Help with Career

[confuzzled10]

Hey guys, I didn't know where to put this, but I need your opinion on my situation. I do not know what I want to do with my life...well, I think I know, but maybe I'm just trying to avoid it for another specialty. So about me: I go to a school in the northeast, Step1 and Step2 are both 25x. I'm 35 years old with a wife and 2 children. I came in wanting to ortho and I have plenty of ortho publications, but I'm starting to have second thoughts about going through an ortho residency with a family. I'm not in love with ortho, but I like it. Here are the pros and cons of the specialties that I've considered.

Ortho-
Pros: I love the OR and I love MSK. I love the tools in the OR. Ortho rotation was the only rotation where I didn't feel like I was watching the clock. I'm a former college athlete and I love dealing with muscles. I love the patient population. I would enjoy doing ortho as a career everyday. Ortho type research is interesting to me.

Cons: It's a tough residency and especially with a family, Idk how they're going to handle it. My wife says she's supportive, but deep down, I feel like she really wants me to do derm/DR instead.

Derm-
Pros: I love the procedures. The residency would be a good lifestyle for my family. Derm people party a lot. Have my Ph.D. in immunology and would enjoy the research opportunities in derm especially with immunotherapy.

Cons: I hate clinic. If I'm not doing a procedure, I really don't seem interested in derm. Medical derm doesn't really interest me in the clinical setting. It interests me more in the research lab. Clinically, I'm only interested in the cosmetic part of derm

Rads-
Pros: I love MSK, I love puzzles, I love that they do procedures as well. The people seem interesting and chill. The residency seems decent for a family and you have time to moonlight if you wanted to. As a career, I wouldn't mind the 10+ weeks of vacation. My radiologist mentor seems to enjoy his life and goes on vacation with his family all the time.

Cons: I don't think I could enjoy working by myself for a long time. I enjoy being part of a team. Rads type research doesn't really interest me that much.


Is there another career option you guys could propose that you think I should look into? I've heard people say "if it's Friday at 5pm and you'd rather be with your family than be in the OR, then surgery is not for you". I don't know if I agree with that. I would definitely rather be with my family at 5pm than be in the OR, but if you ask me would I rather start a 5 hour case on a Friday afternoon at 3pm or be in derm clinic until 5pm, I would rather be in the OR. I just love the OR. I love the smell of it. I just love being in the OR. I just don't know if this residency would be conducive to having a family. Especially with 2 kids.

I grew up with immigrant parents who worked all the time, so to me, not seeing my parents wasn't a big deal. I had many violin and piano recitals and spelling bees and athletic competitions that my parents didn't attend and I was ok with it because I knew they were working hard to support us. My wife grew up in a lovey dovey family that says they love each other all the time, so I think it's why even though she says she supports me with whatever decision I make, she would rather I be home as much as possible.

Any advice you all can give would be appreciated.

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[Sanic Hegehog]

Reading your post it sounds like you really would like to become an orthopedic surgeon, and the only thing that scares you about it is the time commitment in residency. Residency will be a major time commitment in any specialty you choose, and you'll miss significant family time in any of the residencies you listed above. If you really love what you do, balancing family life and residency will be easier, as you'll be in a better mood most of the time. Would you wife rather see you exhausted and unfulfilled at 5 PM every day, or would she rather see you exhausted at 8 PM with a smile on your face and contentment in your heart? Happiness goes a long way in life, and don't discount your enjoyment in your chosen career. As an attending, you can really shape your practice to allow as little call and hours as you please in orthopedic surgery.

 

[confuzzled10]

Reading your post it sounds like you really would like to become an orthopedic surgeon, and the only thing that scares you about it is the time commitment in residency. Residency will be a major time commitment in any specialty you choose, and you'll miss significant family time in any of the residencies you listed above. If you really love what you do, balancing family life and residency will be easier, as you'll be in a better mood most of the time. Would you wife rather see you exhausted and unfulfilled at 5 PM every day, or would she rather see you exhausted at 8 PM with a smile on your face and contentment in your heart? Happiness goes a long way in life, and don't discount your enjoyment in your chosen career. As an attending, you can really shape your practice to allow as little call and hours as you please in orthopedic surgery.

Thank you for your response. If I didn't have a family, I would definitely choose ortho. You make a good point about being in a bad mood at 5pm vs being happy at 8pm. Thank you for that.

 

[slowthai]

Reading your post it sounds like you really would like to become an orthopedic surgeon, and the only thing that scares you about it is the time commitment in residency. Residency will be a major time commitment in any specialty you choose, and you'll miss significant family time in any of the residencies you listed above. If you really love what you do, balancing family life and residency will be easier, as you'll be in a better mood most of the time. Would you wife rather see you exhausted and unfulfilled at 5 PM every day, or would she rather see you exhausted at 8 PM with a smile on your face and contentment in your heart? Happiness goes a long way in life, and don't discount your enjoyment in your chosen career. As an attending, you can really shape your practice to allow as little call and hours as you please in orthopedic surgery.

Derm and DR have significantly cushier lifestyles than ortho during residency. You'll definitely make less sacrifices doing either of those fields than in ortho. As an ortho resident, balance will be difficult to achieve even if you love what you're doing. It's just the nature of training, as it demands a lot from you.

For the most part, in ortho, the only people with a cush lifestyle like you mention are those in the twilight of their careers or those that killed themselves over many years to build a practice and decide to cut back on their hours. You have to be profitable/an asset for whatever practice you choose as an attending, and that requires a lot of investment of time and work, especially early on.

 

[Splenda88]

Rad... Not a grueling residency and ~500k/yr salary.

 

[Iz_FtB]

Not to discount the intensity and commitment in the near term of an ortho residency, but how do you envision your career and life in 10 years? 15? Cost - benefit analysis may change depending on the time horizon.

 

[CyrusHabs7695]

Like others have mentioned, rads has an easier lifestyle in residency and beyond while maintaining a good salary. I personally don't think of rads as being in isolation, since multiple fields of medicine are relying on you and constantly asking for your opinion. Even if you don't go the IR route, DR guys still perform as many procedures as they want. Ive heard from an attending on here that in most practices the DR aren't usually fighting to do more procedures than there coworker, so if thats what youre into, there will usually be plenty to do. (just what ive heard, not sure if 100% true)

 

[confuzzled10]

As some with a family who is going thru IM residency, I can tell you that a grueling residency will take a told on both you and your family. From talking a close friend who is in GS where I am, surgical residency a lot worse than IM, and IM is bad...

If you said you love ortho, I would have said it worth the sacrifice. I don't think it's worth sacrificing time with your love ones for something you just like.

I did not fully understand the told residency was taking on my family until I asked my daughter to go to the store with me, she turned around and asked my spouse if it's ok to go to the store with me. It's a true story...

Yea...when I said I like ortho, I just mean that in the field of medicine, ortho is really the only thing that brings me consistent joy. I love seeing patients come in with issues and then be back to normal function in a couple of days/weeks. That makes me happy. It's the one field in medicine that makes me feel like I'm making a difference. But when I say I don't love it, what I mean by that is that I have plenty of interests outside of medicine that I would do over ortho if you made me choose. If someone paid me to travel the world vs doing ortho or anything in medicine, I would choose getting paid to travel the world. That's what I mean when I say I'm not in love with ortho. However, if I had to choose a job in medicine, ortho is the only one that I didn't have a day that I hated on my rotation. It's the only rotation that I looked forward to going to everyday.

One of the reasons I considered EM/Rads was exactly because I have other things outside of medicine that I like doing. 10+ weeks of vacation per year would give me plenty of time to do the other stuff. I just wouldn't enjoy my work day as much as I would in ortho. I wouldn't feel like I need a vacation all the time with ortho bc I also enjoy working with athletes.

Not to discount the intensity and commitment in the near term of an ortho residency, but how do you envision your career and life in 10 years? 15? Cost - benefit analysis may change depending on the time horizon.

That's a good question. I tried to imagine what my life would be like in 10 years for each specialty and this is what I imagined:

Ortho- By this point, I would have finished my sports medicine fellowship. So a normal day would be waking up and going to the gym at 5, then go to work for the first surgical case at 7:30am. Get back home at 6 or 7pm. On Fridays and saturdays, go to the local high school football/soccer game bc I'm the team physician. My week would basically be 2 days of OR, 1.5 days of clinic, and 1 day of sports medicine research. This by far would be the ideal week for me.

Derm- Work out at 7am, roll into clinic by 9am, do lots of cosmetic procedures and then go home at 4pm. Pick up kids from school. My week would look like 2 days of clinic and 3 days of research. On the weekends, write articles about "getting rid of pimples" for beauty magazines.

Rads- Sit on a computer and read a gagillion studies for 12 hours. Maybe I get a consult to do some breast biopsies or other procedures, and then go home. Repeat every day. I really wouldn't do research if I did DR. I would clock in and read studies all day every day and then clock out. I don't mind shift work, and I would like seeing the different types of cases that pop up. Yes I know the majority will be chest xrays, but you might get a joint MRI one minute and then a brain CT the next. Would definitely keep things interesting. The only thing I would not like about this is the lack of banter between colleagues. Most of the time on my radiology rotation, they didn't chitchat that much.

 

[eggeggeggegg]

Lol, just based on your descriptions there, I would knock rads to the bottom. Sounds like the main benefit there for you would be lifestyle - which you would get from derm as well, but it also has procedures.

I'd hate to be in your boat tbh, I was going along a similar thought process but it's a bit simpler for me - I don't have kids yet, and am a bit younger so it simplifies the decision slightly. Don't have an answer for you but something else to consider - how old are your kids now, what life events are you going to be missing during residency? does your partner work / want to work?

 

[CyrusHabs7695]

I know its not surgery, but another field if you like working with athletes and having a lot of communication with patients and people with a good lifestyle would be PMR

 

[longhaul3]

Do IR. They banter with their rad techs like crazy. You can always read images as a DR too, I think. And don't sell radiology short in terms of "making a difference." Modern medicine would instantly collapse without radiologists. There are very few specialties in which the training is adequate to make major clinical decisions on imaging without a radiologist.

You would have a relatively short career ahead of you as a surgeon. Ortho can make you a lot of money in your 40s and 50s, but it can be physically demanding and may not last you as long as seeing patients in derm clinic or reading studies into your later years. Both derm and DR also lend themselves well to riding part-time off into the sunset.

 

[confuzzled10]

Lol, just based on your descriptions there, I would knock rads to the bottom. Sounds like the main benefit there for you would be lifestyle - which you would get from derm as well, but it also has procedures.

I'd hate to be in your boat tbh, I was going along a similar thought process but it's a bit simpler for me - I don't have kids yet, and am a bit younger so it simplifies the decision slightly. Don't have an answer for you but something else to consider - how old are your kids now, what life events are you going to be missing during residency? does your partner work / want to work?

My kids are 2 and 5 years old. My wife is a CRNA and she stopped working 2 years ago when the last one was born. She wants to get back to working at least part time. The problem is that most of our families are down in Texas and we live in the northeast. Day care is a bit expensive so she decided to not work and to stay home. We're basically living off her CRNA savings and my stipend from medical school. Right now, the plan is that if I match down south, our families can help and she can get back to work,..at least part time.

I know its not surgery, but another field if you like working with athletes and having a lot of communication with patients and people with a good lifestyle would be PMR

You know, I never considered PMR. I have a month before I get back to clinic, so I will try to put in a request to do 2 weeks of PMR. Thank you for that suggestion.

 

[Chlorini]

I was in a similar predicament and chose radiology; I actually answered a similar thread a few days ago. My situation is different (I'm female and my kids are older, it killed me to think I'd be in training for the "best years" of their childhood). My husband works full-time.

However, based on what you've written, I say you should go with orthopedics. If it's not for you, you can always switch into radiology (or another field). I met plenty of residents on the interview trail from other specialities (ortho, gen surg, urology, and EM specifically) that were interviewing for a radiology spot. Some places I interviewed at had a specific PGY2 (R1) spot reserved for those types of residents looking to get out. You wouldn't necessarily even have to lose a year (your ortho year(s) would count as your prelim year required for radiology/anesthesia/derm/PMR/ophtho). Obviously not an ideal plan, but if you are torn you can always do that knowing that there is an out.

As for derm, I don't think anyone really likes rashes and complicated medical skin complaints. A derm resident I followed during my rotation even admitted to me that she didn't--she told me she was perfectly fine with boring and "living her life." She said she thought of it like any job. If you do decide to go derm, I don't think you'd regret your decision--most of them are very happy. You could even do Mohs! Their OR experience is definitely not the same as ortho, but the paycheck (800K +++) is better than ortho's.

 

[Dr G Oogle]

I’m not in ortho, but in a surgical practice where some people work like dogs (including one of my partners) and some people (me) are out most days by 5 pm and spend most weekends at home. I imagine there is similar variation in ortho practices. You may not make as much money working less, but there is probably a salary level beyond which what you make is just “extra”. My advice is not to compromise on your career in terms of what you love to do, compromise by how much time you spend doing it. Not everyone has to work at 99% MGMA.

 

[confuzzled10]

Do IR. They banter with their rad techs like crazy. You can always read images as a DR too, I think. And don't sell radiology short in terms of "making a difference." Modern medicine would instantly collapse without radiologists. There are very few specialties in which the training is adequate to make major clinical decisions on imaging without a radiologist.

You would have a relatively short career ahead of you as a surgeon. Ortho can make you a lot of money in your 40s and 50s, but it can be physically demanding and may not last you as long as seeing patients in derm clinic or reading studies into your later years. Both derm and DR also lend themselves well to riding part-time off into the sunset.

I ruled out IR because the residency lifestyle is also terrible. If I were going to go through that residency, I might as well do the ortho residency. I will say though that my radiology mentor told me to consider doing a fellowship in MSK after radiology residency and just try to work in a setting where I'm mostly doing readings of ortho trauma. That seems interesting to think about as well. Of course I'm sure there's no way I can find a practice where I'm just reading imaging for ortho trauma or sports injuries. So I will still have to read some of the other bread and butter stuff. You also make a good point about practicing in my 50s. That's something I definitely need to take into consideration. Thank you for that suggestion.

 

[OrthoTraumaMD]

Okay, as an orthopedic surgeon, I’d like to dispel some inaccuracies here.

If you think you’re gonna get home at 8pm during ortho residency you’re in for a surprise. I routinely worked 100+ hour weeks. Getting home 9pm and waking up 4am for 5 am rounds. Doable yes but it ain’t cushy, at least not in most places. Some places you’ll get lucky, but no guarantees.

Your “ideal week” in ortho won’t be possible unless you’re a senior surgeon in an academic place, which is not the case for most sports people. Sports surgeons are generally private practice. In private practice, you almost never get “academic days” because the goal of the practice is to make money, not to pay you to sit on your butt and write papers. Additionally, depending on whether you have a Trauma partner or not, you may need to be responsible for the fractures that came in while you were on call, and do them in the OR after your clinic is over at 5 PM. If you have a Trauma partner who takes over those cases (like my partners do) that’s great, but most attendings still take call. As a young surgeon you will also need to take weekend call in addition to your team responsibilities. Sometimes as much as one every four weekends, or as little as one in 15 if you are in a big academic place. Also, your life will depend on whether you have residents, how good your ER is, how your ancillary support is, do your PAs take call or not. At my partner’s previous job, the PA only came in if the surgeon needed help in the operating room. Therefore, if a fracture came in at night and needed to be reduced, it was my partner who came in and the PA stayed home.


This is what I mean when I say unless you love orthopedics, don’t do it. There are too many variables in your future that do not guarantee you to have a cushy life. Could you have it later on, sure. But no one knows exactly when.

Also OP, if you want to learn more about ortho, I have a long running ama thread that’s been around for years with 40+ pages of me answering ortho questions. FYI.

 

[CyrusHabs7695]

Okay, as an orthopedic surgeon, I’d like to dispel some inaccuracies here.

If you think you’re gonna get home at 8pm during ortho residency you’re in for a surprise. I routinely worked 100+ hour weeks. Getting home 9pm and waking up 4am for 5 am rounds. Doable yes but it ain’t cushy, at least not in most places. Some places you’ll get lucky, but no guarantees.

Your “ideal week” in ortho won’t be possible unless you’re a senior surgeon in an academic place, which is not the case for most sports people. Sports surgeons are generally private practice. In private practice, you almost never get “academic days” because the goal of the practice is to make money, not to pay you to sit on your butt and write papers. Additionally, depending on whether you have a Trauma partner or not, you may need to be responsible for the fractures that came in while you were on call, and do them in the OR after your clinic is over at 5 PM. If you have a Trauma partner who takes over those cases (like my partners do) that’s great, but most attendings still take call. As a young surgeon you will also need to take weekend call in addition to your team responsibilities. Sometimes as much as one every four weekends, or as little as one in 15 if you are in a big academic place. Also, your life will depend on whether you have residents, how good your ER is, how your ancillary support is, do your PAs take call or not. At my partner’s previous job, the PA only came in if the surgeon needed help in the operating room. Therefore, if a fracture came in at night and needed to be reduced, it was my partner who came in and the PA stayed home.


This is what I mean when I say unless you love orthopedics, don’t do it. There are too many variables in your future that do not guarantee you to have a cushy life. Could you have it later on, sure. But no one knows exactly when.

Also OP, if you want to learn more about ortho, I have a long running ama thread that’s been around for years with 40+ pages of me answering ortho questions. FYI.

Every school should share this post with their 95 M1s who come in wanting to do ortho because "it'd be cool to work with athletes and have a chill lifestyle"

 

[confuzzled10]

Okay, as an orthopedic surgeon, I’d like to dispel some inaccuracies here.

If you think you’re gonna get home at 8pm during ortho residency you’re in for a surprise. I routinely worked 100+ hour weeks. Getting home 9pm and waking up 4am for 5 am rounds. Doable yes but it ain’t cushy, at least not in most places. Some places you’ll get lucky, but no guarantees.

Your “ideal week” in ortho won’t be possible unless you’re a senior surgeon in an academic place, which is not the case for most sports people. Sports surgeons are generally private practice. In private practice, you almost never get “academic days” because the goal of the practice is to make money, not to pay you to sit on your butt and write papers. Additionally, depending on whether you have a Trauma partner or not, you may need to be responsible for the fractures that came in while you were on call, and do them in the OR after your clinic is over at 5 PM. If you have a Trauma partner who takes over those cases (like my partners do) that’s great, but most attendings still take call. As a young surgeon you will also need to take weekend call in addition to your team responsibilities. Sometimes as much as one every four weekends, or as little as one in 15 if you are in a big academic place. Also, your life will depend on whether you have residents, how good your ER is, how your ancillary support is, do your PAs take call or not. At my partner’s previous job, the PA only came in if the surgeon needed help in the operating room. Therefore, if a fracture came in at night and needed to be reduced, it was my partner who came in and the PA stayed home.


This is what I mean when I say unless you love orthopedics, don’t do it. There are too many variables in your future that do not guarantee you to have a cushy life. Could you have it later on, sure. But no one knows exactly when.

Also OP, if you want to learn more about ortho, I have a long running ama thread that’s been around for years with 40+ pages of me answering ortho questions. FYI.

Thank you very much for this post. I think I basically need to sit down with my wife and tell her realistically what the lifestyle would be like. If it were just me, I guarantee you that what you described sounds fine with me. On my ortho rotation, I did a trauma week with one of the residents, and I loved every minute of it. Obviously I realize that doing it as a medical student for one week is different from doing it as a resident. I honestly don't mind getting up at 3am to go down to the ER and reduce fractures or do whatever else needs to get done. I love it. So the residency part, I'm mostly only worried about not being home. Not worried about physically going through it. Physically going through it would suck, but it sucks less when you like what you're doing.

The part that kinda sucks that you mentioned is the part about not really having time to do research in private practice because I do love sports medicine research. Thank you very much for your feedback and I will definitely check out that thread you mentioned. Thank you.

 

[Mass Effect]

PMR

This is exactly what I was thinking as I was reading your post. PMR would be a great fit for you -- good lifestyle, procedures, MSK, can see a lot of athletes, and a lot of time for sports medicine research.

 

[Eye-eye]

I think a lot of it may come down to the OR. Do you feel like you couldn't live with yourself if you never stepped foot in an OR again? If so, you may just want to bite the bullet and go ortho or at least a heavily procedural field. If you think you would be okay without the OR, think harder about those other fields. Though I will say, if you hate derm clinic like you say, maybe don't do derm...

 

[ACSurgeon]

Everyone defines work/life balance differently. With kids, it’s all the more complicated. I think a lot of this boils down to quality time with your kids, if reduced in quantity. I was fortunate in that I had my first kid 6 months before getting my first job. Honestly, not sure how any residents do it with kids. But, they were very common in my general surgery residency, both men and women.

don’t do something you hate. Find something that’s a compromise that you can truly enjoy. Also, remember that five years into being an attending your kids will be teenagers and won’t care as much about spending time with you.

Family friendly residencies are limited, and are only relatively friendly. In other wards, residency will be a huge sacrifice no matter what. Some other specialties to consider: anesthesia, EM, psych, path. Based on your post, anesthesia and EM can offer some good amount of time off in residency and beyond, and more fun than a full day of clinic every day.

Since you’ll be busy in residency, make sure you don’t chose a field thinking you’ll have a lot of family time only to be disappointed as a radiology resident when you’re working/studying 90 hours a week and never have time for your kids.

finally you’ll find some IM or general surgery residencies with a night float system where an average day is done by 6 pm. Life as an attending also has options. I have a two week on/2 week off general surgery gig and I see my kids plenty even when I’m on.

 

[Tenk]

Everything gets old. Find the lifestyle you want to live then pick the specialty you hate the least that affords you that lifestyle. Your future self will thank you.

 

[confuzzled10]

Thank you guys for all the great advice in the thread. I will definitely take each of your comments into consideration.

 

[mcat_taker]

So what did you end up choosing @confuzzled10 ?

 

[DOVinciRobot]

Also have multiple kids, about to start general surgery residency. I was so much happier on all of my surgical rotations to the point where my wife straight up told me she wouldn’t let me talk myself out of doing it. I know 10+ surgeons and surgery residents with multiple kids and families, and it is definitely possible. I’ve been lucky to have those mentors in my training so far to show me what is and isn’t possible. It just takes compromise, being dedicated to making the most of the time you do get with your family, and a supportive spouse who knows what the surgery life means and is willing to live it with you. It’s definitely not easy, but people make it work all the time.

From reading your posts it’s pretty clear you love orthopedic surgery far more than those other options you listed. If you really love it to the point where you would always feel like you settled if you didn’t do it then sit down with your spouse and have a very honest discussion and see if they will be on board.