Please tell me about specialties

[yesno]

Please tell me. I am a little tired now. But I want to know. So whats the difference between a primary care dr working at a hospital(i.e. having his outpatient office there) versus working at a clinic(like those standalone offices that might have primary care or any other specialties that do not do surgeries)? I understand your own office is a "business", does it mean that the overhead would be hire and it would take more effort "to stay afloat"? Like would it be a viable career choice to open your own practice(or join a small group) in some nice coastal area of florida or california?

Same question for neurology, endocrinology, rheumatology, allergy? Would they make more money than hospitalists? And do outpatient drs often diagnose atypical diseases like vasculitis, hepatitis, tularemia, lyme disease? Or is that confined to big hospitals? And does it even pay if you do a bunch of lab tests to rule out all kinds of diseases on your outpatients? How come infectious disease specialists are confined to work in hospitals?Basically as hospitalists? Is it because diagnosis via physical exam and blood work does not pay relative to overhead?

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[Rendar5]

It's pretty easy to just look up the average salaries of different specialities, realizing that these do vary a lot state by state.

BTW, I wouldn't really classify hepatitis and lyme disease as rare entities. They're not hugely difficult to diagnose for most primary specialists. Most docs wouldn't recognize tularemia if it hit them square in the face as it's a very nonspecific illness. My bet is it'd be diagnosed on autopsy or via culture from a bronchial aspirate (that would be obtained within the hospital since they'd likely be inutbated as teh disease progressed.) Vasculitides are generally figured out in the course of a workup and referred to a rheumatologist to really narrow down the classifications, but plenty of docs diagnose and treat Lupus and Rheumatoid Arthritis every day. I think you'll find the answer to a lot of questions you'll find as you progress, since I'm not really sure you fully understand exactly what you're asking right now.

 

[evilbooyaa]

I would do some basic research on different specialties and come back and ask a more focused question.

Each specialty is widely different for the most part. To sit here and describe each of them in excruciating detail, is something I don't want to do. Google - "What is a hospitalist" (and repeat for all the other specialties that you are interested in)

I will say that I have very rarely seen a specialist with a stand-alone outpatient office that is not affiliated with a hospital. YMMV

I have seen a family med doctor with a stand-alone outpatient office (who then has to worry about overhead, hirings, etc. etc.)

 

[Winged Scapula]

I will say that I have very rarely seen a specialist with a stand-alone outpatient office that is not affiliated with a hospital. YMMV

Really?

I'm a specialist with my own (more than 1 office) that is not affiliated with a hospital. Most of my friends here are specialists (Plastics, Rad Onc, Med Onc, Gen Surg, Uro, ENT, Ortho and Derm) with their own non-hospital affiliated practices.

While I realize you said, "YMMV", its a lot more common than you might appreciate. Things may change in the future but for now, PP as a specialist is a viable option.

 

[ophthope]

Really?

I'm a specialist with my own (more than 1 office) that is not affiliated with a hospital. Most of my friends here are specialists (Plastics, Rad Onc, Med Onc, Gen Surg, Uro, ENT and Derm) with their own non-hospital affiliated practices.

While I realize you said, "YMMV", its a lot more common than you might appreciate.

Not to mention ophtho - almost all of which are non-hospital-affiliated practices, and many ortho clinics which are similar.

 

[NickNaylor]

I would recommend this book: http://www.amazon.com/Ultimate-Choosing-Medical-Specialty-Edition/dp/0071479414/. It sounds stupid, I know, but there's actually quite a bit of good info in there, and I think it teaches you about each specialty as well as a book can. If nothing else it's at least a good place to start.

 

[yesno]

Thank you. Yes, I should read that book, maybe it will help me ask more informed questions. But right now I should be studying... Anyway, another question I have. What about hematology/oncology? Do they see a lot of metastatic cancers and nontreatable leukemias/lymphomas? Do most of their patients die? Like I can see a patient going to a primary care dr, gets his CBC done and then he is directed to you, and you can only tell him that there are different ways that he can die? I mean most of what I read in path seemed interesting in terms of classifying things like platelet dysfunctions, immunophetype. But ultimately all your patients will be crying instead of being happy to see you, right? I wish I could do derm because patients are happy after they see you and at the same time there is $$ and job stability. And you actually make challenging systemic diagnoses. But I am not stupid/ambitious enough to think I could match.

Also interesting review of that book
"It is an informative book. Students will learn a lot from reading this book. But the authors for each specialty are merely telling you the positive aspects of their specialty. Students still should seek more information about some of the issues why you may not want to choose a specific specialty. For an example, in Ob/Gyn the author for that section addresses males in the specialty as 'still having a role' in ob/gyn. True. But, in many, many metropolitan areas males ob/gyns struggle to find jobs. You'll not find information like that in this book. Pathology section doesn't mention how for the past 10 year or so the job market has really suffered. Because the duration of residency has decreased from 5 years to 4 years many residents are not equipped to function fully as an attending. Hence many employers seek out applicants with a fellowship in a subspecialty. This has created a huge demand for fellowship training which is very limited in number in comparison to the number of residents seeking fellowships. It, as I've been told, is one of the few physician specialty where you are not really guaranteed a position after residency. But the book doesn't tell you things like that. Anesthesiology section doesn't paint the real picture of the power struggle between CRNAs taking over MD anesthesiologists' jobs. Rather it more or less states how they all need to work together. In the meanwhile Colorado has just become the 16th state to allow CRNAs to practice without the supervision of an MD. So, use this book as a book that tends to advertise each specialty without informing you on issues that may cause you not to choose a certain specialty. "

 

[yesno]

I think hem/onc is the opposite of what I want. What about endocrinology, allergy, rheum, gynecology? Read some threads on sdn that state that it is dificul to be a successful male gynecologist. Also was at the gym today. And noticed how a personal trainer was really good with an old lady. I definitely do not have the same ability to teach or "show compassion" with certain people. I'd rather be a surgeon if it weren't so hard..

 

[Winged Scapula]

I would recommend this book: http://www.amazon.com/Ultimate-Choosing-Medical-Specialty-Edition/dp/0071479414/. It sounds stupid, I know, but there's actually quite a bit of good info in there, and I think it teaches you about each specialty as well as a book can. If nothing else it's at least a good place to start.

And many of the authors are SDN members!

 

[Feed Me]

I believe specialties is an old, old wooden ship

 

[Law2Doc]

Like would it be a viable career choice to open your own practice(or join a small group) in some nice coastal area of florida or california...?

viability in this context is more a business issue than a medicine one. Most small businesses fail, and medical offices aren't really an exception. Whether a business makes sense depends on the regional demand and the level of competition. Whether it succeeds depends on business decisions and marketing. So whether opening a business is "viable" is not something anyone can answer in a vacuum. Odds are that if it's a nice warm coastal area, you won't be the first one with this idea, but who knows.

 

[evilbooyaa]

Really?

I'm a specialist with my own (more than 1 office) that is not affiliated with a hospital. Most of my friends here are specialists (Plastics, Rad Onc, Med Onc, Gen Surg, Uro, ENT, Ortho and Derm) with their own non-hospital affiliated practices.

While I realize you said, "YMMV", its a lot more common than you might appreciate. Things may change in the future but for now, PP as a specialist is a viable option.

Definitely forgot about ophtho stand alone. Guess we haven't been exposed to a whole lot of it. The more you know.