Specialities with longitudinal patient relationships

[NightSwim]

I'm going to medical school next year and am starting to think about what speciality I want to do. I have a feeling I'm going to want to go into a speciality where I can care for patients over a long period of time (years) and build relationships with them. Besides the primary care options, can anyone suggest specialities that fit this description? One reason I might steer clear of primary care is to care for more challenging/sick patients, and because the research opportunities will be greater in a specialized field (although I could be wrong about this). I still might want to do primary care, I'm really not sure yet. Here are the specialities I can think of that fit what I'm talking about:
GI - IBD patients
Endocrinology - diabetic patients
Gyncecology - pelvic pain patients
Heme/Onc

Suggestions?

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[chibrown01]

IMO oncology has great oppurtunites for wat u r interested in. You just have to b emotionally prepared to tell a patient they have x months to live .

 

[Geekchick921]

Just thinking out loud here, what about pain management?

 

[Rach83]

rheumatology?

 

[BBender716]

Just thinking out loud here, what about pain management?

Yes. One of the reasons I'm looking at anesthesiology. Great opportunity to be in the OR but also have your own practice/establish longitudinal patient relationships.

FWIW, derm also has some longitudinal relationships w/acne and some other pervasive problems. Then again, I just know everyone would love dealing with teens longitudinally, lol

 

[Bartelby]

Psychiatry

 

[TexasPhysician]

Psychiatry

 

[LizzyM]

What you want to think about are chronic conditions that are (for now) incurrable but treatable. Within internal medicine:

HIV (infectious disease)
Hepatitis C (often handled by gastroenterology due to liver complications)
Crohns and Inflammatory Bowel (gastroenterology)
rheumatoid arthritis and lupus (rhematology)
diabetes (endocrinology)
hyperlipidemia and hypertension (general internal medicine)
some leukemias and clotting disorders (hem/onc)
allergists deal with some patients on a long term basis
pulmonary medicine treats asthma, COPD, emphysema

Neurology has a bunch of conditions that fit the bill: epilepsy, multiple sclerosis, ALS

Psychiatry....

OB/GYN if you settle somewhere with a relatively stable population you may treat some women for decades through childbearing years through menopause and beyond....

General surgeons in small towns often get to know multiple generations of some families through routine surgical care (hernias, appendicitis, gall bladder).

 

[Omrianh]

Infectious disease sees many long-term patients who have HIV. Neurology sees PD, Alzheimer's, etc.

I'm pretty sure both have lots of research opportunity/requirement

 

[NightSwim]

Thanks for all the ideas! This is great.

Just thinking out loud here, what about pain management?

I'm curious, can you elaborate on this? What kind of doctors do pain management? Would this be palliative care docs? Or anesthesiologists?

Yes. One of the reasons I'm looking at anesthesiology. Great opportunity to be in the OR but also have your own practice/establish longitudinal patient relationships.

How do anesthesiologists have long-term relationships with patients?

IMO oncology has great oppurtunites for wat u r interested in. You just have to b emotionally prepared to tell a patient they have x months to live .

I like this idea, but it will be hard to tell whether I like oncology until I rotate through it during med school. Same with everything else though.

What you want to think about are chronic conditions that are (for now) incurrable but treatable. Within internal medicine:

Thanks for the ideas LizzyM. I definitely am excited to check out neurology, and that idea about being a general surgeon in a small town is very appealing.

 

[DrYoda]

I'm curious, can you elaborate on this? What kind of doctors do pain management? Would this be palliative care docs? Or anesthesiologists?

Pain med is a fellowship most often done by anesthesiologists and PM&R. You can also do it via neuro and psych but that's less common. It's not necessarily pallative care, there are lots of disorders that cause pain (trigeminal neuralgia for example) that they treat via procedures or meds.

There's actually a pain med sub-forum further down SDN in the resident/attending area.

How do anesthesiologists have long-term relationships with patients?

He's talking about pain med, you can have your own stand alone practice with that.

 

[Geekchick921]

Thanks for all the ideas! This is great.


I'm curious, can you elaborate on this? What kind of doctors do pain management? Would this be palliative care docs? Or anesthesiologists?


How do anesthesiologists have long-term relationships with patients?

I believe they are typically anesthesiologists. I'm pretty sure palliative care is only for hospice patients. Pain management can be for people that suffer from chronic pain as a result of injuries or other problems. According to WebMD, though, neurologists, PM&R docs (I think physiologist is another term for that specialty) and even neurosurgeons and orthos can also be pain management docs. http://www.webmd.com/pain-management/doctors-who-treat-pain

 

[CaliGirl14]

gastroenterology!!!

 

[7starmantis]

No one mentioned cardiology?

 

[Narmerguy]

Pediatrics to a point but it must ultimately end.

 

[LizzyM]

IPM&R docs (I think physiologist is another term for that specialty) [/URL]

Physiatrist is the physician specializing in rehabilitative medicine.

Physiologist is the scientist who studies physiology (physical function, particularly at the system, organ, cellular and molecular level)

 

[BBender716]

I believe they are typically anesthesiologists. I'm pretty sure palliative care is only for hospice patients. Pain management can be for people that suffer from chronic pain as a result of injuries or other problems. According to WebMD, though, neurologists, PM&R docs (I think physiologist is another term for that specialty) and even neurosurgeons and orthos can also be pain management docs. http://www.webmd.com/pain-management/doctors-who-treat-pain

Spot on.

Thanks everyone for answering for me. Pain management is what we're referring to. Nerve blocks, etc. and not necessarily hospice. For instance, my grandmother has debilitating pain due to severe arthritis and prior knee surgeries/injuries, but is too unhealthy/old to undergo the extensive reconstructive surgery that would only possibly alleviate her pain. So she is consistently seen by "her anesthesiologist" who helps her out via pain management.

 

[Geekchick921]

Physiatrist is the physician specializing in rehabilitative medicine.

Physiologist is the scientist who studies physiology (physical function, particularly at the system, organ, cellular and molecular level)

Whoops! I didn't go back to the link I posted to double-check what I typed, but that's what I meant. I usually just said PM&R, but the site referred to them as a physiatrist. So much for me trying to clarify things!

 

[startswithb]

This may not be what you're looking for, but I'd like to comment that OB/Gyn could have the longest and most intimate patient relationships.

For instance, my OB/Gyn delivered me and takes care of me in my 20s. Women also do not like to switch gynecologists ever once they find the "right" one for them. It's very unique.

 

[LizzyM]

This may not be what you're looking for, but I'd like to comment that OB/Gyn could have the longest and most intimate patient relationships.

For instance, my OB/Gyn delivered me and takes care of me in my 20s. Women also do not like to switch gynecologists ever once they find the "right" one for them. It's very unique.

The flip side is that few are "very sick" or challenging intellectually. Maternal Fetal medicine deals with the chronically ill woman during pregnancy and other "high risk" situations but after delivery the woman can often go back to her regular GYN. Reproductive endocrinology deal with women having problems becoming pregnant but that's (usually) short term. Gyn-oncology is, sadly, too often a short term relationship.

 

[7starmantis]

Spot on.

Thanks everyone for answering for me. Pain management is what we're referring to. Nerve blocks, etc. and not necessarily hospice. For instance, my grandmother has debilitating pain due to severe arthritis and prior knee surgeries/injuries, but is too unhealthy/old to undergo the extensive reconstructive surgery that would only possibly alleviate her pain. So she is consistently seen by "her anesthesiologist" who helps her out via pain management.

As a side note, I know a couple pain management docs and they are banking! Not that that is important or anything. One employs 5 PA's and has 5 clinics, and thats in northwest Texas for goodness sake.

 

[smarty666]

I have the very similar interest as you have. I want to eventually work in primary care getting to know and follow patients for many years. EM, Radiology, Surgery, Orthopedics, Anesthesiology, Pathology, Critical Care all are unappealing specialties to me because you will not have long-term patient care and follow-up. You only see patients for a short amount of time. That is another reason why being a hospitalist is a turn off for me as well because you only get to treat and see patients while they are inpatient and then you never know what happens to them when they are discharged. Now you have to take what I say with a grain a salt. That is how I personally feel about what kind of career in medicine I would like, but someone else can feel completely different.

One thing about pain management, and take it from a person who has chronic back problems who has seen several pain management doctors over the years. You will not see patients long-term. You are lucky if you see a patients 3-5 times before the treatment either works and they don't have to come back or it doesn't work and you have to send them off to either a neurologist, orthopedic, neurosurgeon, orthopedic surgeon, PM&R etc.

If you are like me who wants a long-term longitudinal relationship with patients that have chronic diseases your best bet is family medicine, internist, neurology, infectious disease, cardiology, allergy/immunology, dermatology, GI, oncology, nephrology, urology, hematology, pulmonology, pediatrics, rhemuotology, hepatology, psychiatry, OB/GYN and ENT for long-term getting to know your patient specialties and follow them.

For instance, I was with the same pediatrician for 18 years, my internist I've been with for 7 years, my allergist 21 years, and urologist for 10 years. Actually, I've been with my neurosurgeon for almost 2 years now so I guess complicated surgical specialties where you have continued problems, your surgeon can get to know you.

But if others love to work with their hands and cut people open, do more clinical research, etc then this lists will mean nothing to you and you'll be more interested in something like surgery or pathology, etc.

 

[BBender716]

I have the very similar interest as you have. I want to eventually work in primary care getting to know and follow patients for many years. EM, Radiology, Surgery, Orthopedics, Anesthesiology, Pathology, Critical Care all are unappealing specialties to me because you will not have long-term patient care and follow-up. You only see patients for a short amount of time. That is another reason why being a hospitalist is a turn off for me as well because you only get to treat and see patients while they are inpatient and then you never know what happens to them when they are discharged. Now you have to take what I say with a grain a salt. That is how I personally feel about what kind of career in medicine I would like, but someone else can feel completely different.

One thing about pain management, and take it from a person who has chronic back problems who has seen several pain management doctors over the years. You will not see patients long-term. You are lucky if you see a patients 3-5 times before the treatment either works and they don't have to come back or it doesn't work and you have to send them off to either a neurologist, orthopedic, neurosurgeon, orthopedic surgeon, PM&R etc.

If you are like me who wants a long-term longitudinal relationship with patients that have chronic diseases your best bet is family medicine, internist, neurology, infectious disease, cardiology, allergy/immunology, dermatology, GI, oncology, nephrology, urology, hematology, pulmonology, pediatrics, rhemuotology, hepatology, psychiatry, OB/GYN and ENT for long-term getting to know your patient specialties and follow them.

For instance, I was with the same pediatrician for 18 years, my internist I've been with for 7 years, my allergist 21 years, and urologist for 10 years. Actually, I've been with my neurosurgeon for almost 2 years now so I guess complicated surgical specialties where you have continued problems, your surgeon can get to know you.

But if others love to work with their hands and cut people open, do more clinical research, etc then this lists will mean nothing to you and you'll be more interested in something like surgery or pathology, etc.

Refer to my previous post. The elderly do develop long-term relationships with their anesthesiologists in pain management... unless of course, you are elderly in the counterexample you provided.

 

[smarty666]

Refer to my previous post. The elderly do develop long-term relationships with their anesthesiologists in pain management... unless of course, you are elderly in the counterexample you provided.

Well that is certainly possible, but I didn't see any elderly people in any of the pain management clinics at my anesthesiologist's office. But that isn't to say some don't seek out pain management for pain problems when they are much older. Pain management and PM&R are the first two doctors a orthopedic and surgeon will send you too when they can't do anything for you.

You are right, I am not elderly though my pain level and MRI's of my spine would say otherwise. I'm 25 years old and have more trouble bending my back and moving around then my 60 year old father. If that isn't a kick in the butt I don't know what is. Hopefully my neurosurgeon and PM&R physicians can get me back into shape or I won't ever make it through residency the way I am let alone med school. Here is hoping the modern marvel of medicine can help me go to med school eventually.