Specialties/subspeciaties that deal with the 'sickest' and 'healthiest' patients

[Lokhtar]

I'm just wondering because so far I've loved being in an environment where people were trying to take care of patients who were REALLY sick. For the healthiest patient population, I guess general pediatrics might be one? For the sickest, I know neurosurgery always gets extremely sick patients. Also, I guess critical care physicians as well? ER theoretically too, but from my limited volunteering experience, a majority of patients aren't necessarily life-threatening sick.

So what do you guys think? Does anyone have a preference one way or another and which specialties have populations that are extremely sick or disproportionately healthy?

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[MilkmanAl]

Sickest: heme-onc, palliative care
least sick: ortho (especially if you're a private practice, outpatient kind of guy), cosmetic plastics

 

[Smurfette]

critical care (can be through medicine, surgery or anesthesia)
surgery + subspecialties (especially trauma, transplant)
neurosurg (though if multisystem, are normally on trauma service. neurosurg guys where I have been let other specialties deal with things like ventilators, fluids, etc.)
anesthesia (in OR or via critical care service)
nephrology
ID

healthiest:
peds (except neonatology)
general OB/gyne (NOT including gyn-onc or MFM)

 

[ACSurgeon]

Sickest: heme-onc, palliative care
least sick: ortho (especially if you're a private practice, outpatient kind of guy), cosmetic plastics

While palliative care has sick people, you aren't really addressing their illness. You just keep them comfortable (you're not trying to fix them so that might be a different type of sick.)

 

[ACSurgeon]

critical care (can be through medicine, surgery or anesthesia)
surgery + subspecialties (especially trauma, transplant)
neurosurg (though if multisystem, are normally on trauma service. neurosurg guys where I have been let other specialties deal with things like ventilators, fluids, etc.)
anesthesia (in OR or via critical care service)
nephrology
ID

healthiest:
peds (except neonatology)
general OB/gyne (NOT including gyn-onc or MFM)

I would exclude some ortho/ENT/plastics practices from this category. Patients getting knee scopes/ear tubes/breast implants typically aren't very sick. Also, some of these specialties don't really do much in the way of post-op care.

But yes, general surgery and its subspecialties will have some very ill patients AND these surgeons tend to follow their patients more closely.

 

[Smurfette]

I would exclude some ortho/ENT/plastics practices from this category. Patients getting knee scopes/ear tubes/breast implants typically aren't very sick. Also, some of these specialties don't really do much in the way of post-op care.

But yes, general surgery and its subspecialties will have some very ill patients AND these surgeons tend to follow their patients more closely.

oops, yes, I meant general surgery and it's subspecialties. I did not mean to imply ortho/ENT/GU/plastics to be included in that category.

 

[CardiacIntensivist]

Sickest: heme-onc, palliative care
least sick: ortho (especially if you're a private practice, outpatient kind of guy), cosmetic plastics

By that criteria, I'd say derm fits better.

 

[CardiacIntensivist]

Cardiac Anesthesia - super freaking sick

 

[xanthomondo]

By that criteria, I'd say derm fits better.

or ophtho

 

[Law2Doc]

I would exclude some ortho/ENT/plastics practices from this category. Patients getting knee scopes/ear tubes/breast implants typically aren't very sick. Also, some of these specialties don't really do much in the way of post-op care.

But yes, general surgery and its subspecialties will have some very ill patients AND these surgeons tend to follow their patients more closely.

The surgical subspecialties have a huge mix of "healthy" and not healthy individuals. For ortho, the folks with compartment syndrome, osteomyelitis, major traumas and severe degenerative arthritis can be pretty sick. It's not all scoping knees and fixing ACLs. For some, it's very little of that, actually. This is also a field with a relatively high complication rate so you will have more patients with post-operative infections and pulmonary embolisms than most. ENT has plenty of true emergencies -- when inflammation or infection affects the airway the patient can die pretty quickly, and the head, throat and neck cancers are often the least operable and the most aggressive. I don't think you can assume the majority of an ENTs patients will be elective tonsilectomies or ear tubes. While the plastic surgeons you see on TV are the elective cosmetic kind, a lot of what plastic surgeons deal with is post-traumatic, so you have a lot of very mangled and disfigured folks, burn victims and the like. Maybe not as sick, but let's not minimize the field to one that's primarily nips and tucks.

I would have put ID at the top of my list. After that, for what it's worth, the sickest people as a group that you will deal with on the wards are those with end stage liver issues, so anyone specializing in these (hepatologists/GI, IM, surg onc, gen surg, transplant) are going to have patients who are most likely to die on them comparatively young. That's my two cents.

 

[Analytic]

Sickest: Oncology
Healthiest: Plastics

 

[Law2Doc]

Sickest: Oncology
Healthiest: Plastics

Both of these are closer to the middle. Acute disease beats relatively slower growing cancer in terms of "sicker". So the oncologist's patients are really only the sickest at the end. The typical oncology patient will slowly decline over days, weeks, months or even years. Something infectious works much faster, hence you are much sicker during your course of care.

At the other end of the spectrum, as for plastics, there are far more plastics emergencies than something like, say, PM&R. Probably something like sleep medicine or rheum has the fewest emergencies.

 

[ACSurgeon]

The surgical subspecialties have a huge mix of "healthy" and not healthy individuals. For ortho, the folks with compartment syndrome, osteomyelitis, major traumas and severe degenerative arthritis can be pretty sick. It's not all scoping knees and fixing ACLs. For some, it's very little of that, actually. This is also a field with a relatively high complication rate so you will have more patients with post-operative infections and pulmonary embolisms than most. ENT has plenty of true emergencies -- when inflammation or infection affects the airway the patient can die pretty quickly, and the head, throat and neck cancers are often the least operable and the most aggressive. I don't think you can assume the majority of an ENTs patients will be elective tonsilectomies or ear tubes. While the plastic surgeons you see on TV are the elective cosmetic kind, a lot of what plastic surgeons deal with is post-traumatic, so you have a lot of very mangled and disfigured folks, burn victims and the like. Maybe not as sick, but let's not minimize the field to one that's primarily nips and tucks.

I would have put ID at the top of my list. After that, for what it's worth, the sickest people as a group that you will deal with on the wards are those with end stage liver issues, so anyone specializing in these (hepatologists/GI, IM, surg onc, gen surg, transplant) are going to have patients who are most likely to die on them comparatively young. That's my two cents.

That's why I said SOME practices of ortho/ENT/plastics. I realize they can all have very sick patients. And SOME tend to be more hands on (although ortho at our hospital seems to be very hands off, regardless of how sick the patient is, so while they operate, they do little to no management).