EM vs Anesthesia vs General Surgery

[Brules_Rules]

I wasn’t really sure where the best place to post this would be, but figured I would try a couple different spots to hopefully get some advice and maybe some new perspectives.

I’m currently a 3rd (4th?-who knows anymore) year US MD student who will be applying to residency programs this fall. As a 3rd year student I pretty much loved just about every clerkship I did and honestly felt like I would have been happy in most of the specialties I rotated through. Given this, when trying to decide on a specialty my primary focus was on what would be a viable, long term career that would provide personal satisfaction in conjunction with good employment opportunities, while giving me the ability to comfortably pay off my ample student loan debt (in the low 400K range by the end of residency), while maintaining a reasonable quality of life.

Ultimately, in January of this year I was at the point of trying to come to a decision between applying into emergency medicine or anesthesia (and leaning more toward EM). However, with clerkships cancelled over the last couple months I had a lot of extra time to be a little bit more introspective and read into the current state of these specialties more.

In particular, it seems like COVID has exposed a lot of the cracks in both of these fields and really made me question the long term viability of pursuing either of them. In particular, the expansion of emergency medicine residencies over the last couple years in conjunction with the rising number of CMGs has really made me wonder how difficult it will be to obtain employment in that field with a salary that makes it worthwhile (the ED is awesome, but I think some of its short comings would wear on me much more if compensation dropped to that of primary care). This is only exacerbated by the current COVID hiring freezes I’ve heard about for some upcoming EM graduates, which I think will likely reverberate to upcoming classes and certainly exacerbate the projected over supply of emergency medicine physicians.

Unfortunately, the outlook for anesthesia as a specialty does not appear to be too much better. With the VAs recent decision to allow for independent practice for CRNAs I’m concerned that the anesthesia job market will similarly suffer.

With mid level encroachment becoming more of a concern for many specialties, I’m almost at the point of considering a late switch to something like general surgery (another rotation that I really loved). While no specialty is future proof, it does seem like a surgical specialty would provide me with the most job security over the next 20-30 years. However, the reputation of surgical residencies as being grueling, life consuming, and often times malignant definitely scared me away when I was first considering it. However, at this point I’ve gotta wonder if a rough 5 year residency (+/- fellowship) would be worth it in the long run in order to provide good job security and somewhat assured reasonable pay without the constant worry about mid level encroachment, pay cuts, and job availability.

I know that these topics have been discussed a ton in the past, but I do think that COVID has changed things pretty substantially in a short amount of time and would be curious about people’s opinions and speculation regarding the job outlook (and opportunity cost) for pursuing EM vs anesthesia vs general surgery.

(As a side note, my step 1 score was just slightly below average and effectively prevents me from pursuing some of the more competitive specialities like ortho, derm, ENT, or plastics. However, coming from a top 30 MD program with strong clinical grades and a likely improvement on Step 2, it would not be unreasonable for me to match at a mid tier EM, anesthesia, or general surgery program at this point.

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[IMGASMD]

If you wanna do anything else that’s not surgery, then surgery is not for you.
Or
If you cannot live without surgery, then choose surgery.

Same coin.

As far as autonomy, surgery is certainly the best out of three. You also have to balance out, the longest residency out of all three.

 

[efle]

Could go after something like rads --> IR if you want to be a proceduralist without suffering through a surgery residency.

Similarly maybe still do gas, but then a fellowship to insulate a little from the general job market, like Pain fellowship?

 

[Brules_Rules]

Could go after something like rads --> IR if you want to be a proceduralist without suffering through a surgery residency.

Similarly maybe still do gas, but then a fellowship to insulate a little from the general job market, like Pain fellowship?

The rads to IR route initially seemed super intriguing to me actually, but personally the idea of going through the full DR training seemed soul sucking to me. I know the hours/lifestyle/pay are supposed to be great, but I just dont think I'd be able to sit in a dark room reading images all day. IR seems awesome, and by all accounts is doing some of the most cutting edge things in medicine right now, but also seems to be super competitive to get into.

 

[efle]

The rads to IR route initially seemed super intriguing to me actually, but personally the idea of going through the full DR training seemed soul sucking to me. I know the hours/lifestyle/pay are supposed to be great, but I just dont think I'd be able to sit in a dark room reading images all day. IR seems awesome, and by all accounts is doing some of the most cutting edge things in medicine right now, but also seems to be super competitive to get into.

It's only competitive for the up front integrated IR match. The routes into it from DR (ESIR and the regular old IR fellowship) are not nearly as hard to nab.

But, if you think you'd rather be doing 100 hours of gensurg/week than 50 hours of imaging/week, surgery it is!

 

[yeet]

Choosing general surgery for the reason of job security sounds like a bad plan to me. That's a super tough residency and still tough lifestyle afterwards and you should really only be choosing it because you f*cking love operating. Like more than getting off at 5pm to enjoy your hobbies or seeing your family.

Have you considered IM -> fellowship like GI? You wouldn't have to stress about matching IM -> you could work hard once in residency to get GI (procedures and $ to pay off your loans).

Anesthesia -> fellowship is still a solid route IMO. If you hate the OR you can do something like a pain fellowship as mentioned above or do cardiac and do more interesting cases rather than being yelled at to raise / lower the bed by ortho residents.

I hear your feelings about EM tho :/

 

[ACSurgeon]

You can easily drive yourself crazy trying to speculate the future. Nothing is certain. My job is much better than I ever imagined when I decided on general surgery. I also realize it may not last. I don’t assume I’ll have the same lifestyle or pay for the next 30 years. This makes me pay off my loans as fast as possible and try to save up while avoiding huge luxury expenses (debt). I’ll enjoy it while it lasts.

you mention EM would wear on you if the pay dropped. I think you should pick a specialty based on content, training length, and assume you’ll make whatever an average PCP makes and hope to be surprised. If making a certain salary is intimately tied to enjoying a certain specialty, it’s probably not the right speciality because you cannot control compensation (aside from working a ton to make up for any cuts). You should consider compensation in your decision making process, but it cannot be the main factor.

I generally don’t agree with the notion that you should only do surgery if that’s the only thing you can imagine yourself doing. I think it’s very immature to truly believe you can only be happy in one field. It goes without saying that surgical training is more intense and longer in duration than other fields, but you get to be a surgeon at the end, which is pretty darn cool. You accept the higher risk for burn out and attrition and in return hope for a cooler job. If it doesn’t work out, you can always switch to something else (much harder to switch to surgery compared to anesthesia or rads or maybe even EM).

We might be immune to encroachment, but for the next 20+ years administrative misery is much more likely to be the problem than not finding a job. So again, try to find a job that you enjoy, and the rest will work itself out.

 

[ACSurgeon]

Choosing general surgery for the reason of job security sounds like a bad plan to me. That's a super tough residency and still tough lifestyle afterwards and you should really only be choosing it because you f*cking love operating. Like more than getting off at 5pm to enjoy your hobbies or seeing your family.

Have you considered IM -> fellowship like GI? You wouldn't have to stress about matching IM -> you could work hard once in residency to get GI (procedures and $ to pay off your loans).

And if he can’t match GI?

 

[yeet]

And if he can’t match GI?

Yeah I admit its not a guarantee. Also agree with the points you make in your post.

I was just coming from the standpoint of OP should be choosing general surgery for reasons > job security as you touched on.

 

[eggeggeggegg]

Choosing general surgery for the reason of job security sounds like a bad plan to me. That's a super tough residency and still tough lifestyle afterwards and you should really only be choosing it because you f*cking love operating. Like more than getting off at 5pm to enjoy your hobbies or seeing your family.

Have you considered IM -> fellowship like GI? You wouldn't have to stress about matching IM -> you could work hard once in residency to get GI (procedures and $ to pay off your loans).

Anesthesia -> fellowship is still a solid route IMO. If you hate the OR you can do something like a pain fellowship as mentioned above or do cardiac and do more interesting cases rather than being yelled at to raise / lower the bed by ortho residents.

I hear your feelings about EM tho :/

Always been so bizarre when I hear this (along with the surgery is the only field I could do in medicine). People like that definitely exist, but none of the surgeons I've shadowed or worked on their team with have enjoyed taking more call and having to stay late even if they can operate. Sure they love operating but, not to the point they would rather operate than spend time with family...

 

[Gambino.]

People always say don't do surgery if you can imagine doing something else. At the end, you should just pick what makes you the most happy in my opinion. The concerns you have with EM/gas can be fixed with a fellowship in either field. EM has CC and is now able to apply for pain fellowships. Gas has pain, cards, CC, etc.

 

[efle]

Always been so bizarre when I hear this (along with the surgery is the only field I could do in medicine). People like that definitely exist, but none of the surgeons I've shadowed or worked on their team with have enjoyed taking more call and having to stay late even if they can operate. Sure they love operating but, not to the point they would rather operate than spend time with family...

I had a surgery attending tell us frankly that his workaholism ended his marriage (to another doc that was in ROADE, funny enough). And another surgical service's chief resident sat me down and told me the advice about choosing anything else if you could see yourself tolerating anything else (hes now in a fellowship with a private group doing nose jobs in a wealthy city).

The stereotypes dont come out of nowhere, there really are lots of workaholics and burnouts, which makes sense considering the brutal training and lifestyles

 

[eggeggeggegg]

I had a surgery attending tell us frankly that his workaholism ended his marriage (to another doc that was in ROADE, funny enough). And another surgical service's chief resident sat me down and told me the advice about choosing anything else if you could see yourself tolerating anything else (hes now in a fellowship with a private group doing nose jobs in a wealthy city).

The stereotypes dont come out of nowhere, there really are lots of workaholics and burnouts, which makes sense considering the brutal training and lifestyles

Yea, probably dependent on which surgeons you interact with - I'll admit, I have super limited exposure to a handful of residents and attending.

I keep hearing the if you can live with anything else, do that over surgery. I've worked a few different jobs before med, including blue collar work so I know I could pursue other fields and be happy enough doing them. I'm pretty sure I would be happier in surgery, though never been quite as extreme as some classmates who are surgery or bust. Have you met residents/attendings that were split between surgery/non-surgical and regret their choice to choose surgery?

 

[Brules_Rules]

Yea, probably dependent on which surgeons you interact with - I'll admit, I have super limited exposure to a handful of residents and attending.

I keep hearing the if you can live with anything else, do that over surgery. I've worked a few different jobs before med, including blue collar work so I know I could pursue other fields and be happy enough doing them. I'm pretty sure I would be happier in surgery, though never been quite as extreme as some classmates who are surgery or bust. Have you met residents/attendings that were split between surgery/non-surgical and regret their choice to choose surgery?

Fortunately, I've had the luxury of having really great mentors in EM, anesthesia, and surgery. The EM doc loves his job, but has told me the concerns about CMGs, dropping salaries, and a tough job market are very real and not getting better. The anesthesiologist I've worked with extensively actually switched into anesthesia from general surgery after 3 years of surgery residency and has no regrets. However, she was also very intent on having a family, wanted more time at home, has a spouse that is making good money outside of medicine, and did her surgery training at an incredibly malignant program in the NE (she's told me multiple times that had she done surgery training on the west cost she might have been able to finish it). Also, by working at a major academic center she seems somewhat insulated from some of the changes occurring in anesthesia currently (although I haven't had the chance to sit down with her and discuss the changes made at the VA recently with CRNAs). My surgery mentors have been great and certainly dont seem to abide by the "if you can do anything else besides surgery then do that" ethos. One told me he decided on surgery very late in med school and picked it because it was the rotation he hated the least. Moreover, he seems to have a decent lifestyle as an attending and is pretty satisfied with his work/life balance currently. However, when I asked him if he would do it all over again he basically said "I'm really happy where I'm at now, but there is no way I could go through residency again."

 

[yeet]

Always been so bizarre when I hear this (along with the surgery is the only field I could do in medicine). People like that definitely exist, but none of the surgeons I've shadowed or worked on their team with have enjoyed taking more call and having to stay late even if they can operate. Sure they love operating but, not to the point they would rather operate than spend time with family...

When I say this, I don't really mean that surgeons actively want to operate after 5pm and are happy that they won't see their family that night or miss out on a hobby that they had planned. But that going into surgery should mean that someone is willing to make that sacrifice (maybe not forever, but for sure during residency / fellowship) of going to the OR late / on the weekend to do the emergent case that just came in. Last year on my surgery rotations I thought this was super cool on my first couple of late cases that came in. But after a few months of less sleep than I wanted and never hitting the gym, I just wanted to go home at 5pm after having gotten to the hospital to "make the list" at 4:45am. Surgeons are badasses for sure, but that was the moment where I realized it wasn't for me.

 

[Brules_Rules]

When I say this, I don't really mean that surgeons actively want to operate after 5pm and are happy that they won't see their family that night or miss out on a hobby that they had planned. But that going into surgery should mean that someone is willing to make that sacrifice (maybe not forever, but for sure during residency / fellowship) of going to the OR late / on the weekend to do the emergent case that just came in.

I totally get where you are coming from with this, but medicine in general (barring a small minority of specialties) does not seem like a profession where you get off at "5pm on the dot". Even in shift work specialties like EM, there is inevitably a trauma or a crashing patient that occasionally rolls in 15 minutes before the end of the shift that will keep you there a couple hours late. My experience in clinic has also been pretty similar. Even during my family medicine rotation I was lucky to get out before 6 or 7pm every day given that a handful of patients would always show up late or visits that would run over time.

 

[InternistDO]

Did you consider the procedural IM specialties like GI, cards, pulm? Less concern with midlevel encroachment, good salary, reasonable job market (really good market for pulm). Plus a similar vibe as EM and gas in regards to treating sick patients and having some procedural skill. Downside is 6 years of training.

Coming from a good MD program you should have little trouble matching a good IM program that would set you up for fellowship.

 

[7331poas]

It's only competitive for the up front integrated IR match. The routes into it from DR (ESIR and the regular old IR fellowship) are not nearly as hard to nab.

But, if you think you'd rather be doing 100 hours of gensurg/week than 50 hours of imaging/week, surgery it is!

Pretty sure the ESIR and IR fellowship routes do not exist anymore, particularly for the most recent graduating class. One of our residents mentioned to us that he was one of the last in his program that got the option to do ESIR.

 

[Brules_Rules]

Did you consider the procedural IM specialties like GI, cards, pulm? Less concern with midlevel encroachment, good salary, reasonable job market (really good market for pulm). Plus a similar vibe as EM and gas in regards to treating sick patients and having some procedural skill. Downside is 6 years of training.

Coming from a good MD program you should have little trouble matching a good IM program that would set you up for fellowship.

Personally I never really considered myself an "IM guy". Despite having some good relationships with some of the IM faculty at my school, the never ending rounding coupled with a workflow that was at times frustratingly inefficient kind of put me off the field. Admittedly, the end result of some of the IM fellowships is really cool (interventional cardiology, pulm/CC, etc.), but as I understand it many of these IM fellowships are really competitive. Given that there is no guarantee of getting a fellowship position, the risk of getting stuck as a hospitalist (and the accompanying misery) make it a little questionable for me I think.

 

[efle]

Well, I've met an OBGYN resident who realized their mistake and was switching out. Havent met a gensurg resident who was switching yet, but I know there are dozens who switch into Rads, IM and Anesthesia every year.

 

[Splenda88]

Anesthesia and EM are on a shaky ground now. They are arguably the two specialities that the bean counters can save a lot of money on by using midlevels.

I know you say you don't see yourself sitting in a dark room reading imaging, but I think you should give DR--->IR a good look. Over 400k in student loan is something to take very seriously.

 

[efle]

Pretty sure the ESIR and IR fellowship routes do not exist anymore, particularly for the most recent graduating class. One of our residents mentioned to us that he was one of the last in his program that got the option to do ESIR.

Programs are slowly converting over to integrated but they're far from gone. Its gonna be a while before it finishes the change and starts to look like Plastics.

This year had ~150 integrated and ~170 fellowship per NRMP, so not even halfway yet

Edit: and the fellowship match rate was >90%, far more reliable than integrated.

 

[zero0]

Lots of good advice here and you seem to have a good grasp of the issues with each field. EM and anesthesia are both victims of midlevel encroachment and, as most have noticed by now, the midlevel/MBA agenda (I group them together because they both ultimately have the same goals) got a huge push from the whole COVID fiasco. Corporate medicine bean counters and their preference for hiring midlevels on the cheap is the main threat to medicine and it's here in full force right now.

That said, if you are seriously considering GS and willing to suffer through that hell for residency, that's probably the best option of the 3. Anesthesia->CCM fellowship would be a close second if you have any interest in critical care. You can do 3 weeks of OR and 1 week of ICU as that tends to be the most sustainable mix. Pain fellowship is another option but competitive so no guarantee there. EM is probably the worst option on the table right now for reasons already mentioned.

 

[CidHighwind]

Pretty sure the ESIR and IR fellowship routes do not exist anymore, particularly for the most recent graduating class. One of our residents mentioned to us that he was one of the last in his program that got the option to do ESIR.

No it’s still an option, however the catch now is that the “fellowship” is called an independent residency and it’s 2 years long instead of 1. So if you’re willing to spend one more year in training, it’s a viable option.

 

[Tenk]

I thought you always just wanted to be a real baby boy.

All the hunks are in EM btw.

 

[Brules_Rules]

I thought you always just wanted to be a real baby boy.

All the hunks are in EM btw.

In fairness, I'm pretty sure EM docs have been the only ones who have gotten and/or appreciated any of my Tim and Eric references.

 

[Tenk]

In fairness, I'm pretty sure EM docs have been the only ones who have gotten and/or appreciated any of my Tim and Eric references.

I know

 

[zero0]

No it’s still an option, however the catch now is that the “fellowship” is called an independent residency and it’s 2 years long instead of 1. So if you’re willing to spend one more year in training, it’s a viable option.

I may have missed the part about OP considering radiology but fwiw this is not correct. The VIR (basically a 1-year fellowship) track is being phased out after 2020, but the ESIR->IR track will still be available to complete in 6 years total. So if OP wants to be an IR he can still do a DR residency with an ESIR track (sometimes competitive to get into depending on the program) followed by a 1-year IR fellowship (also likely competitive).

Here's a link detailing these changes for those interested:Society of Interventional Radiology- IR Residency.

 

[Franzd'Epinay]

giving me the ability to comfortably pay off my ample student loan debt (in the low 400K range by the end of residency), while maintaining a reasonable quality of life.

Let's say you refinance your loans at the end of residency to a 10-year fixed loan at 4.5%. That should work out to monthly payments of ~$4,200/mo or ~$50,000/yr.

That's not nothing, but that should be doable with any attending salary (assuming you don't get bamboozled). Yeah, maybe you won't be able to live in San Francisco, or have very expensive vacations frequently, but I wouldn't let this loan burden scare you out of any specialties that you really like.

 

[throwaway1000000]

No one has a crystal ball, but so far mid-levels haven't done any damage to the salaries.
There seem to be 2 ways to address physician shortage:
1) to increase mid-levels
2) to increase physicians
I used to be against mid-levels but in terms of the job market for physicians, they seem to be much better than increasing the number of physicians.
In fact, anesthesiologists and EM physicians have been enjoying good salaries despite mid-levels.
Their salaries would have most likely gone down if more EM physicians and anesthesiologists were produced to address the shortage of care instead.
Biggest threat to salary or job market is not mid-levels but drastic increase in physician supply or drop in reimbursement due to a single-payer healthcare system. But in that case all fields will be affected.
Sure, surgery is somewhat more protected now but I mean it's not like mid-levels don't assist in the OR already. It is not very different from a mid-level seeing simple patients and letting the physician see complex patients in a non-procedural field.

 

[OnePunchBiopsy]

Sure, surgery is somewhat more protected now but I mean it's not like mid-levels don't assist in the OR already. It is not very different from a mid-level seeing simple patients and letting the physician see complex patients in a non-procedural field.

Mid-levels do assist, and potentially get procedures started, but the notion of mid-levels doing full cases (even simple ones) in an OR without oversight is likely never going to happen.

Patients became upset with the fact that chief residents were doing full cases while attendings were switching between multiple operating rooms. This has led to the regulations we have today where an attending must be present for the critical portion of a case, and having an attending running multiple OR’s at the same time is viewed very negatively, as is not the case for anesthesia or EM.

 

[throwaway1000000]

Mid-levels do assist, and potentially get procedures started, but the notion of mid-levels doing full cases (even simple ones) in an OR without oversight is likely never going to happen.

Patients became upset with the fact that chief residents were doing full cases while attendings were switching between multiple operating rooms. This has led to the regulations we have today where an attending must be present for the critical portion of a case, and having an attending running multiple OR’s at the same time is viewed very negatively, as is not the case for anesthesia or EM.

Yes, I won't disagree that is the situation today but no one knows what will happen in 10 years. Surgery is a learned skill just like anesthesia or EM. Most surgical skills have very less to do with medical school and are almost learned from scratch in residency.

My point is mid-levels should not be the major factor in deciding a field because they won't be the ones to make a field go to crap. I am just saying you might even see them get involved more and more in the OR which you might think is "protected" from mid-levels

 

[efle]

^ I will say it does seem like a lot of over-education. For these really niche fields like surgical subspecialties, rads, path, etc it makes no sense to require so much prior to the residency.

4 years university +/- gap year + 4 years general medicine education +/- intern or TY year = 8-10 years before getting to the residency that will teach you how to actually do your job.

Surely we can come up with a system more efficient than this, an entire decade of prereqs to slog through is simply too much.

 

[zero0]

^ I will say it does seem like a lot of over-education. For these really niche fields like surgical subspecialties, rads, path, etc it makes no sense to require so much prior to the residency.

4 years university +/- gap year + 4 years general medicine education +/- intern or TY year = 8-10 years before getting to the residency that will teach you how to actually do your job.

Surely we can come up with a system more efficient than this, an entire decade of prereqs to slog through is simply too much.

Unfortunately, making the system more efficient would decrease the abundance of cheap resident labor said system is built on. Never gonna happen with the powers that be.

The sad truth is we are needlessly overeducated in certain specialties for the sake of cheap labor (we mostly have big academia and the suits to blame for this) while midlevels are undereducated. The sweet spot is likely somewhere in between.

 

[InternistDO]

Unfortunately, making the system more efficient would decrease the abundance of cheap resident labor said system is built on. Never gonna happen with the powers that be.

The sad truth is we are needlessly overeducated in certain specialties for the sake of cheap labor (we mostly have big academia and the suits to blame for this) while midlevels are undereducated. The sweet spot is likely somewhere in between.

I'd gladly trade some med school or undergrad years for more residency years. At least then you get paid.

 

[Splenda88]

Unfortunately, making the system more efficient would decrease the abundance of cheap resident labor said system is built on. Never gonna happen with the powers that be.

The sad truth is we are needlessly overeducated in certain specialties for the sake of cheap labor (we mostly have big academia and the suits to blame for this) while midlevels are undereducated. The sweet spot is likely somewhere in between.

I would argue that we are overeducated for almost every single specialty...


Undergrad degree should not be a de facto requirement to get into med school. Meds school should only be 3 yrs and residency should be 2-5 years... The whole process should be 8-11 yrs.

 

[Dr G Oogle]

All things being equal I would choose surgery. If goal is to be a great general surgeon then go to a solid community program and operate from day one and also have a reasonable quality of life working maybe 60-80 hours per week instead 80-100 at a university program where you are stuck doing scut for a while (a generalization i know but on average correct). You’ll be hampering yourself by going to a community program for fellowships one pediatric and surgical oncology, transplant and maybe HPB, but won’t take yourself out of the game and will probably be competive for the other fellowships. A lot of my Med school classmates went into GS via very strong community programs and all practice in PP hospitals (as employees) but are super happy and very valued. Same goes for my university GS friends but all went into fellowships and also are happy. To be sure they work hard but they also love what they do and have very happy personal lives. I am a Urogynecologist and love my job but still about 10-15% of me years for being a GS in a more rural location and sometimes I regret not going that route simply for the quality of life: probably same amount of effort and money but a lot closer to the great outdoors and flexibility of work locale. Honestly I have friends in ER and anesthesiology and while most are generally satisfied there is a lot less griping from the surgeons.

 

[TypeADissection]

It really just comes down to: How do you want to fix problems? and How do you want to spend your days and nights? We are all going to get woken up for something at 0200 - what do you want to be woken up for? If you don't like the idea of being called when off shift, then EM is the way to go. If you enjoy physiology and the cerebral aspect of managing a spectrum of sick patients, then Anesthesia may be a good fit. If you desire a strong technical component to your practice, then think surgery. Going through the process, I knew that I wanted to be a surgeon before I even started med school. I knew that I wasn't a fit for much else outside of the OR and so the lifestyle aspect of it never even occurred to me. I knew it was going to arduous and require a significant commitment of my time and late-20's to early-30's. But I never doubted it because I really couldn't see myself anywhere else. Hope this helps. Don't forget to have some fun along the way. Cheers.

 

[CidHighwind]

I may have missed the part about OP considering radiology but fwiw this is not correct. The VIR (basically a 1-year fellowship) track is being phased out after 2020, but the ESIR->IR track will still be available to complete in 6 years total. So if OP wants to be an IR he can still do a DR residency with an ESIR track (sometimes competitive to get into depending on the program) followed by a 1-year IR fellowship (also likely competitive).

Here's a link detailing these changes for those interested:Society of Interventional Radiology- IR Residency.

Correct, but I’m saying even if you don’t don’t ESIR, you can still do an “independent residency” after regular radiology residency and that’s 2 years.

 

[akwho]

As a surgeon, I agree with the people who say you should only be a surgeon if you can't see yourself doing anything else. I've seen people burn out, drop out and be plain miserable because they got into surgery for the wrong reasons. I love surgery and think it's the best job in the world but I wouldn't recommend it to the majority of medical students. You have to be able to tolerate many years of training, 80-100 hour work weeks, 30-hour in a row call shifts with no sleep and occasional eating/bathroom breaks --- none of this is fun if your heart isn't in it.

For somebody that is happy doing everything and who is money/lifestyle focused here are the best options:
1) Dermatology
2) Dermatology
3) Dermatology
4) IM -> GI
5) Diagnostic rads
6) Anesthesia

 

[Brules_Rules]

This was posted in the EM group recently. I don't know how sound the methodology was here, but I still think that it's worth taking a look at. An estimated oversupply of 3000 EM docs by 2025 is a tough pill to swallow and certainly helps make that choice a little bit easier.

Source: https://bhw.hrsa.gov/sites/default/...projections/fact-sheet-emergency-medicine.pdf

 

[holdthemayo]

This was posted in the EM group recently. I don't know how sound the methodology was here, but I still think that it's worth taking a look at. An estimated oversupply of 3000 EM docs by 2025 is a tough pill to swallow and certainly helps make that choice a little bit easier. View attachment 309241

Source: https://bhw.hrsa.gov/sites/default/...projections/fact-sheet-emergency-medicine.pdf

I've heard these concerns too. It's hard to know how to interpret them or how much it should contribute to specialty selection.

 

[CidHighwind]

I've heard these concerns too. It's hard to know how to interpret them or how much it should contribute to specialty selection.

EM got paid well because they didn’t make enough of them since most emergency physicians were FM or IM docs, so they paid a premium for EM. Now that their market is getting “saturated”, they won’t get those huge locum rates and it will become very difficult to find a job in a desirable part of the country.

 

[Dr. wait for it...]

@Brules_Rules

This thread hits home. I’m in the same situation right now deciding between these, but I’m leaning more towards OB instead of Surg.

Does anyone have insight on doing auditions in two different specialties? My school is really pushing to try and pick and only audition in that one. The reasoning is that if an EM residency sees that I’ve auditioned in OB they might think EM is a back up and that I’m not as dedicated to it.
I feel like auditioning would help me get clarity to pick a residency.
Anyway, if anyone has experience or advice I’m all ears.