Options in IM

[buddym]

Hello all!

For those of you that have not read my threads in other forums, let me introduce my situation. I am a US medical student and I am pondering what field to go into. I have eliminated some specialties based on how I like the work, hours/lifestyle, etc, but still have a lot left that I am considering (IM, FP, Rad, EM). I am unique in that one of my top priorities is what type of city I live in. I would like to live in a medium size town (pop=20,000) and practice in either an office type envt or a clinic type envt (not decided yet), with occasional visits to the hospital. I would not mind working in a larger city, so long as my job had light enough call to where I could commute 1 hour or so to where I live and not be called back to the hospital every night (I do not want to always live 15 minutes from a hospital).

My question is, do these lifestyle requirements definetly rule out or rule in any of the subspecialties in IM? Are there any specialties of IM that are increasingly in demand in smaller cities? What is the job market like for some of the specialties (security is important to me as well)? Thanks for any input!

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[Stormreaver]

Some of the medical subspecialties are tailor-made for your type of situation. I'd say the best fit is rheumatology. The bulk of the work is clinic-based, with occasional in-hospital consults. Call tends to be very light since there really aren't that many rheumatological emergencies that can't wait till morning (and I've never paged the rheum fellow in the middle of the night). The reimbursement is pretty good but not great, although it's likely to take a hit with the recent cut in reimbursement for infusions. Also: rheumatologists are in great demand in most places around the US.

 

[Idiopathic]

Since when is 20,000 a medium-sized town, and how could a town of that size support a rheumatologist? Is that viable? Just wondering...

 

[bariume]

Since when is 20,000 a medium-sized town, and how could a town of that size support a rheumatologist? Is that viable? Just wondering...

Good point. Most common rheumatologic conditions can be handled quite well by the general practitioner. But depending on what town it is, it may also be severely deficient of subspecialists. For example, I was once visiting a small town in florida where a local person told me they had to travel at least 2 hours to see a neurologist.

Thinking about your market base is important, but should come secondary to what appeals to you . Afterall, you are going to be practicing whatever field you choose for decades to come.

 

[buddym]

Thanks everyone for the replies! I actually did a Rheumatology rotation during my medicine clerkship and really liked it. It was pretty laid back, it is a no-stress field. The compensation is not that much more than a generalist, but the workload is real light (at least in academic practice). A friend of mine in school has an uncle who is a rheumatologist in a smaller town, and he has a 6-month waiting least to be seen. I do think that this is the exception to the rule, though.
When I say medium size, I just meant not rural but not a larger metro city, somewhere in between. But as I mentioned in my post, I would be willing to work in a large city and commute, but I needed something that had light enough home call to do that.
It is true that I am looking first and foremost for something I enjoy. But, I will not live 15 minutes from a large hospital in the big city. Forget it, that is the #1 priority for me! After all, work is work!