Cushiest specialties?

[Mad Jack]

Is it really that bad?

Check the rad onc forums

---

Members don't see this ad.

 

[pbrocks15]

Check the rad onc forums

Interesting...

 

[nimbus]

Food for thought...why high volume office practice can kill your soul, even if the hours are “good”.

Why Doctors Hate Their Computers

 

[Lnsean]

It was that forum that completely turned me away from ever seriously considering rad onc.

Its scary to think that you've dedicated like 10+ years in such a specialized field and not able to find a job

 

[Merely]

It was that forum that completely turned me away from ever seriously considering rad onc.

The guys in the rad onc forum are geniuses, they trick naive med students into thinking their field sucks so that the shortage in their field continues to grow and their incomes continue to skyrocket... they’re laughing all the way to the bank

 

[Merely]

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

You seriously introduce yourself as a sub i?

 

[21Rush12]

What’s the recent take on Anesthesiology in this regard, or fellowships like Pain Management?

 

[Mad Jack]

What’s the recent take on Anesthesiology in this regard, or fellowships like Pain Management?

@Psai

 

[Frogger27]

What’s the recent take on Anesthesiology in this regard, or fellowships like Pain Management?

Mixed bag. Doom and gloom if you read the forums over there. I recently talked to one who did a cardiac fellow and loved his job. He said as long as you are okay in a supervising role, not a bad gig. He made it sound like 415k+ with a decent lifestyle (Academic hospital). He said he comes in around 6:30 everyday and is out by 3-4. Downside is overnight call.

Pain is good gig if you can like that patient population or miss clinic (which most anesthesiologists don't)

 

[Stagg737]

What’s the recent take on Anesthesiology in this regard, or fellowships like Pain Management?

Pain is good gig if you can like that patient population or miss clinic (which most anesthesiologists don't)

Pain management is a special kind of torture and is one of the 9 circles of hell. I think it's the 5th one...

 

[VA Hopeful Dr]

Pain management is a special kind of torture and is one of the 9 circles of hell. I think it's the 5th one...

Depends on how you're set up and what you like. Let's see if we can't summon @Birdstrike for his thoughts on the matter

 

[Frogger27]

Pain management is a special kind of torture and is one of the 9 circles of hell. I think it's the 5th one...

hahah I worked with one for a day and actually enjoyed their practice a lot. Only one patient fit the category of the type of obnoxious drug seeking type (and he was more of a psych patient than anything else) that supposedly makes up this patient population. Most of them were normal people with nerve pain and such who came in for their annual nerve ablation and ~6-12 months of relief they felt they couldn't get any other way

 

[Birdstrike]

Pain management is a special kind of torture and is one of the 9 circles of hell. I think it's the 5th one...

I suppose what you're referring to as "Pain management" is "seeing chronic pain patients in the Emergency Department." That's not Pain Medicine. That's not what I do. That's actually what you do (assuming you're in Emergency Medicine).

What I do now is called Interventional Pain Medicine. I've done both (EM and Pain) and what I do currently is a sweet gig. Procedures only, 2 days per week. Clinic 2.5 days per week. No nights, no weekends, no holidays, no call, ever. Cool procedures (epidurals, nerve ablations, spinal cord stimulators, kyphoplasties, joint injections). Choose my own patients. Stress down 90%. Never tired.

I've never thought about going back to working EM shifts, not even for one second, since leaving the ED. But hey, cool. I'm perfectly okay with you thinking what I do is "9 circles of hell." The more people that think what I do is "a circle of hell," the better. That's just job security for me, so I can keep doing what I'm doing, and never have chronic shift-work sleep-dysphoria, again. And what I do now, is 100% sustainable for an entire career. Working in general EM, wasn't, not for me, at least.

But hey, you keep doing you.

 

[Stagg737]

I suppose what you're referring to as "Pain management" is "seeing chronic pain patients in the Emergency Department." That's not Pain Medicine. That's not what I do. That's actually what you do (assuming you're in Emergency Medicine).

What I do now is called Interventional Pain Medicine. I've done both (EM and Pain) and what I do currently is a sweet gig. Procedures only, 2 days per week. Clinic 2.5 days per week. No nights, no weekends, no holidays, no call, ever. Cool procedures (epidurals, nerve ablations, spinal cord stimulators, kyphoplasties, joint injections). Choose my own patients. Stress down 90%. Never tired.

I've never thought about going back to working EM shifts, not even for one second, since leaving the ED. But hey, cool. I'm perfectly okay with you thinking what I do is "9 circles of hell." The more people that think what I do is "a circle of hell," the better. That's just job security for me, so I can keep doing what I'm doing, and never have chronic shift-work sleep-dysphoria, again. And what I do now, is 100% sustainable for an entire career. Working in general EM, wasn't, not for me, at least.

But hey, you keep doing you.

I'm not EM, I'm psych (the EM forum just keeps having interesting threads that pop up on the home page and I've always been interested in EM). What you do is not the type of pain management clinic I was referring to, nor is it what I'd call a "typical" pain management clinic. What you do sounds pretty great, if it were procedure-based with f/ups like a surgery set-up that sound pretty awesome. What I was referring to was the medical, not surgical, management of pain which are typically individuals with chronic pain whose procedures either didn't work or who don't have surgical indications. I feel bad for a lot of these patients because they're chronically miserable and most of the time it's justified. My problem was that most of the patients are chronically miserable even after extensive treatments and they really just have to deal with it (to a certain extent).

So yea, "Interventional PM" sounds pretty sweet. The medical side is not. Just my opinion, but not something I'll have to worry about for the rest of my career (thank god).

 

[21Rush12]

I suppose what you're referring to as "Pain management" is "seeing chronic pain patients in the Emergency Department." That's not Pain Medicine. That's not what I do. That's actually what you do (assuming you're in Emergency Medicine).

What I do now is called Interventional Pain Medicine. I've done both (EM and Pain) and what I do currently is a sweet gig. Procedures only, 2 days per week. Clinic 2.5 days per week. No nights, no weekends, no holidays, no call, ever. Cool procedures (epidurals, nerve ablations, spinal cord stimulators, kyphoplasties, joint injections). Choose my own patients. Stress down 90%. Never tired.

I've never thought about going back to working EM shifts, not even for one second, since leaving the ED. But hey, cool. I'm perfectly okay with you thinking what I do is "9 circles of hell." The more people that think what I do is "a circle of hell," the better. That's just job security for me, so I can keep doing what I'm doing, and never have chronic shift-work sleep-dysphoria, again. And what I do now, is 100% sustainable for an entire career. Working in general EM, wasn't, not for me, at least.

But hey, you keep doing you.

Thank you for this insight — this is similar to what I’ve seen in pain management and I love it. I think I like a bit of clinic and a bit of procedure, and most of the patients I have encountered are helped tremendously by the pain team.

 

[TheIllusionist]

lol I love people are scared of rad onc

 

[Birdstrike]

I'm not EM, I'm psych (the EM forum just keeps having interesting threads that pop up on the home page and I've always been interested in EM). What you do is not the type of pain management clinic I was referring to, nor is it what I'd call a "typical" pain management clinic. What you do sounds pretty great, if it were procedure-based with f/ups like a surgery set-up that sound pretty awesome. What I was referring to was the medical, not surgical, management of pain which are typically individuals with chronic pain whose procedures either didn't work or who don't have surgical indications. I feel bad for a lot of these patients because they're chronically miserable and most of the time it's justified. My problem was that most of the patients are chronically miserable even after extensive treatments and they really just have to deal with it (to a certain extent).

So yea, "Interventional PM" sounds pretty sweet. The medical side is not. Just my opinion, but not something I'll have to worry about for the rest of my career (thank god).

You going to be doing boatloads of listening to people complain of intractable pain that you can't fix, in psych.

 

[Birdstrike]

Thank you for this insight — this is similar to what I’ve seen in pain management and I love it. I think I like a bit of clinic and a bit of procedure, and most of the patients I have encountered are helped tremendously by the pain team.

Some of what we do helps and some of it doesn't. There's a large portion of chronicity. But you do what you can. I tell people day one, I can't cure them, and that if I can reduce their pain 30% when it's flared up, then I'm succeeding. Sometimes you get less, sometimes more. Either way, it's steady work that allows you to have a normal life.

 

[Neopolymath]

I suppose what you're referring to as "Pain management" is "seeing chronic pain patients in the Emergency Department." That's not Pain Medicine. That's not what I do. That's actually what you do (assuming you're in Emergency Medicine).

What I do now is called Interventional Pain Medicine. I've done both (EM and Pain) and what I do currently is a sweet gig. Procedures only, 2 days per week. Clinic 2.5 days per week. No nights, no weekends, no holidays, no call, ever. Cool procedures (epidurals, nerve ablations, spinal cord stimulators, kyphoplasties, joint injections). Choose my own patients. Stress down 90%. Never tired.

I've never thought about going back to working EM shifts, not even for one second, since leaving the ED. But hey, cool. I'm perfectly okay with you thinking what I do is "9 circles of hell." The more people that think what I do is "a circle of hell," the better. That's just job security for me, so I can keep doing what I'm doing, and never have chronic shift-work sleep-dysphoria, again. And what I do now, is 100% sustainable for an entire career. Working in general EM, wasn't, not for me, at least.

But hey, you keep doing you.

How common is your practice set-up? Do you see it being possible for students to create a practice environment like that in the future (10 years)? The independence and more procedures is what makes it appealing. I don't need to be rich, but I would only do this fellowship if it gave me ownership and the ability to make my schedule. Do you manage any meds or is your clinic strictly follow-up/procedure related?

My experience with interventional pain was people like you living the dream and several people working as employees in groups apparently getting screwed and questionable ethics from their partners. The patient population does not bother me at all in the strictly procedural practices I saw because they had great ground rules to weed out the trouble makers. It seemed very rewarding, honestly, but I have no idea what is realistic and what is uncommon.

Thanks.

 

[Birdstrike]

How common is your practice set-up?

I'm not sure how common the set up I'm in, is. I'm in a multispecialty physician-owned group, mostly PCPs and IM subspecialties, and I'm the only Pain guy. So, I can manage my practice pretty much however I want. They're just glad to have someone they can send chronic pain patients to, so I get virtually zero pushback from any of them. They send me what I'll take and refer out what they know I won't. There are quite a few other pain people that I've seen either totally on their own, with large ortho/spine/neurosurg groups or a few hospital employed. There are also bigger Pain-only groups.

Do you see it being possible for students to create a practice environment like that in the future (10 years)?

I don't see why not.

I don't need to be rich, .

Good. Because if you do it right, it won't make you rich.

but I would only do this fellowship if it gave me ownership and the ability to make my schedule.

The schedule is pretty much perfect. Good enough that "making your own" schedule isn't really a thing, since everyone has a perfect schedule from the start. You'd have to go out of your way to find a sh***y schedule.

Do you manage any meds or is your clinic strictly follow-up/procedure related?

I manage some meds but it's only low to moderate dose opiates when completely appropriate. I'm so strict with it, and take such a minimalist approach with opiates, that it's not a big deal. You can do "intervention only" pain medicine, but those jobs are a little harder to find. I may go that route at some point, but I see no reason to take the option completely off the table. I have 90 year olds with broken backs. It would be stupid not to prescribe them what they need. I have a 93 year old, that without a low dose opiate, she can't walk and would be in a nursing home, and she's never abuse or been addicted to a substance in her life. I don't think it's mandatory to be 100% non-opiate. That being said, I probably say, "No" to opiates, twice as much as I say, "Yes" and prescribe. The fact that the pendulum is swinging to the anti-opiate side, is great. It means there's less (maybe zero soon) pressure to prescribe. If fact, there's more pressure now, not to prescribe and that makes it easier to say, "No." You have a convenient scapegoat. "Sorry, risks outweigh the gains." Done. Bye.

Explaining how to make med management "manageable" is a whole thread in and of itself, but in short, it's easy to do. We make the process of getting meds arduous enough, that a desperate addict looking for quick meds to abuse or sell, is much more likely to roll into an ED unannounced, than try to plod through our process. I can explain this process and the policies in more detail if you want., but it would bore everyone else.

My experience with interventional pain was people like you living the dream

I wouldn't go so far as to say it's "living the dream" but it's steady work, good pay with no nights, holidays, weekends or call and with low stress.

My experience with interventional pain was ...several people working as employees in groups apparently getting screwed and questionable ethics from their partners.

This can be a problem. You have to steer clear of these groups and be very, very careful. Some can be really, really bad. It becomes pretty clear, pretty fast, which groups care about good patient care, and which focus too aggressively on money at the expense of ethics. This happens in all specialties, but Pain can be really bad, in this area. There's also the pill mills, but those are obvious and stink from a million miles away.

The patient population does not bother me at all in the ...

ED patients can be very challenging. Pain patients can be challenging. Psych patients can be challenging. Ortho/spine, neurosurg, primary care, rheumatology...we all deal with the same patients with the same problems. It's not the patient, but how you deal with them, and what restrictions you're under in how you're able to deal with them. EMTALA and admin make it hard in the ED. Also, having codes come and managing critical patients while being expected to manage chronic patients ethically in metric-minded time is challenging. But ask yourself, do the ortho/spine or neurosurgeons, the one's with terrible bedside manner, do you think they bang their heads against the wall and get frustrated with patients that have unrealistic expectations with meds or anything else?
No. They just do what they're going to do, say what they're going to say and they're out the door. I'm not saying you should act like that, but there's no rule saying you need to stand and argue with someone irrational and try to convince to agree with you. You simply give your recommendation and you're done. They can always get a second opinion. There's no emtala saying they can walk right back in your door if they're belligerent. If you see patients, you're going to have to deal with chronic pain patients, whether that's in the ED, Pain, surgery or any other setting. You'll see patients that are challenging in other ways. It's up to you to know how to handle them.

because they had great ground rules to weed out the trouble makers.

Yes. You can do this in your office and have tremendous control over this. In the ED you only have a fraction of that.

It seemed very rewarding, honestly

I mean, work is work, but yeah, it can be rewarding at times. I just did a kyphoplasty on a 95 year old. Got her out of a nursing home and back to her condo. That's pretty cool. Other patients you can't help. It just is what it is. You help who you can, and you can't help who you can't help. You send them back to whoever referred them to you. It's that simple. You're not required by law to see anyone. You can discharge anyone, for any reason, or no reason at all, at any time. You can't do that in the ED.

If you can get a fellowship it's worth looking in to.

I recommend all ED residents do some fellowship, any fellowship to give yourself more schedule control options down the road. You'll need it later in your career. You think you won't right now, but you will.

I've known people that have done hyperbarics, cardiovascular, EMS, admin, Pain and Hospice/Palliative. In each case, it's made their careers better and more sustainable, down stream.

 

[Man o War]

What’s the recent take on Anesthesiology in this regard, or fellowships like Pain Management?

None of our residents or fellows have any problem finding 400k plus jobs in anesthesia if that’s what they want. If you insist on being in San Fran or New York City, that doesn’t apply. If you are reasonably geographically flexible, many good jobs to be had. I’m not even talking BFE where nobody wants to live- reasonable as in large metro areas not on the coast.
Cardiac seems to be the hot ticket for now, add another 20-25% or more to the number I quoted above. Easy to find jobs since the trend is toward requiring advanced TEE, which you can only get through an ACGME fellowship now. You will likely take more call on paper, but commonly from home for hearts.
Pain is always a good fellowship if you can stand the patient profile.
The “sky has been falling” in anesthesia for the many decades I’ve been doing it, and I’m still doing more than fine.

 

[Stagg737]

You going to be doing boatloads of listening to people complain of intractable pain that you can't fix, in psych.

Sure, but I don't specifically treat pain and tell my patients that from the start. I just refer them to guys like you

 

[Birdstrike]

Sure, but I don't specifically treat pain and tell my patients that from the start. I just refer them to guys like you

Well, you still see them. You have many patients with chronic pain. You may not give them opiates, but you set the expectations. You tell them a certain thing that allows you to treat them on your terms. But that's no different than anyone else that sees a chronic pain (or any other) patient. You, as the physician, have to set the terms of the interaction. You can be a pain MD and tell them, "I don't treat chronic pain, with opiates," or "I don't prescribe opiates for pain, unless you have cancer," or what ever other terms you want to put on it. Better yet, you can have your scheduler tell the patients and you don't even have to. Or you can be a psych MD and say, "I don't treat pain."

Or, you can choose to be victimized by every attempt at emotional manipulation under the sun. But that occurs in all specialties and all diagnoses. You can't possibly be implying that doesn't happen in psych? That choosing the speciality of psych protects you from patient attempts at manipulation?

The point is, you're not a victim of your patient's pathology unless you choose to be. It's not the diagnosis that matters, or the specialty you slap on your name badge, it's you and how you set the terms of the doctor patient relationship, that matters. You don't have to be manipulated by a patient (or any person's) manipulations, unless you give them permission. This goes for any type of patient, with any type of pathology in any specialty that involves live patients. You're in control of the doctor patient relationship, not them, unless you give them control. This applies to any physician, or provider, in any health care setting. Don't be deceived that there's any convenient shelter from this, other than how you set the terms.

 

[Neopolymath]

I'm not sure how common the set up I'm in, is. I'm in a multispecialty physician-owned group, mostly PCPs and IM subspecialties, and I'm the only Pain guy. So, I can manage my practice pretty much however I want. They're just glad to have someone they can send chronic pain patients to, so I get virtually zero pushback from any of them. They send me what I'll take and refer out what they know I won't. There are quite a few other pain people that I've seen either totally on their own, with large ortho/spine/neurosurg groups or a few hospital employed. There are also bigger Pain-only groups.

I don't see why not.


Good. Because if you do it right, it won't make you rich.


The schedule is pretty much perfect. Good enough that "making your own" schedule isn't really a thing, since everyone has a perfect schedule from the start. You'd have to go out of your way to find a sh***y schedule.

I manage some meds but it's only low to moderate dose opiates when completely appropriate. I'm so strict with it, and take such a minimalist approach with opiates, that it's not a big deal. You can do "intervention only" pain medicine, but those jobs are a little harder to find. I may go that route at some point, but I see no reason to take the option completely off the table. I have 90 year olds with broken backs. It would be stupid not to prescribe them what they need. I have a 93 year old, that without a low dose opiate, she can't walk and would be in a nursing home, and she's never abuse or been addicted to a substance in her life. I don't think it's mandatory to be 100% non-opiate. That being said, I probably say, "No" to opiates, twice as much as I say, "Yes" and prescribe. The fact that the pendulum is swinging to the anti-opiate side, is great. It means there's less (maybe zero soon) pressure to prescribe. If fact, there's more pressure now, not to prescribe and that makes it easier to say, "No." You have a convenient scapegoat. "Sorry, risks outweigh the gains." Done. Bye.

Explaining how to make med management "manageable" is a whole thread in and of itself, but in short, it's easy to do. We make the process of getting meds arduous enough, that a desperate addict looking for quick meds to abuse or sell, is much more likely to roll into an ED unannounced, than try to plod through our process. I can explain this process and the policies in more detail if you want., but it would bore everyone else.

I wouldn't go so far as to say it's "living the dream" but it's steady work, good pay with no nights, holidays, weekends or call and with low stress.


This can be a problem. You have to steer clear of these groups and be very, very careful. Some can be really, really bad. It becomes pretty clear, pretty fast, which groups care about good patient care, and which focus too aggressively on money at the expense of ethics. This happens in all specialties, but Pain can be really bad, in this area. There's also the pill mills, but those are obvious and stink from a million miles away.

ED patients can be very challenging. Pain patients can be challenging. Psych patients can be challenging. Ortho/spine, neurosurg, primary care, rheumatology...we all deal with the same patients with the same problems. It's not the patient, but how you deal with them, and what restrictions you're under in how you're able to deal with them. EMTALA and admin make it hard in the ED. Also, having codes come and managing critical patients while being expected to manage chronic patients ethically in metric-minded time is challenging. But ask yourself, do the ortho/spine or neurosurgeons, the one's with terrible bedside manner, do you think they bang their heads against the wall and get frustrated with patients that have unrealistic expectations with meds or anything else?
No. They just do what they're going to do, say what they're going to say and they're out the door. I'm not saying you should act like that, but there's no rule saying you need to stand and argue with someone irrational and try to convince to agree with you. You simply give your recommendation and you're done. They can always get a second opinion. There's no emtala saying they can walk right back in your door if they're belligerent. If you see patients, you're going to have to deal with chronic pain patients, whether that's in the ED, Pain, surgery or any other setting. You'll see patients that are challenging in other ways. It's up to you to know how to handle them.


Yes. You can do this in your office and have tremendous control over this. In the ED you only have a fraction of that.


I mean, work is work, but yeah, it can be rewarding at times. I just did a kyphoplasty on a 95 year old. Got her out of a nursing home and back to her condo. That's pretty cool. Other patients you can't help. It just is what it is. You help who you can, and you can't help who you can't help. You send them back to whoever referred them to you. It's that simple. You're not required by law to see anyone. You can discharge anyone, for any reason, or no reason at all, at any time. You can't do that in the ED.

If you can get a fellowship it's worth looking in to.

I recommend all ED residents do some fellowship, any fellowship to give yourself more schedule control options down the road. You'll need it later in your career. You think you won't right now, but you will.

I've known people that have done hyperbarics, cardiovascular, EMS, admin, Pain and Hospice/Palliative. In each case, it's made their careers better and more sustainable, down stream.

Thank you for your detailed posts as always! We appreciate it.

 

[Birdstrike]

Thank you for your detailed posts as always! We appreciate it.

You're welcome. Anytime.

 

[Merely]

Pain patients suck everyone knows this lol

 

[Birdstrike]

Pain patients suck everyone knows this lol

What do you know about "patients"?

 

[evilbooyaa]

The guys in the rad onc forum are geniuses, they trick naive med students into thinking their field sucks so that the shortage in their field continues to grow and their incomes continue to skyrocket... they’re laughing all the way to the bank

Not sure if serious. Just because SDN members don't go into Rad Onc doesn't mean that the spots are going to go unfilled. Still going to be the same number of residency grads per year. There is a predicted oversupply of Rad Oncs per most recent analyses, and incomes for MOST attendings (people who get paid professional and not technical) are already decreasing compared to historical averages.

The pluses for Rad Onc is that residency is relatively cush (likely at most 60 hours/week), attending life is as well compared to any specialty that takes serious in-house call, no scheduled weekend hours. Working with cancer patients with a modality that assists in curing patients more than chemo, and palliating those who chemo isn't working for anymore (broad strokes). Cool technology, learning ins and outs can be interesting. Oncology training from day 1, and the most of it (4 years vs 3 for med-onc and 1-2 for surgeons) so a good rad onc is the most versed on the literature and treats cancer, if indicated, anywhere in the body. Obviously sub-specialists exist in academics, but in PP, you could see a H&N cancer, a prostate, and a breast all in the same day.

 

[nimbus]

None of our residents or fellows have any problem finding 400k plus jobs in anesthesia if that’s what they want. If you insist on being in San Fran or New York City, that doesn’t apply. If you are reasonably geographically flexible, many good jobs to be had. I’m not even talking BFE where nobody wants to live- reasonable as in large metro areas not on the coast.
Cardiac seems to be the hot ticket for now, add another 20-25% or more to the number I quoted above. Easy to find jobs since the trend is toward requiring advanced TEE, which you can only get through an ACGME fellowship now. You will likely take more call on paper, but commonly from home for hearts.
Pain is always a good fellowship if you can stand the patient profile.
The “sky has been falling” in anesthesia for the many decades I’ve been doing it, and I’m still doing more than fine.

Demand is certainly there. However, the jobs are not cush. Secretions everywhere, transporting ICU patients with 8 infusion pumps and a balloon pump at 2am, and turning over 300-400lb patients. It’s real physical work.

 

[Candidate2017]

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.

Are these hours on psychiatry services (not off service)? If so, indeed intense for psych... I'm stressed just reading those hours lol.

 

[Candidate2017]

You going to be doing boatloads of listening to people complain of intractable pain that you can't fix, in psych.

We don't get a lot of pain patients because the public associates pain with the body and perceive psychiatrists as docs who treat the mind. Occasionally during an inpatient hospitalization I'll have an chronic pain/opioid seeker slip through. If it's anything beyond Norco 5-325, I get a look of sheer terror of having to remember back to med school and how to convert morphine equivalents. During my 20 minute "opioids bad/mind-body pain connection/alternative treatments for pain/studies on efficacy of meditation for chronic pain" lecture, I'm convinced the terror on my face convinces them I'm convinced they're going to drop dead if I prescribe them additional pain meds. After 10 days of being cooped up and forced to go to group therapy on the hour every daylight hour, their depression is cured, they are no longer suicidal, agree to make an appointment with their PCP or pain doc and they're ready for D/C.

Benzos and stimulants are another story as I can't adequately fake ignorance. Maybe one day.

 

[sloop]

Are these hours on psychiatry services (not off service)? If so, indeed intense for psych... I'm stressed just reading those hours lol.

Yeah, these are inpatient psych hours as a PGY-2 in my program.

We don't get a lot of pain patients because the public associates pain with the body and perceive psychiatrists as docs who treat the mind. Occasionally during an inpatient hospitalization I'll have an chronic pain/opioid seeker slip through. If it's anything beyond Norco 5-325, I get a look of sheer terror of having to remember back to med school and how to convert morphine equivalents. During my 20 minute "opioids bad/mind-body pain connection/alternative treatments for pain/studies on efficacy of meditation for chronic pain" lecture, I'm convinced the terror on my face convinces them I'm convinced they're going to drop dead if I prescribe them additional pain meds. After 10 days of being cooped up and forced to go to group therapy on the hour every daylight hour, their depression is cured, they are no longer suicidal, agree to make an appointment with their PCP or pain doc and they're ready for D/C.

Benzos and stimulants are another story as I can't adequately fake ignorance. Maybe one day.

Really? We see chronic pain patients frequently. We actually have a service for this.

 

[Birdstrike]

We don't get a lot of pain patients because the public associates pain with the body and perceive psychiatrists as docs who treat the mind. Occasionally during an inpatient hospitalization I'll have an chronic pain/opioid seeker slip through. If it's anything beyond Norco 5-325, I get a look of sheer terror of having to remember back to med school and how to convert morphine equivalents. During my 20 minute "opioids bad/mind-body pain connection/alternative treatments for pain/studies on efficacy of meditation for chronic pain" lecture, I'm convinced the terror on my face convinces them I'm convinced they're going to drop dead if I prescribe them additional pain meds. After 10 days of being cooped up and forced to go to group therapy on the hour every daylight hour, their depression is cured, they are no longer suicidal, agree to make an appointment with their PCP or pain doc and they're ready for D/C.

Benzos and stimulants are another story as I can't adequately fake ignorance. Maybe one day.

See, I give myself easy out with benzos and stimulants, "Sorry, those aren't pain medicines. I can't prescribe them." And it's done. Or on the other hand, I could get manipulated and sucked in to prescribing boatloads of those likely some psychiatrists, PCP and Pain MDs do. And you feel pressure to prescribe those medicines, and I feel none. So, it's 6 of one, or half dozen of the other. Patients are human beings. Human beings will try to manipulate those with the power to give them what they want, to the extent the targets will allow it. It doesn't matter what specialty you're in. If you're a doctor, you have powers your patients don't have (whether a prescription pad, the ability to make them feel better, certify disability, make them look better, give them days off work/school, etc) and if you let them, they'll try to toy with you, but only to the extent you allow it.

So, if you're sitting there dreading the thought of some type of patient coming in, who might try to manipulate to do something you don't want to do, then obviously you haven't thought through why you do or do not do certain things. If you don't think opiates are good for people, have the non-negotiable reason why, ready to go. If you feel the same way about benzo/stims, disability paperwork, useless test patient want, unnecessary antibiotics, or anything else, have a pat answer ready, deliver the reason, stick to it and and never, ever argue. If people start to argue, walk out of the room. Done. If they refuse to leave, call the cops. Period. End of story. If they send a bad Press Ganey or complaint letter, so be it. You have your reason and you give it again. Because its "the right thing for the patient. Here's the reason why..."

There's no reason to dread any patient type. We need to be more skilled than that.

 

[hurtem&healem]

Sweet necro.


For everyone talking about EM, there's something I've been wondering every time it's brought up. The biggest downside everyone always points to is the flip-flopping of shifts. That sucks, I know, I've done it. But I do actually enjoy working overnights. Most of my 20's I spent working in bars until 5am, before school started I was working overnights in a hospital for the better part of year. It works for me and my household. Is just solely working overnights an option as a new attending? I would think it would actually be a selling point pretty much anywhere, since I'd be saving other people from having to flip. I mean, there are a lot of nocturnist IM docs nowadays, and my understanding is that they're incentivized to do so. EM groups have got to be looking for that, no? Or are there groups out there that would actually say, "Nah, bro, we alternate days and nights, and you're going to, too."

 

[esob]

Sweet necro.


For everyone talking about EM, there's something I've been wondering every time it's brought up. The biggest downside everyone always points to is the flip-flopping of shifts. That sucks, I know, I've done it. But I do actually enjoy working overnights. Most of my 20's I spent working in bars until 5am, before school started I was working overnights in a hospital for the better part of year. It works for me and my household. Is just solely working overnights an option as a new attending? I would think it would actually be a selling point pretty much anywhere, since I'd be saving other people from having to flip. I mean, there are a lot of nocturnist IM docs nowadays, and my understanding is that they're incentivized to do so. EM groups have got to be looking for that, no? Or are there groups out there that would actually say, "Nah, bro, we alternate days and nights, and you're going to, too."

That is exactly what happens. I know an EM attending who was a "nocturnist" and still they do the flip-flopping, even when someone wants to work only overnights. The best you can hope for is to be somewhere that lets you swap shifts easily. EM would be my number one choice if it wasn't for the flip-flopping.

 

[zapproximator]

Dentistry is arguably the cushiest healthcare field.

 

[cubsrule4e]

Dentistry is arguably the cushiest healthcare field.

And also the most suicidal

 

[MEN2C]

My friend in allergy. I could never do it. Not for a million dollars. But he loves it.

 

[puahate]

Not sure if serious. Just because SDN members don't go into Rad Onc doesn't mean that the spots are going to go unfilled. Still going to be the same number of residency grads per year. There is a predicted oversupply of Rad Oncs per most recent analyses, and incomes for MOST attendings (people who get paid professional and not technical) are already decreasing compared to historical averages.

The pluses for Rad Onc is that residency is relatively cush (likely at most 60 hours/week), attending life is as well compared to any specialty that takes serious in-house call, no scheduled weekend hours. Working with cancer patients with a modality that assists in curing patients more than chemo, and palliating those who chemo isn't working for anymore (broad strokes). Cool technology, learning ins and outs can be interesting. Oncology training from day 1, and the most of it (4 years vs 3 for med-onc and 1-2 for surgeons) so a good rad onc is the most versed on the literature and treats cancer, if indicated, anywhere in the body. Obviously sub-specialists exist in academics, but in PP, you could see a H&N cancer, a prostate, and a breast all in the same day.

is this true for today?

 

[Deecee2DO]

My friend in allergy. I could never do it. Not for a million dollars. But he loves it.

What turns you off about Allergy my experience with it has been awesome the docs seem to have decent lifestyle and pay isnt horrible 300-400 i think? A lot of problem solving

 

[Raney Schauer]

Dead Thread Redemption is the best game ever.

 

[kb1900]

What turns you off about Allergy my experience with it has been awesome the docs seem to have decent lifestyle and pay isnt horrible 300-400 i think? A lot of problem solving

doximity report 2019 showed allergy as fairly low in terms of compensation. wonder if thats bias/low n or reality. i have a tough time imagining doing fellowship after IM for a lower pay right?

 

[Chibucks15]

Saying 300-400k a year “isn’t horrible” is the most SDN thing I’ve ever seen. Dear god

 

[MedicineZ0Z]

Saying 300-400k a year “isn’t horrible” is the most SDN thing I’ve ever seen. Dear god

For this field? We should have those standards.

 

[Deecee2DO]

Saying 300-400k a year “isn’t horrible” is the most SDN thing I’ve ever seen. Dear god

For the amount of time it takes to be an allergist (5 years after med school) no ~350K is not horrible. After all that time studying and training to be a doctor, that amount isn't incredible but it isn't bad. Endocrinologists and ID docs make the same as internists and theyre in school longer (same training length as an allergist) which is horrible pay for the investment IMO

 

[Deecee2DO]

For this field? We should have those standards.

200%

 

[Deecee2DO]

doximity report 2019 showed allergy as fairly low in terms of compensation. wonder if thats bias/low n or reality. i have a tough time imagining doing fellowship after IM for a lower pay right?

Compared to GI and Cards yes, but I am pretty sure more than ID and Endo. I would say middle of the road for IM specialty along with rheum

 

[SDunkey]

Saying 300-400k a year “isn’t horrible” is the most SDN thing I’ve ever seen. Dear god

There was a post on here or reddit that mentioned how you could tell which posters grew up with physician parents.
As someone who's parents both make minimum wage, the potential 200k earnings sounds amazing to me.

 

[Giovanotto]

There was a post on here or reddit that mentioned how you could tell which posters grew up with physician parents.
As someone who's parents both make minimum wage, the potential 200k earnings sounds amazing to me.

Who wants to take this one? I'm too tired right now.

 

[M&L]

Who wants to take this one? I'm too tired right now.

300K student loans before interest , retired parents who need my financial support , starting a family (female , 33 now, engaged), private schools 12-25K a year for each kid, mortgage on east cost (Northern Virginia) is 350K min for a house that is 45 min commute from DC... how am I doing ?