"Growing into" ROAD specialties

[DermViser]

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

You forgot skin cancer.

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[pinecat]

I heard that all through the last year of med school. You know what? Am I gonna lie about wanting a good lifestyle...nope. That said, I have personally seen the way disease manifests itself through the skin. Not all of us are looking to do cosmetics...maybe, just maybe, there's a lot more to it that appeals to the "best and brightest" of us. I truly want to make a difference and I believe I can and I will. Derm bashing is really getting on my nerves

 

[pinecat]

And pimple popper??? Yeah...if can get a kid to feel better about him/herself by clearing up his/her skin I would say there's some healing going on...wow just wow.

 

[DermViser]

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

Because their entire perception of derm is based on a private practice cosmetic derm in NYC/LA/Beverly Hills or based on watching a Proactive commercial. They don't know about the ridiculous amounts of reading you have to do once you go home, preparation for conferences, or grand rounds. Not to mention, at a real academic medical center, you will see much more than just the mundane skin afflictions of suburbia. There are some IM attendings who realize how interesting Derm can be and can see beyond lifestyle.

Especially in the House of Medicine, if you're not stenting a vessel, sticking a scope up someone, pumping someone with IV fluids, or doing a major abdominal operation, etc. then you're not doing real medicine, as far as they're concerned. Internal Medicine (I'm assuming that's your prelim) is one of the worst when it comes to believing it's better than everyone else, bc at one time, it was the specialty that those at the top of the medical school class pursued in droves.

Not too long ago, it was well known that those at the top of the medical school class tended to go for Internal Medicine and General Surgery. Believe it or not, Ortho was for people at the bottom of the class. Same for Radiology and Rad Oncology (known as Therapeutic Radiology) - which were filled in droves by IMGs bc at that time there were only X-rays as MRI and CT hadn't been invented yet.

 

[DermViser]

I heard that all through the last year of med school. You know what? Am I gonna lie about wanting a good lifestyle...nope. That said, I have personally seen the way disease manifests itself through the skin. Not all of us are looking to do cosmetics...maybe, just maybe, there's a lot more to it that appeals to the "best and brightest" of us. I truly want to make a difference and I believe I can and I will. Derm bashing is really getting on my nerves

But the thing is there are many other lifestyle fields that don't get the flack that Derm does. Apparently, in medicine, getting a good night's sleep and having time to eat without inhaling your food, is all of a sudden a "good lifestyle". This from the folks who bring you the term the "golden weekend".

 

[boogaloo]

And pimple popper??? Yeah...if can get a kid to feel better about him/herself by clearing up his/her skin I would say there's some healing going on...wow just wow.

He's being facetious, FYI (hence the Seinfeld reference).

 

[DermViser]

He's being facetious, FYI (hence the Seinfeld reference).

On a complete tangent, I LOVE your avatar. What is that from?

 

[DermViser]

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.

I'm guessing Anesthesiology? That's a common refrain from people who didn't want to do Anesthesiology but rotated in it. Little do they know how much they actually do. The residents just make it look easy.

 

[boogaloo]

On a complete tangent, I LOVE your avatar. What is that from?

Haha, thanks. I'll PM you.

 

[pinecat]

Ok...my over sensitivity has been laid to rest

 

[VisionaryTics]

I'm guessing Anesthesiology? That's a common refrain from people who didn't want to do Anesthesiology but rotated in it. Little do they know how much they actually do. The residents just make it look easy.

Just remember the ABCs of anesthesiology: Airway, bagel, coffee (or crossword).

Also, Miller's Anesthesia just came out with a new volume.

 

[DermViser]

He's being facetious, FYI (hence the Seinfeld reference).

Since you're in Anesthesiology you may like this, as it has gotten a lot of views (they call them anesthetists in the UK):

 

[boogaloo]

Since you're in Anesthesiology you may like this, as it has gotten a lot of views (they call them anesthetists in the UK):

Haha, thanks for that. I remember seeing that video a long time ago, but it's more relatable now that I'm going into the field.

 

[DermViser]

Haha, thanks for that. I remember seeing that video a long time ago, but it's more relatable now that I'm going into the field.

They have a quite a few songs actually. They go by the name "Amateur Transplants": http://www.youtube.com/playlist?list=PL436B3991E9AD1299

 

[anbuitachi]

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.

I thought its just lifestyle in general, but maybe you are right. in that case anesthesia is not very controlled. i guess radiology still is controlled. not sure about optho

 

[DermViser]

I thought its just lifestyle in general, but maybe you are right. in that case anesthesia is not very controlled. i guess radiology still is controlled. not sure about optho

Actually anesthesiology is relatively controlled. No patients that they "own" per say, and when they leave the hospital, no pager to be paged on patients overnight.

 

[maxxor]

As a sidenote, it's interesting that Samuel Shem / Stephen Bergman, the person who coined ROAD, went into psychiatry.

 

[Arkangeloid]

But the thing is there are many other lifestyle fields that don't get the flack that Derm does. Apparently, in medicine, getting a good night's sleep and having time to eat without inhaling your food, is all of a sudden a "good lifestyle". This from the folks who bring you the term the "golden weekend".

Do you think it might be because of the appearance of some of the Derm residents? Every one of them at our hospital looks like a young club girl. I have no idea why...

I think that it's mostly because Derm is the last of the ROAD specialties at this point. Ophth is safe because people think "eye surgery" is badass for some reason.

 

[tco]

As a sidenote, it's interesting that Samuel Shem / Stephen Bergman, the person who coined ROAD, went into psychiatry.

Didn't know that. DECEPTION! "Look over there at all of those easy/high paying fields."

 

[maxxor]

Do you think it might be because of the appearance of some of the Derm residents? Every one of them at our hospital looks like a young club girl. I have no idea why...

When the selection committees can be as choosy as they can be in derm, that's what you get.

 

[username456789]

Do you think it might be because of the appearance of some of the Derm residents? Every one of them at our hospital looks like a young club girl. I have no idea why...

I look nothing like a young club girl.

 

[Arkangeloid]

Didn't know that. DECEPTION! "Look over there at all of those easy/high paying fields."

To be fair, Psych pays about half of what Rads and Anes do IIRC

 

[tco]

To be fair, Psych pays about half of what Rads and Anes do IIRC

Check out how much suboxone clinics make and get back to me.

 

[Arkangeloid]

Check out how much suboxone clinics make and get back to me.

Agreed, but by that same logic couldn't you point out some great jobs in any specialty as exceptions to the norm? Not all Psychiatrists work in suboxone clinics or methadone mills, not all radiologists work 8-5 for 400K+, not all PRS dudes have crazy rich cosmetics practices, and so on.

 

[tco]

Agreed, but by that same logic couldn't you point out some great jobs in any specialty as exceptions to the norm? Not all Psychiatrists work in suboxone clinics or methadone mills, not all radiologists work 8-5 for 400K+, not all PRS dudes have crazy rich cosmetics practices, and so on.

Absolutely. I'm not saying that the average radiologist makes less than the average psychiatrist. I'm also not saying that they all open up addiction clinics and pump out meds. However, one could argue that it's easier (less competitive) to go into psych and deal with addiction than it is to get into rads. The average psychiatrist that gives suboxone to patients is making a nice salary. The two that work at our institution are very comfortable.

As we discussed in other threads, "ROAD" no longer has the glimmer that it once had. If I were looking for lifestyle and at least a decent salary, I'd look at urology, derm, PM&R, psych. There are others, I'm sure. I'm just blanking on them as I'm watching the hockey game on the TV.

 

[maxxor]

Absolutely. I'm not saying that the average radiologist makes less than the average psychiatrist. I'm also not saying that they all open up addiction clinics and pump out meds. However, one could argue that it's easier (less competitive) to go into psych and deal with addiction than it is to get into rads. The average psychiatrist that gives suboxone to patients is making a nice salary. The two that work at our institution are very comfortable.

Of course, this is partially because getting and maintaining suboxone certification is difficult. Aren't there limits on how many suboxone patients you can be the prescriber for at a given time? Last I heard it was 100.

 

[tco]

Of course, this is partially because getting and maintaining suboxone certification is difficult. Aren't there limits on how many suboxone patients you can be the prescriber for at a given time? Last I heard it was 100.

I don't know if this is true. It definitely seemed like I participated in the care of more than 100 patients on "suboxone mill" day.

 

[maxxor]

I don't know if this is true. It definitely seemed like I participated in the care of more than 100 patients on "suboxone mill" day.

http://buprenorphine.samhsa.gov/faq.html#A11

 

[VisionaryTics]

Actually anesthesiology is relatively controlled. No patients that they "own" per say, and when they leave the hospital, no pager to be paged on patients overnight.

Unless they're first call and a case comes in. Or second call when first call is in the OR. Etc...

 

[tco]

http://buprenorphine.samhsa.gov/faq.html#A11

That's interesting. Thanks for the link. I wonder if these guys put the patients under both of their care and just cover each other and up to 200 patients?

 

[anbuitachi]

Actually anesthesiology is relatively controlled. No patients that they "own" per say, and when they leave the hospital, no pager to be paged on patients overnight.

I thought many specialties dont get paged really after they leave.. unless they are on call.

 

[DermViser]

Do you think it might be because of the appearance of some of the Derm residents? Every one of them at our hospital looks like a young club girl. I have no idea why...

There are pretty Derm residents and not pretty Derm residents. Just like residents in other fields.

 

[DermViser]

I thought many specialties dont get paged really after they leave.. unless they are on call.

I'm saying there is no continuity overnight - like in IM or Surgery.

 

[DermViser]

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

Were they actual friends of yours? Or were they just gunners? Or were they people who matched into primary care specialties (IM, Peds, FM)? Sad that they voiced this to you.

 

[pinecat]

Were they actual friends of yours? Or were they just gunners? Or were they people who matched into primary care specialties (IM, Peds, FM)? Sad that they voiced this to you.

IM and FM...I was the 1st and only one who matched into Derm from my school. Although I have to say that others begged me to switch with them

 

[DermViser]

IM and FM...I was the 1st and only one who matched into Derm from my school. Although I have to say that others begged me to switch with them

I figured those were the most likely culprits. These are the same hypocrites who'll be the ones going for GI, Cards, and Allergy after IM. The ones going for FM - didn't have to go for that field and could have easily chosen IM and Peds and subspecialize accordingly, as most urban FM docs don't do OB, only in rural areas. Would it have been any different if you'd gone for Radiology, Ophtho, Anesthesiology, PM&R, or ENT, etc.? Likely not.

It's not as if your school had a prior track record of matching people into Derm so you could get at least a little bit of an idea of what to do. They should at least be happy for you that you did it all on your own, without any help from your school.

 

[atomi]

As a sidenote, it's interesting that Samuel Shem / Stephen Bergman, the person who coined ROAD, went into psychiatry.

Then it shouldn't be surprising that psych is perhaps the greatest lifestyle specialty of them all. Even the residency can be considered a good lifestyle, cushier than even derm's residency. If the number of psych spots were slashed to 300, it would probably become as competitive as derm. Maybe not overnight, but the avg. matched step scores would go through the roof over a few years. Likewise if we had 1000+ derm spots, well what do you think would happen?

I have known quite a few girls who went into med school only wanting to do derm or psych. At first I thought that odd. What do those two fields have in common? Well, nothing academically. But they both allow you to take cash payments, have a chill residency, and control your schedule working as little as 2-3 days a week (I once heard a derm "attending" comment, "I'm worried about dropping back to 1 day a week when I have my 3rd (child) -- I really think you need to work at least 2 days a week to stay sharp." USMLE step 1 determines who goes derm and who goes psych for these people.

 

[DermViser]

Then it shouldn't be surprising that psych is perhaps the greatest lifestyle specialty of them all. Even the residency can be considered a good lifestyle, cushier than even derm's residency. If the number of psych spots were slashed to 300, it would probably become as competitive as derm. Maybe not overnight, but the avg. matched step scores would go through the roof over a few years. Likewise if we had 1000+ derm spots, well what do you think would happen?

I have known quite a few girls who went into med school only wanting to do derm or psych. At first I thought that odd. What do those two fields have in common? Well, nothing academically. But they both allow you to take cash payments, have a chill residency, and control your schedule working as little as 2-3 days a week (I once heard a derm "attending" comment, "I'm worried about dropping back to 1 day a week when I have my 3rd (child) -- I really think you need to work at least 2 days a week to stay sharp." USMLE step 1 determines who goes derm and who goes psych for these people.

Was just going to say this. And yes, this scenario of Derm vs. Psych (or Derm vs. PM&R) definitely plays out in real life.

 

[atomi]

To be fair, Psych pays about half of what Rads and Anes do IIRC

Common med student misunderstanding. It's a shame how many med students make career choices based on salary surveys posted online. So many other factors go into play. Unless you're in a surgical or IM subspecialty, you are probably going to start off around $200k/year and increase your income by 50-100% over the next 10 years, and here's the part that med students don't really get, NO MATTER WHAT FIELD YOU CHOOSE. It's stupid to make specialty choices primarily based on money when the pay is so uniformly good in this profession. Yet the competitiveness of certain specialties based on step scores shows that's exactly what is happening.

Remember, income greater than $185k is taxed at 33% federally and income >$400k is taxed at 40%. With state taxes, you're looking at nearly a 50% cut on anything you're making at those levels. So you choose to go into anestheisology where you start at $275k instead of FM where you start at $200k solely based on the money? Great, that's another $30-40k in your pocket each year. Not chump change, but certainly not enough to make the decision for you IMO. Everytime I hear a med student or resident going into a competitive specialty bitching about how they wanted to do FM but couldn't "afford to pay back my loans" or "provide for my family" or some such nonsense, I get mad. Cognitive dissonance, man.

 

[DermViser]

Common med student misunderstanding. It's a shame how many med students make career choices based on salary surveys posted online. So many other factors go into play. Unless you're in a surgical or IM subspecialty, you are probably going to start off around $200k/year and increase your income by 50-100% over the next 10 years, and here's the part that med students don't really get, NO MATTER WHAT FIELD YOU CHOOSE. It's stupid to make specialty choices primarily based on money when the pay is so uniformly good in this profession. Yet the competitiveness of certain specialties based on step scores shows that's exactly what is happening.

Remember, income greater than $185k is taxed at 33% federally and income >$400k is taxed at 40%. With state taxes, you're looking at nearly a 50% cut on anything you're making at those levels. So you choose to go into anestheisology where you start at $275k instead of FM where you start at $200k solely based on the money? Great, that's another $30-40k in your pocket each year. Not chump change, but certainly not enough to make the decision for you IMO. Everytime I hear a med student or resident going into a competitive specialty bitching about how they wanted to do FM but couldn't "afford to pay back my loans" or "provide for my family" or some such nonsense, I get mad. Cognitive dissonance, man.

I think FM doctors will disagree with you on the 200K starting out.

 

[atomi]

Was just going to say this. And yes, this scenario of Derm vs. Psych (or Derm vs. PM&R) definitely plays out in real life.

Also, I think there is definitely a lag time on competitive specialties. Watch what happens to rads in the next few years. When I started med school, rads was at the tip tops of competitiveness. You needed 240+ to even think about applying and people viewed a rads match with the same level of awe as derm. Now that it has lost its income and lifestyle appeal, there have been progressively more unmatched spots every year, but step scores have remained propped up because there is a 2-3 year lag between preparing step 1 and starting residency. Soon PDs will be forced to be less snobby in regards to step scores if they want to match american grads. Watch the average step 1 dip in the 220s in 5 years. Every time a derm, uro, rad-onc, ent, optho, etc. PGY-1 or 2 spot opens up, there are droves of current R1s applying for it.

Of course these things are cyclic. Go into rads because you want to be in rads and you'll be sitting pretty in 15-20 years. Chase the $$$ and you'll always be buying high and selling low because of the lag, just like in the stock market.

 

[atomi]

I think FM doctors will disagree with you on the 200K starting out.

In saturated urban markets maybe. The ones I know staying local had multiple offers around that level.

 

[DermViser]

Also, I think there is definitely a lag time on competitive specialties. Watch what happens to rads in the next few years. When I started med school, rads was at the tip tops of competitiveness. You needed 240+ to even think about applying and people viewed a rads match with the same level of awe as derm. Now that it has lost its income and lifestyle appeal, there have been progressively more unmatched spots every year, but step scores have remained propped up because there is a 2-3 year lag between preparing step 1 and starting residency. Soon PDs will be forced to be less snobby in regards to step scores if they want to match american grads. Watch the average step 1 dip in the 220s in 5 years. Every time a derm, uro, rad-onc, ent, optho, etc. PGY-1 or 2 spot opens up, there are droves of current R1s applying for it.

Of course these things are cyclic. Go into rads because you want to be in rads and you'll be sitting pretty in 15-20 years. Chase the $$$ and you'll always be buying high and selling low because of the lag, just like in the stock market.

That's bc it takes a while for it to filter down to the medical student level where it affects the match. Right now med students who go for it believe it won't happen to them. Hence the consistent high USMLE Step 1 match score for Rads. It was only recently that the competition for Rads was definitely on par with Derm, and at ALL programs, not just the top tier ones. Radiology kept expanding spots unnecessarily at shady programs, and essentially commoditized itself with Teleradiology, etc.

Now you have this glut where people are forced to bide their time in a fellowship. A fellowship has essentially become a requirement in order to practice Radiology. Of course with hubris like this: http://www.uth.tmc.edu/radiology/radiology-match-guide/, maybe it's karma?

 

[DermViser]

In saturated urban markets maybe. The ones I know staying local had multiple offers around that level.

But most doctors want to work in cities.

 

[tco]

That's bc it takes a while for it to filter down to the medical student level where it affects the match. Right now med students who go for it believe it won't happen to them. Hence the consistent high USMLE Step 1 match score for Rads. It was only recently that the competition for Rads was definitely on par with Derm, and at ALL programs, not just the top tier ones. Radiology kept expanding spots unnecessarily at shady programs, and essentially commoditized itself with Teleradiology, etc.

Now you have this glut where people are forced to bide their time in a fellowship. A fellowship has essentially become a requirement in order to practice Radiology. Of course with hubris like this: http://www.uth.tmc.edu/radiology/radiology-match-guide/, maybe it's karma?

What's your obsession with bringing this guide up at every possible point? You rambled into a line of reasoning that allowed you to post it.

A fellowship is required in radiology because the breadth of knowledge is vast. Private practices are wanting to advertise "MSK radiologist Dr. X will be reading your joint studies" to the clients. Academic programs want highly specialized experts available for the difficult cases.

 

[DermViser]

What's your obsession with bringing this guide up at every possible point? You rambled into a line of reasoning that allowed you to post it.

A fellowship is required in radiology because the breadth of knowledge is vast. Private practices are wanting to advertise "MSK radiologist Dr. X will be reading your joint studies" to the clients. Academic programs want highly specialized experts available for the difficult cases.

Ah, yes, you're the one who was her knight in shining armor defender based on meeting her on an interview: http://forums.studentdoctor.net/thr...a-residency-slot.855776/page-15#post-15016935

Tell me did you ended up matching at her Radiology program since you said you ranked them #1? Sorry, genius, a fellowship is now a requirement bc of the market. Before, Diagnostic Radiology resident graduates were getting offers to read them WITHOUT a fellowship on hand.

 

[tco]

Ah, yes, you're the one who was her knight in shining armor defender based on meeting her on an interview: http://forums.studentdoctor.net/thr...a-residency-slot.855776/page-15#post-15016935

Tell me did you ended up matching at her Radiology program since you said you ranked them #1?

Yeah, and the annoying exchange we had in that thread about the issue is what lead to me blocking you for a number of months. Let's not go there again. I rather enjoy reading some of your posts.

There are eccentrics in every field, and Dr. Oldham is one of them. I could tell from the interview that she is a strange cat, and I'm not surprised by what she wrote. However, I've kept in touch with residents from the program after match day, and none of them are unhappy, which speaks volumes for he program. It's rather unfair for you to draw conclusions of an entire program based on advice written (no matter how arrogant it may seem) on the program website. I will not justify this issue with a further response. Your vendetta is sickening.

 

[DermViser]

Yeah, and the annoying exchange we had in that thread about the issue is what lead to me blocking you for a number of months. Let's not go there again. I rather enjoy reading some of your posts.

There are eccentrics in every field, and Dr. Oldham is one of them. I could tell from the interview that she is a strange cat, and I'm not surprised by what she wrote. However, I've kept in touch with residents from the program after match day, and none of them are unhappy, which speaks volumes for he program. It's rather unfair for you to draw conclusions of an entire program based on advice written (no matter how arrogant it may seem) on the program website. I will not justify this issue with a further response. Your vendetta is sickening.

Like I said, this has no reflection on the residents that match there. It's a reflection on the Radiology PD at that program herself who RUNS that program, who tried to portray her specialty as only for the "chosen ones". Any PD with half a brain would at least keep that distasteful nonsense to themselves. She posted her hubris on her program's website. @atomi had mentioned about specialty selection based on perceived salary calculations by med students. She tried to capitalize on it, as if somehow Radiology is entitled to top notch applicants and high salaries, and one needs to walk on water to match into Radiology and she didn't have the sense to not broadcast it. I find your justifying her behavior sickening.

 

[atomi]

Hence the consistent high USMLE Step 1 match score for Rads.

I believe another factor, and I am far too lazy to look this up, is that PDs are choosing more FMGs and red-flagged AMGs with super high step scores. Normally these people wouldn't have matched, but there are enough 240+ in the applicant pool to keep the averages up for now. Oh the horror that a PD might actually have to rank a bright, young, motivated, and rads-dedicated US senior with a 215 step 1 one day.

 

[atomi]

But most doctors want to work in cities. Manhattan, DC Metro, SoCal, and San Francisco.

Fixed that for you.