Specialty choice for the ridiculously lazy.

[amakhosidlo]

For some reason my choice of procrastinatory reading material today was a blog of yet another resident or student griping about 'the state of medicine' and how terrible things are and how every doctor wants out, on and on and on.

I spend every day surrounded by gunners. Maybe not surrounded, a small group of us have managed to carve out a niche of slacker-dom, but by and large everyone around me takes themselves wayyyyyy too seriously for my taste. The orthopods and neurosurgeons and OB extraordinares of tomorrow .

I'm still pretty sure medicine was the right choice, but now I'm wondering if there's a field that's right for me. One that's short on the gloom & doom, the gunners and tools. I love surgery and working with my hands, but I don't have a surgical personality or the stomach for a surgical residency. I love technology and imaging seems really cool, but I like people and daylight too much. And again, not the most competitive person in the world. Bottom line, I want to feel like I'm practicing medicine, if that makes any sense (Diagnosing, continuity of care, performing procedures, probably in equal measure), and have a lifestyle that allows for sleep and days off, in reasonable amounts, as soon after graduating as possible. Money, after 150-200k, is completely inconsequential to me.

Some people say I'm lazy. I prefer selectively motivated. What fields should I be looking at?

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[ACSurgeon]

For some reason my choice of procrastinatory reading material today was a blog of yet another resident or student griping about 'the state of medicine' and how terrible things are and how every doctor wants out, on and on and on.

I spend every day surrounded by gunners. Maybe not surrounded, a small group of us have managed to carve out a niche of slacker-dom, but by and large everyone around me takes themselves wayyyyyy too seriously for my taste. The orthopods and neurosurgeons and OB extraordinares of tomorrow .

I'm still pretty sure medicine was the right choice, but now I'm wondering if there's a field that's right for me. One that's short on the gloom & doom, the gunners and tools. I love surgery and working with my hands, but I don't have a surgical personality or the stomach for a surgical residency. I love technology and imaging seems really cool, but I like people and daylight too much. And again, not the most competitive person in the world. Bottom line, I want to feel like I'm practicing medicine, if that makes any sense (Diagnosing, continuity of care, performing procedures, probably in equal measure), and have a lifestyle that allows for sleep and days off, in reasonable amounts, as soon after graduating as possible. Money, after 150-200k, is completely inconsequential to me.

Some people say I'm lazy. I prefer selectively motivated. What fields should I be looking at?

Anything primary care, assuming you find a good gig with relatively infrequent call. You'll be working 3.5-4 days per week (depends on where you end up practicing) and can be on call is infrequent as once per week and 1/4 weekends (or better). Most your days will be 8-5. You can make 150K+. And, it's not competitive, offers continuity, and everything else you speak of.

Caveat: if you wind up in a primary care setting where you take care of inpatients, your lifestyle will suffer dramatically. You will be rounding on patients really early in the morning (6 am?) and then have a full day of clinic, then maybe round again at 5pm. Also, you might be on call more often. I hear most larger cities (with hospitalists) do not have PCP's admitting their own patients, so, PCP's only work in an outpatient setting.

Granted I never considered primary care as a field, so take what I say with a grain of salt. I did an 8 week rotation as a 3rd year, and one of my good friends is doing family med (and we talk alot about the nature of work, etc).

 

[amakhosidlo]

Anything primary care, assuming you find a good gig with relatively infrequent call. You'll be working 3.5-4 days per week (depends on where you end up practicing) and can be on call is infrequent as once per week and 1/4 weekends (or better). Most your days will be 8-5. You can make 150K+. And, it's not competitive, offers continuity, and everything else you speak of.

Caveat: if you wind up in a primary care setting where you take care of inpatients, your lifestyle will suffer dramatically. You will be rounding on patients really early in the morning (6 am?) and then have a full day of clinic, then maybe round again at 5pm. Also, you might be on call more often. I hear most larger cities (with hospitalists) do not have PCP's admitting their own patients, so, PCP's only work in an outpatient setting.

Granted I never considered primary care as a field, so take what I say with a grain of salt. I did an 8 week rotation as a 3rd year, and one of my good friends is doing family med (and we talk alot about the nature of work, etc).

Yeah, I'm leaning towards medicine and ER. Something involving shiftwork, where you walk out the door at the end of your 12 or 13 hrs and dust your hands of (most) everything. My friend's brother works IM and does 7 12's, then 7 off. Seems perfect. I should've specified though, I think I'd find chronic disease management (PCP bread & butter) really taxing. The more acute my patients' conditions, and the more amenable they are to treatment, the better.

 

[deleted307836]

PM&R actually seems like a really good fit for you (and I'm not taking the 'lazy' thing into account when saying that, so don't attack me people ). But the field would fit your criteria for a good mix of procedures and the planning of care, and the schedule is very regular.

 

[cartoondoc]

Yeah, PM&R sounds like a good choice for you:

http://doccartoon.blogspot.com/2010/04/what-is-pm.html

 

[AlexMorph]

Yeah, PM&R sounds like a good choice for you:

http://doccartoon.blogspot.com/2010/04/what-is-pm.html

lol

 

[Mattchiavelli]

actually if you don't want to deal with chronic conditions PM&R might not float your boat

It sounds like EM would be a good fit [shift work, procedure potential both diagnostic and therapeutic, acute problems]. Only caveat is EM is not all aortic rupture and penetrating trauma, depending on where you practice there will be more or less urgent care clinic medicine involved. Hospitalist might be good too if you consider acute-on-chronic exacerbations, re-tuning, and discharging interesting.

EDIT: oh and I forgot surgical path as an option if you like surgery but hate surgical personality/residency. Easier residency, still get to gross tumors and cysts and whatnot, get to sit down a lot.

 

[muhali3]

Urology, Allergy/Immunology, Pain Medicine, Neurology.

 

[WDeagle]

Urology, Allergy/Immunology, Pain Medicine, Neurology.

Wait what? Thats a surgical residency which means at least a surgical lifestyle during residency. Plus its super competitive.

 

[PistolPete]

Try: allergy, endo, rheum, PM&R, ophtho (not classically "surgery"), ER, maybe FM, maybe IM hospitalist

 

[massmocha]

Try: allergy, endo, rheum, PM&R, ophtho (not classically "surgery"), ER, maybe FM, maybe IM hospitalist

Is FM a real specialty? Where do they have residencies for it/what's it all about?

 

[drizzt3117]

Is FM a real specialty? Where do they have residencies for it/what's it all about?

Not sure if srs

 

[muhali3]

Wait what? Thats a surgical residency which means at least a surgical lifestyle during residency. Plus its super competitive.

Urology isn't very hardcore compared to other surgical specialties. Offers a good mix of medicine/surgery and allows for good hours in the outpatient setting. Gen Surg residents work 76 hrs/wk on average, while Urology residents work 66 (https://freida.ama-assn.org/Freida/user/specStatisticsSearch.do?method=viewSpecialty&pageNumber=2). But yeah...it is pretty competitive, as are all surgical specialties.

but really OP...you have a lot of options since you're not putting that much of a priority on income. Performing procedures and continuity of care are kind of mutually exclusive, and your lack of competitiveness limits options that would be a good fit for you. Given all that, I'll agree with everyone else and say PM&R is the best fit. ER on the surface seems good, but the shift-work can get taxing, having to work nights, weekends, holidays...

 

[ucsfstudents]

PM&R, ER, Psychiatry - for the lifestyle. You can't be too lazy in medicine. It just won't work -- especially if you're taking care of patients. Consider Pathology if you are ok with not taking care of patients. And agree that laziness and surgery don't mix.

 

[drizzt3117]

I'm sorry but a lot of programs urology residents work the hardest of any surgery residents. You have to remember that self-reported hours are... Self-reported. The reason for the hours is bc most programs are small, with 2 or so residents per class, and cover multiple hospitals. Therefore, call is q2-3, for at least your pgy 2-3 years. Furthermore, you WILL get called, there's always a difficult foley to place somewhere in the hospital.

As far as the floor, your patients are also usually pretty sick patients that you're doing big open surgeries on, and in many cases diverting their urinary systems so you can't necessarily use urine output as a good guide of renal function or fluid status...

IMO this may be the worst possible field to go into if you're lazy.

Life as an attending is significantly easier, though, but that's 6-7 years down the road.

Urology isn't very hardcore compared to other surgical specialties. Offers a good mix of medicine/surgery and allows for good hours in the outpatient setting. Gen Surg residents work 76 hrs/wk on average, while Urology residents work 66 (https://freida.ama-assn.org/Freida/user/specStatisticsSearch.do?method=viewSpecialty&pageNumber=2). But yeah...it is pretty competitive, as are all surgical specialties.

but really OP...you have a lot of options since you're not putting that much of a priority on income. Performing procedures and continuity of care are kind of mutually exclusive, and your lack of competitiveness limits options that would be a good fit for you. Given all that, I'll agree with everyone else and say PM&R is the best fit. ER on the surface seems good, but the shift-work can get taxing, having to work nights, weekends, holidays...

 

[badasshairday]

Yeah, definitely. Urology is tough. I mean, you start of with a surgery internship... that alone makes it not for "lazy" people.

 

[ADORE]

Why hasn't Derm been mentioned. Is it not a field that offers a great lifestyle?

 

[Law2Doc]

I'm sorry but a lot of programs urology residents work the hardest of any surgery residents. You have to remember that self-reported hours are... Self-reported. The reason for the hours is bc most programs are small, with 2 or so residents per class, and cover multiple hospitals. Therefore, call is q2-3, for at least your pgy 2-3 years. Furthermore, you WILL get called, there's always a difficult foley to place somewhere in the hospital.

As far as the floor, your patients are also usually pretty sick patients that you're doing big open surgeries on, and in many cases diverting their urinary systems so you can't necessarily use urine output as a good guide of renal function or fluid status...

IMO this may be the worst possible field to go into if you're lazy.

Life as an attending is significantly easier, though, but that's 6-7 years down the road.

Agree. While I don't think you can be truly "lazy" and go far in an intense professional field, I think that there are certain fields that more or less can meet the OP's lifestyle and salary requirements. The key, though, is finding one you actually enjoy, because take it from a career changer -- working decent hours at something you are not interested in is going to take its toll far more than working long hours at something you actually enjoy. It's not like you are going to work so few hours that you can shrug it off and live for the weekends. You are going to be a professional, and this is going to be the single largest time commitment in your life, even if you find something fairly lifestyle friendly. So sure, you may have more time for other things if you are working 50 vs 80 hours/week, but don't kid yourself into thinking that toiling for 50 hours at something you dislike is "better" than waking up at dawn and coming home late doing something that keeps you interested.

That being said, in terms of hours, adequate salary, and a mix of diagnosis, continuity of care and procedures, as others have said, things like IM to be a hospitalist, some of the medical subspecialties like rheum or endocrinology, although that means a relatively more lengthy training period as well as a bit more competition, and perhaps PM&R would work. Surgical subspecialties like uro and optho make absolutely no sense for someone without the stomach for a surgical residency or hours. Hospitalist basically is a less competitive IM path with a 3 year residency, leading to very reasonable hours at a salary at the bottom of OP's stated requirements. I think EM wouldn't make as much sense because although the hours can be very reasonable, as a young physician starting out you in a practice you are going to get stuck with some of the less desirable shifts as you "pay your dues" so unless you like working nights and weekends in return for logging less hours total per week, that may not work out for the OP. Neuro, Peds, FM and psych can be hit or miss. Some places the residencies and ultimate practices seem very lifestyle friendly, in other settings they seem more intense. Such is usually the case in any specialty which involves some percentage of its patients coming in through the ED. Path and radiology meet some of OPs requirements, but not the continuity of care or as much of the patient contact aspects, and for any of the ROAD specialties it would actually be hard to get far if you were lazy.

 

[Law2Doc]

Why hasn't Derm been mentioned. Is it not a field that offers a great lifestyle?

While the lifestyle is great, I think someone who describes himself as lazy and not wanting to be surrounded by gunners is going to have a tough time navigating his way into any ROAD specialty. The OP has more or less described himself as someone heading into a noncompetitive field. So the question is really which one he likes best.

 

[OncoticPressure]

While the lifestyle is great, I think someone who describes himself as lazy and not wanting to be surrounded by gunners is going to have a tough time navigating his way into any ROAD specialty. The OP has more or less described himself as someone heading into a noncompetitive field. So the question is really which one he likes best.

I think the "work today so you can rest tomorrow" mentality applies to derm. If you want to get into one of these "lazy" (whatever that means) specialties, plan to work harder than others on the front end to get in. It's a few years vs. the rest of your working life.

 

[Law2Doc]

I think the "work today so you can rest tomorrow" mentality applies to derm. If you want to get into one of these "lazy" (whatever that means) specialties, plan to work harder than others on the front end to get in. It's a few years vs. the rest of your working life.

Sure, but bear in mind that "a few years" is often a lot of years. You need to work hard in med school, then again in residency (the ROAD specialties all require prelim/TY intern years at the start of residency, and all do involve call and a decent number of hours/week, some more or less require a fellowship at the end, and all need to be boarded), only to get into a practice where you are the low man on the totem pole and end up "paying your dues" for a lot of hours a week during the early years so the more senior folks don't have to. We are looking at a lot of upfront time folks put in before they can truly settle in and be "lazy", even in the cushier fields. There is definitely delayed gratification here. Which is why if you are truly lazy, professional jobs aren't going to be ideal.

While I don't disagree that someone ready to work really hard for at least a decade starting in med school can pave their way to a very lifestyle friendly career in some of the competitive fields, my read of the OP's original post (and their dislike of gunner personalities, and willingness to take a lower salary) suggests to me that this is someone who is looking for the less competitive paths that don't require as hard work, whether we are talking up front or back end. I apologize to the OP if I inferred too much, but that's my reading of his post.

 

[J ROD]

PMR......EM can be rough with the weekends and nights...

 

[Everglide]

PM&R with some sort of fellowship towards procedures

 

[Doctor4Life1769]

FP/sports, PM&R, or Psych.

 

[tkim]

Not sure if srs

Just got into med school, so doesn't really know.

 

[amakhosidlo]

"better" than waking up at dawn and coming home late doing something that keeps you interested.

This "dawn" you speak of. What is it? A time of day? If so I'm unfamiliar as I can't imagine myself being awake to see it....

Ok, ok I kid. I guess I should clarify further: By 'lazy', I mean not compulsive and gunnerish about school. We're Pass/fail, and I'm just fine with passing slightly below the mean. Sure I could do better, but in the end, a pass is a pass is a pass. I could bust my tail for Step 1, in fact I think I probably will to keep my options open. I guess my definition of lazy is in the context of the people around me. I'm just not that...hardcore? Looking for the specialty where on average, chill/down to earth types predominate over tools.

When it comes to patients and my time in clinic I take things plenty seriously, and I agree that high hours + love > low hours + hate.

Is it juvenile that I'm turned off to Urology because I don't want to look at ***ks all day?

I thought IM and hospitalist were one and the same?

And by "chronic conditions" I mean managing the DMII/HTN/lipid trifecta that repeats endlessly in primary care. Obviously a dif. between that and the types of injury and disability that PMR probably deals with.

On that note, what kind of procedures does PMR do exactly? That comic earlier basically matches my current preconceptions...

Performing procedures and continuity of care are kind of mutually exclusive

See now what about something like ENT or Allergy, or endocrine? It seems like you'd be taking care of the same folks who have these specific problems over the long term and performing whatever interventions over the same time-frame.

 

[thepoopologist]

Work for an HMO. Deny health insurance to the needy.

 

[shadowfox87]

Hospital receptionist?

 

[geogil]

This "dawn" you speak of. What is it? A time of day? If so I'm unfamiliar as I can't imagine myself being awake to see it....

Ok, ok I kid. I guess I should clarify further: By 'lazy', I mean not compulsive and gunnerish about school. We're Pass/fail, and I'm just fine with passing slightly below the mean. Sure I could do better, but in the end, a pass is a pass is a pass. I could bust my tail for Step 1, in fact I think I probably will to keep my options open. I guess my definition of lazy is in the context of the people around me. I'm just not that...hardcore? Looking for the specialty where on average, chill/down to earth types predominate over tools.

When it comes to patients and my time in clinic I take things plenty seriously, and I agree that high hours + love > low hours + hate.

Is it juvenile that I'm turned off to Urology because I don't want to look at ***ks all day?

I thought IM and hospitalist were one and the same?

And by "chronic conditions" I mean managing the DMII/HTN/lipid trifecta that repeats endlessly in primary care. Obviously a dif. between that and the types of injury and disability that PMR probably deals with.

On that note, what kind of procedures does PMR do exactly? That comic earlier basically matches my current preconceptions...



See now what about something like ENT or Allergy, or endocrine? It seems like you'd be taking care of the same folks who have these specific problems over the long term and performing whatever interventions over the same time-frame.

Again, surgical subspecialty. I have classmates with 260/265 step scores who didn't match. So if you don't want to try hard, don't try for ENT. Pathology has a pretty easy residency, as far as hours are concerned (at least in comparison with surgery). There are lots of routes open off of path as well, you can do forensic, lab medicine, surg path, neuro path.

Nobody has mentioned preventative or occupational medicine as career paths. I can't imagine that the call burden is too severe, although the remuneration might not be on a par with some more competitive specialties. Check out Freida for a list of programs. I just searched and there were several dozen.

 

[muhali3]

See now what about something like ENT or Allergy, or endocrine? It seems like you'd be taking care of the same folks who have these specific problems over the long term and performing whatever interventions over the same time-frame.

That's why I tried to qualify, because there are some like Derm/ENT but those don't fit your criteria. I know allergists can have a Derm-like lifestyle and the procedures tend to be very simple (patch/prick test). They can do a lot for their patients in terms of improving quality of life. If you're fine with simple procedures I say allergy would be a good fit. It would require 5 years of training though (3 years IM or Peds + 2 year fellowship).

 

[DrBowtie]

Psych.

 

[J ROD]

That's why I tried to qualify, because there are some like Derm/ENT but those don't fit your criteria. I know allergists can have a Derm-like lifestyle and the procedures tend to be very simple (patch/prick test). They can do a lot for their patients in terms of improving quality of life. If you're fine with simple procedures I say allergy would be a good fit. It would require 5 years of training though (3 years IM or Peds + 2 year fellowship).

A/I is fairly competitive since there are not that many programs out there.

 

[Savage Henry]

occupational medicine

I'm not a med student (still a few years off), just a room-temperature IQ EMT/x-ray tech, so please forgive me if I'm intruding. I won't be offended a bit if a mod type deletes this post.

I worked at an occ med place for a few months. It was effing brutal.

The docs there got absolutely hosed. It was a requirement to see 3.5 pts per hour for a 12 hour shift, five days a week. Every other weekend, the docs would put in an 8 hour Saturday. The work was basically doing DOT physicals, ordering PT that very few pts complied with, and arguing with drug seekers. The paperwork per patient was measured in English long-tons. Lawyers and facility managers transformed into brow-beating Harpies when it wasn't completed perfectly and post-haste. Nobody was happy, nobody was challenged, and the pay sucked for everyone. It was medical purgatory. Abyssinian galley slaves had higher job satisfaction, and certainly smiled more.

Don't plan on being lazy in that field. Reimbursement is fairly low, so they treat the docs like assembly line workers - squeezing them for every second to make an extra nickel. One of my buddies who's a doc and I figured out our respective salaries. We determined that when I was on overtime, I was actually making more money shooting spine films than he was practicing medicine.

I'm sure there are different business models, management styles, etc, but don't count on occ med as some sort of rainbow farting unicorn that'll cure all that ails your medical career.

 

[BluntSurgeon]

PMR seems like a sweet ticket and I'm thinking about it because I am an exercise nut and I am also pretty damn lazy compared to all the wannabe orthopods in my class.

My only worry is that it seems like a field that has ZERO job safety in the future. I mean, what do they do that a physical therapist can't do? Joint injections and EMGs seem like procedures that will be done by mid-levels and such in the future. They're not that hard. Plus joint injections and EMGs are totally covered by other practitioners in the field (orthos, anes/pain, neuros for EMG).

Lastly, it doesn't seem like there's much option for fellowship afterwards. Pain is incredibly competitive.. why would they give spots to PMRs when they can take Anesthesiologists from baller programs? Sports med seems like the only "lazy" option, but that seems pretty competitive too.

 

[muhali3]

A/I is fairly competitive since there are not that many programs out there.

80% of US grads who applied matched. Fairly competitive, but if it's the OP's cup of tea, I don't see why he wouldn't work just a little bit harder to land a position. He did after all get into med school...so he can't be that lazy. But yeah...I still think PM&R is probably the best fit for you OP.

 

[MCAT guy]

PMR seems like a sweet ticket and I'm thinking about it because I am an exercise nut and I am also pretty damn lazy compared to all the wannabe orthopods in my class.

My only worry is that it seems like a field that has ZERO job safety in the future. I mean, what do they do that a physical therapist can't do? Joint injections and EMGs seem like procedures that will be done by mid-levels and such in the future. They're not that hard. Plus joint injections and EMGs are totally covered by other practitioners in the field (orthos, anes/pain, neuros for EMG).

Lastly, it doesn't seem like there's much option for fellowship afterwards. Pain is incredibly competitive.. why would they give spots to PMRs when they can take Anesthesiologists from baller programs? Sports med seems like the only "lazy" option, but that seems pretty competitive too.

Agreed here, definite overlap. Seems replaceable.

But what do I know.

 

[hefe]

As a non-med student with a casual interest, it doesn't seem that PM&R docs are grossly unemployed or anything. PT's in general are leagues away from invading into physician scope when considering DNP's scope and lobby.

I doubt PT's will be able to lobby for joint injections for years to come, though a monkey could be taught injections (when their used is different story). Pills and injection more in the realm of medicine. PT scope is outside of this in all states.

Basic injections can be done by the PCP and referred to therapy in an outpatient settings for basic care.

I know EMGs have been in the scope of PT's for a while, just few PT's would claim competency or wish to try to do it currently. I'd also guess getting insurance reimbursement seems it may be an issue. In general it's not really taught in the PT curriculum, other than a few select top programs. Most are not well trained in this area, and would require significant continuing education or the right mentor to do it well. This is something that many either have to really search for opportunities. There are some PT's out there who can do EMGs and interpretations proficiently. Neurologists seem to be well-trained in EMG's along with PM&R.

From an outsider's view PM&R seems best coupled with pain if you're not a fan of inpatient rehab or something unusual like a SCI specialty setup. What you should do is talk to PM&R docs and they'll probably help.

Is the Plenty of Money & Relaxation moniker not valid or something?

 

[J ROD]

Is the Plenty of Money & Relaxation moniker not valid or something?

not bad....

 

[cartoondoc]

PMR seems like a sweet ticket and I'm thinking about it because I am an exercise nut and I am also pretty damn lazy compared to all the wannabe orthopods in my class.

My only worry is that it seems like a field that has ZERO job safety in the future. I mean, what do they do that a physical therapist can't do? Joint injections and EMGs seem like procedures that will be done by mid-levels and such in the future. They're not that hard. Plus joint injections and EMGs are totally covered by other practitioners in the field (orthos, anes/pain, neuros for EMG).

Lastly, it doesn't seem like there's much option for fellowship afterwards. Pain is incredibly competitive.. why would they give spots to PMRs when they can take Anesthesiologists from baller programs? Sports med seems like the only "lazy" option, but that seems pretty competitive too.

Everyone says that there's no job security in PM&R because PTs and physiatrists are interchangeable. As a physiatrist, this statement makes little sense to me. The PTs I work with teach patients how to walk again, do transfers, perform ADLs. Do you think as physiatrist, you are going to be in the bathroom, teaching your patients how to toilet? I wouldn't know where to begin. Moreover, the PTs don't have nearly as good an understanding of what medications to use and what tests to order in diagnosis.

As for the EMGs, these are not basic tests. It takes years of training to be good at them. Even attendings with years of experience sometimes struggle. Letting midlevels do them would result in tons of misdiagnosis.

As for pain, the good pain programs are competitive, yes. But there are tons of nonaccredited pain fellowships where you can get all the experience you need to prepare you to do these injections on your own.

I'm not going to say that job security isn't an issue, but in this day and age, that's an issue with a lot of fields and sometimes it's hard to say why. I have no idea why pathologists are having so much trouble finding work. It's hard to predict and better to do what you enjoy.

 

[Slack3r]

Is it juvenile that I'm turned off to Urology because I don't want to look at ***ks all day?