Anesthesia v derm

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jacksparrowMD

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I’d be miserable in derm, so it’s not for me.
Midlevels will be a problem going forward IMO.
Better lifestyle in derm for now.
What work do you like better?
 
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IM plus subspecialty of choice.

Derm is a very low hanging fruit. Anesthesia is already ripe and rotting.
 
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IM plus subspecialty of choice.

Derm is a very low hanging fruit. Anesthesia is already ripe and rotting.
People that say cardiology are wrong. Long training, not great pay and subspecialists and interventionalist people have a terrible lifestyle. GI is good but very very competitive. Other IM sub specialties don’t seem all that great.
 
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People that say cardiology are wrong. Long training, not great pay and subspecialists and interventionalist people have a terrible lifestyle.

Regular Cards is the same amount of time as GI...and average mid career salary is about 550k per MGMA data. Many make into the 600-700s. Interventionalists routinely hit 800-1M. That's not great pay?
 
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These two specialties couldn't be more different from one another. First, it must be said, the competitiveness profiles of the two are very different. Think board scores in the top 1 %-ile, pubs, aways, letters from chairs, etc. Assuming this is you, and derm would be a realistic match possibility for you, as others have said, consider the work.

In anesthesia, your time isn't your own, you're often employed in one way or another, meaning someone who may not be a physician is making decisions about your time and your work. As has been said a million different ways, you will be a service provider for a patient who doesn't know you or, mostly, care who you are apart from the other anesthesia providers they could've had. This type of relationship has implications for how you'll be viewed and treated by patients, other physicians, and administrators. Because you don't control patient flow, your leverage for getting the things you want will be less than other types of specialists. On the flip side, it's a fun, interesting job that pays well, and that you can mostly leave at the door when you leave the hospital (I can't emphasize this enough as a quality-of-life factor). The work is fast-paced, at the pointy end of the spear, and involves both cognition and performance (i.e., doing difficult procedures quickly and safely, and handling emergencies with calm).

Dermatology, on the other hand, as I'm sure you can appreciate, is totally different. The work is not acute, mostly, and is more cognitive and less procedural/performance based (with Mohs being the exception). It is much more likely as a dermatologist that you would hang out your shingle and build a practice, as opposed to being employed. This has obvious pros and cons, but the point is, you'll be building a business, marketing, schmoozing, advertising, hiring/firing/managing staff, in addition to practicing medicine. On the flip-side, you'll never find a more motivated patient population. I noticed this as a student, and now as a patient (wicked-bad poison oak); if a patient has an itchy rash, you can tell them to rub dog s**t on it 5 times a day, and they'll do it 6. Derm practices also have a lot of potential for cash-based aesthetic stuff. This can mean lots of money, but you might start to feel like a shill.

In summary, again, assuming you would be competitive for both specialities, start to think about the differences in the actual work. Shadowing, rotations, talking to people in practice. Either can be really rewarding professionally, interpersonally, and financially, but are VERY different.
 
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STOP CHASING THE MONEY! It will not bring happiness.

Do something:
- you are passionate about
- you are good at
- you have a good chance matching into
- that has a relatively safe future
- that offers GOOD ENOUGH money, lifestyle etc.
 
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IM plus subspecialty of choice.

Derm is a very low hanging fruit. Anesthesia is already ripe and rotting.

Is this in regard to mid-levels? What about in GI/Cards where at some instituitions midlevels have started to get access/scope?
 
These two specialties couldn't be more different from one another. First, it must be said, the competitiveness profiles of the two are very different. Think board scores in the top 1 %-ile, pubs, aways, letters from chairs, etc. Assuming this is you, and derm would be a realistic match possibility for you, as others have said, consider the work.

In anesthesia, your time isn't your own, you're often employed in one way or another, meaning someone who may not be a physician is making decisions about your time and your work. As has been said a million different ways, you will be a service provider for a patient who doesn't know you or, mostly, care who you are apart from the other anesthesia providers they could've had. This type of relationship has implications for how you'll be viewed and treated by patients, other physicians, and administrators. Because you don't control patient flow, your leverage for getting the things you want will be less than other types of specialists. On the flip side, it's a fun, interesting job that pays well, and that you can mostly leave at the door when you leave the hospital (I can't emphasize this enough as a quality-of-life factor). The work is fast-paced, at the pointy end of the spear, and involves both cognition and performance (i.e., doing difficult procedures quickly and safely, and handling emergencies with calm).

Dermatology, on the other hand, as I'm sure you can appreciate, is totally different. The work is not acute, mostly, and is more cognitive and less procedural/performance based (with Mohs being the exception). It is much more likely as a dermatologist that you would hang out your shingle and build a practice, as opposed to being employed. This has obvious pros and cons, but the point is, you'll be building a business, marketing, schmoozing, advertising, hiring/firing/managing staff, in addition to practicing medicine. On the flip-side, you'll never find a more motivated patient population. I noticed this as a student, and now as a patient (wicked-bad poison oak); if a patient has an itchy rash, you can tell them to rub dog s**t on it 5 times a day, and they'll do it 6. Derm practices also have a lot of potential for cash-based aesthetic stuff. This can mean lots of money, but you might start to feel like a shill.

In summary, again, assuming you would be competitive for both specialities, start to think about the differences in the actual work. Shadowing, rotations, talking to people in practice. Either can be really rewarding professionally, interpersonally, and financially, but are VERY different.


Most accurate response
 
So what do you do when you shoot for GI/Cards and don’t match?!?

Yea, hard pass.
 
I am competitive for derm but its very much a crap shoot and theres always a real chance of not matching. I don't believe in the notion that one person is "destined" for a certain field because in the end it becomes a job and people can enjoy multiple fields. I personally enjoy certain aspects of both fields and can see myself in them. I think I enjoy anesthesia people the most because I have a very type B relaxed personality which clashes with those in Derm. However I don't know I can choose a field purely based on the certain people I have interacted with. In the end, you're right I just have to do my electives and see.

So pathology/radiology it is!

If you’re choosing based off personality clash of those you work then avoid anesthesiology completely.
 
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I am competitive for derm but its very much a crap shoot and theres always a real chance of not matching. I don't believe in the notion that one person is "destined" for a certain field because in the end it becomes a job and people can enjoy multiple fields. I personally enjoy certain aspects of both fields and can see myself in them. I think I enjoy anesthesia people the most because I have a very type B relaxed personality which clashes with those in Derm. However I don't know I can choose a field purely based on the certain people I have interacted with. In the end, you're right I just have to do my electives and see.

When I was choosing and interviewing, I interviewed in both ENT and Anesthesia, and realized that the reason I liked ENT so much was the people. When I started to realize that wasn't enough (for me), that I was maybe less interested in the actual work (I was trying to imagine being excited about learning about the mastoid bone at 3am) the choice was easier to make. And keep in mind, as a dermatologist, you probably won't really be working with other dermatologists that much.
 
Is this in regard to mid-levels? What about in GI/Cards where at some instituitions midlevels have started to get access/scope?
That will happen in EVERY specialty, more or less. It's just a matter of time. The question is how much extra business remains for docs. In anesthesia, 75% of the cases could be done without an MD (we can debate forever with what risks and consequences). Same goes eventually for colonoscopies and other monkey see monkey do procedures.

The more intellectual a specialty is, the lower the chances it can be taken over completely by midlevels. In the end, there is a reason physicians do years of medical school and GME. Also the stronger, longer and more continuous the patient-doctor relationship is in a specialty, the tougher it is to break it. Hence IM beats derm and anesthesia long-term.

Btw, a lot of the money-making procedures in derm can be learned by any doc (or non-doc). It's not brain surgery.
 
So pathology/radiology it is!

If you’re choosing based off personality clash of those you work then avoid anesthesiology completely.

This. Working effectively with multiple personality types is extremely important in anesthesia. More people struggle with this than the actual anesthesia.
 
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I am competitive for derm but its very much a crap shoot and theres always a real chance of not matching. I don't believe in the notion that one person is "destined" for a certain field because in the end it becomes a job and people can enjoy multiple fields. I personally enjoy certain aspects of both fields and can see myself in them. I think I enjoy anesthesia people the most because I have a very type B relaxed personality which clashes with those in Derm. However I don't know I can choose a field purely based on the certain people I have interacted with. In the end, you're right I just have to do my electives and see.

Really read though @cchoukal post. There's a lot of gold in there. Anesthesiologist have the "relaxed" personality they do for a reason. First, no one wants to see a panicking anesthesiologist in the OR. That's always a bad look. Can we be Type A? Of course, but the fact that we are service providers sometimes you have to put that Type A personality in check. There's a good amount of compromising the goes on in anesthesiology because we aren't the "bread winners" so to speak. You HAVE to know how to play well with others in anesthesiology. That isn't to say you don't need to be collegial in Derm, of course you do or you'll get no referrals, but again, as was said, in Derm you can be your own boss. You work when you want, how you want, and as long as you want, for the most part. We work when there are cases, how we want to do the case (for the most part), and as long as the cases go.

There are definite pros and cons to each field but if you're truly competitive for derm you find yourself in a good position. You can probably get "a" derm resident spots and you can probably get "any" anesthesiology spot. The fields are very different and do have very different personalities and I'm not sure, but it does make me wonder how many of us on this forum, had we been competitive for something like Derm, would we have done it. I'm not sure that answer. Most of us don't really like clinic work so we'd probably all still be on this forum (or maybe the IR suite).
 
Derm. Because you have a backup.

Just asking derm vs anesthesiology means you probably aren't super passionate about one of them especially since they are so different. And besides many people go into XYZ thinking they really like it based on 1 or 2 rotations, and realize it's not what it seemed once they do residency. Many med students choosing anesthesiology dont know much about the political landscape, decreasing salaries, rising work hours, etc of anesthesiology and those things do have an impact on your level of happiness in your 40 yr long career.

Derm is a lifestyle specialty unlike anesthesiology. If you end up not loving it, at least you can work 40 hrs and earn way more than anesthesiology. Or you can open shop and set your own hours, see your own patients. In anesthesiology your days are unpredictable, you probably cant cherry pick your cases, and you dont set your hours. At least for derm you have more control and have time to enjoy life out of work.
 
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