Ophthalmology versus Internal Med

[md2b2012]

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I am a third year medical student deciding between ophtho and internal med. Both are good fields and I am torn. I thought I would always do medicine but did not like my rotation. I can easily identify with the medicine residents at my teaching hospitals; I enjoyed my ophtho rotation and found it very refreshing.

Ophtho:
Pros: Great lifestyle, better compensation, clean field with little b***s*** to deal with, ability to do procedures; feel like you made a difference in people's lives
Cons: I might get bored of the eye; you don't get to use all you learned in medical school; limited to private practice unless you do academics

Internal Medicine:
Pros: Intellectually stimulating, more options for fellowship; more options to teach/consulting/hospitalist; ability to interact with other physicians
Cons: Paperwork, lack of procedures, dealing with people's BS more often, more hours and less compensation

A lot of this can be anxiety as I start applying for the ophthalmology match.

I'm sure many people in this forum went through a similar decision process.

What do people think? Thanks.

 

[JMK2005]

I am a third year medical student deciding between ophtho and internal med. Both are good fields and I am torn. I thought I would always do medicine but did not like my rotation. I can easily identify with the medicine residents at my teaching hospitals; I enjoyed my ophtho rotation and found it very refreshing.

Ophtho:
Pros: Great lifestyle, better compensation, clean field with little b***s*** to deal with, ability to do procedures; feel like you made a difference in people's lives
Cons: I might get bored of the eye; you don't get to use all you learned in medical school; limited to private practice unless you do academics

Internal Medicine:
Pros: Intellectually stimulating, more options for fellowship; more options to teach/consulting/hospitalist; ability to interact with other physicians
Cons: Paperwork, lack of procedures, dealing with people's BS more often, more hours and less compensation

A lot of this can be anxiety as I start applying for the ophthalmology match.

I'm sure many people in this forum went through a similar decision process.

What do people think? Thanks.

I would take better compensation out of that list.

 

[echinoderm]

agree - some of the assessment is not very accurate in my opinion... compensation is almost equivalent to primary care when it comes to comprehensive ophthalmology in a large urban (saturated) metropolitan city. there's also a lot of general medicine when it comes to the eye - uveitis, systemic disease, etc etc... but it's hard knowing everything.. and that's a flaw (or "con") to medicine.

 

[Visionary]

I am a third year medical student deciding between ophtho and internal med. Both are good fields and I am torn. I thought I would always do medicine but did not like my rotation. I can easily identify with the medicine residents at my teaching hospitals; I enjoyed my ophtho rotation and found it very refreshing.

Ophtho:
Pros: Great lifestyle, better compensation, clean field with little b***s*** to deal with, ability to do procedures; feel like you made a difference in people's lives
Cons: I might get bored of the eye; you don't get to use all you learned in medical school; limited to private practice unless you do academics

Internal Medicine:
Pros: Intellectually stimulating, more options for fellowship; more options to teach/consulting/hospitalist; ability to interact with other physicians
Cons: Paperwork, lack of procedures, dealing with people's BS more often, more hours and less compensation

A lot of this can be anxiety as I start applying for the ophthalmology match.

I'm sure many people in this forum went through a similar decision process.

What do people think? Thanks.

I'll agree with the other posters that some of your pros/cons are inaccurate. Here's my two cents:

Lifestyle does tend to be good in ophthalmology, but there are subspecialties in IM that also have a good lifestyle (GI, for instance).

The average compensation for ophthalmology is higher, but there are regional differences, for sure (as mentioned above and discussed ad nauseum in other threads).

There are subspecialties in IM that involve a lot of procedures (GI, is again a good example).

There's BS everywhere, you just had a better first-hand view in IM. I'll grant you that the social issues come into play much more in IM, but you can have staff who handle that. Practice is not like med school/residency. The scut is delegated.

I would say that docs in most fields feel they "make a difference in people's lives."

You can get bored with any medical specialty. You're smart, so the learning is the most exciting part of becoming a doctor. Once you've been in practice for 10+ years, it's going to seem more like a job, regardless of the specialty you pursue.

You will never use everything you learned in medical school. No specialty is that broad. Ophthalmology intersects with many systemic conditions. I see them every day, and in quite a few instances have made or at least prompted the systemic diagnoses.

Limited to private practice or academics? So, what, do you want to be a hospital employee? Wouldn't recommend it, if you can help it. Many are going that route out of necessity, not because they want to.

I think you'll find that a lot of ophthalmologists pursue the specialty because they like the balance of clinic and surgery/procedures, as well as the lifestyle. Some dorks, like me, just like eyes. Sounds like you've pretty much made up your mind. I just wanted to clarify some things.

 

[golfman]

Some dorks, like me, just like eyes.

I love eyes as well. I like the fact that there are no fat, smelly eyes. Plenty of fat, smelly things in other specialties. One reason I didn't want to go into Dentistry or OBGYN is that I don't want to be in a mouth or vagina all day. Nasty.

I think that should be the opening of my personal statement.

 

[Visionary]

I love eyes as well. I like the fact that there are no fat, smelly eyes. Plenty of fat, smelly things in other specialties. One reason I didn't want to go into Dentistry or OBGYN is that I don't want to be in a mouth or vagina all day. Nasty.

I think that should be the opening of my personal statement.

I like it. Unfortunately, eyes are sometimes attached to fat, smelly people. I agree that there is generally less 'nasty,' though.

 

[Hemichordate]

What kinds of career opportunities are there for people who go into academic ophthalmology?

 

[azzarah]

I love ophthalmology and think that it is the coolest and most rewarding field in all of medicine, so it is hard for me to be objective. 😀 I doubt you will ever get bored with the eyes. Go to the library and look at any ophthalmology textbook. You'll see that there are more eye diseases than you ever realized. 🙂

As others mentioned, I think you can have a good lifestyle in any field that you go into. Having a good lifestyle is a personal decision. Also, there are at least 9 subspecialties in ophthalmology, so there are plenty of chances to do fellowships. Also, you will have plenty of opportunities to interact with people in other fields.

As a medical student, I realized that the only time I enjoyed internal medicine was in CPC or Grand rounds when someone was presenting a really fascinating case, but I just knew instinctively that I did not like dealing with the day to day aspects of internal medicine and did not want to be the one on the floor in the front lines dealing with all the issues, drama, and collecting all that information. I also knew that no matter what I told myself, I actually hated admitting patients, writing those really really long notes on a daily basis, adjusting medication dosages, looking at EKGs and rounding all day. Don't get me started on the hospital smell, lack of procedures, waking up at the crack of dawn, etc. 😉

I basically kinda went with my instinct about myself and how much I enjoyed my ophthalmology rotation as a medical student. I'm so glad I went into ophthalmology. No regrets whatsoever. No one field is right for everyone though, so you'd have to decide for yourself.

 

[Slide]

I love ophthalmology and think that it is the coolest and most rewarding field in all of medicine, so it is hard for me to be objective. 😀 I doubt you will ever get bored with the eyes. Go to the library and look at any ophthalmology textbook. You'll see that there are more eye diseases than you ever realized. 🙂

As others mentioned, I think you can have a good lifestyle in any field that you go into. Having a good lifestyle is a personal decision. Also, there are at least 9 subspecialties in ophthalmology, so there are plenty of chances to do fellowships. Also, you will have plenty of opportunities to interact with people in other fields.

As a medical student, I realized that the only time I enjoyed internal medicine was in CPC or Grand rounds when someone was presenting a really fascinating case, but I just knew instinctively that I did not like dealing with the day to day aspects of internal medicine and did not want to be the one on the floor in the front lines dealing with all the issues, drama, and collecting all that information. I also knew that no matter what I told myself, I actually hated admitting patients, writing those really really long notes on a daily basis, adjusting medication dosages, looking at EKGs and rounding all day. Don't get me started on the hospital smell, lack of procedures, waking up at the crack of dawn, etc. 😉

I basically kinda went with my instinct about myself and how much I enjoyed my ophthalmology rotation as a medical student. I'm so glad I went into ophthalmology. No regrets whatsoever. No one field is right for everyone though, so you'd have to decide for yourself.

This.

I'm already a week through my prelim year (I have to do 6 months of medicine for my prelim year, then 6 months of ophthalmology) as an intern at the VA medicine service, and I can't wait to finish in 2 months and move onto ophthalmology. I found aspects like morning report, Q&A, etc. interesting as well as presenting and diagnosing patients, but I dread writing long H&Ps, dealing with patients' disposition, waking up early in the morning to round on patients and leaving late in the day after doing hours of scutwork and dispositions. I really do enjoy the intellectual stimulation that IM provides, but the other aspects, at least in ward medicine, is extremely unappetizing. I came to this realization when I looked at my morning patient list, and realized that I would be working for 10+ hours that day because some patients would be staying due to disposition issues, or would flare up with some acute issue right before discharge. It really is almost like House of God at times.

The only way to know for yourself is to try both at times (that's what MS3 is for), but I am so glad I decided to go into Ophtho. People may gripe about how much lower paying it is compared to other competitive specialties, or how the market is sometimes being crowded out at places, but I would rather deal with those problems while being able to go into a field I enjoy, rather than the opposite.

 

[taco bell]

As a fellow ophtho applicant.. I say do Internal Medicine 😀

 

[azzarah]

As a fellow ophtho applicant.. I say do Internal Medicine 😀

 

[azzarah]

This.

I'm already a week through my prelim year (I have to do 6 months of medicine for my prelim year, then 6 months of ophthalmology) as an intern at the VA medicine service, and I can't wait to finish in 2 months and move onto ophthalmology. I found aspects like morning report, Q&A, etc. interesting as well as presenting and diagnosing patients, but I dread writing long H&Ps, dealing with patients' disposition, waking up early in the morning to round on patients and leaving late in the day after doing hours of scutwork and dispositions. I really do enjoy the intellectual stimulation that IM provides, but the other aspects, at least in ward medicine, is extremely unappetizing. I came to this realization when I looked at my morning patient list, and realized that I would be working for 10+ hours that day because some patients would be staying due to disposition issues, or would flare up with some acute issue right before discharge. It really is almost like House of God at times.

The only way to know for yourself is to try both at times (that's what MS3 is for), but I am so glad I decided to go into Ophtho. People may gripe about how much lower paying it is compared to other competitive specialties, or how the market is sometimes being crowded out at places, but I would rather deal with those problems while being able to go into a field I enjoy, rather than the opposite.

I could almost feel each hair strand on my head losing pigment and turning white each time I glanced at that list to check something off my to-do-list. 😀 Thankfully, no strand ever turned white, because I started ophtho before they could.

Ophtho is great. 😍 I sometimes read the cases in the NEJM, etc but it's good to not have to do the scut work to figure out a cool case. I agree that you need to just do some rotations in both and if you are honest with yourself, you'll quickly figure it out. Good luck!

 

[Dusn]

I would also removed "good lifestyle," at least during residency, from that list. It varies greatly depending on the program you go to. But if you're at a major trauma center, and you're the only trauma center with ophtho in a large area, you could be working pretty hard. All the hospitals in the nearby area will be transferring their emergency cases to you and they will be sending you many cases that aren't true emergencies as well. Even many of the private practices in the nearby area will have you as their "on-call" service, despite the questionable ethics of this. Some programs may be much easier than this if they don't take trauma but, honestly, I think the residents at those types of programs just don't get as good training. And I would say at a busy program, you'll be working just as hard, if not harder, than internal medicine.

 

[doc4444]

Yes, stay away from Ophtho. Make sure you love the eyeball because you will get bored of it. Promise.

 

[Mirror Form]

I would also removed "good lifestyle," at least during residency, from that list. It varies greatly depending on the program you go to. But if you're at a major trauma center, and you're the only trauma center with ophtho in a large area, you could be working pretty hard. All the hospitals in the nearby area will be transferring their emergency cases to you and they will be sending you many cases that aren't true emergencies as well. Even many of the private practices in the nearby area will have you as their "on-call" service, despite the questionable ethics of this. Some programs may be much easier than this if they don't take trauma but, honestly, I think the residents at those types of programs just don't get as good training. And I would say at a busy program, you'll be working just as hard, if not harder, than internal medicine.

While this may be true, the vast majority of ophthalmology attendings are more than happy to never do another ruptured globe again once residency is over.

It's easy to have a great lifestyle in ophtho as an attending in private practice. Sure it's hard work and the pay is nothing close to what it used to be. But compared to most fields of medicine, ophtho lifestyle is up there.

 

[Slide]

Another thing I want to add about medicine; during your residency, a good portion of your work will be nonmedical. I'm not talking about paperwork or talking to families. A good bit of what you do will be basically social work, placing patients in appropriate long-term care. This will be especially true if your medicine residency includes a VA, where over half the patients are on the verge of death yet are in denial about it. It is indeed a good field, but honestly the BS that comes with it makes it not worth it. Basically, everything gets dumped on you, and there's nothing you can do about it. This is true from intern to attending.