Going into something for money and lifestyle - is it really a mistake?

footcramp · Dec 27, 2005

I'm not the type of person that LOVES things. I typically find things fleetingly interesting or acceptable.

That being said, I'd guess that greater than 90% of the world does something to pay the rent and put food on the table rather than because they really enjoy it. And not everyone is committing suicide.

So I wonder if going into a medical field solely for money and lifestyle is a huge mistake or not, as long as it's not something I completely, utterly despite and abhor (neurology, ob). I mean I think I can tolerate a lot of things, but not necessarily "enjoy" them. For example I can find things I like about medicine but the thought of doing IM doesn't exactly excite me.

Interested in your thoughts.

cytoborg · Dec 27, 2005

Have you done your clinical rotations yet? Maybe you will be surprised. But if you've already been-there-done-that and have come to the conclusion that you just don't care for anything you did on the wards, well, that's a more difficult question. Do you have to absolutely 100% love your specialty? My personal opinion is no. You just have to like it enough to spend x hrs a week doing it, and that's going to depend on your definition of "enough," and how many hours you have to do it. To devote, say, 80+ hrs a week as an attending, you probably would want to be pretty passionate about your work - but if you spend 40-50 hrs a week doing whatever, maybe you wouldn't necessarily have to love your work so much, since you'd have time to do other stuff you enjoy. There is some truth to the "ROAD to happiness" - lifestyle does make that road a bit smoother. But, for me personally, even if I am "only" working 40-50 hours, that's still a pretty good chunk of my life and I don't want to waste it being miserable. But that's me.

rs2006 · Dec 27, 2005

Hi all
While I understand the whole Derm and ophtho and possibly rads as part of the whole ROAD to a "good lifestyle," I have yet to understand how anesthesia is considered an excellent lifestyle specialty since it seems to me that anesthesia is simply surgery without rounds and continuity of care-- the anesthesiologist is (hopefully-- at least when I did my surgery rotation) the person who is there before (a few minutes at least) during and after the surgery-- they are the first person in and the last out of the OR (again hopefully, but based on what I have read on this website it seems not, how that is I do not know!!). Also, if an emergency surgery is required (ie appy, lap chole, etc) and anesthesiologist MUST be there (again, at least that is what happened during my surgery rotation-- according to all that is written in the forums on this site, apps done after 5p and on weekends seem to be done without anesthesia!) If anyone can answer this question, please do as I am a confused fourth year med student. As for Rads, I think it is a great lifestyle (at least in terms of hours), but the downside that I hear about is the amount of pressure in reading the films-- there is virtually NO ROOM for error (unless you are looking forward to litigation!). Again, just the worthless rambling of a fourth year med student! Any countering viewpoints are more than welcomed!!! Happy New Year and thanks!!

USAF MD '05 · Dec 27, 2005

As for Rads... there is virtually NO ROOM for error (unless you are looking forward to litigation!).

Hahahahahahahahha! Have you ever read a read on a CT/film/ you name it? Unless the diagnosis is screaming in their face, the hedge all over the place! " Cannot rule out ____... recommend x study or clinical correlation required" seems to be copied and pasted onto the end of 85% of their reads! If I wanted to operate strictly clinically, I wouldn't have ordered the damn study in the first place!
Steve

tigershark · Dec 28, 2005

Why would it be a mistake? What kind of idiot would go into a career in which they werent happy with the pay/lifestyle? What percentage of the workforce do you think is absolutely in "love" with their career?

monkey7247 · Dec 28, 2005

USAF MD '05 said:
Hahahahahahahahha! Have you ever read a read on a CT/film/ you name it? Unless the diagnosis is screaming in their face, the hedge all over the place! " Cannot rule out ____... recommend x study or clinical correlation required" seems to be copied and pasted onto the end of 85% of their reads! If I wanted to operate strictly clinically, I wouldn't have ordered the damn study in the first place!
Steve

I once had a CXR read as "Infiltrate suggestive of viral infiltrate. However, cannot rule out PCP". :scared:

So, it's either totally benign or terrible. They have an awesome job. You rarely have to sack up.

TommyGunn04 · Dec 28, 2005

Perhaps this is the optimist in me, but I see medicine as not just a job but as a "profession" and a "calling" of sorts. Ultimately it's a service profession, for physicians serve others with their knowledge and expertise, in order to improve health and lives. If you don't really "love" what we do in medicine, then you really should rethink whether it'll actually make you happy. A career in medicine entails a committment to life-long learning, and if you're not 100% dedicated to it then chances are you're going to fall behind and end up not doing what's best for your patients. I've seen this a number of times with community physicians who get all of their medical information from drug reps, and then prescribe all the wrong meds for their patients. Then again, if you're doing dermatology this may not be as much of a concern.

I'm not saying you can't be happy viewing medicine as "just a job," but considering all the time, effort, and money that goes into becoming a physician it would seem that there are much more efficient ways to be content and make a similar salary, especially considering how tough it is to get into one of the "lifestyle specialties." Most of us won't be making a real salary until we're about 30, and then we face the prospect of loan repayment. If you don't really love medicine and the opportunities it affords, I'd think that this prospect would tend to make one bitter. There's a reason why dentists have a high suicide rate, and I'd imagine that it's similar to that of an unhappy dermatologist.

JackPB · Dec 28, 2005

My Friends:

I'm a 4th-year resident in anesthesiology. Why did I chose this field? Well, it fits my personality. I like super-critical medicine. I enjoy performing procedures. I like the control over a patient. I like the career freedom and daily flexibility. I'm happy to walk into the hospital every morning. If you have to work for a living, I think anesthesiology is the most fun career there is.

But, yes, money and lifestyle are factors in my specialty choice.

It's dirty to talk about money as a motivation for pursuing any specialty. But let's face it, anesthesiology is a very well compensated field. A quick look at:

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

reveals about a $275,000/yr salary for an anesthesiologist. We can compare this to, say, a pediatrician* who makes $175,000.

That's a $100,000 difference per year!** This is an ivy-league education for your son. It's two catered weddings for your daughters. It's half your student loan balance. It's two well-equipped BMWs or six Hondas. It's five hundred Apple iPODs. An anesthesologist can buy two iPODs every working day and toss them in the lake every night with a plop and still do as well as a pediatrician. He can buy a Honda every two months of his working life and drive that into the lake when the new car smell wears off. This line of thought can be taken to absurdity.

Money won't make you happy! Let's talk about time instead. An anesthesiologist can take off the months of May, June, July, and August every year and still do as well as our pediatrician. Or, he could retire at age 51 instead of the pediatrician's age 60.** This is a lot of extra time! Extra time to raise your children, romance your spouse, volunteer overseas, write a novel, whatever! Time is the most precious commodity, after all. Everyone has only so much, but no one knows how much.***

I'm very lucky that my career preference is well compensated. But what if I liked pediatrics* just as much? Or more? I'd have to ask myself, "how much more?" Six Hondas per year more? Nine years of free time more?

Jack

*I have the utmost respect for pediatricians and for all branches of medicine. Most of my best friends are physicians of all types.

**Yes, oversimplified.

***I can think philosophically, as my residency is nearing an end.

Mirror Form · Dec 28, 2005

rs2006 said:
Hi all
While I understand the whole Derm and ophtho and possibly rads as part of the whole ROAD to a "good lifestyle," I have yet to understand how anesthesia is considered an excellent lifestyle specialty since it seems to me that anesthesia is simply surgery without rounds and continuity of care-- the anesthesiologist is (hopefully-- at least when I did my surgery rotation) the person who is there before (a few minutes at least) during and after the surgery-- they are the first person in and the last out of the OR (again hopefully, but based on what I have read on this website it seems not, how that is I do not know!!). Also, if an emergency surgery is required (ie appy, lap chole, etc) and anesthesiologist MUST be there (again, at least that is what happened during my surgery rotation-- according to all that is written in the forums on this site, apps done after 5p and on weekends seem to be done without anesthesia!) If anyone can answer this question, please do as I am a confused fourth year med student. As for Rads, I think it is a great lifestyle (at least in terms of hours), but the downside that I hear about is the amount of pressure in reading the films-- there is virtually NO ROOM for error (unless you are looking forward to litigation!). Again, just the worthless rambling of a fourth year med student! Any countering viewpoints are more than welcomed!!! Happy New Year and thanks!!

Good questions, there are a couple reasons. The main one is that anesthesia often amounts basically to shift work. Anesthesiologists don't have 2000 patients who think of you as "their doctor." You'll be on call, but only on certain shifts. Yes, you have to get up early. But your hours are very predictable and you can arrange them in any way you like, while still getting compensated well. Also, anesthesiologists realized decades ago that sleep deprivation led to higher rates of medical mistakes. So they don't work the same crazy hours as surgeons.

Solideliquid · Dec 28, 2005

JackPB said:
My Friends:

reveals about a $275,000/yr salary for an anesthesiologist. We can compare this to, say, a pediatrician* who makes $175,000.

That's a $100,000 difference per year!** **Yes, oversimplified.

***I can think philosophically, as my residency is nearing an end.

What kind of malpractice are you going to have to shell out? When I did my peds rotation the guy said he paid $18K/yr in malpractice.

Also don't forget that when Uncle Sam comes around hes taxing that a$$ a lot more for you than the peds guy.

oldbearprofessor · Dec 28, 2005

Okay, I'll grant you that my life would be much better if I had 500 ipods and could drive hondas into the lake on a whim 🙄 , but this one really threw me for a loop.

As I am much closer to 51 than most of the posters here, this issue is a real one. My wonderful wife and I have decided that I would be best off never retiring, let along retiring early.

Why?

Well, for one thing, my kids are teenagers - college students and high-schoolers. They don't exactly need or want me hanging around at home all day. Heck, they're rarely home anyway. My wife has a career of her own and hardly wants me at home all day. And my career as an academic neonatologist and researcher allows me to travel at will and volunteer lots of time overseas. I turn down way more trips than I accept. I can barely write bad poetry (see the pedi forum), so I don't think a novel is in my future either. I don't golf, fish, bowl and don't particularly care to take these up.

If I retire, I'll sit home reading SDN and playing video games that I've lost the reflexes to do as well as you guys. It seems like, since, as you do, I enjoy going into work each day, that I am best off caring for critically ill babies, teaching the next generation of doctors and trying to understand how best to provide nutrition for children. This is what I'm supposed to do with my life in my view and making more money to retire sooner would hardly make me happier, or the people around me better off.

But I would like to have more iMacs (one ipod seems enough, don't you think?)

Regards

OBP

JackPB said:
My Friends:

Or, he could retire at age 51 instead of the pediatrician's age 60.** This is a lot of extra time! Extra time to raise your children, romance your spouse, volunteer overseas, write a novel, whatever! Time is the most precious commodity, after all.

JackPB · Dec 28, 2005

Solideliquid said:
What kind of malpractice are you going to have to shell out? When I did my peds rotation the guy said he paid $18K/yr in malpractice.

Off topic, the malpractice premiums for anesthesiologists are quite low. People still have the perception that anesthesia is dangerous. That was once true; it isn't now, most of the time. Much of this is due to anesthesiologists' very successful efforts to improve patient safety in the last twenty years. The Wall Street Journal did an interesting piece on the subject just this year.

From the article:

Malpractice payments involving the nation's 30,000 anesthesiologists are down, too, and anesthesiologists typically pay some of the smallest malpractice premiums around. That's a huge change from when they were considered among the riskiest doctors to insure. Nationwide, the average annual premium for anesthesiologists is less than $21,000, according to a survey by the American Society of Anesthesiologists. An obstetrician might pay 10 times that amount, Medical Liability Monitor, an industry newsletter, reports.

Reference: The Wall Street Journal, June 21, 2005

zpatel84 · Dec 28, 2005

JackPB said:
Off topic, the malpractice premiums for anesthesiologists are quite low. People still have the perception that anesthesia is dangerous. That was once true; it isn't now. Much of this is due to anesthesiologists' very successful efforts to improve patient safety in the last twenty years. The Wall Street Journal did an interesting piece on the subject just this year.

too bad all your jobs are being taken by Nurse Anesthetists. In about ten years most Anesthesiologists will be left without jobs.

lvspro · Dec 28, 2005

zpatel84 said:
JackPB said:

Off topic, the malpractice premiums for anesthesiologists are quite low. People still have the perception that anesthesia is dangerous. That was once true; it isn't now. Much of this is due to anesthesiologists' very successful efforts to improve patient safety in the last twenty years. The Wall Street Journal did an interesting piece on the subject just this year.

too bad all your jobs are being taken by Nurse Anesthetists. In about ten years most Anesthesiologists will be left without jobs.

Click to expand...

Thank you nostradamus for that omnipotent prediction. Would you be so kind as to give me the direction of a few stocks, and maybe this weeks lottery numbers too? 🙄

Poety · Dec 28, 2005

oldbearprofessor said:
Okay, I'll grant you that my life would be much better if I had 500 ipods and could drive hondas into the lake on a whim 🙄 , but this one really threw me for a loop.

As I am much closer to 51 than most of the posters here, this issue is a real one. My wonderful wife and I have decided that I would be best off never retiring, let along retiring early.

Why?

Well, for one thing, my kids are teenagers - college students and high-schoolers. They don't exactly need or want me hanging around at home all day. Heck, they're rarely home anyway. My wife has a career of her own and hardly wants me at home all day. And my career as an academic neonatologist and researcher allows me to travel at will and volunteer lots of time overseas. I turn down way more trips than I accept. I can barely write bad poetry (see the pedi forum), so I don't think a novel is in my future either. I don't golf, fish, bowl and don't particularly care to take these up.

If I retire, I'll sit home reading SDN and playing video games that I've lost the reflexes to do as well as you guys. It seems like, since, as you do, I enjoy going into work each day, that I am best off caring for critically ill babies, teaching the next generation of doctors and trying to understand how best to provide nutrition for children. This is what I'm supposed to do with my life in my view and making more money to retire sooner would hardly make me happier, or the people around me better off.

But I would like to have more iMacs (one ipod seems enough, don't you think?)

Regards

OBP

What a nice post, thanks OBP, it was inspirational 🙂

Lonestar · Dec 28, 2005

Zpatel84,
God forbid you have to have surgery in the future. Most likely, you will encounter an anesthesiologist. Ignorance begets ignorance.

The ROAD specialties are the way to go in medicine. I am very happy with my choice of anesthesia (PGY2). Let me give you some of the reasons why: no rounding, limited pt interaction, cool procedures, still get to apply your medical knowledge, excellent pay, good hours, long vacation, low malpractice, flexible scheduling of shifts...blah, blah, blah. Each one of the fields has its own pluses and minuses, but after extensive research on the subject (i shadowed a lot of private practices in medschool) i came to the same conclusion as many others had before me. The ROAD specialties rock!!! In all of them: you are an expert, good lifestyle, good pay, good vacation time, you are not everyone's doctor, and minimal rounding.

BTW: when i graduate residency, i am throwing a big Party.

Goofyone · Dec 28, 2005

Lonestar said:
you are an expert, good lifestyle, good pay, good vacation time, you are not everyone's doctor, and minimal rounding.

Let me add no dictating, especially discharge summaries!!!!

DropkickMurphy · Dec 28, 2005

BTW: when i graduate residency, i am throwing a big Party.

Are we all invited? More importantly: Is there going to be an open bar?

rs2006 · Dec 28, 2005

Hi all,

I hope everyone has had an enjoyable Holiday Season and their interviewing is going well. Anesthesia has come up several times on this thread and as a fourth yr med student at a school where greater than 20% of my class is going into the field I wanted to know what it is that is drawing so many people to the field THIS YR (usually in a good yr, the field gets approx 0.5-2% of the class, but this yr and last it was ridiculous (approx 15% last yr)!!!-- It is not as if oxygen and halothane were just discovered yesterday!! Any thoughts. Thanks and happy new yr!!

Sledge2005 said:
Good questions, there are a couple reasons. The main one is that anesthesia often amounts basically to shift work. Anesthesiologists don't have 2000 patients who think of you as "their doctor." You'll be on call, but only on certain shifts. Yes, you have to get up early. But your hours are very predictable and you can arrange them in any way you like, while still getting compensated well. Also, anesthesiologists realized decades ago that sleep deprivation led to higher rates of medical mistakes. So they don't work the same crazy hours as surgeons.

Doctor Bagel · Dec 28, 2005

stupid question, for people on the ROAD path and similar things, did you never really want patient interaction, or did you change your mind in med school? i'm noting that that's mentioned as a plus in threads about those specialties, and as a lowly premed, i think i want lots of patient interaction.

as for the original question, again lowly premed here, but i do have a job, am a career changer and things like that. lifestyle and pay are certainly factors in all career decisions, so i wouldn't discount them. but if you're making a decision solely on those factors, you might wind up unhappy. not enjoying what you do sucks even if you're only doing it for 40 hours a week.

f_w · Dec 28, 2005

Patient interaction is overrated.

In the ROAD specialties you actually have patient interaction, just on a different level. You see them, you do for them what they came for, you send them on their way (in O&D you even have regulars, just as any primary care doc would).

Skrubz · Dec 28, 2005

exlawgrrl said:
stupid question, for people on the ROAD path and similar things, did you never really want patient interaction, or did you change in your mind in med school? i'm noting that that's mentioned as a plus in threads about those specialties, and as a lowly premed, i think i want lots of patient interaction.

it's not that i never enjoyed interacting with patients. actually, i really enjoyed talking with and caring for some of my patients last year (prelim medicine w/ continuity clinic). and some of my fondest memories of med school are of the kids i cared for during peds. but there were by far many more patients and/or families that i didn't want to interact with... like the family who demanded that i give the patient morphine because he was a heroin addict (hospitalized for another round of cellulitis thanks to his skin-popping).

it's true that as an anesthesia resident i don't have that much time to interact with my patients. unless i'm lucky and have enough time to do post-op visits, it's limited to the immediate pre-op holding area and the PACU, plus induction and emergence. but i like to think that the interaction that i have with my patients still makes a difference. some of my attendings have told me that an anesthesiologist's demeanor and rapport with a patient pre-op can be a much better sedative than Versed. 😉 i go home happy when my patients wake up well and are comfortable in the PACU. it's a bonus when they thank me for being with them throughout their surgery. and i feel like i've actually made a difference, as opposed to the days i used to spend in clinic, dreading the next post-discharge train wreck to walk in my door.

of course, i'm a little biased. 🙂

monkey7247 · Dec 28, 2005

exlawgrrl said:
stupid question, for people on the ROAD path and similar things, did you never really want patient interaction, or did you change in your mind in med school?

Ophtho can have oodles of pt interaction if you're looking for it. The field runs the gamut from "FP for your eyes" to "cataract cowboy". Best. Field. Ever.

PS- for all you wanting to cut anesthesia out as a desired field, ask yourselves this question: "What would you rather take, the "ROAD to success" or the "ROD to success" ?"

f_w · Dec 28, 2005

I might add that a fair number of anesthesiologists do outpatient pain management once they hit the world of private practice.

Poety · Dec 28, 2005

PEOPLE PEOPLE DO NOT UNDERESTIMATE THE ANESTHESIOLOGISTS!!!! - take this from someone who recently had a kid would ya? They are right up there with the Gods in my eyes 🙂 Thank heaven for anesthesiologists, and thank God for the one who gave me my epi that didn't even hurt 😀

DropkickMurphy · Dec 28, 2005

f_w said:
I might add that a fair number of anesthesiologists do outpatient pain management once they hit the world of private practice.

For $315,000 to $651,000 a year (according to one website) can you blame them?

DrRobert · Dec 28, 2005

I agree that anesthesia is a great field that allowed one to make a ton of money in the 1980s/1990s. However, the financial draw of anesthesia is rapidly fading. Refer to my thread in the anesthesiology forum. Just read the first post because after that the thread gets hijacked.

psychedoc2b · Dec 28, 2005

footcramp said:
I'm not the type of person that LOVES things. I typically find things fleetingly interesting or acceptable.

That being said, I'd guess that greater than 90% of the world does something to pay the rent and put food on the table rather than because they really enjoy it. And not everyone is committing suicide.

So I wonder if going into a medical field solely for money and lifestyle is a huge mistake or not, as long as it's not something I completely, utterly despite and abhor (neurology, ob). I mean I think I can tolerate a lot of things, but not necessarily "enjoy" them. For example I can find things I like about medicine but the thought of doing IM doesn't exactly excite me.

Interested in your thoughts.

Don't do IM, neuro, or ob then. Find a specialty in which you will remain sane, satisfied, and happy. I think money is important but if you are doing a specialty just for the money, you might become disappointed in the long run. You have to remember you have to work to earn high dollar salaries. Derm may not be hard work but would you actually enjoy diagnosing skin cancers for the rest of your life. If you do, then go for it. The dermpath makes alot of money but takes more training. I don't know what year you are in med school but you should find a specialty that suits your interests without compromising your happiness. I know of people from rads, uro, and ophtho that have changed specialties because of the lack of personal satisfaction and fulfillment.

GAS is considered a specialty in which many others change into. They are usualy from IM, but also can be from surg and other fields. I think the problem I have with GAS is that you are dependent on the demands of the surgeons. GAS people are always playing second fiddle to the surgeons. Also, if you don't have many connections with other surgeons, you may not make as much money. But, GAS people are just as important as any other specialists.

Again, you should do a specialty in which you can see yourself spending long hours day in and day out for the rest of your career. No matter what specialty you choose, if you want the big bucks you must earn it either by extra training and/or working longer hours. Money is important but happiness is fulfillment.

psychedoc2b

JackPB · Dec 28, 2005

oldbearprofessor said:
As I am much closer to 51 than most of the posters here, this issue is a real one. My wonderful wife and I have decided that I would be best off never retiring, let along retiring early.

I agree completely. For me, retiring to a golf course at age 51 is just as absurd as driving my car into the lake. I'd go nuts with boredom. I'd guess that most people who can go through the effort of becoming doctors in the first place would feel the same way. However, it sure would be nice to have the financial freedom to do whatever I want. That "whatever" might just be... to continue anesthesiology.

JPB

f_w · Dec 28, 2005

it sure would be nice to have the financial freedom to do whatever I want. That "whatever" might just be... to continuing anesthesiology.

I think work is a lot more fun if you go there because you like it, not because you have to.
Here and there you will find intelligent physicians who can resist the urge to adjust their spending to their income once they come out of residency. These people are able to maintain a good lifestyle at moderate cost and save up enough money to go part-time in their 50s. (Some academic part-time gig to pay the utility and tax bills on your paid-off home, doing some locums when you please and spending your winters in that nice house in Portugal you bought a couple of years back out of a bank auction.)

JackPB · Dec 28, 2005

I'll agree with another sentiment on this thread:

Anesthesiology. Rocks. Your. World.

The good hours, good pay, fun work, blaw, blaw are well-described. There have been dire predictions about the future of anesthesiology for a long time, but I am not worried. Many such predictions have proven themselves wrong. My fellow graduating residents and I continue to enjoy our work and entertain excellent opportunites.

For those of us who crave patient interaction, there is no need to fear! Those scant minutes before surgery are golden for interaction. The patient and his family are positively mesmerized by my every word. The patient is at his most vulnerable moment, steeling himself for a brush with the gaping maw of Death himself! Under my very hands! In just a couple of minutes! No turning back now!!! His family is also vulnerable--they see themselves offering up their beloved one on a sterile altar to modern medicine. The anesthesiologist's perceived abilities and projected demeanor are absolutely essential to a pleasant patient experience. Post-surgically, nothing beats the looks of relief on the family's faces when I tell them everything went well. You bet these are satisfying interactions which I enjoy.

Anesthesia! WooHooo!!

Yeah!!

cytoborg · Dec 28, 2005

exlawgrrl said:
stupid question, for people on the ROAD path and similar things, did you never really want patient interaction, or did you change your mind in med school? i'm noting that that's mentioned as a plus in threads about those specialties, and as a lowly premed, i think i want lots of patient interaction.

Not a stupid question. I'm on the golden "path," entered med school very primary-care oriented (did the volunteer work at clinics for the underserved, etc). In med school I also really enjoyed patient care - I never did really "change my mind" about it. I still really enjoy my patient interactions doing fine needle aspirations and the like. Choosing a specialty ended up being quite a complicated thing for me, as I liked pretty much everything, including path, which just ended up being the best overall package deal for me.

GoPistons · Dec 29, 2005

why all this buzz about anesthesia??

I don't really understand why they make so much, but we can surely expect big cuts in the future (as with all of medicine)... they are mostly just sitting around all day...

I wanted to love anesthesia so much when I was a medical student, but I just felt that not only was it boring, anesthesiology is way too much like nursing... they put lines into people and then push medicine (similar to nursing)... they also tape IVs to people and get yelled at by surgeons (similar to nursing)... they record vital signs most of the time and are really good at untangling all of those IVs that keep getting all jumbled together (similar to nursing)... I didn't go to medical school to be a nurse...

as a doctor, I want to be an expert in something that other physicians aren't... that's why I picked Rads... don't get me wrong... Rads has its problems too... you are like a glorified factory worker just reading scan after scan after scan... you are at the mercy of other physicians... if they don't like you, they will just keep scanning the uninsured while they know you won't get paid for it... and most physicians think they can read scans better than you even though they really can't... it sucks when every specialty thinks they can do your job better than you can...

ophtho is incredibly boring... who wants to learn about the eye anyway??... in med school we spent 5 days learning about the eye... I don't understand how the residency could take so long!!! even the muscles are so pathetically simple... for God's sake!!... give me a week and I can learn the 25 eye diseases and then point and shoot lasers into people's retinas all day long... worse is that everyone's thinks that you're an optometrist...

derm... c'mon!!!... only super Rhode's Scholar, Westinghouse finalist, National Merit freaks go into derm... and for what??? so you can give everyone topical steroid for every type of rash they have... I have never ordered a derm consult in my life... why? b/c I knew what to do... give steroids... and if that doesn't work... give stronger steroids... and if that didn't work... get a biopsy...

so as you can see the ROAD sucks...

If I had to do it all over again, I would have been a neurosurgeon... Oh wait... they don't have a life... and they get divorced about 4-5 times...

so medicine sucks...

should of went into investment banking...

Buck Strong · Dec 29, 2005

exlawgrrl said:
stupid question, for people on the ROAD path and similar things, did you never really want patient interaction, or did you change your mind in med school? i'm noting that that's mentioned as a plus in threads about those specialties, and as a lowly premed, i think i want lots of patient interaction.

I love patient contact, and initially wanted to do medicine as a pre-med. Then I realized that alot of the patient contact you get in IM isn't very rewarding for me. Example...the drug seekers, the malingering patients, the social admits, the demented/delirious 86 y.o. turf from nursing home...etc. I wanted to find a field where i could see patients, not be rushed and have time to talk to them and get to know them, figure out what their problem was, help them, maybe do surgery if they needed it, and then see them in followup when they're much better. Sure the eye is a very focused area, and med schools don't spend much time on it, but it is one of the most complex parts of the body. Hence...the 75 different fellowships you can do after residency. Plus...it's a very happy field, the residents and attendings are nice people, most of the patients are happy to see you, because you can fix their problem, and the nurses/techs are happy, because the hours are reasonable and the docs aren't demanding. Finally, it's very objective...most of the time, the disease processes can be seen, or not seen...it's pretty hard for a patient fake glaucoma so that they can get a script for weed 😉 . So...the long answer to your short question is...No, I didn't go into ophtho to shy away from patient interaction, but i'm exchanging frustrating interaction for quality patient interaction. But it's not everyone's cup of tea...thank god or it'd be even more competitive than it is...best of luck finding whatever your calling is.

Buck Strong · Dec 29, 2005

Oh, and one more tip for those of you who are still undecided. Find out what you hate about a specialty...and if you can put up with that for the rest of your life, it's a keeper. Find out the best part of that specialty, and if you can see yourself doing that even after you won the lottery, married a hot sugermomma, found oil in your back yard and were independently wealthy...then it's definitely a calling, not just a job for you. Heck, if I win the powerball next week, I'll still be nervous as hell and praying to my gods come Jan 20th when the match results get sent out! 👍

Doctor Bagel · Dec 29, 2005

thanks for the people who answered my question! interesting stuff, and yeah, i can see where you're coming from.

Butch · Dec 30, 2005

I would like to add a few points from my limited experience (I am now a PGY-1 intern ultimately going into radiation oncology) to the original question.

1. You should do what you love and what excites you the most, but definitely appreciate the downside. I think it is a mistake (in fact, a big mistake) to choose a "lifestyle" specialty that you are not interested in. While the money is good, you will be very unhappy as a dermatologist if you are not interested in diseases of the skin. You will spend a LOT of time at your job no matter what field of medicine.

The counterbalancing point is to have an appreciation of the negatives of a field. Litigation in OB/Gyn, hours in surgery, and low-pay in Pediatrics are part of the field.

2. Each field has certain patients and a type of patient. You should enter a field where you feel comfortable.

3. Listen to yourself. There is a lot of pressure from family, significant others, friends, classmates and mentors about the field that you should go into.

4. Nothing is irreversible. You can change if you are unhappy.

For me, radiation oncology is an amazing field. Interesting patients (who are actually sick), technology, clinical evidence, real patient contact (not rushing to see people in 2 minutes because of the HMO), great colleagues, procedures, and also great hours/reimbursement.

Trisomy13 · Dec 30, 2005

DrRobert said:
Just read the first post because after that the thread gets hijacked.

i.e., just read the first post, because after that, people with different opinions contribute.

😉

MD Dreams · Dec 31, 2005

exlawgrrl said:
stupid question, for people on the ROAD path and similar things, did you never really want patient interaction, or did you change your mind in med school? i'm noting that that's mentioned as a plus in threads about those specialties, and as a lowly premed, i think i want lots of patient interaction.

I can completely understand where you are coming from. Most physicians love patient interaction. Unfortunately, the world is no longer what it was. Times have changed and society has changed. Physicians are no longer expected to interact with patients, they are expected to deal with every single problem a patient has, and I'm not talking about just medical problems. Patient interaction is great if you see the patient, take care of their MEDICAL issue and say goodbye. But as you will see when you get into the wards, that's not what many specialties do. I'm doing my internal medicine rotation right now and I can tell you that internists (and this is not to disrespect them) have become glorified secretaries. They spend the entire day ordering this test and that test, making sure labs were drawn, x-rays taken, trying to find housing for the patients in conjunction with social work, etc. They see their patients for maybe a total of 10 minutes in a given day. Some don't even know the names of their patients. In addition to all this they are held responsible for the 1000 medical problems patients present with, many of which are due to their lifestyle. On top of that, they have to deal with all of the unpleasant, ungrateful patients and their demanding families. In addition, there is very little respect from nursing, allied health teams and patients/families and very little money for the hours you put in and what you have to go through. In this day and age people do whatever they want without taking accountability for their actions and at the end of the day they expect the physician to take care of EVERYTHING. If I wanted to take care of peoples social issues, I would have become a social worker. I want to deal with medical problems, not with life problems. This is why many people shy away from primary care and go into specialites which focus only towards a specific medical issue, have very little to do with the patients life problems, get paid well, and have a good lifestyle. This is also why these specialties are some of the most competitive. I hope I made sense with all that I wrote. Again, once you see it you'll know what everyone is talking about.

One other thing, it becomes very frustrating when you see so much money and effort spent on drug abusers, gang bangers, people who don't have any desire to take care of themselves, etc. only too see them temporarily stabalize so that they can go out and do what they did before and end up in the hospital the next week. It takes the joy out of medicine.

DrRobert · Dec 31, 2005

Trisomy13 said:
i.e., just read the first post, because after that, people with different opinions contribute.

😉

Actually the thread was designed to give a real-world perspective on current anesthesia reimbursement. It quickly turned into a MDA vs. CRNA debate, which has nothing to do with my post.

chicamedica · Dec 31, 2005

GoPistons said:
why all this buzz about anesthesia??

I don't really understand why they make so much, but we can surely expect big cuts in the future (as with all of medicine)... they are mostly just sitting around all day...

I wanted to love anesthesia so much when I was a medical student, but I just felt that not only was it boring, anesthesiology is way too much like nursing... they put lines into people and then push medicine (similar to nursing)... they also tape IVs to people and get yelled at by surgeons (similar to nursing)... they record vital signs most of the time and are really good at untangling all of those IVs that keep getting all jumbled together (similar to nursing)... I didn't go to medical school to be a nurse...

as a doctor, I want to be an expert in something that other physicians aren't... that's why I picked Rads... don't get me wrong... Rads has its problems too... you are like a glorified factory worker just reading scan after scan after scan... you are at the mercy of other physicians... if they don't like you, they will just keep scanning the uninsured while they know you won't get paid for it... and most physicians think they can read scans better than you even though they really can't... it sucks when every specialty thinks they can do your job better than you can...

ophtho is incredibly boring... who wants to learn about the eye anyway??... in med school we spent 5 days learning about the eye... I don't understand how the residency could take so long!!! even the muscles are so pathetically simple... for God's sake!!... give me a week and I can learn the 25 eye diseases and then point and shoot lasers into people's retinas all day long... worse is that everyone's thinks that you're an optometrist...

derm... c'mon!!!... only super Rhode's Scholar, Westinghouse finalist, National Merit freaks go into derm... and for what??? so you can give everyone topical steroid for every type of rash they have... I have never ordered a derm consult in my life... why? b/c I knew what to do... give steroids... and if that doesn't work... give stronger steroids... and if that didn't work... get a biopsy...

so as you can see the ROAD sucks...

If I had to do it all over again, I would have been a neurosurgeon... Oh wait... they don't have a life... and they get divorced about 4-5 times...

so medicine sucks...

should of went into investment banking...

thing is. . .what makes an anesthesiologist a doctor is the decision-making. The patient care is acute therefore there is no time for a middle-man (e.g. a nurse) to take the orders and administer the meds, so the anesthesiologist him/her-self does it directly. Likewise for the vitals. its crucial to know the vitals in real time, to be able to make quick medical decisions on the spot. Simply pushing the drugs and straightening out lines is not anesthesia. As for iv's, i think every doctor should be an expert at putting them in. You shouldn't depend on the nurses for everything. . .they are busy themselves. And the iv lets you do little things like resuscitate someone dying in front of you. . .or keep an alive person alive.

it looks like, in general, you seem to have a very superficial idea of what all these specialties entail, and the depth of knowledge and expertise they really require. As you yourself mention, if these fields were really that simple, why would the residency be so long, and why would a strong background in medicine or surgery be required before even starting training in that specialty?
So, you learned about the eye in five days. Are you confident enough to go mess around with people's eyes with a scalpel? You think derm is that simple? Are u set to go just rub some steroids on a patient with TEN?

Trisomy13 · Dec 31, 2005

GoPistons said:
why all this buzz about anesthesia??

I don't really understand why they make so much, but we can surely expect big cuts in the future (as with all of medicine)... they are mostly just sitting around all day...

I wanted to love anesthesia so much when I was a medical student, but I just felt that not only was it boring, anesthesiology is way too much like nursing... they put lines into people and then push medicine (similar to nursing)... they also tape IVs to people and get yelled at by surgeons (similar to nursing)... they record vital signs most of the time and are really good at untangling all of those IVs that keep getting all jumbled together (similar to nursing)... I didn't go to medical school to be a nurse...

as a doctor, I want to be an expert in something that other physicians aren't... that's why I picked Rads...

if you walked away from anesthesiology thinking it is boring, then you didn't get a real sense of what is going on inside the anesthesiologist's head -- anticipating and planning for anything and everything that could possibly go wrong while making sure everything goes right. and getting yelled at by a surgeon more than once speaks more to how one handles interpersonal dynamics. man can tame and teach a polar bear to ride a tricycle - modifying another person's behavior is not too difficult.

as far as not being an expert... I guess human physiology and critical care issues are not "medicine"???? you become an expert in the fundamental underpinnings of the human body's response to stimuli and disease.

I hope you don't get too bored "sitting around all day" in radiology doing "expert" readings of clear lung fields. :laugh:

med99 · Dec 31, 2005

6 honda's, 500 Ipod. One word, "Taxes"

Your paying 33% federal taxes on every penny you earn more than a pediatrician. Depending on what state you live in your state tax rate can be up to 9%. You have to pay sales taxes on many items. SS and FICA add another chunk of taxes.

You will be very lucky if you get even half of that 100K back. Now granted, 50K is still alot of money. But also consider hours worked per week and stress levels, this makes the differances not look quite as stark.

Hurricane · Dec 31, 2005

Trisomy13 said:
if you walked away from anesthesiology thinking it is boring, then you didn't get a real sense of what is going on inside the anesthesiologist's head

I agree. I'm not going into anesthesia (far from it - psych) but I had a great rotation when I did it as an elective. But from talking to my fellow med students who did their rotations elsewhere, most students have boring rotations, and don't see half of what an anesthesiologist can do. My rotation started off pretty boring, but after a couple days the guy in charge of the rotation went on vacation, and his replacement saw me sitting there watching the AA do stuff, and started barking at me that this rotation wasn't all about learning to intubate. After that I basically did all of the cases from start to finish with the AA watching over my shoulder to make sure I didn't kill anybody, and it wasn't boring at all anymore. And I did a couple call nights with a liver and heart transplant, and those cases were quite the opposite of boring. I never sat down the whole evening, we were working so hard. I also got to go with one of the attendings to his pain clinic, where he does spinal steroid injections under fluoroscopy and other procedures. I had no idea anesthesiologists did that, and most of the med students who did rotations elsewhere didn't know it either. And they run ICUs at a lot of hospitals. But unfortunately, most of the rotations give the impression that anesthesiologists just read the paper and get yelled at by surgeons.

toxic-megacolon · Dec 31, 2005

rs2006 said:
it seems to me that anesthesia is simply surgery without rounds and continuity of care

What the hell? What about the whole "operating" thing? And having the supreme authority to choose what radio station is listened to in the OR is nice 😛

Going into something for money and lifestyle - is it really a mistake?

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