"Best" specialty for family life

[nvshelat]

Hello,
I'll be entering MS this fall and a big concern of mine is balancing time with my long term gf (5+ yrs) while being in MS and going thru residency; was wondering your perspectives on the best specialty for this. Most people have told me ER (no beeper/not on call) but I was curious for your opinions.

Also, other than including her in the MS part of my life, is there anything that helps ease the transition/loneliness that comes with the long hours of MS and residency? For MS, we'll be in Long Island, which is good bc she'll have access to the city, where lots of her friends are...

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[flower12]

Work hours are an important factor--but it doesn't matter how many hours a week you are working if you hate your specialty. You need to follow your passion, find what fascinates you and challenges you, and your life will work out. It does for most all of us.

Keep an open mind. There are many specialities that have less demanding work hours. True--ER is usually shift work, but I would not say that ER docs work fewer hours than many other specialists--so you need to do what you want to do the most. Other specialities that have a less demanding work or call schedule, to generalize, may include radiology, dermatology, opthalmology, psychiatry, PM&R, preventative medicine, and pathology.

Just don't jump the gun on getting into the speciality that, you think, offers the nicest lifestyle--you need to pick your specialty based on what you find fascinating and fulfilling. Believe it or not, 40 hours a week can be far more compromising than 70 hours a week if you are not satisfied with what you are doing.

 

[gardengirl]

Just don't jump the gun on getting into the speciality that, you think, offers the nicest lifestyle--you need to pick your specialty based on what you find fascinating and fulfilling. Believe it or not, 40 hours a week can be far more compromising than 70 hours a week if you are not satisfied with what you are doing.

I agree with flower12.

re: transition/loneliness-- Making a relationship work in this situation will take the combined effort of two people. It's not good if the non-medical significant other becomes jealous or has an adversarial relationship with your work (or school...) but your plans on including her are a good start.

 

[MJB]

As a person working a job that I think I would hurt myself or someone if I was forced to do for the rest of my life...PLEASE don't just choose a specialty on anything other than what you truly want to do...especially since (sorry) this is just a GF at this point.

A wife is an entirely different matter, however, imo.

 

[cytoborg]

The old stereotype is the ROAD to happiness, as they say, or ROAD+P (rads, ophtho, anesthesia, derm, and pathology). There is such a wide variety of practice settings out there, though, that you can find nice hours in a variety of specialties. But in general, specialties that don't have a lot of emergencies have better hours. (That's not necessarily going to be true during residency, though.)

It's great that you are thinking ahead about your specialty choice, but you may find the transition to medical school the most difficult step. As for easing the transition, you're doing well already by thinking about the support system she has, whether she has access to friends/activities, etc. Keep her involved in your life, and not let her become an outsider to what you're doing, as it can be tough for people outside medicine to understand what you're going through. That doesn't mean the two of you should hang out with your med school classmates all the time, though. Try to form some mutual friendships outside of med school so the two of you can be on truly common ground. Hopefully she has her own career and social interests that will keep her occupied, and she isn't completely dependent on you.

Once you guys are through the med school phase, it may get easier. I have found residency to actually be easier than med school in terms of maintaining my relationship and my hobbies (I'm a pathology resident).

 

[12R34Y]

Work hours are an important factor--but it doesn't matter how many hours a week you are working if you hate your specialty. You need to follow your passion, find what fascinates you and challenges you, and your life will work out. It does for most all of us.

Keep an open mind. There are many specialities that have less demanding work hours. True--ER is usually shift work, but I would not say that ER docs work fewer hours than many other specialists--so you need to do what you want to do the most. Other specialities that have a less demanding work or call schedule, to generalize, may include radiology, dermatology, opthalmology, psychiatry, PM&R, preventative medicine, and pathology.

Just don't jump the gun on getting into the speciality that, you think, offers the nicest lifestyle--you need to pick your specialty based on what you find fascinating and fulfilling. Believe it or not, 40 hours a week can be far more compromising than 70 hours a week if you are not satisfied with what you are doing.

Most EM docs work HUGELY less hours than almost all other specialities in my experience. Sure individual doc can work more for money, but full -time at my academic institution is 12 8-hour shifts per month. no call..that's ti.

another private suburban group i worked for full time was 12-12 hour shifts per month. that's it.

so yes it is much less hours. The salaries for above are 200,000/year for first job I mentioned and 275,000/year for second.

However, keep in mind that Em docs are also working weekends, nights and holidays for most of their career.

Night shift work carries the same risk factor as smoking after the age of 40 if you do more than 5 per month.

so not always the lifestyle specialty everyone believes it to be, of course I love it and will be matching into in 19 days!!

good luck,

later

 

[Ursus Martimus]

Night shift work carries the same risk factor as smoking after the age of 40 if you do more than 5 per month.

later

With respect to what? That sounds absolutely absurd. You need to back that up with some reference or something. Cv risk?

 

[12R34Y]

With respect to what? That sounds absolutely absurd. You need to back that up with some reference or something. Cv risk?

Pretty common knowledge in the EM crowd I'll do my best to give you some citations. i used to have them all. This is an excellent article outlining increase in ischemic disease and myriad of other horrible problems. It's well known in the literature that night shift work is really bad for you in the long term. I'll get some more.

http://www.emedicine.com/emerg/topic835.htm

 

[Ursus Martimus]

http://www.emedicine.com/emerg/topic835.htm

Dude you really have to do better than that. "has been associated with increased levels of triglyceride levels" is hardly a cv risk equivalent to smoking. I think if this is pretty well known amongst ER physicians, it shows that as a lot you guess are good at misquoting and over-estamating riks. So is the role of an ER physician. Run your smoking equivalent risk by a cards guy sometime, but make sure you a feeling well because he will laugh you down. Although your advice about family friendly is probable correct, I would not try to embellish the health risks of the field.

 

[Ursus Martimus]

So more on this debate, as we all know ER doctors are superficial, at best, in their assessments.

From Circulation. 1995;92:3178-3182.

Compared with women who had never done shift work, the multivariate adjusted relative risks of CHD were 1.21 (95% CI, 0.92 to 1.59) among women reporting less than 6 years and 1.51 (95% CI, 1.12 to 2.03) among those reporting 6 or more years of rotating night shifts.

And from NEJM Volume 317:1303-1309

The number of cigarettes smoked per day was positively associated with the risk of fatal coronary heart disease (relative risk = 5.5 for greater than or equal to 25 cigarettes per day), nonfatal myocardial infarction (relative risk = 5.8)

So although em might be great for family life, if you are easily annoyed by people who give out incorrect information on a consistent basis – I’d try something different like path or derm.

 

[12R34Y]

So more on this debate, as we all know ER doctors are superficial, at best, in their assessments.

From Circulation. 1995;92:3178-3182.

Compared with women who had never done shift work, the multivariate adjusted relative risks of CHD were 1.21 (95% CI, 0.92 to 1.59) among women reporting less than 6 years and 1.51 (95% CI, 1.12 to 2.03) among those reporting 6 or more years of rotating night shifts.

And from NEJM Volume 317:1303-1309

The number of cigarettes smoked per day was positively associated with the risk of fatal coronary heart disease (relative risk = 5.5 for greater than or equal to 25 cigarettes per day), nonfatal myocardial infarction (relative risk = 5.8)

So although em might be great for family life, if you are easily annoyed by people who give out incorrect information on a consistent basis – I’d try something different like path or derm.

Angry are we? dude.......seriously...mellow out.

The first 2 people that told me shift work was correlated with increased risk for cardiac disease were cardiologists (one 24 year attending (he's the one who made the smoking equivalent comment FYI.....the other doing an interventional fellowship)..this was on rounds during a CCU month.

The point is that shift work increases your risk for cardiac disease the equivalent that smoking does.

It obviously doesn't increase your risk of stuff like lung CA, esophageal CA, throat cancer et.c.. like REAL smoking does.

bottom line which know one can argue is shift work=bad for health in general.

oh, and you've profoundly shaken me to the core with the comments about ER docs being superficial. I've talked to my wife about sitting out the match that's coming up in 15 days and maybe matching into radonc. I mean...... at least then I could work more and be completely useless in most situtations. Probably would be malpractice for me to introduce myself as "doctor" in a clinical sense, (physicist maybe) but still maybe I can work on it.

I can't believe all this time I liked the ED.....what was I thinking!

 

[FoughtFyr]

Dude you really have to do better than that. "has been associated with increased levels of triglyceride levels" is hardly a cv risk equivalent to smoking. I think if this is pretty well known amongst ER physicians, it shows that as a lot you guess are good at misquoting and over-estamating riks. So is the role of an ER physician. Run your smoking equivalent risk by a cards guy sometime, but make sure you a feeling well because he will laugh you down. Although your advice about family friendly is probable correct, I would not try to embellish the health risks of the field.

"These results suggest an association between shift work duration and the metabolic risk factors of cardiovascular disease."

"In this study, obesity, high triglycerides, and low concentrations of HDL cholesterol seem to cluster together more often in shift workers than in day workers, which might indicate an association between shift work and the metabolic syndrome."

"We found a significant association between shift work and lipid disturbances (i.e. low HDL-cholesterol and high triglyceride levels)."

"The difference in serum triglyceride levels between day and shift workers could not be explained by obesity, smoking or alcohol intake in the statistical analyses. These results suggest that the prevalence of risk factors for CHD is higher among shift workers."

"Multiple regression analyses demonstrated that shift work was significantly related to serum triglyceride levels also when age, smoking, body mass index, and other variables were controlled for. It was concluded that shift work is associated with several risk factors for coronary artery disease."

"Shift work is an important part of the occupational gradient in CHD risk among industrial workers; some evidence was found for the hypothesis that a direct stress-related mechanism explains part of the increased CHD risk."

"RESULTS: The relative risks were 1, 1.6[95% confidence interval (95% CI) 1.1-2.5], 1.3(95% CI 0.9-2.1), and 2.7(95% CI 1.8-4.1) for the following combinations of shift work (SW) and smoking (SM): SW-&SM-, SW-&SM+, SW+&SM-, and SW+&SM+, respectively; and the corresponding figures for shift work and obesity (BMI > or =28 kg/m2) were 1, 1.2(95% CI0.8-1.9), 1.3(95% CI0.9-1.9), and 2.3(95% CI1.5-3.6), respectively. In both cases the effect was at least multiplicative. For the shift workers the relative risk for CHD rose gradually with increasing numbers of adverse life-style factors, but for the day workers there was no clear dose-response pattern."

Want more, because I have them...

- H "your friendly EM resident with an MPH in environmental and occupational health"

 

[Lady In Rad]

I feel compelled to respond to your ignorance regarding the profession of radiation oncology. It is obvious that you know nothing regarding this profession. Why trash rad onc when it is a much more competitive specialty than ER? Sounds like you are a little insecure. Oh I forgot, only ED doctors save lives

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

http://www.physicianssearch.com/physician/salary2.html

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

Angry are we? dude.......seriously...mellow out.

The first 2 people that told me shift work was correlated with increased risk for cardiac disease were cardiologists (one 24 year attending (he's the one who made the smoking equivalent comment FYI.....the other doing an interventional fellowship)..this was on rounds during a CCU month.

The point is that shift work increases your risk for cardiac disease the equivalent that smoking does.

It obviously doesn't increase your risk of stuff like lung CA, esophageal CA, throat cancer et.c.. like REAL smoking does.

bottom line which know one can argue is shift work=bad for health in general.

oh, and you've profoundly shaken me to the core with the comments about ER docs being superficial. I've talked to my wife about sitting out the match that's coming up in 15 days and maybe matching into radonc. I mean...... at least then I could work more and be completely useless in most situtations. Probably would be malpractice for me to introduce myself as "doctor" in a clinical sense, (physicist maybe) but still maybe I can work on it.

I can't believe all this time I liked the ED.....what was I thinking!

 

[nvshelat]

I got what i needed. Mod, you can close this thread if you'd like.

 

[12R34Y]

I feel compelled to respond to your ignorance regarding the profession of radiation oncology. It is obvious that you know nothing regarding this profession. Why trash rad onc when it is a much more competitive specialty than ER? Sounds like you are a little insecure. Oh I forgot, only ED doctors save lives

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

http://www.physicianssearch.com/physician/salary2.html

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

Yeah...it blows when someone ignorantly bashes your specialty and makes broad gross generalizations about it doesn' it.

I was responding to fussy pants' comments about ER docs. I like returning nasty comments.

later

 

[Ursus Martimus]

The point is that shift work increases your risk for cardiac disease the equivalent that smoking does.:

In correct, even when I give you the data you still misinterpret

bottom line which know one can argue is shift work=bad for health in general..:

Perhaps

sitting out the match that's coming up in 15 days and maybe matching into radonc.

I'm pretty sure that you could never match in the field.

 

[mmmmdonuts]

if ur primary motivation for being a doc is to find something where you dont have to be at work then why are you doing it? so you can feel good to say hi im a doctor? good fer you

 

[FoughtFyr]

In correct, even when I give you the data you still misinterpret

Hey slick, you seem to ignore a large amount of data I provided you to the contrary. You incompletely quoting two studies is hardly conclusive. There exists a significant body of evidence to suggest that shift work increases the risk of heart disease. There is also well documented CAD risk from smoking. Now, if you seem to believe that you can find one study that percisely and accurately quantifies either the risk of shift work OR the risk of smoking, then post them along with some standard that the data are widely accepted as percise. The reality is that significant trends are agreed to, not specific measures.

But if you actually look at the data in these areas two trends emerge. First, it is difficult to directly compare them as there seems to exist a synergistic effect between shift work and other CAD risk factors. Second, there exist significant risks from both shift work and smoking (separately or together).

That said, all you've proven with ad hominum attacks is your own ignorance.

I'm pretty sure that you could never match in the field.

Actually, as a senior resident in a program where 12R34Y applied, I know a bit about his qualifications. If he so desired, he could match into RadOnc (or pretty much any field).

- H

 

[Ursus Martimus]

No one in their right mind will equate the relative risks smoking with shift work as far as CAD risks. You quote the Scand J Work Environ Health vs the NEJM - nice. I'm sure you can dig up the literature to prove almost anything, but if you honestly think that smoking and shift work are equivalent risks, who knows what else you will believe. God help me if I end up in the ED where you work.

 

[FoughtFyr]

No one in their right mind will equate the relative risks smoking with shift work as far as CAD risks. You quote the Scand J Work Environ Health vs the NEJM - nice. I'm sure you can dig up the literature to prove almost anything, but if you honestly think that smoking and shift work are equivalent risks, who knows what else you will believe. God help me if I end up in the ED where you work.

Wow, you sure love to jump to conclusions. Now, let's address your "critiques" in order.

First you state "No one in their right mind will equate the relative risks smoking with shift work as far as CAD risks" then fail to offer any scientific proof to back up this statement. Isn't that what you accused 12R34Y of?

Second you claim that "{I} quote the Scand J Work Environ Health vs the NEJM - nice." Actually, I do no such thing. To quote the study you posted:

"We prospectively examined the incidence of coronary heart disease in relation to cigarette smoking in a cohort of 119,404 female nurses who were 30 to 55 years of age in 1976 and were free of diagnosed coronary disease. During six years of follow-up, 65 of the women died of fatal coronary heart disease and 242 had a nonfatal myocardial infarction. The number of cigarettes smoked per day was positively associated with the risk of fatal coronary heart disease (relative risk = 5.5 for greater than or equal to 25 cigarettes per day), nonfatal myocardial infarction (relative risk = 5.8), and angina pectoris (relative risk = 2.6). Even smoking 1 to 4 or 5 to 14 cigarettes per day was associated with a twofold to three-fold increase in the risk of fatal coronary heart disease or nonfatal infarction." {emphasis added}​

So they looked at nurses without controlling for shift work. Oops - doesn't really help your argument. So then I posted a study that stated:

"The relative risks were 1, 1.6[95% confidence interval (95% CI) 1.1-2.5], 1.3(95% CI 0.9-2.1), and 2.7(95% CI 1.8-4.1) for the following combinations of shift work (SW) and smoking (SM): SW-&SM-, SW-&SM+, SW+&SM-, and SW+&SM+, respectively; and the corresponding figures for shift work and obesity (BMI > or =28 kg/m2) were 1, 1.2(95% CI0.8-1.9), 1.3(95% CI0.9-1.9), and 2.3(95% CI1.5-3.6), respectively. In both cases the effect was at least multiplicative. For the shift workers the relative risk for CHD rose gradually with increasing numbers of adverse life-style factors, but for the day workers there was no clear dose-response pattern. CONCLUSIONS: Shift work seems to trigger the effect of other, lifestyle-related risk factors of CHD and therefore calls for active prevention among shift workers."​

So to translate (since you don't seem to actually read what you post): smoking bad, shift work bad, smoking plus shift work even worse. The Scandinavian journal's findings have been duplicated by many other sources (as I posted). If you can find a NEJM article that directly compares the two risks (smoking and shift work) and that repudiates the study above, please post it. Otherwise it seems that the studies actually agree (as one could safely assume at least some of the 100K nurses in the NEJM article did perform shift work).

BTW - While the NEJM is certainly one of the most well respected journals in medicine, the Scandinavian Journal of Work, Environment & Health is actually quite well respected within occupational medicine. It's ISI aggregate impact factor is 1.99 as compared to the industry average of 1.56. So I wouldn't be too quick to dismiss the findings.

You then (again) resort to ad hominum attack, "I'm sure you can dig up the literature to prove almost anything, but if you honestly think that smoking and shift work are equivalent risks, who knows what else you will believe". I'll save you time. I believe that a careful literature review can demonstrate various risks for health alterations. I also believe that when attempting to compare risks, "head-to-head" studies that directly compare those risks are more meaningful than attempting to meta-analyze other papers where obvious confounders might come into play (regardless of where they are published).

Apparently you read program materials as closely as you do journals, leading you to "threaten lawsuits" against ERAS over $25?!? I hope that you learn to read more critically prior to actually practicing RadOnc. Good luck with the match.

Lastly, "God help me if I end up in the ED where you work." I'm sure sorry you feel that way. I'll endeavor, none the less, to treat you in the manner best supported by evidence should such an untoward event come to pass.

- H

 

[manta]

Hello,
Also, other than including her in the MS part of my life, is there anything that helps ease the transition/loneliness that comes with the long hours of MS and residency? For MS, we'll be in Long Island, which is good bc she'll have access to the city, where lots of her friends are...

what worked for me - a job i loved, my own hobbies and interests, and my own place. there is absolutely, positively no way that she will completely 100% understand and be able to relate to what being a medical student entails - i've been both the GF and the med student. it involved a lot of trust (which i got better at over time, but yeah...i certainly wasn't a natural or anything). and it's great to hear how you're helping your SO on the road to success - so definitely take the time to tell her how much you appreciate her trust and support through a period of crazy personal growth and change. she'll eat it up.

good luck to both of you. and it seems like really the best way to keep busy and meet people is to go back to school, if she is at all interested in that route.

 

[Wifty]

PM&R is a great field to go into if you are interested in having a family life and a medical life.
You generally work office hours 9-5 with little call and you get to play with high-tech 'toys' (a plus for my hubby).

As for easing the transition, what worked for me was going back to college and connecting with the students my hubby studied and played with. I wasn't 'just' the wife back home, I was the person who partied a success with his fellow students and listened to the failures and bumps in the road. And vice versa (though mine were much less intense). I made some life-long friends even though I wasn't the student.

Good luck! Its important to follow your passion, but one of your passions is the person you love and so you have to keep looking to mesh those two. Its sad when one falls to the wayside because of the other....and I don't think that has to be true.

With smiles,
Wifty

 

[LADoc00]

Im going to suggest something often not thought of: Basic science research. IF and that is a big IF, you can swing a tenure track position or a permenant teaching/research position, you can set your own hours, come and go as you please and generally be free of on call responsibilities to devote the maximal time to work. You can be your own boss (sort of) and even bring your kids to work.

I have done everything from basic science, academic med clinical track, government healthcare to partial ownership in my own practice (now) and BY FAR the most flexibility is in basic science research.

The supposed ROAD is more from a compensation and not quality of life standpoint. The downside of research is you will be paid crap. You are going to have to accept that.

 

[Squad51]

So more on this debate, as we all know ER doctors are superficial, at best, in their assessments.

inaccurate and incomplete lit. review snipped

So although em might be great for family life, if you are easily annoyed by people who give out incorrect information on a consistent basis – I’d try something different like path or derm.

From out here in the cheap seats - YOU GOT SERVED!

Man, what is the world coming to when a ER doc beats an RadOnc MD/PhD in literature analysis...?

 

[Ursus Martimus]

From out here in the cheap seats - YOU GOT SERVED!

Man, what is the world coming to when a ER doc beats an RadOnc MD/PhD in literature analysis...?

I'm sure the American Heart Association and the American Stroke association just forgot shift work on their lists of modifiable risk factors for CAD.

http://www.strokeassociation.org/presenter.jhtml?identifier=4726

I would encourage all you "believers" to ask the cardiologist if, Dollar for Dollar, smoking conveys the same CAD risk as smoking. That is still the argument, correct?, because some of you are really scaring me with your ignorance.

 

[12R34Y]

I'm sure the American Heart Association and the American Stroke association just forgot shift work on their lists of modifiable risk factors for CAD.

http://www.strokeassociation.org/presenter.jhtml?identifier=4726

I would encourage all you "believers" to ask the cardiologist if, Dollar for Dollar, smoking conveys the same CAD risk as smoking. That is still the argument, correct?, because some of you are really scaring me with your ignorance.

It's sad/funny when other people on the board who weren't even in the conversation can see that you totally got served.

dude, no one is even listenening. How many more beat downs can you take from FF?

this is hysterical.

 

[FoughtFyr]

I'm sure the American Heart Association and the American Stroke association just forgot shift work on their lists of modifiable risk factors for CAD.

http://www.strokeassociation.org/presenter.jhtml?identifier=4726

I would encourage all you "believers" to ask the cardiologist if, Dollar for Dollar, smoking conveys the same CAD risk as smoking. That is still the argument, correct?, because some of you are really scaring me with your ignorance.

Do you know what scares me? You are an MD/PhD (if your previous posts are to be believed) in one of the more cerebral of the medical sciences (again, according to you), yet as a huge pile of evidence suggests that a significant confounder may be present in previously published research, one where a plausible physiologic mechanism is described (alterations in circadian rhythm and cortisol excretion leading to increased triglycerides and arrhythmogenicity) and studies demonstrate that previously unafflicted individuals show alterations when exposed, thus satisfying Koch's postulates (as commonly adapted to public health); you insist on arguing against it because it was suggested by a medical student going into emergency medicine. Even worse, you seem to believe that specific risks of health alteration can be pinpoint precisely defined and thus compared across studies (without regard for confidence intervals), enabling you to make bold statements about which is "worse" without direct experimental or observational comparison. And let's not even start on your apparent perception that the NEJM is the only credible source of information available (except for public education materials from the AHA !).

Now I am not a "believer" that shift work is (or is not) an equal, lesser, or greater coronary heart disease risk factor than smoking. I believe that data suggests they are both significant risk factors. I believe that there are good data to suggest that shift work may have a synergistic or cumulative effect when occurring alongside other risk factors. I further believe this effect might confound some of the studies attempting to quantify the deleterious health effects of smoking.

So to your quotes:

So more on this debate, as we all know ER doctors are superficial, at best, in their assessments.

and

So although em might be great for family life, if you are easily annoyed by people who give out incorrect information on a consistent basis – I’d try something different like path or derm.

I say "PFFTT!" and suggest that it is you sir/ma'am who is "superficial, at best, in (your) assessment" and guilty of "(giving) out incorrect information on a consistent basis".

Good day,

- H

BTW - 12R34Y, sorry, I just couldn't resist answering this idiot. I don't suffer fools well...

For those looking for further studies on shift work and direct cardiac effects such as arrhythmogenicity, a list of articles is here which I've not had the time to review in it's entirety.

 

[Squad51]

It's sad/funny when other people on the board who weren't even in the conversation can see that you totally got served.

dude, no one is even listenening. How many more beat downs can you take from FF?

this is hysterical.

Yeah, it is sad, but since he came back to take another beat down, I'll say it again, HE GOT SERVED!

I can't wait to apply to Mayo next year. Gotta meet this FF guy...