MS3 deciding specialty-rad/anesthesia/EM

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medschoolwithb

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MS3 not sure what i want to do rest of my life, so I wrote my top 3 specialty pro/con.

A little bit about me- former ICU nurse, introverted/chill person, my favorite hobby is exploring new coffee shops and read/study lol, cooking, swimming/beach on sunny days.

What I want: Lifestyle/want to see sun/fairly predictable hours( but I'd rather do very long 3 days than 8hr 6days), cool procedures, need a dose of stress here and there, SOME* patient interaction, shift work, introverted personality fit

Don’t want: talking/calling people like hospitalists, public speaking, paperwork/social work, don't like vanilla/routine work, TOO much stress
Screenshot 2024-11-05 at 1.20.09 PM.png

I keep going back and forth. I think I could do any of the specialty and be okay. I find anesthesia and EM more thrilled and make me excited to learn. But not sure if i will be "good," because I'm soft spoken. I'm good at learning/test taking so i think i will be good at radiology, but the field doesn't excites me. Any insights?

*DR only, not considering IR.
 
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I'll add 2 cents here. Unless you're out west there will be a lot of supervising midlevels in anesthesia vs one patient at a time. EM is A LOT of patient interaction as well as not necessarily always pleasant interactions with colleagues while trying to admit patients. Interventional radiology involves procedures and hits most of your wants but hours can be surgeon style.

Being soft spoken doesn't eliminate any of the fields you are considering.
 
IkeBoy18 said:
I'll add 2 cents here. Unless you're out west there will be a lot of supervising midlevels in anesthesia vs one patient at a time. EM is A LOT of patient interaction as well as not necessarily always pleasant interactions with colleagues while trying to admit patients. Interventional radiology involves procedures and hits most of your wants but hours can be surgeon style.

Being soft spoken doesn't eliminate any of the fields you are considering.
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Em is supervision now too
 
Hard to change what excites you, but do you think you've had enough taste of radiology to understand what it's like to be the radiologist? Watching over the shoulder a few hours isn't enough. Have you made a diagnosis on a patient before someone else has, on any rotation?
 
EM's future is pretty dim and honestly hard to recommend these days. You'd really have to love that specially to match in it. Also, never discount the pain of working nights, weekends and holidays. Those odd hours aren't so bad when you're young and everything is new/exciting but it gets old very quickly.

I was between these specialties when I was a medical student.

I think you can't go wrong with radiology or anesthesiology (this really echo's r/medicalschool's mantra lol). Choose which you see yourself being happy in and which will be a sustainable job as you get older. Try to get as much exposure as you can in order to help make your decision.

I thought I would do radiology when I was first starting medical school and spent my summer doing research in the radiology department. I really wanted to love the specialty (working from home sounded amazing) but ultimately discovered it wasn't for me. Both pay plenty. Residency goes by pretty quickly. An extra year or two to do the job you enjoy for 20-35 years will seem small in retrospect.
 
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Psychiatrist my friend that is the big growth field with the mental health , remote work, tons of flexibility and the pay is up tremendously in that field. My psych friend didn’t even step foot in her clinic for the last 3 weeks. She was “working” in Naples Florida. Her home base is Memphis suburbs of Germantown TN.
 
nimbus said:
Radiology. That’s where the magic will happen.

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I’d do radiology if I were to choose again. I understand the production pressure there and the concern over missing things, but in anesthesia no one told me I’d very likely be supervising CRNAs unless I lived on the west coast. A lot of the ‘hands on’ and ‘one patient at a time’ enjoyment of anesthesia is completely lost in supervision. Not the case w radiology. Plus radiology seems very mentally stimulating. Maybe too much.

Wouldn’t pick EM. Not a chance.
 
aneftp said:
Psychiatrist my friend that is the big growth field with the mental health , remote work, tons of flexibility and the pay is up tremendously in that field. My psych friend didn’t even step foot in her clinic for the last 3 weeks. She was “working” in Naples Florida. Her home base is Memphis suburbs of Germantown TN.
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Unless your doing PP which most people trust me will not do your looking at 250-300k with midlevels exploding in the field. Sure remote work at some places is great until they get a midlevel at half the cost who will gladly come in person and trust me our clinics are constantly being hounded by newly online minted midlevels always "checking" to see if any psychiatrists are planning on retiring soon. Don't be fooled there is absoultely no shortage in the areas your want to live due to massive NP/PA online psych push. They haven't hired anyone but midlevels in the several years i've been there and the second the bots get full autonomy I'll probably get the boot.
 
dabears505 said:
Rads. No question. Interventional Rads is the future
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100%. I wouldn't even go into medicine nor suggest anyone to go into it if they are not going into something surgical and/or rads, gas, or IM subspeicality procedural based: GI, Cards, pul, cc, heme/onc. Everything else will likely be mid level based with 1 MD supervising the drones.

IMO rads probably has the best job protection after surgical and IM procedural specialities of any field, no mid level threat, insane and ever increasing volume and ability to do work remotely. Insane demand, high pay, and no mid level and a failed AI threat is the trifecta in an era when you have to worry about mid levels competing with docs and they will all be autonomous in next few years nationwide.

We screwed up how we got paid and pharma and insur got the real gold then we let them devalue the whole field on top of that with the whole online mid level movement. Just sad.
 
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Radiology:
My understanding is that it's a common misconception DR doesn't do procedures. I did a med school rotation where the radiologists were doing several procedures per day, such as liver biopsies, in-between reading studies. These procedures involve anesthesiology-like levels of patient interaction. I'd look into how much of a limitation this puts on the dream of reading studies on the beach.

Anesthesiology:
- I used to be a night owl and loved sleeping in. Now I couldn't if I wanted to. Getting to work at 7 am isn't what I'd be doing if I had a billion dollars, but it almost doesn't bother me at all.
- As an attending, I don't have problems with the surgeons I work with. At a minimum, we respect one another and get the job done. I have a "work friend" relationship with most of them. The surgeon problem can be real, but is probably overblown and varies by anesthesiologist.

EM:
I've personally found an inverse relationship between the peak satisfaction high I get from a clinical job and my desire to go into work once it becomes routine.

Having done an above average number of EM rotations, one of my favorite feelings is firing on all cylinders running around the ED. But it's so much emotional, physical, and mental labor, that it quickly becomes unpleasant to shift back-and-forth from resting at home to ED mode. I find my pain practice more like EM in this regard than my anesthesiology practice, and thus don't have the same Sunday scaries about going to work as an anesthesiologist. I assume rads is even more pleasant.
 
A Deep Breath said:
Having done an above average number of EM rotations, one of my favorite feelings is firing on all cylinders running around the ED. But it's so much emotional, physical, and mental labor, that it quickly becomes unpleasant to shift back-and-forth from resting at home to ED mode. I find my pain practice more like EM in this regard than my anesthesiology practice, and thus don't have the same Sunday scaries about going to work as an anesthesiologist. I assume rads is even more pleasant.
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Rads here - it is pleasant generally. After-hours/weekend shifts are the most mentally taxing due to volume and duration but it is all a cognitive labor and zero socioemotional or physical labor. I used to get Friday evening scaries for my extra-long weekend "call" shifts (6x a year) but it's mostly just about making sure I'm going to bed early enough.
 
You have a very poor understanding of radiology. What is your exposure?

Radiology is great. Anesthesiology is great. Several other fields are great. The truth is that most people would be happy in multiple fields barring some specific characteristic of their life/family/career goals. That said, you need to start the decision tree from a true understanding of what each specialty is and is not and what it takes to get to each practice scenario as an attending. I'm not really sure you are there yet and I think there is no replacement for real life exposure to realistic practice settings despite how phenomenal the anesthesia subforum is.
 
ToKingdomCome said:
How Much is rads clearing on average in an average city
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My friend is getting job offers from private practices currently that are pretty consistently in the $600-$800K range, with 10-15 weeks of vacation. One he just showed me was $700K base pay for 4 days/week and no nights or weekends. Plus a $100K sign on bonus. That was western CO though so more small town rural.
 
abolt18 said:
My friend is getting job offers from private practices currently that are pretty consistently in the $600-$800K range, with 10-15 weeks of vacation. One he just showed me was $700K base pay for 4 days/week and no nights or weekends. Plus a $100K sign on bonus. That was western CO though so more small town rural.
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After surgery probably has the most job protection as no mid level threat and the ai issue is not there yet so thats the only thing. Otherwise ability to work remote or more procedural via interven. U r working harder than ever maybe 30-40% more volume than a decade ago and increasing but your job security is off the charts and likely only increasing with the imaging going up.

The downside is just churning through studies non stop but yeah you better not miss anything either so not a cake walk either. IMO the best field in medicine in terms of pay/lifestyle/no midlevel threat and imaging only increasing.
 
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finalpsychyear said:
I have 5 friends/family in the field and everyone is ok talking numbers. They are all 600-700 at the low end non interventional. The numbers above are likely for starting or highly desirable area.
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Ok so a touch more than anesthesia for normal hours. I clear 700K but work a good amount tbh
 
Yeah - there's always going to be a wide range. I saw a spreadsheet recently with anonymous salary contributions. Radiologists range from $350k in an Academic setting in NC to $800k in CA.
 
After a few years, the “excitement” wears off of just about any specialty (the “big stuff” just becomes more stress, rather than excitement). I’m not suggesting you pick something that bores you to tears, just stating the “truth” for 90% of folks.

I don’t see EM as a good recommendation for anyone. I’m sure there’s some decent opportunities out there, but there are SO MANY bad ones, I just can’t imagine committing to a career in something that has the potential to go so wrong.

I tell anyone going into Anesthesiology to plan on doing a fellowship. It’s only one extra year, it makes you WAY more marketable, and in a downturn, you’ll have the opportunity at jobs in peds/cardiac that are WAY better than what the average general anesthesiologist can get.

You’re not gonna starve with any of them, but ask yourself, “Which specialty is going to provide me a relatively “stress-free” life at the age of 45, so that I can do things (be it work or hobbies) that I WANT to do, not that I HAVE to do?”.

Excessive night shifts, holidays, weekends, hours, pandemonium——is NOT where you want to be after age 50. Choose accordingly.
 
I'm biased as an IM radiology prelim. Id say do rads, but cant go wrong with anesthesia too, pain is a good choice out of anesthesia as are the other subspecialties. Would also recommend GI and heme/onc to med students. I think GI/onc/anes/rads are all grouped in high-earning fields that are obtainable if you work hard (unlike derm or nsgy/ortho, need to be a rockstar). Would avoid EM and gen fm/IM like the plague. Psyc seems like its ripe for midlevel takeover.

Also, breast radiology does a lot of procedures, has a lot of patient contact, and has a lot of leverage within groups, look into that OP.
 
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finalpsychyear said:
100%. I wouldn't even go into medicine nor suggest anyone to go into it if they are not going into something surgical and/or rads, gas, or IM subspeicality procedural based: GI, Cards, pul, cc, heme/onc. Everything else will likely be mid level based with 1 MD supervising the drones.

IMO rads probably has the best job protection after surgical and IM procedural specialities of any field, no mid level threat, insane and ever increasing volume and ability to do work remotely. Insane demand, high pay, and no mid level and a failed AI threat is the trifecta in an era when you have to worry about mid levels competing with docs and they will all be autonomous in next few years nationwide.

We screwed up how we got paid and pharma and insur got the real gold then we let them devalue the whole field on top of that with the whole online mid level movement. Just sad.
Click to expand...
One major con I've heard from radiologists; now with the explosion of midlevels, they often check the chart, and more and more often the radiologist is the only MD involved in the patient's case, truly terrifying stuff
 
finalpsychyear said:
I have 5 friends/family in the field and everyone is ok talking numbers. They are all 600-700 at the low end non interventional. The numbers above are likely for starting or highly desirable area.
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Ive been told by pp its give or take 20k a week as a partner, telerads, locums, or interventional stuff could potentially be more
 
DirtDocMD said:
After a few years, the “excitement” wears off of just about any specialty (the “big stuff” just becomes more stress, rather than excitement). I’m not suggesting you pick something that bores you to tears, just stating the “truth” for 90% of folks.
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This is key IMO. The exciting situations as a medical student will instead often cause anxiety as an attending. Residency will only take you so far. When you come an attending, each uncertain scenario you encounter is a chance for a bad patient outcome. That can lead to a lawsuit and further anxiety/unhappiness with your career.

Hence I feel that there is a relatively higher burnout rate in EM (lots of uncertainty in patient encounters, following established clinical decision-making rules or departmental protocol doesn't always protect you, etc.). As a non-EM doc, from my perspective you need to really be strong with uncertainty, and have a lot of emotional bandwidth to deal with difficult patients & consultants to enjoy EM long term IMO.

I keep going back and forth. I think I could do any of the specialty and be okay. I find anesthesia and EM more thrilled and make me excited to learn. But not sure if i will be "good," because I'm soft spoken. I'm good at learning/test taking so i think i will be good at radiology, but the field doesn't excites me. Any insights?
Click to expand...

The best docs in acute situations are those who can keep their cool. Shouting doesn't make you good. If you're literally quiet volume-wise, you will learn to speak to be heard.
 
Clean7795 said:
The best docs in acute situations are those who can keep their cool. Shouting doesn't make you good. If you're literally quiet volume-wise, you will learn to speak to be heard.
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This is true. Best trauma surgeons, cardiac surgeons and anesthesiologists all get quiet, turn off the radio, focus, and speak softly when things go south. They get more chatty and the music goes back on when things are under control.
 
Absolutely do not do EM. Trash field.

Be fast, be perfect, satisfy the patient. How can you do all three?

Way too much patient / nursing interaction.

Way too dependent on whatever resources the hospital chooses to provide that day. Guess who takes the fall for that?

Way too many evening/nights, weekends, holidays.

Extremely non-intellectual.

Stagnant pay.

Wish I did rads.
 
Agree with most sentiments here. Rads vs anesthesia is a question with pros cons and interest determining it for people.

EM is a field that can be and is done by independent online degree NPs. Need docs for high acuity situations but 95% of it is social problems, intoxications and non emergent minor complaints. Very little undifferentiated shock or acute onset pain.

Not to mention skill atrophy is extremely real. I’ve literally never seen a non level 1 trauma center emergency doctor comfortable with doing central or arterial lines on people who need them. Embarrassment to doctors most of the time imo
 
hopefulraddaddypls said:
One major con I've heard from radiologists; now with the explosion of midlevels, they often check the chart, and more and more often the radiologist is the only MD involved in the patient's case, truly terrifying stuff
Click to expand...


Unless it’s an anesthesia case 😂
 
Artificial intelligence has a lot of radiologists worried

Not sure how the future will play out or if it’s a truly real concern.
 
T-burglar said:
AI is going to enhance the field of radiology , not destroy the need for radiologists
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By enhance do you mean increase their productivity?

That could mean increased revenue generation in the short term and decreased demand for radiologists in the long term. You don’t have to replace radiologists entirely to destroy their field.

Just look at what mid levels have done to EM.
 
DesiredMemberName? said:
By enhance do you mean increase their productivity?

That could mean increased revenue generation in the short term and decreased demand for radiologists in the long term. You don’t have to replace radiologists entirely to destroy their field.

Just look at what mid levels have done to EM.
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Radiology hasn't increased training spots, and the average rad is 56 years old
 
DesiredMemberName? said:
By enhance do you mean increase their productivity?

That could mean increased revenue generation in the short term and decreased demand for radiologists in the long term. You don’t have to replace radiologists entirely to destroy their field.

Just look at what mid levels have done to EM.
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No I mean machine learning is already enhancing imaging diagnosis in very interesting ways. If AI ever completely eliminates a radiologist none of us will have jobs
 
T-burglar said:
No I mean machine learning is already enhancing imaging diagnosis in very interesting ways. If AI ever completely eliminates a radiologist none of us will have jobs
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Its also very easy for a rads to pivot into something procedural (pain, breast, it, nir)
 
The last major salary constriction with anesthesia occurred in 1993 with the Clinton administration (3-4 year lag) and salaries tanked for 5-6 years

Same with Obama and Obamacare taking place circa 2013-20218.

So since trump won. Anesthesia should be ok.
 
aneftp said:
The last major salary constriction with anesthesia occurred in 1993 with the Clinton administration (3-4 year lag) and salaries tanked for 5-6 years

Same with Obama and Obamacare taking place circa 2013-20218.

So since trump won. Anesthesia should be ok.
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Hopefully Elon and Vivek won’t have their way. To Elon, we’re no different than workers on a Tesla factory floor.
 
nimbus said:
Hopefully Elon and Vivek won’t have their way. To Elon, we’re no different than workers on a Tesla factory floor.
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Vivek don’t know too much about except he likes tennis. Which I like.
Elon is crazy as we all know. A good article written by his first wife. They met in college.

www.marieclaire.com

"I Was a Starter Wife": Inside America's Messiest Divorce

In the middle of her headline-grabbing divorce settlement from Elon Musk, Justine Musk reveals the truth about her marriage.
www.marieclaire.com www.marieclaire.com

Combination of being spoiled brat growing up. And too much money too early.

But all those tech guys are like that
 
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