Least stressful residency?

[NP545]

What are some of the lesser stressful residencies out there for an MD? Specifically, which would be a good fit to someone who is trying to have a good family, etc..

I searched through the search option on this site but saw varied responses so I'm looking for more input. Also, how stressful is a non invasive cardiology fellowship after the IM residency? I could not find any details on what is needed to become a non-invasive cardiologist after the IM residency so could someone tell me the amount of years, steps needed en route to becoming a non-invasive cardiologist after residency?

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[Cyberdyne 101]

What are some of the lesser stressful residencies out there for an MD? Specifically, which would be a good fit to someone who is trying to have a good family, etc..

I searched through the search option on this site but saw varied responses so I'm looking for more input. Also, how stressful is a non invasive cardiology fellowship after the IM residency? I could not find any details on what is needed to become a non-invasive cardiologist after the IM residency so could someone tell me the amount of years, steps needed en route to becoming a non-invasive cardiologist after residency?

Physical Medicine and Rehabilitation
https://www.aapmr.org/patients/aboutpmr/Pages/physiatrist.aspx

 

[Cyberdyne 101]

(I've already posted this elsewhere, but it's always worth re-advertising)

 

[boaz]

Cardiology is a stressful fellowship. Lots of overnight call, emergencies, etc. (the main cardiology fellowship is non-invasive; invasive cardiology is a fellowship you do after non-invasive)

Residencies that are more conducive to family life:
Psych
Derm (very competitive)
PM&R
Radiology (mildly competitive)
Emergency (very predictable hours, mildly competitive lately)
Anesthesia (mildly competitive)
Rad Onc (very competitive)
Ophtho (very competitive)

Avoid IM and Surgery

 

[Cyberdyne 101]

This study is a few years old, but a lot of this data should still be relevant.

A neurosurgery resident once told me that the pm&r residents were the happiest in her hospital.

http://www.mothersinmedicine.com/2010/03/pm-holy-grail.html?m=1

 

[majestic red]

I would encourage you to enter

This study is a few years old, but a lot of this data should still be relevant.
View attachment 180835
A neurosurgery resident once told me that the pm&r residents were the happiest in her hospital.

http://www.mothersinmedicine.com/2010/03/pm-holy-grail.html?m=1

Note that these statistics look like they apply to attending physicians and not necessarily residents. "Lifestyle" residencies include those listed by boaz above, and I would also add Pathology (which is not competitive).

I should also mention that even Surgery residents often manage to maintain successful marriages, have children, find time to have some fun, etc. during residency. While lifestyle considerations are certainly important to think about, you should try to do what you love. I can definitely say from my 3rd year experience that I'd rather spend 80hrs/week doing something I enjoy than 40hrs/week doing something that I find tedious.

 

[Cyberdyne 101]

I would encourage you to enter


Note that these statistics look like they apply to attending physicians and not necessarily residents. "Lifestyle" residencies include those listed by boaz above, and I would also add Pathology (which is not competitive).

I should also add that even Surgery residents often manage maintain
successful marriages, have children, find time to have some fun, etc. during residency. While lifestyle considerations are certainly important to think about, you should try to do what you love. I can definitely say from my 3rd year experience that I'd rather spend 80hrs/week doing something I enjoy than 40hrs/week doing something that I find tedious.

Totally agree.

 

[CherryRedDracul]

Besides the amount of studying that needs to be done, dermatology has one of the highest, if not the highest, job satisfaction rates out of all medical specialties. A good chunk of it could be attributed to the low stress and the high level of patient satisfaction.

 

[Mad Jack]

Besides the amount of studying that needs to be done, dermatology has one of the highest, if not the highest, job satisfaction rates out of all medical specialties. A good chunk of it could be attributed to the low stress and the high level of patient satisfaction.

And glorious hour to pay ratio and predictable schedule. I don't think I've ever heard of a dermatological emergency.

 

[Narmerguy]

This study is a few years old, but a lot of this data should still be relevant.
View attachment 180835
A neurosurgery resident once told me that the pm&r residents were the happiest in her hospital.

http://www.mothersinmedicine.com/2010/03/pm-holy-grail.html?m=1

Dermatology is just...I don't even...

 

[QofQuimica]

There is no such thing as a residency (or fellowship) that isn't stressful. Residency is meant to be stressful because it is preparing you to practice independently, and practicing independently is very stressful. If you want a career that doesn't stress you very much, you're better off not going to medical school at all.

It's a very bad idea to pick your future specialty based on your perception of lifestyle, especially before you have any experience with living that lifestyle. For example, anyone who really thinks that emergency medicine provides "very predictable hours" that are family-friendly even for most attendings, let alone most residents, is really going to be in for a rude awakening. In spite of emergency docs working fewer hours overall than docs in many other specialties, EM is probably one of the worst specialties for maintaining a normal, predictable family life, considering how many nights/weekends/holidays they work, how irregular their schedules are, and how they keep flipping back and forth between working days, evenings, and nights. Go read the EM forum and see for yourself; the EM docs will be the first to tell you that EM ain't a lifestyle specialty.

The best advice I can give you is that once you get to the point where you're considering specialties (usually the second part of your third year/beginning of your fourth year of med school), you should pick a specialty that you enjoy. Because in any residency, you are going to be spending 60-80 hours per week for the next 3-7 years working in that specialty, and there is nothing more stressful than working that many hours doing something you dislike. Don't be fooled by people promising you that life in any residency anywhere will be "easy." In any residency in any specialty, you should expect to work hard and work long hours. And you should expect it to be stressful.

 

[majestic red]

And glorious houray ratio and predictable schedule. I don't think I've ever heard of a dermatological emergency.

Well... there's Stevens-Johnsons/TEN, which the Dermatologists like to refer to as "skin failure," but those are more or less managed by the burn unit.

 

[Cyberdyne 101]

And glorious hour to pay ratio and predictable schedule. I don't think I've ever heard of a dermatological emergency.

When I was a teen, a brand new zit in the morning was certainly an emergency

 

[Cyberdyne 101]

Dermatology is just...I don't even...

And glorious hour to pay ratio and predictable schedule. I don't think I've ever heard of a dermatological emergency.

Posted by @DermViser in another thread.

 

[A7X]

In my experience female derm residents and attendings tend to be the best looking too.

 

[CW 2010]

And glorious hour to pay ratio and predictable schedule. I don't think I've ever heard of a dermatological emergency.

It's funny, but the last time I went to see my dermatologist, she was late to the appointment and the receptionist apologized and said the doctor had to run to the nearby hospital (the office building is connected to the hospital) because there was an emergency. And I kept wondering what kind of dermatological emergency could there be? I even tried to google it but didn't find anything plausible. Hmm...

 

[butternutsquash]

It's funny, but the last time I went to see my dermatologist, she was late to the appointment and the receptionist apologized and said the doctor had to run to the nearby hospital (the office building is connected to the hospital) because there was an emergency. And I kept wondering what kind of dermatological emergency could there be? I even tried to google it but didn't find anything plausible. Hmm...

Someone had a huge pimple right before yearbook photos/prom.

 

[allantois]

It's funny, but the last time I went to see my dermatologist, she was late to the appointment and the receptionist apologized and said the doctor had to run to the nearby hospital (the office building is connected to the hospital) because there was an emergency. And I kept wondering what kind of dermatological emergency could there be? I even tried to google it but didn't find anything plausible. Hmm...

Probably had to give a cortisone shot into a zit

 

[karayaa]

OP, "lifestyle" specialties are those that have predictable, 9-5 hours with no emergencies, no reasons to work at night or on the weekend, where the problems are not life threatening (which reduces tension and stress in the environment), where the patients are happy (ie where you can give them something that improves their quality of life)

As other have said, residency will likely be difficult no matter what speciality (thought PMR is probably the best)
http://www.mothersinmedicine.com/2010/03/pm-holy-grail.html

Family is what you make of it. You'll have to sacrifice something, between your work, relationships, and hobbies.

 

[NP545]

OP, "lifestyle" specialties are those that have predictable, 9-5 hours with no emergencies, no reasons to work at night or on the weekend, where the problems are not life threatening (which reduces tension and stress in the environment), where the patients are happy (ie where you can give them something that improves their quality of life)

What are some of these specialties/ doctor types? I'm assuming they're in high competition.

I honestly wouldn't mind becoming a doctor who doesn't make more than 200K as long as I can have the 9-5, etc. I'd be willing to sacrifice the extra salary for lifestyle

 

[NickNaylor]

What are some of these specialties/ doctor types? I'm assuming they're in high competition.

I honestly wouldn't mind becoming a doctor who doesn't make more than 200K as long as I can have the 9-5, etc. I'd be willing to sacrifice the extra salary for lifestyle

Almost every field can allow for this kind of setup if you seek it out. There are some exceptions of course, but in most fields it's possible if you make it a priority.

 

[MU420]

What are some of these specialties/ doctor types? I'm assuming they're in high competition.

I honestly wouldn't mind becoming a doctor who doesn't make more than 200K as long as I can have the 9-5, etc. I'd be willing to sacrifice the extra salary for lifestyle

Post residency, many specialties can have those types of hours. If you decide on family medicine for example, you can choose to work 7-7 and be on 24/7 call or just work 830-430 4 days a week. Surgeons (esp gen surg) tend to work longer, but a lot of attendings in surgical subspecialties have pretty decent lifestyle.

If we are talking specifically about residency, the "least stressful" ones are generally non surgical specialties with fairly regular hours and no prelim medicine/surgery year. Psych and path would both fit that criteria.

Derm, rad, PM&R, rad onc, ophtho generally have nice hours after the intern year although it can vary quite a bit between programs. You could do an easy TY instead of med/surg prelim but those are extremely competitive and becoming rarer.

 

[mimelim]

This all depends on how well you want to be trained. You learn by being in the hospital. You learn by taking care of patients. Cushy residencies hurt your education. It isn't enough to read a book, do well on your tests. You will be a bad doctor and take worse care of patients if residency isn't busy. Do not misinterpret. I am not saying that high stress is good or even that long hours are good. They aren't, and that is not even up for debate. But, it does need to be said. If you go to the 'extreme' of picking a 'lighter' residency and more important a 'lighter' program within that specialty, you will be less trained. I was a little disgusted with several May (late in year) transitional year interns (both categorical Derm). This has nothing to do with TY in general or Derm (really, it doesn't), this has to do with understanding that residency is where the bulk of your medical learning is going to happen and you are seriously short changing yourself to minimize how busy you are.

You don't want to be that PGY4 fellow that has your patient taken away from you by the PGY2 from another service because you literally have spent about the same amount of time actually caring for patients as them and don't know what you are doing.

 

[W19]

Almost every field can allow for this kind of setup if you seek it out. There are some exceptions of course, but in most fields it's possible if you make it a priority.

This need to be said more often on SDN... I know Psych/IM/FM/ID docs who work 9-5...

 

[Winged Scapula]

It's funny, but the last time I went to see my dermatologist, she was late to the appointment and the receptionist apologized and said the doctor had to run to the nearby hospital (the office building is connected to the hospital) because there was an emergency. And I kept wondering what kind of dermatological emergency could there be? I even tried to google it but didn't find anything plausible. Hmm...

Dermatological emergencies do exist: Stevens Johnson syndrome and Toxic Epidermal Necrolysis are the most well known. However these are generally managed in an ICU, often by burn surgeons, not the dermatologist.

My guess is that the staff uses the "emergency" excuse any time the physician is late. They must teach them that in MA school. My staff used to do it until I asked them not to; patients worry when they hear emergency as it may imply your patients don't do well.

 

[Cyberdyne 101]

I know an ENT doc who works less than 50 hrs a week. The residency was tough (obviously), but his hard work has definitely been rewarded.

 

[BestDoctorEver]

I know an ENT doc who works less than 50 hrs a week. The residency was tough (obviously), but his hard work has definitely been rewarded.

Too many hours... Psych or PM&R or bust!

 

[karayaa]

What are some of these specialties/ doctor types? I'm assuming they're in high competition.

I honestly wouldn't mind becoming a doctor who doesn't make more than 200K as long as I can have the 9-5, etc. I'd be willing to sacrifice the extra salary for lifestyle

The traditional choices are the ROAD - rads, ophtho, anesthesiology, derm
Like @NickNaylor said, though, you can adjust your lifestyle within most specialties.
In general, the further you move away from clinical care (towards research, admin, teaching, consulting, forensics), the more flexible/normal the lifestyle.

 

[mimelim]

Dermatological emergencies do exist: Stevens Johnson syndrome and Toxic Epidermal Necrolysis are the most well known. However these are generally managed in an ICU, often by burn surgeons, not the dermatologist.

My guess is that the staff uses the "emergency" excuse any time the physician is late. They must teach them that in MA school. My staff used to do it until I asked them not to; patients worry when they hear emergency as it may imply your patients don't do well.

We had a new intensivist last year who consulted Derm for a Stevens Johnson case. Initiated care, did everything that we would normally do in the ICU and the Dermatologist showed up 48 hours later. We had forgotten that they were called. -__-

 

[Frazier]

In regards to residency structure, derm/psych/pmr are among the best when looking at stress.

However, specialty intrinsics matter more, IMO...

Doesnt matter you only work 40 hours a week, if you have a skin phobia and derm conditions freak you out -- might be stressful days.

Doesnt matter if your psych program has virtually no call, if psych patients and talking make you very uncomfortable -- gonna have a bad time.

Same with PMR, if you find SCI/CVA/etc patients super depressing --residency days will be pretty draining.

 

[Winged Scapula]

We had a new intensivist last year who consulted Derm for a Stevens Johnson case. Initiated care, did everything that we would normally do in the ICU and the Dermatologist showed up 48 hours later. We had forgotten that they were called. -__-

Hmph...I don't know any hospitals where 48 hr response time for a consult is acceptable even for a bogus one.

 

[DermViser]

I was a little disgusted with several May (late in year) transitional year interns (both categorical Derm).

Why? Genuinely asking.

 

[DermViser]

Hmph...I don't know any hospitals where 48 hr response time for a consult is acceptable even for a bogus one.

Agree. Our consults are supposed to be seen within 24 hours as policy, but in reality it is never even close to that long. If you are the consult Derm resident, then that is your job. You see the patient that same day when you get the consult.

 

[67552931811]

Posted by @DermViser in another thread.View attachment 180837

It would be interesting to see where PM&R docs fit in that survey. I've never seen them reported in such data, though.

 

[Cyberdyne 101]

It would be interesting to see where PM&R docs fit in that survey. I've never seen them reported in such data, though.

You should find satisfaction in pm&r if you enter the field for the right reasons. A lot of it involves managing chronic conditions such as spine disease, pain, neurodegenerative illnesses, etc. And as @Frazier pointed out, some of the patients are in depressing states i.e. traumatic brain injury and spinal cord injury. Although, as a physiatrist, you're helping them restore as much function as possible. If you're excited about treating such conditions, then it should be a very satisfying endeavor. Also, quite a few pm&r docs treat sports injuries in addition to the other stuff.

 

[mimelim]

Hmph...I don't know any hospitals where 48 hr response time for a consult is acceptable even for a bogus one.

Private hospital, private services, like I said, we (including the intensivist) forgot that they were even called. I don't think that this is right, but... A private Dermatologist gets a call from a random intensivist that they have never heard of about SJS on a Saturday afternoon, you think they are coming into the hospital before Monday? Heck, I don't even know if they got the message until Monday. They probably haven't been to the inpatient hospital in years.

Why? Genuinely asking.

I wrote what I did for a reason. This isn't about TY years or Derm residents. I mentioned Derm residents because, they are smart, at least at baseline I expect them to be somewhat capable/book smart. But, after their particular TY year, they were useless. We have a lot of different institutions that send us residents to this particular ICU because of how it is setup, PGY-1s from GS x2 institutions, IM from one program, FM from one program, Vascular from one program, Ortho from one program, TY from one program, etc. And while n=2, the TY residents were just plain weak. To me, it was clear that their approach to their intern year was to treat it exactly like MS4, minimal responsibility, minimal help, minimal caring for patients, minimal learning and this reflected in their capacity to function in the hospital. I'm not looking for them to put in lines like a GS resident or run a code like one of the IM residents. I'm talking about carrying their weight, seeing patients efficiently, not requiring someone else to be on call with them because they couldn't do the basics that every other intern there over 2 months could. Ya, I get it, this is an intense ICU and is nothing like their future residency or practice. But, you are there, there are real lives being impacted every minute of every day. How about just taking a little bit of pride in your education or in the care of others?

 

[DermViser]

I wrote what I did for a reason. This isn't about TY years or Derm residents. I mentioned Derm residents because, they are smart, at least at baseline I expect them to be somewhat capable/book smart. But, after their particular TY year, they were useless. We have a lot of different institutions that send us residents to this particular ICU because of how it is setup, PGY-1s from GS x2 institutions, IM from one program, FM from one program, Vascular from one program, Ortho from one program, TY from one program, etc. And while n=2, the TY residents were just plain weak. To me, it was clear that their approach to their intern year was to treat it exactly like MS4, minimal responsibility, minimal help, minimal caring for patients, minimal learning and this reflected in their capacity to function in the hospital. I'm not looking for them to put in lines like a GS resident or run a code like one of the IM residents. I'm talking about carrying their weight, seeing patients efficiently, not requiring someone else to be on call with them because they couldn't do the basics that every other intern there over 2 months could. Ya, I get it, this is an intense ICU and is nothing like their future residency or practice. But, you are there, there are real lives being impacted every minute of every day. How about just taking a little bit of pride in your education or in the care of others?

I know you weren't picking on those who do transitional years or Derm residents as you previously stated. To be fair, by the time May rolls around, most prelims and transitionals heading on to another residency have mentally "checked out". People in advanced program specialties don't want to do internships - they have to. I'm not excusing the behavior, just saying that's how it plays out in real life.

There have been threads here in the past to the tune of, "What is the minimum level of work I can do during internship and still pass" (he was headed to Radiology). They could honestly care less if people's lives are being impacted. I also realize your experience in medical school and residency has been very different than for a lot of people in med school (but you're also 2 standard deviations above the average in many respects, so that's neither here nor there).

 

[67552931811]

You should find satisfaction in pm&r if you enter the field for the right reasons. A lot of it involves managing chronic conditions such as spine disease, pain, neurodegenerative illnesses, etc. And as @Frazier pointed out, some of the patients are in depressing states i.e. traumatic brain injury and spinal cord injury. Although, as a physiatrist, you're helping them restore as much function as possible. If you're excited about treating such conditions, then it should be a very satisfying endeavor. Also, quite a few pm&r docs treat sports injuries in addition to the other stuff.

Ugh, obviously. Not sure why you broke down the field to me, as it had nothing to do with my post. I'm fully aware of what their job entails.

 

[Cyberdyne 101]

Ugh, obviously. Not sure why you broke down the field to me, as it had nothing to do with my post. I'm fully aware of what their job entails.

My bad. What I should have said is that the satisfaction should be high (given the hrs and salary) if one goes into the field for the right reasons. I've never seen them reported in that data myself. The few I know are very happy though.

 

[Winged Scapula]

Private hospital, private services, like I said, we (including the intensivist) forgot that they were even called. I don't think that this is right, but... A private Dermatologist gets a call from a random intensivist that they have never heard of about SJS on a Saturday afternoon, you think they are coming into the hospital before Monday? Heck, I don't even know if they got the message until Monday. They probably haven't been to the inpatient hospital in years.
?

I appreciate you giving him the benefit of the doubt but I can guarantee you that every hospital has medical staff requirements that must be met to be on staff regardless of whether this is a private facility or a tertiary care center.

All of the hospitals that I have ever had privileges that, and there are a lot, stipulate that consults must be seen or at least acknowledged (and with a good reason not to be seen), within 24 hours. That goes for all specialties even those that don't know where the ICU is.

This is about respect for your colleagues and for the patient; if you get a consult on Saturday you don't wait until Monday to see the patient unless you are specifically told by the consultant that is acceptable. Even the ward clerks calling these consults (and many hospitals now have rules that consultation requests must be made physician to physician) at job requirements which include documentation of all consultations and other outstanding duties.

I write this as someone who went in to see a new consult, over the holiday weekend, on a patient that could have reasonably seen me after discharge. So I find it somewhatdisappointing that other specialists don't feel the same.

 

[freemontie]

This study is a few years old, but a lot of this data should still be relevant.
View attachment 180835
A neurosurgery resident once told me that the pm&r residents were the happiest in her hospital.

http://www.mothersinmedicine.com/2010/03/pm-holy-grail.html?m=1

People reference that chart a lot here. Should point out that there is a glaring mistake for the neurosurgury bar figure. According to the avg and conf. errors, it should be around #2 but the bar they have for it is wildly wrong.

 

[Cyberdyne 101]

People reference that chart a lot here. Should point out that there is a glaring mistake for the neurosurgury bar figure. According to the avg and conf. errors, it should be around #2 but the bar they have for it is wildly wrong.

It is a glaring error Neurosurgery should be just below (or tied with) critical care internal medicine.

 

[Cyberdyne 101]

I also realize your experience in medical school and residency has been very different than for a lot of people in med school (but you're also 2 standard deviations above the average in many respects, so that's neither here nor there).

Not to be intrusive, but aren't people who enter fields such as vascular surgery and neurosurgery usually a few standard deviations above the average?

 

[DermViser]

Not to be intrusive, but aren't people who enter fields such as vascular surgery and neurosurgery usually a few standard deviations above the rest?

Indeed they probably are.

 

[DermViser]

I appreciate you giving him the benefit of the doubt but I can guarantee you that every hospital has medical staff requirements that must be met to be on staff regardless of whether this is a private facility or a tertiary care center.

All of the hospitals that I have ever had privileges that, and there are a lot, stipulate that consults must be seen or at least acknowledged (and with a good reason not to be seen), within 24 hours. That goes for all specialties even those that don't know where the ICU is.

This is about respect for your colleagues and for the patient; if you get a consult on Saturday you don't wait until Monday to see the patient unless you are specifically told by the consultant that is acceptable. Even the ward clerks calling these consults (and many hospitals now have rules that consultation requests must be made physician to physician) at job requirements which include documentation of all consultations and other outstanding duties.

I write this as someone who went in to see a new consult, over the holiday weekend, on a patient that could have reasonably seen me after discharge. So I find it somewhatdisappointing that other specialists don't feel the same.

We're assuming here that the private practice Dermatologist even got the consult on the same day the consult was put in, at a community hospital, no less. At most academic medical centers, when a consult is put in, it is not only put in to the computer but also called in as well.

 

[Winged Scapula]

We're assuming here that the private practice Dermatologist even got the consult on the same day the consult was put in, at a community hospital, no less. At most academic medical centers, when a consult is put in, it is not only put in to the computer but also called in as well.

Perhaps you forget that I work in a community system.

Yes, it is possible that the consult wasn't put in, but as I noted in my response above, most hospitals have requirements about these, not only for staff but for administrative personnel as well (i.e., any outstanding order not acted on within 24 hrs, is "flagged"; you have to document that the call was made to remove the flag), so I'm not sure why there would be any difference in community vs academic environment. You guys are assuming the consult wasn't received. My POV is that it is just as likely that it was received and not acted on.

It works the same way here: someone (either the physician, mid-level etc) puts the order in the EMR and someone calls it in. Occasionally, the physicians will even talk directly about the consult rather than have the ward clerk call it in.

 

[DermViser]

Perhaps you forget that I work in a community system.

It was more directed at mimelim, than to you, as to why the patient may not have been seen until Monday by the dermatologist, assuming the consult was actually put in properly.

 

[W19]

Not to be intrusive, but aren't people who enter fields such as vascular surgery and neurosurgery usually a few standard deviations above the average?

Few standard deviations! How? Average step 1 is 230 now and stdv is 21... Not sure what you mean by 'few'. Average step 1 for vascular surgery last charting outcome was 237... I would not call that 'few' standard deviation above the mean... Obviously it is not.

 

[W19]

Indeed they probably are.

No they are not....

 

[Cyberdyne 101]

Few standard deviations! How? Average step 1 is 230 now and stdv is 21... Not sure what you mean by 'few'. Average step 1 for vascular surgery last charting outcome was 237... I would not call that 'few' standard deviation above the mean... Obviously it is not.

I don't think @DermViser was referring to Step 1 scores and I certainly wasn't. At least to me, it seems that vascular surgeons, neurosurgeons, etc simply enjoy being in the hospital more than others.