"Growing into" ROAD specialties

[amazin_grace]

I am an MS4 thinking about IM based on interest in various subspecialties (only cards, GI, H/O) versus ROAD (and ROAD-type) specialties based on lifestyle (wanting to be an involved parent, good spouse, support outside interests, etc.). I have done rotations in 3 of the ROAD specialties (all but Derm) and have to say that I was not as interested in the material/practice of any compared to the IM subspecialties I mentioned above. I really threw myself into each ROAD rotation, seeing/examining patients on my own in ophtho, trying to figure out films on my own in rads, and trying to "play anesthesiologist" (with resident supervising me of course).

My question is whether it is possible to "grow into" these specialties after you go into them. I cannot imagine anyone being more interested (purely based on subject matter) in eye disease or skin disease compared to the crazy and more complicated systemic diseases you see in cards or heme/onc, yet many people go into these fields and end up really happy with their decision.

Some people have said that if something doesn't really excite you when you are first learning about it, there is no way I will still like my job after I have been doing it for 10+ years. Others have said that once you learn a lot about a certain field, it becomes more interesting, especially given the cush lifestyle so that you are in a better mood generally.

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[username456789]

My question is whether it is possible to "grow into" these specialties after you go into them.

Of course it is. I know medical school and residency is a very large time commitment and investment, but I also don't understand why people don't realize it's a job, not your entire life. Do you think people in all other vocations even get the option of having this kind of internal debate?

"Boy, I dunno, I mean putting shingles on that roof all day was kinda interesting, but my true passion lies in the beauty of cement mixers."

This is not to denigrate anyone's job. But often we lose perspective in our little medicine bubble. Sure, being happy at your job will be important, but realize that you can also derive a great amount of happiness from life outside of work as well. No one should feel bad for choosing a specialty partially based on schedule/lifestyle, and yet somehow we like to pretend we're super special and should be above such mortal interests. Similarly, no one should feel bad for choosing a field they may not have a "passion" for simply because it's in line with their overall life goals. In the grand scheme of things, as an M3/M4, you're tasked with deciding between many awesome jobs, all with their own set of rewards. Poll a dozen random people on the street and see how many of them chose their careers based on a love or passion for the content of their job. Chances are they do something they can tolerate that pays the bills and lets them enjoy whatever it is they do when they're not at work.

 

[Arkangeloid]

To be fair, a specialty like Cardiology is more of a life than a job, from what I hear.

 

[circulus vitios]

What happens if you can't get into an IM subspecialty? Do you really want to put up inpatient IM or hospitalist work for the rest of your life?

 

[atomi]

What happens if you can't get into an IM subspecialty? Do you really want to put up inpatient IM or hospitalist work for the rest of your life?

By that logic, if a person wants to be anything other than a PCP, he should not go to med school lest he can't get into a specialty and has to "put up with" being a PCP for the rest of his life. I also take it you have rotated through internal medicine given that you are making such statements.

 

[circulus vitios]

By that logic, if a person wants to be anything other than a PCP, he should not go to med school lest he can't get into a specialty and has to "put up with" being a PCP for the rest of his life. I also take it you have rotated through internal medicine given that you are making such statements.

No, I was basing that on the Medscape survey where literally 19% of internists said they would choose IM again.

 

[tco]

It's tough to look at a lot of the "ROAD" specialties and say that you'd enjoy doing them. It's easy to look at something like IM and assess whether you'd like to do it, given your relatively extensive experience on wards by the time you get through your fourth year. You've had enough medicine to say, "Yes, I'd like to do that," or, "No, I don't want to do that." You can't say, "I love reading MRI's" by watching someone else read MRI's. It's the same logic that lead to me laughing at applicants on the interview trail when they'd ask about "Which PACS system do you guys use?" Like they can really judge which system they like the best...

 

[DermViser]

My question is whether it is possible to "grow into" these specialties after you go into them. I cannot imagine anyone being more interested (purely based on subject matter) in eye disease or skin disease compared to the crazy and more complicated systemic diseases you see in cards or heme/onc, yet many people go into these fields and end up really happy with their decision.

Some people have said that if something doesn't really excite you when you are first learning about it, there is no way I will still like my job after I have been doing it for 10+ years. Others have said that once you learn a lot about a certain field, it becomes more interesting, especially given the cush lifestyle so that you are in a better mood generally.

Clinical medicine is MUCH more than an interest in a topic. You'll see very quickly that just bc you like the subject matter (i.e. Neuroscience) doesn't mean you'll like the clinical field associated with it and how it is practice in real life. (Neurology). Also, I know it shocks you, but there are people who go into ROAD specialties and actually enjoy the intellectual content of those specialties. Hard to imagine, I know.

 

[DermViser]

To be fair, a specialty like Cardiology is more of a life than a job, from what I hear.

Not shocking as heart attacks don't just come between the hours of 9 to 5.

 

[DermViser]

What happens if you can't get into an IM subspecialty? Do you really want to put up inpatient IM or hospitalist work for the rest of your life?

BINGO. I tell this to everyone. If you enter IM, and can't stomach the idea of possibly being stuck with hospitalist or primary care IM, then DON'T DO IT. Cards, GI, or Heme/Onc are no way assured to anyone.

 

[DermViser]

By that logic, if a person wants to be anything other than a PCP, he should not go to med school lest he can't get into a specialty and has to "put up with" being a PCP for the rest of his life. I also take it you have rotated through internal medicine given that you are making such statements.

With the way things are going with healthcare reform, if you're interested in primary care medicine, you're better off being an NP or PA. At least the ROI is much better in those cases.

 

[anbuitachi]

the acronym ROAD was started decades ago. these days it's outdated. don't go into ROAD just b/c it was ROAD 40 yrs ago. Anesthesiology has changed drastically, so has radiology, and its likely to change even more. These days the only one of the 4 that rly belongs to ROAD is dermatology.

 

[DermViser]

the acronym ROAD was started decades ago. these days it's outdated. don't go into ROAD just b/c it was ROAD 40 yrs ago. Anesthesiology has changed drastically, so has radiology, and its likely to change even more. These days the only one of the 4 that rly belongs to ROAD is dermatology.

It's not the number of hours. It's the idea of having "controlled" hours, as well as the $ per hour worked. Besides derm, the number of hours has changed but it's still relatively controlled. Hence, why an update to E-ROAD: http://yalemedicine.yale.edu/autumn2007/features/feature/51534

But laments and lambasting alone will not reverse the trends of the last few decades. Doctors have traditionally been willing to work long hours at the cost of personal and family time, perhaps because there are ethical rewards and societal respect that come with doctoring. The postwar “golden age” of medicine, when health care expenditures grew faster than the number of doctors did and doctors enjoyed a great deal of decision-making autonomy, has faded, for better or worse, in the face of a changing health care system.

Another article in JAMA in 2003 was one of several that elucidated the principal factors that make doctors miserable: not only long work hours, but also decreasing autonomy, more time pressure and difficulty in maintaining high-quality care. Today’s pressure to see more patients in less time, the diminished freedom of action that has accompanied managed care and reimbursements for thinking that are far less than for doing (an internist who decides upon a treatment strategy earns much less for his trouble than the gastroenterologist who scopes the patient, for example) have begun, perhaps, to alter students’ ambitions. What has always been a difficult job has become increasingly thankless, and students are quietly rebelling.

 

[PhillyMed777]

I'd add that ROAD specialties still have appeal, specially when they are compared to other options/specialties. Sure rads lost some reimbursement/lifestyle/job market, gas has crnas, and ophtho has lower starting salaries, etc...but as of today, they are still appealing to many. I also know of many who enjoy the content of their ROAD jobs, as I grew up in a family of physicians surrounded by doctor family friends. I know of one person who "grew" into liking radiology (joined the position post-match by chance...long story, but the person never considered rads before this)

I do have a question, and it probably falls within the realm of the one asked here: if you learn what it's truly like to be a physician during residency, how can you be sure about what specialty you are picking? Anyways, this may digress from the original question.

 

[username456789]

I do have a question, and it probably falls within the realm of the one asked here: if you learn what it's truly like to be a physician during residency, how can you be sure about what specialty you are picking? Anyways, this may digress from the original question.

You really can't, completely. You have to use all the information you have available, and sift through the good and the bad to make up your mind. In the end, you hope you made the right choice.

 

[DermViser]

I'd add that ROAD specialties still have appeal, specially when they are compared to other options/specialties. Sure rads lost some reimbursement/lifestyle/job market, gas has crnas, and ophtho has lower starting salaries, etc...but as of today, they are still appealing to many. I also know of many who enjoy the content of their ROAD jobs, as I grew up in a family of physicians surrounded by doctor family friends. I know of one person who "grew" into liking radiology (joined the position post-match by chance...long story, but the person never considered rads before this)

I know people in Rads who would never do other specialties no matter what. They tended to not like the BS (clinical and non-clinical) that a lot of inpatient clinical medicine entails. A lot of times, picking a specialty comes down to what specialty you can stand, vs. what specialty you like. There's a reason that those in IM and FM have one of the worst satisfaction ratings.

 

[amazin_grace]

Of course it is. I know medical school and residency is a very large time commitment and investment, but I also don't understand why people don't realize it's a job, not your entire life. Do you think people in all other vocations even get the option of having this kind of internal debate?

"Boy, I dunno, I mean putting shingles on that roof all day was kinda interesting, but my true passion lies in the beauty of cement mixers."

This is not to denigrate anyone's job. But often we lose perspective in our little medicine bubble. Sure, being happy at your job will be important, but realize that you can also derive a great amount of happiness from life outside of work as well. No one should feel bad for choosing a specialty partially based on schedule/lifestyle, and yet somehow we like to pretend we're super special and should be above such mortal interests. Similarly, no one should feel bad for choosing a field they may not have a "passion" for simply because it's in line with their overall life goals. In the grand scheme of things, as an M3/M4, you're tasked with deciding between many awesome jobs, all with their own set of rewards. Poll a dozen random people on the street and see how many of them chose their careers based on a love or passion for the content of their job. Chances are they do something they can tolerate that pays the bills and lets them enjoy whatever it is they do when they're not at work.

This is a fantastic post and something I am continuing to struggle with. People say to "do what you love" but at the same time I realize that almost no one in society gets to make that kind of decision....this makes me think I should just choose a ROAD specialty with controllable hours and eat dinner with my kids every day and just tolerate my job like 99% of the world. On the other hand, I wonder whether I am blessed to be able to "do what I love" if I so choose, and whether it would be throwing away a unique gift to choose a ROAD specialty that I do not find as intellectually interesting.

What happens if you can't get into an IM subspecialty? Do you really want to put up inpatient IM or hospitalist work for the rest of your life?

This is a good point but for the sake of argument here I am assuming I will get into the subspecialty I ultimately choose, based on speaking to my mentors here and IM senior residents from my home institution (which almost uniformly got into fellowships, although not necessarily at the top places).

It's tough to look at a lot of the "ROAD" specialties and say that you'd enjoy doing them. It's easy to look at something like IM and assess whether you'd like to do it, given your relatively extensive experience on wards by the time you get through your fourth year. You've had enough medicine to say, "Yes, I'd like to do that," or, "No, I don't want to do that." You can't say, "I love reading MRI's" by watching someone else read MRI's. It's the same logic that lead to me laughing at applicants on the interview trail when they'd ask about "Which PACS system do you guys use?" Like they can really judge which system they like the best...

I agree with this esp. for radiology, but for ophtho and anesthesia I do feel like I got a sense of what it really is like by spending a ton of time with attendings and trying to act like a first-year resident during clinics (although more slowly and less accurately).

Clinical medicine is MUCH more than an interest in a topic. You'll see very quickly that just bc you like the subject matter (i.e. Neuroscience) doesn't mean you'll like the clinical field associated with it and how it is practice in real life. (Neurology). Also, I know it shocks you, but there are people who go into ROAD specialties and actually enjoy the intellectual content of those specialties. Hard to imagine, I know.

I know there are people who enjoy the content of the specialties--but I am not asking about those people. I am asking about whether people who choose these lifestyle specialties despite lack of interest end up developing an interest in these specialties.

 

[DermViser]

I know there are people who enjoy the content of the specialties--but I am not asking about those people. I am asking about whether people who choose these lifestyle specialties despite lack of interest end up developing an interest in these specialties.

I don't know anyone who pursues a ROAD specialty to not only 1) be at the top of their class in MS-1, MS-2, and MS-3, 2) have Step scores that are 1 standard deviation above the mean if not higher, 3) do research and actually publish, 4) audition rotate, etc. and not have any interest at all in that field. Their interest is a driver in pushing themselves in all these things.

Certain specialties in medicine are ones in which the barrier to entry is just so much higher (whether deserved or not), and not just based on a Step score either.

 

[amazin_grace]

I don't know anyone who pursues a ROAD specialty to not only 1) be at the top of their class in MS-1, MS-2, and MS-3, 2) have Step scores that are 1 standard deviation above the mean if not higher, 3) do research and actually publish, 4) audition rotate, etc. and not have any interest at all in that field.

Certain specialties in medicine are ones in which the barrier to entry is just so much higher (whether deserved or not), and not just based on a Step score either.

I should rephrase--it is not that I have no interest at all in the field, just that the ROAD specialties have tended to be (unfortunately) less interesting than IM. I have done 1-3 of your list in two of the ROAD specialties "just in case" I choose better lifestyle over more interest, but have not done any away rotations for "audition" purposes since I have not yet chosen a field. But in my case, my having done research in the fields and having done a rotation at my home institution (which also is an audition for that residency program) was not related to interest. I was still exploring the fields, and wanted to know what research and clinical practice in those fields were like.

 

[DermViser]

I should rephrase--it is not that I have no interest at all in the field, just that the ROAD specialties have tended to be (unfortunately) less interesting than IM. I have done 1-3 of your list in two of the ROAD specialties "just in case" I choose better lifestyle over more interest, but have not done any away rotations for "audition" purposes since I have not yet chosen a field. But in my case, my having done research in the fields and having done a rotation at my home institution (which also is an audition for that residency program) was not related to interest. I was still exploring the fields, and wanted to know what research and clinical practice in those fields were like.

Yes, less interesting to you. Sorry, but IM is not interesting to you. The subspecialties of IM are what are interesting to you: which just so happen to be the most competitive ones: GI, Cardiology, Heme/Onc. It also just so happens that you have to go through 3 years of grueling IM residency in order to qualiy to get that prized subspecialty.

Very few people can go their entire lives esp. in a career for nearly 30-40 years, choosing a specialty only based on an intellectual interest. Other factors largely come into play as well: salary, lifestyle, etc. as well as if they are "competitive" on paper to apply to that field (which med school student affairs deans are cracking down on now) In medical school, especially, you can only get a snippet view on what you think a specialty is like.

 

[Silent Cool]

What happens if you can't get into an IM subspecialty? Do you really want to put up inpatient IM or hospitalist work for the rest of your life?

I agree with this but, to be fair, if you treat it like a 'job,' you can make some pretty good bank doing hospitalist work in many parts of the country with a lot of flexibility. I think the key is to remember that, hey, it's work--it's not supposed to be fun. If you can make good coin with high flexibility then it can be pretty tolerable.

 

[DermViser]

I agree with this but, to be fair, if you treat it like a 'job,' you can make some pretty good bank doing hospitalist work in many parts of the country with a lot of flexibility. I think the key is to remember that, hey, it's work--it's not supposed to be fun. If you can make good coin with high flexibility then it can be pretty tolerable.

That's a sad way to approach a career specialty 100% of the time - saying that you don't even like the intellectual material. To be fair, though, I have never heard of a hospitalist who actually ENJOYED their specialty. It is always the money only. They can't wait for their 7 day week to be over and start their 1 week off. It's essentially a "well I don't like outpatient primary care medicine, so let me do this bc at least it pays a lot more". Hence, why there are hospitalists who apply again for fellowship during their hospitalist year. The burnout rate is incredible in hospitalist medicine. You don't see people doing hospitalist type medicine for long periods of time (although it's a relatively new labeled specialty).

 

[ChEMD]

What happens if you can't get into an IM subspecialty? Do you really want to put up inpatient IM or hospitalist work for the rest of your life?

I think this is something that needs to be considered, but I also think a 4th year medical student can also put a certain amount of confidence into getting into an IM subspecialties based on how they've performed throughout medical school. I don't think it's completely unreasonable for a student that has excelled in medical school to go into IM with the mindset that they will get into a subspecialty, because in all likelihood they will be able to do so.

 

[Silent Cool]

That's a sad way to approach a career specialty 100% of the time - saying that you don't even like the intellectual material. To be fair, though, I have never heard of a hospitalist who actually ENJOYED their specialty. It is always the money only. They can't wait for their 7 day week to be over and start their 1 week off. It's essentially a "well I don't like outpatient primary care medicine, so let me do this bc at least it pays a lot more". Hence, why there are hospitalists who apply again for fellowship during their hospitalist year. The burnout rate is incredible in hospitalist medicine. You don't see people doing hospitalist type medicine for long periods of time (although it's a relatively new labeled specialty).

DV,

Do most of these people eventually leave hospitalist medicine for OP medicine even with lower pay? As an aside, I think every field has material that is intellectually interesting, some more than others--but that is of course a personal designation.

 

[DermViser]

DV,

Do most of these people eventually leave hospitalist medicine for OP medicine even with lower pay? As an aside, I think every field has material that is intellectually interesting, some more than others--but that is of course a personal designation.

Yes, they eventually do, either for a fellowship they match into or for outpatient IM. I remember reading some article talking about burn out level being high esp. at the 5 year mark. It's very difficult to keep up the intensity and pace of the 12 hour periods every day, every alternate week for decades at a time.

I'm not saying that inpatient Internal Medicine can't be intellectually interesting. I'm just saying that the ones I know who ended up in hospitalist medicine - the resounding feature they seem to like most about it is the pay and the geographic flexibility (bc all hospitals are going towards the hospitalist model it seems), not the actual specialty itself.

 

[Silent Cool]

Yes, they eventually do, either for a fellowship they match into or for outpatient IM. I remember reading some article talking about burn out level being high esp. at the 5 year mark. It's very difficult to keep up the intensity and pace of the 12 hour periods every day, every alternate week for decades at a time.

I'm not saying that inpatient Internal Medicine can't be intellectually interesting. I'm just saying that the ones I know who ended up in hospitalist medicine - the resounding feature they seem to like most about it is the pay and the geographic flexibility (bc all hospitals are going towards the hospitalist model it seems), not the actual specialty itself.

DV,
What do you think about operating/owing an urgent care center?

 

[DermViser]

DV,
What do you think about operating/owing an urgent care center?

Well, urgent care is very different. It's not a specialty per say. It's a practice model of doing things. I've heard it more on the EM side, but I guess theoretically any full-license physician can do it. I think it very much allows a good work-life balance, and hence physician happiness.

 

[amazin_grace]

Yes, less interesting to you. Sorry, but IM is not interesting to you. The subspecialties of IM are what are interesting to you: which just so happen to be the most competitive ones: GI, Cardiology, Heme/Onc. It also just so happens that you have to go through 3 years of grueling IM residency in order to qualiy to get that prized subspecialty.

Very few people can go their entire lives esp. in a career for nearly 30-40 years, choosing a specialty only based on an intellectual interest. Other factors largely come into play as well: salary, lifestyle, etc. as well as if they are "competitive" on paper to apply to that field (which med school student affairs deans are cracking down on now) In medical school, especially, you can only get a snippet view on what you think a specialty is like.

IM is interesting to me...especially from the resident point of view, it is just that I would not want to be a hospitalist long-term or a PCP, so I want to specialize. I like IM for the same reasons I like its specialties: thinking about the material and the way the other people talk/think. Sure there is "scut work" (dispo, etc.) but to me it felt like R/O/A were all scut work, and all of those have to do a medicine internship where the scut is concentrated. This thread is about whether it is worth it to go into a specialty that feels like 100% scut in order to get a good paycheck with good hours.

That's a sad way to approach a career specialty 100% of the time - saying that you don't even like the intellectual material. To be fair, though, I have never heard of a hospitalist who actually ENJOYED their specialty. It is always the money only. They can't wait for their 7 day week to be over and start their 1 week off. It's essentially a "well I don't like outpatient primary care medicine, so let me do this bc at least it pays a lot more". Hence, why there are hospitalists who apply again for fellowship during their hospitalist year. The burnout rate is incredible in hospitalist medicine. You don't see people doing hospitalist type medicine for long periods of time (although it's a relatively new labeled specialty).

What is this burnout based on? 84 hours per week every other week? Many people go into cards and work 60+ hours per week with overnight call adding another 8-10 hours/week and do that without a week off every other week...

 

[DermViser]

IM is interesting to me...especially from the resident point of view, it is just that I would not want to be a hospitalist long-term or a PCP, so I want to specialize. I like IM for the same reasons I like its specialties: thinking about the material and the way the other people talk/think. Sure there is "scut work" (dispo, etc.) but to me it felt like R/O/A were all scut work, and all of those have to do a medicine internship where the scut is concentrated. This thread is about whether it is worth it to go into a specialty that feels like 100% scut in order to get a good paycheck with good hours.

What is this burnout based on? 84 hours per week every other week? Many people go into cards and work 60+ hours per week with overnight call adding another 8-10 hours/week and do that without a week off every other week...

I don't think you're defining "scut work" based on the traditional definition of "scut work". Radiology and what it entails is hardly defined as "scut work" - it's what the job is. ROAD specialties are definitely not 100% scut are if anything popular due to the much lower amounts of scut work vs. General IM.

http://lmgtfy.com/?q=hospitalist burnout

Cardiologists are also organ specific and thus have a filter - although they usually see patients as inpatient consults not as full admissions. Hospitalists are dumped on for admissions by everyone since there is effectively no filter for them to say "No", unlike specialists. They get that week off bc they need that week off. You don't think if Hospitals could get them to work those hours everyday, they'd do that?

 

[235009]

I don't know anyone who pursues a ROAD specialty to not only 1) be at the top of their class in MS-1, MS-2, and MS-3, 2) have Step scores that are 1 standard deviation above the mean if not higher, 3) do research and actually publish, 4) audition rotate, etc. and not have any interest at all in that field. Their interest is a driver in pushing themselves in all these things.

Certain specialties in medicine are ones in which the barrier to entry is just so much higher (whether deserved or not), and not just based on a Step score either.

What you just said may be applicable for derm and ophtho but you definitely don't have to be anything more than average to do anesthesia or radiology nowadays. In fact you can easily get into it being below average or even SOAP into a position.

Don't underestimate the importance of doing something you enjoy and find intellectually stimulating. There's a big difference between being excited to start the day and dragging yourself out of bed to do your "job".

Finally people on sdn are fixated on this outdated ROAD acronym. What good is a lifestyle specialty if you can't find a job or you are forced to move to an undesirable location? There are a whole bunch of other specialties that have a good lifestyle that no one mentions because they have their ROAD blinders on not least of which is hospitalist medicine (working half the year for $200k with many chances to moonlight). The majority of IM sub specialties are also very lifestyle friendly as they are practiced outpatient. PM&R is also a good lifestyle friendly field.

As reimbursements inevitably drop for all ROAD specialties you'll see a new generation of resentful physicians who chose their specialty based on an acronym that was coined before they were born.

 

[DermViser]

What you just said may be applicable for derm and ophtho but you definitely don't have to be anything more than average to do anesthesia or radiology nowadays. In fact you can easily get into it being below average or even SOAP into a position.

Don't underestimate the importance of doing something you enjoy and find intellectually stimulating. There's a big difference between being excited to start the day and dragging yourself out of bed to do your "job".

Finally people on sdn are fixated on this outdated ROAD acronym. What good is a lifestyle specialty if you can't find a job or you are forced to move to an undesirable location? There are a whole bunch of other specialties that have a good lifestyle that no one mentions because they have their ROAD blinders on not least of which is hospitalist medicine (working half the year for $200k with many chances to moonlight). The majority of IM sub specialties are also very lifestyle friendly as they are practiced outpatient. PM&R is also a good lifestyle friendly field.

As reimbursements inevitably drop for all ROAD specialties you'll see a new generation of resentful physicians who chose their specialty based on an acronym that was coined before they were born.

Until, actually quite very recently, Radiology was just as competitive (from a match perspective it still is based on the average USMLE Step 1 score of those who matched, vs. not matched). Also, you have to understand the landscape has changed greatly for Radiology. The ones that are easy to match into are the very low tier programs whose training is shady and whose matching rate into fellowships is not great. It's now no longer the case where you finish a Diagnostic Radiology residency and you get offers out the wazoo. It's now quite customary to have to do a Radiology residency + fellowship. This could be due to the glut of near-retiring radiologists who were about to retire before the downturn of the economy in 2008 and have now stayed longer past what they intended, and it's affected outcoming radiologists who then shuttle to a fellowship in the meantime.

Again, see my post above, the ROAD mnemonic (or I guess now E-ROAD) is for CONTROLLED lifestyle specialties, with a higher $ per hr. worked, not necessarily easy hour specialties (exception: Derm)

• PM&R is also a lifestyle specialty, but the $/hrs. worked isn't as high as the ROAD specialties, unless one does a heck of a lot of procedures which usually requires a fellowship.
• Hospitalist medicine has a high burnout rate. You don't see as often people who do an entire career in their lifespan of only hospitalist medicine.
• We're talking about residencies here, not fellowships, which you are nowhere guaranteed after a grueling IM residency. If Allergy was a residency, it would be just as popular as Derm, which is why it is called the "Derm of IM" and is a competitive specialty. I know SDN likes to make it look like GI and Allergy are easy to waltz into but they're not.

 

[circulus vitios]

Finally people on sdn are fixated on this outdated ROAD acronym. What good is a lifestyle specialty if you can't find a job or you are forced to move to an undesirable location? There are a whole bunch of other specialties that have a good lifestyle that no one mentions because they have their ROAD blinders on not least of which is hospitalist medicine (working half the year for $200k with many chances to moonlight). The majority of IM sub specialties are also very lifestyle friendly as they are practiced outpatient. PM&R is also a good lifestyle friendly field.

The same could be said for a desirable location and having no time to enjoy what makes the location desirable.

I don't think you're working half of the year, either. You're working 80 hours a week, every other week. It "averages" out to a full time job and you sure as hell feel like you're being worked to death for that week you're on.

 

[Nasrudin]

Until, actually quite very recently, Radiology was just as competitive (from a match perspective it still is based on the average USMLE Step 1 score of those who matched, vs. not matched). Also, you have to understand the landscape has changed greatly for Radiology. The ones that are easy to match into are the very low tier programs whose training is shady and whose matching rate into fellowships is not great. It's now no longer the case where you finish a Diagnostic Radiology residency and you get offers out the wazoo. It's now quite customary to have to do a Radiology residency + fellowship. This could be due to the glut of near-retiring radiologists who were about to retire before the downturn of the economy in 2008 and have now stayed longer past what they intended, and it's affected outcoming radiologists who then shuttle to a fellowship in the meantime.

Again, see my post above, the ROAD mnemonic (or I guess now E-ROAD) is for CONTROLLED lifestyle specialties, with a higher $ per hr. worked, not necessarily easy hour specialties (exception: Derm)

• PM&R is also a lifestyle specialty, but the $/hrs. worked isn't as high as the ROAD specialties, unless one does a heck of a lot of procedures which usually requires a fellowship.
• Hospitalist medicine has a high burnout rate. You don't see as often people who do an entire career in their lifespan of only hospitalist medicine.
• We're talking about residencies here, not fellowships, which you are nowhere guaranteed after a grueling IM residency. If Allergy was a residency, it would be just as popular as Derm, which is why it is called the "Derm of IM" and is a competitive specialty. I know SDN likes to make it look like GI and Allergy are easy to waltz into but they're not.

PM&R has taken a jump up in competitiveness this year I think and the word is out on this nice lifestyle field with decent pay. It's such a small field that a little bit of flight from IM and such per the logic put down in this thread and it could be really competitive in the next few years.

Also if you subtract top pay criteria and add in high demand, geographic flexibility, and ability to go for many years in a specialty, psych should get 2nd tier ROAD status in my opinion.

I also think that given the stress, burn out, lack of sleep schedule control and intensity of EM that it should be 2nd tier in the ROAD schematic as well.

EM, PM&R, Psych, Occupational/Preventive medicine, pathology, and neurology are all fields that fit some ROAD criteria but perhaps lack in pay or something else in my opinion.

 

[thedoc25]

It's extremely realistic for you to chose internal medicine based on your desire to pursue one of its subspecialties. Being a AMG with a good medical school performance gives you a more than solid chance at matching into a competitive IM subspecialty. Yes, you still have to perform well in residency, but who doesn't? We all have to perform well in training to become competent physicians regardless of what specialty we chose. Do you think a crappy radiology resident will make it out of residency and find employment?

I'm a graduating m4 right now, I got a 260 on step 1 and 270+ on step 2. I'm also AOA and have publications. I chose IM because I liked the idea of being trained in general medicine while still having the opportunity to subspecialize into some really cool fields with great lifestyles. I didn't select a specialty solely based on what is currently "competitive". I couldn't be happier with my decision.

Bottom line, the poster said he enjoyed IM and the subspecialties it encompasses the most. He also said he wasn't crazy about the "ROAD" specialties. I'm not sure what else you want him say. You have a lot of options if you go into IM. If you really enjoy it you'll do well in residency and will have the opportunity to match into an IM subspecialty with a good lifestyle.

 

[Priapism4tooLong]

It's extremely realistic for you to chose internal medicine based on your desire to pursue one of its subspecialties. Being a AMG with a good medical school performance gives you a more than solid chance at matching into a competitive IM subspecialty. Yes, you still have to perform well in residency, but who doesn't? We all have to perform well in training to become competent physicians regardless of what specialty we chose. Do you think a crappy radiology resident will make it out of residency and find employment?

I'm a graduating m4 right now, I got a 260 on step 1 and 270+ on step 2. I'm also AOA and have publications. I chose IM because I liked the idea of being trained in general medicine while still having the opportunity to subspecialize into some really cool fields with great lifestyles. I didn't select a specialty solely based on what is currently "competitive". I couldn't be happier with my decision.

Bottom line, the poster said he enjoyed IM and the subspecialties it encompasses the most. He also said he wasn't crazy about the "ROAD" specialties. I'm not sure what else you want him say. You have a lot of options if you go into IM. If you really enjoy it you'll do well in residency and will have the opportunity to match into an IM subspecialty with a good lifestyle.

first post on sdn, 260 and 270+ and AOA.

Something seems fishy.

 

[dyspareunia]

I've heard derm is a lot like IM when it comes to variety and opportunities to specialize. I think a lot of non-derm people get caught up in the fact that it's high pay/great hours and don't realize there's a lot more to it. Just what I've been hearing from current derm residents...

 

[DermViser]

It's extremely realistic for you to chose internal medicine based on your desire to pursue one of its subspecialties. Being a AMG with a good medical school performance gives you a more than solid chance at matching into a competitive IM subspecialty. Yes, you still have to perform well in residency, but who doesn't? We all have to perform well in training to become competent physicians regardless of what specialty we chose. Do you think a crappy radiology resident will make it out of residency and find employment?

I'm a graduating m4 right now, I got a 260 on step 1 and 270+ on step 2. I'm also AOA and have publications. I chose IM because I liked the idea of being trained in general medicine while still having the opportunity to subspecialize into some really cool fields with great lifestyles. I didn't select a specialty solely based on what is currently "competitive". I couldn't be happier with my decision.

Bottom line, the poster said he enjoyed IM and the subspecialties it encompasses the most. He also said he wasn't crazy about the "ROAD" specialties. I'm not sure what else you want him say. You have a lot of options if you go into IM. If you really enjoy it you'll do well in residency and will have the opportunity to match into an IM subspecialty with a good lifestyle.

Great first post!

 

[DermViser]

first post on sdn, 260 and 270+ and AOA.

Something seems fishy.

Fish that has been rotting for months.

 

[thedoc25]

first post on sdn, 260 and 270+ and AOA.

Something seems fishy.

Yes, I created an account today and made my first post because I felt like finally commenting on a thread. I've been reading sdn sporadically for years, I just never felt the need to sign-up or post anything until now.

I'm not sure why my posting frequency would make my stats unbelievable, but whatever...

 

[Priapism4tooLong]

Yes, I created an account today and made my first post because I felt like finally commenting on a thread. I've been reading sdn sporadically for years, I just never felt the need to sign-up or post anything until now.

I'm not sure why my posting frequency would make my stats unbelievable, but whatever...

Its just strange the first post ever is a post about how well you did on steps. It's like a guy walks into a bar and screams his scores on step 1 and 2. SDN is the bar.

 

[thedoc25]

The point of my post was that the poster should chose a field based on what he enjoys the most regardless of what he's "competitive" for. It wasn't to brag about my stats. This is an anonymous forum. I have no reason to brag.

 

[pinecat]

the acronym ROAD was started decades ago. these days it's outdated. don't go into ROAD just b/c it was ROAD 40 yrs ago. Anesthesiology has changed drastically, so has radiology, and its likely to change even more. These days the only one of the 4 that rly belongs to ROAD is dermatology.

I am loving the D!

 

[DermViser]

I am loving the D!

I dare you to go inside an area with a lot of people and scream this out loud.

 

[Kaputt]

The point of my post was that the poster should chose a field based on what he enjoys the most regardless of what he's "competitive" for. It wasn't to brag about my stats. This is an anonymous forum. I have no reason to brag.

Yeah, eventually you should pick what interests you the most. But if you get a 260 on Step 1 you owe it to yourself to shop around. Not that many people get the luxury of being able to pick from any field.

 

[pinecat]

I dare you to go inside an area with a lot of people and scream this out loud.

Hahaha!!! You should see the looks I got after I matched into derm...hateful...simply hateful .....

 

[DermViser]

Yeah, eventually you should pick what interests you the most. But if you get a 260 on Step 1 you owe it to yourself to shop around. Not that many people get the luxury of being able to pick from any field.

Exactly! Thank you. With a 260, no field has been closed off to you yet. Your life is so much more than just the hours you spend in your job, and yes medicine, like any other profession is just a job. The possibility to be a highly satisfying job, but still a job nonetheless. It's why people retire.

 

[DermViser]

Hahaha!!! You should see the looks I got I matched into derm...hateful...simply hateful .....

Definitely not surprised. Just wait till you're in your prelim year (unless you're in a transitional then they're fine). Every other freakin field - ENT, Rad Onc, Radiology, Ophtho, PM&R, Anesthesiology, etc. gets a pass. But derm? Yeah, there's no way one could actually like the specialty itself.

 

[pinecat]

I start prelim in 2 weeks...what is it about our profession that sets that eye rolling in place... It's really irritating.

 

[boogaloo]

Definitely not surprised. Just wait till you're in your prelim year (unless you're in a transitional then they're fine). Every other freakin field - ENT, Rad Onc, Radiology, Ophtho, PM&R, etc. gets a pass. But derm? Yeah, there's no way one could actually like the specialty itself.

I start prelim in 2 weeks...what is it about our profession that sets that eye rolling in place... It's really irritating.

You guys are the best and the brightest. You all should be devoting your life to medicine. It's a shame. Sellouts. The number of comments I get about "getting good at crossword puzzles" is astounding, but I don't take any offense to it. They jelly.

 

[VisionaryTics]

Every other freakin field - ENT, Rad Onc, Radiology, Ophtho, PM&R, Anesthesiology, etc. gets a pass. But derm? Yeah, there's no way one could actually like the specialty itself.

That's because we actually take care of patients, and you are simply "Pimple Popper, MD".