Cushiest specialties?

[zero0]

I think the most stressful part of an EM residency is trying to constantly convince consult services to do your work for you

But wouldn't they just respect your judgment as a fellow physician and do the consult? /s

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[BarcaBest23]

But wouldn't they just respect your judgment as a fellow physician and do the consult? /s

baaaahh, you just made me spit my coffee with that whole respect judgement bit

 

[zero0]

baaaahh, you just made me spit my coffee with that whole respect judgement bit

I'll be here all week

 

[KinesiologyNerd]

I think the most stressful part of an EM residency is trying to constantly convince consult services to do your work for you

Me: "Hi this is Kinesiologynerd a sub-i in the ED"
JULY Intern: "::sighhhhhhhhhh:: k"

 

[hurtem&healem]

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.

Aren't they also at the bottom for "would you choose this specialty again?" i.e., yes, they would still be physicians, but they're not any more content with their job?
something something cherrypicking something disingenuous...

 

[shoal]

I think the most stressful part of an EM residency is trying to constantly convince consult services to do your work for you

do what work for me? take care of the patient i think needs to be admitted? take care of their own clinic patient that they sent me?

EM consults significantly less then other services, and I do the majority of my own work... lac repair, fracture reductions,intubations, chest tubes, lps, i&d, cardioversions,sedations,central lines,a lines..

not sure which field does a wider breadth of procedures on a daily basis. but sure, keep trolling. all i do is convince people to do consults and do my work.

Sent from my VS986 using Tapatalk

 

[FIREitUP]

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.

only 25% of internists and 29% of family medicine physicians in that survey would choose the same field.

 

[giantswing]

do what work for me? take care of the patient i think needs to be admitted? take care of their own clinic patient that they sent me?

EM consults significantly less then other services, and I do the majority of my own work... lac repair, fracture reductions,intubations, chest tubes, lps, i&d, cardioversions,sedations,central lines,a lines..

not sure which field does a wider breadth of procedures on a daily basis. but sure, keep trolling. all i do is convince people to do consults and do my work.

Sent from my VS986 using Tapatalk

It depends on the hospital tho. In our ed, they won't do any reductions at all. Not helpful for the residents imo, but what can you do?

 

[RangerBob]

Aren't they also at the bottom for "would you choose this specialty again?" i.e., yes, they would still be physicians, but they're not any more content with their job?
something something cherrypicking something disingenuous...

I found that rather odd and interesting as well. I guess it sort of makes sense--more PCP's chose medicine and primary care out of a sense of meaning/purpose, but then the actual life of a PCP can be very unfulfilling if you're being pressured to see patients in 15 minute appointments, have to deal with all the paperwork, etc. I see so many primary care notes that are basically copy-pasted opinions from consultants and then assessment/plans that are just the Epic diagnosis and orders placed. The HPI looks more like a surgeon's notes these days. I could see why PCPs might be feeling jaded about primary care, but still have hope the rest of medicine holds meaning and purpose, and less hassle.

On another topic, I find it odd that Medscape includes many medical subspecialties (8 of them!) but still doesn't include PM&R--which is it's own field. I guess Medscape either forgot about us (again!), or the few of us there are were just too busy playing golf to respond to the survey.

They'll probably include undersea and hyperbaric medicine before they include us...

 

[cgk]

I found that rather odd and interesting as well. I guess it sort of makes sense--more PCP's chose medicine and primary care out of a sense of meaning/purpose, but then the actual life of a PCP can be very unfulfilling if you're being pressured to see patients in 15 minute appointments, have to deal with all the paperwork, etc. I see so many primary care notes that are basically copy-pasted opinions from consultants and then assessment/plans that are just the Epic diagnosis and orders placed. The HPI looks more like a surgeon's notes these days. I could see why PCPs might be feeling jaded about primary care, but still have hope the rest of medicine holds meaning and purpose, and less hassle.

On another topic, I find it odd that Medscape includes many medical subspecialties (8 of them!) but still doesn't include PM&R--which is it's own field. I guess Medscape either forgot about us (again!), or the few of us there are were just too busy playing golf to respond to the survey.

They'll probably include undersea and hyperbaric medicine before they include us...

they forgot Rad/Onc as well!

 

[SurfingDoctor]

I found that rather odd and interesting as well. I guess it sort of makes sense--more PCP's chose medicine and primary care out of a sense of meaning/purpose, but then the actual life of a PCP can be very unfulfilling if you're being pressured to see patients in 15 minute appointments, have to deal with all the paperwork, etc. I see so many primary care notes that are basically copy-pasted opinions from consultants and then assessment/plans that are just the Epic diagnosis and orders placed. The HPI looks more like a surgeon's notes these days. I could see why PCPs might be feeling jaded about primary care, but still have hope the rest of medicine holds meaning and purpose, and less hassle.

On another topic, I find it odd that Medscape includes many medical subspecialties (8 of them!) but still doesn't include PM&R--which is it's own field. I guess Medscape either forgot about us (again!), or the few of us there are were just too busy playing golf to respond to the survey.

They'll probably include undersea and hyperbaric medicine before they include us...

Well, paperwork is certainly tedious. Combine that with detailed documentation is necessary for 1) proper billing and reimbursement 2) limiting future ligation, it certainly is a drag. But it is part of the job. Those who let it be the only part of the job will be unfulfilled. Those who don't will be more satisfied. However, the assumption here is that money will led to satisfaction, which it will not. The future of medical pay and reimbursements is very uncertain at this point, but based on recent trends, reimbursements are going down. The addition of bundled care has made the need for documentation for surgical subspecialties mostly pointless (and I suspect this will be adopted by medical subspecialties and diagnoses soon enough), but there is real dollars lost for any mishap, including readmissions, hospital acquired infections, etc. Slowly, the system is moving toward a single payer system and I think it is fine, but then again I see children who mostly on government insurance and have poor reimbursement, so I'm essentially already in a single payer system. If people get into a specialty because they can think they can makes a lot of money, do little work and be satisfied... well the future doesn't look bright for that mentality.

 

[RangerBob]

Well, paperwork is certainly tedious. Combine that with detailed documentation is necessary for 1) proper billing and reimbursement 2) limiting future ligation, it certainly is a drag. But it is part of the job. Those who let it be the only part of the job will be unfulfilled. Those who don't will be more satisfied. However, the assumption here is that money will led to satisfaction, which it will not. The future of medical pay and reimbursements is very uncertain at this point, but based on recent trends, reimbursements are going down. The addition of bundled care has made the need for documentation for surgical subspecialties mostly pointless (and I suspect this will be adopted by medical subspecialties and diagnoses soon enough), but there is real dollars lost for any mishap, including readmissions, hospital acquired infections, etc. Slowly, the system is moving toward a single payer system and I think it is fine, but then again I see children who mostly on government insurance and have poor reimbursement, so I'm essentially already in a single payer system. If people get into a specialty because they can think they can makes a lot of money, do little work and be satisfied... well the future doesn't look bright for that mentality.

I agree, and I didn't mean to suggest that primary care is unfulfilling--just that it can be, depending on your expectations and practice set-up, and how much control you have vs how much control the hospital bureaucrats have over your practice (and thus daily life). But quite honestly I think it can be the most fulfilling as well. I'm planning on going into spinal cord injury medicine, which is essentially primary care for people with SCI, plus some rehab as well.

I completely agree with you that people need to chose a specialty that they find fulfilling. I think people worry too much about how wealthy they're going to be when they should worry more about how fulfilling their job will be and how much they will enjoy it. I didn't marry my wife because she'll make me rich, and I certainly didn't chose my job/medical specialty for wealth either.

 

[ball123]

Just to add to this conversation: From speaking to an ophtho job recruiter, in addition to the countless ophthalmologists I've spoken to both 3-5 years out of residency and 10+ years out of residency, they say they are: incredibly happy, generally have pretty low stress, and a great lifestyle --> ~45 hours (4.5 week days + no weekends generally), and make good to great money (some $300-400K and others $500k+), which seem to be in accordance with MGMA and other data. Glaucoma surgeons are becoming higher earners due to newer treatment/surgical modalities with $350k to $450k averages and retinal surgeons continue to be the most lucrative subspecialty in this field with $500k+.

The caveat according to them is that residency can be very difficult, despite the preconceived notion, since you are learning to be a surgeon in a relatively short time span plus it is a subject that isn't taught much in med school, and starting salary is notoriously low if you are joining a practice ($200k-$250k for the first 2 years, which then generally doubles depending on the success of the practice).

Overall, do what you like but ophtho is still a pretty lucrative specialty with a great lifestyle! Plus, the surgical results are pretty outstanding with very happy patients!

 

[Cuongoff]

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..

I can vouch for it. I have some attendings that work 12-15 hour days and some that work 8-9. Our residency might not seem intense but it is a lot of self-learning. There's not only general dermatology but pediatrics and dermatopathology. So there is a lot of extra learning you have to do on your own and a chunk of it you'll never use in practice. Like knowing all of the interleukins and receptors and pathways. It's like starting med school again.

 

[Little Green Mensch]

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

Can't say if this is typical, but in my week on outpatient neuro at the VA, the most exciting thing I saw was B12 deficiency. Lots of migraines that got turfed to Neuro because the PCP ran out of stuff he was willing to try

 

[Gorne]

the only thing the ED accomplishes when attempting a reduction is make ortho cut the splint and have the patient go through the reduction process twice.

 

[Kuratz]

I'll second ophtho. Although the residents work much harder than most people realize, the lifestyle as an attending can be amazing. A newly minted retinal surgeon attending in private practice, who was taking more than partner levels of call mind you, would regularly work 8:30-4 with a full hour for lunch and half days on Friday. Call (Q7) seemed like it consisted of a handful of phone calls over the weekend and occasionally having to come in for something urgent, but less often than not. Partners easily clearing $500k in a "desirable" location. The importance of the general culture of ophtho and other chill specialties cannot be overstated on their value to one's happiness on a daily basis.

Had I liked the subject matter I would have applied ophtho. Instead going into radiology, which is by no means "the cushiest specialty" but still pretty damn good even in private practice.

 

[Giovanotto]

Psych

 

[mymembernames]

Psych in terms of lifestyle and cushiness

 

[ksharp33]

Psych

 

[sloop]

I’m a psych resident and my life is pretty good. I’m pretty efficient, though (not in my evals, which can take hours, but definitely in terms of creating a prioritized list of tasks after rounds and promptly completing it).

The nice thing about psych is that although there is a lot of work to be done for these patients and some of it is time-consuming or tedious, only a small fraction of it is urgent enough that it must be done that day. Depending on the service, I find it reasonably easy to get the urgent stuff done early and spend the rest of the day keeping up on the other tasks.

I stay late (~11-12 hr days) maybe once a week on most services, which is usually due to a late admission, and do on average ~q10 30 hr call. The rest of the time it’s about 9 hr days. Weekends and holidays off if not on call. This is an “intense” psych residency, whatever that means.

 

[Mass Effect]

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.

Some psych residencies also give an afternoon a week off for academic time to do with what you wish. Other psych residencies have full day didactics once a week where all you have to do is show up and it's not even mandatory. So yeah, I would go with psych.

For those talking about the low pay, the way to make money in psych is by doing different things. A psychiatrist can make a lot of money working the same hours a dermatologist would work or doing a variety of things, such as having an outpatient practice part-time or less (usually cash only), an academic appointment for credibility, speaking engagements, writing books, expert witness work, forensic evaluations (fit for duty) for organizations/corporations all at the same time. I think psych is the only specialty that allows you the time and flexibility to be able to cobble together a bunch of jobs to explore your interests and have more than one income stream.

 

[nimbus]

Path seems very cush. You get to hang out in your office and be left alone most of the time.

 

[nimbus]

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.

Skin Cancers Rise, Along With Questionable Treatments

Why Private Equity Is Furious Over a Paper in a Dermatology Journal

Corporatization is a bigger threat than mid levels will ever be. Same with anesthesia/EM/radiology. And the specialty leadership are feeding at the trough. Doctors are interested in a 30yr career. The overlords are interested in a 3-5yr flip.

 

[shemer77]

Path seems very cush. You get to hang out in your office and be left alone most of the time.

+1 for path. You can't beat kicking back in an office all day in terms of cush. I think it would be very boring but still cush.

 

[The Knife & Gun Club]

Path seems very cush. You get to hang out in your office and be left alone most of the time.

Yea I too have heard unemployment can be very relaxing. You don’t even need to go to work!

 

[nimbus]

Yea I too have heard unemployment can be very relaxing. You don’t even need to go to work!

Have you met one of the mythical unemployed pathologists?

 

[The Knife & Gun Club]

Have you met one of the mythical unemployed pathologists?

Yes my neighbor in my building is a pathologist currently doing his 2nd fellowship because he has been unable to land a job for a year after the first fellowship. He did neuropath, and is now doing immunopath...making him a pgy8.

Sorry, not for me.

 

[7331poas]

EM is by far the easiest. 3 year residency. Not very competitive. Get paid 350k. Work 30 hours a week.

Sure you flip hours, but when you only have 3 shifts a week you get over it.

 

[mymembernames]

EM is by far the easiest. 3 year residency. Not very competitive. Get paid 350k. Work 30 hours a week.

Sure you flip hours, but when you only have 3 shifts a week you get over it.

EM looks good on paper from my limited experience doing EM rotations...

 

[Chibucks15]

EM is by far the easiest. 3 year residency. Not very competitive. Get paid 350k. Work 30 hours a week.

Sure you flip hours, but when you only have 3 shifts a week you get over it.

eh I'd get over it when I'm 35 but when I'm 60 I sure as hell wont. I don't know why that gets overlooked so much through the EM lovefest. But hey to each their own

 

[Stagg737]

I think psych is the only specialty that allows you the time and flexibility to be able to cobble together a bunch of jobs to explore your interests and have more than one income stream.

This. One of my attendings literally had a different job each day of the week including inpt, consults, nursing home, and telepsych. He also helps develop protocols for various hospitals and is a medical director for a psych hospital. He's also notorious in our area for not working very much even with all of those jobs, which is something that can really be said about any other field. Plus psych is the only field where I've heard of residents starting up their own private practice as PGY-3/4's. How many other fields actually have time to do that as residents? Not many.

 

[7331poas]

eh I'd get over it when I'm 35 but when I'm 60 I sure as hell wont. I don't know why that gets overlooked so much through the EM lovefest. But hey to each their own

At 60 you may be able to secure seniority in scheduling.

 

[W19]

This. One of my attendings literally had a different job each day of the week including inpt, consults, nursing home, and telepsych. He also helps develop protocols for various hospitals and is a medical director for a psych hospital. He's also notorious in our area for not working very much even with all of those jobs, which is something that can really be said about any other field. Plus psych is the only field where I've heard of residents starting up their own private practice as PGY-3/4's. How many other fields actually have time to do that as residents? Not many.

Not IM for sure

 

[Chibucks15]

At 60 you may be able to secure seniority in scheduling.

May be able to is the operative phrase and just not worth it for me. I don't want to be sleep deprived and switching shifts away from my family for years just for the opportunity to maybe get shift priority. Idk it just ain't me. I get the appeal cuz of money and short residency but there's a reason EM is one of, if not the highest burnout year after year. More power to people who pursue it, I just don't think the downsides of shift work get enough attention from people and the relative lack of flexibility of practice settings also. No real setting up private practice or even a group practice EM where you can set your own hours too. Just playing some devils advocate here

 

[7331poas]

May be able to is the operative phrase and just not worth it for me. I don't want to be sleep deprived and switching shifts away from my family for years just for the opportunity to maybe get shift priority. Idk it just ain't me. I get the appeal cuz of money and short residency but there's a reason EM is one of, if not the highest burnout year after year. More power to people who pursue it, I just don't think the downsides of shift work get enough attention from people and the relative lack of flexibility of practice settings also. No real setting up private practice or even a group practice EM where you can set your own hours too. Just playing some devils advocate here

Ok. And the pay is high enough you can work 1-2 shifts a week and be fine.

There is no better financial decision than to go EM.

 

[W19]

Financially, EM might be the best specialty out there if one can deal with shift aspect of working day and night.

EM docs can work 8 shifts a month and still make 200k+/yr

 

[nimbus]

Rheumatology, allergy, and endocrine are up there. I don’t consider EM cush at all. A busy ER can make you old fast.

 

[7331poas]

Rheumatology, allergy, and endocrine are up there. I don’t consider EM cush at all. A busy ER can make you old fast.

And 4-5 days off per week can make you young...

 

[Mad Jack]

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.

272k isn't bad for a specialty that works around 40 hours a week

 

[Chibucks15]

And 4-5 days off per week can make you young...

like we've both said, to each their own. Nothing wrong with playing devils advocate on this. no need to get defensive on it

 

[cubsrule4e]

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)

Dentist for the eyes!

 

[NicMouse64]

Dentist for the eyes!

Eh I don't see it being that bad of a comparison. Some of the alternate professional schools such as podiatry or dentistry focus in on one part of the body..... Optho definitely fits that bill.

 

[ortnakas]

272k isn't bad for a specialty that works around 40 hours a week

No argument there! I just meant that when people on SDN talk about “a lot of money” they’re referring to plastics/derm/buy-a-Bentley kind of money.

 

[Stagg737]

Ok. And the pay is high enough you can work 1-2 shifts a week and be fine.

There is no better financial decision than to go EM.

Eh, there's plenty of fields that are financially better than EM. Cash only psych can pay 400+ per hour. If you do IMEs you can be reimbursed 1,000/appt and appt may only be 15 minutes long. And you get paid even if the patient is a no-show. Derm as a whole is also a better financial decision most of the time.

Yes, EM is financially great buck for your bang. The best though? Nah, not even close.

 

[Mad Jack]

No argument there! I just meant that when people on SDN talk about “a lot of money” they’re referring to plastics/derm/buy-a-Bentley kind of money.

It's very possible to make plastics money in psych, there are plenty of high 6/low 7 figure psychiatrists I know personally. Unlike many fields, you have much more flexibility in working multiple positions, taking cash-only, supervising others, etc. I don't know a single full-time psychiatrist making less than 400k outside of academics, but I work in a very high need and entrepreneurial area.

 

[W19]

It's very possible to make plastics money in psych, there are plenty of high 6/low 7 figure psychiatrists I know personally. Unlike many fields, you have much more flexibility in working multiple positions, taking cash-only, supervising others, etc. I don't know a single full-time psychiatrist making less than 400k outside of academics, but I work in a very high need and entrepreneurial area.

If your psych program needs a PGY2, hook me up ... 400k!

 

[pbrocks15]

What about RadOnc?

 

[Mad Jack]

What about RadOnc?

That job market tho

 

[pbrocks15]

That job market tho

Is it really that bad?