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What specialty is this?

Discussion in 'Medical Students - MD' started by PremedSurvivor, Aug 22, 2015.

  1. PremedSurvivor

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    I'm a medical student who is going crazy trying to decide what field to go into. I've shadowed all over the place and it hasn't done much to narrow things down. I realize that liking the science of something is not the same thing as practicing it and enjoying that lifestyle. What fields do you guys think match the following criteria:

    Likes:
    - diversity of cases
    - short interactions with a variety of patients, rather than longitudinal relationships with the same patients
    - decent lifestyle so that I
    1) Have time for other professional commitments (global health, health policy)
    2) Don't need to take work home
    - involves problem solving, "cerebral"
    - prestigious (yes, this does matter to me. please don't shame me for it.)
    - areas of science I'm interested in: physiology of the brain, heart, eye and endocrine system; pharmacology
    - am interested in procedures because I love its impact on people. would like a career that has balanced clinic time and procedure time
    - like hospitals so would prefer inpatient setting
     
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  3. joker2400

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    One of the residents was trying to sell me on IR using a lot of the things you listed the other day
     
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  4. FindMeOnTheLinks

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  5. jqueb29

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    anesthesia
     
  6. Stagg737

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    Optho sounds about right. Perhaps Derm --> Moh's will cover most of those, but from what I understand that's a pretty difficult route to take.
     
  7. group_theory

    group_theory EX-TER-MIN-ATE!'
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    Critical Care Medicine

    - diversity of cases (MICU vs SICU/Trauma ICU vs Neuro ICU vs Cardiac ICU)
    - short interactions with a variety of patients, rather than longitudinal relationships with the same patients (well, there are some "long-term" patients, but definitely no longitudinal, most stay in the ICU for only a few days/weeks ... either they get better or they don't)
    - decent lifestyle so that I
    1) Have time for other professional commitments (global health, health policy)
    2) Don't need to take work home
    - involves problem solving, "cerebral"
    - prestigious (yes, this does matter to me. please don't shame me for it.) (not sure if prestigious or not but you;ll be taking care of the sickest patients)
    - areas of science I'm interested in: physiology of the brain, heart, eye and endocrine system; pharmacology (and lungs, and GI at times, and dealing with multi-system organ failures - also get to play with some cool toys)
    - am interested in procedures because I love its impact on people. would like a career that has balanced clinic time and procedure time (procedures in critical care - yes. If you want clinic, then you will need to do Pulmonary-Critical Care Fellowship)
    - like hospitals so would prefer inpatient setting (hard to do critical care in outpatient settings)
     
  8. sunflower18

    sunflower18 Master of Naps
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    I'm just an MS1 so what do I know, but this sounds like EM to me. There isn't clinic vs procedure time, but lots of procedures and absolutely in a hospital setting. Shift work, so you're not on call. Short interactions for sure. There are definitely cases where problem-solving is involved.

    Good luck OP!
     
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  9. Psai

    Psai Snitches get zero vicryl
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    Another vote for ophtho
     
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  10. sloop

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    I know you said not to shame you for this and I won't, but what do people even mean by this?

    With a few exceptions, most of the specialties that are considered "prestigious" within the medical community are not considered especially prestigious by anyone else. For example:

    Most people don't know the difference between an optometrist and an ophthalmologist.
    Most people barely interact with radiologists and have no clue whether it's harder to get into than other fields.
    Most people just think dermatologists are annoyingly impossible to get an appointment with. If asked, almost all would consider gen surg or emergency medicine more prestigious because they work with more high acuity patients.

    And why does it matter whether people in medicine think your specialty indicates high board scores? People barely think of this anyway. Their impression of you is far more dependent on whether your service actually takes and treats their patients or repeatedly tries to find reasons they can't accept the patient on their service.

    Additionally, what happens if you choose a specialty and, a few years down the line, major changes to the structure of health care, insurance and reimbursement mean that the market for your specialty is flooded, your specialty no longer commands the highest salary, and your specialty no longer attracts the students with the highest board scores? Are you going to cry when the next generation of physicians doesn't know or care that a decade ago yours was the most competitive specialty?

    I understand concern with prestige, but I just think that if you make a specialty decision based on it you're going to be disappointed when nobody treats you any differently.
     
    #9 sloop, Aug 22, 2015
    Last edited: Aug 22, 2015
  11. Stagg737

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    I don't think most people would necessarily see it as presitigious, but idk. Curious though, isn't critical care a pretty tough lifestyle? I mean other than the end of life issues, wouldn't there be a lot of call?

    I'll also add for OP that for the problem aspect: idk how 'cerebral' critical care would be, but I think you'd probably encounter more ethical aspects in this field than in other fields. which is a whole different kind of knowledge.
     
  12. J ROD

    J ROD Watch my TAN walk!!
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  13. FindMeOnTheLinks

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    Critical Care is generally shift work - when you go home, you're off the clock. It is also a very "cerebral" field, as they take care of the sickest patients with multiple organ failures and have to manage those complex interactions.

    OP you should def check out Pulm/CC in addition to the others that have been mentioned. Lots of procedures in the ICU as well as on the Pulm side of things (especially if you think scopes are cool). Check out the Pulm/CC specific resident forum here on SDN. (I mention all this because I myself am very interested in this field, though I am a lowly MS1).
     
  14. TBV

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    I think OP was trying to kindly say they would like to make a ton of money. But that's just what I see when I see words like that.
     
  15. sloop

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    Heh, maybe. If that's the case, medicine is the wrong field. Not that it can't happen but there are better bets for this that require less sacrifice.

    Maybe I'm weird but my desire to work potentially crappier hours or at a less satisfying job for more pay that will be taxed at 50%+ is non-existent.
     
  16. TBV

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    That's not not true
     
  17. Doctor Bob

    Doctor Bob EM/CC
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    I think crit/care is pretty prestigious and cerebral... but I'm biased
     
  18. TBV

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    Everyone wants a cerebral job. What you all don't know its all about the putamen jobs.
     
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  19. sloop

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    What isn't? Better bets for a fortune exist in business, investment banking, etc.

    Or the tax rates? Some of the highest paid medical professionals rake in upwards of 400K/yr. At that point, the marginal income in comparison to other medical specialties at 200-250K/yr will be taxed federally at between 33% and 40%. When you add in Medicare withholding, state income taxes, the fact that people tend to adjust their lifestyles to income and will resultantly pay more on property and sales taxes, etc., the overall tax burden can easily be over 50%.
     
  20. pd1112

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    Closest matches: ER & Pulm/Crit Care.

    But really nothing matches everything you said, so find a way to prioritize the list and it'd be easier for us to give you advice.
     
  21. FindMeOnTheLinks

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    lol i see what you did there
     
  22. Gadofosveset

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    Television doctor
     
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  23. TBV

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    I think you missed the second not
     
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  24. Temeraire

    Temeraire ASA Member
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    A couple of people have suggested gas already. However, based on OP's need for feeling "prestigious," it sounds like he/she is the type of person who relies on external validation-- which, to be honest, is a terrible trait to have for anesthesiology (and, arguably, for life-- but that's another debate). Very few patients ever remember who their anesthesiologist is. Most patients, unfortunately, cannot keep track of who the CRNA is and who the anesthesiologist is. Get used to being confused for a nurse. In the OR, surgeons get snippy if you fail to move the table up/down fast enough. An anesthesiologist's moments of public glory are few and far between, and often involve nightmare airways outside of the OR. In order to be happy in this specialty, you need to derive your validation from within. No one's gonna pat you on the back for taking 82yo grandma w/ every cardiopulmonary risk factor through her TAVR safely. You have to be proud of your own work, and yet be self-aware enough to know of your own weaknesses and limitations. This is not a career for prestige-seekers.

    Other than that minor issue, OP's wishlist fits anesthesia perfectly.
     
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  25. Doctor Bob

    Doctor Bob EM/CC
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    Also, when you say prestigious; to whom are you referring?
    Laypeople think ED is pretty frakking cool. Other docs look down their noses at them.
    Medicine people seem to think otolaryngology is prestigious; the lay public can't even pronounce it and doesn't give it the same wow-factor as other specialties.

    So who are you trying to impress?
     
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  26. ChiTownBHawks

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    Most lay people think physicians are overpaid snobs. So, I am really confused as to who the op is trying to impress...
     
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  27. bc65

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    There's no prestige factor among physicians once you're out of residency.

    If you want to impress lay people, you have to be either a heart surgeon, a brain surgeon, a plastic surgeon, or an ER doctor (because there are often TV. But you have to be a fool to want to impress lay people.

    All specialties are cerebral. You just have to find the specialty that appeals to you. For example, to non-surgeons, surgical fields don't seem to be intellectual, but surgeons know that internists are just half-trained surgeons. Ortho is a very intellectual and academic field, but it's intellectual about bones, which doesn't seem to be cerebral to outsiders.

    I agree with some of the posters above. Look into ER, which will satisfy most of your criteria. However, make sure you like it. ER has a high burn out rate. I couldn't do it.
     
  28. vtucci

    vtucci Attending in Emergency Medicine
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    Emergency medicine definitely check most of your boxes.
     
  29. Crayola227

    Crayola227 The Oncoming Storm
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    Hospitalist.

    Fits better than ED for a lot of reasons.

    I've had fair exposure to both. People are bitterly miserable in both to a similar degree so I can't say that's a good division between the two.

    While people will say the hospitalist has all the same bread and butter, so does ED.

    Hospitalist you get more of a development of the patients course but not more than 3-14 days usually. And you don't spend much more than 5-30 min face to face with any given patient admitted in any given day. You dig deeper into physiology of heart, brain, endo, more pharmacology. More cerebral as you say.

    ED you usually have like 12-18 shoft scattered over a month, hospitalist you are usually 1 week on 1 week off or 2 on 2 off or whatever, 22 weeks a year, so it's easier to get long stretches off to go do some global medicine.

    Work goes "home" in either field in the form of notes but otherwise shift work, although hospitalist there may be some call

    Less prestigious than ER, a lot of people don't know what IM is but I tell them House is an internist/hospitalist and JD from Scrubs and for most people they light right up with that (House being an ass but understood as a genius that solves mysteries)

    Pretty scant on procedures though. ED has no clinic time. Hospitalist usually doesn't but you could theoretically be in and outpatient mixed, outpt clinic would likely have more minor procedures than you would do inpt

    Hospitalist would open you up to a lot of practice options, like crit care as said above, other fellowships that fit well for you
     
  30. Crayola227

    Crayola227 The Oncoming Storm
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    Based on what you say I can't really agree with ED

    I had the almost the same preferences as you, strongly considered ED, have a lot of love for it, did many rotations, but I really don't think it fits what you listed

    Not to say hospitalist does, just closer than ED, but they are both different so procedurez or no, how short a patient interaction you want, weighting of these things to you matters in this advice to you
     
  31. Slack3r

    Slack3r Sicker than your average
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    I think ophtho is best. Surgery (prestige!) but also complex medical problems, LOTS of opportunity for global health, interesting subject material (by your own standards), and a great lifestyle. I don't think any other specialty fits your requirements better.
     
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  32. OnePunchBiopsy

    OnePunchBiopsy General Surgery
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    This sounds like ophtho to me as well.

    There is lots of potential for global health outreach with cataract surgery.

    You are essentially the IM doc, surgeon, pathologist, radiologist, and pharmacist for the eye; this makes the specialty very cerebral.

    Very interesting procedures requiring lots of precision.

    Good mix of OR, hospital, and clinic. I hear ophtho clinic can be boring though.
     
  33. OnePunchBiopsy

    OnePunchBiopsy General Surgery
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    Prestige being a noteworthy exception, based on my experiences.
     
  34. Crayola227

    Crayola227 The Oncoming Storm
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    I don't know that you get enough inpt in optho to meet OP's stated preference for inpt, but that's up to OP to decide I guess

    if someone could offer what optho inpt can look like or what part of the time as attending that might be part of job, or what available optho inpt positions might be
     
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  35. Crayola227

    Crayola227 The Oncoming Storm
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    and as far as pretige in optho the big thing is everyone (laymen) are going to think you're an optometrist and imagine you just give people eyeglass prescriptions all day (not true obviously but w/o explanation this is what they will think, 90% of people don't know diff between opto and optho)
     
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  36. OnePunchBiopsy

    OnePunchBiopsy General Surgery
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    I guess i have always assumed that prestige from a specialty standpoint is from the eyes of other physicians.

    Physician's prestige gives you people like Dr. Denton Cooley, while laymen's prestige gives you Dr. Oz.
     
  37. Crayola227

    Crayola227 The Oncoming Storm
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    Good point, so you have to define prestige

    For me, I was less interested in what other docs thought of my specialty and more concerned with what the gen pop would think in terms of how I look at prestige
     
  38. EMT2ER-DOC

    EMT2ER-DOC Why so Serious?????
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    Critical Care is VERY cerebral. You need to understand physiology and try to put together the big picture of what is going on and why your patient is so very ill. In addition, you really need to know what the side effects of the meds you are giving can cause so that you dont make matters worse. And as for procedures, I mean, Intubation, Central Lines, Arterial lines, Bronchoscopies, Swans, Thorocentesis, Paracentesis, Lumbar Puncture........And watching the patient get better is very satisfying. Helping a patient and their family through the transition period for a dignified death, while sad, is also rewarding in itself.
     
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  39. MPMD

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    In reality there is very little inpatient ophtho work, especially in private practice. Academics is a different story though. We have many inpatients that we are following or co-managing at the moment.

    Some common inpatient ophtho problems (at least at a large referral center):

    Facial fractures or trauma involving the eye/orbit (often combined cases with ENT/plastics)
    Neuro patients with visual/ocular findings that nobody else can figure out/see
    Onc patients with orbital mets or orbital primaries, occasionally choroidal mets/primaries
    Onc patients with ocular GVHD (oddly common)
    Immunosuppressed patients with ocular sequelae (eg CMV, fungal endophthalmitis, HSV keratitis, zoster ophthalmicus)
    SJS/TEN patients
    Critically ill patients with exposure keratitis
    Coagulopathic patients with vitreous/retinal hemorrhages
    Orbital cellulitis/abscess patients
    Mucor patients
    And a whole lot of "blurry vision" and "painful eyes" that turn out to be dryness

    If the OP wants an inpatient career, ophtho is probably not the best fit. Unless you are a consult resident, most of your time will be split between clinic/OR. And although interesting, lots of inpatient ophtho deals with people that have far larger problems and can therefore be kind of unsatisfying at times.

    With regard to the other criteria:

    - diversity of cases: fairly good diversity if you are in the community. Good training will provide you with the ability to do most procedures/surgeries aside from advanced retina and facial/orbital plastics stuff. Anatomically we don't venture outside the orbit very often (some plastics cases deal with midface/forehead), but there is a huge variety of things we do within the orbit.
    - short interactions with a variety of patients, rather than longitudinal relationships with the same patients: This is definitely the case.
    - decent lifestyle: Certainly the case as an attending. Residency is no cakewalk though.
    - involves problem solving, "cerebral:" There is plenty of problem solving, from visual diagnosis, to interpretation of neuro findings, to mechanical problem solving in preparation for surgery.
    - prestigious: Sadly, in the eyes of the public you are equivalent to an optometrist, which is actually very annoying to have to continually correct people on. In reality I think alot of prestige is derived from how you present yourself and how good you are at your job. If I roll into a patients room and introduce myself as a badass intraocular surgeon that's going to save or restore their sight, it impresses them more than if I doddle in and say I'm the eye doctor. Other physicians definitely respect you though.
    - areas of science I'm interested in: physiology of the brain, heart, eye and endocrine system; pharmacology : not too much cardiac physiology, but definitely plenty of neuroscience, and some endocrine (mostly Graves)
    - am interested in procedures because I love its impact on people. would like a career that has balanced clinic time and procedure time: Bingo. The nice part about our procedures is that they are relatively short and make a relatively huge impact.
    - like hospitals so would prefer inpatient setting: as above

    Hope that's helpful
     
  40. premedk

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    I'm just a M4, but I'm surprised no one mentioned cards. I'd have to say this is one of the most prestigious specialities in medicine. Tons of procedures and has traditionally been very highly compensated, although times are-a-changin' as far as that goes.

    @sloop...not sure you if you know any I-bankers, but these guys work extremely hard and only the top guys make the big bucks. It's all about bringing in the money, if your not producing returns, they'll find someone else who can.
     
    #39 premedk, Sep 12, 2015
    Last edited: Sep 12, 2015
  41. wjs010

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    Terrible lifestyle for cards right?
     
  42. Crayola227

    Crayola227 The Oncoming Storm
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    Honestly, I'm not sure cards meets the criteria of being very cerebral and a variety of cases. Global medicine? I don't think so, but I could be wrong on that.
    I think they are a lot more outpt clinic than in hospital.

    Just reasons that it didn't pop into my mind for what the OP said they were looking for.

    Cards can be a *very* nice lifestyle, but for a lot of people lifestyle has to do with money vs hours worked. Anything inpt is more hours. Outpt clinic is easiest way to control hours. But outpt clinic hours usually less procedures, usually less money.

    People forget that the procedure-heavy money-laden specialties often require backbreaking amounts of hard physical labor over many many hours in training. And you're usually sacrificing diversity in cases to get subspecialized enough post-residency to have lighter hours and boo-koo bucks. (Exception is optho or derm as far as backbreaking, but are outpt)

    Non-surgical IM subspecialties with lot of procedures and lots of money but controllable hours are forgoing case diversity.

    GI most money least hours: upper and lower endoscopy outpt day in day out.
    Cards most money least hours: stenting and various stress testing outpt
    Pulmonology: (not including crit care 2/2 hours) a lot of bronchoscopy, asthma clinic day in day out
    Rheum: outpt joint injection, day in day out (now with some groups setting up outpt infusion centers, changing the game for hours and money, but not exactly a "fun" procedure)
    I can't think of a lot of other IM subspecialties that have a lot of procedures beyond that. Nephro does kidney bx but again, they are not a very high procedure high money prestige subspeciality.

    The truth is, I've been told, procedures get really old unless you're in a field with broad procedures available to you.
    Gen surg can give you a lot of breadth, but long hours. Still get like 90% gallbladder and colectomies it seems to me.

    It's all a bit off-topic in that I guess when you think about lifestyle, you have to define hours and money, and when you think about case diversity, IM subspecialists are often doing only a handful of procedures over and over and most of time is outpt clinic. There are exceptions, obviously critical care is favored for variety and procedures.

    There are a couple of threads about "most intellectually challenging" specialties that is interesting as far as getting into variety of cases in each field.
     
  43. repititionition

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    optho -> cornea/cataract fellowship
     
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  44. kp11

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    Status:
    Medical Student
    Optho Cataract surgeon, IR, Rad Onc
     

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