"Quiet" & Slow-paced Specialties in Medicine

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dreamylove

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First post ever.

Currently trying to examine possible specialties. M1, so no rush, I suppose, even though some of my classmates know exactly what they want to do.

I do know one thing though, I cannot seem to be an effective learner in a noisy fast-paced environment. I either need to put earplugs in or otherwise I'll be too distracted. From a previous temporary position in an ER, I realized the ER is the last place I'm fit for. I just can't deal with seeing so many patients at the same time and being expected to learn everything about them/treat them carefully.

So I was wondering what specialties are there that you can take your time and chill with the patient and actually have it be an accurate, meaningful experience, reducing the stress of the job in the process. I've heard pathology and psych are like this. I just don't like the non-physio nature of psych and pathology is OK I guess.

Thoughts?
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I'm not sure what you want exactly. Family med isn't crazy like ER, but they still see ~2.4 patients per hour (about what even slow EM docs see).

You could do genetics. *shrug*
 
dreamylove said:
I do know one thing though, I cannot seem to be an effective learner in a noisy fast-paced environment. I either need to put earplugs in or otherwise I'll be too distracted. From a previous temporary position in an ER, I realized the ER is the last place I'm fit for. I just can't deal with seeing so many patients at the same time and being expected to learn everything about them/treat them carefully.

So I was wondering what specialties are there that you can take your time and chill with the patient and actually have it be an accurate, meaningful experience, reducing the stress of the job in the process. I've heard pathology and psych are like this. I just don't like the non-physio nature of psych and pathology is OK I guess.

Thoughts?
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Wow. I think MS-3 and possibly your internship will be quite rough for you.
 
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Hang up your own shingle in a rural community?
 
DermViser said:
Wow. I think MS-3 and possibly your internship will be quite rough for you.
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I've actually been really worried about ms-3 lately. But I figure I just need to get through it and then practice at my own pace after on. It just gets really stressful. 2.4 patients/hr as mentioned above is fine. i would be really concerned about 5+ per hour. i know doctors in the ER who see 10/hr and that is way too much for me
 
Radiation oncology could be like this depending on the practice type. Otherwise private practice derm, outpatient primary medicine, or basically anything that doesn't require you to take call or be on the wards. That way you can set your own pace.
 
dreamylove said:
I've actually been really worried about ms-3 lately. But I figure I just need to get through it and then practice at my own pace after on. It just gets really stressful. 2.4 patients/hr as mentioned above is fine. i would be really concerned about 5+ per hour. i know doctors in the ER who see 10/hr and that is way too much for me
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Not exactly the best attitude or course of action to have to get thru the hoops of med school, internship, and residency. You wouldn't be the first med student to think if they only just "get thru it", it will get better, though.
 
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dreamylove said:
First post ever.

Currently trying to examine possible specialties. M1, so no rush, I suppose, even though some of my classmates know exactly what they want to do.

I do know one thing though, I cannot seem to be an effective learner in a noisy fast-paced environment. I either need to put earplugs in or otherwise I'll be too distracted. From a previous temporary position in an ER, I realized the ER is the last place I'm fit for. I just can't deal with seeing so many patients at the same time and being expected to learn everything about them/treat them carefully.

So I was wondering what specialties are there that you can take your time and chill with the patient and actually have it be an accurate, meaningful experience, reducing the stress of the job in the process. I've heard pathology and psych are like this. I just don't like the non-physio nature of psych and pathology is OK I guess.

Thoughts?
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If the answer for you isn't derm, it's psych. If the answer isn't psych, it's pmr. If the answer isn't pmr...then dentistry by default. You can go as slow as you want if you're the boss in derm/psych/dentistry/etc, but your practice's bottom line is going to suffer.

Also look into palliative care.

Path could be pretty chill, except for the whole no jobs thing.

On the bright side, maybe you will grow out of the MS1-don't-like-psych-phase come your actual clinical rotation during ms3, but maybe not -- that's no problem. But in regards to practice setup it is likely the closest match to what you requested. Obviously, that wouldn't in any way warrant one to pursue the field in and of itself-- but rather perhaps use it as motivation to at least keep an open mind to the experience come clinical years.
 
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Geriatrics sounds like it would be slow paced
 
No specialty chills. It's called work for a reason. And sure you can call your own shots and make no money trying to keep the doors open on your practice so you can make long, unhurried appointments with your patients. Thing is, most people don't. Private practice people that I've met worked harder than salaried people. Owning your own practice in work in itself outside of clinical work.

If you want to chill, you've chosen the wrong profession.

Now that you're stuck, sure derm might be pretty nice...if you can do everything but chill to earn a spot. But really man it's business and time is money. Nothing really is that relaxing. You won't be going into surgery, OB, ED, etc. PM&R, psych, path, anesthesiology, derm, might offer better options for the chilling-inclined. Internal and family programs and careers can be selected for chill if that's your main concern. Some sub specialties of medicine are chill. Relatively speaking. It's not being a lifeguard on an empty beach or a librarian or archivist chill. But only by comparison to the worst of your 3rd year clerkships.
 
dreamylove said:
I've actually been really worried about ms-3 lately. But I figure I just need to get through it and then practice at my own pace after on. It just gets really stressful. 2.4 patients/hr as mentioned above is fine. i would be really concerned about 5+ per hour. i know doctors in the ER who see 10/hr and that is way too much for me
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There is not a single EM doc in the country that is seeing 10/hr, they would be spending all of their free time charting. Average pt/hr in EM is around 2.5. There are some that get above 3, but going too quickly makes you more susceptible to mistakes.
 
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Frazier said:
If the answer for you isn't derm, it's psych. If the answer isn't psych, it's pmr. If the answer isn't pmr...then dentistry by default. You can go as slow as you want if you're the boss in derm/psych/dentistry/etc, but your practice's bottom line is going to suffer.

Also look into palliative care.

Path could be pretty chill, except for the whole no jobs thing.

On the bright side, maybe you will grow out of the MS1-don't-like-psych-phase come your actual clinical rotation during ms3, but maybe not -- that's no problem. But in regards to practice setup it is likely the closest match to what you requested. Obviously, that wouldn't in any way warrant one to pursue the field in and of itself-- but rather perhaps use it as motivation to at least keep an open mind to the experience come clinical years.
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I would have thought Radiology was chill. Is it not?
 
DermViser said:
I would have thought Radiology was chill. Is it not?
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I do not know for certain. I imagine your exposure is more extensive than mine (assuming you had a rotation or 2 maybe?).

According to the radiology attendings and residents of SDN, it is a resounding "no" when it comes to lifestyle and chill factor.

...Although that seems to be the trend across many of the stereotypical lifestyle fields: Gas forum swears its not lifestyle, Rads swears its not lifestyle, EM swears its not lifestyle.

The Path forum, as brilliant as they are, seem to be perpetually disgruntled... so lifestyle is moot apparently.

I don't read the derm forum much, although I remember some of the attendings say that they grind pretty hard to earn their income and that it isn't as cush as made out to be. What do they tell you?

Psych forum is open and blatant about things being lifestyle friendly/relaxed for most part. Which is --different -- in that their openness/acceptance of the fact is polar opposite to the other ~20 subforums of SDN... but then again, not super surprising, for better/worse psych is kind of a different medical specialty to begin with, no? 🙂
 
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qw098 said:
Why are there no jobs... I thought it was a speciality in demand?
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You can read all about it in their forum.

In as few words as possible: they have become a commodity, in labs owned by others, and they never retire.
 
Frazier said:
I do not know for certain. I imagine your exposure is more extensive than mine (assuming you had a rotation or 2 maybe?).

According to the radiology attendings and residents of SDN, it is a resounding "no" when it comes to lifestyle and chill factor.

...Although that seems to be the trend across many of the stereotypical lifestyle fields: Gas forum swears its not lifestyle, Rads swears its not lifestyle, EM swears its not lifestyle.

The Path forum, as brilliant as they are, seem to be perpetually disgruntled... so lifestyle is moot apparently.

I don't read the derm forum much, although I remember some of the attendings say that they grind pretty hard to earn their income and that it isn't as cush as made out to be. What do they tell you?

Psych forum is open and blatant about things being lifestyle friendly and relaxed. Which is --different -- in that their openness and acceptance of it is polar opposite to the other ~20 subforums of SDN... but then again, not super surprising, psych is kind of a "different" to begin with, no?
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I knew Anesthesiology was kind of a misnomer in terms of lifestyle esp. since **** can hit the fan very quickly. That specialty also has high rates of drug abuse as well, for some reason, so if you're someone who has traits of addiction, that is probably not the field you should enter. It's a "lifestyle" specialty in terms of a set number of hours, not having your own patients. When you're done, you're done, etc. No pager afterwards.

Radiology I thought they sit there and read images the entire time, and field phone calls from consultants. You're working the entire time, but it's not like you're moving around rounding, doing non-medicine stuff, I believe.

I think Psych is pretty clear about it's lifestyle, although it can have quite a huge inpatient (yuck) Psych component in residency, and I don't know if there are a lot of admissions on a call night like on IM. Obviously outpatient Psych, is much more enjoyable.
 
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Frazier said:
I do not know for certain. I imagine your exposure is more extensive than mine (assuming you had a rotation or 2 maybe?).

According to the radiology attendings and residents of SDN, it is a resounding "no" when it comes to lifestyle and chill factor.

...Although that seems to be the trend across many of the stereotypical lifestyle fields: Gas forum swears its not lifestyle, Rads swears its not lifestyle, EM swears its not lifestyle.

The Path forum, as brilliant as they are, seem to be perpetually disgruntled... so lifestyle is moot apparently.

I don't read the derm forum much, although I remember some of the attendings say that they grind pretty hard to earn their income and that it isn't as cush as made out to be. What do they tell you?

Psych forum is open and blatant about things being lifestyle friendly/relaxed for most part. Which is --different -- in that their openness/acceptance of the fact is polar opposite to the other ~20 subforums of SDN... but then again, not super surprising, for better/worse psych is kind of a different medical specialty to begin with, no? 🙂
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Interesting post. I guess you guys who read or have read extensively in those forums would have a better sense of the pulse of these fields. I've only read the EM, PM&R, and Internal medicine forums. And of course the psych forum. Which until you've pointed it out, I hadn't realized talks more openly about good lifestyle.

Psych remains, however, a poor choice for just lifestyle as a solo factor. You would hate those 30-40 weeks if you didn't like the field itself. Psych tends to split people in terms of liking it or not. There's no middle ground, where a lifestyle oriented person could choose it among other fields based on more subtle factors alone. I mean there could be...I just haven't met any of those people.
 
dreamylove said:
I've actually been really worried about ms-3 lately. But I figure I just need to get through it and then practice at my own pace after on. It just gets really stressful. 2.4 patients/hr as mentioned above is fine. i would be really concerned about 5+ per hour. i know doctors in the ER who see 10/hr and that is way too much for me
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Covering 10+ beds is not the same as 10 patients per hour. EM docs are not seeing 80 patients on an 8 hour shift.
 
These days psych is quite the opposite of "non-physio." It's quite the opposite rather. Your expectations of money will dictate the pace. I've seen a Family Med doctor who worked only a 20 hour week and spent 30 min with each patient. Her salary was adjusted based on productivity. I also know 2 psychiatrists who work only part time; again, the salary is scaled down to suit their needs. Other options would be to consider a research career, where you might spend 1 1/2 hours per patient. Derm is quiet, but everyone I know sees patients at a dizzying q5min for a few hours.
 
DermViser said:
I knew Anesthesiology was kind of a misnomer in terms of lifestyle esp. since **** can hit the fan very quickly. That specialty also has high rates of drug abuse as well, for some reason, so if you're someone who has traits of addiction, that is probably not the field you should enter. It's a "lifestyle" specialty in terms of a set number of hours, not having your own patients. When you're done, you're done, etc. No pager afterwards.
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OP, please avoid anesthesiology if you want something quiet and slow-paced. I second the recommendation for psych or PM&R, but you'll probably feel the pinch if you aren't seeing enough patients.
 
boogaloo said:
OP, please avoid anesthesiology if you want something quiet and slow-paced. I second the recommendation for psych or PM&R, but you'll probably feel the pinch if you aren't seeing enough patients.
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And, of course, you have to factor in your own tolerance of seeing morbidity/mortality/suffering; so PM&R isn't all snow cones and novels. Preventive Medicine might even be an option.
 
Pet said:
And, of course, you have to factor in your own tolerance of seeing morbidity/mortality/suffering; so PM&R isn't all snow cones and novels. Preventive Medicine might even be an option.
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I don't know much about the field but isn't PM&R more about degenerative neuromuscular disorders. People don't acutely die in that specialty, or at least not quickly, correct?
 
boogaloo said:
OP, please avoid anesthesiology if you want something quiet and slow-paced. I second the recommendation for psych or PM&R, but you'll probably feel the pinch if you aren't seeing enough patients.
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Or I guess she could do a pain medicine fellowship after Anesthesiology, but that's a whole residency to go thru first to the promised land - and I don't know if pain medicine is still competitive.
 
DermViser said:
Or I guess she could do a pain medicine fellowship after Anesthesiology, but that's a whole residency to go thru first to the promised land - and I don't know if pain medicine is still competitive.
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It's competitive but not too terribly hard to match into, especially coming from anesthesiology. PM&R, psych, and neuro residents can also apply for the same pain fellowships, but I think generally there are fewer spots for them. I think it's increasing in competitiveness due to the huge reimbursement rates, but that might not last very long.

PM&R is actually pretty slow-paced from what I've seen, but my exposure to the field is very limited.
 
TooMuchResearch said:
2.4 per hour may be a lot depending on acuity. ACEP says the safe limit is 2.5/hr.
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And 2.5 is FAST. And honestly patients per hour is highly based on acuity. If all your patients have colds and earaches then you can see a ton of patients quickly (think urgent care patients).

But remember one really sick person can take a lot of time...one patient could require...intubation, central line, and chest tube...then a lengthy conversation with the family and talking to the inpatient team to admit the patient. Nobody can do all of this in 15 or 20 minutes. That patient is going to take over an hour to deal with. That's why critical care billing requires you to take a minimum of 30 minutes.

Family med should be able to see more than the ER in theory because there are less procedures and calls killing all of your time.
 
Quick point: Don't discount path because 'the job market sucks'. These things are very cyclical. If you're an MS1 now it'll likely be 7-9 years before you enter the workforce (depending on fellowships). A lot can (and will) change.
 
Yeah I feel the same way. If I thought I would like path the best I would do it. I think anyway...could it be that bad...? Idk, to tell you the truth. I've heard only rumors. But I tell you what. It feels awesome to know that I will be in demand as a psychiatrist when I graduate. It would suck if I was nearing the job market with crappy prospects and this big debt. So....who knows. It's true that this stuff ebbs and flows.

I always find those curious side streets in medicine that nobody takes kind of interesting too. Like occupational or preventative medicine or nuclear medicine...does anyone still train in nuclear medicine? One thing it does remind you of is that medicine is business and that they compete for market share...one specialty gobbling up or usurping the market of another. Which is another level of security for psych at least from physician competition. Nobody...absolutely nobody...wants to take over the work of psychiatrists. It's demand has engineered itself by the nature of the work alone.

Another thing to consider for the root causes of lifestyle is to think about the patient care demands of the field. It's no accident specialties like derm have a sweet lifestyle...nobody needs to be seen at 3:30 am on a Saturday. If your specialty needs to man those particular hours in force then your lifestyle has the potential to suck. This is a good rule of thumb when touring the clerkships and thinking about how important that is or is not to you.
 
Jabbed said:
Quick point: Don't discount path because 'the job market sucks'. These things are very cyclical. If you're an MS1 now it'll likely be 7-9 years before you enter the workforce (depending on fellowships). A lot can (and will) change.
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I would actually disagree with this. There are alot of factors going against path unfortunately. The mega labs aren't going anywhere. Molecular testing is making histology slightly less important, clincians (urologists/GI) make much more money getting biopsies than path does reading, imaging is more improtant for diagnosis(yes biopsies are still improtant too), etc. Hopefully I am wrong as pathologists are usually the smartest folks around. Path was my second choice as a specialty, and may have been #1 if not for the market. I actually had some young faculty tell me to do another specialty as they had done 2 fellowships at big name places and were stuck in assistant professor positions in fly-over country (when they wanted to be making $$ in private practice.)

As for PM&R it is like any other specialty in that the more you see the more $$ you make. Generally there is no "life and death" stresses, but you still need to see plenty of patients. Some of the procedures (EMG/NCS), and botox injections cannot be done super fast but if you do alot of MSK outpatient you will likely need to get through patient's quickly. The intrarticular injections, msk ultrasound, andtrigger points, and fluoro guided injections can move pretty quick. It really all depends on your set-up and monetary goals.
 
"Quiet" is fairly subjective too. How many of us have seen the III volume 2000 page chart of the TBI'd patient on PM&R. That's not my idea of quiet. Guess you might shift into Sports Medicine from it tho. I'm not sure I know of any gigs that let you "chill" with the patient.

But Family Med might allow you to control the type of patients that you prefer and allow you to balance out your practice style and add some preventive/mental health %s in it.
 
Honestly, how can we expect an MS1 to know what type of practice environment he would thrive in? Its obvious by his responses that he has very minimal clinical experience. He is just in awe of the efficiency of the docs he has witnessed and has difficulty seeing himself ever becoming that clinically adept. I think most of us have been there at one point in our training. He will eventually become more efficient and confident in his clinical abilities. At that point, he can reevaluate what type of practice would best suit his personality and abilities.
 
Zebra Hunter said:
Honestly, how can we expect an MS1 to know what type of practice environment he would thrive in? Its obvious by his responses that he has very minimal clinical experience. He is just in awe of the efficiency of the docs he has witnessed and has difficulty seeing himself ever becoming that clinically adept. I think most of us have been there at one point in our training. He will eventually become more efficient and confident in his clinical abilities. At that point, he can reevaluate what type of practice would best suit his personality and abilities.
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Dreamy love is male? Good point about the confidence; the niche will find you.

There was a psychologist that did a Myers-Briggs on our M1 class, and occupational daydreams. She followed up twice in med school and residency. The Myers-Briggs had good predictability for what spectrum of results matched up with what fields people went into correlated with happiness/unhappiness about chosen field. I don't know if she ever published it. But something along these lines may be worth peeking at http://forums.studentdoctor.net/threads/specialty-based-on-myers-briggs-personality.996295/
 
boogaloo said:
It's competitive but not too terribly hard to match into, especially coming from anesthesiology. PM&R, psych, and neuro residents can also apply for the same pain fellowships, but I think generally there are fewer spots for them. I think it's increasing in competitiveness due to the huge reimbursement rates, but that might not last very long.

PM&R is actually pretty slow-paced from what I've seen, but my exposure to the field is very limited.
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You're wrong. They've been receiving cuts.
 
There was a psychologist that did a Myers-Briggs on our M1 class, and occupational daydreams. She followed up twice in med school and residency. The Myers-Briggs had good predictability for what spectrum of results matched up with what fields people went into correlated with happiness/unhappiness about chosen field. I don't know if she ever published it. But something along these lines may be worth peeking at http://forums.studentdoctor.net/threads/specialty-based-on-myers-briggs-personality.996295/
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INTJ

Match: Psychiatry, Pathology, Neurology, Internal medicine.

I am not shocked.
 
Frazier said:
INTJ

Match: Psychiatry, Pathology, Neurology, Internal medicine.

I am not shocked.
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Ugh this is the second time this week that a personality test has pointed me towards neurology.

You left off gas btw.

INTJ - Psychiatry, Pathology, Neurology, Internal medicine, Anesthesiology
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Ophthalmology might meet that initial criteria set.

Reminds me...my mentor treated an ophthalmologist for a few years for psychotherapy; patient disclosed he was a voyeur. Go figure.
 
Baller MD said:
You're wrong. They've been receiving cuts.
Click to expand...

boogaloo said:
It's competitive but not too terribly hard to match into, especially coming from anesthesiology. PM&R, psych, and neuro residents can also apply for the same pain fellowships, but I think generally there are fewer spots for them. I think it's increasing in competitiveness due to the huge reimbursement rates, but that might not last very long.

PM&R is actually pretty slow-paced from what I've seen, but my exposure to the field is very limited.
Click to expand...
 
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