Worst/ Most Boring Specialty?

[NonTradTwinDad]

Still on my journey but I have absolutely Zero interest in Derm!

Open to all other specialties especially EM, Peds(Pediatric EM), Cardiology, & Anesthesia!

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[LabMonster]

By "zebras live in herds" I referenced local medical diagnosis and activity. Actually, has nothing to do with age - if we were "Gome-docs" we wouldn't get the diagnosis. Example: in my region, IV meth use is rampant - so are the conditions we see with IV drug use. Prior to current practice in my area, (a very "Onion" term, I'll grant) I'd seen maybe 2 cauda equina syndromes. I had seen 1 epidural abscess in a heroin user. In 2 years, I've had 5 of these. In consult, one of our neurosurgeons said, and I quote "I saw maybe two of these in training, and you send me one or two a month from your hospital." Yep. No BS, classic, no BS CES with all of the classic symptoms, sometimes, but usually they come in really sick with back pain and neuro deficits that aren't classic (but urinary retention is clutch.) So, yes zebras run in herds, at the zoo and in Africa - but that's the point. If you're in Africa, Zebras are common. Be sure to know where you work and what beasts live there, because the rare can become "uncommon" - meaning you'll see them every few weeks or months.

Glad we had this talk.

 

[LabMonster]

I've worked in the busiest ER in Ohio, the busiest ER in NC and I agree that most people just want immediate care. Unfortunately, IMHO, urgent care and immediate care don't make good clinical decisions or delineate good clinical plans with patients. So, they show up on our doorstep.

My training is in emergent critical care - recognizing and treating (or risk stratification of lethal medical problems) and I think we are good at it. We're at a point where good FP/IM docs are absent and are (in remote locations) FMGs. Some of these docs are great! Some, well, some folks mostly of the PCP persuasion need help and are better off elsewhere. I go for long stretches of "urgent care" type complaints to weeks of managing really sick patients in the ED who need an ICU or direct OR management without resources - so those times are definitely not boring.

EM is, typically, boring because people coming in really don't have emergencies. But, one never knows how a shift will progress and sometimes I have 2-3 patients out of 10-13 who require critical care. Then, it's not boring. But the same thing applies across all specialties. Occasionally we get odd cases, difficult (not by personality, but by disease) cases and we deal with them. I would say, based on experience at my current shop, about 30-40% of the people need to be there. We have a high acuity, and it's why I work there. If it's any indication to those in the know, I've done two lateral canthotomies in the last 2 years, which was 2 more than my PD did in the last 20.

Zebras herd. Boring is relative. If "action" is what you want, you can move to an area with a "stimulating patient population." This usually means the underserved, poor and involves more remote hospital/clinic placement. If you really want it all - stay in academics and work at a tertiary referral center - they get everything (of course a lot of BS also, but the real nasties also.)

So - again, average of "not boring." Especially when ED docs cover floor and ICU codes. 2 Docs overnight, hospitalist and ED. Limited sub-specialist direct contact (NO ONE in house.) It's not boring.

Again. (I'm holding my head bilaterally - resist the the stupid troll reply rhetoric) Medicine involves repetition, involves boredom. The good docs don't get locked into boredom, repetition. Good docs will alleviate boredom with, funny thing, patient discussion, contact, and will talk about everything (sex, drugs, social situation, etc.)

I listen to and understand those docs who have been out there, working, helping patients as best they can. We owe it to med students and trainees (residents) who either have no clue or are perpetually mislead as to what medicine is. There is limited data on everything that we do.

Folks, it's a job. We have a job to do. We also have an awesome responsibility given our "job" that is only "boring" if we choose to make it so.

So - choose your specialty in something you can handle - i.e. if you hate procedures skip FP/GP, derm, surg, ER - choose IM or an offshoot.

If you like procedures - well then do procedures. This is not rocket science .

 

[Spectre of Ockham]

Thankfully that's not at all what we do.

There sure are quite a few exception but over here that's what we've got. Most dermatologist have their own practice and peddle anti-aging cream and hair growth products to high class life long smokers.

 

[Mad Jack]

There sure are quite a few exception but over here that's what we've got. Most dermatologist have their own practice and peddle anti-aging cream and hair growth products to high class life long smokers.

There isn't a single notable dermatology practice in my state that advertises itself as cosmetic in nature that I know of, you've clearly got a very biased sample. Dermatologists use a skilled eye and a sound understanding of pathophysiology to save lives, improve quality of life, and minimize disfigurement. I've seen far more FPs and NPs than dermies claiming to practice purely aesthetic medicine.

 

[username456789]

There sure are quite a few exception but over here that's what we've got. Most dermatologist have their own practice and peddle anti-aging cream and hair growth products to high class life long smokers.

You must live in some awful hellhole like California.

 

[Stagg737]

There sure are quite a few exception but over here that's what we've got. Most dermatologist have their own practice and peddle anti-aging cream and hair growth products to high class life long smokers.

You must live in some awful hellhole like California.

I'll say that even though I disagree with Spectre regarding derm in general, I will agree that there are plenty dermatologists in some areas that do "purely cosmetic" stuff though. It was like that where I grew up (suburb of major midwestern city). Pretty much all the derm clinics I know of were treating cosmetic issues and acne in high school kids. I'm not talking about the terrible acne cases either, I'm talking about the "Jenny gets a pimple every 3 months, I think she needs accutane" kind of patients.

 

[sloop]

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

I disagree. I've done a couple months of anesthesia rotations and, while I have actually enjoyed it (part of why I did so much of it even though I'm going into psych), it can be pretty boring a lot of the time. A lot of general anesthesia is sitting down and watching a monitor, giving phenylephrine every once in a while when the patient becomes a little hypotensive. The procedural aspect is a lot of fun and there are definitely moments where things can get crazy/exciting but I think that people who pretend that there's not a lot of time where you're not doing much in general anesthesia are deliberately painting a misleading picture.

 

[Psai]

I disagree. I've done a couple months of anesthesia rotations and, while I have actually enjoyed it (part of why I did so much of it even though I'm going into psych), it can be pretty boring a lot of the time. A lot of general anesthesia is sitting down and watching a monitor, giving phenylephrine every once in a while when the patient becomes a little hypotensive. The procedural aspect is a lot of fun and there are definitely moments where things can get crazy/exciting but I think that people who pretend that there's not a lot of time where you're not doing much in general anesthesia are deliberately painting a misleading picture.

What do you want? People to not prepare for their cases and constantly create crises for themselves to deal with? What you're seeing is a modern miracle in action, where our knowledge of pharmacology and physiology is so good that we can get the vast majority of people through surgery safely. When you don't know what's going on, it's going to be boring because you don't know enough to know any better. Anesthesiologists have made surgery so safe that even nurses can practice in the field.

When I'm on an airplane, I want a boring flight so I can get to my destination safely. Going through a bunch of turbulence is not exciting, just scary. Same thing for surgery. No excitement please.

 

[sloop]

What do you want? People to not prepare for their cases and constantly create crises for themselves to deal with? What you're seeing is a modern miracle in action, where our knowledge of pharmacology and physiology is so good that we can get the vast majority of people through surgery safely. When you don't know what's going on, it's going to be boring because you don't know enough to know any better. Anesthesiologists have made surgery so safe that even nurses can practice in the field.

When I'm on an airplane, I want a boring flight so I can get to my destination safely. Going through a bunch of turbulence is not exciting, just scary. Same thing for surgery. No excitement please.

I don't disagree with you that you don't want excitement in anesthesia. I mean no disrespect by any of this. I took a rotation in it and went back for more, so obviously I found it interesting and enjoyed it. I even routinely stayed hours after my residents told me I could go on a fourth year elective rotation because I liked being there. All I'm saying is that I get why some people find it boring and I don't think that feeling can only come from ignorance.

 

[CherryRedDracul]

Looking back on everything, I can't say I found any particular specialty in medicine boring. I knew which ones I didn't want to do, but I found each specialty to be interesting in its own right.

Maybe that's one of the reasons why I chose radiology: I want to know everything.

 

[username456789]

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[LabMonster]

I disagree. I've done a couple months of anesthesia rotations and, while I have actually enjoyed it (part of why I did so much of it even though I'm going into psych), it can be pretty boring a lot of the time. A lot of general anesthesia is sitting down and watching a monitor, giving phenylephrine every once in a while when the patient becomes a little hypotensive. The procedural aspect is a lot of fun and there are definitely moments where things can get crazy/exciting but I think that people who pretend that there's not a lot of time where you're not doing much in general anesthesia are deliberately painting a misleading picture.

Anesthesia can be boring, I agree. I also agree that when you take over another human's physiology, that job is huge.

 

[LabMonster]

Looking back on everything, I can't say I found any particular specialty in medicine boring. I knew which ones I didn't want to do, but I found each specialty to be interesting in its own right.

Maybe that's one of the reasons why I chose radiology: I want to know everything.

Keep that oath, please.

 

[yoyoni]

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.

I'm really curious, what specialties are you interested in?

 

[LabMonster]

Just an aside to this conversation. I took care of a child with probable constipation vs. early gastroenteritis the other night. His clinical course was unremarkable. His mother stopped me after I did my H/P on the child (of 10) and said this: "You probably don't remember me. You saw me about a year ago and told me I had significant cervical dysplasia which turned out to me cancer. I've had a hysterectomy. Thank you for saving my life."

I vaguely remembered the family. But I was shaken, floored, elated with her outcome. It's not always exciting and many times we provide primary care (especially in the rural setting) but DAMN - that one patient's outcome and story made my whole week.

The pelvic exam is boring, but saving lives is not.