Foot Fetish

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Traditionally, the lifestyle specialties were R.O.A.D. (radiology, ophthalmology, anesthesiology, and dermatology), but, based on what I've read on sdn, that has changed nowadays. Radiology is suffering from decreasing reimbursements / increasing case volumes and is no longer considered a lifestyle specialty. The job security of anesthesiology is lower than ever with nurse anesthetist encroachment. I haven't read much on optho, but it seems pretty boring, basically a dentist for the eyes...Derm is still king of lifestyle, but it's impossble to match into...

What are some of the modern lifestyle specialties? (High pay, less hours, lower stress, good job security)
 

Azete

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Maybe it's not the norm, but the one Derm I shadowed had it pretty rough. He was at the office 6am-7pm, 5 days a week; I'm sure a lot of it was by choice and he undoubtedly made a great living, but that's a lot of hours for how tedious the work is. I'm sure there are folks that enjoy it, but FM seemed far more interesting than Derm (but half the money) -- and I didn't particularly like FM.

EM seems pretty cushy these days. Pretty low stress, very high hourly pay, less hours, and demand is reasonably consistent.

Some others to consider based on personal observations (not objective analysis): Urology, IR (opposite trends of DR), Pathology, and PM&R.
 
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mcloaf

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I wouldn't recommend a surgical subspecialty to someone seeking a "cushy" specialty. Better hours than gen surg or neurosurg, but it's still surgery, especially during residency. That probably goes for IR as well.
 

qw098

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derm is a deadly residency, no?

the amount of things you need to know, and the amount of book learning/memorization is second to none from what I've read/seen
 

Azete

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derm is a deadly residency, no?

the amount of things you need to know, and the amount of book learning/memorization is second to none from what I've read/seen
I've heard similar, which is bizarre because the day-to-day seems like something a mid-level could do without much issue. Though, admittedly, I'm painfully uninformed on the subject as I have no interest in derm.
 

racerwad

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Maybe it's not the norm, but the one Derm I shadowed had it pretty rough. He was at the office 6am-7pm, 5 days a week; I'm sure a lot of it was by choice and he undoubtedly made a great living, but that's a lot of hours for how tedious the work is. I'm sure there are folks that enjoy it, but FM seemed far more interesting than Derm (but half the money) -- and I didn't particularly like FM.

EM seems pretty cushy these days. Pretty low stress, very high hourly pay, less hours, and demand is reasonably consistent.


Some others to consider based on personal observations (not objective analysis): Urology, IR (opposite trends of DR), Pathology, and PM&R.
No one should listen to this advice. I wouldn't argue with anyone who says EM is the best specialty, but it is not low stress and the hours can be horrific, despite the lower number of hours per week. Med students should choose EM because they like the work, drunks and all, not because they heard emergency physicians "only" work X numbers of hours per week.
 

LADoc00

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Maybe it's not the norm, but the one Derm I shadowed had it pretty rough. He was at the office 6am-7pm, 5 days a week; I'm sure a lot of it was by choice and he undoubtedly made a great living, but that's a lot of hours for how tedious the work is. I'm sure there are folks that enjoy it, but FM seemed far more interesting than Derm (but half the money) -- and I didn't particularly like FM.

EM seems pretty cushy these days. Pretty low stress, very high hourly pay, less hours, and demand is reasonably consistent.

Some others to consider based on personal observations (not objective analysis): Urology, IR (opposite trends of DR), Pathology, and PM&R.
Urology and cush should never been in the same sentence. I dont think any field of medicine has ever been so brutalized by CMS as Urology, even more than Oncology...

Urology can be outright brutal.

Derm is by far the cushiest followed by Plastics, Path and Rads. Rads will complain the most though about working hard. Do not buy it though. They are like French Football stars and taught from an early age to exaggerate every trauma of their work day.

EM depends on so much but yah shift work. Shift work can be done in the ICU, Hospitalist, in patient Peds coverage etc. Can be cush but can be a mess too.

Derm is only specialty in all of medicine which has actual afternoons off in residency training to read...that is insane compared to the rest of us.
 

Azete

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No one should listen to this advice. I wouldn't argue with anyone who says EM is the best specialty, but it is not low stress and the hours can be horrific, despite the lower number of hours per week. Med students should choose EM because they like the work, drunks and all, not because they heard emergency physicians "only" work X numbers of hours per week.
I appreciate your input, but I didn't offer OP any advice or recommendations. Based on the definition of "cushy" that he provided, EM seemed to fit quite nicely -- especially in a more rural community hospital.
 

qw098

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Derm is only specialty in all of medicine which has actual afternoons off in residency training to read...that is insane compared to the rest of us.
For good reason... the amount you need to learn from the tiniest of minutiae.. name me 30 chemicals you can find in a shoe that can cause irritant/allergic contact dermatitis and name me the IL that each chemical does or does not have an effect on..
 
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Urology and cush should never been in the same sentence. I dont think any field of medicine has ever been so brutalized by CMS as Urology, even more than Oncology...

Urology can be outright brutal.

Derm is by far the cushiest followed by Plastics, Path and Rads. Rads will complain the most though about working hard. Do not buy it though. They are like French Football stars and taught from an early age to exaggerate every trauma of their work day.

EM depends on so much but yah shift work. Shift work can be done in the ICU, Hospitalist, in patient Peds coverage etc. Can be cush but can be a mess too.

Derm is only specialty in all of medicine which has actual afternoons off in residency training to read...that is insane compared to the rest of us.
what is your take on Rad-onc? Lifestyle and in general...
 

racerwad

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I appreciate your input, but I didn't offer OP any advice or recommendations. Based on the definition of "cushy" that he provided, EM seemed to fit quite nicely -- especially in a more rural community hospital.
Except for the low stress part. In addition, while the hours per week are low, most people do not take into account the fact that there are often multiple circadian shifts across those hours.

In a resource poor, geographically isolated rural hospital, the EP is often the only physician in the house. Rural hospitals are arguably the places where EPs have to be the sharpest and most able to deal with whatever may come through the door.

Stress can be mitigated through preparation. Depending upon personality, the stress can be something that is sought after, rather than avoided. Anyhow, I agree that EM is a great specialty with low hours, great compensation, and a great job outlook (for most of the country). I just get annoyed when the same inaccuracies of the job are repeated over and over.
 
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Foot Fetish

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Pathology sounds pretty damn cush....but I heard the job market is among the worst in all of medicine at the moment. Can anyone confirm?
 
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greg1184

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Derm is by far the cushiest followed by Plastics, Path and Rads. Rads will complain the most though about working hard. Do not buy it though. They are like French Football stars and taught from an early age to exaggerate every trauma of their work day.
Radiology is one of the more mentally demanding fields, especially with the increase in volume. Doesn't matter if you "buy" it or not. If one spent time with a radiologist on a busy call night one will see that it can be incredibly busy. Unlike other fields, there is no "down" time. No time to sit down waiting for pages. The reading is essentially non-stop with the increase in utilization of imaging. Its still a decent lifestyle, and for me it is more than worthwhile, but it is definitely not as "cush" as it used to be.

Gotta love the name calling though. Let me guess, you think all we do is sit down and drink coffee all day. :rolleyes:What a collegial field health care is.
 
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Cyal

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Rads will complain the most though about working hard. Do not buy it though. They are like French Football stars and taught from an early age to exaggerate every trauma of their work day.
lol. Do you really believe this?
 

witzelsucht

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EM is great but its not low stress. You are either dealing with the sickest sickies in county, or you are in a place where sucking the door to doc and satisfaction d1ck is paramount. both are stressful. i think psych is super underrated. you can make 300k working cardiologist hours, or less doing your own thing. institutions pay $$$$ for weekend inpatient coverage. agree derm is king, but what a nightmare to match. plastics cush? brutal training, and its hard to get that cash only cosmetics practice going. rads will be fine. anesthesia will be fine. sky is falling, and all that. ophtho is hard to make a buck, but good lifestyle and great outcomes/rewarding. cool procedures sometimes. dependng on subspecialty. id still pick EM again though
 
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PrettyLadyDoc24

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Pathology sounds pretty damn cush....but I heard the job market is among the worst in all of medicine at the moment. Can anyone confirm?
I really do think that Path is a great lifestyle specialty if you don't want to work weekends and the call is minimal, even as a resident. I hear conflicting things about the job market but basically most of us will do a fellowship or two and keeping an ear to the ground will help you find an awesome job.
 

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Psychiatry is 3 for 4... not so great on the "high pay" part, but it's not a bad gig if you don't want the pager lifestyle.
Psych can have pretty great pay if you land the right gig or are willing to work a little more though. I'd be willing to bet that in terms of lifestyle/money compared to ease-of-matching psych probably takes the cake there.

Someone also mentioned PM&R earlier, but I've heard some pretty mixed things about it in terms of pay. I've heard some people say expect to make less than 200k while others have said 300k+ isn't hard to do. From the few PMR docs I've talked to, it seems like the area (sports med vs. pain) and whether or not you do a fellowship makes a huge difference. I'd love to hear the opinion/info of someone with more knowledge in this area though.
 
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zero0

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No one should listen to this advice. I wouldn't argue with anyone who says EM is the best specialty, but it is not low stress and the hours can be horrific, despite the lower number of hours per week. Med students should choose EM because they like the work, drunks and all, not because they heard emergency physicians "only" work X numbers of hours per week.
Second this. Seriously question the judgment of anyone who calls EM "cushy" and "low stress."

You want lifestyle AND $$$? Derm, GI, and rad onc are about it. Gas can also be pretty chill if you wind up doing mostly pain. If you're willing to sacrifice $$$ to some extent, PM&R, allergy, ophtho, and psych can fit the bill.
 
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I have tried liking dermatology, seriously tried, but it has never stuck. There are some cool pathologies like the immunodermatology aspect but that's a pretty low focus in outpatient private care. I tell you what I have found to be immensely entertaining is ortho trauma. It can be brutal at times but it never gets old. Give me a comminuted femur fracture at 3 AM or snakebite to the hand with evidence of impending compartment syndrome and I'm good. Maybe I am just a junkie but working ortho trauma shifts is vastly more entertaining than anything I do in my leisure time.
 
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racerwad

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I was told EM in community hospital in upper middle class 'suburbia' can be low stress...
I think that you'll have to more specifically define "low stress," but as I and others have mentioned, the specialty, by definition, is not "low stress." It has emergency right in the name (insert anecdote about how the overwhelming majority of visits are UC-level, or less...etc, etc, etc). It is certainly true that different clinical settings have different stressful factors about them and one can tailor their practice to limit some of the things they specifically might not like about their job.
 
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OnePunchBiopsy

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Cushiest specialist I ever met was a psychiatrist working at a PTSD center for veterans. Guy worked 10am-3pm Monday-Friday and takes home $250,000/yr PLUS government pension. Also he drives a Shelby GT-350.
 

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Really depends on what you mean by cush.

Money? Lifestyle? Stress? Getting to be your own boss vs being someone's employee? There are a lot of factors that go into it, and there is no one specialty that will guarantee that everything you want will come together, every time, for your whole career. There is also virtually no specialty that can't be what you want it to be, if you negotiate well, are willing to make some compromises, and if you love the work.
 
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What do people think about outpatient neurology? The pay isn't fantastic (probably like 250) but it's not high stress. It's very broad and you see some interesting pathology. Probably similar to derm in some aspects. It could be a crazy rare case or incredibly mundane.


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EM isn't low stress. You're thinking of urgent care.

However, EM does afford with ease an excellent # of raw hours outside the hospital... and currently outstanding hourly pay.

Just with every specialty, take two people and they will have differences to their stress level regarding said specialty.

My MS4 buddy says that he could never even entertain the idea of EM, that malingerers and whiney patients with pain scores of infinity make him want to quit healthcare... he's aiming for cards.

The idea of going through IM and cardiology stresses me out... all that rounding, all those stents. I'm tachy just at the thought.

Rads is basically a 6 year residency, with so/so job market. Path has horrible job market. RadOnc is worrying about bundled payments and has so/so job market.

The only golden goose in medicine is Derm, and she's priced accordingly.
 
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Stagg737

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Cushiest specialist I ever met was a psychiatrist working at a PTSD center for veterans. Guy worked 10am-3pm Monday-Friday and takes home $250,000/yr PLUS government pension. Also he drives a Shelby GT-350.
That's pretty awesome. Wouldn't mind 250k for a 25 hour work week at all. Sounds like heaven. Craziest I knew of was a spinal surgeon (orhto) who did surgery one day a week and did IMEs from 9am til 4pm the rest of the week at $900/exam (15 minute sessions). I did the math with a co-worker and he pulled in just under 7 figures in 8 months working ~40 hour weeks. He did a lot of other medically related stuff in his after work, but on non-surgical days we figured out the guy was pulling in around $2.5k/hour.
 
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Dermatology or one of the highly competitive IM specialties in outpatient/prodecural are probably the best you'll find that has it all: high pay (>$300k), less hours (<50 hours a week), low stress, and good job security/market.
 
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Foot Fetish

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Cushy? You went into medicine to become physicians and surgeons —NOTHING is "cushy" — Once you're in practice - any specialty will have its challenges.
There's nothing wrong with wanting a relatively comfortable lifestyle. I hate the mentality that doctors must sacrifice it all and work themselves to death on principle. Sure, every high-paying career is going to have its challenges, whether it's I-banking, Big Law, etc. There's no such thing as a free lunch...however, that doesn't mean there's anything wrong with doing everything in your power to live comfortably. Just because you're a doctor doesn't mean that medicine has to be your life. That's a naive notion. Personally, medicine is just a job to me. That doesn't mean that I won't work as hard as possible when I'm on the job, but I am not willing to sacrifice my quality of life outside of work for it. I have interests outside of medicine that, frankly, are more important than my job.
 

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It may seem hard to conceptualize, but for medical careers... money will not make you enjoy or be satisfied with a job. If you believe that will be the case, you are probably going to be in for a surprise down the road.

From the Medscape Physician Compensation Report 2016: "Money does not equal happiness. This year, 73% of family physicians and 71% of internists were at the top of the list of physicians most likely to choose medicine again, which is exactly the same as last year, when they were first and third, respectively. Of note, these primary care physicians were within the bottom 10 in earnings." http://www.medscape.com/features/slideshow/compensation/2016/public/overview#page=31

Personally, the things I find most rewarding in medicine often come with little to no monetary award... but that is not for everyone.
 
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solitarius

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Lot of ignorance here.

EM has one of the highest burnout rates in medicine.

Surgical subspecialties are for competitive workaholic$. IM specialties are for the cerebral wonks.

Research other specialties as needed. Future of medicine: working harder for less.
 
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zeppelinpage4

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Cushiest specialist I ever met was a psychiatrist working at a PTSD center for veterans. Guy worked 10am-3pm Monday-Friday and takes home $250,000/yr PLUS government pension. Also he drives a Shelby GT-350.
I haven't been to the VA near our school, but from friends that rotated there and things I've heard...it sounds like the VA is a really sweet gig.

Also gonna agree, based on rotations psych seems to be a good field if you're looking for a nice life. As a whole, they seemed to be the happiest docs I rotated with. Not sure how the pay is, but I think this field is up and coming. I'm only anecdotally speaking, but talking to family friends and a doc on my psych rotation, the demand for child psychiatrists seems to be really high now. It's also one of the few fields where there is a ton of advancement to be made and you could really help pioneer the field. I really wanted to like it, but in the end it just wasn't for me. Emotionally it can be quite taxing, and you're somewhat shooting in the dark with treatments cause we don't know enough about these drugs, and how they interact with the brain, then you gotta factor in social issues too...it's just so complex.
 
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TedStark

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Family medicine MGMA average in the south is 260k/year with most docs working 4.5 days a week with normal hours... All outpatient, no call.

You also have the option to learn a niche like colonoscopies, ER moonlighting, cesarean sections, Minor cosmetic procedures, and shave biopsies to increase revenue. It's also not hard to run a cash practice in almost any city if you're fed up with being an employee. Not too shabby.
 

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If you choose a specialty just because you think it's cushy, you'll be miserable. I would absolutely hate pathology or anything surgical, for example, and no ratio of money/work could make them worthwhile to me.
 
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HelpPleaseMD

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What do people think about outpatient neurology? The pay isn't fantastic (probably like 250) but it's not high stress. It's very broad and you see some interesting pathology. Probably similar to derm in some aspects. It could be a crazy rare case or incredibly mundane.


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Can't say I know neurology well but general practice i'd imagine is very mundane.