pros and cons of different fields

[abc56]

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so im halfway through third year and still have no clue what i want to go into. i thought it would be nice to start a thread where we could talk about pros and cons of different fields. for those of you who have decided, what about that field attracted you?

🙂

 

[fantasty]

There are so many factors that go into making this decision. Have you tried some of the medical specialty aptitude quizzes (they're floating around the forum - I'm sure someone can link to them). Also, the Careers in Medicine website from the AAMC is pretty good too:

http://www.aamc.org/students/cim/

Now, I'm a sick freak with too much free time, so I've actually put together lists of things I like (and want to do in my career) and things I know I'm not interested in (and want to avoid like the plague). At the risk of overkill in this thread, I will put some of the factors done that were important to me (this isn't the exhaustive list but I didn't want to prove my OCD at this time - the sheer fact I made this list suggests IM is probably a good match 🙂 ):

Important factors for me:
1. Deliver preventive services directly to patients (preferably adults with chronic disease)
2. Have protected research time
3. Care for the poor / underserved
4. Have adequate time with patients
5. Have patient interaction (not necessarily “seeing results” but sharing common goals with patients; Reason I'm not going into strict preventive med)
6. Be able to understand and use diagnostic tests
7. Maintain variety in activities (by day or by week)
8. Have relatively narrow expertise (specialize enough to be confident in clinical abilities)
9. Have regular hours / predictability (don’t mind if they are long but cannot change constantly)
10. Improve (personal) understanding of pharmacology & appropriate medication use

Things I’m pretty sure I don’t want to do:

1. Spending a lot of time in the OR
2. Delivering babies
3. Spending a lot of time with coding / critically ill patients
4. Excessive Procedures
5. Focusing in neuroscience and the brain
6. Busy primary care / generalist (too many patients and not enough time)
7. Manage a clinical lab
8. Health care administration
9. Working irregular / long hours (I need some protected home time)

Things I need more info about (in order of importance):
1. Rheumatology
2. Managing HIV/AIDS patients
3. Dying Patients – Palliative / End of Life care
4. Working on an outpatient basis
5. Seeing geriatric patients, dementia, etc
6. Seeing pediatric patients


Anyway, my point is that everyone has their own prioritization. These are in most of those specialty inventories, but some things to consider:

What setting to you like? (Academic, private practice, other)
How do you feel about inpatient services?
How do you feel about ambulatory care?
Do you like the OR?
Do you like seeing lots of patients per day? Few? None?
Do you like being the expert that other doctors consult with?
Do you like kids, adults, babies, women, men, old people?
Do you chronic disease management, acute situations, or neither?
Do you really like a specific system (neurology, cardiology, nephrology, etc)?
Can you reasonably get to specialty you like (competitiveness, etc)?
Do you like psychosocial issues?
If you like surgeries, did you find specific areas, patient populations, or diseases especially interesting?
Do you like predictable hours or variety?
What income do you need?
Do you like to be more independant or part of a team?
Do you want to see immediate results from what you do, or are you ok when not directly observing the impact of your efforts?

And so on 🙂

 

[fantasty]

BTW, I'm thinking of IM with possibly rheum or ID, for the reasons listed above. I think I'd like the patient populations, I'm interesting the diseases and the pathophysiology (and diagnostic tests and treatments), and I feel that they are both narrow enough that I would probably be comfortable with them but close enough to general IM.

This tool also helps:

 

[8744]

There are so many factors that go into making this decision. Have you tried some of the medical specialty aptitude quizzes (they're floating around the forum - I'm sure someone can link to them). Also, the Careers in Medicine website from the AAMC is pretty good too:

http://www.aamc.org/students/cim/

Now, I'm a sick freak with too much free time, so I've actually put together lists of things I like (and want to do in my career) and things I know I'm not interested in (and want to avoid like the plague). At the risk of overkill in this thread, I will put some of the factors done that were important to me (this isn't the exhaustive list but I didn't want to prove my OCD at this time - the sheer fact I made this list suggests IM is probably a good match 🙂 ):

Important factors for me:
1. Deliver preventive services directly to patients (preferably adults with chronic disease)
2. Have protected research time
3. Care for the poor / underserved
4. Have adequate time with patients
5. Have patient interaction (not necessarily “seeing results” but sharing common goals with patients; Reason I'm not going into strict preventive med)
6. Be able to understand and use diagnostic tests
7. Maintain variety in activities (by day or by week)
8. Have relatively narrow expertise (specialize enough to be confident in clinical abilities)
9. Have regular hours / predictability (don’t mind if they are long but cannot change constantly)
10. Improve (personal) understanding of pharmacology & appropriate medication use

Things I’m pretty sure I don’t want to do:

1. Spending a lot of time in the OR
2. Delivering babies
3. Spending a lot of time with coding / critically ill patients
4. Excessive Procedures
5. Focusing in neuroscience and the brain
6. Busy primary care / generalist (too many patients and not enough time)
7. Manage a clinical lab
8. Health care administration
9. Working irregular / long hours (I need some protected home time)

Things I need more info about (in order of importance):
1. Rheumatology
2. Managing HIV/AIDS patients
3. Dying Patients – Palliative / End of Life care
4. Working on an outpatient basis
5. Seeing geriatric patients, dementia, etc
6. Seeing pediatric patients


Anyway, my point is that everyone has their own prioritization. These are in most of those specialty inventories, but some things to consider:

What setting to you like? (Academic, private practice, other)
How do you feel about inpatient services?
How do you feel about ambulatory care?
Do you like the OR?
Do you like seeing lots of patients per day? Few? None?
Do you like being the expert that other doctors consult with?
Do you like kids, adults, babies, women, men, old people?
Do you chronic disease management, acute situations, or neither?
Do you really like a specific system (neurology, cardiology, nephrology, etc)?
Can you reasonably get to specialty you like (competitiveness, etc)?
Do you like psychosocial issues?
If you like surgeries, did you find specific areas, patient populations, or diseases especially interesting?
Do you like predictable hours or variety?
What income do you need?
Do you like to be more independant or part of a team?
Do you want to see immediate results from what you do, or are you ok when not directly observing the impact of your efforts?

And so on 🙂

Or you could just skip all of that gut-wrenching introspection and visit my blog. Look for articles entitled "Two Minute Drill" both on the main page and in the archives for a description of many medical specialties. The management has asked me to caution you that my blog is not for the faint-hearted or the those on the knife-edge of a hissy fit. If you really prefer to think happy thoughts all the time then please visit any one of the many fine Smurf homage sites on the web.

 

[ForbiddenComma]

Here's a positive way of thinking about the various fields.

Pediatrics: Hope you don't care about money. Also, you might like children but they sure hate you and your shots.

Medicine: Feeding and watering gomers as a career must be rewarding on some level.

Surgery: Removing gallbladders from fat people all day and all night is just as glamorous as what you see on "Grey's Anatomy"

Ortho: Welcome to the practice. Here's your Q3 call schedule. And here's Bob the divorce lawyer; you'll be spending a lot of time with him.

Plastics: Saving the world, one boob job at a time

Derm: Saving the world, one botox injection at a time

EM: So you went to med school to become a triage nurse, eh?

Rads: Yay! Your job just got outsourced to India.

OB/GYN: Hope you'll like having your malpractice lawyer on speed-dial. Also hope you don't like benefits such as "high pay" or "sleep"

Family practice: Sorry, we just realized that an NP can do your job for half the pay. Here's phone numbers for some prison infirmaries that are hiring.

GI: Because looking up asses just never gets old.

Cardiologist: I'm sure we can work together to prevent any future heart attacks. Say, is that the fourth grilled cheese you've had this morning?

Pathology: The best medical specialist in the world to diagnose your condition... once you're dead.


Yes, thinking positive thoughts is the way to approach your future career. 😀

 

[Wizard of Oz]

Here's a positive way of thinking about the various fields...

Perhaps the most concise and accurate description of residency choices I've seen. What about ORL, Urology, and Ophtho? Or is it their lack of a presence on lists like this one that make them AOA specialties?

 

[bigdan]

Dante-

That algorithm is fuc*ing HYSTERICAL!

Nice.

dc

 

[AmoryBlaine]

The Cons as I see them...

Peds - watching ignorant parents ruin their children with TV and Pepsi
FP - 10 minutes to try to be the empathetic and wonderful doc we all wrote about in our AMCAS personal statements
Surgery - 80 hrs a week? ha ha ha ha ha ha ha ha ha.
Path - basements
Rad - man I hope I don't miss a lesion on this, the 50th CT C/A/P I have read today
EM - the 11pm to 7am sure seemed alot more fun when I was 28, oh look, another 400 pounder with back pain
Anesth - what will I do when I finish every Sodoku in the world?
Ob/Gyn - sure am glad to have my hand in this vagina at 3am, it's cool though, I hate sleeping
Plastics - oh drat, I didn't match, I guess I'll just do Gen Surg

 

[abc56]

yeah this is tough. im finding things i hate about every field (but also things i like, lets not be too negative here 🙂


when i started med school i wanted to be that doctor that formed these important lifelong connections, was involved with my patients, all that cheesey stuff that was very pcp/family med-ish

as third year progresses im starting to change my mind. being a PCP or family med doc is my worst nightmare- too much paperwork, noncompliant patients, overworked/underpaid.

im thinking about emergency medicine. i like the idea of shiftwork, of never being on call, of not being constantly weighed down by your work. when you go home, youre DONE. i really like that idea.

im also tossing around the idea of hospitalist. what do you all think about that?

 

[Hayden2102]

im thinking about emergency medicine. i like the idea of shiftwork, of never being on call, of not being constantly weighed down by your work. when you go home, youre DONE. i really like that idea.

im also tossing around the idea of hospitalist. what do you all think about that?

Is that really how it works with emergency medicine?

What is a hospatilist anyway? (I'm from Australia, it might be called something different over here...)

 

[8744]

...Is that really how it works with emergency medicine?

No. It's awful. Move along. Nothing to see here. Keep moving.



























Just kidding. It's great.

 

[hye345]

Here's a positive way of thinking about the various fields.

Pediatrics: Hope you don't care about money. Also, you might like children but they sure hate you and your shots.

Medicine: Feeding and watering gomers as a career must be rewarding on some level.

Surgery: Removing gallbladders from fat people all day and all night is just as glamorous as what you see on "Grey's Anatomy"

Ortho: Welcome to the practice. Here's your Q3 call schedule. And here's Bob the divorce lawyer; you'll be spending a lot of time with him.

Plastics: Saving the world, one boob job at a time

Derm: Saving the world, one botox injection at a time

EM: So you went to med school to become a triage nurse, eh?

Rads: Yay! Your job just got outsourced to India.

OB/GYN: Hope you'll like having your malpractice lawyer on speed-dial. Also hope you don't like benefits such as "high pay" or "sleep"

Family practice: Sorry, we just realized that an NP can do your job for half the pay. Here's phone numbers for some prison infirmaries that are hiring.

GI: Because looking up asses just never gets old.

Cardiologist: I'm sure we can work together to prevent any future heart attacks. Say, is that the fourth grilled cheese you've had this morning?

Pathology: The best medical specialist in the world to diagnose your condition... once you're dead.


Yes, thinking positive thoughts is the way to approach your future career. 😀

 

[abc56]

my understanding is that a hospitalist is someone who functions as a ward attending and doesnt necessarily have any of their own patients (in terms of continuity care)

not quite sure if thats a proper definition. anyone else have a better understanding of this?

 

[deleted109597]

Hospitalist is a medicine doc who only works the hospital. Basically like shift work on the floors. He/She doesn't follow the patients in clinic.

 

[DarksideAllstar]

A few of things I dislike/like about my field:

Pros...
Getting to make a diagnosis without being a goddamned social worker.
Having a dramatic impact on treatment by rendering a real (and confirmed) diagnosis.
Good working hours after residency.
No in-house call during or after residency.
Intellectual stimulation everyday vs every few weeks (ugh, Peds).
Ability to integrate clinical hx, radiographic findings, gross findings, ancillary path studies, and morphology to come up with a diagnosis.
Education responsibilities (ie med student labs, teaching other path residents, teaching clinicians).
Lots of attending face time as resident.


Cons...
Perception that you only work with the dead by the lay public and medical professionals alike (ie stupid pathology jokes).
Grossing specimens is kind of a pain in the ass sometimes.
Large volume of reading to do when you leave the hospital each day.
Autopsies.
Surgeons.

 

[Sophie]

Good idea for a thread, OP. And to everyone who posted, that's great info. It always helps to get an inside perspective.

I've looked at the information on the Careers in Medicine website, and it's really helpful, but I haven't managed to get an answer to one of my biggest questions. If possible, I'd really like to have my own practice/business: be my own boss, have my own employees, have a building/office of my own. In which specialties is this feasible? The only ones that come to mind are Dermatology and Plastic Surgery, but I'm sure there must be others.

Thanks. 😀

 

[RxnMan]

Good idea for a thread, OP. And to everyone who posted, that's great info. It always helps to get an inside perspective.

I've looked at the information on the Careers in Medicine website, and it's really helpful, but I haven't managed to get an answer to one of my biggest questions. If possible, I'd really like to have my own practice/business: be my own boss, have my own employees, have a building/office of my own. In which specialties is this feasible? The only ones that come to mind are Dermatology and Plastic Surgery, but I'm sure there must be others.

Thanks. 😀

It's interesting that you mention Derm and Plastics. Really, docs from every specialty can own their own practice, which what I think you're describing. I'd say it's easier to do this in specialities with high numbers of ambulatory procedures - cards, ortho, rehab, pulmonology, as well as derm and plastics.

As much as people talk about the benjamins, I am interested in ortho purely because I want to be a body engineer - working with my hands to make big differences in people's lives. And I like crayons

 

[Sophie]

Thanks for the reply, RxnMan. I didn't realize it's possible for any specialty - I guess it just seems like it'd be hard to be unaffiliated with a hospital if you work based on other doctors referring their patients to you.

 

[Tired]

My thoughts:

Throughout my med school career, I noticed that there was a pretty substantial difference between specialties where it was 'okay' to be a little ambivalent about your career choices, and specialties where they didn't want you unless you were totally committed to the field.

For example, it's clear that a lot of people end up in IM and FP after a long period of not knowing what they want to do with their lives, and the attendings and residents are generally accepting of this. On the other hand, if you tell a Urologist or Orthopedist that you like their field but are also interested in other specialties, they will urge you to do something else.

As you start doing clinical rotations, I would encourage you to keep this in mind. If you're considering one of the highly competitive specialties, on rotations tell them how committed you are to them, even if you're not totally sure about it. I've seen a number of attendings lose interest in students because they weren't 100% positive about what field they wanted to go into. This goes double during your 4th year.

 

[RxnMan]

Thanks for the reply, RxnMan. I didn't realize it's possible for any specialty - I guess it just seems like it'd be hard to be unaffiliated with a hospital if you work based on other doctors referring their patients to you.

You're absolutely right - you need to have a referral network to make money and support your practice. That's why many docs work real hard (residency or better hours) after residency to establish contacts in their area and get those revenue streams.

As a random example, if you were in rehab, you could have your own staff of mid-levels (PTs, mostly) and an office, but you'd need to have surgeons (in the case of post-op treatment) or school contacts (in the case of sports or pediatric rehab) to support everything.

Back home, I know a pulmonologist who sees patients at the local hospital, then crosses the street to his building and sees paitents there. Next door is an endocrinologist who owns his own practice with his own staff. Up the street there's ortho and gen surg practices. Each of them use the hospital's ORs, but see patients pre and post in their clinic. There's many possibilities.

Tired - I've heard before that there's a certain amount of lip service that has to be paid for MSIII and IV - not just for a chance at a good grade, but to get a worthwhile and educational experience. It's hard to get your tuition's worth and learn anything if the attendings ignore you.