Trying to select specialty based on very specific criteria

[Major_Guile]

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Hello, I took the residency selector quiz and my top suggestion was Internal Medicine - Oncology. That seems great, but I was looking on more specific feedback. I want to provide cheap and effective medical care. I am willing to take large pay cuts if I can pay it forward to my patients, is this feasible? I feel like the healthcare industry makes so much profit and I only want enough to be able to continue helping patients.

I know this seems naive, so I would appreciate it if someone had reading recommendations to show me how the healthcare industry is using its money. Also, I am shadowing doctors of many different specialties during a gap year to begin to show me which residency I would like, so I am open to these suggestions as well!

I have also taken public health courses that said primary care providers would be a great way to reduce costs as well. Thoughts on this?

edit: Found this book Amazon product ASIN 0071479414

 

[Dr. Death]

Hello, I took the residency selector quiz and my top suggestion was Internal Medicine - Oncology. That seems great, but I was looking on more specific feedback. I want to provide cheap and effective medical care. I am willing to take large pay cuts if I can pay it forward to my patients, is this feasible? I feel like the healthcare industry makes so much profit and I only want enough to be able to continue helping patients.

I know this seems naive, so I would appreciate it if someone had reading recommendations to show me how the healthcare industry is using its money. Also, I am shadowing doctors of many different specialties during a gap year to begin to show me which residency I would like, so I am open to these suggestions as well!

I have also taken public health courses that said primary care providers would be a great way to reduce costs as well. Thoughts on this?

edit: Found this book Amazon product ASIN 0071479414

I think it is possible to provide cheap and effective care if you are in private practice. But if you work for someone like a hospital, you won't be able to control how much you charge them. A FM that I shadowed treated someone for free because they didn't have money to pay and didn't qualify for medicare until next year. They were so grateful to him, but again it was private practice I'm sure a hospital wouldn't allow stuff like that.

 

[URHere]

If you want to provide cheap, much-needed healthcare, think about global health and international medicine. I know a handful of faculty members who have set up clinics in developing countries, and many more who dedicate a few months at a time to international hospitals or Doctors without Borders.

The health care system in the US is designed in such a way that it is really hard to give out affordable care unless you work at a free clinic, or one of the elusive systems where everything is covered with a monthly fee. Even those have high overhead costs and very specific patient populations. If you work at a free clinic, keep in mind that cheap care in the US isn't always effective - you may be able to see uninsured patients for free, but good luck paying for their MRIs when things get bad. Granted, internationals sites may not have things like MRIs at all, but you can't say you wouldn't be making a difference.

 

[Major_Guile]

Yeah, my current plan is to join the NHSC and serve overseas in Guam or Puerto Rico and then join Doctors Without Borders. I especially want to educate underserved areas, as that does seem to be an effective way to save costs.

 

[DrBowtie]

If you are looking to save costs, it's definitely not by doing oncology. NCCN guidelines include lots of follow up imaging and chemo medications are generally expensive.

 

[mmmcdowe]

Yeah giving up a hundred grand of your salary isnt going to make a dent in millions of dollars in chemo costs. Agree with fm or international outreach. Despite the common belief tyat doctirs are the reason healthcare is expensive, last time I checked we made up no more than 10% of costs overall.

 

[Law2Doc]

If you want to give cheap Medical care to poor people that's great but I think oncology isn't the right path. As is any degree of sub specializing beyond being a generalist. Do FM or IM, don't bother to sub specialize, and get out there to work with the underserved. Doctors Without Borders is fine, but frankly you can do a whole lot more good without ever leaving the country -- we have poor sick people right in our own backyard. People who need to go to exotic foreign venues to do good are basically posers -- it's more about them and their adventurous wants than the cause.

 

[Dizziness and Giddiness]

The medical oncologist I work with can spend upwards of $250,000 a month on chemotherapy alone as a solo provider.

It is simply not feasible for you to provide cheap care in that field. You'll never be able to eat all those costs, unless you limit your scope of practice to the point of being nearly useless.

It's also very difficult for private providers to compete with hospitals who enjoy 340B pricing. Yet another reason small practices are dying off.

 

[eteshoe]

You know you don't have to restructure your life goals just because a quiz says so. Do IM and go help the underserved.

 

[kbeitz]

It's not difficult to figure out where costs come from. Chronic disease is a large component of healthcare spending. So is treatment of the elderly. Hospitals are extremely inefficient. Insurance companies, government restrictions, and malpractice lawyers only exacerbate the problem. Don't assume that your choice of specialty can affect any of these factors which are passed onto patients.

If you have the unlikely gift of convincing your patients to not eat hamburgers or drink soda every day you might make a dent.

 

[Major_Guile]

My other plan, the one I had the longest, was to do primary care in Southeastern KY. It is the poorest area in America and its health is quite bad. I have been shadowing a PCP who wrote my recommendation for med school. He is also the medical director of our Tri-County Hospice. He will be retiring soon(ish) and has offered to bring me onto his team after I get my education. I think I could do a lot of good in this area, especially if I could also manage care for the elderly as he is.

Also, I currently work as a CNA in a nursing home and have seen how poorly doctors care for the elderly... Oh, and my family has a lot of clout in my area, so I think people would be listening to my advice.

Yeah, PCP in Southeastern KY while also managing the care of the elderly and educating the public seems to be the ideal solution to me. Thank y'all for the advice and I welcome any more y'all have!

 

[Dave89]

Peds or IM, w/o fellowship. I'd say FM, but I'm not certain as to the future of that "specialty."

 

[eteshoe]

My other plan, the one I had the longest, was to do primary care in Southeastern KY. It is the poorest area in America and its health is quite bad. I have been shadowing a PCP who wrote my recommendation for med school. He is also the medical director of our Tri-County Hospice. He will be retiring soon(ish) and has offered to bring me onto his team after I get my education. I think I could do a lot of good in this area, especially if I could also manage care for the elderly as he is.

Also, I currently work as a CNA in a nursing home and have seen how poorly doctors care for the elderly... Oh, and my family has a lot of clout in my area, so I think people would be listening to my advice.

Yeah, PCP in Southeastern KY while also managing the care of the elderly and educating the public seems to be the ideal solution to me. Thank y'all for the advice and I welcome any more y'all have!

It sounds like you know what you want to do which is good.

 

[deleted480308]

FM...direct primary care (atlasmd has a whole thread on it here). Then charge as little as you feel like, but let's be honest, the amount you're willing to live on will change as the machine that is medical debt bears down on you

 

[linguistafeliz]

Consider family medicine!! It sounds perfect for what you want to do. Don't listen to Dave89-- on the contrary, I see FM as a specialty that is "up and coming" in this era of acute shortage of primary care physicians and which has a very bright future. Don't forget that FM is not only primary care--you can also train in FM and go on to work as a hospitalist, provide prenatal care and deliver babies or even do C sections, do sports medicine, etc. It is the ideal specialty for someone who wants to care for the underserved, as it does not limit your scope of practice. What your patients need, you can often provide, even when there is a lack of specialists in your area willing to see for example patients without insurance.

If a mom comes in with a sick child, as an IM doctor you will be unable to care for the child, even if there are no pediatricians who are willing to see him or her in your area. (Insurance situations, etc.) I say all this because I go to a med school where FM is very underrepresented, which is a common situation in an era when highly specialized physicians seem to be better reimbursed, and so I think it's important to bring up.

 

[Major_Guile]

I wish I knew how to make MRI setups... I hear they cost $5 million to make. How??

 

[URHere]

Doctors Without Borders is fine, but frankly you can do a whole lot more good without ever leaving the country -- we have poor sick people right in our own backyard. People who need to go to exotic foreign venues to do good are basically posers -- it's more about them and their adventurous wants than the cause.

I'd argue that there's much more good to be done overseas, considering the sheer number of people who still suffer from things like polio, ebola, bubonic plague, malaria...you know, the kinds of diseases that send the US into an outright panic even when there's little to no danger of an outbreak stateside.

Sure, there are underserved populations in the US, especially in urban centers, but in my mind the need is on an entirely different level. To each his own.

 

[Psai]

Consider family medicine!! It sounds perfect for what you want to do. Don't listen to Dave89-- on the contrary, I see FM as a specialty that is "up and coming" in this era of acute shortage of primary care physicians and which has a very bright future. Don't forget that FM is not only primary care--you can also train in FM and go on to work as a hospitalist, provide prenatal care and deliver babies or even do C sections, do sports medicine, etc. It is the ideal specialty for someone who wants to care for the underserved, as it does not limit your scope of practice. What your patients need, you can often provide, even when there is a lack of specialists in your area willing to see for example patients without insurance.

If a mom comes in with a sick child, as an IM doctor you will be unable to care for the child, even if there are no pediatricians who are willing to see him or her in your area. (Insurance situations, etc.) I say all this because I go to a med school where FM is very underrepresented, which is a common situation in an era when highly specialized physicians seem to be better reimbursed, and so I think it's important to bring up.

It's not a specialty because it's general practice. FM people are very rah rah but we will see what the future holds. Don't buy into the hype.

 

[Law2Doc]

...considering the sheer number of people who still suffer from things like polio, ebola, bubonic plague, malaria...you know, the kinds of diseases that send the US into an outright panic even when there's little to no danger of an outbreak stateside...

The panic frequently hasn't stemmed from those diseases themselves as much as from the few irresponsible healthcare workers who go there and then come back to the US and refuse to self quarantine because they are arrogant and "know better".

But you are kidding yourself if you think going to some exotic locale to provide health care for people with front page diseases, while ignoring the local poor and sick with more mundane ailments is about anything other than self fulfillment and personal aspirations. Charity isn't about doing something international and noteworthy and getting recognized for it. The underserved people here without front page diseases that aren't going to get you in the papers is frankly a more worthy cause

 

[URHere]

The panic frequently hasn't stemmed from those diseases themselves as much as from the few irresponsible healthcare workers who go there and then come back to the US and refuse to self quarantine because they are arrogant and "know better".

But you are kidding yourself if you think going to some exotic locale to provide health care for people with front page diseases, while ignoring the local poor and sick with more mundane ailments is about anything other than self fulfillment and personal aspirations. Charity isn't about doing something international and noteworthy and getting recognized for it.

Never said anything about recognition, it's more about leveling the playing field. I think people in developing countries would love to get to the point where they worry about "mundane ailments". It's kind of a moot point anyway. Everyone I know who spends time working internationally also spends some time with underserved and/or refugee populations stateside. I just don't think it's worth downplaying the importance of international work when it can make a huge difference to the communities in question. But again, to each his own.

 

[Law2Doc]

...Everyone I know who spends time working internationally also spends some time with underserved and/or refugee populations stateside...

When a premed says their goal is to be an oncologist working with Doctors Without Borders, they aren't really contemplating working with the underserved stateside. And "everyone you know" isn't exactly enough data to extrapolate from.

 

[Major_Guile]

I never planned on being an oncologist, I just meant that the quiz's suggestion seemed great. My plan was always to work with underserved, but I am still too new to the system to know the best way to do this. For example, I am hopeful that work overseas would allow me to stay busy helping people who want help and do not have access. In my home area of Southeastern KY, we have a large opioid addiction problem. My mentoring physician got burned with a few patients seeking these drugs and then his ability to help others was hurt. I feel like if I work overseas, I could be giving out cheap meds and teaching basics to those who do not have it. I heard of one doctor in Papau New Guinea who mainly works with malaria patients and has saved lives by doing this type of work.

Then again, I also read an article that said buying mosquito nets for malaria stricken areas is the best way to save lives. Alas, I remain conflicted! Still, I thank you all for the advice and continue to welcome more discussion!

 

[futuremdforme]

You could consider moving to a country where such services are part of a national healthcare system. I agree that in oncology in particular, the treatment cost itself, and not your salary, is the major cost driver. I am sure that you will find ways to give back if it's important to you though. (And I think it's amazing that you're thinking about this stuff.)

 

[J ROD]

Do FM and then figure out where you can help most. You can do Kentucky (which heart sound is that!) and then do other overseas stuff if you want. Just do FM so you will be most general and be able to treat adults, peds, OB, etc.

 

[Horse Apiece]

we have poor sick people right in our own backyard. People who need to go to exotic foreign venues to do good are basically posers -- it's more about them and their adventurous wants than the cause.

I see this all the time in undergrad. There are always those in class who talk about their service trips and how, "[they] learned just as much as [they] taught, and.... blah blah blah." Its even worse when the majority of those people do not regularly volunteer their time to the community of poor and under served people we have around us, not to even mention the fact that they went on the trip with no significant work skills to help those they are "serving."

 

[Kera]

But you are kidding yourself if you think going to some exotic locale to provide health care for people with front page diseases, while ignoring the local poor and sick with more mundane ailments is about anything other than self fulfillment and personal aspirations.

Does it have to be an either-or? I'm pretty passionate about global health, but by "global health" I don't mean just outside the borders of the US. I mean that I'm passionate about providing quality health care to populations that haven't traditionally received it. That can happen in rural Kentucky, that can happen in parts of NYC, and that can happen in remote villages of developing countries. We need people working on all of these problems, and there's no moral superiority or inferiority in choosing to work in any of them.

Like when I say I'm interested in, say, EM, a family member will say "But what about all the little children? Don't you care about them? Why don't you want to be a pediatrician?" I absolutely believe pediatrics is important, but that's just not the specialty I'm entering. Likewise, it's important for the children of Kentucky to receive health care, and it's also important for the children of Sierra Leone to receive health care. Just because somebody pursues one path doesn't mean they think the other should be neglected.

Charity isn't about doing something international and noteworthy and getting recognized for it. The underserved people here without front page diseases that aren't going to get you in the papers is frankly a more worthy cause.

I'd change this to "Charity isn't about doing something and getting recognized for it." The vast majority of people working in global health (both in the US and abroad) are not doing it for the notoriety; they're just trying to make a positive change in whatever little sphere of the world they inhabit. Doing something ostensibly good just for the notoriety is reprehensible, regardless of where in the world that "good" is performed.

And this conversation is completely separate from those Medical Brigades programs, which actual global health professionals detest. Perhaps you're referring to those programs, in which case I agree 100%.

 

[Law2Doc]

Does it have to be an either-or? I'm pretty passionate about global health, but by "global health" I don't mean just outside the borders of the US. I mean that I'm passionate about providing quality health care to populations that haven't traditionally received it. That can happen in rural Kentucky, that can happen in parts of NYC, and that can happen in remote villages of developing countries. We need people working on all of these problems, and there's no moral superiority or inferiority in choosing to work in any of them.

Like when I say I'm interested in, say, EM, a family member will say "But what about all the little children? Don't you care about them? Why don't you want to be a pediatrician?" I absolutely believe pediatrics is important, but that's just not the specialty I'm entering. Likewise, it's important for the children of Kentucky to receive health care, and it's also important for the children of Sierra Leone to receive health care. Just because somebody pursues one path doesn't mean they think the other should be neglected.



I'd change this to "Charity isn't about doing something and getting recognized for it." The vast majority of people working in global health (both in the US and abroad) are not doing it for the notoriety; they're just trying to make a positive change in whatever little sphere of the world they inhabit. Doing something ostensibly good just for the notoriety is reprehensible, regardless of where in the world that "good" is performed.

And this conversation is completely separate from those Medical Brigades programs, which actual global health professionals detest. Perhaps you're referring to those programs, in which case I agree 100%.

It doesn't have to be either or, but you'll meet more than a few people who claim to be philanthropically motivated and want to travel the world with Doctors without Borders and the like who lose interest very quickly when you take away the exotic location. You'll see this a lot in medicine -- people lining up to go work in a post disaster relief effort to a foreign country or exotic locale, but nobody signing up for the organizations to help the local poor.

That's why I say these international organizations are more popular with the posers. I have no problem if you want to do something international and exotic, but I think you should own it, not pretend you are doing this for any charity other than yourself.

 

[Kera]

Oh, absolutely, because it sounds like you're talking about the mission-based model of getting medical care to the underserved. Those serve very little medical purpose, and are mostly about satisfying the wanderlust of the participants. Many NGOs are started and continued because of the wants and needs of the founders, not of the people they claim to be serving. That's a huge problem.

But criticizing the entire field of global health based on those awful medical missions is throwing the baby out with the bathwater. Just like people who go into medicine for the status don't represent all doctors, people who go on medical missions for adventure/publicity/whatever certainly don't represent all global health professionals.

For the record, I fully intend on practicing "global health" in the US, so I have no dog in this fight. But I don't view that decision as any more or less charitable than, say, somebody who decides to dedicate their life to decreasing the burden of malaria, which happens not to be in the US. There are many problems in this world, and they all need to be tackled.

Sorry for hijacking the thread. I normally very much agree with most of what Law2Doc writes, so I was surprised to see the difference here.

 

[Law2Doc]

...
But criticizing the entire field of global health based on those awful medical missions is throwing the baby out with the bathwater.
...

I am pretty sure I didn't say global health programs were bad, unnecessary, or that people shouldn't do them if they are interested, but rather that a lot of people who decide in medicine to go do these international missions or join these international organizations are far less interested in the same ailments or condition stateside and frankly are more interested in the travel and international aspects. And that's totally fine but very few people you meet will own the fact that they could often have done more good at less cost in their own backyard, and yet choose not to. And that's what I was calling being a "poser". It's more about them and what they view as life enhancing. It's simply less "sexy" to take care of the local poor as compared to flying to a remote locale. And again you'll meet so few who "do both" that that's an unrealistic counter argument.

 

[Danbo1957]

Alright councilor, enough. "Poser", really?

There's is nothing "sexy" about providing primary care to individuals in an impoverished country. It's down right hard. I've done it every year for the last twenty-four years in a remote area of the Chihuahua mountains; through a simply-run doctor group based here in Texas which includes several specialties. The people in the villages that we serve in those mountains do not have access to any other medical services, so we are filling a basic need at the least.

Serving others in another culture, in another language, can be life enhancing. You might try it down the road of your career... see what happens to you.

 

[TBV]

Yeah, my current plan is to join the NHSC and serve overseas in Guam or Puerto Rico and then join Doctors Without Borders. I especially want to educate underserved areas, as that does seem to be an effective way to save costs.

Ever been to PR? You're going to up a mountain into the boonies to find underserved areas. Also let's not forget they use the USD and EVERYTHING is more expensive there than continental US you better bring your checkbook if you're going to give out all these free meds to the poor.

 

[mpdoc2]

Hello, I took the residency selector quiz and my top suggestion was Internal Medicine - Oncology. That seems great, but I was looking on more specific feedback. I want to provide cheap and effective medical care. I am willing to take large pay cuts if I can pay it forward to my patients, is this feasible? I feel like the healthcare industry makes so much profit and I only want enough to be able to continue helping patients.

I know this seems naive, so I would appreciate it if someone had reading recommendations to show me how the healthcare industry is using its money. Also, I am shadowing doctors of many different specialties during a gap year to begin to show me which residency I would like, so I am open to these suggestions as well!

I have also taken public health courses that said primary care providers would be a great way to reduce costs as well. Thoughts on this?

edit: Found this book Amazon product ASIN 0071479414

Don't do radonc, the linear accelerator alone will cost you 3 million $

 

[22031 Alum]

Serving others in another culture, in another language, can be life enhancing. You might try it down the road of your career... see what happens to you.

You just proved @Law2Doc's point. Some of us find serving others in our own communities just as life-enhancing. Service isn't more special just because you had to go overseas to do it.

 

[Danbo1957]

to

You just proved @Law2Doc's point. Some of us find serving others in our own communities just as life-enhancing. Service isn't more special just because you had to go overseas to do it.

*sigh*

It's not that service to one community is more important than to others, they are all equal in needs. It's just that an exposure to an outlying community might offer a physician learning experiences that (s)he can not get in a overly-familial medical environment.

And feel free, councilor, to call any physician offering medical services to a remote community a "poser"-- say it to his face.

 

[22031 Alum]

to

*sigh*

It's not that service to one community is more important than to others, they are all equal in needs. It's just that an exposure to an outlying community might offer a physician learning experiences that (s)he can not get in a overly-familial medical environment.

And feel free, councilor, to call any physician offering medical services to a remote community a "poser"-- say it to his face.

Well I think learning opportunities are anywhere and everywhere so I'll give you that. Do you mean familiar?? Because I guarantee there are practice settings stateside that can take anyone well oi Not their comfort zone.

I'm coming from the perspective of being told that the patients I take care of are straight up worth less than patients who happen to be located elsewhere, so I will admit that I may have picked up disdain that you weren't actually putting down.

 

[Law2Doc]

to

*sigh*

It's not that service to one community is more important than to others, they are all equal in needs. It's just that an exposure to an outlying community might offer a physician learning experiences that (s)he can not get in a overly-familial medical environment.

And feel free, councilor, to call any physician offering medical services to a remote community a "poser"-- say it to his face.

I think you are misrepresenting what I am saying. I am not saying that one community is not as important as another, or that there aren't equally important needs elsewhere, or that there aren't learning opportunities abroad. I am saying that if you have to go to an exotic locale to do this good work, maybe it's not really the good work that's motivating you.

That's what I am calling being somewhat of a poser, and maybe that's an unfair characterization, and I certainly didn't mean that was everyone, but frankly that's not rare for what I have encountered in terms of people seeking to do "global medicine". Again I am not stating the need isn't everywhere or that these organizations don't do good work; just that the motivations/interest somehow quickly fade if instead we are talking about local domestic need, which telegraphs to me what this is really all about.

And again, that's fine-- just own it. If you want to travel and do international things, that's great, but just own that's it's about you and your personal goals, not because you are helping fix the world.

 

[Kera]

I am pretty sure I didn't say global health programs were bad, unnecessary, or that people shouldn't do them if they are interested, but rather that a lot of people who decide in medicine to go do these international missions or join these international organizations are far less interested in the same ailments or condition stateside and frankly are more interested in the travel and international aspects.

And again, that's fine-- just own it. If you want to travel and do international things, that's great, but just own that's it's about you and your personal goals, not because you are helping fix the world.

I guess I thought you were disparaging all global health programs because you keep stating the second quote without qualifying it.

I think we may be talking apples and oranges here. You're talking about the people, whose regular job would not normally incorporate any aspect of global health, taking off to an exotic locale once a year with these pernicious medical missions. And I agree with you there.

Then there are people who devote their entire careers to tackling problems that just so happen not to be in the US. That's their career, and not a side hobby. And those people don't deserve to be lumped with the first group.

If we want to spend more time talking about how horrible medical missions are for everyone involved, I'm happy to participate!

 

[Optimus-Prime]

Hello, I took the residency selector quiz and my top suggestion was Internal Medicine - Oncology. That seems great, but I was looking on more specific feedback. I want to provide cheap and effective medical care. I am willing to take large pay cuts if I can pay it forward to my patients, is this feasible? I feel like the healthcare industry makes so much profit and I only want enough to be able to continue helping patients.

I know this seems naive, so I would appreciate it if someone had reading recommendations to show me how the healthcare industry is using its money. Also, I am shadowing doctors of many different specialties during a gap year to begin to show me which residency I would like, so I am open to these suggestions as well!

I have also taken public health courses that said primary care providers would be a great way to reduce costs as well. Thoughts on this?

edit: Found this book Amazon product ASIN 0071479414

Used to shadow Rosenberg at NIH, everything was free

Don't know if this will hold true in the future

 

[Major_Guile]

So are people saying that I could do just as much good here in the US (as a Primary Care Physician) as I could overseas (as a Global Health doctor)?

 

[Kera]

Absolutely! In fact, according to the definition of "global health," you can certainly be a global health doctor in the United States. Underserved populations exist all over the world, including the US.