Specialities with few/no procedures?

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biogirl215

biogirl215

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Forgive me if this is in the wrong forum (wasn't sure if it would go in Allo or Residency), but what are some fields requiring little or no procedures? So far, all I can come up with is Psych, Rads, and possibly Rad Onc. (True?), discounting fellowships that would require IM residencies. Any I'm missing?

Thanks.
 
Depends on what you mean by procedures. Pathology comes to mind.
 
Path has autopsies, BMAs, and sections. Basically, by proceduces, I mean anything physical (enough of a sweeping generalization? 😉 ).
 
Well, rads might let you down, because there are some procedures. 😉 You can usually cater to do less, but that would be after residency.

Path is in the same boat. Yea there are biopsies, but you can also sit back and do slides most of the day like a good little recluse.

I think if you did an ID fellowship there tends to be less. Someone can correct me if I am wrong, but I was always under the impression that tends to be on the more cerebral side of the internal medicine fellowship scale...cards and GI being on the other end.
 
If you don't consider keeping track of patients and managing their care throughout the stay of the hospital procedural-based, you could look into being a hospitalist.
 
If you do Family Med in an academic setting, you can most likely do few procedures. The FM clinic at my school has it pretty divided, where there's a procedure clinic and then everything else. Also, I don't believe Allergy and Immunology has procedures, though I don't know for sure.
 
MrBurns10 said:
If you do Family Med in an academic setting, you can most likely do few procedures. The FM clinic at my school has it pretty divided, where there's a procedure clinic and then everything else. Also, I don't believe Allergy and Immunology has procedures, though I don't know for sure.
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Good call on outpatient peds. I think a lot of the procedures associated with family practice (biopsies and excisions, wound draining, gynecological testing, cleaning the gunk out of old peoples' ears...) would be lacking with kids-only. The physical exam itself may be a little more hands-on though. Oh, you weren't actually expecting to make a decent living though were you?
 
You can be a fully practicing physician in most fields without much procedure involvement, except for surgical fields, of course. But once you finish residency in internal medicine or most of its subspecialties, family med, radiology, pathology, psych, pediatrics, you may not have to do any procedures if you are in the right setting. You can also do these fields and do lots of them. The trick would be getting through residency without doing them, and that to a large extent depends on where you do your residency. Some IM programs have limited exposure because nurses do a lot, PAs do a lot, other specialties do them. But other programs have you constantly doing things.

I'm in path, I have very limited procedural exposure during residency, and didn't have to do a prelim year either. I had to do a few FNAs. Autopsies, yes, but those are on dead people so you can't really screw much up. Some path residencies have you doing lots of BM biopsies but not mine. Frozen sections can be tricky, grossing in specimens, but it's hard to hurt someone directly. My experience when people are asking about fields where they don't have to do procedures is that they fall under one of a few categories

1) They have limited dexterity (shakiness, whatever)
2) They just dislike them
3) They're scared of hurting someone.

And frankly, many people in the second category (at least at first) are just projecting or are in denial and actually belong to category 1 or 3. To be honest, you have to get over your fears. Very few people shake so much that they can't do simple procedures. And you are unlikely to severely hurt people if you are careful and learn correctly with supervision (instead of being avoidant of them).

I hate procedures. Mostly because I find them tedious and uninteresting. I don't really get a kick out of doing them like so many others. I have a bit of a nervous tremor and initially I was worried about how I would deal with procedures, but I dealt with it just fine in med school. I wouldn't trust myself to operate on small vessels but I was fine in surgeries when I had to sew wounds and cut things and all that. But very few people are skilled enough to do microsurgery, whether you shake or not. And sticking needles into people wasn't as difficult as I thought.

So ask yourself why the procedure aversion. If it's simple fear, discard the fear (or simply just confront it) and just do some procedures and you'll find you didn't need to be worried. If it's dexterity, do them anyway with supervision and you'll see you have less reason to be worried. But do not avoid them just because you're worried. You'll only hurt yourself and potentially your patients in the future. A lot of medicine is about confronting your own weaknesses, fears, and anxieties. You become a better doctor by learning what your true weaknesses are (and not simply your fears) as well as your strengths (many of which will be unexpected). You do not become a better doctor by avoidant behavior.
 
Doctor Bagel said:
I'm not entirely sure, but I don't think PM&R is very procedure oriented. I don't think neurologists do many procedures, either.
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Inpatient PM&R has little to no procedures, outpatient generally is a much different story. I agree with neuro, it is more cerebral...sorry I had to do it :laugh:
 
tr said:
How about endo or rheum?

Neurologists do LPs all the time, I wouldn't call them a procedure-free specialty.
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I think the OP was trying to avoid going through an IM residency.

I agree that Neuro does a lot of LPs.
 
biogirl215 said:
Forgive me if this is in the wrong forum (wasn't sure if it would go in Allo or Residency), but what are some fields requiring little or no procedures? So far, all I can come up with is Psych, Rads, and possibly Rad Onc. (True?), discounting fellowships that would require IM residencies. Any I'm missing?

Thanks.
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Rad Onc has T&Os, brachy implants
 
Blade28 said:
They do all the FNAs/core needle biopsies here. (Usually breast and neck.)
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Yep...particularly common in academic settings.

1) the surgeons or internists don't have the skills to do ultrasound guided biopsies (in many cases)
2) clinic is not set up for these type of biopsies; equipment is not available in clinic
3) politics decide who does what in academic hospitals

In PP, it behooves you to learn to do these procedures because doing an ultrasound guided biopsy actually PAYS MORE than going to the OR and taking the lesion out (in most cases of Skin and Soft Tissue lesions). Plus, its generally easier on the patient (if it turns out to be benign).
 
Thanks for the replies everyone!

Yaah*,
I guess I'd fall into category 2, with a bit of a complication. I have a disability which affects my fine motor skills, among other things, so I'd have an almost impossible time matching into or completing a residency that requires proceduces, and I don't feel that it would be in the patients' best interest, either. Provided I could get into and through medical school (which, I know, is a big "if"), I'd be very limited into what specialities I could even conceviably match into--I really couldn't be a surgeon, do fine opthamological proceduces, delicate biopsies, LPs, etc. So, before I decide if I should even try at medicine (and the more I look at the field, the less likely that becomes for a variety of reasons), I'd like to get a clear picture of what the options really would be--what specialities I could conceivably do. I have contacted a physician with the same/similar disability who ultimately became a psychiatrist due to her inability to match into ped, likely due, at least in large part, to her disability (psych also seems to be where the blind physicians end up, for some reason). Before I rule out medicine, I wanted a clear look at what specialities (that is, residencies) could be options and if I could see myself doing them.

Well, rads might let you down, because there are some procedures. 😉
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Umm, I know I'm going to look like an idiot here (yeah, sorry), but I can't tell if you're being sarcastic or not...😕
*Random fact: Did you know "yaah" means something like "hey" in Arabic so "hey, yaah" would be "yaah, yaah"? 😀)
 
biogirl215 said:
*Random fact: Did you know "yaah" means something like "hey" in Arabic so "hey, yaah" would be "yaah, yaah"? 😀)
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So you one o'them A-rabs?:scared: Stop contributing to this now. USA...USA...USA.

However, I disagree. "Yaah" is too long to be "hey". It is more like "Ya". But is could however be used as an expression of satisfaction.
 
biogirl215 said:
Umm, I know I'm going to look like an idiot here (yeah, sorry), but I can't tell if you're being sarcastic or not...😕
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He was absolutely not being sarcastic. Rads does plenty of procedures, even those without interventional fellowship training.

When a surgical patient has an abdominal abscess amenable to drainage, we have Rads place a CT guided drain.

A patient with a mammographic abnormality will be referred to Rads for a stereotactic biopsy done in the Rads suite.

...and so on...
 
i've witnessed ECT a few times. i think it's a stretch to call it a procedure, at least in the sense that it requires the physician to have precision with their hands.
 
In practice, you could completely avoid procedures in radiation oncology. However, to get through residency, you have to be signed off on a sufficient number of brachytherapy procedures. Some are simple, but others require more skill. I'm not sure what the extent of your disability is. If it is minor, you might be able to concentrate on simple procedures and get through (an understanding program director would be necessary). Otherwise, you'd have to seek some kind of exemption. If you want more details on brachytherapy procedures, feel free to PM me.
 
Winged Scapula said:
In PP, it behooves you to learn to do these procedures because doing an ultrasound guided biopsy actually PAYS MORE than going to the OR and taking the lesion out (in most cases of Skin and Soft Tissue lesions).
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Another example of the messed-up system of billing we have in this country.
 
DrDawg said:
Never seen a Pathologist do a biopsy.
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OK. I should defer to the expert, I guess. Please disregard everything in my previous post. 🙄

In addition to what I mentioned above, the truth is, some cytopathologists spend most of their day doing fine needle aspirations themselves, and a lot of pathologists do bone marrow biopsies. The heme-oncs do them here too, but at many hospitals this is not true, for whatever reason.



As far as the fine motorskills bit, you need to find out if it actually affects you doing simple procedures. You don't necessarily need superb fine motor skills to do simple procedures.

Psychiatrists have to do a prelim year. Pretty much the only field that doesn't have at least a prelim year with lots of patient contact and procedures is path. But if you are going into path primarily just for the lack of procedures, you are going to be miserable and likely unsuccessful.

And no, my username has nothing to do with arabic. My ethnic heritage is perhaps the furthest thing from arabic on the planet.
 
Winged Scapula said:
Yep...particularly common in academic settings.

1) the surgeons or internists don't have the skills to do ultrasound guided biopsies (in many cases)
2) clinic is not set up for these type of biopsies; equipment is not available in clinic
3) politics decide who does what in academic hospitals

In PP, it behooves you to learn to do these procedures because doing an ultrasound guided biopsy actually PAYS MORE than going to the OR and taking the lesion out (in most cases of Skin and Soft Tissue lesions). Plus, its generally easier on the patient (if it turns out to be benign).
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My bad then. We had a path residency that went under. They didn't do anything outside of the path department, that I recall.
 
As far as the fine motorskills bit, you need to find out if it actually affects you doing simple procedures. You don't necessarily need superb fine motor skills to do simple procedures.
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How would I go about doing this, seeing as I highly doubt anyone is going to just an undergrad. try out the procedures?

So you one o'them A-rabs?
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Nope, just took a semester of it in college. My hertitage is English/Dutch and German/Swedish, so I'm about as boringly white as can be.

However, I disagree. "Yaah" is too long to be "hey". It is more like "Ya". But is could however be used as an expression of satisfaction.
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Really? Our professor always transliterated it as "yaah," and he/we always said it a bit long. Maybe it's a dialect thing? He was from Jerusalem. [/OT]
 
biogirl215 said:
How would I go about doing this, seeing as I highly doubt anyone is going to just an undergrad. try out the procedures?
[/OT]
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Can you flip a pancake without hitting the ceiling? Can you thread a needle without stabbing your finger? Then you should be fine. 🙂
 
if you can't sew then you probably won't have the fine motor skills necessary for any procedures. starting IV, placing central lines, intubating... i could go on for quite a while. all require coordination more precise than does sewing. i'm not trying to be mean here, but if you can't even sew you'd have a very hard time in any specialty outside of psychiatry i think.
 
mlw03 said:
if you can't sew then you probably won't have the fine motor skills necessary for any procedures. starting IV, placing central lines, intubating... i could go on for quite a while. all require coordination more precise than does sewing. i'm not trying to be mean here, but if you can't even sew you'd have a very hard time in any specialty outside of psychiatry i think.
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Remember though that you will shake less once you know what you are doing. 🙂 Seriously do you have trouble tying your shoes? Is this really a problem or are you just nervous about it? Don't worry about this before you even start med school. There is plenty of opportunity to practice suturing on pigs feet and using scalpels and saws on a cadavers.
 
skypilot said:
Remember though that you will shake less once you know what you are doing. 🙂 Seriously do you have trouble tying your shoes? Is this really a problem or are you just nervous about it? Don't worry about this before you even start med school. There is plenty of opportunity to practice suturing on pigs feet and using scalpels and saws on a cadavers.
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not sure what the above has to do with the original question. the poster said he/she lacks the fine motor skills to sew. it's not an issue of being nervous, rather it's some neuromotor disease preventing this person from relaying all the necessary signals to perform the desired task safely. i could practice trying to fly until i die, but it won't happen because humans aren't made to fly. similarly, this person wasn't made with the motor skills most of us have, or he/she has some acquired handicap. physical and occupational therapy can sometimes help patients after a motor defect develops, but if this person has reached a ceiling and still can't sew then that's it.
 
mlw03 said:
not sure what the above has to do with the original question. the poster said he/she lacks the fine motor skills to sew. it's not an issue of being nervous, rather it's some neuromotor disease preventing this person from relaying all the necessary signals to perform the desired task safely. i could practice trying to fly until i die, but it won't happen because humans aren't made to fly. similarly, this person wasn't made with the motor skills most of us have, or he/she has some acquired handicap. physical and occupational therapy can sometimes help patients after a motor defect develops, but if this person has reached a ceiling and still can't sew then that's it.
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You're right. I missed the post in the middle of the thread where the OP said they had a true disability which would make it impossible to sew.

Certainly surgery is out, but internal med might be possible with some special accomodations and psych is definitely a possibility. Many med students make it through med school without doing much in the way of procedures and you might be able to get some special accomodations in residency.
 
I think this answer to the original question is dependent about the hospital, region or personal preference.. Some hospitalists put in their own lines. Sometimes, EM docs are called to do lines. I know neurologists that do LP's regularly, but not everywhere. Some Family docs do all sorts of minor procedures in the office. Some do none.
 
Yes, but if the question is, can a person function as an internal med doctor with almost no procedures the answer is yes. It is mostly about the brain not the hands and you can get other people to do your procedures for you. Certainly there are residencies that will make an accommodation for a disabled person.
 
biogirl215 said:
Forgive me if this is in the wrong forum (wasn't sure if it would go in Allo or Residency), but what are some fields requiring little or no procedures? So far, all I can come up with is Psych, Rads, and possibly Rad Onc. (True?), discounting fellowships that would require IM residencies. Any I'm missing?

Thanks.
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Preventive Medicine
 
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