Help with the a Decision

[desimd77]

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I have completed 2 years of general surgery and 3 years of surgery research. During the last 3 years in the lab, my interest has really drifted away from surgery. I'm no longer interested in being in the field. I've been moonlighting so as to keep up on skills, but the more i work in the hospital, the more i reallize i'm not interested in being in the OR. I don't have the passion to dedicate my life to what is a surgical career. I am also realizing there is so much more to medicine than just the clinical side. I really come to the concusion i'm not interested in clinical medicine.

Over the last six months i've explored many options including pharma and medical consulting. I've had several interviews with the pharma groups, but no realy offers, most saying i just didn't have enough experience. I did have two interviews at the same consulting company who does a lot of healthcare. I'm pretty sure they will offer me a position, but i'm stuck in a deliema of what to do.

I know the RIGHT decision is to go back to my residency in July as a PGY-3 and become BE/BC in surgery. I also know that by completing my residency it will gaurantee a salary in the 250k region to start. It also means i will miss my kids and wife for the next 3 years and probobly the early years starting a practice.

The other option is a medical consulting position. It will be pay around 120k to start. I will have the opportunity to work with a number of people, learn the business of medicine, and most of all, allow me be involved with my kids as they grow up. I am also faciniated my the medical consulting side, working in biodefense, bio-informatics, and other non-clinical areas of medicine. I don't know the potential salary in med consulting, but the way i understand it can become quite substantial if you become an asset to the company you work for.

I am sorry for being so long winded...this is a decision that will affect all of my family. I know the RIGHT decision is to finish residency, its the safe decision and it gaurantees food on the table. It also promises a healthy paycheck.

Please let me know what you guys think......thanks in advance.

 

[scab]

I have completed 2 years of general surgery and 3 years of surgery research. During the last 3 years in the lab, my interest has really drifted away from surgery. I'm no longer interested in being in the field. I've been moonlighting so as to keep up on skills, but the more i work in the hospital, the more i reallize i'm not interested in being in the OR. I don't have the passion to dedicate my life to what is a surgical career. I am also realizing there is so much more to medicine than just the clinical side. I really come to the concusion i'm not interested in clinical medicine.

Over the last six months i've explored many options including pharma and medical consulting. I've had several interviews with the pharma groups, but no realy offers, most saying i just didn't have enough experience. I did have two interviews at the same consulting company who does a lot of healthcare. I'm pretty sure they will offer me a position, but i'm stuck in a deliema of what to do.

I know the RIGHT decision is to go back to my residency in July as a PGY-3 and become BE/BC in surgery. I also know that by completing my residency it will gaurantee a salary in the 250k region to start. It also means i will miss my kids and wife for the next 3 years and probobly the early years starting a practice.

The other option is a medical consulting position. It will be pay around 120k to start. I will have the opportunity to work with a number of people, learn the business of medicine, and most of all, allow me be involved with my kids as they grow up. I am also faciniated my the medical consulting side, working in biodefense, bio-informatics, and other non-clinical areas of medicine. I don't know the potential salary in med consulting, but the way i understand it can become quite substantial if you become an asset to the company you work for.

I am sorry for being so long winded...this is a decision that will affect all of my family. I know the RIGHT decision is to finish residency, its the safe decision and it gaurantees food on the table. It also promises a healthy paycheck.

Please let me know what you guys think......thanks in advance.

perhaps the best person to ask (well 2nd best - since I think You already have the answer) is your wife...

does she feel comfortable with you being so busy, etc?
would the money make your situation easier?

consider the following criteria:

TIME ... Will you be able to find time for ALL your obligations?
EDUCATION... You put a lot into this field, you deserve to get all you can out of it.
SIZE... How large is your family? will they be able to survive on the smaller paycheck have you made any extraordinary purchases based on your perceived income as a surgeon? what about your loans?
SAFETY... Being in a comfortable profession that is high in demand can decrease your stress level and may balance out with surgery's inherent hectic atmosphere.

in the end good luck and remember there are many who wish they had thjis decision to make.

you have a far way!

 

[Winged Scapula]

Take this for what its worth, but if you don't like the OR, you'll be pretty unhappy as a surgeon.

The lifestyle can suck, the patients are PITAs (sometimes) and my best days are in the OR and away from the stress of the office.

As the cliche goes, "if you can find anything else you'd be happy doing, then you should do it."

 

[DarthNeurology]

I really come to the concusion i'm not interested in clinical medicine. I've had several interviews with the pharma groups, but no realy offers, most saying i just didn't have enough experience. I did have two interviews at the same consulting company who does a lot of healthcare. I'm pretty sure they will offer me a position, but i'm stuck in a deliema of what to do.

Even if you are sure that you never want to practice surgery there are still a million and one good reasons to finish residency. Being BE/BC opens ALOT of non-clinical opportunities, by a factor of ten more than what are you looking at with just an M.D. and no residency. People who leave residency have a lot of specialized training, but it doesn't mean much in terms of getting a job if you aren't BE/BC.

As you well know if you are in research having the BE/BC helps with what you can do *for* a company.

I would finish residency if I were you, I'm not you as I like clinical medicine a lot, but I would finish residency as when that door closes you can't go back and finish residency training easily. I am sure you have gotten used to the lab rat lifestyle which can be pretty laid-back, but if you are really into research it can consume you as much as medicine. You may simply not want to make the sacrifice of returning to the surgical residency, but you have already made a lot of sacrifice in internship and in medical school. And you have moonlighted, which to me means that you do like the OR some, it seems more of an issue of "I don't want to go back to not seeing my kids and family."

Realize that if you finish surgical residency you could practice in an academic surgery setting, doing perhaps 2 OR days a week and doing research the rest of the time. Plenty of people do this and it isn't look at as not being committed to surgery.

Your back-up plan may not be as solid as you think as you don't have a job offer yet . . . and the loans for medical school will be due no matter what. Jobs outside of surgery require a lot of sacrifice too, you may have to move your family and may not be able to stay with the same company forever.

Your expectations for a consulting job are a little too optimistic. Which is why I would strongly urge you to consider finishing the surgical residency before bailing.

Typically, the highly paid consultants I know have perhaps 10+ years experience as an attending in say internal medicine or surgery, or often more experience at an attending level. An attending who has 15+ years in oncology would be an asset to a company, mostly because there aren't a lot of oncologists at that level who would leave practice and because they have the required experience.

Sadly, you don't have much experience in research compared to even a PhD and you can't offer clinical expertise as you are viewed by most consulting firms as not having finished residency. Consultants by and large have expertise in a specific area for many years beyond training, and right now you would be on par with someone who just finished an M.D. and did perhaps a post-doc fellowship, the residency training you did doesn't mean much without the BE/BC.

If I need an expert in say drug resistanct TB for something I go to a head hunter who gets me the name of the top people in the field who I then solicit for consulting jobs. The best consulting jobs are the ones they ask you to do, . . . currently no head hunter would have your c.v. in a database and you wouldn't be flagged as an expert on anything.

If you finish surgical residency, and then do a stint for a couple years, maybe in a research fellowship your horizons and opportunities will increase greatly and you can say that you finished surgical residency. You don't want to have to explain for the rest of your life why you didn't finish residency.

Once you have the experience then they wil call you for a lot of interesting consulting work, but first you need to get that experience to get a real consulting job, anything less is just an analyst type position and pays about the same as residency and people don't ask your opinion, but ask you to mine data and file reports. Consultants are the big guns and typically a professor of surgery might go into consulting after being a recognized expert in their field.

Two or three years may seem like a lot of time, but it isn't to make sure you doors are open for years and to complete your training so you won't be viewed as someone who couldn't finish residency, which is how some people would view your c.v.

Believe me, if that consulting you interviewed with really wanted you, I mean *really* wanted to hire you as a consult then they would have made an offer on the spot or within 24 hours.

I get emails/letters from headhunters for consulting work, which is amusing as I am not yet an expert in my field (how in the world did they get my name??) and I point this out for them, so believe me that consulting is a seller's market, if you have had a lukewarm response so far it is unlikely that you will find the type of consulting job you think you could land. Usually they call you, you don't call them.

 

[dragonfly99]

I want to agree with the OP since it seems his heart is in bailing out right now, but I tend to agree with Darth. The problem is, if you leave residency now, you will probably never be able to go back (almost definitely not to a surgical residency). If you can't stomach the thought of 3 more years of surgical residency, I think that you should at least finish some OTHER residency, like pathology or anesthesia. If you just want more time with your family, then switching to something like path. might be an option, and certainly your surgical knowledge would help you. It might be worth exploring...just an idea.

I never was a surgery residency, and I know they work very, very hard, but I just think that you've invested so much in this path (4 years med school, already 5 of residency + research) that I would hate to see you not finish now. Also, in the current economy, residency is a safe job (if not really financially rewarding). I do think you'll be in a much better position to get a business/consulting job after you've finished a residency. I don't think you necessarily have to wait 10 years after you are done, to become an expert...but I do think you should finish residency if there is any way you can stomach it. Now, if you feel that you just can't, and/or that you'll be a danger to patients because you just cannot make yourself do the things you need to do, then my answer would be different.

Finally, I'd just like to say that residency tends to get better as you move up, just because you get more respect from others (hospital staff, etc.). Hopefully the hours get a little better, too (though for surgery I'm not sure).

 

[desimd77]

I wanted to thank everyone for their input.....I luckly have a very supportive family and loans that are semi under control....The concern i have with returning to residency is that after completing a surgery residency, i will almost be forced into practicing surgery. The reason i say that is i will be hard to turn down a salary b/w 25-300k when i've made my family suffer for the last 8 years. Its unfair to put them through that torture, then ask them to stand by me while i explore non-clincical positions that will likely pay <150k.

I agree with some of the other people on SDN, i think we need to start a section for people who are in non-clinical medicine. It would give people in residency and med school an opportunity to interact with people who have careers in non-clinical medicine. It may give people an outlet to ask questions and get a better understanding of whats out there.

thanks again

 

[PostCall]

🙂

 

[dragonfly99]

Well, the hard truth is that once you commit to med school, you are pretty much committing to med school + residency. This is because a medical degree without any residency isn't really much good, in most cases. I mean it leaves you NOT a fully trained physician, but with a very expensive education under your belt that isn't useful for much else.

If the OP doesn't really have a lot of loans, and the OP has no intentions of ever going back to clinical medicine (NO changing his mind if/when he finds out the business world is not to his liking) then I say he should quit if he wants to. But 2 or 3 more years really isn't that long, in the grand scheme of life. And the point of finishing residency is to have a fall-back plan if being a business consultant doesn't work out. I don't get the logic that says that if he finishes he'll be somehow "forced" to practice. He'll have the option to practice, and likely would command a better salary in the business world, plus would be eligible for other nonclinical jobs, like working for the FDA, etc. that he cannot get without having finished a reisdency. Part of this is about risk tolerance. I personally would think it is better to suck it up for another 2-3 years...he has already invested 8-9 years in this (4 years school, 2 residency, 2-3 research years he said).

I think if someone wants to quit med school, the time to do it is during 1st year, before you pay too much in loans to get out. Picking a specialty requires a lot of introspection. Surgery is one of the most demanding and takes the longest to train in. I'm not blaming the OP for his situation totally, as situations and people change, but I was just giving an honest opinion.

 

[dragonfly99]

I wonder why postcall edited his post...makes my last one not make sense...

 

[surg]

One thing to remember is that many if not most consulting careers eventually involve a fair bit of travel, often to non-glamorous places. I had one friend get posted to Kansas City for the better part of a year on a consulting assignment. Interesting work, yes, but for a New Yorker, he wasn't impressed with 4 days/week in KC. Many consultants maintain travel schedules of 4 days/week X 40+ weeks a year. This combined with the constant need to network to find new clients as they move up the ladder, doesn't necessarily provide more time than a surgical career for the family.

If you are willing to sacrifice some money, it is pretty easy to come up with a surgical career that involves fewer hours and fewer on-call responsibilities that still makes a decent living. Yes, you still need to finish residency, but the ability to be self-employed forever after that and set your own hours may yield more family time than you know what to do with. Also don't discount some employed opportunities. Non-tenure academic tracks at Universities, VA jobs, etc. can also yield very manageable hours because of the resident support you get.

Still, having said that, if you honestly don't like surgery or patients, then don't do it. Plenty else careerwise out there. Find the career that you want to be in. If consulting is it, then so be it.

 

[gonogo]

I don't know what kind of consulting you're looking into, but working at a big consulting firm is nothing close to a 9-5 job. The field is really competitive, and you have perform very well in order to advance or even stay. These positions, at least during the first few years, usually involve a lot of travel. On the bright side, although you start making, as you said, around 120k, within a couple of years you make around 300k, and after 5 years, assuming you've done well, you'll be making 7 figures. After a while in consulting you either become a partner (in which case you make millions), or people leave and do other stuff depending on your interest. I know people who started doing consulting and then went in IB or VC firms... and have made way much more than any surgeon would ever make. But again, this is not a 9-5 job, and competition is really tough.

I'd really ponder it well before you decide to leave residency. Good luck!

 

[SocialistMD]

You know, you could change specialties to finish out. Three years of anesthesia, medicine, peds or even EM wouldn't be as painful hours-wise as three years of general surgery. Your intern year will count for anesthesia, EM and maybe even for peds/medicine, meaning your training would be 2 years instead of 3 (in IM/peds). If you hate clinical medicine but want to get your board certification, fewer hours in the hospital might be something worth investigating. Also, anesthesiologists know more about meds (pharma) than surgeons and EM easily allows itself for part-time work to pick up a few extra bucks if you want it.

 

[dragonfly99]

The surgical intern year would not count for medicine or peds.
He would at most get 1-2 months of credit, for any ER months he has done. To do categorical IM you have to have 3 years of a continuity clinic where you take care of your own patients in outpatient clinic for at least 1/2 day/week, which I assume is true for peds as well.

 

[scab]

Why drew you to surgery in the first place?
does that reason no longer hold water for you?

 

[dacrocytic]

soo many years and you feeel that it was too many huh?
what did you want to be when you were 7?

 

[DarthNeurology]

The reason i say that is i will be hard to turn down a salary b/w 25-300k when i've made my family suffer for the last 8 years. Its unfair to put them through that torture, then ask them to stand by me while i explore non-clincical positions that will likely pay <150k.

thanks again

I wouldn't look at this from the salary standpoint. At any rate, the average salary for a healthcare consultant is around $75,000. Which is a good salary compared to a lot of jobs. There aren't many consultants making near $120,000 when starting out, and by far only a very small percentage make over $120,000 (probably the top 5 percent with over 20 years experience). Only high specialized and highly experienced consultants make this amount.

We hired a consultant to do healthcare management at our hospital, and he had tons of healthcare experience administratively, it was a part time gig, about a year or so and was paid around $90,000 or so. I have seen a surgeon who was retired from surgery, in her 60s, who was hired at a higher rate to evaluate basically how the surgery department ran, and she was very efficient and good at what she did via a good reputation, but again she had like 30+ years experience as a surgeon. There isn't much anyone would hire you to do now with your current knowledge/experience that couldn't be done by a PhD in healthcare management or a PhD. Sorry but this is true.

The big consulting firms for the most part don't take people who just have M.D.s and don't have residency or experience. You would likely have to take a salary near a resident's salary, like perhaps $60,000 or likely less and work for many years, perhaps 5 years or more before you would get the type of job you want.

So, you wouldn't necessarily be making that much more than a resident for your first years as a consultant as you would have to start over again in a new profession.

I wouldn't look at the salary though and try to figure out what you want to do in terms of a job/career. With residency completed you could do a lot more, like be an administrator and give your clinical input as a B.E./B.C. surgeon. Without having finished residency you are limited . . . There are plenty of consulting jobs for attendings who are 5 years out of residency. Trying to go head to toe with these folks would be very hard work.

Many years ago I received an offer from a consulting company, I was offered an internship at this big consulting firm in New York, the pay was very reasonable, but the work required was nuts, working seven days a week, perhaps 12 hours a day for a couple years, at the end of it I could have made more than $100,000. I really couldn't see myself working that hard if it wasn't for patient care and just to enrich a corporation, which is what a lot of analyst work is, and just being basically a glorified analyst which is what consultants are. Mostly I think that only people fresh out of college, like I was, can do this entry level consulting/analyst work as it is brutal, like residency, but worse in a lot of respects as there is back-stabbing. Realize for your first consulting type job you will be doing what other people ask you to do and it will be reports and reading and analysis, which may be laughed at or not even looked at and you will be doing six to seven days a week WHILE your skills as a clinician degrade. And if you get laid off you haven't really advanced your education, which finishing a surgical residency would do.

Point being is that a lot of these high flying consultant type jobs are brutal, and you basically work endless hours preparing reports and it is in a corporate environment where you need to kiss booty big time. And you don't have the autonomy of a physician, if there is a big project and your boss wants you to work in the office every day until 9 pm for weeks then you have to do it, if your boss wants you to fly out to a meeting for a couple weeks then you have to . . . worst part is that you won't get to pick what projects you work on.

 

[dragonfly99]

Point being is that a lot of these high flying consultant type jobs are brutal, and you basically work endless hours preparing reports and it is in a corporate environment where you need to kiss booty big time. And you don't have the autonomy of a physician, if there is a big project and your boss wants you to work in the office every day until 9 pm for weeks then you have to do it, if your boss wants you to fly out to a meeting for a couple weeks then you have to . . . worst part is that you won't get to pick what projects you work on.

This is what I have heard r.e. consulting as well. I know someone whose roommate got a job in a consulting firm right out of college, and she worked brutal hours...I mean totally brutal. The only thing was there was no overnight 30 hour shifts, so still easier than residency but the work sounded really dull, and long hours for weeks and weeks on end.