If you could go back in time knowing what you know now, what specialty would you choose?

[odyssey2]

Let’s say you’d be able to match anything. Would you stay EM?

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[Tiger26]

Would you stay EM?

We were actually just discussing this between patients this morning. That's a tough question because I'm at a pretty good gig and I highly value the amount of free time I have every month to do hobbies and other business ventures.

That said, I probably would have done IR or something else with short procedures, like pain. Given the the 3 year residency of EM, I might still do that and then a pain fellowship afterward. I just don't know if that's something I'd want to do now with 3 young kids and several side businesses.

 

[JacobMcCandles]

Yes, the schedule flexibility is invaluable to me.

 

[Brigade4Radiant]

It depends my stats were avg so it was either IM or a low tier rads program that I could maybe get into if I knew at the begining of third year. It is very nice to have days off and also cover an extra expense simply by picking up another shift.

Spending and working more in a fellowship of IM and having to move is painful.

 

[watermanMD]

Psych —> Telepsych —> make my own schedule and make as much or little $ as I want just chillen. Know people pulling 500k w/40hr weeks. Patient no show? Go watch TV or kick back for an hour. I’d workout in AM, see patients, block off a couple hours a day to surf, finish up patients into afternoon. Develop a routine. Not have my circadian rhythm ****ed every month. Can still theoretically see patients w/ VPN while traveling overseas. It’d be nice. I’m sure it’s not as straightforward as I’m imaging. But also, a Psych friend told me it is.

At the same time. I am evolving to appreciate the amount of time off we have in EM. The burnout was preventing me from being able to appreciate—losing days before and after shifts to “cooling off/coming down”, worry, etc. Cutting back and it now becomes clearer. That and being in a better mental headspace.

 

[Cinclus]

I was between EM and psych back in the day. I have a family member who is now involved in private practice psych, and a lot of the patients sound super annoying/entitled, and their psych problems often stem from complicated social issues, many of their own creation, and their lack of appropriate coping skills. And they demand pills for it. "My Adderall ran out early again for the 3rd month in a row, and I'm going to call and b*tch at your office staff because you won't refill it a week early. Again. Don't you know I will WITHDRAW?!" They don't want to be instructed on developing adulting skills. Not sure I'd want to deal with that mess. At least in EM, all types of patients, entitled or otherwise, ultimately leave me. I mean, you CAN fire the butthole patients from your private practice, but in a world of online reviews, you're encouraged to placate them, and there are many of them.

 

[GatorCHOMPions]

Anesthesiology or PMR +/- Pain Fellowship. Lot of options and career flexibility, banker's hours (even for Gas with the right job), brief (awake) patient encounters, good burnout metrics, taste of procedures, and increase in compensation over the years. I'd probably settle into a hybrid split position if possible. I never even really knew what PMR was in medical school.

To this last point, I just looked into another per diem gig and pay has literally remained flat in my neck of the woods since I graduated residency 7 years ago.

 

[HoosierdaddyO]

If it’s ok with OP, I was going to open it up a little more for people.

In addition to a different specialty, knowing what you know now would there be another career choice you wish you would have chosen instead of medicine in general.

Ok I was definitely interested in psych and gas. Both for differing reasons, psych bc the mind and psyche fascinated me… gas bc I’ve seen my fair share of gas docs making investments and trades and Tetris on their phone in the middle of surgery.

If I changed careers, I feel like I would have enjoyed being a biology college professor/teacher of some sort. And there’s always the inner child in me that wanted to join the FBI and still would if the age limit wasn’t already met lol🤷‍♂️!!!

 

[RustedFox]

We do this on here once every six months or so.

 

[JacobMcCandles]

If it’s ok with OP, I was going to open it up a little more for people.

In addition to a different specialty, knowing what you know now would there be another career choice you wish you would have chosen instead of medicine in general.

Ok I was definitely interested in psych and gas. Both for differing reasons, psych bc the mind and psyche fascinated me… gas bc I’ve seen my fair share of gas docs making investments and trades and Tetris on their phone in the middle of surgery.

If I changed careers, I feel like I would have enjoyed being a biology college professor/teacher of some sort. And there’s always the inner child in me that wanted to join the FBI and still would if the age limit wasn’t already met lol🤷‍♂️!!!

Is the question what would your passion job be if money weren’t an issue? There are lots of jobs that seem fun but wouldn’t provide near the financial security of EM.

 

[cyanide12345678]

Psych, ortho, derm, or ophthalmology

The lifestyle is probably the worst for ortho out of the above, but a lot of them are pulling in 700k+. Probably could have a very reasonable work life balance with less hours and a pay cut to make ‘only’ 500k.

 

[Mount Asclepius]

Cardiac anesthesiologist and/or intensivist.

CIA and/or forest service.

 

[Apollyon]

Cardiac anesthesiologist and/or intensivist.

CIA and/or forest service.

Good luck getting picked up for CIA. If you say it, you're not getting it.

 

[BoardingDoc]

Good luck getting picked up for CIA. If you say it, you're not getting it.

If you wanna be a NOC or do wetwork or somesuch, sure. There's literally a very straightforward application process to work for the CIA in a variety of roles.

 

[always.chillin]

Wouldn't have done any other specialty. I couldn't stand more than 3 years of residency. I also don't like procedures very much, and contrary to what people expect, I rarely do procedures at the sites I work. Most lacs/abscesses are done by the midlevels. Rarely do central lines anymore. Bipap avoids intubation in most cases. Probably would've done something in tech. There's tons of money in EM if you choose the right sites.

 

[TexasMed22]

Hem onc seems like a hidden gem, curious why it never comes up in these discussions

 

[Janders]

If it’s the same timeline (I finished residency in 2010) i am content with EM as I’ve found a good group and despite the psychic toll I feel good about things we’ve achieved, and I’ve saved a large % of my income so I should be able to cut back soon.

My top two alternatives were ICU and IR. I always liked ICU medicine but don’t see people my age in that field any happier than I am. I think interventional radiology looks good from the outside but I’m not sure I could have made it through radiology residency intact.

While I can imagine a niche surgical field like ent or ophth being a great career choice, again I don’t find any of them specifically call to me. Anesthesia makes sense, though their fortunes have waxed and waned a lot.

I think the left field answer (for me) would be to do psych or even neuro and set up a cash-only small group practice tightly controlling my patient selection. With an entrepreneurial mindset I think this could be a rewarding, enriching and long-lasting career.

Now if you tell me I’m finishing residency in 2027 my answers are different…

 

[JacobMcCandles]

If not medicine, then I think politics is the right answer. Where else can you get that kind of wealth generation from a $174k/year job?

 

[cyanide12345678]

If not medicine, then I think politics is the right answer. Where else can you get that kind of wealth generation from a $174k/year job?

You could always just follow nancy pelosy stock picks and make a killing too 🤣

 

[DOswag]

I was between EM and psych back in the day. I have a family member who is now involved in private practice psych, and a lot of the patients sound super annoying/entitled, and their psych problems often stem from complicated social issues, many of their own creation, and their lack of appropriate coping skills. And they demand pills for it. "My Adderall ran out early again for the 3rd month in a row, and I'm going to call and b*tch at your office staff because you won't refill it a week early. Again. Don't you know I will WITHDRAW?!" They don't want to be instructed on developing adulting skills. Not sure I'd want to deal with that mess. At least in EM, all types of patients, entitled or otherwise, ultimately leave me. I mean, you CAN fire the butthole patients from your private practice, but in a world of online reviews, you're encouraged to placate them, and there are many of them.

I love being in psych but there are definitely days that wear on you. I do have some that call in the day they take their last adderall and demand a refill. Our nurses answer the phone calls (thankfully I don't have to deal with these directly, they generate a message that gets to me and I can refill through that in our EMR). The nurse kindly explains to them that it can take up to 72 hours for a response. I see the messages that have been generated once it gets sent to me and the patient will call back upset 4 more times before it even makes it to me... The entitlement in some of these patients is real and yes, many of the problems I hear about are very much their own doing that a med is not going to fix. But they often don't like that answer. "adderall and xanax is the only thing that works for me!!!"

Lifestyle is great though, I work 4 days a week, have a 3 day weekend, making plenty of money. I don't know if I would've done anything else in medicine (considered EM for a long time though I'm glad I went psych). I'd probably do something in IT, computer software stuff, become and e-gamer lol. Kids now think they can just start a youtube channel and be the next Mr. Beast (I only know that name because of my kids), or whoever is playing video games for youtubers and making millions.

 

[Tiger26]

You could always just follow nancy pelosy stock picks and make a killing too 🤣

There should be a fund indexed to lawmaker investments ....

 

[comp1]

All these EM docs wanting to do psych warms my heart.

 

[DOswag]

All these EM docs wanting to do psych warms my heart.

Very glad I ended up choosing psych in the end. I think I would be burned out and miserable in EM and I'm not even 40 yet.

 

[JAFERD_MD]

Surprised no one has said radiology or pathology.

I've realized that the general public (or at least the people who consume a lot of healthcare) suck. If I could deal with them less, that would be fantastic.

It was just unfortunate that in medical school, I routinely fell asleep looking at slides and in dark rooms, so I had to nix those specialties.

 

[Brigade4Radiant]

Rads yes path hell no

 

[VA Hopeful Dr]

Surprised no one has said radiology or pathology.

I've realized that the general public (or at least the people who consume a lot of healthcare) suck. If I could deal with them less, that would be fantastic.

It was just unfortunate that in medical school, I routinely fell asleep looking at slides and in dark rooms, so I had to nix those specialties.

Meh, all you need is a specialty where you can fire patients. Makes things way better

 

[BoardingDoc]

There should be a fund indexed to lawmaker investments ....

I think there are. There are at least websites that track individual politicians investments. The problem is that the data is at least a month old by the time you see it, so you've already missed the boat..

How stock market trading is legal for lawmakers who definitionally have insider information on market forces before the rest of the general public is utterly beyond me.

 

[gutonc]

Hem onc seems like a hidden gem, curious why it never comes up in these discussions

Not sure. I love it.

I think it might be because a lot of people who chose EM don’t have 6 years of training in them.

The work-life balance is great if you want it to be, and it’s easy to find a job where you can just grind like a mofo and make 7 figures for a few years and then ramp down. All while sleeping at home every night and having most weekends and holidays off.

 

[gruemd]

I've thought about this probably too much due to "grass is greener" syndrome. Especially every time I pull out of my driveway at some strange hour to go to work and my ophthalmology neighbor is out playing with his kids.

-I hate the OR especially complex cases, so that takes out Gen surg, CT, NSGY, ortho
-I hate dealing with psych patients, though most of that is probably due to the caliber of patients we get in the ED. I could maybe suppress my eyerolls enough to do private practice in an area with blue bloods with good insurance or self pay.
-I hated the monotony of clinic with a fiery passion in med school and residency, FM/derm/ophtho are out
-Don't wanna look at poop chutes all day, no thanks GI
-Was so sick of medical training after med school that I knew I didn't have more than 3 years of training in me, that takes out most of what is above and many others
-Probably could have been happy with anesthesia, I do enjoy intubating and think I'd enjoy the patient management aspect if the patient couldn't talk to me
-Rads sounds good when you hear their salaries, but I think about staring at a screen nonstop all day and that sounds less fun.

If I could do it again, I'd do not medicine. I like the biology and physiology aspects of it, really don't like most of the patients. So yeah, EM works well, feeds my appetite for keeping things novel, makes good money for the time worked, and hopefully will continue providing a good landing for tapering down work hours in the future. Worked a CCH rural shift where I made about $1500 per patient - low pay but crazy low acuity and I played a lot of BG3 and had two full nights of sleep. Not many jobs that I can do that.

 

[MD46]

Not sure. I love it.

I think it might be because a lot of people who chose EM don’t have 6 years of training in them.

The work-life balance is great if you want it to be, and it’s easy to find a job where you can just grind like a mofo and make 7 figures for a few years and then ramp down. All while sleeping at home every night and having most weekends and holidays off.

Lets keep it a hidden Gem

 

[emergentmd]

When I applied, I had #1 Rad vs EM and #2 anesthesiology.

Chose EM b/c tie breaker being 3 vs 5 yrs.

No regrets with EM and flexibility. I think we all forget how great it is to be off when people are working. Plus, I have a job that would make Rad blush plus allowed me plenty of time to do RE and Finance. Looking at a 4th business by years end with all of my free time.

 

[gutonc]

When I applied, I had #1 Rad vs EM and #2 anesthesiology.

Chose EM b/c tie breaker being 3 vs 5 yrs.

No regrets with EM and flexibility. I think we all forget how great it is to be off when people are working. Plus, I have a job that would make Rad blush plus allowed me plenty of time to do RE and Finance. Looking at a 4th business by years end with all of my free time.

Not to burst the EM schedule bubble, but I've only worked about half a dozen Fridays in the last 12 years, all for locums-rate pay ($4k/d) and have similarly had every Tuesday or Wednesday off for the same period of time, with a base comp of ~$350K for the first 5 years or so, >4$00K for the next 5 and >$550K for the last 2.

That said...I did have an extra 3 years of training and until a year ago, still took basically uncompensated weekend call 4-5 times a year.

 

[cyanide12345678]

Surprised no one has said radiology or pathology.

I've realized that the general public (or at least the people who consume a lot of healthcare) suck. If I could deal with them less, that would be fantastic.

It was just unfortunate that in medical school, I routinely fell asleep looking at slides and in dark rooms, so I had to nix those specialties.

I would say radiology but I’ve spent a month on neuroradiology in med school.

I swear ive never struggled more in life to stay awake.

 

[Franzd'Epinay]

Hem onc seems like a hidden gem, curious why it never comes up in these discussions

I was under the impression Heme/Onc was a fairly competitive fellowship (which would make it not hidden). Is this wrong?

 

[TexasMed22]

I was under the impression Heme/Onc was a fairly competitive fellowship (which would make it not hidden). Is this wrong?

The specialty is like half IMGs. I think by definition that makes it not competitive

 

[EctopicFetus]

Psych, ortho, derm, or ophthalmology

The lifestyle is probably the worst for ortho out of the above, but a lot of them are pulling in 700k+. Probably could have a very reasonable work life balance with less hours and a pay cut to make ‘only’ 500k.

I think the issue is you have to be accessible to your post op patients, clinic etc. Also, the issue is it’s hard to do without joining a group, then you run into group politics, call etc. The few orthos i know that run in small groups or solo work insane hours.

 

[EctopicFetus]

Lots of great things about EM. Key is finding the right job. Most residencies dont talk about this. My first job out of residency i picked cause i had a buddy in that group. For family reasons was not an easy decision. That being said, great payer mix, good job, not busy high partner pay. Next job a bit more of a grind but more fitting to my personality. Work hard, play hard. Work isnt simple but pay is outstanding.

If i could pick em and have my career i would do it. If i had to pick and my job was a “normal” em career i think i would have done peds cardiology, picu or Hem/Onc peds or adult.

Lots of great things about EM. Lots of major systemic issues.

 

[MD46]

The specialty is like half IMGs. I think by definition that makes it not competitive

I dont think that makes it less competitive if it has more IMGs, some of the IMGs that you see in Heme Onc were top of their residency class. Also in my experience, AMGs that go into Heme Onc like to be more academic/research heavy ivory tower places.

 

[Emapp20177]

gas 100%

But EM is fine. For now. It probably won't be fine in the near future.

 

[twospadz]

I'm a psychiatrist. I was in between psych and EM during medical school. Glad I went into psych. Pulled 700k+ last year yet was able to go on a international vacation every month (12 times).

 

[RustedFox]

I'm a psychiatrist. I was in between psych and EM during medical school. Glad I went into psych. Pulled 700k+ last year yet was able to go on a international vacation every month (12 times).

eff you, I hate you .


...

...


good for you, bro .

 

[The Knife & Gun Club]

I don’t think I would do medicine again and would probably try for a career in biotech, pharma, or some other stem field. All jobs in medicine these days (except a select few) you’re effectively just a value generating cog in a giant machine. And if you’re not able able to make the Medicare RVU machine go brrrrr and help the corporate overlord of choice collect $$$ you’re worth about as much as the pile of human excrement on the waiting room floor to them. There’s nothing wrong with being a value generating cog in a wheel but I wouldn’t trade half a million dollars in education and a decade of my life to be a cog if given the choice again.

These days with fellowship I’m content with my job and don’t have the same existential angst I had in the ED - but certainly am not happy. I’ve been a little more at peace recently since I finally gave up emotionally that I’d ever have a job I truly enjoy and more focused on having work that’s tolerable with humane working conditions.

 

[HemorrhagicShock]

I'm a psychiatrist. I was in between psych and EM during medical school. Glad I went into psych. Pulled 700k+ last year yet was able to go on a international vacation every month (12 times).

How the hell are you pulling off +$700k?

Are you doing extreme rural locums? Are you working two FTEs?

I don't know of any psychiatrist making this much. Share the secret!

 

[twospadz]

How the hell are you pulling off +$700k?

Are you doing extreme rural locums? Are you working two FTEs?

I don't know of any psychiatrist making this much. Share the secret!

I know a few psychiatrist pulling above 700k+ personally too. I'm not locums. There are many opportunities in psych to earn money. The demand is big and the versatility is unmatched compared to any other specialty. You can work in inpatient hospitals, jails, clinics, courts, rehab centers, tele-psych, nursing homes, emergency rooms etc.

I wouldn't change my freedom for anything. I go on vacation again in 4 days to South East Asia too.

 

[HemorrhagicShock]

It's so painful to be reminded, over and over, that choosing EM (when I was competitive for plastics and derm) is one of the worst things I could have done as an MS4.

Same med school. Same classmates. Same eduction. Such wildly different life outcomes when you look at those who chose EM vs. Gas (or psych or something similar)

What can you do though? Stop comparing and try to be grateful I suppose. Way easier said than done.

 

[emergentmd]

In most specialties, you can make 700K+. Not normal, but there are always niches. You just have to find it, take risks and be willing to work in that niche.

I know 30+ EM docs in my career that made 700K+ and 10+ over 1M. I was making 400-600+/hr working locum shifts back in the days.

 

[comp1]

In biotech or pharma, you'd just be a much less well remunerated cog.

 

[DOswag]

I'm a psychiatrist. I was in between psych and EM during medical school. Glad I went into psych. Pulled 700k+ last year yet was able to go on a international vacation every month (12 times).

I know a few psychiatrist pulling above 700k+ personally too. I'm not locums. There are many opportunities in psych to earn money. The demand is big and the versatility is unmatched compared to any other specialty. You can work in inpatient hospitals, jails, clinics, courts, rehab centers, tele-psych, nursing homes, emergency rooms etc.

I wouldn't change my freedom for anything. I go on vacation again in 4 days to South East Asia too.

That is awesome! I'm psych now but strongly considered EM back in the day. The group I work for has clinics in other states as well and I know there are some that are pulling 6-700K pretty regularly. I'm in my first year on the civilian side post military and I'm on pace to make about 400K this year working straight outpatient mon-thur 10 hr days, no call, no nights, no weekends. So glad I chose psych. I'd love to get to that number though for sure.

 

[always.chillin]

it’s hard to know the right long term fit when you’re in med school. the sad part is med students still go into EM even after being aware it’s going downhill.

 

[Groove]

PMR, FM, or diagnostic rads.

IM hospitalist wouldn't be too bad either.