Happiest Specialty

[Winged Scapula]

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why do you have to study for boards?

Every board recognized specialty has Board Certification exams and most residencies have in-training exams. So in addition to USMLEs (Long Dong may not have taken Step 3 yet), you also have the above exams to study for during residency.

 

[Long Dong]

why do you have to study for boards?

Derm boards are crazy hard, derm residency requires so much reading and I'm a dum arse who needs to study way in advance to do well.

Every board recognized specialty has Board Certification exams and most residencies have in-training exams. So in addition to USMLEs (Long Dong may not have taken Step 3 yet), you also have the above exams to study for during residency.

Did step 3 last year, by far the easiest board exam I've ever taken. Or was it that at that point I just wanted to pass. I think a spent a hole hour studying for it, I did 50 questions and was like I'm just going to take it. Did a TY with 2 months IM, 2 month peds, 2 month surg, 1 month family, 1 month EM, and 4 month of chill electives so guess that training helped me pass.

 

[Ludicolo]

Exams do not end with Step III.

Every specialty (I think - maybe there are exceptions?) has its own board exam so you can be certified in that specialty. I can't speak for every other specialty, but the pathology board exam I took last year was orders of magnitude more difficult and complicated than any other test I have ever taken. I required much much more studying. Step I is a minor blip in comparison. Board exams are where the national board of your specialty tests you on things you should know for practice. Many people will start studying for their board exam many months to years in advance.

If you do a subspecialty within a field (like cardiology within internal medicine, or dermpath within dermatology or pathology) you have to take a second board exam for that as well.

Also don't forget Maintenance of Certification exams every 10 years, not just for your primary specialty but for any recognized subspecialty one chooses to pursue.

 

[pgg]

why do you have to study for boards?

It's generally recommended if passing said boards is on your to-do list.

Residency is a lot more fun than med school, but the academic demands don't go away. All specialties have written boards, and some have oral boards as well.

You can fail them and still practice ... for that matter, there's no law requiring you to do any residency at all. But the day is probably coming when getting reimbursed will depend on board certification.

 

[CambieMD]

RAD

Rads
Anesthesia
Derm

Ophtho has fallen off b/c of the pittance they're getting paid these days.

Don't believe the crap you read from the tree huggers around here. If you don't like patients, RADS is the clear choice. If you like patients, DERM makes a bit more money. If you're not competitive for those, go for ANESTHESIA.

These are the best gigs in medicine and surgery. Everything else blows after about 5 years of practice. Then you'll spend the rest of your life wishing you would've gone into RAD.

If you don't like patients you should not be in medicine. It is sad that so many students choose their specialty based on life style and money. My program tries to weed out applicants who are not really interested in anesthesia. Find something that you love and the rewards will follow. I know several surgeons. They worked hard during residency and have rewarding careers now.

Every specialty has its ups and downs. I don't know if I qualify as a tree hugger. I understand the harsh realities of medicine. Primary care is not considered as glamorous as some other specialities. Specialties need each other to help care for patients. An excellent surgical outcome can be ruined by poor post op care which in addition to wound care involves internal medicine.
All specialties deserve bright highly motivated caring individuals.

Cambie

p.s. I am on call and will be up all night.

 

[gimmederm]

Well not in the town where I'm at, there is just these little dive bars. I was at the gym the other day and over heard the locals talking about how they can't stand the doc/residents at their bars. So I mostly take a 75 minute drive to Minnieapolis every other weekend to get my club on. It's not to bad there, it's no L.A., NYC, Vegas or Miami but you can find a hottie now and then.

As Yaah was saying trips to vegas are cheap sometimes less then $100. One time I was at a club in vegas talking to the hotest girl ever. I was amazed she was even talking to me. Here I am thinking I'm getting my mac on, then she bust out her business card and her rate was $500/a half hour. She was a call girl, they don't call it sin city for nothing.

Gimmederm once you start derm residency you will have to deal with this dilemma too. What to do on a Saturday night after you've spent all the day studying boards fodder. Decisions descisions decisions.

hahahahha. thats too bad. all the good ones are taken or cost too much.

the clubs in ur area.. is there much variety in terms of ethnicity?

 

[Medicinewarrior]

cardiology is the best specialty 😀

 

[gasping81]

The best specialty is the one with the best hours overall with the least demanding crap work. In times when medicine is not so glamorous, I think a specialty or residency with the least amount of crap is best. People can say they love their specialty, but is it worth it at the cost of your family and friends? We are not mammals in medicine. We don't sleep regularly. We get drilled usually on our calls. It's all done wrong.

I wonder which residencies offer the best hours meaning near 50 regardless of specialty.

 

[Old_Mil]

Come on, everybody wants to be the neurosurgeon.

In all seriousness, I'd sooner drive a garbage truck.

 

[euphio]

On the ROAD to happiness, rad onc takes up two lanes 😉

 

[howelljolly]

clever

 

[neurochirrurgie]

Come on, everybody wants to be the neurosurgeon.

deep down inside, definitely true..😉

 

[error404]

In terms of competitiveness:

Dermatology > Ophthalmology > Radiology >> Anesthesiology

It takes high scores to get into the BEST programs in any specialty. In the ROD part of ROAD it takes good scores to get into EVERY residency.

I'm not sure if I agree with this. For most of the top anesthesia programs this year, there's a 230 on Step 1 cutoff. (Yes, there are exceptions.) Last year, the average score at the program I'm hoping for was 242.

I think anesthesia's advantage is that the program size is typically larger. They still run some rough numbers.

 

[kingalls]

The best part of my day is rolling into the physician's lounge at 8am for my cereal and saying hello to my surgery colleagues, who have been there for 2+ hours. A close second is when I'm grabbing cookies on the way out at 5 and saying goodbye to my surgery colleagues, who will be there for 2+ more hours. Radiology baby. Radiology.

I can't think of a rotation I didn't enjoy in med school, and probably nothing was more fascinating that what goes on in the OR. Specialty is a hugely personal choice, but for me, there were just other things (movies, hobbies, parties, sex) I'd rather spend that extra 20+ hours per week (for the rest of my life) on. Know thyself, young physician.

 

[Geri_Gal]

These surveys are largely useless due to the fact that specialty stereotypes about personalities usually hold a decent grain of truth. Geriatric IM ain't the happiest specialty because geriatric IM is so hot. If you made geriatric IM and CT surgeons switch jobs, I bet the former-geriatric IM people would still be happier because they were the type of people likelier to be "happy" in the first place.

As a future Geriatric IM person, I can tell you that I am a born pessimist (though I prefer to think of myself as a realist) & would be a miserable surgeon/radiologist/neonatologist.

BUT - I love the geri's enough to forgo making as much as my private practice general IM brethren. I hypothesize that geriatrics was the happiest specialty in the survey because there are fewer geriatricians than most other subspecialties & those that enter the field truly love what they do. That and our patients are awesome: c'mon! by the time people hit 80, natural selection has weeded out the douchebags.

 

[jettavr6]

In all seriousness, I'd sooner drive a garbage truck.

For you maybe... and that's why you'd probably choose specialize in something else...

But it's a sad commentary as to how we view our fellow colleagues work. There's a piece of every specialty that I find interesting...

 

[mercaptovizadeh]

For you maybe... and that's why you'd probably choose specialize in something else...

But it's a sad commentary as to how we view our fellow colleagues work. There's a piece of every specialty that I find interesting...

I don't think it's disrespect for neurosurgeons. If anything, neurosurgeons and cardiac surgeons probably garner more respect than any other doctors from the general population, and from a good many MDs as well. It's just that those types of careers essentially demand first position in your life. For some people, that provides happiness - knowing that they've cured someone of otherwise-intractable and life-destroying epilepsy by carefully cutting out a piece of the patient's brain. For others, they'd rather have more control over their hours, less risk in what they do hurting the patient, and more time for other things like vacation, hobbies, family, etc.

 

[TRAMD]

I'm not sure if I agree with this. For most of the top anesthesia programs this year, there's a 230 on Step 1 cutoff. (Yes, there are exceptions.) Last year, the average score at the program I'm hoping for was 242.

I think anesthesia's advantage is that the program size is typically larger. They still run some rough numbers.

You say that you don't agree with what I said and then don't say anything that contradicts what I said. I acknowledged that the top programs in EVERY specialty (that includes Gas) require high scores to get into but any graduate from an allopathic school with lower board scores can get into Anesthesia somewhere. The same is NOT true for Radiology, Ophthalmology and Dermatology. This does not discount that I think Anesthesiology is a great specialty but it is definitely easier to get into than the other "ROAD" specialties. That is why it is known as the "Caribbean's Dermatology". Ok . . . so I just made that up.

 

[Doowai]

ENT had the worst ranking in one of those "how satisfied are you with your specialty" polls. I have yet to hear anyone give a convincing reason why this is the case. Anyone want to take a stab at it?

They had a bad day at the orifice and are looking a bit down in the mouth?

 

[Doowai]

Prior to my "medical career" I was in a health profession for 16 years where I had alot of control over hours and made good money. On the average I worked 20-30 hours per week, although for 3 years I worked less than 20. Good money by my standards is not what it is here - overall I tend to look at people who post on SDN as spoiled pampered people who consider anything under half a mill a year a joke. But I made roughly what is quoted as salary for primary care medical physicians, and enjoyed a better lifestyle since I graduated from my first graduate program with about $50K in debt which I paid off in less than 10 years and lived in an area of the midwest where the cost of living was well below national average.

Despite having great control over hours (2-3 hour lunches daily, 4 long vacations a year) etc I was disatisfied. Partly because I did not feel I did enough to earn the money. What I did was valuable and appreciated by patients, but I felt I should do more - this was a large factor in going back to medical school. If I had to do it over again I would have assuaged my ego, or even shot it dead and not listened to it every time it said "You should be doing more to earn your income". I went to medical school looking for greater happiness.

If you go looking for happiness you are probably not going to find it. You simply need to open your eyes to find it. Its where you are now or its probably never going to be there. There are always things you can improve - better finances, better relationships, etc - but happiness is here now or its not.

Victor Frankl had a lot to say about this in his famous book MANS SEARCH FOR MEANING about being in a concentration camp during WWII. I listen to my dad's stories of being a prisoner of war as a downed American pilot during WWII - and met many of his POW friends and several of the guys who were on his plane. They had powerful and great things to say about their war experience - they were stabbed, starved, tortured literally. Locked in solitary for a month or more, solitary in boxes smaller than a single size bed. Forced to march 50 kilometers (about the distance of a marathon) day after day through one of the coldest winters in Germany's history,consuming 500 calories a day or less, piling snow on top of themselves for warmth; some wearing no shoes, some wearing no coats on what is now called historically "the forced march". These guys had already lived through the great depression. Almost all of the meat my dad ate every day growing up was from animals he shot - possum, racoon, squirrel. Yet overall I find my dad and his friends to be happy, and happy with their war experiences. I think it was a different generation - more nieve perhaps, but different. Their music has lyrics seriously like "accentuate the positive, eliminate the negative. latch on to the affirmative, don't mess with Mr.In-between". Todays music has nothing as positive.

Happiness is not about your circumstances.

 

[escape78]

Happiness is not about your circumstances.

I couldn't agree with you more.

Sometimes we strive to better a certain aspect in our lives (eg. Income/Appearance/Grades) assuming that it will lead to happiness thereby making the journey a tribulation in itself.

I do think it is extremely important to take care of ones self, study hard, work hard etc. I try not to kid myself into thinking that the end result will make me 'happy', instead I try to enjoy doing these tasks themselves.

"The self is the friend of a man who masters himself through the self, but for a man without self-mastery, the self is like an enemy at war"

 

[Doowai]

thereby making the journey a tribulation in itself.

I do think it is extremely important to take care of ones self, study hard, work hard etc. I try not to kid myself into thinking that the end result will make me 'happy', instead I try to enjoy doing these tasks themselves.

"The self is the friend of a man who masters himself through the self, but for a man without self-mastery, the self is like an enemy at war"

Your comments remind me of a discussion my son and I had at the gym last night. He and I both have an obsession to take exercise to extreme's at times. We discussed how often people see comfort (with food, drugs, entertainment, etc) and often end up so miserable. Whereas the people we know who don't seek comfort but seek to achieve goals, or reach limits often encounter alot of difficulty, maybe even pain - but it often results in long lasting satisfaction if not happiness.

Not alot of people seem to enjoy the journey and challenge of becoming an MD, but instead find the effort only worthwhile if they receive a pellet of money after tapping on the bar. Somehow the satisfaction and enjoyment of pushing their limits, or a job actually well done is lost on them. Similarly doing ones best is not as important as doing better than others.

 

[rtennis18]

Child psychiatrists are the happiest group 😎

 

[dragonfly99]

Not alot of people seem to enjoy the journey and challenge of becoming an MD, but instead find the effort only worthwhile if they receive a pellet of money after tapping on the bar. Somehow the satisfaction and enjoyment of pushing their limits, or a job actually well done is lost on them. Similarly doing ones best is not as important as doing better than others.

There's a lot of truth in this. These types are the ones who are already burned out shortly after residency, though...when they realize the $$ they thought would make them egregiously happy in fact may not. However, I do think you are being a little harsh...some folks went into 200k debt to get through medical school so it is hard to tell folks they shouldn't be worrying or thinking about money in that situation.

I think that medical education pushes this idea that instead of being competent and striving to be YOUR best, that you always have to be out trying to 1-up the guy next to you, which I think is a crappy attitude to be teaching those in a "helping" profession, which is really what medicine is. Even grades are on the curve, so that one student doing well automatically is at the expense of another student. I know it's important also to reward excellence, but I think that we need to seriously rethink the way we do medical education (and I mean med school as well as residency/fellowship).

 

[Doowai]

There's a lot of truth in this. These types are the ones who are already burned out shortly after residency, though...when they realize the $$ they thought would make them egregiously happy in fact may not. However, I do think you are being a little harsh...some folks went into 200k debt to get through medical school so it is hard to tell folks they shouldn't be worrying or thinking about money in that situation.

I think that medical education pushes this idea that instead of being competent and striving to be YOUR best, that you always have to be out trying to 1-up the guy next to you, which I think is a crappy attitude to be teaching those in a "helping" profession, which is really what medicine is. Even grades are on the curve, so that one student doing well automatically is at the expense of another student. I know it's important also to reward excellence, but I think that we need to seriously rethink the way we do medical education (and I mean med school as well as residency/fellowship).

I am being a bit harsh you are right. Also, grades such as A,B,C,D are definately old school.

 

[escape78]

I think that medical education pushes this idea that instead of being competent and striving to be YOUR best, that you always have to be out trying to 1-up the guy next to you, which I think is a crappy attitude to be teaching those in a "helping" profession, which is really what medicine is.

So true.

It is necessary to force ourselves into challenging situations on order to bring about the best in us, but I believe that focussing on others will only under-mine our abilities to improve ourselves.

It is hard not to keep checking out the competition though..! Guess I have to spend the next half of my life trying to undo the competitive spirit in me!

 

[strv04]

Step I is a minor blip in comparison.

I realize that the dept of knowledge and practical understanding of things on specialty board exams is far and above the material on step I but the stress level is not the same.

I'm also pretty sure you don't take a month of vacation to study +12 hours a day each time your boards come around. Messing up on Step I could have implications for the next 30-40 years of a medical students life. Specialty choice with all the income and job satisfaction that come with it is on the line.

 

[yaah]

I'm also pretty sure you don't take a month of vacation to study +12 hours a day each time your boards come around.

That's because you can't. You're in residency or fellowship, working 60+ hours per week. Might get a month or so of elective in there where you can work less and study more. So instead you study for up to (or beyond) a year. Of course, if you fail a couple of times then you might get a year off to do nothing else but study.

I'm sure step I is stressful for many people, maybe more than boards would be. But at the same time, it's really all you have to focus on for that period of time when you are studying. It really isn't worth arguing about which is "more stressful" because that's likely an individual thing and dependent on dozens of factors. For me, Step I was not that stressful. Boards were stressful. Boards knowledge was Step I x 10.

 

[Winged Scapula]

Some specialties like General Surgery don't allow you to take the boards until you've finished residency. ABS even moved the written boards up to August from October reportedly because too many fellowship directors were complaining that fellows were useless until October.

Ob-Gyn requires you to have been in practice (? 3 years) before taking their boards.

So as yaah notes, you can't take a month off to study 12 hours a day (which I would have relished) because most of us need to work and pay the bills. Whether one or the other is more stressful isn't a worthwhile argument; you don't know what its like taking boards and I haven't taken Step 1 in years. Bear in mind that failing your specialty boards can have repercussions as well.

 

[staphaureus]

The happiest people I've met so far are otolaryngologist. I'm never met a jerk or someone not loving what they do across the age spectrum. The secret must be all that mucous. 😀

 

[PeepshowJohnny]

I realize that the dept of knowledge and practical understanding of things on specialty board exams is far and above the material on step I but the stress level is not the same.

I'm also pretty sure you don't take a month of vacation to study +12 hours a day each time your boards come around. Messing up on Step I could have implications for the next 30-40 years of a medical students life. Specialty choice with all the income and job satisfaction that come with it is on the line.

Radiology is going to be changing their boards in the next few years, but in it's current form, it's a HUGE deal. Pretty much the majority of the final year of residency is dedicated to giving the residents time to study for this monster of the test.

Now, Step 1 IS scary in that it's a "One and done" test. Once you've got a passing Step 1, that's all you got (and Lord help you if you fail). However, there's always Step 2, there's always third year grades, there's always LORs and research.

 

[dragonfly99]

Step I was >>> stressful than taking the internal medicine boards.
For stress level, I would rate them
1) Step 1 (most stressful)
2) Step 3 (b/c of those funky clinical case scenarios)
3) Step 2
4) IM boards
HOWEVER, the IM board exam is very easy compared w/some other specialties, and the pass rate is well over 90%. I'm actually surprised it's not even higher. It's not that the questions are super easy but they don't set the bar for passing super high.

Part of the reason Step 1 was so stressful for me and my classmates though was that the end of our 2nd year was ball-busting, to the point that one didn't really have time to study for Step 1 until after the end of the year exams. The time between end of 2nd year exams and beginning of 3rd year was only about 3 weeks total, so if you wanted any kind of vacation that meant cramming for 2 weeks then taking the test...it was unpleasant to say the least.

 

[ChessMess]

From UC Davis...

http://www.biomedcentral.com/1472-6963/9/166

Background
Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options.

Methods
We analyzed cross-sectional data from 6,590 physicians (response rate, 53%) in Round 4 (2004-2005) of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions

Results
After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349); geriatric medicine (0.323); other pediatric subspecialties (0.270); neonatal/prenatal medicine (0.266); internal medicine and pediatrics (combined practice) (0.250); pediatrics (0.250); dermatology (0.249);and child and adolescent psychiatry (0.203). The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707); pulmonary critical care medicine (-0.273); nephrology (-0.206); and obstetrics and gynecology (-0.188). We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites.

Conclusion
Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they appear to be in critical areas of medicine.

 

[476515678234896]

radiation oncology?

 

[Slack3r]

Thread necromancy?

 

[MLT2MT2DO]

From UC Davis...

http://www.biomedcentral.com/1472-6963/9/166

Background
Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options.

Methods
We analyzed cross-sectional data from 6,590 physicians (response rate, 53%) in Round 4 (2004-2005) of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions

Results
After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349); geriatric medicine (0.323); other pediatric subspecialties (0.270); neonatal/prenatal medicine (0.266); internal medicine and pediatrics (combined practice) (0.250); pediatrics (0.250); dermatology (0.249);and child and adolescent psychiatry (0.203). The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707); pulmonary critical care medicine (-0.273); nephrology (-0.206); and obstetrics and gynecology (-0.188). We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites.

Conclusion
Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they appear to be in critical areas of medicine.

😱

 

[deltamed]

Step I was >>> stressful than taking the internal medicine boards.
For stress level, I would rate them
1) Step 1 (most stressful)
2) Step 3 (b/c of those funky clinical case scenarios)
3) Step 2
4) IM boards
HOWEVER, the IM board exam is very easy compared w/some other specialties, and the pass rate is well over 90%. I'm actually surprised it's not even higher. It's not that the questions are super easy but they don't set the bar for passing super high.

Part of the reason Step 1 was so stressful for me and my classmates though was that the end of our 2nd year was ball-busting, to the point that one didn't really have time to study for Step 1 until after the end of the year exams. The time between end of 2nd year exams and beginning of 3rd year was only about 3 weeks total, so if you wanted any kind of vacation that meant cramming for 2 weeks then taking the test...it was unpleasant to say the least.

derm boards definitely >>>>> way more stressful than step 1, 2 or 3.

step 1 was minimal studying (a normal work day for a month, kinda like a 9-5 job) translating to an easy top score.

step 2 and 3 were jokes (no studyding at all, easy high score).

While in derm we may get out of clinic at 6, the nights must be spent studying (consistently for years) or you will fail. Cause everyone else is VERY good at taking tests and therefore the curve is going to get you.

 

[StanleyCup7]

I honestly have to say Radiation Oncology...not sure I have ever met one that did not LOVE his/her job.

 

[bronx43]

I wonder how happy radiologists are going to be when the diagnostic imaging reimbursements get cut.

 

[Winged Scapula]

I wonder how happy radiologists are going to be when the diagnostic imaging reimbursements get cut.

They are certainly much more aggressive about scheduling biopsies and image guided procedures here than they were a couple of years ago.

 

[Taurus]

It'll be interesting to see how virtual colonoscopy and cardiac CTA plays out in the future. Those are the huge potential "growth" areas for radiology. The question is can they keep out the GI's and cards? The main thing that keeps it in play for rads are the incidental findings in the abdomen and chest.

 

[Ronin2258]

Just to throw my two cents in:

I try not to think of one specialty having the monopoly on happiness. In the end, it is what makes you happy. I may think IM is the most miserable thing on the planet to be in (no offense to IM people.) But there are others who love every minutia of it. Conversely, these same people would rather bang their heads against the wall than deal with what I considered exciting in anesthesiology or surgery (again, no offense to the respective specialties. Setting up for the next couple of paragraphs.)

A friend of mine once said, "A job is something you do to pay the bills. A career is a something you love to do, that you look forward to every day. The trick is finding a job to be a career." To me, *that* is the reason I go for my choice of residency, not what some survey says.

Some people don't mind the hours, don't mind the paperwork or the risk. It is because they enjoy what they do.

As I said to one of my attendings, "There are some of us out there, that well, who love their work just a little more than the rest of us."
His joking response? "Some of us need their medications adjusted."

 

[gutonc]

It'll be interesting to see how virtual colonoscopy and cardiac CTA plays out in the future. Those are the huge potential "growth" areas for radiology. The question is can they keep out the GI's and cards? The main thing that keeps it in play for rads are the incidental findings in the abdomen and chest.

With all the cardiac imaging fellowships out there, I imagine that cards will continue their stranglehold on cardiac CT/MRI, even in the community, for some time to come.

CT colonography is a different story and may end up helping out the Rads folks. Of course, in anything other than a low-risk routine screening situation, it's borderline malpractice. But that's neither here nor there.

 

[filter07]

IMO CT colon screening is a bad idea. Waste of money, excessive radiation. Just pointless.

 

[Taurus]

With all the cardiac imaging fellowships out there, I imagine that cards will continue their stranglehold on cardiac CT/MRI, even in the community, for some time to come.

CT colonography is a different story and may end up helping out the Rads folks. Of course, in anything other than a low-risk routine screening situation, it's borderline malpractice. But that's neither here nor there.

In my opinion, I don't think the current model of cardiology is sustainable. Let's take interventional cards as an example. This is at least how my hospital did. The interventional cards not only did the the interventional work but they also had to do clinic, do consults, round on pts, and read imaging on different days. Basically, one stop-shopping. This is why they're always busting their butts. However, you aren't going to be as efficient and skillful as someone who does only interventional work or imaging full-time. I think the radiologists had it right when they divided the work into interventional radiology and diagnostic radiology.

With no more consult codes and cards procedures getting hit hard this year, I think more and more cards will recognize that they can't be master of everything and that they have to focus on one area. With Obamacare, more and more imaging will be moved to the hospitals. This is where it will get interesting to see what the future of cards and rads play out. I wouldn't discount the extra-cardiac and extra-colonic findings. This is why cardiac CTA is still in play for rads. You simply can't cut out the lung fields as some cards have tried to do. This is especially so when there is no emphasis on radiation dose. Patients shouldn't have to get more radiation exposure than necessary.

 

[FiremedicMike]

c'mon! by the time people hit 80, natural selection has weeded out the douchebags.

You're welcome to come ride at my FD for a few weeks.. might change your opinion on that one 😛

Seriously though, I'm glad there are people who love taking care of geriatrics. Some are fun to talk to, but I think I would rather bash my head with a hammer than exclusively take care of them for the rest of my life.

 

[MOHS_01]

derm boards definitely >>>>> way more stressful than step 1, 2 or 3.

step 1 was minimal studying (a normal work day for a month, kinda like a 9-5 job) translating to an easy top score.

step 2 and 3 were jokes (no studyding at all, easy high score).

While in derm we may get out of clinic at 6, the nights must be spent studying (consistently for years) or you will fail. Cause everyone else is VERY good at taking tests and therefore the curve is going to get you.

True, but you'll never convince anyone outside of the field. The widespread misconception is that derm in cake...

I honestly have to say Radiation Oncology...not sure I have ever met one that did not LOVE his/her job.

Rad Onc will have a tough road to hoe once cost-effectiveness mandates become a reality. The consolidation in the industry will cause significant upheaval. Don't envy them yet...

I wonder how happy radiologists are going to be when the diagnostic imaging reimbursements get cut.

I'm fairly bearish on the whole of medicine (for the practitioner, at least), but particularly so for certain fields such as imaging and the whole of oncology. Eventually the rates will be cut beyond the point of solvency for the private institution, prompting subsidization for privileged class and consolidation into said institutions. Beyond that some form of rationing must take place, and the most politically palatable form of rationing will be via comparative efficacy and cost-efficiency criteria. Either the price of imaging will fall off of a cliff or access will be greatly restricted -- either way, nothing to look for to for the imaging specialist.

Yep, we're hosed -- friggin' politicos and the entitled, dependent, short sighted class of citizenry who keep them in power have effectively annexed our profession and lifestyle. 🙁

 

[Slack3r]

Yep, we're hosed -- friggin' politicos and the entitled, dependent, short sighted class of citizenry who keep them in power have effectively annexed our profession and lifestyle. 🙁

Si se puede!

 

[CyberKnife19]

True, but you'll never convince anyone outside of the field. The widespread misconception is that derm in cake...



Rad Onc will have a tough road to hoe once cost-effectiveness mandates become a reality. The consolidation in the industry will cause significant upheaval. Don't envy them yet...



I'm fairly bearish on the whole of medicine (for the practitioner, at least), but particularly so for certain fields such as imaging and the whole of oncology. Eventually the rates will be cut beyond the point of solvency for the private institution, prompting subsidization for privileged class and consolidation into said institutions. Beyond that some form of rationing must take place, and the most politically palatable form of rationing will be via comparative efficacy and cost-efficiency criteria. Either the price of imaging will fall off of a cliff or access will be greatly restricted -- either way, nothing to look for to for the imaging specialist.

Yep, we're hosed -- friggin' politicos and the entitled, dependent, short sighted class of citizenry who keep them in power have effectively annexed our profession and lifestyle. 🙁

MOHS, I almost always agree with the positions that you take on these forum as you present your arguments in a concise and cogent form. However, I disagree with you on your position on the future of oncology. Due to the very negative public perception of the "cancer" diagnosis (even if it is stage 1a breast cancer), I feel as if there would be a tremendous public outcry if there were cuts to oncology in the future.

Could you please further elaborate on the reasons and ways in which you believe oncological fields will face cuts in the future? Thanks.

 

[Arcan57]

MOHS, I almost always agree with the positions that you take on these forum as you present your arguments in a concise and cogent form. However, I disagree with you on your position on the future of oncology. Due to the very negative public perception of the "cancer" diagnosis (even if it is stage 1a breast cancer), I feel as if there would be a tremendous public outcry if there were cuts to oncology in the future.

Could you please further elaborate on the reasons and ways in which you believe oncological fields will face cuts in the future? Thanks.

The public will go ape if they are denied access to every reasonable (and most unreasonable) treatment modalities available. However, there is nothing saying the government has to continue its current reimbursement model. Chemo will stop being billed as a procedure, and when that happens the bottom will fall out of medical oncology. And there will not be a great public outcry, since access to chemo will not be DIRECTLY effected. There will be certain centers that will move to a cash-only practice, but these centers would need to have serious name recognition (MD Anderson comes to mind) in order to justify the difference in cost to the patient.