Advice from an attending

[docscience]

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He asked me what I wanted to do and i told him medicine perhaps...perhaps critical care. He said "thats a busy lifestyle" (he is a orthopod)

He said, "let me tell you this...whatever specialty you pick...you can have two out of the three: lifestyle, money, or type of practice"

What do you all think? pretty solid advice for the most part...a good generalization..

 

[Purepwnage]

i'll bite

i think hes being pretty vague....

you can have a good lifestyle/money/type of practice you want all in the speciality you prefer, you just sometimes have to compromise, i.e. trade lifestyle for money.... but you can still have a decent lifestyle and a decent ammount of money in your prefered practice type, but you cant have obscene ammount of money/ work 2 hours a day and have a practice that will accomodate you.

 

[bronx43]

The trifecta that usually gets thrown around is money, lifestyle, and location. Pick two out of the three - sometimes even one out of the three.

 

[deleted6669]

I have heard this as specialty, location, or salary. pick 2.
it is the dream job that has all 3.
you can always find a job in your specialty in the area you want that pays badly.
you can always find a job in the location you want for good pay doing something you don't want to do.
you can always find a job in your specialty with great pay in a place you don't want to live.

 

[wine is good]

Critical care actually has pretty good lifestyle. It's mostly shiftwork. You don't take work home, of course, depends on the setup. Being part of a group of critical care physicians who take turn covering the icu and taking call is actually a very life style friendly and lucrative career. It's high in demand. Asking orthopods about this stuff is not the best course of action😀

 

[cartoondoc]

An orthopod attending led my med school ethics section. I remember he took the section out to lunch on the last day and he systematically insulted every single specialty we said we were interested in: peds was like veterinary medicine, neurology was pointless because you couldn't treat anything, psych was only for crazy people, etc.

 

[DrJosephKim]

Career decisions will always involve a balancing act. However, if you plan strategically, then you can find yourself enjoying a nice balance of wealth and a good lifestyle. These decisions must be made early and thoughtfully.

 

[MR1]

It is always a trade off. Take mine for example, ophthalmology. Lifestyle for the most part is very good. Location and money though flip flop. If you want location, money suffers and vice versa. So much that a rural area might pay 5x what San Fran or NYC would per year.

 

[docscience]

It is always a trade off. Take mine for example, ophthalmology. Lifestyle for the most part is very good. Location and money though flip flop. If you want location, money suffers and vice versa. So much that a rural area might pay 5x what San Fran or NYC would per year.

So what did you choose? and why? thanks!

 

[jdh71]

He said, "let me tell you this...whatever specialty you pick...you can have two out of the three: lifestyle, money, or type of practice"

^^^ I think this is a much more appropriate saying than: "lifestyle, money, or location" . . . mostly because when most people say, "location" they generally mean somwhere "urban" on the coast, perferably where it's warm most of the year (think San Diego). You see for me, a guy who grew up in the middle of nowhere, not only do I have ZERO compunction about moving to a rural locations, I think I want to. Somewhere where I can have a lot of land, a self-sufficient garden, a bunch of dogs and I can shoot my guns as much or as little as I want (ostensibly clutching my Bible(s) and cranking up the freedom rock 🙄) . . . so I could VERY easily get lifestyle, money, and location

Now . . . type of practice that's a different beast, especially if you're into some weird and/or rare. Weird or rare basically mean you need to be in a big city, and probably also part of the academic community. Trying to set up you private occular melanoma clinic in wyoming may be tough . . .

Thing is, ironically to this orthopod, if ANYTING comes close to being able to hit all three it it's critical care. Scope of practice?! Come on it's critical care. Critical care is critical care is critical care - if you can do one type, you can do another just as eaily. The pay is really good, easily mid 300's in most places without killing yourself. And as mentioned previously shiftwork = lifestyle. So if you like critical care, you should be able to get all three without too much trouble.

 

[MJB]

^^^ I think this is a much more appropriate saying than: "lifestyle, money, or location" . . . mostly because when most people say, "location" they generally mean somwhere "urban" on the coast, perferably where it's warm most of the year (think San Diego). You see for me, a guy who grew up in the middle of nowhere, not only do I have ZERO compunction about moving to a rural locations, I think I want to. Somewhere where I can have a lot of land, a self-sufficient garden, a bunch of dogs

Amen....I'm not sure there's enough money in the world to get me to live in what many on here consider "desired locations"...

I've been in suburbia hell...I'll take mid-size to small cities, thank you. Or, preferably just outside them.

 

[Excelsius]

1. It's not all specialties that are being compensated at higher rates in rural areas. Some specialties, like plastics, would have a better niche in L.A. than somewhere in Kentucky.

2. If you do choose a field with significantly larger rural compensation, would it be too difficult to practice a few years rurally after finishing residency, getting your finances in order, and then moving to an urbanized locale? You can even choose a state with no income tax and save even more. This seems to make financial sense and I don't see why it can't be done.

 

[kitsunepixie]

2. If you do choose a field with significantly larger rural compensation, would it be too difficult to practice a few years rurally after finishing residency, getting your finances in order, and then moving to an urbanized locale? You can even choose a state with no income tax and save even more. This seems to make financial sense and I don't see why it can't be done.

When I was jobshadowing an EM doc ~4yrs ago, one of the newly minted attendings had just moved from rural Alaska, where she had gone after residency to hammer away at her debt. She said that they offered her a 7-figure salary (!) to stay, but she wanted to return to the Midwest to be with family. I guess if you love nature, it can't be that bad!

I'd personally rather practice somewhere with semi-rural scenic views than in a big city (lived in Tokyo and got my lifetime fill of urban life), but I want to stay in academia, too.

 

[MOHS_01]

.

 

[Laryngophed]

You see for me, a guy who grew up in the middle of nowhere, not only do I have ZERO compunction about moving to a rural locations, I think I want to. Somewhere where I can have a lot of land, a self-sufficient garden, a bunch of dogs and I can shoot my guns as much or as little as I want (ostensibly clutching my Bible(s) and cranking up the freedom rock 🙄) . . . so I could VERY easily get lifestyle, money, and location

x2

Both my SO and I are from smallish towns, or just outside of them, and knowing how desperate areas like that are for docs makes it feel almost like highway robbery. They tend to pay well (depending on specialty and saturation of market, obviously) and provide docs lots of lattitude. As a bonus, your salary in that small town goes quite a bit further. And you can "shoot [your] guns as much or as little as you want (ostensibly clutching [your] Bible(s) and cranking up the freedom rock)" and not be an outcast whilst doing so.

 

[ZDoggMD]

Interesting thread. My 2% of a buck:

The hospitalist gig scores really high on the location part of the equation, because there seems to be a shortage of us suckers everywhere as more and more hospitals begin to adopt the model. So whether you wanna work in rural Kauai or in a big city, chances are there's a group or practice desperate to have you. Especially in Kauai...mosquitos and wild chickens run amok there 😉

Pay (of course) varies with location but can be quite excellent, especially for a speciality that doesn't require further training beyond IM residency. If you go it alone, you usually have to make your pay by busting your arse seeing tons of patients. But if you join a multispecialty group practice or academic institution you can be salaried mostly with an often lighter workload. And of course, growing speciality with relative shortage of docs = more leverage with regards to salary.

Ah, but the rub is lifestyle...or is it? This is where the real variability comes in. Many programs are organized as shift work, some are organized with call cycles that follow housestaff and the like, some are nocturnist-type shifts. There's enough choice that it is really possible to find a work schedule that agrees with your innate temperament (I can't emphasize how important this component is to overall happiness!! NEVER take a job where the schedule seems at odds with how you are wired!)

So I think you can find the sweet spot between location, cash-money bling, and lifestyle as a hospitalist, as long as you take your time and are thorough in your search.