What specialties to avoid if you value lifestyle?

[odyssey2]

Putting aside interest and lifestyle in residency, what specialties should you avoid if you value work-life balance as an attending? Which specialties is it difficult, if not impossible, to get close to 40-50 hours/week with ample time off?

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[DOVinciRobot]

Anything with call

 

[operaman]

Honestly I know attendings in pretty much every specialty with both good and terrible lifestyles. I'm not sure if there's a hard stop avoid list. Certainly things like Neurosurgery and the other surgical fields tend to skew more toward longer hours, but plenty of people are able to build practices that aren't quite so bad. The key differentiator early on is location. It's much easier to negotiate better conditions when you're a hot commodity rather than trying to be the umpteenth -ologist in the Bay Area.

Another key factor is practice environment - academic, private, employed, etc. Each with plusses and minuses, and each having a major impact on lifestyle regardless of specialty. There are plenty of partners in big private groups making serious bank working very reasonable hours with no call, but this is often more about their ancillary revenue streams rather than whatever field they trained in. Conversely, there are academic and employed docs who are still mainly paid for their productivity and so they may have to work harder for longer than their peers who are developing other revenue streams in their private groups.

Another key issue is just how hard someone wants to work. EM is traditionally thought of as a good work-life balance, but I know plenty of EM attendings working extra shifts to pay off loans or retire early, especially those without families yet. I know a couple of neurosurgeons who both busted arse, lived on a shoestring, and retired at 40, so while their lifestyle sure sucked in residency and early attendinghood, now they're not working at all and just travel. Nobody would ever argue that neurosurgery is a cushy lifestyle field, but I know of at least 2 mid-40s neurosurgeons who work zero hours a week.

So yeah, very complex question! All of these questions ultimately boil down to looking primarily at what makes you happy, what you can tolerate and what you can't. I would hesitate to write off any fields until you have your short list of options and then see what's possible from those.

 

[Styrene]

Putting aside interest and lifestyle in residency, what specialties should you avoid if you value work-life balance as an attending? Which specialties is it difficult, if not impossible, to get close to 40-50 hours/week with ample time off?

As an attending, you can work as many or as few hours as you want. The specialty with the lowest number of hours worked on average is psychiatry, around 35 hours per week (75% of psychiatrists are doing outpatient private practice). The real question is the training process. I can't fathom that someone who has lifestyle as a major consideration when choosing a specialty would be okay with working 80-100 hours per week for several years during residency, even if it does end eventually.

 

[altblue]

As an attending, you can work as many or as few hours as you want. The specialty with the lowest number of hours worked on average is psychiatry, around 35 hours per week (75% of psychiatrists are doing outpatient private practice). The real question is the training process. I can't fathom that someone who has lifestyle as a major consideration when choosing a specialty would be okay with working 80-100 hours per week for several years during residency, even if it does end eventually.

Yeah, even if I was passionate about surgery, I couldn't imagine training for 5-8 years with limited opportunity for exercise and hobbies. I know some people can make it work, but the last thing I want to do after working/studying for 14-16 hours is hit the gym or accomplish anything that requires significant concentration

My take is that yeah you can scale your hours back in surgery once you're an attending, but then you have to be choosier with your career path and fellowship (ie maybe not Head/Neck in ENT or trauma/CC in Gen surg). In something like PM&R or psych, you don't have many limitations in the sorts of things you see based on hours worked

 

[YCAGA]

Any speciality where “big” practices are 5-6 doctors. Like peds nrsg and peds CT surgery in top 10-30 cities (population) often ends up being like 2-3 attendings. So that’s Q2-3 call or a week of call every 2-3 weeks…for decades.

 

[NITRAS]

As an attending, you can work as many or as few hours as you want. The specialty with the lowest number of hours worked on average is psychiatry, around 35 hours per week (75% of psychiatrists are doing outpatient private practice). The real question is the training process. I can't fathom that someone who has lifestyle as a major consideration when choosing a specialty would be okay with working 80-100 hours per week for several years during residency, even if it does end eventually.

Very few residencies work 80+ hour weekly for Years on end. The vast majority have busy months were you work close to 80 hour/week and other months where you work 45ish hours A week.

The most hours I worked was in medical school for general surgery and CT surgery rotations. I was expected to get their before the intern (like 4am to 5 am) and stay frequently till 6-7 pm with q 5 24 hour call.

During residency, I had busy days, and some busy months, but nothing that wasn’t unmanageable. Residency is also a season. Even psych residents have to work nights in ED’s. Avoid your surgical specialties and malignant programs and you should be good.

 

[calivianya]

I would say this is more regional than a hard stop by specialty.

I would have thought that general surgery would have been like this... but most weeks my preceptor worked around 30 hours a week. Clinic days were usually something like 8-1 and surgery days were 8 until somewhere between 1-3. Fridays he typically did a couple super small procedures and usually worked 8-9 or 10. Yep, we had some 1 hour Fridays. It was nice.

The tradeoff is the call... he'd be on call for a week straight. But, we only went in twice on the call week I was with him, and those were both on the same night, so...? Six days of call where we had nothing to do wasn't bad.

Pros of small town gen surg lol.

 

[mrbreakfast]

It really comes down to two questions:

1) Do you have to deal with emergencies in your role as a specialist?
2) Do you have to personally deal with those emergencies, or can you handle it over the phone?

Anything else is variable. There is enormous variation in work schedules, coverage schedules, etc.

I know a hospitalist who works 7 on/7 off, but those 7 on days are 12 hours of work and 12 hours of home call. That sounds awful, but in reality it means an evening phone call or two and a good night's sleep, because it's a smaller hospital.

 

[Lem0nz]

Medicine.

 

[Smurfette]

Bear in mind that going into something and working less hours generally translates to less income. Because the more patients you see and more procedures you do, the more you earn. So whatever specialty someone does pick, expect your compensation to be on the lower end for your field if you are working less hours than the average. If employed, physicians often have productivity goals and you can be let go or have your compensation decreased if you don't hit those markers. Jumping from job to job every time your guarantee is up because you didn't hit your productivity goal usually catches up with you eventually (i.e. becomes a red flag in your job search). Going to rural/undesirable locations and some other factors can sometimes allow you to work fewer hours without sacrificing as much in income (because these jobs will pay more to attract people to that location).

Most physicians in practice have control over their schedules and can adjust things (excluding call and emergencies of course) as needed. It's not like being a student or resident.

 

[Tenk]

The ultimate lifestyle field was EM + low cost of living. Can literally work 48 hours a month and make 100,000+. Still doable but future is uncertain.

 

[7331poas]

As an attending, you can work as many or as few hours as you want. The specialty with the lowest number of hours worked on average is psychiatry, around 35 hours per week (75% of psychiatrists are doing outpatient private practice). The real question is the training process. I can't fathom that someone who has lifestyle as a major consideration when choosing a specialty would be okay with working 80-100 hours per week for several years during residency, even if it does end eventually.

If you aren't working much then you aren't going to develop a big enough patient base to support your practice. Those psychiatrists working low hours in the outpatient likely had some catalyst that allowed them to sustain that (worked hard early in their career to build their base, took call, marketing).

 

[Maximus2020]

The ROAD specialties (Radiology, Optho, Anes, Derm) are your go-to when it comes to balancing 1) making a big paycheck and 2) enjoying it/life. They all provide the biggest asset - time.

Both medicine and surgery will fail you in a search for work-life balance yet still bringing in a hefty income. E-ROAD does not exist - that is, emergency medicine does not belong as you will not get paid well.

This is assuming you wish to go after a full-time gig. Plenty of part-time gigs are out there but as discussed above, your pay will suffer.

 

[Candidate2017]

If you aren't working much then you aren't going to develop a big enough patient base to support your practice. Those psychiatrists working low hours in the outpatient likely had some catalyst that allowed them to sustain that (worked hard early in their career to build their base, took call, marketing).

Not really. Many psychiatrists have a small patient panel that fills their schedule with frequent follow ups.

BTW, I only work 3 days as a psychiatrist, banker's hours, no call, and make about the same or more than most fulltime pediatricians. I'm actually unhappy with my pay or hours, and feel taken advantage of, as I have psychiatrist friends who work less but make more than me.

 

[collegestud2013]

Just about any shift-based specialty where you don't own the patients (eg radiology, EM, hospitalist, critical care ) allows a more predictable schedule and being completely off when you're off shift. They also allow easier to increase or decrease your number of shifts based on how income you're after. But that doesn't necessarily mean good lifestyle for everyone - you may still be required to work nights and weekend shifts at some places (unless you're okay to taking a pay cut) when you're on shift it can be very busy to meet your productivity targets. EM and critical care see many very high acuity patients and radiology shifts nowadays involves reading upwards of 200 studies in in typical 12 hr call shift.

The other option would be specialties with close to a 9AM-5PM clinic schedule and minimal or no overnight call. For example, derm, ophtho, endocrinology, and primary care to some extent. It's slightly harder to go part time in these settings since you own the patients and patients often don't want to be someone else in your practice, and your colleagues often don't like covering for someone else's patients.

Being self-employed allows much more control over your schedule but that doesn't mean you can always work less. When you're running a business all the expenses fall on you and there fixed costs to running a practice such as equipment, rent, malpractice insurance that don't really change regardless of the patient volume you're seeing. So to stay in business there's a minimum you will have be brining in to just offset overhead costs.

 

[Styrene]

If you aren't working much then you aren't going to develop a big enough patient base to support your practice. Those psychiatrists working low hours in the outpatient likely had some catalyst that allowed them to sustain that (worked hard early in their career to build their base, took call, marketing).

It's different than internal medicine. You can run a cash-only practice easily, charge a flat fee for intake and med management appointments or by the hour. And depending on location, demand is through the roof. Like 8-12 month waits across all clinics for an intake in my area. It's ridiculous. Even new academic inpatient jobs, 40 hr/wk minimal call, are paying $280-$300k.

 

[Styrene]

2019–2020 Emergency Physician Compensation Report - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

You can argue EM pays better than radiology and ophtho considering its 3 years vs 5-6 (with fellowship for Rads and ophtho). My friends are getting decent offers now even with COVID-era salaries but they're also not picky about living on the coasts. Heck, even FM and IM hospitalists sign on for $270/$300k here

Similar starting salaries for hospital psychiatry in my area. I hope the bubble lasts.

 

[Styrene]

Very few residencies work 80+ hour weekly for Years on end. The vast majority have busy months were you work close to 80 hour/week and other months where you work 45ish hours A week.

The most hours I worked was in medical school for general surgery and CT surgery rotations. I was expected to get their before the intern (like 4am to 5 am) and stay frequently till 6-7 pm with q 5 24 hour call.

During residency, I had busy days, and some busy months, but nothing that wasn’t unmanageable. Residency is also a season. Even psych residents have to work nights in ED’s. Avoid your surgical specialties and malignant programs and you should be good.

That's true. The busiest months in my psych program, not including the four months of IM, is five 12hr shifts per week with weekends off--not bad.

 

[ACSurgeon]

Very few residencies work 80+ hour weekly for Years on end. The vast majority have busy months were you work close to 80 hour/week and other months where you work 45ish hours A week.

The most hours I worked was in medical school for general surgery and CT surgery rotations. I was expected to get their before the intern (like 4am to 5 am) and stay frequently till 6-7 pm with q 5 24 hour call.

During residency, I had busy days, and some busy months, but nothing that wasn’t unmanageable. Residency is also a season. Even psych residents have to work nights in ED’s. Avoid your surgical specialties and malignant programs and you should be good.

The vast majority of surgical residencies work 70-75 hours a week on average. Some weeks will be 90 hours, others 65-70. The average stays below 80 and you meet requirements. Sometimes fudging happens to make the numbers pretty.

I had 1 month in 5 years of surgery where that wasn’t the case: endoscopy as a junior resident. Otherwise, you better believe it’s 5-7 years (fellowship) of consistently working close to 80 hours a week, every week.

 

[ACSurgeon]

Putting aside interest and lifestyle in residency, what specialties should you avoid if you value work-life balance as an attending? Which specialties is it difficult, if not impossible, to get close to 40-50 hours/week with ample time off?

Depends how you define lifestyle. I have the options of being off 1/2 the month every month, but i am on call the 1/4 of the month and and have an easy schedule the other 1/4. This sounds like a great lifestyle in theory, but call can wear you down. Same goes with flipping between days/ nights/swings as a Hospitalist or EM doctor.

I think the typical definition of lifestyle friendly is having a predictable schedule that doesn’t change much from week to week and often doesn’t exceed 4 days a week of 8-5. If this is your definition, you probably need a clinic based specialty with no or minimal call.

 

[Matthew9Thirtyfive]

2019–2020 Emergency Physician Compensation Report - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

You can argue EM pays better than radiology and ophtho considering its 3 years vs 5-6 (with fellowship for Rads and ophtho). My friends are getting decent offers now even with COVID-era salaries but they're also not picky about living on the coasts. Heck, even FM and IM hospitalists sign on for $270/$300k here

Yeah it’s not the pay that makes em not a lifestyle specialty.

 

[deleted1081396]

Inpatient neuro. Outpatient neuro can be really cush with good hours though so that's what I'm going for.

 

[mrbreakfast]

Inpatient neuro.

Inpatient neuro right now is getting the kind of job postings that EM used to have.

 

[deleted1081396]

Inpatient neuro right now is getting the kind of job postings that EM used to have.

What do you mean?

 

[deleted1081396]

$400k/year low hours

Sounds worth looking into especially if the hours are low, even if it's partially inpatient. Could retire or drop to part time by age 40 on that salary.

 

[mrbreakfast]

What do you mean?

I have friends who graduated residency into average of ten 12-hour shifts/month, no nights, $300-350k/year starting salary jobs in bigger cities. Additional pay for teleneurology from home in off weeks. If you're willing to work somewhere less desirable that goes way up. In many mid-sized community hospitals you will be the only neurologist in-house; hospitals will pay for that. Definitely not for everyone though.

 

[deleted1081396]

Yup. I know someone who just landed a 450k contract for 12 shifts. Mid-sized city in the south

Just as a generalist?

 

[mrbreakfast]

Just as a generalist?

Well, neurohospitalists are essentially a subspecialty without a distinct fellowship (yet; it's starting to become one). You see acute strokes, seizures, and other emergencies, see inpatient consults (generally the most-consulted specialty) and read ICU-level EEGs +/- EMGs. You can do it without a fellowship, but many people choose to do a stroke fellowship first. Essentially, you're a specialist in neurological emergencies and inpatient care.

 

[deleted1081396]

Well, neurohospitalists are essentially a subspecialty without a distinct fellowship (yet; it's starting to become one). You see acute strokes, seizures, and other emergencies, see inpatient consults (generally the most-consulted specialty) and read ICU-level EEGs +/- EMGs. You can do it without a fellowship, but many people choose to do a stroke fellowship first. Essentially, you're a specialist in neurological emergencies and inpatient care.

What is life like during the time you're on though? 7 12-hour shifts in a row with call in between?

 

[mrbreakfast]

What is life like during the time you're on though? 7 12-hour shifts in a row with call in between?

Generally speaking, yes. You'll see what it's like during residency, as you'll spend approximately half of neurology residency doing neurohospitalist-style work. But you'll see that, if given the choice between five 9-hour clinic days M-F and three 10-hour inpatient days followed by a 24-hour shift, some residents will choose the former and some the latter.