Originally posted by JKDMed
Although I have quite awhile before I decide which specialty I pursue, I wanted some helpful insight (as well as to narrow down which specialties I shadow). Below you will find a list of my interests, as well as some questions I would like anwered regarding each specialty. Feel free to add anything else you deem necessary.
Specialties:
1) C-L Psychiatry
2) Orthopedic Surgery
3) Trauma Surgery
4) General Surgery
5) Emergency Medicine
Questions:
1) Length of residency and/or fellowship
2) Lifestyle of residency
3) Lifestyle of attending
4) General responsibilities
5) Viability for private practice
I am interested in a private psychiatry group that rotates through area hospitals, but I really have no idea how private practice groups work with hospitals. I imagine such an arrangement for psychiatry would be lucrative, as my area is in need of psychiatrists and malpractice premiums tend to be on the lower-end for psych. At any rate, thank you for the input -- I can save a lot of time by shadowing only a couple fields that interest me the most.
By the way, anyone have that link to the "what specialty suits you" quiz?
Unsure as to what you're really interested in; your last paragraph talks about psychiatry (whats C-L psych, BTW?) but then you list several surgical fields- about as far afield from psych as you can get.
But I can handle a few of the above:
Orthopaedic Surgery
1) 5 year residency with additional years (usually 1-3) for specialty fellowships (ie, spine, upper extremity, foot & ankle)
2) Generally pretty tough residency, especially at trauma centers and during the junior years when you take in-house call and see all trauma patients with ortho injuries and any ED stuff that the ED staff can't handle. Emergencies can (and do) happen at any hour, so you'll often be up all night treating these patients.
3) Attending lifestyle can also be bad for the same reasons above - patients with major trauma often need to be operated on emergently and if you're on the call schedule, guess who goes in to do the case with the residents? However, if you're in private practice, don't take Trauma call and do mostly elective stuff (ie, carpal tunnels, scopes, etc.) your lifestyle will be much better. I'd estimate that at least during your junior attending years, you will be requried to take trauma call for your group if in private practice (and definitely if in an academic practice).
4) General responsibilities - pre and post-op evaluation, trauma call, operative time, clinic/office hours, etc. Sort of like any other surgical specialty. Most residents also rotate through the ED, Gen Surg, Plastics, Rads, and perhaps neurosurg or Rheum.
5) not sure what you mean by viability - there are plenty of orthopedic surgeons who don't operate in academic trauma centers. Your ability to avoid such a situation would depend on your training, your locale, etc.
General Surgery
1) 5 years plus (plus any time for research/lab work, plus time for any fellowships). Most who pursue research do 2-3 years in the lab and most fellowships are 2-3 years.
2) One of the longer and more painful residencies. Like ortho, you may spend a lot of time in the Trauma bay, in the ER evaluating abdominal pain (because some ER staff think anyone with a sore belly must have a surgical consult, even when its obviously gyn in origin or urological, etc.) Some programs have the juniors operate more in the beginning than others which can make it less painful for you. Remains to be seen whether the 80-hour workweek will make things better or worse.
3)See above - general surgeons who take trauma call or don't have residents answering pages for them have a rougher lifestyle. However, people get surgical conditions at all hours and some need to be operated on in the middle of the night - whether at an academic or cush community program.
4) See above.
5) Plenty of opportunities for private practice although most join an existing group because of the start up costs involved in opening a new practice. Often people will stay on in town after completing their residency.
Trauma Surgery
1) 5 years plus General Surgery followed by 1-2 years (there are a few 3 year programs) of Trauma/Critical Care fellowship. If only interested in Trauma, can find programs with only 1 year fellowship after completion of General Surgery.
2) See above- finish general surgery residency then spend the next year or two fielding calls from the junior residents, running traumas, occasionally operating (trauma is becoming less operative these days) etc. If you love it, who cares...it will be fun.
3) See above. You'll either have to field calls from your Chiefs on low-level traumas (some programs may require attending presence at all traumas - sometimes its ok if its an ER physician rather than you) or come in for serious traumas or those requiring trips to the OR. Most Trauma attendings spend their days doing general surgery cases - you have to, there generally isn't enough trauma op to go around. So you'll do choles, appys, gastric bypasses, hernias, etc.
4)See above.
5) Not much. Most Trauma surgeons are on staff at Academic medical centers rather than in private practice. However, if you are a general surgeon who is Trauma trained (there is no BC in trauma) you may enter the Trauma call pool at some places.
Hope this helps...
