Help me decide a specialty

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muhali3

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I want a specialty that...

gives me a good amount of one-on-one time with patients/has a quality physician-patient relationship
has a good lifestyle
has a good job market

the ones that i think fit are...

psychiatry - but seems like a lot of them resort to med-management. (edit: by this I mean it seems that psychs are turfing therapy to other mental health providers, and apart from the initial appointment, it seems like a psychologist does most of the therapy and the psych mostly handles the medication)
pm&r - but apparently bad job market?
rheumatology - kind of want more info on this.
breast imaging radio - don't know if this really fits either.
palliative care - ??
neurology - not really sure if the lifestyle is good.
med onc/heme-onc - also not sure what the lifestyle is like. however, probably one of the closest physician-patient relationship you could find in medicine.
rad onc - probably can't match into it. also seems like you'll have a hard time finding a job where you want to.
ophtho - can't match.

anyone have any insight/advice? thanks.
 
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Family Medicine ticks off all 3 of those boxes.
 
muhali3 said:
I want a specialty that...

gives me a good amount of one-on-one time with patients/has a quality physician-patient relationship
has a good lifestyle
has a good job market

the ones that i think fit are...

psychiatry - but seems like a lot of them resort to med-management
pm&r - but apparently bad job market?
rheumatology - kind of want more info on this.
breast imaging radio - don't know if this really fits either.
palliative care - ??
neurology - not really sure if the lifestyle is good.
med onc/heme-onc - also not sure what the lifestyle is like. however, probably one of the closest physician-patient relationship you could find in medicine.
rad onc - probably can't match into it. also seems like you'll have a hard time finding a job where you want to.
ophtho - can't match.

anyone have any insight/advice? thanks.
Click to expand...
Breast imaging doesn't give you enough one on one time if you want patient contact. Most of my conversations are 5-10 minutes.

Of those you listed, I think Rheum fits the best.
 
DrBowtie said:
Breast imaging doesn't give you enough one on one time if you want patient contact. Most of my conversations are 5-10 minutes.

Of those you listed, I think Rheum fits the best.
Click to expand...

Thanks. What is the lifestyle and demand like for the field?
 
muhali3 said:
Thanks. What is the lifestyle and demand like for the field?
Click to expand...
Lifestyle is good as this is essentially an outpatient only field. There are only a few things that would require inpt consults and none in the middle of the night. You also have a lot less after hours phone calls since you aren't a PCP and can often punt issues not related to Rheum.

I think their job market is pretty good but I don't have anything else other than second hand info.
 
muhali3 said:
Really? I've always got the impression that these guys were seeing too many patients per hour.
Click to expand...

Depends a lot on the practice setting. Some FM docs I know work like 25 hours a week but it's super busy while they're there. Some have a more relaxed day to day schedule but work closer to 40 hours (the horror!).
In the end you can set your schedule in an outpatient clinic (in PP), but the number of patients you see will eventually determine your income. However, the flexibility is there.
 
muhali3 said:
psychiatry - but seems like a lot of them resort to med-management
Click to expand...

Not sure what you mean by the above. Are you saying you don't want to go into psych because they use medications to treat their patients...just like most other non-surgical medical fields?

muhali3 said:
Really? I've always got the impression that these guys were seeing too many patients per hour.
Click to expand...

The FM docs I worked with saw a lot of patients/day, you kind of have to. The difference is they see these people regularly for years so even if your visits are only 15 minutes at a time you still build a strong relationship with your patients.
 
muhali3 said:
psychiatry - but seems like a lot of them resort to med-management
Click to expand...

What do you mean by this? It's not like you get to just prescribe a medication and never follow up?

"Here's some Clozaril. No, don't worry about it, just call if you need me. It's not like I'm one of those shrinks who resorts to med management."

Other than this misguided statement, I think psych fits your criteria well.
 
Neurology is a hard residency but outpatient career may meet your requirements.
 
masaraksh said:
Umm since when?
Click to expand...

Its not a surgical residency, but I saw some data showing that neurology residents worked the most out of all non-surgical specialties. Neurology does a medicine prelim year and their first year of neurology has a notoriously bad call schedule for a non-surgical field. They basically do 2 intern years schedule wise and years 3-4 can have undesirable call schedules as well.

This is 3 years old now but apparently the data was from FREIDA. I don't doubt it. The neuro residents at my institution kept very long hours. http://shortwhitecoats.com/2013/which-residents-work-the-hardest
 
NWwildcat2013 said:
Neurology does a medicine prelim year and their first year of neurology has a notoriously bad call schedule for a non-surgical field. They basically do 2 intern years schedule wise and years 3-4 can have undesirable call schedules as well.
Click to expand...
Currently on my neuro rotation - this description pretty much fits the bill. However, with the exception of the few workaholics who choose to take on a large inpatient and outpatient load, the attendings overall have pretty comfy schedules.
 
What is your Step score? If it is as bad as mine it will be limiting factor. These things don't matter much at all compared to that one test, but do you have good clinical grades, recs, and research.

Also, Neuro was chill. We pre rounded inpatient at 6:30. Rounded at 8. Finished rounds at 11:30. Was out of hospital by 2:30. This was for stroke and in patient. Out pt was even better. The residents did have call, but we watched the olympics when I was on call with them.
 
muhali3 said:
I want a specialty that...

gives me a good amount of one-on-one time with patients/has a quality physician-patient relationship
has a good lifestyle
has a good job market

the ones that i think fit are...

psychiatry - but seems like a lot of them resort to med-management
pm&r - but apparently bad job market?
rheumatology - kind of want more info on this.
breast imaging radio - don't know if this really fits either.
palliative care - ??
neurology - not really sure if the lifestyle is good.
med onc/heme-onc - also not sure what the lifestyle is like. however, probably one of the closest physician-patient relationship you could find in medicine.
rad onc - probably can't match into it. also seems like you'll have a hard time finding a job where you want to.
ophtho - can't match.

anyone have any insight/advice? thanks.
Click to expand...

One on one time with patients is so variable between specialties and physician to physician. I worked with an ENT doc who spent a lot of time with patients and had incredible bedside manner and then a family med doc who sucked.

Having said that, psych seems to fit all your criteria. I had some of the most powerful patient encounters on my psych rotation. Seriously considered going into it.
 
failedatlife said:
What is your Step score? If it is as bad as mine it will be limiting factor. These things don't matter much at all compared to that one test, but do you have good clinical grades, recs, and research.

Also, Neuro was chill. We pre rounded inpatient at 6:30. Rounded at 8. Finished rounds at 11:30. Was out of hospital by 2:30. This was for stroke and in patient. Out pt was even better. The residents did have call, but we watched the olympics when I was on call with them.
Click to expand...

Wow. Must be highly variable between institutions. I was on a stroke service and pre rounded at 6 and was always there till 6. Call was always extremely busy with consults and stroke codes.


Sent from my iPhone using SDN mobile
 
sloop said:
What do you mean by this? It's not like you get to just prescribe a medication and never follow up?

"Here's some Clozaril. No, don't worry about it, just call if you need me. It's not like I'm one of those shrinks who resorts to med management."

Other than this misguided statement, I think psych fits your criteria well.
Click to expand...

By this I mean that psychs seem to turf therapy to other mental health providers, and apart from the initial appointment, it seems like a psychologist does most of the therapy and the psych mostly handles the medication (as med-checks pay more per hour than therapy appointments.)
 
muhali3 said:
I want a specialty that...

gives me a good amount of one-on-one time with patients/has a quality physician-patient relationship
has a good lifestyle
has a good job market

the ones that i think fit are...

psychiatry - but seems like a lot of them resort to med-management. (edit: by this I mean it seems that psychs are turfing therapy to other mental health providers, and apart from the initial appointment, it seems like a psychologist does most of the therapy and the psych mostly handles the medication)
pm&r - but apparently bad job market?
rheumatology - kind of want more info on this.
breast imaging radio - don't know if this really fits either.
palliative care - ??
neurology - not really sure if the lifestyle is good.
med onc/heme-onc - also not sure what the lifestyle is like. however, probably one of the closest physician-patient relationship you could find in medicine.
rad onc - probably can't match into it. also seems like you'll have a hard time finding a job where you want to.
ophtho - can't match.

anyone have any insight/advice? thanks.
Click to expand...
Gonna echo some of the other posts and recommend looking into family medicine. It can get pretty busy in the clinic, but the attending I worked with on rotations had regular hours and seemed to have a nice work life balance. Also, you can build some really great long term relationships. The FM doc I was paired with had seen one patient for 30 years. He also mentioned seeing patients as kids who grew up with his practice.

You could also look into outpatient pediatrics if you like kids. You get to follow a patient from birth to the start of adulthood. I only saw inpatient pediatrics third year, but I imagine outpatient pediatrics would have regular hours like family medicine.

We're very similar. Quality physician-patient interaction and lifestyle are the two most important things for me. I don't care about money as long as I can live comfortably.
Trying to decide between family medicine and pediatrics right now for those very reasons you listed. I briefly considered psych too, but it didn't peak my interest. I could be wrong, but you might get to do more than manage medications. There's CBT, electroconvulsive therapy, and the field seems to have a lot of new things on the way down the road. Also, I heard there's a pretty big demand for child psychiatrists right now, as far as job market is concerned.
 
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muhali3 said:
By this I mean that psychs seem to turf therapy to other mental health providers, and apart from the initial appointment, it seems like a psychologist does most of the therapy and the psych mostly handles the medication (as med-checks pay more per hour than therapy appointments.)
Click to expand...

Sure, but you went to school to be a doctor, didn't you? Besides, you will do even less psychotherapy in any other field of medicine. It's honestly kind of weird to me that someone goes to med school to become a doctor and then complains about how psychiatrists don't primarily do psychotherapy but instead treat people with medicine.

And for what it's worth, some people do have more psychotherapy-oriented practices.
 
Walter Lance said:
Currently on my neuro rotation - this description pretty much fits the bill. However, with the exception of the few workaholics who choose to take on a large inpatient and outpatient load, the attendings overall have pretty comfy schedules.
Click to expand...

Yeah attending life seems nice outside of NCC and vascular.


Sent from my iPhone using SDN mobile
 
muhali3 said:
I want a specialty that...

gives me a good amount of one-on-one time with patients/has a quality physician-patient relationship
has a good lifestyle
has a good job market

the ones that i think fit are...

psychiatry - but seems like a lot of them resort to med-management. (edit: by this I mean it seems that psychs are turfing therapy to other mental health providers, and apart from the initial appointment, it seems like a psychologist does most of the therapy and the psych mostly handles the medication)
pm&r - but apparently bad job market?
rheumatology - kind of want more info on this.
breast imaging radio - don't know if this really fits either.
palliative care - ??
neurology - not really sure if the lifestyle is good.
med onc/heme-onc - also not sure what the lifestyle is like. however, probably one of the closest physician-patient relationship you could find in medicine.
rad onc - probably can't match into it. also seems like you'll have a hard time finding a job where you want to.
ophtho - can't match.

anyone have any insight/advice? thanks.
Click to expand...

The specialty you choose should be because it's what you want to do when you wake up in the morning if you didn't have to work for a living. If you choose for reasons other than that you're going to be looking for a new career by the time you hit 50 or will selling yourself short in life.
 
Phloston said:
The specialty you choose should be because it's what you want to do when you wake up in the morning if you didn't have to work for a living. If you choose for reasons other than that you're going to be looking for a new career by the time you hit 50 or will selling yourself short in life.
Click to expand...

That's overly idealistic.
 
Phloston said:
The specialty you choose should be because it's what you want to do when you wake up in the morning if you didn't have to work for a living. If you choose for reasons other than that you're going to be looking for a new career by the time you hit 50 or will selling yourself short in life.
Click to expand...

This isn't the past where you are expected to dedicate your entire being to medicine. I like medicine but what's most fulfilling for me is a home life with a family, not curing whatever obscure cancer is out there. If I for some reason followed a specialty with horrible hours because it was intellectually stimulating then I would be looking for a new career before 40
 
Good thing that this is an opinion and to me if I didn't have to work I wouldn't. I would be a stay at home dad but alas I do and I enjoy medicine so that's what I'll do. Work to live not live to work my friend. i am most happy In medicine compared to other careers. I will be happy to do any of them so limiting factors become lifestyle
 
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