Please help chose a specialty

[PTCA]

What would be your choice if you were considering ortho,optho,cards.derm.neuro.pulm-crit care,hem-onc,GI?
Please elaborate as much as you feel like, but try to come up with 1 or 2 primary choices.
If you want to support another one please do so, but if you can also give me your insight on the above.
My concerns (optional consideration for contributors)
1 money

2 prospects
(future of the field /interventions/ procedures/trends of morbidities. Bottom line :I don?t want to run out of work or take an unexpected reduction in income. Which of these fields could be favored and which are more likely to take a hit by future developments)

3 employment
(hospital/private practice/opportunities to combine interventions and a practice of non interventional treatment of patients)

4 length of training
(I don?t have a significant problem with lengthy training but I wouldn?t like to train longer than I have to if it doesn?t help me professionally and financially)

5 lifestyle
(I wouldn?t mind a life)

Thank you in advance, for any insight

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[PTCA]

Sorry I forgot
Assume there are no grade or board scores limitations

 

[wundabread]

You really need to check some of these out and figure out what you like. You have a huge list of stuff to consider, and that's important only when you have yourself narrowed down to 2 or 3 things you really like.

You will figure a lot of this out 3rd year of medical school. Nobody can make these decisions for you. All input that you get is biased by the observer, and with a decision as important as this one you owe it to yourself to check things out first hand.

 

[ApacheIndian]

According to your criteria...

#1 Ophtho
#2 Derm

Just my opinion...

 

[fourthyear]

If money and time are the most important, I agree with Dr. Cuts - derm and optho people will continue to be busy in the future - derm with the skin cancers of our aging population as well as our beauty-obsessed culture, and optho with the bright future of laser surgery.

However, with cards, GI, heme-onc, pulm crit care, all being on your list, I'm thinking Internal medicine might cover all your bases, because you can continue to investigate these specialties throughout your residency. Howeve, consider that these all take a 2-3 year fellowship in addition to your 3 years internal medicie, making it just as long as ortho (unless you do a fellowship in ortho too), and I think the same as derm and optho too - I think those are both 4 years on top of the preliminary intern year. So you're looking at 5 years for everything on your list.

How far along are you in your training? I think it's great that you are starting to think of what factors are important to you early on, but you won't know which specialties are for you until you get some experience in them. Try choosing one or two from your list and shaddowing a doctor in that feild starting now - at least that will give you some exposure, since you dont' usually get to rotate through most of those specialties on your list even during third year of med school.

 

[DR]

Do what you like. That's it.

 

[katrientje]

http://www.med-ed.virginia.edu/specialties/

Take this test! You have to answer 130 multiple choice questions (it only takes 15 mins or so) and after that you get a list with specialties. The higher on the list, the more this specialty fits with your nature. I don't know if the test really is reliable though. I hope so because they keep saying I'm a surgery kind of girl

 

[Deuce 007 MD]

Originally posted by katrientje
http://www.med-ed.virginia.edu/specialties/

Wow that's a cool test, it said for me #1 rads and #2 path, and I've been seriously drawn to these two fields. Now lets just see how medical school and boards go, to see if I well still be interested in these fields.

 

[PTCA]

NOOOOOOOOOOOOOOOOOOOOO!!
1 occupational med 41
2 radiology 38
3 thoracic surgery 37
4 plastic surgery 36
5 preventive med 34
6 psychiatry 33
7 physical med & rehabilitation 33
8 general surgery 31
9 urology 30
10 aerospace med 29


What is wrong with this test?
none of these are on my list
Ok, i guess if i dont want to be a radilogist i can allways take the next logical route and become a thoracic surgeon????????
How can anyone be suitable for both occupational medicine and plastic surgery?
I think it has to do with the fact that the questions are general and focused on your personality rather than on your specific interests in medicine?
For instance when asked if I like gadgets I answered yes thinking more about the ICU monitoring rather than rads
No prob ,I intend to manipulate my answers until its 1 cards 2 crit care 3 ortho
Anyway thanks for all the responses. I am sure clinical rotations are defining and I expect scores to be even more ?helpful? in narrowing down my options, However I already have observed (not doing anything) most of these specialties and quite a few more (like ENT ,urology ,gen surg not on my list) for no less than 1 and no more than 2 weeks each .Still that observation was only inside the hospital , very rarely included some emergencies and I only entered the OR for gen surg ,ent, optho. Basically I know what each specialty is about but I have no idea what they do outside the hospital. Plus I don?t really know what its like outside an academic environment. Sure derm in a university hospital is not tedious at all (i.e. bullous disorders that require hydration medication and monitoring much like patients in IM ) but people say private practice is largely cosmetic. Plus they supposedly make lots of money, and I guess they do relatively to the hours they work, but surveys I have seen rank their overall salary below certain IM subspecialties especially cards. I am not starting a conversation about derm here or anything. I am just saying that ?just do what you like ? does not provide all the answers. Some info on a field?s inherent pros and cons is needed before deciding to weather to go into it or not.
If I am not mistaken a few years back primary care was hot .Now, the trend has shifted back towards specialties and yet many of those who made their choice based possibly on outdated data aren?t out of residency yet.
Moreover, I know that you don?t have to choose early but I understand that people who do are able to organize electives and potential research better

 

[PTCA]

BY the way,
Does anyone know any really good and up to date books (or other sites) to assist my choice?
thx

 

[Voxel]

RE: #5. I have some advice. Get to know what it's like in private practice within the top 3 or so specialties. It will give you a much better insight what the world/life will be like for 80+% of the people. Life in the "real world" is in many cases much different from life in academics.

RE #1,2. Just a point I would like to make is that you cannot accurately how sever the cuts will be in terms of reimbursement for procedures/consults in the respective fields. If you look what happened in optho and interventional cards, it would have been a nasty surprise to look at the compensation 6-8 years before finishing interventional cardiolgy as a 4th year med student. The same thing can be said about cardiothoracic and general surg.

Another thing to consider is the rate at which new technology/procedures are incorporated into your specialty field. This is hard to predict of course.

Lastly, if you're specialty has a trend toward non-insurance covered procedures/consults that patients want and pay for out of pocket, you may find that to be less affected by insurance/government trends. This assumes a steady suppply of providers relative to demand, of course.
RE #3 This is a reflection of specialty choice and where you are willing to practice.

RE #4. Length of training. Suck it up and do it if that is what needs to be done. There's really not much you can do about it. Just remember doing anything IM based will require taking both the IM and the subspecialty boards approximately every 10 years. In reality it's more like every 8-9 years, that way it gives you a chance to retake it if you fail.

 

[Tazmaniac]

So I took the online specialty quiz and it was also WAY off. I suppose it just shows how a range of personality types can go into a single field.

And what is up with Occupational Medicine? Workers comp and malingerers...*throw up*

-Todd MSIV USC

 

[DR]

Ok, i guess if i dont want to be a radilogist i can allways take the next logical route and become a thoracic surgeon????????

 

[PTCA]

Voxel,

1,2. Just a point I would like to make is that you cannot accurately how sever the cuts will be in terms of reimbursement for procedures/consults in the respective fields. If you look what happened in optho and interventional cards, it would have been a nasty surprise to look at the compensation 6-8 years before finishing interventional cardiolgy as a 4th year med student. The same thing can be said about cardiothoracic and general surg.

What exactly did happen to optho and interventional cards? They are both on my list (they seem like interesting things to do although I haven?t done much research in their financials _int cards seems to be doing ok on salary surveys). Do you mean that they have done better or worse than expected and that people should or shouldn?t have examined their prospects before pursuing them? If I understand correctly you are saying that what a specialty is making now is not a good predictor of what it will be making in the future. That is true but aren?t there some other indications as to what fields are more or less likely to remain attractive in the future?

 

[Voxel]

Opthamology had a *rather large* cuts to it's bread and butter operations, ie cataracts. It went from a field where people where making 3-400K working 4 days a week to people making 250K 5 days a week and doing many more operations (or so I've been told). However, things like lasix and retinal surgery have boosted income for highly specialized opthamologists, so there is still opportunity there. You just have to work harder (ie more procedures) and be in the better compensated areas either by insurance or out of pocket by patients. The same thing happened in interventional cardiology where the reimbursed fee of PCTA of the coronary vessels was slashed. A nasty surpise for that kind of liability and lifestyle. That's why it's hard to predict what will happen in terms of compensation for various specialties.

Some people got a rather nasty surprise who started thinking they'd make such amount and then when they got out into practice the compensation was significantly less and workload significantly increased to get a little closer to yesterday's compensation. The take home message is do not rely on today's compensation to predict what will happen in the future.

The other thing to factor in is supply and demand. If there is more demand than supply, the providers may be able to increase (at least with private insurances) their compensation significantly more than other specialties, ie GI.

That being said, I believe procedure based specialties will continue to outpace other fields in terms of compensation.