Specialties with the smallest knowledge base needed?

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Neuroguy887

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My memory is much worse than my classmates for specific facts so I feel like I would be bad at specialties requiring a very broad knowledge base like ER or family med. What are some specialties with the least knowledge required?
 
Dermatology - mostly just steroid creams, super easy
Gen surg - appys, choles, hernia repair. send the colons and spleens to a specialist
Anesthesia - sux, propofol, sevo, roc - pretty much it
Pulm/CC - respiratory therapists doing all the work, just write boilerplate orders
Emerg med - have the PAs see the patients, double check stuff on uptodate - no memory required
Ophtho - ODs for refractions, pump out lasiks all day
Ortho/hand - I mean its only one body part! same could be said for ortho doing all TKRs
Trauma surg - find hole, patch hole
OB/GYN - people have been having babies without doctors for millennia, just let nature work
Infectious disease - least memory required here. Vanco/zosyn wait for cx results


But yeah def steer clear of FM
 
lose breadth and gain depth - it doesn't get any easier
 
any specialty, compared to scoring 90% percentile in med school, practicing at bare minimum efficacy does not require tons of memory, granted you have enough brains to complete med school, that is.
 
witzelsucht said:
Dermatology - mostly just steroid creams, super easy
Gen surg - appys, choles, hernia repair. send the colons and spleens to a specialist
Anesthesia - sux, propofol, sevo, roc - pretty much it
Pulm/CC - respiratory therapists doing all the work, just write boilerplate orders
Emerg med - have the PAs see the patients, double check stuff on uptodate - no memory required
Ophtho - ODs for refractions, pump out lasiks all day
Ortho/hand - I mean its only one body part! same could be said for ortho doing all TKRs
Trauma surg - find hole, patch hole
OB/GYN - people have been having babies without doctors for millennia, just let nature work
Infectious disease - least memory required here. Vanco/zosyn wait for cx results


But yeah def steer clear of FM
Click to expand...
Which of these specialties can you work <40 hours a week with no call and make >750k?
 
Dermatology should probably be THE LAST thing you go into dermatology if memorization is not your thing. You will be eaten alive.

The volume of minutiae you will have to learn would astound you. The primary reason program directors select for such high Step I scores is the ridiculousness of the dermatology board exam.

Once you're out in practice, though, you technically have the option of being one of the lazy dermatologists who refuses to prescribe biologics/immunotherapy, and refer all those patients to academic centers.
 
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witzelsucht said:
Infectious disease - least memory required here. Vanco/zosyn wait for cx results
Click to expand...


My initial response to this was "lol wut"

But then I stopped and asked myself "dap, you don't start medical school until next year, what do you know?"

Would someone educate me here? I was under the opposite impression--that ID specialists often had some of the biggest "knowledge bases" out of all subspecialties?
 
dap said:
My initial response to this was "lol wut"

But then I stopped and asked myself "dap, you don't start medical school until next year, what do you know?"

Would someone educate me here? I was under the opposite impression--that ID specialists often had some of the biggest "knowledge bases" out of all subspecialties?
Click to expand...
His post is tongue in cheek.
 
witzelsucht said:
Dermatology - mostly just steroid creams, super easy
Gen surg - appys, choles, hernia repair. send the colons and spleens to a specialist
Anesthesia - sux, propofol, sevo, roc - pretty much it
Pulm/CC - respiratory therapists doing all the work, just write boilerplate orders
Emerg med - have the PAs see the patients, double check stuff on uptodate - no memory required
Ophtho - ODs for refractions, pump out lasiks all day
Ortho/hand - I mean its only one body part! same could be said for ortho doing all TKRs
Trauma surg - find hole, patch hole
OB/GYN - people have been having babies without doctors for millennia, just let nature work
Infectious disease - least memory required here. Vanco/zosyn wait for cx results


But yeah def steer clear of FM
Click to expand...
This is so sad... I hope I never have to be treated by any of you as a patient... Seriously, when does an emerge. med doc have time to lookup how to treat a hypertensive crisis or something that demands an immediate action?

This is as bad as a post in the pharmacy forums trying to find blame in a medication error. People need to take responsibility for their stuff and know it. Yeah there is something to be said about how knowing everything isn't possible, but knowing where to look is important - but really.... at least try.
 
OP: Psych, Ortho, PMR, and probably Anesthesia.
 
Well, the knowledge base of dermatology is only skin deep. Optho's knowledge base is in the eye of the beholder. GI's knowedge base can be discussed about as long as a fart in the wind.

ENT, on the other hand, is a rather large mouthful.
 
To be a good physician in any specialty requires a lot of knowledge. To be a bad one, well the best choice is probably psych.
 
TLAD123 said:
This is so sad... I hope I never have to be treated by any of you as a patient... Seriously, when does an emerge. med doc have time to lookup how to treat a hypertensive crisis or something that demands an immediate action?

This is as bad as a post in the pharmacy forums trying to find blame in a medication error. People need to take responsibility for their stuff and know it. Yeah there is something to be said about how knowing everything isn't possible, but knowing where to look is important - but really.... at least try.
Click to expand...

Whooosh!
 
witzelsucht said:
Dermatology - mostly just steroid creams, super easy
Gen surg - appys, choles, hernia repair. send the colons and spleens to a specialist
Anesthesia - sux, propofol, sevo, roc - pretty much it
Pulm/CC - respiratory therapists doing all the work, just write boilerplate orders
Emerg med - have the PAs see the patients, double check stuff on uptodate - no memory required
Ophtho - ODs for refractions, pump out lasiks all day
Ortho/hand - I mean its only one body part! same could be said for ortho doing all TKRs
Trauma surg - find hole, patch hole
OB/GYN - people have been having babies without doctors for millennia, just let nature work
Infectious disease - least memory required here. Vanco/zosyn wait for cx results


But yeah def steer clear of FM
Click to expand...
Infectious disease doesn't require memory? Good luck treating HIV patients and such.
 
Psych. When I asked the required "why did you choose this specialty" question to the residents, many of them specifically chose it because you can list almost every single diagnosis in the entire field on a single sheet of paper. On top of that you hand off most of your actual therapy to psychologists and social workers.
 
studentp0x said:
Infectious disease doesn't require memory? Good luck treating HIV patients and such.
Click to expand...

Good luck understanding sarcasm by the time you're a med student and actually supposed to post in here...
 
GuyWhoDoesStuff said:
Dermatology should probably be THE LAST thing you go into dermatology if memorization is not your thing. You will be eaten alive.

The volume of minutiae you will have to learn would astound you. The primary reason program directors select for such high Step I scores is the ridiculousness of the dermatology board exam.

Once you're out in practice, though, you technically have the option of being one of the lazy dermatologists who refuses to prescribe biologics/immunotherapy, and refer all those patients to academic centers.
Click to expand...

or because they have the cream of the crop to choose from. if psych or pm&r all of a sudden became supercompetative they would probably select for high step1 scores as well
 
You'll memorize the stuff you need to know through repetition and constant use in the mundane everyday hum of practice. You'll memorize how to handle the emergencies in your field out of fearful preparation and a few vividly terrifying experiences. The rest you can look-up. You memorize in the first 2 years because regurgitation of facts is the easiest skill to evaluate consistently and fairly. It has little to do with actual practice...
 
Leonidis I said:
or because they have the cream of the crop to choose from. if psych or pm&r all of a sudden became supercompetative they would probably select for high step1 scores as well
Click to expand...

Nope, that's just the icing on the cake.
 
I think especially pre-clinical medstudents look at these things a little wrong, generally its not the technical knowledge that is going to make a field challenging to someone. Your going to have years in clinical rotations/residency/fellowship to refine your technical knowledge. Your going to have UpToDate and Epocrates on your phone, a folder of PDFs of the most important trials/guidelines on your computer desktop and the textbooks of choice sitting on your bookshelf.

The thing that I see attendings challenged most by is the things you can't do a study about. For example in the case of ID mentioned above, trying to gauge how likely a patient would be to actually adhere to whatever treatment plan you recommend. Or in pediatrics, trying to judge how reliable those parents really are when your on the fence about admitting a kid, etc.
 
Awesome! Here's my take:
Dermatology - Steroids on rashes
Gen surg - obese patients and removing the organs they mess up along the way; suturing up adipose and sending the patient back to his bariatric bed. Have nurse find the closest Open MRI in the area.
IM: Spiriva/Nebs, Metformin/Lantus, Labetalol/Narcan, Lasix/Lasix, Aspirin/Plavix, Zofran/Maalox
Anesthesia - Insert tube, needle, rx patient and zap their forehead every 10 minutes while playing Angry Birds on your phone
Pulm/CC - RTs do really do all the work based on protocols written by some authority institution that they all follow to the letter or risk Medicare not paying them. Do maybe one super-complicated procedure (lung tap) every few weeks.
Emergency med - Have the Med Students see the patients, Residents staff the notes and check boxes on the standard orders for most ailments seen, truly no memory required
Ophtho - Assembly-line surgery where the Opth spends maybe 20 minutes in each room.
Ortho/hand - Furnish a house completely from IKEA and you'll have a bunch of those little hex screwdrivers and the same training.
Trauma surg - Dead/non-dead; Fix Now/Fix Later; Admit/Discharge home
OB/GYN - Memorably foul smells coming from that region with swabs of substances to match. Aides putting mom in lithotomy position if she spikes a BP of 122/82 and is confused about where her husband parked. You arrive, wade your hands through the urine, blood and feces spewing out and pray you don't see feet first.
Infectious disease - Some type of penicillin with some sort of quinolone with metronidazole for good measure. Return when cultures are back and adjust.
PM&R - Read police report, cast, bandage and write a PT/OT prescription. You, rarely, may have to write an Rx for a pain med.
Psych - Where can I call your Xanax and Zoloft in to? You'll have to carry this Adderall prescription in by hand.

The last 3 have very little overhead with regard to office space, equipment and staff, so your earnings per hour have the potential to be much higher, if you run your practice right. Everything in most fields will become basic to you after doing it for a while, that's what residency is for.

Spend some time learning how the RVU system works. Most doctors get their $30 an RVU multiplied out by something, no matter what specialty, if they take Medicare. Most will still be forced to take it to make things meet for a while. If you actually get paid at least $150/hour (yes, you'll bill for a lot more) for 8 hours per day, 5 days a week, that's between $200-250K per year at a minimum, no matter what your specialty. You keep a lot more of it if you have low overhead.

Under no circumstances should you even consider FM, for any reason. You did not spend $150K ($350K if you went to DO school) to drive the same car you drove in med school to take the family out to Applebee's once a month for the latest coupon meal where you sweat if your three kids are going to be OK with sharing a dessert again.
witzelsucht said:
Dermatology - mostly just steroid creams, super easy
Gen surg - appys, choles, hernia repair. send the colons and spleens to a specialist
Anesthesia - sux, propofol, sevo, roc - pretty much it
Pulm/CC - respiratory therapists doing all the work, just write boilerplate orders
Emerg med - have the PAs see the patients, double check stuff on uptodate - no memory required
Ophtho - ODs for refractions, pump out lasiks all day
Ortho/hand - I mean its only one body part! same could be said for ortho doing all TKRs
Trauma surg - find hole, patch hole
OB/GYN - people have been having babies without doctors for millennia, just let nature work
Infectious disease - least memory required here. Vanco/zosyn wait for cx results


But yeah def steer clear of FM
Click to expand...
 
Last edited:
JGimpel said:
Awesome! Here's my take:
Infectious disease - Some type of penicillin with some sort of quinolone with metronidazole for good measure. Return when cultures are back and adjust.
PM&R - Read police report, cast, bandage and write a PT/OT prescription. You, rarely, may have to write an Rx for a pain med.
Psych - Where can I call your Xanax and Zoloft in to? You'll have to carry this Adderall prescription in by hand.

The last 3 have very little overhead with regard to office space, equipment and staff, so your earnings per hour have the potential to be much higher, if you run your practice right. Everything in most fields will become basic to you after doing it for a while, that's what residency is for.

Spend some time learning how the RVU system works. Most doctors get their $30 an RVU multiplied out by something, no matter what specialty, if they take Medicare. Most will still be forced to take it to make things meet for a while. If you actually get paid at least $150/hour (yes, you'll bill for a lot more) for 8 hours per day, 5 days a week, that's between $200-250K per year at a minimum, no matter what your specialty. You keep a lot more of it if you have low overhead.

Under no circumstances should you even consider FM, for any reason. You did not spend $150K ($350K if you went to DO school) to drive the same car you drove in med school to take the family out to Applebee's once a month for the latest coupon meal where you sweat if your three kids are going to be OK with sharing a dessert again.
Click to expand...

The only difference between those three with low overhead and FM is that FM can treat patients with problems that all three of those specialties handle, and will have a much easier time of not taking medicare for it. (thus lowering overhead much further) ID docs make less than FM with more training, and FM would do much better if they really wanted to earn money (over 200 is the current MGMA average for FM- work smart and you could get much more)
 
JGimpel said:
Awesome! Here's my take:
Dermatology - Steroids on rashes
Gen surg - obese patients and removing the organs they mess up along the way; suturing up adipose and sending the patient back to his bariatric bed. Have nurse find the closest Open MRI in the area.
IM: Spiriva/Nebs, Metformin/Lantus, Labetalol/Narcan, Lasix/Lasix, Aspirin/Plavix, Zofran/Maalox
Anesthesia - Insert tube, needle, rx patient and zap their forehead every 10 minutes while playing Angry Birds on your phone
Pulm/CC - RTs do really do all the work based on protocols written by some authority institution that they all follow to the letter or risk Medicare not paying them. Do maybe one super-complicated procedure (lung tap) every few weeks.
Emergency med - Have the Med Students see the patients, Residents staff the notes and check boxes on the standard orders for most ailments seen, truly no memory required
Ophtho - Assembly-line surgery where the Opth spends maybe 20 minutes in each room.
Ortho/hand - Furnish a house completely from IKEA and you'll have a bunch of those little hex screwdrivers and the same training.
Trauma surg - Dead/non-dead; Fix Now/Fix Later; Admit/Discharge home
OB/GYN - Memorably foul smells coming from that region with swabs of substances to match. Aides putting mom in lithotomy position if she spikes a BP of 122/82 and is confused about where her husband parked. You arrive, wade your hands through the urine, blood and feces spewing out and pray you don't see feet first.
Infectious disease - Some type of penicillin with some sort of quinolone with metronidazole for good measure. Return when cultures are back and adjust.
PM&R - Read police report, cast, bandage and write a PT/OT prescription. You, rarely, may have to write an Rx for a pain med.
Psych - Where can I call your Xanax and Zoloft in to? You'll have to carry this Adderall prescription in by hand.
Click to expand...

I LOLed, hard.
 
OB/GYN is the only rotation where, after 4 weeks, I could intelligently answer questions in clinic. I feel that the "medicine" aspect of that field is a complete joke. The reason it's 4 years long is to gain surgical skills.
 
No one commenting here can really say. You don't know what you don't know and even if you feel you give intelligent answers in clinic after rotation, Or rotated briefly you may hand no idea about the complexities and nuances until someone who is an expert takes you through them individually case by case.

in OB, not even Gyn portion, there is a crap load of medicine that some amazing docs will learn and use as background to change much of there clinical management. there is a ton of diagnostic stuff to know regarding U/S, strips, etc, it's naive and arrogant to say 4 years only for surgical skills. I'm knee deep in IM residency and can appreciate this. Just take a look at their board exam prep material and tell me if you have any idea how to proceed with that. This also true in ortho or whatever.

To the OP, to be GOOD, you have to know a lot in EVERY field. In specialist/sub specialist fields, that knowledge will be more depth. In generalist fields like EM/FM, that knowledge will be breadth. Everyone needs to study a lot and the good ones continue to everyday lifelong. Even in technical fields like somebody who caths all day there is a ton to know and a lot of details that's difficult to appreciate if you're not the one doing it and getting critiqued by someone who is a master in the field.

All in all, if you wanna suck as a doc, then sure you can squeeze by perhaps by not learning a lot, but if you wanna be good there is no field where you can slack and remain good.
 
Last edited:
xenotype said:
The only difference between those three with low overhead and FM is that FM can treat patients with problems that all three of those specialties handle, and will have a much easier time of not taking medicare for it. (thus lowering overhead much further) ID docs make less than FM with more training, and FM would do much better if they really wanted to earn money (over 200 is the current MGMA average for FM- work smart and you could get much more)
Click to expand...

FM can do the initial screening for some of the issues that the other specialties do, maybe even prescribe something until the patient can get in to see the specialist, but that's where the patient should eventually end up. And you're saying that a patient would rather pay cash to have their specialist-worthy issue handled by an FM doctor versus a specialist? Seriously?

Anything close to creeping out of the scope of a generalist will come under the scrutiny of your 3rd party payor, regardless of whom it is. I've never heard of an FP practice doing that well that they don't have some component of Medicare (very poorly) paying their bills. FM is so generic to patients now that if they don't get exactly what they want, when they want it and almost free because their insurance isn't taken there, they'll go down the street to get the same exact standard of care. If I know that I need a statin, a beta-blocker and an ACE-I, why would I go somewhere where I would have to pay more out of pocket?

I do agree that if FM doctors are making under $250K/year, they need to have an MBA with healthcare experience come in and do an overhaul.
 
This thread is literally one serious post followed by two-three hilarious comments followed by another serious post. I don't know which way I want to go with this.
 
todds said:
No one commenting here can really say. You don't know what you don't know and even if you feel you give intelligent answers in clinic after rotation, Or rotated briefly you may hand no idea about the complexities and nuances until someone who is an expert takes you through them individually case by case.

in OB, not even Gyn portion, there is a crap load of medicine that some amazing docs will learn and use as background to change much of there clinical management. there is a ton of diagnostic stuff to know regarding U/S, strips, etc, it's naive and arrogant to say 4 years only for surgical skills. I'm knee deep in IM residency and can appreciate this. Just take a look at their board exam prep material and tell me if you have any idea how to proceed with that. This also true in ortho or whatever.

To the OP, to be GOOD, you have to know a lot in EVERY field. In specialist/sub specialist fields, that knowledge will be more depth. In generalist fields like EM/FM, that knowledge will be breadth. Everyone needs to study a lot and the good ones continue to everyday lifelong. Even in technical fields like somebody who caths all day there is a ton to know and a lot of details that's difficult to appreciate if you're not the one doing it and getting critiqued by someone who is a master in the field.

All in all, if you wanna suck as a doc, then sure you can squeeze by perhaps by not learning a lot, but if you wanna be good there is no field where you can slack and remain good.
Click to expand...

I have not met these medicine-PROFICIENT ob/gyn attendings or residents. My IM attending pimped a 3rd yr on ovarian cancer and she was speechless. Another didn't know what Tylenol 3 is.
 
witzelsucht said:
Dermatology - mostly just steroid creams, super easy
Gen surg - appys, choles, hernia repair. send the colons and spleens to a specialist
Anesthesia - sux, propofol, sevo, roc - pretty much it
Pulm/CC - respiratory therapists doing all the work, just write boilerplate orders
Emerg med - have the PAs see the patients, double check stuff on uptodate - no memory required
Ophtho - ODs for refractions, pump out lasiks all day
Ortho/hand - I mean its only one body part! same could be said for ortho doing all TKRs
Trauma surg - find hole, patch hole
OB/GYN - people have been having babies without doctors for millennia, just let nature work
Infectious disease - least memory required here. Vanco/zosyn wait for cx results


But yeah def steer clear of FM
Click to expand...

Lol
 
It all takes work and knowledge. Everyone wants an easy way to make money and have a great life, but its not commonplace. There is no easy road in medicine with little to learn and lots of rewards.

As for the jokes. I have head them. I get them.

The impact of these things being spread is that when you all land in whatever specialty you chose, you will continue to feel bashed by other specialties. Finally, the public will look at you all this way too. You may say them as jokes, but the more you say them, and the more they are heard, the more you cement your reality. Why is the public going to reward you with money and honor for doing something so lame that it can be joked upon so flippantly? Why should people trust you with their lives or their children without second guessing you when you behave this way?

GROW UP AND TAKE PRIDE IN YOUR FUTURE PROFESSION.
 
JGimpel said:
FM can do the initial screening for some of the issues that the other specialties do, maybe even prescribe something until the patient can get in to see the specialist, but that's where the patient should eventually end up. And you're saying that a patient would rather pay cash to have their specialist-worthy issue handled by an FM doctor versus a specialist? Seriously?

Anything close to creeping out of the scope of a generalist will come under the scrutiny of your 3rd party payor, regardless of whom it is. I've never heard of an FP practice doing that well that they don't have some component of Medicare (very poorly) paying their bills. FM is so generic to patients now that if they don't get exactly what they want, when they want it and almost free because their insurance isn't taken there, they'll go down the street to get the same exact standard of care. If I know that I need a statin, a beta-blocker and an ACE-I, why would I go somewhere where I would have to pay more out of pocket?

I do agree that if FM doctors are making under $250K/year, they need to have an MBA with healthcare experience come in and do an overhaul.
Click to expand...

Not true at all. As FM you can do as much as your comfort/confidence level allows, there is no "creeping out of the scope of a generalist."

If you wanted to you could go to the ER, work as an ER physician - intubate blah blah blah - and still get paid.

You could work on L&D, you can do c-sections(if trained) along with bilateral tubal ligations. You can take call with other OB's and cover their patients while they cover your pregnant patients.

You can decide you love HIV and have the appropriate experience and manage HIV patients without the help of an ID specialist - there are even HIV training programs for FM.

You can work as sports medicine, doing injections - maybe owning your own MRI - having a PT on site - and doing everything short of surgery.

You can be a strict hospitalist, do no clinic, and also have to cover the ICU.
 
Solid post. It's what you make of it. It's so nice to see that there are so many opportunities to build a niche for what you want to do. Sure, it takes more time and effort, but you'll always have your mastered niche to dominate.
 
JGimpel said:
I have no respect for family medicine. They are triage monkeys who weren't smart enough to get into a real specialty, and shouldn't be providing definitive care for anything beyond a cold.
Click to expand...

As styphon's post explains well, this is incorrect.
 
e30ftw said:
Assassins with laryngoscopes.
Click to expand...
quoting an ED doc, lol Actually had Scott Weingart present that lecture to my residency at a grand rounds once. Brilliant guy.

As for FM being able to carve a niche in EM: Unless you got grandfathered in as an older generation FM doc, you can't really do EM as an FP anymore, unless you don't mind rural work .
 
todds said:
in OB, not even Gyn portion, there is a crap load of medicine that some amazing docs will learn and use as background to change much of there clinical management. there is a ton of diagnostic stuff to know regarding U/S, strips, etc, it's naive and arrogant to say 4 years only for surgical skills. I'm knee deep in IM residency and can appreciate this. Just take a look at their board exam prep material and tell me if you have any idea how to proceed with that. This also true in ortho or whatever.
Click to expand...

I was pimped in front of a patient by one of our best attendings on why we manage CIN 2 with cryo vs carcinoma in situ with excision. I said, "I'm not 100% sure, but I would think that ablating the carcinoma in situ would distort the tissue, making it difficult to interpret follow up biopsies. Also, you want a full thickness specimen to assess depth of invasion." He said, "No, CIN 2 is only dysplasia of the top 2/3 of the cervix. Nice try." When we got back to the workroom, I said, "Dr. X, it's dysplasia of the bottom 2/3." He Googled it and said, "Son of a bitch... I've been teaching it that way for 20 years... I don't know why we do it, then."

Yeah, they're such diligent academics.


Sent from my SCH-I535 using Tapatalk
 
tco said:
I was pimped in front of a patient by one of our best attendings on why we manage CIN 2 with cryo vs carcinoma in situ with excision. I said, "I'm not 100% sure, but I would think that ablating the carcinoma in situ would distort the tissue, making it difficult to interpret follow up biopsies. Also, you want a full thickness specimen to assess depth of invasion." He said, "No, CIN 2 is only dysplasia of the top 2/3 of the cervix. Nice try." When we got back to the workroom, I said, "Dr. X, it's dysplasia of the bottom 2/3." He Googled it and said, "Son of a bitch... I've been teaching it that way for 20 years... I don't know why we do it, then."

Yeah, they're such diligent academics.


Sent from my SCH-I535 using Tapatalk
Click to expand...

Sorry... I can't edit with this stupid program... He said, "It's dysplasia of the upper 2/3 of the cervix, so we can ablate it. The cold doesn't reach the bottom 1/3."

Sent from my SCH-I535 using Tapatalk
 
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