Which Speciality should i choose?....

mdfirst said:

Ok, i am a person who is fairly smart, and loves problem solving. But, i get bored very easily with mundane details, and routine. I also im kinda lazy, i will admit. For a person like me, which specialty would you consider?

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emergency medicine perhaps? what did you like in 3rd and 4th years? what were you good at?

ER is probably the best one for people who are easily bored.
Avoid internal medicine and family practice if mundane stuff and paperwork drives you crazy.
Avoid surgical fields because you'll get your a-- kicked and it's really bad hours.
Anesthesia might be OK, but you have to pay attention and be detail oriented.
Derm would be an option if you are top of your class.

Lunch lady.

Hmmm, problem solving. How about getting a public policy degree and help solve the healthcare crisis...

pillowhead said:

emergency medicine perhaps? what did you like in 3rd and 4th years? what were you good at?

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Ive been told that EM becomes mundane, unless you work at a large urban hospital, where it helps to be detail oriented if you don't want to get sued for missing something.

every specialty eventually becomes mundane. be it the fp working up his 100th hypertensive, the pulmonologist consulting on his 100th COPDer, the surgeon doing his 100th hernia...whatever it may be no matter how "cool" it may seem to you now. like last night the attending, a few of us residents, and the med students on call were just hanging out in the lounge watching tv when the trauma pager went off. the med students jumped to their feet all excited while the attending just groaned and muttered something like "not more of this bull$%#"

LOL doctorino...there's a certain amount of truth in that. So you better pick something you'll like to do repetitively. Still, ER has more variety than some other specialties.

I honestly can't imagine that I could ever be bored with EM, not even in 30 years. I mention that because theres a downside to every specialty, and as Im deciding which one to go into myself, Im not coming up with too many objective negatives to EM... But If I cant imagine being bored with EM, Im fairly certian that Im missing something.

but anyway.

Some potential negatives of ER practice.
1) usually you are employed or with a large group practice, so not as easy to "do your own thing" or "run your own show"
2) greater percentage of mean/difficult patients vs. most other specialties because the ER has to take all comers, plus gets the folks on drugs/EtOH first before any other doc sees them
3) higher percentage of patients with "entitlement mentality", most likely, because you'll get some folks who could have waited until tomorrow to see their primary doc for some minor ailment but chose not to, and you get a higher percentage of folks who aren't paying for their care (either b/c they can't/have no money or are on Medicaid, etc.) and may not appreciate the difficulty of what you do
4) ER docs feel they are trained to take care of trauma and other emergencies, but also end up seeing a lot of routine/primary care stuff in some cases
5) having to call other docs/hospital services to "beg" for admission of some patient if the doc/hospital service doesn't want to accept the admission
6) sometimes having to beg a consultant/service to come see a patient if they don't want to
7) I have heard many ER docs complain of "customer service satisfaction surveys" being given out to patients and then hospital administrators coming back to harrass the docs who didn't do that well, even if the reason was the patient had unreasonable expectations or was drug seeking, etc.
8) along with primary care offices, the ER sees a high number of "drug seeking" patients who come in the ER wanting narcs or benzos and may get mean or threatening if they don't get them
9) no patient continuity (could be a good thing, depending on your persepctive, but you also don't get the gratification of a "thank you" most of the time and sometimes don't get to find out "how you did")

dragonfly99 said:

Some potential negatives of ER practice.

5) having to call other docs/hospital services to "beg" for admission of some patient if the doc/hospital service doesn't want to accept the admission
6) sometimes having to beg a consultant/service to come see a patient if they don't want to

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Huh. Not here in Texas. As an IM attending, I would never tell the ER "no" concerning a patient - consults and admissions are part of the job. And if I were in ER and had #5 or #6 to deal with, I assure you it would only happen once.

Thanks for those points.... something to think about.

Someone on the SDN a while ago had mentioned that in EM, more so than other fields, it's important to know how to manage your own "business". I think point #1 above hits on that.

Why is that? I understand that ER groups are a lot like law firms, where you have brand new scut monkeys who have to work where and whenever they are told. And, you have the partners, who work when and where they want, and make all the money.

Ive also heard that with EM you may never have the flexibility of your own schedule... paradoxically. Even though you only have to do 12 shifts a month, even after 30 years in the business, you might still have to do a night or two each month. I realize that EM is a new field... we really cant be sure of this now.

(Most of the old-timer ER docs we know are actually internists and FPs. The very first EM residency in the country was started 38 years ago... Im curious to see how those folks are doing.)

There are many different types of group practices in EM. The "law firm" model certainly would not apply to the majority, and when you finish residency you generally have quite a bit of selection when it comes to choosing your job, so you should not end up in that kind of practice unless you just want to work in such an environment. Every member of the group I work in is paid equally via the same formula - an hourly "base" rate plus an RVU component that pays you for your productivity - how many patients you saw/how sick they were/procedures.

There is quite a bit of schedule flexibility in EM. In my group, we each work 2 true night shifts per month. These are 9 hour night shifts and tend to be scheduled together, pretty painless actually. It is very easy to either request any specific day off you would like or to trade shifts with someone else. I work 15-18 nine hour shifts every month. I'm not sure who is giving you your information, but I can tell you from personal experience that it is not an accurate generalization.

dragonfly99 said:

Anesthesia might be OK, but you have to pay attention and be detail oriented.

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umm not so sure about this. Most of my friends in anesthesia do not have long attention spans or detail oriented. I think it may be a good job for you, particularly if you have an interest in physiology.

mdfirst said:

Ok, i am a person who is fairly smart, and loves problem solving. But, i get bored very easily with mundane details, and routine. I also im kinda lazy, i will admit. For a person like me, which specialty would you consider?

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I immediately thought anesthesia after reading the OP.

anesthesia can be painfully mundane in some hospitals

How about psychiatry? Difficult to get bored, as every one of your patients has their own life story; the field is evolving and you could contribute to its development; plus you will have to learn loads of new skills (psychotherapy, for example) on top of good old palpation, percussion, auscultation....

Just my 2 cents

BabyPsychDoc said:

How about psychiatry? Difficult to get bored, as every one of your patients has their own life story; the field is evolving and you could contribute to its development; plus you will have to learn loads of new skills (psychotherapy, for example) on top of good old palpation, percussion, auscultation....

Just my 2 cents

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Lazy and psychiatry are a bad combination. Thats a huge factor that turned me away from it. I saw a lot of - "Titrate to stupor" and kick the poor chap out the door. If you're lazy, you'll be a bored psychiatrist. If the laziness is ego-syntonic, you'll be a dangerous psychiatrist.

howelljolly said:

Lazy and psychiatry are a bad combination. Thats a huge factor that turned me away from it. I saw a lot of - "Titrate to stupor" and kick the poor chap out the door. If you're lazy, you'll be a bored psychiatrist. If the laziness is ego-syntonic, you'll be a dangerous psychiatrist.

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Agreed. However, an argument can be made that psychiatry is one of the more "laid-back" specialties in medicine. One could also argue that lazy and medicine in general (any subspecialty of it) are a bad combination.

True, I guess that means you have to know what the OP means by Lazy... needs a life-and-death emergency to get up, just laid back, hates to work, will not try to get away with not titrating diabetes meds because any goat will know that the patient is uncontrolled, or will try to get away with not titrating psych meds because a coma is a very tight control of a psychopathology.

Anyway, this isnt that useful.... its just my experience that I went into my 3rd year Psych core thinking psych was for me, and finished with a very different idea.

pillowhead said:

emergency medicine perhaps? what did you like in 3rd and 4th years? what were you good at?

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Hmm... correct me if I'm wrong, but isn't (Lazy x EM) = Lawsuit?

lowbudget said:

Hmm... correct me if I'm wrong, but isn't (Lazy x EM) = Lawsuit?

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Yup

I got a feeling that the OP just made up the initial question to see what the responses would be, and is sitting back with his persian cat on his lap, and snickering at the messy aftermath.

Does that mean youre not dead yet?

What say you be a little more discripitive?

If like "laid back" then youd fit with Psychiatry all the way to Urology, and everything in between with Family Medicine.

Psychiatry and Urology are very cerebral, and FM is what you make of it.

Yes they are laid back, but you're still going to get your a-- kicked as a surgical intern, so don't underestimate that.
Also, urology is one of the most competitive specialties to get (from what I have heard, 2nd only to derm, but I'm sure someone will/could debate that).

About getting an a-- kicking as an intern. What's the best way to get into a program that doesnt have the 'pressure-cooker' mentality of education?

There are plenty of people who learn better under pressure. And there are some perfectly laid back attendings, who consciously turn on a loud, in-your-face persona when they're teaching, and only because they believe that it makes them a better teacher.

That doesnt do me any good. I loose focus, micro-manage some things, skim over others, and probably screw up.

I found I learn and perform better when Im given responsability with the assumption that I'll do just fine. I guess Id rather prove the attendings right, than prove them wrong.

In my clerkships, I can see that there are some distinct differences between programs on this.

How do I look for a program that would support this? I dont think I should just directly say "This is what works for me... what do you do?" I suppose I need to get a feel for it from the residents, and maybe ask them about it indirectly. Then I'll have to go with my gut, and impressions. But... anyone have any other pointers?

I would say-- get out of New York!! That's one thing I HATE about training here.

Honestly, although personality type is by no means environmentally determined, I think a well-functioning hospital in a place where people are pretty happy with life, aren't always thinking about accomplishing the next great thing and ticking off the next big box, have families and belong to community or religious organizations or whatever (ya know, so they interact with 'normal' people at some time during their week)-- that would be a great place to look for people who teach through love of knowledge, efficiency and patience rather than intimidation and belittlement.

I might just be romanticizing, but the time I spent in third year outside of the City, plus my experiences in medicine before med school, make me think New York just isn't the most wholesome training environment sometimes.

mdfirst said:

I did a preceptorship in Urology and I loved it. I liked the residents and doctors. they seemed to be really cool, and the subject matter was really interesting.

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I've heard Public Health can be a pretty sweet desk job in some circumstances. I've also seen an MD/MBA in a financial position that looked pretty cool. You might be able to utilize your previous training or undergrad degree to open some different doors. It's hard to find a good/normal job in medicine. You have to look really hard. Part of it is finding a sweet program regardless of specialty. "Better hour" specialties can still have programs that suck hour wise. You might look into get JD or MPH training, that might open some different doors that you might not need a residency for.

I really have a hard time getting along with all the Type A's in medicine too, don't give up hope!

I guess that means that you can think about doing one of those residencies in General Preventative Med, or Occupational Med.