MS4 looking for guidance on specialty decision

[BlessUp]

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M4 at lower tier MD school in northeast. I've done well on boards (25x, 27x) and in school (mostly honors), not yet sure about AOA. I'm feeling a little lost on specialty decision and any guidance would be appreciated. I enjoyed all of my 3rd year clerkships and could see myself doing just about any specialty, which is a precarious situation to be in. I essentially ruled out surgery a while ago due to not liking the lifestyle and the culture, especially of the residency. I have no problem working hard and actually enjoy being busy, but I also have interests outside of medicine. I have considered basically every non-surgical field and have read threads on here ad nauseam. I'm having the problem that the more I read about a field, the more I stress over all the problems in said field (ie, IM, EM, DR, IR/DR, gas), and it turns into a real "paralysis by analysis". I think my top choice at the moment would be IM, but I'm not completely sold on it. I have enjoyed medical school and enjoy clinical problem solving, but when I read about IM residency, I basically only see bad things about how you are worked like a dog and are essentially just writing notes all the time. IM fellowships with procedural aspects are definitely appealing but I also feel like the length of training is too long. I really wish that I had been "gunning" for a specific specialty from day 1, I'd like to take advantage of the fact that I've done very well but I'm having trouble seeing how to do that outside of competitive surgical specialties. For example, if you're a good student applying EM, you win an extra year of residency for your efforts lol. I know that the classic advice would be to go get experience in different fields and see what you like, and I am going to try to do that, but I still feel like a couple weeks elective in rads or gas or whatever still leaves you making a decision with very limited information. Don't really know what I'm looking for here, just had to get some words down on paper. I guess what I'm looking for is any advice from people who went through a similar struggle and found a way to commit to one of these fields?

 

[throwaway1000000]

Lot of people with your stats go into IM. I think IM has the most number of 250+ scorers amongst any field. I have very similar stats and going into IM. I can't see myself really in any other field.

If you think IM is just note writing, don't think you really should go to IM. Maybe that is IM is at community places but really is not how it is at academic places.

If you are not passionate about IM, I think there are better fields that will get you similar money and lifestyle but with easier training. Like derm, rads, urology. ENT and Ortho seem little more stressful but still not bad.

 

[longhaul3]

You didn't mention, ophtho, which is a great field for high achievers who aren't interested in the surgical ethos.

There are great students who apply in every field. In some ways it makes it easier for you as a high achiever in a less competitive specialty (or IM, which is not competitive overall but extremely competitive at the top) because you don't have to round out the rest of your application with endless research and sub-is. You can just choose a specialty some time during 4th year and your stats will get you into a strong program.

IM residency is 3 years. I'm sure it sucks writing notes and being a social worker from noon til night. But it's 3 years.

 

[BlessUp]

Lot of people with your stats go into IM. I think IM has the most number of 250+ scorers amongst any field. I have very similar stats and going into IM. I can't see myself really in any other field.

If you think IM is just note writing, don't think you really should go to IM. Maybe that is IM is at community places but really is not how it is at academic places.

If you are not passionate about IM, I think there are better fields that will get you similar money and lifestyle but with easier training. Like derm, rads, urology. ENT and Ortho seem little more stressful but still not bad.

Thanks for replying. I didn't mean to say that I think that IM is just note writing, just listing an example of downsides that I read. I enjoyed my inpatient medicine rotation and find it engaging to follow patients with complicated problems over their hospital stay. However, I do think that there are truths to many of the criticisms of certain fields, for example that IM spends a lot of time fine tuning pretty notes and is probably not the most efficient field. I am appealed by the idea of rads as super efficient "pure medicine", but also feel that I am good with people and want to utilize my social skills to help patients and interact with coworkers.

 

[Chlorini]

I was like you. I flip-flopped from everything from obgyn to psych to ortho. I chose radiology. I could've been happy in a lot of different fields.

I got along with the surgery people and I probably would've done well in a surgical field. However, I have other interests (family, kids, hobbies, etc), and it just didn't feel right picking a surgical sub-speciality. I didn't love it enough and lifestyle is important to me.

I had a scary encounter on psych--turned me off to the whole field.

I thought about IM, but I was only really interested in rheumatology, endocrinology, or heme/onc. Rheum/endo are pretty low-paying fields (at least I think so) with 6 years of total training. I'm an older student; I just don't see myself doing more training when I could make the same (or more!) as a hospitalist. Heme/onc is competitive/pays well, but I was mostly concerned about my future practice location. I'd like my speciality be flexible/high in-demand and I want to live generally wherever I want--I knew that would be a struggle with heme/onc. I prefer to be a sub-specialist, not a generalist, so I wasn't interested in being a hospitalist. The other IM specialities didn't really appeal to me at all. If you are even semi-interested in GI or cards, I'd say gun for one of those!

That left very few specialities (anesthesia, pathology, radiology). Path just didn't appeal to me. CRNA encroachment made me scared to pick gas. That left rads. Through shadowing, I discovered a sub-speciality of radiology that pays very well, has great hours, and has patient interaction. The training is still long, which I don't like, but it "checked" other boxes.

That's essentially how I picked my field. I think there is a giant leap of faith involved with anything--but if you stay true to yourself and what you need out of medicine, certain fields will stand out.

I figured out that I needed a controllable schedule, location flexibility, very select/specialized group of patients, procedures, and a good paycheck.

I think you have to put your priorities in order (and only you can do this). You can have passion, prestige, lifestyle, or money. Pick two. The only specialty that has them all is probably derm.

 

[BlessUp]

I was like you. I flip-flopped from everything from obgyn to psych to ortho. I chose radiology. I could've been happy in a lot of different fields.

I got along with the surgery people and I probably would've done well in a surgical field. However, I have other interests (family, kids, hobbies, etc), and it just didn't feel right picking a surgical sub-speciality. I didn't love it enough and lifestyle is important to me.

I had a scary encounter on psych--turned me off to the whole field.

I thought about IM, but I was only really interested in rheumatology, endocrinology, or heme/onc. Rheum/endo are pretty low-paying fields (at least I think so) with 6 years of total training. I'm an older student; I just don't see myself doing more training when I could make the same (or more!) as a hospitalist. Heme/onc is competitive/pays well, but I was mostly concerned about my future practice location. I'd like my speciality be flexible/high in-demand and I want to live generally wherever I want--I knew that would be a struggle with heme/onc. I prefer to be a sub-specialist, not a generalist, so I wasn't interested in being a hospitalist. The other IM specialities didn't really appeal to me at all. If you are even semi-interested in GI or cards, I'd say gun for one of those!

That left very few specialities (anesthesia, pathology, radiology). Path just didn't appeal to me. CRNA encroachment made me scared to pick gas. That left rads. Through shadowing, I discovered a sub-speciality of radiology that pays very well, has great hours, and has patient interaction. The training is still long, which I don't like, but it "checked" other boxes.

That's essentially how I picked my field. I think there is a giant leap of faith involved with anything--but if you stay true to yourself and what you need out of medicine, certain fields will stand out.

I figured out that I needed a controllable schedule, location flexibility, very select/specialized group of patients, procedures, and a good paycheck.

I think you have to put your priorities in order (and only you can do this). You can have passion, prestige, lifestyle, or money. Pick two. The only specialty that has them all is probably derm.

Thank you. I could see myself going the GI or cards route. If you don't mind, what was it about those fields that you didn't like?

 

[bigfootisreal]

What about family?

 

[BlessUp]

What about family?

I had a good experience in my FM clerkship and think I could enjoy being a family doc but I prefer IM over FM mostly because of the fellowship options.

 

[OrangePaint]

If you like everything, then relax. You can't make a wrong decision. Think or ask what the worst/ most boring day of each speciality and chose which ever one you would mind the least dealing with time after time.

 

[Chlorini]

Thank you. I could see myself going the GI or cards route. If you don't mind, what was it about those fields that you didn't like?

Cards: if I was going to go with a field that didn’t have a great lifestyle, then I would’ve preferred to do ortho/another surgical field. Also I don’t really like heart pathology.

GI: Definitely thought about it! I just knew I wouldn’t be a happy hospitalist and it scared me to pick IM with the sole purpose of pursuing GI or bust. Radiology has the same length of training, pay is around the same, and I don’t have to “gun” during training. Also...poop...

If you could be happy as a hospitalist, I’d say IM is the way to go.

 

[Dox4lyfe]

I was like you. I flip-flopped from everything from obgyn to psych to ortho. I chose radiology. I could've been happy in a lot of different fields.

I got along with the surgery people and I probably would've done well in a surgical field. However, I have other interests (family, kids, hobbies, etc), and it just didn't feel right picking a surgical sub-speciality. I didn't love it enough and lifestyle is important to me.

I had a scary encounter on psych--turned me off to the whole field.

I thought about IM, but I was only really interested in rheumatology, endocrinology, or heme/onc. Rheum/endo are pretty low-paying fields (at least I think so) with 6 years of total training. I'm an older student; I just don't see myself doing more training when I could make the same (or more!) as a hospitalist. Heme/onc is competitive/pays well, but I was mostly concerned about my future practice location. I'd like my speciality be flexible/high in-demand and I want to live generally wherever I want--I knew that would be a struggle with heme/onc. I prefer to be a sub-specialist, not a generalist, so I wasn't interested in being a hospitalist. The other IM specialities didn't really appeal to me at all. If you are even semi-interested in GI or cards, I'd say gun for one of those!

That left very few specialities (anesthesia, pathology, radiology). Path just didn't appeal to me. CRNA encroachment made me scared to pick gas. That left rads. Through shadowing, I discovered a sub-speciality of radiology that pays very well, has great hours, and has patient interaction. The training is still long, which I don't like, but it "checked" other boxes.

That's essentially how I picked my field. I think there is a giant leap of faith involved with anything--but if you stay true to yourself and what you need out of medicine, certain fields will stand out.

I figured out that I needed a controllable schedule, location flexibility, very select/specialized group of patients, procedures, and a good paycheck.

I think you have to put your priorities in order (and only you can do this). You can have passion, prestige, lifestyle, or money. Pick two. The only specialty that has them all is probably derm.

If you don't mind me asking, whats this sub specialty that also has good hours? I was always told general had the best hours.

 

[Neopolymath]

If you don't mind me asking, whats this sub specialty that also has good hours? I was always told general had the best hours.

Breast I'm guessing

 

[Chlorini]

If you don't mind me asking, whats this sub specialty that also has good hours? I was always told general had the best hours.

Yeah, breast. It’s generally a M-F, 8-5 gig, no call. Great pay. Can be tedious for some, but I love that it mixes procedures with imaging. I do want to take call because I don’t want to lose my general radiology knowledge, but there are plenty of breast-only jobs. I also like having IR still on the table (you can decide on IR at the end of R2). Lifestyle isn’t great obviously, but I like that I can still pick a more procedural field if breast doesn’t work out.

 

[throwaway1000000]

Thanks for replying. I didn't mean to say that I think that IM is just note writing, just listing an example of downsides that I read. I enjoyed my inpatient medicine rotation and find it engaging to follow patients with complicated problems over their hospital stay. However, I do think that there are truths to many of the criticisms of certain fields, for example that IM spends a lot of time fine tuning pretty notes and is probably not the most efficient field. I am appealed by the idea of rads as super efficient "pure medicine", but also feel that I am good with people and want to utilize my social skills to help patients and interact with coworkers.

you are the describing the downsides of being a primary team. But that's the thing in IM, you are responsible for everything related to the patient when they are in the hospital. you get paid for spending part of your time on managing non-medicine problems like discharging patients safely. At reputable and rich institutions, you don't spend much time on disposition of patients as social work will be taking care of most of it.

Writing notes and spending time on non-medicine things like social work issues etc will be part of any inpatient primary service whether that's IM, cardiology, hem/onc, ICU, nephrology, etc. Whether your like for clinical reasoning and problem solving outweighs your dislike for being on a primary service is something you have to weigh.

Good thing about IM is for the most part is flexible. I don't know all the career paths myself but I know cardiologists that do mainly clinic and come in as a consulting service. But I also know cardiologists (including interventionalists and EPs) that work at institutions where they are required to run the primary service whether that's the heart failure service, CCU, general cardiology service, etc.

Some places have a setup where CCU is run only by HF cardiologists and primary service is run by general cardiologists, so the interventionalists and EPs spend most of their time in the cath lab, so it all varies.

Just realize this is IM and it will never be like derm, rads, optho, urology, anesthesia where you are usually a consultant or have a small primary team without much non-medicine things to do. Some ENT specialists like head and neck surgery seemed like they deal with their own non-medicine issues but some like the sinus specialists seemed to be a much more relaxed field like urology and optho. Same with ortho, seemed like a mix. Joint and hip seemed really chill while ortho trauma dealt with typical inpatient issues.

 

[zero0]

Yeah, breast. It’s generally a M-F, 8-5 gig, no call. Great pay. Can be tedious for some, but I love that it mixes procedures with imaging. I do want to take call because I don’t want to lose my general radiology knowledge, but there are plenty of breast-only jobs. I also like having IR still on the table (you can decide on IR at the end of R2). Lifestyle isn’t great obviously, but I like that I can still pick a more procedural field if breast doesn’t work out.

Been looking into breast lately too. You get all that stuff I liked about medicine, patient interaction and procedures, without any of the downsides. Also seems like from my research that the field is currently wide open and you don't even need a fellowship if you're geographically flexible.

 

[Chlorini]

Been looking into breast lately too. You get all that stuff I liked about medicine, patient interaction and procedures, without any of the downsides. Also seems like from my research that the field is currently wide open and you don't even need a fellowship if you're geographically flexible.

Yup! But you should probably get the fellowship if you want to live somewhere cool haha. In the radiology world it is its own thing. It didn’t have any downsides for me! However, you definitely have to like women/be comfortable with giving multiple breast exams a day and be okay with focusing on essentially one disease. Most people that go into radiology are men and a clinic setting with breast exams everyday are generally what they were trying to avoid when they picked radiology haha. This leaves the field wide open/high in-demand.

 

[libertyyne]

M4 at lower tier MD school in northeast. I've done well on boards (25x, 27x) and in school (mostly honors), not yet sure about AOA. I'm feeling a little lost on specialty decision and any guidance would be appreciated. I enjoyed all of my 3rd year clerkships and could see myself doing just about any specialty, which is a precarious situation to be in. I essentially ruled out surgery a while ago due to not liking the lifestyle and the culture, especially of the residency. I have no problem working hard and actually enjoy being busy, but I also have interests outside of medicine. I have considered basically every non-surgical field and have read threads on here ad nauseam. I'm having the problem that the more I read about a field, the more I stress over all the problems in said field (ie, IM, EM, DR, IR/DR, gas), and it turns into a real "paralysis by analysis". I think my top choice at the moment would be IM, but I'm not completely sold on it. I have enjoyed medical school and enjoy clinical problem solving, but when I read about IM residency, I basically only see bad things about how you are worked like a dog and are essentially just writing notes all the time. IM fellowships with procedural aspects are definitely appealing but I also feel like the length of training is too long. I really wish that I had been "gunning" for a specific specialty from day 1, I'd like to take advantage of the fact that I've done very well but I'm having trouble seeing how to do that outside of competitive surgical specialties. For example, if you're a good student applying EM, you win an extra year of residency for your efforts lol. I know that the classic advice would be to go get experience in different fields and see what you like, and I am going to try to do that, but I still feel like a couple weeks elective in rads or gas or whatever still leaves you making a decision with very limited information. Don't really know what I'm looking for here, just had to get some words down on paper. I guess what I'm looking for is any advice from people who went through a similar struggle and found a way to commit to one of these fields?

You shouldnt be completely judging a specialty by what the residency entails.
IM residency is relatively humane compared to some surgical subs.
Seems like you want a procedural field with relatively short length of training with clinical problem solving.

Optho
Derm
Gas
EM
Gen Surg
Neuro subspecialty.

IM subspecialties could work as well.

You really need to come to terms with the fact that residency is the price you pay for the career in terms of time. Not every surgical program has a terrible culture etc. Most interesting fields require 6 + years of training be it IR or GI or Gen Surg with fellowship

 

[Ho0v-man]

Pm&r or gas —> pain

pm&r or FM —> sports med

 

[Damson]

@Chlorini Can we hear more about that scary psych encounter?

 

[Splenda88]

Radiology then IR... You will set yourself well financial without worrying about midlevel encroachment.

 

[BlessUp]

You shouldnt be completely judging a specialty by what the residency entails.
IM residency is relatively humane compared to some surgical subs.
Seems like you want a procedural field with relatively short length of training with clinical problem solving.

Optho
Derm
Gas
EM
Gen Surg
Neuro subspecialty.

IM subspecialties could work as well.

You really need to come to terms with the fact that residency is the price you pay for the career in terms of time. Not every surgical program has a terrible culture etc. Most interesting fields require 6 + years of training be it IR or GI or Gen Surg with fellowship

Thanks for your input. Yeah I've pretty much come to terms with the fact that most careers I'm interested in require long residencies, but I'm not thrilled about it. I think med students generally underappreciate opportunity cost and the time value of money. I also could be more "on board" with the training length if I felt that the system was efficient and that the powers that be had trainees' best interest at heart. But rather it seems apparent to me that the 4th year of med school is essentially useless, and training for certain fields (some EM programs, peds hospitalist!?, interventional cards) keeps getting longer and longer. I understand that its hard to be a cardiologist but is it 6 years after med school hard? Is that 3 years of IM necessary or could we get equal outcomes with 2 years and then fellowship? But I digress. I agree with you that judging a specialty based on the residency is short-sighted but I also think its crazy when people say things like "well even if gen surg sucks, its only 5 years". In my opinion 5 years in one's late 20s early 30s is pretty damn important and not just for career building.

 

[Splenda88]

Thanks for your input. Yeah I've pretty much come to terms with the fact that most careers I'm interested in require long residencies, but I'm not thrilled about it. I think med students generally underappreciate opportunity cost and the time value of money. I also could be more "on board" with the training length if I felt that the system was efficient and that the powers that be had trainees' best interest at heart. But rather it seems apparent to me that the 4th year of med school is essentially useless, and training for certain fields (some EM programs, peds hospitalist!?, interventional cards) keeps getting longer and longer. I understand that its hard to be a cardiologist but is it 6 years after med school hard? Is that 3 years of IM necessary or could we get equal outcomes with 2 years and then fellowship? But I digress. I agree with you that judging a specialty based on the residency is short-sighted but I also think its crazy when people say things like "well even if gen surg sucks, its only 5 years". In my opinion 5 years in one's late 20s early 30s is pretty damn important and not just for career building.

You are one of the med students that seem to understand the system pretty well.

 

[Chlorini]

Thanks for your input. Yeah I've pretty much come to terms with the fact that most careers I'm interested in require long residencies, but I'm not thrilled about it. I think med students generally underappreciate opportunity cost and the time value of money. I also could be more "on board" with the training length if I felt that the system was efficient and that the powers that be had trainees' best interest at heart. But rather it seems apparent to me that the 4th year of med school is essentially useless, and training for certain fields (some EM programs, peds hospitalist!?, interventional cards) keeps getting longer and longer. I understand that its hard to be a cardiologist but is it 6 years after med school hard? Is that 3 years of IM necessary or could we get equal outcomes with 2 years and then fellowship? But I digress. I agree with you that judging a specialty based on the residency is short-sighted but I also think its crazy when people say things like "well even if gen surg sucks, its only 5 years". In my opinion 5 years in one's late 20s early 30s is pretty damn important and not just for career building.

Yup. It blows. Good luck OP.

 

[Chlorini]

@Chlorini Can we hear more about that scary psych encounter?

Loved outpatient psych. At first I thought I hit the jackpot! I could talk to patients all day about their problems and get paid for it?!?! Sign me up!

Fast forward to my inpatient psych VA rotation: The patients were terrifying. I was told “you look juicy” with inappropriate tongue smacking, I watched a nurse get hit, saw more than one fight between patients, etc. Yes, the patients were sick and definitely needed to be there, but I realized I was never going to be able to give these patients the compassion that they needed. It takes a special person to do psych.

 

[Neopolymath]

Thanks for your input. Yeah I've pretty much come to terms with the fact that most careers I'm interested in require long residencies, but I'm not thrilled about it. I think med students generally underappreciate opportunity cost and the time value of money. I also could be more "on board" with the training length if I felt that the system was efficient and that the powers that be had trainees' best interest at heart. But rather it seems apparent to me that the 4th year of med school is essentially useless, and training for certain fields (some EM programs, peds hospitalist!?, interventional cards) keeps getting longer and longer. I understand that its hard to be a cardiologist but is it 6 years after med school hard? Is that 3 years of IM necessary or could we get equal outcomes with 2 years and then fellowship? But I digress. I agree with you that judging a specialty based on the residency is short-sighted but I also think its crazy when people say things like "well even if gen surg sucks, its only 5 years". In my opinion 5 years in one's late 20s early 30s is pretty damn important and not just for career building.

I agree with your insights. Personally, the longer training wouldn't hurt so bad if it didn't mean spending more years away from where I actually want to live and most importantly, also forcing my family to live somewhere they don't want to live. That's when the 3-4 years versus 6+ years starts to wear thin on me... I just want to get on with it so I can buy a house and do my hobbies in the area we want to raise our family. I don't actually care about being exploited by the machine near as much as that.

 

[Damson]

I was told “you look juicy” with inappropriate tongue smacking

wow.

 

[longhaul3]

Thanks for your input. Yeah I've pretty much come to terms with the fact that most careers I'm interested in require long residencies, but I'm not thrilled about it. I think med students generally underappreciate opportunity cost and the time value of money. I also could be more "on board" with the training length if I felt that the system was efficient and that the powers that be had trainees' best interest at heart. But rather it seems apparent to me that the 4th year of med school is essentially useless, and training for certain fields (some EM programs, peds hospitalist!?, interventional cards) keeps getting longer and longer. I understand that its hard to be a cardiologist but is it 6 years after med school hard? Is that 3 years of IM necessary or could we get equal outcomes with 2 years and then fellowship? But I digress. I agree with you that judging a specialty based on the residency is short-sighted but I also think its crazy when people say things like "well even if gen surg sucks, its only 5 years". In my opinion 5 years in one's late 20s early 30s is pretty damn important and not just for career building.

This is all true, but I don't think it makes sense to base your career decisions on it. You can't do anything about it but levy a conscientious objection. Sure, 5 years of your prime is a big cost, but the decision isn't 5 years vs. 0 years. It's 5 years vs. 3 years at best, and It would be a big mistake to value that two-year difference over a more fulfilling choice of career.

Med students profoundly underappreciate—or knowingly disregard—opportunity cost by the very act of enrolling in med school. The whole thing is a losing value proposition if you place that much value on living comfortably in your 20s and 30s. Once you're committed to training as a physician, trying to recoup that cost by shaving a year or two at the expense of fulfillment is a drop in the ocean and ultimately a fool's errand from my perspective.

 

[libertyyne]

Thanks for your input. Yeah I've pretty much come to terms with the fact that most careers I'm interested in require long residencies, but I'm not thrilled about it. I think med students generally underappreciate opportunity cost and the time value of money. I also could be more "on board" with the training length if I felt that the system was efficient and that the powers that be had trainees' best interest at heart. But rather it seems apparent to me that the 4th year of med school is essentially useless, and training for certain fields (some EM programs, peds hospitalist!?, interventional cards) keeps getting longer and longer. I understand that its hard to be a cardiologist but is it 6 years after med school hard? Is that 3 years of IM necessary or could we get equal outcomes with 2 years and then fellowship? But I digress. I agree with you that judging a specialty based on the residency is short-sighted but I also think its crazy when people say things like "well even if gen surg sucks, its only 5 years". In my opinion 5 years in one's late 20s early 30s is pretty damn important and not just for career building.

I don’t disagree that the elongation of training is not great. Most of the net worth studies that incorporate opportunity cost consistently list longer training associated with higher ROI and net worth at the end of the day.
I guess my perspective is that the average person spends 2 k hours per year working. If I hate those 2k hours they will feel like 4 k hours. If I enjoy what I do those 2k hours won’t be as onerous. So skipping a residency because it ia 6 vs 3 in a 30 year career is not only a bad financial deal it’s a bad deal for happiness if I am going to be miserable at work.
but based on what you have said so far family medicine is probably a better match for you. Better hours , more variety , can focus on small procedures ifyou want to, short training duration .

 

[throwaway1000000]

This is all true, but I don't think it makes sense to base your career decisions on it. You can't do anything about it but levy a conscientious objection. Sure, 5 years of your prime is a big cost, but the decision isn't 5 years vs. 0 years. It's 5 years vs. 3 years at best, and It would be a big mistake to value that two-year difference over a more fulfilling choice of career.

Med students profoundly underappreciate—or knowingly disregard—opportunity cost by the very act of enrolling in med school. The whole thing is a losing value proposition if you place that much value on living comfortably in your 20s and 30s. Once you're committed to training as a physician, trying to recoup that cost by shaving a year or two at the expense of fulfillment is a drop in the ocean and ultimately a fool's errand from my perspective.

2 year difference in training is about half a million dollars (at a minimum). If there is something you like which is lesser amount of time, I would pick that.
I am thinking of going into interventional cardiology and if I liked derm even 1 percent, I would have done that.
3 year difference in training amounting approximately to a million dollars

 

[libertyyne]

2 year difference in training is about half a million dollars (at a minimum). If there is something you like which is lesser amount of time, I would pick that.
I am thinking of going into interventional cardiology and if I liked derm even 1 percent, I would have done that.
3 year difference in training amounting approximately to a million dollars

Family practice docs and pediatrics are clearly financially better off than Ortho pods or god forbid neurosurgeons.

 

[throwaway1000000]

Family practice docs and pediatrics are clearly financially better off than Ortho pods or god forbid neurosurgeons.

Yeah but the comparison here is not between family practice, peds and orthopedic/neuro surgeons.
mostly the OP is contemplating fields with high income potential like gas, rads, derm, EM, IM subspecialities, urology, etc

In the current job market, derm, EM, Gas (assuming their salaries don't drop), are good deals financially if you like them.

I am thinking of going into interventional cardiology and if I liked derm even 1 percent, I would have done that.
3 year difference in training amounting approximately to a million dollars

Not what I said above but even if you wanted to compare a FP and neurosurgeon, you can be successful financially as a family physician even moreso than a neurosurgeon. The difference between both FP and Neurosurgeon is at minimum 4 years of training (approximately a million dollars). This is a FP who works the typical hours (5 days 50 hour weeks)

If a FP works as a neurosurgeon in those 4 years (70-80 hour weeks) to build their practice or bust their a** in PP, they can pull in income similar to an academic neurosurgeon (500-600k). In that case, they will be like 2 million ahead in those 4 years. If they utilized those 4 years to build a solid practice, they are looking at the same if not more yearly income than most neurosurgeons for the rest of their life.

This is not to suggest FPs are financially well off compared to neurosurgeons but if finances matter to you and you're willing to work as hard it takes, you can make it happen.

But I am not comparing FP and neurosurgery here. I am comparing something like derm and GI. Or EM and hem/onc. Or EM and radiology. Or derm and interventional cardiology. It is not an absolute rule. Just a perspective to consider.

 

[libertyyne]

Yeah but the comparison here is not between family practice, peds and orthopedic/neuro surgeons.
mostly the OP is contemplating fields with high income potential like gas, rads, derm, EM, IM subspecialities, urology, etc

In the current job market, derm, EM, Gas (assuming their salaries don't drop), are definitely better financially if you like them.

I am thinking of going into interventional cardiology and if I liked derm even 1 percent, I would have done that.
3 year difference in training amounting approximately to a million dollars

Not what I said above but just if you wanted to compare a FP and neurosurgeon, you can be successful financially as a family physician even more than a neurosurgeon. The difference between both FP and Neurosurgeon is at minimum 4 years of training (approximately a million dollars). This is a FP who works the typical hours (5 days 50 hour weeks)

If a FP works as a neurosurgeon in those 4 years (70-80 hour weeks) to build their practice or bust their a** in PP, they can pull in revenue similar to an academic neurosurgeon (500-600k). In that case, they will be like 2 million ahead in those 4 years. If they utilized those 4 years to build a solid practice, they are looking at the same if not more yearly income than most neurosurgeons.

If you had chosen derm it would have been a bad financial decision too. Compared to dr let alone IR.

obviously there are exceptions to the rule and a family practice doc had some side hustle that took off or some PhD made a block buster drug and can now afford a small island .
But averages and medians speak to the reality of what the average doc does. Also the family practice doctor would have to work 2.5 times as many hours to make income equivalent to a neurosurgeon because the hourly income differential is so large . So your other example is not really great as well.

 

[longhaul3]

2 year difference in training is about half a million dollars (at a minimum). If there is something you like which is lesser amount of time, I would pick that.
I am thinking of going into interventional cardiology and if I liked derm even 1 percent, I would have done that.
3 year difference in training amounting approximately to a million dollars

You basically restated my point. It's not worth it to do something you don't want to do just to spend less of your 20s and 30s in training.

Also, spending two extra years training could mean making at least double, and that 500k+ head start would be wiped out pretty quickly. The average reported neurosurgeon salary is around 800k+. Every year that neurosurgeon is making around 500k more than his/her peers who trained for 3 years and went into practice. That difference in training amounts to well over a million dollars over 3 years and persists for an entire career. From a purely financial perspective that sounds like a good ROI for those extra 4 years in training.

 

[throwaway1000000]

If you had chosen derm it would have been a bad financial decision too. Compared to dr let alone IR.
View attachment 309013
obviously there are exceptions to the rule and a family practice doc had some side hustle that took off or some PhD made a block buster drug and can now afford a small island .
But averages and medians speak to the reality of what the average doc does. Also the family practice doctor would have to work 2.5 times as many hours to make income equivalent to a neurosurgeon because the hourly income differential is so large . So your other example is not really great as well.

I mean it is common sense that on average a neurosurgeon over their lifetime will accumulate more wealth.

but there are a ton of factors in play here. If you have 0 financial sense, then yeah, work as a neurosurgeon or interventional cardiologist and you will be making the most amount of money.

But you don't need to be a neurosurgeon or interventional cardiologist to be accumulate a ton of wealth. You just need some financial discipline and be willing to work the typical number of hours a neurosurgeon or interventional cardiologist does.

 

[throwaway1000000]

You basically restated my point. It's not worth it to do something you don't want to do just to spend less of your 20s and 30s in training.

Also, spending two extra years training could mean making at least double, and that 500k+ head start would be wiped out pretty quickly. The average reported neurosurgeon salary is around 800k+. Every year that neurosurgeon is making around 500k more than his/her peers who trained for 3 years and went into practice. That difference in training amounts to well over a million dollars over 3 years and persists for an entire career. From a purely financial perspective that sounds like a good ROI for those extra 4 years in training.

But you are comparing neurosurgery which is an outlier. In both the salary and the hours they work.

I am comparing something like derm and GI. Or EM and hem/onc. Or EM and radiology.

 

[libertyyne]

I mean it is common sense that on average a neurosurgeon over their lifetime will accumulate more wealth.

but there are a ton of factors in play here. If you have 0 financial sense, then yeah, work as a neurosurgeon or interventional cardiologist and you will be making the most amount of money.

But you don't need to be a neurosurgeon or interventional cardiologist to be accumulate a ton of wealth. You just need some financial discipline and be willing to work the typical number of hours a neurosurgeon or interventional cardiologist does.

You keep on moving the goal post.
the point is throwing away amother career that you would enjoy for short term gain is neither a financially good decision not a good decision for happiness .

 

[libertyyne]

But you are comparing neurosurgery which is an outlier. In both the salary and the hours they work.

I am comparing something like derm and GI. Or EM and hem/onc. Or EM and radiology.

Derm and gI are almost break even. And even with the short term loss rads trumps EM in lifetime earnings . So once again your point doesn’t make sense in terms of long term financial differences.

 

[throwaway1000000]

You keep on moving the goal post.
the point is throwing away amother career that you would enjoy for short term gain is neither a financially good decision not a good decision for happiness .

That is not the point I am making.
This is what I said;
I am thinking of going into interventional cardiology and if I liked derm even 1 percent, I would have done that.
3 year difference in training amounting approximately to a million dollars

To ignore that lost cost of a million dollars by spending 3 extra years in training is stupid. If you don't like it, don't do it. I am not doing it and pursuing one of the most the most lengthiest training pathways, structural and interventional cardiology.

OP here is someone who said they are considering multiple similar high-paying fields, so it makes absolute sense to look at length of training.

You just took that initial point I made and started comparing FP/Peds to neurosurgery.

 

[libertyyne]

That is not the point I am making.
This is what I said;
I am thinking of going into interventional cardiology and if I liked derm even 1 percent, I would have done that.
3 year difference in training amounting approximately to a million dollars

To ignore that lost cost of a million dollars by spending 3 extra years in training is stupid. If you don't like it, don't do it. I am not doing it and pursuing of the most the most lengthiest training pathways of structural and interventional cardiology.

OP here is someone who said they are considering multiple similar high-paying fields, so it makes absolute sense to look at length of training.

You just took that and started comparing FP/Peds to neurosurgery.

I have given enough examples of despite longer training time and loss of the million dollars the longer training time specialties on average will still make more lifetime income.
rads >em
Derm~gi
And rads >derm
I have given you numbers crunched in a peer reviewed published paper. If you want to keep on parroting the 1 million dollar difference more power to you. But I am done with you.

 

[longhaul3]

But you are comparing neurosurgery which is an outlier. In both the salary and the hours they work.

I am comparing something like derm and GI. Or EM and hem/onc. Or EM and radiology.

Derm is probably the biggest outlier of all for training length vs. hours worked vs. income which is why it's so desirable. Your other comparisons make sense but I think even in those, the specialties with longer training still come out on top, except maybe heme/onc. As a structural heart IC doing TAVRs or whatever they're doing in 8 years when you're doing them, I imagine you will still come out on top of EM in terms of lifetime ROI. You won't have that money in your 20s and 30s, but as far as I understand it you are defeating your own point—it is a financially sound move overall despite the $1m left on the table early on.

 

[throwaway1000000]

I have given enough examples of despite longer training time and loss of the million dollars the longer training time specialties on average will still make more lifetime income.
rads >em
Derm~gi
And rads >derm
I have given you numbers crunched in a peer reviewed published paper. If you want to keep on parroting the 1 million dollar difference more power to you. But I am done with you.

Derm and GI breaking even: average derm salary: 419k, avg GI salary: 495k. Difference in training: 2 years. A GI has to catch up 840k in lost earnings. The salary difference is 75k. About 11 years to break even. If the dermatologist is stupid and has 0 idea how to invest the money, that is still a lot of years to break even.
If that dermatologist is somewhat smart and able to invest a portion of that extra million dollars, the GI has to spend a lot more years to break even.
If the dermatologist is working like a GI fellow in those 2 years as an attending, they are looking at a much higher salary at least for those 2 years (more like 500-600k), the break even years keep going higher.

Rads and derm have the same avg salary: 419k per medscape. So not entirely sure how rads will ever catch up with derm.
Rads>EM, let's see: 353k vs 419k (66k difference). 3 years of lost training. About 15 years for that rads person to catch up with the EM physican, if the EM physician was stupid and did 0 investing in those 3 years.

The point is as before: pursue what you like, I am pursuing one of the lengthiest training pathways but if you like multiple high paying fields, consider the one with shorter training. This is not a absolute rule. A perspective to think about.

And, no, I am not comparing neurosurgery with peds and FP.

 

[throwaway1000000]

Derm is probably the biggest outlier of all for training length vs. hours worked vs. income which is why it's so desirable. Your other comparisons make sense but I think even in those, the specialties with longer training still come out on top, except maybe heme/onc. As a structural heart IC doing TAVRs or whatever they're doing in 8 years when you're doing them, I imagine you will still come out on top of EM in terms of lifetime ROI. You won't have that money in your 20s and 30s, but as far as I understand it you are defeating your own point—it is a financially sound move overall despite the $1m left on the table early on.

This is all I am saying: pursue what you like, I am pursuing one of the lengthiest training pathways but if you like multiple high paying fields, consider the one with shorter training. This is not a absolute rule. A perspective to think about.

As a structural IC, I might come out on top of an EM or derm over my lifetime but at what cost. The OP clearly said they value their 20/30s and want to make the best out of them. I don't think pursuing IC over EM or derm is really that good for financial reasons or lifestyle reasons. Sure I might come out on top in 10-20 years but at a significant cost. I will be spending my life away in the hospital. I love it and I am doing it, but might not make sense for every person.
If the EM or derm physician in that 4-5 years, wants to work as I will be as a cardiology fellow, that breakeven years just keeps getting higher.

I think we are making the same points just in different ways. I am saying don't do structural IC because you are going to come out on top compared to a EM or derm physician financially in 10-20 years.

 

[Kuratz]

I know this will sound cliche but I firmly believe it's true:

The most important financial decision you can make is to choose something that excites you.

What income you generate varies dramatically even within a specialty. I can tell you right now there are keen businessmen in FM who are nearing what an average Neurosurgeon makes and there are burnt out subspecialists working at reduced time in saturated cities making near what a typical FM makes. If you want to make great money then you have to be a practice owner. If you are not passionate about what you are doing then it will be that much harder to do practice-building and there will be a higher temptation to just get an employed position and kinda ride it out near or below the median. Building a high volume private practice is not an easy task, and if you are not excited to go pay for a catered lunch at the local FM practices while you give a lecture on what you can offer to their patients you are gonna have a hard time. Your referrers aren't stupid and can sniff out someone who is just kinda "meh" about what they are doing. They are far more likely to send their patients to someone who appears excited to participate in the patient's care, take great care of them, and send them back to the PCP. You'll generate other word-of-mouth referrals this way too. And if you enjoy and take pride in what you are doing then the occasions where you have to stay late are not as much of a burden. You're also more likely to keep working longer which is arguably more important that total salary.

If you are a passionate clinician and take the initiative to learn the business of medicine then you will out-earn many of your specialty colleagues, and by a substantial margin. I don't mean to suggest that an ambitious, passionate Orthopod will be in the same place financially as a like-minded Pediatrician. But I think it's pure folly to hyperanalyze whether an additional 3 years of this vs. 1 year of that will yield a better ROI. At a certain point most fields have similar enough opportunities that trying to split hairs will bite you in the ass. Choose what you enjoy.

 

[Chlorini]

Physician salaries are all over the place--it's hard to say definitively that x speciality makes more than y speciality unless its peds vs neurosurgery.

I found the following MGMA data that someone posted on reddit very interesting. Not sure how true this info is, but if it is I could make essentially 200K more as a radiologist if I took a job in the midwest. That's nuts to me. Also, I had no idea that Mohs made that much.

If you like more than one field, pick the one with shorter training, a better lifestyle, or a better paycheck.

Here's the link, not posting the entire thing here.

 

[libertyyne]

Derm and GI breaking even: average derm salary: 419k, avg GI salary: 495k. Difference in training: 2 years. A GI has to catch up 840k in lost earnings. The salary difference is 75k. About 11 years to break even. If the dermatologist is stupid and has 0 idea how to invest the money, that is still a lot of years to break even.
If that dermatologist is somewhat smart and able to invest a portion of that extra million dollars, the GI has to spend a lot more years to break even.
If the dermatologist is working like a GI fellow in those 2 years as an attending, they are looking at a much higher salary at least for those 2 years (more like 500-600k), the break even years keep going higher.

Rads and derm have the same avg salary: 419k per medscape. So not entirely sure how rads will ever catch up with derm.
Rads>EM, let's see: 353k vs 419k (66k difference). 3 years of lost training. About 15 years for that rads person to catch up with the EM physican, if the EM physician was stupid and did 0 investing in those 3 years.

The point is as before: pursue what you like, I am pursuing one of the lengthiest training pathways but if you like multiple high paying fields, consider the one with shorter training. This is not a absolute rule. A perspective to think about.

And, no, I am not comparing neurosurgery with peds and FP.

Here is this again .since it seems like you missed it the first time.

 

[Yellow345]

Here is this again .since it seems like you missed it the first time.
View attachment 309025

Wow this is very interesting Data where is it from? Plastics, optho are below gen surg and thoracic, vascular, and ent are relatively the same

 

[Yellow345]

Physician salaries are all over the place--it's hard to say definitively that x speciality makes more than y speciality unless its peds vs neurosurgery.

I found the following MGMA data that someone posted on reddit very interesting. Not sure how true this info is, but if it is I could make essentially 200K more as a radiologist if I took a job in the midwest. That's nuts to me. Also, I had no idea that Mohs made that much.

If you like more than one field, pick the one with shorter training, a better lifestyle, or a better paycheck.

Here's the link, not posting the entire thing here.





View attachment 309017

why the hell are all these anesthesiologists and EM docs complaining on sdn there income looks higher than ever. Can any attending comment on the validity of these salaries?

 

[Neopolymath]

why the hell are all these anesthesiologists and EM docs complaining on sdn there income looks higher than ever. Can any attending comment on the validity of these salaries?

Money isn't the only aspect of job satisfaction...

 

[slowthai]

why the hell are all these anesthesiologists and EM docs complaining on sdn there income looks higher than ever. Can any attending comment on the validity of these salaries?

They're complaining because gas is being overrun by midlevels (EM too) and EM is being overrun by new grads secondary to residency expansion. There's a lot to be dissatisfied with.

 

[bigfootisreal]

Just to stir the pot.... what about a family trained doc with no debt out of medical school vs say EM or anesthesia with one’s average debt out of medical school?