Does anyone else find it crazy how most specialties are stratified?

[CidHighwind]

So hear me out. While doing an analysis of all the specialties, I’ve come to a conclusion. It seems like all the “cool” specialties have really long training times and long hours in addition to being super competitive (surgical specialties, IR, and other procedure-heavy fields), the ones that allow you to make ridiculous money but be bored at work are really competitive (derm, rads/radonc, allergy, optho), and then once people find out about how much you can make in a “less competitive” specialty, it suddenly increases in competitiveness, even if the job hasn’t changed (EM and psych are the big ones, PM&R creeping on up). I mean I get why, but then I don’t get why all the premeds keep on lying about how money/lifestyle don’t matter to them, as if Adcoms will be able to find them . You’d think by how people talk about these things you’d need to be AOA to get into primary care.

Now obviously I’m only half-serious. Being any type of doctor allows you to make a difference in someone’s life and be a positive force in the universe. That said, it is kind of funny to me. IDK, just find it funny how FoS most of us are

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[Angus Avagadro]

All specialties are getting more competetive. Primary care not so much. The market determines what the value of your labor really is. People who dont realize this are a set up for disappointment

 

[ACSurgeon]

So hear me out. While doing an analysis of all the specialties, I’ve come to a conclusion. It seems like all the “cool” specialties have really long training times and long hours in addition to being super competitive (surgical specialties, IR, and other procedure-heavy fields), the ones that allow you to make ridiculous money but be bored at work are really competitive (derm, rads/radonc, allergy, optho), and then once people find out about how much you can make in a “less competitive” specialty, it suddenly increases in competitiveness, even if the job hasn’t changed (EM and psych are the big ones, PM&R creeping on up). I mean I get why, but then I don’t get why all the premeds keep on lying about how money/lifestyle don’t matter to them, as if Adcoms will be able to find them . You’d think by how people talk about these things you’d need to be AOA to get into primary care.

Now obviously I’m only half-serious. Being any type of doctor allows you to make a difference in someone’s life and be a positive force in the universe. That said, it is kind of funny to me. IDK, just find it funny how FoS most of us are

You should do what you enjoy otherwise you’ll end up disappointed. Part of enjoying your career is having the right work life balance and feeling adequately paid for your time at work. That feeling is also different for different people and changes over time. Since there’s no way to truly know what your work life balance or pay will be like when you’re a medical student, you really should focus on finding what you enjoy and use rough guesses about what to expect but try to hope for the best prepare for the worst type thing.

Regarding premeds: I think we all start our somewhat naive. Especially those of us without doctor parents . We underestimate the sacrifice and the burden of student loans. Also, as we get older and start families and have kids, your time away from your family becomes increasingly valuable to you, and your perception changes.

So I don’t know that premeds are FOS; perhaps just appropriately naive.

 

[libertyyne]

This just in: water is wet .

 

[sella.turcica]

This just in: water is wet .

Depends on the temperature.

 

[Lucca]

Depends on the temperature.

Broke: depends on the temperature
Woke: depends on the pressure

 

[nlax30]

I'm not sure you can generalize something like a certain field like Ophtho or Rads/RadOnc that could be lucrative would also be boring.

Each field has its own pace what may seem boring or busy to me may not seem that way to someone else. Someone who does highly complex/long procedures or surgeries may have one or two surgeries that day and see a couple additional patients while the Ophtho in the office may see like 30 patients. Who would you consider bored or busy? Everyone has their own interest and to me I couldn't day and day in out see 20-30 office patients. Others may go crazy having like 1 or 2 four hour surgeries.

 

[CidHighwind]

This just in: water is wet .

It’s obvious duh, it’s just funny how you look all over here, and people deny these facts left and right lol. That’s what I’m getting at.

 

[7331poas]

It’s obvious duh, it’s just funny how you look all over here, and people deny these facts left and right lol. That’s what I’m getting at.

Who has ever denied this? Competitive specialties either pay a lot (ortho/nsg) or pay a medium amount for low stress (derm). Its not controversial.

 

[NickNaylor]

You see this with the cliche story of medical student John Smith suddenly being interested in competitive specialties once step 1 scores are returned. It's a reality of life; medicine is a job, and while I think it's important for your own sake to see it as something more (e.g., getting some sense of satisfaction out of the work, feeling like you're doing something meaningful, etc.), the "bottom line" does matter. Becoming a physician isn't free - either in time or money - and that "payment" needs to be repaid somehow.

 

[CherryRedDracul]

What the hell are you talking about.

Rads (both diagnostic and interventional) is not boring.

 

[Moko]

Different strokes for different people. There are no specialties that are seen as universally boring or exciting.

 

[Goro]

People, do what you love, and love what you do. I found my love in teaching med students.

 

[CidHighwind]

People, do what you love, and love what you do. I found my love in teaching med students.

The “do what you love” thing gets repeated as nauseum on here, but I feel like most people in general don’t “love” their job. Some do, but one could make the argument that it’s better to do something where you can have more fun outside of work.

 

[nimbus]

The “do what you love” thing gets repeated as nauseum on here, but I feel like most people in general don’t “love” their job. Some do, but one could make the argument that it’s better to do something where you can have more fun outside of work.

I disagree. Speaking from experience, loving what you do is arguably better than winning the lotto. There are few things better in life than getting paid handsomely to do something you enjoy.

 

[Obnoxious Dad]

It's basic economics. Since time began people have measured the value and status of a job by the amount of money earned for a given amount of time. This stratification wouldn't surprise any economist. Dermatologists make a pile of cash and have their weekends and holidays off. That's why it's tough to match in dermatology.

It's understandable that people are greedy. The real problem is dishonesty in medicine at every level. If you want to get real depressed, read this:

Dishonesty in Medicine Revisited

www.ncbi.nlm.nih.gov

 

[libertyyne]

The “do what you love” thing gets repeated as nauseum on here, but I feel like most people in general don’t “love” their job. Some do, but one could make the argument that it’s better to do something where you can have more fun outside of work.

When you love what you do , working is also fun. One way or the other you are going to put in ~2k hours a year at work. If you hate every minute of it will feel like 10 k hours per year. What is the point of working that job if you feel miserable at it all the time and dread going in.

It's basic economics. Since time began people have measured the value and status of a job by the amount of money earned for a given amount of time. This stratification wouldn't surprise any economist. Dermatologists make a pile of cash and have their weekends and holidays off. That's why it's tough to match in dermatology.

It's understandable that people are greedy. The real problem is dishonesty in medicine at every level. If you want to get real depressed, read this:

Dishonesty in Medicine Revisited

www.ncbi.nlm.nih.gov

Doctors are human, and unfortunately come with all the good things and bad things associated with being human.

 

[kb1900]

The “do what you love” thing gets repeated as nauseum on here, but I feel like most people in general don’t “love” their job. Some do, but one could make the argument that it’s better to do something where you can have more fun outside of work.

I disagree completely. I still remember shift work before medical school where a 3 hour shift could feel like 12 hours.
@libertyyne beat me to the punch

moreover medicine is so diverse, you’d be doing yourself a disservice not trying to seek out the field you love

On top of that most fields in medicine allow you to work how much you want to as long as you’re willing to be flexible in how you’re compensated.

 

[CidHighwind]

I disagree. Speaking from experience, loving what you do is arguably better than winning the lotto. There are few things better in life than getting paid handsomely to do something you enjoy.

Right, but a lot of things influence how much you like work. The bureaucrats and politics at your hospital/practice, the people one works with, the patient population, call schedule, etc. One can enjoy their specialty but absolutely hate their “job”. It’s important to at least be able to tolerate the nuts and bolts of that specialty, but liking a rotation as a med student may not translate into enjoying the actual job.

 

[zanzizic]

So derm, rads/rad onc, allergy, and ophtho are boring?

Hmmmm, I didn’t know that. I feel stupid now for enjoying my dermatology practice and treating all of those skin diseases all these years.

 

[7331poas]

So derm, rads/rad onc, allergy, and ophtho are boring?

Hmmmm, I didn’t know that. I feel stupid now for enjoying my dermatology practice and treating all of those skin diseases all these years.

coke is better than pepsi, doesn't mean that there arent a few pepsi fans out there.

 

[WildcatS11]

What the hell are you talking about.

Rads (both diagnostic and interventional) is not boring.

Exactly - diagnostic rad’s is not boring TO YOU. Ain’t no way I could sit all day doing what rad’s does. I just couldn’t. I appreciate how people like it. But I would hate every minute of it.

Interventional - now that could be more fulfilling (To me).

 

[Tenk]

I disagree. Speaking from experience, loving what you do is arguably better than winning the lotto. There are few things better in life than getting paid handsomely to do something you enjoy.

I disagree with your disagreement. There is not a single job in medicine (to me) that is as fun as snowboarding, mountain biking, or just spending time with my family. I would rate them as 100x more fun and I actually enjoy my job unlike some people. I always tell people to find the specialty they like the most (or hate the least) that matches the life they want to live.

Take myself for example. On the outside I look like a perfect fit for ortho: I've been lifting since college and still do, I love sports/outdoors/sports medicine, I'm very laid back and chill, and I used to do construction/minor carpentry so I've been using power tools since I was in jr high. Problem was ortho docs work, quite a lot, and they take call. Didn't really fit with the lifestyle I wanted to live, so I went with the next best thing: EM.

I work 11 days this month.

Yeah.

 

[993444]

People, do what you love, and love what you do. I found my love in teaching med students.

And cats. Don't forget cats!

 

[993444]

I disagree with your disagreement. There is not a single job in medicine (to me) that is as fun as snowboarding, mountain biking, or just spending time with my family. I would rate them as 100x more fun and I actually enjoy my job unlike some people. I always tell people to find the specialty they like the most (or hate the least) that matches the life they want to live.

Take myself for example. On the outside I look like a perfect fit for ortho: I've been lifting since college and still do, I love sports/outdoors/sports medicine, I'm very laid back and chill, and I used to do construction/minor carpentry so I've been using power tools since I was in jr high. Problem was ortho docs work, quite a lot, and they take call. Didn't really fit with the lifestyle I wanted to live, so I went with the next best thing: EM.

I work 11 days this month.

Yeah.

But would you really be happy if all you did was hobbies and family time? All day every day?

Especially since I'm sure you can't snowboard AND mountainbike at the same time since they require opposite weather patterns Unless you mountainbike in the snow. In that case more power to you!

 

[Drrrrrr. Celty]

Prestige, expertise, and money determine what people go to.

Family medicine makes plenty of solid money. But it's not prestigious and it lacks the expertise factor. I think in many respects it's a massive issue with the procession not marketing itself well. But I think for a career where you can make 250k working 4 days a week and dealing with things in a relaxed setting it's ideal for probably tons of people.

Alternatively Derm offers everything FM does with the added benefit that it makes 100k more and is prestigious. It also offers more opportunity for advancement ex Mohs.

 

[Tenk]

But would you really be happy if all you did was hobbies and family time? All day every day?

Especially since I'm sure you can't snowboard AND mountainbike at the same time since they require opposite weather patterns Unless you mountainbike in the snow. In that case more power to you!

Absolutely I would be.

Snowboarding is a winter sport. Mountain biking is a spring/summer sport.

You can bike in the snow but I’d rather board personally:

 

[993444]

Absolutely I would be.

Snowboarding is a winter sport. Mountain biking is a spring/summer sport.

You can bike in the snow but I’d rather board personally:

Since you graduated college so long ago...... how has your lifting progressed? How has your bench and squat changed? My bench increased rapidly when I was 21 and now i'm approaching my late 20's and it's not increasing as much and I'm bumming out.

Also, how old were you when you started snowboarding and mountianbiking? I want to start rock climbing but feel like i'm a bit old at this point.

 

[CidHighwind]

But would you really be happy if all you did was hobbies and family time? All day every day?

Especially since I'm sure you can't snowboard AND mountainbike at the same time since they require opposite weather patterns Unless you mountainbike in the snow. In that case more power to you!

So you’re basically saying if people didn’t have to work they’d just be bored all day? Isn’t that one of the reasons people look forward to retirement?

Also you’re not thinking laterally enough about these things. It’ll be snowy at a high enough altitude, and if you’re near a beach, you can always surf or water ski.

 

[993444]

So you’re basically saying if people didn’t have to work they’d just be bored all day? Isn’t that one of the reasons people look forward to retirement?

There's a ton of research linking depression and retirement. "Loss of Purpose" is one of the biggest complaints.

 

[Tenk]

Since you graduated college so long ago...... how has your lifting progressed? How has your bench and squat changed? My bench increased rapidly when I was 21 and now i'm approaching my late 20's and it's not increasing as much and I'm bumming out.

Lifting has steadily progressed. My bench capped out a few years ago due to constantly reinjuring my shoulder for various reasons. My legs have capped out this year because my left knee started hurting.

Aging sucks. Don't do it.

 

[993444]

Lifting has steadily progressed. My bench capped out a few years ago due to constantly reinjuring my shoulder for various reasons. My legs have capped out this year because my left knee started hurting.

Aging sucks. Don't do it.

You're scaring me Tenk.

My supervisor (late 40's) is an avid hockey player. Buff as hell. But he has a limp ankle, rotator cuff tear, and a bad hernia. God just hit him at every section.

 

[efle]

My attending on my medicine rotation took us to lunch and their big nugget of wisdom they gave us was: "Rotating through something as a medical student is nothing like attending."

Boy was that confusing. What the hell am I supposed to base my decisions on, if I cant even trust my impression from rotating through the specialty?

Am I really just supposed to ask myself 1) do I like money, 2) do I like free time, and 3) can I better tolerate eyeballs or skin?

 

[CidHighwind]

My attending on my medicine rotation took us to lunch and their big nugget of wisdom they gave us was: "Rotating through something as a medical student is nothing like attending."

Boy was that confusing. What the hell am I supposed to base my decisions on, if I cant even trust my impression from rotating through the specialty?

Am I really just supposed to ask myself 1) do I like money, 2) do I like free time, and 3) can I better tolerate eyeballs or skin?

Right! What we love as a medical student may not be what we love as an attending. Since it seems like a lot of physicians in every specialty have a good amount of “burnout”, it’s probably just part of the job. Even if you enjoy the subject matter, there’s still enough annoying/tedious parts that it’s still work at the end of the day.

 

[efle]

Right! What we love as a medical student may not be what we love as an attending. Since it seems like a lot of physicians in every specialty have a good amount of “burnout”, it’s probably just part of the job. Even if you enjoy the subject matter, there’s still enough annoying/tedious parts that it’s still work at the end of the day.

My buddy who's into neurosurg got that advice from his PI, that even the coolest of surgeries becomes routine when it's something you do on a regular basis.

No wonder that 2 in 3 regret choosing that specialty, if the magic wears off and it actually starts feeling like work, the hours are going to make you miserable.

 

[libertyyne]

My buddy who's into neurosurg got that advice from his PI, that even the coolest of surgeries becomes routine when it's something you do on a regular basis.

No wonder that 2 in 3 regret choosing that specialty, if the magic wears off and it actually starts feeling like work, the hours are going to make you miserable.

could you link that study where 2/3 regret choosing it? Their attrition for residency is lower compared to many average specialties and most of the neurosurgeons I have met have been nothing but positive about their specialty.

 

[efle]

could you link that study where 2/3 regret choosing it? Their attrition for residency is lower compared to many average specialties and most of the neurosurgeons I have met have been nothing but positive about their specialty.

Honestly I don't remember. I think it was phrased like "I would choose this specialty again" and only 1/3 said yes

 

[libertyyne]

Honestly I don't remember. I think it was phrased like "I would choose this specialty again" and only 1/3 said yes

This is a survey from residents surrounding regret in career choice from 2018

Association of Clinical Specialty With Symptoms of Burnout and Regret Among US Resident Physicians

This survey study investigates risk factors for symptoms of burnout and career choice regret among US physicians during their second year of residency.

jamanetwork.com

 

[efle]

This is a survey from residents surrounding regret in career choice from 2018

Association of Clinical Specialty With Symptoms of Burnout and Regret Among US Resident Physicians

This survey study investigates risk factors for symptoms of burnout and career choice regret among US physicians during their second year of residency.

jamanetwork.com

View attachment 275787
View attachment 275788

This is asking residents, yeah? I think what I saw was a survey of attendings/practicing docs

 

[nimbus]

This is asking residents, yeah? I think what I saw was a survey of attendings/practicing docs

Yeah they should ask attendings 10 years out. Residency is very different from attending life.

 

[libertyyne]

This is asking residents, yeah? I think what I saw was a survey of attendings/practicing docs

Id love to see this study. I cant seem to find anything, and medscape usually does not include neurosurgery since they probably dont have enough of a sample size in the survey.

 

[efle]

Id love to see this study. I cant seem to find anything, and medscape usually does not include neurosurgery since they probably dont have enough of a sample size in the survey.

I found this one, but I don't think it's the one I'm remembering:

The values seem to vary wildly depending on methodology though. Some papers everyone is satisfied and other papers everyone hates their life.

But, if there's any specialty where lifestyle as an attending usually still sucks, I'm sure we can agree it's neurosurgery.

 

[993444]

I found this one, but I don't think it's the one I'm remembering:

View attachment 275793

The values seem to vary wildly depending on methodology though. Some papers everyone is satisfied and other papers everyone hates their life.

But, if there's any specialty where lifestyle as an attending usually still sucks, I'm sure we can agree it's neurosurgery.

I made a thread about this: Neurosurgery is truly a life sacrifice.

 

[ConfusedAboutEverything]

I made a thread about this: Neurosurgery is truly a life sacrifice.

Don't forget about EM. Sure there is work-life balance, but there is also high burnout. When you dread coming in to work for those 10-12 shifts a month, it really does hurt.

I was an ED scribe and worked with the doctors: 12 12 hour shifts per month. Yes, I had a lot of work life balance. But man did I feel burned out. It was not a marathon, but it was a sprint. And sprinting is very painful in its own right.

When you work 7p-7a some days, let's say you have the next day off, you go home, go to sleep, wake up in the afternoon, and boom your day is half done. You also need some days to adjust, and you think about how you have an upcoming shift in 3 days and how painful it is going to be. While you are working, compared to other specialties, you have no idea which patient (or how many) will come through the door. And some days, like sunday, you expect a quiet night, but NOPE, and you are left without PAs to deal with the ****show all by yourself while you are biching/moaning about why these people are coming to the ED at 4 AM when you expected a quiet night. At least with other specialties, you know how many patients you are seeing (happiness=reality-expectations) and having those expectations help you mentally.

As a scribe, I burned out, but I was happy to have all those days off when other people were working, but the days that I do work are hectic and painful, and is too much. 12 12 hr shifts per month is harder than it seems.

 

[CidHighwind]

I found this one, but I don't think it's the one I'm remembering:

View attachment 275793

The values seem to vary wildly depending on methodology though. Some papers everyone is satisfied and other papers everyone hates their life.

But, if there's any specialty where lifestyle as an attending usually still sucks, I'm sure we can agree it's neurosurgery.

That burnout for EM looks brutal. It’s basically “I like that I don’t have to be at work often, but I really, really hate being at work when I’m there.”

 

[Tenk]

That burnout for EM looks brutal. It’s basically “I like that I don’t have to be at work often, but I really, really hate being at work when I’m there.”

It’s definitely not for everyone. I am lucky to have a good job but I have worked in some real dumpster fires that make you want to quit medicine entirely.

 

[nimbus]

I found this one, but I don't think it's the one I'm remembering:

View attachment 275793

The values seem to vary wildly depending on methodology though. Some papers everyone is satisfied and other papers everyone hates their life.

But, if there's any specialty where lifestyle as an attending usually still sucks, I'm sure we can agree it's neurosurgery.

Urology looks out of place. They are among the most cheerful docs I know.

 

[993444]

It’s definitely not for everyone. I am lucky to have a good job but I have worked in some real dumpster fires that make you want to quit medicine entirely.

Can you share details about what made those places a poor place to work?

 

[Tenk]

Can you share details about what made those places a poor place to work?

In order of descending badness:

1. Malignant patient population
2. Not enough attending coverage
3. Malignant/bad/lazy/pick your favorite adjective consultants
4. Malignant/bad/lazy/pick your favorite adjective nurses
5. Ridiculous acuity
6. Bad funding/resources

Probably not complete but all I can think of now. The less you have of all of these, the happier you will be.

 

[libertyyne]

I found this one, but I don't think it's the one I'm remembering:

View attachment 275793

The values seem to vary wildly depending on methodology though. Some papers everyone is satisfied and other papers everyone hates their life.

But, if there's any specialty where lifestyle as an attending usually still sucks, I'm sure we can agree it's neurosurgery.

Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey

<section class="abstract"><div id="" class="section"><h3 class="abstractTitle text-title my-1" id="d1303e3">OBJECT</h3><p>The object of this study was to identify and quantify predictors of burnout and career satisfaction among US neurosurgeons.</p></div><div id="" class="section"><h3...

thejns.org

The burnout rate is high but comparable to other specialties, yet 70% would choose neurosurgery again.

I made a thread about this: Neurosurgery is truly a life sacrifice.

Being a doctor is a life sacrifice , sacrifice your youth, sacrifice in training, delay making money longer, and then work more than your peers outside of medicine. Plus being a neurosurgeon one could retire earlier if they wanted compared to their peers in IM yet many continue to work on their 50s-60s and even some in their 70s.