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I think it's time to redefine the "ROAD to Success"

Discussion in 'Pre-Medical Allopathic [ MD ]' started by flatearth22, 05.06.12.

  1. flatearth22

    flatearth22

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    Just like there's promotion and relegation in English football, I think the conventional definition for the "ROAD to Success" (Radiology, Ophthalmology, Anesthesiology, Dermatology) has run its course and needs to be revamped. Here are my changes:

    1) Replace Radiology with Radiation Oncology

    What used to be the best kept secret in medicine is now out of the bag. With Derm lifestyle and pay + uber lay and professional prestige (no one will ever demean you with taunts of "pimple popper" or "botox injector") it's no surprise that Radonc applications have gone way up in quantity and quality in recent years. It has already become a specialty of choice by top students who aren't surgically inclined and by the time the class of 2016 matches, I predict Radonc to be as competitive as Derm if not moreso. Meanwhile, Radiology has become the new Pathology with a tight job market and fellowships pretty much being a prerequisite to landing a job. With over 80 unmatched spots this year and the shady impact that HCR will have on imaging plus potential outsourcing, Radiology has gone down in competitiveness and I expect this trend to continue - http://residency.wustl.edu/medadmin...b1a2b4ee4af135b386256f8f0072972a?OpenDocument

    2) Keep Ophthalmology but understand there are substitutes - Optho is in the ROAD because it's "surgery-lite." That is, surgery salary and sexiness but with a better lifestyle. While Ophto is facing competition from Optomotrists who have recently gained the right to perform surgery in some states, it still has a bright future. Understand, however, that there are other surgical subspecialties that can yield similar lifestyles and $$$ like ENT and Urology.

    3) Replace Anesthesiology with Allergy/Immunology - The downside to Allergy/Immunology is that you have to do an IM residency and that Allergy is the most competitive of IM fellowships. Otherwise, it's basically Derm lifestyle and low stress level with a little lower salary. Gas, on the other hand, is quite stressful despite misconceptions of it being otherwise. Not to mention the CNRA scare. No surprise it's competitiveness has gone way down in recent years - http://residency.wustl.edu/medadmin...a6e8c6b1ba8c35cb86256f8f0071c74f?OpenDocument

    4) Keep Derm as is - The perfect specialty for people (especially women) who want it all - lifestyle, money, low stress, and great job satisfaction (one of the highest of all specialties). The whole nine yards. Very versatile as well - you can focus on cosmetics, cancer, Mohs surgery, dermatopathology, etc. It's the only part of the original "ROAD" that needs no alterations.
  2. Knocked Up

    Knocked Up Sexy and I know it

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    Well Round-earth,

    Another stellar of a post. Informative yet heart-felt.

    I think it is time we redefine the MOPING specialties instead. (credit and citation: Medicinesux circa 2010)

    M- Medicine (Family) (need to know a lot about everything and get paid crap; "noctors" intruding on the field)

    O- Ob/Gyn (wildly erratic hours, malpractice rates that would leave you breathless)

    P- Pediatrics (lowest paid specialty; crazy parents)

    I- Internal Medicine (sucks so bad no explanation needed, only hope out is doing a second residency….I mean fellowship)

    N- Neurosurgery (brutal 7 year residency with brutal hours; essentially sacrificing your life for a higher calling)

    G- General Surgery (demanding 5 year long residency, some very malignant personalities to deal with, your mechanic gets paid more to fix your car than the surgeon who removes your appendix)
  3. Aerus

    Aerus Elemental Alchemist

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    :thumbup:
  4. Lifeman

    Lifeman

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    What's so bad about IM?
  5. Wile

    Wile

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    I thought cards was the most competitive followed by GI?
  6. 235788

    235788 God Complex

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    Make sense - but general is a road to a lot of interesting surgery fields (vascular, plastics, xplant, cancer)

    I think Emergency Med should be thrown in (many places do 7x 12s/2 weeks - 250k). Maybe include pain management anesth (9-5 and a very viable private practice option)?

    Agree, Gen rads/aneth should be out. They'll stay high, but who knows what the future foretells
  7. Brachyury

    Brachyury

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    LOLZ @ pain management

    Rads may decrease, but so will all medical fields.
  8. DrBowtie

    DrBowtie Responsible?!?! PGY3 Moderator Emeritus

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    Also :laugh: at pain management.

    No worse patient population can be found IMO.
  9. GarfieldKoe

    GarfieldKoe

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    Maybe include pain management anesth
    [​IMG]
  10. Charles Darwin

    Charles Darwin KFBR392

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    What about pain management?
  11. Oxer45

    Oxer45

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    RadOnc is highly volatile. What happens when cancer is better treated by another method? Better chemo, immunotherapy, newer surgical technique. Also you have to get all your pts refereed by another doc, esp hematologist. Its the same problems CT surgeons have; cardiologist sees the pts first and caths who they want and gives the complex pts to CT. The key is not which field is good today, but which field will be good for the next 10-35 yr. RadOnc is a great field for the adventurous, but not a "clock-in-clock-out and make a lot" that people look for in ROAD.
  12. tkim

    tkim D-d-d-dilaudid

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    Uh, no. Any specialty where you are required to work nights, weekends and holidays and cannot refuse to see any patient who darkens your door is *NOT* a lifetstyle specialty.
  13. 235788

    235788 God Complex

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    I feel like they make the money and still work far fewer hours than other physicians. One of my buddies dads who was an ER doc was able to coach me all growing up, and I don't think he was an exception.
  14. neusu

    neusu Chief Resident

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    I prefer the spent residents:

    S - Surgery
    P - Plastics
    E - ENT
    N - Neurosurg
    T - Thoracic/vascular

    Sorry ortho, you don't fit nicely in to my acronym.
  15. tkim

    tkim D-d-d-dilaudid

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    Um yeah, you don't get it. It's okay.
  16. Plue00

    Plue00

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    Wait, a bunch of us pre-meds are deciding what specialties are what before we've even entered medical school?

    Totally valid. I do find it funny how some here ignore what attendings/med students/residents have to say though.
  17. Knocked Up

    Knocked Up Sexy and I know it

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    Round-earth is not a premed. He is a fully cultivated, extraordinarily sophisticated, and culturally diverse soon-to-be medical student. Have you not seen the other "gems" he has posted in recent years.

    (sarcasm alert)
  18. CDAstudent

    CDAstudent

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    Your friend's dad might not be an exception per say, but there are certainly EM docs that work a lot of hours. Just like other specialities salary and hours are dependent on a number of different factors, as I'm sure you know (service area, number of physicians in the group, shift set up). My dad is in EM and routinely put in 80 hrs per week when I was younger.
  19. gasblaster

    gasblaster ASA Member

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    Yeah seriously. At least wait until you've started med school, let alone actually rotate through these specialties.
  20. drizzt3117

    drizzt3117 chick magnet

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    Love premed silliness...

    Ophtho lifestyle = surgery? Lmao.

    ROAD specialties aren't defined as such because of hours; they're so defined because for the most part (with ophtho a potential exception) you don't have a service with inpatients that you can be called in to deal with; your job is over when your shift is over except for infrequent call. EM is similar in mentality but has far more variable hours; the other 4 are essentially 8-5 as an attending. Radonc has a bit more patient mgmt/rounding and patients with, for example, brain radiation, can have emergency complications like hemorrhage. Btw, IR isn't the same as diag rads; it may be eventually separated from rads.
  21. Whiskeypunch

    Whiskeypunch

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    Anyone who thinks EM isn't lifestyle is nuts.

    I'm sorry but any job you can work 120/hrs a month and make 300k is lifestyle.

    Oh and anyone who says they don't make mad bank--I'm sorry but it's your own fault. Stop working for team health and go join a democratic group.

    To the guy crying about how he has to see everyone... so what? You do shift-work and make lots of money, and have tons of free time.
  22. DrMediterranean

    DrMediterranean

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    why allergy immunology? :confused:
  23. gettheleadout

    gettheleadout barefoot jackrabbit Moderator

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    DNP + Dermatology "Residency"
  24. EBTrailRunner

    EBTrailRunner

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    Enjoy: http://forums.studentdoctor.net/showthread.php?t=898506.
  25. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    When ROAD was made up, radiation oncology was a subspecialty of radiology, so technically they have always been part of the R of ROAD, no need to change that. Putting IM subspecialties into road misses the point -- none of them are in it because you have to do an IM residency first and won't have matched into your sub-specialization the way you do with the advanced fields.

    EM as a lifestyle field is still in it's infancy, and I think you have to wait another 5 years before you see what that field really evolves into -- this shift approach is very much a work in progress with plenty of dissenters. It's simply too early to talk about this field as being historically lifestyle.
  26. drizzt3117

    drizzt3117 chick magnet

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    You can work 120 hours/month and make $300k as a hospitalist too. Is IM now a lifestyle specialty?

    EM has shift work but it's not a lifestyle specialty the way that the other ones are; you frequently have to work overnights and weekends.

  27. flatearth22

    flatearth22

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    Agreed. A big part of being a lifestyle specialty is regular hours and limited call. Another is low stress level. EM lacks both of these.
  28. Whiskeypunch

    Whiskeypunch

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    That salary seems really high for IM. I know what EM groups pay in the southwest, I can't comment on IM but all the salary surveys tend to indicate like 180-250k for 7 on 7 off? Then again who knows how accurate those are. Also 7 on 7 off 12hr shifts is 168 hours a month not 120. 168 hours a month as EM would be like 400k.
  29. Whiskeypunch

    Whiskeypunch

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    There is no reason you can't have regular hours if you want them. You won't be able to be as selective in choosing your group/location/pay but there are definitely opportunities to be like "I'll do 12-15 6am to 3pm shifts a month."

    There are groups that will accommodate you.

    And there is no call.

    There's definitely stress, but I don't think that's missing in any field of medicine.

    The biggest downside to EM to me is you'll get sued a number of times over your career no matter how good you are, which sucks.
  30. johnnydrama

    johnnydrama I'm no Superman

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    Yeah, that was the one that stuck out to me too. Had never heard of that being competitive - in fact, browsing match lists of places I was considering for prelim (aka not prestigious IM programs) I would often see allergy/immunology matches but no cards/GI.

    Allergy/immunology has a lot of growth potential, but at the moment i wouldn't expect it to be lucrative (although would probably be an easy lifestyle).
  31. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    As a junior person in any EM group, you are not going to get the choice hours. No, "groups that will accommodate you" will not be the norm. You will be working graveyard shifts and weekends until you have seniority. No group is lacking folks who want to work the daylight hours.

    I think folks in pre-allo get a bit too carried away with the notion that you can freely dictate your hours, find part-time gigs and otherwise expect medicine to be flexible to your wants. Some people get that result, but the vast majority don't. Best not to bank on it, or think as a Premed that this is how things work.
  32. EBTrailRunner

    EBTrailRunner

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    After reading Something for the Pain by Paul Austin, it's hard for me view EM as a sweet gig.
  33. Freakfarm0

    Freakfarm0

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    The amount you think you know astounds me. The lack of filter is even more astonishing.

    You are the perfect pre-med.
  34. notbobtrustme

    notbobtrustme Crux Terminatus

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    Even at my mellow ER volunteering gig, there is immense pressure on physicians to treat patients. And we get around 6-10 patients per my 4 hour shift.
  35. DanGee777

    DanGee777

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    80 hours a week as an EM attending? Doesn't this violate some type of state regulation? If not, it should. Most data says the avg EM attending sees patients between 40-45 hours a week. The couple EM docs I know work an average of four 10 hour shifts per week 4x, with rotating start times to deal with the circadian issue. Example: Monday 7am-5pm, Wednesday, 10am-8m, Thursday 2pm-midnight, Saturday 6pm-4am, then 2 days off.

    80 hours a week just seems insane. If people say burnout is a problem for EM docs and the avg one works 40-45 hours per week, what does it do to you when you're working double that? It also seems unsafe for patients. I know hospitalists sometimes work 7on/7off schedules where they're averaging 70-75 hours per week in the on weeks, but there's a couple key differences: they have weeks off in between to recuperate, and on the whole, they don't have as many instances of super high-stress levels during shifts with which to deal.

    Are you sure this schedule wasn't during his residency? Although it still seems high, I know that most residents worked considerably more hours on avg before the work rule changes 10 years ago.

    I guess if people really wanted to do this though, they could probably retire after a 15 year career in EM (working 80 hours a week) vs 30 years, then just go fishing.
    Last edited: 05.07.12
  36. DanGee777

    DanGee777

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    I too have heard that cards/GI are the two most competitive, with allergy a close second (due to the relatively few number of fellowships and the fact that you compete with pediatric resident applicants for at least some of them). I have heard that GI is getting more competitive than cards due to the comparatively better lifestyle, and if you look at the fellowship match rates, the data bears it out. Something like 59% of all GI fellowship applicants matched vs ~68% of cards fellowship applicants, although both percentages include IMG/USIMG/DO applicants in the total so the percentages are probably higher for US MD grads.

    Just a heads up btw, Johnny. I'd like to send you a PM, but it says your PM box is full. :p
  37. drizzt3117

    drizzt3117 chick magnet

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    According to the salary survey from this hospitalist industry website, avg salary was about 230k with 1/3 over 250 and ~15% over 300; so it's doable. Of note, they worked about 174 hours per month on average but their average shift length was 11.6 hours with an average of 15.3 shifts per month.

    http://www.todayshospitalist.com/survey/11_salary_survey/c07.php

    Of note, the average number of shifts for EM was between 15-16 according to the EP daily website; average shift length was shorter at around 9.5 hours.
    Last edited: 05.07.12
  38. johnnydrama

    johnnydrama I'm no Superman

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    Drizz, please tell me you aren't Chosen1. :p
  39. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    this would blow most surgeons out of the water. Are there even this many hours in a week? I'm thinking typo.
  40. drizzt3117

    drizzt3117 chick magnet

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    Yeah I meant per month.
  41. drizzt3117

    drizzt3117 chick magnet

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    Lol I don't go on AM anymore, what a cesspool.
  42. Gfunk6

    Gfunk6 Troublemaker Moderator Lifetime Donor

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    Radiation Oncology has evolved to remain ever relevant. Long gone are the days when you took a piece of radioactive metal, suspended it over the patient, and removed the patient when you thought they were sufficiently irradiated.

    We can now deliver radiation w/ surgical precision using robotic platforms, multiple beam energies and heavy particles (protons, neutrons, carbon ions).

    See this thread in the Rad Onc forum for discussion. Also, refer to the FAQ for a quick primer.

    [​IMG]

    Remember this? This article was published over a decade ago. Guess what happened to the magic bullet? Cancer cells mutated into resistant phenotypes necessitating the use of 2nd and 3rd line agents. And this was for a SPECIFIC subtype of leukemia. Don't expect a universal anti-cancer "magic bullet" in our lifetimes.

    Good point. This is one of the drawbacks of being a sub-specialist. However, its relevancy depends a bit on where you practice.
  43. DrMediterranean

    DrMediterranean

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    I think the only reason he put it there is because it starts with an "A" :laugh:
  44. newdoc2013

    newdoc2013

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    radiology is sweet whether it is in the ROAD mnemonic or not. :thumbup:
  45. tkim

    tkim D-d-d-dilaudid

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    You really don't know what you don't know. But hey that's okay, you just got into med school so you must know more than the attending. Good luck with that in the clinical years.
  46. johnnydrama

    johnnydrama I'm no Superman

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    Definitely.

    And I don't really buy radiation oncology being viable in the long run. No matter what particles you use, radiation is always a somewhat dirty therapy.

    There will be better targeted treatments in the future, and it isn't clear radonc will get them.

    It's too narrow. I'd go traditional med onc or IR instead.

    Plus every now and then your computer or tech screws up and you burn a hole in someone (there was a nytimes series on catastrophic radonc errors in NYC hospitals a year or so ago).
  47. cowme

    cowme ACFAS Member

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    I'm sorry but wustl's site is crazy for saying that OB Gyn is more competitive than Rads. The average person who matched in rads had a 242. The average in OB was 220. (for you premeds, that is like comparing a 34 MCAT to a 28)
  48. link2swim06

    link2swim06 PGY-1

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    Sure but define long run. I would bet serious money in our lifetime it is not going anywhere in our lifetime.

    I think its pretty unlikely the majority of cancers are going to be 100% solved by a "magic bullet(s)" in our lifetime (60 years from now) let alone by the time we plan to retire (40 years from now). Until nanobots are no longer science fiction (maybe near the end of our life?) I have a feeling there will be plenty of people needing radiation.

    Also we have came a long way in radiation in the past 30 years (i.e. gamma knife).
  49. CDAstudent

    CDAstudent

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    I am unsure about current regulations, but this was in the late 80's early 90's. When I asked about work hour limits in the early stages of his career he said they had a strict limit of 168hrs/week. As a member of a very small group (four docs) and the only EM group in the area, that was the norm.
    Twenty years later he is one of the senior partners and has traded some shifts for administrative responsibilities, as others have discussed above.
  50. johnnydrama

    johnnydrama I'm no Superman

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    Genomics and proteomics are about to blow cancer wide open. Just look at the sequencing costs per bp - we'll soon be able to treat cancers based upon their individual genomes. Just need the data and the computational power (and a bit more silicon valley thinking, a bit less medical industry).

    And by soon, I mean a decade for the research, another for implementation For the timescale of medical training though, that's relevant.

    Someone starting school right now might get out of residency to find their specialty about to be made irrelevant.

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