Carson 12,
Many years ago, I faced a similar crossroad as you. I come from a family of 3 surgeons, and I've always looked up to them and wanted to join "the club." During my 3rd year of med school, we were all together during Christmas and the topic of conversation shifted to what I was planning on doing. I told them surgery, and uniformly, all 3 family members told me not to do it unless I would absolutely die without it. They instead instructed me to go into GI. I'm happy I did.
I also enjoyed medicine, at least the way it should be practiced. I also loved the aura of the operating room. The ability to cut somebody open, fix something, then sew them back up, was extremely tempting. However, I chose gastroenterology. I'm extremely satisfied with my decision. Yes, you do a lot of diagnostic procedures (EGD's and colonoscopies... all day). It can get quite monotonous. But my passion lies in therapeutic GI, and the field is expanding at a rapid clip. EUS has really tore down the last frontier in the GI realm, the GI lumen. Now with the ability to "see" outside of the GI lumen, the possibilities are endless. I just attended a meeting on performing TIPS under EUS-guidance. Another course next week on POEM (per-oral endoscopic myotomy) for treatment of achalasia. I'm in my final year of GI fellowship, and I am very excited about starting my life. Job opportunities are plentiful, and my email is flooded with job offers daily (probably 5-10 offers come in PER DAY, no joke). The starting salary ranges anywhere from 250K on the low-side in highly-competitive locations such as los angeles, all the way to a million in less-desirable locations. I was offered TWO jobs, both starting at $800K. Ridiculous. I didn't take them because after a while, you realize that life and family are far more important than money. Plus, you begin to realize that ethically, anyone making that kind of money is really pushing the limits... anyways, I digress.
I'm obviously biased towards the field of GI, but in terms of lifestyle, income, and job satisfaction, it rates near the top.
In terms of clinic... clinic is a necessary evil for every speciality (except radiology and pathology). Personally, I'm not a big fan of clinic, especially GI. It's been estimated that approximately 25% of your patients in clinic will be IBS (irritable bowel syndrome). The typical patient is a young female with other psychosocial issues presenting as IBS. Obviously, a very difficult cohort to work with, as any effective treatments typically require a lot of time, counseling, and reassurance. There are other fields of GI such as inflammatory bowel disorders (Crohns and ulcerative colitis) that typically require a little more clinic than average, and you can choose to subspecialize in these areas. Another option is to focus on hepatology. There's a HUGE need for hepatologists, as most of the gastroenterology fellows gravitate towards mostly luminal GI and neglect liver, for a variety of reasons. If you find a nitch in liver, there will be plenty of jobs looking for a medical transplant hepatologist, which pay pretty well too.
Hope this helps. One of my good friends is a urologist and loves it. Both are good fields =)
