Lifestyle and money

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TRAMD

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I received a lot of angry responses the last time I posted this. I did, however, use constructive responses to change the list. I feel it is definitely better now. If you have a tough time appreciating something for its entertainment value or require someone who says they love you to cite the source of their information then you should probably go read another thread. Please tell me what you think about the specialties’ ranks, your perception of them and the importance of lifestyle and salary to you when making your specialty decision.

Ranking of common specialties by salary compared to lifestyle. Specialties at the top have great lifestyle and relatively high salaries. Specialties in the middle are good lifestyle and fair salary, high salary and poor lifestyle or average for both. Specialties at the bottom have very poor lifestyle or poor lifestyle with low salaries. Lifestyle determined by fewer and more controllable hours, less call, and less nights and weekends. What follows in parenthesis is Median Salary-Salary rank. Preference is shown for lifestyle over high salary. Specialties within tiers have only a slight difference from one another. There are subjective components and this is not a perfect list.

1. Interventional Pain (342,000-9th)
2. Ophthalmology-Retina (386,667-7th)
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3. Radiation Oncology (337,750-11th)
4. Dermatology (232,833-29th)
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5. Radiology (307,143-14th)
6. Pathology (245,800-24th)
7. Spine Surgery (522,667-1st)
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8. Plastic Surgery (336,833-12th)
9. Orthopedics-Hand (412,000-5th)
10. Orthopedics-Joint Replacement (408,000-6th)
11. Nuclear Medicine (264,000-21st)
11. Occupational Medicine (172,500-41st)
13. Ophthalmology (260,286-22nd)
14. Physiatry (202,400-34th)
15. Child Psychiatry (180,750-37th)
16. ENT (279,000-19th)
17. Endocrinology (175,000-40th)
18. Allergy/Immunology (212,200-33rd)
19. Emergency Medicine (214,571-32nd)
19. Psychiatry (165,429-44th)
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21. Urology (305,143-15th)
22. Rheumatology (177,429-39th)
23. Neurology (192,000-36th)
23. Neurosurgery (424,667-4th)
25. Cardiothoracic Surgery (469,500-2nd)
26. Gastroenterology (281,429-17th)
27. Interventional Cardiology (427,333-3rd)
27. Nephrology (224,333-31st)
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29. Anesthesiology (280,714-18th)
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30. Infectious Disease (180,000-38th)
31. Hematology/Oncology (241,143-26th)
32. Orthopedic Surgery (339,286-10th)
33. Cardiology (297,857-16th)
34. Hospitalist (171,500-42nd)
34. Neonatology (241,500-25th)
34. Pediatrics-Heme/Onc (194,667-35th)
34. Vascular Surgery (343,667-8th)
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38. Pediatrics-Cardiology (237,750-28th)
39. Pediatrics (154,857-45th)
40. Pediatric Surgeon (329,000-13th)
41. OB/Gyn (253,714-23rd)
42. Internal Medicine (169,714-43rd)
43. Family Medicine (147,500-46th)
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44. General Surgery (272,333-20th)
45. Pediatrics-Pulm/Crit (240,333-27th)
46. Pulmonology/Critical Care (225,000-30th)

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Opthalmology - Retina has a difficult lifestyle. I'm not sure I would rank it so highly, especially not in the same category as Interventional Pain, which is often 40 hours a week with no call.
 
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Where is transplant surgery?

So far below #46 he didn't even bother :laugh: At least I wouldn't, it arguably has the worst lifestyle of any specialty ever, IMO.

I dunno if this was talked about last time, but I would put gas quite a bit higher. According to my mom, if it weren't for the malpractice she would be begging me to do it still since I would be "home for dinner every night, unlike your father".
 
So far below #46 he didn't even bother :laugh: At least I wouldn't, it arguably has the worst lifestyle of any specialty ever, IMO.

I dunno if this was talked about last time, but I would put gas quite a bit higher. According to my mom, if it weren't for the malpractice she would be begging me to do it still since I would be "home for dinner every night, unlike your father".

Many gas men (Dumb and Dumber, haha) work a lot of hours and those hours are often nights and weekends but you may be right that it should be a little higher.
 
Where is transplant surgery?

The original list died and it was moved to another list . . . ok, jk. I didn't have enough sources for salary data and didn't keep it on the list. I would expect it to be in the mid to high 20s.
 
Many gas men (Dumb and Dumber, haha) work a lot of hours and those hours are often nights and weekends but you may be right that it should be a little higher.

:laugh: Strong work!

Hmmm, I suppose moms was talking about pain management, that makes a ton more sense...
 
Many gas men (Dumb and Dumber, haha) work a lot of hours and those hours are often nights and weekends but you may be right that it should be a little higher.

Really? They do?

Not here. :)
 
I'm liking 5 and 6 myself. 5 has much higher income potential. 6 I worry doesn't...which is too bad since I like it more, so I'm undecided on what to do. Gonna have to work harder to match into 5 too.

Other considerations are length and duration of residency, also competitiveness. But those are peripheral to the main point here I guess.
 
"Spine Surgery"....hmmm is that a fellowship after general or neuro?
 
Way off the charts. The transplant surgeon I know has the worst lifestyle out of any other doctor I know.

They work A LOT and make A LOT.
 
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"Spine Surgery"....hmmm is that a fellowship after general or neuro?

You can be a spine surgeon by being a neurosurgeon with no fellowship and just setting up your practice for spine surgery or you can do a fellowship after orthopedics.
 
They work A LOT and make A LOT.
The one that I know doesn't have enough time off to enjoy it, ever. My wife works with him, and his daughter is in my class, so I get to hear all about his nearly non-stop schedule of 100 hours a week. No thanks!
 
The one that I know doesn't have enough time off to enjoy it, ever. My wife works with him, and his daughter is in my class, so I get to hear all about his nearly non-stop schedule of 100 hours a week. No thanks!

Wow, even at his age??? There comes a point for me where medicine is not worth it anymore, and he exceeded that about 30hrs ago for me...and I've wanted to do this since I was 4...
 
Ok..work A LOT I get, but make A LOT = What? 350k? 500k? 100 billion dollars?
 
Disagree with a couple of specialty placements, but otherwise, a nicely updated list.
 
hmm interesting list. I've actually thought about RadOnc before, but I never knew that salary was that high.

So... can someone enligthen me on the path to RadOnc? Is it an IM residency and then a Onc fellowship?
 
hmm interesting list. I've actually thought about RadOnc before, but I never knew that salary was that high.

So... can someone enligthen me on the path to RadOnc? Is it an IM residency and then a Onc fellowship?

Rad Onc is its own residency, that you can apply to as a 4th year med student. It may be one of those ones that requries you to set up a separate intern year that is in medicine or transitional or whatever.

Due to the good lifestyle and good salary, it is definitely one of the tougher ones to match into, so you gotta start early by doing well on step 1.
 
Surprising that Pathology isn't more popular. I always knew the lifestyle was good, but I didn't think they made that much. Guess I was wrong...
 
Rad Onc is its own residency, that you can apply to as a 4th year med student. It may be one of those ones that requries you to set up a separate intern year that is in medicine or transitional or whatever.

Due to the good lifestyle and good salary, it is definitely one of the tougher ones to match into, so you gotta start early by doing well on step 1.

While a great step 1 score is expected, Rad Onc has probably THE highest research demand of any residency. They have a ridiculously high number of PhD's matching each year and almost everyone has some kind of serious research project. So yeah, if you're interested get a great board score but you also need to seriously look into doing some research.
 
Ok..work A LOT I get, but make A LOT = What? 350k? 500k? 100 billion dollars?

About 150 billion . . .

Probably similar to orthopedic hand or joint replacement surgeons.
 
Disagree with a couple of specialty placements, but otherwise, a nicely updated list.

Thank you, sir.
 
hmm interesting list. I've actually thought about RadOnc before, but I never knew that salary was that high.

So... can someone enligthen me on the path to RadOnc? Is it an IM residency and then a Onc fellowship?

It is its own residency and it is VERY competitive. It would be helpful to have some of the following: high step 1 score, AOA, research experience, a PhD (rad onc has more than any other field) and a physics/math/engineering type undergrad degree.

It is definitely one of the best fields out there if you can match into it.

[edit] I should really read all of the posts before replying to previous ones . . . all this was already stated.
 
Surprising that Pathology isn't more popular. I always knew the lifestyle was good, but I didn't think they made that much. Guess I was wrong...

I am oftentimes surprised that it is not more competitive. I think it is a great specialty if you like looking at slides and don't want to see patients. It is also the only specialty in the top 10 on my list that is not competitive.

I am surprised more people that fail to match into radiology don't go into path. They seem very similar . . . at least they are both found hanging out in the doc's lounge more than the other specialties.
 
Heh, since some of the specialties tend to have more underreported income than others...I think the list should actually have some of them quite a bit higher (basically any procedural specialty where you do elective procedures).

And yes, I really mean derm lol.
 
I am oftentimes surprised that it is not more competitive. I think it is a great specialty if you like looking at slides and don't want to see patients. It is also the only specialty in the top 10 on my list that is not competitive.

At least the sense I get from peers is that this is why most dont go into it. Either they really hate histo, or they like seeing patients live and kickin'. If it werent for the whole being dead thing, I would be much more interested in it, since the rest of it is really cool. I agree that in terms of competitiveness, it should probably be in the upper tier in terms of lifestyle/cheddar.

I am surprised more people that fail to match into radiology don't go into path. They seem very similar . . . at least they are both found hanging out in the doc's lounge more than the other specialties.

Maybe its the dead people thing? :confused:

We are required to watch an autopsy for morning pathology "rounds", and friends of mine who did it already were asking residents about lifestyle. 8-5, no weekends, no call. The attendings "show up when they want". The residents are apparently amazing at dissection too, don't know why they dont show up in anatomy lab...
 
At least the sense I get from peers is that this is why most dont go into it. Either they really hate histo, or they like seeing patients live and kickin'. If it werent for the whole being dead thing, I would be much more interested in it, since the rest of it is really cool. I agree that in terms of competitiveness, it should probably be in the upper tier in terms of lifestyle/cheddar.



Maybe its the dead people thing? :confused:

We are required to watch an autopsy for morning pathology "rounds", and friends of mine who did it already were asking residents about lifestyle. 8-5, no weekends, no call. The attendings "show up when they want". The residents are apparently amazing at dissection too, don't know why they dont show up in anatomy lab...

I think a good deal of path does deal with live patient slides... the autopsy rate has fallen dramatically in the last few decades and it is my understanding that pathologists spend the majority of their time looking at specimens from live patients.

I think this is a common misunderstanding that medical students have.
 
I think a good deal of path does deal with live patient slides... the autopsy rate has fallen dramatically in the last few decades and it is my understanding that pathologists spend the majority of their time looking at specimens from live patients.

I think this is a common misunderstanding that medical students have.

Agree 100%. One of those most valuable thing our pathology department did for our med school is a "What does a Pathologist do?" lecture. Covered a lot of the different options in the field, from those who ran cytology type stuff to surgical path to some forensic pathologists.

I think Path's interest has probably been hurt by the push for the "humanist" approach in admissions. In the old days, dudes who just loved science would be enough to get into med school and a lot of them would be intrigued by the science of path and follow that career. Now adays med schools are focusing more on interpersonal skills, volunteering, etc. So when you have all these people coming into med school who basically entered because they want to work with people, there's less people who are willing to sit in a lab and look at slides all day and not have much patient contact. As for radiology, well, by the time (at our school at least) you get any exposure to the field you've already rotated through medicine, peds, family, etc. and figured out what a pain in the ass some patients can be and people are looking for an escape :) Plus, radiology is more technology based, which appears to the more (self admitted) geek types.
 
Just because you're a pathologist doesn't mean you'll get no patient time. Besides doing things like fine needle aspirations and the like, my dad (a pathologist) would oftentimes go over the diagnosis with the patient. In fact, he's told me stories where he spent literally 2 hours with the same patient talking about their particular diagnosis. He was more interested in the patient side of things, and his practice enabled him to do that. Other pathologists would rather stare down a microscope all day and not see anyone, and that's okay, too. Just know that you can still get some patient contact if you become a pathologist, if you're so inclined.
 
Just because you're a pathologist doesn't mean you'll get no patient time. Besides doing things like fine needle aspirations and the like, my dad (a pathologist) would oftentimes go over the diagnosis with the patient. In fact, he's told me stories where he spent literally 2 hours with the same patient talking about their particular diagnosis. He was more interested in the patient side of things, and his practice enabled him to do that. Other pathologists would rather stare down a microscope all day and not see anyone, and that's okay, too. Just know that you can still get some patient contact if you become a pathologist, if you're so inclined.
Hmm, interesting. If it weren't for the fact that I've kinda always sucked at identifying stuff on a microscope, lol.
 
That's a solid list, something I probably should have paid more attention to before I started intern year... but don't get me wrong I love this 33 hour call every few days.

I'd throw up GI somewhere there, probably on the higher end. They have relatively high salaries 280-300 K and amongst the best lifestyles. It's becoming, if not already, the most difficult IM fellowship to attain. Allergy has a great lifestyle too, but pay is less I think. Non invasive cards could be placed higher too- you can have a great lifestyle doing imaging and not spending your day and nights doing emergent caths.

I still think in terms of competitiveness to match, length of residency, and pay/lifestyle you can't beat rads and then doing a specialty in body, MRI etc etc. You will make bank with a great lifestyle. Rad Onc is obviously great, but just by a numbers game, most of us wouldn't match. Go into transplant if you hate your kids and think your wife is ugly
 
That's a solid list, something I probably should have paid more attention to before I started intern year... but don't get me wrong I love this 33 hour call every few days.

I'd throw up GI somewhere there, probably on the higher end. They have relatively high salaries 280-300 K and amongst the best lifestyles. It's becoming, if not already, the most difficult IM fellowship to attain. Allergy has a great lifestyle too, but pay is less I think. Non invasive cards could be placed higher too- you can have a great lifestyle doing imaging and not spending your day and nights doing emergent caths.

I still think in terms of competitiveness to match, length of residency, and pay/lifestyle you can't beat rads and then doing a specialty in body, MRI etc etc. You will make bank with a great lifestyle. Rad Onc is obviously great, but just by a numbers game, most of us wouldn't match. Go into transplant if you hate your kids and think your wife is ugly

HAHAHAH!

Love my kids . . . hot wife . . . hello PM&R!
 
Wow, even at his age??? There comes a point for me where medicine is not worth it anymore, and he exceeded that about 30hrs ago for me...and I've wanted to do this since I was 4...
Yep. He's somewhere around age 50, I believe (older, if anything). No thanks. I think 60 hours a week is about as much as I'd ever be interested in doing for the duration of a career.
 
Heard hem/onc is getting be more and more competitive, according to the dean of my school. But I also hear that its salary is on the decline. Personally, it's what I want to do most because it seems like your work is SO important. But now, supposedly, I gotta to compete like it's cardiology.

I'm confused as to why they link oncology to hem and why it would be particularly competitive given the incredible demand for this work. What is it 30% who die from cancer? Surprised you ranked it above cardiology, I've never actually met someone my age who's interested in hem/onc, though know a few potential ped oncs.

Alas, I have no serious interest in blood. Does anyone know about hem/onc and care to share about whether it should be higher or lower?
 
That's a solid list, something I probably should have paid more attention to before I started intern year... but don't get me wrong I love this 33 hour call every few days.

I'd throw up GI somewhere there, probably on the higher end. They have relatively high salaries 280-300 K and amongst the best lifestyles. It's becoming, if not already, the most difficult IM fellowship to attain. Allergy has a great lifestyle too, but pay is less I think. Non invasive cards could be placed higher too- you can have a great lifestyle doing imaging and not spending your day and nights doing emergent caths.

I still think in terms of competitiveness to match, length of residency, and pay/lifestyle you can't beat rads and then doing a specialty in body, MRI etc etc. You will make bank with a great lifestyle. Rad Onc is obviously great, but just by a numbers game, most of us wouldn't match. Go into transplant if you hate your kids and think your wife is ugly

The relatively uncertain future of radiology is certainly a factor. Even the editor of the specialty's premier journal recently commented that everyone needs to be prepared for outsourcing (ie not just radiologists). IR just announced that they will split from diagnostic radiology in terms of training. The ongoing turf war with VS and cardiology is also something to consider.

I agree with an above poster about Interventional Pain. Sweet lifestyle. Good reimbursement. Cool procedures and massive potential for growth in terms of implants etc.

OP, I think you're list is much better, but I still doubt you really gave preference to lifestyle over $. It looks more 50/50.
 
Heard hem/onc is getting be more and more competitive, according to the dean of my school. But I also hear that its salary is on the decline. Personally, it's what I want to do most because it seems like your work is SO important. But now, supposedly, I gotta to compete like it's cardiology.

I'm confused as to why they link oncology to hem and why it would be particularly competitive given the incredible demand for this work. What is it 30% who die from cancer? Surprised you ranked it above cardiology, I've never actually met someone my age who's interested in hem/onc, though know a few potential ped oncs.

Alas, I have no serious interest in blood. Does anyone know about hem/onc and care to share about whether it should be higher or lower?

If anything maybe heme/onc should be a little higher. Cardiologists work a lot of hours, typically more than heme/onc. As far as I know cardiology and GI are still quite a bit above any of the other IM sub-specs as far as competitiveness but heme/onc is third. My best friend from medical school is hoping to go into heme/onc. He wanted to since very early in med school, maybe before.
 
The relatively uncertain future of radiology is certainly a factor. Even the editor of the specialty's premier journal recently commented that everyone needs to be prepared for outsourcing (ie not just radiologists). IR just announced that they will split from diagnostic radiology in terms of training. The ongoing turf war with VS and cardiology is also something to consider.

I agree with an above poster about Interventional Pain. Sweet lifestyle. Good reimbursement. Cool procedures and massive potential for growth in terms of implants etc.

OP, I think you're list is much better, but I still doubt you really gave preference to lifestyle over $. It looks more 50/50.

Maybe that is even better. I am trying; maybe I will do another revision one of these days. I guess I wanted to make a list that reflected my preferences for a specialty somewhat and lifestyle was #1 in my book. There are of course MANY other factors but I feel like if all other things were equal and only lifestyle and money were different that this list is fairly close to how I would chose.

I then thought about other factors for me. I don't want to do surgery, but procedures are ok. I prefer clinic/outpatient care. I was not a highly competitive applicant. I chose physiatry. The only specialties that fit my criteria that are above that are occupational medicine and interventional pain. My dad is an occ med doc and I can work with him if I chose and I can go into interventional pain from PM&R. Not sure what my point is but I took the time to write that and I am not deleting it.
 
Huh? Link?

from : http://www.auntminnie.com/forum/tm.aspx?m=107078




" The July/August IRNews has some interesting information about a VIR primary certificate. Dr. Kaufman outlines the details, and Dr. Benenati writes that the proposal will be submitted to the ABR at the end of June 2007 (I wonder if he means 2008?). Basically, the primary certficate would pull IR out from under DR, and IR would stand on equal footing as an entirely separate specialty such as Rad Onc.

Dr. Benenati writes: "The primary certificate in VIR will stand separate from diagnostic radiology but still within the ABR, similar to radiation oncology. Current training options for VIR, all of which lead to first a primary certificate in diagnostic radiology and then a subspecialty certificate in VIR, will co-exist with the primary certificate in VIR.

"However, a fundamental distinction of the primary certificate in VIR is that the product of this training will not be a diagnostic radiologist. The primary certificate in VIR will provide only limited diagnostic imaging training, but extensive clinical and interventional training. In the current proposal, the holder of a primary certificate in VIR could be credentialed in interventional radiology and noninvasive vascular imaging."

As much of diagnostic radiology seems willing to dismiss IR as a dead or dying specialty (a faulty assertion based on the conflation of subspecialty evolution and subspecialty extinction), I am encouraged to see the leaders of IR take the first steps toward a divorce. "


I personally think this hurts both IR and DR... who knows what the fallout will be.
 
Maybe that is even better. I am trying; maybe I will do another revision one of these days. I guess I wanted to make a list that reflected my preferences for a specialty somewhat and lifestyle was #1 in my book. There are of course MANY other factors but I feel like if all other things were equal and only lifestyle and money were different that this list is fairly close to how I would chose.

I then thought about other factors for me. I don't want to do surgery, but procedures are ok. I prefer clinic/outpatient care. I was not a highly competitive applicant. I chose physiatry. The only specialties that fit my criteria that are above that are occupational medicine and interventional pain. My dad is an occ med doc and I can work with him if I chose and I can go into interventional pain from PM&R. Not sure what my point is but I took the time to write that and I am not deleting it.

Interesting. Didn't know pain was an option for PM&R. Are they the same fellowships that take anesthesiology residents? Thats pretty cool.
 
from : http://www.auntminnie.com/forum/tm.aspx?m=107078




" The July/August IRNews has some interesting information about a VIR primary certificate. Dr. Kaufman outlines the details, and Dr. Benenati writes that the proposal will be submitted to the ABR at the end of June 2007 (I wonder if he means 2008?). Basically, the primary certficate would pull IR out from under DR, and IR would stand on equal footing as an entirely separate specialty such as Rad Onc.

Dr. Benenati writes: "The primary certificate in VIR will stand separate from diagnostic radiology but still within the ABR, similar to radiation oncology. Current training options for VIR, all of which lead to first a primary certificate in diagnostic radiology and then a subspecialty certificate in VIR, will co-exist with the primary certificate in VIR.

"However, a fundamental distinction of the primary certificate in VIR is that the product of this training will not be a diagnostic radiologist. The primary certificate in VIR will provide only limited diagnostic imaging training, but extensive clinical and interventional training. In the current proposal, the holder of a primary certificate in VIR could be credentialed in interventional radiology and noninvasive vascular imaging."

As much of diagnostic radiology seems willing to dismiss IR as a dead or dying specialty (a faulty assertion based on the conflation of subspecialty evolution and subspecialty extinction), I am encouraged to see the leaders of IR take the first steps toward a divorce. "


I personally think this hurts both IR and DR... who knows what the fallout will be.

Wow, fascinating stuff.
 
Rad Onc is obviously great, but just by a numbers game, most of us wouldn't match.

Rad onc has been touched on, so I'll be brief. It is definitely a competetive specialty, but I don't know if I would discourage anyone interested based on the numbers. Certainly if all of us applied, well sure, most of us wouldn't match because there are so few spots. But like most of the competetive specialties, it self-selects out those who really have no chance and thus don't even bother to apply. However it might surprise you how little it takes for one to have a chance.

The limiting factor for many people is step I, but you don't need to be off the charts if your application is strong in other ways, especially in research. Mean step I score is 235 with 25th to 75th percentile range 223-248. AOA is not nearly as important as it is for some of the other fields; it certainly helps if you are AOA but it is by no means crucial. Same for PhD. See http://www.nrmp.org/data/chartingoutcomes2007.pdf for details.

What I'm getting at is you CAN get in by working your butt off even if you don't have a stratospheric step I, you just have to start early and do lots of research. The problem is most people have no exposure to rad onc until very late in their clinical rotations, if at all. I had no idea I wanted to go into rad-onc until midway through my third year and I was scrambling to get some research done.
 
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Interesting. Didn't know pain was an option for PM&R. Are they the same fellowships that take anesthesiology residents? Thats pretty cool.

In general, yes. There are PM&R only pain programs I believe (don't quote me on this), but generally I have seen PM&R residents apply to pain programs housed within gas departments. Much easier to get a spot applying as an anesthesia resident though, from what I understand you have to be a pretty great PM&R resident to land a gas spot.
 
Interesting. Didn't know pain was an option for PM&R. Are they the same fellowships that take anesthesiology residents? Thats pretty cool.

They have a few of their own pain fellowships, some accredited, some not. PM&R residents can also apply to anesthesia pain programs. There is some preference given for anesthesia residents but I don't know how much. I suppose it varies by program.
 
At least the sense I get from peers is that this is why most dont go into it. Either they really hate histo, or they like seeing patients live and kickin'. If it werent for the whole being dead thing, I would be much more interested in it, since the rest of it is really cool. I agree that in terms of competitiveness, it should probably be in the upper tier in terms of lifestyle/cheddar.



Maybe its the dead people thing? :confused:

We are required to watch an autopsy for morning pathology "rounds", and friends of mine who did it already were asking residents about lifestyle. 8-5, no weekends, no call. The attendings "show up when they want". The residents are apparently amazing at dissection too, don't know why they dont show up in anatomy lab...

I would agree, but the patient contact in path can't possibly be that much different than the patient contact in radiology. And you don't get headaches from sitting in dark rooms staring at computers...
 
Man, I am allll over 7 thru 10. Hell yes I like loupes and power tools. Fck no I don't want to touch your guts, and my sutures are prettier than yours.
 
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