What should I do? MD with anxiety and crohns

[Nan22]

Hi
First of all, I'm no native English speaker so bear with me.

Here's my situation: I'm becoming an md soon, med school is almost over, and while I'm happy about graduating, I'm also worried about my career.

Crohn's disease
I've had crohn's disease (which means lots of diarrhea and belly pain when it's flaring up, otherwise it's okay) for many years. I've only had a few flares, but I don't know how many flare ups I will have in the future - maybe none, maybe 20.
Anxiety
Other than crohns I have anxiety, which is kinda bad. I've had a kinda rough life, so I'm very bad with "fights" (ie. I hate internal conflicts in organizations, threatening/mad patients etc). I've for too long been the one to stop fights, be a conflict resolver and taken the beating for family's mistakes - and that has taken a toll on me.

Now for the question: what specialty should I aim for in order to minimize future nerve wrecking while still having a job I enjoy?

1. Surgery: Many (all?) surgical specialties are hardcore with night shifts and physically hard - and being an anxious surgeon that can't take a break from an emergency is not optimal. So I think I've given up surgery.

2. Internal medicine: I like this one. Not many night shifts when you get older, but moderate risk of getting infected of patients (I'm immunosuppressed because of my crohns). Also I don't think there are many private practice opportunities, which I think would be ideal for me.

That leaves me with neuro (bad because of emergencies), ophthalmology (okay but still has emergencies), dermatology (risk of infection?, otherwise good) and ENT (high risk of getting every flu in the universe). I love psychiatry, but I can't stand the patients because my anxiety puts me in fight/flight way too often with violent/unstable patients.

I'm not very interested in specialties with limited private practice opportunities because of my health situation.

As a person I'm very smart (when I'm not stressed/anxious), but kinda lazy too (I love the pauses where I can lay down and forget the world with all its stress).

I don't mind getting a ph.d. and I'm fine with working hard with night shifts while I'm young, but it gotta stop in the long run and get easier.

What advice do you have? Any medical specialties you would recommend?

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[Redpancreas]

Rheumatology

 

[Perrotfish]

Hi
First of all, I'm no native English speaker so bear with me.

Here's my situation: I'm becoming an md soon, med school is almost over, and while I'm happy about graduating, I'm also worried about my career.

Crohn's disease
I've had crohn's disease (which means lots of diarrhea and belly pain when it's flaring up, otherwise it's okay) for many years. I've only had a few flares, but I don't know how many flare ups I will have in the future - maybe none, maybe 20.
Anxiety
Other than crohns I have anxiety, which is kinda bad. I've had a kinda rough life, so I'm very bad with "fights" (ie. I hate internal conflicts in organizations, threatening/mad patients etc). I've for too long been the one to stop fights, be a conflict resolver and taken the beating for family's mistakes - and that has taken a toll on me.

Now for the question: what specialty should I aim for in order to minimize future nerve wrecking while still having a job I enjoy?

1. Surgery: Many (all?) surgical specialties are hardcore with night shifts and physically hard - and being an anxious surgeon that can't take a break from an emergency is not optimal. So I think I've given up surgery.

2. Internal medicine: I like this one. Not many night shifts when you get older, but moderate risk of getting infected of patients (I'm immunosuppressed because of my crohns). Also I don't think there are many private practice opportunities, which I think would be ideal for me.

That leaves me with neuro (bad because of emergencies), ophthalmology (okay but still has emergencies), dermatology (risk of infection?, otherwise good) and ENT (high risk of getting every flu in the universe). I love psychiatry, but I can't stand the patients because my anxiety puts me in fight/flight way too often with violent/unstable patients.

I'm not very interested in specialties with limited private practice opportunities because of my health situation.

As a person I'm very smart (when I'm not stressed/anxious), but kinda lazy too (I love the pauses where I can lay down and forget the world with all its stress).

I don't mind getting a ph.d. and I'm fine with working hard with night shifts while I'm young, but it gotta stop in the long run and get easier.

What advice do you have? Any medical specialties you would recommend?

1) What country are you planning to practice in?
2) What country did you go to school in?
3) How much longer do you have left in your education?
4) If applicable, how are your grades and step scores?

 

[ERDOC555]

Hi
First of all, I'm no native English speaker so bear with me.

Here's my situation: I'm becoming an md soon, med school is almost over, and while I'm happy about graduating, I'm also worried about my career.

Crohn's disease
I've had crohn's disease (which means lots of diarrhea and belly pain when it's flaring up, otherwise it's okay) for many years. I've only had a few flares, but I don't know how many flare ups I will have in the future - maybe none, maybe 20.
Anxiety
Other than crohns I have anxiety, which is kinda bad. I've had a kinda rough life, so I'm very bad with "fights" (ie. I hate internal conflicts in organizations, threatening/mad patients etc). I've for too long been the one to stop fights, be a conflict resolver and taken the beating for family's mistakes - and that has taken a toll on me.

Now for the question: what specialty should I aim for in order to minimize future nerve wrecking while still having a job I enjoy?

1. Surgery: Many (all?) surgical specialties are hardcore with night shifts and physically hard - and being an anxious surgeon that can't take a break from an emergency is not optimal. So I think I've given up surgery.

2. Internal medicine: I like this one. Not many night shifts when you get older, but moderate risk of getting infected of patients (I'm immunosuppressed because of my crohns). Also I don't think there are many private practice opportunities, which I think would be ideal for me.

That leaves me with neuro (bad because of emergencies), ophthalmology (okay but still has emergencies), dermatology (risk of infection?, otherwise good) and ENT (high risk of getting every flu in the universe). I love psychiatry, but I can't stand the patients because my anxiety puts me in fight/flight way too often with violent/unstable patients.

I'm not very interested in specialties with limited private practice opportunities because of my health situation.

As a person I'm very smart (when I'm not stressed/anxious), but kinda lazy too (I love the pauses where I can lay down and forget the world with all its stress).

I don't mind getting a ph.d. and I'm fine with working hard with night shifts while I'm young, but it gotta stop in the long run and get easier.

What advice do you have? Any medical specialties you would recommend?

Honestly it seems like psychiatry would be perfect for you. Obviously inpatient would be rough with the issues you mentioned. But there's nothing stopping you from working as few hours as you want in some cush outpatient private practice treating depression/anxiety/ADHD/other low acuity cases.

It seems like a no-brainer to me especially considering you "love" the field. Do some more exploration and see if you can get around that fight-or-flight response, and if you can, I think you have the answer to your question.

 

[doc05]

Hi
First of all, I'm no native English speaker so bear with me.

Here's my situation: I'm becoming an md soon, med school is almost over, and while I'm happy about graduating, I'm also worried about my career.

Crohn's disease
I've had crohn's disease (which means lots of diarrhea and belly pain when it's flaring up, otherwise it's okay) for many years. I've only had a few flares, but I don't know how many flare ups I will have in the future - maybe none, maybe 20.
Anxiety
Other than crohns I have anxiety, which is kinda bad. I've had a kinda rough life, so I'm very bad with "fights" (ie. I hate internal conflicts in organizations, threatening/mad patients etc). I've for too long been the one to stop fights, be a conflict resolver and taken the beating for family's mistakes - and that has taken a toll on me.

Now for the question: what specialty should I aim for in order to minimize future nerve wrecking while still having a job I enjoy?

1. Surgery: Many (all?) surgical specialties are hardcore with night shifts and physically hard - and being an anxious surgeon that can't take a break from an emergency is not optimal. So I think I've given up surgery.

2. Internal medicine: I like this one. Not many night shifts when you get older, but moderate risk of getting infected of patients (I'm immunosuppressed because of my crohns). Also I don't think there are many private practice opportunities, which I think would be ideal for me.

That leaves me with neuro (bad because of emergencies), ophthalmology (okay but still has emergencies), dermatology (risk of infection?, otherwise good) and ENT (high risk of getting every flu in the universe). I love psychiatry, but I can't stand the patients because my anxiety puts me in fight/flight way too often with violent/unstable patients.

I'm not very interested in specialties with limited private practice opportunities because of my health situation.

As a person I'm very smart (when I'm not stressed/anxious), but kinda lazy too (I love the pauses where I can lay down and forget the world with all its stress).

I don't mind getting a ph.d. and I'm fine with working hard with night shifts while I'm young, but it gotta stop in the long run and get easier.

What advice do you have? Any medical specialties you would recommend?

Stay away from ENT, it's surgery.

Neuro and ophthalmology dont deal with too many emergencies, think about both.

 

[siliso]

It is likely that you can adapt to deal with interpersonal stress more easily than you do now, with experience and necessity to get over it. Almost every kind of MD has to make decisions and communicate the decisions and deal with the fallout as it may come, if you’re dealing with patients or colleagues at all. That said, the people in my field who wilt rather than thrive under pressure tend to like rheum and endo and ID.

 

[mistafab]

I would talk to your doctor about what is feasible given your actual medical info.

 

[anbuitachi]

easy decision. PMR. no emergencies. less infections. amazing schedule/life.

No surgery because you will regret it when you have abdominal pain while you are scrubbed into surgery.

 

[Nan22]

Thanks a lot for all your input.

First I need to ask: why did none mention dermatology? Is it high stress?

1) What country are you planning to practice in?
2) What country did you go to school in?
3) How much longer do you have left in your education?
4) If applicable, how are your grades and step scores?

I don't have much left in my education, and I have to have an idea what specialty I want to go into in about a year or so. I'm most probably staying in same country that I'm taking my medical exam in, so that's not a problem. Also, step scores aren't applicable.

Rheumatology

1. Don't they deal with infections as well? Especially with immunosuppressed patients.
2. How hard is it to do all sorts of tests (any heavy lifting?)
3. No emergencies? Night shifts?
4. Are private practices still a thing? I feel like they get so specialized that you can't treat patients in your own practice (tnf-alpha inhibitors needs to infused in hospitals I think)

Honestly it seems like psychiatry would be perfect for you. Obviously inpatient would be rough with the issues you mentioned. But there's nothing stopping you from working as few hours as you want in some cush outpatient private practice treating depression/anxiety/ADHD/other low acuity cases.

It seems like a no-brainer to me especially considering you "love" the field. Do some more exploration and see if you can get around that fight-or-flight response, and if you can, I think you have the answer to your question.

Thanks for your response. To be honest I like the adhd field and "brain chemistry" in general, but I have a hard time with this fight/flight response. In my psychiatry rotation there were many incidences with patients destroying doors, threatening personnel etc., so I have a hard time dealing with all that. Also I should've said that I love psychiatry theory. Practicing psychiatry is very different from theory, and I don't love that part.
Now, there is the child/adolescence field as well, and the patients are generally less psychotic and nice. But the chances of opening a private practice are very low.

Stay away from ENT, it's surgery.

Neuro and ophthalmology dont deal with too many emergencies, think about both.

Can you tell more about neuro? I hear that private practices are rare (and treatment is getting centralized in hospitals).

And what about the risk of getting infected yourself when treating meningitis (and you're supposed to deal with a pneumonia in hospitalized neuro patients as well).
And how isn't there many emergencies? What about stroke, cholinergic/myasthenia crisis, status epilepticus?

It is likely that you can adapt to deal with interpersonal stress more easily than you do now, with experience and necessity to get over it. Almost every kind of MD has to make decisions and communicate the decisions and deal with the fallout as it may come, if you’re dealing with patients or colleagues at all. That said, the people in my field who wilt rather than thrive under pressure tend to like rheum and endo and ID.

Thanks for your kind response.
Endo: no private practice + as internal medical ppl they'll deal with a broad range of patients including those with pneumonias etc = high risk of infection

ID: I'll get infected too often when I'm immunosuppressed + no private practice

Please tell me if you disagree.

I would talk to your doctor about what is feasible given your actual medical info.

My GP says I should take it easy and choose something without night shifts and low stress.
My GI-doc says I can choose anything I like, crohns is no problem.
However, my personal experience says that I should choose something without too much stress.

easy decision. PMR. no emergencies. less infections. amazing schedule/life.

No surgery because you will regret it when you have abdominal pain while you are scrubbed into surgery.

I totally agree with the no surgery advice, thank you. Can you tell more about the pmr? Is it possible to open a private practice? I don't know if it's a specialty I can choose, I think it's a subspecialty where I live.


Thank you all a lot for your time.

 

[el_duderino]

No one probably mentioned dermatology because it's one of the most competitive specialties to get in the US, and it basically requires that you've been grooming yourself via research and contacts well before you get to the point of applying for a specialty. However, seeing as how you're not in the US, that probably doesn't apply. Derm, if you can get into it wherever you are, is probably a decent option. I'm not really sure something that requires you to stick to a schedule of patients and procedures is a great idea, though.

Have you thought about radiology or pathology?

 

[Perrotfish]

I don't have much left in my education, and I have to have an idea what specialty I want to go into in about a year or so. I'm most probably staying in same country that I'm taking my medical exam in, so that's not a problem. Also, step scores aren't applicable.

So the issue is that both the lifestyle and the scope of practice of various specialties varies from country to country. This forum mainly caters to people who practice in the US, or who want to practice here. I'm not sure anyone here would have a good grasp of the practice environment for a given specialty in another country, even if you did tell us exactly which country you are planning to practice in.

 

[anbuitachi]

Thanks a lot for all your input.


I totally agree with the no surgery advice, thank you. Can you tell more about the pmr? Is it possible to open a private practice? I don't know if it's a specialty I can choose, I think it's a subspecialty where I live.


Thank you all a lot for your time.

unfortunately i do not know about PMR in other countries. in the US it's def possible to open Private practice.

 

[Nan22]

No one probably mentioned dermatology because it's one of the most competitive specialties to get in the US, and it basically requires that you've been grooming yourself via research and contacts well before you get to the point of applying for a specialty. However, seeing as how you're not in the US, that probably doesn't apply. Derm, if you can get into it wherever you are, is probably a decent option. I'm not really sure something that requires you to stick to a schedule of patients and procedures is a great idea, though.

Have you thought about radiology or pathology?

Derm is hardcore to get into, but I think it's doable for me. Can you elaborate on how a schedule with patients might be a bad idea?

Both radiology and pathology have limited private practice potential, so they're prioritized as low.

So the issue is that both the lifestyle and the scope of practice of various specialties varies from country to country. This forum mainly caters to people who practice in the US, or who want to practice here. I'm not sure anyone here would have a good grasp of the practice environment for a given specialty in another country, even if you did tell us exactly which country you are planning to practice in.

That makes sense. However, I feel that the different specialties still are similar in many countries (including mine and US) in terms of what the different docs do in the respective specialties. Procedures etc are very similar, and the fact that some doctors can move to another country and practice medicine proves this, so I would still love to hear your opinion on my situation, you can just pretend that I'm American, then I'll try to adjust any information you give me.

unfortunately i do not know about PMR in other countries. in the US it's def possible to open Private practice.

Thanks for answering. I'll look pmr up, it might be interesting.

 

[siliso]

You will be exposed to just about as many infectious risks going to the grocery store or movie theater as in the hospital, really. Except there won’t be signs warning you to don PPE and perform hand hygiene. Are you able to safely be in public crowd situations per your physician? If so you can practice any kind of medicine that resonates with you.

 

[siliso]

Dermatology has the immense stress of obtaining a dermatology position. Also dermatology residents seem surprisingly miserable and stressed out to me, compared to internal medicine residents. It may be a matter of expectation and its fulfillment or lack thereof. Go in expecting stress and overwork and a dermatology rotation is comparatively minimal. Go in expecting stress free lifestyle and even a dermatology residency may be intolerable.

 

[Nan22]

You will be exposed to just about as many infectious risks going to the grocery store or movie theater as in the hospital, really. Except there won’t be signs warning you to don PPE and perform hand hygiene. Are you able to safely be in public crowd situations per your physician? If so you can practice any kind of medicine that resonates with you.

Thanks for replying. The doc that put me on immunosuppressives isn't worried about the infections - I can go in a crowded bus and survive, but the flu I get from it lasts longer and is more intense. I'm not that worried about infections, but I'm imagining that I'll get less sick from working with non-infectious diseases.
Example: I was hospitalized from a gut infection that normal ppl don't need antibiotics for - it wasn't bad or scary, but it's still annoying.
I'm thinking (and I might be wrong) that choosing a field with low germ count means less days being sick. What's your thoughts about that?

Dermatology has the immense stress of obtaining a dermatology position. Also dermatology residents seem surprisingly miserable and stressed out to me, compared to internal medicine residents. It may be a matter of expectation and its fulfillment or lack thereof. Go in expecting stress and overwork and a dermatology rotation is comparatively minimal. Go in expecting stress free lifestyle and even a dermatology residency may be intolerable.

Isn't dermatology known for being the laid back specialty?

 

[Perrotfish]

I feel that the different specialties still are similar in many countries (including mine and US) in terms of what the different docs do in the respective specialties. Procedures etc are very similar, and the fact that some doctors can move to another country and practice medicine proves this,

So just an FYI, you very specifically cannot practice medicine in the US unless you do a full residency in the US. You could be the top CT surgeon in your country and you still need to start over from day 1.

Do you rotate through a hospital as part of your training? Some of the things GS you're saying makes it sound like you haven't had a lot of experience actually practicing medicine. If not, is it possible for you to do so before you choose?

Anyway if you are going to base your decision on US norms the advice above is probably pretty good.

 

[Nan22]

So just an FYI, you very specifically cannot practice medicine in the US unless you do a full residency in the US. You could be the top CT surgeon in your country and you still need to start over from day 1.

Oh ok, I didn't know that. Also I'm not interested in moving to usa, so that's fine.

Do you rotate through a hospital as part of your training? Some of the things GS you're saying makes it sound like you haven't had a lot of experience actually practicing medicine. If not, is it possible for you to do so before you choose?

The finally decision most definitely will be taken after I actually practice medicine as a doc opposed to as a med student. But I need to know what paths to stay away from and what paths to consider

 

[siliso]

Dermatology is known as the no stress specialty. So then when people go and find that it still involves at least some degree of work and stress they get unhinged, it seems.

 

[Nan22]

Dermatology is known as the no stress specialty. So then when people go and find that it still involves at least some degree of work and stress they get unhinged, it seems.

I guess I gotta "try it out" to really know. Every job involves some stress, that's what keeps production up and going, so that's fine.

Any field in which you have contact with patients will expose you to risk of infections. Even derm - they treat skin infections, patients with weird moles (or psych problems, or PM&R problems, etc.) can also have the flu or other infection when they come see you, etc. There is no field with low risk of exposure to germs.

Why do you feel like you need to be in private practice? It seems like path or rads would be a great option if you're concerned about long hours, exposure to infection, etc.

Several reasons why I want the private practice option open: 1) I'm a "minority" in the country I'm at, and the hatred towards my ethnicity is bad and getting worse (i know a few md's with my background that got bullied at work, one of them almost lost her medical license because of fake accusations against her). 2) It's much easier for me with better toilet facilities with my crohns

About radiology:
I've heard of a few private radiologists, but I'm not sure if it's a rare thing.. I'll have to research that

 

[Nan22]

I'm not sure private practice will solve those problems like you think it will.

1) If there is significant prejudice towards your ethnicity, wouldn't that impact your patient population as well? I obviously don't know the details, but if there is that much discrimination how would you attract patients to your practice? And even if you're in private practice, you will still have nurses/medical assistants, office managers, possibly other physicians, etc. that you will need to interact with that could be discriminatory as well.

2) I'm not convinced that toilet access is necessarily better in a private practice...in the private practices I've rotated in, there have been 1-2 bathrooms in the whole clinic. If it's occupied, too bad. At my hospital there are private bathrooms literally everywhere. It would be almost impossible not to find an unoccupied one within about a minute.

And 3) If you are in private practice, you are responsible for supporting your own business. You have to carry enough patients to keep the lights on and the doors open. You have to be available enough to keep your patients coming back to you. You may not be able to take time off if you're sick, work part time, etc. and still make enough money to keep your practice open. As an employed physician, whether outpatient or inpatient, you have more flexibility with those sorts of things because there are more resources, more physicians, etc.

Wise words you got there, I appreciate it!

1) Yes, all that is true, but you can come around it much easier when you're in a clinic: yes, you have a smaller patient population, but you still have enough patients to make it work (especially when patients usually have to wait for weeks to get to see a specialist).
Now with discrimination from nurses, assistants etc., it's much easier when you're the boss yourself. You're the one putting your signature on their paycheck, so you're in control. I'm not saying it's non-problematic, but it's probably much easier that way.

2) But if it's my private practice I can prioritize toilet facilities and make my own private bathroom only for me. But you're right, it's 1-2 bathrooms vs 100 in a hospital... still, I like it much better to have my own bathroom I can go to 10 feet from my office compared to looking for one in a hospital.

3) That's my biggest concern with private practice. If I'm ill for a month, that's one month with no income, but I still gotta pay rent, salaries etc etc.. Maybe there's a way around this if I share a private practice with someone else. I don't know.

The ideal job would actually be in a hospital, where ppl are nice, but it's a risky move because I might end up working for a discriminatory boss. Otherwise I would've chosen radiology.