Worst/ Most Boring Specialty?

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smugass said:
which specialty if the DUMPING GROUND of all specialties?

Path

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Peds, irritating parents but cute kids
geriatrics - ok, old lonely people. I don't think so....
Rehabilitative med - no! I would go nuts knowing these people will probably never walk/talk/chew/like they used to. Major counseling need for these patients because I bet they are depressed/angry as h#ll.
OB/GYN - ok I am a woman, but the only box of cookies I want to be looking at is my own. Altho women are beautiful, I admit it, still ....
Urology - ok, same as previous. No one's penis is as atractive as your spouse's, and too many on too many old people - NO!
Path - because while the slides and samples might be kind of cool, path people tend to be kind of odd and I couldn't handle the lab and them at the same time.

I have no idea what I want to do. :(
 
I think Peds doctors are not paid as much as other specialties because the patients are smaller than adults. :laugh:

Considering that they also have to deal with psycho parents, they should get paid more! :laugh:
 
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Octo dude, look at all them smiley faces you got there ...
 
Paws said:
Octo dude, look at all them smiley faces you got there ...


I am a happy person. I laugh at my own jokes. Don't harsh my buzz.
 
most boring **** in the world is reproductive endocrinology... this is made worse by the fact that u have to suffer thru an obgyn residency to get there.

primary care and fp r not that bad if u like talking to people but dont expect the work to be a thrill a minute...

the worst torture of all is GEN Surge...
first theres the medstudent rotation which is hell.

then as a resident u get the privelage of rotating thru various specialties such as CT, Transplant, Breast clinic, and oncology.

then as an attending u get paid like $150 to drain someones peri-rectal abcesses, so u have to do this like 10 times a day to break even.

while ur doing this u see the dermatologists getting paid the big $$ to hand out stridex pads and leave by 4:00.

no wonder everyone in gen surg is so pleasant.
 
I'm one of those idealists who, at this point, isn't too concerned about the money. I'm sure that will change when I get into med school and realize just how much in debt I'll be when I get out. I'm just curious though. How well-paid are rheumatologists? I'm really interested in that and in psychiatry (and yes, I realize psychiatrists aren't paid that much, but again, right now, it isn't about the money).
 
I wouldn't mind the $$ the repro endo's get. They bill and receive like, 100% of their fees since most people are self-pay for their ivf's etc. And they are mighty fat fees, too. And is there call? I don't think so, or at least not so much. An hour on sunday morning for an IUI, no big deal.

Some RE's skip the ob part and come in through endocrinolgy so no ob residence.
 
:thumbup: I like the idea of FP Sports Med, but there's a really small chance I'll be working with athletes and sports teams, and a really big chance I'd be doing high school sports physicals all day. I also like Gen Surg, or maybe GI. Guts are kinda cool!

:confused: ER, Internal, and Hospitalist all seem kinda cool. I like the more general stuff and you get to see a lot, although I've met such happy ER docs and hospitalists in my time. Oh well, worst case scenario you do an invasive cardio fellowship and bank!

:thumbdown: Path, Rads... BORING! I want to actually DO something while I work. FP might be kind of interesting, but I don't want to treat HTN, asthma, and headaches/bellyaches all day.
 
The worst specialties. Hmm. I don't think any specialty is really bad, actually. They all have their place, and have their share of dedicated people trying to help people.

Although...

I don't want to be feeding and watering gomers all day. So IM is out.

While the thought of dealing with weird diseases is cool, I don't want to spend half my day writing scrips for HIV cocktails, and the other half cleaning up surgical infections. ID is out.

I want to be able to rely on my knowledge and brainpower to solve cases, not hammers and saws. Ortho is out.

I don't want to be locked away from the patients, looking at studies for other doctors. Path and rads are out.

I don't want to deal with kids because kids are icky and gross... therefore, peds and FP are out.

I don't want to be in a service where most of your job is thinking up new ways of telling your patients "You're gonna die." Heme/onc is out.

I don't want to be spending the rest of my life taking gall bladders out of fat people. GS is out.

I don't want to be Pimple-Popper, M.D. Derm is out.

I also don't want to be putting in silicone boobs all day and call that "medicine." Plastics is out.

I want to actually have some idea on what's wrong with the patients. Psych is out.

I don't want to be a glorified triage nurse. EM is out.

As tempting as looking at diseased genitalia all day might be, I'm going to have to pass. OB/GYN and uro are out.

Same thing with the other perineal triangle. GI and colorectal are out.

Therefore, upon reflection, I'm going to be a lawyer.

ha ha haha i was going down your list thinking "so what's left"....and then i read your last sentence. XD
 
:D Here's a fun thread - if you had to make a list, which specialty would you most want to avoid? Which do you think is the worst in general and/ or the worst for you, and why?

This could turn ugly... or be funny :D :D


oh fun fun

Family practice: Only rotation where I checked the watch on a regular basis
General surgery: Crossed it off after seeing my 60 something year old attending coming in Saturdays at 5 am.
Ob-Gyn: Too nasty, lots of bitchy personalities
Peds: Boring
 
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FP and general IM:
I once talked to a patient who talked about her recent visit to the physician. She was morbidly obese and diabetic so the physician urged her to cut down on soda. She had a Mountain Dew with the label ripped off and she thought she was very clever because nobody could prove it was Mountain Dew. She had it at the appointment and when the doctor said "I see you have a soda today. Have you been able to cut down?" she responded with "This aint Mountain Dew!" Those people exist and FP has to try to keep them from killing themselves.

All surgery/OBGYN
I don't like digging around in people and I think surgery is immensely frustrating and tedious. Sometimes I wonder why surgeons do it because many of them seem so miserable during surgery. So angry. So irritated. I think it is like running a marathon. Pain during but somehow some people think it is worth it at the end.

Ophtho:
For as long as I can remember I have hated eyes. Its the only thing that I find gross in medicine. Neuro-ophtho stuff is cool though.

Radiology:
I am a really antsy person and I think I'd go nuts chained to a desk and reading room.

GI:
I don't care how much money you get. I have no interest in colonoscopies or the color of someones stool.

Cards:
I. HATE. THE. HEART. I don't know why but ever since MS1 I have loathed looking at EKGs and talking about arrythmias. The pressure/valve stuff is ok but I couldn't get over my dislike of the electrophysiology stuff.

Gas:
The whole 99% boredom and 1% sheer terror thing doesn't work for me. I would be so anxious during that 99% since Im always worrying about the worst case scenario. For me, the whole jobs would be anxiously sitting and watching the clock count down. Oh and the only things in medicine that makes me want to pass out are procedures involving needles. Central lines, art lines, epidurals, and even IVs still make my head spin no matter how many times I try to watch and desensitize myself.

Pathology:
I still like talking to patients.

PMR:
Im not a fixer. I like to diagnose stuff and could care less about treatment. PMR is like the yin to neurology's yang. All treatment and little diagnosis.

Nephrology:
Any field where I have to calculate something with electrolytes on the regular sounds terrible.

Like
Derm has some cool zebras and I love when there is a dermatologic manifestation of an underlying disease. It would probably be boring the majority of the time though so its not worth killing myself to match into it.

Neuro is amazing. It is like IM with less of the BS and a higher proportion of your patients have something interesting.

I think that a peds subspecialty would be awesome as you are the first to diagnose some either serious or rare conditions.

Maybe
I love pus, rashes, and gnarly abscesses. Im a sicko. Maybe ID?

I like that pathology in psychiatry is dependent on an individuals personality and circumstances. Depression is so different between people unlike choledocolithiasis which doesn't vary much between people.

EM is the great mystery. For every thing that I don't like I would probably encounter something I do like. You also dont see the case through which could be good for a topic you aren't interested in but frustrating for one that you are interested in.
 
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ha ha haha i was going down your list thinking "so what's left"....and then i read your last sentence. XD
nice bump of an 8 year old thread. I was a senior in high school when this thread was last discussed.

worst and most boring are two very different things, IMO
 
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Geriatrics---I don't like old people
Peds---or kids.
Medical genetics---Welcome to Dullsville. Population: you
Preventative Medicine---Wear a condom if you want to prevent the spread of disease.
Ob/Gyn---Gross
Family Medicine---Why not become a real specialist?
Derm, urology, and optho---I don't see how you have to graduate at the top of your class to be in these specialties.
It's "Preventive", not "preventative" /peeves
 
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I like "Dislike's" rundown. I think that stormtrooper is a dermatologist at heart - ;)

Boring is relative. Medicine is all boring until it's interesting.

Say you're a plumber and you unclog ****-pipes all day. Great, you get paid fairly well, but it's boring, until.... You get called to house with such a weird plumbing scheme that you have no idea what is going on. You spend the next 2-3 days diagnosing the problem as a design flaw in the initial construct that will require a novel reconstruction of the home's plumbing both outside and inside.

Medicine is the same. It doesn't matter what specialty you go into. In FP, you deal with everything - and when it gets hairy you refer. If you are an orthopedic surgeon, you fix bones in a particular part of the body. If you are a cardiologist, you treat CAD and Afib. If you sub-specialize in seizures, you are a neurologist who trys to dial in her patients to become seizure free without side effects. General surgery? Gallbladders and appendectomies. Nephrology? You dialyze. Urology? You clear the plumbing. ER? You reassure and send people on their way that largely, they are fine and should stop using drugs and/or drinking so heavily. Path? It's cancer. It's not cancer. I can't tell from this crappy specimen if it's cancer or not.

It's mostly boring. If you want continuous work, work the ER or Trauma service in a large inner city. That will also become boring as the regular influx of GSW and stab wounds = labs/resusc/imaging (or not) OR.

The job of a physician is not uniquely interesting by chief complaint - that is a mistake. It is definitely NOT boring when you delve into the social aspects of our patients. Our job is also not boring when we find zebras - and they're out there. Zebras live in herds, by the way.

Find what you like. Do what you don't hate everyday - medicine can be exceedingly taxing, especially today. Find your niche where the one weird case, the one zebra gets your blood pumping, gets the brain moving and gets you moving faster than you have before.

Money will burn you, hours will burn you. Find your passion - but realize you will mostly be looking at benign, common conditions, Mostly... :D
 
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My worst: Absolutely anything in an OR. Plastics being the absolute worst. I wanted to quit during that rotation. Once you intubate and sedate a patient you ruin my fun. The interpersonal aspect of medicine is the joy of medicine for me. If I can't talk to my patient I would rather not be there. I hate procedures. I hate scrubbing. I hate surgical rounding where you ignore everything but their post op wound. I had surgery as my first rotation and it took everything for me not to just walk.

My Best: Psych and peds. I wanna do child psych. I love interpersonal interaction and complicated family dynamics and helping someone's social situation. I know many people hate this but I am honestly energized by interacting with suicidal crying teenagers.
 
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Just don't say anything like this at your residency interviews ;)

I haven't been using those exact words but I have research in mother-child interactions with depression and lots of experience with adolescent psych and women's mental health and I have made my interest in adolescent well know.
 
Okay, just for funsies. I've personally went through several deciding points since I first posted in this thread. 10 years ago, I had a vague plan, and very much used the "elimination" method when selecting a specialty because I knew I wanted to stay in academics but I wasn't sure what my clinical home should be (assumed IM in ID). About 6 years ago, I had degree of certainty about what I wanted to do, and about 5 years ago, I decided that I was wrong. So, I did a second residency (preventive medicine) and (unfortunately) loved many of the options that presented themselves, so now I sometimes feel more clueless about what I actually want to do (as opposed to what I theoretically "could" do). There are different pros and cons now. And, there are different opportunity costs for me. And, a lot of personal confounding factors that impact my personal decision. But, since it fits into the theme of the thread, I'm just throw out my bulleted list of things that I either was convinced I was going to do at one point, or am contemplating now that I've had more exposure. And, although I may be able to offer some discussion about these fields, I can't promise that I can give a comprehensive and/or unbiased view of each field... but, at least listing them might make other people think about these as options....

  • Clinical infectious diseases (ID) - academic (fellowship needed)
  • Clinical ID - HIV
  • Public health medicine focusing on ID
  • Travel medicine
  • Hospitalist medicine (or nocturnist)
  • General IM - ambulatory only
  • Academic General IM (fellowships are helpful for getting started but not necessary)
  • Geriatrics (fellowship needed)
  • Palliative care (fellowship needed as far as I know)
  • Traditional occupational medicine (an option with preventive medicine residency, although traditionally would require OM residency; can seek many certifications separately)
  • Toxicology (fellowship needed)
  • Urgent care (last I heard, discussion about it becoming a separate specialty)
  • Locums tenans as a generalist for a while
  • Addiction medicine (fellowship needed)
  • Clinical informatics / Chief Information Officer (fellowship recommended if you want to be legitimate, although a lot of people claim to be "informaticists")
  • Hospital quality control & patient safety / Chief Quality Officer
  • Local health department (city, county, or regional) public health medicine (being PM certainly helps)
  • State or regional epidemiologist
  • CDC - Epidemic Intelligence Service (fellowship option)
  • State or federal public health (being PM certainly helps)
  • Concierge / boutique medicine
  • Industry - pharmacovigilance
  • Industry - population health management
  • Social medicine - volunteer & free clinics, or street medicine
  • Purely teaching - various settings
  • Indian Health Service
  • Preventive Cardiology (fellowship helpful, although can seek various certifications separately)
  • Pain medicine (fellowship needed, and not even sure if IM is sufficient)
  • Heart failure (aware of people who took this route with fellowship)
  • Clinical immunology / laboratory medicine (fellowship, focus on lab after rheum, ID, or Allergy/Immunology, last time I checked but that was years ago)
  • Sleep Medicine (fellowship)
  • Corrections medicine
  • University health - Student health and wellness
  • Lifestyle Medicine
  • Culinary medicine (honestly don't know much about this and not interested personally but mentioning as an option)
  • Integrative medicine (not really my thing but considered it for a passing moment)
  • LGBT medicine
  • Clinical pharmacology / pharmacopepidemiology & stewardship
 
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Love the thread topic, for once the necrobump yields something worthwhile. As for worst/most boring fields...

Most boring:
Rads: The idea of sitting in a room trying to figure out whether I actually see something on film or not would drive me crazy. IR might be more bearable, but still sounds pretty awful.
Path: Love reading about path and learning about zebras, but I need to interact with people if I want to stay awake.
Heme/Onc: The basic science and molecular aspect of it is awful. Probably the only field that I would rather quit medicine than actually have to go into.
Gas: Getting paid to play games of my phone or do crosswords sounds like a sweet gig, but I'd rather actually do something.

Worst:
Peds: Some patients are fine, but the idea of having to see screaming kids, or worse, their parents, makes me want to scream. Also, anti-vaxxers.
EM: At a Level 1 trauma center or a location where you mostly get actual emergencies it would be pretty cool, but some of the places I've worked and volunteered where 90+% of the patients are either uninsured and use the ER as primary care, parents who bring in Little Timmy because he coughed once and was "running a fever of 99" for 5 minutes last night, or the frequent flyer who is back for the 4th time this week because their finger is twitches every couple of hours is its own special kind of hell.
 
Love the thread topic, for once the necrobump yields something worthwhile. As for worst/most boring fields...

Most boring:
Rads: The idea of sitting in a room trying to figure out whether I actually see something on film or not would drive me crazy. IR might be more bearable, but still sounds pretty awful.
Path: Love reading about path and learning about zebras, but I need to interact with people if I want to stay awake.
Heme/Onc: The basic science and molecular aspect of it is awful. Probably the only field that I would rather quit medicine than actually have to go into.
Gas: Getting paid to play games of my phone or do crosswords sounds like a sweet gig, but I'd rather actually do something.

Worst:
Peds: Some patients are fine, but the idea of having to see screaming kids, or worse, their parents, makes me want to scream. Also, anti-vaxxers.
EM: At a Level 1 trauma center or a location where you mostly get actual emergencies it would be pretty cool, but some of the places I've worked and volunteered where 90+% of the patients are either uninsured and use the ER as primary care, parents who bring in Little Timmy because he coughed once and was "running a fever of 99" for 5 minutes last night, or the frequent flyer who is back for the 4th time this week because their finger is twitches every couple of hours is its own special kind of hell.

This post makes me question if you have any clinical experience whatsoever
 
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Just don't say anything like this at your residency interviews ;)

I like critically ill patient or patients with serious illnesses so I need to find a better thing to say than "I like dying patients" before I apply for residency.


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This post makes me question if you have any clinical experience whatsoever

I guess to each his own, but I pretty much disagreed with every opinion in that post.

Anyone who finds anesthesia boring hasn't seen enough airways or probably hasn't watched a cabg or a vascular procedure.

And I guess I forgot that emergency departments only see mis, strokes, dka, aaas, gi bleeds, elderly abdominal pain, sepsis, drug overdose, ectopic pregnancy, sbp, pes, and mvas at level 1 trauma centers.
 
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For me, pediatrics sounds like a nightmare. I don't like kids. Teenagers don't like anyone. I REALLY don't like helicopter parents.
 
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The most boring:

Path/diagnostic rads - the lack of patient and coworker interaction is killer. I would have just done bench research if I wanted to bring my lunchbox to work every day and eat alone.

Family practice - The only rotation in medical school where I would look at the clock and have horrible realizations like "I can't believe it's only 10am." I felt like I was in high school english class waiting for the bell to ring every day.

IM - I actually liked the rounds, the diagnostic and thought process, but the amount of note writing, and documentation means you are only spending half the day with patients, the other half is charting for your corporate overlords.
 
This post makes me question if you have any clinical experience whatsoever

I'll admit my clinical experience in anesthesia is limited to my contact with them through working/shadowing other fields (aka time in the OR), and I have no clinical experience in path. I've worked a decent amount in rads and EM departments which were exactly as I described.

I guess to each his own, but I pretty much disagreed with every opinion in that post.

And I guess I forgot that emergency departments only see mis, strokes, dka, aaas, gi bleeds, elderly abdominal pain, sepsis, drug overdose, ectopic pregnancy, sbp, pes, and mvas at level 1 trauma centers.

I'm not saying those only happen at level 1 centers, but the level 2 trauma center I worked at for years averaged about 5% actual emergencies and was 95% not. Of that 95% that wasn't, I'd say 60-70% of those patients had no business coming to the ER as I described above. Of the things in your list, we'd be lucky to see 10 patients in a week that needed to be examined for any of the conditions you listed above. Most of our patients were like the kid I described, uninsured people coming in for a check-up, or elderly pts who came in with SOB that turned out to be nothing (yes, they should be coming in, but they were mostly boring cases).

As I said, the patients ERs see vary a lot from hospital to hospital. My point was that at least with a Level 1 center you're guaranteed to see a good number of patients you actually want to see instead of the bs that most EM docs complain about.
 
I'll admit my clinical experience in anesthesia is limited to my contact with them through working/shadowing other fields (aka time in the OR), and I have no clinical experience in path. I've worked a decent amount in rads and EM departments which were exactly as I described.

I'm not saying those only happen at level 1 centers, but the level 2 trauma center I worked at for years averaged about 5% actual emergencies and was 95% not. Of that 95% that wasn't, I'd say 60-70% of those patients had no business coming to the ER as I described above. Of the things in your list, we'd be lucky to see 10 patients in a week that needed to be examined for any of the conditions you listed above. Most of our patients were like the kid I described, uninsured people coming in for a check-up, or elderly pts who came in with SOB that turned out to be nothing (yes, they should be coming in, but they were mostly boring cases).

As I said, the patients ERs see vary a lot from hospital to hospital. My point was that at least with a Level 1 center you're guaranteed to see a good number of patients you actually want to see instead of the bs that most EM docs complain about.

Don't worry. It's just butt hurt EM hopefuls that will eventually come to realization that EM isn't that great. 90% is a hyperbole, but at least 50-60% of the patients should have gone to a FP doc. The next 20% are probably drug seekers, homeless people, alcoholics, chronic pain, etc. The next 10-15% is your run of the mill pathological abdominal pain, chest pain, infections, and fracture. About 1-5% is actual critical care.

~4 years in 5 hospitals, two different systems, from the very rich to the very poor. Includes a LOT center.
 
I'll admit my clinical experience in anesthesia is limited to my contact with them through working/shadowing other fields (aka time in the OR), and I have no clinical experience in path. I've worked a decent amount in rads and EM departments which were exactly as I described.



I'm not saying those only happen at level 1 centers, but the level 2 trauma center I worked at for years averaged about 5% actual emergencies and was 95% not. Of that 95% that wasn't, I'd say 60-70% of those patients had no business coming to the ER as I described above. Of the things in your list, we'd be lucky to see 10 patients in a week that needed to be examined for any of the conditions you listed above. Most of our patients were like the kid I described, uninsured people coming in for a check-up, or elderly pts who came in with SOB that turned out to be nothing (yes, they should be coming in, but they were mostly boring cases).

As I said, the patients ERs see vary a lot from hospital to hospital. My point was that at least with a Level 1 center you're guaranteed to see a good number of patients you actually want to see instead of the bs that most EM docs complain about.

It's definitely true there's a lot of variation between sites, but I would point out that even 5% actual emergencies means there's a patient on almost every shift who needs you. The lower proportion of positives makes it as challenging or more so to provide good care to those people, which can be pretty interesting. To each his own though.

My no thanks would be outpatient peds. Healthy patients aren't really my thing, and parents are definitely not my thing
 
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Don't worry. It's just butt hurt EM hopefuls that will eventually come to realization that EM isn't that great. 90% is a hyperbole, but at least 50-60% of the patients should have gone to a FP doc. The next 20% are probably drug seekers, homeless people, alcoholics, chronic pain, etc. The next 10-15% is your run of the mill pathological abdominal pain, chest pain, infections, and fracture. About 1-5% is actual critical care.

~4 years in 5 hospitals, two different systems, from the very rich to the very poor. Includes a LOT center.

I guess I need some more fiber in my diet, but 90% of it is being a 4th year med student dealing with 4th year angst. I'm actually cool with the proportion you just described, and 60-40 ratio you described sounds relatively reasonable to me. The 40% including the undesirables can still be pretty sick people, and it's figuring out who's who that's fun in the first place. If they were all sick it would be boring.
 
Don't worry. It's just butt hurt EM hopefuls that will eventually come to realization that EM isn't that great. 90% is a hyperbole, but at least 50-60% of the patients should have gone to a FP doc. The next 20% are probably drug seekers, homeless people, alcoholics, chronic pain, etc. The next 10-15% is your run of the mill pathological abdominal pain, chest pain, infections, and fracture. About 1-5% is actual critical care.

~4 years in 5 hospitals, two different systems, from the very rich to the very poor. Includes a LOT center.

This is a pretty good breakdown of what most of my work in the ER sounded like except we had a lot less fractures and infections that needed more than OTC treatment. I did volunteer at a few places that would have been fun to work at, but of the 2 places I actually worked at, it wasn't nearly as fun/exciting as I hoped it would be. One of the places was a Level 1 center where it wasn't uncommon to go an entire week without seeing someone with chest pain or stroke symptoms and we'd regularly have days with less than 10 patients total. The only way I would want to be a physician there would be if I were over 60 and looking for an easy paycheck.

It's definitely true there's a lot of variation between sites, but I would point out that even 5% actual emergencies means there's a patient on almost every shift who needs you. The lower proportion of positives makes it as challenging or more so to provide good care to those people, which can be pretty interesting. To each his own though.

My no thanks would be outpatient peds. Healthy patients aren't really my thing, and parents are definitely not my thing

That sounds pretty boring to me. I need more than one out of 20 people to actually need more treatment than a prescription for antibiotics or hydration. Plus, I'd be fine with lower numbers of positives if the patients initially present as a possible emergency, but when it's obvious that most pts don't need to be in an ER (or even be seeing a physician at all) it starts wearing me down pretty quick.
 
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I'll admit my clinical experience in anesthesia is limited to my contact with them through working/shadowing other fields (aka time in the OR), and I have no clinical experience in path. I've worked a decent amount in rads and EM departments which were exactly as I described....

You've worked as a diagnostic radiologist?
 
It makes me sad that medical students are able to get through school with these kinds of impressions of various fields that their colleagues will be practicing.
 
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It makes me sad that medical students are able to get through school with these kinds of impressions of various fields that their colleagues will be practicing.
Boring. If you were a specialty I'd put you in this thread.

Thread's supposed to be fun. Don't guilt those of us having it.
 
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The worst specialties are the ones with the most patient interaction.
 
You've worked as a diagnostic radiologist?

I worked in a radiology department with diagnostic radiologists. I talked with them a fair amount since I was applying for med school and found a lot of what they did to be mind-numbing. Not saying it's not an essential field or that I don't have a lot of respect for them, just saying from the experience I had working in that department I found it incredibly boring.
 
I've never understood medical student radiology electives where students sit at the workstation. Rads is probably the most boring field in medicine to watch someone practice. It's about as exciting as watching someone read a book.
 
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My specialty is the best. Everyone else is stupid.
 
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Worst - pediatrics , because when I see neglected/abused kids I want to behead the parents at a minimum.

Most Boring - dermatology , peddling cosmetics to most patients is not worth 12 years of training
 
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