Questions about diff specialties and lifestyle of medicine

[deleted936268]

Hey everyone, I'd like a career in academic medicine and shadowed nsgy and ortho the other day (applying to MD next cycle so still a long road ahead). I was thinking a bit into the future and kind of wanted to ask what the end goal of it all is. For those gunning ortho/nsgy/other comp long specialties, the average age of finishing residency is mid-30s, by which they start generating crazy money that they barely see/enjoy. Coming off of 80 hr+ a week residencies, they keep working hard and staying on call until late 40s or early 50s, by which the ROI of going to medical school and paying debt off and getting enough capital to invest finally sets in.

On the other hand for people choosing less comp specialties/less time spent in residency, their salary is less than those comp specialties and while they can enjoy lifestyle a bit more and see where their money and hard work goes, their avg salary is 250-300k before tax (assuming normal conditions and hrs practiced).

With these 2 (very general) paths in mind, what's the point of grinding medicine and what's with the rush of people towards it? Bit of a lengthy post but I write this after watching nsgy residents being completely overworked and depressed following 3 4-5 hr long ops in a day (and it being normal). I'm someone that has always thought of pursuing a comp specialty and really like medicine for my love of science to help people, but really what's the point if life isn't lived until age 45-50?

Thanks for reading am really curious and also confused.

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[NotAProgDirector]

Here's a crazy idea:

Specialize into the field of medicine you actually enjoy doing. Then, working is actually fun and not drudgery.

And I "lived life" during my residency also. If you define living life = owning a Maserati, then perhaps medicine isn't a great choice.

 

[Bobblehead]

I would reconsider your life choices if you frame medicine in terms of pure financial payoffs.

 

[deleted936268]

I would reconsider your life choices if you frame medicine in terms of pure financial payoffs.

No of course not, it definitely isn't all about money and sorry if it seems framed that way. I plan on pursuing medicine because i really enjoy integrating different scientific concepts and learning more about the relationship of biochem and bio especially, but a lot of my question comes from wanting to make sure I'm comfortable with the lifestyle as well. It is important to me in the future that I make enough to build generational wealth (I come from a lower income background and family) and also that I enjoy work.

Even with liking science and using that knowledge to help my community, I just wanted feedback on how others are dealing with the times where the path seems like a bad ROI (especially with me needing to put 12 more years of training into it of 60-80+ hrs per week and constant stress).

 

[stickgirl390]

Every specialty in medicine will provide you with job security and financial stability in the low-tier upper class. Choosing medicine as a path to financial independence is fine, but thats not why you choose a specialty. I’m sure plenty of neurosurgery/ortho residents would argue that they very much enjoyed their lives during training, because it is their field of passion. You’ll also find a wealth of older medical students who don’t finish residency - in any field - until their 40s. They will also tell you they were happy and had plenty of income to live comfortably.

 

[deleted936268]

Every specialty in medicine will provide you with job security and financial stability in the low-tier upper class. Choosing medicine as a path to financial independence is fine, but thats not why you choose a specialty. I’m sure plenty of neurosurgery/ortho residents would argue that they very much enjoyed their lives during training, because it is their field of passion. You’ll also find a wealth of older medical students who don’t finish residency - in any field - until their 40s. They will also tell you they were happy and had plenty of income to live comfortably.

Yea I talked to a couple nsgy residents yesterday and ortho the week before, a lot of them shared the sentiment that the combined effort of charting/dealing w nurses/dealing w attendings/etc and all while at 80 hrs+ a week really sucks. And that while there are nice, fun times during residency like actually doing ops and surgeries, it's like 20% of their week.

 

[Dantes]

Like the others said, specialize in what you want. Pretty much any specialty will give you enough money to start significantly investing in passive income. Which if wealth is your goal you should look into, since you can only work so many hours

 

[RangerBob]

No of course not, it definitely isn't all about money and sorry if it seems framed that way. I plan on pursuing medicine because i really enjoy integrating different scientific concepts and learning more about the relationship of biochem and bio especially, but a lot of my question comes from wanting to make sure I'm comfortable with the lifestyle as well. It is important to me in the future that I make enough to build generational wealth (I come from a lower income background and family) and also that I enjoy work.

Even with liking science and using that knowledge to help my community, I just wanted feedback on how others are dealing with the times where the path seems like a bad ROI (especially with me needing to put 12 more years of training into it of 60-80+ hrs per week and constant stress).

Everyone ROI ultimately is the same-we die.

I looked at med school and residency simply as part of the journey, and not just steps to a “better” spot. The steps are much more enjoyable that way.

You’ll go crazy if you get too into the financial ROI and all that. You get one life. Think ahead a little obviously, but don’t get so stuck in your own head (which I do it all the time myself) that you forget to enjoy where your at.

The simple reason neurosurgeons do such long surgeries is… they love it! How many surgeons have you met like to sit quietly on the beach sipping Mai Thais? Not many. They’re like Richard Feynman, who if you ever read his writings, clearly always had science turned on in his brain, even on vacation. It was his life, and he loved it. Surgeons (most) just love to operate.

Me? I love medicine, but I also love the other things in my life. I will never write a book chapter or be the top in my field because of that. I’m not a Feynman, Mozart or a Michaelangelo. It’s totally fine—I enjoy my job, make enough to afford Coastal CA without starving, and see my family plenty, so I’m happy.

 

[Matthew9Thirtyfive]

The simple reason neurosurgeons do such long surgeries is… they love it! How many surgeons have you met like to sit quietly on the beach sipping Mai Thais? Not many. They’re like Richard Feynman, who if you ever read his writings, clearly always had science turned on in his brain, even on vacation. It was his life, and he loved it. Surgeons (most) just love to operate.

I get what you’re saying but this also sort of feeds into the false dichotomy OP is painting. Being a surgeon does not preclude you from enjoying life outside the OR. There are plenty of surgeons, including neurosurgeons, who work reasonable hours and enjoy their lives outside the hospital.

 

[RangerBob]

I get what you’re saying but this also sort of feeds into the false dichotomy OP is painting. Being a surgeon does not preclude you from enjoying life outside the OR. There are plenty of surgeons, including neurosurgeons, who work reasonable hours and enjoy their lives outside the hospital.

Absolutely. It's entirely possible once a surgeon is an attending to carve out reasonable work hours. But surgical specialties tend to be more self-selecting in favor of applicants who like to work a lot. The primary reason I did not apply to surgery was I didn't want to work those kind of hours--in residency or in attendinghood.

If you want to go into neurosurgery you have to:
1) Study much more than the average person in college for 4 years to get into medical school
2) Study much more than the average med student to match into neurosurgery, in addition to working much harder on clinical rotations
3) Work 80-100+ weeks for 7-9 years of neurosurgery residency & fellowship (+/- a research year or two).

That's 15-17 years. Obviously other surgical specialties entail less hours, and some are a bit more lifestyle oriented liked optho/ENT, but your average general/ortho/neurosurgeon knows ahead of time what they're getting into and wants to do it--not that many people plan to go through all that and then cut back to what you or I may consider reasonable hours. There are better ways to do things if the goal is to just work less. 15-17 years of the same dedication/hard work flipping houses/renting them out could probably get you a nice retirement in the same timeframe it takes a neurosurgeon to finish residency with $400k in debt.

My bet is the majority of surgeons who are working part-time decided to after they committed to the path, whether it be they got married/had kids/just got burnt out. It's unfortunate, but the truth in surgery (as well as medicine and many other practices) is you need to maintain a certain volume to remain competent. We may often set that thermostat to high, but it's still there.

 

[deleted936268]

Absolutely. It's entirely possible once a surgeon is an attending to carve out reasonable work hours. But surgical specialties tend to be more self-selecting in favor of applicants who like to work a lot. The primary reason I did not apply to surgery was I didn't want to work those kind of hours--in residency or in attendinghood.

If you want to go into neurosurgery you have to:
1) Study much more than the average person in college for 4 years to get into medical school
2) Study much more than the average med student to match into neurosurgery, in addition to working much harder on clinical rotations
3) Work 80-100+ weeks for 7-9 years of neurosurgery residency & fellowship (+/- a research year or two).

That's 15-17 years. Obviously other surgical specialties entail less hours, and some are a bit more lifestyle oriented liked optho/ENT, but your average general/ortho/neurosurgeon knows ahead of time what they're getting into and wants to do it--not that many people plan to go through all that and then cut back to what you or I may consider reasonable hours. There are better ways to do things if the goal is to just work less. 15-17 years of the same dedication/hard work flipping houses/renting them out could probably get you a nice retirement in the same timeframe it takes a neurosurgeon to finish residency with $400k in debt.

My bet is the majority of surgeons who are working part-time decided to after they committed to the path, whether it be they got married/had kids/just got burnt out. It's unfortunate, but the truth in surgery (as well as medicine and many other practices) is you need to maintain a certain volume to remain competent. We may often set that thermostat to high, but it's still there.

This is exactly the response I was looking for tbh, really details what I was expecting. I guess the only way for it to work out well is to make sure that if I decide to pursue nsgy or something competitive that I really enjoy it. That way during the hellish 80-100+ work weeks, I'll still be able to enjoy the little moments and keep pushing. Thanks!

 

[RangerBob]

This is exactly the response I was looking for tbh, really details what I was expecting. I guess the only way for it to work out well is to make sure that if I decide to pursue nsgy or something competitive that I really enjoy it. That way during the hellish 80-100+ work weeks, I'll still be able to enjoy the little moments and keep pushing. Thanks!

Absolutely--choose the specialty you enjoy.

This might sound like a radical opinion, but you are almost guaranteed to not be any happier making $700k compared to $200 or $300k. Most research shows our happiness from income peaks under $100k (once we get our basic necessities and some sense of financial stability).

Obviously your level of student debt affects that statement somewhat, but with income-based plans it's sort of moot if you just view it as another tax.

On the the other hand, your job, relationship with friends/family, generally have a much higher impact on your happiness than your income.

 

[YCAGA]

You are making conclusions based on two of the hardest driving residencies in medicine. Almost all residents in all specialities work a lot and work hard but ortho and nsgy are known for fitting a lot of hours in their “80 hour” weeks. Not saying they are locks at #1 and #2 for crappy lifestyle during residency but they are up there.

As for why medicine…I would rather spend my 20s, 30s and 40s doing something that is interesting, directly helps people, and is prestigious, than something that ends up being 1/3rd of the career earnings, is less gratifying, and makes me suicidal.

Any American physician that starts residency by 30 can retire by their 50’s if that is their goal, can’t say that for many professions.

Also “no time to enjoy it” is not a medicine problem. That is a priorities problem and you see it in law, business, tech, etc. You also see people with balanced lives in all those fields, including medicine.

Finally, if someone replies to argue about “TeCh PAyS wAy MoRE fOr LeSs HOuRz” and how their uncle’s neighbor’s sister-in-law’s ex-pool boy now makes $400k at 26 working at Amazon Google Metaverse I might have an aneurysm.

 

[Matthew9Thirtyfive]

Absolutely. It's entirely possible once a surgeon is an attending to carve out reasonable work hours. But surgical specialties tend to be more self-selecting in favor of applicants who like to work a lot. The primary reason I did not apply to surgery was I didn't want to work those kind of hours--in residency or in attendinghood.

If you want to go into neurosurgery you have to:
1) Study much more than the average person in college for 4 years to get into medical school
2) Study much more than the average med student to match into neurosurgery, in addition to working much harder on clinical rotations
3) Work 80-100+ weeks for 7-9 years of neurosurgery residency & fellowship (+/- a research year or two).

That's 15-17 years. Obviously other surgical specialties entail less hours, and some are a bit more lifestyle oriented liked optho/ENT, but your average general/ortho/neurosurgeon knows ahead of time what they're getting into and wants to do it--not that many people plan to go through all that and then cut back to what you or I may consider reasonable hours. There are better ways to do things if the goal is to just work less. 15-17 years of the same dedication/hard work flipping houses/renting them out could probably get you a nice retirement in the same timeframe it takes a neurosurgeon to finish residency with $400k in debt.

My bet is the majority of surgeons who are working part-time decided to after they committed to the path, whether it be they got married/had kids/just got burnt out. It's unfortunate, but the truth in surgery (as well as medicine and many other practices) is you need to maintain a certain volume to remain competent. We may often set that thermostat to high, but it's still there.

I don’t disagree completely, but I seriously doubt the dozen surgeons I’ve met who are working 50-60 hours a week are incompetent at their jobs. Working those hours makes it very possible to have a good family life. Residency is a different story, but even for neurosurgery it’s temporary.

 

[YCAGA]

I don’t disagree completely, but I seriously doubt the dozen surgeons I’ve met who are working 50-60 hours a week are incompetent at their jobs. Working those hours makes it very possible to have a good family life. Residency is a different story, but even for neurosurgery it’s temporary.

Given old-ish surveys (2010) say surgery averages around 50-60 hours, that person is arguing that the vast majority of surgeons in the US are incompetent. I mention the surveys being old with that assumption that work life balance has gotten a little better.

 

[RangerBob]

I don’t disagree completely, but I seriously doubt the dozen surgeons I’ve met who are working 50-60 hours a week are incompetent at their jobs. Working those hours makes it very possible to have a good family life. Residency is a different story, but even for neurosurgery it’s temporary.

I think we’re in agreement here. I wasn’t trying to say surgery requires 80hr weeks to stay competent-just that it does require a fair time commitment to do so. I think 50-60hrs is plenty enough.