What route of IM can give me the least stressful, most comfortable lifestyle?

[staup]

How do you compare flexibility to EM and anesthesia?

Anesthesia is not a lifestyle specialty, right now they make a lot, but they also work around 12 hour days, not including call.

EM certainly work considerably less hours than most specialties. On average, they work about the same hours as hospitalists do a year while having 4 days off a week instead a week off at a time as hospitalists do. They usually make more money as well, but of course, you have to be a person who can walk into work at any time and be ready to make critical emergency decisions every time you work, which can be grueling when you're in your 50s and 60s. It depends on the job, trauma level, and all that jazz too. That being said, some people absolutely love it.

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[chicamedica]

The OP is asking about a $150k job, not to be a millionaire. Holy crap.
Hospitalist is a great idea. Whatever you have heard about burnout is not evidence based - the field has only developed last 10-15 years. It's not that hard, pays great, and is pretty darn interesting. Allergy is great for lifestyle, as is Rheum, Endocrinology. The latter two may not get you to $150k depending on where you live, but will be close. GI, Cards, Med-Onc will pay you way way way more, but are significantly harder in terms of hours. All will be closer to 55 - 70 hours a week, but $300k and greater after 5 years in, no matter where you live. I don't know much about pulmonology or ICU, but assume pulmonology is pretty good income and ICU even better, but super difficult.

A $150k salary is a fair request for a 40-50 hour week. Be clever and you can find it. I'd say if you have a lot of hobbies and actually like medicine, hospitalist is great - tons of time off and a neat job.

-S

My friend is doing hospitalist at a community hospital and she is burning out, just a year out of residency. She is doing a 7-on 7-off type of thing. Maybe it depends on the hospital, dont know. . .

 

[chicamedica]

Anesthesia is not a lifestyle specialty, right now they make a lot, but they also work around 12 hour days, not including call.

EM certainly work considerably less hours than most specialties. On average, they work about the same hours as hospitalists do a year while having 4 days off a week instead a week off at a time as hospitalists do. They usually make more money as well, but of course, you have to be a person who can walk into work at any time and be ready to make critical emergency decisions every time you work, which can be grueling when you're in your 50s and 60s. It depends on the job, trauma level, and all that jazz too. That being said, some people absolutely love it.

Agreed. anyone who says anesthesia is a lifestyle specialty is lying or MAJORLY deluded.

 

[DrWBD]

Agreed. anyone who says anesthesia is a lifestyle specialty is lying or MAJORLY deluded.

You must be joking. There are plenty of propofol pushers that work full or part time in ASCs, treating ASA 1 and 2 patients, with no or minimal call responsibilities. It is a lot easier to do anesthesia for lifestyle than primary care while still making decent $, if that is your goal.

 

[staup]

You must be joking. There are plenty of propofol pushers that work full or part time in ASCs, treating ASA 1 and 2 patients, with no or minimal call responsibilities. It is a lot easier to do anesthesia for lifestyle than primary care while still making decent $, if that is your goal.

Of course you can do it part time, and possibly it might be easier to get a gas gig doing it part time more than other specialties in a group setting, but you can many specialties part time if you want, and you can definitely get primary care part time or at least part time with some type of admin role, which makes hours more regular and doesn't necessarily worsen pay.

I personally know cardiology, gi, primary care, oncology, and radiology attendings who work part time in a private practice setting. And if you're ok with doing academics, you can definitely trade less clinical hours in almost any specialty for various types of academic or admin roles for a more regular schedule.

 

[docscience]

Apparently some are making a killing writing medical marijuana prescriptions...50K a day? haha. Crazy stuff

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/08/09/ED591ERCHQ.DTL

Written by a Stanford doc.

This guy said he made about a million!!!!!!!!!! http://www.nytimes.com/2010/06/27/business/27pot.html?pagewanted=all
(bottom of the article) CTRL + F Boland (dr. boland)

This I think drive homes the point that medicine is another American business that tries to work through the loopholes and tries to maximize profits under "given legal morality."
If you are comfortable making a million by taking advantage of the new legal issues, in this legalization of marijuana, then I suppose by all means do it. If your morality will not allow that...then oh well.

 

[Rocky Racoon]

in that case, Woman up and go home.

It amazes me the kind of macho attitudes posted here. Most people at some point in their lives desire to have more than just a career. Yes, we all went into medicine to help people, but most of us did not agree to give up all the other good stuff in life so that we could work 24/7 for the rest of our lives.
You can be an excellent doctor and work the same hours as a normal person. Yes, you will make less. But most of us also didn't go into IM so we could make tons of money. We want to help people, have a stimulating career, and still have time to have a LIFE. It is perfectly reasonable to want to work 40-50 hours a week and still have a chance to tuck your kids into bed at night.
Man up my a**......Any idea how hard it is to be a parent/spouse/real person AND work this hard?
Get over yourselves.......Medicine has room for us all.

 

[Pkboi24]

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[LoisLane]

I will say that even though there is room for more in medicine and that part time mommy hospitalists are competent enough to do their job, the best docs will always be the ones who have more time to devote to their craft. The mommy hospitalists of course, understand that (it's just common sense) and are pretty good about consulting the right people when they get into trouble. They are much better than PAs and NPs but given the same number of years out of residency, their full-time colleagues will be much better physicians.

"Mommy hospitalists"? Seriously?

 

[Rocky Racoon]

I will say that even though there is room for more in medicine and that part time mommy hospitalists are competent enough to do their job, the best docs will always be the ones who have more time to devote to their craft. The mommy hospitalists of course, understand that (it's just common sense) and are pretty good about consulting the right people when they get into trouble. They are much better than PAs and NPs but given the same number of years out of residency, their full-time colleagues will be much better physicians.

Wow, comparing female physicians to PAs and NPs simply because they have a family and limit their hours.....amazing. Just when you think medicine has changed some jerk says something so ignorant it just makes you cringe.....

 

[Pkboi24]

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[medftw]

I don't see what's so awful about what I said. Like many female posters have said above, they don't want to devote their entire life to medicine. They want to spend time with family. That is important to them. A similar analogy would be if male physician wanted to be a writer and took a significant amount of time off to do so. There is nothing ignorant or sexist about what I said. Anyone with common sense would realize that you can't be as good at performing a task as someone else if you spend significantly less time practicing. This is why there are very few part-time surgeons and professional athletes. You don't see someone win the Nobel Prize in physiology with a bio of being a part-time physician/scientist. To be the best at something takes a great deal of time and effort. I'm arguing that physicians who want to prioritize other parts of their life before medicine CAN be GOOD physicians, I myself know many such. However, to be a GREAT physician requires SACRIFICE. Anyone who thinks that they can have their cake and eat it too is deeply delusional. This has nothing to do with medicine being sexist and everything to do with people having realistic expectations.

I see that both posters above are medical students. I think that if you ask some physicians who have been in practice for a while, they will undoubtedly tell you the same thing I did.

what about daddy doctors? i assume the uproar is over comparing our female colleagues to nps and pas. probably should stay away from that phrase

 

[piptaz]

I didn't have to go far back to find out that greatness does not require the kinds of sacrifices suggested above - just back to the most recent nobel prize winner in Med/Phys, Elizabeth Blackburn - a mommy scientist:

After completing her postdoc, Blackburn moved to the University of California, Berkeley, as a young​

faculty member; she remained at Berkeley until 1990, during which time she commuted to Berkeley from
San Francisco while her husband, John Sedat, whom she had met at Cambridge, was on the faculty at
UCSF. They still live in the same home in San Francisco today, but a few years after their son Ben was
born in 1986, Blackburn took a position at UCSF. The couple first worked together during their courtship
at Cambridge. Sedat works on three-dimensional structures of chromosomes in nuclei, thus their
research interests have not overlapped significantly until this year when the couple published a paper on
telomere mutants in​

​

​

​

Science. Ben Sedat does manifest an interest in science at home, even suggesting
good ideas for experiments, though Blackburn says cautiously, "we think it would also be great if he
wanted to be a poet." Echoing both his parents' childhoods, he has two parakeets, two cats, one guinea​

pig, and three fish

 

[Pkboi24]

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[drfunktacular]

I like being lectured to about 24/7 lifetime single-minded ultimate dedication to superior nobel-prize winning medicine by someone with almost 1000 posts on SDN

 

[jdh71]

I'm still trying to understand what is "macho" about pointing out the fact that medicine generally requires a lot of hard, long hours, especially during training. And that maximizing income potential for the given training requires more hours than a banker works, including weekends and holidays.

I think people can custom tailor their practices to their desired work hours. I know a number of 9-5 docs who work in the out-pt setting. We need more out-pt internists, and it's not that bad of a gig.

Part of the problem is unrealistic expectations about being able to "have it all". For every possibility on the decision tree, you'll have a different deal with the devil. Every person will need to prioritize what is most important to them and then triage the decision about work hours vs money vs family vs free-time vs etc.

 

[NRAI2001]

What about endocrinology? I hear the field is lower stress than general IM and they have better hours and slightly higher pay than general IM.

 

[MATV78]

I'm a guy and I have it all.
There is nothing wrong with what the original poster wrote.

She is entitled to her life, and can be a GREAT doctor with a family life.
It is part of her right to be human. Maybe if you want to be president of your medical specialty association your family life and hobbies will take a back seat.

How can you even say such a thing. mommie-md or whatever you wrote.
I happen to think they are some of the best doctors out there. They are the best listeners and can empathize with their patients (considering they also have a life), something I think you need to be a "GREAT" doctor.

I worked as a hospitalist, for 2 years between residency and fellowship. My one year as a hospitalist I did locums and travelled around the country for free and got paid room/board and a phat salary. Then I moved to where I was gonna do A/I fellowship and worked as an academic hospitalist at the University. Lifestyle depends on the type of hospitalist program, I did 4 as locums and 1 was really really hard, you had to do codes, rounding and admits. At least I lost some weight I needed to get rid of. The other 3 were easy as hell - I had fun. (I made sure to tell the recruiter I want to go to a program where the hospitalist is not responsible for codes) All 4 locums jobs and the teaching job were way over 150. If I was perm at locums jobs would be 225-250, academic gig was 185k. And except the one place, they were way easier than what I do now.

I graduated 2 years back, and I now have two clinics with a teaching appointment at a nearby med school. I attend clinic there one day a week there and alternate between A/I and IM OP. I have residents and fellows who are moms, who I would trust any day over some of the males who are in clinic with me.

I used to think things were even for the sexes, in terms of medical school enrollment and equality. But boy oh boy, do we have a long way to go !!

 

[WorkaholicsAnon]

She has probably had to make many personal sacrifices of which we are not aware. You don't win a Nobel by taking the weekends off. I'm sure she tried to make as many baseball games and recitals as she could, but she's hardly an average mother. I don't think it would be an exaggeration to say that most people can't do what she does.

LOL this is so false. Cut the crap. Sleep is not overrated. Rest is not overrated. And time with family is not overrated.

You dont win a Nobel prize by burning yourself out. Some of the best inventions and discoveries have been relatively simple things. 90% of it was coming up with the idea, which believe it or not, is possible even with taking weekends off.

And you don't become a great physician either by burning yourself out. A great physician in my opinion can really only be great by maintaining balance in his/her life and by taking care of him or herself first, so that the brainpower can be at top speed, the patience to listen and think can be at a maximum, and the irritability at a minimum. Also, time to read is essential as well. What's the point of just being a work-machine?? That leads to mediocrity and limited creativity and inventiveness. That's maybe what you need to do unfortunately to make decent money in our field these days, but that's a whole separate issue altogether that needs fixing.

Let's stop with this mentality.

 

[WorkaholicsAnon]

I'm a guy and I have it all.
There is nothing wrong with what the original poster wrote.

She is entitled to her life, and can be a GREAT doctor with a family life.
It is part of her right to be human. Maybe if you want to be president of your medical specialty association your family life and hobbies will take a back seat.

How can you even say such a thing. mommie-md or whatever you wrote.
I happen to think they are some of the best doctors out there. They are the best listeners and can empathize with their patients (considering they also have a life), something I think you need to be a "GREAT" doctor.

I worked as a hospitalist, for 2 years between residency and fellowship. My one year as a hospitalist I did locums and travelled around the country for free and got paid room/board and a phat salary. Then I moved to where I was gonna do A/I fellowship and worked as an academic hospitalist at the University. Lifestyle depends on the type of hospitalist program, I did 4 as locums and 1 was really really hard, you had to do codes, rounding and admits. At least I lost some weight I needed to get rid of. The other 3 were easy as hell - I had fun. (I made sure to tell the recruiter I want to go to a program where the hospitalist is not responsible for codes) All 4 locums jobs and the teaching job were way over 150. If I was perm at locums jobs would be 225-250, academic gig was 185k. And except the one place, they were way easier than what I do now.

I graduated 2 years back, and I now have two clinics with a teaching appointment at a nearby med school. I attend clinic there one day a week there and alternate between A/I and IM OP. I have residents and fellows who are moms, who I would trust any day over some of the males who are in clinic with me.

I used to think things were even for the sexes, in terms of medical school enrollment and equality. But boy oh boy, do we have a long way to go !!

I totally agree with everything you said.

And yes there is still a big male chauvinistic attitude in the medical sphere among many doctors. On the surface one would think it's not there, with 50% of med school classes being female nowadays. But it's there. Tons of older male attendings from "the day", and even young and middle aged ones who were raised with that perspective by their own fathers. Heck, some of my male classmates had that sort of demeanor, like taking what their female colleagues say less seriously. Many of the male attendings i had (not all though) seemed to have lower expectations of the female med students or residents, in particular if the females were quieter and not as "manly" on the assertiveness scale. And too frequently there were a lot of "old boys club" sort of cliques formed that really does put the female(s) on the team at a disadvantage.

It also doesnt help when patients assume the female provider is always the nurse and the male is always the doctor. Schools, books, and TV shows for kids should change the images they teach to kids about that. I'm sure it's changing nowadays, but I remember being ingrained with that in grade school too even as late as in the 1980s-90s. The doctor always being referred to as "he" and pictured as an older male, the nurse always referred to as "she" and pictured as a pretty female.

 

[jacksparrow82]

This work hard or go home mentality is fine for people who actually buy into it. If that's the way you want to spend your entire life than fine. But alot of people, like myself, realize at some point that maybe they are not happy living life like that.
I'm a 3rd year IM resident and I've begun to realize recently that I definitely won't be happy working a 12 hour day 6 days a week and having such a stressful job at all times. There's nothing wrong with that. Perhaps I made the wrong decision going into medicine in the first place? Most of us are only 20-21 years of age when we decide to pursue this career and if you're someone like me with parents who weren't doctors and no older brothers or sisters to learn from perhaps you didn't realize what you were getting yourself into.
It sucks to realize these things after you've gotten yourself into 200+K of debt, but that's life. I don't regret where I am now and perhaps I'll end up liking it a lot more when I'm an attending and making some money and paying off my debt, I don't know.
As mentioned, everyone needs to find something they enjoy doing. If you would be happiest spending a large portion of your time at home with family and friends and taking a cut in your earning potential there is nothing wrong with that at all. This is especially true for someone like me who grew up with parents who didn't make much money at all. Even 100k a year will be a lot of money to me once I'm out of debt.

And to the OP, one way to help you decide if a Hospitalist job is something you would enjoy would be to do some moonlighting as a 3rd year. I've been doing moonlighting this year and even though its very hard work I've actually enjoyed it and its helped me realize I'd be fine working as a hospitalist next year.