Which specialty allows you to have a more balanced life?

[Ost3oclast]

I'm curious as to what people think about neurology? I don't start rotations until May but I'm really considering neuro and the people I've seen in the specialty dont seem too miserable

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[e30ftw]

ok so as a med student looking for a good lifestyle field I would split specialties into two categories: hospital based and outpatient based.

hospital based are fields where you will be taking care of critically ill patients. You will give orders to nurses that cause people to stop breathing, you will have bad outcomes and have to discuss with family. You will take people's lives in your hand emergently and attempt to create order from the natural chaos of the world. GS, NSGY, anesthesia, EM, cardiology, GI, OB, ortho etc.

Most of these fields have a pretty crappy lifestyle except EM and anesthesia. But you get the self satisfaction of saving lives here and there and being good at critical patients. plus the hospital has all kinds of cool toys.

Outpatient fields are those that don't really do procedures or anything that involves emergencies. Sure they may identify a 66 y/o with chest pain as someone who they probably shouldn't keep in clinic long but ultimately their ace card is "Send to the ER." "Oh my 25 y/o schizophrenic patient is off his meds and suicidal? Send him to the ER" "Oh, your neonate has a fever? Go to the ER"

etc.

these are fields like psych, outpt FM, peds, pmnr, dermatology, pathology. these can all be great lifestyle fields.

then you have some outliers like urology/ent/ophtho who rarely deal with emergencies and primarily do outpatient work with scheduled surgery but still take ER call. Of course not all subspecialists take ER call. These fields are pretty awesome for people who want to be really good at something, have a good lifestyle, make tons of money, and don't mind the occasional 2am phone call.

Far and away the fields that allow you to have a balanced life are the outpatient fields. The problem is they generally don't reimburse as well and for some people they just seem a bit dull.. but any of these outpatient specialties can be arranged to give you a balanced lifestyle.

I'm in EM and love it. great coworkers, interesting and challenging/rewarding work, short residency, pay is very competitive and I've always had a shift-work mindset so it doesn't bother me. typically > 1/2 the month is off but I do work weekends which just means more free random tuesdays to go do something while everyone else is working.

 

[e30ftw]

I'm curious as to what people think about neurology? I don't start rotations until May but I'm really considering neuro and the people I've seen in the specialty dont seem too miserable

depends what type of neuro.

you can be a stroke neurologist and respond to "code strokes" and primarily take hospital call and work as an inpatient. But you still don't really get to do cool procedures and everything "emergent" gets handled by the ED doc, interventional radiology, vascular surgery, neurosurgery, etc. plus there still really isn't anything beneficial for acute stroke aside from long rehab and prevention.

or you can do outpatient neuro and deal with and endless stream of pseudoseizures, conversion disorder, "my PMD sent me because my hand goes numb intermittently x 10 years", noncompliant seizure patients, etc etc all of whom you can't really do anything about.

very easy to have a decent lifestyle in outpatient neuro but the pay isn't too great and this is just my opinion but it sounds miserable...

 

[charmiedermie]

You think that sounds hard?

Arrive at 6:30, catered breakfast during teaching conference, hour for lunch, done by 5:30 (at the latest). Have to take call once during the entire month (which only goes to 11:00 pm), have to work 20 days out of the month (i.e. 1 in 3 days off)

I was more referring have to come in by 6:20 and then conferences from 6:30 to 7:00/6:45-7:45. I didn't the part till now of only having to be in the dept for 20 days. That's different to say the least.

 

[charmiedermie]

It really sounds like you don't really want to work very much at this whole doctor thing. Maybe I'm wrong, but it seems like you want to take the quick and easy way to a big paycheck...

If big paycheck was a concern, there would be no way I would be willing to act as a derm midlevel forever, if I went unmatched, in the Alternatives thread. So no, you are not correct.

 

[ThoracicGuy]

If big paycheck was a concern, there would be no way I would be willing to act as a derm midlevel forever, if I went unmatched, in the Alternatives thread. So no, you are not correct.

There's no reason you should want to be a derm midlevel forever either... You're blinding yourself.

But you said that those hours at Michigan was just so darn hard. They really aren't too bad at all, especially for training. But then they aren't the cush derm hours either. That's why it suggests that you don't really want to work hard, at least to me. Maybe it'd be better said that you want a quick and easy way to a paycheck, not necessarily a big one.

 

[charmiedermie]

There's no reason you should want to be a derm midlevel forever either... You're blinding yourself.

But you said that those hours at Michigan was just so darn hard. They really aren't too bad at all, especially for training. But then they aren't the cush derm hours either. That's why it suggests that you don't really want to work hard, at least to me. Maybe it'd be better said that you want a quick and easy way to a paycheck, not necessarily a big one.

If I were to go unmatched. Like I said, I hated the other specialties and the one I would be semi-ok with, I'd have to go thru a difficult IM residency and compete all over again, just for a maybe.

I said it seemed hard bc 6:20 is quite early for a supposed ROAD specialty.

Well this thread is about balanced life/lifestyle specialties, so I guess everyone in those specialties fits that criteria, in terms of easy way to a paycheck, in your eyes.

 

[e30ftw]

if you don't want to wake up before seven you probably should either do psych or not anything in healthcare.

RNs wake up at 6...

 

[charmiedermie]

6:30 is not early for any hospital based specialty

Being at the hospital at 6:20, which means waking up an hour before to get there at 6:20. Also, I'm talking about Anesthesiology which is thought to be a good lifestyle/ROAD specialty. I'm sure there are some Anesthesia programs that have you come by 7:30 or 8:00. Or 7.

 

[VisionaryTics]

Being at the hospital at 6:20, which means waking up an hour before to get there at 6:20. Also, I'm talking about Anesthesiology which is thought to be a good lifestyle/ROAD specialty. I'm sure there are some Anesthesia programd programs that have you come by 7:30 or 8:00.

oh dear lord

 

[e30ftw]

I'm sure there are some Anesthesia programs that have you come by 7:30 or 8:00.

I'm not in anesthesia but I truly doubt there are any anesthesia programs where you can routinely arrive in the hospital at 0800.

Why?

OR is the cash cow of the hospital. The more surgeries they can fit in a day the more $$$ the CEO gets to take home.

So the pretty much universal start time for ORs is 0700. Which means anesthesia needs to be there at least 30 min prior to set up the room, preop the patient, set up their coffee/ipad etc

 

[charmiedermie]

I'm not in anesthesia but I truly doubt there are any anesthesia programs where you can routinely arrive in the hospital at 0800.

Why?

OR is the cash cow of the hospital. The more surgeries they can fit in a day the more $$$ the CEO gets to take home.

So the pretty much universal start time for ORs is 0700. Which means anesthesia needs to be there at least 30 min prior to set up the room, preop the patient, set up their coffee/ipad etc

So then why is Anesthesiology held as an easy lifestyle [ROAD] specialty? Doesn't seem to be easy if you're going from 6:30 to God knows what time.

 

[charmiedermie]

oh dear lord

Or 7:00 AM.

 

[charmiedermie]

Did you do any med school rotations? These are questions I would expect a premed to ask, not someone about to match.

I did not rotate in Anesthesiology.

 

[e30ftw]

So then why is Anesthesiology held as an easy lifestyle [ROAD] specialty? Doesn't seem to be easy if you're going from 6:30 to God knows what time.

Because people who are normal tax-paying adults don't consider having to wake up at 0545 to be a big deal if you're done by 1400 and make 4-500k/yr.

 

[VisionaryTics]

I did not rotate in Anesthesiology.

You were required to rotate in surgery. I assume you noticed that the cases tended to start ~7:30am?

 

[charmiedermie]

Because people who are normal tax-paying adults don't consider having to wake up at 0545 to be a big deal if you're done by 1400 and make 4-500k/yr.

Ok, so then its bc of the 400-500k salary. Most anesthesiologists probably don't just work till 2:00 pm, though. That would be a great deal.

 

[ChEMD]

So then why is Anesthesiology held as an easy lifestyle [ROAD] specialty? Doesn't seem to be easy if you're going from 6:30 to God knows what time.

I can't believe someone is actually complaining about being at work by 6:30. We're not in college anymore, grown ups wake up early and go to work.

 

[Frazier]

I guess it would be "lifestyle" friendly because the hours are incredibly cush, but it just gives you more time to go home and be depressed, IMO.

A week into my psych rotation, I knew it wasn't for me. EXTREMELY depressing and demoralizing patient population, and no, there really is no comparison to any other field.

Maybe if you're aiming to do purely outpatient psych for adolescents or wealthy soccer moms, psych might be alright. But if you're going to do adult or inpatient, better get on a prophylactic SSRI just to get through the day.

Can't argue with your experience. If your psych rotation made you extremely depressed and made you see potential in a prophylactic SSRI just to get through the day -- so be it -- can't argue with it (and there's absolutely nothing wrong with you having the foresight to realize it is a terrible field for you). However, fortunately, that is your experience (and, granted, many more people like you) -- but far from everyone. Far from a universal truth.

Not everyone finds it depressing. Pretty sure psychiatrists always rate super high on physician satisfaction surveys

It's obviously not for everyone, but some of us really like that patient population.

Fact. It has been pretty longitudinal over the years. It is clear there is some selection going on among the practitioners. Even more than the surveys -- SDN subforums tell the same tale. It is one of the most (if not most) positive subforums on the entire site. Coincidence? Either psychiatrists actually enjoy their job relative to most other specialties in medicine, or maybe they are all on those prophylactic SSRI's.

Data:

 

[famoussquamous]

I can't believe someone is actually complaining about being at work by 6:30. We're not in college anymore, grown ups wake up early and go to work.

I remember having to wake up at 5:30 in high school to catch the bus in the morning. I don't think I've gotten up that early since.

 

[compstomper]

Depends on what your definition of balanced home/work life is.
There are specialties w/ relatively good hrs and relatively low monetary compensation (Some but not all Psych)
There are specialties w/ relatively good hrs and good monetary compensation; the ideal, if you will. (Derm)
But then there are also specialties w/ bad hours and good/great compensation. (Neurosurgery as the extreme)

To some, compensation figures greatly into the definition of home/work life quality. So for most people, it's a tradeoff between one or the other, as there's way more people who wants to go into specialties like derm than there are actual spots (like med school app all over again).

 

[Slack3r]

Being at the hospital at 6:20, which means waking up an hour before to get there at 6:20. Also, I'm talking about Anesthesiology which is thought to be a good lifestyle/ROAD specialty. I'm sure there are some Anesthesia programs that have you come by 7:30 or 8:00. Or 7.

Every hospital I've ever been in usually starts their first cases at 7 or 730 (sometimes even earlier). So I doubt the anesthesiologist is showing up at/after they're wheeling the first case back...

 

[Psai]

So then why is Anesthesiology held as an easy lifestyle [ROAD] specialty? Doesn't seem to be easy if you're going from 6:30 to God knows what time.

If you don't know what you're talking about, it's probably not a good idea to be sharing your opinion with people who do know what they're talking about

 

[charmiedermie]

If you don't know what you're talking about, it's probably not a good idea to be sharing your opinion with people who do know what they're talking about

I didn't say that I necessarily held that belief of Anesthesiology being an easy lifestyle specialty. Just that it is common to think that it is. It may not be if you're going from 6:30 am to 7:30/8:30 pm as a resident. You should follow your own advice.

 

[ThoracicGuy]

I didn't say that I necessarily held that belief of Anesthesiology being an easy lifestyle specialty. Just that it is common to think that it is. It may not be if you're going from 6:30 am to 7:30/8:30 pm as a resident. You should follow your own advice.

Do you know any anesthesiologists that stay that long each day? I don't. I don't think that @Psai probably does. I would bet that if you had paid attention to anesthesia staff during your surgery rotations you would be better able to answer some of these questions...

 

[famoussquamous]

When you say "easy" lifestyle, you have to keep in mind what the comparison is to. If we're using the baseline of "easy" or "cush" as a doctor that doesn't have to work 80 hours a week and take call every other weekend, or are we talking about someone that only works 3 1/2 days a week and takes no call.

 

[jw3600]

I didn't say that I necessarily held that belief of Anesthesiology being an easy lifestyle specialty. Just that it is common to think that it is. It may not be if you're going from 6:30 am to 7:30/8:30 pm as a resident. You should follow your own advice.

Dude. Every time I see you in a thread you are arguing with people. The majority of your time, your opinion is the minority (and usually just factually incorrect). You never seem to present a logical, thought-out argument and there is always a myriad of posters poking holes in your piles of posts. You also have > 400 posts in less than 2 months. Reconsider the value of your internet time. Right now it's biblically low.

 

[charmiedermie]

Dude. Every time I see you in a thread you are arguing with people. The majority of your time, your opinion is the minority (and usually just factually incorrect). You never seem to present a logical, thought-out argument and there is always a myriad of posters poking holes in your piles of posts. You also have > 400 posts in less than 2 months. Reconsider the value of your internet time. Right now it's biblically low.

Who is arguing? I didn't say I knew everything about Anesthesiology. It was mentioned as a ROAD lifestyle specialty.

I'm waiting for the match, no more med school requirements, and I'm usually on the Derm forum and the Derm Google Doc. I'm not arguing with anyone. The other thread on MDs as alternative midlevels was referring to my personal situation of if I were to be unmatched. I wasn't arguing there.

So chill.

 

[calvnandhobbs68]

So then why is Anesthesiology held as an easy lifestyle [ROAD] specialty? Doesn't seem to be easy if you're going from 6:30 to God knows what time.

what

Not only medicine but like almost every other professional job anyone else does has people getting up before or at 6:00am.

 

[KinasePro]

"Cush" isn't the word I'd use to describe EM docs. Yes, it is cool to only work a few shifts a week. On the other hand, when you're constantly changing your sleep cycle to work overnight for three days, followed by a day shift for two days, then another two days of overnights, it's not exactly "cush" in my book. Also, weekends and holidays don't exist, so unless you marry someone with similar schedule constraints, you could weeks without the same day off as your spouse.

Just my opinion and I'm sure people will disagree, but I think being a hospitalist in IM is more cush than being an ED doc.

Regarding psych: it's certainly not for everyone. Frankly, I don't find it depressing. The patient population can be very sick, yes, but that can be said for many fields.

I'll agree that hospital medicine is more cush. I think hospitalists have a great gig.

But all jobs in medicine are difficult and require ass busting at inopportune times. When you look at all the available gigs in medicine, the lifestyle in EM is clearly one of the better ones. Yeah, the unusual shifts are a drawback, but don't throw out the baby with the bathwater. It's still sweet.

You're right, never mind the multiple studies showing it has one of the highest burn out rates of any specialty in medicine. It's just SDN complainers.

There's plenty of theories why this is the case, but IMO it's not because of the lifestyle. By your same logic, the incredibly low burn out rate of CT surgeons means they have a fabulous lifestyle, right? I think the actual explanation is that different training pathways foster resiliency more than others.

 

[KinasePro]

Only ppl that have no idea what EM is like say EM is uber cush

Tell me more, MS-0, about your vast experience in EM and how it invalidates any opinions contrary to your own.

 

[KinasePro]

I think it's that a large number of people choose EM specifically for the lifestyle. So they have a lower level of engagement at baseline and are more likely to be disengaged and disappointed with what the realities of the field look like.

No one goes into CT thinking it will be Cush. They are less likely to be unpleasantly surprised by their lifestyle.

Agreed. I definitely think self selection and also unrealistic expectations contribute substantially to the burnout.

 

[drkristy85]

So then why is Anesthesiology held as an easy lifestyle [ROAD] specialty? Doesn't seem to be easy if you're going from 6:30 to God knows what time.

you start early, but often get to leave early if there aren't too many cases. Besides, if you've ever been in the OR during a case, anesthesia is usually chilling out, texting and Facebooking during the case.....of course, if there are issues during the case, you deal with those, but most of the time, it's pretty laid back...you're not scrubbed/sterile so you can watch movies on your iPad and just chill

 

[drkristy85]

Because people who are normal tax-paying adults don't consider having to wake up at 0545 to be a big deal if you're done by 1400 and make 4-500k/yr.

ok some of us would sacrifice some of that pay in return for getting to wake up later....not all docs wake up at 0500 am and that's also not when most "tax paying" adults wake up for work. some do, but many folks wake up at 8 and are at work by 9. also, i would rather start later and be done later (ie 9-5). but other people are "morning ppl" and they would prefer 6-2.

on my OBGYN rotation, my attending started her outpt clinic at 1000 everyday. pretty sweet

 

[s5260205]

depends what type of neuro.

you can be a stroke neurologist and respond to "code strokes" and primarily take hospital call and work as an inpatient. But you still don't really get to do cool procedures and everything "emergent" gets handled by the ED doc, interventional radiology, vascular surgery, neurosurgery, etc. plus there still really isn't anything beneficial for acute stroke aside from long rehab and prevention.

or you can do outpatient neuro and deal with and endless stream of pseudoseizures, conversion disorder, "my PMD sent me because my hand goes numb intermittently x 10 years", noncompliant seizure patients, etc etc all of whom you can't really do anything about.

very easy to have a decent lifestyle in outpatient neuro but the pay isn't too great and this is just my opinion but it sounds miserable...

That sounds super depressing...

 

[Wordead]

Why is everyone who wants to do EM so angry when people call it a lifestyle specialty? Such a chip on their shoulders..

 

[Mass Effect]

I'll agree that hospital medicine is more cush. I think hospitalists have a great gig.

But all jobs in medicine are difficult and require ass busting at inopportune times. When you look at all the available gigs in medicine, the lifestyle in EM is clearly one of the better ones. Yeah, the unusual shifts are a drawback, but don't throw out the baby with the bathwater. It's still sweet..

Let's chat again after you have some actual experience. It's only "clearly one of the better ones" to those who want that sort of lifestyle. To me, it's one of the worst ones.

Also, just curious, if the shifts are the drawback, then what exactly makes it so "sweet"?

 

[Mass Effect]

Why is everyone who wants to do EM so angry when people call it a lifestyle specialty? Such a chip on their shoulders..

Wow, talk about totally misunderstanding the thread.

 

[link2swim06]

Why is everyone who wants to do EM so angry when people call it a lifestyle specialty? Such a chip on their shoulders..

Because it's not. The random work schedule and volume during shifts makes it less rosy than it sounds.

 

[LostinLift]

Because it's not. The random work schedule and volume during shifts makes it less rosy than it sounds.

Different strokes. I enjoyed not working on the same schedule every week when I scribed in the ED. I can't comment on how the volume felt aside from doing most of the paperwork. Some docs are just so inefficient with computers. One computer savvy doc didn't use a scribe and was usually finished within 30 minutes of a shift... Although he was probably the angriest doctor there haha.

 

[Wordead]

Because it's not. The random work schedule and volume during shifts makes it less rosy than it sounds.

I didnt say it was rosy; I did a month of ER at a crazy county hospital.

I just find it amusing how up in arms people get. People call ENT a lifestyle specialty too. Who cares? I dont feel a need to defend it.

 

[link2swim06]

Different strokes. I enjoyed not working on the same schedule every week when I scribed in the ED. I can't comment on how the volume felt aside from doing most of the paperwork. Some docs are just so inefficient with computers. One computer savvy doc didn't use a scribe and was usually finished within 30 minutes of a shift... Although he was probably the angriest doctor there haha.

That's fine for now. But you are planning for your entire career. Do you want to spend your 40s and 50s working random shifts throughout the week if you have a family.

EM has tons of upsides but it doesn't really mesh with a 'lifestyle specialty.'

The volume simply makes the hours deceptive. There is far less down time (if any) during your shift. Hence it tires you out faster than say being an anesthesiologist staring at a monitor for over half of your day.

I didnt say it was rosy; I did a month of ER at a crazy county hospital.

I just find it amusing how up in arms people get. People call ENT a lifestyle specialty too. Who cares? I dont feel a need to defend it.

Not defending, just try to stop people from matching into EM for the 'lifestyle' and then become disillusioned later on.

 

[Wordead]

That's fine for now. But you are planning for your entire career. Do you want to spend your 40s and 50s working random shifts throughout the week if you have a family.

EM has tons of upsides but it doesn't really mesh with a 'lifestyle specialty.'

The volume simply makes the hours deceptive. There is far less down time (if any) during your shift. Hence it tires you out faster than say being an anesthesiologist staring at a monitor for over half of your day.



Not defending, just try to stop people from matching into EM for the 'lifestyle' and then become disillusioned later on.

They wont believe you on the internet anyway. They'll figure it out during their aways/subIs. Same way a ton of people switch out of ENT after a subI.

EM though is just a lot more rabid about convincing people that their 40 hours a week is deceptively tough than everyone else, which I dont understand. Anesthesia doesnt. Ophtho doesnt. I just wonder what causes this phenomenon.

 

[famoussquamous]

Why is everyone who wants to do EM so angry when people call it a lifestyle specialty? Such a chip on their shoulders..

Because it being a "lifestyle" specialty makes it more competitive to match into.

 

[JimmyB123]

Tell me more, MS-0, about your vast experience in EM and how it invalidates any opinions contrary to your own.

5-6 years of experience working in the ER is really nothing huh? People come from all paths of life, bud. But I'm sure you already knew that.

 

[Stagg737]

I think the shift thing really depends on the physician. I understand many people don't want to work odd shifts, but I met plenty of ER physicians that were perfectly content to do so. I think the dissatisfaction in the field probably comes less from the lifestyle and more from the patient population and cases. I imagine working with pissy patients consistently day in and day out would begin to take its toll relatively quickly. Not to mention that many patients use ERs like their free family physician. I heard far more complaints when working there about those issues than about having to work odd shifts.

 

[Ost3oclast]

depends what type of neuro.

you can be a stroke neurologist and respond to "code strokes" and primarily take hospital call and work as an inpatient. But you still don't really get to do cool procedures and everything "emergent" gets handled by the ED doc, interventional radiology, vascular surgery, neurosurgery, etc. plus there still really isn't anything beneficial for acute stroke aside from long rehab and prevention.

or you can do outpatient neuro and deal with and endless stream of pseudoseizures, conversion disorder, "my PMD sent me because my hand goes numb intermittently x 10 years", noncompliant seizure patients, etc etc all of whom you can't really do anything about.

very easy to have a decent lifestyle in outpatient neuro but the pay isn't too great and this is just my opinion but it sounds miserable...

Yeah I would be looking at outpatient neuro but wouldnt mind a mix of inpatient if it would be possible. Thanks for your input!

 

[KinasePro]

Let's chat again after you have some actual experience. It's only "clearly one of the better ones" to those who want that sort of lifestyle. To me, it's one of the worst ones.

Also, just curious, if the shifts are the drawback, then what exactly makes it so "sweet"?

One month of actual experience as an M4 is plenty for me to make a judgement on the field's lifestyle. I wasn't in some sleepy small town ER, it was a major urban level 1. Still not seeing why everyone is so soggy about the lifestyle. 35-40 hours a week in discrete shifts is pretty sweet for any job in medicine, regardless of the shift timing.

 

[drkristy85]

Really? wow. I'm not in Anesthesia, but I can't tell you how many Anesthesiologists I saw Facebooking mid-case during my Anesthesia rotation in med school....crazy

 

[drkristy85]

I guess it makes sense....Facebook does have a Time Stamp so you could easily prove the timing of the post....thats a bummer