Which medical specialty is, according to you, the most routine free?

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Kakarrott

Kakarrott

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I don’t really think it’s EM anyways. Probably Psychiatry because no two are the same or possibly Pediatric Cardiology.
 
Syncrohnize said:
Probably Psychiatry because no two are the same
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If you wanted to find a gig doing CL or triage/emergency psych, it would be a good choice, but in general there's a lot of the same stuff over and over with outpatient/inpatient.

Still, I do this because it's more interesting than most stuff out there, but the routine depression/anxiety on inpatient and the cocaine SI on inpatient is stuff I can handle in my sleep.
 
What is a real difference between consultation-liaison psychiatry and what you called general psychiatry? I saw CL in some threads about Zebras or Consultants to doctors that knew nothing. Somebody even called it a Zebra hunting speciality. But I still don't really see what it is on a concrete occasion. (Or my English is not good enough to see the difference just from Wikipedia. 😀 )
 
Trauma surgery
Emergency medicine

Any service where your patients are high-acuity and you're going to take a high call volume will be relatively "routine-free" due to the constant question of which one of your patients is going to decompensate overnight and require you to come in or if its a trauma based specialty. Examples of these would be vascular surgery, CT surg, neurosurg, orthopedics.
 
Of course I’m biased, but I truly think it is my specialty, orthopaedic trauma. There are basic “rules” to fracture care, but beyond that, every fracture is different. Factors in treatment include patient age, biomechanics of the fracture, bone quality, patient compliance, nature of the injury, soft tissue envelope, vascularity, how active the patient is, concurrent injuries, implant availability, surgical skill, and so on. Not to mention there are hundreds of bones, each with its own separate sections and attachments, and each having a handful of options for surgical approaches. Not to mention nonoperative management. You can treat a pilon fracture with a splint, cast, crpp, nail, plate, ilizarov/Taylor frame, or even amputation. There are literally thousands of permutations when all these factors are taken into account. I haven’t seen that sort of variability anywhere else.


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I would vote for either psychiatry or neurological surgery as being the most routine free. Ironically they are very opposite fields in terms of working conditions and necessary skills.

On the opposite side, I would think anesthesiology, internal medicine, and pediatrics would have the most routine lifestyle.

But this is something that is highly opinionated and likely varies depending on many different variables (such as location, hospital size, patient volume, etc).
 
I was heavily considering OB/Gyn for a while for this exact reason. You can see patients in clinic and do well-woman exams, deliver babies vaginally or surgically, perform minor/outpatient procedures like LEEPs or device placement, or do full-blown surgeries in the OR all in the same week. Out of everything it felt like the greatest variety and the only field that I really thought could adequately satiate the desires of someone who really wanted to work extensively both in the clinic and the OR. I think it would also be good for someone who gets bored being in the same setting every day.
 
Stagg737 said:
I was heavily considering OB/Gyn for a while for this exact reason. You can see patients in clinic and do well-woman exams, deliver babies vaginally or surgically, perform minor/outpatient procedures like LEEPs or device placement, or do full-blown surgeries in the OR all in the same week. Out of everything it felt like the greatest variety and the only field that I really thought could adequately satiate the desires of someone who really wanted to work extensively both in the clinic and the OR. I think it would also be good for someone who gets bored being in the same setting every day.
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Couldn't agree with more with this. It still does not make sense to me why there is such a general lack of interest in OBGYN amongst medical students considering the versatility of this field.
 
Small Cell Carcinoma said:
Couldn't agree with more with this. It still does not make sense to me why there is such a general lack of interest in OBGYN amongst medical students considering the versatility of this field.
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Lots of call, high liability, miserable residency, not to mention that not everyone wants to look at vaginas all day just to name a few. Relatively poor lifestyle and liability issues were major reasons I did not end up pursuing the field further (along with generally loving my field of choice).
 
Small Cell Carcinoma said:
Couldn't agree with more with this. It still does not make sense to me why there is such a general lack of interest in OBGYN amongst medical students considering the versatility of this field.
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Really liked OB/GYN in medical school but was turned off by 1) the attitude of the residents of my program (which says nothing about the field as a whole, but it nevertheless colored my experience) and 2) the somewhat inherent weirdness of being a male in OB/GYN.
 
Small Cell Carcinoma said:
Couldn't agree with more with this. It still does not make sense to me why there is such a general lack of interest in OBGYN amongst medical students considering the versatility of this field.
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It will once you rotate on it. Residency is 4 years and it’s as tough as general surgery. Once you’re out the salary is not great either, but you can obviously specialize in GYN/ONC, REI, MFM, and make more but same goes for every field out there. I have a profound level of respect for women & men who are passionate enough to choose this field and practice general OB/GYN.
 
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For every surgical specialty named (neuro, vascular, ortho, etc), there is a radiologist that reads those films. Rads takes the cake here.
 
neurosurgery, there a lots of small niches varied pathology/ anatomy and still an element of trauma.
YoungDoc25 said:
For every surgical specialty named (neuro, vascular, ortho, etc), there is a radiologist that reads those films. Rads takes the cake here.
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some would say the act of reading x-rays, Cts, and MRI's all day, every day in a darkened room is the definition of repetitive.
 
libertyyne said:
neurosurgery, there a lots of small niches varied pathology/ anatomy and still an element of trauma.

some would say the act of reading x-rays, Cts, and MRI's all day, every day in a darkened room is the definition of repetitive.
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Some would say neurosurgeons staring at the same organ in an OR all day, every day is repetitive.
 
libertyyne said:
some would say the act of reading x-rays, Cts, and MRI's all day, every day in a darkened room is the definition of repetitive.
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I agree with this.

I like radiology a lot and even considered it strongly, but I must say that it's extremely repetitive. It's true that the cases are very diverse, but the actual job (pulling up an image and dictating the findings) is very, very routine.

Any specialty that has a good mix of everything (inpatient, outpatient, procedures, consultations, young pts, old pts) fits the bill. Examples I can think of: Ophthalmology, OB/GYN, Urology, ENT, Ortho, Plastic, GI, and Derm.
 
YoungDoc25 said:
Some would say neurosurgeons staring at the same organ in an OR all day, every day is repetitive.
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Cancer , trauma, spine, functional, endovascular , birth defects.clinic ,or, office , call.
 
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Small Cell Carcinoma said:
Couldn't agree with more with this. It still does not make sense to me why there is such a general lack of interest in OBGYN amongst medical students considering the versatility of this field.
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my SO Loves OBGyn for this exact reason, but hearing some of her stories from spending time with the attendings and residents it sounds absolutely miserable.

She’s been called “******ed”, “autistic”, and “a ****ing *****” all while shadowing as an M1/2 - just trying to show interest in the field. Maybe I’m a snowflake, but I think calling an M1 ******ed for not getting a pimp question right in the OR is absurd.

But at the same time it’s a great field with a ton of opportunity to make real differences in a patients life, which is why so many people put up with the BS imho.

Edit: these things were said in response to relatively minor issues. Forgetting to ask a patient a question during an interview, not identifying a structure correctly in the OR, etc. not terrible transgressions.
 
I think my practice has a really good variety. I do regional anesthesiology. So, I see people in pre-op clinic, round (acute pain and perioperative home), do a lot of intraoperative anesthesia work, and have a regional block area that is mostly procedural based.

I think it's a pretty good mix. My cases every day are different, which keeps it from being too routine.
 
NickNaylor said:
Really liked OB/GYN in medical school but was turned off by 1) the attitude of the residents of my program (which says nothing about the field as a whole, but it nevertheless colored my experience) and 2) the somewhat inherent weirdness of being a male in OB/GYN.
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There's nothing wrong with being a male in ob/gyn. It used to be a male dominated field; programs being filled with women is a relatively recent phenomenon and detrimental.
 
I strangely had fun in OBGyn... though it also helped that I had a remote site rotation where you only had to work 4 days per week and Fridays were lectures back in the city.

The only bitchiness I dealt with was getting written up for playing some games on my computer during a really slow L&D night float night when only 3 of our ~13 beds were full with nothing much going on with the patients. The online shoe shopping being done at the same time by the resident who wrote me up was apparently a more professional use of time 🙄.
 
I guess my question to you is what qualifies as repetitive? Like for pure breadth of pathology, rural family medicine with a strong OB practice likely has the most potential to see something new every day...but is repetitive in the fact that it's mostly clinic. That's the same thing with whoever said radiology - you're still sitting in front of a computer screen looking at films which sounds incredibly repetitive to me.

OB/Gyn on the other hand has a breadth of venues, so that a delivery suite is different than doing a C-section, and the OR is not clinic. But the diagnoses are more "repetitive" and you tend to do the same sort of thing for each one (not saying any surgical procedure is exactly the same, but there are general standards)

Trauma surgery certainly fits in that the injuries have nuances and require different techniques (same thing with something like pediatric CT surgery or the person who said neurosurgery), but again could be argued that other than small differences unnoticeable to the novice repetition still reigns.

I personally find that the pediatric specialties provide some degree of novelty, as the same illness presents different challenges in a 6 month compared to a 6 year old compared to a 16 year old. As a pediatric intensivist, I get to see the critically ill portion of any pediatric illness, but would be the first to tell you that the middle of January means that 3/4 of my patients have bronchiolitis due to any number of viruses but are all treated the same.
 
A big driver of this aside from field will be the sort of practice environment you create for yourself. Every field has its bread and butter and you could easily build a practice where you do that and almost nothing else. Then there are practices with high variability.

There’s also the issue of how your own thinking will change as you gain more knowledge. There were parts of my field that seemed so random as an intern that a couple years later now seem very algorithmic and scripted, but at the same time there are new levels of complexity being layered on as I’m growing. What this translates to for the OP is an ever changing definition of “routine.”

Perhaps that’s a more important thing to clarify before diving too far down the specialty rabbit hole. Is it that you don’t want 40 hours of clinic a week or is that ok so long as the patients and pathologies have variation? Do you want a nice mix of clinic and procedure even if the actual issues and cases are more bread and butter?

Any field is going to have some sort of daily routine. Even EM is pretty routine where you do your shifts and see lots of undifferentiated patients with some occasional high acuity stuff tossed in. Traumas are pretty algorithmic though obviously come with an inherent unpredictability.

Once you can better clarify what you mean by routine, we can make some better suggestions. Maybe something like ortho trauma mentioned above where the perioperative decision making is so varied, but then again maybe just being in the OR that much is exactly the sort of routine you want to avoid. Perhaps something more along the lines of anesthesia/critical care where you’re rotating between ORs, procedures, and staffing an ICU.

So many possibilities!
 
operaman said:
is that ok so long as the patients and pathologies have variation?
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This is exactly what I would like. Whenever I think of a routine I imagine an ENT doctor I used to come as a child who was able to diagnose my illnesses just by looking at the date, my ear or the fact that I was a fifth child in a row with the same diagnoses. I would be dead bored by looking at someone being the fifth one in a row with the same thing.

Of course, a combination of procedures and clinic would be a nice perk, but I would rather do just one of those with a wide variety than to swop between the same procedures and patients (diagnoses) every other day.

Also if the field I am looking for is a good field to also do a Research. That would be a great plus.
 
Kakarrott said:
This is exactly what I would like. Whenever I think of a routine I imagine an ENT doctor I used to come as a child who was able to diagnose my illnesses just by looking at the date, my ear or the fact that I was a fifth child in a row with the same diagnoses. I would be dead bored by looking at someone being the fifth one in a row with the same thing.

Of course, a combination of procedures and clinic would be a nice perk, but I would rather do just one of those with a wide variety than to swop between the same procedures and patients (diagnoses) every other day.

Also if the field I am looking for is a good field to also do a Research. That would be a great plus.
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Something I was surprised to find in medicine was just how easy it is to make a diagnosis in almost all cases. You get the occasional head scratcher, but most of the time it’s pretty darn obvious. Television and movies tend to dramatize the diagnostic process but the reality is that the answer is usually apparent to everyone after about 15 seconds.

Your ENT also had the benefit of records from your pediatrician so if you came in for tubes or tonsils and had the documentation supporting surgery, then that’s a pretty straightforward answer even before the doc walks in the room. There’s some additional nuance and things to elicit and examine, and there’s having the conversation about surgery with the family, but much of the physician decision making happens outside the room.

This holds true for most specialists. But the thinking and variation comes from the management. Maybe your ent gets a kid with sleep apnea and takes out tonsils and adenoids - most kids that fixes it but some have persistent disease and now you’re looking at other potential surgical options depending on their level of obstruction. Sure, you might see a lot of kids with OSA, but some will prove quite challenging to get their disease under control requiring multiple interventions and collaboration with other specialists. You’d see a lot of kids with ear disease and most just need a set of tubes, but others will have persistent disease requiring additional interventions plus dozens of other types of ear disease each with its own unique nuances in management. So even what May on the surface seem like routine can actually have a lot of nuance and variation.
 
operaman said:
Something I was surprised to find in medicine was just how easy it is to make a diagnosis in almost all cases. You get the occasional head scratcher, but most of the time it’s pretty darn obvious. Television and movies tend to dramatize the diagnostic process but the reality is that the answer is usually apparent to everyone after about 15 seconds.

Your ENT also had the benefit of records from your pediatrician so if you came in for tubes or tonsils and had the documentation supporting surgery, then that’s a pretty straightforward answer even before the doc walks in the room. There’s some additional nuance and things to elicit and examine, and there’s having the conversation about surgery with the family, but much of the physician decision making happens outside the room.

This holds true for most specialists. But the thinking and variation comes from the management. Maybe your ent gets a kid with sleep apnea and takes out tonsils and adenoids - most kids that fixes it but some have persistent disease and now you’re looking at other potential surgical options depending on their level of obstruction. Sure, you might see a lot of kids with OSA, but some will prove quite challenging to get their disease under control requiring multiple interventions and collaboration with other specialists. You’d see a lot of kids with ear disease and most just need a set of tubes, but others will have persistent disease requiring additional interventions plus dozens of other types of ear disease each with its own unique nuances in management. So even what May on the surface seem like routine can actually have a lot of nuance and variation.
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Maybe it's obvious to you because you've been trained to do the job very well.
 
The Knife & Gun Club said:
my SO Loves OBGyn for this exact reason, but hearing some of her stories from spending time with the attendings and residents it sounds absolutely miserable.

She’s been called “******ed”, “autistic”, and “a ****ing *****” all while shadowing as an M1/2 - just trying to show interest in the field. Maybe I’m a snowflake, but I think calling an M1 ******ed for not getting a pimp question right in the OR is absurd.

But at the same time it’s a great field with a ton of opportunity to make real differences in a patients life, which is why so many people put up with the BS imho.

Edit: these things were said in response to relatively minor issues. Forgetting to ask a patient a question during an interview, not identifying a structure correctly in the OR, etc. not terrible transgressions.
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Wow that's amazing. Any idea why some OBGYN attendings/residents are so hostile and rude to others?
 
All surgery.

From my experience as a nurse / tech in the OR... every surgeon says "But I do it the same way, every time." Then they proceed to ask for things that are definitely not on their preference cards at least 1 out of every 3 procedures they do. I'm being flip, but really, every procedure has the potential to be unique because anatomy does vary and so does pathology. There is a strong wish to make everything in the OR as routine as possible, because the hope is that this will make everything as safe as possible. But honestly, there will always be room for variation. Sometimes every case. At least that is how it can seem to the folks who have to make all of the necessary equipment and supplies be ready at hand.

Also, all medicine.

Again, being a little flip, but really, your practice is just as routine as you let it be. There is virtually no field where you can't shape your practice to fit your preferences to some degree. I think that FM has the widest scope and the most opportunity to see the most varied patients over the course of any given day. If you want to do checkbox, assembly line medicine, you can surely set your clinic up as an algorithm factory. If you want to offer bespoke care plans to every patient you see, you can do that, too. If you want a procedure one minute and a med check another and to provide behavioral health services in the next and patient education right after and follow that up with a bit of detective work... FM is the way to go. What routine? My patients today ranged in age from 2 years to 90 years, with a 7 months pregnant lady in between. I got to suture, to draw blood, to perform an EKG, to give injections, and spend a few moments with each patient providing meaningful education about disease processes, treatment options, side effects, etc. etc.

Your specialty choice alone doesn't dictate all aspects of your future practice. Assuming it does is a poor foundation for getting to do something that you will actually enjoy.
 
Sorry, but Emergency Medicine fits that bill. Super fun.
 
OrthoTraumaMD said:
That’s a shocker....not. Obgyn is full of these angry bitter women. I hear the same stories from multiple people. They need to do something about their reputation , or no one will want to get into the field, especially with the malpractice insurance...


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Obgyn residents are the most intense group of people I have ever met in my life...
 
Ibn Alnafis MD said:
I agree with this.

I like radiology a lot and even considered it strongly, but I must say that it's extremely repetitive. It's true that the cases are very diverse, but the actual job (pulling up an image and dictating the findings) is very, very routine.

Any specialty that has a good mix of everything (inpatient, outpatient, procedures, consultations, young pts, old pts) fits the bill. Examples I can think of: Ophthalmology, OB/GYN, Urology, ENT, Ortho, Plastic, GI, and Derm.
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GI is amazing, but it can get pretty routine too at least as a resident/fellow getting consulted for a non-urgent GI bleed for the 10th time in a day.
 
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Lots of interesting answers, but as a Trauma surgeon I'll weigh in -- Trauma surgery becomes just another job, like all of the other specialties. At some point you can have the "coolest" trauma case on earth and it becomes routine. Not to say it's not fun (I enjoy my job!) but a GSW to the chest is now just one of a thousand that I've taken care of.

Here's a slightly different answer if you are trying to avoid monotony: Go into academia. My Trauma job is fun mainly because it's only one of the 5 other things that I get to do on a week to week basis. Some days I'm a trauma surgeon, other days an elective general surgeon (I keep my own practice on the side), many days an administrator, and I try to be a scientist when I can. You can pick any specialty you like -- just diversify your career enough that it fits whatever works for you. My wife is an MFM and her day to day is clinic, and she likes the stability of knowing that most days she'll just go to clinic and come home. Similarly, she loves her job for that reason.
 
I think oncology (Surg/Med/Rad) is something to consider. Each patient becomes their own story which usually very uniquely differentiates them from other patients (even those with the same diagnosis).

If you're looking for the thrill of unique diagnosis, then maybe not. But the use of unique treatment for individual patients? Pretty cool to me. Of course you have to be into the oncology in general.
 
evilbooyaa said:
I think oncology (Surg/Med/Rad) is something to consider. Each patient becomes their own story which usually very uniquely differentiates them from other patients (even those with the same diagnosis).

If you're looking for the thrill of unique diagnosis, then maybe not. But the use of unique treatment for individual patients? Pretty cool to me. Of course you have to be into the oncology in general.
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If you're going that route, it's even more true for psych. Every patient has their own story, and while they're the same diagnoses, the history is often very different. It's especially true for psychosis. At one point I had 3 patients as a med student who were all inpatient for acute psychotic episodes and were all really different.

One was having visual hallucinations and seeing random animals like rhinos and hippos walking through the unit. One of them had delusions that she was being hunted by an ex-DEA agent who would hide in her house and had killed multiple family members of hers. She'd use the same name for the guy every time and claim that he was waiting outside the hospital to kill her when she d/c'd. The third person seemed *almost* normal, but if you really started asking questions you'd find out they were totally delusional and that he was receiving telepathic messages from Beyonce who was apparently living in Michigan and bringing Motown back.

So there is plenty of variety from patient to patient, which is what I love about the field. It is a lot of the same process in similar environments though, which I think would potentially get boring for people looking for a lot of variety.
 
The reason you're seeing so many different answers is because "routine" means different things to different people. To me, variety of settings and types of visits (mix of clinic visits and procedures) is what prevents monotony. The fields that I worked in as a medical student that come to mind are those that mix a hefty amount of clinic and surgery: ophtho, ENT, derm, but you can see a good mix in many surgical fields. I'd lean towards surgical fields as being the least routine, but you have to be comfortable with the bread and butter of a field when you select it.

Edit - just saw this:

Kakarrott said:
This is exactly what I would like. Whenever I think of a routine I imagine an ENT doctor I used to come as a child who was able to diagnose my illnesses just by looking at the date, my ear or the fact that I was a fifth child in a row with the same diagnoses. I would be dead bored by looking at someone being the fifth one in a row with the same thing.

Of course, a combination of procedures and clinic would be a nice perk, but I would rather do just one of those with a wide variety than to swop between the same procedures and patients (diagnoses) every other day.

Also if the field I am looking for is a good field to also do a Research. That would be a great plus.
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I think the setting you choose is more important than the field. If you choose to work at a big academic tertiary care center, you're more likely to engage in research and more likely to see zebras and diagnostic dilemmas, engage in interspecialty meetings/boards to discuss complex cases, etc. Hem-onc comes to mind. I've always found ICU medicine to be the opposite of monotonous.
 
Stagg737 said:
One of them had delusions that she was being hunted by an ex-DEA agent who would hide in her house and had killed multiple family members of hers. She'd use the same name for the guy every time and claim that he was waiting outside the hospital to kill her when she d/c'd.
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You know what’s funny, I remember a patient on the psych wards when I was a medical student who claimed his family was trying to destroy his livelihood. After speaking with several of his previous doctors… Turns out that it was actually true. He also had other psychiatric issues, but he was actually right about that one and it wasn’t a delusion. Which makes me wonder about all these people who claim someone is following them… Some of them are probably right lol...


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Every field has its bread and butter as has been stated. To me it’s general medicine or critical care - broad differentials, wide variety of pathology and acuity, not limited to any particular organ system, you can look at films and slides but it’s not all you do and it’s relevant to your patient when you do. Keeps my brain satisfied.
 
OrthoTraumaMD said:
You know what’s funny, I remember a patient on the psych wards when I was a medical student who claimed his family was trying to destroy his livelihood. After speaking with several of his previous doctors… Turns out that it was actually true. He also had other psychiatric issues, but he was actually right about that one and it wasn’t a delusion. Which makes me wonder about all these people who claim someone is following them… Some of them are probably right lol...


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I've had two of those as well. Had one antisocial PD guy who was supposedly a big-shot in his field who said he won an international award and a bunch of other stuff. After googling him turns out it was true, but he was an expert of mixing in just the right lies with truths. Ended up catching him in one lie that was pretty huge and changed his entire treatment course. My proudest moment thus far on the forensics side of things, lol. I also had a lady who said she had "invented" a certain breed of pet and made millions off of it then just gave all her money away. We were all thinking holy crap this lady is delusional (she was coming down from mania). Turns out everything she told us was true. Now whenever someone makes a seemingly outrageous claim I always run a quick google search on them/their claim to see if it checks out. It's pretty surprising the kind of accomplishments some of those patients have.
 
Stagg737 said:
I've had two of those as well. Had one antisocial PD guy who was supposedly a big-shot in his field who said he won an international award and a bunch of other stuff. After googling him turns out it was true, but he was an expert of mixing in just the right lies with truths. Ended up catching him in one lie that was pretty huge and changed his entire treatment course. My proudest moment thus far on the forensics side of things, lol. I also had a lady who said she had "invented" a certain breed of pet and made millions off of it then just gave all her money away. We were all thinking holy crap this lady is delusional (she was coming down from mania). Turns out everything she told us was true. Now whenever someone makes a seemingly outrageous claim I always run a quick google search on them/their claim to see if it checks out. It's pretty surprising the kind of accomplishments some of those patients have.
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And yet when I called up the White House for a DNA sample because I had the n'th patient on the ward claiming to be pregnant with Obama's baby...
 
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