What to do?

[Quixotic]

Here is the scenario. Most important to me is money and time after residency. I would like at minimum $185K (better if closer to $200K) a year with incremental raises. In addition, time to spend the wife, however, if I must sacrifice this, then it must be done. I have an interest in Rads, but am not AOA. I will have a better handle on my competitiveness after boards. I also anticipate multiple publications and presentation by the time I apply.

Here is the question: Say I want to do Rads, but only have a 225-230 board score with top 1/3 grades and several publications; Should I
A) Apply to all the programs across the country and hope I get in somewhere?
B) Realize my inferiority in the applicant pool and select another less competitive specialty?

In addition, if I do select (B) another residency should I select the location based on where I can be most financially secure? For instance, if I took a residency in Iowa, Oklahoma, Indiana, Kentucky etc... I could easily find a very nice home and pay off half of it by the time I finish residency. On the other hand, I could go to a much more interesting place like California, Washington, New York and live like a dog in a dump.

It seems to me that the highest pay specialties are either super competitive or require a lot of sacrifice. Gen. Surgery and Ortho seem like good fields, but they take away your life. Pathology is a good field, but the pay and job market isn't any good.

What to do?

Q

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[tiene dolor?]

Pathologists get paid.

 

[PatrickBateman]

I recommend primary care in a highly indigent area or perhaps third world medicine. Your material predilection is an obvious cover for a deeper yearning to give back to the community and nourish your soul.

 

[quark]

How about anesthesia?

 

[tigershark]

Your theoretical stats are fine for rads, you would match at a nice university program somewhere, but not have much chance at the elite programs.

185K isnt that much money and you can make that starting out in private practice in most any specialty.

 

[Quixotic]

First off, I don't want the money for material possessions. In fact, I believe that material possessions will lead to damnation and not enlightenment. I simply want financial security and an opportunity to open programs to help those less fortunate. That being said, I don't necessarily want to work with people all that much. I am not interested in taking care of chronic problems for people who don't give a hoot about themselves and aren't willing to change. Of course there will be those that do care, but I would rather diagnose and walk away; OR fix the problem and have minimal after care. Sounds like ER, I'm just not sure though.

I thought people needed at least a 235-240 minimum to place into Rads? Will it matter that I get my training at say Arkansas as opposed to UMass when it comes to getting a job?

One of the Pathologist I spoke with is just finishing her residency and stated that Pathologists start at around $130-$160 depending on the location. Plus, there aren't as many jobs as for other specialties.

I have considered Anesthesia, although I'm not exactly sure what they do throughout the course of a day. It seems the problem is exposure. Since third year rotations are mapped out at my University there is very little opportunity for exposure in different specialties.

For example, say I may be interested in Anesthesia, Rads and Pathology, well I wouldn't have exposure to those fields until August of 4th year. Since Step 2 has to completed by October, there goes one month to studying, leaving me with one month to do a rotation before I have to submit my application. I guess I better get a nice shiny coin and statistically rule out two of the three.

Q

 

[Gyric]

A path subspecialty would fit the bill. You are correct that the path job market is tighter than radiology or family practice but who knows what it will look like when you finish training. At my path program residents have multiple offers (like 4-6) for excellent jobs (200+ to start, 400+ partner, 9-12 wks vacation) but your stats are not good enough for an interview here. You could go to a less competitive program and hope for a better offer than your friend.

 

[Quixotic]

A path subspecialty would fit the bill. You are correct that the path job market is tighter than radiology or family practice but who knows what it will look like when you finish training. At my path program residents have multiple offers (like 4-6) for excellent jobs (200+ to start, 400+ partner, 9-12 wks vacation) but your stats are not good enough for an interview here. You could go to a less competitive program and hope for a better offer than your friend.

What type of stats are necessary there?

 

[PatrickBateman]

but your stats are not good enough for an interview here. You could go to a less competitive program and hope for a better offer than your friend.

Really? I know somone who got into path at Hopkins with numbers in that range. But then again, I don't know if Hopkins is competitive for path.

 

[debvz]

In addition, if I do select (B) another residency should I select the location based on where I can be most financially secure? For instance, if I took a residency in Iowa, Oklahoma, Indiana, Kentucky etc... I could easily find a very nice home and pay off half of it by the time I finish residency. On the other hand, I could go to a much more interesting place like California, Washington, New York and live like a dog in a dump.

What to do?

Q

I hope you're in the market for a trailer if you're planning to have it half paid off by the time you finish residency on your $40K/yr salary.

 

[Quixotic]

I hope you're in the market for a trailer if you're planning to have it half paid off by the time you finish residency on your $40K/yr salary.

If I got a $200K house with a nice down payment plus my salary and my wifes we could easily pay off more than half by the time I finished a four year residency.

 

[debvz]

First off, I don't want the money for material possessions. In fact, I believe that material possessions will lead to damnation and not enlightenment. I simply want financial security and an opportunity to open programs to help those less fortunate. That being said, I don't necessarily want to work with people all that much.

How nice...

I have considered Anesthesia, although I'm not exactly sure what they do throughout the course of a day. It seems the problem is exposure. Since third year rotations are mapped out at my University there is very little opportunity for exposure in different specialties.

You've considered anesthesia, yet you don't know what the job entails?... What part of it have you considered, besides the income part of the job?

For example, say I may be interested in Anesthesia, Rads and Pathology, well I wouldn't have exposure to those fields until August of 4th year.

Perhaps consider dropping in once and a while prior to 4th yr and spend some time, if you're truly interested.

Since Step 2 has to completed by October, there goes one month to studying, leaving me with one month to do a rotation before I have to submit my application. I guess I better get a nice shiny coin and statistically rule out two of the three.

Plan ahead a little - your best studying will take place by preparing well for the shelf at the end of each of your clerkships. If you have to take step 2 before October, then may consider taking it right after 3rd yr clerkships, when the information is still fresh. You did relatively well on step 1, there's no need to take off a full month to study, unless you really don't want the extra time for rotations to more fully explore what you may be doing for the rest of your life.

I really hope the OP was just trying to stir this forum up a little with this post.

 

[GoofyDoc]

First off, I don't want the money for material possessions. In fact, I believe that material possessions will lead to damnation and not enlightenment. I simply want financial security and an opportunity to open programs to help those less fortunate. That being said, I don't necessarily want to work with people all that much. I am not interested in taking care of chronic problems for people who don't give a hoot about themselves and aren't willing to change. Of course there will be those that do care, but I would rather diagnose and walk away; OR fix the problem and have minimal after care. Sounds like ER, I'm just not sure though.

I don't know what made you get into medicine in the first place, but you might be a good fit for pathology. I believe dermatopathologists make good money, but you have to schedule an elective in surgical pathology to see if it is right for you.

 

[Orange Julius]

Don't do pathology unless boredom is your idea of fun.

 

[roja]

You should really pick a specialty based on something you like. It doesn't really matter in the long run if you aer making the salary you want if you absolutely hate your job.

Lifestyle issues are important but they are only part of the equation. Pretty much outside of surgery, your lifestyle can be achieved.

-EM
-Psych
-FP
-Urology (good lifestyle after the first year or two of residency)
-Peds (can always subspecialize)
etc etc etc.
-IM subspecialties (ID, heme-onc, renal, rheum, endocrine)
-IM hospitalist

You need to think about the broader things in medicine: what are you enjoying on yoru rotations. What kind of patients do you like to care for?

Oh, and you can easily do residency in NYC and not 'live like a dog'.

 

[Quixotic]

I have seen the mundane repetition of treating chronic patients. The doc I work with now spends 4-5 minutes with each patient, writes up their prescriptions refills and orders some labs. Of course there will be mundane things in all specialties; it's just that writing refills is not something I want to have to continuously do. On the other hand, if you spend more time with the patient it begins cutting into your bottom line.

I have considered the subspecialties through IM but would rather not do an IM residency. I would prefer to do a surgical, rads, ER or path residency.

I'm trying to consider a time: rewards system.
Residency Fellowship Salary
ER 3 years None $170-$185
Pathology 4 years 1 year $130-$160
Ortho 5 years 1 year $210-$225
Urology 5 years None $185-$205
Rads 5 years 1 year? $210-$225
Anesth 4 years None $210-$225
Gen Surg 5 years None $190-$210

These are estimated figures for the first two years in practice. Let me know if you think these numbers are off. I have acquired these via hearsay, direct conversations and statistics.

 

[basiligaw]

you also should think about how high your salary can go as you advance---like in er you max out at 300 or less but path in private practice you can go up to 400 or more. you could consider ent
pathologists make more starting than 130 to 160 especially after a yr of fellowship

I have seen the mundane repetition of treating chronic patients. The doc I work with now spends 4-5 minutes with each patient, writes up their prescriptions refills and orders some labs. Of course there will be mundane things in all specialties; it's just that writing refills is not something I want to have to continuously do. On the other hand, if you spend more time with the patient it begins cutting into your bottom line.

I have considered the subspecialties through IM but would rather not do an IM residency. I would prefer to do a surgical, rads, ER or path residency.

I'm trying to consider a time: rewards system.
Residency Fellowship Salary
ER 3 years None $170-$185
Pathology 4 years 1 year $130-$160
Ortho 5 years 1 year $210-$225
Urology 5 years None $185-$205
Rads 5 years 1 year? $210-$225
Anesth 4 years None $210-$225
Gen Surg 5 years None $190-$210

These are estimated figures for the first two years in practice. Let me know if you think these numbers are off. I have acquired these via hearsay, direct conversations and statistics.

 

[2006MD]

Take a year off and get a minimum wage job. That should help you make a decision as to which field will pay you enough.

Or go into business (get a MBA) and you could get a job with what you are currently looking for ($$, no patients, etc.)

 

[Quixotic]

Take a year off and get a minimum wage job. That should help you make a decision as to which field will pay you enough.

Or go into business (get a MBA) and you could get a job with what you are currently looking for ($$, no patients, etc.)

I have worked in many jobs ranging from poor pay to decent pay. It will not change my attitude toward salary.

As far a business goes, I anticipate having two other business ventures in addition to my medical work. An online venue providing medical equipment, articles, forums and for pay advise. Plus another stand alone business unrelated to medicine. With all three I should gain a hold on financial security.

 

[roja]

I still stand by my statement. Basing a career purely on salary/time is a sure-fire way to pretty much hate a good part of your life.

Medicine has a *ton* of BS. Alot of annoyances. And if all you are trying to do is make money/time there are lots of other ways to do this that don't even involve residency.

(MPH, MBA, pharmaceutical... etc etc.)

Your 'fields' are all so different, you may end up hating every minute of your job if you are only basing it on salary.

 

[Quixotic]

I still stand by my statement. Basing a career purely on salary/time is a sure-fire way to pretty much hate a good part of your life.

Medicine has a *ton* of BS. Alot of annoyances. And if all you are trying to do is make money/time there are lots of other ways to do this that don't even involve residency.

(MPH, MBA, pharmaceutical... etc etc.)

Your 'fields' are all so different, you may end up hating every minute of your job if you are only basing it on salary.

I was simply elaborating on one of the criteria I shall be using in selecting a residency. I will most certainly have some interest in the field if I am to work in it for 15 years. But, I am fairly amenable to most situations. I believe in all fields of medicine there is knowledge to be gained and an ever-changing environment. These are the reasons that I chose medicine in addition to financial security. I don't need to love my job to do it; I simply need to be able to tolerate it.

 

[scootad.]

I don't need to love my job to do it; I simply need to be able to tolerate it.

Famous last words.