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Specialty with outpatient clinic + OR/procedures?

Discussion in 'Medical Students - MD' started by PatchAdams25, May 15, 2018.

  1. PatchAdams25

    2+ Year Member

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    I would like a career that has outpatient clinic but also a mix of OR/procedures. I've been thinking of fields that would allow this type of practice but would like some input on these given my naive pre-clinical MS exposure to these fields.

    Internal Med --> GI = Seems like GI would allow this, however getting stuck in IM would be horrible and I don't know other internal med specialties I would like other than possibly cardiology, but not enough exposure yet.

    Urology = good mix of clinic/OR. OR also has mix of large/smaller surgeries. Also like all the technology in this field and that the job market is great/will continue to do great thanks to aging population and AUA controlling residency #s. Heard it is also easy to transition from working more OR as a younger attending to more clinic as older.

    Optho = My perception of this field is similar to Urology in that it has a mix of clinic/OR time. Enjoyed eye anatomy. Did clinic with Optho and liked it, but have not been in the OR with them

    ENT= No interest

    Anesthesia (--> Pain?) = I really like anesthesia, however it doesn't really fall under my outpatient clinic criteria. Pain sounds like it would be a good option, but I heard it was a horrible decision to pick a base specialty banking on a fellowship. I would definitely be more happy in anesthesia than IM though.

    Family Med= No interest

    derm = no interest
     
    #1 PatchAdams25, May 15, 2018
    Last edited: May 15, 2018
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  3. spacegun

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    Maybe first thing to do is decide what kind of "procedures" you want. I'm sure you know procedures vary significantly. Procedures in the OR are really different from small outpatient procedures like in FM. So I guess try to figure out what kind of procedures would most satisfy you.

    IM - as far as "bigger" procedures, GI allows for both procedures and outpatient, you can be virtually all inpatient or outpatient depending on how you set up your practice, same with cardiology, and same with pulm/cc. CC is all inpatient, lots of procedures, similar to anesthesia in a lot of ways so maybe if you like anesthesia but want outpatient, then the pulm part will satisfy you (e.g. bronchs) + cc for tons of other procedures. Hem/onc is mostly outpatient and barely any procedures, though I guess you could count giving chemo a "procedure." Rheum has smaller "procedures" and outpatient, but not sure if joint aspirations etc. are the kinds of procedures you want.

    Uro - sounds like you might want this. True good mix.

    Ophtho - I don't know as much about this, but from what I've seen in private practice they do tons of smaller shorter surgical procedures (e.g. cataracts), could be more financially lucrative to do a ton of shorter (e.g. 30 minutes) procedures vs. a more time-consuming and bigger cardiothoracic and I think You'd have a longer surgical career in ophto and urology too, neurosurgeons and cardiothoracic surgeons seem more burned out to me when they're older.

    Anesthesia is all inpatient and no outpatient. I really like anesthesia, but yah no outpatient though so I guess that's not for you (though for me no outpatient would probably be a good thing as I hate clinics lol). Pain is a completely different specialty, but it does allow for outpatient + procedures, but attendings in anesthesia sometimes say pain patients are . . . a pain .

    I guess another criteria is maybe pick what patient population you want to work with (e.g. kids = pediatrics, women and kids = OBGYN, adults only = IM and subspecialties).

    Also pick the kind of pathology you want to deal with day in and day out. Not just the exciting stuff, but the bread and butter.

    FM - to be fair FM seems to be doing well though, in demand everywhere. I don't really like outpatient so I couldn't pick FM. But they do offer limited smaller procedures and outpatient and the ability to work wherever you want in the entire country if you are more geographically limited.

    Derm - I would reconsider unless you absolutely hate the skin. Great mix of outpatient and procedures (e.g. Mohs surgery). Obviously procedures aren't going to be OR level procedures though.

    Peds - you didn't mention, I don't know how you feel about kids, but general peds is all outpatient, but you can do some inpatient, maybe some procedures. Peds has a lot of subspecialties just like IM that could be really cool (I think PICU is cool).

    Whatever happens, good luck! Hope you find a specialty that resonates with you! (I'm on the same path)
     
    PatchAdams25 likes this.
  4. Oso

    Oso
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    You’ll get a much better idea once you do rotations in these specialties.

    Based on your post, definitely spend some time on urology. Do anesthesia and optho as well. After your IM rotation you’ll see if you can actually do a residency in it or not. I would also consider IR.

    But yeah, the only way to really tell is to do a rotation. You may like clinic when you spend a few hours one day a week shadowing but hate it once you have a half/full day a few times a week and have no time to write notes and have to balance that with OR.

    $0.02
     
    PatchAdams25 likes this.
  5. bommer1389

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    I have similar interests as OP, so I'm not trying to hijack; Is there enough time to do rotations in Uro, Optho, Anesthesia, etc.? For example, my school is traditional 2+2, so would my 3rd year be just the main specialties, or is there time for these electives you discussed? I believe Uro is an early match as well (and maybe Optho?), so I'm a little anxious about not having time to see some/all of these other specialties you listed. I'm only an M1 so I'm trying to use this summer to shadow a little (I figure it's better than no exposure at all). Thanks for any input!
     
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  6. Donald Juan

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    Basically all surgical fields have outpatient clinic and OR time. Don't necessarily rule out general surgery specialties, ortho, etc. Almost all surgical fields are going to be 2-3 days of clinic and 2-3 days of OR a week in practice.
     
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  7. Donald Juan

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    It completely depends on what your years M3 schedule is. For urology, most places your core rotation on surgery will involve some subspecialties that you can choose and you could get exposure that way. At my school Ophtho and anesthesia had to be done as electives, and we only had a single M3 elective so they really couldn't both be done during M3. These things can vary a lot from program to program.

    Shadowing is a great idea if you have some time prior to M3 so that you can have a better idea. Sometimes a small amount of exposure is enough to let you know a certain field is not quite what you expected.
     
  8. PatchAdams25

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    Thanks for the reply! Definitely not ruling out other surgical subs, I still need more exposure to a lot of them. I didn't really list any of the other ones because from my understanding, Urology, ENT and Optho are always the ones that come up when I read about having "more" control over their schedule/practice setup in comparison to other surgical subspecialties (i.e having the option to operate less and do clinic more and still run a viable practice). I do understand this is probably a gross overgeneralization however.
     
  9. PatchAdams25

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    The thought of a residency full of obstetrics :diebanana:
     
  10. LebronManning

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    Literally any surgical specialty would have OR and clinic
     
  11. Lnsean

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    Dermmmmmmm
     
  12. DoctwoB

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    As other people have mentioned, unless you’re doing pure inpatient acute care surgery, your OR cases have to come from somewhere and they need somewhere to follow up, meaning you have clinic. Many academic surgeons get away with one clinic and multiple OR days, but that comes from having a referral pattern that sends them a high volume of cases plus residents and/or PAs to plow through a ton of patients in that one day. As a private surgeon of nearly any specialty you’ll probably have minimum 2 clinic days/week.
     
  13. MSTPlease

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    I might be putting words in OPs mouth but I assumed clinic time meant patients that have problems with non-surgical management for which you are the one expected to be the primary person for said management. I do think of optho and gyn in particular as fulfilling this with uro probably working as well. I wouldn't consider ortho or gen surg to fit into that description as non-surgical management would usually entail referring them out.
     
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  14. michaelrack

    michaelrack All In at the wrong time
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    Ortho will often nonsurgically manage musculoskeletal problems without referring out.. especially if you count injections as nonsurgical management
     
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  15. MSTPlease

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    I would consider that nonsurgical management so that's a fair point. Probably depends on the geography/other physicians available. In my personal experience if ortho decides surgery isn't necessary the patient usually goes to rheum, PM&R, or neurology depending on the diagnosis and will only return to ortho if surgery is being reconsidered. I could easily see how orthos outside of NYC might manage more non-surgical patients themselves though.
     
  16. RangerBob

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    I agree--most ortho surgeons in busy areas have very brief clinic appointments (5-15 minutes at most it seems), and they will typically refer any non-operative MSK to us (PM&R) or another specialty like Rheum if appropriate. We return the favor and refer patients that would benefit from surgery to ortho. It's win/win--they get to operate, which they love, and we get to do non-operative management (meds/injections/PT/lifestyle/bracing/etc), which we love.

    I know some ortho surgeons who do non-op stuff, but they take a big paycut if they're going to do it well (ie., take the time). They get paid a lot more to be in the OR. They still make decent money if they do the non-op clinic stuff--it's just they can make a killing in the OR.

    For the OP--if you're interested in pain but don't want to go the anesthesia route, consider PM&R as a route to a pain fellowship. Anesthesia applicants are typically more competitive for the fellowships, but PM&R trained pain specialists typically do better in clinic since about half or more of our residency is MSK-focused.
     
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  17. nlax30

    nlax30 Fellow
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    Not much more to add besides to echo the suggestion of teasing out which type procedures you enjoy.... major OR cases or more outpatient/office type procedures.

    I'm biased but Cardiology and it's sub-specialities offer a good mix of procedures and obviously office/inpatient clinical duties. EP (electrophysiology) especially is a very procedurally heavy field with a wide variety of procedures ranging from EP studies/ablations in a cath lab setting to complex device extractions at times in the OR.
     
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