Unclear path to take

[OneLastStep]

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I'm a 4th year at a US Allopathic medical school with a competitive app (260+ boards/aoa/pubs). I'm having a tough time choosing between a field with longer hours and less pay and a field with more controllable lifestyle and higher pay. Have any of you gone through this? Did you regret choosing the lifestyle/money over the interest? The truth of the matter is that my interest in either field is boiled down to simply tolerating them, rather than "loving" them or being particularly passionate about either. I just happen to think one is slightly more enjoyable than the other.

Field 1: Ortho (non-trauma)
-intellectually less interesting
-more controllable lifestyle (joints/sports), more pay, less busy call

Field 2: competitive IM subspecialty
-intellectually more interesting
-longer hours, more complications, busier call, less pay

Some say to go with my interest. Others say I'll regret not picking ortho because of the great perks and that eventually everyone learns to adjust to whatever career they get. I only marginally prefer my IM specialty over ortho.

Any advice/input appreciated. For the sake of brevity, I've tried to lay out my ideas as clearly as possibly, so it may come off short-sighted or naive.

 

[Apoplexy__]

If you're already just tolerating the two, then I'd go for lifestyle + pay. Most importantly lifestyle, since you will be less miserable if your interest declines later down the road.

 

[DermViser]

What an interesting selection to say the least.

 

[SouthernSurgeon]

Question #1: Do you like to operate?
Question #2: Do you like to operate?
Question #3: Do you like to operate?

 

[operaman]

Personally I'm trying to figure out which IM subspecialty has longer hours/busier call/worse lifestyle than orthopedic surgery AND has lower pay. Must be some field I've never heard of...

 

[DermViser]

Personally I'm trying to figure out which IM subspecialty has longer hours/busier call/worse lifestyle than orthopedic surgery AND has lower pay. Must be some field I've never heard of...

Cardiology?

 

[Southplains]

Personally I'm trying to figure out which IM subspecialty has longer hours/busier call/worse lifestyle than orthopedic surgery AND has lower pay. Must be some field I've never heard of...

Pulm/CC?

 

[Winged Scapula]

Pulm/CC?

Nah...mostly shift work.

It's gotta be Cards; Heme-Onc and GI can have busy call and emergencies but I do t see their hours being as bad.

 

[operaman]

I was thinking it was cards too, but many of them make a TON of money and have lifestyles comparable to other procedural or surgical fields.

Look up the form 990 (public record tax return) for any community hospital or non--profit physician group and I'll bet one of the highest paid people is a cardiologist.

www.guidestar.org is my favorite site for looking up form 990s. Free but requires a registration.

 

[OneLastStep]

I was thinking it was cards too, but many of them make a TON of money and have lifestyles comparable to other procedural or surgical fields.

Look up the form 990 (public record tax return) for any community hospital or non--profit physician group and I'll bet one of the highest paid people is a cardiologist.

www.guidestar.org is my favorite site for looking up form 990s. Free but requires a registration.

What are some numbers you see? I signed up but can't find a 990 form specific for a cardiologist.

 

[operaman]

What are some numbers you see? I signed up but can't find a 990 form specific for a cardiologist.

Form 990s are just non-profit tax returns and on them they have to list highest paid employees with salary along with salaries of key employees. You would need to look for a hospital or associated physician's group (ie. "YourTown Hospital Physician Associates" or something like that). Then, pull up the latest 990 and start reading until you come to the highest paid employees section (they have to list top 5 at least) and key employees (hospital CEO, etc.). If it's a large non-profit physician group, then generally all the partners will have to list their salary.

Of note, if it's a hospital or other non-profit associated with a state agency (ie. State U University Hospital), then after 2009 they could file a reduced 990 that doesn't include salary data (part of the paperwork reduction act contained in the 2009 stimulus bills).

I do have to say, I looked up one of the hospitals from my wife's home town and 4/5 highest paid employees were orthopedic surgeons (1.2 t0 1.5 million each in 2012) and the other was a cardiologist (1.2 million).

 

[OneLastStep]

Thanks so far.

I guess at the heart of the issue I'm concerned with the drawbacks of an IM subspecialty, particularly cardiology: chronic disease management not involving my organ of interest, declining reimbursements, long hours, complications, non-compliant patients. In that sense I don't LOVE cardiology. I can imagine myself being a 45-year old cardiologist, working long hours, with little time for health, family or friends, and low pay on top of all that. However, what attracts me to the field is the intellectual aspects, the physiology & pathology, the imaging (echos, caridac MRI, angios), and the procedures (minus the radiation exposure...).

On the other hand, despite not LOVING surgery, I also like the mentality behind orthopaedics: replacing things, improving function, quicker surgeries, easy diagnoses w/ imaging, avoiding all the other "BS" of internal medicine, etc. It also has much better pay, patient population, and hours (sports/joints). I could imagine having steadier hours, better pay and a less stressful life with more time for friends, family and outside interests. BUT, I just don't love operating.

I'm not sure what I'm willing to sacrifice. Each field has parts I enjoy and parts I don't.