, and while I thought I had a special kind of hate for being a shift worker hospitalist, this EM stuff has taken the cake. 10 Shifts or so has felt longer than the 2 months of hell I served on inpatient medicine during IM.

So n=10 med student shifts? Pretty low power my man.

Before med school I worked as a ED tech in major trauma center with high-power academics. I'd say the average age of the attendings was about 45-55 with a spread of low/mid 30s to the low 70s (and the guy is great doc). All were residency trained and loved their job. There were tons of weeks where I worked 70-80 hrs/wk due to short staffing and so I got to know many of them pretty well (and the overtime $ didn't hurt). Would things get stressful at times? Sure. Did these docs enjoy their work? Yup.

What's the moral of the story? Different strokes for different folks.

The EM burnout myth is a tired one indeed.

 

[JaggerPlate]

Please prove to me EM has a high burnout rate. The attendings I work with have been doing EM for 25 years or more. This phrase is mentioned so many times without any sort of back up and its just laughable.

I've always felt like this was one of those famous SDN 'telephone game' phrasings that get regurgitated and passed around the sites for YEARS until people reference it as fact (despite the fact that they arise as simple anecdotes). I worked in an ER for a few years, lots of older (60ish) docs, and they didn't seem any more/less burned out than the younger guys. In fact, the most jaded, 'burned out' type doc I saw in the ER was a guy just a year or two out of residency (most jaded physician I've seen in general was an OB). Obviously, it takes a certain personality to do ER (true of any specialty), but I haven't seen much proof (personally and for what it's worth) that the burnout thing is true.

 

[MJB]

So n=10 med student shifts? Pretty low power my man.

Before med school I worked as a ED tech in major trauma center with high-power academics. I'd say the average age of the attendings was about 45-55 with a spread of low/mid 30s to the low 70s (and the guy is great doc). All were residency trained and loved their job. There were tons of weeks where I worked 70-80 hrs/wk due to short staffing and so I got to know many of them pretty well (and the overtime $ didn't hurt). Would things get stressful at times? Sure. Did these docs enjoy their work? Yup.

What's the moral of the story? Different strokes for different folks.

The EM burnout myth is a tired one indeed.

I completely agree on the "different strokes" thing. I knew a LONG time ago that I wouldn't like the ED. Now, if it were TRULY "Emergency Medicine", that would be a different story. I've done quite a bit more ED work in other rotations (Community Med), and volunteer....one ED is the same as any other.

If you wanna do trauma, be a trauma surgeon. Wanna do a walk-in clinic? Do EM.

I'm just glad there are folks out there that like to do it, cause I don't have any desire. Why it's a required rotation in med school is beyond me...it's been a total waste of time for me. People that like/thrive in the ED are a different breed from me, which is fine. I'm bored to death, even when all the rooms are full and the waiting room is full of more ungrateful seekers. Stressful? Other than the type of"customers"? no.

As for burnout, it's not as high as some may think, but it seems rather significant.

http://www.acep.org/content.aspx?id=44050


All that being said, I do see why things such as FP/EM, IM/EM, etc...residencies are popular. At least with those you have the option of doing something other than working shifts in the ED.

Last night was at least decent. I met some patients that actually had REAL problems and weren't total asshats.