How do you define a "stressful" specialty

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Random question, but as I'm in 3rd year (on my surgery rotation) and I'm thinking about the specialties in mind (minus the really time intensive surgical specialties), I'm starting to re-evaluate what interests me and the word "stress" when it comes to a specialty, even one that you enjoy, 10-15 years down the road. And I say down the road because it's unfair to assume that what life after residency is identical to that of med school/residency.

In general, it seems like every specialty has something to offer and is interesting the first time and that's sort of the nature of I guess just learning things for the first time in med school (take out biochem and a lot of boring 1st 2 year stuff, most specialties have something cool to offer)...in the end I figure we all will get proficient at our jobs by the end of residency and things become 2nd nature.

So about the word, "stress" what do you guys see as stressful 20 years down the line (assuming you are working 50 hours a week in these well-compensated specialties):

a.) First case: a high-volume outpatient model seeing lots of patients each day (i.e.- derm) with relatively low insurance overhead
b.) Second case: orthopedic surgeon who does only a handful of meticulous hours-long surgeries a day with high insurance overhead
c.) Third case: mix of both outpatient and surgical (ENT, optho, urology)
d.) 4th case: Anesthesiology (hospitalist vs. outpatient pain management)
e.) 5th case: purely diagnostic specialties (path/rads)

Part of me asks this because I have been thinking about derm for some time but I think about the stress of a.) and then think about how I'm literally pretty stress-free in my anethesiology block right now and really enjoy it...bottomline career specialty choosing sucks and is a hard decision
 
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This is a fatal flaw in thinking about stress and satisfaction.

You are trying to relate stress to circumstances, which can contribute to but rarely determine stress levels.

Don't you know this is true? Haven't you seen some people stress out over the most trivial things while others remain peaceful in chaos?

Trying to find the ideal circumstances is the least effective of strategies. This assumes time to exercise, sleep and have time for relationships (i.e. 50-60 hr work week. It's hard to be balanced and stress free working 100+ hr surgery weeks).

Find what fits your personality (some people think radiology is appealing while others would rather be in clinic all day). Next, pick the subject area you find appealing that allows a reasonable work schedule (<60 hrs week). If there are multiple specialties fitting this bill, then you're in luck. Following the above 2 steps and work 50-60 hrs a week, you can be happy and stress free regardless of specialty or practice environment. The optimists will find the things they enjoy in their specialties while the pessimists will be able to be dissatisfied in any specialty.

As Shakespeare said, "There is no specialty that is good or bad, but thinking makes it so."
 
stress is different to everyone, but most people agree 12-14 hrs/day, 6-7 days a week, is going to be stressful.
 
Just want to put this out there for you, OP: be cautious of the line of thinking that because you're not stressed as a medical student during a rotation with a specific specialty, does not mean that the specialty is stress free. If it's not the work that would stress you, it could be politics, people you work with, etc. There are so many variables that can make your work- situation stressful that this question is hard to answer realistically.
 
Attending life =/= med student life

Anesthesia/Rads are both "chill" for students because you really don't do anything. No rounding (and therefore less pimping), and not much else you can really contribute to the team.

Conversely IM gets a bad rap from med students because they deal with all the crap. Social work, setting appointments, calling consults, endless rounds, getting pimped constantly.

As an attending I imagine life is very different.
 
MerickManual said:
Just want to put this out there for you, OP: be cautious of the line of thinking that because you're not stressed as a medical student during a rotation with a specific specialty, does not mean that the specialty is stress free. If it's not the work that would stress you, it could be politics, people you work with, etc. There are so many variables that can make your work- situation stressful that this question is hard to answer realistically.
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Yeah I realize the additional variables involved of course- paperwork, on-call overhead, interpersonal/hospital team relationships, and most importantly of all- your personality! On a personal reflection the moment I do know one thing for sure and that is I would not do path/rads (e)- too boring or intense surgical specialties with long hours (neurosurg, most general surg fields) no matter how much the $

I think the big dilemma for me in these gray zone specialties that pay similarly (give or take +/- 100k) with similar lifestyles (ent, derm, uro, ortho, anesth, optho) should I pick a field that may be busy with high volume- derm that I moderately like and knowing that it generally speaking is pretty stress-free from the general consensus and opens the doors for me to maintain life-work balance (family, relationships, working out etc...) vs. something in surgery I would really like more but realize that stress may be greater and unpredictable and not allow me to balance other non-occupational things I enjoy.

I realize this is a subject that gets brought over but comes full circle when you are at the time applying for residency and get perspective of the day-to-day of each specialty (in terms of management, types of diagnosis, procedures, etc...) Reflecting back, as a pretty naive 1st year having only lifestyle specialties (particularly derm) in mind, I now realize how diverse of clinical settings you work in (outpatient, inpatient, subspecialized, etc...)...I guess i just don't know whether I like the OR or outpatient work more 🙁 and its at a point where I'd be happy with either of these dream specialties...so to reiterate its not a battle of going into something you hate vs. something you really like, its a battle of going into something you like that offers the door for less overall stress in your life vs. something you like more plus perhaps more stress

Case and example: I feel partially idiotic having worked and invested a lot of time into derm when I'm starting to see myself being able to handle and enjoy other specialties...I'm sure other people have felt the same way at times with other specialties
 
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I would say the main things that define stress are:

-length of work day
- call when you are older (40s and up)
- financial stressors (malpractice, changes in reimbursement)

As you reduce / eliminate those the specialities are much easier 20 years from now
 
I have yet to meet someone in Derm who regrets their decision to go into Derm.

I can't really say that about any other specialty.
 
I'd say it's entirely dependent on you and what kind of things stress you out (or don't). Some people are going to thrive in environments others can't stand, and that's one of the great things about medicine - a lot of different environments to practice in and different things we can do.
 
GuyWhoDoesStuff said:
I have yet to meet someone in Derm who regrets their decision to go into Derm.

I can't really say that about any other specialty.
Click to expand...

That's because it pays well and is prestigious. If you exclude financial/prestigious regrets there are many other specialties out there with derm like benefits.

Money and prestige are highly overrated.
 
GuyWhoDoesStuff said:
And if my aunt had balls she'd be my uncle.
Click to expand...

You sir are a gentleman and a scholar.

I'm sure your high opinion of your own job is completely unbiased.😉

I thoroughly enjoyed my dermatology rotation, so I'm not a hater.
 
Derm it tough to get into...everyone knows that. People (of course not everyone) are generally impressed by that (people here will hate on that, but sorry, it's true). An analogy is someone who goes to Harvard...if one meets someone who goes to Harvard, one is generally impressed. That's not to say that someone who could have gotten into Harvard decided to go to their state school instead....just as someone who could have gotten into Derm went into some other field they liked better.
 
Huh? I got into medicine specifically for the stress...for the demanding nature of the profession. Weird.
 
Dral said:
Derm it tough to get into...everyone knows that. People (of course not everyone) are generally impressed by that (people here will hate on that, but sorry, it's true). An analogy is someone who goes to Harvard...if one meets someone who goes to Harvard, one is generally impressed. That's not to say that someone who could have gotten into Harvard decided to go to their state school instead....just as someone who could have gotten into Derm went into some other field they liked better.
Click to expand...
It might be prestigious among medical students and other doctors, but being a "pimple popper MD" sure as hell isn't prestigious among the general public.
 
circulus vitios said:
It might be prestigious among medical students and other doctors, but being a "pimple popper MD" sure as hell isn't prestigious among the general public.
Click to expand...

Again, going into a field because someone thinks it's viewed as "prestigious" by the public is another way medical students accidentally end up miserable for the rest of their lives.

My merkel cell and melanoma patients love me. My pemphigus patients tell me I've saved their lives. I honestly could not care less what a random passerby thought of my profession. Let them form an opinion once they end up in my clinic. I get to see (and cure) some amazing **** every day, and to me that's pretty exciting.
 
GuyWhoDoesStuff said:
Again, going into a field because someone thinks it's viewed as "prestigious" by the public is another way medical students accidentally end up miserable for the rest of their lives.

My merkel cell and melanoma patients love me. My pemphigus patients tell me I've saved their lives. I honestly could not care less what a random passerby thought of my profession. Let them form an opinion once they end up in my clinic. I get to see (and cure) some amazing **** every day, and to me that's pretty exciting.
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I'm glad people love it, because if I had to look at skin for 8 - 10 hours per day on 60 clinic patients, I would literally kill myself.

Sent from my SCH-I535 using Tapatalk
 
tco said:
I'm glad people love it, because if I had to look at skin for 8 - 10 hours per day on 60 clinic patients, I would literally kill myself.

Sent from my SCH-I535 using Tapatalk
Click to expand...

I would too. I see about 20-25 a day.
 
GuyWhoDoesStuff said:
I would too. I see about 20-25 a day.
Click to expand...

I guess I should be more broad... If I knew I had to step into clinic for virtually every working day for the rest of my life, I would kill myself.

Nothing against derm, specifically, I just hate clinic.
 
People that pick specialties based on prestige are in for a rude awakening. People that bring up how much prestige their specialty has probably picked their specialty based, at least in part, on prestige.
 
Transformers said:
Random question, but as I'm in 3rd year (on my surgery rotation) and I'm thinking about the specialties in mind (minus the really time intensive surgical specialties), I'm starting to re-evaluate what interests me and the word "stress" when it comes to a specialty, even one that you enjoy, 10-15 years down the road. And I say down the road because it's unfair to assume that what life after residency is identical to that of med school/residency.

In general, it seems like every specialty has something to offer and is interesting the first time and that's sort of the nature of I guess just learning things for the first time in med school (take out biochem and a lot of boring 1st 2 year stuff, most specialties have something cool to offer)...in the end I figure we all will get proficient at our jobs by the end of residency and things become 2nd nature.

So about the word, "stress" what do you guys see as stressful 20 years down the line (assuming you are working 50 hours a week in these well-compensated specialties):

a.) First case: a high-volume outpatient model seeing lots of patients each day (i.e.- derm) with relatively low insurance overhead
b.) Second case: orthopedic surgeon who does only a handful of meticulous hours-long surgeries a day with high insurance overhead
c.) Third case: mix of both outpatient and surgical (ENT, optho, urology)
d.) 4th case: Anesthesiology (hospitalist vs. outpatient pain management)
e.) 5th case: purely diagnostic specialties (path/rads)

Part of me asks this because I have been thinking about derm for some time but I think about the stress of a.) and then think about how I'm literally pretty stress-free in my anethesiology block right now and really enjoy it...bottomline career specialty choosing sucks and is a hard decision
Click to expand...

I'll tell you right now the "stress" of Dermatology is NOTHING compared to the stress of Anesthesiology, and who told you that Derm has low reimbursement? There's a reason that Anesthesiology has such a high rate of substance abuse. You're likely enjoying Anesthesia as a student, bc you're not the one actually DOING anything. Just wait till you become a resident in that specialty.
 
Dral said:
Derm it tough to get into...everyone knows that. People (of course not everyone) are generally impressed by that (people here will hate on that, but sorry, it's true). An analogy is someone who goes to Harvard...if one meets someone who goes to Harvard, one is generally impressed. That's not to say that someone who could have gotten into Harvard decided to go to their state school instead....just as someone who could have gotten into Derm went into some other field they liked better.
Click to expand...

Not at all surprised that the House of Medicine, with it's noxious "medicine is a calling at the expense of everything else in your life" fumes, hates Dermatology. Hard to stay happy with all that sleep deprivation, bad effect on family life, incessant pages from nurses, etc.
 
Anastomoses said:
Huh? I got into medicine specifically for the stress...for the demanding nature of the profession. Weird.
Click to expand...

You're in medical school without even having done rotations. You haven't even seen a speck of what "demanding" is yet.
 
DermViser said:
You're in medical school without even having done rotations. You haven't even seen a speck of what "demanding" is yet.
Click to expand...
Obviously. None of this is high pressure, Stuart Little. No lives/responsibility is anywhere near my hands. Yet.
 
circulus vitios said:
It might be prestigious among medical students and other doctors, but being a "pimple popper MD" sure as hell isn't prestigious among the general public.
Click to expand...

You forgot skin cancer:


What are you, a premed? Assuming you actually know what the "general public" thinks is "prestigious" (which is debatable - as in reality, most of them know how difficult it is to obtain a residency in this specialty), why would I care, when the general public, filled with even people who are educated, has so many misconceptions about health care services and health insurance in general. Many of them believe that their copay alone should be enough to pay the doctor.

Funny how when you treat a skin condition and it resolves, the patient is actually happy and satisfied, and thanks you up and down for resolving their problem. When has that ever happened, as a pattern, in hospital inpatients? Ever had a patient thankful that you managed their Diabetes and HTN so well, that you saved them from getting an MI? Yeah, me neither.

Funny, bc when it comes to their health, the general public is more willing to spend cash out of pocket for their skin, but believe insurance should pay for everything else, and could care less about their HTN, Diabetes, COPD, etc. Actions speak louder than words.
 
tco said:
I'm glad people love it, because if I had to look at skin for 8 - 10 hours per day on 60 clinic patients, I would literally kill myself.
Click to expand...

This is the feeling you should have about pretty much every other field but the one you end up in. And it's not a disparaging statement on those fields; it's just confirmation that you ended up in the right specialty.
 
what the derm guy is saying is that if you throw enough money into a specialty and lower the workload, any specialty would report amazing satisfaction rates

currently, derm has the highest money/workload ratio

someone should do a study on it. have people do a task they hate, pay them well and give them easy hours. then have another group do a task they love, but pay them little and give them a grueling schedule. see who posts the higher satisfaction scores.
 
PrideNeverDie said:
what the derm guy is saying is that if you throw enough money into a specialty and lower the workload, any specialty would report amazing satisfaction rates

currently, derm has the highest money/workload ratio

someone should do a study on it. have people do a task they hate, pay them well and give them easy hours. then have another group do a task they love, but pay them little and give them a grueling schedule. see who posts the higher satisfaction scores.
Click to expand...

I'm only speaking for myself here, but I would do Derm even if it paid at the same level as general IM. I would kill myself if I had to do Internal Medicine, even if it paid 400 K or even if it had "easy" hours. I love reading about skin disease, as I loved Immunology and Cell Biology in medical school. I plan on going into Pediatric Derm, which doesn't have really have any procedures, bc it's not often that you would do a skin biopsy on a child (vs. adults)

My point was that when you ask the typical patient what they care more about it's pretty obvious. When they come in as an outpatient, 9 times out of 10, they don't give a flying f that you helped them with their high blood pressure, diabetes, kidney disease, etc. even though you may have averted a possible heart attack or stroke. These are chronic diseases in which you end up just managing them with pill titration. Whoop de doo.

As inpatients, many times the admits you get are not even medically related (waiting fo Nursing home placement) which you can do anything about and and the patient doesn't want to be there. Doesn't really help the doctor-patient relationship much.

Compare this to dermatology, in which you get to effectively treat their condition and they're happy you were able to do so. I'm quoting Amy Derick here bc she words it so well, but here: http://www.practicelink.com/magazine/vital-stats/whos-the-happiest/#sthash.5NKBhaNw.dpuf

“Dermatologists can sub-specialize or do it all: pathology, surgery, cosmetics, pediatrics, adult patients, etc."

“My favorite part about the specialty of dermatology is that it is action-oriented,” Derick says. “When a patient comes in with a problem, I can often do something about it that day. If there is a suspicious lesion, I can take a biopsy to get a firm diagnosis. If a patient has a wart, I freeze it; if she has broken blood vessels, I can zap them with my laser and they disappear. I like the instant gratification that comes with seeing a problem, diagnosing it and treating it immediately.”

It's no wonder that patients (as a whole) tend to be very satisfied with their dermatologists bc our ability to treat their problem effectively and quickly.
 
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One thing that or dean said to us during match day that really resonated with me because it is how I decided on my specialty is... "Forget about academics, money, lifestyle, and prestige. Think about which patients you felt the most at home with. That is the specialty you should pursue."
 
PrideNeverDie said:
what the derm guy is saying is that if you throw enough money into a specialty and lower the workload, any specialty would report amazing satisfaction rates

currently, derm has the highest money/workload ratio

someone should do a study on it. have people do a task they hate, pay them well and give them easy hours. then have another group do a task they love, but pay them little and give them a grueling schedule. see who posts the higher satisfaction scores.
Click to expand...

This experiment has been done many times. It's one of the founding principles in any college Social Psychology course.

It turns out people who do arduous tasks for free are the ones who post "higher satisfaction scores." Mostly it's due to rationalizing. If someone is busting their ass for no monetary reward, and you then ask them how they like it, they'll tell you it's great because they truly begin to believe that "wow I must really like this job/duty or I wouldn't be doing it for free."

It's counterintuitive, but kinda interesting. Clearly, there are other factors at work when it comes to physicians, as the satisfaction surveys don't seem consistent with the studies.
 
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PrideNeverDie said:
then have another group do a task they love, but pay them little and give them a grueling schedule. see who posts the higher satisfaction scores.
Click to expand...

This is pretty much the entire principle underlying academia.
 
Doctor Bob said:
This is the feeling you should have about pretty much every other field but the one you end up in. And it's not a disparaging statement on those fields; it's just confirmation that you ended up in the right specialty.
Click to expand...

I generally agree. You're correct that it's not a disparaging statement on derm specifically...I don't like ambulatory medicine/clinic medicine in general.

However, I enjoyed caring for hospital patients (decided against it because of the "other" social stuff that hospitalists deal with), the ICU, and the OR (decided against it because everyone in the OR that I encountered - including surgeons to ancillary staff - were miserable human beings). I enjoyed the patient care aspect of almost all of the fields except for clinical medicine, and because of that, I feel that I picked the right field. 🙂
 
tco said:
I generally agree. You're correct that it's not a disparaging statement on derm specifically...I don't like ambulatory medicine/clinic medicine in general.

However, I enjoyed caring for hospital patients (decided against it because of the "other" social stuff that hospitalists deal with), the ICU, and the OR (decided against it because everyone in the OR that I encountered - including surgeons to ancillary staff - were miserable human beings). I enjoyed the patient care aspect of almost all of the fields except for clinical medicine, and because of that, I feel that I picked the right field. 🙂
Click to expand...

That's very true, if you don't like ambulatory clinic-type visits as a rule, you will hate Derm.

The ones that I know who went into Radiology liked it bc it's also very visual, liked Gross Anatomy for the most part esp. getting to visualize on imaging, and liked learning about disease processes. It's the BS that's inserted itself into medicine that they didn't like: admitting GOMERs, ridiculously long H&Ps on Medicine, social work admits, playing phone tag with consultants, patient family BS, etc.
 
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