Which specialty in medicine provides the most opportunity to do logical, deductive puzzle-solving?

[deleted781806]

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...the "DEEP satisfaction" you get from relieving/treating a certain symptom for the n-millionth time is really the only thing that gets doctors through the day after a while?

Yeah, having a lasting impact and making a difference in a patient's life is just so *boring* after awhile. Why is this concept so foreign to you? Also please do not lump everyone here into a mythical group where "decent compensation and job security" are the most pertinent factors for choosing a profession for every one of us, come on now, it's much more nuanced than that.

 

[moggat]

Not getting into the argument above, because reasonable points all around, but Genetics has a fair amount of "problem solving" components, especially when it comes to the bajillion storage, metabolic, and mitochondrial diseases. Most of the time you have to put together a bunch of symptoms to figure out which diseases are the most likely, so you can sequence for them. Of course once you figure out the problem, 99% of the time you cant DO anything about it, but that's a different issue.

 

[deleted363248]

Yeah, having a lasting impact and making a difference in a patient's life is just so *boring* after awhile. Why is this concept so foreign to you? Also please do not lump everyone here into a mythical group where "decent compensation and job security" are the most pertinent factors for choosing a profession for every one of us, come on now, it's much more nuanced than that.

FFS chief, I never said those were the MOST pertinent factors, but they are definitely important factors/considerations to everyone who chooses medicine, even though some folks would rather face a firing squad than admit it. You know it and so do I.

 

[redsox93]

Not really, they're more of an advanced triage team for most cases. They may do some diagnosis, but they don't usually get the final say (unless they're not admitting them) and on the major cases they just stabilize the patient and send them off to the specialists. They also don't follow-up with patients, so if you're really curious about what a patient's outcome or diagnosis was, you've got to track down whoever you referred them to on your own time. It's a lot less actual diagnosis than most pre-meds think it is.



That actually sounds about right. You'll get a zebra or some crazy case every once in a while, but it becomes a lot of the same thing over and over again. Sure, some are more intellectually stimulating, but there are other careers that involved A LOT more actual problem solving than medicine. The big gratification most of us get is not from "solving the puzzle", it's from knowing that we're actually making a difference in a patient's life, even if it is something we've done a million times before.

Well they are making differentials on each patient, right? And then using lab results and imaging to rule out/in these differentials. That kinda sounds up the alley of problem solving that OP is looking for.

EDIT: probably no real "zebra cases" or "crossing diagnoses off of whiteboards" though

 

[Lucca]

OP you should read through some of @circulus vitios ' posting history. While it is true that medicine is a stable, financially rewarding career, those elements are not sufficient for sustaining someone through the career. You said it yourself in the OP, it's not worth it if you don't like what you do. And it doesn't sound like you want to take care of patients. Maybe you could still have a fantastic career in medicine, but seeing as you are already accepted, I would definitely run your priorities by physicians in positions you think you would like to have and see what they have to say.

 

[deleted363248]

OP you should read through some of @circulus vitios ' posting history. While it is true that medicine is a stable, financially rewarding career, those elements are not sufficient for sustaining someone through the career. You said it yourself in the OP, it's not worth it if you don't like what you do. And it doesn't sound like you want to take care of patients. Maybe you could still have a fantastic career in medicine, but seeing as you are already accepted, I would definitely run your priorities by physicians in positions you think you would like to have and see what they have to say.

So, by your rationale, Radiologists and Pathologists (who are rarely involved in patient care) got into medicine for the entirely wrong reasons and most of them probably struggle to drag themselves out of the bed in the morning to go to work?

 

[deleted781806]

FFS chief, I never said those were the MOST pertinent factors, but they are definitely important factors to everyone who chooses medicine, even though some folks would rather face a firing squad than admit it. You know it and so do I.

If I wanted to get into a career where money and stability were my major factors, I would have become one of the dime-a-dozen business students who are going to hit six figures next year upon graduation. We choose professions because they're personally fulfilling for us and that we enjoy the work that goes along with them. I'd put myself through all this trouble if it could mean that I could just make enough for rent and food each month. Don't drag everyone down to the same motivations because it helps fit a narrative. In addition, your rads and path boogeymen who abhor patient contact are also not truly representative of the field, as already stated above by various physicians and faculty. Sure, they exist and they're out there, but it's not intrinsic to the field as a whole. (Also, don't call me chief)

 

[Lucca]

So, by your rationale, Radiologists and Pathologists got into medicine for the entirely wrong reasons and most of them probably struggle to drag themselves out of the bed in the morning to go to work?

No, lol, I do not think anything of the sort. I think most (satisfied) doctors go into medicine (at least initially) because they want to see patients. Rads + Path people probably really enjoyed the opportunities and work that those specialties offered them, and might have even discovered that they were not cut out for other specialties. I also think you are over-estimating the intellectual aspects of day-to-day clinical medicine and under-estimating what it means to enter a service profession.

Seriously, read CVs posts. He also thought everyone going into medicine was just drinking the kool-aid and that no one could possibly actually care about studying their days away in the 10-year training treadmill that is medicine more than they valued the dolce vita the profession afforded those who made it to the other side. He quit medical school and is apparently much happier in a different career he finds more interesting and amenable to his priorities.

I'm not saying you are exactly like him and therefore should not enroll in medical school. Way too strong a statement to make to a stranger who you only know from a few posts on the internet, and, again, I'm not trying to put words in your mouth or make decisions for you.

I'm just saying: think about it, dude.

 

[tessellations]

So, by your rationale, Radiologists and Pathologists (who are rarely involved in patient care) got into medicine for the entirely wrong reasons and most of them probably struggle to drag themselves out of the bed in the morning to go to work?

Many of these people probably came into medical school before deciding on what speciality they wanted, so this doesn't really hold, to be honest.

Edit: Lucca beat me to it, you wiley mod 😉

 

[deleted363248]

If I wanted to get into a career where money and stability were my major factors, I would have become one of the dime-a-dozen business students who are going to hit six figures next year upon graduation. We choose professions because they're personally fulfilling for us and that we enjoy the work that goes along with them. I'd put myself through all this trouble if it could mean that I could just make enough for rent and food each month. Don't drag everyone down to the same motivations because it helps fit a narrative. In addition, rads and path boogeymen who abhor patient contact are also not truly representative of the field, as already stated above by various physicians and faculty. Sure, they exist and they're out there, but it's not intrinsic to the field as a whole. (Also, don't call me chief)

Boogymen? Wow. How flattering. Guess now starts your rant about how they're not "REAL DOCTORS" anyway......smh.

 

[TXMED_1695]

You said, "a speciality that would let me do what Dr. House does". Sorry to tell you that speciality does not exist. Go work 3 consecutive 12 hour shifts, it will help you to see what the medical field is really like.

Aaaaaaaaaactually TXMED, from what I've gathered from talking to the doctors that I know, building up the profession of medicine in your mind as some "noble higher calling" as opposed to a stable, secure, interesting, and well-compensated job is WAY more naive than anything I could post about House (which was in jest for chrissakes).

 

[deleted781806]

Boogymen? Wow. How flattering. Guess now starts your rant about how they're not "REAL DOCTORS" anyway......smh.

Where did I ever begin to say or imply this? Per previous postings from physicians and faculty, the way you are making rads and paths out to be is not necessarily true. Like I said, there are definitely people out there that fit the "I just like mental work and don't want patient contact" mold, but it's not representative of the field as a whole. You're making a lot of assumptions about the medical field and they're not necessarily true or well-founded in reality.

*Edit*: For clarification, I used the term "boogeymen" to refer to an oversimplified version of what rads and path are actually like, the version that you are currently trumpeting. I did not mean it to refer to radiologists and pathologists in general.

 

[deleted363248]

If I wanted to get into a career where money and stability were my major factors, I would have become one of the dime-a-dozen business students who are going to hit six figures next year upon graduation. We choose professions because they're personally fulfilling for us and that we enjoy the work that goes along with them. I'd put myself through all this trouble if it could mean that I could just make enough for rent and food each month. Don't drag everyone down to the same motivations because it helps fit a narrative. In addition, your rads and path boogeymen who abhor patient contact are also not truly representative of the field, as already stated above by various physicians and faculty. Sure, they exist and they're out there, but it's not intrinsic to the field as a whole. (Also, don't call me chief)

Only a very TINY fraction of those freakin' dime-a-dozen business students make anywhere close to a stable six figures in their life, let alone right after graduation. On the other hand, all doctors have guaranteed, at least upper-middle class lifestyles upon finishing residency. Money and job security are DEFINITELY important factors for people who choose medicine, but I never said they were the MOST important. You're putting words in my mouth as usual.

 

[deleted363248]

No, lol, I do not think anything of the sort. I think most (satisfied) doctors go into medicine (at least initially) because they want to see patients. Rads + Path people probably really enjoyed the opportunities and work that those specialties offered them, and might have even discovered that they were not cut out for other specialties. I also think you are over-estimating the intellectual aspects of day-to-day clinical medicine and under-estimating what it means to enter a service profession.

Seriously, read CVs posts. He also thought everyone going into medicine was just drinking the kool-aid and that no one could possibly actually care about studying their days away in the 10-year training treadmill that is medicine more than they valued the dolce vita the profession afforded those who made it to the other side. He quit medical school and is apparently much happier in a different career he finds more interesting and amenable to his priorities.

I'm not saying you are exactly like him and therefore should not enroll in medical school. Way too strong a statement to make to a stranger who you only know from a few posts on the internet, and, again, I'm not trying to put words in your mouth or make decisions for you.

I'm just saying: think about it, dude.

Well said. Fair enough. 🙂

 

[Astra]

lol @ this thread.

 

[cactusman]

lol @ this thread.

I want to get some popcorn but I'm not sure if the thread has enough life left in it to enjoy it.

 

[piii]

There is talk in the IR community that many of their bread and butter cases will be poached by other specialties and the field itself may not exist in 2 decades. I spoke to an IR Doc a few months back in detail regarding this, maybe it was just this one person who was pessimistic. Also DR, AI may reduce the need for the number of DR docs we have, so tread carefully. Plus you need to do 1+4+Fellowship to land a job so might as well do IR and you are still certified to read.

I just went to the SIR conference so that is where I learned all my info but IR isn't going anywhere. It is quite the opposite. IR has been around for decades. It has only grown and in fact just recently was board certified as its own speciality/residency - so there is no reason to think it would trend the other way.. Each year there are great increases in residency spots and programs. Currently people have to apply to both IR, and DR/IR residencies and DR + IR fellowships. The ability to apply only to IR in the future will steadily increase. In fact, it is becoming more of a service speciality and not a technician/consultant speciality. Some IRs are running their own services, rounding on the floors, and following pts long term. It is the wild west of medicine right now, with innovation and no ceiling. It is surgery with better outcomes, minimally invasive procedures, and patients are in and out without long hospital stays. There is a lot of prestige and physicians love you because you solve their problems.

The benefit of IR over other specialities is that you can have one guy that put in kidney catheters, treat cerebral strokes and hemorrhages in trauma and emergencies , treat peripheral vascular disease, treat aneurysms and dissections, ablate tumors and masses, do portal systemic shunts and liver disease, drain abscesses, and hundreds of other things. There are obviously turf battles with vascular (but vascular is also turfing with Interventional cards), but IRs have an upper hand in so many physiological systems. The Vascular Surgeon commenting above is obviously going to have a bias lol.

 

[deleted363248]

Where did I ever begin to say or imply this? Per previous postings from physicians and faculty, the way you are making rads and paths out to be is not necessarily true. Like I said, there are definitely people out there that fit the "I just like mental work and don't want patient contact" mold, but it's not representative of the field as a whole. You're making a lot of assumptions about the medical field and they're not necessarily true or well-founded in reality.

*Edit*: For clarification, I used the term "boogeymen" to refer to an oversimplified version of what rads and path are actually like, the version that you are currently trumpeting. I did not mean it to refer to radiologists and pathologists in general.

Ecureil, the few doctors I know have told me, more than once, that this purported "deep emotional satisfaction" you get from talking to patients and their families repeatedly and treating their very familiar symptoms day in and day out wears thin very, VERY fast. They think patient contact is an extremely overrated aspect of medicine which mostly idealistic premeds and M1s and M2s are enamored with. Are the doctors I know just bitter and disgruntled? I dunno. Maybe. You think I'm naive for overestimating and overrating the intellectual aspects of medicine, and that it's really all about the warm fuzzy emotions that flood your body by "making a difference in patients' lives". Fair enough.

But is it possible, just POSSIBLE, that as a mere medical student (not a doctor) yourself, YOU are vastly overrating how "amazing" and "gratifying" this patient contact thing is? Is it possible that YOU may very quickly fall out of love with it and yearn for a more quiet and cerebral specialty yourself, after spending endless hours rounding and actually SEEING the realities of constant patient care/contact?

 

[cactusman]

Ecureil, the few doctors I know have told me, more than once, that this purported "deep emotional satisfaction" you get from talking to patients and their families repeatedly and treating their very familiar symptoms day in and day out wears thin very, VERY fast. They think patient contact is an extremely overrated aspect of medicine which mostly idealistic premeds and M1s and M2s are enamored with. Are the doctors I know just bitter and disgruntled? I dunno. Maybe. You think I'm naive for overthinking and overrating the intellectual aspects of medicine, and that it's really all about the warm fuzzy emotions that flood you by "making a difference in patients' lives". Fair enough.

But is it possible, just POSSIBLE, that as a mere medical student yourself, YOU are vastly overrating how "amazing" and "gratifying" this supposed patient contact is? Is it possible that YOU may quickly fall out of love with it and yearn for a more cerebral specialty yourself, after spending endless hours rounding and actually SEEING the realities of constant patient care?

So I see two possibilities here.

1. Your cited doctors are, in fact, simply bitter and disgruntled.

2. The doctors you have shadowed are not bitter and disgruntled because they've found miraculous, cerebral specialties which don't emphasize patient care. What are their specialties?

 

[deleted363248]

So I see two possibilities here.

1. Your cited doctors are, in fact, simply bitter and disgruntled.

2. The doctors you have shadowed are not bitter and disgruntled because they've found miraculous, cerebral specialties which don't emphasize patient care. What are their specialties?

One is a Radiologist with a Breast imaging subspecialty(she said she quickly realized patient contact sucked a**), one is a IM hospitalist, one is a family doc. Maybe I should pick some surgeons' brains, who supposedly do all the "exciting, pulse-pounding" stuff right?

And btw, none of them are or even appear to be MISERABLE, they just seem to have no illusions/delusions about what patient care is really like.

 

[cactusman]

One is a Radiologist with a Breast imaging subspecialty(she said she quickly realized patient contact sucked a**), one is a IM hospitalist, one is a family doc. Maybe I should pick some surgeons' brains, who supposedly do all the "exciting, pulse-pounding" stuff right?

Unfortunately, you will need at least 11 more years of training to pick brains.

 

[deleted363248]

Unfortunately, you will need at least 11 more years of training to pick brains.

Lmao. Touche. But no, I think I'd rather flip burgers than be a Neurosurgeon. No offense, just personal preference.

 

[cactusman]

Lmao. Touche. But no, I think I'd rather flip burgers than be a Neurosurgeon. No offense, just personal preference.

On the other hand, neurosurgery is probably one of the most cerebral fields, second only to psychiatry.

 

[deleted363248]

On the other hand, neurosurgery is probably one of the most cerebral fields, second only to psychiatry.

Again, I see what you did there. Well played! LOL.

 

[libertyyne]

I just went to the SIR conference so that is where I learned all my info but IR isn't going anywhere. It is quite the opposite. IR has been around for decades. It has only grown and in fact just recently was board certified as its own speciality/residency - so there is no reason to think it would trend the other way.. Each year there are great increases in residency spots and programs. Currently people have to apply to both IR, and DR/IR residencies and DR + IR fellowships. The ability to apply only to IR in the future will steadily increase. In fact, it is becoming more of a service speciality and not a technician/consultant speciality. Some IRs are running their own services, rounding on the floors, and following pts long term. It is the wild west of medicine right now, with innovation and no ceiling. It is surgery with better outcomes, minimally invasive procedures, and patients are in and out without long hospital stays. There is a lot of prestige and physicians love you because you solve their problems.

The benefit of IR over other specialities is that you can have one guy that put in kidney catheters, treat cerebral strokes and hemorrhages in trauma and emergencies , treat peripheral vascular disease, treat aneurysms and dissections, ablate tumors and masses, do portal systemic shunts and liver disease, drain abscesses, and hundreds of other things. There are obviously turf battles with vascular (but vascular is also turfing with Interventional cards), but IRs have an upper hand in so many physiological systems. The Vascular Surgeon commenting above is obviously going to have a bias lol.

Here is the problem with this thought process, "one guy" mentality is wrong considering you already have the other services for specific cases that only they can provide. You are not going to get rid of an OB GYN or Gen Surg or Vascular Surg for that matter. All of those specialties can literally do most if not all of IR cases "under flouro" after some comically short cme. This is already apparent in some IR groups where they get sent patients that the other specialties dont want to touch because of the patient being high risk, or a headache. Will there be IR doc's sure, but the risk with prospecting in the wild west is that you may be left with a parcel of land with no gold deposits. But I have only interacted with two groups of IR docs so my experience may be the minority of sentiment.

 

[deleted781806]

Ecureil, the few doctors I know have told me, more than once, that this purported "deep emotional satisfaction" you get from talking to patients and their families repeatedly and treating their very familiar symptoms day in and day out wears thin very, VERY fast. They think patient contact is an extremely overrated aspect of medicine which mostly idealistic premeds and M1s and M2s are enamored with. Are the doctors I know just bitter and disgruntled? I dunno. Maybe. You think I'm naive for overthinking and overrating the intellectual aspects of medicine, and that it's really all about the warm fuzzy emotions that flood your body by "making a difference in patients' lives". Fair enough.

But is it possible, just POSSIBLE, that as a mere medical student (not a doctor) yourself, YOU are vastly overrating how "amazing" and "gratifying" this supposed patient contact is? Is it possible that YOU may very quickly fall out of love with it and yearn for a more quiet and cerebral specialty yourself, after spending endless hours rounding and actually SEEING the realities of constant patient care/contact?

We've had very different experiences with current physicians and other practitioners within the medical field. I've never denied that there are physicians that exist who really hate patient contact, but I just don't see it as life-giving as a motivation as others mentioned in this thread. I've mostly interacted with physicians who have emphasized that if you aren't heading into medicine with a service-based mindset, then you're not going to last very long (or will become unhappy). This came from newly-minted docs and docs who have been practicing for almost 40 years. Further clarification, I don't think you are naive for overrating the intellectual aspects of medicine, I think it's rather your underrating mentality towards actual patient contact and treatment.

Also thanks for the final bit that is one of the most "pot calling the kettle black" posts I have ever seen in my entire life. Like, we're both "mere future medical students*". I'll just refer you back to mimelim and other practicing students/physicians/faculty that are a little worried about the Dr. House mentality that you are exuding.

 

[TXMED_1695]

Do not give him such a hard time, after all Dr. House is too intectually amazing for patient care too. I mean what kind of stupid, do-gooder doctor wants to actually help patients. I mean, we are all in this for the money, clearly.

In reality me and my license will always stay far away for anyone that needs patient care/patients for any type of personal stimulations.

We've had very different experiences with current physicians and other practitioners within the medical field. I've never denied that there are physicians that exist who really hate patient contact, but I just don't see it as life-giving as a motivation as others mentioned in this thread. I've mostly interacted with physicians who have emphasized that if you aren't heading into medicine with a service-based mindset, then you're not going to last very long (or will become unhappy). This came from newly-minted docs and docs who have been practicing for almost 40 years. Further clarification, I don't think you are naive for overrating the intellectual aspects of medicine, I think it's rather your underrating mentality towards actual patient contact and treatment.

Also thanks for the final bit that is one of the most "pot calling the kettle black" posts I have ever seen in my entire life. Like, we're both "mere future medical students*". I'll just refer you back to mimelim and other practicing students/physicians/faculty that are a little worried about the Dr. House mentality that you are exuding.

 

[deleted363248]

Do not give him such a hard time, after all Dr. House is too intectually amazing for patient care too. I mean what kind of stupid, do-gooder doctor wants to actually help patients. I mean, we are all in this for the money, clearly.

In reality me and my license will always stay far away for anyone that needs patient care/patients for any type of personal stimulations.

Lol, again with the House thing. And I just knooooooow I'll regret keeping this going.......but I don't think the FICTIONAL, UNREALISTIC, INSANE character of House was ever in medicine for the money. He didn't even make that much.

 

[cactusman]

Lol, again with the House thing. And I just knooooooow I'll regret keeping this going.......but I don't think the FICTIONAL, UNREALISTIC, INSANE character of House was ever in medicine for the money. He didn't even make that much.

Of course, we understand that you don't want House's other insane outlandish (but hilarious) shenanigans, lol.

 

[mimelim]

So, by your rationale, Radiologists and Pathologists (who are rarely involved in patient care) got into medicine for the entirely wrong reasons and most of them probably struggle to drag themselves out of the bed in the morning to go to work?

I would say the lion's share of pathologists/radiologists that I know went to medical school for "the wrong reasons". They ended up where they are because those specialties were the most tolerable to them. Now, do they admit that? No, at least not always. And, it isn't a bad thing. The vast majority that I know are very happy with their work and life. I'm glad that they found the specialties that they ended up in and are enjoying themselves. But, that doesn't mean that they should have gone to medical school in the first place. I also know several, mainly radiology residents that hated clinical medicine, went to radiology looking for reprieve and then realized that it was only marginally better and absolutely hate where they are going now. I'm sure you could say the same about every specialty in some way. But, my point is that if patient interaction specialties are of little interest, you should not be applying to medical school. You should be looking at any number of other careers that offer just as much or more intellectual stimulation without the 7-11 years of training.

So from what I gather, mimelim, when you yourself take stock of all the different specialties you can choose in medicine, NOT ONE medical specialty jumps out at you as being somewhat more intellectually stimulating, cerebral, and logical/puzzle-oriented above all the others? Not even one? You think they all basically become boring, routine, and protocol-driven after a couple years, and that the "DEEP satisfaction" you get from relieving/treating a certain symptom for the n-millionth time is really the only thing that gets doctors through the day after a while? Am I reading you right?

I think that what satisfies people about medicine is different based on the individual. Not everyone derives pleasure from helping others or improving the lives of others. But, that is one of the few things that medicine really has going for it that other fields don't. As a physician, you unquestioningly have an opportunity to help people every day and get paid to do it. Does that mean that it NEEDS to be a motivator? No. However, every single physician that I know personally who burned out or left medicine lacked that sense of fulfillment. As someone who spends a good deal of time in medical education, it is a red-flag and a warning sign. Doesn't mean that things are inevitable by any means, but a red-flag none the less.

Every specialty has it's own cerebral and problem solving components. Certainly the types of problem solving is different specialty to specialty and the 'average' cognitiveness of a given specialty (if you could define that) is possibly higher or lower than others, but the range within each specialty is staggeringly huge, which makes comparisons between specialties pointless.

At the end of the day, this is what you need to know: In order to maintain a job/practice, you need to have a steady flow of patients/referrals to justify your billing or salary. If you can find a way to setup that referral network or find someone that will pay you that salary, then you can do whatever you want. The practical reality is, those jobs don't really exist and you have to essentially develop that type of practice. For example, my chairman usually only does 2-3 cases a week, he spends the rest of his time traveling the world, giving talks, doing administrative stuff, etc. But, those 2-3 cases are usually pretty out there, crazy, creative, requiring immense thought and consideration. Yes, the vast majority come to him with the diagnosis known, but no good treatment options, but they are intellectually interesting in their own right. But, you can't just set that practice up. You can't find that in a particular specialty. It comes after a very long academic career. Nobody is going to pay you to faff about. To be honest, THAT is the most unrealistic part of House. Not the personality (there are plenty of those in real medicine), not the antics (again, plenty of that), the illegal stuff, sure don't have that. But, his actual job is more unrealistic than the rest of it. It is simply hard to imagine it being financially viable or worthwhile.

 

[FlowLimited]

You've already made the most important realization: No specialty is perfect and the number of "horses" will always vastly outnumber the number of "zebras."

Radiology is certainly an option. Radiologists make observations based on imaging, help to narrow or broaden a DDx, and can suggest additional imaging if necessary. They may make correlations between imaging and other test results, but the job of synthesizing all the available data to make a final diagnosis typically falls to someone else. The role of a pathologist is likely to be similar. Overall, these fields meet a lot of your criteria.

Medical genetics may also be of interest to you, especially in regards to dealing with obscure biochemical/metabolic disorders. There is a lot of data gathering in this field (physical exam findings, blood work, imaging, etc.) that needs to be made sense of in order to make a diagnosis. However, this involves meeting and talking with patients and families which may not interest you. You will likely follow your patients regularly in clinic for many years and your approach to patients will ultimately become more formulaic over time (like in any other field of medicine).

The specialties mentioned in this thread offer a decent starting point, but you will need to spend time exploring them yourself in order to find the best fit.

 

[mistafab]

OP, pretty much every specialty will have lots of 'bread and butter' type work. You'll get more cerebral stuff if you work in an academic hospital that is big on research, but you'll get bread and butter never the less. I think I read on this thread that you were accepted somewhere. Congrats. I'd suggest that you go shadow some specialties, maybe spend a shift with a resident in three different specialties. The more you get exposed to what a work day is actually like, the more you may get a sense for what you want to do after your four years of school. Also, shadow an attending or two. Talk to them about how they get paid. Talk to them about what pays overhead and how their billing and stuff works. These are realities that are not talked about but you should be exposed to.

I also want to say that people keep saying "radiology" for cerebral work in this thread. Yeah, rads is cool in academic settings sure. Have you seen or heard about what radiologists do to get paid? They turn out a report on an image every 5-10 minutes. They turn out 50 images a shift. They use macros to fill in most of the stuff, cause they've seen it all before countless times. Cerebral? Not too sure about that. If you go into this model hoping to do cerebral work you will be in a dark room flipping images and reports and will probably burn out. I've seen neurorads folks in research doing really cool stuff, though. But again, I don't think people here talking about rads as the "puzzle solver" spec is really what they think it is.

TL;DR - go shadow some folk for a shift or two in as many specialties as you can. See what it is actually like to be a doctor.

 

[MediCane2006]

The OP wants a career where he/she is "crossing out diagnoses on a white board" - honestly the first thing that jumped to my mind when I opened this thread was neurology. Rads I guess could fit but it just seems like so much of it is rote bread and butter stuff (which, tbh, is true for pretty much any specialty)

One of the things that attracted me to plastic surgery is the large amount of problem-solving and creative thinking that goes into most of our cases. So much of what we do is taking a skill-set (or "toolbox") and figuring out a creative way to get from point A to point B. That being said, the other thing that I find attractive about plastic surgery is the extensive amount of patient contact (for example, on a breast cancer recon, the breast surgeon may see the patient 2 or 3 times postop. I see the patient every week or two for months postop). This is, I think, something that wouldn't necessarily appeal to the OP.

I kind of agree with @mimelim that there really isn't a specialty that fits with what the OP is looking for. And also agree with the folks that suggested shadowing a ton as soon as possible and figure out if this medical thing is really for you.

 

[ortnakas]

treating, taking care of, and fraternizing with patients and their families are not high on my totem pole of interests.

I do NOT want to do repetitive cookbook procedures and treatments, however profitable they might be. I want to be able to THINK. ANALYZE. DEDUCE. PUZZLE-SOLVE.

money is important.

BUT, $$$ are a good deal less important to me than having intellectual stimulation.

Based on what I cherrypicked from your post-- you're not really interested in medicine, you're interested in science.

Get a PhD in biology, biomedical sciences, biochemistry, microbiology, something in that genre. Then go into academia or industry.

Some of my very best friends are PhDs in research fields, and I have a huge amount of respect for what they do; there's no judgment at all in this recommendation. But based on what you've said, you wouldn't be happy in medicine.

 

[hawthorn9797]

I shadowed an infectious disease specialist and he told me his job is the "most cerebral field in medicine"

 

[Matthew9Thirtyfive]

Why do people keep suggesting radiology? Because he doesn't want much patient care? Radiology is not very cerebral, or at least not the type of cerebral OP is looking for. It is mostly pattern recognition and making the same diagnoses over and over. Read some of Jalby's posts on being a radiologist. He has macros for everything and just plugs and chugs.

 

[deleted363248]

OP, pretty much every specialty will have lots of 'bread and butter' type work. You'll get more cerebral stuff if you work in an academic hospital that is big on research, but you'll get bread and butter never the less. I think I read on this thread that you were accepted somewhere. Congrats. I'd suggest that you go shadow some specialties, maybe spend a shift with a resident in three different specialties. The more you get exposed to what a work day is actually like, the more you may get a sense for what you want to do after your four years of school. Also, shadow an attending or two. Talk to them about how they get paid. Talk to them about what pays overhead and how their billing and stuff works. These are realities that are not talked about but you should be exposed to.

I also want to say that people keep saying "radiology" for cerebral work in this thread. Yeah, rads is cool in academic settings sure. Have you seen or heard about what radiologists do to get paid? They turn out a report on an image every 5-10 minutes. They turn out 50 images a shift. They use macros to fill in most of the stuff, cause they've seen it all before countless times. Cerebral? Not too sure about that. If you go into this model hoping to do cerebral work you will be in a dark room flipping images and reports and will probably burn out. I've seen neurorads folks in research doing really cool stuff, though. But again, I don't think people here talking about rads as the "puzzle solver" spec is really what they think it is.

TL;DR - go shadow some folk for a shift or two in as many specialties as you can. See what it is actually like to be a doctor.

The OP wants a career where he/she is "crossing out diagnoses on a white board" - honestly the first thing that jumped to my mind when I opened this thread was neurology. Rads I guess could fit but it just seems like so much of it is rote bread and butter stuff (which, tbh, is true for pretty much any specialty)

One of the things that attracted me to plastic surgery is the large amount of problem-solving and creative thinking that goes into most of our cases. So much of what we do is taking a skill-set (or "toolbox") and figuring out a creative way to get from point A to point B. That being said, the other thing that I find attractive about plastic surgery is the extensive amount of patient contact (for example, on a breast cancer recon, the breast surgeon may see the patient 2 or 3 times postop. I see the patient every week or two for months postop). This is, I think, something that wouldn't necessarily appeal to the OP.

I kind of agree with @mimelim that there really isn't a specialty that fits with what the OP is looking for. And also agree with the folks that suggested shadowing a ton as soon as possible and figure out if this medical thing is really for you.

Based on what I cherrypicked from your post-- you're not really interested in medicine, you're interested in science.

Get a PhD in biology, biomedical sciences, biochemistry, microbiology, something in that genre. Then go into academia or industry.

Some of my very best friends are PhDs in research fields, and I have a huge amount of respect for what they do; there's no judgment at all in this recommendation. But based on what you've said, you wouldn't be happy in medicine.

mistafab, thanks for your congratulations. I think what you're saying is that an academic medicine job, while not being as profitable, offers much more opportunities to use your brain than clincal medicine, am I reading that right? If so, I wouldn't have a problem going into academic Neuroradiology or academic Neurology at all.

MediCane, let me be clear. I do NOT abhor patient contact or procedures, I have repeatedly stated that I WOULD indeed like these things to be a part of my day, but in small doses. I would not like to follow patients around forever and a day, and basically play part doctor/part social worker. But I would certainly love the chance to talk to some patients and do a few procedures every week to break up the "mental work" monotony. Variety makes both work AND life better!

ortnakas, I don't think so. I've crossed doing a PhD off my own whiteboard, heh. I don't think I have been blessed with that "purely self-motivated-unquenchable-thirst-for-knowledge mindset" that successful PhD candidates are pretty much required to have. Plus, like I said, while money is not my primary motivation, it is definitely important to me. So, PhD is out. But from what I've gleaned from a lot of these recent posts so far, something like academic Neuroradiology, Pathology, or Neurology in a research-oriented hospital would seem to be the best fit for me. And that is completely acceptable to me, I am not hung up on clinical medicine just because it is more profitable.

 

[MediCane2006]

MediCane, let me be clear. I do NOT abhor patient contact or procedures, I have repeatedly stated that I WOULD indeed like these things to be a part of my day, but in small doses. I would not like to follow patients around forever and a day, and basically play part doctor/part social worker. But I would certainly love the chance to talk to a some patients and do a few procedures every week to break up the "mental work" monotony. Variety makes both work AND life better!

No, I get that.... I'm just saying that most of what I consider to be the more cerebral specialties also require A LOT of patient contact, long-term followup, etc. and thus don't really fit what you're looking for. Idk. Maybe something like academic neurology or path, but if you want patient contact/procedures to only be a small part of your day, I think you gotta cross off neurology too.

I do think it's important to shadow docs in your field of interest very early on, though, as your career interests aren't necessarily typical (as this thread has demonstrated).

 

[deleted363248]

Why do people keep suggesting radiology? Because he doesn't want much patient care? Radiology is not very cerebral, or at least not the type of cerebral OP is looking for. It is mostly pattern recognition and making the same diagnoses over and over. Read some of Jalby's posts on being a radiologist. He has macros for everything and just plugs and chugs.

Matthew9Thirtyfive, what's your thoughts on something like academic Neuroradiology/Neurology?

 

[Stagg737]

Well they are making differentials on each patient, right? And then using lab results and imaging to rule out/in these differentials. That kinda sounds up the alley of problem solving that OP is looking for.

EDIT: probably no real "zebra cases" or "crossing diagnoses off of whiteboards" though

Sure, they're making a list of differentials in their head, but they rarely ever find out what the actual diagnosis was after they pass their patients on. They do get some labs and imaging to rule things out of the dd, but from my experience it's pretty uncommon for the ED to make an actual diagnosis unless it's a trauma case. Maybe those with more experience in the ED forum will say otherwise, but I rarely saw the ER docs make a final diagnosis on someone outside of trauma.

I shadowed an infectious disease specialist and he told me his job is the "most cerebral field in medicine"

I was actually just going to mention this, as trying to deduce which bug caused the patient's diarrhea/fever, meningitis, can be more of a puzzle, but you'll still get a lot of the bread and butter cases. It's one of the few fields that I'd actually consider putting up with the torture of an IM residency to go into.

 

[deleted363248]

Sure, they're making a list of differentials in their head, but they rarely ever find out what the actual diagnosis was after they pass their patients on. They do get some labs and imaging to rule things out of the dd, but from my experience it's pretty uncommon for the ED to make an actual diagnosis unless it's a trauma case. Maybe those with more experience in the ED forum will say otherwise, but I rarely saw the ER docs make a final diagnosis on someone outside of trauma.



I was actually just going to mention this, as trying to deduce which bug caused the patient's diarrhea/fever, meningitis, can be more of a puzzle, but you'll still get a lot of the bread and butter cases. It's one of the few fields that I'd actually consider putting up with the torture of an IM residency to go into.

Ok, along with neurology, Rads, and Path, I'll mark down ID as one of the specialties I should rotate in as well! 😉

 

[Matthew9Thirtyfive]

Matthew9Thirtyfive, what's your thoughts on something like academic Neuroradiology/Neurology?

You have tons of patient contact in neurology. Personally, I think neuro is super cool from a diagnostic perspective as they can narrow down the exact location of the lesion just from an exam, but you will be treating patients all day e'ry day. Neuroradiology, if you mean NIR, is similar to VIR. You're basically a technician and I don't think there is a ton of that cerebral problem solving you're looking for.

To be honest, I think you might want to look into fields other than medicine. Have you thought about medical physics? Or a research field that lets you interact with patients occasionally? We need people who are really good at solving puzzles and stuff to come up with new treatments, etc.

 

[mistafab]

Yes, that is what i'm saying. Academic medicine will allow for more cerebral work over any individual specialty. We need doctors in science, we need clinical trials, and we need comparitive effectiveness work. These types of jobs that allow a balance of 'bread and butter' practice with protected research time would likely provide you the type of stimulus you are looking for.

Are there any particular specialties that allow more cerebral work? Meh - if you go into academic medicine with a good balance of research time, any specialty will give you lots to think about and problem solve. Specialties will really just help narrow the field of topics that you'll be covering with your work. You'll see people in the clinic, find patterns that haven't been described, and then go to your armchair and postulate why this may be. This is the type of cerebral work that helps move medicine forward, something that MD's can uniquely contribute to the future and help multitudes of patients.

mistafab, thanks for your congratulations. I think what you're saying is that an academic medicine job, while not being as profitable, offers much more opportunities to use your brain than clincal medicine, am I reading that right? If so, I wouldn't have a problem going into academic Neuroradiology or academic Neurology at all.

 

[ortnakas]

ortnakas, I don't think so. I've crossed doing a PhD off my own whiteboard, heh. I don't think I have been blessed with that "purely self-motivated-unquenchable-thirst-for-knowledge mindset" that successful PhD candidates are pretty much required to have. Plus, like I said, while money is not my primary motivation, it is definitely important to me. So, PhD is out. But from what I've gleaned from a lot of these recent posts so far, something like academic Neuroradiology, Pathology, or Neurology in a research-oriented hospital would seem to be the best fit for me. And that is completely acceptable to me, I am not hung up on clinical medicine just because it is more profitable.

I'd encourage you to not cross it off the whiteboard quite so fast.

A) The "purely self-motivated-unquenchable-thirst-forknowlege mindset" is a myth. It's more of an extreme like of mysteries, which you have, and an ability to shake off setbacks, which only you know if you have. (@Goro, you're a PhD. Help me out here?)
B) Industry makes $$$$. And academics might not be making bank, but assuming your PhD is grant-funded (i.e. you're living off the government to get it vs. collecting debt as a med student), an academic's salary isn't terrible.

I mean, fine if you cross it off eventually. I won't be personally offended. But as @MediCane2006 said, the more cerebral specialties I can think of for figuring out zebras have a lot of patient contact as their bread-and-butter. Rheumatoid mysteries are confusing, but after you diagnose you'll manage a lot of RA. Neuro mysteries are interesting but you'll manage a lot of MS, epilepsy, status post CVAs. ID mysteries are also confusing, but your day-to-day might be HIV. If you're only going to be happy with mysteries as your bread-and-butter, research might be a better fit.

 

[deleted363248]

I'd encourage you to not cross it off the whiteboard quite so fast.

A) The "purely self-motivated-unquenchable-thirst-forknowlege mindset" is a myth. It's more of an extreme like of mysteries, which you have, and an ability to shake off setbacks, which only you know if you have. (@Goro, you're a PhD. Help me out here?)
B) Industry makes $$$$. And academics might not be making bank, but assuming your PhD is grant-funded (i.e. you're living off the government to get it vs. collecting debt as a med student), an academic's salary isn't terrible.

I mean, fine if you cross it off eventually. I won't be personally offended. But as @MediCane2006 said, the more cerebral specialties I can think of for figuring out zebras have a lot of patient contact as their bread-and-butter. Rheumatoid mysteries are confusing, but after you diagnose you'll manage a lot of RA. Neuro mysteries are interesting but you'll manage a lot of MS, epilepsy, status post CVAs. ID mysteries are also confusing, but your day-to-day might be HIV. If you're only going to be happy with mysteries as your bread-and-butter, research might be a better fit.

Are you a PhD yourself?

 

[ifnotnowwren]

I'd encourage you to not cross it off the whiteboard quite so fast.

A) The "purely self-motivated-unquenchable-thirst-forknowlege mindset" is a myth. It's more of an extreme like of mysteries, which you have, and an ability to shake off setbacks, which only you know if you have. (@Goro, you're a PhD. Help me out here?)
B) Industry makes $$$$. And academics might not be making bank, but assuming your PhD is grant-funded (i.e. you're living off the government to get it vs. collecting debt as a med student), an academic's salary isn't terrible.

I mean, fine if you cross it off eventually. I won't be personally offended. But as @MediCane2006 said, the more cerebral specialties I can think of for figuring out zebras have a lot of patient contact as their bread-and-butter. Rheumatoid mysteries are confusing, but after you diagnose you'll manage a lot of RA. Neuro mysteries are interesting but you'll manage a lot of MS, epilepsy, status post CVAs. ID mysteries are also confusing, but your day-to-day might be HIV. If you're only going to be happy with mysteries as your bread-and-butter, research might be a better fit.

Completely agree about point A. The PhD I am currently working for was discussing how he chose to get a PhD as opposed to an MD and he literally said a lot of what OP said he was looking for - high level thinking, deduction, analysis, and most importantly - problem solving/puzzle solving. Patients are a set of parameters. One person, one body, limited number of diagnoses, limited amount of things we can actually do for them, that is a lot of parameters, that gives you a very narrow scope. If you go into research, you get to set those parameters as wide or as narrow as you want, you aren't handed a very limited puzzle to start with. He wanted to help people, but he didn't want to treat people, he didn't want to be following evidence based practices that someone else figured out, he wanted to be doing the research that goes into that evidence, and that sets those practices. Does he have a drive,"thirst" for knowledge, yes. Is it self-serving in some regards, yes, he wants to be the one to figure things out, he wants to be right. But I also don't see how that was really different from what OP was saying that he or she wanted?

He's not the only PhD I have worked for or interacted with, and a strong constant in all of them has been "I wanted to help people without clinical stuff, I wanted to do my work, solve puzzles, work with people, but not necessarily be doing the service/administering care to patients." And the PhDs who are in my class found that research was not fulfilling without that clinical component, they really wanted to be the ones personally administering care. So to be saying "I want my main job to be problem solving, not patient care, but minimal amounts of patient care would be fine I guess", really seems to align more with the mindset of every PhD (that did not later decide to go to med school) I have interacted with.

 

[FlameBroiledDoc]

The hard truth is that medicine is not much puzzle solving no matter what specialty you're in. The intellectual side of the work is simple pattern recognition in the overwhelming majority of cases, and that process is almost completely independent of the patient's reaction that you'll need to deal with. Those "a-ha!" moments come every now and then, but if you're prone to boredom with the mundane, you should find a different career before you're deeper in debt and resentful as heck once you're up on the wards.

I retired from clinical medicine in my early 40s because of burnout, that among other factors stemmed from the work not being interesting or challenging enough for my liking. What you're looking for is better achieved through a career in engineering, consulting, or the academic side of law. If you have that calling to serve a public purpose, epidemiology and HHS consulting are worthy fields of work that need bright people.

You can PM me if you have questions. Medicine is about people, not puzzles.

 

[RenegadeOkapi]

OP, I hope you realize that Dr. House isn't meant to be a doctor that people should aspire to be. Yes, he's brilliant, but the callousness with which he interacts with some patients is downright appalling.

I'm not saying that doctors should just be glorified social workers - simply comforting patients, but if you are interested in the human body from an academic perspective, why don't you pursue some form of biomedical research? You would probably get to handle human specimens, consider symptoms from the host organism, and work to develop drugs that could possibly target known diseases.

Humans aren't lab rats or broken machines destined to be scrutinized by your very intelligent mind to stroke your own ego and achieve some sort of intellectual orgasm.

PS - Why do you like to use a lot of capitals?

 

[timephone]

So hopefully this post doesn't get buried in the shuffle, but:

MEDICAL TOXICOLOGY. I shadowed a toxicology fellow last week at a poison control center and it was fascinating. Besides the poison control stuff, all the toxicologists do is solve problems with limited information. Usually along the lines of "we think the patient took this, but they're presenting signs of this". When the other hospital docs page the toxicologists for a consult, it's usually along the lines of "here's our patient with X, but for some reason they're presenting signs of Y. Do you think they took something or were poisoned?"

In the afternoon I got to sit in on a medical examiners conference, where the forensic pathologists presented cases of unknown cause of death to the toxicologists to see if they had any opinions. The attendings were incredibly bright. Toxicology itself is a subspecialty of EM, so you get that training first.

 

[xffan624]

So hopefully this post doesn't get buried in the shuffle, but:

MEDICAL TOXICOLOGY. I shadowed a toxicology fellow last week at a poison control center and it was fascinating. Besides the poison control stuff, all the toxicologists do is solve problems with limited information. Usually along the lines of "we think the patient took this, but they're presenting signs of this". When the other hospital docs page the toxicologists for a consult, it's usually along the lines of "here's our patient with X, but for some reason they're presenting signs of Y. Do you think they took something or were poisoned?"

In the afternoon I got to sit in on a medical examiners conference, where the forensic pathologists presented cases of unknown cause of death to the toxicologists to see if they had any opinions. The attendings were incredibly bright. Toxicology itself is a subspecialty of EM, so you get that training first.

My rotation on Toxicology was pretty fun and it did require some thinking at times and aligning the story with the labs and the patient's symptoms to come up with a coherent diagnosis. The only downside for OP I would say is it's a sub-specialty of EM and 90% of the time when you come up with the diagnosis, the treatment is supportive care. It also is a pretty limited specialty. Only larger hospitals have a dedicated toxicologist from what I observed.