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Don't do anesthesia... (#Gunner - gotta get rid of potential competition 
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Hated everything third year...what specialty should I choose?
- Thread starter Anakinmemer
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I feel like rotations aren't the best way to gauge how much you like a certain field. How much I enjoyed a rotation was more dependent on the people I worked with and the culture of the hospital (multiple hospitals in my city, some better than others). For instance, I enjoyed obgyn and peds but it wasn't the content but rather the preceptors that I enjoyed.
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Depends on what they're aiming for. If the goal is to be top dog at a powerhouse medical center then they'll probably need to be a department chair, which means they'll do a residency and then rise through the academic ranks.
If the goal is more like a mid-level administrator or perhaps CEO of a public hospital then they don't need all the academic cred.
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deleted1095841
Are academic medical centers more likely to try new care deliery/ quality improvement strategies compared to non-academic hospitals?
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Run for political office.
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Interesting question. Unfortunately I don't know the answer.
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deleted1095841
I'll try to ask around and find out. In medical school, I feel I am only exposed to the academic side of things, so it's hard to get a balanced perspective. The reason I ask is that I was thinking that because an academic hospital is involved in research (at any given moment, its patients are contributing to dozens of studies), the staff might be more open to trying new ideas in general.
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I remember as a med student I was wanted to do Paeds, then I started internship and wanted to do EM, then I was part way through residence and somewhat older now and happy that I changed to FM. No harm in trying something and changing it down the track. It's all a good experience. I have found you only really know if you can do that specialty once you've worked it as a doctor (not as a student).
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Depends on how you define those terms. Academic centers are more likely to try new things with the goal of advancing medicine and patient care because that’s a big part of their mission.
Non academic centers, especially for profit ones, may be more cutting edge when it comes to efficiency and QI that improves the bottom line. Nobody associates efficiency and cost effectiveness with academic centers (typed while I am waiting for an OR on a Saturday at an academic hospital because efficiency is not that important).
I did have some attendings in training who were very much into QI and operations improvement and they all had MBAs they got while attendings. They actually did some pretty cool stuff with streamlining patient care in certain areas and even published on it quite a bit. That’s kind of an exception to the rule though.
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Generally yes for hospitals that have a GME and in-house residency programs (whether a true academic medical center or a community hybrid). Quality improvement projects are usually done by residents or fellows. In hospitals without in-house residency programs, since there's usually no pay/compensation for this type of work, it's hard to convince attendings or PAs/NPs to do it on a volunteer basis. Changes in patient care more often are reflected by ways to improve the bottom line (eg lower length-of-stay days or re-admission rates for hospital inpatients, or substituting inpatient medications for the cheapest once possible that still gets the job done).
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Rads or path are the usual answers. Both have their downsides though, even though they avoid the headaches commonly experienced in patient-oriented clinical medicine and in some cases could work from home which was a huge benefit during the pandemic.
Rads was very competitive last cycle with only a 83% match rate for USMDs, which was the lowest in a long time (though some of that was attributed to relative shifts in interest to rads away from other specialties such as EM and rad onc due to their poor job markets right now). Pay is good and job market is very good right now with median compensation around $500k. But total training time is longer; including fellowship comes out to usually 6 years, and the job market could change rapidly by the time you graduate from fellowship as it has historically been volatile for rads with lots of ups and downs. Burnout rate for rads has more recently also been on the higher end, and attributed largely to the speed and high volumes that radiologists are now expected to read around the clock (including for the ED and inpatients on nights and weekends) while assuming all the malpractice liability for clinically significant misses.
Path has always had good compensation relative to work hours (mostly Mon-Fri with minimal weekend or night call) and some of the lowest burnout rates compared to other specialties. Median compensation is around low to mid $300ks and it has historically been easy to match into. The only reason it's not competitive is because the job market has consistently been very tight for new grads (often attributed to low turnover in the field including older pathologists that are still working). New grads often have to do at least a 1-2 year fellowship to make themselves decently competitive for the tight job market making total training time 5-6 years after med school, and even then there's a good chance they will have to be geographically flexible and have to move far away from family or move to less desirable location for their first job.
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