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How difficult is it to get into one of the ROAD specialty?
- Thread starter Premed90
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Anesthesia? a competitive specialty? I thought they take pretty much anyone off the street for residency. A lot of competition from crnas too.
Radiation Oncology! This is what I'm talking about..I hear they make huge salaries with sweet hours, you need a full time physicist at the hospital, but it's great work and interesting if you like physics.
Opthamology...eh...Kinda competitive. Their reimbursements took a huge hit, particularly in cataracts, etc. Retinal fellows still make a killing though. Interesting work, but I find the eye kind of gross.
Orthopaedics...Highly competitive. Very much a work hard, make $ field. Big egos and lots of joints. Rarely met an orthopaedic surgeon without work.
Neurosurgery...Very competitive. Cutting on the brain, need I say more? Pays extremely well. Highly academic oriented, a lot of MD/PhDs in the field.
Plastics...The most competitive (I hear). High upside potential and very smart students. Cyclical though, moves with the economy.
Dermatology...Also highly competitive. They can make absurd amounts of money like plastics, and have a very good lifestyle.
ED....Competitive? DOs are matching into top programs like Stanford, Cook County etc., so is it? I dunno, hospitals are losing money on virtually all of their ERs because many patients are uninsured. A lot of it is triage too.
Radiation Oncology! This is what I'm talking about..I hear they make huge salaries with sweet hours, you need a full time physicist at the hospital, but it's great work and interesting if you like physics.
Opthamology...eh...Kinda competitive. Their reimbursements took a huge hit, particularly in cataracts, etc. Retinal fellows still make a killing though. Interesting work, but I find the eye kind of gross.
Orthopaedics...Highly competitive. Very much a work hard, make $ field. Big egos and lots of joints. Rarely met an orthopaedic surgeon without work.
Neurosurgery...Very competitive. Cutting on the brain, need I say more? Pays extremely well. Highly academic oriented, a lot of MD/PhDs in the field.
Plastics...The most competitive (I hear). High upside potential and very smart students. Cyclical though, moves with the economy.
Dermatology...Also highly competitive. They can make absurd amounts of money like plastics, and have a very good lifestyle.
ED....Competitive? DOs are matching into top programs like Stanford, Cook County etc., so is it? I dunno, hospitals are losing money on virtually all of their ERs because many patients are uninsured. A lot of it is triage too.
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Here's the deal. When the ROAD moniker was made up, decades ago, the four fields, radiology, ophthalmology, anesthesiology, and dermatology were examples of four very competitive, very lucrative fields where you didn't have to work that hard. Since that time, anesthesiology has had a roller coaster in terms of popularity, and currently isn't as competitive as the others, although reportedly it's on an upswing. But since the acronym is an old and well known one, it still gets used, and you cannot really add to it and have people understand what you are talking about. You don't get to change the acronym just because EM and anesthesia are now comparable in competitiveness (for the moment), any more than you could change the acronym SCUBA or SNAFU etc. ROAD is part of the medical vernacular. It's a word of art. As for the others mentioned, gen surg, ortho, neurosurg and plastics will NEVER be a part of this category because they don't offer the lifestyle. These are surgical fields. They have very long, very long-houred residencies followed by extensive lifetimes of call and surgeons hours. They do not fit at all with a grouping that includes rads or derm. Doesn't matter what they pay, ROAD isn't about pay, it's about a balance between competitiveness, salary and hours. If you don't have all three, you are in another group altogether. And Rad Onc, which does fit the bill, actually was part of radiology when ROAD was coined. So technically it is already included in there, although the R is radiology, which was the field at the time. As for EM, yes with shift work some argue it now has the lifestyle (although it still has more overnight work than most fields), and it's competitiveness has pretty much caught up with anesthesia (which as mentioned, bottomed out a while back and is working its way back). But that doesn't get it into the acronym because the acronym is historic.
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Competition exists everywhere, in every profession, from bartenders competing for better/more hours, to contractors competing for a building contract, to figure-skaters taking out people's knees to get on the Olympic team, to high-profile Harvard associates competing for tenure.
The Nobel prize-winner in the office down the hall from me needs to compete for NIH funding just like everyone else.
It doesn't stop when you finish residency and become faculty or join a practice. In fact, in some ways, it intensifies because you're on your own and it's nobody's job to help you succeed anymore. They just expect results, billing units, publications, etc.
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No "force" involved... You make choices in life and in school. Folks choose the effort they put forth in high school... thus impacting grades & SAT and ultimate college/university undergrad opportunities. Folks choose the effort they put forth in undergrad... thus impacting grades & MCAT and ultimately medical school options/opportunities. Folks choose the effort they put forth in medical school... thus impacting grades & USMLE & clinical roatation LORs and ultimately residency options/opportunities.
As a pre-med you need to change the mindset and accept that you will determine your opportunities & destiny through your efforts. To ask about being "forced into doing" a career you don't want to, especially at the uber educated level of being a physician is really a "victim" role that is misplaced.
PS: yes, there are numerous slackers in medical school.
ABSOLUTELY
ABSOLUTELY. Focus on the requirements to get into the best medical school possible in order to leave future options open. Do NOT focus on the future options. Your ability to plan is critical... but the ability to focus on the challenge at hand is paramount.
First, pass/fail does NOT make trying hard "straight up not worth it". The pass/fail structure is one of your first "tests". Folks that self motivate and try hard in the face of pass/fail are the same folks that smoke the USMLE.
Second, there are numerous differing levels of preparation for USMLE. Some take courses, some study at home, some do limited reading and use simple self-study/self-help books. Everyone at the same university may have relatively "the same amount of time". However, everyone makes their choices of priorities. In addition, there are folks that work part time jobs on breaks, etc... for bill payment. The argument that everyone is studying equally and not enough time to study approaches "making excuses". Now juxtapose that against the earlier statement relative to working hard for a pass/fail grade.... While there may be some dyslexics & learning disabilities amongst your medical school classmates, I dare say there are specific reasons one medical student out performs the other on rotation shelf exams & USMLE and most of these differences are resulting from individual student choices.... ADULT choices.... My Lord, by the time you have gotten into a medical school, you better have an idea of what type of studying works for you and what effort you need to put forth.
Regards,
JAD
PS: for every individual I find in FP or psych or IM or etc... that cries about how they just couldn't match into their preferred specialty, I find folks that did an extra year of research, did extra years of residency and/or internships, etc.... did whatever they could to get into the career they wanted.... CHOICES! That is what makes the difference between real Goals vs. dreams/fantasy/wishful thinking.
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Also remember that this is by field, not necessarily applicable to specific residencies.
I'd be willing to bet that Stanford or Harvard IM program is more competitive than most Ortho programs
I'd be willing to bet that Stanford or Harvard IM program is more competitive than most Ortho programs
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qft!
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Are you like the historian for your med school or something?.....if not, I would suggest you look into it....
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Are you like the historian for your med school or something?.....if not, I would suggest you look into it....
He speaks the truth. My father-in-law (interventional neuro-rads) says that those have always been competitive.. Even when he finished in 1980.
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There's someone from St. George's in the Caribbean who is one of Harvardd's Psychiatry programs.
That ought to tell a lot right there.
That ought to tell a lot right there.
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I dont doubt he is incorrect. My problem is that we are not "allowed" to adapt our talk in terms of what is additionally competitive today and still have to limit out acroynms in terms of the past.
I can have my own opinions of what is a great life, work, and salary mix...
I really dont care about "how it has always been".....
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Yes it tells you he was probably a hard worker, did well on his USMLE, and impressed the PD on his interview.
Why do people automatically assume that just because someone didn't get into the best school but did very well there denotes that they still are not as smart as someone coming from middle to upper tier schools that scored the same on their USMLE. Sure there won't be as many but the top students at any school are just that, TOP STUDENTS! Please don't make assumptions about students based primarily on the school; it just makes you sound ignorant.
(No i do not go to St. George's)
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You are allowed to make up a new acronym, but the problem is that premeds who don't know what the vernacular read these boards and are going to think that there's something called "ROAD-E" or "adore" or whetever, and end up looking really stupid down the road. The acronym that has survived the ages is ROAD. Older doctors use this term. Anything else is just your own list, not a term that is used in every day parlance. So it's like talking wrong in front of a small child -- he will go on to repeat it and look stupid for it. Because guess what -- other than the two or three people on SDN who might buy into your new updated term, this one isn't going to make it out there.
As mentioned, you kind of need to have a history of being competitive to make the list. Something newly popular and more competitive than in years past, like ED, hasn't survived the tests of time yet. it's still unclear whether this will be a lasting bump in competitiveness or just a couple year blip. Anesthesia has had a roller coaster ride of competitiveness, and is slowly working its way back to where it was when it was deemed part of ROAD. It faces encroachment from CRNAs, and may not make it back to its historic prominence -- that remains to be seen. so to the extent ED has become equivalent to anesthesia at its nadir doesn't really merit expanding the acronym IMHO.
So sure, you can create a new acronym if you'd like, but can't add to an old one and consider it the current update. And you must must must make clear that the only one in parlance outside of this board is ROAD, because your readers are going to look like dolts if they start talking about the ADORE residencies or whatever. Don't set up your audience to be ridiculed.
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how about the hell with acronyms then and we just talk about each specialty in terms of where it has been and where it is going....
because with the new legislation coming who knows what will happen...
primary care might be the new "ROAD"....😱
because with the new legislation coming who knows what will happen...
primary care might be the new "ROAD"....😱
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HAHA nice!
While I think primary care will increase I doubt it will get close to the ROAD specialties. I sure wish this new legislation would better address reimbursements, but we aren't allowed to complain about money since we're in a profession based on self sacrifice and helping others...
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I think it's going to be much ado about nothing when they are done with the mark-up. The doctors across the board will take a minor pay cut, some primary care visits and NP charges will be better reimbursed, and cardiology may have a harder time doing self referrals. Other than that, you will have a lot more medicaid patients
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You misunderstoood me. I meant that he obviously acheived a lot and was able to overcome his obstacles. I agree with you
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but we aren't allowed to complain about money since we're in a profession based on self sacrifice and helping others...
maybe we should complain more....
everyone should be compensated for their time and effort and physicians are one of the most in terms of that I know of....
We should unite and demand pay increase instead of decrease...
together we can stand and divided we will fall....🙂
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My original question was in the sense that when you're an attending, you and your colleagues have already (for the most part) achieved your career goals and you're working together for the good of the patient. You're not trying make each other look bad (see pre-med gunner thread). Anesthesiologists, in particular, seem pretty chill with everyone. This is all based on my shadowing experiences of course.
Yes, let's please work together to try to minimize this. 😀
🙂 Classic video.
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Wouldn't it be terribly sad if you reached attending level and you "achieved your career goals"? What horrible stagnation that would be, at the tender age of 30 or 35 years old! That might sound nice now because everything is so busy and cut-throat, but in reality, it never really stops. Junior attendings have to struggle to become senior attendings, senior attendings struggle for full tenure. Everyone fights for research funding. The promotion structure at tertiary medical centers is kind of like the military. You're either on your way up, or you're on your way out. That doesn't mean you act like a jerk or try to show up your colleagues, but everyone knows there is only so much room for advancement, and not everyone can make it. You want your department chair to think you are wicked smart and critical to the advancement of the program, and you do that through academic and clinical success.
If you choose to eschew the academic environment in favor of a community hospital or private practice, well there's just a different kind of competition. You fight to keep your practice afloat, you fight for OR time, you fight for referrals, etc. Again, you don't slash each other's tires in the parking lot, but you'd certainly like to shunt their referral base to you if possible.
I don't want to sound harsh. I just don't want you to think that the ascension to attending status is some sort of panacea. It's just another landmark.
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Thanks for the insight. I understand what you're saying and I think all of that was in the back of my head (somewhere), but just like the "I'm scared of killing a patient one day" thread, I try not to think about it because it's another scary thought to add to the huge-ass pile of scary/stressful thoughts. Sometimes you want to fast-forward ahead and just be that doctor you've been wanting and working so hard to be, and other times you want to slow down and take everything in. It's all part of the journey...and it's just the beginning for me. That's probably why I'm rambling, so I'll just stop now and check out the lounge forum for a few good laughs. 🙂
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