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So OP is destined to hell?
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The mean importance rating given to medical school prestige is 3.6/5. That's significant and is actually higher than the mean score they gave to many other things, including the Personal Statement, AOA membership, and involvement in research. I'm not arguing that everyone cares, but clearly a lot do and the "90%+ don't care" number you came up with is clearly wrong.
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I'd seriously consider OB if not for the highly litigious nature of the job and comparably lackluster pay.
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The burnout rate in EM is pretty much blown out of proportion. Its just something people like to say who aren't quite completely aware of the diversity of the EM field. Here is a more accurate picture regarding EM in my opinion.
1) The burn out rate used to be much higher a decade or so ago. Physicians working in emergency rooms 10-20 years ago were mostly FM and IM trained physicians who had a different training and a different set of skills that were developed during the training. The burn out rate is definitely higher within this non-EM trained group as compared to actual EM residency trained physicians.
2) If you actually look at recent medscape surveys, EM ranks amongst their top 5 fields as far as overall career satisfaction. Although a low number would pick the field again (44%), that number is really more or less the average when compared to other fields. Its just the general trend in medicine except for derm being the obvious anomaly as far as career satisfaction.
3) I've done shifts in both the busiest ED in the country (Parkland 200k annual visits) and a fancy private hospital ED where you have scribes, significantly lower patient volumes, and sometimes an even better compensation. It is tough to imagine people getting much burned out in the chill private hospital ED life where you see 1.5-2 pts an hour, have your scribes do most of your note taking, have PAs taking care of lower acuity, have 8 hour shifts with 1-2 hour overlap...I mean come on..Saw some of the happiest ED physicians. I cant begin to imagine how relaxing those freestanding EDs would be that average about 1 PPH and still pay between 180-200/hr to the ED doctor. And lets face it...most people start to feel burned out after any job after 5-6 years. EM is sweet in that you can literally stay at home half the month.
I think someone who likes procedures, likes a little bit of everything, likes the challenge of the undifferentiated patient, and wants a relatively decent lifestyle (especially if you choose your work environment wisely), then EM is a really good field to consider. Other fields worth considering: Anesthesia, radiology, derm. Derm though is something you have to plan on starting first year and start publishing papers early on. Lifestyle was a big consideration when I picked fields. Anesthesia and radiology were up there in my options, but their future scares me. EM future seems pretty solid. Hoping on more states to pass legislature to allow more freestanding EDs to spring up, only Texas and Colorado do so right now, but as more states enter the mix, the demand for EM doctors will become ridiculous (the demand right now is quite impressive already).
This could be said about any specialty in medicine, considering that even the least "burnt out" specialties are somewhere around 40%.
Ob/Gyn does seem like it could be a good fit, but you haven't said a word about it. Already have your rotation? Its a field that offers a unique combination of surgery, minor procedures, clinic, and continuity of care. If you haven't had it yet, keep an open mind. If you have and didn't like it, that's fine, I like a lot of the things obgyn has to offer but it was soo not the field for me.
Someone more acquainted with IR can correct me if I'm wrong, but I think it would be an awful fit for someone who wants continuity / clinic. In my experience they hardly get to the know the patient at all, fly in put the line/cholecystostomy/etc and fly out.
PMR to pain management fellowship maybe.
I would have a hard time recommending IM to someone who knows not a ton about what they want but does know they want something procedural and knows they hate rounding. Sure you could eventually get that in medicine, but is it worth going that path compared to taking a chance on something that more directly fits those desires before the point of fellowship?
Someone more acquainted with IR can correct me if I'm wrong, but I think it would be an awful fit for someone who wants continuity / clinic. In my experience they hardly get to the know the patient at all, fly in put the line/cholecystostomy/etc and fly out.
PMR to pain management fellowship maybe.
I would have a hard time recommending IM to someone who knows not a ton about what they want but does know they want something procedural and knows they hate rounding. Sure you could eventually get that in medicine, but is it worth going that path compared to taking a chance on something that more directly fits those desires before the point of fellowship?
I think it depends on the person. I've seen more than a few people go into a residency knowing they hate most things about it, but with a specific practice goal in mind for which that residency was necessary. Most did fine or even great. Some were miserable, but think the end goal was worth it. It's not a decision to rush into but it's not necessarily the end of the world.
Is it considerably more than other fields?
Yes
I agree, and I probably should have qualified my statement. I think it's a fine route for people who are very committed to and could realistically obtain their desired fellowship. The "well, cards or gi would probably fit me ok" in combination with the factors that could lead to residency being miserable is what put me on edge with regard to that choice for the OP
I know everyone is bringing up EM and IR. However if you want continuity of care/clinic time neither are very good choices. Granted every ED has its group of "continuity patient's" to say it nicely. However, these are generally not satisfying patient encounters. I obviously have a bias for EM and have mostly nothing but good things to say about it, but it doesn't seem to meet what you are describing to tell the truth. IR has basically no continuity, maybe the biweekly paracentesis for cirrhotic patients. What you are describing overall seems to be more in line with either a procedural oriented IM sub-specialty, or one of the more lifestyle friendly surgical sub-specialties (ophthalmology, urology, ENT). Another option would be PM&R or anesthesiology to pain management, IMO painful patients but it does have continuity and procedures.
Hi all! Thanks for all the suggestions - I appreciate hearing the variety of opinions! For those who suggested OB, that's actually something that I'm seriously considering, though I've had bad experiences with the residents at my home program, which has tempered my interest somewhat. While I don't think I should let one set of residents should influence my career decision, I do think it's to some extent the stress/long hours of an OB/GYN residency that brings out the worst side in some residents, and those factors would be the same for most programs.
I also strongly considered EM early in medical school, but kind of drifted away as I realized I didn't really want to be triaging patients and doing MI rule-outs all day. But the shift work and procedures were definitely selling points! I still wonder about EM sometimes...
As for subspecialty surgery, unfortunately surgery was my weak rotation (and I wanted to get some input before throwing that out there) -- though I have plenty of (good) excuses for that, I think I would've needed to decide by now in order to have the rest of my app in order to overcome that blip.
I also strongly considered EM early in medical school, but kind of drifted away as I realized I didn't really want to be triaging patients and doing MI rule-outs all day. But the shift work and procedures were definitely selling points! I still wonder about EM sometimes...
As for subspecialty surgery, unfortunately surgery was my weak rotation (and I wanted to get some input before throwing that out there) -- though I have plenty of (good) excuses for that, I think I would've needed to decide by now in order to have the rest of my app in order to overcome that blip.
Your mindset sounds similar to mine, so I am going to recommend reconsidering Ophtho (and derm). The truth about Ophtho is that you will generally not be allowed to do anything on your MS3 rotation. This means you are basically shadowing which is absolutely boring unless you are watching some completely gnarly surgery. Actually using the slit lamp and doing the exam is quite fun and challenging. Depending on your home program, you may or may not learn how to use the equipment/work-up a patient on an M4 rotation. Ophtho has great continuity, very little rounding, very interesting material, and a nice mix of procedures as well as clinic. Hours are harder than some "lifestyle specialties" during residency, but definitely improve later. The sub specialties are extremely different from one another and give you a way of tailoring your practice. Every physical exam feels slightly procedural as a result of the slit lamp and all of the equipment that is used.
I was totally in your boat November of my 3rd year, so I made a leap of faith after a great deal of research, and I am very happy with my decision. Your board score will make you competitive, so you only would need to perform solidly on a home/away rotation. Read Ophtho secrets and Ophthobook to do well in these and also to pique your own interest in the material.
I would avoid IM if I were you. I too hate rounding and cannot imagine rounding regularly for 3 years just to pick a sub specialty where I would have to round more. EM is an awesome specialty, but has no continuity (not the kind you want anyway unless you like drug seekers and alcoholics).
I will also add that I am not from a top school, but it is highly beneficial in the Ophtho match, which will give you a solid advantage.
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So you want 1) short hours in residency, 2) shift work, 3) procedures, 4) not surgery, 5) not rounding. This sounds like radiology and anesthesiology.
Ha. I think everyone wants short hours in residency (come on, in an ideal world?!) but that's not factoring into my decision. I was just trying to give my OB residents the benefit of the doubt in terms of why they were such dicks to students and often to each other.
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FWIW, my obgyn residents were excellent. Very friendly minus one or two, but even those were still good residents, proactive about getting students involved in procedures, teaching, etc. Took me off guard. Obgyn gets a bad rap, and I wouldn't be surprised if my experience was less the norm than an exception, but surgery residents they absolutely were not
The vast majority of OBs in most settings now are either employed or join a "small" group of 5-6+ partners. I know I'm speaking in general terms and without any firsthand experience with it, so someone please correct me if I'm wrong, but this would/does significantly lessen the burden of malpractice insurance and makes it relatively comparable to other fields.
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Which is funny because I had absolutely lovely surgery residents! Goes to show that not all residents meet the stereotypes.
I hate to say it, but I would probably discourage males from going into Obgyn. I know there are plenty of stories of males doing well in this field, but urology would generally be a safer fit. More and more, women seem to prefer female obgyns, and I have heard that certain practices won't even hire males. I personally thought it was a very cool field, but did not pursue it for the above reasons.
I don't discourage males from going into this specialty. There are certainly patients who request or prefer females, but it's a big jump from that, to an inability to find jobs. The subspecialties in particular (Onc, REI, etc.) have patients who aren't picky. I know of lots of male OB/GYNs -many newly out of training- who have robust practices. It may be a function of where I live. You see a lot of practices advertising their all-female staff in saturated places like NYC and Chicago, where you have to have a "draw" to get patients. Meanwhile women in my area are happy to not have a 2-month wait for appointments.
Start right now doing everything you can to match derm. Research, connections, pretending to be interested, sucking up to faculty at your home institution, etc. Especially if you don't feel a burning passion for any specialty, just do derm. Apply to every single program in the country, go to all the interviews you can, and do derm. You will be grateful during residency and for the rest of your life. Being interested etc. don't matter. Survey after survey and anecdote after anecdote prove that the combination derm offers will make you happy and grateful. Just do it. If for whatever reason you can't anesthesia or radiology aren't bad.
Agreed.
I'm sure it gets tiring to look for a female chaperone to be in the room with you at all times for every patient
Look for?? It's not like you have to search for some random person to fill in as a chaperone. Most of the private practices at my hospital assign a nurse AND an MA to each physician. I am not so lucky, but even in the busy resident clinic I supervise, it's a matter of declaring "I need a chaperone in room 2" and waiting at most 20 seconds for one of the MAs to pause what they're doing and walk over. And where I work, female OBs get chaperones too. As do all of the breast surgeons.
I understand what you are saying, but the very fact that you are undesirable to a large percentage of the patient population makes you feel...second class. As a white male, I can't really complain about feeling marginalized much, but I certainly wouldn't pick a specialty where I could essentially guarantee some degree of marginalization. This is especially true for the OP as they are competitive for similar fields such as urology, which have a fair amount of overlap.
We'll have to agree to disagree with the "large percentage of the patient population" thing. It may feel like it as a student, but once you are a doctor and patients no longer consider you superfluous to their care, many women change their tune. I've seen patients whose primary OB is a male, kick out male students.
We will also have to disagree on the amount of overlap with urology, unless you specifically mean urogyn/pelvic reconstruction procedures. "Things in the pelvis" do not similar specialties make.
The fact that you think it's normal to have to call other people over on a regular basis due to fear of being accused of sexual assault by your patients is disturbing
Haha okay. It's the public who regularly equates our routine medical procedures with sexual assault. And I know many physicians across specialties who are chaperoned for exams. But feel free to use that as another excuse to dump on OB, as if anybody here really needs it.
You live in Uganda or something? It's pretty normal for him to have a female chaperone during his pelvic exams...
I was referring mostly to the urogyn/pelvic reconstruction side of things. Again, I don't mean to dump on the specialty, I think it is very cool. I was just emphasizing my reasons for having reservations in entering the specialty. I read many articles regarding the feelings of women and male obstetricians, and the gestalt of the situation seemed to imply that within cities (especially the east and west coast) females were actively pursuing female OB's. This did not seem to be the case in the Midwest, South, and amongst older populations of women. The trend was away from male obstetricians in general, and it was not unusual for a male OB resident to state "don't feel bad if you get turned away; it happens to us too." It just seems in general that male obs are generally less desirable, but I don't think it is impossible to create a bustling practice despite this fact. It just is more of an uphill battle that doesn't exist in other fields. It seems worth considering prior to going to residency.
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With the way things are today, I would rather have a chaperone of some kind in every single exam I ever did with a female patient, even if there is no pelvic/breast exam.
