MD & DO *Theoretical* best specialty?

[tradkeke]

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**This is just a thought experiment, not intended to be career advice**
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Obviously the best specialty is the one that you enjoy the most. But theoretically, if someone came up to you and had the stats to match into anything and said they were completely indifferent what would you recommend (besides derm)?

I was talking with some people the other day about it (due to an M4 at our school being in this exact situation) and the overwhelming answer was derm obviously. However, besides derm I was amazed at how different people's answers were. Some said a surgical due to the high pay, others said FM for the lifestyle, literally every specialty you could think of.

So I figured to procrastinate I'd open the question up here. If someone could go into anything (except derm, just to make it more interesting) and be happy, what would you tell them to do?

 

[catnip12]

I’d tell them to use the search function on here and find a plethora of threads, hashing out this exact topic since SDNs inception. They’ll have a pretty good idea about just about any specialty that exists in medicine

 

[Sephirakra]

I've given this a lot of thought, and I've gotta go with derm.

 

[Tenk]

CEO specialty.

 

[Prehealth1011]

Hospital administration.

 

[Lawpy]

Private equity

 

[I'd Rather Be Camping]

Hedge fund manager

 

[efle]

Derm
Ophtho
ENT
Plastics

 

[Ho0v-man]

Derm
Ophtho
ENT
Plastics

So is DOPE the mnemonic replacing ROAD?

 

[ace_inhibitor111]

Best residency after 4 years: Derm
After 5 years: ENT, Urology
After 6 years: IR, Ortho, GI

Ophtho and Plastics don’t get paid as much as people think (high ceiling, but middle of the road average/median)

 

[efle]

Ophtho and Plastics don’t get paid as much as people think (high ceiling, but middle of the road average/median)

It's more about the hourly pay though. The reason Ortho makes 150% as much as Plastics is because they work 150% as much. Also why the best paid guys in the hospital would never ever ever be on my list

 

[ace_inhibitor111]

It's more about the hourly pay though. The reason Ortho makes 150% as much as Plastics is because they work 150% as much. Also why the best paid guys in the hospital would never ever ever be on my list

You’re probably right, though I don’t know a ton about plastics. My list is more the most “in demand” specialties of the next decade. In terms of money, job security, lifestyle, and short residency, it’s hard to beat derm.

 

[Frazier]

HPM

 

[Chelsea FC]

PM&R

 

[efle]

PM&R

Ah, PM&R and Psych, the poor man's skin and eyeballs

Def also living the good life

 

[TypeADissection]

I often see ENT get listed, but let's be serious, it's still a rigorous surgical subspecialty and if you're in private practice the call can get pretty rough. Especially if you're coming in for airway emergencies in the middle of the night, or taking trauma call. My wife is on faculty and so she has residents to help take body blows for her, but make no mistake, the cases can be long and arduous. The residency is definitely not a chip shot. If you think you're interested I cannot emphasize enough the importance of rotating on the service and actually taking call with the residents as well. Cheers.

 

[AMEHigh]

I often see ENT get listed, but let's be serious, it's still a rigorous surgical subspecialty and if you're in private practice the call can get pretty rough. Especially if you're coming in for airway emergencies in the middle of the night, or taking trauma call. My wife is on faculty and so she has residents to help take body blows for her, but make no mistake, the cases can be long and arduous. The residency is definitely not a chip shot. If you think you're interested I cannot emphasize enough the importance of rotating on the service and actually taking call with the residents as well. Cheers.

Yeah it's surprising to me that anyone would think that any surgical specialty would be considered "the best."
No thank you to 5 year residency, being on call or having to come in in the middle of the night.
Hence why I picked my specialty!

 

[deleted936470]

rural family med

 

[jdh71]

urology

 

[CyrusHabs7695]

Nobodies gonna throw Rads on the list? Seen some pretty nice job listings online

 

[longhaul3]

Yeah it's surprising to me that anyone would think that any surgical specialty would be considered "the best."
No thank you to 5 year residency, being on call or having to come in in the middle of the night.
Hence why I picked my specialty!

For me any field that doesn't operate would be a non-starter in the "best speciality" discussion just because operating is part of what makes it the best.

I was talking to a neurology resident a few years back who said "you guys love the OR, we love writing notes!"

No thanks. Same goes for rashes, punch biopsies, CXRs, slit-lamp exams, clinic days, and the rest. The money and hours have to be part of the "best specialty" discussion but there's a lot more to it.

 

[Mad Jack]

I'd say psych but I'm biased. If you can run a business, you can make good money in the same manner as many dermatologists (by utilizing physician extenders and offering ancillary services like counseling/therapy). If you just want to be a cog, ophtho is pretty sweet.

 

[Thelonious Chunk]

Psychiatry is better than derm

 

[deleted978973]

Theoretically? Pathology. But their job market is horrifically bad so in practice not so much.

 

[You shall know the Truth]

Best residency after 4 years: Derm
After 5 years: ENT, Urology
After 6 years: IR, Ortho, GI

Ophtho and Plastics don’t get paid as much as people think (high ceiling, but middle of the road average/median)

Best after 7 in neurosurg

 

[CidHighwind]

Radiology. Call isn’t that much, with night hawks there’s a lot of people that just do nights (7 on/14 off), lots of technology, no social work BS, still make a lot of money (even though reimbursement is going down, it’s still higher than most specialties) and most of the people in the field are pretty cool. Also if you’re just DYING to do more clinical stuff or more procedures there is always IR fellowship.

 

[WedgeDawg]

I’d tell them to do what they find the most interesting and the best fit. Residency is easier if you’re excited to wake up most days after 4-5 hours of sleep than if you get 7-8 hours but dread going to the hospital/clinic/whatever.

What’s good for one person might be terrible for another. There is no “best” just “best for you”.

 

[WedgeDawg]

Yeah it's surprising to me that anyone would think that any surgical specialty would be considered "the best."
No thank you to 5 year residency, being on call or having to come in in the middle of the night.
Hence why I picked my specialty!

To be fair, it surprises most of us that anything non-surgical could ever be considered “the best” 😛

 

[Kuratz]

I think IR is pretty awesome. Wide variety of pathologies and interventions while still being an expert/consultant. Can "retire" to diagnostics. New endovascular procedures still being developed. Can choose between lifestyle/pay. SO glad I chose this route over just reflexively going Derm with a good Step 1 score.

I think choosing something just for the perceived lifestyle is a recipe for career dissatisfaction but to each their own. Derms who are making the stereotypical big bucks are working their balls off btw.

 

[OrgoCoop]

No love for anesthesia here?? Superheros of the hospital, the absolute gods of resuscitation and saving lives (who would you want if your loved one was crashing, needed an airway and was hypotensive?). Fun procedures, interesting cerebral medicine, great salary, fellowships only a year, job market growing.. etc.

 

[efle]

I think choosing something just for the perceived lifestyle is a recipe for career dissatisfaction but to each their own. Derms who are making the stereotypical big bucks are working their balls off btw.

Idk man the average derm hours are significantly less than the other specialties with their same hourly pay.

And the satisfaction surveys always seem to land on the side of lifestyle >> interesting work

Spoiler: Daaaang Derm $$

 

[Kuratz]

Idk man the average derm hours are significantly less than the other specialties with their same hourly pay.

And the satisfaction surveys always seem to land on the side of lifestyle >> interesting work

Not to get too far into the weeds, but things can and will change. Consolidation is happening everywhere across medicine and Derm not immune (in fact one of the more impacted). What happens if you go through derm residency only to find that you can only get jobs matching the per hour rate of ophtho, allergy, ENT etc because private practices have sold out? What happens if CMS decides to decrease derm reimbursement? What happens if academics decide to push for residency slot expansion a la Rad Onc? That could leave one to be bitter if they hate cranking through 50 skin patients per day because they wanted to maximize the income/free time curve and now find themselves making as much as "only" a Nephrologist with similar hours. Picking based solely on this dichotomy is very short-sighted.

Maximizing income/work is far more dependent on business skills and risk tolerance than choice of specialty.

 

[CidHighwind]

I think IR is pretty awesome. Wide variety of pathologies and interventions while still being an expert/consultant. Can "retire" to diagnostics. New endovascular procedures still being developed. Can choose between lifestyle/pay. SO glad I chose this route over just reflexively going Derm with a good Step 1 score.

I think choosing something just for the perceived lifestyle is a recipe for career dissatisfaction but to each their own. Derms who are making the stereotypical big bucks are working their balls off btw.

Big bucks as in 600k+ sure. There are derms that work 3 days a week and make 300k+. Even if you don’t “love” your job, being a dermatologist lets you do what you love outside of work.

 

[efle]

Not to get too far into the weeds, but things can and will change. Consolidation is happening everywhere across medicine and Derm not immune (in fact one of the more impacted). What happens if you go through derm residency only to find that you can only get jobs matching the per hour rate of ophtho, allergy, ENT etc because private practices have sold out? What happens if CMS decides to decrease derm reimbursement? What happens if academics decide to push for residency slot expansion a la Rad Onc? That could leave one to be bitter if they hate cranking through 50 skin patients per day because they wanted to maximize the income/free time curve and now find themselves making as much as "only" a Nephrologist with similar hours. Picking based solely on this dichotomy is very short-sighted.

Maximizing income/work is far more dependent on business skills and risk tolerance than choice of specialty.

Fear of the sky falling has been quoted forever man, it doesnt scare me enough any more since it can hit any specialty and Derm has been Derm for a very long time.

Hell even when the sky does fall a la reimbursement drop for Mohs, it's that they now "only" make 600k instead of a million. Boo hoo, doubt anybody regretted their life decisions because of that.

If I want to work 4 days per week, live anywhere in a nice house with a nice car and a stay at home spouse with my kids in private school...theres still nothing that touches derm

 

[bobjonesbob]

Does that data account for vacation at all? If not, that would move the surgery $/hr down a decent bit.

 

[CyrusHabs7695]

Does that data account for vacation at all? If not, that would move the surgery $/hr down a decent bit.

Where is this from? These salary numbers seem pretty high for some. Im team rads but 500k median seems pretty high, no?

 

[VincentAdultman]

Lol this is dumb, also ortho is a five year residency not six.

 

[CidHighwind]

Where is this from? These salary numbers seem pretty high for some. Im team rads but 500k median seems pretty high, no?

No, not really, especially in non-saturated markets. You’re just used to seeing the deflated numbers.

 

[efle]

Where is this from? These salary numbers seem pretty high for some. Im team rads but 500k median seems pretty high, no?

The hour numbers are from the JAMA study I believe, check their methods for the vacation question

 

[ace_inhibitor111]

Lol this is dumb, also ortho is a five year residency not six.

90% of residents go on to fellowship so it's effectively six.

 

[VincentAdultman]

90% of residents go on to fellowship so it's effectively six.

I had no idea.

But that’s increasingly the case for most subspecialies as well.

 

[PieOHmy]

what about the specialty office based specialties.. they seem pretty cush..
allergy/immunology, Rheumatology, endocrine
you call any of those specialties and they are booked solid for months and months..

 

[EdgeTrimmer]

what about the specialty office based specialties.. they seem pretty cush..
allergy/immunology, Rheumatology, endocrine
you call any of those specialties and they are booked solid for months and months..

office based are paid less by insurance or govt

 

[nimbus]

Derm
Ophtho
ENT
Plastics

PE companies are buying up derm, ophtho and plastics practices. They are not that far behind anesthesia and EM. Soon all doctors will be working for the man.

 

[Lawpy]

PE companies are buying up derm, ophtho and plastics practices. They are not that far behind anesthesia and EM. Soon all doctors will be working for the man.

But theoretically, if someone came up to you and had the stats to match into anything and said they were completely indifferent what would you recommend (besides derm)?

Private equity

Yep

 

[Gilakend]

No love for anesthesia here?? Superheros of the hospital, the absolute gods of resuscitation and saving lives (who would you want if your loved one was crashing, needed an airway and was hypotensive?). Fun procedures, interesting cerebral medicine, great salary, fellowships only a year, job market growing.. etc.

Maybe CRNA/CAA encroachment and people fearing their job will just be "supervising" is a deterrent? But admittedly these are just rumors I've heard, as someone not too interested in anesthesia I haven't actually looked into it.

 

[efle]

PE companies are buying up derm, ophtho and plastics practices. They are not that far behind anesthesia and EM. Soon all doctors will be working for the man.

I mean, being your own boss is kind of going the way of the dodo across the board though, no? Even outside medicine. All the best gigs in everything (tech, engineering, consulting, finance, law, etc) are with the massive companies or firms. There's always a lot of doomsday talk about the future of every specialty, but I never actually hear of any greener grasses than lifestyle-friendly medicine.

 

[nimbus]

I mean, being your own boss is kind of going the way of the dodo across the board though, no? Even outside medicine. All the best gigs in everything (tech, engineering, consulting, finance, law, etc) are with the massive companies or firms. There's always a lot of doomsday talk about the future of every specialty, but I never actually hear of any greener grasses than lifestyle-friendly medicine.

Sadly you’re correct, independent practices are going extinct. However the few remaining independent practices in anesthesia and EM are the best ones around because they self govern about schedules, staffing and retirement plans and they don’t pay 20-30% of gross receipts to their corporate overlords.

 

[PieOHmy]

Sadly you’re correct, independent practices are going extinct. However the few remaining independent practices in anesthesia and EM are the best ones around because they self govern about schedules, staffing and retirement plans and they don’t pay 20-30% of gross receipts to their corporate overlords.

The problem is the greed of whoever is employing physicians will end this model because it simply is not sustainable.
We see it in Anesthesia already. Practices are telling me they are having a hard time finding people who want to work fulltime. Everyone has conditions on their employment.
So it is cracking. This early.------------------

 

[nimbus]

The problem is the greed of whoever is employing physicians will end this model because it simply is not sustainable.
We see it in Anesthesia already. Practices are telling me they are having a hard time finding people who want to work fulltime. Everyone has conditions on their employment.
So it is cracking. This early.------------------

We’re still holding out.