"Lifestyle" specialties in 2017

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JPSmyth

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Hi guys,

There seems to be a lot of cynicism about "lifestyle" specialties on these forums. I was hoping some current residents/attendings would be able to chime in on this subject.

To me, lifestyle means less than 60 hours per week, pay over 300k, and a moderate call schedule. I understand that there is a trade off between cutting back hours and having a corresponding decrease in salary in any field, but I am asking in general here.

The specialties that I believe may fit this criteria are: derm, rad onc, ophtho, radiology, pathology, anesthesiology (hours ?), PM&R (pay?), neurology (hours?), psych (pay?)

Before I get slaughtered for not searching this on my own, I've been a member on SDN for a few years and I have been looking into this independently for a long time now. I was hoping to spark a discussion and see how my listed fields are looking in 2017 and going forward into the future, and if there are other fields I'm forgetting to mention!

Thanks
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I'd say the lifestyle specialties in 2017 are pretty much the same as the lifestyle specialties in 2016.
 
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For starters, this should be posted here: https://forums.studentdoctor.net/forums/pre-medical-allopathic-md.10/ , hopefully one of the mods can get it moved.

Now, meat and potatoes...

First, definitions. Few people include pay in their definitions of lifestyle. And it throws problems into discussions of specialties for many reasons, some of which I will try to explain. Beyond this, there aren't that many physicians that average more than 60 hours per week. They certainly exist, but after people graduate from residency, the vast majority work less than 60, so it is somewhat of a poor dividing line. Lastly, call schedule. What is moderate? 1 night in 4? 1 weekend a month? It also depends on how brutal the calls are. You can be 'on call' 24/7 like some private practice guys are in many different specialties, but if you only ever get called once a week and only have to come in once a month, it doesn't really matter to most people. These definition issues are a fundamental problem when talking about 'lifestyle' before you start in a career in medicine. Not because it isn't important, but because a lot of it appears to be hand waving and most lack the context to put this into perspective. For example, Vascular Surgery is widely regarded as one of the worst specialties when it comes to lifestyle, but the majority of vascular surgery positions will have you working at just about 60 hours per week, pay you more than 300k and have a reasonable call schedule. I know, having been paying attention to the job market for some time now as a PGY5.

Second, the trap that the vast majority of pre-meds, medical students and even residents fall into is thinking that academic practices are how medicine is administered across the country, when the reality is that the vast majority of physicians do not practice academic medicine. Thus, the vast majority of health care is not delivered by academic clinicians. Practices vary widely, even within specialties and further, it isn't like most people do it one way and a handful do it differently. There are a lot of different business models, systems and compensation structures. It all depends on what you are looking for. It sounds childishly simple, but money does not buy happiness. While everyone wants a higher salary, being happy at your job while making good money tends to rule at the end of the day. Your compensation is less driven by specialty and more driven by practice environment and how you want to practice, baring a fundamental shift in how physicians are reimbursed, this is not going to change for a long time.
 
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mimelim said:
For starters, this should be posted here: https://forums.studentdoctor.net/forums/pre-medical-allopathic-md.10/ , hopefully one of the mods can get it moved.

Now, meat and potatoes...

First, definitions. Few people include pay in their definitions of lifestyle. And it throws problems into discussions of specialties for many reasons, some of which I will try to explain. Beyond this, there aren't that many physicians that average more than 60 hours per week. They certainly exist, but after people graduate from residency, the vast majority work less than 60, so it is somewhat of a poor dividing line. Lastly, call schedule. What is moderate? 1 night in 4? 1 weekend a month? It also depends on how brutal the calls are. You can be 'on call' 24/7 like some private practice guys are in many different specialties, but if you only ever get called once a week and only have to come in once a month, it doesn't really matter to most people. These definition issues are a fundamental problem when talking about 'lifestyle' before you start in a career in medicine. Not because it isn't important, but because a lot of it appears to be hand waving and most lack the context to put this into perspective. For example, Vascular Surgery is widely regarded as one of the worst specialties when it comes to lifestyle, but the majority of vascular surgery positions will have you working at just about 60 hours per week, pay you more than 300k and have a reasonable call schedule. I know, having been paying attention to the job market for some time now as a PGY5.

Second, the trap that the vast majority of pre-meds, medical students and even residents fall into is thinking that academic practices are how medicine is administered across the country, when the reality is that the vast majority of physicians do not practice academic medicine. Thus, the vast majority of health care is not delivered by academic clinicians. Practices vary widely, even within specialties and further, it isn't like most people do it one way and a handful do it differently. There are a lot of different business models, systems and compensation structures. It all depends on what you are looking for. It sounds childishly simple, but money does not buy happiness. While everyone wants a higher salary, being happy at your job while making good money tends to rule at the end of the day. Your compensation is less driven by specialty and more driven by practice environment and how you want to practice, baring a fundamental shift in how physicians are reimbursed, this is not going to change for a long time.
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Vascular surgery isn't a fellowship?
 
mimelim said:
There are two primary pathways, 2 year fellowship after general surgery and 5 year residency straight out of medical school. They both end at the same point, board certification in vascular surgery.
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Wow that is awesome.
Matthew9Thirtyfive said:
Also, if you troll the pathology forum, it seems like path is the ultimate lifestyle specialty since you won't have a job after residency. Although you won't be getting paid either.
Click to expand...
I guess that is a field where connections literally matter and what residency you go to.
 
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JPSmyth said:
The specialties that I believe may fit this criteria are: derm, rad onc, ophtho, radiology, pathology, anesthesiology (hours ?), PM&R (pay?), neurology (hours?), psych (pay?)
Click to expand...
Off the top of my (non-expert) head:

derm, ophtho, radios, ENT, urology, plastics come to mind as the most hyped for "lifestyle" balance between pay, effort, and schedule

Emergency tends to be less competitive but can let you work a clock in, clock out style schedule for a few (long) days per week

Psych also less competitive but yeah, if you like that kind of work, you can have a nice schedule and hours

Then there are a lot of not very competitive options where you can find ways to work lower hours but you also won't make a lot (e.g. pediatrics, PM&R)
 
efle said:
Off the top of my (non-expert) head:

derm, ophtho, radios, ENT, urology, plastics come to mind as the most hyped for "lifestyle" balance between pay, effort, and schedule

Emergency tends to be less competitive but can let you work a clock in, clock out style schedule for a few (long) days per week

Psych also less competitive but yeah, if you like that kind of work, you can have a nice schedule and hours

Then there are a lot of not very competitive options where you can find ways to work lower hours but you also won't make a lot (e.g. pediatrics, PM&R)
Click to expand...

I've read a couple things on the resident forums that ENT has an opportunity for being a lifestyle specialty in practice, but a lot of them still work pretty long hours. And they get hammered in residency.
 
Well here is some fun data !

Hours worked by specialty, realtive to FM (2011):

ild15019f1.png


Regression for percentage reporting they are "very satisfied" and "dissatisfied" (2002)

ZR7rrt3.png
Ipsw2g5.png


Mean ratings and regression relative to FM (2009) - too big to embed I think

All of this from freely available sources

1 and 2 and 3
 
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To make sense of that data... is that total hours per year compared to FM? What is the base number for FM used in this?
 
efle said:
Well here is some fun data !

Hours worked by specialty, realtive to FM (2011):

ild15019f1.png


Regression for percentage reporting they are "very satisfied" and "dissatisfied" (2002)

ZR7rrt3.png
Ipsw2g5.png


Mean ratings and regression relative to FM (2009) - too big to embed I think

All of this from freely available sources

1 and 2 and 3
Click to expand...

Surprised Neurosurgery is below several other surgical specialties, although the range is greater for individual responses. Also, been a while since I did stats, so how are these satisfaction/dissatisfaction numbers to be interpreted?
 
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Frogger27 said:
To make sense of that data... is that total hours per year compared to FM? What is the base number for FM used in this?
Click to expand...
Yep total hours relative to FM. They actually don't state what the FM median was. Easiest way to think of it is to divide the hours over/under by ~50 and call that "weeks" in my opinion. Derm gets ~7 weeks less per year relative to FM (while earning more per year!!), while an oncologist works ~7 weeks more than FM.
 
efle said:
Yep total hours relative to FM. They actually don't state what the FM median was. Easiest way to think of it is to divide the hours over/under by ~50 and call that "weeks" in my opinion. Derm gets ~7 weeks less per year relative to FM (while earning more per year!!), while an oncologist works ~7 weeks more than FM.
Click to expand...

I am guessing the median for FM can't be that much over 40hrs/week... The fact that derm is 7 weeks less is amazing. Time to become a gunner.
 
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UNMedGa said:
Surprised Neurosurgery is below several other surgical specialties, although the range is greater for individual responses. Also, been a while since I did stats, so how are these satisfaction/dissatisfaction numbers to be interpreted?
Click to expand...
Been a while for me too, but I'm pretty certain you read it as "based on our survey, we find that a randomly selected geriatric IM physician is 2.04 times as likely to describe themselves as very satisfied than a randomly selected FM physician"

Or "a random ENT doc is 1.78 times as likely to describe themselves as dissatisfied relative to a random FM doc"
 
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efle said:
Been a while for me too, but I'm pretty certain you read it as "based on our survey, we find that a randomly selected geriatric IM physician is 2.04 times as likely to describe themselves as very satisfied than a randomly selected FM physician"

Or "a random ENT doc is 1.78 times as likely to describe themselves as dissatisfied relative to a random FM doc"
Click to expand...

Yep. The odds ratio is the ratio of the odds of an event occur in in one group to the odds of it occurring in a second group. So given a sample of IM physicians and FM physicians, a randomly chosen IM doc is 2.04x as likely to describe themselves as very satisfied relative to a random FM doc.
 
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efle said:
Been a while for me too, but I'm pretty certain you read it as "based on our survey, we find that a randomly selected geriatric IM physician is 2.04 times as likely to describe themselves as very satisfied than a randomly selected FM physician"

Or "a random ENT doc is 1.78 times as likely to describe themselves as dissatisfied relative to a random FM doc"
Click to expand...

That's kind of what I thought. I'm not sure I like that metric in lieu of a simple "xx% of respondent physicians in the specialty surveyed said they were satisfied, somewhat satisfied, neutral, dissatisfied etc." kind of like the way Medscape does it. I don't like comparing relative to other specialties when I don't know what the median satisfaction response was for FM.
 
Hows the lifestyle in space medicine?
 
If they standardized this for average income wouldn't this truly give us the "lifestyle" specialties?
 
UNMedGa said:
That's kind of what I thought. I'm not sure I like that metric in lieu of a simple "xx% of respondent physicians in the specialty surveyed said they were satisfied, somewhat satisfied, neutral, dissatisfied etc." kind of like the way Medscape does it. I don't like comparing relative to other specialties when I don't know what the median satisfaction response was for FM.
Click to expand...
I agree. I used that one because they infuriatingly did not sort by % reporting very satisfied in the table showing distributions...ugh.
 
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UNMedGa said:
Surprised Neurosurgery is below several other surgical specialties, although the range is greater for individual responses. Also, been a while since I did stats, so how are these satisfaction/dissatisfaction numbers to be interpreted?
Click to expand...


They messed up neurosurgery on the hours worked graph. It should actually be 688 not 270 (you can't have your number be outside your 95% CI lol - it should be right in the middle), which would make it 3rd on the list.
 
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WedgeDawg said:
They messed up neurosurgery on the hours worked graph. It should actually be 688 not 270 (you can't have your number be outside your 95% CI lol - it should be right in the middle), which would make it 3rd on the list.
Click to expand...

Thought that was weird, but I didn't look at the numbers. Good catch.
 
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WedgeDawg said:
They messed up neurosurgery on the hours worked graph. It should actually be 688 not 270 (you can't have your number be outside your 95% CI lol - it should be right in the middle), which would make it 3rd on the list.
Click to expand...
I think the error was accidentally putting a minus sign in front of the 418. (-418 + 958) / 2 = 270. 688 makes a lot more sense.

Edit: nevermind, pretty sure this was published in the main JAMA IM. Come on people!
 
Last edited:
JPSmyth said:
Hi guys,

There seems to be a lot of cynicism about "lifestyle" specialties on these forums. I was hoping some current residents/attendings would be able to chime in on this subject.

To me, lifestyle means less than 60 hours per week, pay over 300k, and a moderate call schedule. I understand that there is a trade off between cutting back hours and having a corresponding decrease in salary in any field, but I am asking in general here.

The specialties that I believe may fit this criteria are: derm, rad onc, ophtho, radiology, pathology, anesthesiology (hours ?), PM&R (pay?), neurology (hours?), psych (pay?)

Before I get slaughtered for not searching this on my own, I've been a member on SDN for a few years and I have been looking into this independently for a long time now. I was hoping to spark a discussion and see how my listed fields are looking in 2017 and going forward into the future, and if there are other fields I'm forgetting to mention!

Thanks
Click to expand...
Family med in ND/thread
 
efle said:
I think the error was accidentally putting a minus sign in front of the 418. (-418 + 958) / 2 = 270. 688 makes a lot more sense.

Edit: nevermind, pretty sure this was published in the main JAMA IM. Come on people!
Click to expand...

Even JAMA reviewers miss things
 
I'm interested in PM&R, but the specialty seems kind of vague. Is it stable?
 
efle said:
Well here is some fun data !

Hours worked by specialty, realtive to FM (2011):

ild15019f1.png


Regression for percentage reporting they are "very satisfied" and "dissatisfied" (2002)

ZR7rrt3.png
Ipsw2g5.png


Mean ratings and regression relative to FM (2009) - too big to embed I think

All of this from freely available sources

1 and 2 and 3
Click to expand...
For those of you wondering where gas falls in, it's right around 60 hrs based on what I've seen and heard. As for the range, your guess is as good as mine.
 
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efle said:
I think the error was accidentally putting a minus sign in front of the 418. (-418 + 958) / 2 = 270. 688 makes a lot more sense.

Edit: nevermind, pretty sure this was published in the main JAMA IM. Come on people!
Click to expand...

I think you can contact the authors of the paper if you find an error
 
zero0 said:
For those of you wondering where gas falls in, it's right around 60 hrs based on what I've seen and heard. As for the range, your guess is as good as mine.
Click to expand...
Gastro is on there! 60 might be a bit of an overestimate I think, the paper did say that ~2400/year (or ~48/week) was the overall average among physicians. I think Gastro would be more like ~50/week.
 
efle said:
Gastro is on there! 60 might be a bit of an overestimate I think, the paper did say that ~2400/year (or ~48/week) was the overall average among physicians. I think Gastro would be more like ~50/week.
Click to expand...
I'm kinda shocked you don't know this. Gas = anesthesiology; GI = gastroenterology for the purpose of these forums.
 
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zero0 said:
I'm kinda shocked you don't know this. Gas = anesthesiology; GI = gastroenterology for the purpose of these forums.
Click to expand...
No kidding, in a couple years and thousands of posts I don't think I ever saw anesthesia get called anything but anesthesia
 
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efle said:
Gastro is on there! 60 might be a bit of an overestimate I think, the paper did say that ~2400/year (or ~48/week) was the overall average among physicians. I think Gastro would be more like ~50/week.
Click to expand...

I think "gas" usually refers to anesthesiology. (Edit: got sniped! Still wondering why it isn't in that chart though.)
 
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wildcherry said:
I'm interested in PM&R, but the specialty seems kind of vague. Is it stable?
Click to expand...

It's quite well defined, but people outside PM&R don't always know what we do. Put simply, we diagnose and treat people with disabling conditions and our focus is on improving function. There are a number of stickies in the PM&R forums that go more into more depth, but that's the basic one-liner.

The field is very stable. As the boomers age, MSK problems and stroke/TBI/SCI become more prevalent, putting us in more demand (most other specialties are also going to have increased demand due to the aging population). In addition, others are better understanding what PM&R does and what we can offer, so our field is also growing because we're getting more referrals.
 
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efle said:
Well here is some fun data !

Hours worked by specialty, realtive to FM (2011):

ild15019f1.png


Regression for percentage reporting they are "very satisfied" and "dissatisfied" (2002)

ZR7rrt3.png
Ipsw2g5.png


Mean ratings and regression relative to FM (2009) - too big to embed I think

All of this from freely available sources

1 and 2 and 3
Click to expand...

Interesting that in the mean ratings link geriatrics and infectious diseases have the highest satisfaction : dissatisfaction ratio even though most people aren't really clamoring over themselves to go into these specialties. I'm still not evens sure what infectious disease physicians do on a day to day basis -- seems like it would be mostly research-oriented, no?

On a side note, wouldn't allergy + immunology and infectious diseases have quite a bit of overlap, at least in an academic setting (esp. the immunology side)?
 
numbersloth said:
Interesting that in the mean ratings link geriatrics and infectious diseases have the highest satisfaction : dissatisfaction ratio even though most people aren't really clamoring over themselves to go into these specialties. I'm still not evens sure what infectious disease physicians do on a day to day basis -- seems like it would be mostly research-oriented, no?

On a side note, wouldn't allergy + immunology and infectious diseases have quite a bit of overlap, at least in an academic setting (esp. the immunology side)?
Click to expand...

ID probably self selects for people who are really interested in the field. It isn't like some of the others in that I don't think it's particularly lucrative, but the hours aren't bad and the work is generally interesting if you're into that sort of thing. I believe research can definitely be a part of it, but lots of ID docs practice mostly clinical medicine consulting on cases where the bug is unknown or running a primary care clinic for HIV patients.
 
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Matthew9Thirtyfive said:
ID probably self selects for people who are really interested in the field. It isn't like some of the others in that I don't think it's particularly lucrative, but the hours aren't bad and the work is generally interesting if you're into that sort of thing. I believe research can definitely be a part of it, but lots of ID docs practice mostly clinical medicine consulting on cases where the bug is unknown or running a primary care clinic for HIV patients.
Click to expand...

Yes, lots of work with STDs (especially HIV) on the clinical side for them if I understand right. I figure these are the guys heavily involved in global and population health and groups like MSF as well.
 
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The median and mean are between 2300-2500. If i had to guess FP docs worked 1900ish hours.
 
efle said:
Well here is some fun data !

Hours worked by specialty, realtive to FM (2011):

ild15019f1.png


Regression for percentage reporting they are "very satisfied" and "dissatisfied" (2002)

ZR7rrt3.png
Ipsw2g5.png


Mean ratings and regression relative to FM (2009) - too big to embed I think

All of this from freely available sources

1 and 2 and 3
Click to expand...

Did they give significance data for the "hours worked" on average compared to family practice? The error bars are heavily overlapping


Sent from my iPhone using Tapatalk
 
LnSin said:
Did they give significance data for the "hours worked" on average compared to family practice? The error bars are heavily overlapping
Click to expand...
The bars are 95% CI so I believe heavy overlap between two given specialties means the difference is not likely significant? Can only be really certain about some of the extreme comparisons like Derm vs FM vs Surgical stuff
 
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