Balance between work and home life

[dk.hirsch]

Looking for some advice pertaining to choosing specialties that contain a decent work-life balance. I'll begin med school in July and I understand I have years before I make any significant decision, but I want to try and get an idea as to what specialities offer decent work-life balance. I've worked in an ER now for almost 10 years and initially was wanting to do emergency medicine, but with what I'm kind of seeing from multiple facilities is the influx of NPs and PAs in the ER and I don't want to find myself in a position where I won't have a job or am competing for a job. (nothing against NPs/PAs by the way. Just want to ensure I can keep a job once I get one and not lose it over a dollar sign)

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[Neopolymath]

Psych. The world is your oyster.

 

[hallowmann]

Psych. The world is your oyster.

Shhhhhh! Stop telling people!!

 

[Neopolymath]

Shhhhhh! Stop telling people!!

Sometimes, I wish I did psych. I enjoyed it so much. It would have made my life a lot less complicated too. Oh well. No way to switch now and I'm happy so it doesn't even matter anyways.

 

[hallowmann]

Sometimes, I wish I did psych. I enjoyed it so much. It would have made my life a lot less complicated too. Oh well. No way to switch now and I'm happy so it doesn't even matter anyways.

To be fair, there's a lot of psych that can be heavy and bring you down. Outside of psychiatrists a lot of people don't talk about the emotional toll or the toll it takes dealing with patients that constantly self-sabotage, seek external validation, the weight of completed suicides, or simply have bad ASPD/BPD. The reason is because most of the people in psychiatry are still happy with their choice. Every field has pros and cons, and you really want to make sure you enjoy the bread and butter when you choose a specialty. Post-residency almost any specialty can afford a good balance.

As much as I joke that Psychiatry is the promised land, there are some days where I'm just like, I think I need some FM today, some simple HTN and DM2 management, MSK diagnoses, etc. Its why I'm glad where I am.

 

[dk.hirsch]

To be fair, there's a lot of psych that can be heavy and bring you down. Outside of psychiatrists a lot of people don't talk about the emotional toll or the toll it takes dealing with patients that constantly self-sabotage, seek external validation, the weight of completed suicides, or simply have bad ASPD/BPD. The reason is because most of the people in psychiatry are still happy with their choice. Every field has pros and cons, and you really want to make sure you enjoy the bread and butter when you choose a specialty. Post-residency almost any specialty can afford a good balance.

As much as I joke that Psychiatry is the promised land, there are some days where I'm just like, I think I need some FM today, some simple HTN and DM2 management, MSK diagnoses, etc. Its why I'm glad where I am.

I got to agree. I guess I never really thought about psych. I think mainly due to those aspects that aren't talked about and I can only imagine how much of a struggle it would be to treat a patient and have to wait months at a time to see any minute amount of progress. Than again, I haven't spent any time with psych outside of the seeing the patients in the ER before they're released or transferred to another facility. I'm going to have to check psych out. Can't knock it before I rock it

 

[dk.hirsch]

I do have to also ask. Why psych? Just due to the demand for psych? Or am I missing a piece of the puzzle? Also, are any specialties with surgery essentially out of the question for a nice balance?

 

[hallowmann]

I do have to also ask. Why psych? Just due to the demand for psych? Or am I missing a piece of the puzzle? Also, are any specialties with surgery essentially out of the question for a nice balance?

In demand everywhere, good pay differential for the hours, OK residency, relatively varied practice options, most people are working 32-36 hrs a week outpatient and still bringing in $250-$300k.

Surgery residencies will be out of the question not necessarily the attending life, but you can create a scenario in which any field could give you a balanced life, depending on what that means for you. Even EM, if you switch to only UC, you can easily have a balanced life, but for some people they would be miserable doing that. Certain surgical fields are pretty nice, the residencies notwithstanding. ENT, Ophtho, etc. can all have relatively easy 8-5 schedules but still make a ton of money. It really depends on what you want to do and what you're willing to go through in school/residency.

 

[ciestar]

To be fair, there's a lot of psych that can be heavy and bring you down. Outside of psychiatrists a lot of people don't talk about the emotional toll or the toll it takes dealing with patients that constantly self-sabotage, seek external validation, the weight of completed suicides, or simply have bad ASPD/BPD. The reason is because most of the people in psychiatry are still happy with their choice. Every field has pros and cons, and you really want to make sure you enjoy the bread and butter when you choose a specialty. Post-residency almost any specialty can afford a good balance.

As much as I joke that Psychiatry is the promised land, there are some days where I'm just like, I think I need some FM today, some simple HTN and DM2 management, MSK diagnoses, etc. Its why I'm glad where I am.

Geri-psych was particularly difficult for me.

 

[Zendo]

Sometimes, I wish I did psych. I enjoyed it so much. It would have made my life a lot less complicated too. Oh well. No way to switch now and I'm happy so it doesn't even matter anyways.

Do you mind sharing how it would have made your life a lot less complicated?

 

[Neopolymath]

Do you mind sharing how it would have made your life a lot less complicated?

You can hang a shingle essentially anywhere versus my worry in rads that true partnership private practice groups might not exist where my family wants to live. Imagine going through all this training and trying to move back to an unpopular suburb and you still might not get an actual good job potentially because the boomers in the area sold out the specialty. That's very worrisome. I won't take a 30% haircut from some corporate losers so that means moving which would make me feel guilty.

Can open with little infrastructure or work in other prefabricated setups for other people to build you side practice that can become your main practice.

Get tired of inpatient? Go out patient. Vice versa. Very flexible specialty but not the downsides of primary care patients (preference).

The government and or insurance companies act like even bigger idiots than they do right now wrt healthcare? Oh yeah, it might be perfect but I can just only take 1 insurance or none at all with some tradeoffs.

Radiology is an amazing field and I'm super excited about locking that in but 5.5 years from now when boomers sell out even more private practices I'm going to be wondering if I should have cut some time off training and just done psych (or anesthesia). Rads needs more infrastructure. It's rigid. When good things disappear they don't have a way to come back. Every time a group loses a contract and corporate villains take over, that area is done for good jobs. It's just incredibly improbable for things to line up for a private practice group to take the contract back.

Oh and non competes. No non compete as a sole proprietor psych doc.

 

[Zendo]

You can hang a shingle essentially anywhere versus my worry in rads that true partnership private practice groups might not exist where my family wants to live. Imagine going through all this training and trying to move back to an unpopular suburb and you still might not get an actual good job potentially because the boomers in the area sold out the specialty. That's very worrisome. I won't take a 30% haircut from some corporate losers so that means moving which would make me feel guilty.

Can open with little infrastructure or work in other prefabricated setups for other people to build you side practice that can become your main practice.

Get tired of inpatient? Go out patient. Vice versa. Very flexible specialty but not the downsides of primary care patients (preference).

The government and or insurance companies act like even bigger idiots than they do right now wrt healthcare? Oh yeah, it might be perfect but I can just only take 1 insurance or none at all with some tradeoffs.

Radiology is an amazing field and I'm super excited about locking that in but 5.5 years from now when boomers sell out even more private practices I'm going to be wondering if I should have cut some time off training and just done psych (or anesthesia). Rads needs more infrastructure. It's rigid. When good things disappear they don't have a way to come back. Every time a group loses a contract and corporate villains take over, that area is done for good jobs. It's just incredibly improbable for things to line up for a private practice group to take the contract back.

Oh and non competes. No non compete as a sole proprietor psych doc.

Man, I feel for you and really hope everything works out for the best for you and your family. All of your points really showcase how ultimately most of us just want good jobs where we'd like to settle down. Psych today is what most of medicine used to be like back in the day, from what I gather.

Appreciate the insight on your concerns with rads. Wouldn't anesthesia have similar issues with private practices dying out? Are there any other specialties you would feel good about besides these three?

 

[Calizboosted76]

While I know everyone is worried about the future of EM, the fact of the matter is (at least from my point of view and from the director of multiple community ERs that I worked at as a scribe for years) there will always be a need for EM physicians. Yes having Np/Pa counterparts may have an effect on physician salaries, I know it may be hard but if you are open to different areas you can find a private group to join and make partner and be set.

I have tried to be recruited, yes my friend physicians from where I was a scribe at have tried talking me into going EM with offers of for sure hiring me after training (like the directors will still be the same or the group even still around lol).

Just dont count out a specialty if you fall in love with it. Good luck!

 

[Neopolymath]

Man, I feel for you and really hope everything works out for the best for you and your family. All of your points really showcase how ultimately most of us just want good jobs where we'd like to settle down. Psych today is what most of medicine used to be like back in the day, from what I gather.

Appreciate the insight on your concerns with rads. Wouldn't anesthesia have similar issues with private practices dying out? Are there any other specialties you would feel good about besides these three?

That's very kind of you. I'm not actively worried. I'm excited and optimistic, but this is a common feeling among trainees. You don't know how the otherside lives so you can have moments of worry. It's completely natural. The stakes are high.

Anesthesia is slightly better in this aspect than radiology although it suffers from many similar issues. Locums as an anesthesiologist is possible and has better hours/$ than doing telerads. I know a lot of anesthesia folks so I feel confident that in the worst case scenario of not having a great permanent group to work with, many people just prey on the corporate groups for obscene locums rates. Technically they are locums but it's less than an hour from their homes so it's just playing these AMCs against themselves when they end up running the practice into the ground and need bodies. It's a great tactic if you want to live somewhere without good groups... But there are still pretty good groups out there and they are further along in the cycle against AMCs than radiology for example. Rads probably still has a ways to go getting worse before it hopefully gets better. In anesthesia there are even a few places that took back contracts from AMCs.

The last question is personal and difficult to answer. As a business man I have a different perspective on some of these things and obviously what you are competitive for matters. The landscape of medicine can radically change any second so best to find some specialties you like pretty well (you might not love any and that's normal) and then decide based on other factors like pay after that. Most people aren't 1 specialty/1 love people. A number of them could work.

Surgical subs is the easy answer. ENT docs have one of the best jobs in medicine from a content standpoint, setup, hours and compensation mix.

 

[Neopolymath]

While I know everyone is worried about the future of EM, the fact of the matter is (at least from my point of view and from the director of multiple community ERs that I worked at as a scribe for years) there will always be a need for EM physicians. Yes having Np/Pa counterparts may have an effect on physician salaries, I know it may be hard but if you are open to different areas you can find a private group to join and make partner and be set.

I have tried to be recruited, yes my friend physicians from where I was a scribe at have tried talking me into going EM with offers of for sure hiring me after training (like the directors will still be the same or the group even still around lol).

Just dont count out a specialty if you fall in love with it. Good luck!

The threat to EM is tangible oversupply of physicians as well as corporate consolidation of practices not midlevels. Midlevels are really annoying but mostly a med student and premed boogy man in a lot of ways. They are terrible for patients and the government could wreck physician lives easily but I can assure the issue with EM isn't NPs doing dumb stuff and taking jobs. The ED docs themselves already don't have enough jobs to go around against each other.

 

[Calizboosted76]

The threat to EM is tangible oversupply of physicians as well as corporate consolidation of practices not midlevels. Midlevels are really annoying but mostly a med student and premed boogy man in a lot of ways. They are terrible for patients and the government could wreck physician lives easily but I can assure the issue with EM isn't NPs doing dumb stuff and taking jobs. The ED docs themselves already don't have enough jobs to go around against each other.

Thats understandable. I guess my area was just understaffed and the people working in that area were just blind to the fact that more EM residencies are opening or whatever the case may be.

The group was great however they were unable to keep new physicians on board for long.