PAGuyana

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So I will be about 42 when I graduate medical school. Help me choose a specialty. What are the most popular choices for those in my situations? I am interested in a short residency/bang for the buck situations. Save the do what your heart desires/fluff advice. I know it already and have heard it too many times.
 

DrMidlife

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Short answer: probably hospitalist or EM, willing to work in an underserved area for a big corporate HMO. 3-4 yr residency, $150k-$300k. (imho: ugh.)

Long answer: there's 42-going-on-50 and there's 42-going-on-27.

If you're the former, maybe your primary concern is how soon you can pay off your debt so you don't have to work so much. Maybe you want to retire at 65 or earlier, and you want that nice house paid off. Carnival Cruise Lines has such a nice buffet. Hospitalist. EM. Maybe anesthesia.

If you're the latter, you probably wouldn't be happy selling out to profit-driven lowest-common-denominator medicine, and maybe you're looking at what's going to make the rest of your life resonate with satisfaction and service. Maybe you have a 401k from your previous career, but you don't know how much is in it. Maybe retirement planning is something you associate with what your father talks about with his golf buddies. Family med, peds, ob/gyn, gen surg.

Not that people fit in buckets.
 

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For something not too physically demanding in terms of hrs, short residency, good money, I would look at psy, EM, hosp, and maybe gen surgery....

But, flipping night and days are hard for some folks so EM may not be that great as well as hosp...

I think psy can be a great field as long as the patient pop does not bother you. I was a Psy major and find crazy folks interesting....:laugh:

There is also teh little knowm PM&R....actually it might be exactly what you are looking for....

derm if you are really smart too!!
 

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So I will be about 42 when I graduate medical school. Help me choose a specialty. What are the most popular choices for those in my situations? I am interested in a short residency/bang for the buck situations. Save the do what your heart desires/fluff advice. I know it already and have heard it too many times.
Right. I've though along similar lines. For perhaps related reasons. Decrepitude has to be accounted for. One has to look at the upsides of the down.

Bang for buck. Depends on your bang I guess. How about: CompetitivenessofResidencyAppCoeffiecient(lifestyle + interest)/pay + Nasurdincoefficient(time of residency training) = rank number. Lowest score is your top choice.

This from my thoughts echoed though discussion with physicians and others:

Occupational Medicine. Good lifestyle. Good pay. Lot's of insurance Worker's comp issues. Gigs working for The Man. Short and Easy as Sh!t Residency. Interesting? Vaguely not. Knowing nothing.

PM&R. Good lifestyle. Decent pay. Lot's of chronically F'd up patients. Pain med slangin. reasonable residency. too many gigs that are inter-depedent on other specialties for revenue streams. Knowing jack.

Radiology. Seems cool. Great pay. Competitive limit. Residency spots fewer far between. Could end up in Kentucky for match. Knowing nothing about it.

Internal medicine. ****ty grind. Social work overwhelm/primary care brunt. Many residency spots. Flexible career paths. Crappy hours. Could lead to something endgame cool to me. like palliative care. or sleep medicine. Specialties within require long training--residency plus fellowship. could make good pay as a hospitalist. would that be cool or suck? Knowing nada

Pediatrics. Fun work. short residency. Social work downside. Systems in use not designed for job required = basic daily frustration. pay sucks. Sleep good at night. knowing all crimes are solved/lives saved. but also because hearing babies yelp in agony all day is exhausting. From watching my boss.

OB/Gyn. Uh. No. Surgery. Too exhausting/long/arduous. EM. Burnout would be hard to beat as an aged rookie--depends on your mental getup and preferences for hectic environs. But good lifestyle if you dig the work flow. From watching my former bosses.

Those are my guesses going in green accommodated for agedness.
 

PAGuyana

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What's PM&R?

Guessing it is some sort of pain management....


Do residency programs practice age discrimination? I know they aren't supposed to, but...
 

DrMidlife

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What's PM&R?

Guessing it is some sort of pain management....
physical med & rehabilitation. I was going to say what it was, but realized I have no idea.

Do residency programs practice age discrimination? I know they aren't supposed to, but...
Short answer: sure, also fat discrimination, ugly discrimination etc.

Other short answer: there are douchebags everywhere you go.
 

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physical med & rehabilitation. I was going to say what it was, but realized I have no idea.


Short answer: sure, also fat discrimination, ugly discrimination etc.

Other short answer: there are douchebags everywhere you go.
Yeah. Physical medicine and rehabilitation. I'm not sure about the acronym. I think they follow muscular skeletal disorder patients. And inpatient physical therapy or something. And surgical recovery. And some do pain medicine. <<<That would suck. Not as bad as OB. But close.

Pandabear has a blog entry about this type of physician that cracked me the F up.
 

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So I will be about 42 when I graduate medical school. Help me choose a specialty. What are the most popular choices for those in my situations? I am interested in a short residency/bang for the buck situations. Save the do what your heart desires/fluff advice. I know it already and have heard it too many times.
Your grades and your board scores may make the choice for you. Cool your jets and see what you might be competitive for. There are plenty of budding "lifestyle" specialists out there that find their choices significantly narrowed when residency application time comes around.
 

Nasrudin

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Your grades and your board scores may make the choice for you. Cool your jets and see what you might be competitive for. There are plenty of budding "lifestyle" specialists out there that find their choices significantly narrowed when residency application time comes around.
Naturally. And also why I'm wondering what my capabilities are. Wondering if I have what it takes to excel at that level. Also why I've spent hours pouring over you study technique/approach. And from those doubts wondering about what's a good plan B. With physical limitations much like the OP's concerns. Lifestyle to me means different things.

And like DrMidlife said aging is a personal thing. Being of the 36 going on 96 variety. Could be useful to talk about different fields given certain limitations. Now. While we're all just waiting around for the slaughter to begin. If only useful for killing time. And settling nerves.
 
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I'm 42 now and I just matched into PMR at my first choice. It's a good lifestyle, patients are grateful and (in my opinion) less stressful. Financially, it's a good choice, looking better daily.
I was going to choose FM but this is my "bang for the buck" too. Just one extra year (or more, if you choose).
Definitely look into it!
 
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Doesn't surgery have a unwritten retirement age of around 65?
My first neurosurgeon who did my hemilaminectomy was 69 when he performed the operation so I think that statement is a lot of baloney! Maybe each hospital has a different retirement age.
 
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I'm 42 now and I just matched into PMR at my first choice. It's a good lifestyle, patients are grateful and (in my opinion) less stressful. Financially, it's a good choice, looking better daily.
I was going to choose FM but this is my "bang for the buck" too. Just one extra year (or more, if you choose).
Definitely look into it!
PMR is a interesting specialty and sometimes it is hard to find those specialist. They are good at looking at all your problems and tests results and trying to put the picture together, at least that is what my PT told me. I have to see one within the next month because of all my spinal problems post lumbar fusion last year that I am continuing to have.
 

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Sports medicine?
That's either family med or ortho, from what I've seen. If you go the family med route, you're looking at family med money - $80k to $120k - after a 3 yr residency, plus CME for sports med. If you go the ortho route, that's big money, after you do an extremely competitive residency for 5-7 years.

Look up sports med in the nearest biggish city and run through the docs at the clinics - you'll see one-stop-shops that have a roster of ortho, PM&R, podiatry & physical therapy. You'll see at least one massive HMO that lists a sports med department, with family med docs. Plenty in between.
 

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Family medicine pay is so ridiculously bad and not going to get any better. There is a sports medicine clinic here at Duke I bet those docs do pretty well and I mean the regular sports med not the surgeons.. but yeah you would have to hook up with celebrity clients and be a celeb yourself.

I never really thought about my age re what areas I would go into... I just think more about how I can get paid the most for doing the least... lol. This is a great interview answer, BTW.

Just off topic a little, and I'll post this on another thread, but there is a fantastic guy right nearby here who has a cash only family medicine practice, it's a win win for everyone. I am trying to find the link to the article now...

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=652945


That's either family med or ortho, from what I've seen. If you go the family med route, you're looking at family med money - $80k to $120k - after a 3 yr residency, plus CME for sports med. If you go the ortho route, that's big money, after you do an extremely competitive residency for 5-7 years.

Look up sports med in the nearest biggish city and run through the docs at the clinics - you'll see one-stop-shops that have a roster of ortho, PM&R, podiatry & physical therapy. You'll see at least one massive HMO that lists a sports med department, with family med docs. Plenty in between.
 
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That's either family med or ortho, from what I've seen. If you go the family med route, you're looking at family med money - $80k to $120k - after a 3 yr residency, plus CME for sports med. If you go the ortho route, that's big money, after you do an extremely competitive residency for 5-7 years.

Look up sports med in the nearest biggish city and run through the docs at the clinics - you'll see one-stop-shops that have a roster of ortho, PM&R, podiatry & physical therapy. You'll see at least one massive HMO that lists a sports med department, with family med docs. Plenty in between.
It also depends on what area of the country you are in. Up here in NJ, family practitioners make anywhere from 130k-160k, while internists make between 150k-190k. All depends on scope of practice, where specifically they are, and what reimbursements they get.

Though I should point out, and as you eluded to, family medicine is still the lowest paid specialty, no matter where in the country you go.
 

PAGuyana

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Lots of great info here. Thank you guys.

Btw, how long are PM&R residencies and what are starting salaries?
 

DrMidlife

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PAGuyana

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While we're at it, are there any reputable studies out there that show what specialties older graduates tend to choose and their satisfaction?
 

DrMidlife

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While we're at it, are there any reputable studies out there that show what specialties older graduates tend to choose and their satisfaction?
I wouldn't let a study tell me what's going to be satisfying to me. I have very little in common with most people my age, in terms of how I work, or why I work.

Trying to figure this out before 3rd year is premature, imho.
 

Nasrudin

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Trying to figure this out before 3rd year is premature, imho.
dang. now you're eatin all my doritos.

If I don't stuff my head with vapid nonsense. Who will. What's the alternative. Don't look down. But you just bet 400 large on some makeshift bullsh!t. Of which my dumb @ss gets the worst of. Bon Appetit.
 

DrMidlife

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dang. now you're eatin all my doritos.

If I don't stuff my head with vapid nonsense. Who will. What's the alternative. Don't look down. But you just bet 400 large on some makeshift bullsh!t. Of which my dumb @ss gets the worst of. Bon Appetit.
Mmmm, doritos.
 

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Given that many physicians continue to work past 65, almost any specialty would work if you're passionate about medicine.

I think in the era of health care reform, we will see a growing shortage of primary care providers, so you'll always have job stability if you pursue primary care.
 

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PAGuyana

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Dr. Kim, thank you for your input. Indulge me, if you will...

At the same time however, an increasing amount of physicians are retiring at around age 65. Albeit it may be based on dissatisfaction with the system, but I can't help but think there might be some dissatisfaction with their field thrown in there. And as someone pointed out earlier, there aren't many surgeons out there older than 65...I know this personally, because I'm a surgical PA. Granted there will be an ever increasing demand for PCPs, and the huge influx of patients coming into the system, I question whether it is the place to be for a "senior" physician. Think about all the workload, paperwork and just volume that you'd have to churn out just to keep pace to cover expenses and make a decent living.

Yes, the demand will be there, but that's just one half of the coin. To your point about passion--that's a given, but there are practical considerations here. There are many physicians retiring early and I am sure a lot of them are passionate about their field--so there is more than meets the eye.

As someone who will be entering residency at age 42, I am keen on choosing specialties which will give me the opportunity to work well into my 70s along with a decent quality of life so I can share my passion for medicine in the years to come.


I'm very interested in your take or anyone else's for that matter.

Counterpoint??
 
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forgot about rads....another good option

especially if you are good at Physics.

Have to be very competitive though.....
I never doubt they're gonna "offshore/outsource" rad positions in the near future: let the rad technicians do the actual scans, and some "virtual" doctors around the world read them overnight to turn in the results to a handful of "real" doctors at the "center" physically located here in the States to just sign as if they did the readings. It's the same thing in finance and IT fields that we've been experiencing... I wanna be the "doctor" who likes fair-play... Just another point of view.
 

Nasrudin

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How about preventative medicine.

I see myself smoking a pipe. George Plimpton Style. Smoking jacket. Chain. Watch. Whole deal.

Giving an NPR interview. Making broad stroke big picture health care insights. Reporter scribbling. (Do they still scribble?) And I'm mid thought. And I just fall asleep. Mid-Sentence. Leaving awkward dead air. Interviewer in my study. silent. tick. tock. huh..? I come too. And carry on elegantly with the thought.

And that'd be my job. more or less.
 

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I like your casual irreverence. Hope we are in med school together. We can discuss ennui over Pernod during afternoon nap time.

m.

How about preventative medicine.

I see myself smoking a pipe. George Plimpton Style. Smoking jacket. Chain. Watch. Whole deal.

Giving an NPR interview. Making broad stroke big picture health care insights. Reporter scribbling. (Do they still scribble?) And I'm mid thought. And I just fall asleep. Mid-Sentence. Leaving awkward dead air. Interviewer in my study. silent. tick. tock. huh..? I come too. And carry on elegantly with the thought.

And that'd be my job. more or less.
 

J ROD

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I never doubt they're gonna "offshore/outsource" rad positions in the near future: let the rad technicians do the actual scans, and some "virtual" doctors around the world read them overnight to turn in the results to a handful of "real" doctors at the "center" physically located here in the States to just sign as if they did the readings. It's the same thing in finance and IT fields that we've been experiencing... I wanna be the "doctor" who likes fair-play... Just another point of view.
I keep hearing this about rads but I will believe it when I see it.....
 
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I keep hearing this about rads but I will believe it when I see it.....
Well, I don't wanna be at that situation, cause it's gonna be too late to turn back... Its technical requirements have already been matured, tested and setup. The transatlantic data cables as well as those dedicated satellite uplinks are far more than enough to transmit any type of image on the fly. No one can even feel that those scan images were read by someone else on the other side of the world if someone signs them here.

I am also aware of that it's been a while they're testing "remote surgery" in robotic surgery rooms. Crazy, isn't it? However, I guess, nobody will admit to be examined or cut by a virtual doctor. So, it might not be stretched to the point to make things "cheaper" by private insurance companies.

Keep out of "virtuality" to secure your job, or don't come to me later crying (take it as a computer engineer + scientist's humble comments on that subject matter, and welcome the future from now, before late)
 

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Well, I don't wanna be at that situation, cause it's gonna be too late to turn back... Its technical requirements have already been matured, tested and setup. The transatlantic data cables as well as those dedicated satellite uplinks are far more than enough to transmit any type of image on the fly. No one can even feel that those scan images were read by someone else on the other side of the world if someone signs them here.

I am also aware of that it's been a while they're testing "remote surgery" in robotic surgery rooms. Crazy, isn't it? However, I guess, nobody will admit to be examined or cut by a virtual doctor. So, it might not be stretched to the point to make things "cheaper" by private insurance companies.

Keep out of "virtuality" to secure your job, or don't come to me later crying (take it as a computer engineer + scientist's humble comments on that subject matter, and welcome the future from now, before late)
Very intriguing perspective.

But. Maybe immigrating to India as a mid level imaging manager for ImageCorp wouldn't be the worst thing.

Who knows what's around the next corner. It's vaguely reminiscent of Arthur Clarke's Monoliths. A vague indeterminable future bearing down hard an increasingly unsustainable present.

I still feel like the volume of imaging studies will flow massively. Where it will go. ?.
 
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Very intriguing perspective.

But. Maybe immigrating to India as a mid level imaging manager for ImageCorp wouldn't be the worst thing.

Who knows what's around the next corner. It's vaguely reminiscent of Arthur Clarke's Monoliths. A vague indeterminable future bearing down hard an increasingly unsustainable present.

I still feel like the volume of imaging studies will flow massively. Where it will go. ?.
:laugh:
You need to wait for your own turn after hundreds of millions of "specialists" already exist in India...

Everything is done to increase the living standards for human beings... :cool:

(I'm kidding, it's obviously the gross effort of some to make the rich richer, and the poor poorer.)

Trying to "slurp" down all of the wealth that exists in this world till the very last drop smells like having kinda religious base that gives speed for those kind of efforts. Slavery was by force back in the day, now it's "volunteer slavery" in those countries like india and china.

Sharing this world with others is the most expected behavior from the "human" kind. I'm proud of my "human" kind.
 

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So I will be about 42 when I graduate medical school. Help me choose a specialty. What are the most popular choices for those in my situations? I am interested in a short residency/bang for the buck situations. Save the do what your heart desires/fluff advice. I know it already and have heard it too many times.
Family medicine, peds, or internal medicine. They have the shortest residencies (three years each), they offer the greatest number of residency slots compared with other specialties, and they're on the less competitive side. Chances are pretty good you'll end up in one of these specialties, regardless of whether you're a nontrad or a trad. About half of all med school grads do. :)

http://www.nrmp.org/data/advancedatatables2010.pdf (See page 2.)