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Kind of off topic, but how difficult is it for FM docs to get gigs working in the ED or even hospitalist spots?
Opinions-Which specialty has the most variety?
Started by Deecee2DO
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Difference being that FM docs see kids more often than not. And a good FM does way more women’s health than any internist would ever do.
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From what I understand it depends on what area you live in and what the hospital systems are. Both are less common, but I'd imagine rural positions would be the easiest way to accomplish those as an FM doc.
Yeah; where I’m at I do on average 10-20 well woman exams per month. Plenty of Gyn visits (iud’s, DUB, vaginitis etc) and I see TONS of kids.
I think I get these due to a young population in town (college town = lots of contraception visits, and a fair # of young married couples), and the fact that when I’m hospitalist I usually do the baby rounds for all the kids our OB delivers. And when I become a new baby’s PCP, I usually pick up mom and dad as patients too.
If you want variety in patient presentations, go with neuro hospitalist at a major academic center.
If you want variety in your job, go with psychiatry. You can do therapy to med management to emergency psych to inpatient psych to consults to addiction to forensics. If you're in a small town, you can do all the above.
If you want variety in your job, go with psychiatry. You can do therapy to med management to emergency psych to inpatient psych to consults to addiction to forensics. If you're in a small town, you can do all the above.
I feel like it depends on what kind of variety you want. If you want varied pathology you want to specialize as much as possible. If you variety in patient presentations be a generalist. I really enjoy getting into the nitty gritty of disease processes and as a specialist I get to do that. What may be just a "neck mass" or "vertigo" to a generalist may be any of number of things to me that each get treated in specific ways.
PM&R has greatest variety and breadth intraspeciatly amongst all of the medical specialties. In fact, it is so broad that residents typically feel overwhelmed at the decisions they are faced with (again) regarding what they want to do when they start residency. Inpatient neurorehab....TBI vs SCI...vastly different beasts. Amputee medicine.. Outpatient neurorehab clinics, spasticity clinics, amputee clinics, MSK/sports medicine, electrodiagnostics, team physician, adaptive sports medicine... then there is the interventionalist and proceduralist path for pain/sport&spine etc. You like neurology, there is something for you. You like medicine, there is something for you. You like MSK/orthopedics, there is something for you. You like 100% referal based procedure life...yep you can do that too.
What is the most "medicine-like" sub-speciality that a PMR doc can do? I wish there was something like a IM/PMR or FM/PMR dual residency - as crazy as that sounds. I'd love to be able to do PCP/MSK Full-spectrum
General inpatient PM&R. Inpatient PM&R (at least in residency) is like 90-95% medical management 5-10% rehab specific things.
What you are describing, if I'm understanding you correctly, seems to be more about the outpatient setting. The closest thing to what you are describing is FM->Primary sports medicine fellowship training.
silkysmooth
New Member
EM. end of discussion.
ITT: everybody names their specialty
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I'll add that you will also see a lot of psych.. not the psych like you'd see as an inpatient psychiatrist, but you may have patients with PTSD from a traumatic amputation, depression over being in rehab or big changes in their lives, anxiety, etc.
The only thing you won't really see directly is surgery, though many of the patients will need surgery or will be recovering from surgery.
Also keep in mind that it's a great place to apply OMM since you'll be a DO, and with the experience of being a chiro adds to that as well.
Already noted in a previous comment that FM/Sports is exactly what you're describing, but wanted to add that IM/Sports is less common but also a possibility. You'll have less of the neuro stuff and will primarily be MSK in addition to the primary care training as FM or IM.
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deleted610572
I am a DO, and yes I can do OMM, but I am fascinated as well by nerve conduction studies which unfortunately only Neuro/PMR get exposure to
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deleted610572
you are fascinated by them??? have you done one? lol.
I think they are cool theoretically, but those were by far the worst days of my PMR rotation.
Haha, true. No, I have not done one. You're right, theoretically they are cool and I like the knowledge involved because the nervous system is really cool. But, you're right, I may be disillusioned.
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deleted610572
PMR was one of my top choices prior to medical school due to my mentor being a sports med PMR guy that worked in an ortho group, but once I saw the day to day of PMR outside of sports I was really turned off. I could def do sports med PMR but I didn't want to gamble going PMR hoping that the 4 years would pay off in a sports job. So I went with something else I ultimately loved a higher % of the specialty lol.
Which was what, if you don't mind sharing?
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deleted610572
peds
I'm only an OMS-1, I pray I just fall in love with something on rotations cuz whenever I have downtime from studying the existential crisis of what I want to do - what type of life I want after this prison (med school) - how much I want to earn - what I want to help treat - creeps into my mind and I can't help it - it sucks. I think its a mental dissociation to help see the light at the end of the tunnel lol
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deleted610572
ya the first 2 years are really a grind. The way I separated it was "do I want to do surgery or medicine" and then I went with the population I enjoyed the most. Not only medically but interacting with and talking to.
When the time comes for me to do rotations and schedule them - What do you recommend in terms of the order? Lets say I have no idea medicine vs surgery - but I'm leaning more toward medicine. Should I try to do Surgery first to see if it's like for sure something I want to do to kind of get it out of the way? And if I go into medicine rotations after and realize definitely want that over surgery, I can focus more on getting rdy for 4th year rotations?
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deleted610572
There is no best order in terms of doing them for learning purposes. I just made sure I had a few of my interests by December of 3rd year so I could be sure to apply for always when they first opened.
Norwood-Sano
Full Member
Trauma/Critical Care/Acute Care Surgery has plenty of variety for the surgically inclined from what I have heard and read. Depending on your location of course.
Also Ped Surgery which is going to be a tough match no matter what letters are behind your name.
Also Ped Surgery which is going to be a tough match no matter what letters are behind your name.
Do the things you think you won't like early. If your surprised, you will have time to adjust app, but if your right, you will be loving life the second half of third year.
Anesthesiology. 100%.
Specialize. Do you want to do Cardiac? Neurology? OB/GYN?
You don't like working in the OR? Do Critical Care in the ICU
You don't like either and want to work in an office setting? Pain Management
You like procedures? Specialize in Regional.
You enjoy end of life care? Do palliative medicine.
You actually like anesthesia? Be an anesthesiologist.
You enjoy paperwork? Don't become an anesthesiologist.
Specialize. Do you want to do Cardiac? Neurology? OB/GYN?
You don't like working in the OR? Do Critical Care in the ICU
You don't like either and want to work in an office setting? Pain Management
You like procedures? Specialize in Regional.
You enjoy end of life care? Do palliative medicine.
You actually like anesthesia? Be an anesthesiologist.
You enjoy paperwork? Don't become an anesthesiologist.
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I would argue that radiology is a great specialty that offers a lot of variety (obviously I am biased).
Ob/gyn
In the vein of doing surgery/medical stuff, I would say that ENT is also very broad. I was surprised at the amount of stuff my attending was doing when I rotated there. Allergy, nuero, PT, sinus surgery, plastics, etc. It was all over the place.
Trying to set up an ENT rotation 4th year, just for fun. If only I could pursue it...
I would argue that just because a specialty has a variety of "pathways", doesn't mean each pathway leads to extremely diverse day-to-day activities. IM may be super diverse, but once youre a gastroenterologist, you're either going in the attic or the basement all day long.
Variety seems to come from patient population more than just the specialty. Every specialty has things they do 90% of the time. If you really want variety, actually go practice in an under served area like the inner city. You'll see some crazy stuff because of lack of adequate health care and risk factors that nobody else has. if you're in the rich suburbs you don't exactly have the most 'at risk' populations, so unless there's some crazy genetic disease you're stuck with the normal stuff
Which is why EM is probably still the most diverse
in the right area yeah. I worked in a suburban ER and it was pretty tame except for a couple times. Sure there was some wild things but not the majority. When I did stuff downtown Chicago things got real haha
When I think of variety, I think variety in patient population but also variety in types of procedures that are available, different work environments, etc. Which is why, again, I will vote for radiology as the most diverse specialty. On top of that, it is also the most technologically advanced and driven specialty in medicine, which makes it all the more exciting 🙂
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deleted997790
Sleep medicine is the most technologically advanced field...radiology is up there though...
This is a first. Could you say what is soo advanced technologically in sleep.
There’s robots doing surgery and watching someone sleep is the most advanced?! Haha
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deleted997790
The entire field is based off technology. Same with radiology. U don’t have a sleep physician or a radiologist without technology. One requires X-ray, ultrasound, MRI, CT, fluoroscopy. The other requires polysomnography, cpap/bipap, home sleep study, etc.
Actually, I stand corrected. Sleep docs can diagnose insomnia, etc without technology (even though in reality, sleep medicine = sleep apnea for the most part).
Sleep doctors , I didn't realize they did surgery. To my recollection it was a specialization from IM.
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deleted997790
Depends on which field u practice from. The ENT guys do the surgery. The IM and pulm docs do the diagnosis (polysomnography, etc)...the dentists make the mouth splints (they have dentists that specialize in sleep medicine).
It’s like primary care sports medicine vs ortho sports medicine.
Yeah, so the polysom advanced, but not so much more than any other eeg or emg or even ekg. And the sleep docs are not using the robots , hence my confusion.
Neurosurgery: consulted on a devastating hemorrhage this AM and comforted a family at the end of life...then saw a patient who would need a carpal tunnel surgery in clinic. Then saw an MVA in the ER that’s going to need a cervical fusion tomorrow. Saw a meningioma that will get a repeat MRI in a couple months. Saw a patient with leg pain with a huge disc herniation that we took out today. All in one day’s work. So much variety in this field.
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Not trying to discredit your line of work (Super props to all that, and you seem super passionate about what you do which I admire) but I still don't think it's the 'most diverse' - At the end of the day, the Family Physician had to see that Carpal Tunnel, Disc Herniation, headache/w/e presenting symptoms (Meningioma), to get that patient to you in the first place. So I feel like that just goes back to Primary Care being one of the most diverse fields, because for every Neural complaint they see and send you, they then go and see the next patient who is Cardiac, Endocrine, Rheum, sports med, etc.
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