What's the best specialty?

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Dr Blue

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@ Title. what do you believe is the best and why you think so!
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You can make bank in any anything, have a good lifestyle in anything, and find anything interesting. I made a list based off my opinion/hearsay.


$$$$, Great Lifestyle: Derm
$$$$, Decent Lifestyle, Fix Things: Urology, Opthalmology, ENT (?)
$$$$$, Fix Things: Orthopedics, Neurosurgery
$$$$, Fix Things: Vascular (more hrs), IR,
$$$$, cerebral, some fixes: Cardiology, GI
$$$, very cerebral: Hematology
$$$, cerebral,hands on: PCCM
$$$, aren't paranoid about the future: Anesthesiology, Radiology
$$$, Decent lifestyle if you can tolerate shifts, some fixes: EM
$$, cerebral non-negotiable: Nephrology, Neurology
$$-$$$, less worried about prestige, Great lifestyle: PM&R, Psychiatry, Allergy
$$, less lifestyle, Fix things non-negotiable General Surgeon
$$, less lifestyle, cerebral/usage of vast knowledge-base non-negotiable: Hospitalist
$$, passion for women's health non-negotiable, working with hands: OB-GYN
$, Great Lifestyle: Family Medicine, Some IM subspecialties


Based off this, you have to find out what's important to you. Do you want to see immediate results/work with your hands and is that non-negotiable? You should consider surgical specialties. Do you prefer to think and are not that keen on tons of OR time? Then maybe something in medicine is more suited for you. Is salary/lifestyle optimization your only end-goal? Then pick Dermatology.
 
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Members don't see this ad :)
Backtothebasics8 said:
You can make bank in any anything, have a good lifestyle in anything, and find anything interesting. I made a list based off my opinion/hearsay.


$$$$, Great Lifestyle: Derm
$$$$, Decent Lifestyle, Fix Things: Urology, Opthalmology, ENT (?)
$$$$$, Fix Things: Orthopedics, Neurosurgery
$$$$, Fix Things: Vascular (more hrs), IR,
$$$$, cerebral, some fixes: Cardiology, GI
$$$, very cerebral: Hematology/PCCM
$$$, aren't paranoid about the future: Anesthesiology, Radiology
$$$, Decent lifestyle if you can tolerate shifts, some fixes: EM
$$, cerebral: Nephrology, Neurology
$$-$$$, less worried about prestige, Great lifestyle: PM&R, Psychiatry, Allergy
$$, less lifestyle, Fix things non-negotiable General Surgeon
$$, less lifestyle, cerebral/usage of vast knowledge-base non-negotiable: Hospitalist
$$, passion for women's health non-negotiable, some fixes: OB-GYN
$, Great Lifestyle: Family Medicine, Some IM subspecialties


Based off this, you have to find out what's important to you. Do you want to see immediate results/work with your hands and is that non-negotiable? You should consider surgical specialties. Do you prefer to think and are not that keen on tons of OR time? Then maybe something in medicine is more suited for you. Is salary/lifestyle optimization your only end-goal? Then pick Dermatology.
Click to expand...
Neurosurgery and ortho have some of the most poor and dubious outcomes, respectively. The number of ortho bread and butter procedures that have zero proven benefit is high, while many neurosurg procedures are salvage ops that will leave your patient less brain damaged but still a shell of their former self. Don't get me wrong, if you're doing hips and total knees as ortho you'll be making a big difference, but if you're doing arthroscopic and sooner stuff, well... The outcomes speak for themselves. And nsurg you'll save a few lives, but you'll have enough profoundly brain damaged patients that it'll be kind of a wash.
 
What's the best specialty for you depends on what you most want to prioritize in life.

There are many priorities, but the three big ones most people usually consider are: money, lifestyle and location. For example:

1) Do you want to make lots of money but don't care about lifestyle or where you live? Then be a solo or small group proceduralist in private practice (e.g., neurosurg, ortho), move to the Midwest or South since a lot of these states tend to have favorable economic and legal (e.g., tort reform) climates for physicians, and work your arse off, take call all by yourself all the time, etc.

2) Do you want to have a great lifestyle, live in a popular but saturated part of the nation like NYC or Boston or Southern California, but don't care about how much money you make? Then pick a specialty that isn't as dependent on hospitals, insurance companies, or the government, so others aren't as in control over when you start work, when you finish work, what you have to do, what you aren't allowed to do, and so on. Maybe an all or mostly outpatient private practice so you don't have as many emergencies in the middle of the night. Join a big group so you can split your call and also not have to work as many hours. Pick a mommy friendly group so you can even work part-time if you like. FM, peds, general IM, psych, urgent care, locums and a few others would do well with these criteria because they're in demand even in popular parts of the nation.

3) Do you want all three? Good luck! Perhaps derm, but that's too competitive for the majority of med students. Maybe teleradiology or emergency radiology employed with a hospital system that has a significant number of privately insured patients, but then you have to do a lot of nights which isn't "lifestyle" friendly if you don't like doing nights.

4) A fourth criterion people sometimes care about is job security. But that's more difficult to figure out because a lot depends on what the federal government does with healthcare in the future, the use of bundled payments becoming increasingly common, midlevels encroaching on most specialties, the legal environment of the state you want to work in, the fact that many private groups are being bought out and many physicians becoming employees of one organization or another, and many other factors. But generally speaking, most people seem to think proceduralists will be safer than non-proceduralists, "owning" your own patients will be safer than being in specialties that don't own their own patients, working in a state that has a good legal environment for physicians is better than working in a state that doesn't, being in a specialty that's more immune to (less dependent on) potential future healthcare changes is better than being in a specialty that's not as immune to potential future healthcare changes such as when policy changes in hospitals, insurance companies, and/or the government have a greater impact on your specialty than other specialties.

5) However, you can be in a specialty that has a great lifestyle, makes a lot of money, and where you can live in a popular locale, but still hate your specialty and not enjoy it. For example, I did rotations in derm, and did well, but in the end I decided it just wasn't for me, no matter how attractive it was. So you still have to do what you enjoy or at least can tolerate to some degree.
 
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Mad Jack said:
The number of ortho bread and butter procedures that have zero proven benefit is high, while many neurosurg procedures are salvage ops that will leave your patient less brain damaged but still a shell of their former self. Don't get me wrong, if you're doing hips and total knees as ortho you'll be making a big difference, but if you're doing arthroscopic and sooner stuff, well... The outcomes speak for themselves.
Click to expand...

Slight derailment, but do you have any thoughts on what this means for the future of ortho? Might reimbursement be slashed for those procedures with more dubious benefits once people catch on, making ortho a lot less lucrative for those not cranking out joint replacements on privately insured patients?
 
Backtothebasics8 said:
You can make bank in any anything, have a good lifestyle in anything, and find anything interesting. I made a list based off my opinion/hearsay.

$$$$, Great Lifestyle: Derm
$$$$, Decent Lifestyle, Fix Things: Urology, Opthalmology, ENT (?)
$$$$$, Fix Things: Orthopedics, Neurosurgery
$$$$, Fix Things: Vascular (more hrs), IR,
$$$$, cerebral, some fixes: Cardiology, GI
$$$, very cerebral: Hematology/PCCM
$$$, aren't paranoid about the future: Anesthesiology, Radiology
$$$, Decent lifestyle if you can tolerate shifts, some fixes: EM
$$, cerebral: Nephrology, Neurology
$$-$$$, less worried about prestige, Great lifestyle: PM&R, Psychiatry, Allergy
$$, less lifestyle, Fix things non-negotiable General Surgeon
$$, less lifestyle, cerebral/usage of vast knowledge-base non-negotiable: Hospitalist
$$, passion for women's health non-negotiable, some fixes: OB-GYN
$, Great Lifestyle: Family Medicine, Some IM subspecialties


Based off this, you have to find out what's important to you. Do you want to see immediate results/work with your hands and is that non-negotiable? You should consider surgical specialties. Do you prefer to think and are not that keen on tons of OR time? Then maybe something in medicine is more suited for you. Is salary/lifestyle optimization your only end-goal? Then pick Dermatology.
Click to expand...

For the most part radiologists make more then ENT, uro, and ophtho outside of retina. IR def makes more. I wouldn't call uro decent lifestyle, they work average 55-60ish hours/week.
 
I guess I can answer your question w/ a similarly broad question: what is the best ice-cream flavor?
 
Mad Jack said:
Neurosurgery and ortho have some of the most poor and dubious outcomes, respectively. The number of ortho bread and butter procedures that have zero proven benefit is high, while many neurosurg procedures are salvage ops that will leave your patient less brain damaged but still a shell of their former self. Don't get me wrong, if you're doing hips and total knees as ortho you'll be making a big difference, but if you're doing arthroscopic and sooner stuff, well... The outcomes speak for themselves. And nsurg you'll save a few lives, but you'll have enough profoundly brain damaged patients that it'll be kind of a wash.
Click to expand...

I think this can be said about all surgical subspecialties besides Urology. I rotated on Vascular surgery for a month and they're outcomes weren't amazing either.
 
Backtothebasics8 said:
I think this can be said about all surgical subspecialties besides Urology. I rotated on Vascular surgery for a month and they're outcomes weren't amazing either.
Click to expand...
General surgeons have pretty solid outcomes. Those thyroids and gallbladders could kill if not removed.
 
Mad Jack said:
Neurosurgery and ortho have some of the most poor and dubious outcomes, respectively. The number of ortho bread and butter procedures that have zero proven benefit is high, while many neurosurg procedures are salvage ops that will leave your patient less brain damaged but still a shell of their former self. Don't get me wrong, if you're doing hips and total knees as ortho you'll be making a big difference, but if you're doing arthroscopic and sooner stuff, well... The outcomes speak for themselves. And nsurg you'll save a few lives, but you'll have enough profoundly brain damaged patients that it'll be kind of a wash.
Click to expand...

This may be one of the dumbest posts I've ever read on SDN, which as you know is saying something.

Spend a couple weeks with an ortho and watch children with misshapen limbs run again. Or Grandma after hip fracture get up and walk the next day. Or your uncle go play golf again after being housebound for years due to knee pain, after he gets his new total knee. Or the NFL wide receiver return to the league after an ACL replacement.

Spend a couple weeks with a neurosurgeon and watch them carefully remove an acoustic schwannoma in a 16-hour surgery and suddenly your sister doesn't have debilitating tinnitus every day anymore. Or watch them shunt a hydrocephalus that saves a neonates life granting them 7+ extra decades on this planet. Or watch them do a crash crani on a trauma patient and see them come back to trauma survivors day a year later and they've resumed their normal job.

SMH at the level of profound ignorance on display here.
 
Mad Jack said:
Neurosurgery and ortho have some of the most poor and dubious outcomes, respectively. The number of ortho bread and butter procedures that have zero proven benefit is high, while many neurosurg procedures are salvage ops that will leave your patient less brain damaged but still a shell of their former self. Don't get me wrong, if you're doing hips and total knees as ortho you'll be making a big difference, but if you're doing arthroscopic and sooner stuff, well... The outcomes speak for themselves. And nsurg you'll save a few lives, but you'll have enough profoundly brain damaged patients that it'll be kind of a wash.
Click to expand...

Oh yes, open reduction internal fixation (ORIF) of unstable bone broken's (fractures) is dubious. As is correction of deformity.
 
masaraksh said:
Oh yes, open reduction internal fixation (ORIF) of unstable bone broken's (fractures) is dubious. As is correction of deformity.
Click to expand...
MMS: Error

Link works even though it says error, just click it. I didn't say all orthopedic procedures are worthless, but that a lot of them are. I've seen quotes as high as half to two thirds of orthopedic procedures providing zero benefit.

Here's one on meniscal tears:
Why arthroscopic partial meniscectomy?
 
Mad Jack said:
Neurosurgery and ortho have some of the most poor and dubious outcomes, respectively. The number of ortho bread and butter procedures that have zero proven benefit is high.
Click to expand...

There is always ongoing debate about indications for a surgical procedure. The recent NEJM articles are part of a healthy debate about if the indications for partial menisectomy should be scaled back. One ongoing debate about indications for one procedure in one subspecialty in orthopaedics does not equate to "the number of ortho bread and butter procedures that have zero proven benefit is high."

Just own up to your ignorant statement and move on.
 
akwho said:
There is always ongoing debate about indications for a surgical procedure. The recent NEJM articles are part of a healthy debate about if the indications for partial menisectomy should be scaled back. One ongoing debate about indications for one procedure in one subspecialty in orthopaedics does not equate to "the number of ortho bread and butter procedures that have zero proven benefit is high."

Just own up to your ignorant statement and move on.
Click to expand...
The evidence base for orthopaedics and sports medicine | The BMJ

Only 20% of orthopedic procedures have even one small RCT to back them up. The majority of orthopedic procedures are not evidence-based, and that's a straight up fact. It's a field with a notoriously poor evidence base, and denying that doesn't change the fact that a field without evidence is unscientific at best and unintentionally negligent at worst.
 
If all of that is true, why is Ortho so competitive? I was told Ortho and Derm are the two most difficult specialties to match to
 
Pompacil said:
Most surgical specialties are what you make your practice to be.
Click to expand...

Ok, to rephrase: If you are interested in making the "average" salary for a general surgeon (350k/year), approximately how many hours would you have to work per week + how many nights on call?

Please differentiate if the time would be different in private practice or hospital-employed situations.

bashwell said:
What's the best specialty for you depends on what you most want to prioritize in life.

There are many priorities, but the three big ones most people usually consider are: money, lifestyle and location. For example:

1) Do you want to make lots of money but don't care about lifestyle or where you live? Then be a solo or small group proceduralist in private practice (e.g., neurosurg, ortho), move to the Midwest or South since a lot of these states tend to have favorable economic and legal (e.g., tort reform) climates for physicians, and work your arse off, take call all by yourself all the time, etc.

2) Do you want to have a great lifestyle, live in a popular but saturated part of the nation like NYC or Boston or Southern California, but don't care about how much money you make? Then pick a specialty that isn't as dependent on hospitals, insurance companies, or the government, so others aren't as in control over when you start work, when you finish work, what you have to do, what you aren't allowed to do, and so on. Maybe an all or mostly outpatient private practice so you don't have as many emergencies in the middle of the night. Join a big group so you can split your call and also not have to work as many hours. Pick a mommy friendly group so you can even work part-time if you like. FM, peds, general IM, psych, urgent care, locums and a few others would do well with these criteria because they're in demand even in popular parts of the nation.

3) Do you want all three? Good luck! Perhaps derm, but that's too competitive for the majority of med students. Maybe teleradiology or emergency radiology employed with a hospital system that has a significant number of privately insured patients, but then you have to do a lot of nights which isn't "lifestyle" friendly if you don't like doing nights.

4) A fourth criterion people sometimes care about is job security. But that's more difficult to figure out because a lot depends on what the federal government does with healthcare in the future, the use of bundled payments becoming increasingly common, midlevels encroaching on most specialties, the legal environment of the state you want to work in, the fact that many private groups are being bought out and many physicians becoming employees of one organization or another, and many other factors. But generally speaking, most people seem to think proceduralists will be safer than non-proceduralists, "owning" your own patients will be safer than being in specialties that don't own their own patients, working in a state that has a good legal environment for physicians is better than working in a state that doesn't, being in a specialty that's more immune to (less dependent on) potential future healthcare changes is better than being in a specialty that's not as immune to potential future healthcare changes such as when policy changes in hospitals, insurance companies, and/or the government have a greater impact on your specialty than other specialties.

5) However, you can be in a specialty that has a great lifestyle, makes a lot of money, and where you can live in a popular locale, but still hate your specialty and not enjoy it. For example, I did rotations in derm, and did well, but in the end I decided it just wasn't for me, no matter how attractive it was. So you still have to do what you enjoy or at least can tolerate to some degree.
Click to expand...

Fourth year friend of mine put it this way:

Money, Free time, Prestige. Pick two.

GoPelicans said:
For the most part radiologists make more then ENT, uro, and ophtho outside of retina. IR def makes more. I wouldn't call uro decent lifestyle, they work average 55-60ish hours/week.
Click to expand...

I've read on here that the job market for radiology/IR is terrible. Thoughts?

eteshoe said:
I guess I can answer your question w/ a similarly broad question: what is the best ice-cream flavor?
Click to expand...

Second Mint-chocolate

Backtothebasics8 said:
I think this can be said about all surgical subspecialties besides Urology. I rotated on Vascular surgery for a month and they're outcomes weren't amazing either.
Click to expand...

Smokers and fatties...
 
Mad Jack said:
The evidence base for orthopaedics and sports medicine | The BMJ

Only 20% of orthopedic procedures have even one small RCT to back them up. The majority of orthopedic procedures are not evidence-based, and that's a straight up fact. It's a field with a notoriously poor evidence base, and denying that doesn't change the fact that a field without evidence is unscientific at best and unintentionally negligent at worst.
Click to expand...

There is tons of level 1 data in all subspecialties of ortho. Barring that, it is often impossible to do an RCT on certain orthopaedic conditions because of the ethics, patient choice, etc. Lack of RCTs, however, is far from being "not evidence based." Some of the best work out there is retrospective, case controls, etc. "Unintentionally negligent"... Lol.
 
Mad Jack said:
The evidence base for orthopaedics and sports medicine | The BMJ

Only 20% of orthopedic procedures have even one small RCT to back them up. The majority of orthopedic procedures are not evidence-based, and that's a straight up fact. It's a field with a notoriously poor evidence base, and denying that doesn't change the fact that a field without evidence is unscientific at best and unintentionally negligent at worst.
Click to expand...
Give me RCTs or give me death!

But seriously, not everything is conducive to double-blind RCTs.
 
Jabbed said:
Give me RCTs or give me death!

But seriously, not everything is conducive to double-blind RCTs.
Click to expand...
Oh I know, I might just be riling people up for the sake of riling them up. I'm big on critical care medicine myself, which is equally as dubious from an EBM perspective, but we know what works and what doesn't... Or do we?
 
this is sad to say but for me the best is family medicine (an absolute personal opinion based on my own interests), however, i know i won't be doing this since i am interested in having a good amount of free time and a decent salary. Where I am going to practice (outside US) fam medicine doesn't allow neither of those.
 
Backtothebasics8 said:
You can make bank in any anything, have a good lifestyle in anything, and find anything interesting. I made a list based off my opinion/hearsay.


$$$$, Great Lifestyle: Derm
$$$$, Decent Lifestyle, Fix Things: Urology, Opthalmology, ENT (?)
$$$$$, Fix Things: Orthopedics, Neurosurgery
$$$$, Fix Things: Vascular (more hrs), IR,
$$$$, cerebral, some fixes: Cardiology, GI
$$$, very cerebral: Hematology/PCCM
$$$, aren't paranoid about the future: Anesthesiology, Radiology
$$$, Decent lifestyle if you can tolerate shifts, some fixes: EM
$$, cerebral non-negotiable: Nephrology, Neurology
$$-$$$, less worried about prestige, Great lifestyle: PM&R, Psychiatry, Allergy
$$, less lifestyle, Fix things non-negotiable General Surgeon
$$, less lifestyle, cerebral/usage of vast knowledge-base non-negotiable: Hospitalist
$$, passion for women's health non-negotiable, some fixes: OB-GYN
$, Great Lifestyle: Family Medicine, Some IM subspecialties


Based off this, you have to find out what's important to you. Do you want to see immediate results/work with your hands and is that non-negotiable? You should consider surgical specialties. Do you prefer to think and are not that keen on tons of OR time? Then maybe something in medicine is more suited for you. Is salary/lifestyle optimization your only end-goal? Then pick Dermatology.
Click to expand...
I wouldn't put ophtho in the same league as ENT or urology, unless you're strictly speaking retina. The average ophtho doc does not make as much as you'd think. Their money comes from surgical volume, so if you're not busting your ass doing 40 cataract surgeries a week, good luck cracking 300K.
 
Gurby said:
Slight derailment, but do you have any thoughts on what this means for the future of ortho? Might reimbursement be slashed for those procedures with more dubious benefits once people catch on, making ortho a lot less lucrative for those not cranking out joint replacements on privately insured patients?
Click to expand...

Even if it was all true ortho isn't going anywhere soon. Given the number of baby boomers reaching the golden years, the power of the AARP lobby, and the RVUs associated with any surgical procedure with immediately measurable outcomes ortho will keep pulling in bank unless a single-payer system gets implemented. Then again if that happens we'll probably all be screwed.

Kkshake said:
If all of that is true, why is Ortho so competitive? I was told Ortho and Derm are the two most difficult specialties to match to
Click to expand...

$$$$$$$$$$

That and getting to use power tools on a living person is pretty cool...
 
Mad Jack said:
The evidence base for orthopaedics and sports medicine | The BMJ

Only 20% of orthopedic procedures have even one small RCT to back them up. The majority of orthopedic procedures are not evidence-based, and that's a straight up fact. It's a field with a notoriously poor evidence base, and denying that doesn't change the fact that a field without evidence is unscientific at best and unintentionally negligent at worst.
Click to expand...
[/QUOTE]

Aren't you going into psych?

Seems pretty pot kettle-y....
 

Aren't you going into psych?

Seems pretty pot kettle-y....[/QUOTE]
:laugh: Oh I was just busting stones. My two favorite fields (psych and critical care) have problems with EBM. Ortho is perhaps one of the more notorious fields in the evidence sense though, if you spend time in circles that talk about that sort of thing. Every single psych medication has at least one large RCT behind it and is FDA approved, the former of which can't be said for ortho. Critical care is just a mess though- many of the major studies in the field seen to have been designed to prove hypotheses rather than reject the null, which leaves many of us with CC backgrounds sharply divided on certain topics (sepsis and ventilation, anyone?).
 
Mad Jack said:
The evidence base for orthopaedics and sports medicine | The BMJ

Only 20% of orthopedic procedures have even one small RCT to back them up. The majority of orthopedic procedures are not evidence-based, and that's a straight up fact. It's a field with a notoriously poor evidence base, and denying that doesn't change the fact that a field without evidence is unscientific at best and unintentionally negligent at worst.
Click to expand...

Call me crazy, but while some of this is a bit strong, it's not all wrong.

Ortho was founded on the idea of aligning the skeleton (orthopaedics is literally "straight child"). So a lot of their elective procedures are based on the idea that if you correct anatomy, you correct biomechanics, and thus correct pathology. Well, orthopods are not biomechanists. There's lots of evidence showing that normal anatomy does not necessarily mean normal biomechanics and vice versa. The idea of normal or optimal anatomy or biomechanics is in itself questionable as what is normal for me may not be normal or optimal for you (presuming no gross deformity). I don't think anyone is arguing the important role that orthos have, especially in trauma or major deformity where ortho can be life/limb saving/changing, but certainly some of the elective cases should be questioned, and studies are starting to show that.

Ortho is not alone though. Other competitive and high income specialties like Derm or Plastics also are relatively far behind in EBM compared to things like cardio, neuro, or even gen surg. Good EBM is hard to do, regardless of specialty.
 
LoGo said:
Call me crazy, but while some of this is a bit strong, it's not all wrong.

Ortho was founded on the idea of aligning the skeleton (orthopaedics is literally "straight child"). So a lot of their elective procedures are based on the idea that if you correct anatomy, you correct biomechanics, and thus correct pathology. Well, orthopods are not biomechanists. There's lots of evidence showing that normal anatomy does not necessarily mean normal biomechanics and vice versa. The idea of normal or optimal anatomy or biomechanics is in itself questionable as what is normal for me may not be normal or optimal for you (presuming no gross deformity). I don't think anyone is arguing the important role that orthos have, especially in trauma or major deformity where ortho can be life/limb saving/changing, but certainly some of the elective cases should be questioned, and studies are starting to show that.

Ortho is not alone though. Other competitive and high income specialties like Derm or Plastics also are relatively far behind in EBM compared to things like cardio, neuro, or even gen surg. Good EBM is hard to do, regardless of specialty.
Click to expand...

I disagree. The best orthopaedic surgeons are also extremely well versed in biomechanics. If you don't understand biomechanics, then you cannot understand orthopaedics because the musculoskeletal system is literally dependent on forces. Radin's "practical biomechanics for the orthopaedic surgeon" should be required reading. I would also like to see what evidence you cite that "normal anatomy does not equal normal biomechanics." By "normal" I mean average person, variance between individuals is not that large, which is why anatomic approaches are so predictable.
 
OrthoTraumaMD said:
I disagree. The best orthopaedic surgeons are also extremely well versed in biomechanics. If you don't understand biomechanics, then you cannot understand orthopaedics because the musculoskeletal system is literally dependent on forces. Radin's "practical biomechanics for the orthopaedic surgeon" should be required reading. I would also like to see what evidence you cite "normal anatomy does not equal normal biomechanics." By "normal" I mean average person, variance between individuals is not that large, which is why anatomic approaches are so predictable.
Click to expand...

Neurodegenerative diseases come to mind. For example, an otherwise anatomically intact and normal 26 year old female with progressive MS could very well not have normal biomechanics?
 
Light at end of tunnel said:
Neurodegenerative diseases come to mind. For example, an otherwise anatomically intact and normal 26 year old female with progressive MS could very well not have normal biomechanics?
Click to expand...

Fair, but normal anatomy implies that everything is working properly including the nervous system. The muscles of an ms patient do not respond correctly, therefore their function isn't "anatomic." But it's just semantics at that point.
 
The best specialty is the one that allows you to spend time with your family, pursue your personal interests, and grow as a person.

Have you ever heard of someone in their deathbed regretting how little they worked or how little time they spent in their office? What about people that regret not spending more time with their loved ones or pursuing their dreams?

After a while every single specialty will become a job that you may or may not like. Hopefully what you do for a living will not define you as a person.
 
LoGo said:
Good EBM is hard to do, regardless of specialty.
Click to expand...

Thats not really the problem. If you don't have good EBM, then you use mechanistic knowledge. This is how medicine should work. However, the problem is when you do have good EBM which arthroscopic knee surgery does have (i.e. it being no better than a placebo) and is citing in multiple writings by physicians and PhDs, BUT the evidence is ignored and the procedure done anyway. This right here is a large problem with medicine.
 
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If you are looking for maximizing earning potential, then there's no correct answer. How much you make, regardless of specialty, depends on how much you want to work, where you want to live, what model you want to work in, and which patient population you want to serve.

Every doc can easily make 6 figures and have 100% job security. Smart thing to do is make smart investments and let that annual 6 figure salary grow itself.


Sent from my iPhone using SDN mobile
 
OrthoTraumaMD said:
I disagree. The best orthopaedic surgeons are also extremely well versed in biomechanics. If you don't understand biomechanics, then you cannot understand orthopaedics because the musculoskeletal system is literally dependent on forces. Radin's "practical biomechanics for the orthopaedic surgeon" should be required reading. I would also like to see what evidence you cite that "normal anatomy does not equal normal biomechanics." By "normal" I mean average person, variance between individuals is not that large, which is why anatomic approaches are so predictable.
Click to expand...

And I would disagree here. Some orthopaedic surgeons may be reasonably versed in biomechanics (those with backgrounds in a related area), but the typical ortho is not, nor do they need to be. The typical ortho has learned a little about mechanics in an applied context so that they know how to put something back together without it falling apart, or are taught that X procedure corrects Y biomechanics because of Z, where Z is only understood topically. For example, probably every ortho could tell you a varus knee tends to develop medial knee osteoarthritis (and probably most doctors could at least appreciate this intuitive fact), but probably very few could show me how they'd calculate loading at the knee to prove why that's the case - intuitively it makes sense, but there's a difference between knowing something and understanding why and that is the difference between an orthopod who has some basic training in clinically relevant biomechanics so their patients can walk straight and an engineer/biomechanist whose job it is to be an expert in those areas only. Source: my PhD in engineering. I have cringed many times hearing orthos try to explain something in real biomechanical terms.

This is not exclusive to ortho. Neuroscientist vs neurologist, microbiologist vs ID, cell biologist studying IBD vs a gastroenterologist treating IBD. Yes there's overlap and both have a basic understanding of the other, but neither is an expert in the other's field.... unless you're an MD/PhD 🙂

Regarding examples of within normal limits of anatomy and abnormal biomechanics, there are plenty of studies showing neutral alignment is not associated with loading during gait or injury development. Also, within the limits of normal anatomy, why does an inversion injury cause a Weber A for some, an ATFL sprain for others and a peroneus brevis avulsion for others? It's due to biomechanical differences from one person to the next. I'm not saying restoring "normal" anatomy is incorrect. I'm just saying that within normal anatomy, there's a lot of biomechanical variability that anatomy, on the macro scale that ortho deals with, does not predict. Running injuries are another good example.

This is all besides the original discussion - evidence is weak in ortho, as it is in other specialties for certain procedures or treatments. Uptake of strong data against certain approaches is slow, not just for ortho but across medical specialties.
 
LoGo said:
And I would disagree here. Some orthopaedic surgeons may be reasonably versed in biomechanics (those with backgrounds in a related area), but the typical ortho is not, nor do they need to be. The typical ortho has learned a little about mechanics in an applied context so that they know how to put something back together without it falling apart, or are taught that X procedure corrects Y biomechanics because of Z, where Z is only understood topically. For example, probably every ortho could tell you a varus knee tends to develop medial knee osteoarthritis (and probably most doctors could at least appreciate this intuitive fact), but probably very few could show me how they'd calculate loading at the knee to prove why that's the case - intuitively it makes sense, but there's a difference between knowing something and understanding why and that is the difference between an orthopod who has some basic training in clinically relevant biomechanics so their patients can walk straight and an engineer/biomechanist whose job it is to be an expert in those areas only. Source: my PhD in engineering. I have cringed many times hearing orthos try to explain something in real biomechanical terms.

This is not exclusive to ortho. Neuroscientist vs neurologist, microbiologist vs ID, cell biologist studying IBD vs a gastroenterologist treating IBD. Yes there's overlap and both have a basic understanding of the other, but neither is an expert in the other's field.... unless you're an MD/PhD 🙂

Regarding examples of within normal limits of anatomy and abnormal biomechanics, there are plenty of studies showing neutral alignment is not associated with loading during gait or injury development. Also, within the limits of normal anatomy, why does an inversion injury cause a Weber A for some, an ATFL sprain for others and a peroneus brevis avulsion for others? It's due to biomechanical differences from one person to the next. I'm not saying restoring "normal" anatomy is incorrect. I'm just saying that within normal anatomy, there's a lot of biomechanical variability that anatomy, on the macro scale that ortho deals with, does not predict. Running injuries are another good example.

This is all besides the original discussion - evidence is weak in ortho, as it is in other specialties for certain procedures or treatments. Uptake of strong data against certain approaches is slow, not just for ortho but across medical specialties.
Click to expand...

And as an orthopod with a heavy interest in research, I will dispute your claim that the evidence is weak, about 10 excellent peer reviewed journals a month (CORR, JOT, BJJ just to name a few) will tell you otherwise, so I am not sure where you are getting this idea. Certainly in my subspecialty it is quite strong. Weakest tends to be in sports. We don't pull our procedures from thin air.

In terms of your example about ankle inversion injuries, I will just point out that yes, the anatomy on the micro scale may differ, but it is clinically irrelevant since all three injury versions you mentioned are treated exactly the same way.
 
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