I can find interest in most specialties, but have not found a specialty that jumps out as "the one" for me. I guess you could say I have yet to find a specialty that I absolutely love and most things are ok - I've never had the epiphany that most students seem to get where they suddenly knew a certain specialty was for them. I have a preference towards procedural specialties. I enjoy the OR and surgery, but not too long or complex cases. I am ok with medical consults, but don't like spending too long per consult. I do like interacting with patients, ideally patients who are otherwise healthy or at least not highly complex. I am ok with hospitals, but probably prefer a clinic. My preference is for little call (or at least not call in the middle of the night), ideally most weekends off. I'd like a specialty that is flexible to allow for consistent time to do research. In total, not more than 40-50hr work week max after residency (and the lighter the residency the better). Does a specialty exist that aligns with this?
If I were to do a surgical specialty, how flexible is this later on in terms of restricting clinical work to say 3 days per week with not much call?
If medical, what would fit with the patient profile and procedural based aspect?
Since I am ok with most things, but do not seem to love anything specific, should I just aim for ROAD and use that to split time for research?
Another plug for ophtho. In terms of the bolded items above,
Procedural - most clinics are procedural/surgical. Some subspecialties have more procedures and surgeries, some less.
Enjoy OR but not too long/complex - most attendings have 1-2 days of OR/week with short cases (15-60 mins, depending on subspecialty)
Medical consults - most ophtho consults are medical (aside from trauma), and can usually be completed in ~30 minutes or so once you get fast.
Interacting with patients - talk with patients in clinic, most visits are short (5-10 mins, sometimes less)
Otherwise healthy - most are, and if they have other complex issues, you don't have to wade through all of them. Hospital patients you consult on are usually sick (cancer/ID/trauma/neuro patients), but this is more a factor in residency than as an attending
Little call - completely dependent on your organization structure and subspecialty once done. I know attendings that take no call, and attendings that are on very frequently. The upside is that most calls as an attending can be managed via phone, with some exceptions. Call in residency sucks and is really only infrequent at larger programs that can spread out the call, but the worst of it (primary call) is over after 1-2 years.
Most weekends off - As an attending almost uniformly yes (again subspecialty dependent, the more surgical subspecialties may end up coming in over the weekend for an urgent case). Even as a resident you have more weekends off than not (depending on call structure of your program). The tradeoff for most weekends off as an attending is that as a resident on weekend call you end up dealing with all the community dumps to the academic center so the attendings can live the sweet life.
Flexible time to allow for research - This can be accomplished in academia. And to the points made by other posters, you don't necessarily need a fellowship to accomplish this. I know a few (keyword few) attendings who are not fellowship trained but spend significant time (50-75%) on research. Fellowship training is helpful for landing an academic job though, which can open up more opportunities to split clinical and research time.
40-50 hours work week - certainly possible as an attending, and probably the norm. The good weeks in residency will be 50-60 hours, but if you happen to have a busy call night or weekend, can be 60-80, and occasionally can go over 80 hours (but these hours are generally limited to when you take primary call, again which is for 1-2 years).
Lighter residency - Here's the rub...residency is not easy (despite the seemingly widespread perception otherwise). The learning curve is steep for the first year or two. Given that nobody knows much about the eye, and what is and is not emergent, other specialties have a low threshold to consult and expect you to see nearly everything quickly. The community docs dump on you, especially over the weekends. There is a good amount of trauma (program dependent), which never seems to happen between 8am and 8pm. You don't get to do much surgery early on (program dependent), and take on a lot of the duties/patients nobody else wants to deal with. This all makes the first year pretty unpleasant, but improves as you move forward, and by the time you're a third year life is pretty sweet. Attending life is nothing like residency though, and most attendings seem significantly happier than the first year residents.
Hope that helps. PM me with other questions.
