? for Residents/Attendings in The "ROAD" Specialties

[winsicle]

Rads
Ophtho
Anest
Derm

I'm an MS3 and happen to be considering a few of these, and I'm curious to hear some residents opininons concerning these classically "lifestyle" specialties. Especially those of you that were considering more than one of these fields.

How did you decide?
Has your residency experience been what you anticipated?
If you had to choose again, would you change your mind?
What's the general sense as to the future of the field
(diminishing reimbursement, turf wars, etc.)?


thanks for any input, I appreciate it

---

Members don't see this ad.

 

[gwen]

hey there,

fyi - i am an internist and was never interested in any of the ROAD specialties.

all 4 are amazing fields. derm will always remain in demand as long as they keep the number of residency spots small (and they will). rads, anesth. and ophtho are specialties that go up and down in trends. they are obviously on a high right now. a few years ago, no one wanted to go into anes and now ppl are dying for it. rads is pretty much the same way.

i have a family member who is a neuroradiologist and a friend who is almost done with ophtho and both are struggling to find a good practice to stay with. its not to say that they are not finding jobs...they are just having a difficult time in the big cities they are looking at. the demand is not that high and they both feel that the two fields may not be as lucrative in just a few years (since the # of rads and ophtho's is growing fast and private practices may start to lower their offers). so both are trying to get good sign on bonuses and get into partnership tracks fast.

this is not my opinion, just what two of my close friends have told me. reality could be far from it. anyone else?

 

[Coastie]

I'm a gas res, and Anesthesiology rocks. Be prepared to work hard with sick patients. Also be prepared to fight the onslaught of nurses claiming to do doctors' jobs. It's a political fight because they have brought it on, and we need intelligent, hard-working Anesthesiologists to keep the fight against these mid-levels (who are also encroaching on every other field in medicine).

Ophtho is becoming saturated, with poor medicare reimbursement, and a very hard pp field due to a few people holding all the lasik eyeballs. Very hard to make a good buck in this field now-a-days I'm told. You start low (100k), and have a hard time climbing up.

Rads is ever growing, but with reimbursements being cut across the board, you never know. Like all specialties, when the government gets involved, we get screwed. Still a great place to be.

Derm. Obviou$ benefit$. If you can't get it, become an FP, focus on derm, and out corner them on the business front.

For every specialty, fight off government involvement. Do NOT vote for any Presidential candidate who wants socialized medicine and increased taxes.

Rads
Ophtho
Anest
Derm

I'm an MS3 and happen to be considering a few of these, and I'm curious to hear some residents opininons concerning these classically "lifestyle" specialties. Especially those of you that were considering more than one of these fields.

How did you decide?
Has your residency experience been what you anticipated?
If you had to choose again, would you change your mind?
What's the general sense as to the future of the field
(diminishing reimbursement, turf wars, etc.)?


thanks for any input, I appreciate it

 

[InductionAgent]

I don't see anesthesiology as a lifestyle field. I'm training in it because I enjoy the specialty. I get the impression that you have to work very hard in private practice if you want the big paycheck. The supply/demand curve will not be as favorable in the future, with residencies churning out more anesthesiologists, and CRNAs ever-increasing in their numbers and scope of practice.

With anesthesiology, or any other field, only do it if you love the work, blah, blah. But it's true. Your life is everything you do. If you do spend the majority of your waking hours doing something you enjoy less simply because you'll have more money, what's the point? I can understand wanting more time for family, hobbies, or whatever floats you, but I'd rather do something I enjoy 70 hours a week than something I can barely stand 40 hours a week. The thing is, if you're willing to make less money, you can generally get into a group situation these days where you can have more flexible hours. You should know how to live relatively frugally from being a med student and a resident. And that big house and the fancy car will not make you happy. I'll get off my soapbox now.

BTW, you forgot to ask about path and psych, the other "non-patient care" specialties mentioned in The House of God.

 

[Pinkertinkle]

hey there,

fyi - i am an internist and was never interested in any of the ROAD specialties.

all 4 are amazing fields. derm will always remain in demand as long as they keep the number of residency spots small (and they will). rads, anesth. and ophtho are specialties that go up and down in trends. they are obviously on a high right now. a few years ago, no one wanted to go into anes and now ppl are dying for it. rads is pretty much the same way.

i have a family member who is a neuroradiologist and a friend who is almost done with ophtho and both are struggling to find a good practice to stay with. its not to say that they are not finding jobs...they are just having a difficult time in the big cities they are looking at. the demand is not that high and they both feel that the two fields may not be as lucrative in just a few years (since the # of rads and ophtho's is growing fast and private practices may start to lower their offers). so both are trying to get good sign on bonuses and get into partnership tracks fast.

this is not my opinion, just what two of my close friends have told me. reality could be far from it. anyone else?

I was wondering why the # of ophtho's is growing? 10 years ago there were 447 ophtho spots a year and this year there are 450, they certainly aren't training many more these days.

 

[Pir8DeacDoc]

I don't think anesthesia residency is a cake walk but it's hard to convince me they work hard once they finish. Good friend a few years out of residency works 36 hours a week and makes over 200K. That's serious change for a guy whose only job is to supervise other people and place the occasional central line or epidural. Maybe his situation is atypical but somehow I don't think so.

 

[Coastie]

I don't see anesthesiology as a lifestyle field. I'm training in it because I enjoy the specialty. I get the impression that you have to work very hard in private practice if you want the big paycheck.

Depends on how you define big, I guess.

 

[swpm]

How did you decide?
Has your residency experience been what you anticipated?
If you had to choose again, would you change your mind?
What's the general sense as to the future of the field (diminishing reimbursement, turf wars, etc.)?

Another anesthesiology resident here ...

1) This could be a very long answer, with endless details concerning why anesthesia is a perfect fit for me. But suffice it to say that as a med student, I was happiest in the OR putting people to sleep. And I saw plenty of people flee medicine and surgery to do 2nd residencies in anesthesiology ... yet to this day I've never met anyone who's left anesthesia for something else.

2) Residency is a grind, but no more so than med school. Anesthesia is not the "lifestyle" easy kick-back residency everyone said it would be, but that's OK. I don't mind working hard so long as I'm not rounding, doing idiotic paperwork, chasing down consults from surly consultants who wish they'd chosen anesthesiology, looking for nursing homes, getting paged to deal with Mr. HONDA's dangerously high 141/91 blood pressure, or stumbling into the ER at 3 AM to admit another gomer. I even like call, because when I get paged it's to do something, and if I happen to have a quiet night, I still get the postcall day off.

3) I would not choose differently. Now that I'm here, the miserable nightmare that is primary care is really thrown into focus. I'd rather eat shards of broken glass or dive into a swimming pool full of double edge razor blades than do primary care.

4) Lower reimbursement across the board is a probably a given for all specialties. We have CRNAs to deal with, which is probably going to be problematic for future anesthesiologists who just want to do their own cases. It'll still pay better than many of the alternatives, though.

 

[8744]

Another anesthesiology resident here ...

1) This could be a very long answer, with endless details concerning why anesthesia is a perfect fit for me. But suffice it to say that as a med student, I was happiest in the OR putting people to sleep. And I saw plenty of people flee medicine and surgery to do 2nd residencies in anesthesiology ... yet to this day I've never met anyone who's left anesthesia for something else.

2) Residency is a grind, but no more so than med school. Anesthesia is not the "lifestyle" easy kick-back residency everyone said it would be, but that's OK. I don't mind working hard so long as I'm not rounding, doing idiotic paperwork, chasing down consults from surly consultants who wish they'd chosen anesthesiology, looking for nursing homes, getting paged to deal with Mr. HONDA's dangerously high 141/91 blood pressure, or stumbling into the ER at 3 AM to admit another gomer. I even like call, because when I get paged it's to do something, and if I happen to have a quiet night, I still get the postcall day off.

3) I would not choose differently. Now that I'm here, the miserable nightmare that is primary care is really thrown into focus. I'd rather eat shards of broken glass or dive into a swimming pool full of double edge razor blades than do primary care.

4) Lower reimbursement across the board is a probably a given for all specialties. We have CRNAs to deal with, which is probably going to be problematic for future anesthesiologists who just want to do their own cases. It'll still pay better than many of the alternatives, though.

Har. Great post. What I like best about my Emergency Medicine? The patient's chronic 180/95 blood pressure isn't really my problem unless he's having symptoms which they never do. Ah, what a grind that kind of practice must be.

My favorite realization about Emergency Medicine? That the patients rarely stick around long enough for their second set of cardiac enzymes.

 

[Pir8DeacDoc]

Another anesthesiology resident here ...

2) Residency is a grind, but no more so than med school. Anesthesia is not the "lifestyle" easy kick-back residency everyone said it would be, but that's OK. I don't mind working hard so long as I'm not rounding, doing idiotic paperwork, chasing down consults from surly consultants who wish they'd chosen anesthesiology, looking for nursing homes, getting paged to deal with Mr. HONDA's dangerously high 141/91 blood pressure, or stumbling into the ER at 3 AM to admit another gomer. I even like call, because when I get paged it's to do something, and if I happen to have a quiet night, I still get the postcall day off.

No one needs to wish they had chosen anesthesia. If anyone with a passing board score wanted it, then they'd have just applied for it. Don't be so arrogant as to think anesthesia is the only field in medicine worth a darn.

 

[Coastie]

Surgeons.

No one needs to wish they had chosen anesthesia. If anyone with a passing board score wanted it, then they'd have just applied for it. Don't be so arrogant as to think anesthesia is the only field in medicine worth a darn.

 

[johankriek]

I don't think anesthesia residency is a cake walk but it's hard to convince me they work hard once they finish. Good friend a few years out of residency works 36 hours a week and makes over 200K. That's serious change for a guy whose only job is to supervise other people and place the occasional central line or epidural. Maybe his situation is atypical but somehow I don't think so.

those jobs are hard to come by.. Think about doing call every 4th night and having a high high likelihood of coming in for csections, epidurals, small bowel obstructions, labor epidurals intubations and always a ruptured triple a that is always lurking in yoru mind .. and every other nightmare that can happen at a hospital at night.. if any of the operating specialties are working any of them.. you are the go to guy... do that for a cuppla years and tell me its a lifestyle specialty.. put it this way.. if you are in a medium hospital with a few general surgeons a cuppla vascular surgeons and a labor suite that delivers about 1200 a year.. you are toast..

 

[rad_one]

3rd year Rads resident. Love the technology, physics and consulting role. Interactions with referring physicians can be very fulfilling/gratifying. Radiology exams seem to be replacing the physical exam at times. However, there still are some very astute clinicians using rad exams to confirm their suspicions before starting treatment. Job security at this point seems to be strong for the future. Volumes of exams ordered continues to increase. The goverment, however, believes the way to curb this growth is to decrease reimbursement. Doesn't make sense, I know!
Being the one to totally change the direction a patient's care is going by reporting a significant/unanticipated finding is very gratifying. The potential for the big paycheck also helps, but this never compensates if you hate your job. Bottom line, I firmly believe that Radiologists are the best trained physicians to provide imaging based diagnosis, procedures and consultation.
Remember, an order for a CXR/CT/MRI, etc is not a "lab test", it is a consultation request to a Radiologist Physician. The key is finding the specialty you can do for the rest of your life.

 

[Pir8DeacDoc]

those jobs are hard to come by.. Think about doing call every 4th night and having a high high likelihood of coming in for csections, epidurals, small bowel obstructions, labor epidurals intubations and always a ruptured triple a that is always lurking in yoru mind .. and every other nightmare that can happen at a hospital at night.. if any of the operating specialties are working any of them.. you are the go to guy... do that for a cuppla years and tell me its a lifestyle specialty.. put it this way.. if you are in a medium hospital with a few general surgeons a cuppla vascular surgeons and a labor suite that delivers about 1200 a year.. you are toast..

If you're taking call every fourth night as an attending then your group is too small.

 

[Pir8DeacDoc]

Surgeons.

Laugh if you will but we both know it's true. If you disagree, then feel free to provide a rebuttal.

 

[Coastie]

I know plenty of people who switch into Anesthesia from other fields, including surgery. It's getting harder to get into, with some programs pretty easy to get into, others not so much. Have fun in surgery, I'll be having fun in Anesthesiology...

Laugh if you will but we both know it's true. If you disagree, then feel free to provide a rebuttal.

 

[swpm]

Don't be so arrogant as to think anesthesia is the only field in medicine worth a darn.

Of course anesthesia isn't the only field worth a darn. After all, where would we be without all the other specialties to do the scut work?

Don't be so indignantly humorless that you can't recognize that a comment sandwiched between "idiotic paperwork" and "Mr. HONDA" is deliberately tongue-in-cheek. A not-so-subtle reflection of your own surgical superiority complex, if you will.

Surgeons. Sheesh.

 

[Museless]

I'd rather eat shards of broken glass or dive into a swimming pool full of double edge razor blades than do primary care.

BUSTED!

It is NOT COOL to plagiarize Weird Al Yankovic (the above is from "One More Minute").

10-yard penalty, repeat first down.

 

[swpm]

BUSTED!

It is NOT COOL to plagiarize Weird Al Yankovic (the above is from "One More Minute").

10-yard penalty, repeat first down.

Sigh. I like to put semi-obscure references to many things/people in lots of my posts. And sometimes, when someone picks up on a reference, it generates a subthread derailment that's fun in its own right ... oh, never mind, explaining the concept just ruins it.

But just between you and me, I didn't coin the phrase in my sig, either. Don't tell anyone, OK?

 

[elwademd]

The key is finding the specialty you can do for the rest of your life.

i think far too many people overlook this.

love what you do, do what you love. or at least like... or not hate...

 

[Mman]

I guess anesthesia is a little overrepresented on this thread, but here's one more.

As a resident, I definitely don't feel my day to day job is easy. I work a hell of a lot harder than I did as an intern on any medicine or surgery service. But then again, it is in a sense shift work and when I get relieved at the end of the day I go home without taking any work home with me. Every day is a new day. I generally get my weekends completely off. And I have a very predictable schedule. Those things all help having a life, but the hour to hour and day to day stuff can be intense.

I probably average 55-65 hours a week (sometimes in the 70+ range but that's rare) so I can't really complain, however I'm usually beat at the end of the day.

When I "grow up" and get a real job, I anticipate having the flexibility of finding a job that will let me work as much as I want to (with pay commensurate with how much I want to work) or as little as I want to.

 

[chicamedica]

I guess anesthesia is a little overrepresented on this thread, but here's one more.

As a resident, I definitely don't feel my day to day job is easy. I work a hell of a lot harder than I did as an intern on any medicine or surgery service. But then again, it is in a sense shift work and when I get relieved at the end of the day I go home without taking any work home with me. Every day is a new day. I generally get my weekends completely off. And I have a very predictable schedule. Those things all help having a life, but the hour to hour and day to day stuff can be intense.

I probably average 55-65 hours a week (sometimes in the 70+ range but that's rare) so I can't really complain, however I'm usually beat at the end of the day.

Another anesthesia resident here, and i feel the same way.

 

[funkless]

I'd rather...dive into a swimming pool full of double edge razor blades than do primary care.

Did I just catch a Weird Al reference???

 

[funkless]

BUSTED!

It is NOT COOL to plagiarize Weird Al Yankovic (the above is from "One More Minute").

10-yard penalty, repeat first down.

DAMMIT!

Props. You beat me to it.

 

[Lonestar]

Life is like a box of chocolates. you never know what you gonna get.

 

[peduncle]

any rads attendings/residents out there that wish they had chosen differently? Any feel unsatisfied or predict a not-so-fruitful future?

 

[Whisker Barrel Cortex]

As a radiology grad (in fellowship for a year), I don't regret going into radiology. I am quite happy with my role as consultant and feel that I do help patients a great deal, even if the majority of the time its indirectly. I like the variety of radiology (from the brain US on a neonate to the knee MRI on a 20 y/o to the chest CT on a 80 year old, we do it all). I also like the fact that I can do procedures (not just in interventional, general rads do biopsies, fluid drainages, etc). The satisfaction you get from radiology is much different than in other fields, and it can take a while to get used to that.

Do I occasionally think it would be nice to have some more direct patient contact? Very occasionally, I do feel it would be nice to be a "real doctor" as my clinical friends like to refer to it. It usually passes very quickly.

Are there annoying things? Certainly there are, as there are in every field. I don't like some of the uncertainty that comes with imaging. Radiologists don't like finding those incidental possible lesions any more than clinicians do. I also don't like not giving people a good answer to the clinical question. There is a lot that radiology can help diagnose. However, there are inherent limitations to imaging diagnosis that can be frustrating. While the majority of my interactions with clinicians is stimulating and satisfying, there are those who are demanding and condescending to my field. There are those that don't understand imaging and its limitations. Then there are those who feel they know imaging better than you. Interactions with those few clinicians can definitely ruin my morning. Luckily, its few and far between (and much more common in academia, where the egos are huge, than in the private practice world).

As for the future of radiology, I'm fairly certain the current high reimbursement will go down in the near future. I don't think it will go down enough to bother me greatly, but its something to think about when choosing the field. I will be making a great living no matter what. The current market will likely not last more than 5-10 years. I don't think finding a position will be a concern as it was in the early 90s, but the options will be a little less. The shortage of rads has abated somewhat, but is still present and will likely remain so for quite a while, in my opinion.

 

[Pir8DeacDoc]

As a radiology grad (in fellowship for a year), I don't regret going into radiology. I am quite happy with my role as consultant and feel that I do help patients a great deal, even if the majority of the time its indirectly. I like the variety of radiology (from the brain US on a neonate to the knee MRI on a 20 y/o to the chest CT on a 80 year old, we do it all). I also like the fact that I can do procedures (not just in interventional, general rads do biopsies, fluid drainages, etc). The satisfaction you get from radiology is much different than in other fields, and it can take a while to get used to that.

Do I occasionally think it would be nice to have some more direct patient contact? Very occasionally, I do feel it would be nice to be a "real doctor" as my clinical friends like to refer to it. It usually passes very quickly.

Are there annoying things? Certainly there are, as there are in every field. I don't like some of the uncertainty that comes with imaging. Radiologists don't like finding those incidental possible lesions any more than clinicians do. I also don't like not giving people a good answer to the clinical question. There is a lot that radiology can help diagnose. However, there are inherent limitations to imaging diagnosis that can be frustrating. While the majority of my interactions with clinicians is stimulating and satisfying, there are those who are demanding and condescending to my field. There are those that don't understand imaging and its limitations. Then there are those who feel they know imaging better than you. Interactions with those few clinicians can definitely ruin my morning. Luckily, its few and far between (and much more common in academia, where the egos are huge, than in the private practice world).

As for the future of radiology, I'm fairly certain the current high reimbursement will go down in the near future. I don't think it will go down enough to bother me greatly, but its something to think about when choosing the field. I will be making a great living no matter what. The current market will likely not last more than 5-10 years. I don't think finding a position will be a concern as it was in the early 90s, but the options will be a little less. The shortage of rads has abated somewhat, but is still present and will likely remain so for quite a while, in my opinion.

Nice to read a post on here that's well thought out and not inflammatory. Thanks...