The reason I said I was “looking for light at the end of the tunnel” was because, as I’m sure you know very well, the first two year of med school involves burying your head in books and notes and minimal patient contact.
The reason I am asking the question now is because in about a year from now I will have to decide what specialty I want to pursue. While I can sit here and say that I’m definitely interested in many different fields of medicine (even with the little experience I’ve had), my decision certainly will be made with inadequate data–just as you noted. That’s why I figured I’d ask for the opinions of people who have the experience. If not now, when would be a good time to ask for the pro’s and con’s of the different specialties?
I’ve talked to many people who love the field they have chosen…and just as many who hate theirs.
I don’t intend on choosing my profession based on an online forum…just simply looking for some info that would be hard to find elsewhere.
The period of your life where you are going to have the most time, at least for the next 10 years or so, is right now. And, no, you don’t really have to decide your specialty during your third year. You will probably know and will make a basic decision whether you want medicine or surgery but the real decision isn’t made until you are in your internship, perhaps later. Lots of people think they want one thing and find out later it is not for them then change.
Ok, your residency choice is your lifestyle choice esp. once you get into practice. Residencies are more similar really, the difference is in the years involved.
I chose primary care because I wanted to one day practice in a small town away from the large hospitals and city/suburbs. Also Family Practice primary care Docs are the nicest people. Keep this in mind as you will be around the group you choose for your residency and your entire career.
Small town practice is ideal for training. Access to low traffic roads and trails, better air quality outdoors. The biggest drawback is the extended travel neccesary for racing. But that’s what vacations are for.
I am an EM attending at an academic program and I’m very busy compared to the community EM physicians. I do not, however, work as hard as them when I’m on my shifts, because the residents do most of the work. With research, office hours, teaching commitments, etc. I spend a lot of non-clinical time on other things. I make that sacrifice realizing that to me it is worth that trade off. I find balancing time between family, working out and working to be extremely challenging.
As far as choosing a speciality, I am going concur with everything that Frank said and pose some questions.
Do you want to be a good doctor?
Do you want to be the doctor who can do the procedure, make the diagnosis, or save the patient when others can’t?
How important is triathlon and being in peak physical condition?
How important is your social life, free time for other hobbies and family?
Realistically, can you accomplish all of the above tasks?
Many medical students think that they can do them all, but realistically very few can and very few residents can and very few attendings can. By very few I mean 1 in thousands. I’m not saying this to depress or deter you, but to help you assess your own goals and to be realistic. If you want to be the smartest doctor, plain and simple, you are going to have to study your ass off. This might mean sacrificing being the best triathlete that you can be.
I’d also point out that many people in this thread have mentioned happiness. Nobody can live life being happy at every moment, but people can be satisfied and successful. Each individual needs to define what these things mean to him or her.
Finally, choose the speciality that fits your personality and what you want to accomplish not the easiest.
By the way, I love my job!
Viva Orthodontia…
MKB - and other ST med students,
It is great that you are gaining some insight into the various specialties. You are likely a goal oriented individual, and as being such, setting a goal will likely help you stay motivated during the remainder of this year and the following 2 years. Some seem to think that you have quite a while to decide but with the 3rd year starting July 1 it is not as far off as it seems, especially if you are afforded some elective time during the third year, which you will have to schedule soon.
As for me, I studied exercise physiology as undergrad and as part of my program did some cardiovascular research. I was drawn to cardiothoracic surgery for many reasons including the fact I had witnessed what an impact the profession can have on a patient ( my father had an aortic valve replacement) the physiology involved and the technical portions of the various procedures. I gained experience, during my time off school, with a two surgeon group who allowed me to assist in surgery. I did 4 wks of thoracic surgery my 3rd yr and 4 addl weeks as acting intern during my 4th year. Well, when it came down to the hard decision making about what to choose - I chose lifestyle. I wasn’t that excited by general surgery and to think of doing 5yrs of gen surg residency and then not matching for a 3yr CT fellowship didn’t set well.
The thought of doing the 5yr residency, the 3 yr fellowship and then being a junior partner working 80h a week and being on call every other, then becoming senior and then being ready to retire and die and looking back and thinking - wow, I’ve done a lot of CT surgery but what have I really done?? didn’t set well either.
Whatever your interest may be, now or in the future, - “How does (family, friends, other outside interests) fit in to the hectic lifestyle?” it will be affected by your decision.
All physicians are biased of course…and many of the specialties are glamorized… no one will tell you outright that they regret what they are doing.
All careers are rewarding and frustrating at the same time.
All careers have the potential to become “jobs”. If you have mastered the area will it still interest you?
Great lifestyle & no call: EM and some Rad.
Emergency medicine provides opportunities that most specialties do not
- freely mobile - practice in any state within a couple of months.
- ability to schedule significant time off during any given month - or even take a month off depending on the practice.
Good lifestyle & no call (depending on practice): Derm and Rad - or even better telerad - I would like, no wait - love to be reading brain CTs at $200 a pop while on the computrainer.
Good lifestyle & some - mostly home call: the medical subs such as rheum and nephro, and neuro.
Life and call: general surgery and ortho and the many surgical subs.
Most all careers within medicine compensate well enough that this should not play a significant role in your decision making.
I completed a four year emergency residency followed by a year of primary care sports medicine fellowship (which can be done via EM, IM, Peds or PM&R).
I choose to do the fellowship not only because I enjoy healthy patients, but also because I have seen some physicians that need to move on to their second career and didn’t have a second one to move on to -(we can’t all be the inventor of Powercranks!)- thus they become dissatisfied, practice poor medicine and are not a real joy to work around…I don’t ever want to become “that” doctor. The fellowship also allows an option to the shift work of EM that becomes old and more tiring later in the career.
When I “look back” in just this past year - I graduated from law school, ran 3 road marathons, one trail marathon, 3 half IMs, did the greatest part of “Redman”, completed IM Florida (10:12 for my first effort -meeting Frank Day, spinning on the Powercranks and trying to talk him out of a set two days before IM definitely improved my ride and run time but I digress), spearfished / offshore fished ~10 days, archery hunted elk in colorado 10 days, and generally spent way too much time lurking on ST - mostly being entertained by the exercise phys and sports medicine questions and of course the “great debate” (is LA clean or not), and probably wrote the longest 3rd or 4th post by an individual in ST history by responding to your question.
Oh, and I did some emergency medicine in there some where…
Kevin
I’ll bite because I think you’re getting some strange advice … maybe well intended… and for once I probably agree with Frank a lot.
If you’re picking your medical career based on triathlon training, you must not be that interested in medicine or just haven’t had that much exposure. Medicine is a lifelong career with responsibility for peoples lives … triathlon is a participation sport for fun. Decide what your medical career is by what interests you and will keep your career positive for you and rewarding. If you are trying to find a medical career to avoid that … you probably ought to do something else than medicine.
I’ve done private practice int med for many years and have always found a way to be active in many sports but with challenges at times. Small town practice is much more smothering of your time, but rewarding. Large cities offer many different options and a more set schedule … how much hospital inpatient care you do makes huge differences in uncontrollable time.
You must be a smart guy or you wouldn’t be in med school. Forget about triathlon for now … concentrate on being a well educated physician and let your options and interests in medicine guide you to career choices. Next you’ll have family issues to work into your career. Finally … decide what physical/sport issues are important to you that you wish to participate in for fun. Get your priorities figured out for the right reasons. I’ve done 15 IM events personally which isn’t a lot … but none of that has any resemblance to the personal and professional satisfaction that you’ll get for people trusting you with their lives and having lifelong relationships with them.
Dave
ER doc here… There is the potential for a large amount of free time. My group works 5 shifts on, then 5 days off with shifts being 8-12 hours, plus vacation time. You can certainly work less than that, and still make pretty good money. No call is a major bonus. When you are off you are off, and so forth. Just got in to tri last year (former runner/cyclist who learned to swim) and am doing my second HIM in July. My schedule certainly would allow for full IM training… Best of luck to ya!
Matt
Emergency Medicine.
No call. Relatively few hours. The downsides Jodi mentioned including working evenings and weekends, but it works out very well to have lots of weekday time to train when my family is busy anyway. Having my schedule made out for the whole year makes it very easy to adjust before heavy training months by trading shifts. Before IM Florida last year and IM Louisville this year I reduced my schedule to about 10 shifts per month for the 2 months before the races.
I’ll bite because I think you’re getting some strange advice … maybe well intended… and for once I probably agree with Frank a lot.
If you’re picking your medical career based on triathlon training, you must not be that interested in medicine or just haven’t had that much exposure. Medicine is a lifelong career with responsibility for peoples lives … triathlon is a participation sport for fun. Decide what your medical career is by what interests you and will keep your career positive for you and rewarding. If you are trying to find a medical career to avoid that … you probably ought to do something else than medicine.
I’ve done private practice int med for many years and have always found a way to be active in many sports but with challenges at times. Small town practice is much more smothering of your time, but rewarding. Large cities offer many different options and a more set schedule … how much hospital inpatient care you do makes huge differences in uncontrollable time.
You must be a smart guy or you wouldn’t be in med school. Forget about triathlon for now … concentrate on being a well educated physician and let your options and interests in medicine guide you to career choices. Next you’ll have family issues to work into your career. Finally … decide what physical/sport issues are important to you that you wish to participate in for fun. Get your priorities figured out for the right reasons. I’ve done 15 IM events personally which isn’t a lot … but none of that has any resemblance to the personal and professional satisfaction that you’ll get for people trusting you with their lives and having lifelong relationships with them.
Dave
Dave,
I was going to post something similar to you but decided to avoid being preachy (glad you did it instead :-)). Unfortunately, what you describe at the outset in the mindset of a lot of young physicians right now. I’m not that old (40), but am shocked at the (lack of) work ethic of my newer partners. Getting home early seems to be their top priority. Dumping on a partner to get out is so common-place for them that they do it without apology. They leave patients for the on call doc without so much as a phone call to the patient or the doc (how’d you like to be the patient in labor who finds out that her doctor is not going to be the one who delivers the baby when the “other” doctor walks in the room? shows a lot of consideration, huh?) With limited work weeks and shift hours in training and an emphasis on “float” schedules and “-ists” (hospitalists, laborists, etc.) I fear that the days of the dedicated, patient-first doctor is waning. I literally fear what our doctors in the next generation will be like. I already hear some younger doctors savoring the idea of nationalized health care with a “good I’ll just work less” attitude. Work less? I don’t know how to do my job any way other than the way I do it now which is full speed the whole time I’m working. That’s ingrained in me and it won’t change. I’m afraid there’s something different ingrained in the coming generations.
Man, I sound old. (steps off soapbox)
Spiriidion Louis,
I am almost the same age as you and I agree with your sentiments. While in med school, and general surgery residency (before ophthalmology), I did not like working the 120+ hrs per week common during that time. Looking back, it is something I would never trade. It really does teach you the continuity of care of your pt. And, I feel that it makes you a more dedicated doc. You realize the sacrifice needed to “be there” for the pts, no matter the time of day or night.
Even after my med school general surgery rotation limited the student’s hours, they still complained how bad they had it and were more eager to get out of the hospital than learn about an interesting surgical case or see a critical pt being managed in those early hours after a difficult surgery. Those were hard days but I will never forget them and I never want to either.
I agree I was preachy but it needed to be said… and I think is was quite to the point. I’m old school as well, but I do have faith in many younger docs and those in training…certainly not like in the past though. I always had great role models to help me see the light … I think medical schools are lacking those anymore, so no surprise that ethics suffer. To me, younger docs only need consider what kind of physician they would want taking care of their family when things are tough and be caring about their reputation amongst their fellow physicians … then they’ll make good choices. If your biggest concern is when you’ll get your workout in … probably wrong career choice.
Dave 
I thought you were going to do Radiology. Was I mistaken? If not, why the change? If I’m wrong, I must have misread one of your earlier posts.
“I’ve done a lot of CT surgery but what have I really done??”
I pulled this quote just because I thought I should point something out. If you worked hard, studied enough, and were innovative enough as someone named Debakey (just to name a CT surgeon), that time performing CT surgery would have a pretty big impact.
I thought you were going to do Radiology. Was I mistaken? If not, why the change? If I’m wrong, I must have misread one of your earlier posts.
Not Mistaken- I changed my mind in August after doing an emergency medicine acting internship at our level I trauma center. Fell in love with it. Plus, I can do a sports fellowship!
Jodi
“If you worked hard, studied enough, and were innovative enough as someone named Debakey (just to name a CT surgeon), that time performing CT surgery would have a pretty big impact.”
In continuance of stating the obvious, a.k.a. “If my Aunt had a … she’d be my Uncle” - I pulled this quote just because I thought I should point something out. If you (future physician) worked hard, studied enough, but wasn’t quite as innovative as DeBakey (just to capitalize the B as he likely preferred) you may also have a pretty big impact just as a fellow triathlete Dr. Drummond-Webb demonstrated to his friends, family and patients. In one of the links he speaks about doing triathlons to merely to himself in shape for surgery.
http://agonist.org/story/2004/12/28/45854/619
Colleagues said Drummond-Webb was his toughest critic.
“Some would say they saved 98 out of 100,” said the Arkansas Children’s Hospital’s chief executive, Dr. Jonathan Bates. "He looked at it and said, ‘I lost two out of 100.’ "
In 18 months, Drummond-Webb, the hospital’s chief of pediatric and congenital cardiac surgery, performed 830 operations, with a 2 percent mortality rate. He also collaborated with Dr. Michael DeBakey, 96, considered the father of modern cardiovascular surgery.
“I just can’t understand how this happened,” DeBakey said, noting that Drummond-Webb seemed eager to work on more cases with the newly approved miniature heart pump.
“I think he had this motivation to pursue excellence and you see that in some of the leaders in the field,” Debakey said. “People like that are almost always constantly frustrated.” http://www.boston.com/news/nation/articles/2005/01/16/a_doctor_with_gift_takes_his_own_life/
In a highly non-scientific study I have yet to complete, I will calculate the odds ratio of any past, present, or future reader of ST being mentioned in either a current or future volume on the history of cardiothoracic surgery as approaching 0.
Zero, which for those ST readers not in the know about DeBakey, ( http://en.wikipedia.org/wiki/Debakey#cite_note-14 ) is about the same odds ratio of someone in present company (ST’s) working hard, eating right, having all the right gear, and becoming the next Merckx.
I will cite to previous research performed finding that physicians commit suicide at between 28 and 40 per 100k as compared to the general populations ~12 / 100k. “The high-risk physician has been described as driven, competitive, compulsive, individualistic, ambitious, and often a graduate of a high-prestige school.” http://www.medscape.com/viewarticle/410643_2
Wait, was that describing a high-risk physician or a triathlete??
Now overreaching, and without any significant understanding of statistics, I will finally attempt to calculate the odds of an individual physician committing suicide versus the odds of the same physician becoming a Blalock, Barnard or Cooley, much less than that of a house-hold name such as DeBakey; and I will conclude that physician suicide occurs much more commonly, but of course, additional research will have to be performed. But if you worked hard, studied enough…
In every area of medicine there is potential to have a pretty big impact. (“Ohh, skin cancer!!” Seinfield upon breaking up with ‘pimple popper M.D.’ only to hear someone thank her for saving their life.)
When choosing my specialty it became obvious to me that I didn’t want to live and breathe 100% of my career 100% of my life (which is what you pretty much have to do with some sub-specialties such as CTS) - which is why I didn’t go into the specialty that I was initially drawn to.
I live and breathe 100% career while at work and 0% while away from work.
Here is a truth…if you are on slowtwitch and just happen to be a second year med student - you my friend, have some outside interest.
If this outside interest is of importance to you, as any other interest such as family, friends, travel, etc, there are certain areas you should entertain and there are some that you should avoid.
Perhaps, in a non-scientific study, someone can poll the M.D.s and D.O.s and see what specialties are represented on ST and in what number.
I saw Dr. Webb at the Lake DeGray 1/2 in the fall of 2004. I just looked at the archives - he went 5:29, pretty respectable on the 2004 course. I really wish I would have went over and introduced myself at that time - and for some reason wished so even more after hearing of his death.
-Kevin
KLG,
I think you misinterpreted my use of your quote. It wasn’t to point out that you had made the wrong choice. I am after all an Emergency Medicine physician. It was to demonstrate that every physician regardless of specialty should make every effort to become the best physician that they can be. Occasionally though, admittedly rarely, the combination of a person choosing the right specialty and working hard could result in becoming the next DeBakey. And if that person doesn’t become DeBakey all that hard work and extra time means saving and enriching extra human lives. That is my point. On the other hand I have worked with doctors who only focus on their outside interests or don’t like medicine very much. Occasionally, patients die because of them. Think about that.
Sure workout and relieve your stress but nothing should take precedent over becoming the smartest most talented physician that you can be. As far as choosing the right speciality choose the one that fits best. If you posted asking which bike to choose people would jump right on here and say take the one that fits the best not the one that looks the best.
As far as the odds of any Slowtwitcher going on to be the next DeBakey or Merkx for that matter being 0, there is a 95% confidence interval around that; meaning that even if you say the odds are zero there is still a possibility. A point estimate is just that…an estimate.
When deciding you should not only consider if you like the specialty, but if you like the lifestyle of the specialty. I love my job, but I love time off even more.
joe
There seems to be several EM docs on ST… just out of curiousity, how real is the “burnout” that I seem to hear so much about?
There seems to be several EM docs on ST… just out of curiousity, how real is the “burnout” that I seem to hear so much about?
My best guess is that “burnout” occurs more often in those who chose this specialty for the lifestyle and not for the “love of the action”.
Sure workout and relieve your stress but nothing should take precedent over becoming the smartest most talented physician that you can be. As far as choosing the right speciality choose the one that fits best.
I don’t think you can “become” smart or talented. You can become wise, experienced, and compassionate.
I also think that some things take precedent over being a doctor - I consider myself a father and husband before physician. And a person (with interests) before a physician.
I also think that a person can choose a “lifestyle” specialty for the lifestyle, and still be a good physician (delivering good care to patients, compassionate care to patients, and working well with other health professionals).
For the OP: radiology, derm, rheum, allergy offer stable office hours, few call obligations, and free weekends. I think an overlooked lifestyle specialty is pathology, which is also well-compensated. You lose excitement or direct patient care when you go for the good lifestyle specialties, but everything in life is a trade-off.